Primary prevention of diabetes: what can be done and how much can be
 prevented?

 Schulze MB, Hu FB.

 Department of Nutrition and Epidemiology, Boston, Massachusetts 02115,
 USA. mschulze@mail.dife.de

 Although it is widely believed that type 2 diabetes mellitus is the
 result of a complex interplay between genetic and environmental
 factors, compelling evidence from epidemiologic studies indicates that
 the current worldwide diabetes epidemic is largely due to changes in
 diet and lifestyle. Prospective cohort studies and randomized clinical
 trials have demonstrated that type 2 diabetes can be prevented largely
 through moderate diet and lifestyle modifications. Excess adiposity is
 the most important risk factor for diabetes, and thus, maintaining a
 healthy body weight and avoiding weight gain during adulthood is the
 cornerstone of diabetes prevention. Increasing physical activity and
 reducing sedentary behaviors such as prolonged TV watching are
 important both for maintaining body weight and improving insulin
 sensitivity. There is increasing evidence that the quality of fat and
 carbohydrate plays a more important role than does the quantity, and
 thus, public health strategies should emphasize replacing saturated
 and trans fats with unsaturated fats and replacing refined grain
 products with whole grains. Recent studies have also suggested a
 potential role for coffee, dairy, nuts, magnesium, and calcium in
 preventing diabetes. Overall, a healthy diet, together with regular
 physical activity, maintenance of a healthy weight, moderate alcohol
 consumption, and avoidance of sedentary behaviors and smoking, could
 nearly eliminate type 2 diabetes. However, there is still a wide gap
 between what we know and what we practice in the field of public
 health; how to narrow that gap remains a major public health
 challenge.

No mention of sugar at all.

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