Post on 24-Jul-2020
transcript
Supplemen
tary
Table
1dCom
parisonof
stud
ydesign
andresults
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Carbo
hyd
rate
amou
nt:lower
carboh
ydrate
(10)
Boden
2005
Clin
icaltrial,
singlearm/
14day
Typ
e2
10adults
Low-CHO
diet
21gCHO/day
A1C
decreased0.5%
(P5
0.00
6);m
ean
24-h
plasmaglucose
andinsulin
decreased
(P5
0.00
2and
P5
0.03
9,respectively);FB
Gdecreasedfrom
7.5to
6.3mmol/L
(P5
0.02
5).Insulin
sensitivity
(by
euglycem
ic-
hyperinsulin
emic
clam
p)im
proved
by75
%.
TCdecreasedfrom
4.68
to4.24
mmol/L
(P5
0.02
);TG
decreasedfrom
1.84
to1.19
mmol/L
(P,
0.00
01).
Metabolic-unit–type
stud
ySign
ificant
weightloss
(11)
Daly20
06RCTparallel,
2arms/3mon
ths,
multicenter
Typ
e2
79adults
Low-CHO
dietvs.
low-fatdiet
Low-CHO
diet:
goalof
upto
70gCHO/day
(achieved11
0g/day)vs.low
-fatdiet:stand
ard
advice
toreduce
portions
andfat
(achieved16
9g
CHO/day)
Glycemicmeasures:NS
TC:HDL-Cratio
improvedin
low-
CHO
grou
pvs.
low-fatgrou
p(2
0.48
vs.2
0.10
,P5
0.01
1)
77%
completionrate
Weight-loss
stud
y
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 1
S Y S T E M A T I C R E V I E W
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(12)
Davis20
09RCTparallel,
2arms/1year
Typ
e2
85adults
Lower-CHO
diet
(Atkinstype)
vs.
lower-fatdiet
(DPP
type)
Low-CHO
diet:
initialgoalo
f20
–25
gCHO/
day,increased
by5-gincrem
ents
each
weekas
participantslost
weight(achieved
33.4%
CHO,
43.9%
fat)vs.
low-fatdiet:goalo
f25
%fat(achieved
30.8%
fat,50
.1%
CHO).50
0kcal/
daydeficitfor
both
arms
Glycemicmeasures:NS
HDL-Cincreased
moreat6mon
ths
inthelow-CHO
grou
p(1
0.16
mg/dL
,P5
0.00
2)and
increase
was
sustainedat
12mon
ths
Weight-loss
stud
y(bothgrou
ps
achieved
a3.4%
weightreduction
)Su
bjectsun
der
good
controlat
baselin
e(A1C
7.4–
7.5%
)
(13)
Dyson
2007
RCTparallel,
2arms/3mon
thsTyp
e2
12adultswith
diabetes
(22total)
Low-CHO
dietvs.
healthyeatin
g(DiabetesUK
nutrition
recommendation
s),
calorie-restricted
diet
Low-CHO
diet:
#40
gCHO/day
(achieved57
gCHO/day)vs.
“healthy
eatin
g”with50
0kcal/day
energy
deficit
(achieved16
7g
CHO/day)
Glycemicmeasures:NS
CVDrisk
measures:NS
Weight-loss
stud
y
2 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(14)
Yancy20
05Clin
icaltrial,
singlearm/
16weeks
Typ
e2
21adults
Low-CHO
diet
InitialC
HO
goalof
,20
gCHO/day,
increasingCHO
by5g/day
each
weekaftersome
weightloss(8
subjectswith
adequatefood
recordsachieved
34gCHO/day
atweek16
)
A1C
decreasedby
16%
from
7.5to
6.3%
(P,
0.00
1)TGdecreased42
%from
2.69
to1.57
mmol/L
(P5
0.00
1)
75%
retentio
nrate
20of
the21
participants
weremen
Weight-loss
stud
yDiabetesmedications
werediscon
tinu
edin
7participants,
redu
cedin
10participants
(15)
Stern20
04RCTparallel,
2arms/1year
Mainlytype2
34adultswith
diabetes
(87total)
Low-CHO
dietvs.
lower-fat(N
HLB
Igu
idelines)
calorie-restricted
diet
LowCHO:,
30g
CHO/day
(achieved12
0g
CHO/day)vs.
convention
alweight-loss
diet:
restrictcalorie
intake
by50
0calories/day
with
,30
%fat
(achieved23
0g
CHO/day)
A1C
decreasedmore
inthelowCHO
grou
pwith
diabetes
(20.7%
)vs.the
calorie-restricted
grou
pwith
diabetes
(20.1%
)after
adjustmentfor
baselin
edifferences
andweigh
t-loss
amou
nt(P
50.01
9)CVDrisk
measures:
notprovided
for
diabetes
grou
pon
ly
Weight-loss
stud
y62
%retentio
nrateforpeop
lewithdiabetes
83%
ofsubjects
weremen
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 3
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(16)
Westm
an20
08RCTparallel,2
arms/6
mon
ths
Typ
e2
50adults
Low-CHO
dietvs.
low-G
I,reduced-calorie
diet
Low-CHO
diet:
goal,20
gCHO/day
(achieved49
g6
33gCHO/day)
vs.low
-GI,
reduced-calorie
diet(500
kcal/day
energy
deficit):
goal55
%CHO
(achieved44
%CHO)
A1C
reduced
1.5%
inlow-CHO
diet
vs.2
0.5%
inlow-GIdiet,P
50.03
HDL-Cincreased
by5.6mg/dL
inlow-CHO
diet
vs.n
ochange
inlow-GIdiet,
P,
0.05
58%
retentio
nrate
Weight-loss
stud
y“Low
GI”no
tdefined
(17)
Haimoto
2009
Clin
icaltrial,
singlearm/6
mon
ths
Typ
e2
31adults
Lower-CHO
diet
Lower-CHO
goal:
30%
CHO,4
4%fat,20
%protein;
achieved:
306
10%
CHO,
446
10%
fat,
206
4%protein
A1C
decreased
from
10.9
to7.4%
(P,
0.00
1)LD
L-Cdecreased
from
142to
128mg/dL
(P5
0.03
6);H
DL-C
increasedfrom
52to
59mg/dL
(P5
0.00
8)
Weight-loss
stud
y
(18)
Miyashita
2004
RCTparallel,2
arms/4
weeks
Typ
e2
22adults
Lower-CHO
dietvs.
higher-CHO
diet
Lower-CHO
diet:
39%
CHO,3
5%fat,25
%protein
vs.h
igher-CHO
diet:6
2%CHO,
10%
fat,26
%protein
Fastinginsulin
decreased30
%in
lower
CHO
vs.
10%
inhigh
erCHO
(P,
0.05
)HDL-Cincreased
15%
inlower
CHO
vs.0
inhigh
erCHO
( P,
0.01
)
Metabolic-unitstud
yWeight-loss
stud
y:weightdeclined
similarlyin
both
grou
ps:lower
CHO,
73→64
kg;h
igher
CHO,7
1→64
kgFibersimilarin
both
diets
4 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(19)
Wolever
2008
RCTparallel,3
arms/1-year
multicenter
stud
y
Typ
e2
130adults
HigherGIvs.low
erGIvs.low
erCHO/high
MUFA
End
ofstud
y:high
erGI:
46.5%
CHO,
30.8%
fat,
12.3%
MUFA,
20.4%
protein,
GI5
63%,G
L535
gvs.low
erGI:52
%CHO,
26.5%
fat,10
.7%
MUFA,2
0.6%
protein,
GI5
55%,G
L5
133gvs.low
erCHO:3
9.3%
CHO,4
0%fat,
18.3%
MUFA,
19%
protein,
GI5
59%,G
L5
110g
Glycemicmeasures:NS
HDL-C4%
lower
andTG12
%high
eron
lower-G
Idiet
than
lower-CHO
diet(P
,0.05
for
both);high
erGI
was
interm
ediate
Weightno
tcontrolled,
butbo
dyweightno
tsign
ificantly
differentamon
gdiets
Diabetescontrolled
bydietalon
eand
subjectswerein
optimalglycem
iccontrol
Key
food
sprovided
Lower-GIdiethad
30%
lower
CRPthan
thehigher
GI(P
50.00
78)
(20)
Jönsson
2009
RCTcrossover/3
mon
thseach
(nowasho
utperiod
)
Typ
e2
13adults
Tradition
aldiabetic
dietvs.P
aleolithic
diet
Traditio
nald
iet:
high
erfiber/
who
legrains,
lower
saturated
fatvs.P
aleolithic
diet:leanmeats,
fish,fruit,
vegetables,eggs,
nuts
A1C
lower,P
aleolithic
vs.tradition
aldiet:
5.5vs.5
.9%
(P5
0.02
)HDL-Chigh
erby
0.08
mmol/L,P
aleolithic
vs.tradition
al(P
50.03
)TGlower
by0.4mmol/L,
Paleolithicvs.
traditional(P5
0.00
3)
76%
completionrate
Weightno
tcontrolled
(BMIdecreased
sign
ificantly,
Paleolithicvs.
tradition
al)(P
50.04
)
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 5
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Carbo
hyd
rate
amou
nt:mod
erateto
highcarboh
ydrate
(21)
Barnard
2009
RCTparallel,
2arms/74
weeks
Typ
e2
83adults
Lower-fatvegan
dietvs.
convention
al“
diabetes”diet
Vegan:
CHO
75→66
.3%
Fat10
→22
.3%
SFA5.1%
achieved
Protein15
→14
.8%
vs.
Con
vention
aldiet:
CHO60–70→46.5%
Fat3
3.7%
achieved
SFA,7→
9.9%
Protein15–20→21.1%
Glycemicmeasures:NS
CVDrisk
measures:NS
Ancillary
analysis
lastavailableor
observed
before
medication
adjustment:
A1C
20.40
and
0.01
%in
vegan
andconvention
aldiets,respectively
(P5
0.03
)TC220
.4and26.8
mg/dLin
thevegan
andconvention
aldietgrou
ps,
respectively
(P5
0.01
)LD
L-C213
.5and
23.4mg/dL
inthe
veganand
conv
ention
algrou
ps,respectively
(P5
0.03
)Weightreduction
ifoverweight;weigh
tcontrolledin
some
regression
analyses
6 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(22)
Gerhard
2004
RCTcrossover/6
weeks
each
with6–
12-
weekwasho
ut
period
Typ
e2
11adults
Lower-fatdiet
vs.h
igher-MUFA
diet
Lower-fatdiet:
CHO
65→64
.7%
Fat20
→20
.8%
MUFA8.3%
achieved
vs. Higher-MUFAdiet:
CHO
45→45
.1%
Fat40
→39
.6%
MUFA26
→25
.1%
Proteinconstant
forbo
thdiets
(15%
)
Glycemicmeasures:NS
CVDrisk
measures:NS
Mealsprepared
inmetabolickitchen
Bodyweigh
tdecreased
sign
ificantly
(21.53
kg,P
,0.00
1)on
lower-fat
diet
Onbo
thdiets,subjects
wereprovided
25%
abovemaintenance
energy
requ
irem
ent
(mean3,55
5kcal/
day)
toallowself-
selectionfor
quantity
(23)
Wycherley
2010
RCTparallel,
4arms/16
weeks
Typ
e2
59adults
Standard-CHO
dietvs.h
igh-
proteindiet
Stud
yhas4grou
ps:
StandardCHO:
CHO
53→53
.6%
Fat26
→22
.6%
Protein19
→18
.6%
vs.
Highprotein:
CHO
43→47
.4%
Fat22
→17
.7%
Protein33
→32
%Fo
rtheother
2grou
ps,resistance
exercise
training
was
addedto
each
diet.
Glycemicrespon
se:N
SCVDrisk
measures:NS
Weight-loss
stud
y,withbo
thdiets
energy
restricted
(;1,40
0kcal/day
forwom
en,
;1,70
0formen)
Key
food
swere
supp
lied(50%
totalenergy)
71%
completionrate
Significant
redu
ctions
inall
grou
psforweight,
A1C
,FBG
,TC,
LDL-C,andTG
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 7
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
numbe
rAuthor/
year
Studytype/
duration
Diabetes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(24)
Brinkw
orth
2004
RCTparallel,
2arms/
52-w
eekfollo
w-
upof
a12
-week
interventio
n
Type2
38adults
Higherproteinvs.
lower
protein
Higher-protein
goals:
40%
CHO,
30%
fat,
30%
proteinvs.
lower-protein
goals:
55%
CHO,
30%
fat,
15%
protein
Glycemicmeasures:NS
CVDrisk
measures:NS
SeeParker
2002
for
stud
yof
first8
weeks
Weigh
tun
controlled
58%
retention
rate
HDL-Cincreasedin
both
grou
ps(17%
)Duringthe12
-mon
thfollo
w-up,
urinary
urea:creatinineratio
remained
stablein
both
grou
ps,
indicating
compliancewith
theprotein
prescription
(25)
Ganno
n20
03RCTcrossover/
5weeks
each
with2–
5-week
washo
utperiod
Type2
12adults
Higherproteinvs.
control(higher
CHO)
Higherprotein:
40%
CHO,
30%
fat,
30%
proteinvs.
higher
CHO:
55%
CHO,
30%
fat,
15%
protein
A1C
sign
ificantly
decreaseddu
ring
higher-protein
diet
(8.1–7.3%
)vs.
higher-CHO
diet
(8.0–7.7%
)(P
,0.05
)Mean24
-hintegrated
glucose
area
respon
se(fasting
glucose
concentrationas
baselin
e)sign
ificantly
decreasedafterthe
higher-protein
dietvs.the
higher-
CHO
diet(P
,0.02
)TGlower
onhigh
er-
proteindietvs.h
igher-
CHO
diet(161
vs.1
99mg/dL(P
50.03
)
Metabolic-unit–type
stud
y;allfoo
dsprovided
Weigh
tcontrolled
8 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(26)
Rod
rígu
ez-
Villar
2004
RCTcrossover/6
weeks
each,
withno
washo
ut
period
Typ
e2
22adults
HigherCHO
vs.
higher
MUFA
(oliveoil)diet
HigherCHO:
CHO
50→52
.3%
Fat30
→27
.9%
MUFA12
→13
.6%
Protein15
→18
.9%
vs.
HigherMUFA:
CHO
40→41
.4%
Fat40
→40
.2%
MUFA25
→24
.9%
Protein15
→17
.5%
Glycemicmeasures:NS
Higher-MUFA
dietdecreased
VLD
LTGs16
%(P
50.01
6)and
VLD
Lcholesterol
by35
%(P
50.02
3)compared
with
thehigher-CHO
diet.
Weightun
controlled
butstable(isocaloric
bydesign
)Fibersign
ificantly
higher
inCHO
diet
vs.h
igher-MUFA
(26g/day
vs.2
0.7,
P5
0.00
1)
(27)
Kod
ama
2009
Meta-analysis/
1966
–20
07Typ
e2
19stud
ies,30
6adults
HFLC
dietsvs.
LFHCdiets
Mediandiet
compo
sition
ofCHO/fatin
the
HFLC
andLF
HC
dietswere24
/58%
and40
/40%
,respectively
2-hPP
G(10trials),
fastinginsulin
(22
trials),and2-h
fastinginsulin
(9trials)increasedon
LFHCvs.H
FLC
(10.3%
,P,
0.00
1;8%
,P5
0.02
;12.8%
,P,
0.00
1,respectively)
HDL-Cdecreasedby
5.6%
(P,
0.00
1)on
LFHCvs.H
FLC
(20trials)
FastingTGincreased*
by13
.4%
(P,
0.00
1)on
LFHCvs.H
FLC
(22trials)
Weight-loss
trials
includedin
the
meta-analysis
Ofthe19
stud
ies
includedin
the
meta-analysis,o
nly
3werepu
blished
during
this
system
aticreview
timeperiod
andare
includedin
this
system
aticreview
(Miyashita[18],and
Rod
ríguez-Villar
[26],andLo
vejoy
[30])
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 9
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(28)
Kirk20
08Meta-analysis/
1980
–20
06Typ
e2
13stud
ies,26
3adults
Lower-CHO
diets
vs.h
igher-CHO
diets;lower-CHO
diets,single-arm
stud
ies
Lower-CHO
diets:
296
14%
kcal
from
CHO,range
4–45
%vs.h
igher-
CHO
comparison
diets:55
68%
kcalfrom
CHO,
range
40–70
%
Greater
meanreductio
nwithlower
CHO
vs.
high
erCHO
forFP
G;
regression
analysis:
10%
increase
inCHO
calorieintake
associated
with
3.26
1.2%
increase
inglucose,P
50.04
7A1C
was
reduced
more
onlower-CHO
diet
(9of
the11
trials)
Inregression
controlling
fordiet-phase
duration
,stron
grelation
ship
betw
een
low-CHO
phaseand
lower-TGlevels,1
0%increase
inCHO
calorieintake
associated
with7.66
0.6%
increase
inTG
change,P
50.00
1TGreduction
sfor
both
lower-and
high
er-CHO
diets
(11of
the11
trials)
Weightlossa
confou
ndingfactor
in6studies
Ofthe
13studies
inthe
meta-analysis,o
nly
4werepu
blished
during
this
system
aticreview
timeperiod
andmet
thissystem
atic
review
criteria
(Bod
en[10],Y
ancy
[14],G
erhard
[22],
andGanno
n[25])
10 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(29)
Rosenfalck
2006
RCTcrossover/
3mon
thseach
Typ
e1
10adults
Lower-fatdietvs.
convention
al“diabetes”diet
(European
Associationforthe
Stud
yofDiabetes)
Lower-fatdiet:
CHO
55→51
.4%
Fat25
→26
.2%
Protein20
→21
.1%
vs.
Con
vention
aldiet:
CHO
55→48
.7%
Fat30
→31
.2%
Protein15
→15
.1%
Insulin
sensitivity
byeuglycem
ic-
hyperinsulin
emic
clam
pim
proved
onthelower-fatdiet
comparedwiththe
convention
aldiet
(7.06vs.5
.52
g/kg/m
in,P
50.03
)CVDrisk
measures:
notdo
ne
77%
completionrate
Washo
utperiod
notprovided
Bodycompo
sition
remainedconstant
(isocaloricby
design
)Raw
food
materialsfor
lower-fatdietwere
delivered
topatients
whothen
prepared
theirow
nmeals
A1C
increasedfrom
baselin
efor
both
diets
(30)
Lovejoy
2002
RCTcrossover,
doubleblind,
4arms/4weeks
each
(minim
umof
2-week
washo
utperiod
)
Typ
e2
30adults
Higherfat/high
almon
dvs.low
erfat/high
almon
dvs.h
igherfat
controlvs.
lower-fatcontrol
Higherfat/high
almon
ds:
CHO48
%Fat3
7%(10%
from
almon
ds)
Protein15%
vs.
Lowerfat/high
almon
ds:
CHO60
%Fat2
5%(10%
from
almon
ds)
Protein15%
vs.
Higher-fatcontrol:
CHO48
%Fat3
7%(10%
from
oliveor
cano
laoil)
Protein15%
vs.
Lower-fatcontrol:
CHO60
%Fat2
5%(10%
from
oliveor
cano
laoil)
Protein15%
Glycemicmeasures:NS
HDL-Clower
inthe
almon
d-enriched
grou
ps(P
50.00
2)
Allfood
sprovided
during
thestudy
Weightcontrolled
Fiberalmostdo
ubled
during
thealmon
ddietsvs.the
control
Alm
onds
(57–11
3g/day
depend
ingon
total
energy
level)andthe
controloils
wereall
high
inMUFA
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 11
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Carbo
hyd
rate
type:GI
(31)
Kabir20
02RCTcrossover/4
weeks
each
(15-day
washo
ut
period
)
Typ
e2
13men
Higher-GIvs.
lower-GI
breakfast
Higher-GIbreakfast:
who
le-grain
cereal,
who
le-w
heatbread
vs.low
er-GI
breakfast:who
le-
grainbreadand
mueslicon
taining
3gb-glucanfrom
oats
Glycemicmeasures:NS
TClower
afterthelower-
GIbreakfastperiod
than
thehigher-GI
breakfastperiod
(P,
0.03)
Weightno
tcontrolled
Fibercontent
comparablebetween
breakfasts
(19)
Wolever
2008
See“Carbo
hydrate
amou
nt:low
ercarboh
ydrate”
(32)
Rizkalla
2004
RCTcrossover/4
weeks
Typ
e2
12men
Lower-GIvs.
higher-G
Idiets
Usualdietwith
change
intype
ofCHO
only
LowerGI:pu
mpernickel,
pasta,lentils,
haricot,mun
gbeans,chickpeas;
achieved
GI5
39un
itsvs.
HigherGI:
whole-m
ealbread,
French
baguettes,
potatoes,w
hiterice;
achieved
GI5
71un
its
A1C
lower
onlower-GI
dietvs.h
igher-GIdiet
(7.17vs.7
.57%
)(P
,0.05
)Increm
entalAUCsforplasma
glucose(8-h
metabolic
profilesat4weeks)
loweron
lower-GIdiet
vs.higher-GIdiet
(P,
0.05)
TCandLD
L-Cdecreased
onlower-GIdietvs.
higher-GIdiet
(P,
0.05)
Weightno
tcontrolled,
didno
tchange
Fibersignificantlyhigher
onlower-GIdietvs.
higher-GIdiet
(P,
0.0001)
Insulin
sensitivity
(clamptechniqu
e)significantlyhigher
onlower-GIdietvs.
higher-GIdiet
(glucose
disposal:
7vs.4.8mgglucose/
kg/m
in)(P
,0.001)
Apo
lipop
rotein
Bdecreasedmoreon
lower-GIdietvs.
higher-GIdiet
(P,
0.01)
12 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(33)
Jimenez-
Cruz20
03RCTcrossover/6
weeks
(6-w
eek
washo
ut
period
)
Typ
e2
14adults
Lower
vs.
higher
GI
Typ
icallower-GI
food
s:oranges,
beans,yogurt,p
asta,
corn
tortillas;
achieved
GIand
GL,
44and86
units,respectively
vs.
Typ
icalhigher-G
Ifood
s:corn
flakes,
whitebread,
potatoes,ripe
bananas;achieved
GIandGL,
56and
139un
its,
respectively
A1C
lower
afterthe
lower-G
Iperiod
vs.
afterthehigh
er-GI
period
(8.1
vs.8
.6%)
(P5
0.02
)FB
Glower
during
the
lower-G
Iperiod
vs.
thehigh
er-GIperiod
(8.9
vs.1
0.0mmol/L)
(P5
0.04
)CVDrisk
measures:NS
39%
completionrate
Weightno
tcontrolled
(weigh
tdecreased
sign
ificantlymore
withlower
GIvs.
higher
GI[90.1vs.
92.0
kg,P
50.04
])Fiberhigh
eron
lowerGI(P5
0.00
3)
(34)
Heilbronn
2002
RCTparallel/8
weeks
Typ
e2
45adults
Lower-GIvs.
higher-G
Idiets
Both
dietswere
similarin
compo
sition
:Lo
wer
GI:
CHO
60→58
.9%
Fat15
→17
.9%
Protein20
→22
%GIgoal43
units
vs.
HigherGI:
CHO60→60.8%
Fat1
5→17.1%
Protein20→21
.7%
GIgoal75
units
Glycemicmeasures:NS
CVDrisk
measures:NS
Weight-loss
stud
yKey
food
swere
provided
AchievedGIun
its/
grou
pno
tprovided
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 13
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(35)
Jenkins
2008
RCTparallel/6
mon
ths
Typ
e2
155adults
High–
cerealfiber
dietvs.low
-GI
diet
Goaltokeep
fiber
constantwhile
reducingGI
10-20po
ints
End
-of-stud
ylower-G
Idiet:
69.6
unitsand
18.7
gfiber/1,00
0kcalvs.h
igh–
cerealfiberdiet:
83.5
unitsand
15.7
gfiber/1,00
0kcal
InITTanalysis:
A1C
decreased
by20.50
%absoluteun
itsin
thelower-G
Icompared
with20.18
%in
the
high
–cerealfiberdiet
(P,
0.00
1).T
he
difference
was
still
sign
ificantafter
controlling
forchanges
inbo
dyweight,fiber,
orcarboh
ydrate
FBGdecreasedin
lower
GI
vs.h
igher-cerealfiber
(P,
0.02
)HDL-Cincreasedin
the
lower-G
Idietby
1.7
mg/dL
comparedwith
adecrease
of20.2
mg/dL
inthe
high
–cerealfiber
diet(P
50.00
5)
Weightun
controlled
74%
completionrate
14 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(36)
Ma20
08RCTparallel/1
2mon
ths
Typ
e2
40adults
Lower-GIvs.
traditional
diabetes
diet
Lifestyleeducation:
Both
grou
ps:
goalof
55%
CHO,N
CEPfat
guidelines
Lower-G
Igrou
p:
reduceGIto
55un
itsfrom
baselin
e.AchievedGIat
12mon
ths;76
unitsvs.
traditional
diabetes
grou
p:
CHO
counting.
AchievedGIat
12mon
ths;
80un
its
Glycemicmeasure
(A1C
):NS
LDL-Chigher
inthe
lower-G
Igrou
pthan
inthetraditional
diabetes
grou
pat12
mon
ths,94
.50vs.
71.49mg/dL
(P5
0.04
8)
Weightno
tcontrolled;
notaweight-loss
stud
y;weightand
waistcircumference
didno
tdiffer
betweengrou
ps
Both
dietsreduced
A1C
andTCfrom
baselin
eto
endof
stud
y
(16)
Westm
an20
08See“Carbo
hydrate
amou
nt:low
ercarboh
ydrate”
(37)
Gilb
ertson
2001
Prospective,
stratified,
rando
mized,
parallelstudy
/12
mon
ths
Typ
e1
89youths
Lower-GIdietvs.
CHO-exchanges
diet
Lifestyleinterventio
n:MeasuredCHO-
exchange
dietsvs.
amoreflexible
food
pyramid–type
dietwithlower-GI
dietaryadvice
A1C
was
lower
for
lower
GI(7.776
0.79
%)compared
withCHO
exchanges
(8.766
1.07
%)(P
50.00
2)CVDrisk
measures:
notdo
ne
Weightno
tcontrolled
Despite
difference
indietaryinstruction,
therewas
nodifference
inmean
achieved
GIbetween
the2grou
ps(56.56
4.0and55
.36
4.8)
(P5
0.26
)Manypatients
appeared
toun
der-
repo
rtfood
intake
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 15
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(38)
Burani
2006
Retrospective
coho
rt(pre/
post)
Typ
es1and2
21adults
GI
Pre–
andpo
st–low-
GImedical
nutritiontherapy
Inindividualswith
stable/im
proved
A1C
afterinitiation
oflow-GImedical
nutritiontherapy,
A1C
improved
(pre:
7.5%
topo
st:6
%)
(P,
0.00
05)
BMIsign
ificantly
redu
ced
Medsreduced
inmost
subjects
GIsign
ificantly
redu
ced(m
ean
pre5
59vs.
post5
44)
(39)
Cheon
g20
09RCTparallel/1
6weeks
Typ
e2
38adults
Walkvs.eatmore
lower-GIfood
sandwalk
Lifestyleeducation:
Walkmorevs.eat
morelower-GI
food
sandwalk
more
Glycemicmeasure
(A1C
):NS
CVDrisk
measures:
notdo
ne
Subjectswerein
good
glycem
iccontrolb
eforethe
stud
y
(40)
Brand-
Miller
2003
Meta-analysis/
1981
–20
01Typ
e1and2
14stud
ies,35
6youthsand
adults
Lower
GIvs.h
igher
GI
Lower
GI:average
65vs.h
igherGI:
average83
A1C
reduced
0.34
%po
intsmoreand
fructosam
inereduced
0.18
mmol/L
more
withlower-GIdiet
vs.h
igher-GIdiet,
adjustingforbaselin
eandassuming
independence
CVDrisk
measures:no
tdo
ne
Allmeta-analysis
references,except
Gilb
ertson
(37),
werepu
blished
before
thestartdate
ofthissystem
atic
review
16 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(41)
And
erson
2004
Meta-analysis
Articlesincluded
werepu
blished
between19
78and20
00
Typ
e1and2
a.17
4b.
167
c.14
3
a.MCHFvs.M
CLF
b.HCHFvs.M
CLF
c.Lo
wGIvs.h
ighGI
Mod
erateCHO:
30–59
.9%
kcal
HigherCHO:
$60
%kcal
Higherfiber:
$20
g/1,00
0kcal
Lower
fiber:
,10
g/1,00
0kcal
PPGreduced
sign
ificantly
(anaverageof
21%)withMCHF
vs.M
CLF
TC,L
DL-C,and
TGredu
ced
sign
ificantly(7,8
,and8%
,respectively)
withMCHFvs.
MCLF
MCHFvs.M
CLF
associated
with
aninsign
ificant
decrease
inFB
G,
averagedaily
plasma
glucose
andHDL-C
HCHFvs.M
CLF
associated
with
redu
cedFB
G,P
PG,
averageplasma
glucose,A
1C,T
C,
LDL-C,H
DL-C,and
TG
LowGIvs.h
igh
GIassociated
with
redu
cedFB
Gand
A1C
Allmeta-analysis
references
were
publishedbefore
the
startdateof
this
system
aticreview
(42)
Tho
mas
2009
Meta-analysis/
inception
ofdatabases
(MEDLINE,
EMBA
SE,
CIN
AHL,
Cochrane)
toJune
2008
Typ
e1and2
11stud
ies,40
2youthsand
adults
Lower
GI/GL
Lower
GIin
individualswith
diabetes
not
optimally
controlled
A1C
decreasedby
0.5%
withlower-
GIdiet(P
50.02
forparalleltrials
andP5
0.03
for
crossovertrials)
CVDrisk
measures:
notdo
ne
CochraneLibrary
Ofthe11
stud
ies
includedinthemeta-
analysis,o
nly3were
publisheddu
ring/
after20
01andare
includedin
this
system
aticreview
(Rizkalla
[32],
Jimenez-Cruz[33],
andGilb
ertson
[37])
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 17
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(43)
Qi2
005
Cross-sectio
nal
Typ
e2
780men
Semiquantitative
FFQ
in19
86,
1990
,and19
94
GI,GLintake
ofdietaryfibers
andadipon
ectin
Glycemicand
CVDrisk
measures:
notdo
ne
HealthProfession
als’
Follo
w-upStudy
Trendtowardlower
adipon
ectinlevels
withincreasing
quintilesof
GI(13%
lower
inhigh
est
adipon
ectinqu
intile
comparedto
the
lowestP5
0.00
5)andalso
withGL
(18%
lower
inhighestqu
intile
than
thelowestP
fortrend5
0.00
4);
adipon
ectinlevels
19%
high
erin
highestqu
intile
than
lowestqu
intile
forcerealfiberintake
(Pfortrend
50.00
3)Carbo
hyd
rate
type:dietary
fiber
(45)
Ziai 2005
RCTparallel,
doubleblind,
2arms/8
weeks
Typ
e2
36adults
Psylliu
mfibervs.
inertcontrol
(cellulose)
2packets(5.1-g
each)of
psylliu
m/
dayin
water
vs.
microcrystalline
cellu
lose
A1C
decreasedfrom
10.5
to8.9%
(P,
0.00
1)in
psylliu
mgrou
pandincreased
from
9.1to
10.5%
(P,
0.05
)in
control
grou
pHDL-Cincreasedin
psylliu
mgrou
pand
decreasedin
control
grou
p(P
,0.05
betw
eengrou
ps)
Weightcontrolled
73%
completionrate
18 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(46)
Magno
ni
2008
RCTparallel,
doubleblind,
2arms/12
weeks
Typ
e2
36adults
Diabetes-specific
oralnu
trition
supp
lementvs.
control(isocaloric
standard
oral
supp
lement)
Inaddition
toregu
lar
diet,sub
jects
consumed
two
200mL/day
ofadiabetes-specific
supp
lement:35
%CHO,4
9%fat
(34%
kcalas
MUFA),2.5g
fiber/10
0mLvs.
astandard
supp
lement:
55%
CHO,3
4%fat(17%
kcalas
MUFA),0fiber
At12
weeks,1
50-
and21
0-min
PPG
increaseswere
sign
ificantlylower
ininterventio
ngrou
pvs.
control(P,
0.00
1)CVDrisk
measures:
notdo
ne
Weightun
controlled
(47)
Lu20
04RCTcrossover/
5-weeks
each
(nowasho
utperiod
)
Typ
e2
15adults
Arabino
xylanfiber
inbreadvs.b
read
witho
utthefiber
Fiber-enriched
bread/m
uffin
prod
ucts(50%
who
le-w
heatflou
r,36
%whiteflou
r,14
%fiber-enriched
flou
r)vs.con
trol
prod
ucts(50%
who
le-w
heatflou
rand50
%white).
Subjectsreplaced
moststarchyfood
swith4–
5slices
ofbreadand1–
2muffins,d
epending
onenergy
needs
Add
ed-fiberdiet2-h
PPG(by75
-gOGTT)
was
lower
than
controld
iet(P
50.00
1),aswas
serum
insulin
(P5
0.01
5);serum
fructosam
inewas
lower
afterfiberdiet
vs.con
trol
(P5
0.02
)CVDrisk
measures:NS
Weightun
controlled
butno
sign
ificant
difference
between
grou
ps
Com
pletionrateno
tprovided
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 19
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(48)
Vuk
san
2007
RCTcrossover,
singleblind/12
weeks
each
(4–6-week
washo
ut
period
)
Typ
e2
20adults
Salba(novelwho
legrain)vs.w
heat
bran
376
4g/day
ofSalbaor
wheat
bran
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightcontrolled
74%
completionrate
A1C
sign
ificantly
redu
ced(6.9–6.7%
from
baselin
eto
12weeks
inSalba
grou
p(P
,0.05
)High-sensitivity
CRP
lower
inSalbagrou
p(P
50.04
)vs.w
heat
bran
(49)
Jenkins
2002
RCTcrossover/
3mon
thseach
(2-m
onth
washo
ut
period
)
Typ
e2
23adults
Wheatbran
fiber
vs.con
trol
(no
wheatbran)
Wheatbran-enriched
breadandcereal
(24%
ofdaily
energy
needs,
averageof
19g
fiber/day)
vs.
controlw
hitebread
andcereal(24%
daily
energy
needs,
4gfiber/day)
provided
assole
source
ofbreadand
cerealfor3-mon
thperiod
each
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightun
controlled,
butno
sign
ificant
difference
between
grou
ps
34%
completionrate
20 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(50)
Cho
2005
RCTparallel,
2arms/2
mon
ths
Typ
e2
30adults
Solublefiber(Cassia
tora,a
herbal
legume)
vs.
maltodextrin
Powderpacket
containing
2g
solublefiberfrom
Cassiatora
plus
200mg
a-tocop
herol,
500mgvitamin
C,
300mg
maltodextrin
vs.
3-gpacketof
maltodextrin
only
(2packets/dayfor
2mon
ths)
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightun
controlled,
butanthropo
metric
indicesdidno
tchange
71%
completionrate
(51)
Ble-Castillo
2010
RCTcrossover/4
weeks
(blin
ded
withinsubject)
(nowasho
utperiod
)
Typ
e2
28ob
eseadults
Nativebanana
starch
vs.soy
milk
24gnativ
ebanana
starch
powderper
dayvs.con
trol
of24
gsoymilk
powder,each
dissolvedin
water
Glycemicmeasures:NS
Soymilk
sign
ificantly
reduced
serum
TG(baselineto
end,
P,
0.05
)and
comparedwiththe
nativebanana
starch
(P5
0.01
2)
Weightun
controlled
(moreweigh
twas
lostwithnative
banana
starch
than
withsoymilk
)Other
treatm
entsand
medicines
werecon
trolled
Fastinginsulin
concentrationand
insulin
sensitivity
(HOMA)im
proved,
baselin
eto
endfor
native
bananastarch
grou
p(P
50.01
and
P,
0.05
,respectively)
(35)
Jenkins
2008
See“Carbo
hydrate
type:G
I”
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 21
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(52)
DeNatale
2009
RCTcrossover/4
weeks
each
(nowasho
utperiod
)
Typ
e2
18adults
HigherCHO
(higher
fiber,lower
fat
andGI)vs.h
igher
MUFA
(low
erCHO
andfiber,
higher
fatandGI)
Isocaloricdiets:
HigherCHO
vs.
high
erMUFA
(achieved)
CHO:5
1vs.4
4%Fiber:27
vs.
8g/1,00
0kcal
Fat:30
vs.3
7%MUFA:1
7vs.2
3%GI:60
vs.8
7
After
theendof
stud
y,high
er-CHO,h
igher-
fibertestmealvs.the
MUFAtestmeal:
Plasmaglucose
IAUC
decreasedun
tilthe
thirdho
ur(P
,0.05
)Sign
ificantredu
ction
ininsulin
IAUC(by
14and21
%)at3and
6h,
respectively
(P,
0.05
)Decreaseof
nearly50
%in
postprandialglycemic
variability
(P,
0.02
)FastingTC,L
DL-C,
andHDL-C
sign
ificantlyreduced,
high
erCHO
vs.
MUFA(P
,0.05
for
each)
22 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(53)
Qi2
006
Cross-sectio
nal
Typ
e2
902wom
enSemiquantitative
FFQ,p
astyear
Intake
ofcerealand
fruitfiber,dietary
GLandGI,and
markerof
insulin
sensitivity
(adipon
ectin)
GlycemicandCVD
risk
measures:
notdo
ne
Nurses’HealthStud
yWeightcontrolled
Cerealfi
berand
fruitfiberpo
sitively
associated
with
increasing
adipon
ectin(P
50.00
2andP5
0.03
6,respectively)
afteradjustingfor
confou
nding
variables
GLandGInegatively
associated
with
adipon
ectinon
lyafteradjustment
forBM
I(P
50.01
andP5
0.03
,respectively)
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 23
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(54)
Qi2
006
Cross-sectio
nal
Typ
e2
902wom
enFF
QIntake
ofwho
legrain,
bran,cerealfi
ber,
dietaryGLandGI,
andmarkersof
system
atic
inflam
mation
(CRP,
TNF)
GlycemicandCVD
risk
measures:
notdo
ne
Nurses’HealthStud
yWeightcontrolled
Decreasinglevelsof
CRPwithhigh
erintakesof
who
legrainsandbran
(Pfortrend5
0.03
,Pfortrend5
0.00
7,respectively)
Decreasinglevelsof
TNF-R2withhigh
erintakesof
who
legrains(P
for
trend5
0.01
7)Highdietaryglycem
icindexwas
associated
withsign
ificantly
increasing
trendof
CRPandTNF-R2
levels(P
fortrend5
0.04
and0.00
08,
respectively)
24 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(55)
Steembu
rgo
2009
Cross-sectio
nal
Typ
e2,
withor
witho
utthe
metabolic
syndrom
e
214adults
3-dayweighed
diet
Dietary
fiberintake
Glycemicmeasures:NS
Protective
effect
withsolublefiber
from
who
le-grain
food
sforTG,
metabolicsyndrom
evs.n
ometabolic
syndrom
e(P
50.03
)
Subjectswithbo
thdiabetes
andthe
metabolicsyndrom
ehadlower
intakesof
both
totald
ietary
fiberandsoluble
fiber,mainlyfrom
fruitsandwho
legrains(16.7g/day
vs.1
9.5,
P,
0.01
0and5.3g/day
vs.6
,P,
0.01
1,respectively)than
subjectswith
diabetes
butwith
out
themetabolic
syndrom
e(41)
And
erson
2004
See“Carbo
hydrate
type:G
I”(43)
Qi2
005
See“Carbo
hydrate
type:G
I”(56)
He20
10Prospective
coho
rt/
1980
–20
02
Typ
e2
7,82
2wom
enSemiquantitative
FFQ
(7years)
Who
legrain,cereal
fiber,bran,and
germ
Glycemicmeasures:no
tdo
ne
Inafully
adjusted
mod
el(lifestyleanddietary
variablesconsidered),
onlytheinverse
associationbetw
een
bran
intake
andCVD-
specificmortalitywas
sign
ificant
Nurses’HealthStud
y
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 25
Wheeler and Associates
Supplemen
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Tab
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Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Fat
amou
nt
(21)
Barnard
2009
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(22)
Gerhard
2004
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(29)
Rosenfalck
2006
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(23)
Wycherley
2010
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(57)
Mostad
2004
Clin
icaltrial/3
days
Typ
e2
19adultswith
hypertriglyceridemiaUsualdietvs.
low-fatdiet
Usualdiet(fat39
%)
vs.low
-fatdiet
(sub
jectsadvised
toincrease
fiber-
rich
andlow-fat
food
sandto
decrease
intake
ofvisiblefatin
anisoenergetic
manner):fat22
%
Glycemicmeasures:NS
TCandHDL-C
decreased6.3–
6.2
mmol/L
(P,
0.00
5)and1.13
–1.10
mmol/L
(P,
0.04
8)
Weightno
tcontrolled,
andnegative
energy
balance
resulted
with
redu
ctionof
fatin
diet
26 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(58)
Cop
pell
2010
RCTparallel,
2arms/6
mon
ths
Typ
e2
94adultswith
persistently
unsatisfactory
glycem
iccontrol
Intensive
dietary
advice
grou
pvs.con
trol
grou
p
Intensive
dietary
advice
grou
p,
recommendatio
nsbasedon
EASD
:CHO
45–60
→48
%Fat,30
→28
.7%
SFA,8–
10→9.7%
PUFA
10→5.6%
Proteinno
recommendation→
22.1%
Fiber40
→26
.3g/day
vs.
Con
trol:n
oadvice
CHO
→48
.5%
Fat→29
.9%
SFA→11
.3%
PUFA
→4.7%
Protein→20
.4%
Fiber→23
.5g/day
A1C
decreasedmore
inintervention
grou
p(8.9
to8.4%
)vs.
controlgroup
(stable
at8.6%
)after
adjustmentfor
baselin
evalues,age,
andsex(P
50.00
7)CVDrisk
measures:NS
Weightlosswas
apartof
intervention
Interventio
ngrou
predu
ceddiabetes
medssign
ificantly
(59)
Yip20
01RCTparallel,
3arms/12
weeks
Typ
e2
57adults
Mealreplacements
vs.exchange
dietplan
Slim
-Fast(con
taining
lactose,fructose,
sucrose)
Sugar-free
Slim
-Fast
(fructoseandsucrose
replacedwith
oligosaccharides)
Exchange
dietplan
(55–
65%
CHO,
,30
%fat,10
–20
%protein)
FBGdecreasedin
the
Slim
-Fastgrou
ps
over
timecompared
withtheexchange
dietplan
grou
p(P
50.01
2)CVDrisk
measures:NS
Weight-loss
stud
y76
%completion
rate
Nosign
ificant
differencesbetw
een
Slim
-Fastandsugar-
free
Slim
-Fast,so
they
werepo
oled
andcomparedwith
theexchange
diet
plan
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 27
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(60)
Li20
05RCTparallel,
2arms/12
mon
ths
Typ
e2
77adults
Soy-basedmeal
replacementvs.
individu
aldiet
plan
1–3meals/day
replacedwith
Slim
-Fastvs.
individualized
diet(55–
65%
CHO,,
30%
fat,
10–20
%protein).
500-calorie/day
energy
deficit.
A1C
decreased,
Slim
-Fastvs.ind
ividualized
diet,at3mon
thson
ly(P
,0.05
)FB
Gdecreased,
Slim
-Fast
vs.individu
alized
diet,
at3and6mon
ths
only(P
,0.05
)CVDrisk
measures:NS
74%
completionrate
Weight-loss
stud
y
(61)
Snell-
Bergeon
2009
Cross-sectio
nal/
case-con
trol
Typ
e1
571and69
6control
Examined
diet
variablesand
correlationwith
CHDrisk
factors
Self-administered
FFQ
A1C
correlated
with
%fat(0.07),%
saturatedfat(0.06),
%MUFA(0.06),%
CHO
(20.07
),P,
0.05
(all
correlations)
TCcorrelated
with%
fat(0.14),%
saturated
fat(0.12),%
transfat
(0.11),%
MUFA
(0.14),%
CHO
(20.14
),P,
0.00
1(allcorrelations)
LDL-Ccorrelated
with
%fat(0.15),%
saturated
fat(0.14),%
transfat
(0.12),%
MUFA
(0.16),%
PUFA
(0.06),
%CHO
(20.13
),P,
0.00
1(allcorrelations)
HDL-Cnegatively
correlated
andTG
positivelycorrelated
withGI(P
,0.05
andP,
0.00
1,respectively)
Weightcontrolled
Partof
thebaselin
eexam
inationof
the
CACTIstud
y
28 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Saturatedfat
(62)
Rivellese
2008
RCTcrossover/3
weeks
each
(washou
tperiod
notspecified)
Typ
e2
11adults
SFAvs.M
UFA
Dietsisoenergetic
bydesign
.SFA-
rich
dietgoal:
17%
SFA,1
5%MUFAvs.M
UFA-
rich
dietgoal:8
%SF
A,2
3%MUFA
Both
dietswere
design
edto
contain
46%
CHO,3
7%fat,
17%
protein,
21g
fiber.Cho
lesterol
was
428mgon
the
SFAdietand13
0mg
ontheMUFAdiet.
Glycemicmeasures:NS
Decreasein
small
VLD
Ltriglyceride
increm
entalareaafter
theMUFAdiet
(213
.66
4.7
mg/dL
at6h
vs.2
2.26
3.7mg/dL
at6h,
P,
0.00
5)
Alllunches
and
dinn
ersprovided
tosubjects
Weightun
controlled,
butno
sign
ificant
difference
inbo
dy
weight
Omega-3fattyacids
(63)
Mostad
2006
RCTparallel,
singleblind/9
weeks
Typ
e2
26adults
Fish
oilvs.
corn
oil
Fish
oilgroup
:20ml
fish
oilenriched
withom
ega-3fatty
acidsvs.cornoil
(equ
alam
ount)
FBGincreasedin
the
fish
oilgroup
(;1mmol/L
high
erthan
thecorn
oil
grou
p,P5
0.03
5)CVDrisk
measures:NS
Weightno
tsign
ificantly
changeddu
ring
intervention
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 29
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(64)
Woo
dman
2002
RCTparallel,
doubleblind/6
weeks
Typ
e2
51adults
EPA
orDHA
vs.o
liveoil
4gof
each
oil/d
ayFB
Gin
theEPA
and
DHAgrou
psincreased
1.40
and0.98
mmol/L
(P5
0.00
2foreach),
respectively,vs.olive
oil
TGin
EPA
andDHA
grou
psdecreased
19and15
%(P
50.02
2each),
respectively,vs.olive
oil
HDL-2in
theEPA
andDHAgrou
psincreased16
%(P
50.02
6)and12
%(P
50.05
),respectively,vs.
oliveoil
HDL-3decreased11
%(P
50.02
6)with
EPA
vs.o
liveoil
Weight
controlled
(65)
Pedersen
2003
RCTparallel,
doubleblind/8
weeks
Typ
e2
44adults
EPA
1DHAvs.
corn
oil
EPA
1DHA:2
.6-g
daily
in4capsules
(76%
omega-3
and3.4%
omega-6
PUFA
)vs.4
capsulesof
corn
oil(0%
omega-3
and55
.9%
omega-6PU
FA)
Glycemicmeasures:NS
HDL-Chigh
erin
fish
oilgroup
(10.07
mmol/L)vs.2
0.01
incorn
oil,P5
0.04
5TGlower
infish
oil
grou
p(2
0.53
mmol/L)vs.2
0.08
incorn
oil,P5
0.02
5LD
L-Cun
saturation
index
increasedin
fish
oilgroup
vs.cornoil
grou
p
Weight
uncontrolled
30 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(66)
Pooya20
10RCTparallel,
doubleblind/2
mon
ths
Typ
e2
81adults
Omega-3fatty
acidsvs.con
trol
ofsunfl
ower
oil
Omega-3fattyacid
capsules/day
(1,548
mgEPA
,82
8mgDHA,
338mgother
omega-3fatty
acid)vs.con
trol
capsules/day
(2,100
mg
sunfl
ower
oil,
12%
SFA,7
1%lin
oleicacid,
15%
MUFA)
A1C
decreasedin
omega-3fattyacid
grou
p(2
0.75
%)vs.
0.26
incontrol,P,
0.00
1CVDrisk
measures:NS
Weightun
controlled
(67)
Hartweg
2009
Meta-analysis/
1966
–20
08Typ
e2
24trials
1,53
3adults
Fish
oil,om
ega-3
fattyacid,P
UFA
,EPA
,DHAvs.
placebo/control
Average
daily
intake
offish
oild
uring
totalp
eriodwas
;2.4gom
ega-3
PUFA
sover
24weeks
forthe7
stud
iesadded
2007
–20
08
Glycemicmeasures:NS
TGdecreasedwith
omega-3PU
FA
supplem
entation
by7%
(mean20.17
mmol/L;2
4trials;
1,53
0participants)
vs.con
trol
(P,
0.00
01)
LDL-Cincreasedwith
omega-3PU
FAby
3%(m
ean0.08
mmol/L;2
1trials;
1,10
4participants)
vs.con
trol
(P5
0.00
6)
Ofthe23
stud
ies
includedin
the
meta-analysis,6
meeting
this
system
aticreview
criteriawere
publisheddu
ring
thesystem
atic
review
timeperiod
(Mostad[63],
Woo
dman
[64],
Pedersen
[65],
Petersen
[68],
Kabir[69],and
Shidfar[70])
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 31
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(68)
Petersen
2002
RCTparallel,
doubleblind/8
weeks
Typ
e2
42adults
Fish
oilvs.
corn
oil
4gdaily
ofeither
fish
oilo
rcorn
oil
Glycemicmeasures:NS
TGdecreased0.54
mmol/L
infish
oilgroup
vs.0
.04
mmol/L
incorn
oil
grou
p,P5
0.02
5HDL-2a
redu
ction
was
smallerin
the
fish
oilgroup
than
inthecorn
oilgroup
(P5
0.00
7)
Weightcontrolled
(69)
Kabir20
07RCTparallel,
doubleblind/2
mon
ths
Typ
e2
27po
stmenop
ausal
wom
enFish
oilvs.
paraffinoil
Fish
oilcapsules:
3g/day
(1.8
gom
ega-3PU
FAs:
1.08
gEPA
10.72
gDHA)vs.
paraffinoil
capsules:3g/day
Glycemicmeasures:NS
TGandratioof
TG-to-HDL-C
(atherogenicindex)
werelower
inthefish
oilgroup
than
inthe
paraffinoilgroup
(P,
0.03
foreach)
Bodyweigh
tun
changed
(70)
Shidfar
2008
RCTparallel,
doubleblind/10
weeks
Typ
e2
50adults
omega-3fatty
acidsvs.
control
omega-3fattyacid
capsules:52
0mg
EPA
148
0mg
DHAdaily
vs.
controlcapsules:
300mgSF
A,
100mgMUFA,
600mglin
oleic
acid
Glycemicmeasures:NS
TGdecreasedby
31%
andTG-to-
HDL-Cratio
decreasedfor
omega-3grou
pvs.
control(P5
0.01
andP5
0.04
,respectively)
Weightcontrolled
32 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(71)
Kesavulu
2002
Clin
icaltrial,
singlearm/2
mon
ths
Typ
e2
34adults
EPA
1DHA
1,08
0mgEPA
172
0mgDHA
daily
Glycemicmeasures:NS
HDL-Cincreased,
0.93
mmol/L
before
vs.
1.04
mmol/L
after
therapy(P
,0.01
)TGdecreased,
2.07
mmol/L,b
eforevs.
1.54
mmol/L
after
therapy(P
,0.05
)VLD
L-Cdecreased
aftertreatm
ent
(P,
0.05
)(73)
Belalcazar
2010
Prospective
coho
rt/
baselin
eand
1year
Typ
e2
2,39
7FF
QMarineom
ega-3
fattyacid
intake
basedon
8lin
eitem
sin
theFF
Qinqu
iringabou
tseafoo
dconsumption
A1C
:noassociation
atbaselin
eBaselin
emarine
omega-3fattyacid
intake
was
1626
138mg/dandwas
inverselyassociated
withTGs(P
,0.00
1)
Weightlosswas
agoal
ofRCTfrom
which
thedatacame
(Loo
kAHEAD)
1-year
marineom
ega-3
fattyacid
andfried
fish
intake
decreased
withtheintensive
lifestyleintervention
(P,
0.00
1)Protein
(25)
Ganno
n20
03See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 33
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(74)
Parker
2002
RCTparallel/12
weeks
(8-w
eeks’
weightloss
intervention
14-weeks’weight
maintenance)
Typ
e2
54adults
Higherproteinvs.
lower
protein
Higher-protein
diet:
CHO
40→42
.1/
42.6%†
Fat30
→27
.8/27.6%
Protein30
→28
.1/
27.7%
vs.
Lower-protein
diet:
CHO60→54.8/55.0%
Fat2
5→26.3/26.7%
Protein15→16
.4/
16/0%
Fattyacid
%same
inboth
diets
Glycemicmeasures:NS
TCandLD
L-Cwere
lower
after12
weeks
inthehigher-
proteingrou
pvs.
lower-protein
grou
p(P
50.00
9for
diet-by-time
interaction)
Weight-loss
stud
ySomefood
supplied
Fiberintake
sign
ificantlyhigh
erin
thelower-protein
grou
pdu
ringweight
losspartof
thestud
ySeeBrinkw
orth
2004
fora1-year
follo
w-
upof
thestud
y
(24)
Brinkw
orth
2004
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(23)
Wycherley
2010
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
34 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Protein/diabetickidney
disease
(75)
Pijls
2002
RCTparallel,
physician
blinded/24
mon
ths
Typ
e2with
micro-or
macroalbu
minuria,
orwith
diabetes
.5years
131adultswith
afollo
w-upof
.12
mon
ths
Lower-protein
dietvs.u
sual-
proteindiet
Lower-protein
grou
p:p
rotein
0.8g/kg/day→
1.11
g/kg/day
(at24
mon
ths)
vs.
Usual-protein
grou
p:p
rotein
1.07
g/kg/day
achieved
at24
mon
ths
Glycemicmeasures:
notdo
ne
CVDrisk
measures:
notdo
ne
Weightno
tcontrolled
59%
retention
rateat
24mon
ths
Nosign
ificant
differencesbetw
een
grou
psforGFR
oralbu
minuria
(76)
Melon
i20
04RCT parallel/
1year
Typ
es1(24)
and
2(56)
with
macroalbu
minuria
80adults
Lower-protein
dietvs.free-
proteindiet
Lower-protein
diet:p
rotein
0.8g/kg/day
→0.86
g/kg/day
vs.
Free-protein
diet:p
rotein
1.24
g/kg/day
achieved
Glycemicmeasures:NS
CVDrisk
measures:NS
Meanbo
dyweigh
tdecreased
sign
ificantlyin
lower-protein
grou
pvs.free-protein
grou
pNosign
ificant
difference
inrenal
functio
n(GFR,A
ER)
betweengrou
ps
Nosign
sof
malnu
trition
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 35
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(77)
Hansen
2002
RCT parallel/
4years
Typ
e1with
macro-
albu
minuria
72(at1year)
adults
Lower-protein
dietvs.u
sual-
proteindiet
Lower-protein
grou
p:p
rotein
0.6g/kg/day→
0.89
g/kg/day
(range
0.83
–0.95
g)vs.
Usual-protein
grou
p:p
rotein
achieved
1.02
g/kg/day
(range
0.95
–1.1g)
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightno
tcontrolled,
butno
sign
ificant
difference
betweengrou
ps
Nosign
ificant
difference
between
grou
psfor
albu
minuriaor
GFR
(78)
Dussol
2005
RCT parallel/
2years
Typ
es1and2
41adultswith
micro-
albu
minuria,
6with
macroalbu
minuria
Lower-protein
dietvs.u
sual-
proteindiet
Lower-protein
grou
p(actual):16
63%
kcalas
protein
vs.u
sual-protein
grou
p(actual):
196
4%kcalas
protein.
How
ever,
calculated(M
aron
iform
ula)as
gprotein/kg/day,the
lower-protein
grou
p(0.8
g/kg/day
prescribed)at
baselin
e,12
mon
ths,
and24
mon
thswas
1.08
,1.02,
1.10
vs.
theusual-protein
grou
p(1.13,
1.18
,1.03
)
Glycemicmeasures:NS
CVDrisk
measures:NS
75%
completionrate
Duringstud
y,bo
dyweightandserum
albu
min
were
similarbetw
een
grou
ps
Nosign
ificant
difference
between
grou
psforGFR
,AER,o
rurinary
urea
excretion
Allsubjectsun
derstrict
bloo
dpressure
control
36 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(79)
Pan20
08Meta-analysis/
1966
–20
07/
duration
.6
mon
ths
Typ
es1and
2with
macro-
albu
minuria
8studies/
519adults
Lower-protein
dietsvs.
control(usual
protein)
Lower-protein
grou
ps:average
proteinintake
0.91
g/kg/day
vs.
usual-protein
grou
ps:average
proteinintake
1.27
g/kg/day,
P5
0.04
for
difference
A1C
decreased
sign
ificantly,
lower
protein
vs.con
trol
(weigh
tedmean
difference,
0.31
%)
CVDrisk
measures:
notdo
ne
Ofthe8studies
includedin
the
meta-analysis,4
werepu
blished
during/after
2001
andareincludedin
thissystem
atic
review
(Pijls[75],
Melon
i[76
],Hansen
[77],andDussol
[78])
Overall,
achange
inweightedmean
difference
for
GFR
orcreatinine
clearanceratewas
notsign
ificantly
associated
with
alower-protein
diet
Altho
ugh
thebenefit
oflower-protein
diet
therapyon
proteinu
riawas
sign
ificant
(P,
0.00
3),great
heterogeneity
was
observed
Inasubgroup
analysis,
thechange
inthe
weightedmean
difference
forserum
albu
min
was
sign
ificant
(reductionof
1.18
g/L;
95%
CI:21.33
to1.03
g/L)
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 37
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(80)
Rob
ertson
2007
Meta-analysis/
beginningof
databases
searched
throug
hJuly
2006
/duration
.4mon
ths
Typ
es1and
2with
macroalbu
minuria
12stud
ies/
585adults
Mod
ified/
restricted-
proteindiets
vs.con
trol
Lower-protein
diet:actual
intake
0.7–
1.1g/kg/day
vs.u
sual-
proteindiet:
actualintake
1–2g/kg/day
Glycemicmeasures:NA
CVDrisk
measures:NA
CochraneLibrary
Ofthe12
stud
ies
includedin
the
meta-analysis,3
werepu
blished
during/after
2001
andmetthis
system
aticreview
criteria(Pijls[75],
Melon
i[76
],and
Hansen[77]).
Nosign
ificant
difference
between
lower-protein
and
usual-protein
dietsforGFR
38 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(81)
Gross 2002
RCTcrossover,
3arms/4
weeks
each
(4-w
eek
washo
ut
period
s)
Typ
e2
28adults(15with
norm
oalbuminuria
and13
with
microalbu
minuria
Usualdiet
(meat)vs.
chickendiet
vs.low
er-
protein/
vegetarian
diet
Usualdiet(m
eat):
protein1.2–
1.5g/kg/day
→1.43
g/kg/day
vs.
Chicken
diet
(usual-diet
meatreplaced
bychickenlegs):
protein1.2–
1.5g/kg/day
→1.35
g/kg/day
vs.
Lower-protein,
vegetarian
diet
(protein
from
milk
and
vegetable
sourceson
ly):
protein0.5–
0.8g/kg/day
→0.66
g/kg/day
Glycemicmeasures:NS
TCsign
ificantly
lower
after
chickendiet
andlow-protein/
vegetarian
diet
ascompared
withusualdiet
(P,
0.05
)in
microalbu
minuric
subjectson
ly
Weightno
tcontrolled;
energy
intake
andweight
sign
ificantlylower
during
thelow-
protein/vegetarian
dietthan
other
2diets
GFR
sign
ificantlylower
afterlow-protein/
vegetarian
diet
comparedwith
other
2diets
(P,
0.05
),microalbu
minuric
subjectson
lyUAER(in
microalbu
minuric
subjectson
ly)
sign
ificantlylower
afterchickendiet
comparedwith
other
2diets,
P,
0.05
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 39
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(82)
Teixeira
2004
RCT crossover/8
weeks
each
(4-w
eek
washo
ut
period
)
Typ
e2with
macroalbu
minuria
14men
Isolated
soy
proteinvs.
casein
0.5g/kg/day
isolated
soy
proteinpo
wder
vs.0
.5g
protein/kg/day
casein
powder
Glycemicmeasures:NS
HDL-Csign
ificantly
increased0.04
mmol/L
after
isolated
soy
protein(P
50.00
41);
decreased
0.03
mmol/L
aftercasein
(P5
0.08
47);effectof
dietdepend
edon
baselin
eHDL-C
(P5
0.03
91for
interaction)
with
larger
differences
betw
eentreatm
ents
inmen
withhigher
baselin
eHDL-C
41%
completion
rate
Nodifferencesin
BMI
bystudy
period
(multipleregression
)Su
bjectsaddedprotein
powdersdu
ring
the
intervention
period
sinsteadof
substituting
foro
ther
proteins
asinstructed
UACsign
ificantly
decreasedafter
isolated
soyprotein
dietvs.casein(P
,0.00
1)with
larger
differencesbetw
een
dietsin
men
with
higher
baselin
eUAC
40 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(83)
Azadb
akht
2008
RCTparallel/
4years
Typ
e2with
macroalbu
minuria
41adults
Soyprotein
vs.con
trol
Soyprotein
grou
p:0
.8g
protein/kg/
day(35%
anim
alprotein,
35%
textured
soy
protein,
30%
vegetable
protein)
prescribed.
Proteinachieved
was
55–57
g/day
(617
–23
)vs.
controlgroup
:0.8gprotein/
kg/day
(70%
anim
alprotein,
30%
vegetable
protein)
prescribed.
Protein
achieved
was
55–58
g/day
(617
–23
)
FBGmean
change
insoy
grou
p218
mg/dL
vs.1
11mg/dL
incontrol(P5
0.03
)TCmeanchange
insoygrou
p223
mg/dL
vs.
110
mg/dL
incontrol(P5
0.01
)LD
L-Cmeanchange
insoygrou
p220
mg/dL
vs.1
6mg/dL
incontrol(P5
0.01
)TGmeanchange
insoygrou
p224
mg/dL
vs.2
5mg/dL
incontrol(P5
0.01
)
Weightcontrolled
inanalyses
CRPmeanchange
insoygrou
p21.31
mg/dLvs.1
0.33
mg/dLin
control
(P5
0.02
)Sign
ificant
improvem
entin
proteinu
ria(2
0.15
vs.0
.02g/day,P
50.00
1)soyvs.
control;ho
wever,
thesign
ificance
disappeared
after
controlling
for
changesin
thebloo
dlip
idprofi
le
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 41
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(84)
deMello
2006
RCTcrossover,
3arms/4weeks
each
(4-w
eek
washo
ut
period
s)
Typ
e2
17adultswith
macroalbu
minuria
SeeGross
2002
SeeGross,2
002.
Usualdiet:p
rotein
17–25
→21
.9%
vs.
chickendiet:
protein17
–
25→21
.2%
vs.
lower-protein/
vegetarian
diet:
0.5–
0.8g/kg/
day→
11.6%
kcal
Glycemicmeasures:NS
TGsign
ificantly
lower
after
chickendietvs.
usualdietor
lower-protein/
vegetarian
diet
(P5
0.01
2)
43%
completion
rate(m
ost
excludedfor
revertingto
microalbu
minuria)
Weightno
tcontrolled;
BMIandenergy
intake
sign
ificantly
lower
afterlower-
protein/vegetarian
dietthan
other
2diets
Nosign
ificant
difference
amon
ggrou
psforGFR
UAERsign
ificantly
lower
afterchicken
andlower-protein/
vegetarian
diets
comparedwith
usualdiet,P,
0.00
1Nuts
(85)
Ma 20
10RCTcrossover,
singleblind/
8weeks
each
(8-w
eek
washo
ut
period
)
Typ
e2
21adults
Walnu
ts56
gshelled,
unroasted
Eng
lishwalnu
ts/
dayisocalorically
substitutedfor
food
sin
anad
libdietvs.adlib
diet
Glycemicmeasures:NS
CVDrisk
measures:NS
Walnu
tsprovided
tosubjects
End
othelialfun
ction
(flow
-mediated
dilation
)im
proved
sign
ificantlyafter
consum
ptio
nof
thewalnu
t-enriched
dietcomparedwith
theno
walnu
tdiet
(2.2
61.7%
vs.
1.26
1.6%
,P5
0.04
)
42 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(86)
Tapsell
2004
RCTparallel,
3arms/6
mon
ths
Typ
e2
55adults
Lower-fat
dietsvs.
lower-fat
diet1
walnu
ts
Lower-fatdiet:
,30
%fat,with
portion
controlledCHO
coun
ting
meal
plansandgeneral
dietaryadvice
for
reducingtotal
andSF
Avs.
mod
ified
lower-
fatdiet:sam
eas
lower-fatdietbu
twithmore
structured
advice,
mealp
lansbased
onenergy
requ
irem
ents,
andexchange
lists
forMUFA
and
PUFA
vs.m
odified
lower-fatdiet1
30g/daywalnu
ts
Glycemicmeasures:NS
The
walnu
tgrou
pachieved
asign
ificantly
greaterincrease
inHDL-C-to-total
cholesterolratio
(P5
0.04
9)and
HDL-C(P
50.04
6)than
the
2other
treatm
ent
grou
ps
Walnu
ts(highin
PUFA
)provided
tosubjects
Gillen
2005
contains
dietaryvariables
anddietarygoals
outcom
einform
ation
(87)
Gillen 2005
SeeTapsell
2004
Targetrangesof
,10
%SF
A,
.7%
PUFA,
2.22
gALA
,0.65
gDHA,and
omega-6:om
ega-3
ratio,10
Prim
aryou
tcom
esforthisstud
yweredietary
variablesand
goals.See
Tapsell20
04forstud
ydetails
and
clinical
outcom
es
100%
ofindividu
als
inthewalnu
tgrou
preached
desiredintakes
forSF
As(P
,0.01
),totalP
UFA
(P,
0.00
1),and
omega-6:om
ega-3
ratio
(P,
0.05
)at3and6mon
ths.
Other
grou
pswere
notsuccessful
inachievingtargets
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 43
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(30)
Lovejoy
2002
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(88)
Mantzoros
2006
Cross-sectio
nal
Typ
e2
987wom
enMediterranean-
dietpattern
determ
ined
from
FFQ
(current
dietarydata
and4FF
Qs
from
thepast
10years)
Patternassessed
by0–
9po
int
scale:1po
int
givenifintake
abovemedian
forfish,fruit,
legu
mes,n
uts,
PUFA
:SFA
ratio,
vegetables,w
hole
grains;below
medianforred/
processedmeat
andifalcohol
intake
5–15
g/day
Glycemicmeasures:NS
HDL-Chigh
erin
highesttertile
ofadherence
toMediterranean
dietas
compared
tolower
2tertiles
(P5
0.03
)TGlower
inhigh
est
tertile
ofadherence
toMediterranean
dietas
compared
tolower
2tertiles
(P5
0.04
)
Nurses’HealthStud
yAdipon
ectin:
a.high
esttertile
ofadherence
toMediterranean
diet
over
10yearshad
adipon
ectinlevels
25.9%
higher
than
lowesttertile
controlling
forage
andtotalenergy
intake,P
,0.01
for
trendacross
tertiles
b.sign
ificant
independent
effects
byalcoho
l,nu
ts(12%
high
erlevelsin
highestnu
tintake
quintilecomparedto
lowest)andwho
legrains(22%
high
erlevelsin
high
est
intake
quintile
comparedto
lowest)
c.no
effectforfruit,
vegetables,fi
sh,
legumes,red/
processedmeats,
protein,
total
carboh
ydrate,total
fat,fiber,or
PUFA
/SFA
44 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(89)
Li20
09Prospective
coho
rtTyp
e2
6,30
9wom
enNutconsumption
from
FFQ
every2–
4years
between19
80and20
02
Dietary
intake
measure
ofnu
t(nuts
orpeanut
butter)
consumption
Glycemicmeasures:
notdo
ne
Increasingnu
tconsumptionwas
sign
ificantly
associated
withamore
favorable
plasmalip
idprofi
le,including
lower
LDL-C,
non-H
DL-C,
TC,and
apolipop
rotein-
B-10
0concentrations
Nurses’Health
Stud
yAfter
adjustmentfor
conv
ention
alCVD
risk
factors,
consum
ptio
nof
atleast5-servings/
weekof
nutsor
peanut
butter
(serving
size,2
8-g
[1oz.]fornu
tsand
16-g
[1tablespoo
n]
forpeanut
butter)
was
sign
ificantly
associated
with
alower
risk
ofCVD
(relativerisk
50.56
;95
%CI:0.36
–0.89
)Wholegrains
(48)
Vuk
san
2007
See “C
arbo
hyd
rate
type:
dietaryfiber”
(47)
Lu20
04See“Carbo
hydrate
type:d
ietary
fiber”
(54)
(56)
Qi2
006,
He20
10See“Carbo
hydrate
type:d
ietary
fiber”
(88)
Mantzoros
2006
See“N
uts”
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 45
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Legumes
(91)
Pipe20
09RCTcrossover,
double
blind/57
days
each
(28-day
washo
ut
period
)
Typ
e2
29adults
Soyprotein
isolatevs.
milk
protein
isolate
supp
lements
Subjects
supp
lemented
usuald
ietwith
either
soyor
milk
protein
isolates.D
aily
packetsof
supp
lements
contained
200kcal;
8–9gCHO;
40gprotein
from
isolated
soyproteinor
milk
(caseinand
whey)
protein;
1gfat;1–
10mg
cholesterol;
1,40
0–1,60
0mg
calcium.T
hesoy
proteincontained
88mgisofl
avon
es(65%
genistein,
31%
daidzein,
4%glycitein)
and
themilk
protein
contained0mg
isofl
avon
es
Glycemicmeasures:NA
LDL-Cdecreased
withsoy
interventio
nfrom
2.95
to2.78
mmol/L
vs.m
ilk(P
50.04
)LD
L-C:HDL-Cratio
decreasedwithsoy
interventio
nvs.
milk
(P5
0.02
)
Bodyweigh
tdidno
tdiffer
betweenperiod
s
(92)
Gob
ert
2010
SeePipe20
09forstud
ydesign
details
Glycemicmeasures:NS
CVDrisk
measures:
notdo
ne
46 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(93)
Hermansen
2001
RCTcrossover,
doubleblind/
6weeks
(3-w
eek
washo
ut
period
)
Typ
e2
20adults
Soyprotein
vs.casein
Soyprotein
(Abalon):
50gisolated
soyprotein
(.16
5mg
isofl
avon
es)
and20
gcotyledon
fiber
vs.con
trol:5
0g
casein
and20
gcellu
lose
Glycemicmeasures:NS
TClower
after
Abalonthan
after
control(5.11
vs.5
.45mmol/L,
P,
0.01
)LD
L-Clower
after
Abalonthan
after
control(3.01
vs.
3.33
mmol/L,
P,
0.01
)
Weightcontrolled
(94)
Kim 20
05RCTparallel,
double
blind/13
weeks
Typ
e2
30adults
Soybean-
derivedpinitol
vs.lactose
Soybean-derived
pinitol:6
00-m
goraldo
se,twice
daily
vs.lactose:
twicedaily
Glycemicmeasures:NS
CVDrisk
measures:NS
Nosign
ificant
difference
inBM
Ibetweengrou
psat
baselin
e,andno
change
over
course
ofstud
y(50)
Cho 20
05See“Carbo
hydrate
type:d
ietary
fiber”
(95)
Fujita
2001
RCTparallel,
double
blind/3
mon
ths
Typ
e2
36adults
Ferm
ented
soybean-
derived
Tou
chiextract
vs.steam
edsoybean-
derived
control
Both
supplem
ents
incorporated
into
powdered
tea.Su
bjects
mixed
teawith
water
anddrank
1cupwith
each
meal.Eachcup
ofteacontained
0.3gsupp
lement
A1C
lower,T
ouchi
vs.con
trol
(5.6
vs.6
.2%,
P,
0.05
)FB
Glower,T
ouchi
vs.con
trol
(6.4
vs.
7.1mmol/L,
P,
0.05
)CVDrisk
measures:NS
Weight
uncontrolled,b
utno
significant
difference
between
grou
ps
(60)
Li20
05See“Fatam
ount”
(52)
DeNatale
2009
See“Carbo
hydrate
type:d
ietary
fiber”
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 47
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(96)
Jayagopal
2002
RCTcrossover,
doubleblind/
12weeks
each
(2-w
eekwasho
ut
period
)
Typ
e2
32po
stmenop
ausal
wom
en
Soy ph
ytoestrogen
vs.p
lacebo
243-kcalpacket
containing
30g
isolated
soy
proteinwith
132mg
isofl
avon
es(53%
genistein,3
7%daidzein,1
0%glycitein)
vs.
placebo
(microcrystalline
cellu
lose),
nokcal
A1C
decreased,
soyvs.p
lacebo
(20.64
vs.1
1.08
%,
P5
0.04
8)Fastingserum
insulin
decreased,
soyvs.
placebo(2
8.09
vs.
19.92
%,P
50.00
6)TCdecreased,
soyvs.
placebo(2
4.07
vs.
12.83
%,P
50.00
4)LD
L-Cdecreased,
soyvs.p
lacebo
(27.09
vs.1
5.35
%,
P5
0.00
1)
Weight
uncontrolled,b
utno
change
inweightdu
ring
stud
yCaloriedifference
betweensoyand
placebowas
aconfou
nding
factor
astherewas
noassessmentof
dietor
statistical
controlfor
calorie
intake
HOMA-IRdecreased,
soyvs.p
lacebo
(26.27
vs.1
14.7%,
P5
0.00
3)(97)
Gon
zález
2007
RCTcrossover,
doubleblind/
12weeks
each
(4-w
eek
washo
ut
period
)
Typ
e2
26po
stmenop
ausal
wom
en
Isofl
avon
esvs.p
lacebo
Tabletwith
132mg
isofl
avon
es(53%
genistein,3
7%diadzein,1
0%glycitein)
vs.
placebotablet
(cellulose)
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightno
tcontrolled
48 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(98)
How
es20
03RCTcrossover,
doubleblind/
4weeks
each
(4-w
eek
washo
ut
period
)
Typ
e2
16po
stmenop
ausal
wom
en
Isofl
avon
esfrom
red
clover
vs.
control
2isofl
avon
etablets(25mg
form
onon
etin,
2.5mgbiochanin,
,1mggenistein
anddaidzein
per
tablet)vs.con
trol
tablets
Glycemicmeasures:NS
CVDrisk
measures:NS
Weightno
tcontrolled,
butno
sign
ificant
differencesbetw
een
period
sNodescriptio
nof
contentof
control
tablets(exceptno
isofl
avon
es)
Bloo
dpressure
and
endo
thelialfunctio
nweremainou
tcom
esstud
ied
Vegetablesan
dfruits
(99)
Sobenin
2008
RCTparallel,
double
blind,
4arms/4
weeks
Typ
e2
34adults
Garlic
powder
(Allicor)vs.
control
Group
1:mon
otherapy
with30
0mg
ofAllicortwice
adayor
control
withoral
diabetes
medications
discon
tinu
edGroup
2:same
exceptthatoral
diabetes
medications
continued
Serum
fructosam
ine
decreased
sign
ificantly,
Allicorvs.
control,bo
thmon
otherapy
andcombined
therapy(P
,0.05
)CVDrisk
measures:NS
Weightno
tcontrolled
Group
1:FB
G#8
mmol/L;G
roup
2:FB
G.8mmol/L
Con
trol
isno
tdescribed,somay
notbe
aplacebo
TGdecreased
sign
ificantlyin
Allicorgrou
p,baselin
eto
endof
stud
y,bo
thmon
otherapy
and
combinedtherapy
(P,
0.05
)(52)
DeNatale
2009
See“Carbo
hydrate
type:d
ietary
fiber”
(88)
Mantzoros
2006
See“N
uts”
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 49
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Dairy
(100
)Moh
amad
2009
RCTparallel/
16weeks
Typ
e1
54youn
gadults
(17–
20years)
Cam
elmilk
Con
trol
grou
preceived
usual
care
vs.u
sual
care
150
0mL
daily
ofcamel
milk
Cam
elmilk
grou
pvs.u
sualcare
grou
p:A1C
,FB
G,anddaily
insulin
dose
sign
ificantly
lower
(7.16
vs.9
.59%
,99
vs.2
27mg/dL,
23vs.4
8un
its,
respectively),
allP
,0.00
1CVDrisk
measures:NS
Weightno
tcontrolled(BMI
sign
ificantlyhigh
erin
camelmilk
grou
pvs.u
sualcare
grou
p)(24.3vs.18.4kg/m
2)
(101
)Sh
ahar
2007
Ancillary
stud
yof
anRCT
Typ
e2
259adults
Dairy
calcium
3isocaloricdiets
wereassessed
forcalcium
intake:
1.mixed
GICHO
2.lower
GI
3.mod
ified
Mediterranean
Glycemicmeasures
(A1C
,FBG
):NS
CVDrisk
measures:NS
Stud
yfoun
dno
association
betweendairy
calcium
intake
andother
diabetes/
CVDdiseaseindexes
(91)
Pipe 2009
See“Legum
es”
(92)
Gob
ert
2010
See“Legum
es”
(93)
Hermansen
2001
See“Legum
es”
(94)
Kim
2005
See“Legum
es”
Meats,p
oultry,andfish
(81)
Gross 2002
See“Protein”
50 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
numbe
rAuthor/
year
Studytype/
duration
Diabetes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(84)
deMello
2006
See“Protein”
(102
)Qi2
007
Prospective
coho
rtType2
6,16
1wom
enRed
meatintake
Red
meatand
hemeiron
(intake
assessed
ascumulative
averagefrom
FFQs
1980
,198
4,19
86,
1990
,199
4,and
1998
;FFQ
asked
abou
tintake
frequencyand
amou
ntover
past
year;red
meat
definedasbeef,pork,
orlambasmaindish,
beefas
asandw
ichor
mixed
dish,
hambu
rger,h
otdo
g,processed
meat,or
bacon
Glycemicmeasures:
notdo
ne
CVDrisk
measures:
notdo
ne
Nurses’HealthStudy
Highhemeiron
andredmeatintakes
wereassociated
with
high
intakesof
saturatedfat,low
intakesofcerealfiber
andvitamin
C,and
lowdietaryGL
After
adjustmentfor
ageandBM
I,high
intakesof
both
heme
iron
andredmeat
wereassociated
with
asign
ificantly
increasedrisk
offatal
CHD,coron
ary
revascularization
,andtotalC
HD
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 51
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(103
)Möllsten
2001
Case-control
Typ
e1with
micro-/
macro-
albu
minuria
75case
and
225control,
youth
Fish
fatand
protein
Fish
intake:
FFQ
forpast
12mon
ths
Glycemicmeasures:
notdo
ne
CVDrisk
measures:
notdo
ne
Highconsumersof
fish
protein(m
ean
intake
9.35
gfish
protein/day,i.e.,
approxim
ately53
gfish/day)hadlower
oddsratios
for
microalbu
minuria
than
individu
als
consum
ingless
fish
protein(m
ean2.72
g/day)
Whenfish
proteinand
fatwereadjusted
for
each
other,a
high
intake
offish
protein
butn
otoffish
fatw
asstill
sign
ificantly
associated
with
adecrease
inthe
risk
for
microalbu
minuria
52 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Med
iterraneandiets
(104
)Esposito
2009
RCTparallel/
4years
Typ
e2
195adults
Lower
CHO
Mediterranean
dietvs.low
er-
fatdiet
(American
HeartAssociation
guidelines)
Lower-CHO
Mediterranean-
stylediet:richin
vegetables,w
hole
grains,with
poultryandfish
replacingred
meats;goal,
50%
CHO
and$30
%fat;achieved
44.2%
CHO,1
0%SF
A,
17.6%
MUFA,
11.5%
PUFA,
18%
proteinvs.
Lower-fatdiet:rich
inwho
legrains,
restricted
inadded
fats,sweets,and
high
-fatsnacks;
goal,30
%fat,
,10
%SF
A;
achieved:5
1.8%
CHO,9
.4%
SFA,
12.4%
MUFA,
7.6%
PUFA
,17
.9%
protein
A1C
andFB
Gsign
ificantly
lower
inlower-
CHO
Mediterranean
dietvs.low
er-fat
diet,all4years
HDL-Cincreased
sign
ificantlyand
TGdecreased
sign
ificantly,lower-
CHO
Mediterranean
dietvs.low
er-fatdiet,
all4
years
Weight-lossstud
yIncrease
infatin
lower-CHO
Mediterranean
diet
was
from
30–50
goliveoil
Prim
aryou
tcom
e(tim
eto
antih
yperglycem
ictherapy):after
4years,44
%of
patientsin
lower-CHO
Mediterranean–diet
grou
prequ
ired
treatm
entvs.7
0%in
lower-fat-dietgrou
p
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 53
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(105
)Karantonis
2006
RCTparallel/
4weeks
Typ
e2
45adults
Mod
ified
Mediterranean
fast-foo
d–type
diet(usingfood
shighestin
platelet
anti-aggregatin
gactiv
ity)vs.
control
(traditio
nal
Greek
Mediterranean
fast-foo
ddiet)
Mod
ified
fast
food
sincluded
macaron
iand
cheese,chicken
fillet,pitabu
rger,
chef’ssalad,
potato
salad:5
0%CHO,3
8%fat
(13%
SFA,1
7%MUFA,8
%PU
FA),
16.5%
protein,
22gfiber(end
-of-
stud
yvalues)vs.
controld
iet
includedfastfood
ssuch
asroasted
meat/fish
with
potatoes,b
eef
andmacaron
i,carrot
andcabb
age
salad:5
3%CHO,
24%
fat(12%
SFA,7
%MUFA,
4%PU
FA),25
%protein,
16g
fiber(end
-of-
stud
yvalues)
Glycemicmeasures:NS
CVDrisk
measures:NS
Seecommentsin
Antonop
oulou
2006
54 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(106
)Anton
o-po
ulou
2006
RCTparallel/
4weeks
Typ
e2
47adults
Mod
ified
Greek
Mediterranean
dietusingfood
shighestin
plateletactivating
factor
antagonists
vs.con
trol
(typ
icalGreek
Mediterranean
diet)
Mod
ified
diet
includedfood
ssuch
ascodfi
shsoup
,beefand
friedpo
tato,
chickenand
gumbo
,and
lettucesalad.
Tradition
aldietincluded
food
ssuch
asbo
iledchicken
andrice,roasted
fish
andpo
tato
Mod
ified:5
0%CHO,3
8%fat
(10%
SFA,2
1%MUFA,4
%PU
FA),15
%protein(prescribed)
vs.typ
ical:5
0–55
%CHO,2
0–25
%fat
(7%
SFA,1
2%MUFA,2
.4%
PUFA
),25
%protein
Glycemic
measure
(FBG):NS
CVDrisk
measures:NS
Food
swere
provided
toall
participantsdu
ring
thestud
y,isocaloric
totypicaldiets
previous
tostud
ySign
ificant
reductio
nin
platelet-activating
factor
andadenosine
5diph
osph
ate-
indu
cedaggregation
ofplateletson
the
mod
ified
dietbu
tno
change
onthe
typicald
iet
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 55
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(107
)Aronis
2007
RCTparallel/
4weeks
Typ
e2
35adults
Fast-foo
dMediterranean–
type
diet(m
eals
withmost
potentin
vitro
antioxidative
activ
ity)vs.
control
(traditio
nal
Greek
fast-
food
diet)
Mediterranean
fastfood
sincluded
macaron
iwith
cheese
and
tomatopaste,
hambu
rger,
chef’ssalad,
kidneybean
salad:5
3%CHO,
43%
fat(15%
SFA,1
9%MUFA
,9%
PUFA
),16
%protein,
23g
fiber(end
-of-stud
yvalues)vs.con
trol:
53%
CHO,2
4%fat(12%
SFA,7
%MUFA,4
%PU
FA),
25%
protein,
16g
fiber(end
-of-stud
yvalues)
Glycemicmeasures:NS
CVDrisk
measures:NS
Food
swere
provided
forbo
thgrou
psof
subjects,
isocaloricto
typical
dietsprevious
tostud
yDiabetesoralagents
wereun
changed
during
thestudy
Plasmaoxidationlag
timeincreased
sign
ificantlyin
fast-
food
grou
pbu
tdid
notchange
incontrolgroup
(52)
DeNatale
2009
See“Fiber”
56 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
(108
)Ciccarone
2003
Case-control
Typ
e2
144cases
withPA
D/288
controls(no
macrovascular
complications,
adults)
Mediterranean
dietscoring
ofaFF
Q
Scoring:1po
int
forvegetables
($3tim
es/week),
fruits($
7tim
es/
week),fi
sh($
1times/week),
oliveoil(1–
2times/day),
alcoho
l(#3
glasseswine/day),
eggs
(#2tim
es/
week),m
eat(#
2times/week),
processedmeat
(0tim
es/week),
cheese
(#2
times/week)
Glycemicmeasure
(A1C
):NS
CVDrisk
measures:
notdo
ne
BMIcontrolledin
multiv
ariate
analyses
Inmultiv
ariateanalysis,
highestdietaryscore
(111
points)
sign
ificantlyand
independently
associated
with
56%
reductio
nin
risk
ofPA
D
(109
)Marfella
2006
RCTparallel/
12mon
ths
Typ
e2
115adults,
post-M
IRed
wine
vs.con
trol
Red
wine,4-oz.
daily
vs.
control(no
alcoho
l)Bo
thgrou
pscoun
seled
onMediterranean
diet(m
eanintake
178gCHO,9
gSF
A,1
7gMUFA,
8gPU
FA,7
3g
protein,
lower
sodium,h
igher
fiber)
Glycemicmeasures:
NS;
however,
fastinginsulin
andHOMAwere
high
erin
wine
grou
pvs.con
trol
(P,
0.05
)HDL-Chigh
erin
wine
grou
pvs.con
trol
(P,
0.05
)
Weightno
tcontrolled;
however,
weightloss
not
statistically
different
betweengrou
ps
(88)
Mantzoros
2006
See“N
uts”
Nurses’Health
Stud
y
care.diabetesjournals.org DIABETES CARE, VOLUME 35, FEBRUARY 2012 57
Wheeler and Associates
Supplemen
tary
Tab
le1d
Con
tinu
ed
Ref.
number
Author/
year
Studytype/
duration
Diabe
tes
n‡Com
parison
summary
Interven
tion
detail{
dietary
variab
leof
interest
for
observational
studies
Sign
ificant
results**
Com
men
ts/study
limitations#
Vegetariandiets
(21)
Barnard
2009
See“Carbo
hydrate
amou
nt:
mod
erateto
high
carboh
ydrate”
(110
)Turner-
McG
rievy
2008
SeeBarnard
2009
for
stud
ydetails
Both
vegan
andtraditional
dietssign
ificantly
improved
intakesof
energy,totalfat,
transfat,cholesterol,
andsodium
but
werebelow
recommended
intakesforvitamin
D,E
,calcium,and
potassium
Vegan
dietim
proved
intake
offiber,folate,
magnesium,and
vitaminsA,C
,K(81)
Gross
2002
See“Protein”
(84)
deMello
2006
See“Protein”
A1C
,glycatedhemoglobin;A
ER(orUAER),albu
min
excretionrate(orurinaryalbu
min
excretionrate);ALA
,alpha-linolenicacid;A
UC,areaun
derthecurve;CACTI,Coron
aryArteryCalcification
inTyp
e1Diabetes
study;C
GMS,continuou
sglucosemon
itoringsystem
;CHD,coron
aryheartd
isease;C
HO,carbo
hydrate;C
RP,
C-reactiveprotein;C
VD,cardiovasculardisease;DHA,d
ocosahexaenoicacid;D
PP,D
iabetesPrevention
Program;EASD
,Europ
eanAssociation
forthe
Stud
yofDiabetes;EPA
,eicosapentaenoicacid;FFQ
,foo
dfrequency
questio
nnaire;GFR,glomerularfi
ltrationrate;G
I,glycem
icindex;GL,glycem
icload;G
LP-1,glucagon-
likepeptid
e1;HCHF,
high
ercholesterol/h
igherfiber;HDL-C,H
DLcholesterol;HFL
C,h
igherfat/lowercholesterol;HOMA,h
omeostasismod
elassessment;IAUC,incrementalareaun
derthecurve;ITT,intention
totreat;LD
L-C,LD
Lcholesterol;LF
HC,lower
fat/higher
carboh
ydrate;Lp
B:C,apoB
-con
taininglip
oprotein;MCHF,mod
eratecarboh
ydrate/higherfiber;MCLF
,mod
eratecarboh
ydrate/lo
wer
fiber;MI,myocardial
infarction
;MUFA
,mon
ounsaturated
fattyacid;N
CEP,
NationalC
holesterol
Edu
catio
nProgram;N
HLB
I,NationalH
eart,L
ung,andBloo
dInstitu
te;N
S,no
tsign
ificant;OGTT,o
ralglucose
tolerancetest;P
AD,p
e-riph
eralarterialdisease;PG
,plasm
aglucose;P
PG,p
ostprandialglucose;PU
FA,p
olyu
nsaturated
fattyacid;R
CT,random
ized
controlledtrial;TC,totalcholesterol;TG,triglyceride;TNF,
tumor
necrosisfactor;SFA
,saturatedfattyacid;U
AER,u
rinaryalbu
min
excretionrate.‡
,num
berof
subjectscompleting
study.{
,%CHO,fat,and
/orproteinreferto
%kcalfrom
CHO,fat,and
/orprotein;
goal→achieved.
**,results
areon
lypresentedforRCTsifthesign
ificance
isbetw
eengrou
ps;for
one-armed
studies,ifthe
sign
ificance
isbetw
eenbeginn
ingandend;
glycem
icmeasures,in
general(A1C
,FBG
,PPG
);CVDrisk
measures,in
general(TC,
LDL-C,H
DL-C,T
G).#,
retentionratedeterm
ined
tobe
alim
itationif,80
%.*
,insignificant
whenaccompanied
byenergy
restriction.
†,w
eigh
tloss/weightmaintenance.
58 DIABETES CARE, VOLUME 35, FEBRUARY 2012 care.diabetesjournals.org
Medical nutrition therapy in managing diabetes