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Diabetes:isalow-caloriediettheanswer?
PamelaDysonPhDOCDEM
ChurchillHospitalOxfordOX37LJ
DisclosureInformaFon
PamelaDysonhasreceivedhonorariaforlecturesfrompharmaceuFcalcompaniesincludingAbboJDiabetesCare,Lilly,MSD,NovoNordisk,JanssenandSanofi,andunrestrictedgrantsfromAbbotLaboratories,theSugarBureau,thePepsiCoFoundaFonandNovoNordisk
Diabetes:isalowcaloriediettheanswer?
• Background• CurrentguidelinesandrecommendaFons• Weightmanagementstrategies• Summary
Diabetes:isalowcaloriediettheanswer?
• Background• CurrentguidelinesandrecommendaFons• Weightmanagementstrategies• Summary
DiabetesintheUK
PrevalenceofdiabetesintheUK:
- In2015,justunder3.5millionpeople(6.2%)haddiagnoseddiabetes
- Type1:approximately10%ofcases-350,000peopleincluding42,000childrenandyoungpeople
- Type2:approximately90%ofcases–3.15million
(Source:DiabetesUKFactsandStats2015)
Prevalenceofdiabetes1980-2015
0
0.5
1
1.5
2
2.5
3
3.5
4
1980 1985 1990 1995 2000 2005 2010 2015
563,000
3.5m
1
0
2
3
4
5
6
1.2%
6.2% N
um
be
r (m
illio
ns)
Preva
len
ce
(%)
Obesityandtype2diabetes
IntheUK,90%ofadultswithtype2diabetesareoverweightorobese(BMI>25kg/m2)and50%areobese(BMI>30kg/m2)(PHE2014)
0
25
50
75
100
T2DM: 90%
T2DM: 50%
UK: 62%
UK: 25%
Pre
vale
nc
e (
%)
Overweight or obese Obese
Diabetes:isalowcaloriediettheanswer?
• Background• CurrentguidelinesandrecommendaFons• Weightmanagementstrategies• Summary
Diabetes:isalowcaloriediettheanswer?
Yes
CurrentUKguidelines
Foradultswithtype2diabeteswhoareoverweight,setaniniFalbodyweightlosstargetof5-10%
WeightmanagementshouldbetheprimarynutriFonalstrategyforthosewhoare
overweightorobese
Evidenceforweightmanagement
Inpeoplewithtype2diabetes,5-10%weightlossisassociatedwith:
- ImprovedglycaemiccontrolwithHbA1creducFonsof2-30mmol/mol(0.25–2.9%)
- 28%reducFonincardiovascularmortality- 25%reducFonintotalmortality- 30%reducFoninproteinuria- Improvementsinsleepapnoea,mobility,physical
funcFon,urinaryinconFnence,erecFledysfuncFon,depressionandqualityoflife(Wilding,J.IntJClinPract2014;68:682-91)
Diabetes:isalowcaloriediettheanswer?
Yes
But does a specific low-calorie diet
demonstrate superiority?
Diabetes:isalowcaloriediettheanswer?
• Background• CurrentguidelinesandrecommendaFons• Weightmanagementstrategies• Summary
WeightlossdietsAtoZ
Atkins EatMoreWeightLess
GI Martha’sVineyard
PriFkin SugarBusters
BabyFood EatRight Grapefruit Metabolism ProteinPower Dukan
BestLife EatThis Hallelujah MayoClinic RawFood ThinforLife
BiggestLoser FastFood hCG Medifast Rice 3-Day
BodyforLife 5Factor HealthyeaFng Mediterranean Shangri-La 3-Hour
CabbageSoup FlatBelly JennyCraig NaturallyThin SkinnyVegan Ultra
Cheater’s FlavorPoint InnerSkinny BeverlyHills Slim-Fast Volumetrics
Cookie 4-Day LAPlan Nutrisystem Sonoma WeightLossCure
DASH FrenchWomen Lemonade ParkAvenue SouthBeach
DrAndrewWeil
FruitFlush Low-carbliving Perricone Spectrum Weight-watchers
DrPhil’sUlFmate
Genotype MacrobioFc PersonalityType Step Zone
WeightlossdietsAtoZ
Atkins EatMoreWeightLess
GI Martha’sVineyard
PriFkin SugarBusters
BabyFood EatRight Grapefruit Metabolism ProteinPower Dukan
BestLife EatThis Hallelujah MayoClinic RawFood ThinforLife
BiggestLoser FastFood hCG Medifast Rice 3-Day
BodyforLife 5Factor HealthyeaFng Mediterranean Shangri-La 3-Hour
CabbageSoup FlatBelly JennyCraig NaturallyThin SkinnyVegan Ultra
Cheater’s FlavorPoint InnerSkinny BeverlyHills Slim-Fast Volumetrics
Cookie 4-Day LAPlan Nutrisystem Sonoma WeightLossCure
DASH FrenchWomen Lemonade ParkAvenue SouthBeach
DrAndrewWeil
FruitFlush Low-carbliving Perricone Spectrum Weight-watchers
DrPhil’sUlFmate
Genotype MacrobioFc PersonalityType Step Zone
WeightlossdietsAtoZ
Atkins EatMoreWeightLess
GI Martha’sVineyard
PriFkin SugarBusters
BabyFood EatRight Grapefruit Metabolism ProteinPower Dukan
BestLife EatThis Hallelujah MayoClinic RawFood ThinforLife
BiggestLoser FastFood hCG Medifast Rice 3-Day
BodyforLife 5Factor HealthyeaFng Mediterranean Shangri-La 3-Hour
CabbageSoup FlatBelly JennyCraig NaturallyThin SkinnyVegan Ultra
Cheater’s FlavorPoint InnerSkinny BeverlyHills Slim-Fast Volumetrics
Cookie 4-Day LAPlan Nutrisystem Sonoma WeightLossCure
DASH FrenchWomen Lemonade ParkAvenue SouthBeach
DrAndrewWeil
FruitFlush Low-carbliving Perricone Spectrum Weight-watchers
DrPhil’sUlFmate
Genotype MacrobioFc PersonalityType Step Zone
WeightlossdietsAtoZ
Atkins EatMoreWeightLess
GI Martha’sVineyard
PriFkin SugarBusters
BabyFood EatRight Grapefruit Metabolism ProteinPower Dukan
BestLife EatThis Hallelujah MayoClinic RawFood ThinforLife
BiggestLoser FastFood hCG Medifast Rice 3-Day
BodyforLife 5Factor HealthyeaFng Mediterranean Shangri-La 3-Hour
CabbageSoup FlatBelly JennyCraig NaturallyThin SkinnyVegan Ultra
Cheater’s FlavorPoint InnerSkinny BeverlyHills Slim-Fast Volumetrics
Cookie 4-Day LAPlan Nutrisystem Sonoma WeightLossCure
DASH FrenchWomen Lemonade ParkAvenue SouthBeach
DrAndrewWeil
FruitFlush Low-carbliving Perricone Spectrum Weight-watchers
DrPhil’sUlFmate
Genotype MacrobioFc PersonalityType Step Zone
WeightlossdietsAtoZ
Atkins EatMoreWeightLess
GI Martha’sVineyard
PriFkin SugarBusters
BabyFood EatRight Grapefruit Metabolism ProteinPower Dukan
BestLife EatThis Hallelujah MayoClinic RawFood ThinforLife
BiggestLoser FastFood hCG Medifast Rice 3-Day
BodyforLife 5Factor HealthyeaFng Mediterranean Shangri-La 3-Hour
CabbageSoup FlatBelly JennyCraig NaturallyThin SkinnyVegan Ultra
Cheater’s FlavorPoint InnerSkinny BeverlyHills Slim-Fast Volumetrics
Cookie 4-Day LAPlan Nutrisystem Sonoma WeightLossCure
DASH FrenchWomen Lemonade ParkAvenue SouthBeach
DrAndrewWeil
FruitFlush Low-carbliving Perricone Spectrum Weight-watchers
DrPhil’sUlFmate
Genotype MacrobioFc PersonalityType Step Zone
Dietarystrategiesforweightloss
• HealthyeaFng• Lowcarbohydrate• Mealreplacements• Verylowenergydiets(VLED)• Mediterraneandiets• LowGIdiets• Commercialgroups–Weightwatchers,RosemaryConley,SlimmingWorld
• Fast(5:2)dietorintermiJentfasFng
Strong evidence of efficacy
No evidence of efficacy – studies have been done
No evidence – studies not done
HealthyeaFng
• Adietbasedonwholegrains,fruit,vegetables,legumes,nuts,lowfatdairy,seafoodandleanmeatandlowinsugar,salt,saturatedfatandprocessedfoods
• IntheLookAHEADtrial,at10yearsfollow-up,healthyeaFngcombinedwithphysicalacFvity:– Reducedweightby6%– Improvedglycaemiccontrol– Reducedcardiovascularrisk(Wingetal,NEnglJMed
2013;369:145-54)
Mediterraneandiet
• AMediterraneandietisbasedonvegetables,fruits,nuts,legumes,cerealgrains,oliveoilandfish
• Ameta-analysiscomparingMediterraneandietswithotherdietsconcludedthattherewas:– Greaterweightloss– Greaterimprovementsinglycaemiccontrolandcardiovascularriskfactors(Huoetal,EuJClinNutr2015;69:1200-8))
Mealreplacements
• Commonlybasedon2mealreplacements(shakes,soups,bars)and1healthylowfatmealeachday
• Overtheshort-term(6months)mealreplacementsincreaseweightlossandimproveglycaemiccontrol(Heymsfieldetal,IntJObesRelatMetabDisord2003;27:537-49)
Verylowenergyliquiddiets(VLELD)
• Proprietaryliquidformulaeproviding~800kcal/day• Mustbeusedundermedicalsupervision• MoreeffecFveforweightlossandimprovementsinglycaemiccontrolcomparedtoalowcaloriediet(Norrisetal,CochraneDatabaseSystRev2005;CD0044095)
• SmallintervenFonstudiesreporteddiabetesremissionin60%ofthesubjects,butlongertermdatafromalargerstudyareawaited(Stevenetal,DiabetMed2013;30:e135-8)
Lowcarbohydratediets
• Lowcarbohydratecommonlyavoidallsugaryandstarchyfoodsandarebasedonmeat,fish,poultry,cheese,eggs,andlimitedamountsofgreenvegetables,salad,fruitandmilkproducts
• TheyaremoreeffecFveforweightlossandimprovingglycaemiccontrolthanlowfatdietsovertheshort-term,butnotthelongerterm(VanWyketal,Diabe[cMed2016;33:148-57)
Differentdietsandweightloss
75
80
85
90
95
100
105
110
0 3 6 9 12
Healthy eating
Slimfast
VLCD
Low carbohydrate
Mediterranean
We
igh
t (k
g)
Time (months)
CurrentUKguidelines
Diabetes:isalowcaloriediettheanswer?
• Background• CurrentguidelinesandrecommendaFons• Weightmanagementstrategies• Summary
Dietarystrategiesforweightloss
• Significantweightlossesoccurwithanylowfatorlowcarbohydratediet,anddifferencesbetweendifferentdietsaresmallandinsignificant(Johnstonetal.JAMA2014;312:923-33;Naudeetal.PLoSOne2014;9:e100652)
• Behaviouralstrategiesincreaseweightloss(Johnsetal.JAcadNutrDiet2014;114:1557-68)
Diabetes:isalowcaloriediettheanswer?
Yes and
No
Whyaren’tlowcaloriedietstheanswer?
• Diabetesisstronglyassociatedwithobesity,unhealthydietsandphysicalinacFvity
• Prescribingdietscansupportweightlossintheindividual,butpopulaFon-basedstrategiesareneeded
• AmulF-sectoralapproachisrequiredinvolving:– LocalandnaFonalgovernment– EducaFon,health,townplanningandenvironmentalservices
– Foodindustry– CommuniFes,familiesandindividuals