EATING PATTERNS
Consensus recommendations
- A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
- Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:
- ○ Emphasize nonstarchy vegetables.
○ Minimize added sugars and refined grains.
○ Choose whole foods over highly processed foods to the extent possible.
- Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
- For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.
What is the evidence for specific eating patterns to manage prediabetes and prevent type 2 diabetes?
The most robust research available related to eating patterns for prediabetes or type 2 diabetes prevention are Mediterranean-style, low-fat, or low-carbohydrate eating plans (26,69,74,75). The PREDIMED trial, a large RCT, compared a Mediterranean-style to a low-fat eating pattern for prevention of type 2 diabetes onset, with the Mediterranean-style eating pattern resulting in a 30% lower relative risk (69). Epidemiologic studies correlate Mediterranean-style (76), vegetarian (77–80), and Dietary Approaches to Stop Hypertension (DASH) (76,81) eating patterns with a lower risk of developing type 2 diabetes, with no effect for low-carbohydrate eating patterns (82).
Several large type 2 diabetes prevention RCTs (26,74,83,84) used low-fat eating plans to achieve weight loss and improve glucose tolerance, and some demonstrated decreased incidence of diabetes (26,74,83). Given the limited evidence, it is unclear which of the eating patterns are optimal.
What is the evidence for specific eating patterns to manage type 2 diabetes?
Mediterranean-Style Eating Pattern
The Mediterranean-style pattern has demonstrated a mixed effect on A1C, weight, and lipids in a number of RCTs (85–90). In the Dietary Intervention Randomized Controlled Trial (DIRECT), obese adults with type 2 diabetes were randomized to a calorie-restricted Mediterranean-style, a calorie-restricted lower-fat, or a low-carbohydrate eating pattern (28% of calories from carbohydrate) without emphasis on calorie restriction. A1C was lowest in the low-carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group (90).
One of the largest and longest RCTs, the PREDIMED trial, compared a Mediterranean-style eating pattern with a low-fat eating pattern. After 4 years, glycemic management improved and the need for glucose-lowering medications was lower in the Mediterranean eating pattern group (89). In addition, the PREDIMED trial showed that a Mediterranean-style eating pattern intervention enriched with olive oil or nuts significantly reduced CVD incidence in both people with and without diabetes (91).
Vegetarian or Vegan Eating Patterns
Studies of vegetarian or vegan eating plans ranged in duration from 12 to 74 weeks and showed mixed results on glycemia and CVD risk factors. These eating plans often resulted in weight loss (92–97). Two meta-analyses of controlled trials (98,99) concluded that vegetarian and vegan eating plans can reduce A1C by an average of 0.3–0.4% in people with type 2 diabetes, and the larger meta-analysis (99) also reported that plant-based eating patterns reduced weight (weight reduction of 2 kg), waist circumference, LDL cholesterol (LDL-C), and non–HDL-C with no significant effect on fasting insulin, HDL-C, triglycerides, and blood pressure.
Low-Carbohydrate or Very Low-Carbohydrate Eating Patterns
Low-carbohydrate eating patterns, especially very low-carbohydrate (VLC) eating patterns, have been shown to reduce A1C and the need for antihyperglycemic medications. These eating patterns are among the most studied eating patterns for type 2 diabetes. One meta-analysis of RCTs that compared low-carbohydrate eating patterns (defined as ≤45% of calories from carbohydrate) to high-carbohydrate eating patterns (defined as >45% of calories from carbohydrate) found that A1C benefits were more pronounced in the VLC interventions (where <26% of calories came from carbohydrate) at 3 and 6 months but not at 12 and 24 months (110).
Another meta-analysis of RCTs compared a low-carbohydrate eating pattern (defined as <40% of calories from carbohydrate) to a low-fat eating pattern (defined as <30% of calories from fat). In trials up to 6 months long, the low-carbohydrate eating pattern improved A1C more, and in trials of varying lengths, lowered triglycerides, raised HDL-C, lowered blood pressure, and resulted in greater reductions in diabetes medication (111). Finally, in another meta-analysis comparing low-carbohydrate to high-carbohydrate eating patterns, the larger the carbohydrate restriction, the greater the reduction in A1C, though A1C was similar at durations of 1 year and longer for both eating patterns (112).
发布于 2023-07-25 11:26・IP 属地中国香港