XX Conference of the Graduate Committee of the Argentine Diabetes Society. Topic: Obesity and diabetes. Table 2: Nutritional treatment and physical activity
DOI:
https://doi.org/10.47196/diab.v58i3Sup.1268Keywords:
diabetes, obesity, non-caloric sweeteners, intermittent fasting, veganism, sarcopenia, ketogenic, paleolithic, Mediterranean, DASH, nutrigenomics, exercise, HIT, MICT, technologyAbstract
Introduction: the comprehensive management of diabetes mellitus (DM) and obesity requires a personalized, multidisciplinary, evidence-based, and person-centered approach. Nutritional therapy and physical activity are the pillars of treatment for both diabetes mellitus and obesity. The objective of this paper is to review the literature on nutritional therapy and physical activity in relation to DM and obesity.
Materials and methods: a review of the literature published in PubMed was conducted to select relevant studies. Publications with a high level of evidence were prioritized, including clinical guidelines, systematic reviews, meta-analyses, and controlled clinical trials published less than 10 years ago. Observational studies of good methodological quality were also included when they provided specific information not covered by higher-ranking studies.
Results: regarding nutritional strategies, intermittent fasting (IF) shows benefits in weight loss and metabolic profile in people with obesity and T2DM, but is not superior to continuous calorie restriction and carries risks of hypoglycemia in certain patients. Well-planned vegetarian and plant-based diets are associated with a lower risk of chronic diseases, including T2DM, and improve BMI and glycemic control. Ketogenic diets offer short-term benefits in obesity, such as satiety and metabolic improvement, but require strict supervision and do not outperform other diets in the long term. The Paleolithic diet, although with some reported metabolic benefits, has methodological limitations and adherence issues, so it is not recommended as a first-line option. The Mediterranean and DASH diets are patterns with strong scientific support for the prevention and control of cardiovascular disease in people with T2DM, showing improvements in clinical markers. Regarding non-caloric sweeteners (NCS), evidence suggests neutral or modestly beneficial effects in the short and medium term on weight and adiposity, with no negative impact on appetite or glycemia. However, observational associations with increased risk of type 2 DM could be influenced by reverse causality bias. Sarcopenia in aging requires higher protein intake and physical exercise, with heterogeneous evidence on omega-3 and vitamin D supplementation. Managing the coexistence of type 1 DM and obesity requires a comprehensive approach with tailored nutrition and physical activity. Nutrigenomics and nutrigenetics open the door to personalized precision nutrition strategies. Both HIIT and MICT are effective in improving glycemic control and body composition. Finally, digital technologies can improve adherence to physical activity and nutrition interventions.
Conclusions: the Mediterranean and DASH diets have strong scientific support for the prevention and control of cardiovascular disease in people with type 2 diabetes. Ketogenic diets may be helpful in the short term for overweight and obesity under professional supervision, but they are not a long-term or universal solution. The Paleolithic diet shows some benefits for weight management, but the evidence is limited. Well-planned vegetarian and plant-based diets are recommended at all life stages due to their metabolic benefits and their role in preventing T2DM and cardiovascular disease, highlighting their sustainability. Intermittent fasting (IF) appears promising for T2DM and obesity, requiring individualization and medical-nutritional supervision, with continuous glucose monitoring being a useful tool. On the other hand, while non-caloric sweeteners (NCS) are safe within a comprehensive approach, more long-term research is needed on their cardiometabolic impact. In the management of type 1 diabetes mellitus (T1DM) and obesity, specific recommendations are still needed, and further research on safe and effective strategies is warranted. It is also crucial to include comprehensive interventions such as education, exercise, and behavioral support in all cases. For sarcopenia, a combined approach of adequate nutrition, strategic supplementation, and tailored physical activity is essential. Nutrigenetics and nutrigenomics represent a step toward more personalized medicine. Personalized physical activity is essential in the comprehensive management of type 1 diabetes mellitus (T1DM) and type 2 diabetes (T2DM), as well as obesity, for both prevention and treatment, regardless of age. Finally, digital health is emerging as a promising tool with professional guidance and adaptation to patient preferences.
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