Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study
Authors: Anjana Ranjit Mohan , Srinivasan Seshadhri , Sudha Vasudevan , Joshi Shashank R. , Saboo Banshi , Tandon Nikhil , Das Ashok Kumar , Jabbar Puthiyaveettil Kottayam , Madhu Sri Venkata , Gupta Arvind , Bajaj Sarita , Chowdhury Subhankar , Kalra Sanjay , Gayathri Rajagopal , Abirami Kuzhandaivelu , Manasa Valangaiman Sriram , Padmapritha Thamotharan , Lakshmipriya Nagarajan , Geetha Gunasekaran , Deepa Mohan , Pradeepa Rajendra , Unnikrishnan Ranjit , Kurpad Anura Viswanath , Krishnaswamy Kamala , Kaur Tanvir , Dhaliwal Rupinder Singh , Mohan Viswanathan ,   for the ICMR-INDIAB Collaborative Study Group, Mohan Viswanathan , Anjana Ranjit Mohan , Unnikrishnan Ranjit , Pradeepa Rajendra , Deepa Mohan , Sudha Vasudevan , Nirmal Elangovan , Subashini Radhakrishnan , Venkatesan Ulagamathesan ,   ICMR-INDIAB Expert Group:, Nath L.M. , Mahajan R.C. , Ramachandran K. , Gupte M.D. , Lakshmy R. , Mahanta Jagadish , Narain Kanwar , Madhu Sri Venkata , Das Ashok Kumar , Pandey Arvind , Tandon Nikhil , Dhaliwal R.S. , Kaur Tanvir , Bhargava Balram ,   ICMR-INDIAB State Principal Investigators and Co-investigators:, Rao P.V. , Rao Modugu Nageswara , Jampa Lobsang , Kaki T. , Das H.K. , Borah P.K. , Kumar Ajay , Sharma Smita , Bhansali Anil , Dash Kalpana , Shrivas Vijay Kumar , Tandon Nikhil , Krishnan Anand , Desai Ankush , Dias Amit , Saboo Banshi , Padhiyar Jayendrasinh M. , Kalra Sanjay , Kalra Bharti , Moktha Jatinder Kumar , Gulepa Ramesh , Dhandhania V.K. , Adhikari Prabha , Rao B. Sathish , Jabbar P.K. , Jayakumari C. , Jain Sunil M. , Gupta Gaurav , Joshi Shashank , Yajnik Chittaranjan , Joshi Prashant P. , Ningombam Somorjit , Singh Th. Bhubhonchandra , Budnah R.O. , Basaiawmoit M.R. , Rosangluaia  , Lalramenga P.C. , Suokhrie Vizolie , Tripathy Saroj Kumar , Sahu Nirmal Chandra , Purty Anil J. , Das Ashok Kumar , Bhansali Anil , John Mary , Gupta Arvind , Gupta B. Lal , Shrivastava Sandeep K. , Tobgay Karma Jigme , Kaleon Tempo Tsewang , Mohan Viswanathan , Anjana Ranjit Mohan , Pradeepa Rajendra , Deepa Mohan , Sudha Vasudevan , Reang Taranga , Das Swapan Kumar , Bajaj Sarita , Mathur Manoj Kumar , Modi Sagar , Kakkar Rakesh , Chowdhury Subhankar , Ghosh Sujoy 
Published: August 2022

OBJECTIVE
To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach.

RESEARCH DESIGN AND METHODS
Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression to T2D in PD and NGT groups.

RESULTS
Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49–54%; protein, 19–20%; and fat, 21–26%; 2) PD remission to NGT: carbohydrate, 50–56%; protein,18–20%; fat, 21–27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54–57% and 56–60%; protein, 16–20% and 14–17%, respectively; and fat 20–24% for PD and NGT.

CONCLUSIONS
We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.