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, which are reaching epidemic proportions worldwide.

Upcoming

The task force is shaping a potential new activity on ‘The Role of Proteins in Diabetes Prevention’. It is currently not recommended for diabetics to have a high protein intake. Yet, there are some implications that intake of specific, high quality proteins, might be beneficial, for example via stimulation of insulin secretion. The task force is interested to find out the long term effects of high quality protein in diabetic patients.

Further, the task force is considering a New Activity Proposal on ‘Targeting Fatty Liver by Dietary Intervention – Impact on Metabolic Risk Factors’. Non-alcoholic liver disease (NAFLD) has become the most prevalent form of liver disease (affecting 25% of European adults and 70-80% of obese individuals and diabetics). At present there are no licensed drugs available to successfully treat or reverse NAFLD. The aim could be to quantify the relationship between diet-induced liver fat changes and metabolic risk factor changes.

What’s New

A New Activity on ‘Nutrition Guidelines for Diabetes – A Review of Methods’ will kick-off in early 2018.

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 and target ‘at-risk’ populations and to sensitively establish the benefits of dietary interventions.
As a member of this task force, you will work at the forefront of science, providing answers and consensus in debated topics on obesity and diabetes with other relevant industrial colleagues in collaboration with highly renowned scientists and decision makers in the field. You will be exposed to discussions and critique, workshops and conferences on the latest research findings in the dietary management of obesity, diabetes and associated co-morbidities and how this translates to product innovation.

Impact

The task force has produced publications in the areas of blood glucose and inflammation regulation through dietary strategies, such as the systematic review on chronic low-grade inflammation by P. Calder et al., 2011 that was cited over 350 times.

Further, the task force has contributed to several major scientific conferences (e.g. Federation of European Nutrition Societies (FENS) European Nutrition Conference) and have co-organised well attended workshops, such as the workshop on ‘The Gut Microbiome: Our Misunderstood Friend and Foe’ in Brussels, Belgium on 3-4 December 2015 (I. Rowland et al., 2017).

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), so far the manuscript was cited 21 times.

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 on low-grade inflammation. It was featured in several media, including Medical News Today, currently the largest independent medical and health news website.

Joint Activity

  • The task force iso collaborating with the Early Nutrition and Long-Term Health Task Force in an expert group working on ‘Gestational Diabetes & Diet’;
  • The Obesity & Diabetes Task Force and Dietary Carbohydrates Task Force will join forces to address ‘Nutrition Guidelines for Diabetes – a Review of Methods’;
  • ILSI Europe, with input from both its Obesity and Diabetes and Functional Foods Task Forces, is a partner in the EU-funded project PATHWAY-27. The project aims to determine the impact of bioactive enriched foods on physiologically-relevant endpoints related to the metabolic syndrome. Prof. Minihane, Co-Chair of the Obesity and Diabetes Task Force, was appointed to the Scientific Advisory Board of the project. More information on PATHWAY-27.

For more detailed information, please contact Ms Nevena Hristozova at NHristozova@ilsieurope.be

Task Force Members

Expert Groups

Nutrition Guidelines for Diabetes – A Review of Methods – NEW
In collaboration with the Dietary Carbohydrates Task Force

Objectives

Guidelines for dietary intake for diabetes (management and prevention) provide important guidance for health care providers, patients and the food industry. A lack of consistency between the methodologies used to develop global and national guidelines for diabetes, as well as unexplained differences between diabetes and general nutrition guidelines are confusing for patients and undesirable for efficiently communicating public health messages and hampers food innovation.

Activity

A dataset on the published dietary guidelines for diabetes will be created and reviewed. This dataset will include detailed recommendations for a limited selection of nutrients (proposed to focus on macronutrients; carbohydrate, fat content and quality protein). In addition, it will describe the methodology used to derivate these guidelines, e.g. type of studies included, grading, definition of exposure, population, outcomes, weighing of evidence on different outcomes, and whether guidelines were derived for population subgroups. The similarities and differences in methods applied will be described. The discussion will include a comparison of advice given in diabetes dietary recommendations with general nutrition recommendations. It is currently considered to discuss the initial conclusions in a workshop before finalising a peer-reviewed publication.

Expected Output

This review will contribute to understanding the range and basis of similarities and differences in specific dietary guidelines for diabetes. It will increase clarity in methodology for setting such recommendations and thereby support efforts of smaller, local organisations in setting guidelines. Ultimately, this review will contribute towards a better alignment of diabetes and general nutrition guidelines and different global and national diabetes nutrition guidelines. Consistency and transparency in guidelines for diabetes will reduce confusion for diabetes patients, enable stronger and more consistent public health messages, aid health care professionals and provide more globally harmonised guidance for food industry innovation.

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. A wide array of measures of these features are available, 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 is reviewing markers of insulin sensitivity and beta-cell function. It 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:

  • A critical review on the use of the different markers of insulin sensitivity and secretion; and
  • 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 fetus. 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 assesses state-of-the-art nutritional management of GDM by means of a systematic literature review. It focuses on treatment options via diet and lifestyle based on their effect on selected maternal and fetal outcomes. Maternal outcomes covered 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, limitations and gaps in the existing literature have been identified. 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 Diabetes in Pregnancy (DIP) Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy (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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