Transcultural diabetes nutrition algorithm (tDNA): Venezuelan application.
Medical nutrition therapy (MNT) is a necessary component of comprehensive type 2 diabetes (T2D) management, but optimal outcomes require culturally-sensitive implementation. Accordingly, international experts created an evidence-based transcultural diabetes nutrition algorithm (tDNA) to improve understanding of MNT and to foster portability of current guidelines to various dysglycemic populations worldwide. This report details the development of tDNA-Venezuelan via analysis of region-specific cardiovascular disease (CVD) risk factors, lifestyles, anthropometrics, and resultant tDNA algorithmic modifications. Specific recommendations include: screening for prediabetes (for biochemical monitoring and lifestyle counseling); detecting obesity using Latin American cutoffs for waist circumference and Venezuelan cutoffs for BMI; prescribing MNT to people with prediabetes, T2D, or high CVD risk; specifying control goals in prediabetes and T2D; and describing regional differences in prevalence of CVD risk and lifestyle. Venezuelan deliberations involved evaluating typical food-based eating patterns, correcting improper dietary habits through adaptation of the Mediterranean diet with local foods, developing local recommendations for physical activity, avoiding stigmatizing obesity as a cosmetic problem, avoiding misuse of insulin and metformin, circumscribing bariatric surgery to appropriate indications, and using integrated health service networks to implement tDNA. Finally, further research, national surveys, and validation protocols focusing on CVD risk reduction in Venezuelan populations are necessary.
Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Cardio-Metabolic Unit, Barquisimeto 3001, Venezuela. nietoramfis@gmail.com.
Ramfis
R
Nieto-Martínez
Joslin Diabetes Center, Harvard University, Boston, MA 02215, USA. osama.hamdy@joslin.harvard.edu.
Osama
O
Hamdy
Endocrinology Service, Centro Médico Docente "La Trinidad", Caracas 1080A, Venezuela. daniel.marante@gmail.com.
Daniel
D
Marante
Internal Medicine Department, Centro Médico "Guerra Méndez", Valencia 2001, Venezuela. mariainesmarulanda@gmail.com.
María Inés
MI
Marulanda
MedERA, Inc., New York, NY 10019, USA. albertmarchetti@yahoo.com.
Albert
A
Marchetti
Abbott Nutrition International, Columbus, OH 43219, USA. refaat.hegazi@abbott.com.
Refaat A
RA
Hegazi
Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. jeffreymechanick@gmail.com.
Jeffrey I
JI
Mechanick
D000465:Algorithms; D050110:Bariatric Surgery; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D005247:Feeding Behavior; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D044623:Nutrition Therapy / Q000379:methods; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control; D012016:Reference Values; D012424:Rural Population; D014505:Urban Population; D014687:Venezuela