Guide Collection: Medical nutrition is the foundation, 8 diabetic diet options, suitable for most people to eat

▎Editor of WuXi AppTec content team

China has the largest number of diabetics in the

In this article, we combine multiple Chinese diabetes guidelines and elaborate

Image source: 123RF

Overweight and obesity are the main causes of diabetes, and a reasonable diet should be kept in mind

The prevalence of diabetes in China is increasing year by year, mainly due to the increase

Therefore, on the basis of assessing our own nutritional status, we should set reasonable medical nutrition treatment goals and plans, control the intake of total energy, distribute various nutrients reasonably and evenly, achieve metabolic control goals, and meet our own dietary preferences

5 main dietary nutritional factors, diabetic patients need to know

The main dietary nutritional factors include energy, fat, carbohydrates, protein, micronutrients, etc

• Energy:

For all overweight or obese diabetics, lifestyle adjustments should be made, total energy intake should be controlled, and at least 5%

It is recommended that the energy intake of diabetics be calculated according to 105-126 KJ (25-30 kcal)/kg (standard body weight)/d

▲Daily energy supply [KJ(kcal)/kg standard body weight of adult diabetics with different levels of physical activity [screenshot source: reference [2])

• Fat:

It is generally believed that the energy provided by fat in the diet should account for 20% to 30%
of the total energy.

If it is a high-quality fat, the fat-to-energy ratio can be increased to 35%.

The intake of saturated fatty acids and trans fatty acids should be limited as much as possible
.

Monounsaturated fatty acids and n-3 polyunsaturated fatty acids (such as fish oil, some nuts, and seeds) help improve blood sugar and lipids, which can be appropriately increased
.

Excessive dietary intake
of cholesterol should be controlled.

• Carbohydrates:

Carbohydrates are one
of the energy substances of the human body.

For diabetics, carbohydrate intake not only prevents hypoglycemia, but also avoids eating inappropriately and raising blood sugar
.

Patients can reduce the intake of refined carbohydrates (such as white rice, pasta, biscuits, etc.
) and sugary drinks, and replace 1/3 of the staple foods such as refined white rice and noodles with whole grains or mixed legumes
.

Foods with a low glycemic load are advocated
.

It is recommended that most people with diabetes provide 50% to 65% of the energy provided by carbohydrates in their diet
.

Diabetics with poor postprandial glycemic control can appropriately reduce the carbohydrate energy supply ratio
.

Long-term use of a very low-carbohydrate diet
is not recommended.

• Protein:

Protein is an important part of human muscles, and rapid protein supplementation after exercise helps repair damaged muscles and tissues, increase muscle fiber content, and improve muscle strength levels
.

For diabetic patients with normal kidney function, the recommended protein energy supply ratio is 15% to 20%, and ensure that high-quality protein accounts for more than
half of the total protein.

Patients with diabetes mellitus with dominant proteinuria or decreased glomerular filtration rate should have protein intake controlled at 0.
8 g/kg of body weight
per day.

• Micronutrient:

Diabetics are prone to deficiency of B vitamins, vitamin C, vitamin D, and a variety of micronutrients such as chromium, zinc, selenium, magnesium, iron, and manganese, which can be supplemented
in moderation according to the results of nutritional assessment.

Diabetics without micronutrient deficiencies do not need to supplement vitamins and trace elements for a long time
.

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Eight dietary patterns are different, and individualized nutritional interventions are true

For the management of diabetes, the dietary patterns that can be adopted include: energy-limited balanced diet, Mediterranean diet, Deshu diet, Jiangnan diet; and other short-term (4 to 12 weeks) phased diets, including high-protein diets, ketogenic diets, low-carb diets, and very low-carb diets
.

• Energy Limit Balanced Diet:

An energy-limited balanced diet refers to a daily reduction in energy intake of 500 kcal to 1000 kcal on the basis of target energy intake, or a decrease of 1/3 of the total energy compared with the recommended intake, of which carbohydrates account for 55% to 60% of total daily energy and fat accounts for 25% to 30%
of total daily energy.

A growing body fat diet is a growing body fat study that suggests an energy-restricted diet is an effective weight management method that can reduce the weight of obese people and reduce body fat levels
.

An energy-restricted diet may cause micronutrient deficiencies in obese people, and the risk of insufficient intake of vitamins or trace elements is higher
.

Therefore, during the weight-loss diet intervention, multivitamins and trace elements need to be supplemented to prevent nutrient deficiencies caused by restricted diets
.

• Mediterranean Diet:

The Mediterranean diet is one of the best diets for treating diabetes, mainly plant foods, including vegetables, fruits, nuts, whole grains, legumes, etc.
; Fish, poultry, eggs, dairy products in moderation, a small amount of red meat and its products; Edible oil is mainly olive oil
.

Its nutritional characteristics are: fat energy supply ratio of 25% to 35%, of which saturated fatty acid intake is low (7% to 8%), unsaturated fatty acid intake is higher
.

The Mediterranean diet not only reduces the risk of cardiovascular disease, but also facilitates blood sugar regulation
.

• Deshu Diet (DASH):

Emphasize increasing the intake of vegetables, fruits, low-fat (or non-fat) milk, whole grains, reducing the intake of red meat, oil, refined sugar and sugary drinks, eating appropriate nuts and legumes, so as to provide rich potassium, magnesium, calcium and other minerals and dietary fiber, increase the intake of high-quality protein and unsaturated fatty acids, and reduce the intake
of fat, especially saturated fatty acids and cholesterol.

Compared with the regular diet, the DASH diet is effective in reducing body weight, BMI, and body fat content
in overweight/obese people.

• Gangnam Diet:

Take coarse grain brown rice as the main food, moderate intake of chicken, duck, fish, shrimp, crab and other white meat, soy products, nuts, milk and rice wine, to ensure vegetable intake and appropriate amount of fruit, the use of vegetable oil such as rapeseed oil for low-temperature cooking, reduce polished rice noodles, red meat consumption, more suitable for the Chinese group of eating habits
.

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• Special diet patterns for short-term (4-12 weeks) stages:

Including high-protein diets, ketogenic diets, low-carb diets, and very low-carb diets all help with weight loss and relief of type 2 diabetes
.

These dietary patterns need to be individualized by the dietitian according to the patient's living habits and physical condition, and the effect is regularly evaluated and adjusted
.

1) High-protein diet: High-protein diet includes the definition of relative quantity (protein energy ratio) and absolute amount (protein intake), most high-protein diets refer to daily protein intake exceeding 20% of total daily energy, or more than 1.
5 g/(kg•d) by body weight, but generally not more than 30% of total daily energy or > 2.
0 g/(kg•d).

2) Ketogenic diet: Ketogenic diet is a very special type of very low-carbohydrate diet, which is a high-fat, low-carbohydrate-based, supplemented by moderate amounts of protein and other nutrients
.

A number of studies have confirmed that the use of a ketogenic diet in patients with type 2 diabetes can effectively reduce body mass, reduce blood sugar, reduce blood sugar fluctuations, improve insulin resistance, and improve metabolic indicators
.

3) Low carbohydrate diet: usually refers to a type of diet
in which the carbohydrate energy supply ratio is ≤ 40%, the fat energy supply ratio is ≥ 30%, the protein intake is relatively increased, and the total energy intake is limited or not restricted.

The adoption of a low-carb diet in overweight/obese type 2 diabetics in the short to medium term is beneficial for improved blood sugar control
.

4) Very low-carbohydrate diet: Aim to ≤ 20% of the carbohydrate energy supply ratio in the diet
.

In summary, type 2 diabetes is a common health problem in adults, with a heavy
burden of disease.

The medical nutrition treatment of diabetes is the basic measure to control the hyperglycemia of type 2 diabetes, and it is also an indispensable measure for the prevention and control of each stage of the natural course of the disease, and should be included in the whole process of patient management
.

There are many modes of diabetes diet treatment, but the current evidence does not prove that a certain diet model is more advantageous, and when formulating the dietary structure, attention should be paid to food diversity, prefer whole grain foods, and increase the intake
of non-starchy vegetables.

For people with diabetes, a dietary model
with a single capacity nutrient ratio is not recommended.

Multiple dietary patterns can be recommended to help people with diabetes lose weight, but require professional guidance and selection
based on the patient's metabolic goals and personal preferences.

Resources

[1] Diabetes Branch of Chinese Medical Association, National Office of Diabetes Prevention and Management at the Primary Level.
National Guidelines for the Prevention and Management of Primary Diabetes (2022)[J].
Chinese Journal of Internal Medicine, 2022, 61(3): 249-262.

Wang Mingyi, Kang Tao, Yang Jiewen.
Expert consensus on the alleviation of type 2 diabetes mellitus with exercise combined nutrition[J].
Chinese Journal of Medical Frontiers(Electronic Edition), 2022, 14(6): 12-21.

Nutrition and Metabolism Management Branch of China Association for the Promotion of International Healthcare Exchanges, Clinical Nutrition Branch of Chinese Nutrition Society, Diabetes Branch of Chinese Medical Association, et al.
Guidelines for medical nutrition treatment of overweight/obesity in China (2021)[J].
Chinese Journal of Medical Frontiers(Electronic Edition), 2021, 13(11): 1-55.

Jiang Bo, Zou Dajin, Ma Xianghua, et al.
Chinese expert consensus on ketogenic diet intervention for type 2 diabetes mellitus (2019 edition)[J].
JOURNAL OF PRACTICAL CLINICAL MEDICINE, 2019, 23(3): 1-6.

Chinese Medical Association Diabetes Branch.
Guidelines for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J].
Chinese Journal of Diabetes, 2021, 13(4): 315-409.

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.

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.

This article is also not a recommended
treatment plan.

For guidance on treatment options, visit a regular hospital
.