Dietary Patterns and Cardiovascular Disease Risk in People with Type 2 Diabetes

Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

The aim of this study was to assess the effects of different dietary approaches on low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels in patients with type 2 diabetes (T2D) by applying network meta-analysis (NMA). Systematic electronic and hand searches were conducted until January 2018. Randomized controlled trials (RCTs) with an intervention period of ≥ 12 weeks, focussing on adults with T2D, and comparing dietary approaches regarding LDL, HDL or TGs, were included. For each outcome measure, random effects NMA was performed in order to determine the effect of each dietary approach compared to every other dietary intervention. Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated, and for the ranking, the surface under the cumulative ranking curves (SUCRA) was determined. Additionally, the credibility of evidence was evaluated. 52 RCTs (44 for LDL, 48 for HDL and 52 for TGs) comparing nine dietary approaches (low fat, vegetarian, Mediterranean, high protein, moderate carbohydrate, low carbohydrate, control, low glycaemic index/glycaemic load and Palaeolithic diet) enrolling 5360 T2D patients were included. The vegetarian diet most effectively reduced LDL levels [MD (95% CI): - 0.33 (- 0.55, - 0.12) mmol/L; compared to the control diet]. The Mediterranean diet beneficially raised HDL [MD (95% CI): 0.09 (0.04, 0.15) mmol/L] and decreased TG levels [MD (95% CI): - 0.41 (- 0.72, - 0.10) mmol/L] compared to the control diet. The Mediterranean diet was the most effective dietary approach to manage diabetic dyslipidaemia altogether (SUCRA: 79%). The overall findings are mainly limited by low credibility of evidence.

Meat Analogs from Different Protein Sources: A Comparison of Their Sustainability and Nutritional Content

Meat analogs are processed foods designed to mimic meat products. Their popularity is increasing among people seeking foods that are healthy and sustainable. Animal-sourced protein products differ in both their environmental impact and nutritional composition. The protein sources to produce meat analogs come from different plants. There is a lack of published research data assessing differences in these two aspects of meat analogs according to the plant protein source. This study compared the greenhouse gas (GHG) emissions of different types of meat analogs according to their main source of protein (wheat, soy, wheat and soy, or nuts), and their nutritional composition. We also compared totally plant-based products with those containing egg. We performed life cycle analyses of 56 meat analogs from ingredient production to the final commercial product. The nutrient profile of the meat analogs was analyzed based on ingredients. Descriptive statistics and differences between means were assessed through t-test and ANOVA. No differences in GHG emissions were observed among products with different major sources of protein. However, egg-containing products produced significantly higher amounts of GHG (p < 0.05). The nutritional composition of all meat analogs was found to be quite similar. Altogether, total plant-based meat analogs should be the choice for the sake of the environment.

Associations between fatigue, sleep disturbance and eating style in adults with type 2 diabetes: A correlational study

AIMS AND OBJECTIVES

To test the hypothesis that fatigue and sleep disturbance account for a significant amount of variation in eating styles among people with type 2 diabetes (T2D).

BACKGROUND

Healthy eating is an important component of diabetes self-care but remains a major challenge. In people with T2D, symptoms of fatigue and sleep disturbance are pervasive. However, there is limited understanding of whether fatigue and sleep disturbance are associated with eating style in people with T2D.

DESIGN

Correlational design.

METHODS

This study was reported following the STROBE checklist. Data were collected between February 2017 and January 2018. A convenience sample of 64 T2D adults completed the Three-Factor Eating Questionnaire-R18V2 to measure eating style (e.g., emotional eating, cognitive restraint and uncontrolled eating). Diabetes distress, fatigue and sleep disturbance were measured using validated questionnaires. Hierarchical regression analyses were performed.

RESULTS

Only age was a significant predictor (β = -0.344) of cognitive restraint. Participant demographics, psychological factor and health-related factors contribute significantly to the model predicting emotional eating, but only diabetes distress was a significant predictor (β = 0.433). Introducing fatigue and poor sleep quality explained an additional 12.0% of the variation in emotional eating. The final model explained 24.9% of the variation in emotional eating; both diabetes distress (β = 0.294) and fatigue (β = 0.360) were significant predictors.

CONCLUSION

There is a strong, independent relationship of fatigue and diabetes distress with emotional eating T2D patients. The effect of improving fatigue and diabetes distress on eating style should be explored.

RELEVANCE TO CLINICAL PRACTICE

In clinical practice, nurses are recommended to include a detailed assessment of fatigue and distress in patients with diabetes. Additional to the conventional nutrition therapy focusing on diet advice, eating style should also be incorporated in diet education by diabetes nurses.

[Nutrition in type 2 diabetes mellitus]

The increasing incidence of metabolic diseases, such as type 2 diabetes mellitus, poses a major problem for the healthcare system. Healthy food habits represent an important therapeutic measure to prevent health sequelae, such as cardiovascular diseases. According to recent data these are less due to individual dietary components and more to the composition of nutrition. A positive effect on glucose and fat metabolism in type 2 diabetes has been confirmed for various forms of nutrition. In addition to the type of nutrition, the so-called glycemic index of foodstuffs is also decisive for blood glucose control. Additionally, beneficial effects for particular foodstuffs, such as coffee, could be determined in patients with diabetes.

Regularity of Breakfast Consumption and Diet: Insights from National Adult Nutrition Survey

Breakfast is considered to be one of the most important meals of the day. Its omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality. Using data from the National Adult Nutrition Survey (NANS)-a food consumption survey conducted among 1500 Irish men and women over 18 years of age, residing in the Republic of Ireland at the time the survey was conducted-we aimed to characterize breakfast regularity, identify dietary patterns associated with regular breakfast consumption, and assess the nutritional quality of such dietary patterns, using the nutrient-rich food index score NRF9.3. We determined two breakfast regularity categories and assessed dietary quality, by means of adherence to the principal component analysis derived dietary patterns and the NRF9.3 dietary index. Regular breakfast consumers were identified as those who consumed breakfast 3⁻4 times out of the 4 days of the collection period; such consumers comprised the majority of the population (94.4%). They had the highest adherence to healthier dietary patterns, namely, the "vegetarian" (odds ratio (OR): 2.59: 95% Confidence Interval (CI): 1.40, 4.77), "fish and vegetables" (OR: 2.88: 95% CI: 1.63, 5.10), and "breakfast cereals" (OR: 4.62: 95% CI: 2.43, 8.79) dietary patterns. Breakfast significantly contributed to the daily micronutrient intake by providing, on average, 24% of dietary fiber, 32% of iron, 30% of calcium, 32% of folate, and 37% of riboflavin. The importance of regular breakfast consumption on those who skip breakfast should be highlighted, in order to improve compliance with nutritional recommendations and adherence to a healthy lifestyle.

Myocardial Protective Effects of Nicorandil on Rats with Type 2 Diabetic Cardiomyopathy

Background

Diabetic cardiomyopathy (DCM) is a common but underestimated cause of heart failure in patients with diabetes. This study investigated the myocardial-protective effects of nicorandil (Nic) on rats with DCM.

Material/Methods

A total of forty-seven 180–220 g male Wistar rats were randomly divided into 4 groups: a control group (control, n=8), a DCM group (DCM, n=13), a nicorandil-pretreated DCM group (Nic₁, n=13), and a nicorandil-treated DCM group (Nic₂, n=13). A rat model of type 2 diabetes was induced by high-fat and high-sugar diet and intraperitoneal injection of streptozotocin (STZ). Nicorandil (3 mg/kg/d) was orally administrated to rats in the Nic₁ group starting at week 4. Nicorandil (3 mg/kg/d) was orally administrated only after the induction of diabetes in the Nic₂ group. The serum lipoids, plasma glucose, insulin levels, heart weight index, serum creatine kinase (CK), lactate dehydrogenase (LDH) levels, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) were analyzed in all groups.

Results

The DCM group showed increased heart weight index, serum LDH, CK, and MDA content and decreased serum SOD activity, as compared with the control group (P<0.05). The DCM-induced increases in heart weight index, serum LDH, CK, and MDA content and decrease in serum SOD activity were attenuated in both Nic₁ and Nic₂ groups (P<0.05). However, there was no significant difference between Nic₁ and Nic₂ groups (P>0.05).

Conclusions

Nicorandil has protective effects on cardiac hypertrophy in DCM rats through increased SOD activity and decreased MDA content. Therefore, nicorandil may be a therapeutic method for diabetic patients with DCM.

Determining the Glycaemic Index of Standard and High-Sugar Rodent Diets in C57BL/6 Mice

The glycaemic index (GI) is a useful tool to compare the glycaemic responses of foods. Numerous studies report the favorable effects of low GI diets on long term metabolic health compared with high GI diets. However, it has not been possible to link these effects to the GI itself because of other components such as macronutrients and dietary fibre, which are known to affect GI. This study aimed to create and evaluate isocaloric diets differing in GI independent of macronutrient and fibre content. The GIs of eight diets differing in carbohydrate source were evaluated in mice; cooked cornstarch (CC), raw cornstarch (RC), chow, maltodextrin, glucose, sucrose, isomaltulose, and fructose. A glucose control was also tested. The GIs of all eight diets were different from the GI of the glucose control (GI: 100; p < 0.0001). The GIs of the glucose (mean ± SEM: 52 ± 3), maltodextrin (52 ± 6), CC (50 ± 4), RC (50 ± 6), and chow (44 ± 4) diets were similar, while the GIs of the sucrose (31 ± 4), isomaltulose (24 ± 5), and fructose (18 ± 2) diets were lower than all other diets (p < 0.05). This is the first trial to report GI testing in vivo in mice, resulting in three main findings: chow is relatively high GI, the glucose availability of raw and cooked cornstarch is similar, and the GI of different sugar diets occur in the same rank order as in humans.

Inflammation, not Cholesterol, Is a Cause of Chronic Disease

Since the Seven Countries Study, dietary cholesterol and the levels of serum cholesterol in relation to the development of chronic diseases have been somewhat demonised. However, the principles of the Mediterranean diet and relevant data linked to the examples of people living in the five blue zones demonstrate that the key to longevity and the prevention of chronic disease development is not the reduction of dietary or serum cholesterol but the control of systemic inflammation. In this review, we present all the relevant data that supports the view that it is inflammation induced by several factors, such as platelet-activating factor (PAF), that leads to the onset of cardiovascular diseases (CVD) rather than serum cholesterol. The key to reducing the incidence of CVD is to control the activities of PAF and other inflammatory mediators via diet, exercise, and healthy lifestyle choices. The relevant studies and data supporting these views are discussed in this review.

Diabetic Cardiomyopathy: Impact of Biological Sex on Disease Development and Molecular Signatures

Diabetic cardiomyopathy refers to a unique set of heart-specific pathological variables induced by hyperglycemia and insulin resistance. Given that cardiovascular disease (CVD) is the leading cause of death in the world, and type 2 diabetes incidence continues to rise, understanding the complex interplay between these two morbidities and developing novel therapeutic strategies is vital. Two hallmark characteristics specific to diabetic cardiomyopathy are diastolic dysfunction and cardiac structural mal-adaptations, arising from cardiac cellular responses to the complex toxicity induced by hyperglycemia with or without hyperinsulinemia. While type 2 diabetes is more prevalent in men compared to women, cardiovascular risk is higher in diabetic women than in diabetic men, suggesting that diabetic women take a steeper path to cardiomyopathy and heart failure. Accumulating evidence from randomized clinical trials indicate that although pre-menopausal women have lower risk of CVDs, compared to age-matched men, this advantage is lost in diabetic pre-menopausal women, which suggests estrogen availability does not protect from increased cardiovascular risk. Notably, few human studies have assessed molecular and cellular mechanisms regarding similarities and differences in the progression of diabetic cardiomyopathy in men versus women. Additionally, most pre-clinical rodent studies fail to include female animals, leaving a void in available data to truly understand the impact of biological sex differences in diabetes-induced dysfunction of cardiovascular cells. Elegant reviews in the past have discussed in detail the roles of estrogen-mediated signaling in cardiovascular protection, sex differences associated with telomerase activity in the heart, and cardiac responses to exercise. In this review, we focus on the emerging cellular and molecular markers that define sex differences in diabetic cardiomyopathy based on the recent clinical and pre-clinical evidence. We also discuss miR-208a, MED13, and AT2R, which may provide new therapeutic targets with hopes to develop novel treatment paradigms to treat diabetic cardiomyopathy uniquely between men and women.