Report from the Commission to the European Parliament and the Council on foods for persons suffering from carbohydrate metabolism disorders (diabetes)
Date: 2008-06-26
Institutions: European Commission
Subjects: diabetes, dietary product, health legislation, health policy, nutrition, public health, report, therapeutics

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 26.6.2008 
COM(2008) 392 final 

REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND 
THE COUNCIL 

ON FOODS FOR PERSONS SUFFERING FROM CARBOHYDRATE 
METABOLISM DISORDERS (DIABETES) 

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TABLE OF CONTENTS 

1. 

2. 

Purpose of the report .................................................................................................... 3 

Diabetes mellitus.......................................................................................................... 3 

2.1. 

Metabolic disorder ....................................................................................................... 4 

3. 

4. 

4.1. 

4.2. 

Treatment of diabetes................................................................................................... 4 

Dietary advice .............................................................................................................. 5 

Scientific basis for dietary advice ................................................................................ 5 

European Dietary Recommendations........................................................................... 5 

4.2.1.  Diabetes and Nutrition Study Group of the European Association for the Study of 

Diabetes Recommendations ......................................................................................... 5 

4.2.2.  Member States' National Diabetes Organisation Recommendations........................... 6 

4.3. 

Summary of dietary advice .......................................................................................... 6 

5. 

5.1. 

5.2. 

5.3. 

6. 

6.1. 

6.2. 

7. 

Information provided by Member States and other interested parties on food for 
people with diabetes..................................................................................................... 7 

Current regulatory position in some EU Member States ............................................. 7 

Foods marketed as suitable for diabetics currently on the European market............... 8 

Views of other interested parties.................................................................................. 9 

Legislation.................................................................................................................... 9 

Current legislative framework ..................................................................................... 9 

Possible legislative options ........................................................................................ 11 

Conclusions ................................................................................................................ 11 

REFERENCES......................................................................................................................... 13 

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REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND 
THE COUNCIL 

ON FOODS FOR PERSONS SUFFERING FROM CARBOHYDRATE 
METABOLISM DISORDERS (DIABETES) 

1. 

PURPOSE OF THE REPORT 

Directive  89/398/EEC  relating  to  foods  for  particular  nutritional  uses1,  otherwise 
called dietetic foods, provides that the Commission would report on the desirability 
of  special  provisions  for  foods  for  people  with  carbohydrate-metabolism  disorders 
(diabetes).  This  report  summarises  the  dietary  recommendations  for  people  with 
diabetes and the current European legislation on foods intended for them so that the 
desirability of special provisions for foods for people with diabetes can be assessed. 

2. 

DIABETES MELLITUS 

Diabetes  mellitus  is  a  group  of  metabolic  disorders  characterised  by  chronic 
hyperglycaemia (high level of blood glucose) and glucose intolerance due to insulin 
deficiency,  impaired  effectiveness  of  insulin  action  or  both.  Normally  the  hormone 
insulin, produced by the pancreas, controls the level of glucose in the blood through 
the movement of glucose from the blood into the body’s cells where it is used as an 
energy source. 

The  World  Health  Organisation  has  defined  two  main  classifications  for  diabetes 
mellitusi: 

Type 1 diabetes (formerly known as insulin dependent diabetes mellitus (IDDM) or 
juvenile  onset  diabetes),  in  which  the  pancreas  fails  to  produce  the  insulin  that  is 
essential for survival. This form of diabetes develops most frequently in children and 
adolescents,  but  is  being  increasingly  noted  later  in  life.  It  is  treated  by  insulin 
injections and dietary management. 

Type  2  diabetes  (formerly  known  as  non-insulin  dependent  diabetes  mellitus 
(NIDDM)  or  maturity  onset  diabetes),  which  results  from  the  body's  inability  to 
respond properly to the action of insulin produced by the pancreas. Type 2 diabetes 
accounts for around 90% of all diabetes cases worldwide. It occurs most frequently 
in adults, but is being increasingly seen in younger adults and children. This form of 
diabetes is usually treated by changes in lifestyle such as diet and physical activity 
alone  or  together  with  oral  hypoglycaemic  agents,  although  sometimes  insulin 
injections may be required. 

1 

Council Directive 89/398/EEC of 3 May 1989 on the approximation of the laws of the Member States 
relating to foodstuffs intended for particular nutritional uses. OJ L 186, 30.6.1989, p. 27. 

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There are other classifications of diabetes arising from genetic defects, disease of the 
pancreas, and drug or chemical-induced disorders. There is also gestational diabetes, 
which affects women during pregnancy and usually disappears after delivery of the 
baby.  Women  who  have  had  gestational  diabetes  are  at  higher  risk  of  developing 
diabetes in later life. 

2.1.  Metabolic disorder 

The  metabolic  effect  of  diabetes  mellitus  is  more  than  a  disorder  of  carbohydrate 
metabolism as it also includes disturbances in protein and fat metabolism that are due 
to  the  deficient  action  of  insulin  on  target  tissues  resulting  from  insensitivity  to  or 
lack of insulin. As a result, the body's ability to convert glucose to energy is reduced. 

Diabetes  usually  manifests  itself  as  hyperglycaemia,  which  is  the  result  of  glucose 
entering the circulation at a rate greater than it can be removed. Blood glucose levels 
during fasting and after eating (postprandial) are regulated by mechanisms that are, 
to some extent, different. Postprandial blood glucose levels are largely dependent on 
meal  composition,  whereas  fasting  blood  glucose  levels  mainly  reflect  the  rate  of 
glucose production by the liver. 

There  are  various  dietary  parameters  that  influence  blood  glucose,  such  as  the 
amount and types of foods consumed and their properties. It has been observed that 
some common foods containing the same type and amount of carbohydrates can have 
different  effects  on  blood  glucose  levels  (glycaemic  response).  The  different 
glycaemic responses to foods containing the same amount of carbohydrates depend 
mainly on the rate of absorption from the small intestine. The type of carbohydrate is 
a  major  factor  affecting  absorption.  Other  influences  on  the  rate  of  absorption  are 
cooking and food processing. 

Alcohol affects blood glucose levels as it suppresses the production of glucose in the 
liver, leading to a lowering of plasma glucose levels. But, if habitually consumed in 
large  amounts,  alcohol  impairs  insulin  sensitivity,  leading  to  increased  plasma 
glucose levels. 

Poorly treated diabetes increases the risk of vascular and neurological diseases and 
shortens  life.  There  are  also  complications,  such  as  loss  of  sight,  associated  with 
damage to the blood vessels and nerves caused by persistently raised levels of blood 
glucose.  The  maintenance  of  tight  control  over  blood  glucose  (and  blood  pressure) 
can reduce the likelihood of complications. 

3. 

TREATMENT OF DIABETES 

The aim of the treatment of people with diabetes is to normalise blood glucose levels 
and also to minimise the complications arising from diabetes. The treatment needs to 
be tailored to the individual, who has to learn to integrate blood glucose monitoring 
with  dietary  management  and  physical  activity  and,  if  needed,  oral  hypoglycaemic 
agents or insulin injections. 

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4. 

DIETARY ADVICE 

Historically, the recommended diet for people with diabetes focused on carbohydrate 
intake.  Prior  to  the  1980s  it  was  thought  that  blood  glucose  control  could  not  be 
achieved  without  carbohydrate  restriction.  The  advice  was  to  restrict  carbohydrate 
intake,  especially  sucrose  intake,  and  that  carbohydrates  should  therefore  provide 
less  than  40%  of  energy  intake.  Research  since  the  1970s  has  shown  that  a  more 
liberal  carbohydrate  intake  is  not  detrimental  to  good  blood  glucose  control  and, 
according  to  the  theory  developed  in  the  early  1980s,  it  was  total  energy  intake, 
rather than carbohydrate intake, that had an impact on glucose levels. In addition, a 
high-fat  diet  contributed  to  the  development  of  complications  of  diabetes  such  as 
vascular damage leading to heart disease. In the 1980s the dietary advice changed to 
increasing  the  contribution  of  carbohydrates  to  energy  intake  and  decreasing  the 
proportion  of  energy  from  fat,  especially  saturated  fat,  and  protein.  It  was 
recommended that the diet should be higher in fibre and that the amount of fruit and 
vegetables  eaten  should  be  increased.  Currently,  the  dietary  advice  for  people  with 
diabetes  is  based  on  the  same  healthy  eating  advice  as  is  given  to  the  general 
population, tailored to their individual needs.  

4.1. 

Scientific basis for dietary advice 

In  2004,  on  behalf  of  the  Diabetes  and  Nutrition  Study  Group  of  the  European 
Association  for  the  Study  of  Diabetes  (DNSG  of  the  EASD),  Mannii  reviewed  the 
evidence  for  dietary  advice  for  people  with  diabetes  and  made  recommendations. 
Annex I summarises the main points noted in the review. 

In 2002 a team led by Franziii published a technical review of the evidence base for 
the  nutrition  principles  and  recommendations  for  the  treatment  and  prevention  of 
diabetes and related complications, which formed the basis of the American Diabetes 
Association position statementiv on this issue. The overall conclusions of the Franziii 
technical review were similar to those of Mannii. 

4.2. 

European Dietary Recommendations  

4.2.1.  Diabetes  and  Nutrition  Study  Group  of  the  European  Association  for  the  Study  of 

Diabetes Recommendations 

In  many  EU  countries,  for  example  Denmark,  Finland,  Greece,  Germany,  Sweden, 
Hungary  and  Slovenia,  the  dietary  advice  to  people  with  diabetes  is  based  on  the 
recommendations  of  the  Diabetes  and  Nutrition  Study  Group  of  the  European 
Association for the Study of Diabetes (DNSG of the EASD). 

The  2004  DNSG  recommendations  took  into  account  evidence  on  the  roles  of 
different  unsaturated  fatty  acids,  the  value  of  low  glycaemic  index  foods,  the 
potential cardioprotective effects of antioxidant nutrients, the need to avoid excessive 
intakes of protein and the benefits of physical activity. The DNSG stresses that the 
dietary recommendations for people with diabetes are very similar to those aimed at 
the  population  as  a  whole  for  the  promotion  of  good  health.  A  summary  of  the 
recommendations and dietary advice is given in Annex II. 

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4.2.2.  Member States' National Diabetes Organisation Recommendations 

their  own  dietary  advice 

Some  national  diabetes  organisations  have  their  own  guidelines  for  the  overall 
nutrient  profile  of  diets  for  diabetics.  For  example,  France,  Sweden  and  the  United 
to  people  with  diabetes.  The 
Kingdom  provide 
recommendations  on  macronutrients  are  similar,  i.e.  carbohydrates  contributing 
around  45-60%  of  total  energy,  fats  providing  <30-35%  of  energy,  and  protein 
providing  10-15%  of  energy  intake.  The  contribution  of  the  different  types  of  fatty 
acids to energy intake is also similar: saturated or trans fatty acids providing <10% 
energy;  polyunsaturated  fatty  acids  also  providing  <10%  energy  intake;  and 
monounsaturated 
fatty  acids  providing  around  10-20%  of  energy.  These 
recommendations are also in line with the advice of the DNSG of the EASD. 

Annex  II  summarises  the  specific  advice  for  the  dietary  management  of  diabetes 
from various organisations within Europe. 

4.3. 

Summary of dietary advice 

Diabetes is a disorder of macronutrient metabolism. The main objective of treatment 
is  to  control  blood  glucose  levels  and  to  reduce  the  risk  of  complications  such  as 
vascular or neurological damage. It may also be necessary for people with diabetes to 
aim  to  achieve  optimal  blood  lipid  status.  These  objectives  can  be  achieved  by 
different means, including eating an appropriate diet. 

Two  technical  reviews  on  the  evidence  for  the  nutritional  management  of  patients 
with diabetes, one produced on behalf of the Diabetes and Nutrition Study Group of 
the European Association for the Study of Diabetes (DNSG of the EASD), and the 
other  produced  for  the  American  Diabetes  Association,  indicate  that  in  the  light  of 
the scientific evidence the overall dietary advice to people with diabetes is that they 
should choose a healthy diet and should be able to do so from normal foods. 

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The  dietary  recommendations  to  people  with  diabetes  within  the  different  Member 
States are similar. In general, the dietary advice to people with diabetes is the same 
as  the  healthy  eating  advice to  the  general  population.  There  is  no  need  to  exclude 
particular  foods  or  nutrients  from  the  diet  but  the  balance  of  the  diet  overall  is 
important.  Individuals  with  diabetes  need  to  plan  their  meals  in  such  a  way  as  to 
minimise changes in blood glucose concentrations and need to choose a diet to match 
their individual needs, taking into consideration the macronutrient composition of the 
foods eaten and their rate of absorption. The overall advice is that individuals should 
achieve or maintain an optimal body weight. Carbohydrate-rich foods should provide 
the major part of the diet. Foods rich in dietary fibre or with a low glycaemic index 
(for example pulses, wholegrain cereals and pasta) are especially recommended. The 
fat content of the diet should be less than 35% of energy, with monounsaturated fatty 
acids (found in olive oil and rapeseed oil, for example) providing 10-20% of energy. 
Both  saturated  fatty  acids  (found  in  animal  products  and  hard  edible  fats,  for 
example) and polyunsaturated fatty acids (found in vegetable oils, soft edible fats and 
fish, for example) should each provide less than 10% of energy intake, and protein 
intake should meet the requirements of the individual.  

The overall advice is: 

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choose a variety of foods; 

base  meals  and  snacks  on  starchy  foods  such  as  wholegrain  cereals,  breads, 
potatoes and other starch vegetables; 

eat plenty of fruit and vegetables, at least five portions a day; 

have  moderate  intakes  of  dairy  products  and  meat,  fish  or  their  alternatives 
(soy products, nuts, etc.); and 

limit intakes of fatty or sugary foods and alcohol. 

Annex I gives a more detailed summary of the dietary advice. 

5. 

INFORMATION  PROVIDED  BY  MEMBER  STATES  AND  OTHER  INTERESTED  PARTIES 
ON FOOD FOR PEOPLE WITH DIABETES 

The  Commission  sought  information  from  Member  States  on  the  current  situation 
with regard to dietary advice, regulation of foods marketed as suitable for diabetics, 
the use of the claim “suitable for diabetics”, and the main products available on their 
market. Information was received from eighteen Member States. 

5.1. 

Current regulatory position in some EU Member States 

Below is a brief summary of the information provided by Member States concerning 
their national provisions. Annex III provides a more detailed summary. 

Dietary advice – In general, dietary advice for people with diabetes is in line with the 
healthy  eating  recommendations  for  the  population  as  a  whole  but  tailored  as 

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necessary to meet the needs of the individual. In many countries the advice is based 
on the recommendations of the DNSG of the EASD. 

Regulations on foods intended for people with diabetes – Five Member States have 
compositional  standards.  In  France  there  are  compositional  standards  for  “low-
carbohydrate  foods”;  in  Hungary  for  food  that  "can  be  consumed  by  diabetics"  or 
with the indication "Diabetic (name of the product)" or "for diabetic"; in Germany, 
Spain  and  Slovakia  there  are  certain  compositional  requirements  for  foods  that  can 
make a claim that they are “suitable for diabetics”. 

The  French  regulation  (Decree  No  91-827  as  amended)  stipulates  that  in  products 
intended  as  low-carbohydrate  foods  the  total  weight  of  assimilable  carbohydrates 
must be less than 50% of the content of corresponding normal foods. However, under 
certain specified conditions, the percentage can rise to 70% for starch products and 
foods containing fructose or sorbitol. The foods must be sold with descriptions that 
include  the  terms  “low  in  carbohydrates”  or  “reduced  carbohydrate  content”.  In 
addition,  the  assimilable  carbohydrate  content  must  be  indicated,  followed  by  the 
statement “to be included in the daily quantity prescribed by the doctor”. 

The  regulations  in  Germany  (Verordnung  über  diätetische  Lebensmittel  §  12) 
governing foods produced specifically for people with diabetes include details of the 
sugars that may be added and under what conditions. In addition there are restrictions 
on  the  energy  content  of  bread  and  the  carbohydrate  content  of  beer.  Following 
advice from the scientific community these regulations are under review. 

The  Spanish  regulations  include  restrictions  on  the  carbohydrate  content  of  foods, 
sugars  that  may  be  added,  and  the  fat  content.  There  are  certain  labelling 
requirements for products containing sorbitol or aspartame.  

The Hungarian regulation includes restrictions on the carbohydrate content of foods 
as well as restrictions on the use of mono- and disaccharides carbohydrate including 
fructose.  

The Slovak regulation includes restrictions on the carbohydrate content of foods, the 
energy value, and the fat, animal protein, cholesterol and salt content.  

Provisions  for  making  the  claim  “suitable  for  diabetics”  –  In  Hungary,  the  Slovak 
Republic,  Germany  and  Spain  products  have  to  comply  with  the  compositional 
requirements specified in their national legislation. In the majority of other reporting 
Member States, the claim should be in line with the rules on labelling of foods for 
particular  nutritional  purposes.  Some  Member  States  discourage  the  use  of  such 
claims in the light of the conclusion of the DNSG of the EASD that specific diabetic 
products are not scientifically justified.  

5.2. 

Foods marketed as suitable for diabetics currently on the European market 

The examples given by Member States as types of products specifically marketed for 
people  with  diabetes  were  chocolate,  confectionery,  drinks,  biscuits  and  jams  with 
fructose,  polyols  or  artificial  sweeteners  in  place  of  sucrose.  As  noted  above,  in 
the  compositional 
France  “low-carbohydrate  foods”  have 
requirements  specified  in  the  national  legislation.  It  is  permissible  to  indicate  that 

to  comply  with 

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they can be advised by a doctor for use as part of the diet of certain diabetics. Pure 
fructose, aqueous fructose and sorbitol are also included in the French regulation as 
products  for  low-carbohydrate  diets  when  intended  to  be  used  as  sweeteners.  In 
Germany, the national legislation on foods for diabetics includes specific provisions 
for bread and beer. Products that comply with the labelling provisions include bakery 
products,  jams,  chocolate,  sweets,  desserts  and  milk  products  containing  fructose 
and/or sugar alcohols instead of sucrose. In Portugal there are some foods intended 
for enteral nutrition that are foods for special medical purposes and are suitable for 
people  with  diabetes.  In  addition,  some  ordinary  foodstuffs  with  reduced  energy 
content  and  with  sucrose  replaced  by  fructose,  polyols  or  artificial  sweeteners  are 
marketed  as  “suitable  for  diabetics”.  However,  none  of  these  ordinary  foodstuffs 
have  gone  through  the  foreseen  procedure  that  allows  foodstuffs  for  normal 
consumption  which  are  suitable  for  a  particular  nutritional  use  to  indicate  such 
suitability.  

5.3. 

Views of other interested parties 

From  the  information  provided  by  Member  States  and  interested  parties  it  appears 
that  many  diabetes  research  and  patient  support  organisations  are  not  in  favour  of 
foods specifically produced or marketed for people with diabetes. They consider that 
the  promotion  of  these  foods  can  detract  from  the  general  dietary  advice  to  people 
with  diabetes,  their  reasons  being  that  the  overall  dietary  recommendations  for 
diabetics are the same as the healthy eating recommendations for the population as a 
whole. Some Member States note that ordinary foods with reduced fat, sugar and/or 
energy  content  may  make  it  easier  for  people  with  diabetes  to  comply  with  the 
dietary recommendations. 

On  the  other  hand,  some  patients  and  manufacturer  organisations  believe  that  new 
food  products  with  proven  benefit  could  be  developed  and  used  as  part  of  an 
improved  diet.  This  may  include  products  that  differ  from  commonly  eaten 
alternative products in, for example, the amount and type of fat or the fibre content, 
or which may have a low glycaemic index. The organisations view industrially pre-
prepared  and  fast  food  as  an  important  area  for  development.  They  believe  that,  if 
developed, such foods might also be suitable for the population as a whole since they 
may be beneficial in helping people to achieve a lifestyle that would reduce the risk 
of developing diabetes. 

6. 

LEGISLATION 

6.1. 

Current legislative framework 

Dietetic  foods  are  defined  in  Article  1(2)  of  Directive  89/398/EEC  (framework 
Directive) by three major characteristics: 

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they  are  clearly  distinguishable  from  normal  foods  (special  composition  or 
manufacturing process); 

they  are  intended  for  specific  groups  of  people  and  not  for  the  general 
population; 

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• 

they  satisfy  the  particular  nutritional  requirements  of  the  persons  for  whom 
they  are  intended.  This  should  be  supported  by  generally  accepted  scientific 
data. 

Certain groups of products for particular nutritional uses, listed in the Annex of the 
above-mentioned  Directive,  are  regulated  by  specific  Directives  which  lay  down 
compositional criteria and/or labelling provisions in order to ensure that the products 
are  used  appropriately  and  that  they  provide  minimum  and/or  maximum  levels  of 
certain  nutrients.  Some  of  these  are  products  that  might  be  the  sole  source  of 
nutrition, for example infant formula and some foods for special medical purposes. 
Such products have to satisfy the complete nutritional requirements of the individual 
as  in  certain  circumstances  there  might  not  be  an  alternative  source  of  nutrition. 
Other  products  such  as  cereal-based  foods  and  baby  foods,  and  foods  intended  for 
weight reduction could be viewed as "convenience products" because the particular 
nutritional needs of the persons for whom they are intended may also be covered by a 
careful selection of normal foods.  

Foods for particular nutritional uses that are not listed in the Annex may be marketed 
under the provisions of Article 9 of the framework Directive. Under these provisions 
manufacturers or importers have to fulfil two procedural obligations when marketing 
these products: 

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• 

They must notify the competent authority of the Member State concerned that 
the product is being placed on the market and must, at the same time, forward a 
model of the label used. When the same product is subsequently placed on the 
market in another Member State, they must repeat the notification procedure. 

They  must  keep  at  the  disposal  of  the  competent  authorities  a  file  containing 
the scientific work and the data establishing that the product is in compliance 
with the definition of foods for particular nutritional uses, in other words, that 
the  product  fulfils  particular  nutritional  requirements  of  the  group  of  persons 
for whom it is intended. 

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Products that comply with the provisions of the framework Directive and the relevant 
specific  Directives  may  circulate  freely  in  the  Community.  Controls  carried  out  by 
the competent authorities must be in conformity with relevant Community legislation 
and should be post-market ones. Member States are also responsible for ensuring that 
products  marketed  under  the  rules  laid  down  in  Article  9  of  Directive  89/398/EEC 
are indeed dietetic foods. 

The  labelling  of  dietetic  foods,  as  in  the  case  of  all  foods,  should  comply  with  the 
provisions laid down in Directive 2000/13/EC on labelling of foodstuffs. In addition, 
according to the framework Directive, their labelling should indicate: 

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the particular nutritional characteristics of the product; 

the  particular  qualitative  or  quantitative  elements  of  the  composition  with 
regard to the intended use; and 

the energy, protein, carbohydrate and fat content of the product. 

6.2. 

Possible legislative options 

The  Commission  has  at  this  stage  identified  three  possible  legislative  options  for 
dealing  with  foods  intended  for  persons  with  carbohydrate-metabolism  disorders 
(diabetes): 

A.  Adopt  a  Commission  Directive 
requirements for such products. 

laying  down  specific  compositional 

B.  Amend the framework Directive 89/398/EEC so that these products are deleted 
from Annex I, i.e. they will not be the subject of a specific Directive but may 
be marketed under the provisions of Article 9. 

C.  Amend  the  framework  Directive  89/398/EEC  so  that  foods  intended  for 
persons  with  diabetes  are  excluded  from the  scope  of  that  Directive,  i.e.  they 
cannot be marketed as foods for particular nutritional uses. 

7. 

CONCLUSIONS 

Two  technical  reviewsii  &  iii  on  the  evidence  for  the  nutritional  management  of 
patients with diabetes have been considered in this report. Both reviews indicate that 
people with diabetes should choose a healthy diet and should be able to do so from 
normal  foods.  In  the  light  of  these  reviews  there  are  no  grounds  for  developing 
specific compositional requirements for foods intended for people with diabetes. 

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The  Scientific  Committee  on  Food  was  asked  to  comment  on  the  scientific 
conclusions of this report, in particular with regard to the scientific basis for defining 
specific compositional criteria for foods for persons suffering from diabetes mellitus. 
The Committee supports the following: Dietary choices by people with diabetes can 
affect their long term health risks associated with the disease. The desirable dietary 
composition  for  people  with  diabetes  is  similar  to  that  recommended  for  the 
population as a whole. Therefore, people with diabetes should be able to meet their 
dietary  needs  by  appropriate  selection  from  normal  foods.  There  are  no  scientific 
grounds  for  specific  compositional  criteria  for  foods  for  particular  nutritional  uses 
in people with diabetes. However, people with diabetes should have information on 
dietary needs in diabetes, and on composition of foods, to enable them to choose a 
balanced diet that meets their individual requirementsv. 

Consequently,  in  the  light  of  these  considerations,  the  Commission  would  propose 
that Directive 89/398/EEC be amended in order that no specific Directive is required 
for  that  category  of  foods.  The  most  appropriate  and  balanced  solution  for  dealing 
with  foods  intended  for  persons  with  carbohydrate-metabolism  disorders  (diabetes) 
would be elaborated and presented in the framework of the revision of that Directive. 
In  this  context,  the  various  policy  options  will  be  carefully  examined  and  assessed 
taking into account the potential scientific and technological developments and other 
relevant legitimate factors such as e.g. the legal situations in the Member Sates and 
the health and socio-economic impacts. 

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REFERENCES 

i. 

ii. 

iii. 

iv. 

v. 

World  Health  Organisation.  Definition,  diagnosis  and  classification  of  diabetes 
mellitus and its complications. Report of a WHO Consultation. Part 1: Diagnosis and 
classification  of  diabetes  mellitus.  WHO/NCD/99.2.  1999,  Geneva,  Department  of 
Noncommunicable Disease Surveillance. 
(http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf) 

Mann,  J.I.  et  al.  Evidence-based  nutritional  approaches  to  the  treatment  and 
prevention of diabetes mellitus. Nutrition, Metabolism, and Cardiovascular Diseases 
(2004) 14: 373-394. 

Franz  M.J.  et  al.  Evidence-based  nutrition  principles  and  recommendations  for  the 
treatment  and  prevention  of  diabetes  and  related  complications  (Technical  review). 
Diabetes Care, 2002, 25: 148-198.   
(http://care.diabetesjournals.org/cgi/content/full/25/1/148) 

American  Diabetes  Association.  Nutrition  principles  and  recommendations  in 
diabetes  (Position  statement).  Diabetes  Care,  2004,  27,  Suppl.  1:  S36-S46. 
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Minutes of the 132nd Plenary meeting of the Scientific Committee on Food held on 
15/16/17 April 2002 in Brussels, p. 5. 
http://ec.europa.eu/food/fs/sc/scf/out132_en.pdf  

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