Abstract
Medical nutrition therapy (MNT) is a necessary component of comprehensive type 2 diabetes (T2D) management, but optimal outcomes require culturally-sensitive implementation. Accordingly, international experts created an evidence-based transcultural diabetes nutrition algorithm (tDNA) to improve understanding of MNT and to foster portability of current guidelines to various dysglycemic populations worldwide. This report details the development of tDNA-Venezuelan via analysis of region-specific cardiovascular disease (CVD) risk factors, lifestyles, anthropometrics, and resultant tDNA algorithmic modifications. Specific recommendations include: screening for prediabetes (for biochemical monitoring and lifestyle counseling); detecting obesity using Latin American cutoffs for waist circumference and Venezuelan cutoffs for BMI; prescribing MNT to people with prediabetes, T2D, or high CVD risk; specifying control goals in prediabetes and T2D; and describing regional differences in prevalence of CVD risk and lifestyle. Venezuelan deliberations involved evaluating typical food-based eating patterns, correcting improper dietary habits through adaptation of the Mediterranean diet with local foods, developing local recommendations for physical activity, avoiding stigmatizing obesity as a cosmetic problem, avoiding misuse of insulin and metformin, circumscribing bariatric surgery to appropriate indications, and using integrated health service networks to implement tDNA. Finally, further research, national surveys, and validation protocols focusing on CVD risk reduction in Venezuelan populations are necessary.
Highlights
At present, 346 million people worldwide have diabetes mellitus
In 140 subjects with mean age of 48 years, with body mass index (BMI) of 32.1 kg/m2, and who were randomly assigned to an intensive lifestyle (ILS, n = 70) intervention group or standard intervention control (n = 70) group for two years, significant improvements from baseline were observed in weight, waist circumference, diastolic blood pressure, triglycerides, HDL-cholesterol, fasting blood glucose, and cardiovascular health scores, ILS group vs. control [97]
Prevention and appropriate treatment of prediabetes, type 2 diabetes (T2D), and related or associated cardiovascular risk factors must be based on lifestyle changes that include an increase in physical activity and the correct implementation of Medical nutrition therapy (MNT)
Summary
346 million people worldwide have diabetes mellitus. It has been estimated that the prevalence of type 2 diabetes mellitus (T2D) will increase more in Latin America (65%) than worldwide (54%) between 2010 and 2030 [1]. There are salient differences in lifestyle and dietary habits, patterns of physical activity, food availability, medical resources, and clinical practices within the country. These issues must be considered prior to any innovative process to improve diabetes care, such as the proposed Latin America Diabetes Association (ALAD) CPG that convey culturally-adapted recommendations from various international diabetes organizations [8]. The present report represents the current stage of tDNA adaptation in Venezuela, whereby a specific culture and locale will create its own version based on epidemiological, physiological, nutritional, and pathological parameters, as well as body composition and lifestyle. We describe the Venezuelan tDNA application (Figure 1) and prepare it for eventual validation protocols
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