The effect of a brown-rice diets on glycemic control and metabolic parameters in prediabetes and type 2 diabetes mellitus: a meta-analysis of randomized controlled trials and controlled clinical trials
Authors: Abdul Rahim Anis Farhanah , Norhayati Mohd Noor , Zainudin Aida Maziha 
Published: May 2021

Background
Brown rice is a whole-grain food that is often assumed to have a lower glycemic index compared to white rice. A few studies have objectively confirmed the effect of a brown-rice diet on glycemic control and metabolic parameters compared to a white-rice diet. The purpose of this study is to determine the effect of brown rice on improving glycemic control and metabolic parameters in prediabetes and type 2 diabetes. The researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and controlled clinical trials.

Methods
PRISMA guidelines were used as the basis of this systematic review. Relevant studies were identified by searching the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), as well as Epistemonikos for randomized controlled trials (RCTs) and controlled clinical trials published not later than January 2021 involving adults with prediabetes and diabetes mellitus who were consuming brown rice compared to those consuming white rice. The primary outcomes measured were glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels. The secondary outcomes were body weight, waist circumference, systolic and diastolic blood pressure levels, LDL and HDL-cholesterol levels. The mean differences (MDs) with 95% confidence intervals (CIs) between brown and white-rice-diet groups were calculated using a random-effects model.

Results
Seven trials involving 417 adults with prediabetes or type 2 diabetes were included in this study. Brown-rice diet did not improve the glycemic control because it had no effect on the HbA1c level (p = 0.15) and the FBG level (p = 0.95) compared to white-rice diet. Brown-rice diet reduced body weight (p < 0.00001; MD −2.2 kg; 95% CI [−3.13 to −1.26]; I2 = 0%). However, it had no effect on the waist circumference (p = 0.09), systolic blood pressure (p = 0.60) and diastolic blood pressure level (p = 0.40). HDL-cholesterol level is increased in brown-rice diet (p = 0.01; MD 0.10, 95% CI [0.02 to 0.17]; I2 = 44%) but it had no effect on the LDL-cholesterol level (p = 0.81).

Conclusions
The available evidence indicated that consuming brown rice in substitute for white rice does not affect glycemic control (HbA1c and FBG levels) in pre-diabetes and type 2 diabetes patients. Brown rice, however, may be used as an alternative for white rice in such patients because it was found to reduce body weight and increase the HDL-cholesterol level. The benefits of a brown-rice diet on glycemic control may not be detected in short-term studies. The obtained evidence in this meta-analysis ranged from low to moderate quality. Thus, more high-quality trials with a larger sample size and a longer follow-up duration are needed to further investigate the effects of a brown-rice diet on diabetes glycemic control with stronger evidence.
PROSPERO registration number: CRD42019143266