Mumbai, Sunday, November 14, 2010 5

A DNA Promotional Feature

NUTRITION PRINCIPLES Reduced intake

of total fat like
saturated fat,
Pregnancy and lactation with diabetes
The goals of medical nutrition therapy for pregnancy are to provide
adequate maternal and fetal nutrition, energy intake for appropriate

and THE VISIBLE IMPACT

Dr. Sharad
may reduce risk
for diabetes
day result in a significant reduction in
weight gain, and any necessary vitamin and mineral supplements.
During pregnancy complicated by diabetes, medical nutrition
therapy is also important in achieving and maintaining optimal
glycemic control. Unless a woman begins pregnancy with depleted
body reserves, energy needs do not increase in the first trimester.
An additional 300 kcal/day are suggested during the second and
Kasarle, total daily energy intake or improve-
third trimester for increases in maternal blood volume and
Nutraceuticals, ment in long-term glycemia. The use increases in breast, uterus and adipose tissue, placental growth,
Functional of sugar alcohols appears to be safe; fetal growth, and amniotic fluids. However, successful pregnancy
Foods Expert however, they may cause diarrhea, es- outcomes have been reported with lower energy intakes. In
pecially in children. addition to adequate energy intake, pregnant women need to
Clinical trial data The Food and Drug Administra- eat a healthy diet with adequate protein (0.75 g · kg?1 · day?1
from both the U.S. tion has approved four non-nutritive plus an additional 10 g/day). Nutrient requirement during
and Finland now sweeteners for use in the U.S.-saccha- pregnancy and lactation are similar for women with and
strongly support rin, aspartame, acesulfame potassi- without diabetes. For all women who are capable of becoming
the potential for moderate weight loss um, and sucralose. Before being al- pregnant, 400 ?g/day of folic acid from fortified foods and/or
to reduce the risk for diabetes. An ac- lowed on the market, all underwent a supplement, as well as food folate from a variety of foods, is
tive lifestyle also has been demon- rigorous scrutiny and were shown to recommended for the prevention of neural tube defects and
strated in a number of prospective be safe when consumed by the public, other congenital abnormalities.
studies to prevent or delay the devel- including people with diabetes and
opment of type 2 diabetes. Both mod- during pregnancy.
erate and vigorous exercise decrease
risk of impaired glucose tolerance Recommendations Energy balance and obesity
and type 2 diabetes. Reduced intake of ● Foods containing carbohydrate
Because of the effects of obesity on
total fat, particularly saturated fat, from whole grains, fruits, vegeta- insulin resistance, weight loss is an
may reduce risk for diabetes. bles, and low-fat milk should be in- important therapeutic objective for
Increased diabetes incidence is re- diabetes are as follows: individual's wishes and willingness to cluded in a healthy diet. persons with type 2 diabetes. Short-term
ported with increased intake of di- 1. Attain and maintain optimal meta- change. ● With regard to the glycemic effects
studies have demonstrated that weight
etary fat, independent of total calories, bolic outcomes including of carbohydrates, the total amount loss in subjects with type 2 diabetes is
although this effect is not demonstrat- ● Blood glucose levels in the normal Sweeteners of carbohydrate in meals or associated with decreased insulin
ed in all studies. It appears that all range or as close to normal as is In subjects with diabetes, fructose snacks is more important than the resistance, improved measures of
types of dietary fat (except n-3 fatty safely possible to prevent or re- produces a lower postprandial re- source or type. glycemia and dyslipidemia, and reduced
acids) may have an adverse effect on duce the risk for complications of sponse when it replaces sucrose or ● As sucrose does not increase
blood pressure. However, long-term data
insulin sensitivity. Saturated fat may diabetes. starch in the diet; however, this bene- glycemia to a greater extent than assessing the extent to which these
have the greatest effect. Increased in- ● A lipid and lipoprotein profile that fit is tempered by concern that fruc- isocaloric amounts of starch, su- improvements can be maintained are not
take of polyunsaturated fat, in the con- reduces the risk for macrovascu- tose may adversely effect plasma crose and sucrose-containing available. The reason long-term weight
text of appropriate total energy intake lar disease. lipids. Therefore, the use of added foods do not need to be restricted loss is difficult for most people to
for weight management, may reduce ● Blood pressure levels that reduce fructose as a sweetening agent is not by people with diabetes; however, accomplish is probably because energy
the risk for type 2 diabetes. the risk for vascular disease. recommended; however, there is no they should be substituted for oth- intake, energy expenditure and thereby
Recent studies have provided evi- 2. Prevent and treat the chronic reason to recommend that people er carbohydrate sources or, if body weight are regulated by the central
dence for reduced risk of diabetes complications of diabetes. Modify nu- with diabetes avoid naturally occur- added, covered with insulin or oth- nervous system. This regulation appears
with increased intake of whole grains trient intake and lifestyle as appropri- ring fructose in fruits, vegetables, and er glucose-lowering medication. to be influenced by genetic factors.
and dietary fiber. Moderate alcohol ate for the prevention and treatment other foods. ● Non-nutritive sweeteners are safe Furthermore, environmental factors often
intake has been related to improved of obesity, dyslipidemia, cardiovascu- Sugar alcohols produce a lower when consumed within the accept- make losing weight difficult for those
insulin sensitivity and reduced risk lar disease, hypertension, and postprandial glucose response able daily intake lev- genetically predisposed to obesity.
for diabetes. No nutritional recom- nephropathy. than fructose, sucrose, or els estab- Evidence demonstrates that structured,
mendations can be made for preven- 3. Improve health through healthy glucose and have lower lished by intensive lifestyle programs involving
tion of type 1 diabetes. Breastfeeding food choices and physical activity. available energy val- the FDA. participant education, individualized
may be beneficial. 4. Address individual nutritional ues. However, there is counseling, reduced dietary fat and energy
needs taking into consideration per- no evidence that the skasarle@ intake, regular physical activity, and Recommendations
Goals of medical nutrition thera- sonal and cultural preferences amounts likely to be gmail.com frequent participant contact are necessary A-Level evidence
py that apply to all persons with and lifestyle while respecting the consumed in a meal or to produce long-term weight loss of as ● In insulin-resistant individuals, reduced
much as 5-7% of starting weight. When energy intake and modest weight loss
dieting to lose weight, fat is probably the improve insulin resistance and glycemia
Alcohol and diabetes most important nutrient to restrict. in the short-term.
Spontaneous food consumption and total ● Structured programs that emphasize
For persons with diabetes, the same precautions alcoholic beverage consumed.
apply regarding the use of alcohol that apply to the Alcohol can have both hypoglycemic and energy intake are increased when the diet lifestyle changes, including education,
is high in fat and decreased when the diet reduced fat (<30% of daily energy) and
general population. Abstention from alcohol should hyperglycemic effects in people with diabetes.
is low in fat. Exercise by itself has only a energy intake, regular physical activity,
be advised for women during pregnancy and for These effects are determined by the amount of
modest effect on weight loss. However, and regular participant contact, can
people with other medical problems such as alcohol acutely ingested, if consumed with or
exercise is to be encouraged because it produce long-term weight loss on the
pancreatitis, advanced neuropathy, severe without food and if use is chronic and excessive.
improves insulin sensitivity, acutely lowers order of 5-7% of starting weight.
hypertriglyceridemia, or alcohol abuse. In studies using moderate amounts of alcohol
blood glucose, and is important in long- ● Exercise and behavior modification are
If individuals choose to drink alcohol, no more than ingested with food in people with type 1 or type
term maintenance of weight loss. Weight most useful as adjuncts to other weight
two alcohol containing drinks per day for adult men 2 diabetes, alcohol had no acute effect on blood
loss with behavioral therapy alone also loss strategies. Exercise is helpful in
and no more than one drink per day for adult women glucose or insulin levels. Therefore, alcoholic
has been modest, and behavioral maintenance of weight loss.
is recommended. One drink, or alcoholic beverage, beverages should be considered an addition to
approaches may be most useful as an ● Standard weight reduction diets, when
is commonly defined as 12 oz of beer, 5 oz of wine, the regular food/meal plan for all people with used alone, are unlikely to produce
or 1.5 oz of distilled spirits, each of which contains diabetes, and no food should be omitted. adjunct to other weight loss strategies.
However, optimal strategies for preventing long-term weight loss. Structured
15 g of alcohol. The cardioprotective effects of Heavy or excessive alcohol consumption is a intensive lifestyle programs are
alcohol appear not to be determined by the type of leading avoidable cause of death in the U.S. and treating obesity long-term have yet to
be defined. necessary.

A global health threat

he need for Diabetes produces little or no insulin, a lies talk about family health ● Losing weight if you need
Protein and diabetes
In the U.S., protein intake accounts for
15-20% of average energy intake, is
fairly consistent across all ages from
infancy to older age, and appears to
adequate protein intake are needed.
Because most adults eat at least 50%
more protein than required, people
with diabetes appear to be protected
hypoglycemia, time to peak glucose
levels, and subsequent rate of
glucose fall were similar after
treatment with either carbohydrate

T prevention, education
and treatment is so
strong that 200 Diabetes asso-
hormone needed to allow sug-
ar (glucose) to enter cells to
produce energy.
history and diabetes:
● Does anyone in the family
have Type 2 Diabetes?
●
●
to
Being physically active
Not smoking
be similar in persons with diabetes. It
has been assumed that in people with
diabetes, abnormalities of protein
against protein malnutrition when
consuming a usual diet.
A number of studies in healthy
alone or carbohydrate and protein.

Expert consensus
ciations in more than 160 Type 2 Diabetes (once ● Has anyone in the family ● Limiting alcoholic drinks metabolism were less affected by subjects and in persons with ● For persons with diabetes, there is
countries have come together known as adult-onset or non- been told he or she might insulin deficiency and insulin controlled type 2 diabetes have no evidence to suggest that usual
to advocate for patients. This insulin-dependent Diabetes) get Diabetes? DIABETES MANAGEMENT resistance than glucose metabolism. demonstrated that glucose from protein intake (15-20% of total daily
effort has resulted in each No- is the most common Diabetes. ● Has anyone in the family THROUGH LIFE STYLE However, in subjects with type 2 ingested protein does not appear in energy) should be modified if renal
vember 14 being designated The patient's body is resistant been told he or she needs CHANGES diabetes, it has been demonstrated the general circulation, and therefore function is normal.
as "World Diabetes Day." to the effects of insulin or to lower their weight or in- Follow the healthy eating that moderate hyperglycemia can protein does not increase plasma ● The long-term effects of diets high
doesn't produce enough in- crease their physical activ- plan that you and your doctor contribute to an increased turnover of glucose concentrations. Furthermore, in protein and low in carbohydrate
More than 285 million sulin to maintain a normal ity to prevent Type 2 Dia- or dietitian have worked out. protein, which suggests an increased the peak glucose response to are unknown. Although such diets
people worldwide have glucose level. Many people betes? ● At least 30 minutes of need for protein. In subjects with type carbohydrate alone is similar to that may produce short-term weight loss
diabetes with Type 2 Diabetes have one Narrowed blood vessels brisk walk or physical ac- 1 diabetes treated with conventional of carbohydrate and protein, and improved glycemia, it has not
Left untreated, Diabetes or more family members with lead to high blood pressure. tivity; insulin therapy, short-term kinetic suggesting that protein does not slow been established that weight loss is
can lead to serious complica- the disease, such as a mother, Other factors, such as kidney ● Take your medicines as di- studies have demonstrated increased the absorption of carbohydrate. In maintained long-term. The long-
tions such as Heart Disease, father, brother or sister. problems and being over- rected. protein catabolism, suggesting that subjects with type 1 diabetes, the rate term effect of such diets on plasma
Stroke, kidney disease, blind- Knowing your family's health weight, also can lead to high ● Check your blood glucose near-normal glycemia and an of restoration of euglycemia after LDL cholesterol is also a concern.
ness and amputation. For the history is important because blood pressure. Many people & record periodically
estimated 57 million Ameri- it gives you and your health with diabetes also have high ● Check your feet every day
cans with pre-diabetes, their care team information about blood pressure. If you have for cuts, blisters, sores,
condition places them at in- your risk for Type 2 Diabetes. heart, eye, or kidney problems swelling, redness, or sore Dietary fat and diabetes
creased risk for eveloping The Surgeon General's from diabetes, high blood toenails. Fatty acids and dietary cholesterol
Type 2 Diabetes and Heart Family Health History Initia- pressure can make them ● Brush and floss your teeth The primary dietary fat goal in persons
Disease. Type 1 Diabetes (once tive web-based tool, My Fami- worse. You may also be able to every day. with diabetes is to limit saturated fat
known as juvenile Diabetes or ly Health Portrait makes it control your blood pressure by ● Control your blood pres- and dietary cholesterol intake.
insulin-dependent) usually be- easier for families to assem- ● Eating more fruits and sure and cholesterol. Saturated fat is the principal dietary
gins in children and young ble and share their health his- vegetables ● Don't smoke. determinant of plasma LDL
adults. This is a chronic con- tory, and the NDEP offers ● Eating less salt and high- ● Avoid / Limit the consump- cholesterol. Furthermore, persons with
dition in which the pancreas some questions to help fami- sodium foods tion of Alcohol diabetes appear to be more sensitive
to dietary cholesterol than the general
public. In metabolic study diets, in
Micronutrients and diabetes which energy intake and weight are
held constant, diets low in saturated
Persons with diabetes should be E, selenium, beta carotene, and other option. The use of nicotinamide to fat and high in carbohydrate or
educated about the importance of carotenoids-have not demonstrated preserve ?-cell mass in newly enriched with cis-monounsaturated
consuming adequate amounts of protection against cardiovascular diagnosed subjects with type 1 fatty acids (monounsaturated fat)
vitamins and minerals from natural disease, diabetes, or cancer. Although diabetes is under investigation; lower plasma LDL cholesterol metabolism is
food sources as well as the potential large observational studies have however, a beneficial effect has not equivalently. Low-saturated fat (i.e., not likely to be adversely affected with
toxicity of megadoses of vitamin and shown a correlation between dietary or been clearly demonstrated. 10% of energy) high carbohydrate diets their use. N-3 supplements may be
mineral supplements. Although supplemental consumption of Deficiencies of certain minerals, such increase postprandial levels of plasma recommendations. Furthermore, ethnic most beneficial in the treatment of
difficult to ascertain, if deficiencies of antioxidants and cardiovascular as potassium, magnesium, and glucose, insulin, triglycerides and, in or cultural preferences may play a role severe hypertriglyceridemia. While n-3
vitamins and minerals are identified, benefit, large placebo-controlled trials possibly zinc and chromium, may some studies, decrease plasma HDL in determining whether saturated fat is fatty acid studies in persons with
supplementation can be beneficial. have failed to show a benefit and, in aggravate carbohydrate intolerance. cholesterol when compared in to be replaced with carbohydrate or diabetes have primarily used
Select populations, such as the elderly, some instances, have suggested Whereas the need for potassium or metabolic studies to isocaloric high monounsaturated fat. supplements, there is evidence from
pregnant or lactating women, strict adverse effects of antioxidant magnesium replacement is relatively monounsaturated fat diets. However, Polyunsaturated fats have not been the general population that foods
vegetarians, and those on calorie- vitamins. easy to detect based on low serum high-monounsaturated fat diets have well studied in persons with diabetes. containing n-3 fatty acids have
restricted diets, may benefit from The role of folate in preventing birth levels, the need for zinc or chromium not been shown to improve fasting When compared with saturated fat, cardioprotective effects. Two to three
supplementation with a multivitamin defects is widely accepted, but the role supplementation is more difficult to plasma glucose or HbA1c values. There polyunsaturated fats appear to lower servings of fish per week provide
preparation. of folate supplementation to lower detect. is concern that when such high plasma total and LDL cholesterol, but dietary n-3 polyunsaturated fat and
Because diabetes may be a state of homocysteine and to reduce A daily intake of 1,000-1,500 mg of monounsaturated fat diets are eaten not as well as monounsaturated fats. can be recommended.
increased oxidative stress, there has cardiovascular events is not clear. The calcium, especially in older subjects ad libitum outside of a controlled N-3 polyunsaturated fatty acid Major sources of trans fatty acids in
been interest in prescribing role of vitamins B1, B6, and B12 in the with diabetes, is recommended. This setting, it may result in increased supplements have been shown to the diet include products made from
antioxidant vitamins to people with treatment of diabetic neuropathy has recommendation appears to be safe energy intake and weight gain. lower plasma triglyceride levels in partially hydrogenated oils such as
diabetes. In general, megadoses of not been established and cannot be and likely to reduce osteoporosis in Therefore, both the metabolic profile persons with type 2 diabetes. Although baked products (including crackers
dietary antioxidants-vitamin C, vitamin recommended as a routine therapeutic older persons. and the need to lose weight will the accompanying rise in plasma LDL and other snack foods), cookies,
determine nutrition therapy cholesterol is of concern, glucose doughnuts, breads, and such products.