Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
- Marion J. Franz, RD, CDE, Co-Chair1,
- John P. Bantle, MD, Co-Chair2,
- Christine A. Beebe, RD, CDE3,
- John D. Brunzell, MD4,
- Jean-Louis Chiasson, MD5,
- Abhimanyu Garg, MD6,
- Lea Ann Holzmeister, RD, CDE7,
- Byron Hoogwerf, MD8,
- Elizabeth Mayer-Davis, PhD, RD9,
- Arshag D. Mooradian, MD10,
- Jonathan Q. Purnell, MD11 and
- Madelyn Wheeler, RD, CDE12
- 1Nutrition Concepts by Franz, Inc., Minneapolis, Minnesota
- 2Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- 3University of Illinois, Chicago, Illinois
- 4Department of Medicine, University of Washington, Seattle, Washington
- 5Research Center, Centre Hospitalier de l’Université de Montréal, Campus Hōtel-Dieu and Department of Medicine, University of Montreal, Montreal, Ontario, Canada
- 6Department of Internal Medicine and Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas
- 7Holzmeister Nutrition Consulting, Tempe, Arizona
- 8Department of Endocrinology, Cleveland Clinic Foundation, Cleveland, Ohio
- 9Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia, South Carolina
- 10Division of Endocrinology, St. Louis University Medical Center, St. Louis, Missouri
- 11Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
- 12Diabetes Research and Training Center, Indiana University School of Medicine, Indianapolis, Indiana
Historically, nutrition principles and recommendations for diabetes and related complications have been based on scientific evidence and diabetes knowledge when available and, when evidence was not available, on clinical experience and expert consensus. Often it has been difficult to discern the level of evidence used to construct the nutrition principles and recommendations. Furthermore, in clinical practice, many nutrition recommendations that have no scientific supporting evidence have been and are still being given to individuals with diabetes. To address these problems and to incorporate the research done in the past 8 years, this 2002 technical review provides principles and recommendations classified according to the level of evidence available. It reviews the evidence from randomized, controlled trials; cohort and case-controlled studies; and observational studies, which can also provide valuable evidence (1,2), and takes into account the number of studies that have provided consistent outcomes of support. In this review, nutrition principles are graded into four categories based on the available evidence: those with strong supporting evidence, those with some supporting evidence, those with limited supporting evidence and those based on expert consensus.
Evidence-based nutrition recommendations attempt to translate research data and clinically applicable evidence into nutrition care. However, the best available evidence must still be moderated by individual circumstances and preferences. The goal of evidence-based recommendations is to improve the quality of clinical judgments and facilitate cost-effective care by increasing the awareness of clinicians and patients with diabetes of the evidence supporting nutrition services and the strength of that evidence, both in quality and quantity.
Before 1994, the American Diabetes Association’s (ADA’s) nutrition principles and recommendations attempted to define an “ideal” nutrition prescription that would apply to everyone with diabetes (3,4,5). Although individualization was a major principle of all recommendations, it was usually done within defined …
