Dieta y ejercicio | Endocrinología y Nutrición

Article information

El tratamiento no farmacológico de la diabetes tipo 2 consiste en medidas precisas y escalonadas en el estilo de vida: alimentación y actividad física. La estrategia nutricional, cuando coexiste obesidad, estriba en la aplicación de una dieta moderadamente hipocalórica que consiga pérdidas modestas de grasa (especialmente visceral), y el mantenimiento de dicha pérdida, conservando la masa magra. El reparto energético entre lípidos, proteínas e hidratos de carbono tiene un margen muy amplio, y debe individualizarse según la edad, la presencia o no de sobrepeso y otras comorbilidades (dislipemia, hipertensión, etc.). En diabéticos tipo 2 no obesos el tratamiento es el mismo, pero sin restricción calórica.

Estas medidas se acompañarán de un incremento en la actividad física diaria y la recomendación individualizada de ejercicio físico más intenso semanal, por el potente efecto de mejora de la sensibilidad a la insulina y los factores de riesgo cardiovascular asociados. En esta exposición se aportan algunas propuestas de prescripción individualizada de ambos elementos del estilo de vida, basándonos en las evidencias científicas del momento.

Palabras clave:

Plan alimentario

Actividad física

Ejercicio

Reparto calórico

Diabetes tipo 2

Non-pharmacological treatment of type 2 diabetes consists of well-defined and progressive lifestyle measures: diet and exercise. In obese diabetic patients, the nutritional strategy consists of a moderately hypocaloric diet to achieve modest fat loss (especially visceral fat) and to maintain this loss while conserving lean tissue mass. Calorie distribution among lipids, proteins and carbohydrates has a wide margin and should be individually tailored according to age and the presence or absence of overweight and other comorbidities (dyslipidemia, hypertension etc.). Treatment is the same in non-obese type 2 diabetics, but without calorie restriction. These measures should be accompanied by an increase in daily physical exercise and individualized recommendations for more intense weekly physical activity due to its strong effect on improving insulin sensitivity and associated cardiovascular risk factors. The present article discusses some recommendations for the individualized prescription of both types of lifestyle modification, based on the latest scientific evidence.

Key words:

Dietary plan

Physical activity

Exercise

Calorie distribution

Type 2 diabetes

Full text is only aviable in PDF

Bibliografía

[1.]

American Diabetes Association.

Nutrition Recommendatiosn and Interventions for Diabetes. A position statement of the American Diabetes Association.

Diabetes Care, 30 (2007), pp. S48-S63

http://dx.doi.org/10.2337/dc07-S048 | Medline

[2.]

NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Clinical guidelines. The evidence report. Bethesda: National Institutes of Health; 1998.

[3.]

A.G. Dulloo, J. Jacquet, L. Girardier.

Poststarvation hyperphagia and body fat overshooting in humans: a role for feed back signals from lean and fat tissues.

Am J Clin Nutr, 65 (1997), pp. 717-723

Medline

[4.]

S.L. Norris, X. Zhang, A. Avenell, E. Gregg, C.H. Schmid, C. Kim, et al.

Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: a metanalysis.

Arch Intern Med, 164 (2004), pp. 1395-1404

http://dx.doi.org/10.1001/archinte.164.13.1395 | Medline

[5.]

H. Buchwald, Y. Avidor, E. Braunwald, M.D. Jennsen, W. Pories, K. Fahrbach, et al.

Bariatric surgery: a systematic review and metaanalysis.

JAMA, 292 (2004), pp. 1724-1737

http://dx.doi.org/10.1001/jama.292.14.1724 | Medline

[6.]

P.E. O’Brien, J.B. Dixon, C.H. Laurie, S. Skinner, J. Proietto, J. McNeil, et al.

Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program.

Ann Intern Med, 144 (2006), pp. 625-633

Medline

[7.]

M.J. Franz, J.P. Bantle, A. Beebe, J.D. Brunzell, J.L. Chiasson, A. Garg, et al.

Nutrition principles and recommendations in diabetes.

Diabetes Care, 27 (2004), pp. S36-S46

Medline

[8.]

American Diabetes Association.

ADA Position Statement. Standards of medical care in diabetes 2006.

Diabetes Care, 29 (2006), pp. S4-S42

Medline

[9.]

J.W. Anderson, K.M. Randles, C.W. Kendall, D.J. Jenkins.

Carbohydrate and fiber recommendations for individual with diabetes: a quantitative assessment and meta-analysis of the evidence.

J Am Coll Nutr, 23 (2004), pp. 5-17

Medline

[10.]

S. Kelly, G. Frost, V. Whittaker, C. Summerbell.

Low glycaemic index diets for coronary heart disease.

Cochrane Database Syst Rev, 18 (2004),

[11.]

K.L. Teff, S.S. Elliott, M. Tschop, T.J. Kieffer, D. Rader, M. Heiman, et al.

Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women.

J Clin Endocrinol Metab, 89 (2004), pp. 2963-2972

[12.]

G.H. Anderson, N.L. Catherine, D.M. Woodend, T.M. Wolever.

Inverse association between the effect of carbohydrates on blood glucose and subsequent short-term food intake in young men.

Am Nutr, 76 (2002), pp. 1023-1030

[13.]

S. Andersen, I. Tarnow, P. Rossing, B.V. Hansen, H.H. Parving.

Renoprotective effects of angiotensin II receptor blockade in type 1 diabetic patients with diabetic nephropathy.

Kidney Int, 57 (2000), pp. 601-606

[14.]

American Diabetes Association.

Standards of medical care in diabetes.

Diabetes Care, 28 (2005), pp. S4-S36

Medline

[15.]

R.R. Wolfe.

The underappreciated role of muscle in health and disease.

Am J Clin Nutr, 84 (2006), pp. 475-482

Medline

[16.]

Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults.

Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).

JAMA, 285 (2001), pp. 2486-2497

Medline

[17.]

D. Mozaffarian, M.B. Katan, A. Ascherio, M.J. Stampfer, W.C. Willett.

Trans fatty acids and cardiovascular disease.

N Engl J Med, 354 (2006), pp. 1601-1603

http://dx.doi.org/10.1056/NEJMra054035 | Medline

[18.]

J.T. Chen, R. Wesley, R.D. Shamburek, F. Pucino, G. Csako.

Metanaalysis of natural therapies for hyperlipidemia: plant sterols and stanol versus policosanol.

Pharmacotherapy, 25 (2005), pp. 171-183

http://dx.doi.org/10.1592/phco.25.2.171.56942 | Medline

[19.]

Institute of Medicine. Dietary Reference Intakes: energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein and aminoacids. Washington DC: National Academic Press; 2002.

[20.]

A.J. Nordmann, A. Nordmann, M. Briel, U. Keller, W.S. Yancy Jr, B.J. Brehm, et al.

Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials.

Arch Intern Med, 166 (2006), pp. 285-293

http://dx.doi.org/10.1001/archinte.166.3.285 | Medline

[21.]

M.D. Althuis, N.E. Jordan, E.A. Ludeington, J.T. Wittes.

Glucose and insulin responses to dietary chromium supplements: a meta-analysis.

Am J Clin Nutr, 76 (2002), pp. 148-155

[22.]

M.S. Farvid, M. Jalali, F. Siassi, N. Saadat, M. Hosseini.

Comparison of the effects of vitamins and/or mineral supplementation on glomerular and tubular dysfunction in type 2 diabetes.

Diabetes Care, 28 (2005), pp. 2458-2464

Medline

[23.]

M.S. Farvid, M. Jalali, F. Siassi, N. Saadat, M. Hosseini.

The impact of vitamins and/or mineral supplementation on blood pressure in type 2 diabetes.

J Am Coll Nutr, 3 (2004), pp. 272-279

[24.]

I. De Leeuw, W. Engelen, C. De Block, L. Van Gaal.

Long-term supplementation fluences favourably the natural evolution of neuropaty in Mg-depleted type 1 diabetic patients.

Mag Res, 17 (2004), pp. 109-114

[25.]

B. Canovas, M.A. Koning, C. Muñoz, C. Vázquez.

Nutrición equilibrada en el paciente diabético.

Nutr Hosp, 16 (2001), pp. 31-40

Medline

[26.]

Cavill N, Kahlmeier S, Racioppi F, editors. WHO Europe Report: physical activity and health in Europe: evidence for action. Denmark; 2006.

[27.]

Dieta, nutrición y prevención de enfermedades crónicas. Documento técnico 916. Ginebra: OMS; 2003.

[28.]

M. Neira, M. de Onís.

Estrategia NAOS: prevenir la obesidad, una prioridad de salud pública en España.

Lancet (ed esp), 365 (2005), pp. 1386

[29.]

De Teresa C, Vázquez C, Ortega RM, Sosa V, Cos AI, Pousa L, et al. Objetivos nutricionales y de actividad física. En: Ministerio de Sanidad y Consumo, editor. Agencia Española de Seguridad Alimentaria. Nutrición, actividad física y prevención de la obesidad. Madrid: Editorial Panamericana; 2006. p. 123-51.

[30.]

D.E. Thomas, E.J. Elliott, G.A. Naughton.

Exercise for type 2 diabetes mellitus.

Cochrane Database Syst Rev, 3 (2006),

http://dx.doi.org/10.1002/14651858.CD009601.pub2 | Medline

[31.]

S. Klein, N.F. Sheard, X. Pi-Sunyer, A. Daly, J. Wylie-Rosett, K. Kulkarni, et al.

Weight management through lifestyle modifications for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the study of the obesity, and the Society for Clinical Nutrition.

Diabetes Care, 27 (2004), pp. 2067-2073

Medline

[32.]

S.L. Norris, X. Zhang, A. Avenell, E. Gregg, T.J. Brown, C.H. Schmid, et al.

Long-term non pharmacologic wight loss interventions for adults with type 2 diabetes.

Cochrane Database Syst Rev, 18 (2005),

[33.]

N.G. Boule, G.P. Kenny, E. Haddad, G.A. Wells, R.J. Sigal.

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus.

Diabetologia, 46 (2003), pp. 1071-1081

http://dx.doi.org/10.1007/s00125-003-1160-2 | Medline

[34.]