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17-04-2023 | Nutrition | Guidelines

Evidence-based European recommendations for the dietary management of diabetes

Author: The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD)

Published in: Diabetologia | Issue 6/2023

Abstract

Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.

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Mann JI, De Leeuw I, Hermansen K et al (2004) Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 14(6):373–394. https://doi.org/10.1016/S0939-4753(04)80028-0CrossRefPubMed

Brouwers MC, Kerkvliet K, Spithoff K, AGREE Nexts Steps Consortium (2016) The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ 352:i1152. https://doi.org/10.1136/bmj.i1152CrossRefPubMedPubMedCentral

World Health Organization (2012) Guideline: sodium intake for adults and children. World Health Organization, Geneva

Uusitupa M, Khan TA, Viguiliouk E et al (2019) Prevention of type 2 diabetes by lifestyle changes: a systematic review and meta-analysis. Nutrients 11(11):2611. https://doi.org/10.3390/nu11112611CrossRefPubMedPubMedCentral

Massara P, Viguiliouk E, Glenn A et al (2020) Nordic dietary pattern and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials. Curr Dev Nutr 4(Supplement_2):546–546PubMedCentral

Chiavaroli L, Viguiliouk E, Nishi SK et al (2019) DASH dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and meta-analyses. Nutrients 11(2):338. https://doi.org/10.3390/nu11020338CrossRefPubMedPubMedCentral

Khan TA, Field D, Chen V et al (2023) Combination of multiple low-risk lifestyle behaviors and incident type 2 diabetes: a systematic review and dose-response meta-analysis of prospective cohort studies. Diabetes Care 46(3):643–656. https://doi.org/10.2337/dc22-1024

Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L (2019) Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 393(10170):434–445. https://doi.org/10.1016/S0140-6736(18)31809-9CrossRefPubMed

Schwingshackl L, Hoffmann G, Lampousi A-M et al (2017) Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol 32(5):363–375. https://doi.org/10.1007/s10654-017-0246-yCrossRefPubMedPubMedCentral

10.

Livesey G, Taylor R, Livesey HF et al (2019) Dietary glycemic index and load and the risk of type 2 diabetes: a systematic review and updated meta-analyses of prospective cohort studies. Nutrients 11(6):1280. https://doi.org/10.3390/nu11061280CrossRefPubMedPubMedCentral

11.

Li G, Zhang P, Wang J et al (2014) Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2(6):474–480. https://doi.org/10.1016/S2213-8587(14)70057-9CrossRefPubMed

12.

Aro A, Kauppinen A, Kivinen N et al (2019) Life style intervention improves retinopathy status-The Finnish Diabetes Prevention Study. Nutrients 11(7):1691. https://doi.org/10.3390/nu11071691CrossRefPubMedPubMedCentral

13.

Group Diabetes Prevention Program Research Group (2015) Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 3(11):866–875. https://doi.org/10.1016/S2213-8587(15)00291-0CrossRef

14.

Uusitupa M, Peltonen M, Lindström J et al (2009) Ten-year mortality and cardiovascular morbidity in the Finnish Diabetes Prevention Study—secondary analysis of the randomized trial. PloS One 4(5):e5656. https://doi.org/10.1371/journal.pone.0005656CrossRefPubMedPubMedCentral

15.

Sun H, Saeedi P, Karuranga S et al (2022) IDF Diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183:109119. https://doi.org/10.1016/j.diabres.2021.109119CrossRefPubMed

16.

United Nations (2011) Political declaration of the high-level meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 66th Session of the United Nations General Assembly. United Nations, New York, NY

17.

Lindström J, Peltonen M, Eriksson J et al (2013) Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia 56(2):284–293. https://doi.org/10.1007/s00125-012-2752-5CrossRefPubMed

18.

Uusitupa M, Lindström J, Tuomilehto J (2018) Prevention of type 2 diabetes—success story that is waiting for next steps. Eur J Clin Nutr 72(9):1260–1266. https://doi.org/10.1038/s41430-018-0223-xCrossRefPubMed

19.

Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KV, Ali MK (2018) Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care 41(7):1526–1534. https://doi.org/10.2337/dc17-2222CrossRefPubMedPubMedCentral

20.

Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B (2015) A systematic review of real-world diabetes prevention programs: learnings from the last 15 years. Implement Sci 10(1):1–17CrossRef

21.

Salas-Salvadó J, Bulló M, Estruch R et al (2014) Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Int Med 160(1):1–10. https://doi.org/10.7326/M13-1725CrossRefPubMed

22.

Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q (2019) Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA Int Med 179(10):1335–1344. https://doi.org/10.1001/jamainternmed.2019.2195CrossRef

23.

Pan X-R, Li G-W, Hu Y-H et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care 20(4):537–544. https://doi.org/10.2337/diacare.20.4.537CrossRefPubMed

24.

Griswold MG, Fullman N, Hawley C et al (2018) Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 392(10152):1015–1035. https://doi.org/10.1016/S0140-6736(18)31310-2CrossRef

25.

Marlatt GA, Witkiewitz K (2002) Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addict Behav 27(6):867–886. https://doi.org/10.1016/S0306-4603(02)00294-0CrossRefPubMed

26.

Nutt DJ, Rehm J (2014) Doing it by numbers: a simple approach to reducing the harms of alcohol. J Psychopharmacol 28(1):3–7. https://doi.org/10.1177/0269881113512038CrossRefPubMed

27.

Churuangsuk CHJ, Reynolds A, Griffin S, Combet E, Lean M (2022) Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 65(1):14–36. https://doi.org/10.1007/s00125-021-05577-2CrossRefPubMed

28.

Noronha JC, Nishi SK, Braunstein CR et al (2019) The effect of liquid meal replacements on cardiometabolic risk factors in overweight/obese individuals with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care 42(5):767–776. https://doi.org/10.2337/dc18-2270CrossRefPubMed

29.

Carreiro AL, Dhillon J, Gordon S et al (2016) The macronutrients, appetite, and energy intake. Annu Rev Nutr 36(1):73–103. https://doi.org/10.1146/annurev-nutr-121415-112624CrossRefPubMedPubMedCentral

30.

Hall KD, Guo J (2017) Obesity energetics: body weight regulation and the effects of diet composition. Gastroenterology 152(7):1718–1727 e1713. https://doi.org/10.1053/j.gastro.2017.01.052

31.

Kahn SE, Cooper ME, Del Prato S (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 383(9922):1068–1083. https://doi.org/10.1016/S0140-6736(13)62154-6CrossRefPubMed

32.

World Health Organization (2021) Obesity and overweight. Available from: www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed: 4 August 2021

33.

Koopman RJ (2005) Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000. Ann Fam Med 3(1):60–63. https://doi.org/10.1370/afm.214CrossRefPubMedPubMedCentral

34.

Wilmot EG, Davies MJ, Yates T, Benhalima K, Lawrence IG, Khunti K (2010) Type 2 diabetes in younger adults: the emerging UK epidemic. Postgrad Med J 86(1022):711. https://doi.org/10.1136/pgmj.2010.100917CrossRefPubMed

35.

Hall LM, Moran CN, Milne GR et al (2010) Fat oxidation, fitness and skeletal muscle expression of oxidative/lipid metabolism genes in South Asians: implications for insulin resistance? PLoS One 5(12):e14197. https://doi.org/10.1371/journal.pone.0014197CrossRefPubMedPubMedCentral

36.

Taylor R, Al-Mrabeh A, Zhyzhneuskaya S et al (2018) Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for beta cell recovery. Cell Metab 28(4):547–556 e543. https://doi.org/10.1016/j.cmet.2018.07.003

37.

Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K (2017) Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLOS ONE 12(5):e0177175. https://doi.org/10.1371/journal.pone.0177175CrossRefPubMedPubMedCentral

38.

Gautier A, Balkau B, Lange C, Tichet J, Bonnet F (2010) Risk factors for incident type 2 diabetes in individuals with a BMI of <27 kg/m2: the role of γ-glutamyltransferase. Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetologia 53(2):247–253. https://doi.org/10.1007/s00125-009-1602-6CrossRefPubMed

39.

Ntuk UE, Gill JM, Mackay DF, Sattar N, Pell JP (2014) Ethnic-specific obesity cutoffs for diabetes risk: cross-sectional study of 490,288 UK biobank participants. Diabetes Care 37(9):2500–2507. https://doi.org/10.2337/dc13-2966CrossRefPubMed

40.

Haase CL, Lopes S, Olsen AH, Satylganova A, Schnecke V, McEwan P (2021) Weight loss and risk reduction of obesity-related outcomes in 0.5 million people: evidence from a UK primary care database. Int J Obes 45(6):1249–1258. https://doi.org/10.1038/s41366-021-00788-4CrossRef

41.

Wing RR, Lang W, Wadden TA et al (2011) Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 34(7):1481–1486. https://doi.org/10.2337/dc10-2415CrossRefPubMedPubMedCentral

42.

American Diabetes Association (2021) 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2021. Diabetes Care 44(Suppl 1):S100–S110. https://doi.org/10.2337/dc21-S008CrossRef

43.

Dyson PA, Twenefour D, Breen C et al (2018) Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med 35(5):541–547. https://doi.org/10.1111/dme.13603CrossRefPubMed

44.

Lean ME, Leslie WS, Barnes AC et al (2018) Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 391(10120):541–551. https://doi.org/10.1016/S0140-6736(17)33102-1CrossRefPubMed

45.

Lean MEJ, Leslie WS, Barnes AC et al (2019) Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 7(5):344–355. https://doi.org/10.1016/S2213-8587(19)30068-3CrossRefPubMed

46.

Steven S, Hollingsworth KG, Al-Mrabeh A et al (2016) Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care 39(5):808–815. https://doi.org/10.2337/dc15-1942CrossRefPubMed

47.

Hall KD, Kahan S (2018) Maintenance of lost weight and long-term management of obesity. Med Clin North Am 102(1):183–197. https://doi.org/10.1016/j.mcna.2017.08.012CrossRefPubMedPubMedCentral

48.

Christensen P, Bliddal H, Riecke BF, Leeds AR, Astrup A, Christensen R (2011) Comparison of a low-energy diet and a very low-energy diet in sedentary obese individuals: a pragmatic randomized controlled trial. Clin Obes 1(1):31–40. https://doi.org/10.1111/j.1758-8111.2011.00006.xCrossRefPubMed

49.

Wadden TA, West DS, Neiberg RH et al (2009) One-year weight losses in the Look AHEAD study: factors associated with success. Obesity 17(4):713–722. https://doi.org/10.1038/oby.2008.637CrossRefPubMed

50.

Churuangsuk C, Griffiths D, Lean MEJ, Combet E (2019) Impacts of carbohydrate-restricted diets on micronutrient intakes and status: A systematic review. Obes Rev 20(8):1132–1147. https://doi.org/10.1111/obr.12857CrossRefPubMed

51.

Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA (2018) The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med 35(9):1258–1263. https://doi.org/10.1111/dme.13663CrossRef

52.

Spoke C, Malaeb S (2020) A case of hypoglycemia associated with the ketogenic diet and alcohol use. J Endocr Soc 4(6):bvaa045. https://doi.org/10.1210/jendso/bvaa045CrossRefPubMedPubMedCentral

53.

Charoensri S, Sothornwit J, Trirattanapikul A, Pongchaiyakul C (2021) Ketogenic diet-induced diabetic ketoacidosis in a young adult with unrecognized type 1 diabetes. Case Rep Endocrinol 2021:6620832. https://doi.org/10.1155/2021/6620832CrossRefPubMedPubMedCentral

54.

Marzban S, Arbee M, Vorajee N, Richards GA (2020) Non-diabetic ketoacidosis associated with a low carbohydrate, high fat diet in a postpartum lactating female. Oxf Med Case Rep 2020(8):omz026. https://doi.org/10.1093/omcr/omz026CrossRef

55.

Tougaard NH, Faber J, Eldrup E (2019) Very low carbohydrate diet and SGLT-2-inhibitor: double jeopardy in relation to ketoacidosis. BMJ Case Rep 12(4):e227516. https://doi.org/10.1136/bcr-2018-227516CrossRefPubMedPubMedCentral

56.

White-Cotsmire AJ, Healy AM (2020) Ketogenic diet as a trigger for diabetic ketoacidosis in a misdiagnosis of diabetes: a case report. Clin Diabetes 38(3):318–321. https://doi.org/10.2337/cd20-0001CrossRefPubMedPubMedCentral

57.

Thom G, Messow CM, Leslie W et al (2021) Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Med 38(8):e14395. https://doi.org/10.1111/dme.14395CrossRefPubMed

58.

Ismail K, Winkley K, Rabe-Hesketh S (2004) Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet 363(9421):1589–1597. https://doi.org/10.1016/S0140-6736(04)16202-8CrossRefPubMed

59.

American Diabetes Association (2021) 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2021. Diabetes Care 44(Suppl 1):S53–S72. https://doi.org/10.2337/dc21-S005CrossRef

60.

Unick JL, Neiberg RH, Hogan PE et al (2015) Weight change in the first 2 months of a lifestyle intervention predicts weight changes 8 years later. Obesity 23(7):1353–1356. https://doi.org/10.1002/oby.21112CrossRefPubMed

61.

Lean M, Hankey C (2018) Keeping it off: the challenge of weight-loss maintenance. Lancet Diabetes Endocrinol 6(9):681–683. https://doi.org/10.1016/S2213-8587(17)30405-9CrossRefPubMed

62.

Dambha-Miller H, Day A, Kinmonth AL, Griffin SJ (2021) Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study. Fam Pract 38(2):141–146. https://doi.org/10.1093/fampra/cmaa086CrossRefPubMed

63.

Group LAR (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154. https://doi.org/10.1056/NEJMoa1212914CrossRef

64.

The Look AHEAD Research Group (2016) Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 4(11):913–921. https://doi.org/10.1016/S2213-8587(16)30162-0CrossRef

65.

The Look AHEAD Research Group (2014) Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2(10):801–809. https://doi.org/10.1016/S2213-8587(14)70156-1CrossRefPubMedCentral

66.

Lazo M, Solga SF, Horska A et al (2010) Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes. Diabetes Care 33(10):2156–2163. https://doi.org/10.2337/dc10-0856CrossRefPubMedPubMedCentral

67.

Kuna ST, Reboussin DM, Borradaile KE et al (2013) Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 36(5):641–649. https://doi.org/10.5665/sleep.2618CrossRefPubMedPubMedCentral

68.

The Look AHEAD Research Group (2014) Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 37(6):1544–1553. https://doi.org/10.2337/dc13-1928CrossRefPubMedCentral

69.

Korsmo-Haugen HK, Brurberg KG, Mann J, Aas AM (2019) Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 21(1):15–27. https://doi.org/10.1111/dom.13499CrossRefPubMed

70.

Reynolds AN, Akerman AP, Mann J (2020) Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med 17(3):e1003053. https://doi.org/10.1371/journal.pmed.1003053CrossRefPubMedPubMedCentral

71.

Chiavaroli L, Lee D, Ahmed A et al (2021) Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 374:n1651. https://doi.org/10.1136/bmj.n1651

72.

McGlynn ND, Khan TA, Wang L et al (2022) Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk: a systematic review and meta-analysis. JAMA Netw Open 5(3):e222092. https://doi.org/10.1001/jamanetworkopen.2022.2092CrossRefPubMedPubMedCentral

73.

Lee JJ, Khan TA, McGlynn N et al (2022) Relation of change or substitution of low-and no-calorie sweetened beverages with cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies. Diabetes Care 45(8):1917–1930. https://doi.org/10.2337/dc21-2130CrossRefPubMedPubMedCentral

74.

Vaz EC, Porfírio GJM, Nunes HRDC, Nunes-Nogueira VDS (2018) Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis. Arch Endocrinol Metab 62(3):337–345. https://doi.org/10.20945/2359-3997000000045CrossRefPubMedPubMedCentral

75.

Choo VL, Viguiliouk E, Mejia SB et al (2018) Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies. BMJ 363:k4644. https://doi.org/10.1136/bmj.k4644

76.

World Health Organization (2015) Guidleine: sugars intake for adults and children. World Health Organization, Geneva

77.

Sylvetsky AC, Edelstein SL, Walford G et al (2017) A high-carbohydrate, high-fiber, low-fat diet results in weight loss among adults at high risk of type 2 diabetes. J Nutr 147(11):2060–2066. https://doi.org/10.3945/jn.117.252395CrossRefPubMedPubMedCentral

78.

Simpson HCR, Lousley S, Geekie M et al (1981) A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet 317(8210):1–5. https://doi.org/10.1016/S0140-6736(81)90112-4CrossRef

79.

Anderson JW, Ward K (1979) High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr 32(11):2312–2321. https://doi.org/10.1093/ajcn/32.11.2312CrossRefPubMed

80.

Lousley S, Jones D, Slaughter P, Carter R, Jelfs R, Mann J (1984) High carbohydrate-high fibre diets in poorly controlled diabetes. Diabetic Med 1(1):21–25. https://doi.org/10.1111/j.1464-5491.1984.tb01916.xCrossRefPubMed

81.

Truswell AS, Mann J (2017) Essentials of human nutrition. Oxford University Press, Oxford

82.

Tosh SM, Chu Y (2015) Systematic review of the effect of processing of whole-grain oat cereals on glycaemic response. Br J Nutr 114(8):1256–1262. https://doi.org/10.1017/S0007114515002895CrossRefPubMed

83.

Reynolds AN, Mann J, Elbalshy M et al (2020) Wholegrain particle size influences postprandial glycemia in type 2 diabetes: a randomized crossover study comparing four wholegrain breads. Diabetes Care 43(2):476–479. https://doi.org/10.2337/dc19-1466CrossRefPubMed

84.

Åberg S, Mann J, Neumann S, Ross AB, Reynolds AN (2020) Whole-grain processing and glycemic control in type 2 diabetes: a randomized crossover trial. Diabetes Care 43(8):1717–1723. https://doi.org/10.2337/dc20-0263CrossRefPubMedPubMedCentral

85.

Aune D, Giovannucci E, Boffetta P et al (2017) Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 46(3):1029–1056. https://doi.org/10.1093/ije/dyw319CrossRefPubMedPubMedCentral

86.

Sievenpiper JL, de Souza RJ, Mirrahimi A et al (2012) Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann Int Med 156(4):291–304. https://doi.org/10.7326/0003-4819-156-4-201202210-00007CrossRefPubMed

87.

Chiavaroli L, de Souza RJ, Ha V et al (2015) Effect of fructose on established lipid targets: a systematic review and meta-analysis of controlled feeding trials. J Am Heart Assoc 4(9):e001700. https://doi.org/10.1161/JAHA.114.001700CrossRefPubMedPubMedCentral

88.

Ayoub-Charette S, Chiavaroli L, Liu Q et al (2021) Different food sources of fructose-containing sugars and fasting blood uric acid levels: a systematic review and meta-analysis of controlled feeding trials. J Nutr 151(8):2409–2421. https://doi.org/10.1093/jn/nxab144CrossRefPubMedPubMedCentral

89.

Semnani-Azad Z, Khan TA, Mejia SB et al (2020) Association of major food sources of fructose-containing sugars with incident metabolic syndrome: a systematic review and meta-analysis. JAMA Netw Open 3(7):e209993. https://doi.org/10.1001/jamanetworkopen.2020.9993CrossRefPubMedPubMedCentral

90.

Liu Q, Ayoub-Charette S, Khan TA et al (2019) Important food sources of fructose-containing sugars and incident hypertension: a systematic review and dose-response meta-analysis of prospective cohort studies. J Am Heart Assoc 8(24):e010977. https://doi.org/10.1161/JAHA.118.010977CrossRefPubMedPubMedCentral

91.

Ayoub-Charette S, Liu Q, Khan TA et al (2019) Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 9(5):e024171. https://doi.org/10.1136/bmjopen-2018-024171CrossRefPubMedPubMedCentral

92.

Khan TA, Tayyiba M, Agarwal A et al (2019) Relation of total sugars, sucrose, fructose, and added sugars with the risk of cardiovascular disease: a systematic review and dose-response meta-analysis of prospective cohort studies. Mayo Clin Proc 94(12):2399–2414. https://doi.org/10.1016/j.mayocp.2019.05.034CrossRefPubMed

93.

Snorgaard O, Poulsen GM, Andersen HK, Astrup A (2017) Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care 5(1):e000354. https://doi.org/10.1136/bmjdrc-2016-000354CrossRefPubMedPubMedCentral

94.

Naude CE, Brand A, Schoonees A, Nguyen KA, Chaplin M, Volmink J (2022) Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk. Cochrane Database Syst Rev Issue 1, Art. no.: CD013334. https://doi.org/10.1002/14651858.CD013334.pub2

95.

Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA (2018) Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 139:239–252. https://doi.org/10.1016/j.diabres.2018.02.026CrossRefPubMed

96.

Qian F, Korat AA, Malik V, Hu FB (2016) Metabolic effects of monounsaturated fatty acid–enriched diets compared with carbohydrate or polyunsaturated fatty acid–enriched diets in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care 39(8):1448–1457. https://doi.org/10.2337/dc16-0513CrossRefPubMedPubMedCentral

97.

Jenkins DJ, Wong JM, Kendall CW et al (2009) The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Int Med 169(11):1046–1054. https://doi.org/10.1001/archinternmed.2009.115CrossRef

98.

Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B et al (2022) Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr 116(1):40–56. https://doi.org/10.1093/ajcn/nqac06CrossRefPubMed

99.

Parry Strong A, Wright-McNaughten M, Weatherall M et al (2022) Very low carbohydrate (ketogenic) diets in type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Diabetes Obes Metab 24:2431–2442. https://doi.org/10.1111/dom.14837CrossRefPubMedPubMedCentral

100.

Noto H, Goto A, Tsujimoto T, Noda M (2013) Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS One 8(1):e55030. https://doi.org/10.1371/journal.pone.0055030CrossRefPubMedPubMedCentral

101.

Seidelmann SB, Claggett B, Cheng S et al (2018) Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 3(9):e419–e428. https://doi.org/10.1016/S2468-2667(18)30135-XCrossRefPubMedPubMedCentral

102.

Mazidi M, Katsiki N, Mikhailidis DP et al (2019) Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. Eur Heart J 40(34):2870–2879. https://doi.org/10.1093/eurheartj/ehz174CrossRefPubMed

103.

Churuangsuk C, Lean ME, Combet E (2020) Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016. Eur J Nutr 59(6):2771–2782. https://doi.org/10.1007/s00394-019-02122-1

104.

Muscogiuri G, El Ghoch M, Colao A, Hassapidou M, Yumuk V, Busetto L (2021) European guidelines for obesity management in adults with a very low-calorie ketogenic diet: a systematic review and meta-analysis. Obes Facts 14(2):222–245. https://doi.org/10.1159/000515381CrossRefPubMedPubMedCentral

105.

World Health Organization (2018) Draft guidelines on saturated fatty acid and trans-fatty acid intake for adults and children. Available from: https://cdn.who.int/media/docs/default-source/nutritionlibrary/cfs-vgfsyn/draft-who-sfa-tfa-guidelines-public-consultation.pdf?sfvrsn=dc29c6af_5. Accessed: 30 September 2021

106.

Schwab U, Reynolds AN, Sallinen T, Rivellese AA, Riserus U (2021) Dietary fat intakes and cardiovascular disease risk in adults with type 2 diabetes: a systematic review and meta-analysis. Eur J Nutr 60(6):3355–3363. https://doi.org/10.1007/s00394-021-02507-1CrossRefPubMed

107.

Imamura F, Micha R, Wu JH et al (2016) Effects of saturated fat, polyunsaturated fat, monounsaturated fat, and carbohydrate on glucose-insulin homeostasis: a systematic review and meta-analysis of randomised controlled feeding trials. PLoS Med 13(7):e1002087. https://doi.org/10.1371/journal.pmed.1002087CrossRefPubMedPubMedCentral

108.

Mensink RP (2016) Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. World Health Organization, Geneva

109.

Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (2020) Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev Issue 8, Art. no.: CD011737. https://doi.org/10.1002/14651858.CD011737.pub3

110.

Silverman MG, Ference BA, Im K et al (2016) Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA 316(12):1289–1297. https://doi.org/10.1001/jama.2016.13985CrossRefPubMed

111.

Ference BA, Ginsberg HN, Graham I et al (2017) Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 38(32):2459–2472. https://doi.org/10.1093/eurheartj/ehx144CrossRefPubMedPubMedCentral

112.

Rosqvist F, Smedman A, Lindmark-Månsson H et al (2015) Potential role of milk fat globule membrane in modulating plasma lipoproteins, gene expression, and cholesterol metabolism in humans: a randomized study. Am J Clin Nutr 102(1):20–30. https://doi.org/10.3945/ajcn.115.107045CrossRefPubMed

113.

Reynolds A, Hodson L, de Souza R, Tran Diep Pham H, Vlietstra L, Mann J (2023) Saturated fat and trans-fat intakes and their replacement with other macronutrients: a systematic review and meta-analysis of prospective observational studies. World Health Organization, Geneva

114.

Wang S, Tian W, Liu Y et al (2021) Temporal trend of circulating trans-fatty acids and risk of long-term mortality in general population. Clin Nutr 40(3):1095–1101. https://doi.org/10.1016/j.clnu.2020.07.010CrossRefPubMed

115.

Schwab U, Lauritzen L, Tholstrup T et al (2014) Effect of the amount and type of dietary fat on cardiometabolic risk factors and risk of developing type 2 diabetes, cardiovascular diseases, and cancer: a systematic review. Food Nutr Res 58. https://doi.org/10.3402/fnr.v58.25145

116.

Schulze MB, Minihane AM, Saleh RNM, Riserus U (2020) Intake and metabolism of omega-3 and omega-6 polyunsaturated fatty acids: nutritional implications for cardiometabolic diseases. Lancet Diabetes Endocrinol 8(11):915–930. https://doi.org/10.1016/S2213-8587(20)30148-0CrossRefPubMed

117.

Reiner Z, Catapano AL, De Backer G et al (2011) ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 32(14):1769–1818. https://doi.org/10.1093/eurheartj/ehr158CrossRefPubMed

118.

Jakobsen MU, Dethlefsen C, Joensen AM et al (2010) Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr 91(6):1764–1768. https://doi.org/10.3945/ajcn.2009.29099CrossRefPubMed

119.

Hirahatake KM, Jiang L, Wong ND et al (2019) Diet quality and cardiovascular disease risk in postmenopausal women with type 2 diabetes mellitus: The Women's Health Initiative. J Am Heart Assoc 8(19):e013249. https://doi.org/10.1161/JAHA.119.013249CrossRefPubMedPubMedCentral

120.

Estruch R, Ros E, Salas-Salvadó J et al (2018) Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378(25):e34. https://doi.org/10.1056/NEJMoa1800389CrossRefPubMed

121.

Becerra-Tomás N, Paz-Graniel I, Hernández-Alonso P et al (2021) Nut consumption and type 2 diabetes risk: a systematic review and meta-analysis of observational studies. Am J Clin Nutr 113(4):960–971. https://doi.org/10.1093/ajcn/nqaa358CrossRefPubMed

122.

Hu FB, Cho E, Rexrode KM, Albert CM, Manson JE (2003) Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation 107(14):1852–1857. https://doi.org/10.1161/01.CIR.0000062644.42133.5FCrossRefPubMed

123.

Pfeiffer AFH, Pedersen E, Schwab U et al (2020) The effects of different quantities and qualities of protein intake in people with diabetes mellitus. Nutrients 12(2):365. https://doi.org/10.3390/nu12020365CrossRefPubMedPubMedCentral

124.

Vogtschmidt YD, Raben A, Faber I et al (2021) Is protein the forgotten ingredient: effects of higher compared to lower protein diets on cardiometabolic risk factors. A systematic review and meta-analysis of randomised controlled trials. Atherosclerosis 328:124–135. https://doi.org/10.1016/j.atherosclerosis.2021.05.011CrossRefPubMed

125.

Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14(8):542–559. https://doi.org/10.1016/j.jamda.2013.05.021CrossRefPubMed

126.

Pedersen AN, Cederholm T (2014) Health effects of protein intake in healthy elderly populations: a systematic literature review. Food Nutr Res 58. https://doi.org/10.3402/fnr.v58.23364

127.

Viguiliouk E, Stewart SE, Jayalath VH et al (2015) Effect of replacing animal protein with plant protein on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutrients 7(12):9804–9824. https://doi.org/10.3390/nu7125509CrossRefPubMedPubMedCentral

128.

Li SS, Blanco Mejia S, Lytvyn L et al (2017) Effect of plant protein on blood lipids: A systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc 6(12):e006659. https://doi.org/10.1161/JAHA.117.006659CrossRefPubMedPubMedCentral

129.

Viguiliouk E, Glenn AJ, Nishi SK et al (2019) Associations between dietary pulses alone or with other legumes and cardiometabolic disease outcomes: an umbrella review and updated systematic review and meta-analysis of prospective cohort studies. Adv Nutr 10(Supplement_4):S308–S319. https://doi.org/10.1093/advances/nmz113CrossRefPubMedPubMedCentral

130.

Becerra-Tomás N, Paz-Graniel I, Kendall CWC et al (2019) Nut consumption and incidence of cardiovascular diseases and cardiovascular disease mortality: A meta-analysis of prospective cohort studies. Nutr Rev 77(10):691–709. https://doi.org/10.1093/nutrit/nuz042CrossRefPubMedPubMedCentral

131.

Blanco Mejia S, Messina M, Li SS et al (2019) A meta-analysis of 46 studies identified by the FDA demonstrates that soy protein decreases circulating LDL and total cholesterol concentrations in adults. J Nutr 149(6):968–981. https://doi.org/10.1093/jn/nxz020CrossRefPubMedPubMedCentral

132.

Jenkins DJ, Blanco Mejia S, Chiavaroli L et al (2019) Cumulative meta-analysis of the soy effect over time. J Am Heart Assoc 8(13):e012458. https://doi.org/10.1161/JAHA.119.012458CrossRefPubMedPubMedCentral

133.

Sabaté J, Oda K, Ros E (2010) Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Int Med 170(9):821–827. https://doi.org/10.1001/archinternmed.2010.79CrossRef

134.

Nishi SK, Viguiliouk E, Blanco Mejia S et al (2021) Are fatty nuts a weighty concern? A systematic review and meta-analysis and dose–response meta-regression of prospective cohorts and randomized controlled trials. Obes Rev 22(11):e13330. https://doi.org/10.1111/obr.13330CrossRefPubMedPubMedCentral

135.

Zurbau A, Au-Yeung F, Blanco Mejia S et al (2020) Relation of different fruit and vegetable sources with incident cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc 9(19):e017728. https://doi.org/10.1161/JAHA.120.017728CrossRefPubMedPubMedCentral

136.

Huang H, Chen G, Liao D, Zhu Y, Xue X (2016) Effects of berries consumption on cardiovascular risk factors: a meta-analysis with trial sequential analysis of randomized controlled trials. Sci Rep 6(1):1–11

137.

Reynolds ANAA, Kumar S, Diep Pham HT, Coffey S, Mann J (2022) Dietary fibre in hypertension and cardiovascular disease management: systematic review and meta analyses. BMC Med 20(1):139. https://doi.org/10.1186/s12916-022-02328-xCrossRefPubMedPubMedCentral

138.

Schwingshackl L, Schwedhelm C, Hoffmann G, Boeing H (2019) Potatoes and risk of chronic disease: A systematic review and dose–response meta-analysis. Eur J Nutr 58(6):2243–2251. https://doi.org/10.1007/s00394-018-1774-2CrossRefPubMed

139.

Viguiliouk E, Blanco Mejia S, Kendall CW, Sievenpiper JL (2017) Can pulses play a role in improving cardiometabolic health? Evidence from systematic reviews and meta-analyses. Ann N Y Acad Sci 1392(1):43–57. https://doi.org/10.1111/nyas.13312CrossRefPubMedPubMedCentral

140.

Pearce M, Fanidi A, Bishop TRP et al (2021) Associations of total legume, pulse, and soy consumption with incident type 2 diabetes: federated meta-analysis of 27 studies from diverse world regions. J Nutr 151(5):1231–1240. https://doi.org/10.1093/jn/nxaa447CrossRefPubMedPubMedCentral

141.

Ibsen DB, Steur M, Imamura F et al (2020) Replacement of red and processed meat with other food sources of protein and the risk of type 2 diabetes in European populations: The EPIC-InterAct Study. Diabetes Care 43(11):2660–2667. https://doi.org/10.2337/dc20-1038CrossRefPubMedPubMedCentral

142.

Salas-Salvadó J, Becerra-Tomás N, García-Gavilán JF, Bullo M, Barrubes L (2018) Mediterranean diet and cardiovascular disease prevention: what do we know? Prog Cardiovasc Dis 61(1):62–67. https://doi.org/10.1016/j.pcad.2018.04.006CrossRefPubMed

143.

Blanco Mejia S, Kendall CWC, Viguiliouk E et al (2014) Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 4(7):e004660. https://doi.org/10.1136/bmjopen-2013-004660CrossRefPubMedPubMedCentral

144.

Viguiliouk E, Kendall CWC, Blanco Mejia S et al (2014) Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLOS ONE 9(7):e103376. https://doi.org/10.1371/journal.pone.0103376CrossRefPubMedPubMedCentral

145.

Becerra-Tomás N, Blanco Mejía S, Viguiliouk E et al (2020) Mediterranean diet, cardiovascular disease and mortality in diabetes: a systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr 60(7):1207–1227. https://doi.org/10.1080/10408398.2019.1565281CrossRefPubMed

146.

Viguiliouk E, Kendall CW, Kahleová H et al (2019) Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr 38(3):1133–1145. https://doi.org/10.1016/j.clnu.2018.05.032CrossRefPubMed

147.

Glenn AJ, Viguiliouk E, Seider M et al (2019) Relation of vegetarian dietary patterns with major cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. Front Nutr 6:80. https://doi.org/10.3389/fnut.2019.00080CrossRefPubMedPubMedCentral

148.

Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D (2015) A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 5(8):e008222. https://doi.org/10.1136/bmjopen-2015-008222CrossRefPubMedPubMedCentral

149.

Soltani S, Jayedi A, Shab-Bidar S, Becerra-Tomás N, Salas-Salvadó J (2019) Adherence to the Mediterranean diet in relation to all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr 10(6):1029–1039. https://doi.org/10.1093/advances/nmz041CrossRefPubMedPubMedCentral

150.

Díaz-López A, Babio N, Martínez-González MA et al (2015) Mediterranean diet, retinopathy, nephropathy, and microvascular diabetes complications: a post hoc analysis of a randomized trial. Diabetes Care 38(11):2134–2141. https://doi.org/10.2337/dc15-1117CrossRefPubMed

151.

Esposito K, Maiorino MI, Ciotola M et al (2009) Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Int Med 151(5):306–314. https://doi.org/10.7326/0003-4819-151-5-200909010-00004CrossRefPubMed

152.

Basterra-Gortari FJ, Ruiz-Canela M, Martínez-González MA et al (2019) Effects of a Mediterranean eating plan on the need for glucose-lowering medications in participants with type 2 diabetes: a subgroup analysis of the PREDIMED trial. Diabetes Care 42(8):1390–1397. https://doi.org/10.2337/dc18-2475CrossRefPubMedPubMedCentral

153.

Glenn AJ, Lo K, Jenkins DJ et al (2021) Relationship between a plant-based dietary portfolio and risk of cardiovascular disease: findings from the Women's Health Initiative Prospective Cohort Study. J Am Heart Assoc 10(16):e021515. https://doi.org/10.1161/JAHA.121.021515CrossRefPubMedPubMedCentral

154.

Lo K, Glenn AJ, Yeung S et al (2021) Prospective association of the Portfolio diet with all-cause and cause-specific mortality risk in the Mr. OS and Ms. OS Study. Nutrients 13(12):4360. https://doi.org/10.3390/nu13124360CrossRefPubMedPubMedCentral

155.

Glenn AJ, Hernández-Alonso P, Kendall CW et al (2021) Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study. Clin Nutr 40(5):2825–2836. https://doi.org/10.1016/j.clnu.2021.03.016CrossRefPubMed

156.

Willett WC, Sacks F, Trichopoulou A et al (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61(6):1402S–1406S. https://doi.org/10.1093/ajcn/61.6.1402SCrossRefPubMed

157.

Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348(26):2599–2608. https://doi.org/10.1056/NEJMoa025039CrossRefPubMed

158.

Cano-Ibáñez N, Quintana-Navarro GM, Alcala-Diaz JF et al (2022) Long-term effect of a dietary intervention with two-healthy dietary approaches on food intake and nutrient density in coronary patients: results from the CORDIOPREV trial. Eur J Nutr 61(6):3019–3036. https://doi.org/10.1007/s00394-022-03006-7

159.

Slimani N, Fahey M, Welch A et al (2002) Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5(6b):1311–1328. https://doi.org/10.1079/PHN2002407CrossRefPubMed

160.

Mithril C, Dragsted LO, Meyer C, Blauert E, Holt MK, Astrup A (2012) Guidelines for the New Nordic Diet. Public Health Nutr 15(10):1941–1947. https://doi.org/10.1017/S136898001100351XCrossRefPubMed

161.

Adamsson V, Reumark A, Cederholm T, Vessby B, Risérus U, Johansson G (2012) What is a healthy Nordic diet? Foods and nutrients in the NORDIET study. Food Nutr Res 56:18189. https://doi.org/10.3402/fnr.v56i0.18189CrossRef

162.

Adamsson V, Reumark A, Fredriksson I-B et al (2011) Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Int Med 269(2):150–159. https://doi.org/10.1111/j.1365-2796.2010.02290.xCrossRef

163.

Kanerva N, Kaartinen NE, Schwab U, Lahti-Koski M, Männistö S (2014) The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries. Public Health Nutr 17(8):1697–1705. https://doi.org/10.1017/S1368980013002395CrossRefPubMed

164.

Uusitupa M, Hermansen K, Savolainen MJ et al (2013) Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome – a randomized study (SYSDIET). J Intern Med 274(1):52–66. https://doi.org/10.1111/joim.12044

165.

Chiavaroli L, Nishi SK, Khan TA et al (2018) Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis 61(1):43–53. https://doi.org/10.1016/j.pcad.2018.05.004CrossRefPubMed

166.

Health Canada (2010) Plant sterols and blood cholesterol lowering. Available from: www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/health-claims/assessments/plant-sterols-blood-cholesterol-lowering-nutrition-health-claims-food-labelling.html. Accessed: 20 October 2022

167.

Health Canada (2015) Summary of Health Canada’s Assessment of a Health Claim about Soy Protein and Cholesterol Lowering. Available from: www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/health-claims/assessments/summary-assessment-health-claim-about-protein-cholesterol-lowering.html. Accessed: 20 October 2022

168.

Health Canada (2021) List of dietary fibres reviewed and accepted by Health Canada’s Food Directorate. Available from: www.canada.ca/en/health-canada/services/publications/food-nutrition/list-reviewed-accepted-dietary-fibres.html. Accessed: 20 October 2022

169.

US Food and Drug Administration (2022) Qualified health claims: letters of enforcement discretion. Available from: www.fda.gov/food/food-labeling-nutrition/qualified-health-claims-letters-enforcement-discretion. Accessed: 20 October 2022, DOI: https://doi.org/10.52628/88.4.07

170.

EFSA (2006) Scientific Opinion on the substantiation of a health claim related to 3 g/day plant sterols/stanols and lowering blood LDL-cholesterol and reduced risk of (coronary) heart disease pursuant to Article 19 of Regulation (EC) No 1924/2006. Available from: www.efsa.europa.eu/en/efsajournal/pub/2693

171.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2006) Scientific Opinion on the substantiation of a health claim related to oat beta glucan and lowering blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA J 2010 8(12):1885. https://doi.org/10.2903/j.efsa.2010.1885CrossRef

172.

Keith M, Kuliszewski MA, Liao C et al (2015) A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease. Clin Nutr 34(3):541–548. https://doi.org/10.1016/j.clnu.2014.06.010CrossRefPubMed

173.

Tuomisto HL (2018) Importance of considering environmental sustainability in dietary guidelines. Lancet Planet Health 2(8):e331–e332. https://doi.org/10.1016/S2542-5196(18)30174-8CrossRefPubMed

174.

Vermeulen SJ, Campbell BM, Ingram JS (2012) Climate change and food systems. Ann Rev Environ Resour 37:195–222. https://doi.org/10.1146/annurev-environ-020411-130608CrossRef

175.

Willett W, Rockström J, Loken B et al (2019) Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 393(10170):447–492. https://doi.org/10.1016/S0140-6736(18)31788-4CrossRefPubMed

176.

Clark MA, Springmann M, Hill J, Tilman D (2019) Multiple health and environmental impacts of foods. Proc Natl Acad Sci 116(46):23357–23362. https://doi.org/10.1073/pnas.1906908116CrossRefPubMedPubMedCentral

177.

Schanes K, Dobernig K, Gözet B (2018) Food waste matters - a systematic review of household food waste practices and their policy implications. J Clean Prod 182:978–991. https://doi.org/10.1016/j.jclepro.2018.02.030CrossRef

178.

UNEP (2018) Single-use plastics: a roadmap for sustainability. In. United Nations Environment Programme. Available from: www.unep.org/resources/report/single-use-plastics-roadmap-sustainability. Accessed: 20 October 2022

179.

Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S (2014) From public to planetary health: a manifesto. Lancet 383(9920):847. https://doi.org/10.1016/S0140-6736(14)60409-8CrossRefPubMed

180.

Monteiro CA (2009) Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr 12(5):729–731. https://doi.org/10.1017/S1368980009005291CrossRefPubMed

181.

Baker P, Machado P, Santos T et al (2020) Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers. Obes Rev 21(12):e13126. https://doi.org/10.1111/obr.13126CrossRefPubMed

182.

Monteiro CA, Cannon G, Lawrence M, Costa Louzada MD, Pereira Machado P (2019) Ultra-processed foods, diet quality, and health using the NOVA classification system. FAO, Rome

183.

Srour B, Fezeu LK, Kesse-Guyot E et al (2019) Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ 365:l1451. https://doi.org/10.1136/bmj.l1451

184.

Narula N, Wong EC, Dehghan M et al (2021) Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ 374:n1554. https://doi.org/10.1136/bmj.n1554

185.

Ivancovsky-Wajcman D, Fliss-Isakov N, Webb M et al (2021) Ultra-processed food is associated with features of metabolic syndrome and non-alcoholic fatty liver disease. Liver Int 41(11):2635–2645. https://doi.org/10.1111/liv.14996CrossRefPubMed

186.

Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I et al (2019) Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ 365:l1949. https://doi.org/10.1136/bmj.l1949

187.

Canella DS, Levy RB, Martins APB et al (2014) Ultra-processed food products and obesity in Brazilian households (2008–2009). PloS One 9(3):e92752. https://doi.org/10.1371/journal.pone.0092752CrossRefPubMedPubMedCentral

188.

Monteiro CA, Moubarac J-C, Levy RB, Canella DS, da Costa Louzada ML, Cannon G (2018) Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr 21(1):18–26. https://doi.org/10.1017/S1368980017001379CrossRefPubMed

189.

Fiolet T, Srour B, Sellem L et al (2018) Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ 360:k322. https://doi.org/10.1136/bmj.k322

190.

Chen X, Zhang Z, Yang H et al (2020) Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutr J 19(1):1–10CrossRef

191.

Hall KD, Ayuketah A, Brychta R et al (2019) Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab 30(1):67–77.e3. https://doi.org/10.1016/j.cmet.2019.05.008CrossRefPubMedPubMedCentral

192.

Litterbach E, Holmes-Truscott E, Pouwer F, Speight J, Hendrieckx C (2020) 'I wish my health professionals understood that it's not just all about your HbA1c!'. Qualitative responses from the second Diabetes MILES–Australia (MILES-2) study. Diabetic Med 37(6):971–981. https://doi.org/10.1111/dme.14199CrossRefPubMed

193.

Rees S, Williams A (2009) Promoting and supporting self-management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter. JBI Evid Synth 7(13):492–582. https://doi.org/10.11124/01938924-200907130-00001CrossRef

194.

Zare S, Ostovarfar J, Kaveh MH, Vali M (2020) Effectiveness of theory-based diabetes self-care training interventions; a systematic review. Diabetes Metab Syndr Clin Res Rev 14(4):423–433. https://doi.org/10.1016/j.dsx.2020.04.008CrossRef

195.

Liu NF, Brown AS, Folias AE et al (2017) Stigma in people with type 1 or type 2 diabetes. Clin Diabetes 35(1):27–34. https://doi.org/10.2337/cd16-0020CrossRefPubMedPubMedCentral

Title: Evidence-based European recommendations for the dietary management of diabetes
Author: The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD)
Publication date: 17-04-2023
Publisher: Springer Berlin Heidelberg
Keywords: Nutrition
Type 2 Diabetes
Diabetes Prevention
Diabetes
Endocrinology
Published in: Diabetologia / Issue 6/2023
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-023-05894-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

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Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

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Incentivised to exercise

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New intervention for STEMI-related cardiogenic shock

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Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

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Abstract

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The prediabetes conundrum: striking the balance between risk and resources

Drug target Mendelian randomisation: are we really instrumenting drug use?

A large portion of diabetes cases in sub-Saharan African populations with HIV represent drug-induced diabetes

Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders

Identifying blood biomarkers for type 2 diabetes subtyping: a report from the ORIGIN trial

Significant impact of time-of-day variation on metformin pharmacokinetics

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