Aims and Goals of Nutritional Advice

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There is a general agreement among the various scientific organizations mentioned above regarding the goals of MNT in diabetes. These goals are generally the following, as addressed in the ADA statement [5]:

• Attain and maintain recommended metabolic outcomes, including glucose and HbA1c levels, LDL cholesterol, HDL cholesterol, triglyceride levels, blood pressure and body weight.

• Prevent and treat the chronic complications and comorbidities of diabetes. Modify nutrient intake and lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia, cardiovascular disease, hypertension and nephropathy.

• Improve health through healthy food choices and physical activity.

• Address individual nutritional needs, taking into consideration personal and cultural preferences and lifestyle, while respecting the individual's wishes and willingness to change.

Goals of MNT that apply to specific situations include the following:

• For youth with type-1 diabetes mellitus, MNT should provide adequate energy to ensure normal growth and development. Insulin regimens should be integrated into usual eating and physical activity habits.

• For youth with type-2 diabetes mellitus, who are usually overweight/ obese, appropriate changes in eating and physical activity habits should be facilitated.

• For pregnant and lactating women, adequate energy and nutrients needed for optimal outcomes should be provided.

• For older adults, nutritional and psychological needs of an aging individual should be addressed.

• For individuals treated with insulin or insulin secretagogues, self-management education for treatment (and prevention) of hypoglycemia, acute illness and exercise-related blood glucose problems should be provided.

• For individuals at risk of diabetes, physical activity and food choices that facilitate moderate weight loss, or at least prevent weight gain, should be encouraged.

The DNSG of the EASD does not provide specific aims and goals of nutritional advice in its most recent publication [6], although the previous one in 1999 generally - albeit briefly - agrees with the aforementioned statements of ADA [12]. The Canadian Diabetes Association [7], the AACE [9] and Diabetes UK [10] also generally and briefly agree with them. The Joslin Diabetes Center and Joslin Clinic additionally emphasizes the goals of improving postprandial hyperglycemia, postprandial hypertriglyceridemia, body fat distribution with reduction of visceral fat and reduction of cardiovascular risk, as evidenced by improvement of endothelial function and endothelial markers and reduction of inflammatory cytokines [8].

All the scientific organizations (with the exception of the DNSG of the EASD, which does not make any specific recommendation) generally agree that, given the complexity of the dietary issues, a registered dietitian, familiar with the components of diabetes MNT should be part of the team that provides dietary advice to the diabetic individual.

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