Not all carbs are created equal

In patients with type 2 diabetes a healthy eating pattern including the frequent intake of whole carbohydrates, dairy, white meat, fish, fruits and vegetables was associated with lower fasting plasma glucose, HbA1c, and LDL cholesterol levels as compared with an eating pattern with high consumption of refined carbohydrates, ultraprocessed foods, sweets, and desserts. The carbohydrate use did not differ between the unhealthy and healthy group. 

JES

 

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JOURNAL OF THE ENDOCRINE SOCIETY

cross-sectional

JANUARY 2018

 

Purpose

To evaluate the relationship between eating patterns and therapeutic target’s achieving in patients with type 2 diabetes.

 

Methods

In this cross-sectional study, patients underwent clinical, laboratory, and nutritional evaluations. Dietary intake was assessed by a quantitative food frequency questionnaire and eating patterns identified by cluster analysis.

The therapeutic targets were as follows: blood pressure, <140/90 mm Hg; BMI, <25 kg/m2 (<27 kg/m2 for elderly); waist circumference, <94 cm for men and <80 cm for women; fasting plasma glucose, <130 mg/dL; HbA1c, <7%; triglycerides, <150 mg/dL; HDL-cholesterol, >40 mg/dL for men and >50 mg/dL for women; LDL-cholesterol, <100 mg/dL.

 

Results

One hundred ninety seven (197) patients were studied. We identified two eating patterns: “unhealthy” (n = 100)—high consumption of refined carbohydrates, ultra-processed foods, sweets and desserts (P < 0.05); and “healthy” (n = 97)—high intake of whole carbohydrates, dairy, white meat, fish, fruits and vegetables (P < 0.05).

The healthy group more frequently achieved therapeutic targets for fasting plasma glucose, HbA1c, and LDL-cholesterol than the unhealthy group. Poisson regression confirmed the association of healthy eating pattern with attaining the therapeutic target for fasting plasma glucose (PR, 1.59), HbA1c (PR, 2.09) and LDL-cholesterol (PR, 1.37)

 

Conclusions

A healthy eating pattern, including the frequent intake of whole carbohydrates, dairy, white meat, fish, fruits, and vegetables, is associated with reduced fasting plasma glucose, HbA1c, and LDL cholesterol levels in patients with type 2 diabetes.


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More from the publication:

Several eating patterns defined a priori such as Mediterranean, low glycemic index, moderately low carbohydrate, or vegetarian diets have been recommended for the management of weight and glucose control in diabetes. However, recently the American Diabetes Association stated that there is no single ideal dietary distribution of calories from carbohydrates, fats, and protein for diabetes patients. In this context, the choice of eating pattern should be individualized, taking into account the patient’s current consumption preferences and the goal of metabolic targets.

The aim of this cross-sectional study was to evaluate the relationship between eating patterns defined a posteriori and achieving recommended therapeutic targets (blood pressure, body weight, glycemic control, and lipid profile) in patients with type 2 diabetes in Southern Brazil.

In this cross-sectional study, we obtained data from 197 patients with type 2 diabetes and identified two eating patterns by cluster analysis. The healthy eating pattern, characterized by high consumption of whole carbohydrates, dairy, white meat, fish, fruits, and vegetables, was associated with better glycemic and lipid control than the unhealthy eating pattern. Patients in the healthy eating pattern had lower fasting plasma glucose, HbA1c, and LDL cholesterol and most frequently reached the recommended therapeutic targets for these parameters as compared with patients from the unhealthy eating pattern. As expected, patients in the healthy group had a higher intake of protein, total, soluble, and insoluble fiber, omega-3 fatty acid, calcium, magnesium, iron, potassium, and vitamin C. 

It is known that carbohydrates are the nutrients that most affect blood glucose levels. However, up to now there is no consensus evidence about the ideal amount of carbohydrate intake for people with diabetes. In fact, in the present study, the carbohydrate consumption did not differ between the unhealthy and healthy group. The association between healthy eating pattern and glycemic control could be better explained by the quality of carbohydrate intake than the amount of this macronutrient. In agreement with this, we demonstrated a higher consumption of whole carbohydrates, fruits, and vegetables in this group of patients. As a consequence, these patients consumed diets with a lower glycemic index and glycemic load values as compared with patients in the unhealthy eating pattern. Currently, diets with a low glycemic index have been associated with improved glycemic control.

Another nutrient probably related to the best observed glycemic control in our study is dietary fiber. Accordingly, in our patients in the healthy eating pattern, a higher total, soluble, and insoluble fiber consumption was observed. It has already been demonstrated that a high fiber intake was associated with better glycemic control in patients with diabetes. However, up to now, the beneficial effects of fiber intake, especially soluble fibers, could not be isolated from the effects of glycemic index and glycemic load because most foods that have a low glycemic index also have a high fiber content.

In conclusion, in patients with type 2 diabetes a healthy eating pattern including the frequent intake of whole carbohydrates, dairy, white meat, fish, fruits and vegetables was associated with lower fasting plasma glucose, HbA1c, and LDL cholesterol levels as compared with an eating pattern with high consumption of refined carbohydrates, ultraprocessed foods, sweets, and desserts.