Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study
Author:
Anjana Ranjit Mohan1ORCID, Srinivasan Seshadhri2, Sudha Vasudevan3, Joshi Shashank R.4, Saboo Banshi5, Tandon Nikhil6ORCID, Das Ashok Kumar7, Jabbar Puthiyaveettil Kottayam8, Madhu Sri Venkata9ORCID, Gupta Arvind10ORCID, Bajaj Sarita11, Chowdhury Subhankar12, Kalra Sanjay13, Gayathri Rajagopal3, Abirami Kuzhandaivelu3, Manasa Valangaiman Sriram3, Padmapritha Thamotharan14, Lakshmipriya Nagarajan3, Geetha Gunasekaran3, Deepa Mohan15, Pradeepa Rajendra16ORCID, Unnikrishnan Ranjit1, Kurpad Anura Viswanath17, Krishnaswamy Kamala3, Kaur Tanvir18, Dhaliwal Rupinder Singh18, Mohan Viswanathan1ORCID, Mohan Viswanathan, Anjana Ranjit Mohan, Unnikrishnan Ranjit, Pradeepa Rajendra, Deepa Mohan, Sudha Vasudevan, Nirmal Elangovan, Subashini Radhakrishnan, Venkatesan Ulagamathesan, Nath L.M., Mahajan R.C., Ramachandran K., Gupte M.D., Lakshmy R., Mahanta Jagadish, Narain Kanwar, Madhu Sri Venkata, Das Ashok Kumar, Pandey Arvind, Tandon Nikhil, Dhaliwal R.S., Kaur Tanvir, Bhargava Balram, Rao P.V., Rao Modugu Nageswara, Jampa Lobsang, Kaki T., Das H.K., Borah P.K., Kumar Ajay, Sharma Smita, Bhansali Anil, Dash Kalpana, Shrivas Vijay Kumar, Tandon Nikhil, Krishnan Anand, Desai Ankush, Dias Amit, Saboo Banshi, Padhiyar Jayendrasinh M., Kalra Sanjay, Kalra Bharti, Moktha Jatinder Kumar, Gulepa Ramesh, Dhandhania V.K., Adhikari Prabha, Rao B. Sathish, Jabbar P.K., Jayakumari C., Jain Sunil M., Gupta Gaurav, Joshi Shashank, Yajnik Chittaranjan, Joshi Prashant P., Ningombam Somorjit, Singh Th. Bhubhonchandra, Budnah R.O., Basaiawmoit M.R., Rosangluaia , Lalramenga P.C., Suokhrie Vizolie, Tripathy Saroj Kumar, Sahu Nirmal Chandra, Purty Anil J., Das Ashok Kumar, Bhansali Anil, John Mary, Gupta Arvind, Gupta B. Lal, Shrivastava Sandeep K., Tobgay Karma Jigme, Kaleon Tempo Tsewang, Mohan Viswanathan, Anjana Ranjit Mohan, Pradeepa Rajendra, Deepa Mohan, Sudha Vasudevan, Reang Taranga, Das Swapan Kumar, Bajaj Sarita, Mathur Manoj Kumar, Modi Sagar, Kakkar Rakesh, Chowdhury Subhankar, Ghosh Sujoy, , ,
Affiliation:
1. 1Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India 2. 2International Research Centre, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India 3. 3Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India 4. 4Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India 5. 5Dia Care–Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India 6. 6Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi - National Capital, India 7. 7Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Pudcherry - Union Territory, India 8. 8Department of Endocrinology, Government Medical College, Trivandrum, Kerala, India 9. 9Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India 10. 10Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Jaipur, Rajasthan, India 11. 11Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India 12. 12Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India 13. 13Bharti Hospital, Karnal, Haryana, India 14. 14Department of Instrumentation and Control Engineering, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India 15. 15Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India 16. 16Department of Research Operations, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India 17. 17Department of Physiology, St. John’s Medical College, Bengaluru, Karnataka, India 18. 18Non-Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
Abstract
OBJECTIVE
To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach.
RESEARCH DESIGN AND METHODS
Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression to T2D in PD and NGT groups.
RESULTS
Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49–54%; protein, 19–20%; and fat, 21–26%; 2) PD remission to NGT: carbohydrate, 50–56%; protein,18–20%; fat, 21–27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54–57% and 56–60%; protein, 16–20% and 14–17%, respectively; and fat 20–24% for PD and NGT.
CONCLUSIONS
We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.
Funder
Department of Health Research, Government of India Indian Council of Medical Research Ministry of Health and Family Welfare, Government of India
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
6 articles.
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