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

Abstract

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.

Figure 1. Global dietary trend changes over time

A high diet 1 score indicates a high availability of sugars; meat, animal products, animal fats, milk, and eggs; and total calories, in addition to low availability of pulses and cereals based on the United Nations Food and Agriculture Organization food balance sheets.

Figure 2. Summary of meta-analyses of prospective cohort studies on nutrient intake and type 2 diabetes

DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid. Relative risks (RR) are comparison of extreme categories, except for DHA/EPA (per 250 mg/d increase) and alpha-linolenic acid (per 0.5 g/d). All nutrients were assessed from dietary intake, except vitamin D for which blood 25-hydroxyvitamin D was used.

Figure 3. Summary of meta-analyses of prospective cohort studies on food and beverage intake and type 2 diabetes

Relative risks (RR) are comparison of extreme categories, except for processed meat (per 50 g/d increase), unprocessed red meat and fish/sea food (per 100g/d), white rice (per each serving/d), whole grains (per 3 servings/d), sugar-sweetened beverages in European cohorts (per 336g/d), alcohol (abstainers with 22 g/d for men and with 24 g/d for women)