Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes

Davis, Nichola; Tomuta, Nora; Schechter, Clyde B.; Isasi, Carmen R.; Segal-Isaacson, C. J.; Stein, Daniel T.; Zonszein, Joel; Wylie‐Rosett, Judith

doi:10.2337/dc08-2108

Cited by 221 publications

(295 citation statements)

References 24 publications

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“…The participants in the intervention group lost more weight than those in the control group at 3 and 6 months, but at 1 year, the results were not significant [39]. The faster weight loss after 3 months achieved with the very low-carb protocol, but similar results at 1 year, were confirmed later in an RCT that included 105 overweight individuals with type 2 diabetes [40]. However, the nonsustainability weight loss was no longer a limitation, after a recent meta-analysis of 13 RCTs (around half of the studies included patients with type 2 diabetes in addition to high BMI) found that very low-carb diets (<50 g carbs/d) were more effective in producing weight loss even at 1 year than low-fat diets [41].…”

Section: Step 1: Is the Patient Overweight (Bmi ≥ 25)?supporting

confidence: 67%

“…However, a common message is that high carbohydrate intake (>50%) does not favorably affect TG and HDL in patients with diabetes. A benefit of low-carb versus low-fat diets has also been reported in other studies regarding HDL levels [40,43,48,56], TC/HDL ratio [27,56], and triglycerides [27,43,48,56].…”

Section: Step 4: Does the Patient Have A Disturbed Lipid Profile?mentioning

confidence: 57%

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Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Koloverou

Panagiotakos

2016

Rev Diabet Stud

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■ AbstractMedical nutrition therapy constitutes an important lifestyle intervention in diabetes management. Several nutrition patterns have been effective in improving diabetes control, but there has been a debate about the optimal macronutrient composition in diabetes meal planning. For many years, the recommended diets for persons with and without diabetes were similar, i.e. heart-healthy and low in fat. For almost three decades, carbohydrates have been lauded, lipids demonized, and proteins considered of little importance. However, in the past few years, this concept has been questioned and reassessed. Modern nutritional recommendations for people with diabetes are headed towards individualization, but lack specific guidelines. Nutritional algorithms may help nutritionists in diabetes meal planning. This review aims to discuss: 1) the effects of the three major macronutrients (carbohydrates, proteins, and lipids) on glucose levels, 2) current recommendations for macronutrient intake for people with diabetes, and 3) specific parameters that need to be taken into consideration when determining the macronutrient composition for a person with diabetes, for example body mass index, degree of insulin resistance, HbA1c value, and lipid profile (especially triglycerides and HDL cholesterol). These aspects are analyzed in the context of the results of recent studies, especially randomized controlled trials (RCTs). Finally, we introduce an individualized nutritional concept that proposes carbohydrate over lipid restriction, substitution of SFAs with MUFAs and PUFAs, and adequate intake of dietary fiber, which are key factors in optimizing diabetes management.

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Section: Step 1: Is the Patient Overweight (Bmi ≥ 25)?supporting

confidence: 67%

Section: Step 4: Does the Patient Have A Disturbed Lipid Profile?mentioning

confidence: 57%

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Koloverou

Panagiotakos

2016

Rev Diabet Stud

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“…Currently, there is no ideal macronutrient distribution for all people with diabetes, according to the ADA recommendations for nutrition therapy16. For example, some studies showed better glycemic control and insulin sensitivity in patients taking lower levels of carbohydrate23, 24, 25, whereas some others showed no difference26, 27. Conflicting results were also reported by various studies regarding the clinical outcomes in patients having higher or usual protein intake28, 29, 30, 31.…”

Section: Discussionmentioning

confidence: 99%

Dietary and physical activity of adult patients with type 2 diabetes in Zhejiang province of eastern China: Data from a cross‐sectional study

Pan

Ming-xia

et al. 2016

J of Diabetes Invest

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Aims/IntroductionLifestyle management helps improve the clinical outcome of patients with type 2 diabetes. The present study aimed to obtain lifestyle data on the dietary and physical activity of adult type 2 diabetes patients in Zhejiang province of eastern China for better patient education and improvement of clinical management.Materials and MethodsA cross‐sectional survey of 607 adult type 2 diabetes patients was carried out in 12 hospitals within eight cities of Zhejiang province. Data were collected for sex, age, basic physical measurement (blood pressure, height, weight, waist circumference and hip circumference), dietary favor and habit (vegetarian diets vs meat diets, preference of salty or light flavors), detailed dietary intake (24‐h recall method), as well as the weekly physical activity.ResultsThe mean age of the patients in the analysis was 56.39 ± 12.29 years, and 38.71% of the patients had higher levels of body mass index than recommended. The average daily total energy intake was 1887.71 ± 575.10 kcal. The percentage of calories from carbohydrate, protein and fat were 61.36 ± 11.59%, 13.29 ± 3.37% and 25.35 ± 11.16%, respectively. For physical activity, the patients generally spent most of their daily time sitting and sleeping, and the time for moderate vigorous activity was limited.ConclusionsAdult patients with type 2 diabetes in Zhejiang province have a relatively high carbohydrate and low protein diet, with very limited physical activity. Patient education to achieve a better lifestyle intervention needs to improve in this region.

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“…Davis et al demonstrated similar modest weight loss but no significant improvement in glycemic control in those with T2DM on a low fat or low carbohydrate diet after 1 year. 42 In the longest very low carbohydrate diet trial currently reported, a −0.9% reduction in HbA1c at 2 years was achieved compared with −0.5% in a Mediterranean diet and −0.4% in a low fat diet; however, the difference between groups was not significant. Only a small proportion of the study group had diabetes, limiting the power of this conclusion.…”

Section: Glycemic Controlmentioning

confidence: 99%

“…Improvement in glycemic control has not been demonstrated in other short-term studies 55 or after 1 year. 42 In the Diabetes Excess Weight Loss (DEWL) randomized controlled trial, there was no difference in glycemic control in subjects with T2DM over 2 years when the dietary intervention was implemented in a manner similar to standard clinical practice. 51 Initial changes in intake as prescribed returned to habitual consumption over time.…”

Section: Glycemic Controlmentioning

confidence: 99%

Importance of low carbohydrate diets in diabetes management

Hall¹,

Parry‐Strong²,

Krebs³

2016

NDS

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Dietary strategies are fundamental in the management of diabetes. Historically, strict dietary control with a low carbohydrate diet was the only treatment option. With increasingly effective medications, the importance of dietary change decreased. Recommendations focused on reducing dietary fat to prevent atherosclerotic disease, with decreasing emphasis on the amount and quality of carbohydrate. As the prevalence of obesity and diabetes escalates, attention has returned to the macronutrient composition of the diet. Very low carbohydrate diets (VLCD's) have demonstrated effective initial weight loss and improvement in glycemic control, but difficult long-term acceptability and worsening lipid profile. Modifications to the very low carbohydrate (VLC) have included limiting saturated fat and increasing carbohydrate (CHO) and protein.Reducing saturated fat appears pivotal in reducing low-density lipoprotein (LDL) cholesterol and may mitigate adverse effects of traditional VLCD's. Increased dietary protein enhances satiety, reduces energy intake, and improves glycemic homeostasis, but without sustained improvements in glycemic control or cardiovascular risk over and above the effect of weight loss. Additionally, recent studies in type 1 diabetes mellitus suggest promising benefits to diabetes control with low carbohydrate diets, without concerning effects on ketosis or hypoglycemia. Dietary patterns may highlight pertinent associations. For example, Mediterranean-style and paleolithic-type diets, low in fat and carbohydrate, are associated with reduced body weight and improved glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM). A feature of these dietary patterns is low refined CHO and sugar and higher fiber, and it is possible that increasing sugar consumption is having a substantial effect on global escalations in obesity and T2DM. Dietary recommendations in type 1 diabetes and T2DM are changing. Dietary CHO is unquestionably important, but long-term acceptability of any diet is critical to sustain improvements in health benefits. Personalized dietary management, using a variety of dietary approaches, may be the key to optimal diabetes outcomes.

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Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes

Cited by 221 publications

References 24 publications

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Dietary and physical activity of adult patients with type 2 diabetes in Zhejiang province of eastern China: Data from a cross‐sectional study

Importance of low carbohydrate diets in diabetes management

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