Table 1.
Currently available recommendations for medical nutrition therapy for the management of diabetes mellitus
| RSSDI | ADA | ICMR |
|---|---|---|
| Carbohydrates | ||
| Recommended intake: 45–65% of total daily calories (minimum intake: 130 g/day) | No specified recommended intake | Recommended intake: 55–60% of total daily calories |
| High fiber diet: increased intake of soluble and insoluble fibers | High-fiber and low-glycemic index diet | Intake of fiber-rich foods |
|
Preferred sources: pulses, legumes, coarse grains, sprouted grams, unprocessed vegetables and fruits Substitution of polished white rice with millets and brown rice |
Preferred sources: fruits, vegetables, whole, grains, legumes and dairy products (milk and yoghurt) |
Preferred sources: cereals, mixed coarse grains, whole grains (e.g., ragi, oats, barley, jowar), whole pulses, whole fruits, salads and soybeans, leafy vegetables, fenugreek seeds Restricted intake of all-purpose flour (maida)-based products |
| Proteins | ||
| Recommended intake: 10–15% of total daily calories |
Typically 15–20% of total energy in individuals without diabetic kidney disease Recommended daily allowance in individuals with T2DM and compromised renal function: of 0.8 g/kg body weight/day |
Recommended intake: 10–15% of total daily calories |
| Preferred sources: not mentioned | Preferred sources: not mentioned | Preferred sources: vegetable sources, low-fat milk and milk products, fish and lean meat |
| Fats | ||
| Recommended calorie intake: no specified ideal intake | Recommended calorie intake: no specified ideal intake | Recommended calorie intake: 20–25% total daily calories |
|
Restricted intake of saturated fats: < 10% of total daily calories Minimal intake of trans fats |
Restricted intake of saturated fats: < 10% total daily calories Minimal intake of trans fats |
Restricted intake of saturated fats: < 7% total daily calories Minimal intake of trans fats (hydrogenated vegetable fats) |
| Restricted intake of dietary cholesterol: < 300 mg/day | Restricted intake of dietary cholesterol: < 300 mg/day | Restricted intake of dietary cholesterol: < 300 mg/day |
|
Preferred sources of MUFA/PUFA: moderate intake of fish/seafood, chicken without skin and red meata as a source of PUFA Not recommended: sunflower oil |
Preferred sources of MUFA/PUFA: fatty fish, nuts and seeds | Preferred sources of MUFA/PUFA: groundnut, sesame, cotton seed, rice bran or safflower along with soybean, mustard, canola, etc., as preferred choices for edible oils containing MUFA and PUFA |
| Sugars and sweeteners | ||
| Reduced intake of refined sugars | Reduced intake of HFCS and sucrose | Avoidance of sugar, honey, jaggery |
| Moderate intake of non-nutritive artificial sweeteners | Substitute nutritive sweeteners with non-nutritive sweetener | Restricted use of artificial sweeteners and avoidance in pregnant/lactating women with diabetes |
| Avoid consumption of HFCS | Natural fructose/free fructose from fruits (3–4% of energy intake and not > 12) is permissible | Avoidance of very sweet fruits and fruit juices |
| Micronutrients and other dietary recommendations | ||
| Inclusion of micronutrients (chromium, alpha-lipoic acid, magnesium and zinc) as adjunct to standard careb | Not recommended | Not recommended |
| Restricted intake of dietary salt: < 5 g/dayc | Restricted sodium intake: < 2300 mg/dayc | Restricted intake of dietary salt: ≤ 6 g/day |
|
Avoidance of alcohol consumption Cessation of tobacco use |
Moderate alcohol consumption |
Moderate of alcohol consumption Cessation of any form of tobacco use |
aParticularly in patients with established cardiovascular disease
bInsufficient evidence available
cFurther restriction in patients with diabetes and hypertension
ADA American Diabetes Association, HFCS high-fructose corn syrup, ICMR Indian Council of Medical Research, MUFA mono-unsaturated fatty acids, PUFA poly-unsaturated fatty acids, RSSDI Research Society for the Study of Diabetes in India, T2DM type 2 diabetes mellitus