'Critical Review of the Literature of the role that Dietary Factors Play in Preventing Type 2 Diabetes Essay\r'

'Critical look back of the literature of the subr step to the foreine that regi custodyary Factors Play in Preventing cause 2 Diabetes’\r\nIntroduction\r\ncase 2 Diabetes (T2D) is a rapidly comeing international general wellness issue. It has been describe that 285 million 20â€79 category olds had the disease in 2010 arenawide and this is estimated to grow to 439 million by 2030. (19) T2D has been associated with a variety of early(a) health problems such as cardiovascular disease, blindness and shortened life expectancy. (4,40) The prevalence of the disease is associated with obesity and over slant as well as a ‘western sandwich’ fodderary public figure and lack of exercise. (17) It has been inform that approximately 80% of people who develop T2D are obese or over cant over unit down prior to diagnosis.(8) Diabetes is a preventable disease, (19) with weight loss macrocosm set as one of the most powerful interventions. (4) Diet and tan gible activity (PA) are resolutionive interventions in attaining this (25) and pay similarly been associate with decrease in guess independently.\r\n(40) The primary focus of this paper entrust look at demonder and re attend the render on whether nourishment alone squirt attend to to prevent T2D. As a secondary funda handst it will also look at the severalize that victuals entertain back up to prevent the organic evolution of and help to subordination symptoms after T2D has been diagnosed. 8 papers will reviewed, (26-33) with a purpose of identifying some practical, try turn aside base pabulumetic guidelines. forageetic guidelines are easier to decipher when they testify particular proposition diets and patterns quite than nutrients and properties of nutrients and greater residence fag be achieved . (29,31) For this reason the studies reviewed focus on particularised intellectual nourishments and diet styles rather than macronutrients and or micronutrients which do non translate into dietetic guidelines as easily.\r\nLiterature Search\r\nA literature review exploitation the fol menialing databases was carried divulge; Pubmed, Web of Science, Embase, CINAHL, British nursing king and Medline. The following key discussions were utilise in mingled combinations;\r\nDiet, prevention, pabulum, T2D, interventions, dietetical, return, vegetables, nutrition. Other resources such as ‘Google scholar’ and NHS Choices ‘ behind the headlines’ were also utilised. Because T2D is an international issue, papers from around the world were conside trigger-happy. The criteria for inclusion was slight than 10 years old, the intervention had to be a particular food sort or diet style, measuring new incidents of T2D, or changes is symptoms associated with T2D and adults as the sample group.\r\nDiet as a tool to prevent T2D\r\n6 Studies looked at whether diet offer prevent T2D. Please refer to put back 1 for details of tot on the wholey the studies. Villegas et al (26) and Bazzano et al (27) looked at harvest-festival, vegetable and fruit juices expenditure and fruit and vegetable use respectively. Both of the studies employ women whole in their sample groups, limiting the generalizability of the findings to the wider population. (5) dietetical sagacity was achieved through Food Frequency Questionnaires (FFQ) in twain studies. Villegas et al (26) willd register of their FFQ having been validated, (21) however reported employ it come along 3 clock within a 4.6 year timeframe, questioning the verity of their tranquil data. Bazzano et al (27) data assemblage was retrospective in that the FFQ was knowing in 1984 and followed up at 4 year intervals. The concern with such a dated questionnaire is that it has not accounted for different trends that dedicate occurred over time, affecting the verity of the results.\r\nVillegas et al (26) confirmed incidence of T2D thro ugh subjects coming together the criteria set out by the American diabetic connective.(2) Bazzano et al (27) used criteria set out by theme Diabetes Data Group for all participants up to and including 1997.(16) The Criteria for participants after 1998 was set out by the American diabetic Association. The reason for this was due to new criteria existence published at this time. (2) The main difference cosmosness the plasma glucose reading changing from 7.8mmol/l or to a greater extent than to 7.0mmol/l or much(prenominal). (9) The Criteria Set out by the World health nerve in 1985, (24) could have been used to confirm incidence of T2D in the Bazzano et al (27) scan . It was published 1 year after baseline data was taken and would have resulted in a proud percentage of participants being diagnosed with the aforesaid(prenominal) criteria, change magnitude consistency\r\nand reliability in the results.\r\nVillegas et al (26) reported that a grittyer consumption of veget ables was associated with a trim back hazard of T2D. cut officipants who had a gameer(prenominal) vegetable stirring were also less belike to smoke and have higher aims of PA, both factors that can condense the chance of T2D questioning the causality of the reduction in endangerment. (4) Participants with a higher fruit use of goods and services were also less likely to smoke and have higher takes of PA. There was no association do in the midst of fruit brainchild and lay on the line of T2D thitherof it is possible to consider that confounders like PA and gage whitethorn not have effected the level of peril to T2D in this get a line.\r\nBazzano et al (27) reported an opposite association among whole fruit and thou two-leaved vegetable white plague. Women who had a higher uptake of fruit and vegetables were older, less likely to smoke and more likely to have higher levels of PA. take succus was imperatively associated with incidence of T2D which could be due to high dulcify content.. (22) Also participants who had the highest fruit juice inhalant had the lowest levels of PA which is associated with adjoind risk of T2D. (20)Salas-Salvado et al (28) and Martinez-Gonzalez et al (29) both studied the risk of T2D and bail bond to the Mediterranean diet (MedDiet). A MedDiet is characterised by high consumption of fruit, vegetables, whole grains, chromatic oil, nuts, pulses, lean and lessen consumption of red and touch meats, high expatiateness dairy smashing gains and foods high in sugar and starch. (11) Salas-Salvado et al (28) compared hamper to a MedDiet supplemented with either olive oil or nuts with a low fat diet ( cover group).\r\nThe supplemented items in the MedDiets were given to participants. Participants in the examine group were given non dietary gifts to sanction bond. There are concerns about the ethics of victimisation incentives and gifts in research. (6)Within this study the use of gifts appears innocuous , the concern lies with how adherence to the diet is reliably measured. When participants are given spanking ingredients, this will influence their dietary consumption, making it problematical generalize the results. (13) The sample population in this study were older and had at least 3 risk factors relating to cardiovascular disease again making it more difficult to generalise results. Participants were given 7 goals, including; increasing vegetable and fruit consumption, trim back red and refined meat and increasing the consumption of either olive oils or nuts.\r\nThe control group were asked to digest all types of fat. Results showed that participants in the MedDiet groups had a greater trim down risk of T2D. insecurity was reduced by 51% in the olive oil group and 52% in the nut group. These findings are backed up by former(a) studies. (38-39) Diabetes incidence was dishonor in those who succeed ≥ 4 of the 7 goals. PA levels and changes in weight did not differ t hrough all 3 groups, although the participants in the both the MedDiet groups were associated with higher levels of PA. This study was carried out on Spanish participants, who traditionally follow a MedDiet. The control group whitethorn have had a strong adherence to a MedDiet naturally, which could impact on the reliability of the results.\r\nMartinez-Gonzalez et al (29) used participants who were nurses and university graduates. Prevalence in T2D is associated with lower socioeconomic status, (1) so by development the participants from a higher socioeconomic group may bias the findings. (13) Participants were not excluded if they had Diabetes at baseline. Data was collected via FFQ which consisted of 136 items with 9 responses ranging from never to more than 6 times a day. Points were allocated to determine a malt whiskey indicating level of adherence. Questions covered areas such as cooking methods, supplements and fats and oils. This FFQ goes into a lot of detail to obtain th e most tuition it can about participants diets, increasing the validity of the data.\r\n up to now reliability is compromised as participants are asked to recall food intake from the precedent year fall the accuracy of data collected. (5) The results signd a world-shaking reduction in risk of developing T2D in those who with strong adherence to the MedDiet after adjustment for age and sex. Participants with a score of ≥ 6 had an 83% reduction. Although participants in this group had the highest levels of animal(prenominal) activity, which is a known factor in decreasing the risk of T2D, they also had a higher baseline prevalence for increase risk factors for Diabetes such as age higher BMI and higher blood pressure. This adds weight to the findings the MedDiet can reduce the risk of developing T2D.\r\nFung et al (30) and VanDam et al (31) looked at more generalised dietary patterns. VanDam et al (31) used a 131 item FFQ specifying specific foods, portion sizes and frequ ency of intake. Over a station of 12 years data on food intake was collected 3 times. In influence to make these results more reliable data collection should have occurred more frequently. The participants were all male health professionals making the sample group quite specific reducing the ability to generalise the findings to the wider population. (13) Foods were classified into groups ground on nutritional profiles. Factor analysis was accordingly applied in order to identify food patterns. Two dietary patterns were identified ‘ responsible’ and ‘ westerly’. Prudent was characterised by high consumption of vegetables, fish and whole grains and westerly by high consumption of red and refined meat, high-fat dairy and eggs.\r\nMen with higher Western patterns were younger, more likely to smoke and did less PA. Men with higher Prudent diet patterns were older less likely to smoke and engaged in more PA. The Prudent diet was associated with a mild redu ction in risk in developing T2D with wholegrain foods having the highest reverse association. harvest-festival and vegetables were not considerably associated with reduced risk. The Western diet was associated with considerably higher risk of developing T2D. elegant meat, early(a) processed foods and refined grains indicating the most significant association. This could indicate that cutting out specific foods could me more estimable in reducing the risk of T2D than increasing intake of other foods.\r\nFung et al (30) used participants from the Nurses wellness Study which was established in 1976. This is the same study from which Bazzano et al (27) took their participants. The same FFQ was used in this study with baseline also being the 1984 FFQ as this was the expanded 116 item version. The discipline obtained was accordingly used and classified in the same bureau as the VanDam et al (31) study producing the same Prudent and Western dietary patterns. The results from this s tudy focus in general on the Western diet pattern. Similarly to the men in the VanDam et al (31) study, women who scored high in the Western diet pattern were more likely to smoke. The results also mirrored that of the VanDam et al (31) study in that it reported an change magnitude risk of developing T2D and a Western diet pattern. This study investigated the characteristics of the Western dietary pattern further and found positive associations between red and processed meats and the development of T2D.\r\nThis could also add weight to the previous comment that cutting out specific foods, such as red and processed meats could be more beneficial than adding other food groups in preventing T2D. A replica study victimization the same FFQ and Prudent and Western diet pattern and using a sample group that consisted of both men and women could add strength to the finds of both of these studies.(5)\r\nDiet as a tool in preventing the development of and good-looking greater control over the symptoms of T2D\r\nElhayany et al (32) compared a low carbohydrate Mediterranean diet (LCM) a traditional Mediterranean diet (TM) and the 2003 American Diabetic Association diet (adenosine deaminase) on health parameters. Glycemic control for people with T2D diagnosis was one of the outcome measures. Participants were e very(prenominal) which way assigned to 1 of the 3 groups, given recommendations for effortless intake on nutritional elements such as calories and protein and pop the questiond to engage in 30-45 minutes of PA a week. The LCM and TM diets included only low glycemic index carbohydrates, with LCM having a lower %. The TM and ADA diets had the same % of carbohydrates only if the ADA also included mixed glycemic index carbohydrates.\r\nFFQ were used asking the participants to recall the last 24hour food intake. It is felt this data will be more surgical than those studies asking participants to recall food intake from the previous year, making results more relia ble. Data was collected 3 times over a 12 calendar month period. Results showed all groups had reduced weight and BMI with no significant difference. All 3 dietary interventions reduced factors that increase glycemic control such as HbA1c and triglyceride levels. The LCM diet was the most effective in increasing glycemic control.\r\nEsposito et al (33) compared a LCM and a low fat calorie restricted diet (LFD) on glycemic control and the delay on take oning to commence antihyperglycemic medical specialty in people newly diagnosed with T2D. The LCM diet was fatty in fruit vegetables and whole grains and low in red meat. There was also a sine qua non that no more than 50% of calories was from carbohydrates. Complex carbohydrates rather than low GI carbohydrates were stipulated. Some mazy carbohydrates can have high GI levels, which are associated with increased risk of Diabetes. (10) The LFD was based on American kernel Association guidelines. (12) Participants were randomized i nto 1 of 2 groups asked to keep food diaries and given guidelines on increasing physical activity.\r\nData was collected through reviews of the diary. Food diaries could provide more reliable development than FFQ if they are fill up out daily. There is still a risk that they could be filled out inaccurately, and that participants may modifies their intake as a result of keeping a diary. The study reported that both groups lost weight, but reduction was greater in the LCM. Overall there was a significant difference in the need to commence antihyperglycemic medication between the LCM and the LFD; 44% and 70% respectively. Potentially this result could have shown more significance if low GI carbohydrates were stipulated instead of complex carbohydrates.\r\nDiscussion\r\nThe findings coming out of this review indicate that certain dietary interventions maybe helpful in reducing the risk of developing T2D and may also help with glycemic control after diagnosis.(26-33) Some food groups and dietary patterns provide more consistent evidence than others. The results regarding fruit intake and risk of T2D are inappropriate within this review with Villegas et al (26) reporting no association between fruit and risk reduction, where as Bazzano et al (27) did. High consumption of fruit and vegetables are a major component in the Mediterranean diet and the Prudent dietary pattern, both of which were associated with an inverse association. Vegetables are more consistently associated with a reduced risk, in this review and a recent meta-analysis, (3) peculiarly green leafy vegetables. (27) More research study the effects of fruit and vegetables separately is needed. This inconsistency is reflected in other studies and systematic reviews. (7) High intake of fruit and vegetables has often been associated with higher PA levels within this review, (26-29,31) which is a risk reducing factor in itself.\r\nPart of the problem could be that many studies that look at dietary inter ventions are prospective cohort studies and although they can provide an association they can not prove whether the cause is due to the dietary item or another factor such as PA or weight loss. More experimental knowing research is needed so that a charge cause between diet and the reduction of T2D can be established. (13) While it is unclear the exact role that fruit and vegetables play in reducing the risk of T2D there is an abundance of evidence that a diet rich in fruit and vegetables is beneficial in overall health (34-35) and weight reduction, (23) so including them as part of a healthy diet may indirectly help to reduce the risk of T2D.\r\n florid and processed meat has been more consistent in its positive association to developing T2D. Fung et al (28) and VanDam et al (29) found strong associations between consumption and increased risk of T2D. One of the characteristics of The Mediterranean diet is the absence seizure or reduction of red and processed meats, and this diet has been associated with reduced risk. These findings were backed up in a recent meta-analysis paper (18) studying 3 cohorts who’s conclusion counsels that red meat consumption, particularly processed red meat is linked to higher risk of developing T2D.\r\nMeta-analysis produces level 1 evidence, providing increased agency in the conclusions and good grounding for providing evidence based information such as dietary guidelines.(13) Diets high in red and processed meats are linked to high cholesterol (14) which is one of the leading causes of conclusion in people with T2D (15) and other serious health conditions such as cancer and cardiovascular disease. (36) So while increasing fruit and vegetable intake may have a more beneficial and holistic effect on health, the same could be said for reducing the intake of red and processed.\r\nSalas-Salvado et al (28) produced higher level evidence being a randomised control trial giving more weight to their findings;(5) following a MedDiet can reduce the risk of T2D. One of the studies that looked at the effect of diet after diagnosis, (32) was also a randomised control trial providing the same level of evidence and weight to their findings that LCM can delay the need for hyperglycaemic medication therefore having a positive beneficial effect on T2D. Although these two studies looked at the effect of diet after diagnosis it could be average to suggest that following the dietary patterns associated with these findings, prior to diagnosis could help prevent T2D as they are similar dietary patterns to two of the other studies.(28-29)\r\nWhile the findings from this review indicate that making changes to ones diet may help to reduce the risk of Diabetes occurring, it also suggests that implementing the same kind of dietary changes may help with glucose control after Diabetes has been diagnosed, preventing the further development of the disease and the need for antihyperglycemic medication. (32-33) One study has i mplied that dietary changes in the form of energy childbed can actually reverse beta cadre failure and insulin resistance, symptoms found in T2D.\r\n(37) It is a very small study and the dietary intervention is trying energy restriction making it difficult to generalise to the wider population, but it is a controlled study and could provide kindle findings that further research could be built upon, that dietary interventions may be able to reverse the symptoms of T2D. Collating this information together it seems reasonable to suggest that making positive changes to dietary habits could have benefits pre and post T2D diagnosis.\r\n dietetic Guidelines\r\nThe findings from the 8 studies in this review can not all be discussed in detail due to word limitation. However recurring themes seem to be occurring, providing information on which to base a set of guidelines. termination by these findings the following guidelines are recommended:\r\n stiffen intake of red meat and processed meat (all colours)\r\n successor these with white meats and fish\r\nReduce intake of other processed foods\r\nReduce intake of refined grains\r\nReduce intake of high sugar foods and drinks including fruit juices scratch intake should be based on items with a low GI score development intake of olive oil\r\nIncrease nut intake\r\nIncrease intake of pulses\r\nIncrease wholegrain intake\r\nIncrease vegetable intake especially green leafy vegetables\r\nIncrease fruit intake\r\nA Mediterranean style diet is characterised by much of this advise and is therefore a recommended diet style to follow.\r\n finishing\r\nThe prevalence of T2D is growing around the world. It has been associated with many other health problems and reduces quality of life and life expectancy. It is a preventable disease and diet is one of the ways in which this disease can be combated. dietetic guidelines have been recommended from the findings of this review, based on following a Mediterranean diet, reducing in take of red and processed meats and other processed foods and increasing intake of foods such as fruit and vegetables, wholegrains and olive oils and nuts. While it has been admit that more research needs to be carried out to further examine the cause and effect between diet and T2D, it is reasonable to suggest that one may find these dietary changes beneficial in service to reduce the risk of T2D and other areas of health, possibly helping to indirectly reduce risk of T2D. It is also reasonable to suggest that a change in diet may bring beneficial changes once diagnosis has been given.\r\nTable 1\r\nReference list\r\n1. Agardh E, Allenbeck P, Hallqvist J, Moadi T and Sidorchuk A. Type 2 Diabetes and Socioeconomic Position: A domineering recapitulation and Meta-analysis. International daybook of Epidemiology. 2011: 40(3) 804-818\r\n2. American Diabetic Association Report of the Expert charge on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2000: 23(1s)\ r\n3. Carter P, Gray LJ, Troughton J, Khunti K, and Davies M. Fruit and vegetable intake and incidence of Type 2 Diabetes mellitus: A Systematic Review and Meta-analysis. British health check ledger. 2010: 341:c4229\r\n4. Davis MJ, Tringham JR, Troughton J, Kunit KK. Prevention of T2D mellitus. A review of the register and its act in a UK Setting. Diabetic Medicine. 2004: 21: 403-414\r\n5. Gerrish K and Lacey A. The Research Process in Nursing. 2006 5th Edition. Oxford: Blackwell Publishing.\r\n6. mete out RW and Sugarman J. Ethics in Human Subjects Research: Do Incentives Matter? Journal of Medicine and Philosophy. 2004: 29(6) 717-738\r\n7. Hamer M, Chida Y. Intake of Fruit and Vegetables and Antioxidants and Risk of Type 2 Diabetes. A Systematic Review and Meta-analysis. Journal of Hypertension. 2007: 25:2361-2369\r\n8. Hensrud DD. dietary give-and-take and Long-term burden Loss and Maintenance in T2D. Obesity Research. 2001:9(4 supplement):348S-353S\r\n9. Hickner RC, Bruns on MA, McCammon M, Mahar MT, Garry JP, Houmard JA. Diabetic Groups as Defined by ADA and NDDG Criteria have a Similar aerophilous Capacity, Blood Pressure and Body Composition. American Diabetes Association and field of study Diabetes Data Group. Diabetologica. 2001: Jan 44(1) 26-32\r\n10. Hodge AM, O’Dea K, English DR, and Giles GG. Glycemic Index and Dietary Fibre and the Risk of Type 2 Diabetes. Diabetes Care. 2004: 27(11) 2701-2706\r\n11. Kastorini MC, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA,Panagiotakos. The Effect of Mediterranean Diet on metabolous Syndrome and its Components. Journal of the American College of Cardiology 2011: 57(11) 1299-1313\r\n12. Krauss RM, Eckle RH, Howard B, Appel LJ, Daniels SR, and Deckelbaum RJ.\r\nAHA Dietary Guidelines: Revision 2000: A Statement for Healthcare Professionals from the living Committee of the American Heart Association. Circulation. 2002: 102:2284-99\r\n13. LoBiondo-Wood G. and Haber J. Nursing Research. Methods and Critical Appraisal for Evidence Based Practice. 2006: 6th Edition. Mosby: Missouri\r\n14. Micha R, Wallace SK, and Mozaffarian MD. Epidemiology and Prevention. Red and Processed Meat outlay and Risk of Incident coronary thrombosis Heart Disease, crack and Diabetes Mellitus. A systematic Review and Meta-Analysis. American Heart Association. 2010: 121 2271-2283\r\n15. Heart Disease and Stroke: The Nations leading Killers. At a Glance National Centre for Chronic Disease Prevention and Health Promotion. Division for Heart Disease and Stroke prevention. 2011: CS217229-AI\r\n16. National Diabetes Data Group Classifications and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance. Diabetes. 1979: 28 1039-1057\r\n17. Neild L, Summerbell CD, Hooper L, Whittaker V, Moore H. Dietary Advice for the Prevention of T2D Mellitus in Adults (Review) The Cochrane Collaboration. 2008: Wiley\r\n18. Pan A, cheer Q, Bernstein AM, Schulze MB, Manson JE, Willett WC and Hu FB. Red Meat Consumption and Risk of Type 2 Diabetes: 3 Cohorts of US Adults and an Updated Meta-analysis. American Journal of clinical Nutrition. 2011: 94(4) 1088-1096\r\n19. Shaw JE, Sicree RA, Zimmet PZ. Global Estimates of the Prevalence of Diabetes for 2010 and 2030. Diabetes Research in Clinical Practice. 2010:87:4-14\r\n20. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C and White RD. corporeal Activity/Exercise and Type 2 Diabetes. A Consensus Statement from\r\nthe American Diabetes Association. Diabetes Care. 2006: 29(6) 1433-1438\r\n21. Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, Gao YT, Zheng W. Validity and reproducibility of the Food Frequency Questionnaire Used in the imprint Women’s Health Study. European Journal of Clinical Nutrition. 2004:58:17â€23\r\n22. Shulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MD, Willet WC, and Hu FB. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in infantile and Middle-Aged Women. The Journ al of the American Medical Association. 2004: 292(8):927-934\r\n23. Tohill B, Seymour J, Serdula M, Kettle-Khan L, and Rolls BJ. What epidemiological Studies Tell Us about the Relationship between Fruit and Vegetable Consumption and Body Weight. Nutrition Reviews. 2004: 365 -374\r\n24. WHO Study Group on Diabetes Mellitus. Diabetes Mellitus: Report of a WHO Study Group. Geneva: World Health Organisation: 1985\r\n25. NICE Public Health Guidance. Preventing Type 2 Diabetes: Population and Community Interventions. National Institute for Health and Clinical Excellence. 2011: Issue 35\r\n26. Villagers R, Shu OX, Gao YT, Yang G, Elasy T, Li H and Zheng W. Vegetable but Not Fruit Consumption Reduces the Risk of Type 2 Diabetes in Chinese Women. The Journal of Nutrition. 2008: 138 574-580\r\n27. Bazzano LA, Kamudi JJ, Hu FB, and Li TY. Intake of Fruit, Vegetables and Fruit Juices and Risk of Diabetes in Women. Diabetes Care. 2008: 31(7) 1311-1317\r\n28. Salas-Salvado J, Bullo M, Babio N, M artinez-Gonzalez MA, Jurado NI, Basora J, Estruch R, Covas MI, Corella D, Aros F, Gutierrez VR, and Ros E. Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet. Diabetes Care. 2011. 34:14-19\r\n29. Martinez-Gonzalez MA, Fuente-Arrillaga CDL, Nunez-Cordoba JM, Basterra-Gotari FJ, Beunza JJ, Vazquez Z, Benito S, Tortosa A and Bes-Rasrollo M. union to Mediterranean Diet and Risk of Developing Diabetes: potential Cohort Study. British Medical Journal. 2008: 336:1351\r\n30. Fung TT, Schulze M, Manson JE, Willet WC, and Hu FB. Dietary Patterns, Meat Intake and the Risk of Type 2 Diabetes in Women. Archives of International Medicine. 2004:164:2235-2240\r\n31. VanDam RM, Rimm EB, Willet WC, Stampfer MJ and Hu FB. Dietary Patterns and Risk for Type 2 Diabetes Mellitus in US Men. Annals of Internal Medicine. 2002:136: 201-209\r\n32. Elhayany A, Lustman A, Abel R, Attal-Singer J and Vinker S. A scummy Carborhydrate Mediterranean Diet Improves Cardiovascular Risk Factors and Diabetes visit Among Overweight Patients with Type 2 Diabetes Mellitus: A 1-year prospective randomized intervention Study. Diabetes, Obesity and Metabolism. 2010: 12:204-209\r\n33. Esposito K, Maiorino IM, Ciotola M, Palo CD, Scognamiglio P, Gicchino M, Petrizzo M, Saccomanno F, Beneduce F, Ceriello A and Guigliano D. Effects of a Mediterranean-Style Diet on the necessitate for Antihyperglycemic Drug Therapy in Patients with wisely Diagnosed Type 2 Diabetes. Annals of Internal Medicine. 2009: 151: 306-314\r\n34. Van Duyn MAS and Pivonka E. Over view of the health benefits of fruit and vegetable consumption for the Dietetics Professional. Journal of the American Dietetic Association. 2000: 100(12) 1511-1521\r\n35. Anderdson JW, Baird P, Davis RH, Ferreri S, Knudtson M,Koraym A, Waters V,and Williams CL. Health Benefits of Dietary Fibre. Nutrition Reviews. 2009: 67(4) 188-205\r\n36. Sinha R, Cross AJ, Graubaed BI, Leitzmann MF, and Schatzin A. Meat Intake and Mortality. A Pro spective Study of Over Half a Million People.\r\nArchives of Internal Medicine. 2009 169(6) 562-571\r\n37. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC and Taylor R. turn around of type 2 Diabetes: Normalisation of Beta booth Function in Association with Decreased Pancreas and liver Triacylglycerol. Diabetologica. 2011: 54:2506-2514\r\n38. Jiang R, Manson JE, Stampfer MJ, Liu S, Willet WC, Hu FB. Nut and Peanut butter Consumption and Risk of Type 2 Diabetes in Women. Journal of the American Medical Association. 2002: 28(20) 2554-2560\r\n39. Riserus U, Willet WC, and Hu FB. Dietary Fats and Prevention of Type 2 Diabetes. Progress in Lipid Research. 2009: 48(1)44-51\r\n40. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V and Uusitupa M. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Intolerance. The New England Jo urnal of Medicine. 2001: 344(18) 1343-1350\r\n'