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Effects of high protein, low-glycemic index diet on lean body mass, strength, and physical performance in late postmenopausal women: a randomized controlled trial. ACTA ACUST UNITED AC 2020; 28:307-317. [PMID: 33201025 DOI: 10.1097/gme.0000000000001692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether increasing protein consumption to twice the recommended daily allowance (RDA) by The Institute of Medicine affects lean body mass (LBM), muscle strength, and physical performance in late postmenopausal women. METHODS Parallel-group randomized trial with 26 apparently healthy women aged ≥ 65 years. Participants were randomly assigned to low-glycemic index diets with protein consumption at current RDA (0.8 g/kg body weight) or twice the RDA (2RDA, 1.6 g/kg body weight). Protein intake was assessed by 24-hours urinary nitrogen excretion. Change in LBM was measured by dual-energy X-ray absorptiometry at 3 and 6 months. Secondary outcomes were appendicular lean mass, handgrip strength by dynamometry, and physical performance by gait speed. RESULTS Mean age was 70.8 ± 3.6 years, and mean BMI was 26.1 ± 3.5 kg/m2 in the overall sample. The RDA and 2RDA groups did not differ regarding baseline dietary intake. Changes from baseline in LBM (0.07 kg; 95% CI, -0.39; 0.52 kg; P = 0.100) and appendicular lean mass (0.07 kg; 95% CI, -0.34; 0.47 kg; P = 0.100) did not differ between the groups. Total body fat (-1.41 kg; 95% CI, -2.62; 0.20 kg; P = 0.019) and trunk fat mass (-0.90 kg; 95% CI, -1.55; -0.24 kg; P = 0.005) decreased similarly in both groups at the end of intervention. Adjusting for baseline BMI did not alter these findings. Handgrip strength and 4-m gait speed increased after the intervention, with no significant difference between the groups. CONCLUSIONS Protein intake exceeding the RDA did not increase LBM, strength, and physical performance in a sample of late postmenopausal woman consuming a low-glycemic index diet for 6 months.
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Duarte CK, dos Santos ALT, Kirst C, Nunes GDS, de Franceschi K, de Azevedo MJ, Zelmanovitz T. Dietary source of saturated fat and percentage body fat of patients with type 2 diabetes mellitus: A cross-sectional study. Food Sci Nutr 2019; 7:195-204. [PMID: 30680173 PMCID: PMC6341160 DOI: 10.1002/fsn3.853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The influence of dietary fat on the body fat of patients with diabetes is not well established. This cross-sectional study aimed to analyze the association between percentage body fat (PBF) and dietary sources of fat from the usual diet of patients with type 2 diabetes. METHODS Outpatients were submitted to PBF evaluation estimated by bioelectrical impedance. The patient's usual diet was assessed by a 3-day weighed diet record (WDR), and compliance was analyzed by comparing the protein intake estimated from the WDR and that from 24-hr urinary nitrogen output. RESULTS A total of 188 patients with type 2 diabetes (aged 62.5 ± 8.8 years; 57% female, body mass index [BMI] 29.3 ± 3.8 kg/m²) were analyzed and divided into groups with high and low PBF according to mean PBF (men: 26.6 ± 7.1%; women: 39.8 ± 5.9%). Patients with high PBF consumed an increased proportion of red meat (52.0% of total meat), processed meat (5.4%), and saturated fat from red meat (2.1% of energy) compared to low PBF individuals (42.3% [p = 0.036]; 3.0% [p = 0.010]; 1.5% of energy [p = 0.032], respectively). According to Poisson's regression, the consumption of red meat (PR = 1.008 [95% CI = 1.002-1.013]; p = 0.006) and the reuse of frying oil (PR = 1.670 [95% CI = 1.240-2.249]; p = 0.001) were associated with higher PBF. In the adjusted analysis, the upper tertile of processed meat intake was associated with higher PBF (PR = 1.522 [95% CI = 1.226-1.891]; p = 0.001) compared to the lower tertile. CONCLUSIONS The present study suggested that a higher ingestion of dietary sources of saturated fat was associated with high PBF in patients with type 2 diabetes.
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Affiliation(s)
- Camila Kümmel Duarte
- Nutrition Departament of Escola de EnfermagemUniversidade Federal de Minas GeraisBelo HorizonteBrasil
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | | | - Claudia Kirst
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Graziela da S. Nunes
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Karine de Franceschi
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Mirela Jobim de Azevedo
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Themis Zelmanovitz
- Endocrine Unit of Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
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dos Santos ALT, Duarte CK, Santos M, Zoldan M, Almeida JC, Gross JL, Azevedo MJ, Lichtenstein AH, Zelmanovitz T. Low linolenic and linoleic acid consumption are associated with chronic kidney disease in patients with type 2 diabetes. PLoS One 2018; 13:e0195249. [PMID: 30092058 PMCID: PMC6084813 DOI: 10.1371/journal.pone.0195249] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/19/2018] [Indexed: 01/25/2023] Open
Abstract
Aim This cross-sectional study aimed to assess the association of the fat content in the diet with Diabetic Kidney Disease (DKD) in patients with type 2 diabetes. Methodology Patients from the Diabetes research clinic at Hospital de Clínicas de Porto Alegre (Brazil) were consecutively recruited. The inclusion criterion was the diagnosis of type 2 diabetes. The exclusion criteria were as follows: body mass index >40 kg/m2, heart failure, gastroparesis, diabetic diarrhea, dietary counseling by a registered dietitian during the previous 12 months, and inability to perform the weighed diet records (WDR). The dietary fatty acids (saturated, monounsaturated and polyunsaturated) consumption was estimated by 3-day WDR. Compliance with the WDR technique was assessed by comparison of protein intake estimated from the 3-day WDR and from the 24-h urinary nitrogen output performed on the third day of the WDR period. The presence of DKD was defined as urinary albumin excretion (UAE) ≥ 30 mg / 24 h or/and glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Urinary albumin was measured twice and eGFR was estimated by using the CKD-EPI equation. Results A total of 366 patients were evaluated; of these, 33% (n = 121) had DKD. Multivariate analysis showed that the intake of linolenic acid was negatively associated with DKD (OR = 0.57; 95% CI 0.35–0.93; P = 0.024), adjusted for gender, smoking, cardiovascular disease, ACE inhibitors and/or angiotensin receptor blocker use, systolic blood pressure, fasting plasma glucose and HDL cholesterol. In a separate model, similar results were observed for linoleic acid, adjusting to the same co-variables (OR = 0.95; 95% CI 0.91–0.99; P = 0.006). Conclusion The lower intake of polyunsaturated fatty acids, especially linolenic and linoleic acid, is associated with chronic kidney disease in patients with type 2 diabetes.
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Affiliation(s)
- Ana Luiza Teixeira dos Santos
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Kummel Duarte
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoella Santos
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maira Zoldan
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jussara Carnevalle Almeida
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jorge Luiz Gross
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mirela Jobim Azevedo
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alice Hinda Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, MA, United States of America
| | - Themis Zelmanovitz
- Medical Sciences Post-Graduate Program: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
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Beretta MV, Bernaud FR, Nascimento C, Steemburgo T, Rodrigues TC. Higher fiber intake is associated with lower blood pressure levels in patients with type 1 diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:47-54. [PMID: 29694634 PMCID: PMC10118680 DOI: 10.20945/2359-3997000000008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/17/2017] [Indexed: 11/23/2022]
Abstract
Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.
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Affiliation(s)
- Mileni Vanti Beretta
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Fernanda R Bernaud
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Ciglea Nascimento
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Thais Steemburgo
- Departamento de Nutrição, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Ticiana C Rodrigues
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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Eccel Prates R, Beretta MV, Nascimento FV, Bernaud FR, de Almeira JC, Rodrigues TC. Saturated fatty acid intake decreases serum adiponectin levels in subjects with type 1 diabetes. Diabetes Res Clin Pract 2016; 116:205-11. [PMID: 27321337 DOI: 10.1016/j.diabres.2016.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/29/2016] [Accepted: 03/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adiponectin is a protein secreted by adipose tissue. It plays a key role in insulin resistance and has anti-inflammatory and anti-atherogenic functions. Changes in diet can influence adiponectin levels. Different dietary interventions, especially those altering fatty acid intake, have been reported as possible mediators of adiponectin levels. METHODS We conducted a cross-sectional study of 122 subjects with type 1 diabetes (T1DM). Dietary intake was evaluated by 3-day weighed-diet records. Adiponectin levels were categorized into tertiles (T1, <10.260μg/mL; T2, 10.261-18.280μg/mL; T3, >18.281μg/mL). RESULTS Mean age was 38±11years, and mean duration of diabetes was 17±9years. After multiple regression analysis, waist-to-hip ratio (WHR) (r=-0.19, p = 0.03), age (r=-0.22, p=0.01), systolic blood pressure (SBP) (r=-0.27, p=0.002), diastolic blood pressure (DBP) (r=-0.19, p=0.30), total lipid intake (g) (r=-0.20, p=0.02), saturated fatty acid (SFA) intake (r=-0.25, p=0.004), monounsaturated fatty acid (MUFA) intake (r=-0.21, p=0.02), cholesterol intake (mg) (r=-0.20, p=0.021), sodium intake (g) (r=-0.19, p=0.03), and urinary albumin excretion rate (UAE) (μg/24h) (r=0.26, p=0.02) correlated with adiponectin levels. Even after adjustment for age, SBP or DBP, UAE, and WHR in all models, inverse associations between adiponectin levels and intake of total SFA and MUFA and polyunsaturated fatty acid fractions were observed. Subjects in the first and third tertiles of adiponectin exhibited the greatest differences between adiponectin levels, with a trend toward increasing levels with higher SFA intake. CONCLUSIONS The present study suggests that high SFA intake may be associated with lower adiponectin levels in patients with T1DM.
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Affiliation(s)
- Raquel Eccel Prates
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Mileni V Beretta
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Filipe V Nascimento
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Fernanda R Bernaud
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Ticiana C Rodrigues
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
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ANTONIO JP, SILVA FM, CAMEY SA, AZEVEDO MJD, ALMEIDA JCD. Development of a Healthy Eating Index for patients with type 2 diabetes. REV NUTR 2015. [DOI: 10.1590/1415-52732015000500006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective:This study sought to develop a dietary index for assessment of diet quality aiming for compliance with dietary recommendations for diabetes: The Diabetes Healthy Eating Index.Methods:Cross-sectional study with 201 outpatients with type 2 diabetes (61.4±9.7 years of age; 72.1% were overweight; 12.1±7.7 years of diagnosis; 7.3±1.3% mean HbA1c). Clinical and laboratory evaluations were performed together with 3-day weight diet records. The dietary index developed included 10 components: "diet variety", "fresh fruits", "vegetables", "carbohydrates and fiber sources", "meats and eggs", "dairy products and saturated fatty acids", "oils and fats", "total lipids", "cholesterol", and "transunsaturated fatty acids". The performance of each component was evaluated using the Item Response Theory, and diet quality was scored from 0-100%.Results:Overall, diet quality in this sample was 39.8±14.3% (95%CI=37.8-41.8%), and only 55 patients had a total diet quality score >50%. Good compliance was observed in only four index components: "total lipids", "variety", "fiber sources", and "dairy and saturated fatty acids". The components that differentiated patients with poor dietary quality from those with good dietary quality were "vegetables", "diet variety", "dairy and saturated fatty acids" and "total lipids". The greatest determinants of dietary quality were the components "diet variety", "vegetables", and "total lipids".Conclusion:This dietary index proposed assesses diet quality in compliance with the specific nutritional recommendations for diabetes. In clinical practice, this novel index may be a useful tool for the assessment and management of diet of patients with type 2 diabetes.
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Sarmento RA, Antonio JP, Riboldi BP, Montenegro KR, Friedman R, de Azevedo MJ, de Almeida JC. Reproducibility and validity of a quantitative FFQ designed for patients with type 2 diabetes mellitus from southern Brazil. Public Health Nutr 2014; 17:2237-45. [PMID: 24107661 PMCID: PMC10282628 DOI: 10.1017/s1368980013002644] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/11/2013] [Accepted: 08/25/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the reproducibility and validity of a previously constructed FFQ to assess the usual diet of patients with type 2 diabetes mellitus (T2DM). DESIGN Cross-sectional survey using two quantitative FFQ (1-month interval) supported by a food photograph portfolio, a 3 d weighed diet record (WDR) and urinary N output measurement (as a biomarker of protein intake). SETTING Group of Nutrition in Endocrinology, southern Brazil. SUBJECTS Out-patients with T2DM. RESULTS From a total of 104 eligible T2DM patients, eighty-eight were included in the evaluation of FFQ reproducibility and seventy-two provided data for the validity study. The intakes estimated from the two FFQ did not differ (P > 0·05) and the correlation coefficients were significant (P < 0·01) for energy and nutrients, ranging from 0·451 (soluble fibre) to 0·936 (PUFA). Regarding the validity evaluation, data from the FFQ were higher than those from the WDR for total (28·3%), soluble (27·4%) and insoluble fibres (29·1%), and SFA (13·5%), MUFA (11·1 %) and total lipids (9·2%; all P < 0·05). There were significant correlation coefficients between the FFQ and WDR for most nutrients, when adjusted for energy intake and de-attenuated. Also, the Bland-Altman plots between the FFQ and WDR for energy and macronutrient intakes showed that the FFQ may be used as alternative method to the WDR. The validity coefficient (using the method of triads) for the FFQ protein intake was 0·522 (95% CI 0·414, 0·597). CONCLUSIONS This quantitative FFQ was valid and precise to assess the usual diet of patients with T2DM, according to its validity and reproducibility.
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Affiliation(s)
- Roberta Aguiar Sarmento
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Peçanha Antonio
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - Bárbara Pelicioli Riboldi
- Nutrition College, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Karina Romeu Montenegro
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
- Nutrition College, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Friedman
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mirela Jobim de Azevedo
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jussara Carnevale de Almeida
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
- Nutrition College, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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dos Santos ALT, Weiss T, Duarte CK, Gross JL, de Azevedo MJ, Zelmanovitz T. Dietary fat composition and cardiac events in patients with type 2 diabetes. Atherosclerosis 2014; 236:31-8. [PMID: 25014032 DOI: 10.1016/j.atherosclerosis.2014.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/07/2014] [Accepted: 06/18/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate associations of dietary fat composition with the development of cardiac events in patients with type 2 diabetes, without ischemic heart disease who were followed for at least 12 months. METHODS In this prospective cohort study the usual diet of patients was retrospectively assessed by a 3-day weighed diet record (WDR). Compliance with the WDR technique was assessed by comparing protein intake estimated from 3-day WDR and 24-h urinary nitrogen output. The following were considered cardiac events: myocardial infarction, myocardial revascularization procedures, congestive heart failure, new-onset angina pectoris, and sudden death. RESULTS A total of 227 patients with type 2 diabetes (aged 59 ± 10 years; 46.0% male), were followed during 4.6 years. In a multivariate Cox regression analysis, the intake of polyunsaturated fatty acids had a protective effect for cardiac events (HR = 0.31, 95% CI: 0.11-0.89; P = 0.03) adjusted for age, gender, duration of diabetes, smoking, compliance with WDR, using hypolipidemic agents, and the presence of hypertension and diabetic nephropathy. When the fat intake was divided into quartiles, the highest intake of α-linolenic acid (>1.25% of energy) was negatively associated with cardiac events (HR = 0.58, 95% CI: 0.39-0.85; P = 0.006), adjusted for the same covariates.. CONCLUSION In patients with type 2 diabetes without ischemic heart disease, a high intake of polyunsaturated fatty acids, especially alpha linolenic acid, was protective for the development of cardiac events..
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Affiliation(s)
- Ana Luiza Teixeira dos Santos
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Tanara Weiss
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Camila Kümmel Duarte
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Jorge Luiz Gross
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Mirela Jobim de Azevedo
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Themis Zelmanovitz
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350/ Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, RS, Brazil.
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Morimoto Y, Sakuma M, Ohta H, Suzuki A, Matsushita A, Umeda M, Ishikawa M, Taketani Y, Takeda E, Arai H. Estimate of dietary phosphorus intake using 24-h urine collection. J Clin Biochem Nutr 2014; 55:62-6. [PMID: 25120281 PMCID: PMC4078069 DOI: 10.3164/jcbn.14-15] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/18/2014] [Indexed: 01/19/2023] Open
Abstract
Increases in serum phosphorus levels and dietary phosphorus intake induces vascular calcification, arterial sclerosis and cardiovascular diseases. Limiting phosphorus intake is advisable, however, no assessment methods are capable of estimating dietary phosphorus intake. We hypothesized that urinary phosphorus excretion can be translated into estimation of dietary phosphorus intake, and we evaluated whether a 24-h urine collection method could estimate dietary phosphorus intake. Thirty two healthy subjects were recruited for this study. Subjects collected urine samples over 24 h and weighed dietary records. We calculated dietary protein intake and phosphorus intake from dietary records and urine collection, and investigated associations between the two methods in estimating protein and phosphorus intake. Significant positive correlations were observed between dietary records and UC for protein and phosphorus intake. The average intakes determined from dietary records were significantly higher than from urine collection for both protein and phosphorus. There was a significant positive correlation between both the phosphorus and protein difference in dietary records and urine collection. The phosphorus-protein ratio in urine collection was significantly higher than in dietary records. Our data indicated that the 24-h urine collection method can estimate the amount of dietary phosphorus intake, and the results were superior to estimation by weighed dietary record.
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Affiliation(s)
- Yuuka Morimoto
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Masae Sakuma
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Hiroyuki Ohta
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Akitsu Suzuki
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Asami Matsushita
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Minako Umeda
- School of Nursing Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Makoto Ishikawa
- School of Nursing Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Yutaka Taketani
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Eiji Takeda
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Hidekazu Arai
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
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10
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Bernaud FSR, Beretta MV, do Nascimento C, Escobar F, Gross JL, Azevedo MJ, Rodrigues TC. Fiber intake and inflammation in type 1 diabetes. Diabetol Metab Syndr 2014; 6:66. [PMID: 25002911 PMCID: PMC4083349 DOI: 10.1186/1758-5996-6-66] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/29/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Higher intake of dietary fiber is associated with lower risk of coronary heart disease, the leading cause of mortality among people with type 1 diabetes. The protective effect includes the anti-inflammatory properties of some foods. Population-based studies have shown an inverse association between some nutritional habits and high sensitive -C-reactive protein (hs-CRP). This study aimed to ascertain the association between fiber intake and hs-CPR levels in patients with type 1 diabetes. METHODS This cross-sectional study was conducted with 106 outpatients with type 1 diabetes; age 40 ± 11 years; diabetes duration of 18 ± 8.8 years. Dietary intake was evaluated by 3-day weighed-diet records. Patients were categorized in 2 groups, according to fiber intake (>20 g/day and <20 g/day). RESULTS The group with fiber intake > 20 g/day had lower hs-CRP levels [median (25(th-)75(th)) 0.7 mg/dl (0.4-2.4) vs. 1.9 mg/dl (1.0-4.4); P = 0.002], than the other group. Controlled for HbA1c and energy intake, an inverse relation was observed between hs-CRP levels and total fiber [ß = - 0.030 (SE: 0.0120), P = 0.02], soluble fiber [ß = - 0.078 (SE: 0.0421), P = 0.06] and insoluble fiber [ß = - 0.039 (SE: 0.01761), P = 0.026]. Even, after additional adjustment fibers remained associated with lower hs-CRP levels. Total fibers were stratified in 4 groups: < 10 g/day, from 10 to < 20 g/day, from 20 to 30 g/day and > 30 g/day. Compared to the group who ingested < 10 g/day of total fiber (referent group), the group who consumed > 30 g/d had significantly lower hs-CRP levels [-2.45 mg/L, P = 0.012] independent of the HbA1c values. CONCLUSIONS The present study suggests that an increased consumption of dietary fiber > 30 g/day may play a role in reducing inflammation in individuals with type 1 diabetes.
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Affiliation(s)
- Fernanda S R Bernaud
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Mileni Vanti Beretta
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Cigléa do Nascimento
- Division of Endocrinology of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Fabrícia Escobar
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Jorge L Gross
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
- Division of Endocrinology of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Mirela J Azevedo
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
- Division of Endocrinology of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
| | - Ticiana C Rodrigues
- Departament of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
- Division of Endocrinology of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS, Brazil
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11
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Sarmento RA, Riboldi BP, da Costa Rodrigues T, de Azevedo MJ, de Almeida JC. Development of a quantitative food frequency questionnaire for Brazilian patients with type 2 diabetes. BMC Public Health 2013; 13:740. [PMID: 23938026 PMCID: PMC3751547 DOI: 10.1186/1471-2458-13-740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 08/07/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years. The present manuscript aims to develop a quantitative food frequency questionnaire (FFQ) and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with type 2 diabetes to be used in future studies. METHODS Dietary data using 3-day weighed diet records (WDR) from 188 outpatients with type 2 diabetes were used to construct the list of usually consumed foods. Foods were initially clustered into eight groups: "cereals, tubers, roots, and derivatives"; "vegetables and legumes"; "fruits"; "beans"; "meat and eggs"; "milk and dairy products"; "oils and fats", and "sugars and sweets". The frequency of food intake and the relative contribution of each food item to the total energy and nutrient intakes were calculated. Portion sizes were determined according to the 25th, 50th, 75th, and 95th percentiles of intake for each food item. RESULTS A total of 62 food items were selected based on the 3-day WDR and another 27 foods or how they are prepared and nine beverages were included after the expert examination. Also, a portfolio with food photos of each included food item and portion sizes was made to assist the patients in identifying the consumed portion. CONCLUSIONS We developed a practical quantitative FFQ and portfolio with photos of 98 food items covering those most commonly consumed in the past 12 months, to assess the usual diet pattern of patients with type 2 diabetes in Southern Brazil.
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Affiliation(s)
- Roberta Aguiar Sarmento
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Bárbara Pelicioli Riboldi
- Nutrition Graduate Program, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ticiana da Costa Rodrigues
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mirela Jobim de Azevedo
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jussara Carnevale de Almeida
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
- Nutrition Graduate Program, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Steemburgo T, Azevedo MJ, Gross JL, Milagro FI, Campión J, Martínez JA. The rs9939609 polymorphism in the FTO gene is associated with fat and fiber intakes in patients with type 2 diabetes. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2013; 6:97-106. [PMID: 23689376 DOI: 10.1159/000350741] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 03/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The common polymorphism in the FTO gene (rs9939609) has been associated with obesity, type 2 diabetes, and appetite regulation. The aim of this study was to evaluate possible associations of FTO rs9939609 with dietary factors in patients with type 2 diabetes. METHODS This was a cross-sectional study of 236 patients with type 2 diabetes (age 60.0 ± 10.3 years; diabetes duration 12.7 ± 8.2 years; 53.4% females) who were genotyped for FTO rs9939609. Patients underwent clinical and laboratory evaluations and 3-day weighed diet records. Data on dietary intake were categorized as high or low, based on median values. RESULTS The AA genotype in the FTO gene was positively associated with high fat (>34% energy; OR = 2.17; 95% CI 1.02-4.63) and low fiber intakes (<16 g/day; OR = 2.42; 95% CI 1.05-5.57), adjusted for gender, BMI, total energy intake, systolic blood pressure, and HbA1c. When gender was taken into account, AA females had higher fat (37.4 ± 5.3 vs. 32.6 ± 7.5 and 32.2 ± 6.2% energy; p = 0.005) and lower fiber intakes (12.4 ± 4.4 vs. 15.1 ± 6.3 and 16.7 ± 5.6 g/day; p = 0.023) than patients with TT and AT genotypes. Multiple logistic regression models confirmed female associations for high fat (OR = 9.73; 95% CI 2.12-44.66) and low fiber intakes (OR = 4.28; 95% CI 1.14-16.06; p < 0.05 for all models). CONCLUSIONS Patients with type 2 diabetes, who were carriers of the AA genotype of the FTO rs9939609, had increased fat and decreased fiber consumption, independently of BMI.
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Affiliation(s)
- Thais Steemburgo
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Lunch energy density and the metabolic syndrome in patients with type 2 diabetes mellitus. Br J Nutr 2013; 110:1656-63. [PMID: 23611470 DOI: 10.1017/s0007114513000846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the present study was to investigate the possible associations between dietary energy density (ED) and the metabolic syndrome (MetS) in patients with type 2 diabetes. In the present case-control study, the dietary ED of 125 patients with type 2 diabetes (seventy-eight with (cases) the MetS and forty-seven without (controls) the MetS; mean age 62·0 (SD 9·4) years, mean diabetes duration 12·5 (SD 8·4) years and mean glycated Hb 7·2 (SD 1·3) %) was assessed by weighed diet records. The MetS was defined according to the 2009 Joint Interim Statement and ED by the amount of energy (kJ) in a given weight of food. Data are expressed as means (standard deviations) or medians (interquartile ranges). Patients with the MetS reported lower intakes of total energy and fibre, and a higher total food amount than the controls; the total ED did not differ, but the cases had a higher ED at lunch (mean 6·3 (SD 1·3) v. 5·9 (SD 0·8) kJ/g; P= 0·017). In this meal, patients with the MetS had lower intakes of beans (median 0·7 (interquartile range 0·4-1·1) v. 1·1 (interquartile range 0·6-1·6) g/kg; P= 0·020), vegetables (median 1·2 (interquartile range 0·6-1·7) v. 1·4 (interquartile range 1·0-2·0) g/kg; P= 0·046) and total meat (median 1·3 (interquartile range 1·0-1·6) v. 1·4 (interquartile range 1·2-1·8) g/kg; P= 0·034) than patients without the MetS. The associations between lunch ED (kJ/g) and food groups (g/kg) were confirmed for vegetables (r - 0·584; P< 0·001), fruits (r - 0·233; P= 0·070), beans (r - 0·189; P= 0·037) and oils (r 0·323; P< 0·001). In a multivariate logistic regression model, a high lunch ED was associated with the MetS (OR 6·89, 95 % CI 1·35, 35·15; P =0·020) after adjusting for confounders. In conclusion, a high ED at lunch increased the odds of the presence of the MetS in patients with type 2 diabetes. Beans and vegetables may be the major contributors to this association and their consumption might be considered to decrease ED.
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Validation of protein and potassium intakes assessed from 24 h recalls against levels estimated from 24 h urine samples in children and adolescents of Turkish descent living in Germany: results from the EVET! Study. Public Health Nutr 2011; 15:640-7. [PMID: 22017884 DOI: 10.1017/s1368980011002734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nutrition-related health problems such as obesity are frequent among children and adolescents of Turkish descent living in Germany, yet data on their dietary habits are scarce. One reason might be the lack of validated assessment tools for this target group. We therefore aimed to validate protein and K intakes from one 24 h recall against levels estimated from one 24 h urine sample in children and adolescents of Turkish descent living in Germany. DESIGN Cross-sectional analyses comprised estimation of mean differences, Pearson correlation coefficients, cross-classifications and Bland-Altman plots to assess the agreement between the nutritional intake estimated from a single 24 h recall and a single 24 h urine sample collected on the previous day. SETTING Dortmund, Germany. SUBJECTS Data from forty-three study participants (aged 5-18 years; 26% overweight) with a traditional Turkish background were included. RESULTS The 24 h recall significantly overestimated mean protein and K intake by 10·7 g/d (95% CI of mean difference: 0·6, 20·7 g/d) and 344 mg/d (95% CI 8, 680 mg/d), respectively. Correlations between intake estimates were r = 0·25 (P = 0·1) and 0·31 (P = 0·05). Both methods classified 70% and 69% of the participants into the same/adjacent quartile of protein and K intake and misclassified 7% and 7%, respectively, into the opposite quartile. Bland-Altman plots indicated a wide scattering of differences in both protein and K intake. CONCLUSIONS Among children and adolescents of traditional Turkish descent living in Germany, one 24 h recall may only be valid for categorizing subjects into high, medium or low consumers.
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Silva FM, Steemburgo T, de Mello VD, Tonding SF, Gross JL, Azevedo MJ. High Dietary Glycemic Index and Low Fiber Content Are Associated with Metabolic Syndrome in Patients with Type 2 Diabetes. J Am Coll Nutr 2011; 30:141-8. [DOI: 10.1080/07315724.2011.10719953] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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