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New nutrition recommendations issued for prevention, management of diabetes
The goal of the recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions.
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The American Diabetes Association has issued an updated position statement of nutrition recommendations and interventions for the prevention and management of diabetes.
Published in a recent issue of Diabetes Care, the ADA’s revised medical nutrition therapy recommendations update statements published in 2002 and 2004 using the most recent scientific data available.
For the first time, the guidelines categorize medical nutrition advice according to a person’s medical condition, breaking out recommendations for people at high risk for diabetes, managing existing diabetes, and trying to prevent or slow the rate of development of diabetes complications.
Specific recommendations are also included for people with type 1 diabetes, pregnant or nursing mothers with diabetes, older adults, and those living in long-term care facilities or managing acute illnesses such as kidney disease.
“When you’re talking about diabetes, there is no ‘one-size-fits-all’ diet,” said Ann Albright, PhD, RD, president-elect, Health Care & Education, ADA. “For people with diabetes and those at risk for type 2 diabetes, medical nutrition therapy should be tailored to a person’s specific health issues and personal preferences to help maintain optimum health by controlling blood glucose levels, blood pressure, cholesterol and other risk factors. We hope these recommendations will help people make better choices about what they eat and how they live to maximize their chances of staying healthy.”
Guidelines for those at risk
For people who are at risk for diabetes, the guidelines call for a diet high in fiber and nutrient-rich foods (14 grams of fiber for every 1,000 calories), with whole grains making up half of all grain intake. In emphasizing the importance of weight loss, the ADA notes that medications may be useful for some individuals if combined with lifestyle changes, and that for the very obese, weight loss surgery has shown considerable health benefits.
They also caution people who use meal replacements to lose weight that research finds the weight loss is only maintained as long as people stay on the meal replacement plan. Exercise is recommended independent of weight loss because studies show it helps lower blood glucose levels, increases insulin sensitivity and improves cardiovascular risk factors regardless of whether the person loses any weight.
“There is no evidence that these diets are successful at helping people keep weight off once they lose it, and there are ample concerns about the fiber, vitamins and minerals people give up when they severely restrict their diet, say by sharply limiting carbohydrate intake,” Albright said in a news release. “Fad diets come and go. We want people to be provided with sound nutrition advice that will help them in making choices for maintaining good health for the long term.”
For people who already have diabetes, the nutrition guidelines are more specific. The dietary recommendations include an intake of carbohydrates from fruits, vegetables, whole grains, legumes and low-fat milk; eating fiber-rich foods; keeping saturated fats to less than 7% of total caloric intake; eating at least two servings of non-fried fish per week; limiting trans fats; and restricting cholesterol intake to less than 200 mg/day.
People with diabetes are advised to keep alcohol intake moderate and to consume alcohol with food to avoid hypoglycemia.
Patient populations
The new recommendations were also tailored to address issues within specific patient populations. People with type 1 diabetes should integrate their insulin therapy into their dietary and physical activity pattern. Rapid-acting insulin by injection or an insulin pump should be adjusted to coordinate with the carbohydrate content of meals, the recommendations said.
For those women with gestational diabetes, adequate energy intake to provide for appropriate weight gain is recommended. After delivery, lifestyle modifications aimed at decreased weight and increased physical activity are appropriate.
Older adults with diabetes may benefit from “modest energy restriction and an increase in physical activity,” the recommendations said. A daily multivitamin may also be appropriate.
The recommendations note that there is no evidence that type 1 diabetes can be prevented through medical nutrition therapy.
They also caution that, although there is not yet sufficient evidence to include guidelines for children at risk for or living with type 2 diabetes, it is reasonable to assume the same general advice given to adults would benefit children. Studies looking specifically at how medical nutrition therapy affects children are currently underway.
For more information:
- American Diabetes Association. Nutrition recommendations and interventions for diabetes – 2006: a position statement of the American Diabetes Association. Diabetes Care. 2006;29:2140-2157.