In older women, lowering fat intake alone did not affect diabetes risk; in black women, sugar-sweetened drinks were associated with excess diabetes risk. In the quest for modifiable diabetes risk factors, dietary alteration is a prime target. But should we simply counsel overweight patients to lower their BMIs, or should we also target specific dietary components, such as fats or sugar-sweetened drinks? In two studies, investigators addressed these questions.
In the Women’s Health Initiative Dietary Modification Trial, 48,835 healthy postmenopausal women (age range, 50–79) were randomized to a usual-diet comparison group or to an individualized dietary intervention that specified 20% of energy from fat. The intervention group received self-monitoring instructions and group sessions; the comparison group was given reading material about dietary guidelines. Dietary intake was monitored with a standardized food frequency questionnaire (FFQ) at baseline and at regular intervals; incident cases of treated diabetes were self-reported. Complete data were available for 45,887 women (mean follow-up, 8 years). Diabetes incidence did not differ significantly between the intervention and comparison groups (1303 cases [7.1%] vs. 2039 cases [7.4%]). A trend toward lower diabetes incidence in the intervention group likely was attributable to weight loss rather than to the low-fat diet alone.
The authors of the Black Women’s Health Study investigated the relation of sugar-sweetened beverage consumption to self-reported incident diabetes among women in this ethnic group (who are twice as likely to develop diabetes as are white women). Almost 44,000 women were followed for 10 years and completed standardized FFQs at regular intervals. Participants (age range at baseline, 21–69) reported their intake of "regular" (non-diet) soft drinks, orange or grapefruit juice, and "other fruit juices, fortified fruit drinks, or Kool-Aid." Overall, 2713 women developed diabetes. In analyses adjusted for age, family history, and BMI, daily consumption of 
2 soft drinks compared with <1>P=0.002). The highest level of sweetened fruit-drink intake, 2 drinks daily, also was associated with higher diabetes risk (IRR, 1.31; P=0.001) compared with <1>
Comment:
Although these studies both shed some light on the effects of fats and certain refined carbohydrates on the likelihood of developing diabetes in high-risk groups, they probably won’t alter our nutrition advice — most of which, an editorialist observes, is not evidence-based. Until we have more information, our best approach to diabetes prevention is to counsel overweight and obese patients about reducing total calorie intake and exercising more (or at all) and, when possible, to refer them to resources such as nutritionists, diabetes educators, the American Diabetes Association and the American Dietetic Association for additional support.
— Diane E. Judge, APN/CNP
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