Prevention of Type2 Diabetes

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During the last few years well-conducted, randomized studies have unequivocally shown that type-2 diabetes mellitus can be effectively prevented or delayed by lifestyle modification programs in people at risk of developing it [2-4]. The ADA, the DNSG of the EASD and Diabetes UK have incorporated diabetes prevention guidelines in their nutritional recommendations. The ADA gives emphasis to the fact that structured programs that focus on lifestyle changes, including education, reduced fat and energy intake, regular physical activity and regular participant contact, can reduce the risk of developing diabetes. The DNSG of the EASD state that weight reduction and maintenance of weight loss in overweight individuals is a critical component of the lifestyle modification program, which may be expected to reduce the risk of developing type-2 diabetes. The appropriate macronutrient composition of the diet is a total fat <30% of energy intake, saturated fat <10% and fiber intake >15g/1,000kcal. Diabetes UK state that structured programs of lifestyle change which emphasize weight loss by reduced energy and fat intake and increased physical activity can reduce the risk of overweight people with impaired glucose tolerance to develop type-2 diabetes.

In both studies of diabetes prevention mentioned above [3, 4] frequent ingestion of wholegrain products, vegetables, fruits, low-fat milk and meat products, soft margarines and vegetable oils rich in MUFAs was the means of facilitating the appropriate macronutrient composition of the diet for achieving a weight loss of 5-7% of the initial body weight. Thus, for people who are overweight/obese, especially if there is a strong family history of diabetes or if they have impaired glucose metabolism, weight loss with diet and exercise should be strongly advised.


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Ms. Franz: It is essential that nutrition recommendations be evidence-based, but it is also important to have evidence that recommendations can be implemented in the 'real world' and that outcomes from free-living subjects are similar to the findings from subjects in controlled research settings. For example, a number of small, short-term studies have reported benefits from a diet with 30% of energy intake from protein [1]. However, in a study comparing long-term compliance to diets low in fat and high in either protein or carbohydrate, at the 52-week follow-up protein intake was similar in each group suggesting that long-term it is difficult to change protein intake [2].

Dr. Katsilambros: Thank you very much for your comments.


1 Gannon MC, Nuttall FQ, Saeed A, et al: An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr 2003;78:734-741.

2 Brinkworth GD, Noakes M, Keogh JB, et al: Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord 2004;28:661-670.

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