Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence

Abstract

The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.

Keywords: MENA region; dietary management; insulin glucose homeostasis; insulin resistance; obesity; type 2 diabetes.

Figure 1

Diabetes prevalence in countries of the Middle Eastern and North African (MENA) region based on International Diabetes Federation (IDF) estimates 2019 [1]. MENA countries include Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, State of Palestine, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen.

Figure 2

Overview of mechanistic links between obesity and type 2 diabetes. NEFA: Non-esterified fatty acids. Large arrows indicate influence.

Figure 3

Summary of considerations, concerns and recommendations for macronutrient-focused diets in diabetes management.GI: glycemic index; GL: glycemic load; SSB: sugar sweetened beverages; PUFA: polyunsaturated fatty acids; MUFA: monounsaturated fatty acids; SFA: saturated fatty acids.