Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: the ICMR-INDIAB National Study.

Objective: To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. Research Design and Methods: Dietary, behavioral and demographic assessments were performed on 18,090 adults, participating in the nationally representative, population-based ICMR-INDIAB study. Fasting and two-hour post glucose challenge capillary blood glucose and glycosylated haemoglobin (HbA1c) were estimated. With HbA1c as outcome, a linear regression model was first obtained for various glycemic categories [Newly diagnosed diabetes (NDD), pre-diabetes (PD) and normal glucose tolerance (NGT)]. Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) so as to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression (≤ 6.5% for both NDD and PD). Results: Four macronutrient recommendations (%E- Energy) emerged for-1) Diabetes remission in NDD: carbohydrate 49-54%, protein 19-20%, fat 21-26%; 2) PD remission to NGT: carbohydrate 50-56%, protein18-20%, fat 21-27%; 3&4) Prevention of progression to T2D in PD and NGT: carbohydrate 54-57% and 56- 60%protein 16-20% and14-17% respectively; fat 20-24% for PD and NGT. Conclusions: We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.