1. Successful use of Nutritional Guidelines to Prevent Type II Diabetes James J. Kenney PhD, RD

2. Modern Low Satiety Diet & Inactivity Excessive Energy Intake Increase Body fat Stores Pathophysiology of Insulin Resistance and It ’ s Metabolic Sequelae Insulin Resistance (Hyperinsulinemia Dyslipemeia Salt Retention & NO Loss of Beta Cells Small Dense LDLs + TG + HDL BP BS & IGT Atherosclerosis HTN Type 2 Diabetes CVD Kidney failure Other DM Complications

3. Modern Low Satiety Diet & Inactivity Excessive Energy Intake Increase Body fat Stores Pathophysiology of Insulin Resistance and It ’ s Metabolic Sequelae Insulin Resistance (Hyperinsulinemia Dyslipemeia Salt Retention & NO Loss of Beta Cells Small Dense LDLs + TG + HDL BP BS & IGT Atherosclerosis HTN Type 2 Diabetes CVD Kidney failure Other DM Complications

4. NCEP Guidelines for Clinical Classification of those with the Metabolic Syndrome

5. Risk FactorDefining Level 1.Abdominal Obesity Waist circumference Men>40 in. Women >35 in

6. NCEP Guidelines for Clinical Classification of those with the Metabolic Syndrome Risk FactorDefining Level 1.Abdominal Obesity Waist circumference Men>40 in. Women >35 in 2.Triglycerides>150mg/dl

7. NCEP Guidelines for Clinical Classification of those with the Metabolic Syndrome Risk FactorDefining Level 1.Abdominal Obesity Waist circumference Men>40 in. Women >35 in 2.Triglycerides>150mg/dl 3.High-density lipoprotein cholesterol Men<40mg/dl Women<50mg/dl

8. NCEP Guidelines for Clinical Classification of those with the Metabolic Syndrome Risk FactorDefining Level 1.Abdominal Obesity Waist circumference Men>40 in. Women >35 in 2.Triglycerides>150mg/dl 3.High-density lipoprotein cholesterol Men<40mg/dl Women<50mg/dl 4. Blood pressure>130/>85mm Hg

9. NCEP Guidelines for Clinical Classification of those with the Metabolic Syndrome Risk FactorDefining Level 1.Abdominal Obesity Waist circumference Men>40 in. Women >35 in 2.Triglycerides>150mg/dl 3.High-density lipoprotein cholesterol Men<40mg/dl Women<50mg/dl 4. Blood pressure>130/>85mm Hg 5. Fasting glucose>110mg/dl

10. Ford ES, et. al. JAMA 2001;287:356 Percent of Adults Classified as Having the Metabolic Syndrome Using New NCEP Criteria

11. Fasting Insulin Levels and Body Weight Bagdade et al. J Clin Invest. 1967;46:1549

12. Colditz GA, et al. Ann Intern Med 1995;122:481 Relative risk of developing Type 2 DM in middle-aged US women

13. Incidence of new diagnoses of diabetes in participants of the Diabetes Prevention Program 40 _ 30 _ 20 _ 10 _ 0 0 1 2 3 4 Years from Randomization Cumulative Incidence (%) Placebo (n = 1082) Metformin (n = 1073, p<.001 vs. placebo Lifestyle (n=1079, P<.001 vs. metformin, P<.001 vs. placebo Adapted d from Knowler WC, et al. N Engl J Med 2002;346(6):394-403 Risk Reduction 31% by Metformin 58% by lifestyle

14. Effect of Dietary Fat on Ad Libitum Energy Intake Lissner L. et al. Am J Clin Nutr 1987;46:886

15. Effects of High- and Low-Energy Density Diets on Ad Libitum Calorie Intake Stubbs RJ, et al. Int J Obesity 1998;22:885-92 Energy Intake (Kcalories) 4200 3800 3350 2850 2400 1900 1400,,

18. Impact of High-Fat, Moderate-Fat and Very-Low- Fat Diets Fed Isocalorically or Ad Libitum on Fasting Triglyceride Levels Parks EJ. Am J Clin Nutr 2000;71:424

19. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Fleming RM. Prev Cardiol 2002;5:110

20. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Diet WeightTCLDLHDLTG HcyLp(a) Fibrinogen Fleming RM. Prev Cardiol 2002;5:110 MF = Moderate Fat; LF-1 =10% Fat, LF-2 =15% Fat, and HF = High-Fat Atkins-style diet

21. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Diet WeightTCLDLHDLTG HcyLp(a) Fibrinogen MF-2.6-5.0-6.1 -1.5+1.0+9.7 +4.7 -0.6 Fleming RM. Prev Cardiol 2002;5:110 MF = Moderate Fat;

22. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Diet WeightTCLDLHDLTG HcyLp(a) Fibrinogen MF-2.6-5.0-6.1 -1.5+1.0+9.7 +4.7 -0.6 LF-1-18.4-39.1-52.0+9.0 -37.3 -13.6 -7.4 -11.0 Fleming RM. Prev Cardiol 2002;5:110 MF = Moderate Fat; LF-1 =10% Fat,

23. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Diet WeightTCLDLHDLTG HcyLp(a) Fibrinogen MF-2.6-5.0-6.1 -1.5+1.0+9.7 +4.7 -0.6 LF-1-18.4-39.1-52.0+9.0 -37.3 -13.6 -7.4 -11.0 LF-2 -12.6-30.4-38.8+3.6-36.9 -14.6 -10.8 -6.3 Fleming RM. Prev Cardiol 2002;5:110 MF = Moderate Fat; LF-1 =10% Fat, LF-2 =15% Fat,

24. The Average % Change in CVD-Risk Factors After One Year on 4 Different Weight Loss Dietary Programs Diet WeightTCLDLHDLTG HcyLp(a) Fibrinogen MF-2.6-5.0-6.1 -1.5+1.0+9.7 +4.7 -0.6 LF-1-18.4-39.1-52.0+9.0 -37.3 -13.6 -7.4 -11.0 LF-2 -12.6-30.4-38.8+3.6-36.9 -14.6 -10.8 -6.3 HF-13.7 + 4.3 +6.0-5.8 +9.8 +12.4 +31.0 +11.9 Fleming RM. Prev Cardiol 2002;5:110 MF = Moderate Fat; LF-1 =10% Fat, LF-2 =15% Fat, and HF = High-Fat Atkins-style diet

26. Bread is considered the standard

27. Glycemic Index of Selected Foods Croissant67Bananas54 Cake, pound54Grapes46 Doughnuts76Apples38 Cookies55Oranges44 Crackers71Watermelon72 Sweet corn55Peach42 Mars Candy Bar64Pear37 Peanuts15Plum39 Yogurt36Mango56 Waffles76Kiwi53 Ice Cream, low-fat51Grapefruit25

28. Glycemic Index of Selected Foods Jellybeans80Cherries22 Popcorn55Raisins64 M&Ms, peanut32Pineapple66 White Bread71Cantaloupe65 French fries54Apricots57 Pasta, white41Dates103 Rice, brown55Lentils29 Rice, white58Soybeans18 Bread, wh wheat69Kidney Beans29

29. Satiety Index of Common Foods

34. Effect of S.A.D. and DASH Diets on SBP at different Sodium Intake levels.

41. 10 Best Reasons to Avoid the Atkins Diet 1. Heart Disease Risk Increases 2. Cancer Risk Increases 3. Poor Long-Term Weight Control 4. Reduced Athletic Performance 5. Rising Blood Pressure Likely 6. Kidney Stones 7. Gout 8. Osteoporosis 9. Fainting 10. Keto-breath By Dr. James J. Kenney, PhD, RD, FACN.