The Role Of Protein In Diabetes Management – Analysis Science and Nutrition Policy Dietary and nutritional approaches to the prevention and management of type 2 diabetes 2018; 361 doi: https://doi.org/10.1136/.k2234 (published 13 June 2018) Cite this as: 2018;361:k2234 Food for thought Other articles in this collection click here for winter
Nita G Forouhi and colleagues provide an overview of dietary interventions for the prevention, treatment and potential remission of type 2 diabetes.
Dietary factors are of great importance in the treatment and prevention of type 2 diabetes. Despite progress in formulating evidence-based dietary advice, disagreement and confusion remain. In this article, we review the evidence for areas of consensus as well as uncertainty or controversy regarding dietary advice for type 2 diabetes. What is the best diet method? Is it possible to achieve remission of type 2 diabetes with lifestyle changes, or is it a condition that inevitably leads to a progressive decline in health? We also examine the impact of nutritional transitions and population-specific factors in a global context and discuss future directions and implementation of effective dietary and nutritional approaches to manage type 2 diabetes.
Diabetes is one of the biggest global health problems: from 425 million people in 2017 to 629 million people in 2045, it is predicted to increase with health, social and economic costs.1 Slow it or even kill it Urgent solutions to change this trend, especially in modifiable factors such as diet, physical activity and weight should be invested. According to the Global Burden of Disease Study conducted in 188 countries, diet is the leading cause of morbidity and mortality worldwide.2 The importance of diet in the management and prevention of type 2 diabetes through its impact on weight and metabolic control is clear. But nutrition is one of the most controversial and difficult aspects of type 2 diabetes management.
The idea of being “on a diet” for a lifelong chronic disease like diabetes is enough to make many people find it difficult to know what to eat and maintain an optimal eating pattern. Medical nutrition therapy has been introduced to guide a systematic and evidence-based approach to the management of diabetes through diet and has been shown to be effective, 3 but challenges remain. Although most diabetes guidelines recommend starting pharmacotherapy only after the first lifestyle changes in diet and physical activity, this is not always the case globally. Most doctors are not trained in nutrition, and this is a barrier to advising patients.45 In addition, it is time-consuming to talk to patients about nutrition. In most settings, except in specialized diabetes centers with trained nutritionists/educators, diabetes nutrition advice is at best a menu printed on the patient. In resource-poor settings, when type 2 diabetes is diagnosed, the patient often leaves the clinic with a list of new medications and little else. There is wide variation in the use of dietary modification alone to treat type 2 diabetes: for example, less than 5–10% of patients with type 2 diabetes in India and less than 31% in the UK have been reported, but patients are treated with lifestyle. measures may be less well controlled than in patients taking medication for type 2 diabetes.7 Although systems are generally in place to record and monitor diabetes care, there is little evidence for diet. Although attention is given, dietary information is often neglected. necessary to achieve adequate glycemic control. Family doctors and hospital clinics should routinely collect this information, but how to do so is difficult.58
Progress has been made in understanding the best dietary recommendations for diabetes, but broader challenges remain. For example, increasing the consumption of vegetables and fruits is recommended in many dietary guidelines, but their costs are very high in many contexts: the price of two portions of fruit and three portions of vegetables per person per day (to complete 5 servings per day) ) ” guideline) accounted for 52%, 18%, 16% and 2% of household income in low-, lower-middle-, upper-middle- and high-income countries, respectively.9 Expensive food market for people to use. There is also diabetes, and the products are usually healthier, and sometimes less healthy, than regular foods. Following new EU legislation, food laws in some countries, including the UK, were updated in July 2016 to ban such misleading labels. However, this is not the case elsewhere and it is unclear what will happen to such arrangements after the UK leaves the EU, underscoring the importance of the political environment.
Dietary guidelines for the treatment of diabetes in some, mostly developed countries, have shifted from focusing on a low-fat diet to focusing on macronutrient quality (ie, type versus amount of macronutrient). processed foods (especially processed starch and sugar) and overall eating patterns. Many systematic reviews and national dietary advice have evaluated the evidence for optimal dietary recommendations, and we will not repeat the evidence review. We will focus on important principles and areas of action. uncertainty, but we begin by describing three main features.
First, the understanding of healthy diet for the prevention and treatment of type 2 diabetes derives mainly from limited evidence from long-term prospective studies and randomized controlled trials in the general population supplemented by evidence from people with type 2 diabetes. Most published guidelines and reviews have used assessment criteria, and this evidence is of moderate quality in an evidence hierarchy that often places randomized controlled trials at the top. Elsewhere, various types of evidence that assess consistency across multiple study designs, including large population-based prospective studies of clinical endpoints, controlled trials with intermediate pathways, and prospective randomized trials with clinical endpoints, are evidence-based nutrition. It is emphasized that they should be used together for instructions regarding 19
Second, it is recognized that dietary recommendations for the prevention and treatment of type 2 diabetes overlap and should not be viewed as separate entities (Figure 1). However, in patients with type 2 diabetes, the level of glycemic control, type and dosage of antidiabetic drugs should be coordinated with dietary intake.12 With certain dietary interventions, such as very low-calorie or low-carbohydrate diets, people with diabetes get it. usually stop. or reduce diabetes medications and monitor closely as discussed in the next section.
Third, in recognition of the importance of diet for weight management, there is greater understanding of the multiple pathways through which dietary factors affect health through obesity-related and obesity-independent mechanisms. Dietary effects on weight, glycemia, and glucose-insulin homeostasis are directly related to glucose control in diabetes, while other outcomes, such as cardiovascular complications, are related to dietary effects on blood lipids, apolipoproteins, blood pressure, and endothelial function. thrombosis, coagulation, systemic inflammation and vascular adhesions. The effect of food and nutrients on the gut microbiome may also be relevant to the pathogenesis of diabetes, but further research is needed. Therefore, the quality and quantity of the diet is important for the long-term prevention and treatment of diabetes and its complications through a wide range of metabolic and physiological processes.
Type 2 diabetes is often associated with overweight or obesity and insulin resistance. Therefore, weight loss and maintaining a healthy weight is an important part of clinical management. Weight loss is also associated with improvements in glycemia, blood pressure and lipids, and thus may delay or prevent complications, especially cardiovascular disease.
Many guidelines recommend promoting weight loss among overweight or obese individuals by reducing energy intake. Portion control is a strategy to limit energy intake along with a healthy eating pattern that focuses on a diet composed of whole or unprocessed foods combined with physical activity and ongoing support.
The evidence points to promoting the consumption of foods high in vegetables, fruits, whole grains, legumes, nuts and dairy products such as yogurt, but with some caution. First, some diets (such as low-carb diets) recommend limiting fruit, whole grains, and legumes because of their high sugar or starch content. Opinions are divided among researchers and clinicians about fruit consumption, especially among people with diabetes (see Appendix). Many guidelines still recommend fruit, but because of the additional micronutrients, phytochemicals and fiber in fruit, fruit sugar intake is preferable to isocaloric intake of sucrose or starch. Second, despite evidence from randomized controlled trials and prospective studies10 that nuts may help prevent type 2 diabetes, there are some (potentially misplaced) concerns about their high energy content. Further research in people with type 2 diabetes will help clarify this.
There is also consensus about the benefits of certain diets, such as the Mediterranean diet, for the prevention and treatment of type 2 diabetes. Expert guidelines also support other healthy eating habits, taking into account local socio-cultural factors and personal preferences.
There is agreement to reduce or avoid the consumption of processed red meat, refined grains
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