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Herrmann A, Gonnet A, Millogo RM, d'Arc Kabré WJ, Beremwidougou TR, Coulibaly I, Ouili I, Zoromé S, Weil K, Fuelbert H, Soura A, Danquah I. Sustainable dietary weight loss intervention and its effects on cardiometabolic parameters and greenhouse gas emissions: study protocol of a randomised controlled trial with overweight and obese adults in Ouagadougou, Burkina Faso. BMJ Open 2023; 13:e070524. [PMID: 37015795 PMCID: PMC10083789 DOI: 10.1136/bmjopen-2022-070524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION The global obesity epidemic and its adverse health effects have reached sub-Saharan Africa. In some urban settings, like Burkina Faso's capital Ouagadougou, up to 43% of the adult population are overweight or obese. At the same time, modernised food systems are responsible for 26% of global greenhouse gas emissions, 50% of land use and 70% of freshwater use. International guidelines on the treatment of overweight and obesity recommend dietary intervention programmes that promote reduced calorie intake and increased physical activity. So far, weight loss interventions rarely consider sustainable dietary concepts, including healthfulness, affordability, cultural appropriateness and environmental friendliness. Therefore, we present a study protocol of a novel randomised controlled trial that aims to establish the effects of a sustainable weight loss intervention on cardiometabolic and environmental outcomes in urban Burkina Faso. METHODS AND ANALYSIS We conduct a non-blinded randomised controlled trial, comparing a 6-month sustainable diet weight loss intervention programme (n=125) with a standard weight loss information material and 5 min oral counselling at baseline (n=125). Primary outcome is a reduction in fasting plasma glucose of ≥0.1 mmol/L. Outcome measures are assessed at baseline, after 6 months and after 12 months. ETHICS AND DISSEMINATION Ethical approval for the study has been obtained from the Medical Faculty of Heidelberg University (S-376/2019) and from the Ministry of Health and the Ministry of Higher Education, Scientific Research and Innovation in Ouagadougou, Burkina Faso (No 2021-01-001). The results of the study will be disseminated to local stakeholders at a final project meeting and to the wider research community through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER DRKS00025991.
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Affiliation(s)
- Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Anais Gonnet
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Roche Modeste Millogo
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Tenin Rosine Beremwidougou
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Issa Coulibaly
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Idrissa Ouili
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Souleymane Zoromé
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Konstantin Weil
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Hannah Fuelbert
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
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Nwayyir HA, Mutasher EM, Alabid OM, Jabbar MA, Abdulraheem Al-Kawaz WH, Alidrisi HA, Alabbood M, Chabek M, AlZubaidi M, Al-Khazrajy LA, Abd Alhaleem IS, Al-Hilfi ADA, Ali FM, AlBayati A, Al Saffar HB, Khazaal FAK. Recommendations for the prevention and management of obesity in the Iraqi population. Postgrad Med 2023:1-15. [PMID: 36803631 DOI: 10.1080/00325481.2023.2172914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Obesity is a chronic metabolic disease that has become one of the leading causes of disability and death in the world, affecting not only adults but also children and adolescents. In Iraq, one third of the adult population is overweight and another third obese. Clinical diagnosis is accomplished by measuring body mass index (BMI) and waist circumference (a marker for intra-visceral fat and higher metabolic and cardiovascular disease risk). A complex interaction between behavioral, social (rapid urbanization), environmental and genetic factors underlies the etiology of the disease. Treatment options for obesity may include a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioral modification, pharmacotherapy and bariatric surgery. The purpose for these recommendations is to develop a management plan and standards of care that are relevant to the Iraqi population and that can prevent/manage obesity and obesity-related complications, for the promotion of a healthy community.
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Affiliation(s)
- Hussein Ali Nwayyir
- University of Basra, College of Medicine, Department of Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Centre, Iraq
| | - Esraa Majid Mutasher
- Department of Pediatric Endocrinology, Children Welfare Teaching Hospital, Medical City Complex, Iraq
| | | | | | | | | | - Majid Alabbood
- Department of Endocrinology, Almawani Hospital, Basra, Iraq
| | - Muhammed Chabek
- Consultant Obstetrics and Gynecology, Private Practice, Iraq
| | - Munib AlZubaidi
- Department of paediatrics, University of Baghdad College of Medicine, Iraq
| | - Lujain Anwar Al-Khazrajy
- Department of Family medicine, Consultant Family Physician, Al-Kindy College of Medicine, University of Baghdad, Iraq
| | | | | | | | - Ali AlBayati
- Department of Endocrinology Consultant Endocrinology, Professor of medicine, Babylon medical college, Iraq
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Suleiman N, Alkasem M, Al Amer Z, Salameh O, Al-Thani N, Hamad MK, Baagar K, Abdalhakam I, Othman M, Dughmosh R, Al-Mohanadi D, Al Sanousi A, Bashir M, Chagoury O, Taheri S, Abou-Samra AB. Qatar Diabetes Mobile Application Trial (QDMAT): an open-label randomised controlled trial to examine the impact of using a mobile application to improve diabetes care in type 2 diabetes mellitus-a study protocol. Trials 2022; 23:504. [PMID: 35710428 PMCID: PMC9205079 DOI: 10.1186/s13063-022-06334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 04/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Mobile health (mHealth) is increasingly advocated for diabetes management. It is unclear if mobile applications are effective in improving glycaemic control, clinical outcomes, quality of life and overall patient satisfaction in patients with type 2 diabetes (T2DM). A new mobile application was specifically built for people with T2DM with the help of the local expertise. The objective of the study was to evaluate the effectiveness of the mobile app. Methods The planned study is an ongoing open-label randomised controlled trial in which adults living with T2DM treated with insulin will be randomised 1:1 to the use of this diabetes application versus current standard care. The primary outcome will be the difference in mean HbA1c from baseline to 6 months. Other outcome measures include anthropometric measures, hypoglycaemic events, medication adjustments, number of clinical interactions and missed appointments and patient perceptions of their disease and diabetes self-management. The study will randomise 180 subjects for assessment of the primary outcome. Discussion We hypothesise that the diabetes-specific mobile application will improve glycaemic control, increase patient empowerment for self-management of diabetes and improve interaction between patients and healthcare providers. If the Qatar Diabetes Mobile Application Trial (QDMAT) demonstrates this, it will inform clinical services for the future self-management of T2DM. Trial registration ClinicalTrials.gov Identifier: NCT03998267. Registered on 26 June 2019
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Affiliation(s)
- Noor Suleiman
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar. .,Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar. .,Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Meis Alkasem
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Zaina Al Amer
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Obada Salameh
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Noora Al-Thani
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Khair Hamad
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Baagar
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | | | - Manal Othman
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ragae Dughmosh
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Dabia Al-Mohanadi
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ali Al Sanousi
- Clinical Information Systems Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Bashir
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Odette Chagoury
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Shahrad Taheri
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - New York, New York, USA
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine - New York, New York, USA
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Nunes CL, Carraça EV, Jesus F, Finlayson G, Francisco R, Silva MN, Santos I, Bosy-Westphal A, Martins P, Minderico C, Sardinha LB, Silva AM. Changes in food reward and intuitive eating after weight loss and maintenance in former athletes with overweight or obesity. Obesity (Silver Spring) 2022; 30:1004-1014. [PMID: 35347875 DOI: 10.1002/oby.23407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to explore the following: 1) the impact of Champ4Life's intervention on intuitive eating and food reward; and 2) associations between changes in eating behavior and changes in body composition. METHODS A total of 94 former athletes (mean [SD], BMI = 31.1 [4.3] kg/m2 , age = 43.0 [9.4] years, 34% female) assigned to intervention (n = 49) and control groups (n = 45) underwent 4 months of active weight loss (WL) followed by 8 months of WL maintenance. Intuitive eating and food reward were assessed by the Intuitive Eating Scale and the Leeds Food Preference Questionnaire, respectively. RESULTS The WL was -4.8% (4.9%) and 0.3% (2.6%) for the intervention and control groups, respectively. Participants reported a decrease in fat bias for explicit/implicit wanting and explicit liking after 4 months and 1 year. For intuitive eating, the unconditional permission to eat decreased after 4 months, and the body-food choice congruence increased after 1 year. Changes in unconditional permission to eat and in body-food choice congruence were positively and negatively associated with both Δweight and with Δfat mass, respectively. Changes in explicit wanting for fat and taste bias were associated with Δweight. CONCLUSIONS Food reward decreased after a moderate WL intervention. Participants successfully maintained their reduced weight, and most of the changes in eating behavior remained significant at the end of the follow-up period. Lifestyle interventions aiming at WL should also consider intuitive eating and food reward.
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Affiliation(s)
- Catarina L Nunes
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Eliana V Carraça
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Graham Finlayson
- Appetite Control Energy Balance Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Rúben Francisco
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Marlene N Silva
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
- Programa Nacional para a Promoção da Atividade Física, Direcção-Geral da Saúde, Lisbon, Portugal
| | - Inês Santos
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES): Lusophone University, Lisbon, Portugal
- Nutrition Laboratory, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Anja Bosy-Westphal
- Department of Human Nutrition, Institute of Human Nutrition and Food Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Paulo Martins
- Laboratory of Sport Psychology, Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Cláudia Minderico
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, Centro Interdisciplinar de Performance Humana (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada, Portugal
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Hassanein M, Al Sifri S, Al Awadi F, Alessa T, Shaaban A. A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2022. [DOI: 10.1159/000525074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The safety and effectiveness of gliclazide modified release (MR) in patients with type 2 diabetes mellitus (T2DM) who fasted during Ramadan were previously published. Here, we carried out a regional analysis among patients living in Gulf Cooperation Council (GCC) countries. <b><i>Patients and Methods:</i></b> DIA-RAMADAN was a real-world, observational, international, noncomparative study conducted in nine countries that included >1200 T2DM adults receiving gliclazide MR for at least 90 days before inclusion. The study comprised 2 visits: at inclusion, 6–8 weeks before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1). The primary endpoint was the proportion of patients reporting ≥1 symptomatic hypoglycemic event as collected using a patient diary. Changes in HbA<sub>1c</sub>, fasting plasma glucose (FPG), and weight were also analyzed. This manuscript represents data collected in GCC countries (Kuwait, Saudi Arabia, and United Arab Emirates). <b><i>Results:</i></b> Data from 161 patients were analyzed: mean (SD) age 56.8 (10.6) years, 30.4% women, body mass index 29.1 (3.7) kg/m<sup>2</sup>, T2DM disease duration 6.7 (3.3) years, baseline HbA1c 7.9% (0.8). The proportions of patients reporting ≥1 symptomatic hypoglycemic event or confirmed hypoglycemia during Ramadan were 4.3% and 0.6%, respectively. No cases of severe hypoglycemia were reported. Significant reductions in main variables were observed before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1): HbA1c (from 7.9 [0.8] to 7.6 [0.7]%; <i>p</i> value <0.001), FPG (from 143.5 [24.3] to 137.9 [25.2] mg/dL; <i>p</i> value = 0.031), and weight (from 79.0 [73.0–86.0] to 78.0 [72.0–85.0] kg; <i>p</i> value = 0.018). <b><i>Conclusions:</i></b> These real-world data indicate that patients with T2DM treated with gliclazide MR during Ramadan in the selected GCC countries have a low risk of hypoglycemia and maintain glycemic control and weight while fasting.
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Zaghloul H, Elshakh H, Elzafarany A, Chagoury O, McGowan B, Taheri S. A systematic review of randomized controlled trials of dietary interventions for weight loss in adults in the Middle East and north Africa region. Clin Obes 2021; 11:e12434. [PMID: 33369151 PMCID: PMC7988652 DOI: 10.1111/cob.12434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
The prevalence and incidence of obesity, and associated complications, such as type 2 diabetes, in the Middle East and north Africa (MENA) region rank among the highest in the world. Little is known about the effectiveness of dietary weight loss interventions conducted in the MENA region. We conducted a systematic review of randomized clinical trials aiming to assess the effectiveness of dietary interventions for weight loss in the adult population originating from and residing in the MENA region. In accordance with PRISMA guidelines, PubMed, CINAHL, Cochrane, and EMBASE were systematically searched for randomized controlled trials (RCT) using dietary interventions for weight loss conducted in the MENA region. RCTs examining weight loss as an outcome in adults (≥ 18 years old) were included. The Cochrane Collaboration tool for assessing risk of bias was used to ascertain the quality of the eligible RCTs and the Template for Intervention Description and Replication for population health and policy interventions (TIDieR-PHP) checklist was used to evaluate the reporting of the interventions. Twenty-nine RCTs including 2792 adults from five countries in the MENA region met the search criteria. Study participants were predominantly middle-aged females. Duration of follow up was mostly 3 months or less. Weight loss ranged from -0.7 to 16 kg across all intervention groups and the average weight loss was 4.8 kg. There was paucity of description of the weight loss interventions and variations amongst studies did not allow a meta-analysis of findings. It was not possible to draw firm conclusions on the effectiveness of dietary weight loss interventions in the region. High quality studies using more structured interventions of longer duration with standardized outcome measures are needed in the MENA region to support clinical practice with evidence-based interventions for obesity.
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Affiliation(s)
- Hadeel Zaghloul
- Department of MedicineWeill Cornell MedicineDohaQatar
- Department of MedicineWeill Cornell MedicineNew YorkUSA
- National Obesity Treatment CentreQatar Metabolic Institute, Hamad Medical CorporationDohaQatar
- Department of DiabetesKing's College LondonLondonUK
| | - Hadya Elshakh
- Department of MedicineWeill Cornell MedicineDohaQatar
| | | | - Odette Chagoury
- Department of MedicineWeill Cornell MedicineDohaQatar
- National Obesity Treatment CentreQatar Metabolic Institute, Hamad Medical CorporationDohaQatar
| | - Barbara McGowan
- Department of DiabetesKing's College LondonLondonUK
- Department of Diabetes and EndocrinologyGuy's and St Thomas' NHS TrustLondonUK
| | - Shahrad Taheri
- Department of MedicineWeill Cornell MedicineDohaQatar
- Department of MedicineWeill Cornell MedicineNew YorkUSA
- National Obesity Treatment CentreQatar Metabolic Institute, Hamad Medical CorporationDohaQatar
- Department of DiabetesKing's College LondonLondonUK
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Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021; 13:nu13041060. [PMID: 33805161 PMCID: PMC8064070 DOI: 10.3390/nu13041060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.
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