Adherence to the dietary approaches to stop hypertension diet reduces the risk of diabetes mellitus: a systematic review and dose-response meta-analysis

Abstract

Background: Despite several epidemiological studies reporting a significant association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of diabetes mellitus, the results remain controversial. In this systematic review and meta-analysis, we aimed to summarize the existing evidence from published observational studies and evaluate the dose-response relationship between adherence to the DASH diet and diabetes mellitus risk.

Methods: We performed a systematic search for relevant articles published up to September 2023 using electronic databases of PubMed, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). A random-effects model was applied to calculate the combined relative risks (RR) with 95% confidence intervals (CIs) for the highest compared to the lowest categories of DASH score in relation to diabetes mellitus risk. Heterogeneity among the included studies was assessed using the Cochran's Q test and I-squared (I²) statistic. Literature search, study selection, data extraction, and quality assessment were performed by two independent reviewers.

Results: Fifteen studies involving 557,475 participants and 57,064 diabetes mellitus cases were eligible for our analyses. Pooled analyses from included studies showed that high adherence to the DASH diet was significantly associated with a reduced risk of diabetes mellitus (RR: 0.82; 95% CI: 0.76-0.90, P < 0.001). Moreover, the dose-response meta-analysis revealed a linear trend between adherence to the DASH diet and diabetes mellitus (RR:0.99; 95%CI: 0.97-1.02, P_{dose-response} = 0.546, P_nonlinearity = 0.701). Subgroup analyses further revealed a significant inverse association between adherence to the DASH diet and diabetes mellitus risk in case-control studies (RR: 0.65; 95%CI: 0.29-1.43, P < 0.001), with a marginal inverse association in cohort studies (RR:0.83; 95%CI: 0.76-0.91, P < 0.001). Additionally, we conducted analyses separately by comparison and found a significant inverse association between DASH diet and diabetes mellitus risk in T3 vs T1 comparison studies (RR = 0.74; 95%CI: 0.64-0.86, P = 0.012).

Conclusion: The findings of this study demonstrate a protective association between adherence to the DASH diet and risk of diabetes mellitus. However, further prospective cohort studies and randomized controlled trials are needed to validate these findings.

Keywords: DASH diet; Diabetes mellitus; Dietary Approaches to Stop Hypertension; Epidemiology; Meta-analysis; Systematic review.

Fig. 1

Flow chart of the process of study selection

Fig. 2

Forest plot of the association between adherence to the DASH diet and risk of DM

Fig. 3

Dose-response association between adherence to the DASH diet and risk of DM in the analysis of twelve studies

Fig. 4

Dose-response association between adherence to the DASH diet and risk of DM in the analysis of cohort studies

Fig. 5

Subgroup analyses of DASH diet and risk of DM according to study design

Fig. 6

Subgroup analyses of DASH diet and risk of DM according to country

Fig. 7

Subgroup analyses of DASH diet and risk of DM according to age

Fig. 8

Subgroup analyses of DASH diet and risk of DM according to comparison