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<18.5 18.5-25.0 >25.0-30.0 >30.0 I I Hyperlipidemia □ Hypertension

FIGURE 1 Prevalence of hyperlipidemia and hypertension (n%) by categories of BMI (kg m-2) in a sample of 1988 persons with diabetes [930 male, 1058 female; mean age 57 ± 13 years; mean diabetes duration 8 (1-56) years].

TABLE 1 Nutritional Factors and their Possible Impact on Insulin Resistance

Total energy reduction

m

Increased fiber intake

i

Low-glycemic index food

i

Small amounts of alcohol

i

Saturated fat intake

îî

Total fat

î

Salt

î

.[decrease, "increase

.[decrease, "increase insulin sensitivity and glucose tolerance and reduces lipid levels and blood pressure. Weight loss may lead to greater improvements in cardiac risk factors in persons with a high waist circumference (42).

Those who are overweight should be encouraged to reduce caloric intake so that their BMI moves towards the recommended range of 18.5 to 24.9 kg m-2. Advice concerning the reduction of high fat and energy-dense foods, in particular those high in saturated fat and free sugars will usually help to achieve a weight loss. Fiber intake should be encouraged. If such measures do not result in a desired weight reduction, it may be necessary to offer specific weight reduction programs, which also include increased physical activity and behavior modification approaches (6,40). The use of very low-energy diets should be restricted to persons with a BMI > 35 kg m-2 (6).

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