Transcript Diet and risk of type 2 diabetes File

DIET AND RISK OF TYPE 2
DIABETES
Arja Erkkilä, UEF
CONTENT
Risk factors and development of diabetes
Evidence on dietary factors
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Energy balance
Fat (quality and quantity)
Carbohydrates (fiber, sugar, glycemic index)
Vitamins and minerals
Dietary patterns
Lifestyle interventions to reduce risk of type 2 diabetes
Prevention of T2DM in primary health care
DIABETES BURDEN
382 million adults worldwide 2013
Projected to rise to 592 million by 2035 (www.idf.org)
Figure 2 Role of genes and the environment in development of obesity and type 2 diabetes Interaction of genes that affect body
adiposity with environmental factors results in development of obesity and associated insulin resistance. However, only when genes
for abnormal β-cell function are present along with those for body adiposity does interaction with the environment result in
development of type 2 diabetes.
Steven E Kahn , Mark E Cooper , Stefano Del Prato. Pathophysiology and treatment of type 2 diabetes: perspectives on the
past, present, and future. The Lancet, Volume 383, Issue 9922, 2014, 1068 - 1083
RISK FACTORS FOR TYPE 2 DIABETES
Obesity, especially central obesity
Low physical activity
High fat, high saturated fat diet
Low intake of dietary fiber
High glycemic index diet
Fetal malnutrition
Some drugs
Others:
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genetic factors,
previous glucose metabolism disturbance (eg. gestational diabetes)
features of metabolic syndrome (high blood pressure, high serum triglyserides, insulin resistance)
aging
WEIGHT CHANGE, ENERGY BALANCE
Obesity, especially abdominal obesity increase the risk of T2DM
Even modest wight loss can significantly reduce the incidence of T2DM
in subjects who have multiple risk factors for diabetes (see next slide)
Incidence of type 2 diabetes during the 1-year follow-up according to weight loss.
Saaristo T et al. Dia Care 2010;33:2146-2151
Copyright © 2014 American Diabetes Association, Inc.
FAT QUALITY AND QUANTITY
High total fat intake can increase risk of T2DM (intake should be less than 35% of
energy)
Saturated fat (hard fat) intake increases risk of T2DM
 Might not be independent of BMI
 Strong evidence
 Saturated fat should be less than 10% of energy
Mono- and polyunsaturated fat are soft fats.
Increase in polyunsaturated fat intake can reduce risk of T2DM.
 Linoleic acid (n-6 PUFA, eg. from sunflower oil) reduces risk
 Moderate evidence
 PUFA intake should be less than 10% of energy.
Long-chain n-3 fatty acids (from fish or fish oils) do not significantly affect the risk
(in some studies fish oils have increased the risk)
 However, n-3 fatty acids can have beneficial effects on cardiovascular risk factors
Monounsaturated fat (from eg. olive and rapeseed oil) are possibly protective.
Diabetes and Nutrition Study Group/European Association for the the Study of Diabetes Recommendation 2004.
CARBOHYDRATES
Total amount of carbohydrates does not have a clear association with
diabetes risk.
High fiber diet, especially cereal fiber, can reduce the risk of T2DM.
 Strong evidence
 Recommendation: 40 g/d or 20 g/1000 kcal/day
Sugar sweetened beverages increase the risk.
Simple sugars in diet possibly increase the risk.
 Recommendation less than 10% of energy.
High glycemic index diet is suggested to increase the risk
Diabetes and Nutrition Study Group/European Association for the the Study of Diabetes Recommendation 2004.
MICRONUTRIENTS
Dietary intake of magnesium inversely and iron directly associated
with T2DM risk in observational studies.
Vitamin D inversely associated in observational studies.
 Level of evidence moderate.
However, there are no clinical studies yet, so the importance of these
associations is still unclear and more studies are needed
SOME FOODS
Coffee and tea have been associated with reduced risk at dose of 4
cups per day
Alcohol consumption in U-shaped association with the risk.
 Moderate consumption possibly protective. (Moderate consumption up to 10g/day
alcohol for women and up to 20 g/d alcohol for men, for those who choose to drimk).
 Excessive consumption possibly promotive.
 Alcohol consumption should be limited by those who are overweight, hypertensive or
hypertriglyceridemic.
Nut consumption has been associated with reduced risk.
DIETARY PATTERNS
Dietary patterns characterized by high consumption of
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Whole grains
Fruit and vegetables
Fish
Low-fat dairy
have been associated with lower risk of T2DM (see next slide for
details)
Salas-Salvado et al. Nutr Metab Cardiovasc Dis 2011;21:B32-B48
DIABETES PREVENTION TRIALS
THE FINNISH DIABETES PREVENTION
STUDY
The goals of the intervention were:
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weight reduction at least 5% from baseline weight;
total fat intake <30% energy intake;
saturated fat intake <10% energy intake,
Fibre intake at least 15 g/4.2 MJ (1000 kcal);
moderate-to-vigorous exercise of at least 0.5 h/d.
Intervention lasted for 4 years. Follow-up of new T2DM cases has
lasted for 13 years.
Figure 2 Diabetes by treatment group Follow-up time is truncated at 8 years, since number of participants at risk beyond this point
was low, but they are included in the calculation of hazard ratios.
Lindström , et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish
Diabetes Prevention Study. The Lancet, Volume 368, Issue 9548, 2006, 1673 - 1679
SUSTAINED BENEFIT FROM 4-Y LIFESTYLE
INTERVENTION SEEN IN BODY WEIGHT IN A
FOLLOW UP OF 13 YEARS
Lindström et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised
Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013 Feb;56(2):284-93. doi: 10.1007/s00125-012-2752-5.
SUSTAINED BENEFIT FROM 4-Y LIFESTYLE
INTERVENTION SEEN IN PLASMA GLUCOSE IN
A FOLLOW UP OF 13 YEARS
Lindström et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised
Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013 Feb;56(2):284-93. doi: 10.1007/s00125-012-2752-5.
COMMUNITY PREVENTION OF
T2DM
FROM RESEARCH TO PREVENTION ON COMMUNITY LEVEL
http://www.diabetes.fi/en/finnish_diabetes_association/dehko
Diabetes prevention in a primary health care setting
Figure 1. Changes in estimated 10-year risk for cardiovascular disease (CVD) events estimated by the Framingham
Risk Score (FRS) during the one-year follow-up according to changes in physical activity (PA) and dietary pattern in
a healthier direction in individuals at high risk for type 2 diabetes (T2D).
Rautio N et al. Eur J Cardiovasc Nurs
2014;1474515114521713
Copyright © by European Society of Cardiology
EXTRA INFORMATION ON COMMUNITY
DIABETES PREVENTION FROM THE USA
National Diabetes Prevention Program by NIH and CDC in the USA
http://www.cdc.gov/diabetes/prevention/
http://www.youtube.com/watch?v=976SFoINOU0
SOURCES
Hey SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type
2 diabetes: dietary components and nutritional strategies. Lancet
2014;383:1999-2007.
Lindström J, Peltonen M, Tuomilehto J, for the Finnish Diabetes Prevention
Study Group. Lifestyle strategies for weight control: experience from the
Finnish Diabetes Prevention Study. Proceedings of the Nutrition Society
2005;64:81-88, DOI:10.1079/PNS2004394412
Salas-Salvado J, Martinez-Gonzalez MA, Bullo M, Ros E. The role of diet
in the prevention of type 2 diabetes. Nutrition, Metabolism &
Cardiovascular Diseases 2011;21,B32-B48.
Thomas T and Pfeiffer AFH. Foods for the prevention of diabetes: how do
they work?. Diabetes Metab. Res. Rev., 2012; 28: 25–49.
doi: 10.1002/dmrr.1229.