Medical Nutrition Therapy and Weight Loss Questions for the Evidence Analysis Library Prevention of Type 2 Diabetes Project: Systematic Reviews

Published:September 25, 2017DOI:



      Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library’s prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong.


      Present the basis of systematic reviews for MNT and weight loss recommendations.


      Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months.

      Main outcome measures

      Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated.


      For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure.


      Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        Diabetes Report Card 2012.
        Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA2012
        • Menke A.
        • Casagrande S.
        • Geiss L.
        • Cowie C.C.
        Prevalence of and trends in diabetes among adults in the United States, 1988-2012.
        JAMA. 2015; 314: 1021-1029
        • Paulweber B.
        • Valensi P.
        • Lindström J.
        • et al.
        A European evidence-based guideline for the prevention of type 2 diabetes.
        Horm Metab Res. 2010; 42: S3-S36
        • American Diabetes Association
        Standards of medical care in diabetes: 2017.
        Diabetes Care. 2017; 40: S11-S25
        • National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final report.
        Circulation. 2002; 106: 3143-3421
      1. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. World Health Organization, Geneva, Switzerland1999
        • Ervin R.B.
        Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006.
        Natl Health Stat Report. 2009; 13: 1-7
        • Abdul-Ghani M.A.
        • Abdul-Ghani T.
        • Ali N.
        • DeFronzo R.A.
        One-hour plasma glucose concentration and the metabolic syndrome identify subjects at high risk for future type 2 diabetes.
        Diabetes Care. 2008; 31: 1650-1655
        • Grundy S.M.
        Pre-diabetes, metabolic syndrome, and cardiovascular risk.
        J Am Coll Cardiol. 2012; 59: 635-643
        • Lorenzo C.
        • Okoloise M.
        • Williams K.
        • Stern M.P.
        • Haffner S.M.
        The metabolic syndrome as a predictor of type 2 diabetes: The San Antonio Heart Study.
        Diabetes Care. 2003; 26: 3153-3159
        • Handu D.
        • Moloney L.
        • Wolfram T.
        • et al.
        Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the Evidence Analysis Library.
        J Acad Nutr Diet. 2016; 116: 311-318
        • Lindström J.
        • Neumann A.
        • Sheppard K.E.
        • et al.
        Take action to prevent diabetes: The IMAGE toolkit for the prevention of type 2 diabetes in Europe.
        Horm Metab Res. 2010; 42: S37-S55
        • Pajunen P.
        • Landgraf R.
        • Muylle F.
        • et al.
        Quality indicators for the prevention of type 2 diabetes in Europe: IMAGE.
        Horm Metab Res. 2010; 42: S56-S63
        • Orozco L.J.
        • Buchleitner A.M.
        • Gimenez-Perez G.
        • et al.
        Exercise or exercise and diet for preventing type 2 diabetes mellitus.
        Cochrane Database Syst Rev. 2008; 3: CD003054
        • Corpeleijn E.
        • Feskens E.J.
        • Jansen E.H.
        • et al.
        Improvements in glucose tolerance and insulin sensitivity after lifestyle intervention are related to changes in serum fatty acid profile and desaturase activities: The SLIM study.
        Diabetologia. 2006; 49: 2392-2401
        • Dyson P.A.
        • Hammers M.S.
        • Morris R.J.
        • et al.
        The Fasting Hyperglycaemia Study: II. Randomized controlled trial of reinforced healthy-living advice in subjects with increased but not diabetic fasting plasma glucose.
        Metabolism. 1997; 46: 50-55
        • Eriksson J.
        • Lindström J.
        • Valle T.
        • et al.
        Prevention of type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland: Study design and 1-year interim report on the feasibility of the lifestyle intervention programme.
        Diabetologia. 1999; 42: 793-801
        • Gagnon C.
        • Brown C.
        • Couture C.
        • et al.
        A cost-effective moderate-intensity interdisciplinary weight-management programme for individuals with prediabetes.
        Diabetes Metab. 2011; 37: 410-418
        • Katula J.A.
        • Vitolins M.Z.
        • Rosenberger E.L.
        • et al.
        One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project.
        Diabetes Care. 2011; 34: 1451-1457
        • Lindstrom J.
        • Louheranta A.
        • Mannelin M.
        • et al.
        The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity.
        Diabetes Care. 2003; 26: 3230-3236
        • Mensink M.
        • Blaak E.E.
        • Corpeleijn E.
        • et al.
        Lifestyle intervention according to general recommendations improves glucose tolerance.
        Obes Res. 2003; 11: 1588-1596
        • Mensink M.
        • Feskens E.J.M.
        • Saris W.H.M.
        • de Bruin T.W.A.
        • Blaak E.E.
        Study on Lifestyle Intervention and Impaired Glucose Tolerance Maastricht (SLIM): Preliminary results after one year.
        Int J Obes. 2003; 27: 377-384
        • Munakata M.
        • Honma H.
        • Akasi M.
        • et al.
        Repeated counselling improves the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome: J-STOP-METS final results.
        Hypertens Res. 2011; 34: 612-616
        • Oldroyd J.C.
        • Unwin N.C.
        • White M.
        • et al.
        Randomized controlled trial evaluating the effectiveness of behavioral interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: Outcomes at six months.
        Diabet Res Clin Pract. 2001; 52: 29-43
        • Oldroyd J.C.
        • Unwin N.C.
        • White M.
        • Mathers J.C.
        • Alberti K.G.
        Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance.
        Diabetes Res Clin Prac. 2006; 72: 117-127
        • Aizawa K.
        • Shoemaker J.K.
        • Overend T.J.
        • Petrella R.J.
        Effects of lifestyle modification on central artery stiffness in metabolic syndrome subjects with pre-hypertension and/or pre-diabetes.
        Diabetes Res Clin Prac. 2009; 83: 249-256
        • Allen P.
        • Thompson J.L.
        • Herman C.J.
        • et al.
        Impact of periodic follow-up testing among urban American Indian women with impaired fasting glucose.
        Prev Chronic Dis. 2008; 5: A76
        • Al-Sarraj T.
        • Saadi H.
        • Volek J.S.
        • Fernandez M.L.
        Metabolic syndrome prevalence, dietary intake, and cardiovascular risk profile among overweight and obese adults 18-50 years old from the United Arab Emirates.
        Metab Syndr Relat Disord. 2010; 8: 39-46
        • Bihan H.
        • Takbou K.
        • Cohen R.
        • et al.
        Impact of short-duration lifestyle intervention in collaboration with general practitioners in patients with the metabolic syndrome.
        Diabetes Metab. 2009; 35: 185-191
        • Burtscher M.
        • Gatterer H.
        • Kunczicky H.
        • Brandstatter E.
        • Ulmer H.
        Supervised exercise in patients with impaired fasting glucose: Impact on exercise capacity.
        Clin J Sport Med. 2009; 19: 394-398
        • Busnello F.M.
        • Bodanese L.C.
        • Pellanda L.C.
        • Santos Z.E.
        Nutritional intervention and the impact on adherence to treatment in patients with metabolic syndrome.
        Arq Bras Card. 2011; 97: 217-224
        • Caiazzo R.
        • Arnalsteen L.
        • Pigeyre M.
        • et al.
        Long-term metabolic outcome and quality of life after laparoscopic adjustable gastric banding in obese patients with type 2 diabetes mellitus or impaired fasting glucose.
        Br J Surg. 2010; 97: 884-891
        • Chan D.C.
        • Watts G.F.
        • Ng T.W.K.
        • Yamashita S.
        • Barrett P.H.R.
        Effect of weight loss on markers of triglyceride-rich lipoprotein metabolism in the metabolic syndrome.
        Eur J Clin Invest. 2008; 38: 743-751
        • Christian J.G.
        • Byers T.E.
        • Christian K.K.
        • et al.
        A computer support program that helps clinicians provide patients with metabolic syndrome tailored counseling to promote weight loss.
        J Am Diet Assoc. 2011; 111: 75-83
        • Cicero A.F.
        • Derosa G.
        • Bove M.
        • et al.
        Effect of a sequential training programme on inflammatory, prothrombotic and vascular remodelling biomarkers in hypertensive overweight patients with or without metabolic syndrome.
        Euro J Cardiovasc Prev Rehabil. 2009; 16: 698-704
        • de la Cruz-Munoz N.
        • Messiah S.E.
        • Arheart K.L.
        • et al.
        Bariatric surgery significantly decreases the prevalence of type 2 diabetes mellitus and pre-diabetes among morbidly obese multiethnic adults: Long-term results.
        J Am Coll Surg. 2011; 212: 505-511
        • Kim M.K.
        • Tanaka K.
        • Kim M.J.
        • Matsuo T.
        • Ajisaka R.
        Exercise training-induced changes in heart rate recovery in obese men with metabolic syndrome.
        Met Synd Relat Disord. 2009; 7: 469-476
        • Lee K.
        • Lee J.
        • Bae W.K.
        • et al.
        Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double-blind, randomized controlled trial of two diet plans—one high in protein and one nutritionally balanced.
        Int J Clin Prac. 2009; 63: 195-201
        • Lu Y.H.
        • Lu J.M.
        • Wang S.Y.
        • et al.
        Outcome of intensive integrated intervention in participants with impaired glucose regulation in China.
        Adv Therapy. 2011; 28: 511-519
        • Mujica V.
        • Urzua A.
        • Leiva E.
        • et al.
        Intervention with education and exercise reverses the metabolic syndrome in adults.
        J Am Soc Hypertens. 2010; 4: 148-153
        • Ng T.W.
        • Chan D.C.
        • Barrett P.H.
        • Watts G.F.
        Effect of weight loss on HDL-apoA-II kinetics in the metabolic syndrome.
        Clin Sci. 2009; 118: 79-85
        • Oh E.G.
        • Bang S.Y.
        • Hyun S.S.
        • et al.
        Effects of a six-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome.
        Metabolism. 2010; 59: 1035-1043
        • Parikh P.
        • Simon E.P.
        • Fei K.
        • et al.
        Results of a pilot diabetes prevention program intervention in East Harlem, New York City: Project HEED.
        Am J Public Health. 2010; 100: S232-S239
        • Sakane N.
        • Sato J.
        • Tsushita K.
        • et al.
        Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance.
        BMC Pub Health. 2011; 11: 40
        • Seligman B.G.
        • Polanczyk C.A.
        • Santos A.S.
        • et al.
        Intensive practical lifestyle intervention improves endothelial function in metabolic syndrome independent of weight loss: A randomized controlled trial.
        Metabolism. 2011; 60: 1736-1740
        • Straznicky N.E.
        • Grima M.T.
        • Lambert E.A.
        • et al.
        Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals.
        J Hypertension. 2011; 29: 553-564
        • Straznicky N.E.
        • Lambert E.A.
        • Grima M.T.
        • et al.
        The effect of dietary weight loss with or without exercise training on liver enzymes in obese metabolic syndrome subjects.
        Diabetes Obes Metab. 2012; 14: 139-148
        • Straznicky N.E.
        • Lambert E.A.
        • Nestel P.J.
        • et al.
        Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects.
        Diabetes. 2010; 59: 71-79
        • Yassine H.N.
        • Marchetti C.M.
        • Krishnan R.K.
        • et al.
        Effects on exercise and caloric restriction on insulin resistance and cardiometabolic risk factors in older obese adults: A randomized clinical trial.
        J Gerontol A Biol Sci Med Sci. 2009; 64: 90-95
        • Bhopal R.S.
        • Douglas A.
        • Wallia S.
        • et al.
        Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: A family-cluster randomised controlled trial.
        Lancet Diabetes Endocrinol. 2014; 2: 218-227
        • Chen C.N.
        • Chuang L.M.
        • Korivi M.
        • Wu Y.T.
        Home-based exercise may not decrease the insulin resistance in individuals with metabolic syndrome.
        J Physical Act Health. 2015; 12: 74-79
        • de la Iglesia R.
        • Lopez-Legarrea P.
        • Abete I.
        • et al.
        A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: The MEtabolic Syndrome REduction in NAvarra (RESMENA) project.
        Br J Nutr. 2014; 111: 643-652
        • Di Daniele N.
        • Petramala L.
        • Di Renzo L.
        • et al.
        Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome.
        Acta Diabetologica. 2013; 50: 409-416
        • Fritz T.
        • Caidahl K.
        • Krook A.
        • et al.
        Effects of Nordic walking on cardiovascular risk factors in overweight individuals with type 2 diabetes, impaired or normal glucose tolerance.
        Diabetes Metab Res Rev. 2013; 29: 25-32
        • Fuller N.R.
        • Pearson S.
        • Lau N.S.
        • et al.
        An intragastric balloon in the treatment of obese individuals with metabolic syndrome: A randomized controlled study.
        Obesity (Silver Spring). 2013; 21: 1561-1570
        • Jahangiry L.
        • Shojaeizadeh D.
        • Abbasalizad Farhangi M.
        • et al.
        Interactive web-based lifestyle intervention and metabolic syndrome: Findings from the Red Ruby (a randomized controlled trial).
        Trials. 2015; 16: 418
        • Jakubowicz D.
        • Barnea M.
        • Wainstein J.
        • Froy O.
        High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women.
        Obesity (Silver Spring). 2013; 21: 2504-2512
        • Katula J.A.
        • Vitolins M.Z.
        • Morgan T.M.
        • et al.
        The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial.
        Am J Prev Med. 2013; 44: S324-S332
        • Landaeta-Diaz L.
        • Fernandez J.M.
        • Da Silva-Grigoletto M.
        • et al.
        Mediterranean diet, moderate-to-high intensity training, and health-related quality of life in adults with metabolic syndrome.
        Euro J Prev Cardiol. 2013; 20: 555-564
        • Ma Y.
        • Olendzki B.C.
        • Wang J.
        • et al.
        Single-component versus multicomponent dietary goals for the metabolic syndrome: A randomized trial.
        Ann Intern Med. 2015; 152: 248-257
        • Mafort T.T.
        • Madeira E.
        • Madeira M.
        • et al.
        Six-month intragastric balloon treatment for obesity improves lung function, body composition, and metabolic syndrome.
        Obes Surg. 2014; 24: 232-240
        • Marrero D.G.
        • Palmer K.N.
        • Phillips E.O.
        • et al.
        Comparison of commercial and self-initiated weight loss programs in people with prediabetes: A randomized control trial.
        Am J Public Health. 2016; 106: 949-956
        • Mora-Rodriguez R.
        • Ortega J.F.
        • Guio de Prada V.
        • et al.
        Effects of simultaneous or sequential weight loss diet and aerobic interval training on metabolic syndrome.
        Int J Sports Med. 2016; 37: 274-281
        • Perez-Cornago A.
        • de la Iglesia R.
        • Lopez-Legarrea P.
        • et al.
        A decline in inflammation is associated with less depressive symptoms after a dietary intervention in metabolic syndrome patients: A longitudinal study.
        Nutr J. 2014; 13: 36
        • Prior S.J.
        • Blumenthal J.B.
        • Katzel L.I.
        • Goldberg A.P.
        • Ryan A.S.
        Increased skeletal muscle capillarization after aerobic exercise training and weight loss improves insulin sensitivity in adults with IGT.
        Diabetes Care. 2014; 37: 1469-1475
        • Sattin R.W.
        • Williams L.B.
        • Dias J.
        • et al.
        Community trial of a faith-based lifestyle intervention to prevent diabetes among African-Americans.
        J Community Health. 2016; 41: 87-96
        • Weinstock R.S.
        • Trief P.M.
        • Cibula D.
        • Morin P.C.
        • Delahanty L.M.
        Weight loss success in metabolic syndrome by telephone interventions: Results from the SHINE Study.
        J Gen Intern Med. 2013; 28: 1620-1628
        • American Diabetes Association
        Prevention or delay of type 2 diabetes.
        Diabetes Care. 2017; 40: S44-S47
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and The Obesity Society.
        Circulation. 2014; 129: S102-S138


      H. A. Raynor is a professor, University of Tennessee, Knoxville.


      P. G. Davidson is an assistant professor, West Chester University of Pennsylvania, West Chester.


      H. Burns is a diabetes educator and dietitian, Endocrine and Diabetes of Southern Illinois, Herrin, IL.


      M. D. H. Nadelson is a clinical assistant professor, Family Medicine Center Silver Clinic, University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City.


      S. Mesznik is an instructor, Teachers College of Columbia University, New York, NY.


      V. Uhley is an assistant professor, biomedical sciences, and nutrition discipline director, Oakland University William Beaumont School of Medicine, Rochester, MI.


      L. Moloney is evidence-based practice manager, Evidence Analysis Library, Academy of Nutrition and Dietetics, Chicago, IL.