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Kim HN, Song SW. Association between carbohydrate intake and body composition: The Korean National Health and Nutrition Examination Survey. Nutrition 2018; 61:187-193. [PMID: 30822750 DOI: 10.1016/j.nut.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/25/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Several studies have investigated the effects of dietary carbohydrate intake on body composition. However, the results are controversial and few studies have been conducted on an Asian population. The aim of this study was to investigate whether dietary carbohydrate intake is associated with body composition in Korean adults. METHODS The present study used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians, conducted from 2008 to 2011. The study analyzed 9594 participants. Carbohydrate intake was defined as the proportion of energy consumed from carbohydrate. Waist circumference, body mass index, and lean and fat mass using a whole-body dual-energy x-ray absorptiometry scanner were measured as body composition parameters. RESULTS After adjusting for age, household income, smoking, alcohol consumption, physical activity, history of diabetes, hypertension, dyslipidemia, and intake of energy and fiber per day, the proportion of carbohydrate intake was positively correlated with total limb lean mass in men (β = 0.141, P = 0.046), and in women, the proportion of carbohydrate intake was positively associated with appendicular skeletal muscle mass index (β = 0804, P = 0.003) but negatively associated with trunk fat percentage (β = -0.075, P = 0.026). Total limb lean mass and appendicular skeletal muscle mass index in women showed an increasing trend as the proportion of carbohydrate intake increased. CONCLUSIONS No positive association was found between the proportion of carbohydrate intake and any measure of obesity or body fat mass in either men or women. Further studies are needed to evaluate the effects of quantity and quality of carbohydrate intake on body composition.
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Affiliation(s)
- Ha-Na Kim
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Wook Song
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Martínez-González MA, Buil-Cosiales P, Corella D, Bulló M, Fitó M, Vioque J, Romaguera D, Martínez JA, Wärnberg J, López-Miranda J, Estruch R, Bueno-Cavanillas A, Arós F, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Delgado-Rodríguez M, Matía P, Ros E, Fernández-Aranda F, Botella C, Portillo MP, Lamuela-Raventós RM, Marcos A, Sáez G, Gómez-Gracia E, Ruiz-Canela M, Toledo E, Alvarez-Alvarez I, Díez-Espino J, Sorlí JV, Basora J, Castañer O, Schröder H, Navarrete-Muñoz EM, Zulet MA, García-Rios A, Salas-Salvadó J, Corella D, Estruch R, Fitó M, Martínez-González MA, Ros E, Salas-Salvadó J, Babio N, Ros E, Sánchez-Tainta A, Martínez-González MA, Fitó M, Schröder H, Marcos A, Corella D, Wärnberg J, Martínez-González MA, Estruch R, Fernández-Aranda F, Botella C, Salas-Salvadó J, Razquin C, Bes-Rastrollo M, Sanchez Tainta A, Vázquez Z, SanJulian Aranguren B, Goñi E, Goñi L, Barrientos I, Canales M, Sayón-Orea MC, Rico A, Basterra Gortari J, 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L, Giner-Valero M, Monfort-Sáez R, Nadal-Sayol J, Pascual-Fuster V, Martínez-Pérez M, Riera C, Belda MV, Medina A, Miralles E, Ramírez-Esplugues MJ, Rojo-Furió M, Mattingley G, Delgado MA, Pages MA, Riofrío Y, Abuomar L, Blasco-Lafarga N, Tosca R, Lizán L, Guillem-Saiz P, Valcarce AM, Medina MD, Monfort R, de Valcárcel S, Tormo N, Felipe-Román O, Lafuente S, Navío EI, Aldana G, Crespo JV, Llosa JL, González-García L, Raga-Marí R, Pedret Llaberia R, Gonzalez R, Sagarra Álamo R, París Palleja F, Balsells J, Roca JM, Basora Gallisa T, Vizcaino J, Llobet Alpizarte P, Anguera Perpiñá C, Llauradó Vernet M, Caballero C, Garcia Barco M, Morán Martínez MD, García Rosselló J, Del Pozo A, Poblet Calaf C, Arcelin Zabal P, Floresví X, Ciutat Benet M, Palau Galindo A, Cabré Vila JJ, Dolz Andrés F, Boj Casajuana J, Ricard M, Saiz F, Isach A, Sanchez Marin Martinez M, Bulló M, Babio N, Becerra-Tomás N, Mestres G, Basora J, Mena-Sánchez G, Barrubés Piñol L, Gil Segura M, Papandreou C, Rosique Esteban N, Chig S, Abellán Cano I, Ruiz García V, Salas-Huetos A, Hernandez P, Canudas S, Camacho-Barcia L, García-Gavilán J, Diaz A, Castañer O, Muñoz MA, Zomeño MD, Hernaéz A, Torres L, Quifer M, Llimona R, Gal LA, Pérez A, Farràs M, Elosua R, Marrugat J, Vila J, Subirana I, Pérez S, Muñoz MA, Goday A, Chillaron Jordan JJ, Flores Lerroux JA, Benaiges Boix D, Farré M, Menoyo E, Muñoz-Aguayo D, Gaixas S, Blanchart G, Sanllorente A, Soria M, Valussi J, Cuenca A, Forcano L, Pastor A, Boronat A, Tello S, Cabañero M, Franco L, Schröder H, De la Torre R, Medrano C, Bayó J, García MT, Robledo V, Babi P, Canals E, Soldevila N, Carrés L, Roca C, Comas MS, Gasulla G, Herraiz X, Martínez A, Vinyoles E, Verdú JM, Masague Aguade M, Baltasar Massip E, Lopez Grau M, Mengual M, Moldon V, Vila Vergaz M, Cabanes Gómez Ciurana R, Gili Riu M, Palomeras Vidal A, Garcia de la Hera M, González Palacios S, Torres Collado L, Valera Gran D, Compañ Gabucio L, Oncina Canovas A, Notario Barandiaran L, Orozco Beltran D, Pertusa Martínez S, Cloquell Rodrigo B, Hernándis Marsán MV, Asensio A, Altozano Rodado MC, Ballester Baixauli JJ, Fernándis Brufal N, Martínez Vergara MC, Román Maciá J, Candela García I, Pedro Cases Pérez E, Tercero Maciá C, Mira Castejón LA, de los Ángeles García García I, Zazo JM, Gisbert Sellés C, Sánchez Botella C, Fiol M, Moñino M, Colom A, Konieczna J, Morey M, Zamanillo R, Galmés AM, Pereira V, Martín MA, Yáñez A, Llobera J, Ripoll J, Prieto R, Grases F, Costa A, Fernández-Palomeque C, Fortuny E, Noris M, Munuera S, Tomás F, Fiol F, Jover A, Janer JM, Vallespir C, Mattei I, Feuerbach N, del Mar Sureda M, Vega S, Quintana L, Fiol A, Amador M, González S, Coll J, Moyá A, Abete I, Cantero I, Cristobo C, Ibero-Baraibar I, Lezáun Burgui MD, Goñi Ruiz N, Bartolomé Resano R, Cano Cáceres E, Elcarte López T, Echarte Osacain E, Pérez Sanz B, Blanco Platero I, Andueza Azcárate SA, Gimeno Aznar A, Ursúa Sesma E, Ojeda Bilbao B, Martinez Jarauta J, Ugalde Sarasa L, Rípodas Echarte B, Güeto Rubio MV, Fernández-Crehuet Navajas J, Gutiérrez Bedmar M, García Rodriguez A, Mariscal Larrubia A, Carnero Varo M, Muñoz Bravo C, Barón-López FJ, Fernández García JC, Pérez-Farinós N, Moreno-Morales N, del C Rodríguez-Martínez M, Pérez-López J, Benavente-Marín JC, Crespo Oliva E, Contreras Fernández E, Carmona González FJ, Carabaño Moral R, Torres Moreno S, Martín Ruíz MV, Alcalá Cornide M, Fuentes Gómez V, Criado García J, Jiménez Morales AI, Delgado Casado N, Ortiz Morales A, Torres Peña JD, Gómez Delgado FJ, Rodríguez Cantalejo F, Caballero Villaraso J, Alcalá JF, Peña Orihuela PJ, Quintana Navarro G, Casas R, Domenech M, Viñas C, Castro-Barquero S, Ruiz-León AM, Sadurní M, Frontana G, Villanueva P, Gual M, Soriano R, Camafort M, Sierra C, Sacanella E, Sala-Vila A, Cots JM, Sarroca I, García M, Bermúdez N, Pérez A, Duaso I, de la Arada A, Hernández R, Simón C, de la Poza MA, Gil I, Vila M, Iglesias C, Assens N, Amatller M, Rams LL, Benet T, Fernández G, Teruel J, Azorin A, Cubells M, López D, Llovet JM, Gómez ML, Climente P, de Paula L, Soto J, Carbonell C, Llor C, Abat X, Cama A, Fortuny M, Domingo C, Liberal AI, Martínez T, Yañez E, Nieto MJ, Pérez A, Lloret E, Carrazoni C, Belles AM, Olmos C, Ramentol M, Capell MJ, Casas R, Giner I, Muñoz A, Martín R, Moron E, Bonillo A, Sánchez G, Calbó C, Pous J, Massip M, García Y, Massagué MC, Ibañez R, Llaona J, Vidal T, Vizcay N, Segura E, Galindo C, Moreno M, Caubet M, Altirriba J, Fluxà G, Toribio P, Torrent E, Anton JJ, Viaplana A, Vieytes G, Duch N, Pereira A, Moreno MA, Pérez A, Sant E, Gené J, Calvillo H, Pont F, Puig M, Casasayas M, Garrich A, Senar E, Martínez A, Boix I, Sequeira E, Aragunde V, Riera S, Salgado M, Fuentes M, Martín E, Ubieto A, Pallarés F, Sala C, Abilla A, Moreno S, Mayor E, Colom T, Gaspar A, Gómez A, Palacios L, Garrigosa R, García Molina L, Riquelme Gallego B, Cano Ibañez N, Maldonado Calvo A, López Maldonado A, Garrido EM, Baena Dominguez A, García Jiménez F, Thomas Carazo E, Jesús Turnes González A, González Jiménez F, Padilla Ruiz F, Machado Santiago J, Martínez Bellón MD, Pueyos Sánchez A, Arribas Mir L, Rodríguez Tapioles R, Dorador Atienza F, Baena Camus L, Osorio Martos C, Rueda Lozano D, López Alcázar M, Ramos Díaz F, Cruz Rosales Sierra M, Alguacil Cubero P, López Rodriguez A, Guerrero García F, Tormo Molina J, Ruiz Rodríguez F, Rekondo J, Salaverria I, Alonso-Gómez A, Belló MC, Loma-Osorio A, Tojal L, Bruyel P, Goicolea L, Sorto C, Casi Casanellas A, Arnal Otero ML, Ortueta Martínez De Arbulo J, Vinagre Morgado J, Romeo Ollora J, Urraca J, Sarriegui Carrera MI, Toribio FJ, Magán E, Rodríguez A, Castro Madrid S, Gómez Merino MT, Rodríguez Jiménez M, Gutiérrez Jodra M, López Alonso B, Iturralde Iriso J, Pascual Romero C, Izquierdo De La Guerra A, Abbate M, Aguilar I, Angullo E, Arenas A, Argelich E, Bibiloni MM, Bisbal Y, Bouzas C, Busquets C, Capó X, Carreres S, De la Peña A, Gallardo L, Gámez JM, García B, García C, Julibert A, Llompart I, Mascaró CM, Mateos D, Montemayor S, Pons A, Ripoll T, Rodríguez T, Salaberry E, Sureda A, Tejada S, Ugarriza L, Valiño L, Bernal López MR, Macías González M, Ruiz Nava J, Fernández García JC, Muñoz Garach A, Vilches Pérez A, González Banderas A, Alcaide Torres J, Vargas Candela A, León Fernández M, Hernández Robles R, Santamaría Fernández S, Marín JM, Valdés Hernández S, Villalobos JC, Ortiz A, Álvarez-Pérez J, Díaz Benítez EM, Díaz-Collado F, Sánchez-Villegas A, Pérez-Cabrera J, Casañas-Quintana LT, García-Guerra RB, Bautista-Castaño I, Ruano-Rodríguez C, Sarmiento de la Fe F, García-Pastor JA, Macías-Gutiérrez B, Falcón-Sanabria I, Simón-García C, Santana-Santana AJ, Álvarez-Álvarez JB, Díaz-González BV, Castillo Anzalas JM, Sosa-Also RE, Medina-Ponce J, Abajo Olea S, Adlbi Sibai A, Aguado Arconada A, Álvarez L, Carriedo Ule E, Escobar Fernández M, Ferradal García JI, Fernández Vázquez JP, García González M, González Donquiles C, González Quintana C, González Rivero F, Lavinia Popescu M, López Gil JI, López de la Iglesia J, Marcos Delgado A, Merino Acevedo C, Reguero Celada S, Rodríguez Bul M, Vilorio-Marqués L, Santos-Lozano JM, Miró-Moriano L, Domínguez-Espinaco C, Vaquero-Díaz S, García-Corte FJ, Santos-Calonge A, Toro-Cortés C, Pelegrina-López N, Urbano-Fernández V, Ortega-Calvo M, Lozano-Rodríguez J, Rivera-Benítez I, Caballero-Valderrama M, Iglesias-Bonilla P, Román-Torres P, Corchado-Albalat Y, Mayoral-Sánchez E, de Cos AI, Gutierrez S, Artola S, Galdon A, Gonzalo I, Más S, Sierra R, Luca B, Prieto L, Galera A, Gimenez-Gracia M, Figueras R, Poch M, Freixedas R, Trias F, Sarasa I, Fanlo M, Lafuente H, Liceran M, Rodriguez-Sanchez A, Pallarols C, Monedero J, Corbella X, Corbella E, Altés A, Vinagre I, Mestres C, Viaplana J, Serra M, Vera J, Freitas T, Ortega E, Pla I, Ordovás JM, Micó V, Berninches L, Concejo MJ, Muñoz J, Adrián M, de la Fuente Y, Albertos C, Villahoz E, Cornejo ML, Gaforio JJ, Moraleda S, Liétor N, Peis JI, Ureña T, Rueda M, Ballesta MI, Moreno Lopera C, Aragoneses Isabel C, Sirur Flores MA, Ceballos de Diego M, Bescos Cáceres T, Peña Cereceda Y, Martínez Abad M, Cabrera Vela R, González Cerrajero M, Rubio Herrera MA, Torrego Ellacuría M, Barabash Bustelo A, Ortiz Ramos M, Garin Barrutia U, Baños R, García-Palacios A, Cerdá Micó C, Estañ Capell N, Iradi A, Fandos Sánchez M. Cohort Profile: Design and methods of the PREDIMED-Plus randomized trial. Int J Epidemiol 2018; 48:387-388o. [PMID: 30476123 DOI: 10.1093/ije/dyy225] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Miguel A Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Pilar Buil-Cosiales
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Monica Bulló
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Montserrat Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
| | - Jesús Vioque
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Dora Romaguera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Clinical Epidemiology and Public Health Department, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - J Alfredo Martínez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Navarra, Department of Nutrition, Food Science and Physiology, IDISNA, Pamplona, Spain
| | - Julia Wärnberg
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nursing, School of Health Sciences, University of Málaga-IBIMA, Málaga, Spain
| | - Jose López-Miranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ramón Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Aurora Bueno-Cavanillas
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Granada, Granada, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Cardiology, University Hospital Araba, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Josep A Tur
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Francisco Tinahones
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Virgen de la Victoria Hospital, Department of Endocrinology, University of Málaga, Málaga, Spain
| | - Lluis Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Las Palmas de Gran Canaria, Research Institute of Biomedical and Health Sciences (IUIBS), Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Jose Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Clotilde Vázquez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology, Fundación Jiménez-Díaz, Madrid, Spain
| | - Xavier Pintó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Vidal
- CIBER Diabetes y enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Miguel Delgado-Rodríguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain
| | - Pilar Matía
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Hospitalet del Llobregat, Barcelona, Spain
| | - Cristina Botella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - María Puy Portillo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nutrition and Food Science, Faculty of Pharmacy and Lucio Lascaray Research Center, Universidad del País Vasco (UPV/EHU), Vitoria, Spain
| | - Rosa M Lamuela-Raventós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, -UB, School of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Ascensión Marcos
- Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Guillermo Sáez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology, University Hospital Dr. Peset, University of Valencia, Valencia, Spain
| | | | - Miguel Ruiz-Canela
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Estefania Toledo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Ismael Alvarez-Alvarez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
| | - Javier Díez-Espino
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, Pamplona, Spain
- Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - José V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Josep Basora
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Olga Castañer
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
| | - Helmut Schröder
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eva María Navarrete-Muñoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Maria Angeles Zulet
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- University of Navarra, Department of Nutrition, Food Science and Physiology, IDISNA, Pamplona, Spain
| | - Antonio García-Rios
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Rovira i Virgili University, Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
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203
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Ebbeling CB, Feldman HA, Klein GL, Wong JMW, Bielak L, Steltz SK, Luoto PK, Wolfe RR, Wong WW, Ludwig DS. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ 2018; 363:k4583. [PMID: 30429127 PMCID: PMC6233655 DOI: 10.1136/bmj.k4583] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure. DESIGN Randomized trial. SETTING Multicenter collaboration at US two sites, August 2014 to May 2017. PARTICIPANTS 164 adults aged 18-65 years with a body mass index of 25 or more. INTERVENTIONS After 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53; or low, 20%, n=57) for 20 weeks. Test diets were controlled for protein and were energy adjusted to maintain weight loss within 2 kg. To test for effect modification predicted by the carbohydrate-insulin model, the sample was divided into thirds of pre-weight loss insulin secretion (insulin concentration 30 minutes after oral glucose). MAIN OUTCOME MEASURES The primary outcome was total energy expenditure, measured with doubly labeled water, by intention-to-treat analysis. Per protocol analysis included participants who maintained target weight loss, potentially providing a more precise effect estimate. Secondary outcomes were resting energy expenditure, measures of physical activity, and levels of the metabolic hormones leptin and ghrelin. RESULTS Total energy expenditure differed by diet in the intention-to-treat analysis (n=162, P=0.002), with a linear trend of 52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate to total energy intake (1 kcal=4.18 kJ=0.00418 MJ). Change in total energy expenditure was 91 kcal/d (95% confidence interval -29 to 210) greater in participants assigned to the moderate carbohydrate diet and 209 kcal/d (91 to 326) greater in those assigned to the low carbohydrate diet compared with the high carbohydrate diet. In the per protocol analysis (n=120, P<0.001), the respective differences were 131 kcal/d (-6 to 267) and 278 kcal/d (144 to 411). Among participants in the highest third of pre-weight loss insulin secretion, the difference between the low and high carbohydrate diet was 308 kcal/d in the intention-to-treat analysis and 478 kcal/d in the per protocol analysis (P<0.004). Ghrelin was significantly lower in participants assigned to the low carbohydrate diet compared with those assigned to the high carbohydrate diet (both analyses). Leptin was also significantly lower in participants assigned to the low carbohydrate diet (per protocol). CONCLUSIONS Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion. TRIAL REGISTRATION ClinicalTrials.gov NCT02068885.
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Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Henry A Feldman
- Harvard Medical School, Boston, MA, USA
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Gloria L Klein
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Julia M W Wong
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa Bielak
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sarah K Steltz
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Patricia K Luoto
- Department of Food and Nutrition, Framingham State University, Framingham, MA, USA
| | - Robert R Wolfe
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William W Wong
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA, USA
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204
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Ha K, Joung H, Song Y. Low-carbohydrate diet and the risk of metabolic syndrome in Korean adults. Nutr Metab Cardiovasc Dis 2018; 28:1122-1132. [PMID: 30139686 DOI: 10.1016/j.numecd.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The association of low-carbohydrate diet with weight loss and the risk of cardiovascular diseases has recently been the focus of increasing research attention. However, studies on low-carbohydrate diet in the Asian population are limited. The present study was aimed to examine the association between low-carbohydrate diet and metabolic syndrome among Korean adults. METHODS AND RESULTS A total of 16,349 participants aged 30 years or older who participated in a 24-h dietary recall survey of the fifth and sixth Korea National Health and Nutrition Examination Survey were included in this study. Low-carbohydrate diet was evaluated using the low-carbohydrate-diet score, which was calculated based on the percentage of energy from carbohydrate, protein, and fat by sex. The association between the low-carbohydrate-diet score and metabolic syndrome was analyzed using multiple logistic regression analysis. A low-carbohydrate diet was not associated with metabolic syndrome and its components such as waist circumference, blood pressure, and triglyceride levels. However, women in the highest decile of the animal- or plant-based low-carbohydrate-diet score showed a decreased risk of reduced high-density lipoprotein (HDL)-cholesterol levels, and men in the highest decile of the animal-based low-carbohydrate-diet score showed a decreased risk of reduced HDL-cholesterol levels than those in the lowest decile of the low-carbohydrate-diet score. CONCLUSION These findings indicate that, in Korea, a low-carbohydrate diet did not increase the risk of metabolic syndrome among adults who typically consume a high-carbohydrate low-fat diet. However, it may moderately decrease the risk of reduced HDL-cholesterol levels.
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Affiliation(s)
- K Ha
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - H Joung
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Y Song
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, Gyeonggi, Republic of Korea.
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205
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Harris CP, von Berg A, Berdel D, Bauer CP, Schikowski T, Koletzko S, Heinrich J, Schulz H, Standl M. Association of Dietary Fatty Acids with Blood Lipids is Modified by Physical Activity in Adolescents: Results from the GINIplus and LISA Birth Cohort Studies. Nutrients 2018; 10:nu10101372. [PMID: 30257483 PMCID: PMC6213167 DOI: 10.3390/nu10101372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 11/16/2022] Open
Abstract
The role of consuming different types of fatty acids (FA) at the expense of carbohydrates (CHO), on the blood lipid profile of adolescents is largely unknown, as is the modulating effect of different levels of physical activity (PA). Children from the GINIplus and LISA birth cohorts, with complete data on dietary FA (assessed by food-frequency questionnaires), objectively-measured PA (assessed by accelerometers) and blood lipids (lipoprotein cholesterol and triglycerides) at age 15 years, were included (N = 837). Sex-stratified associations between dietary FA and blood lipids were assessed by linear regression in substitution models which represented isocaloric replacements of CHO with saturated FA (SFA), monounsaturated FA (MUFA), n-3 polyunsaturated FA (PUFA) or n-6 PUFA. To assess the interactions with PA, analyses were then performed stratified by tertiles of different PA levels (sedentary, lifestyle, moderate-to-vigorous (MVPA)). Both sexes presented a significant inverse association between MUFA and triglycerides, and females a direct association between n-3 PUFA and high-density lipoprotein. Stratifying by PA tertiles, associations were mainly restricted to participants with the lowest levels of lifestyle PA, or the highest time spent sedentary. The effects of dietary FA on the lipid profile vary in an activity-specific manner, emphasizing possible synergistic roles of diet and PA.
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Affiliation(s)
- Carla P Harris
- Institute of Epidemiology, Helmholtz Zentrum München⁻German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, 80337 Munich, Germany.
| | - Andrea von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany.
| | - Dietrich Berdel
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany.
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, 80804 Munich, Germany.
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany.
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, 80337 Munich, Germany.
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München⁻German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), 80336 Munich, Germany.
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia.
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München⁻German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research, 81337 Munich, Germany.
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München⁻German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
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206
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Guess ND. Dietary Interventions for the Prevention of Type 2 Diabetes in High-Risk Groups: Current State of Evidence and Future Research Needs. Nutrients 2018; 10:E1245. [PMID: 30200572 PMCID: PMC6163866 DOI: 10.3390/nu10091245] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/13/2022] Open
Abstract
A series of large-scale randomised controlled trials have demonstrated the effectiveness of lifestyle change in preventing type 2 diabetes in people with impaired glucose tolerance. Participants in these trials consumed a low-fat diet, lost a moderate amount of weight and/or increased their physical activity. Weight loss appears to be the primary driver of type 2 diabetes risk reduction, with individual dietary components playing a minor role. The effect of weight loss via other dietary approaches, such as low-carbohydrate diets, a Mediterranean dietary pattern, intermittent fasting or very-low-energy diets, on the incidence of type 2 diabetes has not been tested. These diets-as described here-could be equally, if not more effective in preventing type 2 diabetes than the tested low-fat diet, and if so, would increase choice for patients. There is also a need to understand the effect of foods and diets on beta-cell function, as the available evidence suggests moderate weight loss, as achieved in the diabetes prevention trials, improves insulin sensitivity but not beta-cell function. Finally, prediabetes is an umbrella term for different prediabetic states, each with distinct underlying pathophysiology. The limited data available question whether moderate weight loss is effective at preventing type 2 diabetes in each of the prediabetes subtypes.
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Affiliation(s)
- Nicola D Guess
- Department of Nutritional Sciences, King's College London, 150 Stamford Street, Room 4.13, London SE1 9NH, UK.
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207
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Westman EC, Tondt J, Maguire E, Yancy WS. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab 2018; 13:263-272. [PMID: 30289048 DOI: 10.1080/17446651.2018.1523713] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) has reached epidemic proportions in the modern world. For individuals affected by obesity-related T2DM, clinical studies have shown that carbohydrate restriction and weight loss can improve hyperglycemia, obesity, and T2DM. AREAS COVERED Reducing carbohydrate intake to a certain level, typically below 50 g per day, leads to increased ketogenesis in order to provide fuel for the body. Such low-carbohydrate, ketogenic diets were employed to treat obesity and diabetes in the 19th and early 20th centuries. Recent clinical research has reinvigorated the use of the ketogenic diet for individuals with obesity and diabetes. Although characterized by chronic hyperglycemia, the underlying cause of T2DM is hyperinsulinemia and insulin resistance, typically as a result of increased energy intake leading to obesity. The ketogenic diet substantially reduces the glycemic response that results from dietary carbohydrate as well as improves the underlying insulin resistance. This review combines a literature search of the published science and practical guidance based on clinical experience. EXPERT COMMENTARY While the current treatment of T2DM emphasizes drug treatment and a higher carbohydrate diet, the ketogenic diet is an effective alternative that relies less on medication, and may even be a preferable option when medications are not available.
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Affiliation(s)
- Eric C Westman
- a Division of General Internal Medicine, Department of Medicine , Duke University Medical Center , Durham , NC , USA
| | - Justin Tondt
- b Geisinger Commonwealth School of Medicine , Scranton , PA , USA
| | | | - William S Yancy
- a Division of General Internal Medicine, Department of Medicine , Duke University Medical Center , Durham , NC , USA
- d Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham , NC , USA
- e Duke Diet and Fitness Center , Duke University Health System , Durham , NC , USA
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208
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Abstract
Despite intensive research, the causes of the obesity epidemic remain incompletely understood and conventional calorie-restricted diets continue to lack long-term efficacy. According to the carbohydrate-insulin model (CIM) of obesity, recent increases in the consumption of processed, high-glycemic-load carbohydrates produce hormonal changes that promote calorie deposition in adipose tissue, exacerbate hunger, and lower energy expenditure. Basic and genetic research provides mechanistic evidence in support of the CIM. In animals, dietary composition has been clearly demonstrated to affect metabolism and body composition, independently of calorie intake, consistent with CIM predictions. Meta-analyses of behavioral trials report greater weight loss with reduced-glycemic load vs low-fat diets, though these studies characteristically suffer from poor long-term compliance. Feeding studies have lacked the rigor and duration to test the CIM, but the longest such studies tend to show metabolic advantages for low-glycemic load vs low-fat diets. Beyond the type and amount of carbohydrate consumed, the CIM provides a conceptual framework for understanding how many dietary and nondietary exposures might alter hormones, metabolism, and adipocyte biology in ways that could predispose to obesity. Pending definitive studies, the principles of a low-glycemic load diet offer a practical alternative to the conventional focus on dietary fat and calorie restriction.
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Affiliation(s)
- David S Ludwig
- The New Balance Foundation Obesity Prevention Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cara B Ebbeling
- The New Balance Foundation Obesity Prevention Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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209
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Abstract
PURPOSE OF REVIEW Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health. RECENT FINDINGS Low-carbohydrate diets are at least as effective for weight loss as other diets, but claims about increased energy expenditure and preferential loss of body fat are unsubstantiated. Glycemic control and hyperinsulinemia are improved by low-carbohydrate diets, but insulin sensitivity and glucose-stimulated insulin secretion may be impaired, especially in the absence of weight loss. Fasting lipid parameters are generally improved, but such improvements may depend on the quality of dietary fat and the carbohydrates they replaced. Postprandial hyperlipemia is a potential concern given the high fat content typical of low-carbohydrate diets. SUMMARY Low-carbohydrate diets have several potential benefits for treatment of obesity and type 2 diabetes, but more research is required to better understand their long-term consequences as well as the variable effects on the endocrine control of glucose, lipids, and metabolism.
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Affiliation(s)
| | - Stephanie T Chung
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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210
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Affiliation(s)
- S. S. Prakash
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
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211
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Koliaki C, Spinos T, Spinou Μ, Brinia ΜE, Mitsopoulou D, Katsilambros N. Defining the Optimal Dietary Approach for Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults. Healthcare (Basel) 2018; 6:healthcare6030073. [PMID: 29958395 PMCID: PMC6163457 DOI: 10.3390/healthcare6030073] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 01/06/2023] Open
Abstract
Various dietary approaches with different caloric content and macronutrient composition have been recommended to treat obesity in adults. Although their safety and efficacy profile has been assessed in numerous randomized clinical trials, reviews and meta-analyses, the characteristics of the optimal dietary weight loss strategy remain controversial. This mini-review will provide general principles and practical recommendations for the dietary management of obesity and will further explore the components of the optimal dietary intervention. To this end, various dietary plans are critically discussed, including low-fat diets, low-carbohydrate diets, high-protein diets, very low-calorie diets with meal replacements, Mediterranean diet, and diets with intermittent energy restriction. As a general principle, the optimal diet to treat obesity should be safe, efficacious, healthy and nutritionally adequate, culturally acceptable and economically affordable, and should ensure long-term compliance and maintenance of weight loss. Setting realistic goals for weight loss and pursuing a balanced dietary plan tailored to individual needs, preferences, and medical conditions, are the key principles to facilitate weight loss in obese patients and most importantly reduce their overall cardiometabolic risk and other obesity-related comorbidities.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Medicine, National Kapodistrian University of Athens, Laiko University Hospital, Athens 11527, Greece.
| | - Theodoros Spinos
- Medical School, National Kapodistrian University of Athens, Athens 11527, Greece.
| | - Μarianna Spinou
- Medical School, National Kapodistrian University of Athens, Athens 11527, Greece.
| | - Μaria-Eugenia Brinia
- Medical School, National Kapodistrian University of Athens, Athens 11527, Greece.
| | - Dimitra Mitsopoulou
- Medical School, National Kapodistrian University of Athens, Athens 11527, Greece.
| | - Nicholas Katsilambros
- First Department of Propaedeutic Medicine, National Kapodistrian University of Athens, Laiko University Hospital, Athens 11527, Greece.
- Research Laboratory Christeas Hall, Medical School, National Kapodistrian University of Athens, Athens 11527, Greece.
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212
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Forouhi NG, Krauss RM, Taubes G, Willett W. Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance. BMJ 2018; 361:k2139. [PMID: 29898882 PMCID: PMC6053258 DOI: 10.1136/bmj.k2139] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Nita G Forouhi
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute and University of California, San Francisco, USA
| | - Gary Taubes
- Nutrition Science Initiative, San Diego, California, USA
| | - Walter Willett
- Departments of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, USA
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213
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Ludwig DS, Hu FB, Tappy L, Brand-Miller J. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ 2018; 361:k2340. [PMID: 29898880 PMCID: PMC5996878 DOI: 10.1136/bmj.k2340] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Luc Tappy
- Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Jennie Brand-Miller
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
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214
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Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018; 361:k2234. [PMID: 29898883 PMCID: PMC5998736 DOI: 10.1136/bmj.k2234] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, and National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
| | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Roy Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - William Yancy
- Duke University Diet and Fitness Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, North Carolina, USA
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Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS, Ludwig DS. Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet. Pediatrics 2018; 141:peds.2017-3349. [PMID: 29735574 PMCID: PMC6034614 DOI: 10.1542/peds.2017-3349] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records. RESULTS Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia. CONCLUSIONS Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.
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Affiliation(s)
- Belinda S. Lennerz
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anna Barton
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, Virginia
| | | | | | | | - Sarah Hallberg
- Virta Health and Indiana University Health, School of Medicine, Indiana University, Indianapolis, Indiana; and
| | | | - Cara B. Ebbeling
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - David S. Ludwig
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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Schwingshackl L, Chaimani A, Schwedhelm C, Toledo E, Pünsch M, Hoffmann G, Boeing H. Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis. Crit Rev Food Sci Nutr 2018; 59:2674-2687. [DOI: 10.1080/10408398.2018.1463967] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lukas Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114–116, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Anna Chaimani
- Paris Descartes University, Paris, France
- INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris, France
- Cochrane France, Paris, France
| | - Carolina Schwedhelm
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114–116, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Estefania Toledo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Calle Irunlarrea 1, Pamplona, Spain
- Centro del Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Av. Monforte de Lemos 3–5, Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, Pamplona, Spain
| | - Marina Pünsch
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114–116, Nuthetal, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Althanstraße 14, Vienna, Austria
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114–116, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
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217
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Bhanpuri NH, Hallberg SJ, Williams PT, McKenzie AL, Ballard KD, Campbell WW, McCarter JP, Phinney SD, Volek JS. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovasc Diabetol 2018; 17:56. [PMID: 29712560 PMCID: PMC5928595 DOI: 10.1186/s12933-018-0698-8] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/02/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of death among adults with type 2 diabetes mellitus (T2D). We recently reported that glycemic control in patients with T2D can be significantly improved through a continuous care intervention (CCI) including nutritional ketosis. The purpose of this study was to examine CVD risk factors in this cohort. METHODS We investigated CVD risk factors in patients with T2D who participated in a 1 year open label, non-randomized, controlled study. The CCI group (n = 262) received treatment from a health coach and medical provider. A usual care (UC) group (n = 87) was independently recruited to track customary T2D progression. Circulating biomarkers of cholesterol metabolism and inflammation, blood pressure (BP), carotid intima media thickness (cIMT), multi-factorial risk scores and medication use were examined. A significance level of P < 0.0019 ensured two-tailed significance at the 5% level when Bonferroni adjusted for multiple comparisons. RESULTS The CCI group consisted of 262 participants (baseline mean (SD): age 54 (8) year, BMI 40.4 (8.8) kg m-2). Intention-to-treat analysis (% change) revealed the following at 1-year: total LDL-particles (LDL-P) (- 4.9%, P = 0.02), small LDL-P (- 20.8%, P = 1.2 × 10-12), LDL-P size (+ 1.1%, P = 6.0 × 10-10), ApoB (- 1.6%, P = 0.37), ApoA1 (+ 9.8%, P < 10-16), ApoB/ApoA1 ratio (- 9.5%, P = 1.9 × 10-7), triglyceride/HDL-C ratio (- 29.1%, P < 10-16), large VLDL-P (- 38.9%, P = 4.2 × 10-15), and LDL-C (+ 9.9%, P = 4.9 × 10-5). Additional effects were reductions in blood pressure, high sensitivity C-reactive protein, and white blood cell count (all P < 1 × 10-7) while cIMT was unchanged. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score decreased - 11.9% (P = 4.9 × 10-5). Antihypertensive medication use was discontinued in 11.4% of CCI participants (P = 5.3 × 10-5). The UC group of 87 participants [baseline mean (SD): age 52 (10) year, BMI 36.7 (7.2) kg m-2] showed no significant changes. After adjusting for baseline differences when comparing CCI and UC groups, significant improvements for the CCI group included small LDL-P, ApoA1, triglyceride/HDL-C ratio, HDL-C, hsCRP, and LP-IR score in addition to other biomarkers that were previously reported. The CCI group showed a greater rise in LDL-C. CONCLUSIONS A continuous care treatment including nutritional ketosis in patients with T2D improved most biomarkers of CVD risk after 1 year. The increase in LDL-cholesterol appeared limited to the large LDL subfraction. LDL particle size increased, total LDL-P and ApoB were unchanged, and inflammation and blood pressure decreased. Trial registration Clinicaltrials.gov: NCT02519309. Registered 10 August 2015.
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Affiliation(s)
| | - Sarah J. Hallberg
- Virta Health, San Francisco, CA USA
- Medically Supervised Weight Loss, Indiana University Health Arnett, Lafayette, IN USA
| | | | | | - Kevin D. Ballard
- Department of Kinesiology and Health, Miami University, Oxford, OH USA
| | - Wayne W. Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN USA
| | - James P. McCarter
- Virta Health, San Francisco, CA USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO USA
| | | | - Jeff S. Volek
- Virta Health, San Francisco, CA USA
- Department of Human Sciences, The Ohio State University, Columbus, OH USA
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219
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Abstract
In the past, different types of diet with a generally low-carbohydrate content (< 50–< 20 g/day) have been promoted, for weight loss and diabetes, and the effectiveness of a very low dietary carbohydrate content has always been a matter of debate. A significant reduction in the amount of carbohydrates in the diet is usually accompanied by an increase in the amount of fat and to a lesser extent, also protein. Accordingly, using the term “low carb–high fat” (LCHF) diet is most appropriate. Low/very low intakes of carbohydrate food sources may impact on overall diet quality and long-term effects of such drastic diet changes remain at present unknown. This narrative review highlights recent metabolic and clinical outcomes of studies as well as practical feasibility of low LCHF diets. A few relevant observations are as follows: (1) any diet type resulting in reduced energy intake will result in weight loss and related favorable metabolic and functional changes; (2) short-term LCHF studies show both favorable and less desirable effects; (3) sustained adherence to a ketogenic LCHF diet appears to be difficult. A non-ketogenic diet supplying 100–150 g carbohydrate/day, under good control, may be more practical. (4) There is lack of data supporting long-term efficacy, safety and health benefits of LCHF diets. Any recommendation should be judged in this light. (5) Lifestyle intervention in people at high risk of developing type 2 diabetes, while maintaining a relative carbohydrate-rich diet, results in long-term prevention of progression to type 2 diabetes and is generally seen as safe.
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220
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Hammarsten J, Damber JE, Haghsheno MA, Mellström D, Peeker R. A stage-dependent link between metabolic syndrome components and incident prostate cancer. Nat Rev Urol 2018; 15:321-333. [PMID: 29434372 DOI: 10.1038/nrurol.2018.8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Metabolic syndrome is associated with increased cancer risk and progression at almost all sites, including the prostate in high-stage prostate cancer. However, several reports have described an inverse relationship between metabolic syndrome and its components and low-stage incident prostate cancer. Such anomalies in cancer research hamper efforts to fight cancer. Evidence suggests that metabolic syndrome and its components have two distinct effects in prostate cancer, concealing prostate cancer in low-stage disease and promoting progression to high-stage incident, nonlocalized, and lethal prostate cancer. The concealment of prostate cancer by metabolic syndrome and its components might be related to bias mechanisms that reduce PSA level and lead to a delayed diagnosis of low-stage prostate cancer, meaning that fewer men with metabolic syndrome are diagnosed with low-stage disease. The inverse link between metabolic syndrome and its components and low-stage incident prostate cancer might simply be the result of such bias and the shortcomings of the diagnostic procedure rather than being related to prostate cancer biology itself. The evidence summarized here supports the hypothesis that the link between metabolic syndrome and its components and incident prostate cancer is a two-way and stage-dependent one, a theory that requires further research.
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Affiliation(s)
- Jan Hammarsten
- Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Bruna stråket 11 B, SE-413 45 Göteborg, Sweden
| | - Jan-Erik Damber
- Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Bruna stråket 11 B, SE-413 45 Göteborg, Sweden
| | - Mohammad A Haghsheno
- Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Bruna stråket 11 B, SE-413 45 Göteborg, Sweden
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, and at Geriatric Medicine, Institute of Medicine, The Sahlgrenska Academy, Building K, 6th Floor, Sahlgrenska University Hospital, Mölndal, SE-431 80 Mölndal, Sweden
| | - Ralph Peeker
- Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Bruna stråket 11 B, SE-413 45 Göteborg, Sweden
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221
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Low-carbohydrate diets increase LDL-cholesterol, and thereby indicate increased risk of CVD. Br J Nutr 2018; 115:2264-6. [PMID: 27376624 DOI: 10.1017/s0007114516001343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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222
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Dietary management of dyslipidaemias. Is there any evidence for cardiovascular benefit? Maturitas 2018; 108:45-52. [DOI: 10.1016/j.maturitas.2017.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
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223
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Cucuzzella MT, Tondt J, Dockter NE, Saslow L, Wood TR. A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal. JOURNAL OF INSULIN RESISTANCE 2017. [DOI: 10.4102/jir.v2i1.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Metabolic syndrome has become a significant problem, with the American Diabetes Association estimating the cost of diabetes and pre-diabetes in the United States alone to be $322 billion per year. Numerous clinical trials have demonstrated the efficacy of low-carbohydrate diets in reversing metabolic syndrome and its associated disorders.Aim: This study was designed to examine how voluntary adherents to a low-carbohydrate diet rate its effectiveness and sustainability using an online survey.Setting and methods: The 57-question survey was administered online and shared internationally via social media and ‘low-carb’ communities. Where appropriate, chi-squared tests and paired t-tests were used to analyse the responses.Results: There were 1580 respondents. The majority of respondents had consumed less than 100 g of carbohydrates per day for over a year, typically for reasons of weight loss or disease management. There was a reported decrease in waist circumference and weight with a simultaneous decrease in hunger and increase in energy level. Of those who provided laboratory values, the majority saw improvements in their HbA1c, blood glucose measurements, and lipid panel results. There was a reduction in usage of various medications, and 25% reported medication cost savings, with average monthly savings of $288 for those respondents. In particular, the usage of pain relievers and anti-inflammatories dropped with a simultaneous decreased rating of pain and increase in mobility.Conclusion: We conclude that low-carbohydrate diets are a sustainable method of metabolic syndrome reversal in a community setting.
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Effects of low-fat compared with high-fat diet on cardiometabolic indicators in people with overweight and obesity without overt metabolic disturbance: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2017; 119:96-108. [DOI: 10.1017/s0007114517002902] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractRandomised controlled trials comparing low- v. high-fat diets on cardiometabolic risk factors in people with overweight or obesity have shown inconsistent results, which may be due to the mixed metabolic status of people with excess adiposity. The role of dietary fat manipulation in modifying cardiometabolic indicators in people with overweight or obese without metabolic disturbance is unclear. Thus, meta-analysis was conducted to compare low- v. high-fat diets on cardiometabolic indicators in people who are overweight or obese without metabolic disturbance in the present study. Databases were searched until October 2016. The pooled effects of outcomes with heterogeneity were calculated with a random-effects model, heterogeneities were analysed by subgroup and meta-regression. As a result, twenty studies with 2106 participants were included in the meta-analysis. Total cholesterol and LDL-cholesterol levels were lower following low-fat diets compared with high-fat diets: weighted mean difference (WMD) was −7·05 mg/dl (−0·18 mmol/l; 95 % CI −11·30, −2·80; P=0·001) and −4·41 mg/dl (−0·11 mmol/l; 95 % CI −7·81, −1·00; P=0·011), respectively. Conversely, significant higher level of TAG (WMD: 11·68 mg/dl (0·13 mmol/l), 95 % CI 5·90, 17·45; P<0·001) and lower level of HDL-cholesterol (WMD: −2·57 mg/dl (−0·07 mmol/l); 95 % CI −3·85, −1·28; P<0·001) were found following low-fat diets compared with high-fat diets. In conclusion, dietary fat manipulation has a significant influence on blood lipid levels in people with overweight or obesity without metabolic disturbances.
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225
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Hammarsten J. Anomalous observation with regard to prostate cancer in cancer research. BJU Int 2017; 120:456-457. [PMID: 29206352 DOI: 10.1111/bju.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan Hammarsten
- Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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226
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Clifton P. Assessing the evidence for weight loss strategies in people with and without type 2 diabetes. World J Diabetes 2017; 8:440-454. [PMID: 29085571 PMCID: PMC5648990 DOI: 10.4239/wjd.v8.i10.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/15/2017] [Accepted: 09/01/2017] [Indexed: 02/05/2023] Open
Abstract
This review will examine topical issues in weight loss and weight maintenance in people with and without diabetes. A high protein, low glycemic index diet would appear to be best for 12-mo weight maintenance in people without type 2 diabetes. This dietary pattern is currently being explored in a large prevention of diabetes intervention. Intermittent energy restriction is useful but no better than daily energy restriction but there needs to be larger and longer term trials performed. There appears to be no evidence that intermittent fasting or intermittent severe energy restriction has a metabolic benefit beyond the weight loss produced and does not spare lean mass compared with daily energy restriction. Meal replacements are useful and can produce weight loss similar to or better than food restriction alone. Very low calorie diets can produce weight loss of 11-16 kg at 12 mo with persistent weight loss of 1-2 kg at 4-6 years with a very wide variation in long term results. Long term medication or meal replacement support can produce more sustained weight loss. In type 2 diabetes very low carbohydrate diets are strongly recommended by some groups but the long term evidence is very limited and no published trial is longer than 12 mo. Although obesity is strongly genetically based the microbiome may play a small role but human evidence is currently very limited.
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Affiliation(s)
- Peter Clifton
- Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5001, Australia
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227
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Gibbs BB, Tudorascu D, Bryce CL, Comer D, Fischer GS, Hess R, Huber KA, McTigue KM, Simkin-Silverman LR, Conroy MB. Diet and Physical Activity Behaviors in Primary Care Patients with Recent Intentional Weight Loss. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2017; 2:114-121. [PMID: 29130068 PMCID: PMC5679021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Lifestyle habits of primary care patients with recent, intentional weight loss are unclear and need to be better understood to aid in translational health promotion efforts. We aimed to characterize diet and exercise habits in primary care patients with recent, intentional weight loss, comparing those with greater (≥10%) vs. lesser (5 to <10%) weight loss. METHODS This was a cross-sectional analysis of baseline data from a randomized trial comparing weight loss maintenance interventions. The study included primary care patients, 18-75 years old, with ≥5% intentional weight loss via lifestyle change in the past 2 years. Participants (74% female, 87% white) had mean age 53 (12) years, body mass index 30.4 (5.9) kg/m2, and recent weight loss of 11 (8)%. Dietary habits were measured by the Diet Habits Survey. Physical activity and sedentary behavior were measured by self-report and objectively by pedometer. RESULTS On average, participants reported high fruits and vegetables intake (5 servings/day), and low intake of fried foods (1 serving/week), desserts (1 serving/week) and sugar-sweetened beverages (0 servings/week). Those with greater vs. lesser weight loss had higher intake of fruits and vegetables (p=0.037) and low fat foods or recipes (p=0.019). Average self-reported moderate-vigorous physical activity was 319 (281) minutes/week, with significant differences between greater (374 (328) minutes/week) vs. lesser (276 (230) minutes/week) weight loss groups (p=0.017). By pedometer, 30% had ≥7,500 steps/day; the proportion was higher in greater (43%) vs. lesser (19%) weight loss groups (p=0.005). CONCLUSIONS For weight loss, clinical patients typically employ simple strategies such as 5+ fruits and vegetables per day, fried foods and desserts ≤1 per week, elimination of sugary drinks, choosing low fat foods/recipes, and physical activity 45-60 min/day.
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228
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Walle P, Takkunen M, Männistö V, Vaittinen M, Käkelä P, Ågren J, Schwab U, Lindström J, Tuomilehto J, Uusitupa M, Pihlajamäki J. Alterations in fatty acid metabolism in response to obesity surgery combined with dietary counseling. Nutr Diabetes 2017; 7:e285. [PMID: 28869586 PMCID: PMC5637104 DOI: 10.1038/nutd.2017.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/24/2017] [Accepted: 07/16/2017] [Indexed: 12/14/2022] Open
Abstract
Background: The effects of obesity surgery on serum and adipose tissue fatty acid (FA) profile and FA metabolism may modify the risk of obesity-related diseases. Methods: We measured serum (n=122) and adipose tissue (n=24) FA composition and adipose tissue mRNA expression of genes regulating FA metabolism (n=100) in participants of the Kuopio Obesity Surgery Study (KOBS, age 47.2±8.7 years, BMI 44.6±6.0, 40 men, 82 women) before and one year after obesity surgery. As part of the surgery protocol, all the subjects were instructed to add sources of unsaturated fatty acids, such as rapeseed oil and fatty fish, into their diet. The results were compared with changes in serum FA composition in 122 subjects from the Finnish Diabetes Prevention study (DPS) (age 54.3±7.1 years, BMI 32.2±4.6, 28 men, 94 women). Results: The proportion of saturated FAs decreased and the proportion of n-3 and n-6 FAs increased in serum triglycerides after obesity surgery (all P<0.002). Weight loss predicted changes in quantitative amounts of saturated FAs, monounsaturated FAs, n-3 and n-6 FAs in triglycerides (P<0.002 for all). Moreover, the changes in adipose tissue FAs reflected the changes in serum FAs, and some of the changes were associated with mRNA expression of elongases and desaturases in adipose tissue (all P<0.05). In line with this the estimated activity of elongase (18:1 n-7/16:1 n-7) increased significantly after obesity surgery in all lipid fractions (all P<4 × 10−7) and the increase in the estimated activity of D5D in triglycerides was associated with higher weight loss (r=0.415, P<2 × 10−6). Changes in serum FA profile were similar after obesity surgery and lifestyle intervention, except for the change in the absolute amounts of n-3 FAs between the two studies (P=0.044). Conclusions: Beneficial changes in serum and adipose tissue FAs after obesity surgery could be associated with changes in endogenous metabolism and diet.
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Affiliation(s)
- P Walle
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - M Takkunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - V Männistö
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - M Vaittinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - P Käkelä
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J Ågren
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - U Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - J Lindström
- National Institute for Health and Welfare, THL, Helsinki, Finland
| | - J Tuomilehto
- National Institute for Health and Welfare, THL, Helsinki, Finland.,Center for Vascular Prevention, Danube University Krems, Krems, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - M Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - J Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
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Abstract
Recent research has found important links between poor dietary choices, a toxic food environment, and high national and global burdens of chronic diseases. These findings serve as an impetus for a Food Revolution. The Gardner Nutrition Studies Research Group, along with a diverse range of collaborators, has been focusing on solution-oriented research to help find answers to the problems that plague the current food system. Research topics include (1) a recently completed weight loss diet study contrasting Healthy Low-Fat to Healthy Low-Carbohydrate diets among 609 overweight and obese adults; (2) a quasi-experimental study conducted among Stanford undergraduates that examined social and environmental, rather than health-focused, motivations for dietary change; (3) links between dietary fiber, the human microbiome, and immune function; and (4) ongoing collaborations with university chefs to create unapologetically delicious food for campus dining halls that is also healthy and environmentally sustainable. Most of these approaches emphasize plant-based diets. The decreased consumption of animal products has created some concern over the ability of one to obtain adequate protein intake. Evidence is presented that adequate protein is easily obtainable from vegetarian, vegan, and other diets that contain significantly less meat and fewer animal foods than the standard American diet.
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Affiliation(s)
- Christopher D Gardner
- Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford, California
| | - Michelle E Hauser
- Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford, California
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230
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Zinn C, McPhee J, Harris N, Williden M, Prendergast K, Schofield G. A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel. Appl Physiol Nutr Metab 2017; 42:1158-1164. [PMID: 28700832 DOI: 10.1139/apnm-2017-0260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Overweight, obesity, and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel. In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids, and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t statistic and interpreted using a p < 0.05 level of statistical significance. Between-group mean differences and confidence intervals were analysed using effect sizes and magnitude-based inferences. Twenty-six participants completed the trial (14 intervention, 12 control). Both groups showed statistically significant weight and waist circumference reductions; the intervention group significantly reduced triglycerides and serum glucose and significantly increased high-density lipoprotein cholesterol (HDLc). Relative to control, the intervention group showed small, possibly to likely beneficial effects for weight, triglycerides, glucose, insulin, and homeostasis model assessment of insulin resistance; moderate, likely beneficial effects for HDL cholesterol, triglyceride:HDLc ratio and HbA1c; and a small, likely harmful effect for low-density lipoprotein cholesterol. This dietary approach shows promise for short-term weight loss and improved metabolic health outcomes conditions compared with mainstream recommendations. It should be offered to defence force personnel at least as a viable alternative means to manage their weight and health.
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Affiliation(s)
- Caryn Zinn
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Julia McPhee
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Nigel Harris
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Micalla Williden
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Kate Prendergast
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Grant Schofield
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
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231
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Wood K, Carragher J, Davis R. Australian consumers' insights into potatoes - Nutritional knowledge, perceptions and beliefs. Appetite 2017; 114:169-174. [DOI: 10.1016/j.appet.2017.03.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/14/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
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232
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Aragon AA, Schoenfeld BJ, Wildman R, Kleiner S, VanDusseldorp T, Taylor L, Earnest CP, Arciero PJ, Wilborn C, Kalman DS, Stout JR, Willoughby DS, Campbell B, Arent SM, Bannock L, Smith-Ryan AE, Antonio J. International society of sports nutrition position stand: diets and body composition. J Int Soc Sports Nutr 2017. [PMID: 28630601 PMCID: PMC5470183 DOI: 10.1186/s12970-017-0174-y] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of diet types (macronutrient composition; eating styles) and their influence on body composition. The ISSN has concluded the following. 1) There is a multitude of diet types and eating styles, whereby numerous subtypes fall under each major dietary archetype. 2) All body composition assessment methods have strengths and limitations. 3) Diets primarily focused on fat loss are driven by a sustained caloric deficit. The higher the baseline body fat level, the more aggressively the caloric deficit may be imposed. Slower rates of weight loss can better preserve lean mass (LM) in leaner subjects. 4) Diets focused primarily on accruing LM are driven by a sustained caloric surplus to facilitate anabolic processes and support increasing resistance-training demands. The composition and magnitude of the surplus, as well as training status of the subjects can influence the nature of the gains. 5) A wide range of dietary approaches (low-fat to low-carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition. 6) Increasing dietary protein to levels significantly beyond current recommendations for athletic populations may result in improved body composition. Higher protein intakes (2.3–3.1 g/kg FFM) may be required to maximize muscle retention in lean, resistance-trained subjects under hypocaloric conditions. Emerging research on very high protein intakes (>3 g/kg) has demonstrated that the known thermic, satiating, and LM-preserving effects of dietary protein might be amplified in resistance-training subjects. 7) The collective body of intermittent caloric restriction research demonstrates no significant advantage over daily caloric restriction for improving body composition. 8) The long-term success of a diet depends upon compliance and suppression or circumvention of mitigating factors such as adaptive thermogenesis. 9) There is a paucity of research on women and older populations, as well as a wide range of untapped permutations of feeding frequency and macronutrient distribution at various energetic balances combined with training. Behavioral and lifestyle modification strategies are still poorly researched areas of weight management.
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Affiliation(s)
- Alan A Aragon
- Department of Family and Consumer Sciences, California State University, Northridge, CA USA
| | | | | | | | - Trisha VanDusseldorp
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA USA
| | - Lem Taylor
- Department of Exercise and Sports Science, University of Mary Hardin-Baylor, Belton, TX USA
| | - Conrad P Earnest
- Exercise and Sports Nutrition Laboratory, Texas A&M University, College Station, TX USA
| | - Paul J Arciero
- Health and Exercise Science, Skidmore College, Saratoga Springs, NY USA
| | - Colin Wilborn
- Department of Exercise and Sports Science, University of Mary Hardin-Baylor, Belton, TX USA
| | | | - Jeffrey R Stout
- Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL USA
| | - Darryn S Willoughby
- Department of Health, Human Performance and Recreation, Baylor University, Waco, TX USA
| | - Bill Campbell
- Performance & Physique Enhancement Laboratory, Exercise Science Program, University of South Florida, Tampa, FL USA
| | - Shawn M Arent
- Department of Kinesiology & Health, IFNH Center for Health & Human Performance, Rutgers University, New Brunswick, NJ USA
| | | | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC USA
| | - Jose Antonio
- Department of Health and Human Performance, Nova Southeastern University, Davie, FL USA
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233
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The differential effects of changes in individual macronutrient intake on changes in lipid concentrations during childhood: From the Ewha Birth & Growth Cohort. Clin Nutr 2017; 37:1027-1033. [PMID: 28506448 DOI: 10.1016/j.clnu.2017.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/01/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS High carbohydrate or fat intake is responsible for abnormal lipid concentrations in adults, but few studies of children have been reported. Using data from a Korean children's cohort study, we assessed the association between macronutrient intake and lipid profile with a longitudinal association during a 4-year follow-up. METHODS Using 2 days of 24-h dietary data obtained at 3 (n = 323) and 7 (n = 292) years old from the Ewha Birth & Growth Cohort, we calculated changes (n = 103) in macronutrient intake in terms of energy-adjusted intake and percent total energy for nutrients. Changes in lipid profiles (TC: total cholesterol, TG: triglyceride, HDL-c: high-density lipoprotein cholesterol, LDL-c: low-density lipoprotein cholesterol) are the primary outcomes in this study. The effects of individual changes in macronutrient intake on changes in lipid profiles over time were assessed using multiple regression analyses. RESULTS The percentages of total energy from carbohydrates and fat were 59.1% and 27.4% at baseline, respectively. Those in the highest tertile of carbohydrate intake showed the highest mean TG and lowest mean TC and HDL-c levels, regardless of observation time. By contrast, those with the highest fat intake indicated the lowest mean TG and highest mean TC and HDL-c at 7 years old. In addition, increased intake of carbohydrates had an unfavorable effect on TG, while increased intake of fat, especially animal-based fat, increased LDL-c levels over time. CONCLUSIONS Our study showed that a relatively high intake of carbohydrate or fat among children had an unfavorable effect on lipid concentrations based on a longitudinal approach.
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234
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Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med 2017; 51:133-139. [PMID: 28053201 DOI: 10.1136/bjsports-2016-096491] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/15/2022]
Abstract
Low-carbohydrate high-fat (LCHF) diets are a highly contentious current topic in nutrition. This narrative review aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control and cardiovascular risk factors while addressing some common concerns and misconceptions. Blood total cholesterol and LDL-cholesterol concentrations show a variable, highly individual response to LCHF diets, and should be monitored in patients adhering to this diet. In contrast, available evidence from clinical and preclinical studies indicates that LCHF diets consistently improve all other markers of cardiovascular risk-lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD). This particular combination of favourable modifications to all these risk factors is a benefit unique to LCHF diets. These effects are likely due in part to reduced hunger and decreased ad libitum calorie intake common to low-carbohydrate diets, allied to a reduction in hyperinsulinaemia, and reversal of NAFLD. Although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. LCHF diets may also be particularly beneficial in patients with atherogenic dyslipidaemia, insulin resistance, and the frequently associated NAFLD.
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Affiliation(s)
- Timothy David Noakes
- Department of Human Biology, University of Cape Town, Sports Science Institute of South Africa, Newlands, Cape Town, South Africa
| | - Johann Windt
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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235
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Abstract
AbstractBody mass and fat intake are multifactorial traits that have genetic and environmental components. The gene with the greatest effect on body mass is FTO (fat mass and obesity-associated), but several studies have shown that the effect of FTO (and of other genes) on body mass can be modified by the intake of nutrients. The so-called gene–environment interactions may also be important for the effectiveness of weight-loss strategies. Food choices, and thus fat intake, depend to some extent on individual preferences. The most important biological component of food preference is taste, and the role of fat sensitivity in fat intake has recently been pointed out. Relatively few studies have analysed the genetic components of fat intake or fatty acid sensitivity in terms of their relation to obesity. It has been proposed that decreased oral fatty acid sensitivity leads to increased fat intake and thus increased body mass. One of the genes that affect fatty acid sensitivity is CD36 (cluster of differentiation 36). However, little is known so far about the genetic component of fat sensing. We performed a literature review to identify the state of knowledge regarding the genetics of fat intake and its relation to body-mass determination, and to identify the priorities for further investigations.
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236
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Zazpe I, Santiago S, Gea A, Ruiz-Canela M, Carlos S, Bes-Rastrollo M, Martínez-González MA. Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project. Nutr Metab Cardiovasc Dis 2016; 26:1048-1056. [PMID: 27524801 DOI: 10.1016/j.numecd.2016.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD. METHODS AND RESULTS We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD. CONCLUSION In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.
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Affiliation(s)
- I Zazpe
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Santiago
- Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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237
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The cardiovascular risk reduction benefits of a low-carbohydrate diet outweigh the potential increase in LDL-cholesterol. Br J Nutr 2016; 115:1126-8. [PMID: 26858234 DOI: 10.1017/s0007114515005450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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