diabetes: is a low-calorie diet the answer?d3hip0cp28w2tg.cloudfront.net › uploads › 2016-12 ›...

Diabetes:isalow-caloriediettheanswer?

PamelaDysonPhDOCDEM

ChurchillHospitalOxfordOX37LJ

[email protected]

DisclosureInformaFon

PamelaDysonhasreceivedhonorariaforlecturesfrompharmaceuFcalcompaniesincludingAbboJDiabetesCare,Lilly,MSD,NovoNordisk,JanssenandSanofi,andunrestrictedgrantsfromAbbotLaboratories,theSugarBureau,thePepsiCoFoundaFonandNovoNordisk

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


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)


Yes

But does a specific low-calorie diet

demonstrate superiority?

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

Dietarystrategiesforweightloss

•  Significantweightlossesoccurwithanylowfatorlowcarbohydratediet,anddifferencesbetweendifferentdietsaresmallandinsignificant(Johnstonetal.JAMA2014;312:923-33;Naudeetal.PLoSOne2014;9:e100652)

•  Behaviouralstrategiesincreaseweightloss(Johnsetal.JAcadNutrDiet2014;114:1557-68)


Yes and

No

Whyaren’tlowcaloriedietstheanswer?

•  Diabetesisstronglyassociatedwithobesity,unhealthydietsandphysicalinacFvity

•  Prescribingdietscansupportweightlossintheindividual,butpopulaFon-basedstrategiesareneeded

•  AmulF-sectoralapproachisrequiredinvolving:–  LocalandnaFonalgovernment–  EducaFon,health,townplanningandenvironmentalservices

–  Foodindustry–  CommuniFes,familiesandindividuals

diabetes: is a low-calorie diet the answer?d3hip0cp28w2tg.cloudfront.net › uploads › 2016-12 ›...

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