On Mon, 06 Jun 2005 18:55:54 +0200, toccalenuvole wrote in
Post by toccalenuvolePost by Enrico CPost by toccalenuvoleTenendo conto di questo effetto biochimico un diabetico in genere può
assumere un range di carbo che vanno dal 45 al 55%,
Che ne pensi delle nuove indicazioni di Harvard che invece parlano del 40%?
40% secco per i diabetici?
"Approximately" 40% carbo, 2-30% proteine, 30-35 grassi...
con le avvertenze che dicevo, ovvero che si tratta di indicazione di
massima da personalizzare con il proprio medico, cautela con le proteine in
caso di problemi renali, e comunque non scendere troppo di carbo (min 130 g
giornalieri).
Diabete tipo 2 e "prediabete" con obesità o sovrappeso.
Joslin Diabetes Center Announces New Nutrition Guidelines for People with
Type 2 Diabetes or Pre-Diabetes who are Overweight or Obese
April 6, 2005 - BOSTON – As Americans’ waistlines continue to expand,
contributing to a burgeoning epidemic of type 2 diabetes, the scientific
jury is in and the verdict is clear: weight loss and increased physical
activity is directly related to improved diabetes control. To help
Americans fight the dramatic increase in type 2 diabetes, Joslin Diabetes
Center has crafted new nutrition and physical activity guidelines for
overweight and obese individuals with type 2 diabetes and those at risk for
developing diabetes (pre-diabetes).
“Since obesity doesn’t seem to be slowing down and the complications of
diabetes are so serious, we were especially alarmed about the health of the
American public. We felt the best way to impact the largest number of
people was to strengthen our nutrition guidelines,” said James L.
Rosenzweig, M.D, head of Joslin’s clinical guidelines committee. The team
of physicians, dietitians, exercise physiologists and educators spent
months reviewing the scientific literature to draw up new guidelines. “The
search was on for guidelines that would improve insulin sensitivity,
cardiovascular health and reduce body fat. And most importantly, we wanted
to deliver a plan that makes clear what people need to do to achieve their
goals,” said Dr. Rosenzweig, who also is Director of Joslin’s Disease
Management Program and Assistant Professor of Medicine at Harvard Medical
School.
The new guidelines recommend approximately 40 percent of a person’s daily
calories come from carbohydrates; 20 to 30 percent from protein (unless the
person has kidney disease); 30-35 percent come from fat (mostly mono- and
polyunsaturated fats); and at least 20-35 grams of fiber. To initiate and
continue weight reduction, a modest goal of one pound every one to two
weeks is advised by reducing daily caloric intake by 250 to 500 calories.
Total daily calories should not be less than 1,000 to 1,200 for women and
1,200 to 1,600 for men. A target of 60 to 90 minutes of modest intensity
physical activity most days of the week with a minimum of 150-175
minutes/week is encouraged and should include cardiovascular, stretching
and resistance activities to maintain or increase lean body mass. Two out
of three people in the U.S. are overweight or obese, resulting in a
skyrocketing rate of type 2 diabetes that now affects at least 18.2 million
Americans, including an increasing number of young people. An estimated 41
million Americans have pre-diabetes and are at risk of developing
full-blown type 2 diabetes unless they lose weight and increase physical
activity. Diabetes is a leading cause of heart disease, stroke, blindness,
kidney disease, amputations and other complications. “Setting the standards
for diabetes treatment for more than 100 years, Joslin Diabetes Center’s
approach to diabetes management has always been to focus on the individual
and not dictate a ‘one size fits all’ strategy. While these guidelines are
very straightforward, Americans should meet with their healthcare team so
they can adapt the guidelines to meet their personal needs,” said Osama
Hamdy, M.D., Ph.D., Clinical Director of Joslin’s Obesity Program and an
obesity researcher, who co-chaired the committee that developed the new
guidelines.
“Eating smaller portions, modest carbohydrates and slightly more protein
with careful selection of fat, protein and carbohydrate sources is the way
to go if you are overweight or obese and have diabetes or pre-diabetes and
normal kidney function. These recommendations can help people lose weight,
have better diabetes control and prevent serious cardiovascular
complications,” Dr. Hamdy added.
Catherine Carver, M.S., A.N.P., C.D.E., Director, Educational Services and
New Clinic Program Development, also co-chaired the workgroup that wrote
the guidelines. Amy P. Campbell, M.S., R.D., C.D.E., Education Program
Manager of Joslin’s Affiliates Programs/Disease Management Program, also
was integral to developing the guidelines.
Among the highlights of the new Joslin guidelines are the following
recommendations:
Carbohydrate: Approximately 40 percent of a person’s daily calories should
come from carbohydrate; the total should not be less than 130 grams daily.
This is a significant change from Joslin’s previous recommendations that
promoted a higher carbohydrate intake. Scientific data show that reducing
one’s carbohydrate intake while simultaneously increasing healthier protein
and fat choices may be a better approach to weight control. It may also
help decrease cardiovascular disease in overweight people with type 2
diabetes. The best sources are fresh vegetables, fruits and beans. Whole
grain foods are preferable to eating pasta, white bread, white potatoes and
low fiber cereal. Fiber intake should be approximately 50 grams daily if
that amount can be tolerated; a minimum of 20-35 grams per day is
recommended and an external supplement may be needed. High-fiber foods
include fruits, vegetables, whole grain cereals, breads, nuts and seeds.
Fat: Approximately 30 to 35 percent of a person’s daily calories should
come from fat. Most should come from mono- and polyunsaturated fats, such
as olive oil, canola oil, nuts, seeds and fish (especially those high in
omega-3 fatty acids, such as salmon, mackerel, lake trout, herring and
sardines). Foods that are high in saturated fat, such as beef, pork, lamb
and high-fat dairy products (cream cheese, whole milk) should be eaten in
small amounts. Foods that are high in trans fats such as fast foods,
commercially baked goods, crackers, cookies and some margarines should be
avoided. Cholesterol intake should be less than 300 mg daily; or less than
200 mg in people with an LDL (“bad”) cholesterol that is more than 100
mg/dL.
Protein: While anyone with signs of kidney disease should consult their
provider before increasing the daily amount of protein, approximately 20 to
30 percent of a person’s total calories should come from protein. This is a
higher percentage than Joslin recommended in the past. Scientific data
reveal that eating more protein helps people feel “full” and thus causes
people to eat less calories overall. Protein also helps to maintain lean
body mass during weight loss. Examples of protein include fish, skinless
chicken or turkey, nonfat or lowfat dairy products and legumes such as
kidney beans, black beans, chick peas and lentils.
Weight Loss Guidelines: A modest weight loss of one pound every one to two
weeks is advised. Reducing daily calories should be by 250 to 500 calories;
total daily calories should not be less than 1,000 to 1,200 for women and
1,200 to 1,600 for men. Weight loss is different for each person and should
be continued until a person reaches a target body mass index, or BMI (ask
your provider about how to obtain this measurement.) Meal replacements,
such as shakes, bars and ready-to-mix powders that match these guidelines
can be helpful for some people. Blood glucose patterns often change with
these types of replacements and thus people should monitor their blood
glucose.
Physical Activity Guidelines: Physical activity is extremely important to a
weight loss plan. A minimum of 150 to 175 minutes of moderate intensity
physical activity is recommended. Examples of this include walking, biking,
swimming and dancing. A target of 60 to 90 minutes most days of the week is
encouraged. Physical activity should be a mix of cardiovascular, stretching
and resistance activities to maintain or increase lean body mass.
About Joslin Diabetes Center
Joslin Diabetes Center, dedicated to conquering diabetes in all of its
forms, is the global leader in diabetes research, care and education.
Founded in 1898, Joslin is an independent nonprofit institution affiliated
with Harvard Medical School. Joslin research is a team of more than 300
people at the forefront of discovery aimed at preventing and curing
diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical
Center in Boston, the nationwide network of Joslin Affiliated Programs, and
the hundreds of Joslin educational programs offered each year for
clinicians, researchers and patients, enable Joslin to develop, implement
and share innovations that immeasurably improve the lives of people with
diabetes. As a nonprofit, Joslin benefits from the generosity of donors in
advancing its mission.
Editor’s Note: To schedule an appointment with a member of Joslin Clinic’s
Nutrition Staff, call (617) 732-2440. For more information on Joslin, call
1-800-JOSLIN-1 or visit www.joslin.org.
Note: Here is a link to a pdf containing the new nutrition guidelines on
Joslin’s website:
https://diabetesmanagement.joslin.org/Guidelines/Nutrition_ClinGuide.pdf
JOSLIN DIABETES CENTER & JOSLIN CLINIC
CLINICAL NUTRITION GUIDELINE FOR OVERWEIGHT AND OBESE ADULTS WITH TYPE 2
DIABETES, PREDIABETES OR AT HIGH RISK FOR DEVELOPING TYPE 2 DIABETES
The Joslin Clinical Nutrition Guideline For Overweight and Obese Adults
With Type 2 Diabetes, Prediabetes or at High Risk for Developing
Type 2 Diabetes is designed to assist primary care physicians, specialists,
and other healthcare providers in individualizing the care of and
set goals for adult, non-pregnant patients with type 2 diabetes or
individuals at high risk for developing type 2 diabetes. This guideline
focuses on the unique needs of those individuals, and complements the 2005
Dietary Guidelines for Americans, which is jointly developed
by the Department of Health and Human Services and the Department of
Agriculture. It is not intended to replace sound medical judgment
or clinical decision-making and may need to be adapted for certain patient
care situations where more or less stringent interventions are
necessary.
The objectives of the Joslin Clinical Diabetes Guidelines are to support
clinical practice and to influence clinical behaviors in order to
improve clinical outcomes and assure that patient expectations are
reasonable and informed. Guidelines are developed and approved through
the Clinical Oversight Committee that reports to the Chief Medical Officer
of the Joslin Diabetes Center, Joslin Clinic Inc. The Clinical
Guidelines are established after careful review of current evidence,
medical literature and sound clinical practice.
As general guidance, the following symbols indicate the strength of
scientific evidence:
** indicates strong scientific evidence to support this recommendation
* indicates some scientific evidence to support this recommendation
§ indicates limited scientific evidence to support this recommendation
¶ indicates no available evidence but clinical experience and expert
consensus support this recommendation
These Guidelines will be reviewed periodically and the Joslin Diabetes
Center will maintain, upgrade or downgrade the rating for each
recommendation when new evidence mandates such changes.
Target Individuals and General Goals of Clinical Nutrition Guideline
Target
Population
BMI > 25 kg/m2
or Waistline > 40”/102 cm (men)
and
Type 2 Diabetes
or
Prediabetes IGT (impaired glucose tolerance)
IFG (impaired fasting glucose)
or
High Risk for The Metabolic Syndrome (ATP III Criteria)
Type 2 Diabetes Family history of type 2 DM (first degree relative)
Confirmed diagnosis of insulin resistance
(e.g., high basal insulin)
Goals
1. To improve overall metabolic control while achieving gradual weight
reduction and maintaining achieved
weight loss.
2. To improve postprandial hyperglycemia and overall glycemic control in
order to prevent or reduce
complications of diabetes.
3. To improve postprandial hypertriglyceridemia as a major lipid
abnormality in the target population.
4. To improve lipid profile including increase of HDL-cholesterol and
decrease of LDL-cholesterol.
5. To improve insulin sensitivity as a major precursor of type 2 diabetes.
6. To improve body fat distribution and to reduce visceral fat burden.
7. To reduce cardiovascular risk as evidenced by improvement of endothelial
function and endothelial markers.
8. To reduce inflammatory cytokines, and markers of inflammation and
increased coagulation.
9. To improve blood pressure as a contributing risk factor for
cardiovascular and renal complications.
10. To enhance thermogenesis and maintain lean body mass.
11. To improve overall health through increased physical activity.
12. To prevent and treat the chronic complications of diabetes.
Post by toccalenuvoleComunque
quello che penso io sulle linee guida e sull'applicabilità di
percentuali secche penso sia chiaro.
Sì, loro stessi avvertono di personalizzare con il medico. Certo che se poi
uno vuol leggere come se fosse una formuletta ingegnerestica... ;)
Post by toccalenuvolePost by Enrico CHarvard consiglia cautela con le proteine a chi ha problemi renali, e - ai
diabetici - di consultare in ogni caso il proprio medico curante per
formulare una dieta personalizzata.
uno dei problemi maggiori dei diabetici
Già, il rischio è proprio queste, che alcune indicazioni, magari sensate
per alcune categorie e prese con le dovute cautele, vengano lette e
divulgate solo per gli aspetti che "attirano", magari generalizzandole o
traendone conclusioni arbitrarie del tipo "meno carbo mangi meglio
stai..."!
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