Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study
Ranjit Mohan Anjana, Seshadhri Srinivasan, Vasudevan Sudha, Shashank Joshi, Banshi Saboo, Nikhil Tandon, Ashok Kumar Das, Puthiyaveettil Kottayam Jabbar, Sri Venkata Madhu, Arvind Gupta, Sarita Bajaj, Subhankar Chowdhury, Sanjay Kalra, Rajagopal Gayathri, Kuzhandaivelu Abirami, Valangaiman Sriram Manasa, Padmapritha Thamotharan, Nagarajan Lakshmipriya, Gunasekaran Geetha, Mohan Deepa, Rajendra Pradeepa, Ranjit Unnikrishnan, Anura V. Kurpad, Kamala Krishnaswamy, Tanvir Kaur, Rupinder Singh Dhaliwal, Viswanathan Mohan, for the ICMR-INDIAB Collaborative Study Group, Viswanathan Mohan, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Rajendra Pradeepa, Mohan Deepa, Vasudevan Sudha, Elangovan Nirmal, Radhakrishnan Subashini, Ulagamathesan Venkatesan, ICMR-INDIAB Expert Group:, L M Nath, Rahul Mahajan, K. Ramachandran, M D Gupte, R. Lakshmy, Jagadish Mahanta, Kanwar Narain, Sri Venkata Madhu, Ashok Kumar Das, Arvind Pandey, Nikhil Tandon, Rupinder Singh Dhaliwal, Tanvir Kaur, Balram Bhargava, ICMR-INDIAB State Principal Investigators and Co-investigators:, Paturi Vishnupriya Rao, Modugu Nageswara Rao, Lobsang Jampa, Tao Kaki, Harisankar Kannankott Das, Prasanta Kumar Borah, Ajay Kumar, Smita Sharma, Anil Bhansali, Kalpana Dash, Vijay Kumar Shrivas, Nikhil Tandon, Anand Krishnan, Ankush Desai, Amit Dias, Banshi Saboo, Jayendrasinh M. Padhiyar, Sanjay Kalra, Bharti Kalra, Jatinder Kumar Moktha, Ramesh Gulepa, Vinay Kumar Dhandhania, Prabha Adhikari, B. Sathish Rao, Puthiyaveettil Khadar Jabbar, C. Jayakumari, Sunil Kumar, Gaurav Gupta, Shashank Joshi, Chittaranjan S. Yajnik, Prashant P. Joshi, Somorjit Singh Ningombam, Th. Bhubhonchandra Singh, Richard O Budnah, Manoj Risbud Basaiawmoit, Rosangluaia, P.C. Lalramenga, Vizolie Suokhrie, Saroj Kumar Tripathy, Nirmal Chandra Sahu, Anil J Purty, Ashok Kumar Das, Anil Bhansali, Mary John, Arvind Gupta, B. Lal Gupta, S. K. Shrivastava
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 in 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.