ADA Urges Medical Nutrition Therapy for Multilevel Diabetes Interventions

A focus on overweight and obesity and the inclusion of three levels of intervention are the biggest changes in the American Diabetes Association's (ADA's) Nutrition Recommendations and Interventions for Diabetes–2006 from previous updates, says Judith Wylie-Rosett, EdD, RD, co-chair of the position statement's writing panel.^1–3

“Organizing these recommendations according to the three distinct levels of intervention—primary to prevent the development of diabetes, secondary to limit the complications of diabetes, and tertiary to limit morbidity and mortality for people who already have diabetic complications—puts greater emphasis on prevention and the importance of achieving glycemic control,” explains Wylie-Rosett, professor of epidemiology and population health at Albert Einstein College of Medicine in The Bronx, New York.

ADA's goal in issuing the evidence-based position statement is to bring awareness of beneficial nutritional interventions to people with diabetes and their health care providers. But the recommendations also emphasize the diabetes-preventative aspects of nutrition, such as the association between drinking sugared beverages and the obesity epidemic, the connection between obesity and the risk of diabetes, and the importance for all Americans of consuming recommended levels of fiber.

The 2006 medical nutrition therapy recommendations “accentuate the impact of food intake in the diabetic population; the need to monitor blood glucose after meals and monitor blood pressure and cholesterol; and how diet affects these values,” Wylie-Rosett notes. “They are very similar to the 2005 U.S. Department of Agriculture (USDA) dietary guidelines for Americans in general, as well as American Heart Association recommendations.”

The 2006 ADA update recommends:

1. Lifestyle changes, including nutritional education and behavior modification, reduced calorie and fat intake, and regular physical activity for overweight and obese individuals;

2. Daily fiber intake of 14 g/1,000 kcals (as recommended by the USDA);

3. Saturated fat intake of <7% of total calories, minimal trans fat intake, and cholesterol intake of <200 mg per day for individuals with diabetes, plus carbohydrate monitoring to regulate blood glucose;

4. Normal dietary protein intake (15–20% of energy) and avoidance of high-protein weight-loss diets and micronutrient supplementation except for specific deficiencies;

5. Limited daily alcohol intake: one drink for women and two drinks for men; and

6. Specific nutritional interventions for individuals with diabetes who are experiencing microvascular complications, cardiovascular disease, hypertension, hypoglycemia, and acute illness.

   Because patients look to clinicians for guidance on how to integrate nutrition into their overall diabetes management, Wylie-Rosett suggests addressing nutrition issues at each patient visit, helping patients find nutrition information, and following ADA recommendations to refer diabetic patients to registered dietitians.

“The diet for preventing chronic disease is the optimal diet for everybody [and] not only will boost energy and maintain weight but will lower one's risk of diabetes, heart disease, cancers, and stroke,” says American Dietetic Association spokesperson Cynthia Sass, MPH, MA, RD, LD/N.

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