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Peña-Jorquera H, Cid-Jofré V, Landaeta-Díaz L, Petermann-Rocha F, Martorell M, Zbinden-Foncea H, Ferrari G, Jorquera-Aguilera C, Cristi-Montero C. Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome-A Comprehensive Review. Nutrients 2023; 15:3244. [PMID: 37513660 PMCID: PMC10386413 DOI: 10.3390/nu15143244] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Atherosclerosis, chronic non-communicable diseases, and metabolic syndrome are highly interconnected and collectively contribute to global health concerns that reduce life expectancy and quality of life. These conditions arise from multiple risk factors, including inflammation, insulin resistance, impaired blood lipid profile, endothelial dysfunction, and increased cardiovascular risk. Adopting a plant-based diet has gained popularity as a viable alternative to promote health and mitigate the incidence of, and risk factors associated with, these three health conditions. Understanding the potential benefits of a plant-based diet for human health is crucial, particularly in the face of the rising prevalence of chronic diseases like diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Thus, this review focused on the plausible advantages of consuming a type of food pattern for the prevention and/or treatment of chronic diseases, emphasizing the dietary aspects that contribute to these conditions and the evidence supporting the benefits of a plant-based diet for human health. To facilitate a more in-depth analysis, we present separate evidence for each of these three concepts, acknowledging their intrinsic connection while providing a specific focus on each one. This review underscores the potential of a plant-based diet to target the underlying causes of these chronic diseases and enhance health outcomes for individuals and populations.
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Affiliation(s)
- Humberto Peña-Jorquera
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Viña del Mar 2530388, Chile
| | - Valeska Cid-Jofré
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9160019, Chile
| | - Leslie Landaeta-Díaz
- Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago 7500975, Chile
- Núcleo en Ciencias Ambientales y Alimentarias, Universidad de las Américas, Santiago 7500975, Chile
| | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago 8370068, Chile
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, Centre for Healthy Living, University of Concepción, Concepción 4070386, Chile
| | - Hermann Zbinden-Foncea
- Laboratorio de Fisiología del Ejercicio y Metabolismo, Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Santiago 7500000, Chile
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Gerson Ferrari
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Av. Pedro de Valdivia 425, Providencia 7500912, Chile
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile
| | - Carlos Jorquera-Aguilera
- Escuela de Nutrición y Dietética, Facultad de Ciencias, Universidad Mayor, Santiago 8580745, Chile
| | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Viña del Mar 2530388, Chile
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Dhillon J, Jacobs AG, Ortiz S, Diaz Rios LK. A Systematic Review of Literature on the Representation of Racial and Ethnic Minority Groups in Clinical Nutrition Interventions. Adv Nutr 2022; 13:1505-1528. [PMID: 35108358 PMCID: PMC9526835 DOI: 10.1093/advances/nmac002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes, such as cardiometabolic, inflammation, cancer, bone health, and kidney function outcomes, etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases (i.e., PubMed, Cochrane Library, and Web of Science) were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group compared with non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with 1 diet arm that accounted for race or ethnicity in their analyses and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black compared with White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared with Whites particularly with DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.
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Affiliation(s)
- Jaapna Dhillon
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
- Department of Molecular & Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, USA
| | | | - Sigry Ortiz
- Department of Molecular & Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, USA
| | - L Karina Diaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA, USA
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Pour Abbasi MS, Shojaei N, Farhangi MA. Low-carbohydrate diet score is associated with improved blood pressure and cardio-metabolic risk factors among obese adults. Physiol Rep 2022; 10:e15375. [PMID: 35822420 PMCID: PMC9277405 DOI: 10.14814/phy2.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 05/29/2023] Open
Abstract
Obesity is associated with numerous co-morbidities and diet, is one of the modifiable risk factors for prevention against these obesity-related metabolic disorders. In the current study, we aimed to evaluate the association between adherence to low carbohydrate diet (LCD) score and serum lipids, glycemic markers, blood pressure, and anthropometric parameters among obese individuals. The current cross-sectional study is a combination of two projects with total participants of 359 obese individuals (body mass index [BMI] ≥ 30 kg/m2 ) aged 20-50 years were included. Dietary intake was assessed by a validated semi-quantitative food frequency questionnaire (FFQ) of 132 food items. Low carbohydrate diet score was estimated by deciles of dietary intakes. Metabolic syndrome (MetS) was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Enzymatic methods were used to assess serum lipids, glucose, and insulin concentrations. Blood pressure was measured by sphygmomanometer and body composition with bioelectrical impedance analysis (BIA). Higher adherence to LCD score was associated with significantly lower DBP and triglyceride (TG) concentrations and increased high density lipoprotein (HDL)-C levels after adjustment for the confounders (p < 0.05). A non-significant reduction in systolic blood pressure (SBP) and total cholesterol (TC) values were also observed. Also, high adherence to LCD score was associated with reduced prevalence of metabolic syndrome (p < 0.05). Higher BMI, fat mass, and lower fat-free mass were also accompanied with higher adherence to LCD score. According to our study, low carbohydrate diet score was associated with more favorable cardio-metabolic risk factors independent of some confounders like age, BMI, sex, and physical activity level. Further studies in different communities will help for generalization of our findings.
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Affiliation(s)
| | - Niloofar Shojaei
- School of MedicineZanjan University of Medical SciencesZanjanIran
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Hafiz MS, Campbell MD, O'Mahoney LL, Holmes M, Orfila C, Boesch C. Pulse consumption improves indices of glycemic control in adults with and without type 2 diabetes: a systematic review and meta-analysis of acute and long-term randomized controlled trials. Eur J Nutr 2022; 61:809-824. [PMID: 34585281 PMCID: PMC8854292 DOI: 10.1007/s00394-021-02685-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Findings from randomized controlled trials (RCTs) evaluating the effect of pulse intake on glycemic control are inconsistent and conclusive evidence is lacking. The aim of this study was to systematically review the impact of pulse consumption on post-prandial and long-term glycemic control in adults with and without type 2 diabetes (T2D). METHODS Databases were searched for RCTs, reporting outcomes of post-prandial and long-term interventions with different pulse types on parameters of glycemic control in normoglycemic and T2D adults. Effect size (ES) was calculated using random effect model and meta-regression was conducted to assess the impact of various moderator variables such as pulse type, form, dose, and study duration on ES. RESULTS From 3334 RCTs identified, 65 studies were eligible for inclusion involving 2102 individuals. In acute RCTs, pulse intake significantly reduced peak post-prandial glucose concentration in participants with T2D (ES - 2.90; 95%CI - 4.60, - 1.21; p ≤ 0.001; I2 = 93%) and without T2D (ES - 1.38; 95%CI - 1.78, - 0.99; p ≤ 0.001; I2 = 86%). Incorporating pulse consumption into long-term eating patterns significantly attenuated fasting glucose in normoglycemic adults (ES - 0.06; 95%CI - 0.12, 0.00; p ≤ 0.05; I2 = 30%). Whereas, in T2D participants, pulse intake significantly lowered fasting glucose (ES - 0.54; 95%CI - 0.83, - 0.24; p ≤ 0.001; I2 = 78%), glycated hemoglobin A1c (HbA1c) (ES - 0.17; 95%CI - 0.33, 0.00; p ≤ 0.05; I2 = 78) and homeostatic model assessment of insulin resistance (HOMA-IR) (ES - 0.47; 95%CI - 1.25, - 0.31; p ≤ 0.05; I2 = 79%). CONCLUSION Pulse consumption significantly reduced acute post-prandial glucose concentration > 1 mmol/L in normoglycemic adults and > 2.5 mmol/L in those with T2D, and improved a range of long-term glycemic control parameters in adults with and without T2D. PROSPERO REGISTRY NUMBER: (CRD42019162322).
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Affiliation(s)
- Maryam S Hafiz
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
- Faculty of Applied Medical Sciences, Department of Clinical Nutrition, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Matthew D Campbell
- School of Nursing and Health Sciences, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Melvin Holmes
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Caroline Orfila
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Christine Boesch
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK.
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Chiavaroli L, Lee D, Ahmed A, Cheung A, Khan TA, Blanco S, Mejia, Mirrahimi A, Jenkins DJA, Livesey G, Wolever TMS, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 2021; 374:n1651. [PMID: 34348965 PMCID: PMC8336013 DOI: 10.1136/bmj.n1651] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Library searched up to 13 May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. OUTCOME AND MEASURES The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI (body mass index), waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. RESULTS 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. CONCLUSIONS This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, blood pressure, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. STUDY REGISTRATION ClinicalTrials.gov NCT04045938.
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Sonia Blanco
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- Independent Nutrition Logic, Wymondham, UK
- INQUIS Clinical Research, Toronto, ON, Canada
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | | | - Thomas M S Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- INQUIS Clinical Research, Toronto, ON, Canada
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
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Lukus PK, Doma KM, Duncan AM. The Role of Pulses in Cardiovascular Disease Risk for Adults With Diabetes. Am J Lifestyle Med 2020; 14:571-584. [PMID: 33117097 PMCID: PMC7566181 DOI: 10.1177/1559827620916698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death among adults while associated comorbidities like diabetes further increase risks of CVD-related complications and mortality. Strategies to prevent and manage CVD risk, such as dietary change, are a key component for CVD and diabetes prevention and management. Pulses, defined as the dried edible seeds of plants in the legume family, have received attention for their superior nutritional composition as high-fiber, low-glycemic index foods and have been studied for their potential to reduce CVD and diabetes risk. Both observational and experimental studies conducted among adults with and without diabetes have provided support for pulses in their ability to improve lipid profiles, glycemic control, and blood pressure, all of which are major modifiable risk factors of CVD. These capabilities have been attributed to various mechanisms associated with the nutrient and phytochemical composition of pulses. Overall, this evidence provides support for the consumption of pulses as an important dietary strategy to reduce risk of CVD for those living with and without diabetes.
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Affiliation(s)
- Patricia K. Lukus
- Department of Human Health and Nutritional Sciences,
University of Guelph, Guelph, Ontario, Canada
| | - Katarina M. Doma
- Department of Human Health and Nutritional Sciences,
University of Guelph, Guelph, Ontario, Canada
| | - Alison M. Duncan
- Department of Human Health and Nutritional Sciences,
University of Guelph, Guelph, Ontario, Canada
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7
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Zafar MI, Mills KE, Zheng J, Regmi A, Hu SQ, Gou L, Chen LL. Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr 2019; 110:891-902. [PMID: 31374573 DOI: 10.1093/ajcn/nqz149] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/24/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Low-glycemic index (GI) diets are thought to reduce postprandial glycemia, resulting in more stable blood glucose concentrations. OBJECTIVE We hypothesized that low-GI diets would be superior to other diet types in lowering measures of blood glucose control in people with type 1 or type 2 diabetes, or impaired glucose tolerance. METHODS We searched PubMed, the Cochrane Library, EMBASE, and clinical trials registries for published and unpublished studies up until 1 March, 2019. We included 54 randomized controlled trials in adults or children with impaired glucose tolerance, type 1 diabetes, or type 2 diabetes. Continuous data were synthesized using a random effects, inverse variance model, and presented as standardized mean differences with 95% CIs. RESULTS Low-GI diets were effective at reducing glycated hemoglobin (HbA1c), fasting glucose, BMI, total cholesterol, and LDL, but had no effect on fasting insulin, HOMA-IR, HDL, triglycerides, or insulin requirements. The reduction in fasting glucose and HbA1c was inversely correlated with body weight. The greatest reduction in fasting blood glucose was seen in the studies of the longest duration. CONCLUSIONS Low-GI diets may be useful for glycemic control and may reduce body weight in people with prediabetes or diabetes.
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Affiliation(s)
- Mohammad Ishraq Zafar
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Kerry E Mills
- Faculty of Science and Technology, University of Canberra, Canberra, Australia
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Anita Regmi
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Sheng Qing Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Luoning Gou
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Lu-Lu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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8
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Zafar MI, Mills KE, Zheng J, Peng MM, Ye X, Chen LL. Low glycaemic index diets as an intervention for obesity: a systematic review and meta-analysis. Obes Rev 2019; 20:290-315. [PMID: 30460737 DOI: 10.1111/obr.12791] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Low glycaemic index (GI) diets may aid in weight loss by reducing postprandial blood glucose excursions, leading to more stable blood glucose concentrations and therefore a reduction in hunger. To test this hypothesis, we conducted a systematic review and meta-analysis of randomized controlled trials comparing low GI diets with other diet types. METHODS We included 101 studies involving 109 study arms and 8,527 participants. We meta-analysed the studies using a random-effects model and conducted subgroup analyses and meta-regression based on control diet, blood glucose control, baseline BMI and dietary GI. RESULTS Low GI diets resulted in small but significant improvements in body weight, BMI, LDL and total cholesterol overall, although no individual control diet was significantly different from low GI diets. Studies in people with normal blood glucose who achieved a difference in GI of 20 points or more resulted in a larger reduction in body weight (SMD = -0.26; 95% CIs [-0.43, -0.09]), and total cholesterol (SMD = -0.24; 95% CIs [-0.42, -0.05]) than studies that only achieved a smaller reduction in GI. CONCLUSIONS Low GI diets, especially diets achieving a substantial decrease in GI, were moderately effective in lowering body weight. However, efforts should be made to increase compliance with low GI diets, in order for them to be effective in people with overweight and obesity.
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Affiliation(s)
- M I Zafar
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - K E Mills
- Faculty of Science and Technology, University of Canberra, Canberra, Australia
| | - J Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M M Peng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - X Ye
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - L L Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Clar C, Al-Khudairy L, Loveman E, Kelly SA, Hartley L, Flowers N, Germanò R, Frost G, Rees K. Low glycaemic index diets for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2017; 7:CD004467. [PMID: 28759107 PMCID: PMC6483287 DOI: 10.1002/14651858.cd004467.pub3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The glycaemic index (GI) is a physiological measure of the ability of a carbohydrate to affect blood glucose. Interest is growing in this area for the clinical management of people at risk of, or with, established cardiovascular disease. There is a need to review the current evidence from randomised controlled trials (RCTs) in this area. This is an update of the original review published in 2008. OBJECTIVES To assess the effect of the dietary GI on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible randomised controlled trials. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL in July 2016. We also checked reference lists of relevant articles. No language restrictions were applied. SELECTION CRITERIA We selected RCTs that assessed the effects of low GI diets compared to diets with a similar composition but a higher GI on cardiovascular disease and related risk factors. Minimum trial duration was 12 weeks. Participants included were healthy adults or those at increased risk of cardiovascular disease, or previously diagnosed with cardiovascular disease. Studies in people with diabetes mellitus were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently screened and selected studies. Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using GRADE, and extracted data following the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. Analyses were checked by a second reviewer. Continuous outcomes were synthesized using mean differences and adverse events were synthesized narratively. MAIN RESULTS Twenty-one RCTs were included, with a total of 2538 participants randomised to low GI intervention (1288) or high GI (1250). All 21 included studies reported the effect of low GI diets on risk factors for cardiovascular disease, including blood lipids and blood pressure.Twenty RCTs (18 of which were newly included in this version of the review) included primary prevention populations (healthy individuals or those at high risk of CVD, with mean age range from 19 to 69 years) and one RCT was in those diagnosed with pre-existing CVD (a secondary prevention population, with mean age 26.9 years). Most of the studies did not have an intervention duration of longer than six months. Difference in GI intake between comparison groups varied widely from 0.6 to 42.None of the included studies reported the effect of low GI dietary intake on cardiovascular mortality and cardiovascular events such as fatal and nonfatal myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, and stroke. The unclear risk of bias of most of the included studies makes overall interpretation of the data difficult. Only two of the included studies (38 participants) reported on adverse effects and did not observe any harms (low-quality evidence). AUTHORS' CONCLUSIONS There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters.
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Kim SJ, de Souza RJ, Choo VL, Ha V, Cozma AI, Chiavaroli L, Mirrahimi A, Blanco Mejia S, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ, Sievenpiper JL. Effects of dietary pulse consumption on body weight: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2016; 103:1213-23. [PMID: 27030531 DOI: 10.3945/ajcn.115.124677] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity is a risk factor for developing several diseases, and although dietary pulses (nonoil seeds of legumes such as beans, lentils, chickpeas, and dry peas) are well positioned to aid in weight control, the effects of dietary pulses on weight loss are unclear. OBJECTIVE We summarized and quantified the effects of dietary pulse consumption on body weight, waist circumference, and body fat by conducting a systematic review and meta-analysis of randomized controlled trials. DESIGN We searched the databases MEDLINE, Embase, CINAHL, and the Cochrane Library through 11 May 2015 for randomized controlled trials of ≥3 wk of duration that compared the effects of diets containing whole dietary pulses with those of comparator diets without a dietary pulse intervention. Study quality was assessed by means of the Heyland Methodologic Quality Score, and risk of bias was assessed with the Cochrane Risk of Bias tool. Data were pooled with the use of generic inverse-variance random-effects models. RESULTS Findings from 21 trials (n = 940 participants) were included in the meta-analysis. The pooled analysis showed an overall significant weight reduction of -0.34 kg (95% CI: -0.63, -0.04 kg; P = 0.03) in diets containing dietary pulses (median intake of 132 g/d or ∼1 serving/d) compared with diets without a dietary pulse intervention over a median duration of 6 wk. Significant weight loss was observed in matched negative-energy-balance (weight loss) diets (P = 0.02) and in neutral-energy-balance (weight-maintaining) diets (P = 0.03), and there was low evidence of between-study heterogeneity. Findings from 6 included trials also suggested that dietary pulse consumption may reduce body fat percentage. CONCLUSIONS The inclusion of dietary pulses in a diet may be a beneficial weight-loss strategy because it leads to a modest weight-loss effect even when diets are not intended to be calorically restricted. Future studies are needed to determine the effects of dietary pulses on long-term weight-loss sustainability. This protocol was registered at clinicaltrials.gov as NCT01594567.
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Affiliation(s)
- Shana J Kim
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit
| | - Russell J de Souza
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada;
| | - Vivian L Choo
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit
| | - Vanessa Ha
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Adrian I Cozma
- Department of Nutritional Sciences, Department of Medicine, and Toronto 3D Knowledge Synthesis and Clinical Trials Unit
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit
| | - Marco Di Buono
- Department of Nutritional Sciences, American Heart Association, Dallas, TX
| | - Adam M Bernstein
- Department of Nutrition, Harvard School of Public Health, Boston, MA; Wellness Institute of the Cleveland Clinic, Cleveland, OH
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Department of Medicine, and Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Li Ka Shing Knowledge Institute, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA; and
| | - Vladimir Vuksan
- Department of Nutritional Sciences, Department of Medicine, and Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Li Ka Shing Knowledge Institute, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
| | - Joseph Beyene
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Cyril Wc Kendall
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Department of Medicine, and Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Li Ka Shing Knowledge Institute, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Li Ka Shing Knowledge Institute, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
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11
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Omidizadeh A, Yusof RM, Roohinejad S, Ismail A, Abu Bakar MZ, El-Din A. Bekhit A. Anti-diabetic activity of red pitaya (Hylocereus polyrhizus) fruit. RSC Adv 2014. [DOI: 10.1039/c4ra10789f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study investigated the anti-diabetic activity of red pitaya (Hylocereus polyrhizus) fruit.
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Affiliation(s)
- Alireza Omidizadeh
- Department of Nutrition and Dietetics
- Faculty of Medicine and Health Sciences
- Universiti Putra Malaysia
- , Malaysia
| | - Rokiah Mohd Yusof
- Department of Nutrition and Dietetics
- Faculty of Medicine and Health Sciences
- Universiti Putra Malaysia
- , Malaysia
| | - Shahin Roohinejad
- Department of Food Science
- University of Otago
- Dunedin 9054, New Zealand
| | - Amin Ismail
- Department of Nutrition and Dietetics
- Faculty of Medicine and Health Sciences
- Universiti Putra Malaysia
- , Malaysia
| | - Mohd Zuki Abu Bakar
- Department of Anatomy
- Faculty of Veterinary Medicine
- Universiti Putra Malaysia
- , Malaysia
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12
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Sáyago-Ayerdi SG, Tovar J, Zamora-Gasga VM, Bello-Pérez LA. Starch digestibility and predicted glycaemic index (pGI) in starchy foods consumed in Mexico. STARCH-STARKE 2013. [DOI: 10.1002/star.201200206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sonia G. Sáyago-Ayerdi
- Instituto Tecnológico de Tepic, Laboratorio Integral de Investigación en Alimentos, División de Estudios de Posgrado; Av Instituto Tecnológico No 2595, Col Lagos del Country CP; Tepic Nayarit, México
| | - Juscelino Tovar
- Functional Food Science Centre; Lund University; Lund Sweden
| | - Victor M. Zamora-Gasga
- Instituto Tecnológico de Tepic, Laboratorio Integral de Investigación en Alimentos, División de Estudios de Posgrado; Av Instituto Tecnológico No 2595, Col Lagos del Country CP; Tepic Nayarit, México
| | - Luis A. Bello-Pérez
- Centro de Desarrollo de Productos Bióticos (CEPROBI) del Instituto Politécnico Nacional, Yautepec; Morelos México
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13
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Van Rompay MI, McKeown NM, Castaneda-Sceppa C, Ordovás JM, Tucker KL. Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes. J Nutr 2013; 143:182-8. [PMID: 23269655 PMCID: PMC3542909 DOI: 10.3945/jn.112.168914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.
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Affiliation(s)
- Maria I. Van Rompay
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | - Nicola M. McKeown
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | | | - José M. Ordovás
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | - Katherine L. Tucker
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and,Department of Health Sciences, Northeastern University, Boston, MA,To whom correspondence should be addressed. E-mail:
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14
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Shen RL, Cai FL, Dong JL, Hu XZ. Hypoglycemic effects and biochemical mechanisms of oat products on streptozotocin-induced diabetic mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2011; 59:8895-8900. [PMID: 21749041 DOI: 10.1021/jf200678q] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Oat products are abundant in β-glucan, which could lower the glycemic index of products or foods. A low glycemic index is beneficial in the control of postprandial glycemia. The study examined the hypoglycemic effects of oat products that had the same percentage of oat β-glucan and were added into the diet fed to streptozotocin-induced diabetic mice for 6 weeks, and potential mechanisms are discussed here. Oat products significantly decreased fasting blood glucose and glycosylated serum protein (p < 0.05), but the hypoglycemic effect was not more than that of metformin (p > 0.05). Oat products increased glycogen, hormone, and nuclear receptor levels (p < 0.05), decreased free fatty acid content and succinate dehydrogenase activity (p < 0.05), and inhibited pancreatic apoptosis (p < 0.05). The results showed oat products had hypoglycemic effects. Hypoglycemic effects of oat products might be regulating glucose and fat metabolisms, stimulating hormone secretion, activating the nuclear receptor, and protecting organ function.
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Affiliation(s)
- Rui-Ling Shen
- School of Food and Biological Engineering, Zhengzhou University of Light Industry, Zhengzhou, Henan, China.
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15
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Waldstein A. Popular medicine and self-care in a Mexican migrant community: toward an explanation of an epidemiological paradox. Med Anthropol 2010; 29:71-107. [PMID: 20391159 DOI: 10.1080/01459740903517386] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While Hispanics are among the most economically disadvantaged groups in the United States, immigrants from Latin America have health profiles equal to or better than Americans of European descent. Research on this epidemiological paradox suggests that aspects of Hispanic culture prevent negative health outcomes associated with poverty, poor education, and barriers to professional care. However, little attention has been given to the ethnomedical beliefs and practices of any Hispanic subgroup. Here I present an ethnographic study of women's popular medicine in a Mexican migrant community in Athens, Georgia. Migrant women promote healthy behaviors, diagnose sick family members, and prescribe home remedies. These practices stem from long traditions of self-medication and family care, which have experienced less disruption by the biomedical profession than have other North American popular medical systems. Examining Mexican popular medicine within the context of scientific literature suggests that these self-care practices protect health and should be considered by investigators of the "Hispanic health paradox." The study also suggests that directing more attention to self-care will be fruitful for medical anthropology.
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Affiliation(s)
- Anna Waldstein
- School of Anthropology and Conservation, University of Kent, Marlowe Building, Canterbury CT2 7NR, UK.
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16
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Sievenpiper JL, Kendall CWC, Esfahani A, Wong JMW, Carleton AJ, Jiang HY, Bazinet RP, Vidgen E, Jenkins DJA. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia 2009; 52:1479-95. [PMID: 19526214 DOI: 10.1007/s00125-009-1395-7] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 03/30/2009] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Dietary non-oil-seed pulses (chickpeas, beans, peas, lentils, etc.) are a good source of slowly digestible carbohydrate, fibre and vegetable protein and a valuable means of lowering the glycaemic-index (GI) of the diet. To assess the evidence that dietary pulses may benefit glycaemic control, we conducted a systematic review and meta-analysis of randomised controlled experimental trials investigating the effect of pulses, alone or as part of low-GI or high-fibre diets, on markers of glycaemic control in people with and without diabetes. METHODS We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for relevant controlled trials of >or=7 days. Two independent reviewers (A. Esfahani and J. M. W. Wong) extracted information on study design, participants, treatments and outcomes. Data were pooled using the generic inverse variance method and expressed as standardised mean differences (SMD) with 95% CIs. Heterogeneity was assessed by chi (2) and quantified by I (2). Meta-regression models identified independent predictors of effects. RESULTS A total of 41 trials (39 reports) were included. Pulses alone (11 trials) lowered fasting blood glucose (FBG) (-0.82, 95% CI -1.36 to -0.27) and insulin (-0.49, 95% CI -0.93 to -0.04). Pulses in low-GI diets (19 trials) lowered glycosylated blood proteins (GP), measured as HbA(1c) or fructosamine (-0.28, 95% CI -0.42 to -0.14). Finally, pulses in high-fibre diets (11 trials) lowered FBG (-0.32, 95% CI -0.49 to -0.15) and GP (-0.27, 95% CI -0.45 to -0.09). Inter-study heterogeneity was high and unexplained for most outcomes, with benefits modified or predicted by diabetes status, pulse type, dose, physical form, duration of follow-up, study quality, macronutrient profile of background diets, feeding control and design. CONCLUSIONS/INTERPRETATION Pooled analyses demonstrated that pulses, alone or in low-GI or high-fibre diets, improve markers of longer term glycaemic control in humans, with the extent of the improvements subject to significant inter-study heterogeneity. There is a need for further large, well-designed trials.
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Affiliation(s)
- J L Sievenpiper
- Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
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17
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Carvalho GQ, Alfenas RDCG. Índice glicêmico: uma abordagem crítica acerca de sua utilização na prevenção e no tratamento de fatores de risco cardiovasculares. REV NUTR 2008. [DOI: 10.1590/s1415-52732008000500010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As doenças cardiovasculares são consideradas um grande problema de saúde pública, uma vez que são a principal causa de morte no Brasil e no mundo. Essas doenças possuem etiologia multifatorial. Além da susceptibilidade genética, outros fatores, tais como idade e presença de hipertensão arterial, dislipidemias, obesidade, diabetes mellitus, inatividade física e alguns hábitos alimentares inadequados, são considerados importantes fatores de risco para o desenvolvimento de doenças cardiovasculares. O elevado consumo de carboidratos tem sido associado ao aumento da obesidade, às dislipidemias, à intolerância à glicose/diabetes mellitus e à resistência insulínica, estando, dessa forma, entre os fatores de risco das doenças cardiovasculares. Entretanto, existem controvérsias acerca da influência da qualidade do carboidrato ingerido no desenvolvimento de tais doenças, independentemente da quantidade ingerida. O índice glicêmico é um indicador da qualidade do carboidrato ingerido. Sua utilidade em condições de vida livre tem sido questionada, devido à interferência de vários fatores, os quais são difíceis de serem controlados sob tais condições. Este trabalho objetivou analisar criticamente os estudos que avaliaram o efeito do índice glicêmico dos alimentos na manifestação de doenças cardiovasculares e seus fatores de risco.
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18
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Rizkalla SW, Laromiguiere M, Champ M, Bruzzo F, Boillot J, Slama G. Effect of baking process on postprandial metabolic consequences: randomized trials in normal and type 2 diabetic subjects. Eur J Clin Nutr 2006; 61:175-83. [PMID: 16943848 DOI: 10.1038/sj.ejcn.1602514] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the impact of the form, fibre content, baking and processing on the glycaemic, insulinaemic and lipidaemic responses of different French breads. DESIGN AND SUBJECTS First study: Nine healthy subjects were randomized to consume in a crossover design one of six kinds of French bread (each containing 50 g available carbohydrate): classic baguette, traditional baguette, loaf of wholemeal bread (WM-B), loaf of bread fermented with yeast or with leaven, a sandwich and a glucose challenge as reference. RESULTS The glycaemic index (GI) values ranged from 57+/-9% (mean+/-s.e.m.), for the traditional baguette, to 85+/-27% for the WM-B. No significant difference was found among the different tested bread. The insulinaemic index (II), however, of the traditional baguette and of the bread fermented with leaven were lower than the other breads (analysis of variance: P<0.01). Postprandial plasma triglycerides showed similar profiles. The traditional baguette tended to decrease postprandial free fatty acids compared to levels after the classic baguette. RESULTS The GI of the traditional baguette was lower than that of the classic baguette (n=8, venous blood: 70+/-4 vs 75+/-4, P=0.002; capillary blood: 69+/-5 vs 83+/-6, P=0.028, respectively). CONCLUSIONS Some varieties of French bread (the TB) have lower II, in healthy subjects, and lower GI, in type 2 diabetic subjects, than that of the other varieties. These results might be due to bread processing difference rather than fibre content. SPONSORSHIPS Supported by grants from the National French Milling Association.
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Affiliation(s)
- S W Rizkalla
- Department of Diabetes, INSERM, Hotel-Dieu Hospital, Paris, France.
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19
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Cruz ML, Shaibi GQ, Weigensberg MJ, Spruijt-Metz D, Ball GDC, Goran MI. Pediatric obesity and insulin resistance: chronic disease risk and implications for treatment and prevention beyond body weight modification. Annu Rev Nutr 2005; 25:435-68. [PMID: 16011474 DOI: 10.1146/annurev.nutr.25.050304.092625] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The study of childhood obesity has continued to grow exponentially in the past decade. This has been driven in part by the increasing prevalence of this problem and the widespread potential effects of increased obesity in childhood on lifelong chronic disease risk. The focus of this review is on recent findings regarding the link between obesity and disease risk during childhood and adolescence. We describe recent reports relating to type 2 diabetes in youth (2), prediabetes (69, 166), metabolic syndrome (33, 35), polycystic ovarian syndrome (77), and nonalcoholic fatty liver disease (58, 146), and the mediating role of insulin resistance in these conditions. In addition, we review the implications of this research for the design of more effective treatment and prevention strategies that focus more on the improvement of obesity-related metabolic abnormalities and chronic disease risk reduction than on the conventional energy balance approach that focuses on weight management.
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Affiliation(s)
- M L Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California 90033, USA.
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20
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Abstract
BACKGROUND The glycaemic index (GI) is a physiological measure of the ability of a carbohydrate to affect blood glucose. Interest is growing in the low GI carbohydrate concept for the clinical management of people at risk of, or with established coronary heart disease. There is a need to review the current evidence from controlled trials in this area. OBJECTIVES The primary objective is to review the current evidence from RCTs that assess the relationship between the consumption of low glycaemic index diets and the effects on coronary heart disease and on risk factors for coronary heart disease. SEARCH STRATEGY We searched CENTRAL (Issue 4, 2003), MEDLINE (1966 to 2003), EMBASE (1980 to 2003) and CINAHL (1982 to 2003). We also contacted experts in the field. SELECTION CRITERIA We selected randomised controlled trials that assessed the effects of low glycaemic index diets, over a minimum of 4 weeks, on coronary heart disease (CHD) and risk factors. Participants included were adults who carry at least one major risk factor for coronary heart disease such as abnormal lipids, diabetes or being overweight. DATA COLLECTION AND ANALYSIS Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information when this was appropriate. MAIN RESULTS Fifteen randomised controlled trials met the inclusion criteria. No studies found reported the effect of low glycaemic index diets on CHD mortality or CHD events and morbidity. All fifteen included studies report the effect of low glycaemic index diets on major risk factors for CHD. Meta-analysis detected limited and weak evidence of a relationship between low glycaemic index diets and slightly lower total cholesterol, compared with higher glycaemic index diets. There is also limited and weak evidence of a small reduction in HbA1c after 12 weeks on low glycaemic index diets but not at 4 to 5 weeks. There is no evidence that low glycaemic index diets have an effect on LDL cholesterol or HDL cholesterol, triglycerides, fasting glucose or fasting insulin levels. REVIEWERS' CONCLUSIONS The evidence from randomised controlled trials showing that low glycaemic index diets reduces coronary heart disease and CHD risk factors is weak. Many of the trials identified were short-term, of poor quality and conducted on small sample sizes. There is a need for well designed, adequately powered, randomised controlled studies, of greater than 12 weeks duration to assess the effects of low glycaemic index diets for CHD.
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Affiliation(s)
- S Kelly
- School of Health and Social Care, University of Teesside, Middlesbrough, TS1 3BA, UK.
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21
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Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, Elgrably F, Slama G. Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial. Diabetes Care 2004; 27:1866-72. [PMID: 15277409 DOI: 10.2337/diacare.27.8.1866] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether a chronic low-glycemic index (LGI) diet, compared with a high-glycemic index (HGI) diet, has beneficial effects on plasma glucose control, lipid metabolism, total fat mass, and insulin resistance in type 2 diabetic patients. RESEARCH DESIGN AND METHODS Twelve type 2 diabetic men were randomly allocated to two periods of 4 weeks of an LGI or HGI carbohydrate diet separated by a 4-week washout interval, in a crossover design. RESULTS The LGI diet induced lower postprandial plasma glucose and insulin profiles and areas under the curve than after the HGI diet. At the end of the two dietary periods, the 7-day dietary records demonstrated equal daily total energy and macronutrient intake. Body weight and total fat mass were comparable. Four-week LGI versus HGI diet induced improvement of fasting plasma glucose (P < 0.01, Delta changes during LGI vs. HGI), HbA(1c) (P < 0.01), and whole-body glucose utilization measured by the euglycemic-hyperinsulinemic clamp (P < 0.05). LGI diet induced a decrease in fasting plasma total and LDL cholesterol (Delta changes LGI vs. HGI, P < 0.01), free fatty acids (P < 0.01), apolipoprotein B, and plasminogen activator inhibitor 1 activity. CONCLUSIONS Only 4 weeks of an LGI diet was able to improve glycemic control, glucose utilization, some lipid profiles, and the capacity for fibrinolysis in type 2 diabetes. Even if changes in glycemic control were modest during the 4-week period, the use of an LGI diet in a longer-term manner might play an important role in the treatment and prevention of diabetes and related disorders.
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Affiliation(s)
- Salwa W Rizkalla
- Department of Diabetes, INSERM U465, Hôtel-Dieu Hospital, 1 Place du Parvis Nôtre-Dame, 75004 Paris, France.
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