A meta-analysis evaluates the efficacy of personalized dietary advice on the prevention of Type 2 diabetes in people at risk.
An English meta-analysis of Nield and colleagues published in the journal in 2008 Cochrane Collaboration review the efficacy of personalized advice made by a dietitian on the prevention of Type 2 Diabetes in adults at risk. The results show that the risk of type 2 diabetes in the six years after the dietary intervention was reduced by 33% compared to people who did not receive counseling.
The Study Rationale
Type 2 Diabetes is a metabolic disease. The organism has a defect in insulin secretion or insulin action, or both. The disease results in a too high level of sugar in the blood, called chronic hyperglycemia. Long-term complications of this chronic disease especially affect the eyes, kidneys, nerves and blood vessels. The risk of developing cardiovascular disease is also increased. In 80% of cases, obesity is the cause of Type 2 Diabetes because it helps to increase intolerance to insulin. Possible causes of type 2 diabetes are as advanced age, low birth weight, family history of diabetes and physical inactivity.
2,350,000 English are diabetic. This figure increases exponentially. Type 2 Diabetes is not always detected in time by doctors. Patients ignore the signs because the symptoms are not obvious as in other chronic diseases. Most type 2 diabetic patients had hyperglycemia within 5 to 10 years before diagnosis. This disease has no cure and becomes chronic.
The cost of treatment is considerable, about 1.8 billion pounds per year just for England. Treatments include dietary monitoring to help slow the progression of diabetes to serious complications, but it is already too late to avoid irreversible damage. The challenge of this article is how to prevent by appropriate dietary advice the onset of type 2 diabetes among reasonable people be more exposed, that is most at risk, and whether these strategies are effective.
80% of cases of type 2 diabetes is linked to obesity. Acting early to obese people through appropriate dietary advice could avoid this chronic diabetes and significantly reduce healthcare costs.
A dietary program to change eating habits he really reduces the risk of having type 2 diabetes?
The authors identified 3946 publications on the subject until December 2007. 132 publications have attracted attention for their relevance. Of these 132 publications, 127 of which 88 were excluded because the methodology was not using the randomized controlled trial. The Cochrane systematic review is thus based on two randomized controlled trials have been the subject of five publications. Both studies compiled by the meta-analysis were made up in total of 358 participants, 176 in the control group and 182 in the diet group. The average age of men and women was 45 years.
Participants in the study of Pan and his colleagues published in 1997 randomly placed in the dietary group or the control group. They were recruited following a screening of a reduced glucose tolerance. The study was conducted for 6 years. The primary endpoint of the study was the incidence of type 2 diabetes in study participants Torjesen and colleagues also published in 1997 have reduced glucose tolerance. The measures concerned glycemic control and duration between the implementation of the intervention and diagnosis of type 2 diabetes.
The Non-Pharmacological Intervention (NPI) assessed
Pan in the study, the objective of the dietary intervention was to reduce body weight. The dietary program asked participants to increase their consumption of vegetables rich in fiber and reduce fat intake (especially those saturated) and sugars. Participants who had a body mass index (BMI) of less than 25kg / m2 received a dietary equivalent to from 25 to 30 kcal per kg body weight, composed of 55 to 65% carbohydrates, 10-15% protein and 25 to 30% fat. Patients with a BMI greater than 25 kg / m2 were encouraged to reduce their calorie intake in order to lose weight in the range of 0.5 to 1 kg per month to reach a normal BMI of 23 kg / m2. Patients with high blood pressure should reduce their salt intake. A list containing the recommended daily dietary intake was provided. All patients received individual counseling from their doctor about their daily diet. They also attended small group sessions with a dietician every week during the first month and then monthly during the first quarter and then quarterly for 6 years. The sessions took place in a specialized center.
In the study of Torjesen, the goal was to reduce the total food intake of calories. Dieticians asked participants to increase servings of fish, vegetables and carbohydrates rich in fiber and lower fat and too sweet food. A reduction of body weight of 0.5 kg to 1 kg per month was referred. A reduction of 2 kg per month was recommended for obese people (BMI greater than 25kg / m2). At the end of each session supervised and individualized, patients received a diet program with 5-10 most important points. Their dietary habits were monitored three months and nine months. The sessions took place in a specialized center.
The results of the study show a Pan incidence reduction of type 2 diabetes by 33% thanks to a dietary intervention compared to the control group. This intervention had a beneficial effect on fasting glucose, weight, waist circumference and blood pressure. In the control group, the risk of type 2 diabetes is higher in individuals who are overweight or obese (> 25 kg / m2) than individuals with a BMI below 25 kg / m2. Dietary advice had a favorable effect on the incidence of diabetes in individuals overweight or obese. The results of the study show Torjesen improved insulin tolerance, insulin, fasting blood glucose, weight and BMI for the group receiving dietary advice. For cons, the risk of developing type 2 diabetes for people with a weight below 25 kg / m2 is not modified by dietary intervention.
The risk of occurrence of Type 2 Diabetes is reduced by 33% with dietary advice.
What it means for Patients
Eat more fruits, fiber-rich vegetables, fish and reduce the consumption of fatty, sugary and salty 3 decreases the risk of type 2 diabetes in overweight people. Consult a dietician proves more useful to avoid this risk very debilitating in the long chronic disease.
What it means for Healthcare Professionals
This meta-analysis provides evidence that individual dietary advice or in groups supervised by a professional divides by 3 the risk of type 2 diabetes in people who are overweight or obese. The objective of this intervention is to reduce body weight. It favors the selection of food consumed and escalation and does not fit into the logic of short-term calorie diets.
What it means for Researchers
The meta-analysis shows promising results of a dietary advice program to prevent the onset of type 2 diabetes Unfortunately, this conclusion is based on two randomized controlled trials, which limits its scope. New studies will compare the role of taking individual and collective empowerment. Future studies are also needed to evaluate the effectiveness of such interventions on mortality, comorbidities, quality of life and side effects in people at risk and compare their cost-effectiveness.
What it means for Policymakers
A dietary counseling program reduces by 33% the risk of developing type 2 diabetes in overweight or obese. This chronic disease, the number is increasing, costs 1.8 billion pounds a year to the British health system. A prevention-based dietary advice could reduce the occurrence of new cases of type 2 diabetes and largely reduce the human and financial costs.
Nield L, Summerbell CD, Hooper L, Whittaker V, Moore H (2008). Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database of Systematic Reviews, 3, CD005102.
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To reference this Blog en Sante © article.
Ninot G (2015). Dietary Advice Prevents Type 2 Diabetes. Blog en Sante, A42.
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