[New dietetic recommendations in diabetes mellitus: the implications in enteral nutrition]

In diabetes mellitus there are qualitative and quantitative alterations in the lipid metabolism, which contribute to ischaemic heart disease. The monounsaturated fatty acids (MUFA) may favorably influence the cardiovascular risk factors, and they could replace the saturated fats, in detriment of polyunsaturated fatty acids (PUFA) and carbohydrates (CHO). A series of studies have been done, always on NIDDM patients, which have given rise to reconsidering the dietary recommendations in diabetes mellitus: There is no change in the contribution of proteins (10-20% of the caloric intake), saturated fats (< 10% of the caloric intake), dietary cholesterol (< 300 mg/day), PUFA (10% of the caloric intake), fibre (20-35 g/day), and sodium (< 2.4 g/day), however, the caloric distribution of MUFA and CHO is not defined, but is left up to the judgement of the physician. Enteral nutrition has a series of special characteristics which influence the blood glucose levels of the diabetic patient, as well as having different objectives. In the few published studies, the influence on plasma lipids of an enteral diet rich in MUFA is similar to that published for the oral diets. With respect to the blood glucose, this was less than with the standard formulae, especially in diabetics treated with insulin. In conclusion, we can for see a change of course in the international recommendations on "the diet of the diabetic", even though these may be very slight for the time being.(ABSTRACT TRUNCATED AT 250 WORDS)