The role of diet in diabetes, obesity and cardio-metabolic dysfunction

Background

Diabetes is a chronic disease that, over time, leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. Prevalence of diabetes has risen sharply over the past decades. It is also increasing dramatically in low- and middle-income countries. Obesity, in particular central obesity, is a major risk factor for a number of non-communicable diseases including diabetes, cardiovascular diseases, cancer and dementia. Together with an ageing population, this leads to an increasing prevalence of diabetes and other obesity-associated cardio-metabolic disorders, reaching epidemic proportions worldwide.

Objectives

The task force aims to explore the aetiology, prevention, metabolic consequences and management of diabetes, obesity and associated co-morbidities. A particular focus is on dietary strategies for the prevention and treatment of diabetes, obesity and cardio-metabolic diseases. In addition, the task force aims to review methodologies and biomarkers used to assess the risk or severity of cardio-metabolic diseases in order to identify ‘at-risk’ populations that could benefit from dietary interventions.

Impact

  • A systematic review (P. Calder et al., 2011) was cited over 350 times. This review helps to understand the nature of chronic low-grade inflammation in the context of being overweight or obese. It describes the key modulators of inflammation, in particular those related to diet. The publication was downloaded over 300 times in Mendeley.
  • A publication on low grade inflammation (A.M. Minihane et al., 2015) was produced along with a podcast on the series of ILSI Europe’s publications in the area of low-grade inflammation. It was featured in several media, including Medical News Today, currently the largest independent medical and health news website with over 11 million unique users per month. It shows that controlling inflammation is crucial to human health and prevention of inflammation is a key future preventive and therapeutic target.

What’s New

  • A comprehensive review summarises the results from human dietary interventions exploring the impact of dietary components on blood glucose levels (W.R. Russell et al., 2016).
  • The task force is currently developing a new activity that will review dietary guidelines for diabetes.

For more detailed information, please contact Ms Lilou van Lieshout at lvanlieshout@ilsieurope.be

Task Force Members

Expert Groups

Alternative Markers for Insulin Sensitivity and Secretion

Objectives

Insulin resistance and diminished insulin secretion are the key features of development and progression of type 2 diabetes. There is a wide range of measures of these features ranging from fasting blood sample measurements to relatively invasive clamp methodology. Despite a large body of literature on the methodology and validation of these measures, there is currently no consensus on the optimal markers for use in dietary intervention studies. The aim of this expert group is to critically evaluate the efficacy of markers of insulin sensitivity and secretion and more specifically to provide guidance on the use of different markers in dietary intervention studies.

Activity

This activity will review markers of insulin sensitivity and beta-cell function. The current activity complements the activity of the Dietary Carbohydrates Task Force on ‘Characterisation of and Criteria for Glycaemic Exposure Markers in the Non-Diabetic Population’ which focuses on markers that can identify (diet-induced) changes in glycaemic exposure. This activity will result in a publication split into two main sections: (1) a critical review on the quality of fasting and postprandial markers on the different physiological aspects of insulin sensitivity and secretion; and (2) a systematic review on the use of selected markers in dietary intervention trials.

Expected Output

Academic and industrial research would benefit greatly from an increased understanding and confidence in the use of established markers to evaluate efficacy on key intervention targets for diabetes (insulin sensitivity and secretion).

Gestational Diabetes & Diet

In collaboration with the Early Nutrition and Long-Term Health Task Force

Objectives

Gestational Diabetes Mellitus (GDM) is defined as a glucose intolerance (of any degree), which occurs during pregnancy. It is estimated that 2-6% of pregnancies in Europe result in GDM and the numbers are much higher in Asia. High maternal weight is associated with a higher risk of GDM. Nutritional advice on GDM aims to control postprandial glucose levels and to provide adequate nutrition for the developing foetus. But as yet, there is still no consensus on the optimal nutritional recommendations for GDM management. The overall aim will be to provide a clear, comprehensive and critical overview of the current knowledge on treatment of GDM via diet.

Activity

This activity will assess state-of-the-art nutritional management of GDM by means of a systematic literature review. The focus will be on treatment options via diet and lifestyle based on their effect on selected maternal and fetal outcomes. Maternal outcomes to be included are mean glucose, fasting glucose, post-meal glucose, insulin use, HOMA-IR (HOmeostatic Model Assessment for Insulin Resistance) or any other insulin sensitivity index, HbA1c (Hemoglobin A1c), mode of delivery (number of caesarean sections), pre-eclampsia and weight gain. Fetal / neonatal outcomes included are large-for-gestational-age, small-for-gestational-age, macrosomia, neonatal hypoglycaemia requiring treatment, preterm birth, birthweight and admission to neonatal intensive care unit. Moreover, the activity will identify limitations and gaps in the existing literature. The expert group is collaborating with the International Federation of Gynecology and Obstetrics (FIGO) to ensure a more active uptake of the results by health practitioners.

Expected Output

It is anticipated that such an initiative would support the development of evidence-based recommendations by national and international policymakers. Thereby this activity will contribute to reducing short- and long-term complications for mother and baby. The results have been presented at the 1St South Asia and Asia Pacific International Congress on Diabetes in Pregnancy (8-10 September 2016, Colombo, Sri Lanka) and at the 9th International DIP Symposium on diabetes, hypertension, metabolic syndrome and pregnancy of which maternal medicine meets fetal medicine (8-12 March 2017, Barcelona, Spain).

Establishment of the Efficacy of Intervention in those with the Metabolic Syndrome

Objectives

The objectives of this project are to better understand the independent and interactive impacts of single components of the metabolic syndrome (i.e. low HDL-cholesterol, high blood pressure, hyperglycaemia / insulin resistance, hypertriglyceridaemia and adiposity), on the risk of cardio-metabolic diseases. Leading on from this, the expert group aims to establish an efficacy model for food interventions so that the overall benefits of dietary change can be assessed based on a selection of disease biomarkers. The dietary benefits are likely to be underestimated if a single risk biomarker is considered in isolation versus considering the wider physiological dysfunction which constitutes the metabolic syndrome.

Activity

A multi-disciplinary expert panel is systematically reviewing the literature on associations between metabolic syndrome and the main related diseases. Moreover it is identifying any published methods that assess the impact of treatment (drug or lifestyle) on multiple combined features of the metabolic syndrome. The activity takes on two challenges. First, it is preparing a systematic review on the effect of diet on the hallmarks of the metabolic syndrome. Second, a systematic review will be performed on the relationship between the hallmarks of the metabolic syndrome and the final disease risk (type 2 diabetes and cardiovascular diseases).

Expected Output

A ‘fit-for-purpose’ model will be developed to illustrate the impact of foods, food extracts and dietary supplements on the risk, presence or penetrance of the metabolic syndrome.

Expert Group Members

Alternative Markers for Insulin Sensitivity and Secretion

Gestational Diabetes & Diet

Establishment of the Efficacy of Intervention in those with the Metabolic Syndrome

Poster

Nutritional Management of Blood Glucose Levels

Publications

All Publications

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