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India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascula...
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Increased consumption of unhealthy foods compounded with increased prevalence of overweight in middle-to-low-income countries is typically referred to as the " Nutrition Transition. " It occurs in conjunction to the epidemiology transition and has serious implications in terms of public health outcomes, risk factors, economic growth and internation...
Aim: This review aims to reassess the role of saturated fatty acids (SFAs) in the diet in light of recent evidence which shows that consumption of SFAs is probably safer than previously thought.
Background: SFAs are an integral component of dietary fat. The association between SFAs and non-communicable diseases has been studied and debated for dec...
Citations
... In India, Apple (Malus pumia) is grown mainly in the states of Jammu, Kashmir, Himachal Pradesh and Uttrakhand. Apple promotes oral health, cardiovascular health (Boyer and Liu 2004), healthy snack for diabetes (Misra et al. 2011), improves respiratory health, prevents osteoporosis (von Hurst and Wham 2007), keeps gut healthy, maintains neurological health, boosts your energy levels, prevents premature aging, controls body weight, prevents hemorrhoids, works as detoxifier. anti-cancerous (McCann et al. 2007), anti-cholesterol, boosts immunity (Kondo et al. 2002), preventing Alzheimer, preventing asthma, prevent gallstones (Zúñiga et al. 2008, detoxify liver, prevent cataract, increase endurance, aid digestion, prevent brain cell damage, aid blood circulation, analgesic properties, improve night vision (Jia et al. 2018), reduces dark complexion, anti-aging benefits (Rossi et al. 2008), UV protection, acne, blemishes, dark sports, prevent skin cancer, prevents against dandruff, improve blood circulation, great toner, prevent skin cancer, prevent hair loss. ...
Natural products, especially plants and herbs, have always been a common medicament source, either as pure active principles or traditional preparations. Traditional medicine has been used in developing and developed countries for centuries, and still, 80% of the population uses plant-based medicines for their health care needs. The present review discusses all the possible pharmacological activity reported in various literature and active chemical constituents of herbs. A list of various herbs/plants used by Ayurvedacharya Ratiram Sharma (93-year-old and practicing since 1952) and mentioned in Ayurvedic texts. The curated list was prepared by their general availability in the household and local market. This study comprehensively documented the medicinal value of sixty-six dominant plant species used in Ayurveda and local people. In the present review, each herb is discussed with its scientific and common names, geographical distribution, traditional medicinal uses, beneficial plant parts, and active chemical constituents. For each plant, pharmacological activities of different parts of plants are displayed with their chemical constituents and structure. Toxicologists, phytologists, medicinal chemists, and other researchers who are interested in the various therapeutic and related applications of plant materials will be benefited from present review. This information will open new horizons of application for the many novel drugs and drug candidates.
... 10,13,28 European 37 and Canadian guidelines on nutrition therapy recommend that, 38 protein should make up 10-20% of total calories, carbohydrates should make up 45-60%, and fat should make up no more than 35%. Similarly, dietary guidelines for healthy living and prevention of obesity, in Asian Indians recommend obtaining 50-60% of energy from carbohydrates, 10−15% from protein, and less than 30% from fat. 39 Despite a considerable reduction in carbohydrate intake from the baseline, the intervention group had attained an acceptable macronutrient intake level. ...
Background
Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D.
Methods
An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24−64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367.
Findings
Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: −0.80 to −0.16), while it increased in the control group by 0.22 (95% CI: −0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: −1.04 to −0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: −36.12 to −1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group.
Interpretation
The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs.
Funding
The research was funded by the University Grants Commission (UGC), Nepal.
... 21 current eating patterns. 10 The dietary guidelines for Asian Indians (National Dietary Guidelines Consensus Group, 2011) suggest energy from protein as 10-15%, 18 the Indian Council of Medical Research (ICMR) 2018 guidelines suggest 12-15%, 19 while the recent Research Society for the Study of Diabetes in India (RSSDI) 2022 recommends 15%. 20 Recently derived macronutrient recommendation using a data-driven optimization model from the ICMR-INDIAB (2022) study suggests increasing protein intake to 19-20% of energy for T2DM remission in newly diagnosed PWD. ...
Background: Obesity, prediabetes, and type 2 diabetes mellitus (T2DM) pose a triple burden in India. Almost two-thirds of people with diabetes (PWD) in India are found to have suboptimal glycemic, blood pressure, and lipid control. Medical nutrition therapy (MNT) in diabetes has emphasized on the amount and type of carbohydrates for years. However, protein, an important macronutrient in diabetes management, needs to be focused upon, especially in India, where the consumption is found to be lower than the recommendations provided by most guidelines. Aim: An expert committee attempted to review the role of dietary protein in the management of T2DM, arrive at a consensus on the significance of increasing dietary protein for various benefits, and offer practical guidance on ways to improve protein intake among Indians. Methodology: A total of 10 endocrinologists and diabetologists, one nephrologist, and three registered dietitians representing four zones of India formed the expert committee. An in-depth review of literature in the Indian context was carried out, and the draft document was shared with the expert committee, and their views were incorporated into the same. The expert committee then assembled virtually to deliberate on various aspects of the role of protein in T2DM management. The experts from various specialties gave their valuable inputs and suggestions from their extensive personal clinical experience and research work, which helped to reach a consensus on the role and significance of protein in the management of T2DM and its complications in India. Results: There is abundant evidence that MNT is essential for the prevention and management of T2DM and its complications. Experts agreed that increasing protein intake offers myriad health benefits, namely reducing glycemic variability, improving glycemic control, increasing insulin sensitivity, improvement in lipid profile and immunity, and helping in weight management and preservation of muscle mass in PWD. The expert committee suggested aiming for an increase in protein intake by at least 5-10% of the current intake in lieu of carbohydrates in PWD. Experts also highlighted the need for more data quantifying the unmet protein needs in the Indian PWD, especially among vegetarians. Randomized controlled trials to study the effect of protein in diabetes complications such as cardiovascular disease (CVD) and diabetic kidney disease (DKD) and comorbid conditions such as sarcopenia among the Indian population are also warranted. Conclusion: Increasing protein quantity and quality in the diets of Indian PWD could significantly contribute to positive health outcomes. Increased protein intake, preferably through dietary sources to meet the requirements and, when required using diabetes-specific protein supplements (DSPS), is recommended in the prevention and control of T2DM.
... Applying these recommendations correctly will aid Asian Indians' rising "epidemics" of obesity, metabolic syndrome, hypertension, T2DM, and CVD. [15] Because of their limited time, many doctors can only offer basic nutritional recommendations. Lack of information about a balanced diet, frequent festivals and socializing, and lack of access to professional nutrition guidance are obstacles to Asian Indians sticking to their diets successfully. ...
Background: A large percentage of non‑communicable diseases are preventable through the reduction of behavioral risk factors which is due
to physical inactivity and unhealthy diet. Reducing the burden of obesity is likely to make a substantial impact on mitigating the mortality and
morbidity due to non‑communicable diseases. This study aims to evaluate the effectiveness of a nurse‑led intervention on weight reduction
among urban adults. Methods: This trial is a two‑arm parallel group randomized controlled trial comparing the intervention arm‑nurse‑led
intervention (NLI, n = 219) with the control arm‑general care (GC, n = 219). Participants randomized to the NLI group will receive the
interventional package for 12 months which includes health education and motivational strategies during follow‑up. Baseline, 6‑month and
12‑month follow‑ups will be conducted to assess primary and secondary outcomes for both arms using the WHO Steps questionnaire. The analysis
will use an intention‑to‑treat approach to examine the change in behavioral and physical and biochemical parameters. Conclusion: The nurse‑led
intervention aims to provide an evidence‑based acceptable and flexible support strategy for weight reduction in obese adults. This will impart
healthy life skills to adults and also improve their health status and enable an adult to take charge of their health and this will ultimately prevent
or delay non‑communicable diseases. Trial Registration: Clinical Trials Registry India, CTRI/2021/12/038785. Registered prospectively
with CTRI on 21/12/2021.Original Article
... dietaryguidelines.gov/). Correspondingly, dietary guidelines in Europe and Asia also recommend restricting red meat consumption, to reduce chronic conditions including CVD. [11][12][13] Red meat is increasingly attracting attention, not only for individual health but also for planetary health. 14 Several observational studies have reported red meat consumption related to higher risk of CVD, [15][16][17][18][19] coronary heart disease (CHD), 20,21 stroke, 22,23 heart failure, 24,25 and type 2 diabetes mellitus (T2DM); [26][27][28][29] other studies have shown a null association [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and even beneficial effects of red meat consumption on CHD 45 or stroke in women. ...
Aims:
Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear.
Methods and results:
This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex.
Conclusion:
Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.
... The quantity of carbohydrate consumed influences blood glucose levels and insulin responses. This is because high-GI carbohydrate sources are quickly broken down during digestion and release glucose quickly into the bloodstream, whereas the reverse is true for low-GI carbohydrate sources where glucose is released gradually into the bloodstream [28]. ...
Background
Enteral nutrition (EN) is the preferred method to extend nutritional support and mitigate the chances of malnutrition in patients who are critically ill. In these patients, the risk of hyperglycemia is high and can result in poor clinical outcomes and delayed recovery. Hence, estimation of the glycemic index (GI) of supplements used in EN becomes important to reduce all such risks.
Objective
To estimate the GI of a nutritional supplement formulated for critically ill patients during hospitalization and after recovery.
Methods
Ten healthy participants (mean age: 25 years; mean body mass index: 21 kg/m ² ) were included in the study. The test food was a high protein energy dense supplement, that derived 25 g of available carbohydrates which was fed to all the participants. The reference food used was 27.5 g of glucose monohydrate drink. Capillary blood glucose was measured at fasting (0 min) and at an interval of 15 min till 120 min, after consuming the reference and test food, for estimating the GI. Glycemic index values were computed by using the method suggested by the Food and Agriculture Organization of the United Nations (FAO) and the the World Health Organization (WHO).
Results
The mean GI of the test food was 39 ± 3 when calculated using the internationally recognized GI protocol.
Conclusion
The GI of the test food was found to be in the category of low GI.
... Applying these recommendations correctly will aid Asian Indians' rising "epidemics" of obesity, metabolic syndrome, hypertension, T2DM, and CVD. [15] Because of their limited time, many doctors can only offer basic nutritional recommendations. Lack of information about a balanced diet, frequent festivals and socializing, and lack of access to professional nutrition guidance are obstacles to Asian Indians sticking to their diets successfully. ...
Background:
A large percentage of non-communicable diseases are preventable through the reduction of behavioral risk factors which is due to physical inactivity and unhealthy diet. Reducing the burden of obesity is likely to make a substantial impact on mitigating the mortality and morbidity due to non-communicable diseases. This study aims to evaluate the effectiveness of a nurse-led intervention on weight reduction among urban adults.
Methods:
This trial is a two-arm parallel group randomized controlled trial comparing the intervention arm-nurse-led intervention (NLI, n = 219) with the control arm-general care (GC, n = 219). Participants randomized to the NLI group will receive the interventional package for 12 months which includes health education and motivational strategies during follow-up. Baseline, 6-month and 12-month follow-ups will be conducted to assess primary and secondary outcomes for both arms using the WHO Steps questionnaire. The analysis will use an intention-to-treat approach to examine the change in behavioral and physical and biochemical parameters.
Conclusion:
The nurse-led intervention aims to provide an evidence-based acceptable and flexible support strategy for weight reduction in obese adults. This will impart healthy life skills to adults and also improve their health status and enable an adult to take charge of their health and this will ultimately prevent or delay non-communicable diseases.
Trial registration:
Clinical Trials Registry India, CTRI/2021/12/038785. Registered prospectively with CTRI on 21/12/2021.
... Metabolic syndrome is a cluster of conditions manifested by visceral obesity, hypertension, glucose intolerance, hyperinsulinism, and atherogenic dyslipidemia [1][2][3][4]. Data from the Centers for Disease Control (CDC) indicate that 1 in 3 adults now fit the criteria for metabolic syndrome [5]. This escalation correlates with the introduction of high fructose corn syrup and elevated dietary salt intake that began in the late 1960s [6]. ...
... Chronic diseases driven by metabolic syndrome accounted for approximately $543 billion in direct healthcare costs in the US in 2017 [12]. Hypertension is a major component of metabolic syndrome and is associated with a significant increase in premature morbidity and mortality due to stroke, cardiovascular ailment, and kidney disease [1][2][3][4]. Although the increase in the incidence of metabolic syndrome is attributed to increased caloric intake and decreased physical activity, the pathogenesis of hypertension in this disease remains poorly understood. ...
... Association of Obesity with Hypertension in the Million Veteran Program (MVP). Published reports have pointed to a strong association between hypertension and obesity [71,72], as well as dietary fructose and salt intake in metabolic syndrome [1][2][3]. The Million Veteran Program (MVP) is a database administered by the Veterans Administration Department that has collected clinical and genetic data from over 900,000 veterans and nonveteran individuals. ...
Metabolic syndrome is manifested by visceral obesity, hypertension, glucose intolerance, hyperinsulinism, and dyslipidemia. According to the CDC, metabolic syndrome in the US has increased drastically since the 1960s leading to chronic diseases and rising healthcare costs. Hypertension is a key component of metabolic syndrome and is associated with an increase in morbidity and mortality due to stroke, cardiovascular ailments, and kidney disease. The pathogenesis of hypertension in metabolic syndrome, however, remains poorly understood. Metabolic syndrome results primarily from increased caloric intake and decreased physical activity. Epidemiologic studies show that an enhanced consumption of sugars, in the form of fructose and sucrose, correlates with the amplified prevalence of metabolic syndrome. Diets with a high fat content, in conjunction with elevated fructose and salt intake, accelerate the development of metabolic syndrome. This review article discusses the latest literature in the pathogenesis of hypertension in metabolic syndrome, with a specific emphasis on the role of fructose and its stimulatory effect on salt absorption in the small intestine and kidney tubules.
... Participants on the control diet consumed a standard diet advised according to guidelines for Asian Indians in India [15]. Instructions were given verbally and in written form and were discussed in detail individually and during group meetings. ...
Background
Rapid conversion from prediabetes to diabetes and frequent postprandial hyperglycemia (PPHG) is seen in Asian Indians. These should be the target of dietary strategies.
Objectives
We hypothesized that dietary intervention of preloading major meals with almonds in participants with prediabetes will decrease overall glycemia and PPHG.
Design
The study included two phases: (1) an oral glucose tolerance test (OGTT)-based crossover randomized control study, the effect of a single premeal almond load (20 g) given before OGTT was evaluated (n = 60, 30 each period). (2) The continuous glucose monitoring system (CGMS)-based study for 3 days including premeal almond load before three major meals was a free-living, open-labeled, crossover randomized control trial, where control and premeal almond load diets were compared for glycaemic control (n = 60, 30 in each period). The study was registered at clinicaltrials.gov (registration no. NCT04769726).
Results
In the OGTT-based study phase, the overall AUC for blood glucose, serum insulin, C-peptide, and plasma glucagon post-75 g oral glucose load was significantly lower for treatment vs. control diet (p < 0.001). Specifically, with the former diet, PPHG was significantly lower (18.05% in AUC on OGTT, 24.8% at 1-h, 28.9% at 2-h post OGTT, and 10.07% during CGMS). The CGMS data showed that premeal almond load significantly improved 24-glucose variability; SD of mean glucose concentration and mean of daily differences. Daily glycaemic control improved significantly as per the following: mean 24-h blood glucose concentration (M), time spent above 7.8 mmol/L of blood glucose, together with the corresponding AUC values. Premeal almond load significantly decreased following: overall hyperglycemia (glucose AUC), PPHG, peak 24-h glycaemia, and minimum glucose level during night.
Conclusion
Incorporation of 20 g of almonds, 30 min before each major meal led to a significant decrease in PPHG (as revealed in OGTT-based study phase) and also improved insulin, C-peptide, glucagon levels, and improved glucose variability and glycemic parameters on CGMS in participants with prediabetes.
Clinical trial registry
The study was registered at clinicaltrials.gov (registration no. NCT04769726).
... This includes a low-calorie diet with a higher fiber intake, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted sugar intake. 749 High-protein meal replacement diet-based intervention in overweight/obese Asian Indians has shown a significant reduction in weight, abdominal obesity, blood pressure, lipids, glycemic parameters, and hepatic enzymes compared with a standard control diet in Indians. 750 Although studies assessing the ideal carbohydrate intake for people with diabetes are inconclusive, modifying carbohydrate intake considering the blood glucose response is of value, especially in the Indian context, where carbohydrate intake across all regions of India is very high. ...
This is a comprehensive management guidelines for Diabetes 2022
