Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable?

Micronutrient Inadequacy Differs by Intake of Fat Amount and Class Among Adults That Consume a Restricted Carbohydrate Diet: National Health and Nutrition Examination Survey, 2007-2018

BACKGROUND

Restricted carbohydrate diets remain among the most popular for weight loss and general health improvement. Recent evidence demonstrates that carbohydrate restricted diets are low in overall diet quality, yet their association with micronutrient inadequacy has not been well characterized at a population-level in adults in the United States.

OBJECTIVE

To evaluate the prevalence of not meeting daily micronutrient recommendations in US adults that met the Acceptable Macronutrient Distribution Ranges and those who restricted carbohydrate intake to <45% energy, and to examine the effect of total fat and fat class on these results for the restricted carbohydrate group.

DESIGN

This study utilized 24-hour recall data on food and nutrient intake from respondents in the National Health and Nutrition Examination Survey 2007-2018.

PARTICIPANTS/SETTING

This study included 15 029 respondents who were aged 20 years and older, had complete and reliable nutrient intake data, and were not pregnant or breastfeeding.

MAIN OUTCOME MEASURES

The main outcome was the prevalence of not meeting daily micronutrient recommendations based on Dietary Reference Intakes.

STATISTICAL ANALYSES PERFORMED

The National Cancer Institute's usual intake methodology was used to estimate usual dietary intake and the prevalence of the US adult population not meeting the Dietary Reference Intakes.

RESULTS

Compared with participants that met the Acceptable Macronutrient Distribution Ranges, those that consumed restricted carbohydrate diets had greater prevalence of inadequacy (%

CONCLUSION

This study shows that there are different types of restricted carbohydrate diets that can be characterized by fat amount and class, each with their own association with micronutrient intake. This information can be used by clinicians to provide more targeted dietary counseling to their patients who restrict carbohydrates, depending on the amount and type of fat they consume.

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Key Words

• Carbohydrate restriction
• Fat composition
• Micronutrient inadequacy
• NHANES
• Popular diet

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MESH Headings

• Humans
• Female
• Male
• Adult
• Micronutrients/administration & dosage
• United States
• Nutrition Surveys
• Middle Aged
• Dietary Fats/administration & dosage
• Diet, Carbohydrate-Restricted/statistics & numerical data
• Diet, Carbohydrate-Restricted/methods
• Young Adult
• Recommended Dietary Allowances
• Aged
• Energy Intake

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Affiliation(s)

Alaa Ilayan Department of Human Sciences, The Ohio State University, Columbus, Ohio. Current Affiliation: Post-Master's Fellow, Oak Ridge Institute for Science and Engineering, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
Dakota Dustin The Ohio State University Nutrition PhD Program, Graduate School, The Ohio State University, Columbus, Ohio
Corina Kowalski College of Arts & Sciences, William & Mary, Williamsburg, Virginia
Martha A Belury Department of Food Science and Technology, The Ohio State University, Columbus, Ohio
LuAnn K Johnson Independent Contractor, Warren, Minnesota
Zach Conrad Department of Kinesiology, William & Mary, Williamsburg, Virginia; Global Research Institute, William & Mary, Williamsburg, Virginia.

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Dietary therapy to halt the progression of diabetes to diabetic kidney disease

Diabetic Kidney Disease (DKD) is a common and serious complication of diabetes, particularly Type 2 Diabetes Mellitus (T2DM), which significantly contributes to patient morbidity and mortality. The limitations of traditional treatments like ACE inhibitors and ARBs in managing DKD progression highlight the need for innovative therapeutic strategies. This review examines the impact of various dietary patterns, such as the Mediterranean diet, ketogenic diet, intermittent fasting, DASH diet, and vegetarian diet, on the management of DKD. Evidence suggests these diets can halt the progression of DKD, although further research is needed to confirm their long-term effectiveness and safety. Personalized dietary approaches tailored to individual needs may enhance outcomes for DKD patients.

The Impact of Ketogenic Nutrition on Obesity and Metabolic Health: Mechanisms and Clinical Implications

The ketogenic diet (KD) has recently gained increasing popularity. This high-fat, adequate-protein, and carbohydrate-poor eating pattern leads to nutritional ketosis. The KD has long been known for its antidiabetic and antiepileptic effects and has been used therapeutically in these contexts. Recently, the KD, due to its effectiveness in inducing weight loss, has also been proposed as a possible approach to treat obesity. Likewise, a KD is currently explored as a supporting element in the treatment of obesity-associated metabolic disorders and certain forms of cancer. Here, we discuss the metabolic and biochemical mechanisms at play during the shift of metabolism to fatty acids and fatty acid-derived ketone bodies as main fuel molecules, in the substitution of carbohydrates, in ketogenic nutrition. Different sources of ketone bodies and KDs as alternatives to glucose and carbohydrates as main energy substrates are discussed, together with an attempt to weigh the benefits and risks posed by the chronic use of a KD in the context of weight loss, and also considering the molecular effects that ketone bodies exert on metabolism and on the endocrine system.

Low-carbohydrate diet enriched with omega-3 and omega-9 fatty acids modulates inflammation and lipid metabolism in the liver and white adipose tissue of a mouse model of obesity

BACKGROUND AND AIM

The low-carbohydrate high-fat (LCHF) diet lipids are often overlooked for obesity management. We hypothesized that unsaturated lipids enhance fatty acid metabolism, and influence obesity-related metainflammation.

METHODS AND RESULTS

Male Swiss mice were fed an obesity-inducing diet for ten weeks. Subsequently, the obese mice were divided into four groups, each receiving a LCHF diet enriched with different types of lipids: saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA) ω-3, PUFA ω-6, and monounsaturated fatty acids (MUFA) ω-9 during six weeks as an obesity intervention. For comparison, a lean control (CTL) group and an obesity control (HFC) group were also included, spanning the entire 16-week experimental protocol. We evaluated body mass gain, fatty acid profiles via gas chromatography, elongase, and desaturase activities, NFκBp65 expression by western blotting, and cytokine by ELISA kits in serum, liver, and retroperitoneal adipose tissue (RET) samples. Our results highlight that ω-3 and ω-9 LCHF diets facilitate weight loss and enhance unsaturated fatty acid incorporation in liver, RET, and serum compared to the other groups. The ω-3 LCHF diet notably reduced the ω-6/ω-3 ratio and improved inflammatory status by reducing cytokines such as IL-4, IL-17, IL-33, CXCL1/KC, and inhibiting NFκBp65 activity compared to the HFC group. Desaturase (delta-9 desaturase-18, delta-6 desaturase) and elongase (ELOVL5 and ELOVL6) activities were modulated in liver, RET, and serum samples by ω-3 and ω-9 compared to the HFC group.

CONCLUSIONS

ω-3 and ω-9 fats were most effective in obesity treatment with the LCHF diet, highlighting the significance of lipid type in carbohydrate-restriction for obesity management.

Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission?

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

Impact of Time-Restricted Eating and High-Intensity Exercise on Nutrient Intake in Women with Overweight/Obesity: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Inadequate micronutrient intakes are common in individuals with overweight/obesityand can exacerbate cardiovascular and metabolic disease risk. Diet and exercise are primary strategies for managing overweight and may influence nutrient intakes. In this secondary analysis of dietary data collected in a randomized controlled trial (RCT, ClinicalTrials.gov (NCT04019860), 15 June 2019) of time-restricted eating (TRE), high-intensity interval training (HIIT), a combination (TREHIIT), or a control group (CON), we investigated intervention effects on energy and nutrient intakes in women with overweight/obesity.

METHODS

We randomized 131 women (body mass index (BMI) ≥ 27 kg/m2) to 7 weeks of TRE (≤10-h daily eating window with ad libitum energy intake), HIIT (3 sessions/week, performed at ≥90% maximal heart rate), TREHIIT, or CON. Participants recorded all energy intake in an online food diary during a baseline week (week 0) and at the end of the study (week 6 and week 7). We investigated between-group differences in changes in mean energy, macronutrient, and micronutrient intakes.

RESULTS

TRE had reduced intakes of potassium, magnesium, and phosphorus compared with CON (p < 0.01). TREHIIT had non-significant reduced intakes of potassium, thiamine, magnesium, copper, and phosphorus (0.01< p < 0.05). HIIT alone did not negatively impact micronutrient intakes. TRE and TREHIIT induced suboptimal intakes for a greater number of micronutrients compared with HIIT and CON.

CONCLUSIONS

A ≤10-h TRE window might increase the risk of micronutrient inadequacy in women with overweight/obesity. Future research is needed to investigate the effects of integrating nutritional guidelines with TRE interventions to mitigate the risk of micronutrient inadequacy in individuals with overweight/obesity.

A reduced carbohydrate diet improves glycemic regulation in hyperglycemic older people in a retirement home: the SAGE study

Poor glucose regulation associated with gradual insulin resistance is a significant risk factor in several age-related chronic diseases. An eating plan that promotes a lower carbohydrate intake may have a beneficial effect on glucose metabolism. This study aimed to evaluate how a diet reduced in carbohydrate by 32% (RCHO) over a 2 month period would influence the metabolic profile of older individuals (N = 24) living in a retirement home (RH). A continuous glucose monitor was used to measure blood glucose during four periods: the standard diet before (baseline) and after (washout) the intervention, during the 4 initial days of the RCHO diet (RCHO-early), and the final days of the 2 month intervention (RCHO-end). The blood metabolic profile was also measured (glucose, ketones, insulin, triglycerides, and cholesterol). RCHO intake decreased average blood glucose compared to the standard diet in hyperglycemic participants: RCHO-early 7.8 ± 1.0 vs 7.5 ± 1.1 mM (p = 0.012) and RCHO-end 7.8 ± 1.0 vs 7.0 ± 0.9 mM (p = 0.050). In the hyperglycemic participants, the percentage of time spent in hyperglycemia (>10.0 mM) decreased by 50% during the RCHO-early (p = 0.012) and by 66% at RCHO-end (p  = 0.021) compared to baseline. Glycated hemoglobin was significantly lower at RCHO-end in both hyperglycemic and normoglycemic participants compared to baseline (p < 0.008). Plasma ketones increased threefold in hyperglycemic participants at RCHO-end compared to baseline (p < 0.028). This study shows that an RCHO diet has metabolic health benefits in an older population and confirms its safety, tolerability, and acceptability in an RH (NCT06022094).

1,3-butanediol administration as an alternative strategy to calorie restriction for neuroprotection - Insights into modulation of stress response in hippocampus of healthy rats

Ketogenic diet has a wide range of beneficial effects but presents practical limitations due to its low compliance, hence dietary supplements have been developed to induce ketosis without nutrient deprivation. The alcohol 1,3-butanediol (BD) is a promising molecule for its ability to induce ketosis, but its effects on brain have been investigated so far only in disease models, but never in physiological conditions. To support BD use to preserve brain health, the analysis of its activity is mandatory. Therefore, we investigated, in healthy rats, the effect of a fourteen-days BD-administration on the hippocampus, an area particularly vulnerable to oxidative and inflammatory damage. Since BD treatment has been reported to reduce energy intake, results were compared with those obtained from rats undergoing a restricted dietary regimen, isoenergetic with BD group (pair fed, PF). Reduced pro-inflammatory signaling pathways and glial activation were revealed in hippocampus of BD treated rats in comparison to control (C) and PF groups. ROS content and the extent of protein oxidative damage were lower in BD and PF groups than in C. Interestingly, higher amounts of nuclear factor erythroid 2-related factor 2 (Nrf2), decreased level of lipid hydroperoxides, lower susceptibility to oxidative insult, higher amounts of superoxide dismutase-2, glutathione reductase and glutathione peroxidase (GPx), and increased GPx activity were observed in BD animals. BD administration, but not dietary restriction, attenuated endoplasmic reticulum stress, reduced autophagic response activation, and was associated with an increase of both the neurotrophin BDNF and pre-synaptic proteins synaptophysin and synaptotagmin. Our results highlight that BD plays a neuroprotective role in healthy conditions, thus emerging as an effective strategy to support brain function without the need of implementing ketogenic nutritional interventions.

Comparison of Body Mass Index, Energy and Macronutrient Intake, and Dietary Inflammatory Index Between Type 2 Diabetic and Healthy Individuals

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic disorder diagnosed by elevated blood sugar. Key risk factors for T2DM include obesity, a sedentary lifestyle, and poor dietary habits. The proportion of macronutrients and the dietary inflammatory index (DII) seem to be associated with the risk of T2DM. This study aimed to assess and compare the macronutrient intake, DII, and BMI of newly diagnosed T2DM patients with healthy individuals in Kermanshah, Iran. Study design: This study employed a case-control design.

METHODS

A total of 105 newly diagnosed T2DM patients were selected as the case group, while an equal number of control participants were selected from their non-diabetic friends or neighbors. Dietary intake was assessed using a validated food frequency questionnaire. Energy, macronutrients, fatty acids intake, and DII were estimated using ShaFA software. Statistical significance was set at P values below 0.05.

RESULTS

The study included 105 newly diagnosed T2DM and 105 healthy individuals. Diabetic patients had significantly lower intake of protein, total fat, polyunsaturated fatty acids (PUFA), and monounsaturated fatty acids (MUFA), while their body mass index (BMI) and DII were higher. Multiple logistic regression indicated that protein, PUFA, and MUFA are protective factors for T2DM, while BMI, carbohydrates, and saturated fat intake are risk factors. A higher DII was correlated with an increased risk of T2DM risk, even after adjusting for BMI.

CONCLUSION

Lower BMI and DII, balanced macronutrient intake, and consumption of MUFA and omega-3 fatty acids may be beneficial in preventing or delaying the onset of T2DM. Further research is needed to explore these associations in greater depth.

A network meta-analysis of the comparative efficacy of different dietary approaches on glycaemic control and weight loss in patients with type 2 diabetes mellitus and overweight or obesity

Background: Despite considerable literature supporting the benefit of dietary interventions in individuals with type 2 diabetes mellitus (T2DM) and overweight/obesity, which diet works best is currently unknown. We conducted a systematic review and network meta-analysis (NMA) to evaluate the comparative effectiveness of different dietary approaches in overweight or obese adults with T2DM. Methods: We searched EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed up till July 2023 for controlled studies using different dietary approaches. Next, we updated the literature search to September 2024 but found no new relevant studies. Glycated hemoglobin A1c (HbA1c) levels and body weight were used as primary outcomes. For each outcome, a pooled effect was determined for each intervention compared with other interventions. Mean differences (MDs) and 95% confidence intervals (95% CIs) were computed. The surface under the cumulative ranking curve (SUCRA) was used for ranking the dietary approaches. Moreover, confidence was assessed using the CINeMA (confidence in network meta-analysis) framework. Results: Overall, 31 trials that compared eight diet interventions (Mediterranean, moderate-carbohydrate, low-carbohydrate, vegetarian, low-glycaemic index/load, low-fat, high-protein and control diets) and involved 3096 people were included. In terms of glycemic control, the Mediterranean diet yielded the best ranking (SUCRA: 88.15%), followed by the moderate-carbohydrate diet (SUCRA: 83.3%) and low-carbohydrate (LC) diet (SUCRA: 55.7%). In terms of anthropometric measurements, the LC diet (SUCRA: 74.6%) ranked first, followed by the moderate-carbohydrate diet (SUCRA: 68.7%) and vegetarian diet (SUCRA: 57%). These results also showed that the differences in almost all dietary patterns regarding anthropometric measurements were mostly small and often trivial. Conclusions: In summary, the Mediterranean diet was the most efficient dietary intervention for the improvement of glycaemic control, and the LC diet obtained the highest score for anthropometric measurements in individuals with T2DM and concurrent overweight/obesity.

Ketogenic Diet: A Review of Composition Diversity, Mechanism of Action and Clinical Application

The ketogenic diet (KD) is a special high-fat, very low-carbohydrate diet with the amount of protein adjusted to one's requirements. By lowering the supply of carbohydrates, this diet induces a considerable change in metabolism (of protein and fat) and increases the production of ketone bodies. The purpose of this article is to review the diversity of composition, mechanism of action, clinical application and risk associated with the KD. In the last decade, more and more results of the diet's effects on obesity, diabetes and neurological disorders, among other examples have appeared. The beneficial effects of the KD on neurological diseases are related to the reconstruction of myelin sheaths of neurons, reduction of neuron inflammation, decreased production of reactive oxygen species, support of dopamine production, repair of damaged mitochondria and formation of new ones. Minimizing the intake of carbohydrates results in the reduced absorption of simple sugars, thereby decreasing blood glucose levels and fluctuations of glycaemia in diabetes. Studies on obesity indicate an advantage of the KD over other diets in terms of weight loss. This may be due to the upregulation of the biological activity of appetite-controlling hormones, or to decreased lipogenesis, intensified lipolysis and increased metabolic costs of gluconeogenesis. However, it is important to be aware of the side effects of the KD. These include disorders of the digestive system as well as headaches, irritability, fatigue, the occurrence of vitamin and mineral deficiencies and worsened lipid profile. Further studies aimed to determine long-term effects of the KD are required.

Melatonin protects zebrafish pancreatic development and physiological rhythms from sodium propionate-induced disturbances via the hypothalamic-pituitary-thyroid axis

BACKGROUND

The widespread use of sodium propionate as a preservative in food may affect public health. We aimed to assess the effects of sodium propionate on circadian rhythms and pancreatic development in zebrafish and the possible underlying mechanisms.

RESULTS

In this experiment, we analyzed the relationship between circadian rhythms and pancreatic development and then revealed the role of the thyroid endocrine system in zebrafish. The results showed that sodium propionate interfered with the rhythmic behavior of zebrafish, and altered the expression of important rhythmic genes. Experimental data revealed that pancreatic morphology and developmental genes were altered after sodium propionate exposure. Additionally, thyroid hormone levels and key gene expression associated with the hypothalamic-pituitary-thyroid axis were significantly altered. Melatonin at a concentration of 1 μmol L-1, with a mild effect on zebrafish, observably alleviated sodium propionate-induced disturbances in circadian rhythms and pancreatic development, as well as regulating the thyroid system.

CONCLUSION

Melatonin, while modulating the thyroid system, significantly alleviates sodium propionate-induced circadian rhythm disturbances and pancreatic developmental disorders. We further revealed the deleterious effects of sodium propionate as well as the potential therapeutic effects of melatonin on circadian rhythm, pancreatic development and the thyroid system. © 2024 Society of Chemical Industry.

Dietary and Lifestyle Strategies for Obesity

The prevalence of obesity globally has tripled over the last half century, and currently affects around 650 million adults and 340 million children and adolescents (ages 5-19 years). Obesity contributes towards >50 co-morbidities and premature mortality. Obesity is a highly stigmatised condition that is associated with much mental and emotional distress and dysfunction. Thus, obesity is a major contributor to healthcare expenditure globally. Traditionally, the management of obesity stratifies into three major groups that include metabolic (bariatric) surgery, pharmacotherapies, and lifestyle (primarily dietary) strategies. Although listed as a separate category, dietary strategies for obesity remain a central component of any management plan, and often complement other surgical and pharmacotherapeutic options. Indeed, the effectiveness of any management approach for obesity relies upon successful behavioural changes, particularly relating to eating behaviours. In this concise review, we explore the foundational pillars of dietary strategies for obesity: sleep, listening, routine, de-stressing and optimisation of social conditions. We then discuss the importance of balancing dietary macronutrients (including dietary fibre, carbohydrates, protein and ultra-processed foods [UPFs]) as a key dietary strategy for obesity. Although we focus on general principles, we should provide bespoke dietary strategies for our patients, tailored to their individual needs. Rather than judging the utility of a diet based simply on its associated magnitude of weight loss, we should adopt a more holistic perspective in which a dietary strategy is valued for its overall health benefits, including the nurturing of our gut microbiota, to enable them to nurture and protect us.

Improved Gut Health May Be a Potential Therapeutic Approach for Managing Prediabetes: A Literature Review

Given the growing global threat and rising prevalence of type 2 diabetes mellitus (T2DM), addressing this metabolic disease is imperative. T2DM is preceded by prediabetes (PD), an intermediate hyperglycaemia that goes unnoticed for years in patients. Several studies have shown that gut microbial diversity and glucose homeostasis in PD or T2DM patients are affected. Therefore, this review aims to synthesize the existing literature to elucidate the association between high-calorie diets, intestinal permeability and their correlation with PD or T2DM. Moreover, it discusses the beneficial effects of different dietary interventions on improving gut health and glucose metabolism. The primary factor contributing to complications seen in PD or T2DM patients is the chronic consumption of high-calorie diets, which alters the gut microbial composition and increases the translocation of toxic substances from the intestinal lumen into the bloodstream. This causes an increase in inflammatory response that further impairs glucose regulation. Several dietary approaches or interventions have been implemented. However, only a few are currently in use and have shown promising results in improving beneficial microbiomes and glucose metabolism. Therefore, additional well-designed studies are still necessary to thoroughly investigate whether improving gut health using other types of dietary interventions can potentially manage or reverse PD, thereby preventing the onset of T2DM.

Association of low carbohydrate diet score with the risk of type 2 diabetes in an Australian population: A longitudinal study

AIMS

We aimed to assess the association of a low carbohydrate diet score (LCD) with the incidence of type 2 diabetes (T2D) using Melbourne Collaborative Cohort Study (MCCS) data.

METHODS

Between 1990 and 1994, the MCCS recruited 41,513 people aged 40-69 years. The first and second follow-ups were conducted in 1995-1998 and 2003-2007, respectively. We analyzed data from 39,185 participants. LCD score was calculated at baseline as the percentage of energy from carbohydrate, fat, and protein. The higher the score the less percentage of carbohydrates contributed to energy intake. The association of LCD quintiles with the incidence of diabetes was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic and other confounders. Mediation of the association by adiposity (BMI) was assessed.

RESULTS

LCD was positively associated with diabetes risk. Higher LCD score (p for trend = 0.001) was associated with increased risk of T2D. Quintile 5 (38 % energy from carbohydrates) versus quintile 1 (55 % energy from carbohydrates) showed a 20 % increased diabetes risk (incidence risk ratio (IRR) = 1.20 (95 % CI: 1.05-1.37)). A further adjustment for BMI (Body Mass Index) and WHR (Waist-to-Hip-Ratio) eliminated the association. Mediation analysis demonstrated that BMI mediated 76 % of the LCD & diabetes association.

CONCLUSIONS

Consuming a low carbohydrate diet, reflected as a high LCD score, may increase the risk of T2D which is largely explained by obesity. Results highlight the need for further studies, including clinical trials investigating the effects of a low carbohydrate diet in T2D.

The association between multiple trajectories of macronutrient intake and the risk of new-onset diabetes in Chinese adults

BACKGROUND

The association between macronutrient intake and diabetes is unclear. We used data from the China Health and Nutrition Survey to explore the association between macronutrient intake trajectories and diabetes risk in this study.

METHODS

We included 6755 participants who did not have diabetes at baseline and participated in at least three surveys. The energy supply ratio of carbohydrate, protein, and fat was further calculated from dietary data; different macronutrient trajectories were determined using multitrajectory models; and multiple Cox regression models were used to evaluate the association between these trajectories and diabetes.

RESULTS

We found three multitrajectories: decreased low carbohydrate-increased moderate protein-increased high fat (DLC-IMP-IHF), decreased high carbohydrate-moderate protein-increased low fat (DHC-MP-ILF), and balanced-macronutrients (BM). Compared to the BM trajectory, DHC-MP-ILF trajectories were significantly associated with increased risk of diabetes (hazard ratio [HR]: 3.228, 95% confidence interval [CI]: 1.571-6.632), whereas no association between DLC-IMP-IHF trajectories and diabetes was found in our study (HR: 0.699, 95% CI: 0.351-1.392).

CONCLUSIONS

The downward trend of high carbohydrate and the increasing trend of low fat increased the risk of diabetes in Chinese adults.

Secular trends in dietary energy, carbohydrate, fat, and protein intake among Korean adults, 2010-2020 KHANES

OBJECTIVES

The composition and balance of macronutrient intake play key roles in promoting a longer lifespan. In this study, we aimed to investigate the secular trends in carbohydrate, fat, and protein intakes in South Koreans from 2010 to 2020.

METHODS

We examined the dietary nutritional intake of South Koreans using data from the Korean National Health and Nutrition Examination Survey. A total of 60,190 adults aged ≥19 y who completed the 24-h dietary recall interviews in a single day on all survey periods were included in this study. The outcomes included changes in macronutrient intake according to subgroups, such as age; sex; and the presence of diabetes, dyslipidemia, stroke, or heart disease, as well as energy intake from macronutrients.

RESULTS

The study population showed a significant decrease in total energy intake from 2010 to 2020, with a corresponding decrease in the percentage of energy intake from carbohydrates (p-values for trend < 0.001). Conversely, the proportions of energy intake from proteins and fats increased during the same period (p < 0.001). Subgroup analyses revealed variations in macronutrient intake trends according to age, sex, obesity status, and underlying diseases. The analysis of trends in energy intake from various fat subtypes, total sugar, and fiber revealed a decrease in the energy intake percentage of total sugar from 2016 to 2020 and an increase in the energy intake percentage of all fat subtypes and fiber from 2013 to 2020.

CONCLUSIONS

In the past 10 y, the dietary patterns in Korea have shifted toward the consumption of high-fat and high-protein diets with reduced carbohydrate intake.

Hepatic Effects of Low-Carbohydrate Diet Associated with Different Lipid Sources: Insights into Oxidative Stress, Cytotoxicity, and Epigenetic Markers in a mouse Model of Obesity

BACKGROUND

Low-carbohydrate and high-fat diet (LCHF) models have been widely explored as alternatives for treating obesity and promoting weight loss. Their effect is attributed to the change in energy substrate that stimulates ketogenic pathways that can metabolically overload the liver. However, little has been studied about the impact of lipid sources prioritized in the LCHF diet.

OBJECTIVES

This study aims to evaluate the impact of different fat sources in the LCHF diet on markers of liver injury, oxidative stress, and epigenetics in obesity.

METHODS

Adult male mice were initially induced to obesity by a high-fat and high-sugar diet for 10 wk. Subsequently, they underwent a weight-loss treatment intervention involving an LCHF diet with various sources of fats, including saturated, omega-3 (ω-3) (n-3), omega-6 (ω-6) (n-6), and omega-9 (ω-9) (n-9). At the end of the treatment, markers of liver injury, oxidative stress, and epigenetics were evaluated.

RESULTS

The LCHF diet was effective in inducing weight loss. However, unsaturated lipid sources (omegas) exhibited superior outcomes. Specifically, the ω-9 group displayed diminished oxidative stress concentrations and decreased markers of liver injury. The ω-3 group demonstrated efficacy in modulating epigenetic markers, thereby reducing oxidative stress, mutagenicity, and markers of liver injury. Correlation tests demonstrated that there was an interaction between the activity of antioxidants and epigenetic enzymes.

CONCLUSIONS

Our results suggest that LCHF diets associated with ω-3 and ω-9 have the potential for weight loss and liver health recovery in obesity through antioxidant and epigenetic mechanisms.

Does a Ketogenic Diet Have a Place Within Diabetes Clinical Practice? Review of Current Evidence and Controversies

Carbohydrate restriction has gained increasing popularity as an adjunctive nutritional therapy for diabetes management. However, controversy remains regarding the long-term suitability, safety, efficacy and potential superiority of a very low carbohydrate, ketogenic diet compared to current recommended nutritional approaches for diabetes management. Recommendations with respect to a ketogenic diet in clinical practice are often hindered by the lack of established definition, which prevents its capacity to be most appropriately prescribed as a therapeutic option for diabetes. Furthermore, with conflicted evidence, this has led to uncertainty amongst clinicians on how best to support and advise their patients. This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies.

Momordica balsamina improves glucose handling in a diet-induced prediabetic rat model

Prolonged exposure to high energy diets has been implicated in the development of pre-diabetes, a long-lasting condition that precedes type 2 diabetes mellitus (T2DM). A combination of pharmacological treatment and dietary interventions are recommended to prevent the progression of pre-diabetes to T2DM. However, poor patient compliance leads to negligence of the dietary intervention and thus reduced drug efficiency. Momordica balsamina (MB) has been reported to possess anti-diabetic effects in type 1 diabetic rats. However, the effects of this medicinal plant in conjunction with dietary intervention on pre-diabetes have not yet been established. Consequently, this study sought to evaluate the effects of MB on glucose homeostasis in a diet-induced pre-diabetes rat model in the presence and absence of dietary intervention. Pre-diabetes was induced on male Sprague Dawley rats by a high fat high carbohydrate (HFHC) diet for a period of 20 weeks. Pre-diabetic male Sprague Dawley rats were treated with MB (250 mg/kg p.o.) in both the presence and absence of dietary intervention once a day every third day for a period of 12 weeks. The administration of MB with and without dietary intervention resulted in significantly improved glucose homeostasis through reduced caloric intake, body weights, with reduced plasma ghrelin concentration and glycated hemoglobin by comparison to the pre-diabetic control. MB administration also improved insulin sensitivity as evidenced by the expression of glucose transporter 4 (GLUT 4) and glycogen synthase on the prediabetic treated animals. These results suggest that MB has the potential to be used to manage pre-diabetes and prevent the progression to overt type 2 diabetes as it demonstrated the ability to restore glucose homeostasis even in the absence of dietary and lifestyle intervention.

Moringa oleifera: a valuable insight into recent advances in medicinal uses and pharmacological activities

Moringa oleifera is an important medicinal plant in several countries; for example, Nigeria, the USA, Turkey, Germany, Greece, and Ukraine. The abundant bioactive and nutritional properties of this plant make it useful in many and diverse areas of life, including the health, cosmetic, agricultural, and food industries to mention but a few. Research has found that the presence of proteins, carbohydrates, lipids, vitamins, minerals, flavonoids, phenols, alkaloids, fatty acids, saponins, essential oils, folate, aromatic hydrocarbons, sterols, glucosinolates, and glycosides, among others, characterize the moringa nutrient profile and, as a result, give rise to its remedial effects on ailments such as wounds, stomach and duodenal ulcers, allergies, obesity, diabetes, inflammation, asthma, and so on. It is the aim of this review to provide an insight into such medicinal and pharmacological remedies attributed to moringa, stating both the past and recent discoveries. This review article also takes a look into the botanical features, bioactive compounds, antinutrients, food applications, bacterial fermentation products, biosafety, industrial applications, and other uses of moringa. Finally, with the belief that knowledge is progressive, we acknowledge that there are things yet undiscovered about this wonder plant that will be of value both to medicine and general life; we therefore recommend that research work continues on the moringa plant. © 2023 Society of Chemical Industry.

A low-carbohydrate diet with different fatty acids' sources in the treatment of obesity: Impact on insulin resistance and adipogenesis

BACKGROUND

The search for nutritional intervention strategies against obesity has grown, highlighting the low-carbohydrate diet model. However, little is known about the impact of the quality of fatty acids consumed in this diet. Thus, we aim to investigate the influence of fatty acid quality on dietary strategy on obesity.

METHODS

Male Swiss mice were diet-induced to obesity. Afterward, mice consume a low-carb diet with different types of fat: saturated, polyunsaturated ω-3, ω-6, and monounsaturated ω-9 fatty acids. Weight gain and food consumption were monitored weekly. An oral glucose tolerance test was performed and blood and tissue samples were collected for analysis of insulin resistance markers. Protein expression of insulin signaling pathway molecules, lipid metabolism, mitochondrial function, macrophage polarization, and cytokine production were analyzed.

RESULTS

The high-fat diet was able to induce obesity and glucose intolerance. The switch to a low-carbohydrate dietary pattern reversed the glucose intolerance, with better results in the ω-3 and ω-9 groups. After the low-carbohydrate diet, groups ω-3 and ω-9 presented improved fasting serum glucose, insulin, and HOMA indexes. The low-carbohydrate diet also increased the activity of insulin pathway proteins such as IR, IRS1, and AKT. Furthermore, the ω-3 diet group showed greater activity of mitochondrial complexes and AMPK signaling pathway proteins. The ω-6 and ω-9 -rich diet induced M2-type macrophage polarization, as well as cytokine production modulation by the low-carbohydrate diet in the ω-3 and ω-9 groups.

CONCLUSIONS

Consuming a low-carbohydrate diet pattern promotes weight loss and improves glucose intolerance in obesity. Also, the quality of lipids has a direct influence, demonstrating that the consumption of ω-3 polyunsaturated and ω-9 monounsaturated lipids can lead to more favorable outcomes for the improvement of glucose intolerance, lipid metabolism, and anti-inflammatory effects.

Optimization of nutritional strategies using a mechanistic computational model in prediabetes: Application to the J-DOIT1 study data

Lifestyle interventions have been shown to prevent or delay the onset of diabetes; however, inter-individual variability in responses to such interventions makes lifestyle recommendations challenging. We analyzed the Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1) study data using a previously published mechanistic simulation model of type 2 diabetes onset and progression to understand the causes of inter-individual variability and to optimize dietary intervention strategies at an individual level. J-DOIT1, a large-scale lifestyle intervention study, involved 2607 subjects with a 4.2-year median follow-up period. We selected 112 individuals from the J-DOIT1 study and calibrated the mechanistic model to each participant's body weight and HbA1c time courses. We evaluated the relationship of physiological (e.g., insulin sensitivity) and lifestyle (e.g., dietary intake) parameters with variability in outcome. Finally, we used simulation analyses to predict individually optimized diets for weight reduction. The model predicted individual body weight and HbA1c time courses with a mean (±SD) prediction error of 1.0 kg (±1.2) and 0.14% (±0.18), respectively. Individuals with the most and least improved biomarkers showed no significant differences in model-estimated energy balance. A wide range of weight changes was observed for similar model-estimated caloric changes, indicating that caloric balance alone may not be a good predictor of body weight. The model suggests that a set of optimal diets exists to achieve a defined weight reduction, and this set of diets is unique to each individual. Our diabetes model can simulate changes in body weight and glycemic control as a result of lifestyle interventions. Moreover, this model could help dieticians and physicians to optimize personalized nutritional strategies according to their patients' goals.

Opposite effects of low-carbohydrate high-fat diet on metabolism in humans and mice

BACKGROUND

Low-carbohydrate diet (LCD) is effective for weight loss and glycaemic control in humans. Here, the study aimed to explore the effects of LCD/high-fat diet (HFD) in both humans and mice.

METHODS

Twenty-two overweight or obese participants received LCD for 3 weeks. Based on carbohydrate intake > 10% or ≤ 10% of calories, the participants were divided into moderate LCD (MLCD) and very LCD (VLCD) groups. The participants completed a 10-question food preference survey. Meanwhile, C57BL/6J mice were assigned to five groups: chow diet (CD, 10% fat), HFD with 60%, 70%, and 75% fat from cocoa butter (HFD-C), and HFD with 60% fat from lard (HFD-L) and fed for 24 weeks. Eight mice were acclimatised for the food-choice test.

RESULTS

LCD decreased the total energy intake in humans. The VLCD group showed greater weight loss and better glycaemic control than the MLCD group. A food preference survey showed that 65% of participants tended to choose high-carbohydrate foods. In mice, HFD resulted in energy overconsumption, obesity, and metabolic disorders. When CD and HFD-L were administered simultaneously, mice rarely consumed CD. In the HFD-C groups, the energy intake and body weight increased with increasing dietary fat content. Compared with the HFD-C group, the HFD-L group consumed more energy and had poorer metabolism.

CONCLUSIONS

Lower carbohydrate intake contributed to lower energy intake and improved metabolism in humans. In mice, diets with a higher proportion of fat become more attractive and obesogenic by fixing the fat sources. Since the mice preferred lard to cocoa butter, lard induced excess energy intake and poorer metabolism. Different food preferences may be the underlying mechanism behind the opposite effects of the LCD/HFD in humans and mice.

TRIAL REGISTRATION

The clinical trial was registered with the Chinese Clinical Trial Registry ( www.chictr.org.cn ). The registration number is ChiCTR1800016786. All participants provided written informed consent prior to enrolment.

Glucose restriction induces AMPK-SIRT1-mediated circadian clock gene Per expression and delays NSCLC progression

The rhythmic expression of the circadian clock is intimately linked to the health status of the body. Disturbed circadian clock rhythms might lead to a wide range of metabolic diseases and even cancers. Our previous study showed that glucose restriction was able to inhibit non-small cell lung cancer (NSCLC). In the current study, we found that glucose restriction enhanced apoptosis and cell growth delay in NSCLC cells. In addition, we used GEPIA database analysis to derive different effects of each circadian clock gene on lung cancer tissue. Among these circadian clock genes, Per (Period) is lowly expressed in cancer tissues and highly expressed in normal tissues. Moreover, the higher expression of Per in cancer patients has a better prognostic significance. Furthermore, we revealed that glucose restriction induced the expression of the circadian clock gene Per in NSCLC cells by upregulating SIRT1 (Sirtuin1) via activation of the energy response factor AMPK (AMP-activated protein kinase). Changes in Per expression following upregulation or downregulation of AMPK were consistent with AMPK expression. Additionally, a low-carbohydrate ketogenic diet significantly delayed tumor progression in a xenograft tumor model of severe combined immunodeficiency (SCID) mice. Meanwhile, the ketogenic diet increased the expression of AMPK, SIRT1 and Per in vivo. Besides, the ketogenic diet was found to restore the normal rhythmic level of Per by Zeitgeber Time (ZT) experiments. Taken these together, these results indicated a novel mechanism that glucose restriction induces AMPK-SIRT1 mediated circadian clock gene Per expression and delays NSCLC progression, which provided more evidence for glucose restriction as an adjuvant clinical therapeutic strategy in NSCLC.

Comparison of the Ketogenic Ratio of Macronutrients With the Low-Carbohydrate Diet Score and Their Association With Risk of Type 2 Diabetes in Postmenopausal Women: A Secondary Analysis of the Women's Health Initiative

BACKGROUND

Previous attempts to identify low-carbohydrate diets (LCDs) in epidemiological studies relied on the LCD Score, which is unable to identify ketogenic dieters. Ketogenic ratios of macronutrients are clinical equations proposed to predict ketogenic diets; however, their utility in epidemiological studies is unknown.

OBJECTIVE

To determine the number of participants consuming a ketogenic diet, compare ketogenic ratios to the LCD Score, and evaluate their association with type 2 diabetes mellitus (T2DM).

DESIGN

Secondary analysis of the Women's Health Initiative with 17.9 ± 6.03 years of follow-up. Baseline food frequency questionnaires were used to calculate the ketogenic ratio as follows: (0.9 × grams fat + 0.46 × grams protein) / (0.1 × grams fat + 0.58 × grams protein + grams net carbohydrate), a value ≥1.5 is the minimum threshold for a ketogenic diet.

PARTICIPANTS/SETTING

One hundred twenty-five nine hundred eighty-two postmenopausal women without diabetes (aged 50 to 79 years) enrolled in the multicenter Women's Health Initiative observational study and clinical trials were included.

MAIN OUTCOME MEASURES

Risk of self-reported incident T2DM.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazards models, adjusted for age, race, ethnicity, education, income, health insurance, relationship status, geographic region, Women's Health Initiative study component, female hormone use, smoking status, alcohol use, recreational physical activity, total energy intake, diet quality, body mass index, hyperlipidemia, and hypertension, were used to compare hazard ratios and 95% CIs for T2DM among quintiles of the ketogenic ratio.

RESULTS

A total of 18,775 incident cases of T2DM occurred. The median ketogenic ratio was 0.35 (interquartile range 0.28 to 0.42) and 15 individuals (0.01%) exceeded the threshold for a ketogenic diet. Higher ketogenic ratio quintiles were associated with increased risk of T2DM in a dose-dependent manner. Comparing extreme quintiles of the ketogenic ratio, the hazard ratio for diabetes was 1.24 (95% CI 1.18 to 1.31; Ptrend < 0.001) in fully adjusted models. Similarly, comparing extreme quintiles, the hazard ratio for diabetes was 1.36 (95% CI 1.29 to 1.43; Ptrend < 0.001) for the LCD Score and 1.13 (95% CI 1.07 to 1.19; Ptrend < 0.001) for the simplified ketogenic ratio in fully adjusted models.

CONCLUSIONS

Increasing ketogenic ratio values are associated with increased risk of T2DM and align well with LCD Scores; however, too few participants consumed a ketogenic diet to determine its association with T2DM.

Compliance with Nutritional Recommendations and Gut Microbiota Profile in Galician Overweight/Obese and Normal-Weight Individuals

Different research studies have identified specific groups or certain dietary compounds as the onset and progression of obesity and suggested that gut microbiota is a mediator between these compounds and the inflammation associated with pathology. In this study, the objective was to evaluate the dietary intake of 108 overweight (OW), obese (OB), and normal-weight (NW) individuals and to analyze their gut microbiota profile to determine changes and associations with Body Mass Index (BMI) and diet. When individuals were compared by BMI, significant differences in fiber and monounsaturated fatty acids (MUFAs) intake were observed, showing higher adequacy for the NW group. The analysis of gut microbiota showed statistical differences for 18 ASVs; Anaerostipes and Faecalibacterium decreased in the OW/OB group, whereas the genus Oscillospira increased; the genus was also found in the LEFSe analysis as a biomarker for OW/OB. Roseburia faecis was found in a significantly higher proportion of NW individuals and identified as a biomarker for the NW group. Correlation analysis showed that adequation to nutritional recommendation for fiber indicated a higher abundance of Prevotella copri, linearly correlated with F. prausnitzii, Bacteroides caccae, and R. faecis. The same correlation was found for the adequation for MUFAs, with these bacteria being more abundant when the intake was adjusted to or below the recommendations.

Brain Injury: How Dietary Patterns Impact Long-Term Outcomes

Purpose of Review

Individuals with a history of traumatic brain injury (TBI) are at a much greater risk for developing cardiovascular disease (CVD) compared to the general population. This review discusses dietary patterns as a means of addressing modifiable risk factors following TBI exposure. Evidence-based resources for practicing Physiatrists and Brain Injury Medicine specialists pertaining to nutrition education and counseling are also provided.

Recent Findings

We examined Mediterranean, Dietary Approaches to Stop Hypertension, plant-based, ketogenic, and intermittent fasting dietary patterns through publications of clinical trials and systematic reviews. While many reviews had significant positive findings, some were limited by generalizability.

Summary

While there is extensive literature on the immediate nutrition goals in the inpatient setting following an acute TBI exposure, there is limited literature discussing the nature of diet and nutrition in the post-acute setting. Fortunately, most individuals with TBI exposure survive their initial injury and continue into the recovery phase. The scientific literature supports increased morbidity and mortality with chronic TBI exposure compared to matched counterparts, most notably with CVD. A diet rich in fiber and nutrients but limited in added sugars, saturated fats, and excess calories would likely have the greatest cardiovascular and related neurologic protection. Future studies are needed to assess the specific impact of dietary interventions in the chronic phase of brain injury recovery.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Is anyone truly healthy? Trends in health risk factors prevalence and changes in their associations with all-cause mortality

OBJECTIVE

The purpose of the study was to determine trends in the prevalence of individual health risk factors across time and to examine if their associations with mortality have changed over time.

METHODS

Data from the National Health and Nutrition Examination Surveys (NHANES III- 1988-1994 and NHANES 1999-2014; age ≥20 years) was used to examine differences in the odds ratio (OR) of 5-year mortality risk associated with various common health risk factors over the two survey periods using weighted logistic regression analysis adjusting for age, sex, obesity category and white ethnicity (n = 28,279).

RESULTS

Over 97% of individuals had at least one of the 19 risk factors examined with no difference in the prevalence over time (P>0.34). The prevalence of lifestyle, social/mental and physical risk factors (2.2 to 19.1%) increased over time (P<0.0002), while the prevalence of having physiological risk factors decreased by ~6.5% (P<0.0001). Having any lifestyle or social/mental risk factor was significantly associated with a higher 5-year OR for mortality risk in 1999-2014, than 1988-94. In particular, having low education or use of mental health medication were not associated with mortality risk in 1988-94 (P>0.1), but were significantly associated with a higher 5-year OR for mortality in 1999-2014 (P<0.0001). Conversely, physiological risk factors were more weakly related with mortality risk in 1988-1994, than 1999-2014. Having any physical risk factor, and poor self-rated health were similarly related with 5-year mortality risk at both timepoints.

CONCLUSION

Health risk factors have both increased and decreased in prevalence over time, along with changes in the association between many of the risk factors and mortality risk. Taken together, these changes complicate interpretation of temporal trends and warrant cautious interpretation of population health patterns based on surveillance data.

Eating window and eating habits of adults in China: A cross-sectional study

Objective

Previous studies have demonstrated that eating time and habits play key roles in human health. However, there is a paucity of research on the epidemiology of eating window and eating habits in China. This study aimed to investigate the relationship between eating window and eating habits among adults in mainland China and explore the factors influencing these parameters.

Design

Cross-sectional study.

Setting

A questionnaire comprising demographic data, metabolic index, eating window and eating habits was administered via the Internet.

Participants

1596 adults from mainland China.

Results

Eating window of all participants was 13.03 ± 2.02 h (mean ± standard deviation [SD]), which was longer than previously reported in smaller more controlled studies from China. Area of residence and occupation were significant factors influencing eating window after controlling for other factors (area of residence: β, -0.499; 95% confidence interval [CI], -0.897 to -0.101, p = 0.014; occupation: β, -0.309, 95% CI, -0.496 to -0.121, p = 0.001). Participants typically commenced eating at 08:00 h (interquartile range [IQR]: 8:00-9:00) and ceased eating at 20:00 h (IQR: 20:00-22:00). Regular meals which mean two or three meals per day regularly constituted the dominant eating pattern of participants (n = 1233, 77.3%) and 819 (51.1%) participants preferred cooking for themselves.

Conclusion

This study revealed that eating window of adults in China generally around 13 h. Area of residence and occupation were the main factors influencing eating window. Our data provide a foundation for future studies on eating window and eating habits in China.

Ketogenic Diet in Children and Adolescents: the Effects on Growth and Nutritional Status

The ketogenic diet is known to be a possible adjuvant treatment in several medical conditions, such as in patients with severe or drug-resistant forms of epilepsy. Its use has recently been increasing among adolescents and young adults due to its supposed weight-loss effect, mediated by lipolysis and lowered insulin levels. However, there are still no precise indications on the possible use of ketogenic diets in pediatric age for weight loss. This approach has also recently been proposed for other types of disorder such as inherited metabolic disorders, Prader-Willi syndrome, and some specific types of cancers. Due to its unbalanced ratio of lipids, carbohydrates and proteins, a clinical evaluation of possible side effects with a strict evaluation of growth and nutritional status is essential in all patients following a long-term restrictive diet such as the ketogenic one. The prophylactic use of micronutrients supplementation should be considered before starting any ketogenic diet. Lastly, while there is sufficient literature on possible short-term side effects of ketogenic diets, their possible long-term impact on growth and nutritional status is not yet fully understood, especially when started in pediatric age.

Relationship between a Low-Carbohydrate, High-Fat Diet and Risk of Metabolic Syndrome in Korean Women

Background

Prevalence of metabolic syndrome with aging is higher in women than in men, and it increases after menopause. Interventions to reduce the risk of metabolic syndrome in women are important. A low-carbohydrate, high-fat diet is effective in weight loss and improvement cardiovascular risk factors including abdominal circumference, blood pressure, and blood lipid profile. We aimed to determine the relationship between a low-carbohydrate, high-fat diet and the risk of metabolic syndrome in Korean women.

Methods

This cross-sectional study was conducted using secondary data from the 2014-2018 Korean National Health and Nutrition Examination Survey. Overall, 8,222 women aged >19 yr were included. The effect of a low-carbohydrate, high-fat diet on the risk of metabolic syndrome was analyzed by multiple logistic regression analysis using a complex sampling procedure.

Results

The diet significantly reduced the likelihood of metabolic syndrome development (P=0.044). In addition, regardless of the fat type, the diet significantly reduced the likelihood of low high-density lipoprotein cholesterolemia (low-carbohydrate, high-total fat, P=0.013; low-carbohydrate, high-unsaturated fat, P=0.006; low-carbohydrate, high-saturated fat, P=0.006).

Conclusion

A low-carbohydrate, high-fat diet is an important intervention that can reduce the risk of metabolic syndrome, and the reduced consumption of carbohydrates can decrease the risk of low high-density lipoprotein cholesterolemia regardless of fat type. Therefore, it is necessary to actively explore the potential of this diet, targeting Asians, including Koreans.

Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and Visualized Analysis

Diet has been recognized as a vital risk factor for non-communicable diseases (NCDs), climate changes, and increasing population, which has been reflected by a rapidly growing body of the literature related to healthy eating. To reveal a panorama of the topics related to healthy eating, this study aimed to characterize and visualize the knowledge structure, hotspots, and trends in this field over the past two decades through bibliometric analyses. Publications related to healthy eating between 1 January 2002 and 31 December 2021 were retrieved and extracted from the Web of Science database. The characteristics of articles including publication years, journals, authors, institutions, countries/regions, references, and keywords were assessed. The analyses on co-authorship, co-occurrence, and co-citation were performed and network visualization maps were constructed by VOSviewer. Major subdomains identified by bibliometrics were further discussed and analyzed. A total of 12,442 articles on healthy eating were identified. Over the past two decades, the annual global publications increased from 71 to 1764, showing a nearly 25-fold growth. The journal Nutrients published the most articles and The American Journal of Clinical Nutrition possessed the highest citations. The United States, Harvard University, and Hu, Frank B. were identified as the most productive and influential country, institution, and author, respectively. The co-occurrence cluster analysis of the top 100 keywords formed four clusters: (1) the food insecurity environment for youths highlighting the necessity and significance of implementing healthy eating in early life; (2) sustainable advantages of the Mediterranean diet; (3) the importance of an overall healthy lifestyle optimization leveraged by eHealth; (4) the challenges during the course of healthy eating against obesity, which are prominent in reflecting the knowledge structure, hotspots, and trends. Moreover, COVID-19, orthorexia nervosa, sustainability, microbiota, food insecurity, and e-health are identified keywords that represented the latest high-frequency keywords and indicated the emerging frontiers of healthy eating. This study indicates that the number of publications on healthy eating will increase in the future and that healthy dietary patterns and clinical applications of healthy eating will be the next hotspots in this research field.

How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal

Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.

Ketogenic Diet as a Promising Non-Drug Intervention for Alzheimer’s Disease: Mechanisms and Clinical Implications

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is mainly characterized by cognitive deficits. Although many studies have been devoted to developing disease-modifying therapies, there has been no effective therapy until now. However, dietary interventions may be a potential strategy to treat AD. The ketogenic diet (KD) is a high-fat and low-carbohydrate diet with adequate protein. KD increases the levels of ketone bodies, providing an alternative energy source when there is not sufficient energy supply because of impaired glucose metabolism. Accumulating preclinical and clinical studies have shown that a KD is beneficial to AD. The potential underlying mechanisms include improved mitochondrial function, optimization of gut microbiota composition, and reduced neuroinflammation and oxidative stress. The review provides an update on clinical and preclinical research on the effects of KD or medium-chain triglyceride supplementation on symptoms and pathophysiology in AD. We also detail the potential mechanisms of KD, involving amyloid and tau proteins, neuroinflammation, gut microbiota, oxidative stress, and brain metabolism. We aimed to determine the function of the KD in AD and outline important aspects of the mechanism, providing a reference for the implementation of the KD as a potential therapeutic strategy for AD.

Low carbohydrate high fat-diet in real life assessed by diet history interviews

BACKGROUND

Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet.

METHODS

A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed.

RESULTS

The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits.

CONCLUSIONS

Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern.

Effect of a combination of pemafibrate and a mild low-carbohydrate diet on obese and non-obese patients with metabolic-associated fatty liver disease

BACKGROUND AND AIM

Recently, pemafibrate and a low-carbohydrate diet (LCD) have each been reported to improve fatty liver disease. However, it is unclear whether their combination improves fatty liver disease and is equally effective in obese and non-obese patients.

METHODS

In 38 metabolic-associated fatty liver disease (MAFLD) patients, classified by baseline body mass index (BMI), changes in laboratory values, magnetic resonance elastography (MRE), and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) were studied after 1 year of combined pemafibrate plus mild LCD.

RESULTS

The combination treatment resulted in weight loss (P = 0.002), improvement in hepatobiliary enzymes (γ-glutamyl transferase, P = 0.027; aspartate aminotransferase, P < 0.001; alanine transaminase [ALT], P < 0.001), and improvement in liver fibrosis markers (FIB-4 index, P = 0.032; 7 s domain of type IV collagen, P = 0.002; M2BPGi, P < 0.001). Vibration-controlled transient elastography improved from 8.8 to 6.9 kPa (P < 0.001) and MRE improved from 3.1 to 2.8 kPa (P = 0.017) in the liver stiffness. MRI-PDFF improved from 16.6% to 12.3% in liver steatosis (P = 0.007). In patients with a BMI of 25 or higher, improvements of ALT (r = 0.659, P < 0.001) and MRI-PDFF (r = 0.784, P < 0.001) were significantly correlated with weight loss. However, in patients with a BMI below 25, the improvements of ALT or PDFF were not accompanied by weight loss.

CONCLUSIONS

Combined treatment with pemafibrate and a low-carbohydrate diet resulted in weight loss and improvements in ALT, MRE, and MRI-PDFF in MAFLD patients. Although such improvements were associated with weight loss in obese patients, the improvements were observed irrespective of weight loss in non-obese patients, indicating this combination can be effective both in obese and non-obese MAFLD patients.

Association between Different Types of Exercise and Intake of Nutrients including Carbohydrate, Fat, Protein, and B Vitamins in Young Adults

PURPOSE

This cross-sectional study aimed to investigate the association between different types of exercise and nutrient intake to provide a basis for promoting the overall health of young adults.

METHODS

A total of 427 young adults (217 women) aged 21 to 35 were recruited. Participants self-reported time spent (min/week) in endurance exercise, resistance exercise, sports, walking, and other structured physical activity (PA). Nutrient intake was determined via telephone-administered 24 h recalls.

RESULTS

Resistance exercise was positively associated with intake of protein, vitamins B2, B3, B5, B6, and B12 and the percentage of total calories from protein (PCT-PRO), and negatively associated with the percentage of total calories from carbohydrate (PCT-CHO) (p < 0.05). Time spent in aerobic exercise was positively associated with fiber, pectin, and vitamin B6 intake, and negatively associated with PCT-PRO (p < 0.05). Time spent exercising was negatively associated with fiber and pectin intake (p < 0.05). Time spent performing other structured PA was positively associated with pectin intake (p < 0.05). Participants' total exercise time was positively associated with intake of vitamins B2, B5, B12, and PCT-Fat, PCT-PRO, and negatively associated with PCT-CHO (p < 0.05).

CONCLUSION

The results showed an association between various exercise types and specific nutrients. It may be worthwhile to point out the negative association of exercise with CHO intake, which may need to be examined more closely in active young adults. In addition, the supplementation of B vitamins and pectin may be beneficial for their exercise performance and post-exercise recovery.

Influence of anti-obesity strategies on brain function in health and review: A review

The aim of this review was to investigate in the literature the application of strategies such as low carbohydrate diet (LCD), ketogenic diet (KD) and intermittent fasting (IF) and their effects on the CNS. We performed a narrative review of the literature. The search was specifically carried out in PubMed, selecting articles in English, which had the following keywords: obesity, central nervous system, low carb diet, ketogenic diet and intermittent fasting, using the narrative review methodology. The studies found show that the benefits of the LCD, KD and IF strategies, at the CNS level, have a strong influence on the mechanisms of hunger and satiety, as well as on the reduction of food reward and show improvement in memory and mood influenced by the interventions.

"A disease that god has given me" patients and caregivers' perspectives on diabetes in southeastern Tanzania

BACKGROUND

Prompt diagnosis and appropriate management of diabetes has the potential of improving survival and patient health outcomes. Yet many diabetes patients present themselves to health facilities at an advanced stage of the disease which complicates its management. Individual perceptions about diseases are known to play a critical role in informing responses and actions including seeking health care and self-care practices. However, little is documented in Tanzania regarding the perspectives of diabetes patients and their caregivers about the disease especially in rural settings.

METHODS

We conducted 26 in-depth interviews involving 19 diabetes patients and 7 diabetes patient caregivers to explore in detail their perspectives on diabetes as a disease. Data was analyzed using thematic analysis with the help of NVivo9.

RESULTS

Both patients and caregivers expressed mixed perceptions on diabetes causes. In addition to heredity, and the failure of the pancreas to function well, lifestyle factors including lack of physical activity and eating too many sugary and oily foods were common reported causes. However, none of the participants were clear on the mechanisms between the perceived causes and the actual occurrence of the disease. Perception on susceptibility to diabetes was low even among participants with the disease as they reported not having ever thought of getting the condition before they were diagnosed. Some caregivers expressed worry and fear on their susceptibility to inheriting diabetes from their relatives who had the condition. Diabetes was perceived as a severe and life-threatening condition that can easily cause death if not well managed. Participants indicated uncertainty on its prevention.

CONCLUSION

This study shows mixed perspectives on the causes, susceptibility, severity and prevention of diabetes which were informed by the participants' limited knowledge and awareness about the disease. Interventions to strengthen responses to diabetes, which include buy-in from the patients and their caregiver's perspectives are essential to improve prevention, early diagnosis and appropriate management in rural settings.

Effect of the Ketogenic Diet on the Prophylaxis and Treatment of Diabetes Mellitus: A Review of the Meta-Analyses and Clinical Trials

The exponentially growing frequency of diagnosing diabetes mellitus means that a verification of the previous dietetic approach to treating the disease seems justified. The simultaneous growth of interest in the ketogenic diet and the development of knowledge in this field have contributed to the increasingly frequent application of the ketogenic diet in diabetes treatment. This paper also deals with that issue; its aim includes an extensive analysis of the influence of the ketogenic diet on the prophylaxis and treatment of diabetes. The paper has been prepared based on a wide, meticulous analysis of the available literature on the subject. Among other findings, a favorable effect of that nutrition model has been demonstrated on the values of glycated hemoglobin, glucose, insulin, or other metabolic parameters in diabetes patients. The effect of the ketogenic diet on the pharmacotherapy of type 1 and type 2 diabetes has been presented and compared with the standard nutritional management plan recommended for that disease. Further research is needed in this field, especially studies with a long follow-up period. The discussed articles report interesting therapeutic advantages to the ketogenic diet in comparison with standard diets.

Effects of lifestyle intervention on adults with metabolic associated fatty liver disease: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis evaluates the overall effects of lifestyle interventions upon hepatic fat content and metabolism-related indicators among adults with metabolic associated fatty liver disease.

METHODS

It was registered under PROSPERO (CRD42021251527). We searched PubMed, EMBASE, MEDLINE, Cochrane, CINAHL, Scopus, CNKI, Wan-fang, VIP, and CBM from the inception of each database to May 2021 for RCT studies of lifestyle interventions on hepatic fat content and metabolism-related indicators. We used Review Manager 5.3 for meta-analysis and used text and detailed tabular summaries when heterogeneity existed.

RESULTS

Thirty-four RCT studies with 2652 participants were included. All participants were obesity, 8% of whom also had diabetes, and none was lean or normal weight. Through subgroup analysis, we found low carbohydrate diet, aerobic training and resistance training significantly improved the level of HFC, TG, HDL, HbA1c, and HOMA-IR. Moreover, low carbohydrate diet is more effective in improving HFC than low fat diet and resistance training is better than aerobic training in reduction in HFC and TG (SMD, -0.25, 95% CI, -0.45 to -0.06; SMD, 0.24, 95% CI, 0.03 to 0.44, respectively).

DISCUSSION

Overall, this is the first review that systematically synthesizes studies focused on the effects of various lifestyle on adults with MAFLD. The data generated in this systematic review were more applicable to obesity MAFLD rather than lean or normal weight MAFLD.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier (CRD42021251527).

[Nutrition for diabetic patients (Update 2023)]

All patients with diabetes require individual and personalized nutritional consultation with professionals. The patient's needs should be the primary focus of the dietary therapy, taking their lifestyle and the type of diabetes into consideration. With the recommendations to the patient's diet, there need to be specific metabolic goals to reduce the disease's progression and to avoid long term health effects. Therefore, practical guidelines such as portion size and meal planning tips should be the main focus.According to the latest national and international standards, patients suffering from diabetes should have access to nutrition consulting and nutritional training. During consultation they can be supported on- how to manage their health condition and choosing food and beverage to improve their health.These practical recommendations sum up the latest literature on nutritional aspects of diabetes treatment.

A bibliometric and visual analysis of low carbohydrate diet

Introduction

Numerous studies have confirmed the effects of low carbohydrate diet (LChD) on metabolism and chronic diseases. However, there were no bibliometric studies on LChD. This study was conducted through a bibliometric analysis to investigate the current status, hotspots and frontiers trends.

Methods

We searched all research publications related to LChD from 2002 to 2021 on the Web of Scientific Core Collection (WoSCC). CiteSpace and VOSviewer software was used to analyze countries/regions, institutions, journals, authors, references, and keywords.

Results

A total of 6938 papers were included, with an increasing trend of annual publication. LChD categories mainly included nutrition, endocrinology, and neurosciences which reflected the interdisciplinary characteristics. USA was with the largest number and the world science center in LChD field. Universities were main research institutions and five of the top 10 institutions were from USA. Eric Heath Kossoff had 101 publications and ranked first. Nutrients was the leading journal. "A randomized trial of a low-carbohydrate diet for obesity" and "Obesity" were considered to be the most co-cited and cited reference respectively. The hotspots of LChD are four aspects, "ketogenic diet", "metabolism disease", "cardiovascular disease" and "cancer". We summarized that "oxidative stress", "gut microbiota", and "inflammation factors" are becoming frontiers trends of LChD research in the future and deserve further study.

Discussion

Over the past 20 years research on LChD has gained great attention. To better explore LChD field, multilevel mechanism studies will be required in the future.

Obesity and diabetes: the final frontier

INTRODUCTION

Obesity is a key target in the treatment and prevention of diabetes and independently to reduce the burden of cardiovascular disease. We reviewed the options now available and anticipated to deal with obesity.

AREAS COVERED

We considered the epidemiology, genetics, and causation of obesity and the relationship to diabetes, and the dietary, pharmaceutical, and surgical management of the condition. The literature search covered both popular media via Google Search and the academic literature as indexed on PubMed with search terms including obesity, childhood obesity, adipocytes, insulin resistance, mechanisms of satiety, bariatric surgery, GLP-1 receptor agonists, and SGLT2 inhibitors.

EXPERT OPINION

Although bariatric surgery has been the primary approach to treating obese individuals, the emergence of agents impacting the brain satiety centers now promises effective, non-invasive treatment of obesity for individuals with and without diabetes. The GLP-1 receptor agonists have assumed the primary role in treating obesity with significant weight loss. Long-term results with semaglutide and tirzepatide are now approaching the success seen with bariatric surgery. Future agents combining the benefits of satiety control and thermogenesis to dissipate caloric excess are under investigation.

Low carbohydrate ketogenic diets reduce cardiovascular risk factor levels in obese or overweight patients with T2DM: A meta-analysis of randomized controlled trials

Background

The purpose of this meta-analysis was to explore the effects of low-carbohydrate ketogenic diets on cardiovascular risk factors in overweight or obese patients. However, there are limited literature data about effects of low-carbohydrate ketogenic diets on cardiovascular risk factors in obese or overweight patients.

Methods

We systematically searched PubMed, EMBASE, Web of Science, OVID, and Cochrane Library databases (last updated in September 2022) for randomized controlled trials (RCTs) which recruited overweight or obesity patients on ketogenic diets in order to control cardiovascular risk factors (blood glucose, weight, and lipids). The overall effect size for continuous variables was expressed as a weighted standardized mean difference (SMD) with a confidence interval of 95%. Considering type 2 diabetes mellitus (T2DM) status at baseline, subgroup analyses were performed when appropriate, based on T2DM comorbidity among patients. The effect model was selected according to heterogeneity.

Results

We finally selected 21 studies. Low carbohydrate ketogenic diets exerted a greater impact on cardiovascular risk factors in obese/ overweight patients with T2DM when compared with those on non-ketogenic diets, with lower fasting plasma glucose (FPG) (SMD, -0.75; P < 0.001) and hemoglobin A1c (HbA1c) (SMD, -0.53; P < 0.001) levels identified. Low-carbohydrate ketogenic diets significantly reduced body mass index (BMI) (SMD, -2.27; P = 0.032), weight (SMD, -6.72; P < 0.001), and waist circumference (SMD, -4.45; P = 0.003) in obese/ overweight patients with T2DM. Also, ketogenic diets improved lipid profiles in these patients; triglyceride (TG) (SMD, -0.32; P = 0.013) levels were lowered and high density lipoprotein (HDL) showed an upward trend with the P-value close to statistically significant level (SMD, -0.32; P = 0.052). In general, irrespective of diabetic status at baseline, ketogenic diets were more effective in reducing TG (SMD, -0.2; P = 0.02) and increasing HDL (SMD, 0.11; P = 0.03) levels when compared with non-ketogenic diets.

Conclusions

Low-carbohydrate ketogenic diets effectively improved cardiovascular risk factors (blood glucose, weight, and lipids) in obese/ overweight patients, especially those with T2DM when compared with non-ketogenic diets.

Combining Exercise and Carbohydrate Restriction in Patients with Type 2 Diabetes Mellitus-A Critical Look at Possible Intervention Effects

Combining regular exercise and a healthy diet is recommended in international guidelines to fight type 2 diabetes mellitus (T2DM). Low- and very low-carbohydrate diets have attracted attention in the last years. This article takes a critical look at the possible effects when regular exercise and carbohydrate restriction are combined. An increased intervention effect on the oxidative capacity as well as glucose and lipid profiles can be assumed (at least for a short period of time). However, anabolic signaling pathways might be blunted during a very low-carbohydrate diet and increasing ketosis. Thus, muscle build-up can become difficult or impossible. Furthermore, maximal performance during high-intensity workouts may be attenuated due to a possible reduced anaerobic glycolysis and metabolic inflexibility in T2DM patients. However, more studies are needed to evaluate the effects of this combination in comparison to those of exercise and other types of diet.

Low-Carbohydrate High-Fat Diet: A SWOC Analysis

Insulin resistance (IR) plays a role in the pathogenesis of many diseases, such as type 2 diabetes mellitus, cardiovascular disease, non-alcoholic fatty liver disease, obesity, and neurodegenerative diseases, including Alzheimer's disease. The ketogenic diet (KD) is a low-carbohydrate/high-fat diet that arose in the 1920s as an effective treatment for seizure control. Since then, the KD has been studied as a therapeutic approach for various IR-related disorders with successful results. To date, the use of the KD is still debatable regarding its safety. Some studies have acknowledged its usefulness, while others do not recommend its long-term implementation. In this review, we applied a SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis that revealed the positive, constructive strengths of the KD, its potential complications, different conditions that can make used for it, and the challenges faced by both physicians and subjects throughout a KD. This SWOC analysis showed that the KD works on the pathophysiological mechanism of IR-related disorders such as chronic inflammation, oxidative stress and mitochondrial stress. Furthermore, the implementation of the KD as a potential adjuvant therapy for many diseases, including cancer, neurodegenerative disorders, polycystic ovary syndrome, and pain management was proven. On the other hand, the short and long-term possible undesirable KD-related effects, including nutritional deficiencies, growth retardation and nephrolithiasis, should be considered and strictly monitored. Conclusively, this review provides a context for decision-makers, physicians, researchers, and the general population to focus on this dietary intervention in preventing and treating diseases. Moreover, it draws the attention of scientists and physicians towards the opportunities and challenges associated with the KD that requires attention before KD initiation.