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ABSTRACT: This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.
Journal of the American Dietetic Association 12/2010; 110(12):1852-89. · 3.59 Impact Factor
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Marion J Franz
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ABSTRACT: The clinical application of the glycemic index (GI) to the prevention and treatment of chronic diseases is controversial. No evidence exists for the implementation of low-GI diets for a reduction in coronary heart disease (CHD) mortality, events, or morbidity. Observational studies report conflicting evidence on the role of low-GI diets in CHD and risk factors for CHD. Randomized clinical trials report a small reduction in total cholesterol (-6.6 mg/dL) from low-GI diets compared with high-GI diets, but no reduction in other risk factors, such as low-density lipoprotein or high-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin, or body weight. Currently, the research suggests a minimal role for the implementation of low-GI diets in the prevention or treatment of CHD.
Current Atherosclerosis Reports 01/2009; 10(6):497-502. · 2.66 Impact Factor
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ABSTRACT: In the 1990s, the American Dietetic Association (ADA) began developing nutrition practice guidelines for registered dietitians (RDs) and evaluating how their use affected clinical outcomes. Clinical trials and outcomes research report that diabetes medical nutrition therapy, delivered using a variety of nutrition interventions and multiple encounters, is effective in improving glycemic and other metabolic outcomes. The process of developing nutrition practice guidelines has evolved into evidence-based nutrition practice guidelines, which are disease/condition-specific recommendations and toolkits. An expert work group identified important clinical questions related to diabetes nutrition therapy. Research studies were analyzed and evidence summaries and conclusion statements written and graded for strength of research design. Based on the research conclusions, evidence-based nutrition recommendations and guidelines for adults with type 1 and type 2 diabetes were formulated. The ADA evidence-based nutrition practice guidelines for diabetes are published in the Web-based evidence analysis library. The recommendations are similar to those of the American Diabetes Association, although developed using a different method. To define the RD's professional practice, the ADA has published the Scope of Dietetics Practice Framework, the Standards of Practice and Standards of Professional Performance, and specialized standards for the RD in diabetes nutrition care. The latter defines the knowledge, skills, and competencies required by RDs to provide diabetes care at the generalist, specialist, and advanced practice level.
Journal of the American Dietetic Association 05/2008; 108(4 Suppl 1):S52-8. · 3.59 Impact Factor
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John P Bantle,
Judith Wylie-Rosett,
Ann L Albright,
Caroline M Apovian,
Nathaniel G Clark, Marion J Franz,
Byron J Hoogwerf,
Alice H Lichtenstein,
Elizabeth Mayer-Davis,
Arshag D Mooradian,
Madelyn L Wheeler
Diabetes care 02/2008; 31 Suppl 1:S61-78. · 8.09 Impact Factor
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ABSTRACT: To assist health professionals who counsel patients with overweight and obesity, a systematic review was undertaken to determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight-loss outcomes from such interventions.
A search was conducted for weight-loss-focused randomized clinical trials with >or=1-year follow-up. Eighty studies were identified and are included in the evidence table.
The primary outcomes were a measure of weight loss at 6, 12, 24, 36, and 48 months. Eight types of weight-loss interventions-diet alone, diet and exercise, exercise alone, meal replacements, very-low-energy diets, weight-loss medications (orlistat and sibutramine), and advice alone-were identified. By using simple pooling across studies, subjects mean amount of weight loss at each time point for each intervention was determined.
Efficacy outcomes were calculated by meta-analysis and provide support for the pooled data. Hedges' gu was combined across studies to obtain an average effect size (and confidence level).
A mean weight loss of 5 to 8.5 kg (5% to 9%) was observed during the first 6 months from interventions involving a reduced-energy diet and/or weight-loss medications with weight plateaus at approximately 6 months. In studies extending to 48 months, a mean 3 to 6 kg (3% to 6%) of weight loss was maintained with none of the groups experiencing weight regain to baseline. In contrast, advice-only and exercise-alone groups experienced minimal weight loss at any time point.
Weight-loss interventions utilizing a reduced-energy diet and exercise are associated with moderate weight loss at 6 months. Although there is some regain of weight, weight loss can be maintained. The addition of weight-loss medications somewhat enhances weight-loss maintenance.
Journal of the American Dietetic Association 11/2007; 107(10):1755-67. · 3.59 Impact Factor
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Judith Wylie-Rosett,
Ann A Albright,
Caroline Apovian,
Nathaniel G Clark,
Linda Delahanty, Marion J Franz,
Byron Hoogwerf,
Karmeen Kulkarni,
Alice H Lichtenstein,
Elizabeth Mayer-Davis,
Arshag D Mooradian,
Madelyn Wheeler
Journal of the American Dietetic Association 09/2007; 107(8):1296-304. · 3.59 Impact Factor
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Marion J Franz
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ABSTRACT: Nutrition therapy interventions for the metabolic syndrome include weight reduction or maintenance, physical activity, whole grains and fiber, and type and amount of food fats. Interventions related to carbohydrate--amount and type--and alcohol are controversial. The role of the dietitian is to assist persons with the metabolic syndrome to make lifestyle changes that modify the factors that increase risk of diabetes and cardiovascular disease.
Current Diabetes Reports 03/2007; 7(1):60-5. · 2.50 Impact Factor
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ABSTRACT: Although numerous guidelines and standards address the management of diabetes in outpatient settings, only recently has evidence been provided to issue standards of care to guide clinicians in optimal inpatient glycemic control for hospitalized individuals with diabetes or illness-induced hyperglycemia. Both the American Diabetes Association and the American College of Endocrinology recommend critically ill patients keep their blood glucose level as close to 110 mg/dL (6.1 mmol/L) as possible. In the noncritically ill patient, the American Diabetes Association recommends to keep pre-meal blood glucose as close to 90 to 130 mg/dL (5.0 to 7.2 mmol/L) as possible, whereas the American College of Endocrinology recommends pre-meal blood glucose be kept at 110 mg/dL (6.1 mmol/L) or less. Both organizations agree that peak post-prandial blood glucose should be 180 mg/dL (10.0 mmol/L) or less. Recent evidence has also led the Joint Commission on Accreditation of Healthcare Organizations to develop standards for a voluntary certification in the management of the patient with diabetes in the inpatient setting. It is important that food and nutrition professionals familiarize themselves with these recommendations and implement nutrition interventions in collaboration with other members of the health care team to achieve these new glycemic control targets. Food and nutrition professionals have a key role in developing screening tools, and in implementing nutrition care guidelines, nutrition interventions, and medical treatment protocols needed to improve inpatient glycemic control.
Journal of the American Dietetic Association 02/2007; 107(1):105-11. · 3.59 Impact Factor
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John P Bantle,
Judith Wylie-Rosett,
Ann L Albright,
Caroline M Apovian,
Nathaniel G Clark, Marion J Franz,
Byron J Hoogwerf,
Alice H Lichtenstein,
Elizabeth Mayer-Davis,
Arshag D Mooradian,
Madelyn L Wheeler
Diabetes Care 10/2006; 29(9):2140-57. · 8.09 Impact Factor
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Marion J Franz
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ABSTRACT: There is debate among professionals regarding the use of the glycemic index (GI) for meal planning. In type-1 diabetes, there are 4 studies (average duration approximately 4 weeks) comparing high versus low GI diets; none reported improvements in HbA1c, and although 2 reported improvements in fructosamine, 2 reported no differences. In type-2 diabetes, there are 12 studies (average duration approximately 5 weeks); 3 reported improvements in HbA1c and fructosamine, 5 reported no differences in HBA1c, and 3 reported no differences in fructosamine. In adults, there is limited evidence that a low GI diet is beneficial for weight loss or satiety. Three epidemiologic studies reported that a low GI/glycemic load (GL) is associated with a reduced risk of developing diabetes or prevalence of insulin resistance; however, 5 studies report no association between GI/GL and the risk of developing diabetes, fasting insulin or insulin resistance, or adiposity. In general, the total amount of carbohydrate in a meal is the primary meal-planning strategy for people with diabetes. The GI can be used as an adjunct for the fine tuning of postprandial blood glucose responses. Other food/meal-planning interventions have been shown to be more effective than the use of the GI.
Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:57-68; discussion 69-72.
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Marion J Franz
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ABSTRACT: Overweight and obesity in women contribute to increased risk of many health problems, including type 2 diabetes. A systematic review of the weight loss literature found 17 articles in which women were the sole subjects and studies were a minimum of 1 year or longer in duration. Data were pooled and average weight loss and maintenance for women at 6 and 12 months was determined for each of the six interventions. Diet as the primary intervention resulted in a weight loss of approximately 7 kg at 6 months (approximately 13% of their initial weight), which was maintained to 12 months. When specific goals for physical activity or weight loss medications were combined with diet, better outcomes were experienced. Regardless of the intervention, at approximately 6 months a weight loss plateau occurred. All of the studies included at least monthly follow-up.
Current Diabetes Reports 11/2004; 4(5):387-93. · 2.50 Impact Factor
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ABSTRACT: Human milk is recommended for infants throughout at least the first year of life. Breastfeeding is also recommended for infants of women with preexisting diabetes or gestational diabetes. Dietary Reference Intakes (DRIs) 2002 provides recommendations for energy and macronutrients for all ages and for pregnancy and lactation. During the first 6 months, infants receive an average of 500 kcal/d from human milk, and during the second 6 months 400 kcal/d. To cover this need for the first 6 months of lactation, women need an additional energy intake of 330 kcal/d plus the approximately 170 kcal/d that is supplied by the women's tissue stores, and for the second 6 months 400 kcal/d. The DRIs also set recommended levels for both the infant and mother for carbohydrate, protein, and fats. Women with type 1 diabetes may have problems initiating breastfeeding, and with hypo- and hyperglycemia during lactation. Breastfeeding may have long-term beneficial effects on glycemia in women with gestational diabetes. More research is needed on all aspects of lactation in women with diabetes.
Current Diabetes Reports 11/2004; 4(5):370-6. · 2.50 Impact Factor
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Diabetes Care 10/2004; 27(9):2266-71. · 8.09 Impact Factor
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Marion J Franz
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ABSTRACT: The 2002 American Diabetes Association (ADA) nutrition principles and recommendations are classified according to the level of evidence available using the ADA evidence grading system. Research also supports medical nutrition therapy (MNT) as an effective therapy in reaching treatment goals for glycemia, lipids, and blood pressure. Recommendations for carbohydrate, protein, dietary fat, micronutrients, and alcohol are summarized. The first priority for persons requiring insulin therapy is to identify a food/meal plan that can be used to integrate an insulin regimen into the person's lifestyle. MNT for type 2 diabetes progresses from prevention of obesity or weight gain to improving insulin resistance to contributing to improved metabolic control. The progressive decline in beta-cell failure requires that MNT progress from MNT as monotherapy to MNT in combination with oral glucose-lowering agents to MNT with insulin therapy. Monitoring of outcomes is essential to assess the outcomes of lifestyle interventions or to determine if changes in medication(s) are necessary.
Nutrition in Clinical Practice 05/2004; 19(2):137-44. · 1.59 Impact Factor
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Diabetes Care 02/2004; 27 Suppl 1:S55-7. · 8.09 Impact Factor
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Marion J Franz,
John P Bantle,
Christine A Beebe,
John D Brunzell,
Jean-Louis Chiasson,
Abhimanyu Garg,
Lea Ann Holzmeister,
Byron Hoogwerf,
Elizabeth Mayer-Davis,
Arshag D Mooradian,
Jonathan Q Purnell,
Madelyn Wheeler
Diabetes Care 02/2004; 27 Suppl 1:S36-46. · 8.09 Impact Factor
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ABSTRACT: Human observational studies report no association between protein intakes less than 20% of energy intake and the development of renal disease. With protein intakes greater than 20% of energy intake there is an association between protein with increased albumin excretion rate. Once albuminuria is present, intervention studies suggest a beneficial effect on renal function with a reduction of protein to 0.8 to 1.0 g/kg/d with microalbuminuria and to 0.8 g/kg/d with macroalbuminuria. Restriction of sodium to 2400 mg/d or possibly for some to 2000 mg/d assists in the control of hypertension. In macroalbuminuria, there may be additional benefits in lowering phosphorus intake to 500 to 1000 mg/d. There is no strong evidence to suggest benefit from vegetable or plant proteins over animal protein, but there is evidence for benefit on renal function, glucose, lipids, and blood pressure from weight-maintaining diets meeting guidelines for a healthy diet.
Current Diabetes Reports 11/2003; 3(5):412-7. · 2.50 Impact Factor
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Marion J Franz
Current Diabetes Reports 11/2003; 3(5):395-6. · 2.50 Impact Factor
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Marion J Franz
Journal of the American Dietetic Association 09/2003; 103(8):977-81. · 3.59 Impact Factor
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Diabetes forecast 09/2003; 56(8):60-2.
