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from research to practice perspectives on meal planning intervention study diabetes obes metab 16 koloverou e esposito k giugliano effects of the mediterranean diet greek 2010 12 204 209 d ...

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                           FROM RESEARCH TO PRACTICE / PERSPECTIVES ON MEAL PLANNING
                           intervention study. Diabetes Obes Metab                   16. Koloverou E, Esposito K, Giugliano                    effects of the Mediterranean diet: Greek 
                           2010;12:204–209                                           D, Panagiotakos D. The effect of                          EPIC prospective cohort study. BMJ 
                           11. Toobert DJ, Glasgow RE, Strycker LA,                  Mediterranean diet on the development of                  2009;338:b2337
                           et al. Biologic and quality-of-life outcomes              type 2 diabetes mellitus: a meta-analysis of              22. Bozzetto L, Alderisio A, Giorgini M, et 
                           from the Mediterranean Lifestyle Program.                 10 prospective studies and 136,846 partici-               al. Extra-virgin olive oil reduces glycemic 
                                                                                     pants. Metabolism 2014;63:903–911                         response to a high-glycemic index meal 
                           Diabetes Care 2003;26:2288–2293                           17. Bantle AE, Chow LS, Steffen LM, et al. 
                           12. Itsiopoulos C, Brazionis L, Kaimakamis                Association of Mediterranean diet and car-                in patients with type 1 diabetes: a ran-
                           M. Can the Mediterranean diet lower                       diorespiratory fitness with the development               domized controlled trial. Diabetes Care 
                           HbA1c in type 2 diabetes? Results from a                  of pre-diabetes and diabetes: the Coronary                2016;39:518–524
                           randomized cross-over study. Nutr Metab                   Artery Risk Development in Young Adults                   23. Academy of Nutrition and Dietetics. 
                           Cardiovasc Dise 2011;21:740–747                           (CARDIA) study. BMJ Open Diabetes Res                     Diabetes type 1 and 2 systematic review 
                           13. Toobert DJ, Strycker LA, King                         Care 2016:4:e000229                                       and guidelines, 2015 [Internet]. Available 
                           DK, et al. Long-term outcomes from                        18. Salas-Salvadó J, Bulló M, Babio N,                    from http://www.andeal.org/topic.
                           a multiple-risk-factor diabetes trial for                 et al. Reduction in the incidence of type                 cfm?menu=5305. Accessed 11 November 
                           Latinas: ¡Viva Bien! Transl Behav Med                     2 diabetes with the Mediterranean diet:                   2016
                           2011;1:416–426                                            results of the PREDIMED-Reus nutrition                    24. Mayo Clinic. Mediterranean diet 
                                                                                     intervention randomized trial. Diabetes                   for health [Internet]. Available from 
                           14. Esposito K, Maiorino MI, Petrizzo M,                  Care 2011;34:14–19                                        www.mayoclinic.org/healthy-lifestyle/
                           Bellastella G, Giugliano D. The effects of                19. Martinez-González MÁ, de la Fuente-                   nutrition-and-healthy-eating/in-depth/
                           a Mediterranean diet on need for diabetes                 Arrillaga C, Nunez-Cordoba JM, et al.                     mediterranean-diet/art-20047801?pg=2.                         Downloaded from http://diabetesjournals.org/spectrum/article-pdf/30/2/76/505261/76.pdf by guest on 02 January 2023
                           drugs and remission of newly diagnosed                    Adherence to Mediterranean diet and risk                  Accessed 11 November 2016
                           type 2 diabetes: follow-up of a randomized                of developing diabetes: prospective cohort                25. EatingWell. 8 ways to follow the 
                           trial. Diabetes Care 2014;37:1824–1830                    study. BMJ 2008;336:1348–1351                             Mediterranean diet for better health 
                           15. Huo R, Du T, Xu Y, et al. Effects of                  20. Esposito K, Chiodini P, Maiorino MI,                  [Internet]. Available from www.
                           Mediterranean-style diet on glycemic                      et al. Which diet for prevention of type 2                eatingwell.com/healthy_cooking/
                           control, weight loss and cardiovascular                   diabetes? A meta-analysis of prospective                  healthy_cooking_101_basics_techniques/
                           risk factors among type 2 diabetes indi-                  studies. Endocrine 2014;47:107–116                        shopping_cooking_guides/8_ways_to_ 
                           viduals: a meta-analysis. Eur J Clin Nutr                 21. Trichopoulou A, Bamia C,                              follow_the_Mediterranean_diet.  
                           2015:69:1200–1208                                         Trhiuchopoulos D. Anatomy of health                       Accessed 11 November 2016 
                           DASH Eating Plan: An Eating Pattern  
                           for Diabetes Management
                           Amy P. Campbell
                                                                                     ■ IN BRIEF The DASH (Dietary Approaches to Stop Hypertension) eating 
                                                                                     plan is an acceptable eating pattern for people who have diabetes. In addition 
                                                                                     to promoting blood pressure control, this eating pattern has been shown to 
                                                                                     improve insulin resistance, hyperlipidemia, and even overweight/obesity. This 
                           Good Measures, LLC, Boston, MA                            balanced approach promotes consumption of a variety of foods (whole grains, 
                           Corresponding author: Amy P. Campbell,                    fat-free or low-fat dairy products, fruits, vegetables, poultry, fish, and nuts) and 
                           aepeterson@hotmail.com                                    is appropriate for the entire family.
                           https://doi.org/10.2337/ds16-0084                                  he U.S. Department of Agri-                      Guidelines. Specifically, three food pat-
                           ©2017 by the American Diabetes Association.                        culture (USDA) has described  terns have been developed: the Healthy 
                           Readers may use this article as long as the work          Tseveral food patterns designed  U.S.-Style Pattern, the Healthy 
                           is properly cited, the use is educational and not  
                           for profit, and the work is not altered. See http://      to help people follow the recom-                          Vegetarian Pattern, and the Healthy 
                           creativecommons.org/licenses/by-nc-nd/3.0                                                                           Mediterranean-Style Pattern. The 
                           for details.                                              mendations set forth in its Dietary 
                           76 SPECTRUM.DIABETESJOURNALS.ORG
                                                                                                                                      campbell
                     American Diabetes Association, in its     a diastolic blood pressure of 80–95  calorie needs. Based on the above 
                     2013 position statement “Nutrition  mmHg. Subjects in the study ini-                 recommendations, Table 1 provides 
                     Therapy Recommendations for  tially followed a control diet low in  examples of daily and weekly serv-
                     the Management of Adults With  fruits, vegetables, and dairy products,               ings that meet DASH targets for a 
                     Diabetes,” also promotes the use of a     along with a fat intake of 37% of cal-     2,000-calorie eating plan (7,8).
                     variety of eating patterns to help with   ories (representative of the typical          In terms of macronutrient com-
                     the management of diabetes (1).           American diet). After 3 weeks of this      position, the nutrient goals of the 
                        One of the eating patterns pro-        run-in diet, subjects were random-         DASH eating pattern are as follows:
                     moted in these recommendations  ized to one of the following diets for  •  Total fat: 27% of calories
                     is the DASH (Dietary Approaches  8 weeks: the control diet, a diet rich  •  Saturated fat: 6% of calories
                     to Stop Hypertension) plan. This  in fruits and vegetables, or a diet that           •  Protein: 18% of calories
                     eating plan is one of several eating  combined fruits, vegetables, and low-          •  Carbohydrates: 55% of calories
                     patterns that is appropriate for dia-     fat dairy foods. Body weight, physical     •  Cholesterol: 150 mg
                     betes educators to recommend to  activity, and sodium intake were held               •  Sodium: 2,300 mg (A lower goal 
                     their patients with diabetes. This  constant during the trial.                          of 1,500 mg sodium was tested                FROM RESEARCH T
                     dietary approach is a nutritious, bal-        The combination diet reduced              and found to be even better for            Downloaded from http://diabetesjournals.org/spectrum/article-pdf/30/2/76/505261/76.pdf by guest on 02 January 2023
                     anced, and sustainable eating plan  systolic blood pressure by 5.5 mmHg                 lowering blood pressure, partic-
                     that can improve a number of health       and diastolic blood pressure by 3.0           ularly for middle-aged and older 
                     parameters, including hypertension,  mmHg, whereas the fruits and veg-                  individuals, African Americans, 
                     insulin resistance, hyperlipidemia,  etables diet reduced systolic blood                and those who already had high 
                     and overweight/obesity. People with  pressure by 2.8 mmHg and dia-                      blood pressure [9].)
                     diabetes have a higher risk of develop-   stolic blood pressure by 1.1 mmHg.  •  Potassium: 4,700 mg
                     ing hypertension than people without      Subgroup analyses showed that  •  Calcium: 1,250 mg
                     diabetes; in addition, the percentage     African Americans and individuals  •  Magnesium: 500 mg                                    O PRA
                     of adults with diabetes ≥18 years of  with hypertension showed the great-            •  Fiber: 30 g
                     age who have hypertension was 57.1%       est reductions in blood pressure (3).
                     in 2009 compared to 46.2% in 1995         DASH Diet: What Is It?                        The DASH eating pattern is                   CTICE
                     (2). Clearly, efforts to help prevent                                                closely aligned with the USDA’s 
                     and manage hypertension must be  The NHLBI, part of the National  dietary recommendations, as outlined 
                     increased, especially in the diabetes  Institutes of Health (NIH), promotes          in the 2015–2020 Dietary Guidelines 
                     population.                               the DASH diet, or eating pattern, as a     for Americans. As described in chapter 
                        The appeal of the DASH eating  means of preventing and controlling  1 of the USDA guidelines, the “Key 
                     pattern for patients is that it is also   blood pressure without the use of  Recommendations” for healthy eat-
                     practical; it does not require spe-       medication. The DASH eating pat-           ing patterns are as follows:
                     cial foods or supplements, and it is  tern is also promoted as a healthful  •  Consume a healthy eating pattern 
                     an approach that is appropriate for  option for the general population                  that accounts for all foods and 
                     patients’ entire family to follow. This   (4–6).                                        beverages within an appropriate 
                     article introduces diabetes educators         The DASH eating pattern pro-              calorie level.
                     to the DASH eating pattern in more        motes blood pressure reduction by  •  A healthy eating pattern includes:
                     detail, providing the evidence behind     encouraging the consumption of                 ❍  A variety of vegetables from 
                     the plan and suggesting practical tips    foods that are low in saturated fat,              all of the subgroups—dark 
                     for introducing the DASH eating  total fat, cholesterol, and sodium and                     green, red and orange, legumes 
                     plan to patients.                         high in potassium, calcium, magne-                (beans and peas), starchy, and 
                                                               sium, fiber, and protein. In terms of             other
                     Overview of the DASH Trial                actual food choices, the DASH eating           ❍  Fruits, especially whole fruits
                     The DASH eating plan was developed        pattern encourages whole grains, fat-          ❍  Grains, at least half of which 
                     as an approach to help lower blood  free or low-fat dairy products, fruits,                 are whole grains
                     pressure without the use of medica-       vegetables, poultry, fish, and nuts.           ❍  Fat-free or low-fat dairy, 
                     tion. A multicenter trial, funded by  Foods that are limited include fatty                  including milk, yogurt, cheese, 
                     the National Heart, Lung, and Blood       meats, full-fat dairy products, tropi-            and/or fortified soy beverages
                     Institute (NHLBI) and published in  cal oils (e.g., coconut, palm, and palm              ❍  A variety of protein foods, 
                     1997, was conducted to study the  kernel oils), and sweets and sugar-                       including seafood, lean meats 
                     effects of dietary patterns on blood  sweetened beverages.                                  and poultry, eggs, legumes 
                     pressure in 459 adults with a systolic        The number of servings of foods               (beans and peas), nuts, seeds, 
                     blood pressure of <160 mmHg and  is based on a person’s estimated                           and soy products
                     VOLUME 30, NUMBER 2, SPRING 2017                                                                                          77
                      FROM RESEARCH TO PRACTICE / PERSPECTIVES ON MEAL PLANNING
                          TABLE 1. Examples of Daily and Weekly Servings That Meet                                  ❍  Oils
                                DASH Targets for a 2,000-Calorie Eating Plan (7,8)                               •  A healthy eating pattern limits:
                             Food Group                  Daily Servings                Serving Sizes                ❍  Saturated fats and trans fats, 
                                                       (except as noted)                                                added sugars, and sodium
                       Grains and grain                         7–8              1 slice bread                      Key Recommendations that are 
                       products                                                  1 cup ready-to-eat              quantitative are provided for several 
                                                                                 cereal*                         components of the diet that should be 
                                                                                 1/2 cup cooked rice,            limited. These components are of par-
                                                                                 pasta, or cereal                ticular public health concern in the 
                       Lean meats, poultry,                     ≤2               3 oz cooked lean meat,          United States, and the specified limits 
                       and fish                                                  skinless poultry, or fish       can help individuals achieve healthy 
                       Vegetables                              4–5               1 cup raw leafy                 eating patterns within calorie limits:
                                                                                 vegetable                       •  Consume <10% of calories per 
                                                                                 1/2 cup cooked                     day from added sugars
                                                                                 vegetable                       •  Consume <10% of calories per                  Downloaded from http://diabetesjournals.org/spectrum/article-pdf/30/2/76/505261/76.pdf by guest on 02 January 2023
                                                                                 6 oz vegetable juice               day from saturated fats
                                                                                                                 •  Consume <2,300 mg per day of 
                       Fruit                                   4–5               1 medium piece of fruit            sodium
                                                                                 1/4 cup dried fruit             •  If alcohol is consumed, it should 
                                                                                 1/2 cup fresh, frozen,             be consumed in moderation—≤1 
                                                                                 or canned fruit                    drink per day for women and ≤2 
                                                                                 6 oz fruit juice                   drinks per day for men—and only 
                       Low-fat or fat-free dairy                2–3              8 oz milk                          by adults of legal drinking age 
                       foods                                                     1 cup yogurt                       Both the USDA dietary guide-
                                                                                 1 1/2 oz cheese                 lines and the DASH eating pattern 
                       Nuts, seeds, and dry               4–5 per week           1/3 cup or 1 1/2 oz nuts        strongly encourage the intake of 
                       beans                                                     1 Tbsp. or 1/2 oz seeds         vegetables, fruits, whole grains, and 
                                                                                                                 lower-fat dairy products, while limit-
                                                                                 1/2 cup cooked dry              ing the intake of sugars, saturated fat, 
                                                                                 beans                           and sodium (5).
                       Fats and oils†                           2–3              1 tsp. soft margarine           DASH–Sodium Trial
                                                                                 1 tsp. low-fat                  Interestingly, although the DASH 
                                                                                 mayonnaise                      diet was not low in sodium (provid-
                                                                                 2 Tbsp. light salad             ing 2,400 mg of sodium per day), 
                                                                                 dressing                        blood pressure was still reduced. To 
                                                                                 1 tsp. vegetable oil            understand the effect of sodium re-
                       Sweets                              ≤5 per week           1 Tbsp. sugar                   striction, the DASH–Sodium trial 
                                                                                 1 Tbsp. jelly or jam            was conducted. This trial included 
                                                                                 1/2 oz jelly beans              412 subjects who were randomized 
                                                                                 8 oz lemonade                   to a control diet or the DASH diet 
                       Sodium††                             <2,300 mg            Total from prepared/            for 90 days. Within each group, sub-
                                                                                 packaged foods and              jects were then assigned to three diets: 
                                                                                 added during cooking            a high-sodium diet (3.5 g/day), a 
                                                                                 or at the table                 moderate-sodium diet (2.3 g/day), or 
                       *Serving sizes vary between 1/2 and 1 1/4 cups. Check product nutrition                   a low-sodium diet (1.2 g/day), each 
                       labels.                                                                                   for 30 days. For those on the DASH 
                       †Fat content changes serving counts for fats and oils (e.g., 1 Tbsp. regular              diet, the greater the reduction in so-
                       salad dressing is 1 serving, whereas 1 Tbsp. low-fat salad dressing is 1/2                dium, the greater was the reduction 
                       serving, and 1 Tbsp. fat-free salad dressing is 0 servings).                              in blood pressure, although there was 
                       ††Limiting sodium to 1,500 mg daily lowers blood pressure even further than               no significant difference on diastol-
                       2,300 mg sodium daily (8).                                                                ic blood pressure between the high- 
                                                                                                                 and moderate-sodium intake levels. 
                                                                                                                 Furthermore, lowering sodium intake 
                      78 SPECTRUM.DIABETESJOURNALS.ORG
                                                                                                                                         campbell
                     to 1.2 g/day would be challenging,             Is the DASH eating pattern ben-          DASH Eating Pattern in 
                     given the amount of sodium used by          eficial for people who have diabetes?       Gestational Diabetes
                     the food industry in food processing        As previously mentioned, the DASH           A healthy eating plan is a key factor in 
                     (4,10).                                     eating pattern can provide upwards  the management of gestational diabe-
                     OmniHeart Study                             of 55% of calories from carbohydrate,       tes mellitus (GDM); specifically, the 
                     The OmniHeart (Optimal Macro-               which may be too high a carbohy-            goal is to prevent or reduce adverse 
                     nutrient Intake Trial for Heart  drate intake for some people with  maternal and newborn outcomes 
                     Health) study compared three heart-         type 2 diabetes. Furthermore, there  without instigating any short-term 
                     healthy diets that were known to low-       is little research demonstrating the  harmful effects. Various dietary ap-
                     er blood pressure and improve blood         glycemic benefits of the DASH eating        proaches have been studied, includ-
                     lipids. These three diets were based  plan for people who have diabetes.  ing a low–glycemic index (GI) diet, a 
                     on the DASH diet but differed in the        Yet, in one study of 31 subjects with       low-carbohydrate diet, and a calorie- 
                     amount of carbohydrate, protein, and        type 2 diabetes (14), the DASH eat-         restricted diet. In a systematic review 
                                                                 ing plan did improve blood lipids and       and meta-analysis of randomized 
                     unsaturated fat, while being equiva-        blood pressure while also decreasing        clinical trials of dietary interventions        FROM RESEARCH T
                     lent in calories. The higher protein  A1C (by 1.7 percentage points) and  in GDM, Viana et al. (19) conclud-                           Downloaded from http://diabetesjournals.org/spectrum/article-pdf/30/2/76/505261/76.pdf by guest on 02 January 2023
                     (25 vs. 15% of calories) and higher  fasting blood glucose levels (by 29%).             ed that, although the low-GI eating 
                     unsaturated fat (10 vs. 8% of calo-         Of note, De Paula et al. (15) found  plan was associated with less frequent 
                     ries) diets showed the most benefit on      that fruits and vegetables were the  insulin use and lower birth weight 
                     blood pressure and blood lipids and  two food groups of the DASH eating                 than the other diets, the DASH diet 
                     reduced the estimated 10-year risk of       plan that helped to lower blood pres-       also holds promise for patients with 
                     heart disease compared to the higher-       sure in a group of 225 subjects with        GDM. In a small trial (20), women 
                     carbohydrate diet. Of note, the high-       type 2 diabetes.                            with GDM followed the DASH diet 
                     er-protein diet emphasized plant               However, the benefits of the  for 4 weeks. The DASH diet during                          O PRA
                     sources of protein, which have been  DASH eating plan may be applicable                 pregnancy lowered insulin use, re-
                     associated with reduced blood pres-         to people who have type 2 diabetes in       duced cesarean rates, and lowered 
                     sure (11). Although the OmniHeart  other ways. For example, the diets of                birth weights. Although the DASH                CTICE
                     study was not specifically geared to-       women in the Nurses’ Health Study  approach looks promising for the 
                     ward diabetes or glycemic manage-           and the Nurses’ Health Study II, and        management of GDM, further re-
                     ment, the fact that heart disease is the    of men in the Health Professionals  search is warranted, as, in this study, 
                     leading cause of death among people         Follow-Up Study were measured  the diet was not followed throughout 
                     with diabetes makes its results appli-      every 4 years. Adherence scores  the pregnancies and deliveries. 
                     cable to this population.                   were computed for the Alternate  DASH Eating Pattern for 
                     DASH Eating Pattern for                     Mediterranean Diet, the Alternate  Diabetes Prevention
                     Diabetes                                    Health Eating Index–2010, and  The DASH eating plan or DASH-like 
                     The DASH eating pattern has prov-           the DASH diet. Improvement in  eating plans have also led to improve-
                     en to be beneficial for those who are       all three of these scores was associ-       ments in insulin sensitivity, further 
                     aiming to control or prevent hyper-         ated with less weight gain, especially      demonstrating that this type of eating 
                     tension. Nearly two out of three indi-      in younger women or overweight  plan may be helpful for individuals 
                     viduals with diabetes have hyperten-        individuals (16). Weight control is  with prediabetes or who are at risk 
                     sion (12), so it is reasonable to expect    linked with improved glycemic con-          for type 2 diabetes (21,22). A meta- 
                     that the DASH eating plan would be          trol in people with type 2 diabetes  analysis (23) of prospective cohort 
                     of benefit for people who have both  (17). Interestingly, the DASH diet 
                                                                 is ranked by U.S. News & World  studies looked at the differences 
                     hypertension and diabetes. In a study       Report as being “#1 in best diets over-     among various diets’ effects in pre-
                     by Paula et al. (13), 40 patients with      all” for helping to manage not only  venting type 2 diabetes. The au-
                     type 2 diabetes and uncontrolled  blood pressure but also weight (18).  thors concluded that several diets, 
                     blood pressure were randomized to  Although the DASH eating pattern is                  including the DASH diet and the 
                     either the DASH diet and increased  not specifically aimed at weight loss,              Mediterranean diet, were associated 
                     physical activity or a control diet and     its emphasis on fruits and vegetables,      with a 20% decrease in the risk of fu-
                     instructions to maintain their usual  lower-fat dairy foods, and reduced  ture type 2 diabetes.
                     level of physical activity. Reductions      consumption of red meat and sweets             The ADA’s nutrition recommen-
                     in blood pressure were greater in the       can be beneficial for patients who are      dations for adults with diabetes state 
                     intervention group compared to the  aiming to lose weight or maintain  that “there is no ‘ideal’ conclusive 
                     control group.                              their weight at a healthy level.            eating pattern that is expected to 
                     VOLUME 30, NUMBER 2, SPRING 2017                                                                                              79
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...From research to practice perspectives on meal planning intervention study diabetes obes metab koloverou e esposito k giugliano effects of the mediterranean diet greek d panagiotakos effect epic prospective cohort bmj toobert dj glasgow re strycker la development b et al biologic and quality life outcomes type mellitus a meta analysis bozzetto l alderisio giorgini m lifestyle program studies partici extra virgin olive oil reduces glycemic pants metabolism response high index care bantle ae chow ls steffen lm itsiopoulos c brazionis kaimakamis association car in patients with ran can lower diorespiratory fitness domized controlled trial hbac results pre coronary randomized cross over nutr artery risk young adults academy nutrition dietetics cardiovasc dise cardia open res systematic review king guidelines available dk long term salas salvado j bullo babio n http www andeal org topic multiple factor for reduction incidence cfm menu accessed november latinas viva bien transl behav med pre...

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