What You Eat Really Does Matter

Diet and lifestyle advice should not differ between patients with diabetes and the general public but may be more beneficial to patients with diabetes, according to a study published in Diabetologia. Intake of certain foods may be more beneficial or detrimental to the health of patients with diabetes, the study showed. 

“At this moment, diet and lifestyle advice in diabetes with respect to long-term complications do not differ from the general population,” said Diewertje Sluik, DrPH, currently Postdoctoral Fellow, Division of Human Nutrition, Wageningen University, The Netherlands. “This is, however, mainly due to the fact that the evidence supporting these recommendations has rarely been derived from studies of people with diabetes. We have now provided empirical evidence that it is justified that these recommendations are the same,” she said.

“The study by Sluik et al shows that lifestyle changes can adjust mortality risk for all individuals, those with and without diabetes,” commented Abigail Kennedy-Grant, MS, RD, CDN, Registered Dietitian at the Mount Sinai Diabetes Center, New York, NY. “While there were minimal instances of significant differences between the populations, this could largely be due to the difference in group sizes and perhaps the higher prevalence of male than female participants with diabetes,” she said adding that these differences make the results less generalizable to the larger population. “The study had a strong strength in emphasizing detail in analyzing food frequency questionnaires to determine food intake of the participants,” she noted.

Large, Prospective Study

Dr. Sluik and colleagues from the Department of Epidemiology at the German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany, analyzed data from the European Prospective Investigation into Cancer and Nutrition (EPIC), to investigated whether the associations between lifestyle factors and mortality risk differ between 6,384 participants with diabetes with and 258,911 participants without diabetes. Fifty-four percent of the diabetes group was male compared with 40% of the nondiabetic group. 

Butter and Margarine Linked to Increased Mortality Risk

As expected, overall mortality was 62% higher in people with diabetes compared with those without. In patients with diabetes, intake of fruit, vegetables, nuts, seeds, pasta, poultry, and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk. These associations were also found in nondiabetics, but were stronger in patients with diabetes.

No differences between people with and without diabetes were detected for other lifestyle factors including adiposity, alcohol consumption, physical activity, and smoking.

Clinical Implications

These findings “may indicate that individuals with diabetes may benefit more from a healthy diet than people without diabetes. However, since the directions of association were generally the same, recommendations for a healthy diet should be similar for people with or without diabetes,” the authors noted. “We recommend further studies to look into this,” Dr. Sluik said.

“Our findings highlight that the difficulties in recognizing and diagnosing diabetes and its different stages are of minor importance with respect to healthy diet and lifestyle recommendations, because no difference in recommendations depending on the stage of the disease seems necessary,” Dr. Sluik said.

“Choosing more heart healthy, lower fat, fiber rich foods are positive dietary changes that may assist in improving or maintaining weight and health for all individuals, regardless of whether they have diabetes,” commented Ms. Kennedy-Grant. Furthermore, “the article indicates an important component of diabetes care in the form of lifestyle counseling. A team approach to diabetes care and diabetes prevention most effectively includes medical management in addition to weight and dietary counseling. Individuals with diabetes can improve their health by working with their doctors, nurses, nurse practitioners, and registered dietitians, as well as any other certified diabetes educators who are part of their team.

“The goals that have been shown to improve health and decrease risk for developing diabetes include engaging in physical activity for 30 minutes daily and reducing saturated fat intake while increasing fiber intake with fruits, vegetables, legumes, beans, and whole grains, along with including lean sources of protein,” Ms. Kennedy-Grant said. “Diet and lifestyle modifications such as this can assist in improving weight status and possibly decrease cardiovascular risks,” she added.