Diyabetli Bireylere Hangi Beslenme Modeli Önerilmeli?

Bin dokuz yüzlü yılların özellikle ikinci çeyreğinden itibaren başlayan ve günümüze dek artarak devam eden çalışmalarla “diyabet yönetiminde en etkili beslenme modeli” arayışı sürmektedir. Bu konudaki araştırmalar daha çok “çok düşük kalorili diyetler”, “düşük karbonhidratlı ve düşük yağlı diyetler”, “vejetaryen ya da vegan beslenme”, “DASH beslenme modeli” ve “Akdeniz tipi beslenme modeli” üzerine yoğunlaşmıştır. Bu derlemede, bahsi geçen diyet ve beslenme modellerinin diyabet tedavisindeki yerlerinin bilimsel literatür doğrultusunda incelenmesi hedeflenmiştir. Çeşitli kılavuzlarda, Akdeniz, DASH ve bitkisel bazlı diyetlerin, diyabetik bireyler ile ilişkili olumlu sonuçları nedeniyle sağlıklı beslenme modellerine örnek teşkil ettiği vurgulanmaktadır. Düşük karbonhidratlı diyetlerin rolü ise henüz net değildir. Sonuç olarak bireyselleştirilmiş beslenme planı, belirli beslenme modellerinin önerilmesinden ziyade kişisel tercihler, ihtiyaç ve hedefler üzerine odaklanmalıdır.

PDF

___

1. Yamada S. Paradigm shifts in nutrition therapy for type 2 diabetes. Keio J Med. 2017;66:33-43.

2. Rabinowitch IM. Experiences with a high carbohydrate-low calorie diet for the treatment of diabetes mellitus. Can Med Assoc J. 1930;23:489-98.

3. Leslie WS, Taylor R, Harris L, Lean ME. Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis. Int J Obes (Lond). 2017;41:96-101.

4. Henry RR, Scheaffer L, Olefsky JM. Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1985;61:917-25.

5. Taylor R. Banting Memorial lecture 2012: reversing the twin cycles of type 2 diabetes. Diabet Med. 2013;30:267-75.

6. Taylor R. Type 2 diabetes: etiology and reversibility. Diabetes Care. 2013;3:1047-55.

7. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011; 54: 2506–14.

8. Murakami R, Saisho Y, Watanabe Y, Inaishi J, Tsuchiya T, Kou K, et al. Pancreas fat and β cell mass in humans with and without diabetes: an analysis in the Japanese population. J Clin Endocrinol Metab. 2017;102:3251-60.

9. Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes Care. 1991;14:802-23.

10. Vertes V. Very low calorie diets--history, safety and recent developments. Postgrad Med J. 1984;60:56-8.

11. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391:541-51.

12. Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Look AHEAD Research Group. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489-96. 13. IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care-2017. Available at: https://www.idf.org/e-library/guidelines/128-idf-clinical-practice-recommendations-for-managing-type-2-diabetes-in-primary-care.html. Accessed October 5,2018.

14. American Diabetes Association. Lifestyle Management: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018; 41: S38-S50.

15. Diyabet Diyetisyenliği Derneği. Diyabetin Önlenmesi ve Tedavisinde Kanıta Dayalı Beslenme Tedavisi Rehberi-2019. Armoni Nüans Baskı Sanatları A.Ş. Nisan 2019, İstanbul.

16. Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5:e000354.

17. Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, et al. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat dietversus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab. 2018;20:858-71.

18. Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, et al. Long-term effects of a very low carbohydrate compared with a high carbohydrate diet on renal function in individuals with type 2 diabetes: A randomized trial. Medicine (Baltimore). 2015;94:e2181.

19. Sylvetsky AC, Edelstein SL, Walford G, Boyko EJ, Horton ES, Ibebuogu UN, et al.:Diabetes Prevention Program Research Group. A high-carbohydrate, high-fiber, low-fat diet results in weight loss among adults at high risk of type 2 diabetes. J Nutr. 2017;147:2060-66.

20. Lindström J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M, et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia. 2006;49:912-20.

21. Miller CK. For newly diagnosed type 2 diabetes, a low-carbohydrate Mediterranean diet may delay need for medication and improve chance of remission compared to a low-fat diet. Evid Based Nurs. 2015;18:74.

22. Meckling KA, O’Sullivan C, Saari D. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004;89:2717-23.

23. Guldbrand H, Lindström T, Dizdar B, Bunjaku B, Östgren CJ, Nystrom FH, et al. Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus. Diabetes Res Clin Pract. 2014;106:221-7.

24. Jonasson L, Guldbrand H, Lundberg AK, Nystrom FH. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Ann Med. 2014;46:182-7.

25. Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy G. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67:255-63.

26. Craig WJ, Mangels AR. American Dietetic Association. Position of the American Dietetic Association: Vegetarian diets. J Am Diet Assoc. 2009;109:1266-82.

27. Agnoli C, Baroni L, Bertini I, Ciappellano S, Fabbri A, Papa M, et al. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis. 2017;27:1037-52.

28. Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Green A, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009;89:1588S-1596S.

29. Barnard ND, Levin SM, Gloede L, Flores R. Turning the Waiting Room into a Classroom: Weekly Classes Using a Vegan or a Portion-Controlled Eating Plan Improve Diabetes Control in a Randomized Translational Study. J Acad Nutr Diet. 2018;118:1072-79.

30. Kahleova H, Hrachovinova T, Hill M, Pelikanova T. Vegetarian diet in type 2 diabetes--improvement in quality of life, mood and eating behaviour. Diabet Med. 2013;30:127-9.

31. Challa HJ, Uppaluri KR. DASH Diet (Dietary Approaches to Stop Hypertension) StatPearls. Treasure Island (FL): StatPearls Publishing; 2018-.2018 Sep 21. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29494120. Accessed: October 5, 2018.

32. Campbell AP. DASH Eating Plan: An eating pattern for diabetes management. Diabetes Spectr. 2017;30:76-81.

33. Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition. 2013;29:939-47.

34. Paula TP, Viana LV, Neto AT, Leitão CB, Gross JL, Azevedo MJ. Effects of the DASH diet and walking on Blood Pressure in Patients with Type 2 Diabetes and uncontrolled hypertension: a randomized controlled trial. J Clin Hypertens (Greenwich). 2015;17:895-901.

35. Peairs AD, Shah AS, Summer S, Hess M, Couch SC. Effects of the dietary approaches to stop hypertension (DASH) diet on glucose variability in youth with Type 1 diabetes. Diabetes Manag (Lond). 2017;7:383-91.

36. Guasch-Ferré M, Merino J, Sun Q, Fitó M, Salas-Salvadó J. Dietary polyphenols, Mediterranean diet, prediabetes, and type 2 diabetes: a narrative review of the evidence. Oxid Med Cell Longev. 2017;2017:6723931.

37. Emenaker NJ, Vargas AJ. The Mediterranean diet, the OGG1 gene, and disease risk: Early evidence. J Acad Nutr Diet. 2018;118:547-49.

38. Sleiman D, Al-Badri MR, Azar ST. Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review. Front Public Health. 201528;3:69.

39. Koloverou E, Panagiotakos D, Pitsavos C, Georgousopoulou E, Chrysohoou C, Skoumas I, et al. Mediterranean diet and ten-year type 2 diabetes risk. Potential mediation of the relationship from inflammatory factors: Results from ATTICA study (2002-2012). Clin Nutr ESPEN. 2016 Jun;13:e57.

40. Salas-Salvadó J, Guasch-Ferré M, Lee CH, Estruch R, Clish CB, Ros E. Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr. 2016; 146:920-27.

41. Torres-Peña JD, Garcia-Riosa A, Delgado-Casado N, Gomez-Luna P, Alcala-Diaz JF, Yubero-Serrano EM, et al. Mediterranean diet improves endothelial function in patients with diabetes and prediabetes: A report from the CORDIOPREV study. Atherosclerosis. 2018;269:50-6.

42. Maiorino MI, Bellastella G, Petrizzo M, Gicchino M, Caputo M, Giugliano D, et al. Effect of a Mediterranean diet on endothelial progenitor cells and carotid intima-media thickness in type 2 diabetes: Follow-up of a randomized trial. Eur J Prev Cardiol. 2017;24:399-408.

43. Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol. 2018;33:157-70.

44. Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL.: Diabetes Canada Clinical Practice Guidelines Expert Committee. Nutrition therapy. Can J Diabetes. 2018;42:S64-S79.