Diabetes and obesity are both increasing at a fast pace and giving rise to a new epidemic called diabesity. Lifestyle interventions including diet play a major role in the treatment of diabetes, obesity and diabesity. There are many guidelines on dietary management of diabetes or obesity globally and also from South Asia. However, there are no global or South Asian guidelines on the non-pharmacological management of diabesity. South Asia differs from the rest of the world as South Asians have different phenotype, cooking practices, food resources and exposure, medical nutrition therapy (MNT) practices, and availability of trained specialists. Therefore, South Asia needs its own guidelines for nonpharmacological management of diabesity in adults. The aim of the Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective is to recommend therapeutic and preventive MNT in the South-Asians with diabesity.

It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60–70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.

Medical nutrition therapy is a therapeutic approach to treat medical conditions and their associated symptoms via using a specifically tailored diet devised under the supervision of a doctor and a registered dietitian or nutrition professional. Ketogenic diet primarily consists of the high amount of fats, a moderate amount of proteins, and very low carbohydrates. It is known to stimulate the metabolic effects of starvation by forcing the body to use primarily fat as a fuel source. Ketogenic diet was developed in the 1920s. Nowadays, it is gaining considerable attention as a potential weight-loss strategy because of the low-carb diet. However, it is being considered for use in several diseases/disorders also because of the beneficial effects on the metabolic health and nervous system. This review revisits the therapeutic potential of ketogenic diets in many pathological conditions and its role as a medical nutrition therapy. It also talks about the ill effects that the keto diet can have in case of self-usage and monitoring.

Medical nutrition therapy interventions among type 2 diabetes patients administered by registered dieticians are said to be beneficial to the extent of reducing glycated hemoglobin by 1%–2%. Despite patient-centered dietary interventions, adherence continues to remain a challenge in the Indian setting due to the carbohydrate-rich dietary pattern, dietary myths coupled with lack of nutritional awareness, poor literacy, financial burden, and lack of motivation. On the contrary, the evolution of “FAD” diets through drastic dietary changes present individuals with type 2 diabetes with a possibility of reversal of the disease further increasing the nutritional dilemma. These FAD diets extend beyond being mere trends and show improvements in several biochemical processes by reducing the intake of calories either through restriction (very low-calorie diet) or fasting (intermittent fasting) or low carbohydrate diets up to one year. This article by evaluating the suitability of these promising diets to Indian adults with type 2 diabetes aimed to provide evidence that could improve diabetes-related dietary knowledge. Through this narrative review, we conclude that a single drastic dietary modification as seen in very low-calorie diets (≤ 800 kcal/day) or the low-carbohydrate diet (≤ 75 g/d) is not suitable for Indians and such dietary measures will further hamper the sustainability of prescribed diets. The future directions in diet and disease would be to develop clinical trials that will show the effectiveness of dietary regimens constituting optimal energy deficit and macronutrient balances that will contribute to the remission of disease while preventing macronutrient deficiencies and relapse in the dietary regimen.

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