Elsevier

The Lancet

Volume 383, Issue 9933, 7–13 June 2014, Pages 1999-2007
The Lancet

Series
Prevention and management of type 2 diabetes: dietary components and nutritional strategies

https://doi.org/10.1016/S0140-6736(14)60613-9Get rights and content

Summary

In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities.

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

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

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