Insulin resistance has been proposed as the strongest single predictor for the development of Type 2 Diabetes (T2DM). Chronic oversupply of energy from food, together with inadequate physical activity, have been recognized as the most relevant factors leading to overweight, abdominal adiposity, insulin resistance, and finally T2DM.
Weight loss with the reduction of abdominal fat mass almost invariably reverses insulin resistance as a consequence of chronic excessive energy intake in relation to physical activity levels. Therefore, any safe and balanced life-style measures that lead to weight loss and can be sustained in the long term have the potential to improve insulin resistance and glycemic control. However, particularly in patients with T2DM, long-term-sustained weight loss appears to be difficult to achieve. In this situation, isoenergetic changes of the macronutrient composition and the quality of ingested foods may exert important additional effects on insulin sensitivity. Nutritional measures that could be useful in this context include a Mediterranean-like dietary pattern, but avoiding excess intake of dietary fat; substituting SFA and TFA by MUFA and n-6 PUFA; increasing cereal fiber intake, particularly when choosing a high-protein dietary strategy. Weight loss, the macronutrient composition of the respective diet, aerobic exercise, and resistance training all appear to improve insulin resistance, by distinct mechanisms. Therefore, a combination of these interventions tailored to the requirements of each subject should be one of the cornerstones of management [8, 19, 182]. For the planning of an optimal diet, further aspects are likely to be important which may include the consideration of gender differences , varying effects of specific diets depending on the ethnic background , genetic variation including potential differences in response to a diet in carriers of certain single-nucleotide polymorphisms, differences between individuals in the metabolite profiles, comorbidities, the intake and interactions of certain drugs, and the exposure to other environmental factors than the diet. Further, elucidating these aspects may ultimately lead to personalized dietary strategies that are tailored to the specific needs of the individual.
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