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Diet

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Introduction:

Insulin resistance is associated with type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), both independently and in association with the metabolic syndrome. Impaired insulin sensitivity has been documented in those known to be at risk for diabetes, such as normoglycemic first-degree relatives of people of T2DM, and women with history of gestational diabetes. Although present in most people who developed T2DM, insulin resistance is generally present for many years before changes in blood glucose concentrations are evident. Despite possible influences from genetic and perinatal factors, diet and physical activity are likely to have greater and overriding influence in generation of the metabolic syndrome and T2DM. Dietary intakes of vegetable fat, polyunsaturated fatty acid, dietary fiber (particularly cereal fiber), magnesium, and caffeine are significantly inversely correlated and intakes of trans fatty acid and heme-iron, glycemic index, and glycemic load are significantly positively correlated with the incidence of type 2 diabetes (Murakami K et al J Nutr Sci Vitaminol (Tokyo) 2005; 51:292-310). Studies have shown a significantly decreased risk for T2DM with the higher consumption of grain (particularly whole grain), and significantly increased risk with processed meat consumption (J Nutr Sci Vitaminol (Tokyo) 2005; 51:292-310).

Increased obesity is associated with insulin resistance. Other important factors contributing to insulin resistance include accumulation of omental fat and fat in the myocellular compartment, both of which can exist independent of degree of generalized adiposity. Insulin resistance may be associated with dyslipidemia comprising elevated plasma triglyceride concentrations, low concentrations of high density lipoprotein cholesterol and elevated concentrations of low density lipoprotein cholesterol, all of which

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