Comments on Overall Diet Composition

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Regardless of the approach for creating a dietary energy deficit, in the case of WR for individuals with type 2 diabetes, the advice of a nutritionist/registered dietitian should be sought for the design and individualization of the dietary plan. In these patients, maintenance of a healthy body mass may require long-term calorie restriction to some degree even for weight maintenance. So, it is important that the diet plan does not limit the intakes of essential nutrients (e.g., protein, vitamins, minerals) and that the diet provides a wide variety of nutritious foods in the long term. Any need for nutritional supplements (e.g., vitamins or minerals not consumed at adequate levels from the diet) should also be identified at this point. A diet history or typical diet record or recall may be collected to provide a profile of the usual intake and food preferences so that these can be taken into account in the diet plan whenever possible.

Noting the need for individualization of dietary approaches, the joint recommendation of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition for type 2 diabetic patients needing to lose weight is to achieve a 500-1000 Kcal/d energy deficit and to choose a dietary intake pattern that is consistent with current recommendations to ameliorate comorbidities associated with obesity (8).

A summary of other dietary recommendations to enhance overall health and minimize CVD risk includes the following:

Saturated fat: Limit to less than 10 percent of total Kcal per day

Cholesterol: Limit to < 300 mg/day

Fiber: Consume 20-35 g/day dietary fiber, both soluble and insoluble

Sodium: If not hypertensive, sodium intake should be in the range of 2400-3000 mg/day

Alcohol: Men, limit to two drinks/day; women, limit to one drink/day, consumed with food

Vitamins and minerals: Insure adequate intakes from wide variety of dietary sources that meet recommended intake levels (Table 3.2).

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