Evidence-based recommendations to nutrition therapy and the prevention of diabetes mellitus

M. Toeller, Duesseldorf

Evidence-based nutritional recommendations which followed a formal search of the literature using an agreed set of descriptors and relevant data banks are now available for the treatment and prevention of diabetes mellitus in European countries [Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes: Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 14: 373-394 ].

These evidence-based nutritional guidelines were published in agreement with all relevant German Diabetes and Nutrition Associations: Deutsche Diabetes-Gesellschaft, Deutsche Adipositas-Gesellschaft, Deutsche Gesellschaft für Ernährungsmedizin and Deutsche Gesellschaft für Ernährung.

Scientific evidence of nutritional recommendations to the treatment of persons with diabetes is now more clearly documented than previously. Protein restriction to 0.8 g/kg body weight is recommended in patients with type 1 diabetes and established nephropathy (macroalbuminuria) as randomised controlled studies have documented its significant potential to reduce albuminuria and the rate of GFR decrease. The beneficial effect of oils rich in monounsaturated fatty acids on serum lipid levels, lipoprotein concentration and composition as well as on insulin sensitivity is clearly documented provided that total fat intake remains below 35 % of total energy.

The recommendation of very low carbohydrate diets in diabetes has not been scientifically substantiated. Dietary fibre intake should ideally be more than 40 g/day as this has been shown to improve postprandial glucose levels, to reduce haemoglobin A1c concentrations and to lower total and LDL-cholesterol. High-carbohydrate food with a low glycaemic index are suitable carbohydrate-rich choices in individuals with diabetes provided other attributes of the foods are also appropriate. Saccharose and other free sugars may be included in the diet of persons with type 1 and type 2 diabetes but should not exceed 10 % of total energy.

The intake of food naturally rich in dietary antioxidants, trace elements and other vitamins should be encouraged. There are no recommendations of supplements and functional food in view of insufficient scientific evidence for their beneficial effects in persons with diabetes. Moderate use of alcohol (up to 10g for women and up to 20g for men) is acceptable for those with diabetes who choose to drink alcohol. To prevent type 2 diabetes the daily diet should contain total fat