Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective

Abstract

In recent years, several alternative dietary approaches, including high-protein and low-glycaemicload diets, have produced faster rates of weight loss than traditional low-fat, high-carbohydrate diets. These diets share an under-recognised unifying mechanism: the reduction of postprandial glycaemia and insulinaemia. Similarly, some food patterns and specific foods (potatoes, white bread, soft drinks) characterised by hyperglycaemia are associated with higher risk of adiposity and type 2 diabetes. Profound compensatory hyperinsulinaemia, exacerbated by overweight, occurs during critical periods of physiological insulin resistance such as pregnancy and puberty. The dramatic rise in gestational diabetes and type 2 diabetes in the young may therefore be traced to food patterns that exaggerate postprandial glycaemia and insulinaemia. The dietary strategy with the strongest evidence of being able to prevent type 2 diabetes is not the accepted low-fat, high-carbohydrate diet, but alternative dietary approaches that reduce postprandial glycaemia and insulinaemia without adversely affecting other risk factors.

Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS)

“…Discussion continues about the optimal lifestyle intervention, especially the role of the macronutrient composition of a diet to prevent diabetes [18]. Our study was not designed to compare different diets but rather to test the feasibility and efficacy of a diet that was considered the healthy choice-even the control group participants were advised on the same type of lifestyle, but without individualised counselling or continuity.…”

Prevention strategies for type 2 diabetes should be based on evidence-based medical nutrition data. Reply to Uusitupa M, Lindström J, Tuomilehto J [letter]

“…To the Editor: In a recent issue of Diabetologia, Uusitupa et al responded to our review 'Optimal dietary approaches to prevent type 2 diabetes', published in Diabetologia last year [1,2]. We are grateful for their detailed critique which contributes to the much needed constructive debate on this topic.…”

“…sourdough rye breads) [5]; it is thus possible that the benefits observed with the dietary approach chosen in the DPS are partly attributable to reduced postprandial glycaemia and insulinaemia. However, in our review, our main argument was that the DPS and Diabetes Prevention Program are commonly interpreted as evidence supporting the preferential use of 'low-fat, high-carbohydrate' dietary approaches for the prevention of type 2 diabetes [2].In addition, these impressive landmark randomised controlled trials were not designed to compare the effectiveness of different dietary approaches [3,4]. We therefore integrated evidence from other relevant studies.…”

Prevention strategies for type 2 diabetes should be based on evidence-based medical nutrition data

“…Simultaneously, the intake of dietary fibre was increased in the intervention group, in line with the recommendation. Therefore, labelling the diet recommended in the DPS 'a conventional low-fat high-carbohydrate diet' [1] is a misleading. Of note, the weight reduction in both the DPS and the DPP was comparable with that in the studies with different diet modifications cited by Buyken et al [1].…”

“…Therefore, labelling the diet recommended in the DPS 'a conventional low-fat high-carbohydrate diet' [1] is a misleading. Of note, the weight reduction in both the DPS and the DPP was comparable with that in the studies with different diet modifications cited by Buyken et al [1]. Importantly, in the DPS the incidence of diabetes was lowest (almost complete protection) and weight reduction greatest among people who were able to achieve four or five of the lifestyle intervention goals (weight loss >5%, intake of fat <30 E%, intake of saturated fats <10 E%, intake of dietary fibre ≥15 g/4,200 kJ [1,000 kcal] and physical activity for at least 4 h/week) [2,5].…”