EU Dietary Directive emphasizes whole grains, fruits and vegetables for diabetes

Key points to remember:

• Updated recommendations from the EASD advise people with diabetes to eat more whole grains, fruits, vegetables, legumes and nuts.
• People with diabetes should reduce their consumption of meat and refined grains.

According to an updated guideline published in Diabetes.

The Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes has published evidence-based dietary recommendations for people with diabetes. The group found that several eating habits, including the Mediterranean dietthe Nordic diet and the vegetarian diet, could all be beneficial for people with diabetes.

“I liked that we found a wide range of weight loss programs and that the diets were appropriate, giving patients choice,” Andrew Reynolds, PhD, MPH, MSc, senior researcher at the Department of Medicine at the University of Otago Medical School in New Zealand, Healio said. “It was really beautiful to see, and something I didn’t expect; there is no one way of eating that everyone should follow. Having this flexibility and freedom in what is promoted allows for all of these cultural, social and personal preferences that we have, which means that long-term adherence should be possible, because normally the more extreme or different the diet, the more it is difficult to follow. ”

The Diabetes and Nutrition Task Force recommendations were an update of recommendations published in 2004. The authors wrote that the document was written to provide evidence-based recommendations and advice on macronutrients, foods, eating habits and the broader lifestyle context for type 2 diabetes prevention and management.

Andrew Reynolds

“The guidelines were developed for healthcare professionals to inform discussion with their patients,” Reynolds said. “They are a starting point for nutritional therapy, which all people with diabetes need and deserve. We consider this to be particularly important because the vast majority of healthcare professionals are not trained to provide nutritional support. »

Diets high in fiber and low in sugar

For the prevention of type 2 diabetes, the authors recommend that people who are overweight or obese lose at least 5% of their body weight to reduce their risk. A combination of a healthy diet, regular physical activity, avoiding excess weight and not smoking is also recommended for the prevention of diabetes.

The group pointed out that a variety of diet types and macronutrient compositions can induce and maintain weight loss, as long as they follow dietary recommendations. Low-energy formulas can be used either temporarily for the induction of weight loss as a total food replacement, or as a replacement for one to two meals per day. Remission of type 2 diabetes can be achieved through sustained weight loss, and a low-energy total diet replacement program for 12 to 20 weeks, with carefully adjusted hypoglycemic and antihypertensive drugs, may provide relief. 10% to 15% weight loss to induce remission of type 2 diabetes. Extremely high carbohydrate diets and very low ketogenic diets are not recommended for weight loss.

For carbohydrate intake, the group emphasized foods naturally high in dietary fiber, especially minimally processed whole grains, vegetables, legumes, seeds, nuts and whole fruits. Sugar intake should be less than 10% of a person’s total energy intake, and non-nutritive sweeteners can be used in place of sugar.

The recommendations state that dietary fat should come from plant-based foods high in monounsaturated and polyunsaturated fats. Saturated fats should represent less than 10% of a person’s total energy and trans fats should represent less than 1% of total energy.

The protein intake of a person with diabetes and normal weight should be 10-20% of total energy intake. Higher intakes are recommended for someone aged 65 and over. For people with type 2 diabetes and overweight or obese with an estimated glomerular filtration rate greater than 60 mL/min/1.73 m², protein intake can be increased by 23-32% in the short term when dieting. Protein intake should be 10% to 15% for people with moderate diabetic nephropathy.

Whole grains, fruits and vegetables recommended

The study group recommended several key foods to base meals and snacks for people with diabetes, including minimally processed whole grains, whole vegetables and fruits, legumes, nuts and seeds. All diets that emphasize these foods, including the Mediterranean diet, the Nordic diet, and the vegetarian diet, are recommended for people with diabetes. The study group also listed foods and drinks to avoid, including meat, sugary drinks, sweets and refined grains.

Reynolds noted that while the recommendations provided by the group are broad, more research is needed on how to promote long-term behavior change in people with diabetes. Additionally, Reynolds said future recommendations should explore what governments can do to help promote healthy eating.

“Changing the food environment, for example by removing taxes on certain foods or having clear guidelines on what foods are available in public institutions, should help, as would tackling some of the business determinants of health, such as imposing restrictions on the advertising or marketing of food. foods that contribute to poor health outcomes,” Reynolds said.

For more information:

Andrew Reynolds, PhD, MPH, MSc, can be attached to [email protected].

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