We searched PubMed and Google Scholar, mainly for original research articles, meta-analysis or systematic reviews, and organisation recommendations published up to January, 2014. We used the main search terms “type 2 diabetes”, “nutrition”, “diet”, “prevention”, and “management” in combination with specific terms on nutrient or dietary pattern. We largely selected publications in the past 5 years but did not exclude frequently referenced and highly regarded older publications. We also
SeriesPrevention and management of type 2 diabetes: dietary components and nutritional strategies
Introduction
382 million adults (8·3%) worldwide are living with diabetes, and the estimate is projected to rise to more than 592 million by 2035.1 At least US$147 billion was spent on diabetes health care in Europe, whereas North America and the Caribbean spent $263 billion in 2013.1 Diabetes has become a major cause of death in people younger than 60 years.1 Investment in effective diabetes prevention and management has become necessary to battle this global epidemic.
Along with urbanisation and economic growth, many countries have experienced dietary changes favouring a rise in caloric consumption and decline in overall diet quality.2 Although an unhealthy diet has been regarded as a major contributor to diabetes development for a long time, only in the past two decades has the evidence vastly accumulated from both prospective observational studies and randomised controlled trials (RCTs). In this Series, we examine the role of diet in the prevention and management of diabetes.
Section snippets
Nutrition transition and global dietary trends
At a macrolevel, the type 2 diabetes epidemic has been attributed to urbanisation and environmental transitions, including work pattern changes from heavy labour to sedentary occupations, increased computerisation and mechanisation, and improved transportation. Economic growth and environmental transitions have led to drastic changes in food production, processing, and distribution systems and enhanced the accessibility of unhealthy foods.3
Fast food restaurants have experienced exponential
Positive energy balance and excess adiposity
In the past few decades, men and women worldwide have gained weight, largely as a result of changes in dietary patterns and decreased physical activity levels.4 Excess adiposity shown by a higher body-mass index (BMI) is the strongest risk factor for diabetes, and Asian populations tend to develop diabetes at a much lower BMI than do those of European ancestry.5 The risk of diabetes rises as excessive body fat increases, starting from the lower end of the normal range of BMI or waist
Individual foods and food groups
Prospective studies have provided evidence that intake of several individual food items or food groups might play a part in diabetes prevention (figure 3, appendix).25, 26, 27, 28, 29, 30, 31, 32, 33, 34 Wholegrain intake has been consistently associated with a lower risk of diabetes even after adjustment for BMI.25 Conversely, greater intake of white rice, a processed grain, was associated with an increased risk of diabetes,26 especially in Asian populations with white rice as a staple food
Bodyweight loss intervention trials and surgeries
Nutritional therapy recommendations from various organisations for diabetes management support intensive lifestyle interventions to achieve modest weight loss and weight maintenance.61, 62, 63, 64 In the Action for Health in Diabetes (Look AHEAD) trial,65, 66 an intensive lifestyle intervention for weight loss in overweight or obese adults with type 2 diabetes, weight loss was greater in the intervention group than in the control group (8·6% and 0·7% at 1-year; 6·0% and 3·5% at 9·6-year
Summary and global perspectives
Economic growth and globalisation of trade have led to drastic changes in food production, processing, and distribution systems and have increased the accessibility of unhealthy foods.3 With nutrition transitions, men and women worldwide have experienced excess bodyweight gain accompanied by increased diabetes incidence and complications.4
In the past two decades, evidence from prospective cohort studies and RCTs has shown the importance of individual nutrients, foods, and dietary patterns in
Search strategy and selection criteria
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