Other Evidence for Dietary Effects

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Although the technical review published by the American Diabetes Association found insufficient evidence for recommending food selection based on the glycemic index [3], there is some evidence suggesting that a lower glycemic index (effect of a food on raising the blood glucose) or glycemic load (a product of the amounts of food with their glycemic indices) may reduce the incidence of type-2 diabetes. The Health Professional Follow-up Study of Men reported that neither glycemic load nor cereal fiber intake alone was strongly related to subsequent diabetes. The combination of low cereal fiber intake and high glycemic load, however, was associated with an approximate doubling of the risk of developing diabetes [14].

There has also been substantial controversy regarding the potential benefits of several recently popular diets, especially those with extremes of fat and carbohydrate content. A recent randomized controlled clinical trial attempted to evaluate four such diet plans ranging from the lowest carbohydrate and highest fat content (the Atkins diet) to the lowest fat and highest carbohydrate content (the Ornish diet) [15]. Forty persons were randomized to each of the four diets and followed for 1 year. As is typical in many published diet clinical trials, the dropout rate was high, making interpretation difficult, because dropping out of a weight loss trial may not be random but related to success with weight loss. Perhaps because of the dropout problem and the limited sample sizes, there were no significant differences between the treatment groups in weight loss or changes in lipids or other cardiovascular risk factors. Such studies, directly comparing different diet regimens for longer periods of time, but with larger sample sizes and more complete follow-up of all participants regardless of weight loss, are needed to provide firm evidence for recommending the optimal diet.

Concern has been raised recently that the rapidly increasing consumption of high fructose corn syrup in the United States, due to its becoming the major sweetener used in beverages since the 1970s, is a major contributor to the increasing prevalence of obesity in the United States [16]. Reported consumption of sweetened beverages predicted the incidence of diabetes in the Nurses Health Study, in which persons reporting consumption of at least 1 beverage/day had about double the incidence rate of diabetes as those reporting such consumption less than once per month [17].

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