Role of Macronutrients and Suitability of Upcoming Dietary Trends for Asian Adults with Type 2 Diabetes

Abstract

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.

Effectiveness of lifestyle interventions/culturally bespoke programmes in South Asian ethnic groups targeting weight loss for prevention and/or remission of type 2 diabetes: a systematic review and meta‐analysis of intervention trials

“…The slight decrease in FBG (−0.19 mmol/L [95% CI: −0.31, −0.07], p = 0.002) is likely to have little or no clinical relevance. Contrary to this evidence, a previous meta‐analysis on dietary and physical activity interventions in South Asians reported a similar decrease in body weight to our study, but with a 7.4% absolute risk reduction in diabetes incidence 59 ; this meta‐analysis was, however, limited by the small number of trials (including those with duration ≥12 months), the considerable loss of participants to follow‐up and the lack of consideration of study intensity. Carefully planned long‐term interventions will be able to identify the association between the degree of weight loss and the decrease in diabetes incidence in South Asians.…”

“…Two proof‐of‐concept trials held in both the United Kingdom and India assigned participants to receive ~850 kcal in the form of total diet replacement or 1000 kcal of food‐based diet, leading to T2DM remission rates of 38.5% 15 and 50%, 44 respectively. However, previous reports highlighted the potential lack of sustainability of very low‐calorie diets and low‐carbohydrate diets (≤75 g) in people with South Asian heritage 59 . This suggests that tailored interventions that are co‐designed with the community may need to be considered.…”

The role of serotonin hormone on weight loss maintenance after sleeve gastrectomy: a systematic review

“…Individuals might experience significant challenges in weight loss maintenance post-LSG due to factors such as metabolic adaptation, dietary factors, and psychological elements. The body adapts to various metabolic changes and hormone regulations over time, potentially leading to weight gain [ 24 ]. Increases in ghrelin, for instance, can lead to increased appetite and, thus, weight gain.…”

Culturally Tailored Dietary Interventions for Improving Glycaemic Control and Preventing Complications in South Asians with Type 2 Diabetes: Success and Future Implications

“…T2DM remission through a very low-calorie diet (~850 Kcal) [ 26 ] has gained wide recognition over the last few years and its feasibility has also been reported in the South Asian population [ 27 , 28 ]. However, these diets, which create a significant calorie deficit, may not be widely acceptable among South Asians and can result in a lack of adherence [ 29 ]. Additionally, remission trials have primarily included patients diagnosed with T2DM within the last 6 years [ 27 , 28 ].…”