Effects of Insoluble Cereal Fibre on Body Fat Distribution in the Optimal Fibre Trial

Individual cereals intake is associated with progression of diabetes and diabetic chronic complications

BACKGROUND AND AIMS

The relationship between cereals intake and diabetes is unclear. We aimed to explore associations between individual cereals intake and risks of incident and progression of diabetes.

METHODS

We included 502,490 participants from UK Biobank at baseline. A single touchscreen food frequency questionnaire was used to estimate the intake of individual cereals (bran, biscuit, oat, muesli, and other cereals). Main outcomes included incident diabetes and diabetic complications of cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetic retinopathy (DR). Polygenic risk score (PRS) of glycosylated hemoglobin (HbA1c) was calculated for mediating effects analysis.

RESULTS

Among participants without diabetes, when compared to subjects who never had cereals, hazard ratios (95%CI) of developing diabetes in those who had ≥6 bowls/week were 0.72 (0.67-0.78) for bran, 0.86 (0.81-0.92) for biscuit, 0.75(0.66-0.84) for oat, and 0.57(0.53,0.61) for muesli. Among people with diabetes without CVD, a higher intake of aforementioned four individual cereals was associated with a 13%-32 % lower risk of developing CVD. Among people with diabetes without CKD, a higher intake of aforementioned four individual cereals was associated with a 9%-28 % lower risk of developing CKD. We observed a significant mediating effect of the PRS of HbA1c for the association between aforementioned four individual cereals and developing diabetes.

CONCLUSION

A higher consumption of cereals was significantly associated with lower risks of diabetes and diabetic complications. Polygenic of HbA1c mediates the effect of cereals on incident diabetes.

What's New in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a serious health problem due to its high incidence and consequences. In view of the existing controversies, new therapeutic options for NAFLD are still being sought. Therefore, the aim of our review was to evaluate the recently published studies on the treatment of NAFLD patients. We searched for articles in the PubMed database using appropriate terms, including "non-alcoholic fatty liver disease", "nonalcoholic fatty liver disease", "NAFLD", "diet", "treatment", "physical activity", "supplementation", "surgery", "overture" and "guidelines". One hundred forty-eight randomized clinical trials published from January 2020 to November 2022 were used for the final analysis. The results show significant benefits of NAFLD therapy associated with the use of not only the Mediterranean but also other types of diet (including low-calorie ketogenic, high-protein, anti-inflammatory and whole-grain diets), as well as enrichment with selected food products or supplements. Significant benefits in this group of patients are also associated with moderate aerobic physical training. The available therapeutic options indicate, above all, the usefulness of drugs related to weight reduction, as well as the reduction in insulin resistance or lipids level and drugs with anti-inflammatory or antioxidant properties. The usefulness of therapy with dulaglutide and the combination of tofogliflozin with pioglitazone should be emphasized. Based on the results of the latest research, the authors of this article suggest a revision of the therapeutic recommendations for NAFLD patients.

Predicting Factors for Metabolic Non-Response to a Complex Lifestyle Intervention-A Replication Analysis to a Randomized-Controlled Trial

BACKGROUND

T2DM heterogeneity affects responsiveness to lifestyle treatment. Beta-cell failure and nonalcoholic fatty liver disease (NAFLD) independently predict T2DM, but NAFLD inconsistently predicts metabolic response to lifestyle intervention.

AIM

We attempt to replicate a prediction model deducted from the Tübinger Lifestyle Intervention Program by assessing similar metabolic factors to predict conversion to normal glucose regulation (NGR) in a comparable lifestyle intervention trial.

METHODS

In the Optimal Fiber Trial (OptiFiT), 131 Caucasian participants with prediabetes completed a one-year lifestyle intervention program and received a fiber or placebo supplement. We compared baseline parameters for responders and non-responders, assessed correlations of major metabolic changes and conducted a logistic regression analysis for predictors of remission to NGR.

RESULTS

NGR was achieved by 33 participants, respectively. At baseline, for the placebo group only, 1 h and 2 h glucose levels, glucose AUC and Cederholm index predicted conversion to NGR. HOMA-beta, HOMA-IR or liver fat indices did not differ between responders and non-responders of the placebo or the fiber group. Changes in waist circumference or fatty liver index correlated with changes in glycemia and insulin resistance, but not with changes in insulin secretion. Insulin-resistant NAFLD did not predict non-response. Differences in compliance did not explain the results.

CONCLUSIONS

Higher post-challenge glucose levels strongly predicted the metabolic non-response to complex lifestyle intervention in our cohort. Depending on the specific intervention and the investigated cohort, fasting glucose levels and insulin sensitivity might contribute to the risk pattern. Beta-cell function did not improve in accordance with other metabolic improvements, qualifying as a potential risk factor for non-response. We could not replicate previous data suggesting that an insulin-resistant fatty liver is a specific risk factor for treatment failure. Replication studies are required.