From the Adult Diabetes and Clinical Research sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts.
Objective. The Joslin Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes (T2D) or Prediabetes, or Those at High Risk for Developing T2D is designed to assist primary care physicians, specialists, and other healthcare providers in individualizing the care of and setting goals for adult, nonpregnant patients with T2D or individuals at high risk for developing the disease. This guideline focuses on the unique needs of those individuals. Several components complement the 2015-2020 Dietary Guidelines for Americans. The Dietary Guidelines for Americansare jointly developed every 5 years by the US Department of Health and Human Services and the US Department of Agriculture. This Guideline is not intended to replace sound medical judgment or clinical decision making and may need to be adapted for certain patient-care situations where more or less stringent interventions are necessary. This guideline was approved October 19, 2016; updated on January 28, 2018.TABLE 1. Individuals Targeted for Intervention Meet 1 Criterion in Each of 2 Categories
Amount. There is general agreement that the type of fat consumed is more important than the quantity (generally 30% to 40% of total calories). Trans fats from partially hydrogenated oil should be eliminated [1B].
Amount. Protein intake should range between 1.0-1.5 grams/kg of adjusted body weight. To calculate adjusted body weight, first calculate excess weight: Excess weight = current weight — ideal body weight (IBW). Adjusted body weight = IBW + 0.25 of excess body weight. This amount generally accounts for 20% to 30% of total caloric intake.
Recommended. Fish, skinless poultry, lean meat, dairy, egg whites, nuts, seeds, soy, and other legumes [2B].
Not Recommended. Sources of protein that are high in saturated fat (eg nonlean pork, lamb, beef; processed meats) as they may be associated with increased cardiovascular risk[1B]. Heme iron in meat is also associated with an increased risk of T2D [2B].
Patients with renal issues. Although reducing total calories may result in a reduction of the total amount of protein intake, any patient with signs of kidney disease (both of the following: proteinuria; estimated glomular filtration rate <60 ml/min) should consult a nephrologist before increasing the total or percentage of protein in their diet [1B]. Protein intake for these patients should be modified, but not lowered to a level that may jeopardize their overall health or increase their risk for malnutrition or hypoalbuminemia.
Amount. The total daily intake of carbohydrate should be at least 130 grams/day and preferably 40% to 45% of the total caloric intake. Intake should be adjusted to meet the cultural and food preferences of the individual.
Consideration of glycemic index/glycemic load. The glycemic index/glycemic load is an important factor that patients should apply in their daily selection of carbohydrate foods. Foods with a lower glycemic index content should be selected [2B] (eg, whole grains, legumes, fruits, green leafy and nonstarchy vegetables, milk, yogurt).
Recommended. Green leafy and nonstarchy vegetables, whole fruits, legumes, whole and minimally processed grains, oats, milk, yogurt [2B].
Sodium. Daily consumption should be <2300 mg (about 1 tsp of salt) per day [1A]. Further reduction to 1500 mg is recommended in people aged >50 years, especially those including those with hypertension or chronic kidney disease [2B].
All FDA-approved nonnutritive sweeteners are permissible in moderate quantities.
The following dietary patterns have been shown to be effective in the prevention and management of diabetes:
The following specific foods have been shown in some study results to be associated with a reduced risk of developing T2D:
Guidelines for healthy adults with diabetes or prediabetes:
Additional guidelines for adults with medical or physical limitations:
TABLE 2. Suggested Approximate Macronutrient Distribution According to Clinical Guideline
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Other Pertinent References