The Importance and Effect of Dietary Fiber in Diabetes Prevention with Particular Consideration of Whole Grain Products

Abstract

The state of prediabetes is characterized by an increase in insulin resistance and a decrease in pancreatic beta cell function. The prestage of type 2 diabetes mellitus can be identified by an impaired glucose tolerance and/or by an impaired fasting blood sugar. Apart from weight loss and increase in physical activity, the development of type 2 diabetes mellitus can also be prevented by dietary changes. A low-fat diet with a dietary fiber intake of more than 30 g/d was shown to represent an effective preventive approach. A high-fiber diet has many positive effects on the physical health status. In addition to positive effects in the gastrointestinal tract it has an obvious potential to support weight reduction and to improve disturbances of carbohydrate and fat metabolism. At the present state of knowledge, insoluble dietary fibers as found in whole grain cereal products are considered to be especially effective in the prevention of type 2 diabetes mellitus. A high intake of fruits and vegetables as well as pulses also exerts health-promoting properties. A high-fiber diet also plays an important role in the prevention of obesity and coronary heart diseases.

Dietary fiber - type 2 diabetes mellitus - glucose intolerance - insulin resistance - prevention - insoluble dietary fibers - healthy lifestyle

References

• 1 Trajkovski M. et al . Genes of type 2 diabetes in Beta cells.  Endocrinol Metab Clin North Am. 2006;  35 357-369
• 2 Ostergard T. et al . Influence of the PPAR-gamma2 Pro12Ala and ACE I/D polymorphisms on insulin sensitivity and training effects in healthy offspring of type 2 diabetic subjects.  Horm Metab Res. 2005;  37 99-105
• 3 Schwarz PE. et al . Haplotypes in the promoter region of the ADIPOQ gene are associated with increased diabetes risk in a German caucasian population.  Horm Metab Res. 2006;  38 447-451
• 4 Kiessling A, Ehrhart-Bornstein M. Transcription factor 7-like 2 (TCFL2) - a novel factor involved in pathogenesis of type 2 diabetes. Comment on: Grant et al. Nature Genetics 2006, Published online 15 January 2006.  Horm Metab Res. 2006;  38 137-138
• 5 Hoffmann K, Mattheisen M, Dahm S, Nurnberg P, Roe C, Johnson J. et al . A German genome-wide linkage scan for type 2 diabetes supports the existence of a metabolic syndrome locus on chromosome 1p36.13 and a type 2 diabetes locus on chromosome 16p12.2.  Diabetologia. 2007;  50 ((7)) 1418-1422
• 6 Schwarz PEH. et al . Genetic variation of CAPN10 affects susceptibility to type 2 diabetes in German and Czech population.  Diabetes. 2001;  50 A232
• 7 Haffner SM. et al . Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican-Americans.  Diabetes. 1995;  44 1386-1391
• 8 Gaede P, Pedersen O. Multi-targeted and aggressive treatment of patients with type 2 diabetes at high risk: what are we waiting for?.  Horm Metab Res. 2005;  37 ((Suppl 1)) 76-82
• 9 Heliovaara MK. et al . Association of serum adiponectin concentration to lipid and glucose metabolism in healthy humans.  Horm Metab Res. 2006;  38 336-340
• 10 Ferris WF. et al . The relationship between insulin sensitivity and serum adiponectin levels in three population groups.  Horm Metab Res. 2005;  37 695-701
• 11 Johanson EH. et al . Fat distribution, lipid accumulation in the liver, and exercise capacity do not explain the insulin resistance in healthy males with a family history for type 2 diabetes.  J Clin Endocrinol Metab. 2003;  88 4232-4238
• 12 Schwarz PE, Bornstein SR. Pre-diabetes and metabolic syndrome in Germans.  Horm Metab Res. 2006;  38 359
• 13 Benjamin SM. et al . Estimated number of adults with prediabetes in the US in 2000: opportunities for prevention.  Diabetes Care. 2003;  26 645-649
• 14 Program TDP. Strategies to identify adults at high risk for type 2 diabetes.  Diabetes Care. 2005;  28 ((No. 1)) 138-144
• 15 Kanauchi M. et al . New “pre-diabetes” category and the metabolic syndrome in Japanese.  Horm Metab Res. 2005;  37 622-626
• 16 Diamantopoulos EJ. et al . Metabolic syndrome and prediabetes identify overlapping but not identical populations.  Exp Clin Endocrinol Diabetes. 2006;  114 ((7)) 377-383
• 17 Schwarz PE. Report from the Congress of the American Diabetes Association (ADA): Orlando 2005-65th Annual Scientific Sessions in San Diego, CA, USA, June 10th -14th 2005.  Exp Clin Endocrinol Diabetes. 2005;  113 ((8)) 475-479
• 18 Schwarz PE. Congress report from the American Diabetes Association 66th Annual Scientific Sessions in Washington, USA.  Exp Clin Endocrinol Diabetes. 2006;  114 ((10)) p. 605-610
• 19 Haffner SM. et al . Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state.  Circulation. 2000;  101 975-980
• 20 Schwarz PE, Bornstein SR, Hanefeld M. Elevated fasting glucose levels predicts IGT and diabetes also in middle-age subjects.  Diabetes Res Clin Pract. 2007;  77 148-150
• 21 Linnemann B. et al . C-reactive protein is a strong independednt predictor of death in type 2 diabetes: association with multiple facets of the metaboic syndrome.  Exp Clin Endocrinol Diabetes. 2006;  114 ((3)) 127-134
• 22 Knowler WC. et al . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 393-403
• 23 Tuomilehto J. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
• 24 Chiasson JL. et al . Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.  Lancet. 2002;  359 2072-2077
• 25 Pan XR. et al . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.  Diabetes Care. 1997;  20 537-544
• 26 Ou HY. et al . Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects.  Horm Metab Res. 2006;  38 106-111
• 27 Torgerson JS. et al . XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.  Diabetes Care. 2004;  27 155-161
• 28 Hernan WH. et al . Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program.  Diabetes Care. 2003;  26 36-47
• 29 Watts G. Huge numbers must change lifestyle to prevent epidemic of diabetes.  BMJ. 2003;  327 1365
• 30 Narayan KM, Bowman BA, Engelgau ME. Prevention of type 2 diabetes.  BMJ. 2001;  323 63-64
• 31 Schwarz PE. et al . Development of a diabetes prevention management program for clinical practice.  Public Health Rep. 2007;  122 258-263
• 32 Schwarz PEH, Li J, Wegner H, Bornstein SR, Lindström J, Tuomilehto J. An Accurate Risk score based on Anthropometric, Dietary, and Lifestyle Factors to Predict the Development of Type 2 Diabetes, Response to Schulze et al.  Diabetes Care. 2007;  30 ((8)) e87
• 33 Schwarz PE. et al . Diabetes prevention - from physiology to implementation.  Horm Metab Res. 2006;  38 460-464
• 34 Gittelsohn J. et al . Specific patterns of food consumption and preparation are associated with diabetes and obesity in a Native Canadian community.  J Nutr. 1998;  128 541-547
• 35 WHO . Diet, nutrition and the prevention of chronic diseases.  World Health Organ Tech Rep Ser. 2003;  916 i-viii , 1-149, backcover
• 36 Wenying Y, Zhaojun Y. Obesity and hypertension as two anthropometric predictors for metabolic syndrome.  Horm Metab Res. 2006;  38 469-470
• 37 Toeller M. Evidenz-basierte Ernährungsempfehlungen zur Behandlung und Prävention des Diabetes mellitus.  Diabetes und Stoffwechsel. 2005;  14 75-94
• 38 Bunzel M, Steinhart H. Ballaststoffe aus Pflanzenzellwänden-Chemische und strukturelle Merkmale.  Ernährungs-Umschau. 2003;  50 469-475
• 39 AACC .The Definition of Dietary Fiber. In: CFW AACC Report 2001: 112-126
• 40 SMUL 1 . Sächsische Verzehrsstudie.  2001;  , Sächsisches Staatsministerium für Umwelt und Landwirtschaft Dresden
• 41 Ernährung DGf. Ernährungsbericht 2000. ed. D.G.f. Ernährung. 2000 Frankfurt am Main Deutsche Gesellschaft für Ernährung
• 42 Fung TT. et al . Whole-grain intake and the risk of type 2 diabetes: a prospective study in men.  Am J Clin Nutr. 2002;  76 535-540
• 43 Montonen J. et al . Whole-grain and fiber intake and the incidence of type 2 diabetes.  Am J Clin Nutr. 2003;  77 622-629
• 44 Züger T. Der postprandiale Blutzucker am Beispiel eines Typ-1-Diabetikers.  Schweiz Med Forum. 2003;  8 189-195
• 45 Schulze MB. et al . Fiber and magnesium intake and incidence of type 2 diabetes: a prospective study and meta-analysis.  Arch Intern Med. 2007;  167 956-965
• 46 ADA . Position of the American Dietetic Association: Health implications of dietary fiber.  J Am Diet Assoc. 2002;  102 993-1000
• 47 Kiefer I. Möglichkeiten der Beeinflussung des Ernährungsverhaltens und der Nährstoffaufnahme durch Ernährungsberatung und deren präventive Konsequenzen.  J Ernährungsmed. 2000;  5 11-17
• 48 Roberts SB, Heyman MB. Dietary composition and obesity: do we need to look beyond dietary fat?.  J Nutr. 2000;  130 ((2S Suppl)) 267S
• 49 Koh-Banerjee P. et al . Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men.  Am J Clin Nutr. 2004;  80 1237-1245
• 50 Liu S. et al . Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women.  Am J Clin Nutr. 2003;  78 920-927
• 51 Meyer KA. et al . Carbohydrates, dietary fiber, and incident type 2 diabetes in older women.  Am J Clin Nutr. 2000;  71 921-930
• 52 Laube H, Mehnert H. Diabetologie. Ernährungstherapie. 1999 Stuttgart: Georg Thieme Verlag 128
• 53 Stevens J. et al . Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study.  Diabetes Care. 2002;  25 1715-1721
• 54 Weickert MO, Pfeiffer AFH. Ballaststoffe und Prävention des Typ-2-Diabetes.  Ernährung Med. 2005;  20 185-189
• 55 Weickert MO. et al . Impact of cereal fibre on glucose-regulating factors.  Diabetologia. 2005;  48 2343-2353
• 56 MacKeown NM. et al . Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study.  Am J Clin Nutr. 2002;  76 390-398
• 57 Ylonen K. et al . Associations of dietary fiber with glucose metabolism in nondiabetic relatives of subjects with type 2 diabetes: the Botnia Dietary Study.  Diabetes Care. 2003;  26 1979-1985
• 58 Slavin JL. et al . Plausible mechanisms for the protectiveness of whole grains.  Am J Clin Nutr. 1999;  70 ((3 Suppl)) 459S-463S
• 59 Juntunen KS. et al . High-fiber rye bread and insulin secretion and sensitivity in healthy postmenopausal women.  Am J Clin Nutr. 2003;  77 385-391
• 60 Juntunen KS. et al . Postprandial glucose, insulin, and incretin responses to grain products in healthy subjects.  Am J Clin Nutr. 2002;  75 254-262
• 61 Behall KM, Scholfield DJ, Hallfrisch J. The effect of particle size of whole-grain flour on plasma glucose, insulin, glucagon and thyroid-stimulating hormone in humans.  J Am Coll Nutr. 1999;  18 591-597
• 62 Schulze MB. et al . Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.  Am J Clin Nutr. 2004;  80 348-356
• 63 MacIntosh GH. et al . Whole-grain rye and wheat foods and markers of bowel health in overweight middle-aged men.  Am J Clin Nutr. 2003;  77 967-974
• 64 Burton-Freeman B. Dietary fiber and energy regulation.  J Nutr. 2000;  130 ((2S Suppl)) 272S-275S
• 65 Roberts SB, MacCrory MA, Saltzman E. The influence of dietary composition on energy intake and body weight.  J Am Coll Nutr. 2002;  21 140S-145S
• 66 Liese AD. et al . Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study.  Am J Clin Nutr. 2003;  78 965-971
• 67 Pereira MA. et al . Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults.  Am J Clin Nutr. 2002;  75 848-855
• 68 Anderson JW. et al . Whole grain foods and heart disease risk.  J Am Coll Nutr. 2000;  19 ((3 Suppl)) 291S-299S
• 69 Salmeron J. et al . Dietary fat intake and risk of type 2 diabetes in women.  Am J Clin Nutr. 2001;  73 1019-1026
• 70 Dam RM van. The epidemiology of lifestyle and risk for type 2 diabetes.  Eur J Epidemiol. 2003;  18 1115-1125
• 71 Nimptsch K. Ballaststoffaufnahme in der EPIC-Potsdam Studie: Determinanten und Einfluss auf das Myokardinfarktrisiko.  Ernährungs-Umschau. 2006;  3 106-107
• 72 Li H. et al . Selective agenesis of the dorsal pancreas in mice lacking homeobox gene Hlxb9.  Nat Genet. 1999;  23 67-70
• 73 Wolk A. et al . Long-term intake of dietary fiber and decreased risk of coronary heart disease among women.  JAMA. 1999;  281 1998-2004
• 74 Weickert MO. et al . Cereal fiber improves whole-body insulin sensitivity in overweight and obese women.  Diabetes Care. 2006;  29 775-780
• 75 Mohlig M. et al . Arabinoxylan-enriched meal increases serum ghrelin levels in healthy humans.  Horm Metab Res. 2005;  37 303-308
• 76 Lampe JW. Health effects of vegetables and fruit: assessing mechanisms of action in human experimental studies.  Am J Clin Nutr. 1999;  70 ((3 Suppl)) 475S-490S
• 77 Pereira MA. et al . Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies.  Arch Intern Med. 2004;  164 370-376
• 78 Parhofer KG. Beyond LDL-cholesterol:HDL-cholesterol as a target for atherosclerosis prevention.  Exp Clin Endocrinol Diabetes. 2005;  113 ((8)) 414-417
• 79 Wu H. et al . Dietary fiber and progression of atherosclerosis: the Los Angeles Atherosclerosis Study.  Am J Clin Nutr. 2003;  78 1085-1091
• 80 Schneeman BO. Building scientific consensus: the importance of dietary fiber.  Am J Clin Nutr. 1999;  69 1
• 81 Suter PM, Moser C. Interessantes zum Früchte- und Gemüsekonsum.  Praxis. 2005;  94 1723-1730
• 82 Maessina MJ. Legumes and soybeans: overview of their nutritional profiles and health effects.  Am J Clin Nutr. 1999;  70 ((3 Suppl)) 439S-450S
• 83 Diet, nutrition and the prevention of chronic diseases.  World Health Organ Tech Rep Ser. 2003;  916 i-viii , 1-149, backcover
• 84 Lindstrom J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M. et al . High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study.  Diabetologia. 2006;  49 ((5)) 912-920
• 85 Schwarz PE. et al . Prevention of diabetes mellitus: The future of German diabetology.  Hamostaseologie. 2007;  27 13-21
• 86 Enas EA. et al . Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations.  Indian Heart J. 2003;  55 310-338
• 87 Bunzel M. et al . Sinapate dehydrodimers and sinapate-ferulate heterodimers in cereal dietary fiber.  J Agric Food Chem. 2003;  51 1427-1434
• 88 Brown L. et al . Cholesterol-lowering effects of dietary fiber: a meta-analysis.  Am J Clin Nutr. 1999;  69 30-42

Correspondence