Table 15.

Recommended Meal Patterns for Persons with Diabetes Mellitus

Meal pattern	Macronutrient characteristics	Outcome evidence in diabetes (see text)	Comments
Mediterranean 694,695,697–700,724–726,814,815,821,925,926	Uses olive oil as the principal source of dietary fat; fish and other seafood; vegetables, nuts, fruits, beans; whole grains; moderate dairy products; red meat on occasion; wine with meals; limited sweets	Reduces risk of DM; lowers A1C, BP, and triglycerides; improves hepatic steatosis; primary and secondary prevention of major CVD events and mortality	Only meal pattern with RCTs showing long-term benefits regarding CVD events and mortality
Low fat 678,690,701–704,827,927,928	Emphasizes vegetables, fruits, starches (eg, breads, pasta, whole grains, starchy vegetables), lean protein sources, and low-fat dairy products. Defined here as total fat intake ≤30% of total calories and saturated fat intake ≤10%	As part of a structured lifestyle intervention, reduces risk of DM and reduces A1C, BP, triglycerides in T2D	No long-term safety data
Low carbohydrate 702–704,707–714,926,929,930	Often defined as a reduction in carbohydrates to 26% to 45% of total calories. Emphasizes (i) vegetables low in carbohydrate content, (ii) meat, poultry, fish, shellfish, eggs, cheese, nuts, (iii) oils, butter, and avocado. Avoids foods high in starch and sugars such as pasta, rice, potatoes, bread, and some fruits	Reduces A1C, body weight, BP, and triglycerides, and increases HDL-C in T2D	No long-term safety data. When compared with low-fat diet, there are greater benefits early (3–6 mo) followed by equilibration at 1–2 y.
Very low carbohydrate 705,706	Often defined as limiting nonfiber carbohydrate to 20 to 50 grams/d in order to induce ketosis, resulting in > 50% of calories from fat. Otherwise, similar to low carbohydrate
Vegetarian/vegan 722–726,837,839,937,938	Vegetarian: plant-based diets devoid of all flesh foods but including egg (ovo) and/or dairy (lactose) products. Vegan: eliminates all flesh foods and animal-derived products.	Reduces risk of DM; lowers A1C; weight loss; lowers LDL-C and non–HDL-C	No long-term safety data; may require supplementation of vitamins and minerals
Dietary Approaches to Stop Hypertension (DASH) 727–729	Limitations in sodium and adequate potassium; whole grains, vegetables, fruits; low-fat dairy products; poultry, fish; limits on saturated fat, red meat; limit sweets, and sugar-containing beverages.	Reduces risk of DM; reduces glycemia, BP, and lipids in DM	No long-term safety data

Abbreviations: A1C = hemoglobin A1c; BP = blood pressure; CVD = cardiovascular disease; DM = diabetes mellitus; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; RCT = randomized controlled trial; T2D = type 2 diabetes