SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
VOLUME 10 NUMBER 3 • SEPTEMBER 2013
91
to 6.8% (6.3–7.3) (
p
= 0.012).
61
Finally, newly diagnosed patients
were randomised to either a low-fat or a Mediterranean diet, and
time to initiation of antidiabetic therapy measured. After four years
significantly fewer in the Mediterranean diet group (44% c.f. 70%,
p
< 0.001) had needed to start antidiabetic therapy.
58
Cardiovascular risk
Positive results have also been reported for Mediterranean diets
and cardiovascular risk.
58,62
In the Melbourne Collaborative Study,
participants of Greek or Italian heritage with diabetes were assessed
for level of adherence to a Mediterranean diet and followed for a
minimum of ten years.
63
In that time the hazard ratios for CVD
mortality per unit of Mediterranean diet score were 0.94 (95% CI
0.89–0.99) in men and 0.94 (95% CI 0.87–1.01) in women. The
study found those with higher diet scores had higher intakes of
MUFA, fibre, omega-3 fatty acids, fruit and vegetables and lower
intakes of saturated fat. Improvements in endothelial function have
also been demonstrated in a group with the metabolic syndrome in
a study over 2 years of a Mediterranean diet.
64
Conclusion
There is an abundance of literature examining the effectiveness
of various dietary interventions and approaches, including “fad
diets”, for weight management and impact on metabolic and
cardiovascular markers and outcomes in obese individuals with and
without diabetes.
3,65,66
This area is a minefield to interpret due to
reciprocal changes in macronutrient composition, differences in
degree of energy restriction, confounding with changes in physical
activity, additional effects of behavioural change intervention,
difficulty in accurately measuring dietary intake particularly over
extended periods, and differences between highly controlled studies
and free living studies to name a few of the challenges. Despite this
three things are very clear. First, the simple truth of the first law
of thermodynamics over-rides all of this discussion. Unless energy
intake is reduced below energy expenditure over a sustained period
of time, weight loss will not occur. Second, is that weight loss
achieved with any dietary approach over the long-term is modest,
though compared with the natural history of weight gain in obesity
is clinically important. Third, that evidence supports flexibility in
dietary composition with no single dietary approach superior to
another. Most importantly there is evidence that adherence to any
given dietary approach is more important than the macronutrient
prescription.
67
So the best diet for those with type 2 diabetes is the
one that works for them, and most importantly the one that they
can maintain in the long term.
References
1. American Diabetes Association. Nutrition Recommendations and Interventions
for
Diabetes. Diabetes Care
2008;
31
(Supplement 1): S61–S78.
2. Mann JI, De Leeuw I, Hermansen K,
et al
. Evidence-based nutritional approaches
to the treatment and prevention of diabetes mellitus.
Nutr Metab Cardiovasc Dis
2004;
14
: 373–94.
3. Day C, Bailey CJ. The hypocaloric diet in type 2 diabetes – déjà vu.
Br J Diabetes
Vasc Dis
2012;
12
: 48–51.
4. Truswell AS, Thomas BJ, Brown AM. Survey of dietary policy and management in
British diabetic clinics.
Br Med J
1975;
4
(5987): 7–11.
5. Hockaday TD, Hockaday JM, Mann JI,
et al
. Prospective comparison of modified
fat-high-carbohydrate with standard low-carbohydrate dietary advice in the
treatment of diabetes: one year follow-up study.
Br J Nutr
1978;
39
: 357–62.
6. Simpson RW, Mann JI, Eaton J,
et al
. Improved glucose control in maturity-onset
diabetes treated with high-carbohydrate-modified fat diet.
Br Med J
1979;
1
(6180): 1753–6.
7. Simpson HC, Simpson RW, Lousley S,
et al
. A high carbohydrate leguminous fibre
diet improves all aspects of diabetic control.
Lancet
1981;
1
(8210): 1–5.
8. Lousley SE, Jones DB, Slaughter P,
et al
. High carbohydrate-high fibre diets in
poorly controlled diabetes.
Diabetic Med
1984;
1
: 21–5.
9. Gerhard GT, Ahmann A, Meeuws K,
et al.
Effects of a low-fat diet compared with
those of a high-monounsaturated fat diet on body weight, plasma lipids and
lipoproteins, and glycemic control in type 2 diabetes.
Am J Clin Nutr
2004;
80
:
668–73.
10. Luscombe-Marsh ND, Noakes M, Wittert GA,
et al
. Carbohydrate-restricted diets
high in either monounsaturated fat or protein are equally effective at promoting
fat loss and improving blood lipids.
Am J Clinical Nutr
2005;
81
: 762–72.
11. Foster GD, Wyatt HR, Hill JO,
et al
. A randomized trial of a low-carbohydrate diet
for obesity.
New J Engl Med
2003;
348
: 2082–90.
12. Samaha FF, Iqbal N, Seshadri P,
et al
. A low-carbohydrate as compared with a
low-fat diet in severe obesity.
New J Engl Med
2003;
348
: 2074–81.
13. Leidy HJ, Carnell NS, Mattes RD,
et al
. Higher protein intake preserves lean mass
and satiety with weight loss in pre-obese and obese women.
Obesity
2007;
15
:
421–9.
14. Vander Wal JS, Marth JM, Khosla P,
et al
. Short-term effect of eggs on satiety in
overweight and obese subjects. Journal of the
Am Coll Nutr
2005;
24
: 510–5.
15. Latner JD, Schwartz M, Latner JD, Schwartz M. The effects of a high-carbohydrate,
high-protein or balanced lunch upon later food intake and hunger ratings.
Appetite
1999;
33
: 119–28.
16. Barkeling B, Rossner S, Bjorvell H,
et al
. Effects of a high-protein meal (meat)
and a high-carbohydrate meal (vegetarian) on satiety measured by automated
computerized monitoring of subsequent food intake, motivation to eat and food
preferences.
Inter J Obesity
1990;
14
: 743–51.
17. Poppitt SD, McCormack D, Buffenstein R. Short-term effects of macronutrient
preloads on appetite and energy intake in lean women.
Physiol Behav
1998;
64
:
279-85.
18. Porrini M, Santangelo A, Crovetti R,
et al
. Weight, protein, fat, and timing of
preloads affect food intake.
Physiol Behav
1997;
62
: 563–70.
19. Rolls BJ, Hetherington M, Burley VJ. The specificity of satiety: the influence of
foods of different macronutrient content on the development of satiety.
Physiol
Behav
1988;
43
: 145–53.
20. Raben A, Agerholm-Larsen L, Flint A,
et al
. Meals with similar energy densities
but rich in protein, fat, carbohydrate, or alcohol have different effects on energy
expenditure and substrate metabolism but not on appetite and energy intake.
Am J Clin Nutr
2003;
77
: 91–100.
21. Westerterp-Plantenga MS, Rolland V, Wilson SA,
et al
. Satiety related to 24 h
diet-induced thermogenesis during high protein/carbohydrate vs high fat diets
measured in a respiration chamber.
Eur J Clin Nutr
1999;
53
: 495–502.
22. Robinson SM, Jaccard C, Persaud C,
et al
. Protein turnover and thermogenesis in
response to high-protein and high-carbohydrate feeding in men.
Am J Clin Nutr
1990;
52
: 72–80.
23. Crovetti R, Porrini M, Santangelo A,
et al
. The influence of thermic effect of food
on satiety.
Eur J Clin Nutr
1998;
52
: 482–8.
24. Gannon MC, Nuttall FQ, Neil BJ,
et al
. The insulin and glucose responses to meals
of glucose plus various proteins in type II diabetic subjects.
Metab Clin Exp
1988;
37
: 1081–8.
25. Karamanlis A, Chaikomin R, Doran S,
et al
. Effects of protein on glycemic and
incretin responses and gastric emptying after oral glucose in healthy subjects.
Am
J Clin Nutr
2007;
86
: 1364–8.
26. Krebs JD, Elley CR, Parry-Strong A,
et al
. The Diabetes Excess Weight Loss (DEWL)
Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets
over 2 years in type 2 diabetes.
Diabetologia
2012;
55
: 905–14.
27. Larsen RN, Mann NJ, Maclean E, Shaw JE. The effect of high-protein, low-
carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised
controlled trial.
Diabetologia
2011;
20
: 20.
28. Luscombe ND, Clifton PM, Noakes M,
et al
. Effects of energy-restricted diets
containing increased protein on weight loss, resting energy expenditure, and the
thermic effect of feeding in type 2 diabetes.
Diabetes Care
2002;
25
: 652–7.
29. Brinkworth GD, Noakes M, Parker B,
et al
. Long-term effects of advice to
consume a high-protein, low-fat diet, rather than a conventional weight-loss diet,
in obese adults with type 2 diabetes: one-year follow-up of a randomised trial.
Diabetologia
2004;
47
: 1677–86.
30. Sargrad KR, Homko C, Mozzoli M,
et al
. Effect of high protein vs high carbohydrate
intake on insulin sensitivity, body weight, hemoglobin A
1c
, and blood pressure in
patients with type 2 diabetes mellitus.
J Am Diet Assoc
2005;
105
: 573–80.
31. Evangelista LS, Heber D, Li Z,
et al
. Reduced body weight and adiposity with a
high-protein diet improves functional status, lipid profiles, glycemic control, and
quality of life in patients with heart failure: a feasibility study.
J Cardiovasc Nurs
2009;
24
:207–15.
