Composition of macronutrients in the diabetic diet

Česká verzia

Authors: Zdeněk Rušavý; Michal Žourek
Authors place of work: I. interní klinika LF UK a FN Plzeň
Published in the journal: Vnitř Lék 2016; 62(Suppl 4): 94-99
Category: Reviews

Summary

The diabetic diet is one of the pillars of diabetes treatment. The rapid development of knowledge relating to the treatment of diabetes also includes diet. The paper focuses on the importance of a diet in the treatment of type 2 diabetes and prevention of atherosclerosis. Its main goal is to assess the impact of a composition of macronutrients on individuals with type 2 diabetes. The paper is divided into several parts, each of which ends with a conclusion. The first part examines weight reduction. The diet aimed at a weight loss is effective, it can effectively prevent diabetes, it leads to improvements in glucose control and reduction of the risk factors for atherosclerosis, however it will not impact on cardiovascular morbidity and mortality until after more than 20 years. The second part deals with “healthy” foods. The studies exploring this area are not convincing. The only really rational component of food in relation to atherosclerosis is dietary fibres. Important is a balanced diet combined with regular physical activities. The third part focuses on the composition of macronutrients. It turns out that, considering a low-calorie diet, the effects of high- and low-carbohydrate diets on people with diabetes are similar with regard to weight loss and lowering of HbA_1c, however the low-carbohydrate diet is associated with lower glycemic variability and a reduced need for anti-diabetic drugs. We do not know how the comparison of the two extreme diets would come out regarding individuals with a high energy diet. Currently it is useful to focus on the quality of individual macronutrients. Choose foods containing carbohydrates with a low glycemic index and high fibre foods, prefer fats that contain a low proportion of saturated fatty acids. The fourth part discusses the recent recommendation of the Czech Diabetes Society regarding the composition of macronutrients in the diabetic diet. As compared with the diet proposed earlier, lower intake of fibre-rich carbohydrates and higher intake of proteins and fats with a low content of saturated fatty acids is now recommended. Experts’ recommendations on this subject are included.

Key words:
atherosclerosis – diabetic diet – HbA_1c – macronutrients – low-carbohydrate diet – obesity – dietary fibres – high-carbohydrate diet – health food

Zdroje

1. Hite AH, Feinman RD, Guzman GE et al. In the face of contradictory evidence: Report of the dietary guidelines for americans committee. Nutrition 2010; 26(10): 915–924. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2010.08.012>.

2. Jirkovská A, Pelikánová T, Anděl M. Doporučený postup dietní léčby pacientů a diabetem. DMEV 2012; 15(4): 235–243.

3. Wing RR, Bolin P, Brancati FL et al. [Look AHEAD research group]. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369(2): 145–154. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1212914>. Erratum in N Engl J Med. 2014; 370(19): 1866.

4. Xiao-Ren Pan, Guang-Wei Li, Ying-Hua Hu et al. Effects of diet and exercise in preventing NIDM in people with impaired glucose tolerance: the Da Qing IGT and diabetes study. Diabetes Care 1997; 20(4): 537–544.

5. Guang-Wei Li, Ping Zhang, Jinping Wang et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008; 371(9626): 1783–1789. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(08)60766–7>.

6. Li G, Zhang P, Wang J et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2014; 2(6): 474–480. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(14)70057–9>.

7. Gijsbers L, Ding EL, Malik VS et al. Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies. Am J Clin Nutr 2016; 103(4): 1111–1124. Dostupné z DOI: <http://dx.doi.org/10.3945/ajcn.115.123216>.

8. Pimpin L, Wu JH, Haskelberg H et al. Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. PLoS One 2016; 11(6): e0158118. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0158118>.

9. Schoenaker DAJM, Toeller M, Chaturvedi N et al. [EURODIAB Prospective Complications Study Group]. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia 2012; 55(8): 2132–2141. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–012–2550–0>.

10. Whincup PH, Donin AS. Cereal fibre and type 2 diabetes: time now for randomised controlled trials? Diabetologia 2015; 58(7): 1383–1385. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–015–3644–2>.

11. Tay J, Luscombe-Marsh ND, Thompson CB et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 2015; 102(4): 780–790. Dostupné z DOI: <http://dx.doi.org/10.3945/ajcn.115.112581>.

12. Jensen R, Ryan DH, Apovian CM et al. AHA/ACC/ guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association. J Am Coll Cardiol 2014; 63(25 Pt B): 2985–3023. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2013.11.004>. Erratum in J Am Coll Cardiol. 2014; 63(25 Pt B): 3029–3030.

13. Musso G, Gambino R, Cassader M. Interaction between gut microbiota and host metabolism predisposes to obesity and diabetes. Annu Rev Med 2011; 62: 361–380. Dostupné z DOI: <http://dx.doi.org/10.1146/annurev-med-012510–175505>.

14. Shen J, Obin MS, Zhao L. The gut microbiota, obesity and insulin resistance. Mol Aspects Med 2013; 34(1): 39–58. Dostupné z DOI: <http://dx.doi.org/10.1016/j.mam.2012.11.001>.

15. Deutz NE, Bauer JM, Barazzoni R et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from ESPEN Expert group. Clin Nutr 2014; 33(6): 829–836. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2014.04.007>.

16. Feinman RD, Pogozelski WK, Astrup A et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition 2015; 31(1): 1–13. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2014.06.011>.

17. Steven S, Hollingsworth KG, Al-Mrabeh A et al. Very-Low-Calorie Diet and 6 month of weight stability in type 2 diabetes: Pathophysiologic changes in responders and nonresponders. Diabetes Care 2016; 39(5): 808–815. Dostupné z DOI: <http://dx.doi.org/10.2337/dc15–1942>.