Dietary Patterns and Whole Plant Foods in Type 2 Diabetes Prevention and Management

Abstract

A healthy lifestyle including habitual intake of a high quality dietary pattern, regular physical activity, and weight control are key components of type 2 diabetes (diabetes) prevention and management. Prospective cohort studies show that high quality dietary patterns including the Alternative Healthy Eating Index score have a significant inverse association with diabetes risk, and Western dietary patterns have a positive association with risk. Higher adherence to the Mediterranean diet (MedDiet) is associated with a 19–23% reduced risk of developing diabetes, while the results of randomized controlled trials (RCTs) show that the MedDiet can reduce risk of diabetes by 30% and can reduce glycosylated hemoglobin (HbA1c) levels by 0.30–0.47% in people with diabetes. Other healthy dietary patterns which are effective in reducing diabetes risk and in management of diabetics’ health are the Dietary Approaches to Stop Hypertension (DASH), vegan and the healthy Nordic food index diets. Prospective cohort studies show that whole (minimally processed) plant foods including whole-grains, fruits, vegetables, dietary pulses, and nuts and flaxseed are significantly associated with lower risk of diabetes. For whole grains, 3 servings/day reduced diabetes risk by 23% and of the whole-grains oats and oat bran are the most effective in managing glycemic control in people with diabetes. For fruits and vegetables, higher intake of fruits, especially berries, and green leafy vegetables, yellow vegetables, non-starchy root and cruciferous vegetables are particularly effective in lowering diabetes risk. Three weekly servings of French fries significantly increase diabetes risk by 41% compared to only 5% for other forms of potatoes (baked, boiled or mashed). Higher intake of sugar sweetened fruit juice is significantly associated with increased diabetes risk by 28%, while higher intake of 100% fruit juice is not associated with diabetes risk. Higher intake of dietary pulses, peanuts, tree nuts and flaxseed are also associated with lower diabetes risk. Healthy dietary patterns and specific whole foods beneficially affect glycemic and cardiometabolic risk factors, which are important for preventing and managing diabetes, by helping to control body weight, visceral fat, glucose-insulin homeostasis, oxidative stress, inflammation, and endothelial health, lipoprotein concentrations, and blood pressure.

Appendices

Appendix AComparison of Western and Healthy Dietary Patterns per 2000 kcal (Approximated Values)

Components	Western dietary pattern (US)	USDA base pattern	DASH diet pattern	Healthy Mediterranean pattern	Healthy vegetarian pattern (lact-ovo based)	Vegan pattern
Emphasizes	Refined grains, low fiber foods, red meats, sweets, and solid fats	Vegetables, fruit, whole-grain, and low-fat milk	Potassium rich vegetables, fruits, and low fat milk products	Whole grains, vegetables, fruit, dairy products, olive oil, and moderate wine	Vegetables, fruit, whole-grains, legumes, nuts, seeds, milk products, and soy foods	Plant foods: vegetables, fruits, whole grains, nuts, seeds, and soy foods
Includes	Processed meats, sugar sweetened beverages, and fast foods	Enriched grains, lean meat, fish, nuts, seeds, and vegetable oils	Whole-grain, poultry, fish, nuts, and seeds	Fish, nuts, seeds, and pulses	Eggs, non-dairy milk alternatives, and vegetable oils	Non-dairy milk alternatives
Limits	Fruits and vegetables, whole-grains	Solid fats and added sugars	Red meats, sweets and sugar-sweetened beverages	Red meats, refined grains, and sweets	No red or white meats, or fish; limited sweets	No animal products allowed
Estimated nutrients/components
Carbohydrates (% Total kcal)	49	51	55	52	55	57
Protein (% Total kcal)	16	18	18	18	14–15	13–14
Total fat (% Total kcal)	33	33	27	32	34	33
Saturated fat (% Total kcal)	11	8	6	8	8	7
Unsat. fat (% Total kcal)	22	25	21	24	26	25
Fiber (g)	16	31	29+	31	35+	40+
Potassium (mg)	2800	3350	4400	3350	3300	3650
Vegetable oils (g)	19	27	25	27	19–27	18–27
Sodium (mg)	3600	1790	1100	1690	1400	1225
Added sugar (g)	79 (20 tsp)	32 (8 tsp)	12 (3 tsp)	32 (8 tsp)	32 (8 tsp)	32 (8 tsp)
Plant food groups
Fruit (cup)	≤1.0	2.0	2.5	2.5	2.0	2.0
Vegetables (cup)	≤1.5	2.5	2.1	2.5	2.5	2.5
Whole-grains (oz.)	0.6	3.0	4.0	3.0	3.0	3.0
Legumes (oz.)	−	1.5	0.5	1.5	3.0	3.0+
Nuts/Seeds (oz.)	0.5	0.6	1.0	0.6	1.0	2.0
Soy products (oz.)	0.0	0.5	−	−	1.1	1.5

1. U.S. Department of Agriculture, Agriculture Research Service, Nutrient Data Laboratory. 2014. USDA National Nutrient Database for Standard Reference, Release 27. http://www.ars.usda.gov/nutrientdata. Accessed 17 Feb 2015
2. Dietary Guidelines Advisory Committee. Scientific Report. Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Appendix E-3.7: Developing vegetarian and Mediterranean-style food patterns. 2015;1–9
3. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office. 2010; Table B2.4; http://www.choosemyplate.gov/. Accessed 22 Aug 2015

Appendix BEstimated Range of Energy, Fiber, Nutrients and Phytochemicals Composition of Whole or Minimally Processed Foods/100 g Edible Portion

Components	Whole-grains	Fresh fruit	Dried fruit	Vegetables	Legumes	Nuts/seeds
Nutrients and phytochemicals	Wheat, oats, barley, brown rice, whole grain bread, cereal, pasta, rolls and crackers	Apples, pears, bananas, grapes, oranges, blueberries, strawberries, and avocados	Dates, dried figs, apricots, cranberries, raisins, and prunes	Potatoes, spinach, carrots, peppers, lettuce, green beans, cabbage, onions, cucumber, cauliflower, mushrooms, and broccoli	Lentils, chickpeas, split peas, black beans, pinto beans, and soy beans	Almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, walnuts, peanuts, sunflower seeds, and flaxseed
Energy (kcal)	110–350	30–170	240–310	10–115	85–170	520–700
Protein (g)	2.5–16	0.5–2.0	0.1–3.4	0.2–5.0	5.0–17	7.8–24
Available Carbohydrate (g)	23–77	1.0–25	64–82	0.2–25	10–27	12–33
Fiber (g)	3.5–18	2.0–7.0	5.7–10	1.2–9.5	5.0–11	3.0–27
Total fat (g)	0.9–6.5	0.0–15	0.4–1.4	0.2–1.5	0.2–9.0	46–76
SFAa (g)	0.2–1.0	0.0–2.1	0.0	0.0–0.1	0.1–1.3	4.0–12
MUFAa (g)	0.2–2.0	0.0–9.8	0.0–0.2	0.1–1.0	0.1–2.0	9.0–60
PUFAa (g)	0.3–2.5	0.0–1.8	0.0–0.7	0.0.0.4	0.1–5.0	1.5–47
Folate (ug)	4.0–44	<5.0–61	2–20	8.0–160	50–210	10–230
Tocopherols (mg)	0.1–3.0	0.1–1.0	0.1–4.5	0.0–1.7	0.0–1.0	1.0–35
Potassium (mg)	40–720	60–500	40–1160	100–680	200–520	360–1050
Calcium (mg)	7.0–50	3.0–25	10–160	5.0–200	20–100	20–265
Magnesium (mg)	40–160	3.0–30	5.0–70	3.0–80	40–90	120–400
Phytosterols (mg)	30–90	1.0–83	–	1.0–54	110–120	70–215
Polyphenols (mg)	70–100	50–800	–	24–1250	120–6500	130–1820
Carotenoids (ug)	–	25–6600	0.6–2160	10–20,000	50–600	0.0–1200

1. Ros E, Hu FB. Consumption of plant seeds and cardiovascular health epidemiological and clinical trial evidence. Circulation. 2013;128:553–65
2. USDA. What We Eat in America, NHANES 2011–2012, individuals 2 years and over (excluding breast-fed children). Available: www.ars.usda.gov/nea/bhnrc/fsrg
3. Rodriguez-Casado A. The health potential of fruits and vegetables phytochemicals: notable examples. Crit Rev Food Sci Nutr. 2016;56(7):1097–107
4. Rebello CJ, Greenway FL, Finley JW. A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev. 2014;15:392–407
5. Gebhardt SE, Thomas RG. Nutritive Value of Foods. 2002; U.S. Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin 72
6. Holden JM, Eldridge AL, Beecher GR, et al. Carotenoid content of U.S. Foods: an update of the database. J Food Comp An. 1999;12:169–96
7. Lu Q-Y, Zhang Y, Wang Y, et al. California Hass avocado: profiling of carotenoids, tocopherol, fatty acid, and fat content during maturation and from different growing areas. J Agric Food Chem. 2009;57(21):10408–413
8. Wu X, Beecher GR, Holden JM, et al. Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. J Agric Food Chem. 2004;52:4026–37
9. SFA saturated fat, MUFA monounsaturated fat, PUFA polyunsaturated fat
10. U.S. Department of Agriculture, Agriculture Research Service, Nutrient Data Laboratory. 2014. USDA National Nutrient Database for Standard Reference, Release 27. http://www.ars.usda.gov/nutrientdata. Accessed 17 Feb 2015