Recommendations for the nutritional management of patients with diabetes mellitus

Ha, Thomas; Lean, Michael E. J.

doi:10.1038/sj.ejcn.1600599

Cited by 76 publications

(64 citation statements)

References 160 publications

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“…A diet with a high content of dietary fiber and low glycemic load is also associated with reduced incidence of type 2 diabetes (12,13). Dietary recommendations for type 2 diabetic subjects largely target reducing total and saturated fat and replacing the fat with complex carbohydrates (14). This dietary therapy is also generally recommended for lowering plasma cholesterol before resorting to drug treatments.…”

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confidence: 99%

Beneficial Effects of a Soy-Based Dietary Supplement on Lipid Levels and Cardiovascular Risk Markers in Type 2 Diabetic Subjects

et al. 2001

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OBJECTIVE -Consumption of soy protein has recently been shown to improve the blood lipid levels in nondiabetic subjects. The purpose of this study was to evaluate if a dietary supplement of soy protein, isoflavones, and cotyledon fiber (Abalon) affects cardiovascular risk markers, blood glucose, and insulin levels in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS RESULTS -The results are expressed as means ± SD. The percentage mean treatment difference between Abalon and placebo demonstrated significantly lower mean values afterAbalon for LDL cholesterol (10 ± 15%, P Ͻ 0.05), LDL/HDL ratio (12 ± 18%, P Ͻ 0.05), apolipoprotein (apo) B100 (30 ± 38%, P Ͻ 0.01), triglycerides (22 ± 10%, P Ͻ 0.05), and homocysteine (14 ± 21%, P Ͻ 0.01), whereas the total cholesterol value tended to be less significant but still lower (8 ± 15%, P Ͻ 0.08). No change occurred in HDL cholesterol, apo B100/apo A1 ratio, plasminogen activator inhibitor 1, factor VIIc, von Willebrand factor, fibrinogen, lipoprotein(a), glucose, HbA 1c , or 24-h blood pressure. CONCLUSIONS -These results indicate beneficial effects of dietary supplementation withAbalon on cardiovascular risk markers in type 2 diabetic subjects. This improvement is seen even in individuals with near-normal lipid values.

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Beneficial Effects of a Soy-Based Dietary Supplement on Lipid Levels and Cardiovascular Risk Markers in Type 2 Diabetic Subjects

et al. 2001

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“…Nutrition therapy is an integral part of the treatment of diabetes mellitus and patient self-management (4)(5)(6)(7)(8) . Classically, more emphasis has been placed on the relative amounts and types of carbohydrate and fat to include in the diet (5)(6)(7)(8)(9)(10) , but some studies have also reported beneficial effects of increasing dietary protein in type 2 diabetes (11)(12)(13) . This could be related to the fact that proteins do not increase plasma glucose concentrations in subjects with controlled diabetes, while ingested proteins are just as potent a stimulant of insulin secretion as carbohydrates (14)(15)(16)(17) .…”

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Validation of an FFQ to assess dietary protein intake in type 2 diabetic subjects attending primary health-care services in Mali

Coulibaly

O’Brien

Galibois

2009

Public Health Nutr.

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Objective: To validate a 53-item quantitative FFQ (QFFQ) for the assessment of dietary protein intake in type 2 diabetic outpatients in Bamako, Mali. Design: Consumption of protein-containing foods over the week preceding the interview was measured with a 7 d QFFQ and compared with intakes measured with 48-h recalls. Setting: Centre National de Lutte contre le Diabète. Subjects: Seventeen male and forty female adults with type 2 diabetes. Results: Correlation between protein intakes estimated using the QFFQ and 48 h recalls was 0?63 (P , 0?0001). There was no significant difference between the two methods concerning the total protein daily intakes and intakes per kilogram of body weight. The QFFQ indicated that foods of animal origin were a lesser source of protein. Animal protein intake did not differ between men and women but sources did. In men, the main sources were beef (54 % of total animal protein), fish (15 %) and milk powder (8 %). In women, the principal sources were fish (28 %), beef (20 %) and birds (13 %). In contrast, plant protein intake was significantly higher in men than in women (P 5 0?01), but the same plant foods contributed in similar proportions for both genders, rice being by far the greatest source (47 % of plant protein in men, 53 % in women). Conclusion: The QFFQ developed in this study is a valid tool to evaluate dietary protein intakes in Malian diabetic subjects. While the total protein intakes were low in both men and women, differences in choices and amounts of protein food sources were shown.

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“…The literature on recommendations varies to a minor degree, and cultural differences may have an influence (9), but a total fat level of Յ30% energy (10) and Ͻ10% saturated fat is reasonably well accepted (11,12). There is some concern that PUFAs are more susceptible to oxidation and therefore may be more atherogenic (11), so a level of Ͻ10% energy for PUFAs is seen with greater flexibility in the proportions of carbohydrate and MUFA (13).…”

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“…There is some concern that PUFAs are more susceptible to oxidation and therefore may be more atherogenic (11), so a level of Ͻ10% energy for PUFAs is seen with greater flexibility in the proportions of carbohydrate and MUFA (13). Within the PUFA fraction of the diet, the ratio of -6 to -3 fatty acids is also considered (9) with daily recommendations for a 2,000-kcal diet of 0.65 g for the long-chain -3s (EPA ϩ DHA) and 2.22 g for ALA (14) and the -6 -to--3 ratio reduced to substantially Ͻ10 (14a).…”

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Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes

et al. 2004

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OBJECTIVE -The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 Ϯ 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA 1c , total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model. RESULTS -The walnut group achieved a significantly greater increase in HDL cholesterolto-total cholesterol ratio (P ϭ 0.049) and HDL (P ϭ 0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P ϭ 0.032) and time (P ϭ 0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA 1c levels. The higher dietary polyunsaturated fat-to-saturated fat ratio and intakes of -3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake.CONCLUSIONS -Structured "whole of diet" advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes. The literature on recommendations varies to a minor degree, and cultural differences may have an influence (9), but a total fat level of Յ30% energy (10) and Ͻ10% saturated fat is reasonably well accepted (11,12). There is some concern that PUFAs are more susceptible to oxidation and therefore may be more atherogenic (11), so a level of Ͻ10% energy for PUFAs is seen with greater flexibility in the proportions of carbohydrate and MUFA (13). Within the PUFA fraction of the diet, the ratio of -6 to -3 fatty acids is also considered (9) with daily recommendations for a 2,000-kcal diet of 0.65 g for the long-chain -3s (EPA ϩ DHA) and 2.22 g for ALA (14) and the -6 -to--3 ratio reduced to substantially Ͻ10 (14a). Diabetes CareFish are the major source of EPA ϩ DHA, but fish oil supplements produce a decreased oxidative stability of plasma LDL (15,16). In contrast, consumption of fish itself may be protective against type 2 diabetes (17). Nuts provide substantial amounts of dietary PUFA, and nut consumption is inversely associated with the risk of type 2 diabetes in women (18). There is no net effect on glucose homeostasis from nut supplementation, but more interestingly, no net weight gain when nuts were used as a replacement food (19). In subjects with dyslipidemia (total cholesterol Ͼ5.17; LDL Ͼ3.36; triglycerides Ͼ2.26 mmol/l), a low-fat diet supplemented with walnuts was found to reduce total choles...

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Recommendations for the nutritional management of patients with diabetes mellitus

Cited by 76 publications

References 160 publications

Beneficial Effects of a Soy-Based Dietary Supplement on Lipid Levels and Cardiovascular Risk Markers in Type 2 Diabetic Subjects

Beneficial Effects of a Soy-Based Dietary Supplement on Lipid Levels and Cardiovascular Risk Markers in Type 2 Diabetic Subjects

Validation of an FFQ to assess dietary protein intake in type 2 diabetic subjects attending primary health-care services in Mali

Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes

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