ADA updates nutrition guidelines to address varied eating patterns

The American Diabetes Association (ADA) recently released new recommendations on nutrition therapy for adults with type 1 or type 2 diabetes.

The recommendations, which were published by Diabetes Care on Oct. 9 and replace a set issued in 2008, note that “there is not a ‘one-size-fits-all’ eating plan for individuals with diabetes.” In general, diabetes patients should eat a variety of nutrient-dense foods in appropriate portion sizes, with diet specifics individualized based on their personal and cultural preferences, health literacy and numeracy, access to food and willingness and ability to change. Both medical nutrition therapy and diabetes self-management education are recommended by the guidelines for patients with either type of diabetes.

The recommendations also included the following advice:

• Evidence has not determined an ideal percentage or quantity of carbohydrates, protein or fat that patients with diabetes should consume, so choices should be individualized. Monitoring carbohydrate intake is key to achieving glycemic control, however.
• Patients with diabetes should follow the same nutritional guidelines as the general public with regard to consumption of fiber and whole grains, foods containing long-chain omega-3 fatty acids, saturated and trans fats, sodium and cholesterol.
• A Mediterranean-style diet is an effective alternative to a lower-fat, higher-carbohydrate eating pattern.
• Substituting low-glycemic load foods for high-glycemic load foods may modestly improve glycemic control.
• Patients with diabetes should limit or avoid sugar-sweetened beverages and drink alcohol only in moderation (1 drink per day for women, 2 for men).
• There is no clear evidence to support supplementation with vitamins, minerals, omega-3, or cinnamon and other herbs for patients with diabetes.
• For overweight or obese adults with type 2 diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss.

The recommendations also include specific advice on coordinating food with different types of diabetes medications. The authors called for additional research on a number of topics, including Mediterranean-style, low-glycemic index and low-carbohydrate diets, as well as the effects of nonnutritive sweeteners.

“Nutrition interventions should emphasize a variety of minimally processed nutrient-dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term,” the recommendations concluded.