OBJECTIVE To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. RESEARCH DESIGN AND METHODS Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. RESULTS Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49–54%; protein, 19–20%; and fat, 21–26%; 2) PD remission to NGT: carbohydrate, 50–56%; protein,18–20%; fat, 21–27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54–57% and 56–60%; protein, 16–20% and 14–17%, respectively; and fat 20–24% for PD and NGT. CONCLUSIONS We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.
There is conflicting evidence about the association between dairy products and cardiometabolic risk (CMR). We aimed to assess the association of total dairy intake with CMR factors and to investigate the association of unfermented and fermented dairy intake with CMR in Asian Indians who are known to have greater susceptibility to type 2 diabetes and cardiovascular diseases compared to white Europeans. The study comprised 1033 Asian Indian adults with normal glucose tolerance chosen from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was assessed using a validated open-ended semi-quantitative food frequency questionnaire. Metabolic syndrome (MS) was diagnosed based on the new harmonising criteria using central obesity, dyslipidaemia [low high-density lipoprotein cholesterol (HDL) and increased serum triglycerides (TG)], hypertension and glucose intolerance. Increased consumption of dairy (≥5 cups per day of total, ≥4 cups per day of unfermented or ≥2 cups per day of fermented dairy) was associated with a lower risk of high fasting plasma glucose (FPG) [hazards ratio (HR), 95% confidence interval (CI): 0.68, 0.48–0.96 for total dairy; 0.57, 0.34–0.94 for unfermented dairy; and 0.64, 0.46–0.90 for fermented dairy; p < 0.05 for all] compared to a low dairy intake (≤1.4 cups per day of total dairy; ≤1 cup per day of unfermented dairy; and ≤0.1 cup per day of fermented dairy). A total dairy intake of ≥5 cups per day was also protective against high blood pressure (BP) (HR: 0.65, 95% CI: 0.43–0.99, p < 0.05), low HDL (HR: 0.63, 95% CI: 0.43–0.92, p < 0.05) and MS (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤1.4 cups per day. A high unfermented dairy intake (≥4 cups per day) was also associated with a lower risk of high body mass index (BMI) (HR: 0.52, 95% CI: 0.31–0.88, p < 0.05) compared to a low intake (≤1 cup per day), while a reduced risk of MS was observed with a fermented dairy intake of ≥2 cups per day (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤0.1 cup per day. In summary, increased consumption of dairy was associated with a lower risk of MS and components of CMR.
<p> </p> <p><em><strong>Objective:</strong></em> To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. </p> <p><em><strong>Research Design and Methods:</strong></em> Dietary, behavioral and demographic assessments were performed on 18,090 adults, participating in the nationally representative, population-based ICMR-INDIAB study. Fasting and two-hour post glucose challenge capillary blood glucose and glycosylated haemoglobin (HbA1c) were estimated. With HbA1c as outcome, a linear regression model was first obtained for various glycemic categories [Newly diagnosed diabetes (NDD), pre-diabetes (PD) and normal glucose tolerance (NGT)]. Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) so as to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression (≤ 6.5% for both NDD and PD). </p> <p><em><strong>Results: </strong></em>Four macronutrient recommendations (%E- Energy) emerged for-1) Diabetes remission in NDD: carbohydrate 49-54%, protein 19-20%, fat 21-26%; 2) PD remission to NGT: carbohydrate 50-56%, protein18-20%, fat 21-27%; 3&4) Prevention of progression to T2D in PD and NGT: carbohydrate 54-57% and 56- 60%protein 16-20% and14-17% respectively; fat 20-24% for PD and NGT.</p> <p><em><strong>Conclusions:</strong></em> We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia. </p>
<p> </p> <p><em><strong>Objective:</strong></em> To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. </p> <p><em><strong>Research Design and Methods:</strong></em> Dietary, behavioral and demographic assessments were performed on 18,090 adults, participating in the nationally representative, population-based ICMR-INDIAB study. Fasting and two-hour post glucose challenge capillary blood glucose and glycosylated haemoglobin (HbA1c) were estimated. With HbA1c as outcome, a linear regression model was first obtained for various glycemic categories [Newly diagnosed diabetes (NDD), pre-diabetes (PD) and normal glucose tolerance (NGT)]. Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) so as to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression (≤ 6.5% for both NDD and PD). </p> <p><em><strong>Results: </strong></em>Four macronutrient recommendations (%E- Energy) emerged for-1) Diabetes remission in NDD: carbohydrate 49-54%, protein 19-20%, fat 21-26%; 2) PD remission to NGT: carbohydrate 50-56%, protein18-20%, fat 21-27%; 3&4) Prevention of progression to T2D in PD and NGT: carbohydrate 54-57% and 56- 60%protein 16-20% and14-17% respectively; fat 20-24% for PD and NGT.</p> <p><em><strong>Conclusions:</strong></em> We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia. </p>
Objectives The present study aimed to evaluate the efficacy of almonds consumption on insulin resistance, glycemia and lipid profile in overweight Asian Indian adults with cardiometabolic risks. Methods A parallel-arm open-labelled, randomized controlled trial was conducted on 184 adults with cardiometabolic risks (CMR) (92 in each group). Adults with CMR were identified using the harmonizing criteria which includes presence of minimum of 3 of the following conditions: raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), impaired fasting glucose, and central obesity. The intervention group received 43g (1.5 oz) almonds/day for 12 weeks. The control group was instructed to follow their habitual diet except to exclude nuts in any form. The anthropometric, clinical, biochemical and dietary data of the participants were assessed periodically and their change from baseline were analysed using generalized linear model in SAS 9.4 version. Results The study was completed by 165 adults (response rate 82.5%). Their mean age was 40 years and waist circumference 97 ± 9.6 cm at baseline. Significant reductions [mean (95%CI)] in IR (−0.5(−1.0–0.0); P = 0.04), serum total cholesterol (−10.6 mg/dl (−17.8- −3.4); P = 0.004) and low-density lipoprotein cholesterol (−7.5 mg/dl (−14.2- −0.8); P = 0.03) were observed in the intervention group compared to the control group. Within the intervention group, significant reduction of 1% each for body weight, body mass index, waist circumference, 3% fasting glucose and 2% serum triglyceride were noted compared to baseline. Multiple 24hr dietary recall as a compliance marker revealed significant increase in total fat, MUFA, PUFA calories and dietary fibre with a propionate reduction in carbohydrate calories in the intervention group compared to control group. Conclusions Daily intake of 43g almonds reduced IR, total and LDL serum cholesterol in obese Asian Indians with CMR. Almond consumption also improved the overall quality of the diet. Funding Sources The present study was funded by Almond Board of California, Modesto, CA, USA.
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