The Role of Nutritional Modifications in the Prevention of Macrovascular Complications of Diabetes

A wide range of dietary changes is likely to reduce the risk of macrovascular complications of diabetes. It is critically important to recommend a balance of macronutrients different from that currently consumed in most Western countries. Saturated fatty acids, especially myristic and palmitic acids, and trans fatty acids must be reduced to lower LDL cholesterol. Intake of polyunsaturated fatty acids should not be excessive (less than 10% total energy). Fiber-rich carbohydrate, derived from cereals, vegetables, and fruit with intact cell walls, and cis monounsaturated fatty acids should provide the bulk of total energy. These changes are likely to be associated with the most favorable lipoprotein profile and increase intake of dietary antioxidants and so reduce the level of oxidative stress. A reduction of sodium to below 6 g per day will help to reduce blood pressure levels. Optimal glycemie control has not yet been proved to reduce the risk of macrovascular complications, though this is a desirable goal for many other reasons. Ensuring appropriate energy balance (so that BMI is within the desirable range), using low glycemie index foods, and appropriately balancing carbohydrate intake with hypoglycemic drug therapy provide the best nutritional means of achieving satisfactory blood glucose levels. Successful implementation of nutritional recommendations requires the availability of dietitians capable of translating appropriate nutrition into appropriate foods acceptable to people with diabetes and their families. Clear food labeling and the availability of appropriate manufactured foods will further help patients with diabetes to achieve the dietary recommendations.