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Diamond DM, Mason P, Bikman BT. Opinion: Are mental health benefits of the ketogenic diet accompanied by an increased risk of cardiovascular disease? Front Nutr 2024; 11:1394610. [PMID: 38751739 PMCID: PMC11095042 DOI: 10.3389/fnut.2024.1394610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- David M. Diamond
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | | | - Benjamin T. Bikman
- Department of Cell Biology and Physiology, Brigham Young University, Provo, UT, United States
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Hassell Sweatman CZW. Modelling remission from overweight type 2 diabetes reveals how altering advice may counter relapse. Math Biosci 2024; 371:109180. [PMID: 38518862 DOI: 10.1016/j.mbs.2024.109180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
The development or remission of diet-induced overweight type 2 diabetes involves many biological changes which occur over very different timescales. Remission, defined by HbA1c<6.5%, or fasting plasma glucose concentration G<126 mg/dl, may be achieved rapidly by following weight loss guidelines. However, remission is often short-term, followed by relapse. Mathematical modelling provides a way of investigating a typical situation, in which patients are advised to lose weight and then maintain fat mass, a slow variable. Remission followed by relapse, in a modelling sense, is equivalent to changing from a remission trajectory with steady state G<126 mg/dl, to a relapse trajectory with steady state G≥126 mg/dl. Modelling predicts that a trajectory which maintains weight will be a relapse trajectory, if the fat mass chosen is too high, the threshold being dependent on the lipid to carbohydrate ratio of the diet. Modelling takes into account the effects of hepatic and pancreatic lipid on hepatic insulin sensitivity and β-cell function, respectively. This study leads to the suggestion that type 2 diabetes remission guidelines be given in terms of model parameters, not variables; that is, the patient should adhere to a given nutrition and exercise plan, rather than achieve a certain subset of variable values. The model predicts that calorie restriction, not weight loss, initiates remission from type 2 diabetes; and that advice of the form 'adhere to the diet and exercise plan' rather than 'achieve a certain weight loss' may help counter relapse.
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Affiliation(s)
- Catherine Z W Hassell Sweatman
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, 55 Wellesley Street East, Auckland 1010, New Zealand.
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Love SAM, Collins JM, Anthony KM, Buchheit SF, Butler EN, Bey GS, Gondalia R, Hayden KM, Zannas AS, Bick AG, Manson JE, Desai PM, Natarajan P, Bhattacharya R, Jaiswal S, Barac A, Reiner A, Kooperberg C, Stewart JD, Whitsel EA. Individual and Neighborhood-level Socioeconomic Status and Somatic Mutations Associated With Increased Risk of Cardiovascular Disease and Mortality: A Cross-Sectional Analysis in the Women's Health Initiative. Womens Health Issues 2024; 34:197-207. [PMID: 38061917 PMCID: PMC10978295 DOI: 10.1016/j.whi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Clonal hematopoiesis of indeterminate potential (CHIP), the expansion of leukemogenic mutations in white blood cells, has been associated with increased risk of atherosclerotic cardiovascular diseases, cancer, and mortality. OBJECTIVE We examined the relationship between individual- and neighborhood-level socioeconomic status (SES) and CHIP and evaluated effect modification by interpersonal and intrapersonal resources. METHODS The study population included 10,799 postmenopausal women from the Women's Health Initiative without hematologic malignancy or antineoplastic medication use. Individual- and neighborhood (Census tract)-level SES were assessed across several domains including education, income, and occupation, and a neighborhood-level SES summary z-score, which captures multiple dimensions of SES, was generated. Interpersonal and intrapersonal resources were self-reports. CHIP was ascertained based on a prespecified list of leukemogenic driver mutations. Weighted logistic regression models adjusted for covariates were used to estimate risk of CHIP as an odds ratio (OR) and 95% confidence interval (95% CI). RESULTS The interval-scale neighborhood-level SES summary z-score was associated with a 3% increased risk of CHIP: OR (95% CI) = 1.03 (1.00-1.05), p = .038. Optimism significantly modified that estimate, such that among women with low/medium and high levels of optimism, the corresponding ORs (95% CIs) were 1.03 (1.02-1.04) and 0.95 (0.94-0.96), pInteraction < .001. CONCLUSIONS Our findings suggest that reduced risk of somatic mutation may represent a biological pathway by which optimism protects contextually advantaged but at-risk women against age-related chronic disease and highlight potential benefits of long-term, positive psychological interventions.
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Affiliation(s)
- Shelly-Ann M Love
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Jason M Collins
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kurtis M Anthony
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sophie F Buchheit
- Division of Biology and Medicine, Brown University, Providence, Rhode Island
| | - Eboneé N Butler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ganga S Bey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rahul Gondalia
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Injury Surveillance and Analytics, Real-World Analytics Solutions, IQVIA, Durham, North Carolina
| | - Kathleen M Hayden
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony S Zannas
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Institute for Trauma Recovery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medicine, Neuroscience Curriculum, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Pinkal M Desai
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, New York
| | - Pradeep Natarajan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Romit Bhattacharya
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Siddhartha Jaiswal
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Ana Barac
- Division of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, District of Columbia; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Alex Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Soto-Mota A, Flores-Jurado Y, Norwitz NG, Feldman D, Pereira MA, Danaei G, Ludwig DS. Increased low-density lipoprotein cholesterol on a low-carbohydrate diet in adults with normal but not high body weight: A meta-analysis. Am J Clin Nutr 2024; 119:740-747. [PMID: 38237807 DOI: 10.1016/j.ajcnut.2024.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Low-density lipoprotein (LDL) cholesterol change with consumption of a low-carbohydrate diet (LCD) is highly variable. Identifying the source of this heterogeneity could guide clinical decision-making. OBJECTIVES To evaluate LDL cholesterol change in randomized controlled trials involving LCDs, with a focus on body mass index (BMI) in kg/m2. METHODS Three electronic indexes (Pubmed, EBSCO, and Scielo) were searched for studies between 1 January, 2003 and 20 December, 2022. Two independent reviewers identified randomized controlled trials involving adults consuming <130 g/d carbohydrate and reporting BMI and LDL cholesterol change or equivalent data. Two investigators extracted relevant data, which were validated by other investigators. Data were analyzed using a random-effects model and contrasted with results of pooled individual participant data. RESULTS Forty-one trials with 1379 participants and a mean intervention duration of 19.4 wk were included. In a meta-regression accounting for 51.4% of the observed variability on LCDs, mean baseline BMI had a strong inverse association with LDL cholesterol change [β = -2.5 mg/dL/BMI unit, 95% confidence interval (CI): -3.7, -1.4], whereas saturated fat amount was not significantly associated with LDL cholesterol change. For trials with mean baseline BMI <25, LDL cholesterol increased by 41 mg/dL (95% CI: 19.6, 63.3) on the LCD. By contrast, for trials with a mean of BMI 25-<35, LDL cholesterol did not change, and for trials with a mean BMI ≥35, LDL cholesterol decreased by 7 mg/dL (95% CI: -12.1, -1.3). Using individual participant data, the relationship between BMI and LDL cholesterol change was not observed on higher-carbohydrate diets. CONCLUSIONS A substantial increase in LDL cholesterol is likely for individuals with low but not high BMI with consumption of an LCD, findings that may help guide individualized nutritional management of cardiovascular disease risk. As carbohydrate restriction tends to improve other lipid and nonlipid risk factors, the clinical significance of isolated LDL cholesterol elevation in this context warrants investigation. This trial was registered at PROSPERO as CRD42022299278.
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Affiliation(s)
- Adrian Soto-Mota
- Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico; Tecnologico de Monterrey, School of Medicine, Mexico City, Mexico
| | - Yuscely Flores-Jurado
- Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico; National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | | | - David Feldman
- Citizen Science Foundation, Las Vegas, NV, United States
| | - Mark A Pereira
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, United States
| | - Goodarz Danaei
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - David S Ludwig
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, MA, United States.
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Liu YJ, Duan JW, Lu DH, Zhang F, Liu HL. Association between vitamin D status and cardiometabolic risk factors in adults with type 2 diabetes in Shenzhen, China. Front Endocrinol (Lausanne) 2024; 15:1346605. [PMID: 38419955 PMCID: PMC10899682 DOI: 10.3389/fendo.2024.1346605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Evidence of vitamin D status and cardiometabolic health in adults with type 2 diabetes mellitus (T2DM) is still limited. This study aimed to investigate the association between vitamin D status and cardiometabolic risk factors among adults with T2DM in Shenzhen, China. Methods This cross-sectional study included 164 adults (aged ≥18 years) with T2DM who were hospitalized at Peking University Shenzhen Hospital from March 1, 2023, to May 31, 2023. Serum 25-hydroxyvitamin D [25(OH)D] concentration, the active marker of vitamin D, and three major cardiometabolic risk factors including blood pressure (BP), glucose metabolism-related indicators, and blood lipid profiles were collected. Vitamin D deficiency (VDD) was defined as 25(OH)D < 20 ng/mL. Correlation, Regression, and Logistic analysis were applied to verify the association among serum 25(OH)D concentration, VDD, and 11 cardiometabolic risk factors. Results Median 25(OH)D concentration was 21.78 [interquartile range (IQR)=17.51-28.05] ng/mL. The prevalence of VDD was 40.24%. Serum 25(OH)D concentration was significantly negatively correlated with diastolic BP (DBP) and glycated hemoglobin A1c (HbA1c) rather than systolic BP, plasma glucose, plasma C-peptide, and blood lipid profiles among adults with T2DM in both correlation and linear regression analysis. Furthermore, the adjusted odd ratio for poor DBP control (≥90 mmHg) of T2DM patients with VDD was 3.164 (95% confidence interval=1.303, 7.683; P=0.011) compared to those without VDD. Conclusion In China, VDD was highly prevalent among adults with T2DM and associated with greater cardiovascular risk factors, especially with increased chances of uncontrolled DBP. These findings suggest that vitamin D levels should be monitored in T2DM patients, especially those with high DBP.
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Affiliation(s)
- Yan-Jing Liu
- Department of Endocrinology and Metabolism, Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jing-Wen Duan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dong-Hui Lu
- Department of Endocrinology and Metabolism, Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Fan Zhang
- Department of Endocrinology and Metabolism, Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hong-Li Liu
- Department of Endocrinology and Metabolism, Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Dinesh S, Sharma S, Chourasiya R. Therapeutic Applications of Plant and Nutraceutical-Based Compounds for the Management of Type 2 Diabetes Mellitus: A Narrative Review. Curr Diabetes Rev 2024; 20:e050523216593. [PMID: 37151065 DOI: 10.2174/1573399819666230505140206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 05/09/2023]
Abstract
Diabetes mellitus is a condition caused by a deficiency in insulin production or sensitivity that is defined by persistent hyperglycemia as well as disturbances in glucose, lipid, and protein metabolism. Uncurbed diabetes or incessant hyperglycemic condition can lead to severe complications, including renal damage, visual impairment, cardiovascular disease, neuropathy, etc., which promotes diabetes-associated morbidity and mortality rates. The therapeutic management of diabetes includes conventional medications and nutraceuticals as complementary therapies. Nutraceuticals are bioactive compounds derived from food sources that have health-promoting properties and are instrumental in the management and treatment of various maladies. Nutraceuticals are clinically exploited to tackle DM pathogenesis, and the clinical evidence suggests that nutraceuticals can modulate biochemical parameters related to diabetes pathogenesis and comorbidities. Hypoglycemic medicines are designed to mitigate DM in traditional medicinal practice. This review intends to emphasize and comment on the various therapeutic strategies available to manage this chronic condition, conventional drugs, and the potential role of nutraceuticals in managing the complexity of the disease and reducing the risk of complications. In contrast to conventional antihyperglycemic drugs, nutraceutical supplements offer a higher efficacy and lesser adverse effects. To substantiate the efficacy and safety of various functional foods in conjunction with conventional hypoglycemic medicines, additional data from clinical studies are required.
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Affiliation(s)
- Susha Dinesh
- Department of Bioinformatics, BioNome, Bengaluru, 560043, India
| | - Sameer Sharma
- Department of Bioinformatics, BioNome, Bengaluru, 560043, India
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Chen S, Su X, Feng Y, Li R, Liao M, Fan L, Liu J, Chen S, Zhang S, Cai J, Zhu S, Niu J, Ye Y, Lo K, Zeng F. Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis. Nutrients 2023; 15:4161. [PMID: 37836444 PMCID: PMC10574428 DOI: 10.3390/nu15194161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Numerous studies have examined the effects of ketogenic diets (KD) on health-related outcomes through meta-analyses. However, the presence of biases may compromise the reliability of conclusions. Therefore, we conducted an umbrella review to collate and appraise the strength of evidence on the efficacy of KD interventions. We conducted a comprehensive search on PubMed, EMBASE, and the Cochrane Database until April 2023 to identify meta-analyses that investigated the treatment effects of KD for multiple health conditions, which yielded 23 meta-analyses for quantitative analyses. The evidence suggests that KD could increase the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), the respiratory exchange rate (RER), and could decrease total testosterone and testosterone levels (all p-random effects: <0.05). The combination of KD and physical activity can significantly reduce body weight and increase the levels of LDL-C and cortisol. In addition, KD was associated with seizure reduction in children, which can be explained by the ketosis state as induced by the diet. Furthermore, KD demonstrated a better alleviation effect in refractory childhood epilepsy, in terms of median effective rates for seizure reduction of ≥50%, ≥90%, and seizure freedom. However, the strength of evidence supporting the aforementioned associations was generally weak, thereby challenging their credibility. Consequently, future studies should prioritize stringent research protocols to ascertain whether KD interventions with longer intervention periods hold promise as a viable treatment option for various diseases.
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Affiliation(s)
- Shiyun Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Xin Su
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Ruojie Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Minqi Liao
- Institute of Epidemiology, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Ingolstadt Landstr. 1, 85764 Neuherberg, Germany;
| | - Laina Fan
- Department of Clinical Medicine, International School, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China;
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shasha Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jianxiang Niu
- General Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Road, Hohhot 010000, China;
| | - Yanbin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China;
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
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Li S, Du Y, Meireles C, Sharma K, Qi L, Castillo A, Wang J. Adherence to ketogenic diet in lifestyle interventions in adults with overweight or obesity and type 2 diabetes: a scoping review. Nutr Diabetes 2023; 13:16. [PMID: 37709770 PMCID: PMC10502148 DOI: 10.1038/s41387-023-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND/OBJECTIVES Despite the evidence supporting the efficacy of the ketogenic diet (KD) on weight and type 2 diabetes (T2D) management, adherence to the KD is challenging. Additionally, no studies have reported changes in PA among individuals with overweight/obesity and T2D who have followed KD. We mapped out the methods used to assess adherence to the KD and level of physical activity (PA) in lifestyle interventions for weight and T2D management in individuals with overweight/obesity and T2D and compared levels of KD adherence and PA in these interventions. METHODS Articles published between January 2005 and March 2022 were searched in MEDLINE, CINAHL, and Scopus. Studies that included KD in lifestyle interventions for adults with T2D and overweight/obesity and measured ketone levels were included. RESULTS The eleven included studies comprised eight randomized controlled trials. They mainly used self-reported measures to evaluate adherence to the KD and level of PA. We found studies reported higher carbohydrate intake and lower fat intake than the KD regimen. Great inconsistencies were found among studies on the measurement and reporting of ketone and PA levels. CONCLUSION Our results demonstrated the need to develop intervention strategies to improve adherence to the KD, as well as the necessity of developing standardized diet and PA assessment tools to establish a stronger evidence base for including KD in lifestyle interventions for weight and T2D management among adults with overweight/obesity and T2D.
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Affiliation(s)
- Shiyu Li
- School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Yan Du
- School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | | | - Kumar Sharma
- Center for Precision Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, USA.
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Di Renzo L, Gualtieri P, Zomparelli S, De Santis GL, Seraceno S, Zuena C, Frank G, Cianci R, Centofanti D, De Lorenzo A. Modified Mediterranean-Ketogenic Diet and Carboxytherapy as Personalized Therapeutic Strategies in Lipedema: A Pilot Study. Nutrients 2023; 15:3654. [PMID: 37630844 PMCID: PMC10457774 DOI: 10.3390/nu15163654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, the use of the ketogenic diet as a proper nutritional treatment for lipedema has been hypothesized in the literature. This is the first clinical study evaluating the ketogenic diet and carboxytherapy in lipedema patients. In the present study, it was decided to use a modified Mediterranean ketogenic diet (MMKD) in combination with carboxytherapy. Since lipedema is characterized by microangiopathy, local hypoxia, and increased subcutaneous adipose tissue (SAT) deposition, carboxytherapy could improve painful symptoms and skin tone. A total of 22 subjects were included in the data analysis, divided into three groups; 8 patients underwent MMKD combined with carboxytherapy sessions (KDCB group), 8 underwent MMKD nutritional treatment alone (KD group), and 6 patients underwent only carboxytherapy sessions (CB group), for a total of 10 weeks of treatment for all three groups. It was observed that the ketogenic diet effectively induced weight and fat mass loss, including in the limbs, areas considered unresponsive to diet therapy in lipedema patients. However, the best results were obtained from the combination of the ketogenic diet and carboxytherapy, which showed improvements in both body composition and skin texture and a reduction in pain, along with an improvement in sleep quality. It would be helpful to conduct a clinical trial on a larger scale and over a more extended period to observe the results in the long term as well.
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Affiliation(s)
- Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Samanta Zomparelli
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Gemma Lou De Santis
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Silvia Seraceno
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Zuena
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giulia Frank
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | | | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Scott SN, Hayes C, Zeuger T, Davies AP, Andrews RC, Cocks M. Clinical Considerations and Practical Advice for People Living With Type 2 Diabetes Who Undertake Regular Exercise or Aim to Exercise Competitively. Diabetes Spectr 2023; 36:114-126. [PMID: 37193206 PMCID: PMC10182970 DOI: 10.2337/dsi22-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This article provides practical tips for advising people with type 2 diabetes on how to engage in regular exercise safely and effectively. Its focus is on individuals who wish to exceed the minimum physical activity recommendation of 150 minutes/week of moderate-intensity exercise or even compete in their chosen sport. Health care professionals who work with such individuals must have a basic understanding of glucose metabolism during exercise, nutritional requirements, blood glucose management, medications, and sport-related considerations. This article reviews three key aspects of individualized care for physically active people with type 2 diabetes: 1) initial medical assessment and pre-exercise screenings, 2) glucose monitoring and nutritional considerations, and 3) the combined glycemic effects of exercise and medications.
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Affiliation(s)
- Sam N. Scott
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA
| | | | - Thomas Zeuger
- Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Andrew P. Davies
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, U.K
| | - Rob C. Andrews
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Matthew Cocks
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, U.K
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Enders J, Elliott D, Wright DE. Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxid Redox Signal 2023; 38:989-1000. [PMID: 36503268 PMCID: PMC10402707 DOI: 10.1089/ars.2022.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Significance: Diabetic peripheral neuropathy (DPN), a complication of metabolic syndrome, type I and type II diabetes, leads to sensory changes that include slow nerve conduction, nerve degeneration, loss of sensation, pain, and gate disturbances. These complications remain largely untreatable, although tight glycemic control can prevent neuropathy progression. Nonpharmacologic approaches remain the most impactful to date, but additional advances in treatment approaches are needed. Recent Advances: This review highlights several emerging interventions, including a focus on dietary interventions and physical activity, that continue to show promise for treating DPN. We provide an overview of our current understanding of how exercise can improve aspects of DPN. We also highlight new studies in which a ketogenic diet has been used as an intervention to prevent and reverse DPN. Critical Issues: Both exercise and consuming a ketogenic diet induce systemic and cellular changes that collectively improve complications associated with DPN. Both interventions may involve similar signaling pathways and benefits but also impact DPN through unique mechanisms. Future Directions: These lifestyle interventions are critically important as personalized medicine approaches will likely be needed to identify specific subsets of neuropathy symptoms and deficits in patients, and determine the most impactful treatment. Overall, these two interventions have the potential to provide meaningful relief for patients with DPN and provide new avenues to identify new therapeutic targets.
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Affiliation(s)
- Jonathan Enders
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Elliott
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Douglas E. Wright
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Mousavi SM, Ejtahed HS, Marvasti FE, Taghavi M, Siadat SD, Hasani-Ranjbar S, Larijani B, Esmaillzadeh A. The Effect of a Moderately Restricted Carbohydrate Diet on Cardiometabolic Risk Factors in Overweight and Obese Women With Metabolic Syndrome: A Randomized Controlled Trial. Clin Ther 2023; 45:e103-e114. [PMID: 36872171 DOI: 10.1016/j.clinthera.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Metabolic syndrome (MetS) is a major public health concern that increases the risk of cardiovascular disease and mortality. In previous studies of MetS management, low-carbohydrate diets have been strongly emphasized, despite the fact that many apparently healthy individuals have difficulties adhering to these diets on a long-term basis. The purpose of the present study was to elucidate the effects of a moderately restricted carbohydrate diet (MRCD) on cardiometabolic risk factors in women with MetS. METHODS This parallel 3-month, single-blind randomized controlled trial was conducted in Tehran, Iran, among 70 women with overweight or obesity aged 20 to 50 years with MetS. Patients were randomly allocated to receive either MRCD (42%-45% carbohydrates and 35%-40% fats) (n = 35) or a normal weight loss diet (NWLD) (52%-55% carbohydrates and 25%-30% fats) (n = 35). Both diets contained the same quantity of protein, which accounted for 15% to 17% of total energy. Anthropometric measurements, blood pressure, lipid profile, and glycemic indices were all assessed before and after the intervention. FINDINGS Compared with the NWLD group, following an MRCD significantly decreased weight (-4.82 vs -2.40 kg; P = 0.01), body mass index (-1.88 vs -0.94 kg/m2; P = 0.01), waist circumference (-5.34 vs -2.75 cm; P = 0.01), hip circumference (-2.58 vs -1.11 cm; P = 0.01), serum triglyceride (-26.8 vs -7.19 mg/dL; P = 0.01), and increased serum HDL-C levels (1.89 vs. 0.24 mg/dL; P = 0.01). There was no significant difference between the 2 diets in waist-to-hip ratio, serum total cholesterol, serum LDL-C, systolic and diastolic blood pressure, fasting blood glucose, insulin levels, or the homeostasis model assessment for insulin resistance. IMPLICATIONS Moderate carbohydrate replacement with dietary fats significantly improved weight, body mass index, waist circumference, hip circumference, serum triglyceride, and HDL-C levels among women with MetS. Iranian Registry of Clinical Trials identifier: IRCT20210307050621N1.
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Affiliation(s)
- Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Microbiota Research Group, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Ettehad Marvasti
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - MinaSadat Taghavi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran.
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Amin AM, Mostafa H, Khojah HMJ. Insulin resistance in Alzheimer's disease: The genetics and metabolomics links. Clin Chim Acta 2023; 539:215-236. [PMID: 36566957 DOI: 10.1016/j.cca.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease with significant socioeconomic burden worldwide. Although genetics and environmental factors play a role, AD is highly associated with insulin resistance (IR) disorders such as metabolic syndrome (MS), obesity, and type two diabetes mellitus (T2DM). These findings highlight a shared pathogenesis. The use of metabolomics as a downstream systems' biology (omics) approach can help to identify these shared metabolic traits and assist in the early identification of at-risk groups and potentially guide therapy. Targeting the shared AD-IR metabolic trait with lifestyle interventions and pharmacological treatments may offer promising AD therapeutic approach. In this narrative review, we reviewed the literature on the AD-IR pathogenic link, the shared genetics and metabolomics biomarkers between AD and IR disorders, as well as the lifestyle interventions and pharmacological treatments which target this pathogenic link.
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Affiliation(s)
- Arwa M Amin
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Saudi Arabia.
| | - Hamza Mostafa
- Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Food Innovation Network (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), 08028 Barcelona, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Hani M J Khojah
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
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Bogataj Jontez N, Kenig S, Šik Novak K, Petelin A, Jenko Pražnikar Z, Mohorko N. Habitual low carbohydrate high fat diet compared with omnivorous, vegan, and vegetarian diets. Front Nutr 2023; 10:1106153. [PMID: 37125046 PMCID: PMC10133707 DOI: 10.3389/fnut.2023.1106153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background Dietary patterns which exclude whole food groups, such as vegetarian, vegan and low carbohydrate high fat diet (LCHF), are increasingly popular in general public. When carefully planned, all these diets have some known benefits for health, but concerns are also raised in particular for LCHF. The quality of LCHF diet which individuals follow in real life without supervision is not known. Methods One hundred thirty healthy individuals with stable body mass following LCHF, vegan, vegetarian and omnivorous diet for at least six months, were compared in a cross-sectional study. Diet was analyzed through 3-day food records and FFQ, anthropometric measurements were performed and serum metabolic biomarkers determined from fasting blood. Results Participants on LCHF diet had the intakes of micronutrients comparable to other groups, while the intakes of macronutrients differed in line with the definition of each diet. The intakes of saturated fats, cholesterol and animal proteins were significantly higher and the intakes of sugars and dietary fibers were lower compared to other groups. Healthy eating index 2015 in this group was the lowest. There were no differences in the levels of glucose, triacylglycerols and CRP among groups. Total and LDL cholesterol levels were significantly higher in LCHF group, in particular in participants with higher ketogenic ratio. Fatty acids intakes and intakes of cholesterol, dietary fibers and animal proteins explained 40% of variance in total cholesterol level, with saturated fatty acids being the strongest positive predictor and monounsaturated fatty acids a negative predictor. Conclusion None of the self-advised diets provided all the necessary nutrients in optimal levels. Due to the detected increased levels of serum cholesterols, selection of healthy fat sources, higher intake of dietary fibers and partial replacing of animal sources with plant sources of foods should be recommended to the individuals selecting LCFH dietary pattern.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04347213.
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15
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Hansen CD, Gram-Kampmann EM, Hansen JK, Hugger MB, Madsen BS, Jensen JM, Olesen S, Torp N, Rasmussen DN, Kjærgaard M, Johansen S, Lindvig KP, Andersen P, Thorhauge KH, Brønd JC, Hermann P, Beck-Nielsen H, Detlefsen S, Hansen T, Højlund K, Thiele MS, Israelsen M, Krag A. Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease : A Randomized Controlled Trial. Ann Intern Med 2023; 176:10-21. [PMID: 36508737 DOI: 10.7326/m22-1787] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM), and the effect on nonalcoholic fatty liver disease (NAFLD) has not been investigated. OBJECTIVE To investigate the effect of a calorie-unrestricted LCHF diet, with no intention of weight loss, on T2DM and NAFLD compared with a high-carbohydrate, low-fat (HCLF) diet. DESIGN 6-month randomized controlled trial with a 3-month follow-up. (ClinicalTrials.gov: NCT03068078). SETTING Odense University Hospital in Denmark from November 2016 until June 2020. PARTICIPANTS 165 participants with T2DM. INTERVENTION Two calorie-unrestricted diets: LCHF diet with 50 to 60 energy percent (E%) fat, less than 20E% carbohydrates, and 25E% to 30E% proteins and HCLF diet with 50E% to 60E% carbohydrates, 20E% to 30E% fats, and 20E% to 25E% proteins. MEASUREMENTS Glycemic control, serum lipid levels, metabolic markers, and liver biopsies to assess NAFLD. RESULTS The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A1c (mean difference in change, -6.1 mmol/mol [95% CI, -9.2 to -3.0 mmol/mol] or -0.59% [CI, -0.87% to -0.30%]) and lost more weight (mean difference in change, -3.8 kg [CI, -6.2 to -1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up. LIMITATION Open-label trial, self-reported adherence, unintended weight loss, and lack of adjustment for multiple comparisons. CONCLUSION Persons with T2DM on a 6-month, calorie-unrestricted, LCHF diet had greater clinically meaningful improvements in glycemic control and weight compared with those on an HCLF diet, but the changes were not sustained 3 months after intervention. PRIMARY FUNDING SOURCE Novo Nordisk Foundation.
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Affiliation(s)
- Camilla Dalby Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Eva-Marie Gram-Kampmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Johanne Kragh Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Mie Balle Hugger
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Bjørn Stæhr Madsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Jane Møller Jensen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Sara Olesen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Nikolaj Torp
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Ditlev Nytoft Rasmussen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Maria Kjærgaard
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Stine Johansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Katrine Prier Lindvig
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense SV, Denmark (K.P.L.)
| | - Peter Andersen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Katrine Holtz Thorhauge
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Jan Christian Brønd
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (J.C.B.)
| | - Pernille Hermann
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark (P.H.)
| | - Henning Beck-Nielsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Sönke Detlefsen
- Institute of Clinical Research, University of Southern Denmark, and Department of Pathology, Odense University Hospital, Odense, Denmark (S.D.)
| | - Torben Hansen
- Novo Nordisk Foundation, Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark (T.H.)
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Maja Sofie Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Mads Israelsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark (A.K.)
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Du Y, Oh C, No J. Effects of the ketogenic diet on components of the metabolic syndrome: A systematic review and meta-analysis. NUTR CLIN METAB 2023. [DOI: 10.1016/j.nupar.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Sekgala MD, Opperman M, Mpahleni B, Mchiza ZJR. Association between Macronutrient and Fatty Acid Consumption and Metabolic Syndrome: A South African Taxi Driver Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15452. [PMID: 36497525 PMCID: PMC9737240 DOI: 10.3390/ijerph192315452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
We aimed to examine the association between macronutrient and fatty acid intake and metabolic syndrome (MetS) and its components in South African male mini-bus taxi drivers. One hundred and eighty-five (n = 185) male taxi drivers, aged 20 years and older, who operate in the Cape Town metropole, South Africa, were included. The International Diabetes Federation (IDF) algorithm was used to define MetS. The association between macronutrient and fatty acid intake (assessed using 24 h recall) and MetS were analyzed using multivariable nutrient density substitution models. Overall, protein consumption significantly increased the likelihood of high blood pressure (HBP) and significantly lowered the likelihood of having low levels of high-density lipoprotein cholesterol (HDL-C). In an isoenergetic state, the intake of protein instead of carbohydrates (CHOs) and total fat, reduced the likelihood of elevated triglycerides by 6.7% and 6.6%, respectively. The intake of CHOs instead of protein and total fat, reduced the likelihood of HBP by 2.2% and 2.8%, respectively. In the same isoenergetic state, the intake of saturated fatty acids (SFAs) instead of mono-unsaturated fatty acids (MUFAs) increased the likelihood of HBP by 9.8%, whereas the intake of polyunsaturated fatty acids (PUFAs) instead of SFAs decreased the likelihood of HBP by 9.4%. The current study showed that when total food energy intake is kept constant, a diet that is high in protein, CHOs and PUFAs reduces triglycerides and BP, whereas the intake of total fat and SFAs had the opposite effect. It should, however, be noted that these outcomes were produced using mathematical models, as such we recommend further prospective studies in real life that will reveal the actual associations between the consumption of macronutrients and fatty acids and MetS and its components.
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Affiliation(s)
- Machoene Derrick Sekgala
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa
- Human and Social Capabilities, Human Sciences Research Council, Cape Town 8000, South Africa
| | - Maretha Opperman
- Functional Foods Research Unit, Department of Biotechnology and Consumer Science, Cape Peninsula University of Technology, Cape Town 7535, South Africa
| | - Buhle Mpahleni
- Functional Foods Research Unit, Department of Biotechnology and Consumer Science, Cape Peninsula University of Technology, Cape Town 7535, South Africa
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
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18
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He M, Wang J, Liang Q, Li M, Guo H, Wang Y, Deji C, Sui J, Wang YW, Liu Y, Zheng Y, Qian B, Chen H, Ma M, Su S, Geng H, Zhou WX, Guo X, Zhu WZ, Zhang M, Chen Z, Rensen PC, Hui CC, Wang Y, Shi B. Time-restricted eating with or without low-carbohydrate diet reduces visceral fat and improves metabolic syndrome: A randomized trial. Cell Rep Med 2022; 3:100777. [PMID: 36220069 PMCID: PMC9589024 DOI: 10.1016/j.xcrm.2022.100777] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 07/24/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022]
Abstract
Overconsumption of carbohydrate-rich food combined with adverse eating patterns contributes to the increasing incidence of metabolic syndrome (MetS) in China. Therefore, we conducted a randomized trial to determine the effects of a low-carbohydrate diet (LCD), an 8-h time-restricted eating (TRE) schedule, and their combination on body weight and abdominal fat area (i.e., primary outcomes) and cardiometabolic outcomes in participants with MetS. Compared with baseline, all 3-month treatments significantly reduce body weight and subcutaneous fat area, but only TRE and combination treatment reduce visceral fat area (VFA), fasting blood glucose, uric acid (UA), and dyslipidemia. Furthermore, compared with changes of LCD, TRE and combination treatment further decrease body weight and VFA, while only combination treatment yields more benefits on glycemic control, UA, and dyslipidemia. In conclusion, without change of physical activity, an 8-h TRE with or without LCD can serve as an effective treatment for MetS (ClinicalTrials.gov: NCT04475822).
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Affiliation(s)
- Mingqian He
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Jingya Wang
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Qian Liang
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Meng Li
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Hui Guo
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Cuomu Deji
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Jing Sui
- Department of Endocrinology and International Medical Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Ya-wen Wang
- Biobank, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China,Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Yufeng Liu
- Biobank, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Yixuan Zheng
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Buyue Qian
- Network and Information Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Huaixi Chen
- Network and Information Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Mao Ma
- Physical Examination Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Shi Su
- Physical Examination Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Hui Geng
- Physical Examination Center, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Wen-xu Zhou
- Department of Internal Medicine, The Hospital of Xi’an JiaoTong University, No. 28, West Xianning Road, Xi’an, Shaanxi 710049, P.R. China
| | - Xiaoxiao Guo
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Wen-zhi Zhu
- Med-X institute, Center for Immunological and Metabolic Diseases, the First Affiliated Hospital of Xi’an JiaoTong University, Xi’an JiaoTong University, Xi’an, Shaanxi 710061, P.R. China
| | - Meng Zhang
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Ziyi Chen
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Patrick C.N. Rensen
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China,Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 Leiden, the Netherlands
| | - Chi-chung Hui
- Program in Developmental & Stem Cell Biology, The Hospital for Sick Children, and Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Yanan Wang
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China,Med-X institute, Center for Immunological and Metabolic Diseases, the First Affiliated Hospital of Xi’an JiaoTong University, Xi’an JiaoTong University, Xi’an, Shaanxi 710061, P.R. China,Corresponding author
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi’an JiaoTong University, No. 277, West Yanta Road, Xi’an, Shaanxi 710061, P.R. China,Corresponding author
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19
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Diamond DM, Bikman BT, Mason P. Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet. Curr Opin Endocrinol Diabetes Obes 2022; 29:497-511. [PMID: 35938780 DOI: 10.1097/med.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although there is an extensive literature on the efficacy of the low carbohydrate diet (LCD) for weight loss and in the management of type 2 diabetes, concerns have been raised that the LCD may increase cardiovascular disease (CVD) risk by increasing the level of low-density lipoprotein cholesterol (LDL-C). We have assessed the value of LDL-C as a CVD risk factor, as well as effects of the LCD on other CVD risk factors. We have also reviewed findings that provide guidance as to whether statin therapy would be beneficial for individuals with high LDL-C on an LCD. RECENT FINDINGS Multiple longitudinal trials have demonstrated the safety and effectiveness of the LCD, while also providing evidence of improvements in the most reliable CVD risk factors. Recent findings have also confirmed how ineffective LDL-C is in predicting CVD risk. SUMMARY Extensive research has demonstrated the efficacy of the LCD to improve the most robust CVD risk factors, such as hyperglycemia, hypertension, and atherogenic dyslipidemia. Our review of the literature indicates that statin therapy for both primary and secondary prevention of CVD is not warranted for individuals on an LCD with elevated LDL-C who have achieved a low triglyceride/HDL ratio.
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Affiliation(s)
- David M Diamond
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Benjamin T Bikman
- Department of Cell Biology and Physiology, Brigham Young University, Provo, Utah, USA
| | - Paul Mason
- Concord Orthosports, Concord, New South Wales, Australia
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20
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Abstract
Alzheimer’s disease (AD) is the most common major neurocognitive disorder of ageing. Although largely ignored until about a decade ago, accumulating evidence suggests that deteriorating brain energy metabolism plays a key role in the development and/or progression of AD-associated cognitive decline. Brain glucose hypometabolism is a well-established biomarker in AD but was mostly assumed to be a consequence of neuronal dysfunction and death. However, its presence in cognitively asymptomatic populations at higher risk of AD strongly suggests that it is actually a pre-symptomatic component in the development of AD. The question then arises as to whether progressive AD-related cognitive decline could be prevented or slowed down by correcting or bypassing this progressive ‘brain energy gap’. In this review, we provide an overview of research on brain glucose and ketone metabolism in AD and its prodromal condition – mild cognitive impairment (MCI) – to provide a clearer basis for proposing keto-therapeutics as a strategy for brain energy rescue in AD. We also discuss studies using ketogenic interventions and their impact on plasma ketone levels, brain energetics and cognitive performance in MCI and AD. Given that exercise has several overlapping metabolic effects with ketones, we propose that in combination these two approaches might be synergistic for brain health during ageing. As cause-and-effect relationships between the different hallmarks of AD are emerging, further research efforts should focus on optimising the efficacy, acceptability and accessibility of keto-therapeutics in AD and populations at risk of AD.
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21
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Kirkpatrick CF, Willard KE, Maki KC. Keto is Trending: Implications for Body Weight and Lipid Management. Curr Cardiol Rep 2022; 24:1093-1100. [PMID: 35794438 DOI: 10.1007/s11886-022-01731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Very-low-carbohydrate (VLC) and ketogenic diets (KDs) have been used for weight loss and more recently in patients with insulin resistance and type 2 diabetes. The impact of VLC and KDs on lipids/lipoproteins is a concern. The purpose of this review is to discuss the impact of KDs on body weight and lipids/lipoproteins. RECENT FINDINGS VLC/KDs contribute to greater weight loss in the short term (< 6 months) compared to higher carbohydrate diets, but there is typically no difference between the diets by 12 months. Triglyceride and high-density lipoprotein cholesterol levels generally improve, but there is a variable response in low-density lipoprotein cholesterol levels, with some individuals experiencing a dramatic increase, particularly those with latent genetic dyslipidemias. Healthcare professionals should educate patients on the risks and benefits of following VLC/KDs and encourage the consumption of carbohydrate-rich foods associated with positive health outcomes.
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Affiliation(s)
- Carol F Kirkpatrick
- Midwest Biomedical Research, Suite 3, Addison, IL, USA. .,Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, 83209, USA.
| | | | - Kevin C Maki
- Midwest Biomedical Research, Suite 3, Addison, IL, USA.,Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, 47405, USA
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22
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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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23
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Choi JH, Cho YJ, Kim HJ, Ko SH, Chon S, Kang JH, Kim KK, Kim EM, Kim HJ, Song KH, Nam GE, Kim KI. Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension. J Obes Metab Syndr 2022; 31:100-122. [PMID: 35670159 PMCID: PMC9284571 DOI: 10.7570/jomes22009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwang Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
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24
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Koerich ACC, Borszcz FK, Thives Mello A, de Lucas RD, Hansen F. Effects of the ketogenic diet on performance and body composition in athletes and trained adults: a systematic review and Bayesian multivariate multilevel meta-analysis and meta-regression. Crit Rev Food Sci Nutr 2022; 63:11399-11424. [PMID: 35757868 DOI: 10.1080/10408398.2022.2090894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This systematic review with meta-analysis aimed to determine the effects of the ketogenic diet (KD) against carbohydrate (CHO)-rich diets on physical performance and body composition in trained individuals. The MEDLINE, EMBASE, CINAHL, SPORTDiscus, and The Cochrane Library were searched. Randomized and non-randomized controlled trials in athletes/trained adults were included. Meta-analytic models were carried out using Bayesian multilevel models. Eighteen studies were included providing estimates on cyclic exercise modes and strength one-maximum repetition (1-RM) performances and for total, fat, and free-fat masses. There were more favorable effects for CHO-rich than KD on time-trial performance (mode [95% credible interval]; -3.3% [-8.5%, 1.7%]), 1-RM (-5.7% [-14.9%, 2.6%]), and free-fat mass (-0.8 [-3.4, 1.9] kg); effects were more favorable to KD on total (-2.4 [-6.2, 1.8] kg) and fat mass losses (-2.4 [-5.4, 0.2] kg). Likely modifying effects on cyclic performance were the subject's sex and VO2max, intervention and performance durations, and mode of exercise. The intervention duration and subjects' sex were likely to modify effects on total body mass. KD can be a useful strategy for total and fat body losses, but a small negative effect on free-fat mass was observed. KD was not suitable for enhancing strength 1-RM or high-intensity cyclic performances.
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Affiliation(s)
- Ana Clara C Koerich
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Fernando Klitzke Borszcz
- Physical Effort Laboratory, Sports Center, Federal University of Santa Catarina, University Campus, Pantanal, Florianópolis, Santa Catarina, Brazil
| | - Arthur Thives Mello
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Ricardo Dantas de Lucas
- Physical Effort Laboratory, Sports Center, Federal University of Santa Catarina, University Campus, Pantanal, Florianópolis, Santa Catarina, Brazil
| | - Fernanda Hansen
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
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25
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Choi JH, Cho YJ, Kim HJ, Ko SH, Chon S, Kang JH, Kim KK, Kim EM, Kim HJ, Song KH, Nam GE, Kim KI. Effect of carbohydrate-restricted diets and intermittent fasting on obesity, type 2 diabetes mellitus, and hypertension management: consensus statement of the Korean Society for the Study of obesity, Korean Diabetes Association, and Korean Society of Hypertension. Clin Hypertens 2022; 28:26. [PMID: 35642007 PMCID: PMC9158277 DOI: 10.1186/s40885-022-00207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. METHODS A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled clinical trials (RCTs) of carbohydrate-restricted diets and ten articles on eight RCTs of IF was performed. RESULTS Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. CONCLUSION Here, we describe the results of our analysis and the evidence for these recommendations.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, South Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, South Korea.
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea.
| | - Kwang Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
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26
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Choi JH, Cho YJ, Kim HJ, Ko SH, Chon S, Kang JH, Kim KK, Kim EM, Kim HJ, Song KH, Nam GE, Kim KI. Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension. Diabetes Metab J 2022; 46:355-376. [PMID: 35656560 PMCID: PMC9171155 DOI: 10.4093/dmj.2022.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 12/17/2022] Open
Abstract
Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwang Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Committee of Clinical Practice Guidelines
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Korean Society for the Study of Obesity (KSSO)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Committee of Clinical Practice Guidelines and Committee of Food and Nutrition, Korean Diabetes Association (KDA)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Policy Committee of Korean Society of Hypertension (KSH)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
| | - Policy Development Committee of National Academy of Medicine of Korea (NAMOK)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Korea
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27
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Buga A, Welton GL, Scott KE, Atwell AD, Haley SJ, Esbenshade NJ, Abraham J, Buxton JD, Ault DL, Raabe AS, Noakes TD, Hyde PN, Volek JS, Prins PJ. The Effects of Carbohydrate versus Fat Restriction on Lipid Profiles in Highly Trained, Recreational Distance Runners: A Randomized, Cross-Over Trial. Nutrients 2022; 14:nu14061135. [PMID: 35334791 PMCID: PMC8955386 DOI: 10.3390/nu14061135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/01/2023] Open
Abstract
A growing number of endurance athletes have considered switching from a traditional high-carbohydrate/low-fat (HCLF) to a low-carbohydrate/high-fat (LCHF) eating pattern for health and performance reasons. However, few studies have examined how LCHF diets affect blood lipid profiles in highly-trained runners. In a randomized and counterbalanced, cross-over design, athletes (n = 7 men; VO2max: 61.9 ± 6.1 mL/kg/min) completed six weeks of two, ad libitum, LCHF (6/69/25% en carbohydrate/fat/protein) and HCLF (57/28/15% en carbohydrate/fat/protein) diets, separated by a two-week washout. Plasma was collected on days 4, 14, 28, and 42 during each condition and analyzed for: triglycerides (TG), LDL-C, HDL-C, total cholesterol (TC), VLDL, fasting glucose, and glycated hemoglobin (HbA1c). Capillary blood beta-hydroxybutyrate (BHB) was monitored during LCHF as a measure of ketosis. LCHF lowered plasma TG, VLDL, and TG/HDL-C (all p < 0.01). LCHF increased plasma TC, LDL-C, HDL-C, and TC/HDL-C (all p < 0.05). Plasma glucose and HbA1c were unaffected. Capillary BHB was modestly elevated throughout the LCHF condition (0.5 ± 0.05 mmol/L). Healthy, well-trained, normocholesterolemic runners consuming a LCHF diet demonstrated elevated circulating LDL-C and HDL-C concentrations, while concomitantly decreasing TG, VLDL, and TG/HDL-C ratio. The underlying mechanisms and implications of these adaptive responses in cholesterol should be explored.
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Affiliation(s)
- Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (A.B.); (J.S.V.)
| | - Gary L. Welton
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Katie E. Scott
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Adam D. Atwell
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Sarah J. Haley
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Noah J. Esbenshade
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Jacqueline Abraham
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Jeffrey D. Buxton
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Dana L. Ault
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
| | - Amy S. Raabe
- Department of Human Ecology, Youngstown State University, Youngstown, OH 44555, USA;
| | - Timothy D. Noakes
- Department of Applied Design, Cape Peninsula University of Technology, Cape Town 8000, South Africa;
| | - Parker N. Hyde
- Department of Kinesiology, University of Northern Georgia, Dahlonega, GA 30597, USA;
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (A.B.); (J.S.V.)
| | - Philip J. Prins
- Department of Exercise Science, Grove City College, Grove City, PA 16127, USA; (G.L.W.); (K.E.S.); (A.D.A.); (S.J.H.); (N.J.E.); (J.A.); (J.D.B.); (D.L.A.)
- Correspondence: ; Tel.: +1-724-458-3863
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Intake of carbohydrates and SFA and risk of CHD in middle-age adults: the Hordaland Health Study (HUSK). Public Health Nutr 2022; 25:634-648. [PMID: 32907659 PMCID: PMC9991815 DOI: 10.1017/s1368980020003043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk. DESIGN Prospective cohort study. SETTING We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25). PARTICIPANTS 2995 men and women, aged 46-49 years. RESULTS Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90). CONCLUSIONS Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.
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Lee JH, Duster M, Roberts T, Devinsky O. United States Dietary Trends Since 1800: Lack of Association Between Saturated Fatty Acid Consumption and Non-communicable Diseases. Front Nutr 2022; 8:748847. [PMID: 35118102 PMCID: PMC8805510 DOI: 10.3389/fnut.2021.748847] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
We reviewed data on the American diet from 1800 to 2019. Methods: We examined food availability and estimated consumption data from 1800 to 2019 using historical sources from the federal government and additional public data sources. Results: Processed and ultra-processed foods increased from <5 to >60% of foods. Large increases occurred for sugar, white and whole wheat flour, rice, poultry, eggs, vegetable oils, dairy products, and fresh vegetables. Saturated fats from animal sources declined while polyunsaturated fats from vegetable oils rose. Non-communicable diseases (NCDs) rose over the twentieth century in parallel with increased consumption of processed foods, including sugar, refined flour and rice, and vegetable oils. Saturated fats from animal sources were inversely correlated with the prevalence of NCDs. Conclusions: As observed from the food availability data, processed and ultra-processed foods dramatically increased over the past two centuries, especially sugar, white flour, white rice, vegetable oils, and ready-to-eat meals. These changes paralleled the rising incidence of NCDs, while animal fat consumption was inversely correlated.
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Affiliation(s)
- Joyce H. Lee
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miranda Duster
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
| | - Timothy Roberts
- New York University, Health Sciences Library, New York, NY, United States
| | - Orrin Devinsky
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
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Kolb H, Kempf K, Röhling M, Lenzen-Schulte M, Schloot NC, Martin S. Ketone bodies: from enemy to friend and guardian angel. BMC Med 2021; 19:313. [PMID: 34879839 PMCID: PMC8656040 DOI: 10.1186/s12916-021-02185-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023] Open
Abstract
During starvation, fasting, or a diet containing little digestible carbohydrates, the circulating insulin levels are decreased. This promotes lipolysis, and the breakdown of fat becomes the major source of energy. The hepatic energy metabolism is regulated so that under these circumstances, ketone bodies are generated from β-oxidation of fatty acids and secreted as ancillary fuel, in addition to gluconeogenesis. Increased plasma levels of ketone bodies thus indicate a dietary shortage of carbohydrates. Ketone bodies not only serve as fuel but also promote resistance to oxidative and inflammatory stress, and there is a decrease in anabolic insulin-dependent energy expenditure. It has been suggested that the beneficial non-metabolic actions of ketone bodies on organ functions are mediated by them acting as a ligand to specific cellular targets. We propose here a major role of a different pathway initiated by the induction of oxidative stress in the mitochondria during increased ketolysis. Oxidative stress induced by ketone body metabolism is beneficial in the long term because it initiates an adaptive (hormetic) response characterized by the activation of the master regulators of cell-protective mechanism, nuclear factor erythroid 2-related factor 2 (Nrf2), sirtuins, and AMP-activated kinase. This results in resolving oxidative stress, by the upregulation of anti-oxidative and anti-inflammatory activities, improved mitochondrial function and growth, DNA repair, and autophagy. In the heart, the adaptive response to enhanced ketolysis improves resistance to damage after ischemic insults or to cardiotoxic actions of doxorubicin. Sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors may also exert their cardioprotective action via increasing ketone body levels and ketolysis. We conclude that the increased synthesis and use of ketone bodies as ancillary fuel during periods of deficient food supply and low insulin levels causes oxidative stress in the mitochondria and that the latter initiates a protective (hormetic) response which allows cells to cope with increased oxidative stress and lower energy availability. KEYWORDS: Ketogenic diet, Ketone bodies, Beta hydroxybutyrate, Insulin, Obesity, Type 2 diabetes, Inflammation, Oxidative stress, Cardiovascular disease, SGLT2, Hormesis.
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Affiliation(s)
- Hubert Kolb
- Faculty of Medicine, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,West-German Centre of Diabetes and Health, Duesseldorf Catholic Hospital Group, Hohensandweg 37, 40591, Duesseldorf, Germany
| | - Kerstin Kempf
- West-German Centre of Diabetes and Health, Duesseldorf Catholic Hospital Group, Hohensandweg 37, 40591, Duesseldorf, Germany.
| | - Martin Röhling
- West-German Centre of Diabetes and Health, Duesseldorf Catholic Hospital Group, Hohensandweg 37, 40591, Duesseldorf, Germany
| | | | - Nanette C Schloot
- Faculty of Medicine, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Stephan Martin
- Faculty of Medicine, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,West-German Centre of Diabetes and Health, Duesseldorf Catholic Hospital Group, Hohensandweg 37, 40591, Duesseldorf, Germany
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Jayawardena R, Sooriyaarachchi P, Misra A. Abdominal obesity and metabolic syndrome in South Asians: prevention and management. Expert Rev Endocrinol Metab 2021; 16:339-349. [PMID: 34586004 DOI: 10.1080/17446651.2021.1982381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prevalence of metabolic syndrome (MetS) and abdominal obesity are escalating in South Asian countries. It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular diseases. South Asians have an increased risk of MetS due to a variety of factors including unhealthy lifestyle and their unique body composition. AREAS COVERED In this review, we discuss the prevalence, associated risk factors, and evidence-based preventive and curative strategies for MetS and abdominal obesity in South Asians. A literature search through PubMed®, Web of Science®, and Scopus® was performed for studies published before 31st April 2021. A combination of the following keywords was used with the names of the individual South Asian countries: 'metabolic syndrome,' 'syndrome X,' 'abdominal obesity,' 'central obesity,' 'visceral obesity,' 'prevention,' and 'management.' EXPERT OPINION According to current evidence, MetS and abdominal obesity are highly prevalent among South Asians. Several risk factors, such as lifestyle, socio-demography, cultural, and body composition, are associated with MetS. Limited research shows culturally tailored lifestyle interventions are effective in preventing and managing MetS and abdominal obesity among South Asians.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Piumika Sooriyaarachchi
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
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Abstract
PURPOSE OF REVIEW This review outlines recent research in the application of low carbohydrate diets (LCD) for insulin resistance (IR) and metabolic syndrome (MetS). RECENT FINDINGS Studies included in this review explore how a LCD can be used in the management of patients with IR and MetS. LCDs have been shown to result in Type 2 Diabetes Mellitus (T2DM) remission, improve lipid profiles and dramatically reduce intrahepatic fat. SUMMARY The field of nutritional science is notoriously complex. The LCD has a simple narrative, which can easily and safely be applied in clinical practice. Current guidelines recognise and encourage the use of LCD as a valid option for patients with T2DM and obesity. Structured, evidence-based education should be available for all clinicians to increase confidence and ensure consistency and quality control. Further real-world evidence into the application and scalability of a LCD are required. The use of digital health solutions and improved health technology should see significant advances in this field, with dietary habit being driven by patient-derived health data in response to food, and not population-based food guidelines. The narrative around MetS and IR needs to change from progression to remission, with a LCD being a valid option for this.
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[Saturated fatty acids and cardiovascular risk : Is a revision of the recommendations on nutrition indicated?]. Herz 2021; 47:354-365. [PMID: 34554285 PMCID: PMC9355924 DOI: 10.1007/s00059-021-05067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
Die „Fetthypothese der koronaren Herzkrankheit“, derzufolge „gesättigte Fettsäuren“ („saturated fatty acids“, SFA) die LDL(„low-density lipoprotein“)-Cholesterin-Konzentration (LDL-C) steigern und folglich das Risiko für kardiovaskuläre Erkrankungen erhöhen, prägte die Ernährungsempfehlungen der letzten 60 Jahre, zunächst in den USA und später auch in Europa. Über die Jahre mehrte sich Evidenz aus Epidemiologie und kontrollierten klinischen Studien, dass der Konsum von SFA per se nicht mit einem erhöhten kardiovaskulären Risiko einhergeht bzw. die Einschränkung des Konsums von SFA keine präventive Wirkung zeigt. Die Fokussierung auf den SFA-Gehalt negiert die biologisch heterogenen und zum Teil biologisch günstigen Wirkungen unterschiedlicher SFA. Zudem wird hierbei außer Acht gelassen, dass SFA in intakten Lebensmitteln in unterschiedliche komplexe Matrizes eingebunden sind, die aus Dutzenden Nährstoffen mit unterschiedlicher Struktur und Begleitstoffen bestehen und damit jeweils unterschiedliche biologische Antworten und metabolische Effekte auslösen. Entsprechend sind solche nährstoffbasierten Empfehlungen prinzipiell wenig zielführend und zudem schlecht umsetzbar. Hinzu kommt, dass LDL‑C kein geeigneter Marker ist, um den Effekt von Lebensstilintervention wie der Ernährung oder aber der körperlichen Aktivität auf das globale kardiovaskuläre Risiko zu beurteilen.
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Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets. Nutrients 2021; 13:nu13103299. [PMID: 34684300 PMCID: PMC8537012 DOI: 10.3390/nu13103299] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of cardiovascular disease (CVD) and other diet-related chronic diseases. Moreover, the lack of flexibility in the DGA as it pertains to low carbohydrate approaches does not align with the contemporary trend toward precision nutrition. We argue that personalizing the level of dietary carbohydrate should be a high priority based on evidence that Americans have a wide spectrum of metabolic variability in their tolerance to high carbohydrate loads. Obesity, metabolic syndrome, and T2D are conditions strongly associated with insulin resistance, a condition exacerbated by increased dietary carbohydrate and improved by restricting carbohydrate. Low-carbohydrate diets are grounded across the time-span of human evolution, have well-established biochemical principles, and are now supported by multiple clinical trials in humans that demonstrate consistent improvements in multiple established risk factors associated with insulin resistance and cardiovascular disease. The American Diabetes Association (ADA) recently recognized a low carbohydrate eating pattern as an effective approach for patients with diabetes. Despite this evidence base, low-carbohydrate diets are not reflected in the DGA. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.
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Ketogenesis controls mitochondrial gene expression and rescues mitochondrial bioenergetics after cervical spinal cord injury in rats. Sci Rep 2021; 11:16359. [PMID: 34381166 PMCID: PMC8357839 DOI: 10.1038/s41598-021-96003-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/29/2021] [Indexed: 11/08/2022] Open
Abstract
A better understanding of the secondary injury mechanisms that occur after traumatic spinal cord injury (SCI) is essential for the development of novel neuroprotective strategies linked to the restoration of metabolic deficits. We and others have shown that Ketogenic diet (KD), a high fat, moderate in proteins and low in carbohydrates is neuroprotective and improves behavioural outcomes in rats with acute SCI. Ketones are alternative fuels for mitochondrial ATP generation, and can modulate signaling pathways via targeting specific receptors. Here, we demonstrate that ad libitum administration of KD for 7 days after SCI rescued mitochondrial respiratory capacity, increased parameters of mitochondrial biogenesis, affected the regulation of mitochondrial-related genes, and activated the NRF2-dependent antioxidant pathway. This study demonstrates that KD improves post-SCI metabolism by rescuing mitochondrial function and supports the potential of KD for treatment of acute SCI in humans.
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Ketogenic Diet, Physical Activity, and Hypertension-A Narrative Review. Nutrients 2021; 13:nu13082567. [PMID: 34444726 PMCID: PMC8398985 DOI: 10.3390/nu13082567] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.
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Noakes TD. Hiding unhealthy heart outcomes in a low-fat diet trial: the Women's Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low-fat 'heart-healthy' diet. Open Heart 2021; 8:e001680. [PMID: 34290045 PMCID: PMC8296783 DOI: 10.1136/openhrt-2021-001680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
The Women's Health Initiative Randomized Controlled Dietary Modification Trial (WHIRCDMT) was designed to test whether the US Department of Agriculture's 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases. The only significant finding in the original 2006 WHIRCDMT publication was that postmenopausal women with CHD randomised to a low-fat 'heart-healthy' diet in 1993 were at 26% greater risk of developing additional CHD events compared with women with CHD eating the control diet. A 2017 WHIRCDMT publication includes data for an additional 5 years of follow-up. It finds that CHD risk in this subgroup of postmenopausal women had increased further to 47%-61%. The authors present three post-hoc rationalisations to explain why this finding is 'inadmissible': (1) only women in this subgroup were less likely to adhere to the prescribed dietary intervention; (2) their failure to follow the intervention diet increased their CHD risk; and (3) only these women were more likely to not have received cholesterol-lowering drugs. These rationalisations appear spurious. Rather these findings are better explained as a direct consequence of postmenopausal women with features of insulin resistance (IR) eating a low-fat high-carbohydrate diet for 13 years. All the worst clinical features of IR, including type 2 diabetes mellitus (T2DM) in some, can be 'reversed' by the prescription of a high-fat low-carbohydrate diet. The Women's Health Study has recently reported that T2DM (10.71-fold increased risk) and other markers of IR including metabolic syndrome (6.09-fold increased risk) were the most powerful predictors of future CHD development in women; blood low-density lipoprotein-cholesterol concentration was a poor predictor (1.38-fold increased risk). These studies challenge the prescription of the low-fat high-carbohydrate heart-healthy diet, at least in postmenopausal women with IR, especially T2DM. According to the medical principle of 'first do no harm', this practice is now shown to be not evidence-based, making it scientifically unjustifiable, perhaps unethical.
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Affiliation(s)
- Timothy David Noakes
- Applied Design, Cape Peninsula University of Technology, Bellville, South Africa
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Prediction of Insulin Resistance by Modified Triglyceride Glucose Indices in Youth. Life (Basel) 2021; 11:life11040286. [PMID: 33800541 PMCID: PMC8066260 DOI: 10.3390/life11040286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
The triglyceride glucose (TyG) index, derived from a combination of fasting glucose and triglycerides, has been suggested as a useful marker for insulin resistance (IR), in addition to modified TyG indices that combine obesity parameters. This study investigated the association and utility of TyG and modified TyG indices for IR prediction in youth. Based on the Korea National Health and Nutritional Examination Survey, the data of 3728 youth aged 10–19 years were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) of tertiles 2 and 3 for each parameter were calculated and compared with tertile 1 as a reference. To compare the parameters for identifying IR, receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. The ORs and 95% CIs for insulin resistance (IR) progressively increased across tertiles of each parameter. Overall, all modified TyG indices presented higher ORs and AUC than the TyG index. The TyG-body mass index standard deviation score showed the largest AUC for IR detection in all subjects. In conclusion, TyG and modified TyG indices could be used as valuable markers for the prediction of IR in youth. Moreover, modified TyG indices had better diagnostic accuracy than the TyG index.
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Galvin AE, Friedman DB, Hébert JR. Focus on disability-free life expectancy: implications for health-related quality of life. Qual Life Res 2021; 30:2187-2195. [PMID: 33733432 PMCID: PMC7970769 DOI: 10.1007/s11136-021-02809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Since the end of the industrial revolution, advances in public health and clinical medicine have contributed to dramatic decreases in infant and childhood mortality, improvements in health-related quality of life (HRQoL), increases in overall life expectancy (LE), and rectangularization of survival curves. OBJECTIVES In this article, we focus on disability that has occurred with the overall lengthening of LE in many populations and the implications this has for decreased HRQoL. METHODS We utilize the concept of rectangularization of population survival to depict the rising prevalence of disability associated with increased LE, especially among racial and ethnic minorities and people of low socioeconomic status (SES) and relate this to HRQoL. RESULTS Disability-free life expectancy (DFLE) and healthy life expectancy (HLE) are defined in terms of HRQoL. Specific attention is focused on disability experienced by disparate populations around the globe. By focusing on disparities in DFLE, and the need to expand LE to include HLE as a central component of HRQoL, this work provides an important counterpoint to the attention that has been paid to LE disparities according to race, gender, ethnicity, education, and SES. DISCUSSION By calling attention to those factors that appear to be the most important drivers of the differences in quality and length of DFLE between different groups (i.e., the components of the social gradient, exposure to chronic stress, systemic inflammation, and the psychological and biological mechanisms associated with the gut-brain axis) and, by logical extension, HRQoL, we hope to promote research in this arena with the ultimate goal of improving DFLE, HLE, and overall HRQoL, especially in disparate populations around the globe.
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Affiliation(s)
- Ashley E Galvin
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA.,Pediatric Hematology-Oncology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02215, USA
| | - Daniela B Friedman
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hébert
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA. .,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA.
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40
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Amin AM. The metabolic signatures of cardiometabolic diseases: Does the shared metabotype offer new therapeutic targets? LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Arwa M. Amin
- Department of Clinical and Hospital Pharmacy College of Pharmacy Taibah University Medina Saudi Arabia
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Greater Loss of Central Adiposity from Low-Carbohydrate versus Low-Fat Diet in Middle-Aged Adults with Overweight and Obesity. Nutrients 2021; 13:nu13020475. [PMID: 33572489 PMCID: PMC7911139 DOI: 10.3390/nu13020475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/12/2023] Open
Abstract
The objective of this study is to determine whether middle-aged adults prescribed a low carbohydrate-high fat (LCHF) or low fat (LF) diet would have greater loss of central fat and to determine whether the insulin resistance (IR) affects intervention response. A total of 50 participants (52.3 ± 10.7 years old; 36.6 ± 7.4 kg/m2 BMI; 82% female) were prescribed either a LCHF diet (n = 32, carbohydrate: protein: fat of 5%:30%:65% without calorie restriction), or LF diet (n = 18, 63%:13–23%: 10–25% with calorie restriction of total energy expenditure—500 kcal) for 15 weeks. Central and regional body composition changes from dual-x-ray absorptiometry and serum measures were compared using paired t-tests and ANCOVA with paired contrasts. IR was defined as homeostatic model assessment (HOMA-IR) > 2.6. Compared to the LF group, the LCHF group lost more android (15.6 ± 11.2% vs. 8.3 ± 8.1%, p < 0.01) and visceral fat (18.5 ± 22.2% vs. 5.1 ± 15.8%, p < 0.05). Those with IR lost more android and visceral fat on the LCHF verses LF group (p < 0.05). Therefore, the clinical prescription to a LCHF diet may be an optimal strategy to reduce disease risk in middle-aged adults, particularly those with IR.
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Legrand P, Catheline D, Rioux V. [Lipids should not be demonized in adults and in infants]. Med Sci (Paris) 2021; 37:41-46. [PMID: 33492217 DOI: 10.1051/medsci/2020257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Following a long and dogmatic period, which has demonized the dietary lipids, a cautious review of the literature led the scientists to propose a new paradigm and rehabilitation for lipids. French guidelines have endorsed it since 2010, and recent data confirm this new and necessary approach, especially for infants.
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Affiliation(s)
- Philippe Legrand
- Laboratoire de biochimie et nutrition humaine, Institut Agro, 65 rue de Saint-Brieuc, 35042, Rennes, France - Inserm, INRAe, Univ Rennes, Institut NUMECAN (nutrition metabolisms and cancer) UMR_A 1341, UMR_S 1241, 35000, Rennes, France
| | - Daniel Catheline
- Laboratoire de biochimie et nutrition humaine, Institut Agro, 65 rue de Saint-Brieuc, 35042, Rennes, France - Inserm, INRAe, Univ Rennes, Institut NUMECAN (nutrition metabolisms and cancer) UMR_A 1341, UMR_S 1241, 35000, Rennes, France
| | - Vincent Rioux
- Laboratoire de biochimie et nutrition humaine, Institut Agro, 65 rue de Saint-Brieuc, 35042, Rennes, France - Inserm, INRAe, Univ Rennes, Institut NUMECAN (nutrition metabolisms and cancer) UMR_A 1341, UMR_S 1241, 35000, Rennes, France
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Waldman HS, Smith JW, Lamberth J, Fountain BJ, Bloomer RJ, Butawan MB, McAllister MJ. A 28-Day Carbohydrate-Restricted Diet Improves Markers of Cardiovascular Disease in Professional Firefighters. J Strength Cond Res 2021; 34:2785-2792. [PMID: 32740289 DOI: 10.1519/jsc.0000000000003749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Waldman, HS, Smith, JW, Lamberth, J, Fountain, BJ, Bloomer, RJ, Butawan, MB, and McAllister, MJ. A 28-day carbohydrate-restricted diet improves markers of cardiovascular disease in professional firefighters. J Strength Cond Res 34(10): 2785-2792, 2020-This study compared the effects of a 4-week, nonketogenic, carbohydrate-restricted (<25% of calories) diet (CRD) on markers of inflammation and oxidative stress in professional firefighters (FF). Subjects (n = 15) reported to the laboratory for 2 sessions (i.e., baseline and post-CRD) where blood was drawn from an antecubital vein after a 10-hour overnight fast. Dependent variables measured at baseline and post-CRD included adiponectin, insulin, human growth hormone, cortisol, C-reactive protein, albumin, lipids, glucose, amylase, creatine kinase, malondialdehyde (MDA), advance oxidation protein products (AOPP), total nitrate + nitrite, and soluble intracellular adhesion molecule-1. Compared with baseline, the CRD resulted in dramatic improvements to subjects' cardiometabolic profiles, including decreases in AOPP (51.3 ± 27.3 vs. 32.9 ± 7.9 ng·ml), MDA (1.6 ± 0.6 vs. 1.1 ± 0.5 µmol·L), and triglycerides (84.4 ± 34.4 vs. 64.2 ± 14.4 mg·dl), respectively. In addition, the CRD increased total cholesterol (151.5 ± 23.0 vs. 167.7 ± 38.2 mg·dl) and high-density lipoprotein cholesterol (46.3 ± 12.7 vs. 50.6 ± 15.5 mg·dl), but no differences were found with low-density lipoprotein cholesterol. Overall, our results show a 4-week CRD can favorably improve some markers of cardiovascular health in male FF.
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Affiliation(s)
- Hunter S Waldman
- Department of Kinesiology, Human Performance Lab, University of North Alabama, Florence, Alabama.,Department of Kinesiology, Applied Physiology Lab, Mississippi State University, Starkville, Mississippi
| | - JohnEric W Smith
- Department of Kinesiology, Applied Physiology Lab, Mississippi State University, Starkville, Mississippi
| | - John Lamberth
- Department of Kinesiology, Applied Physiology Lab, Mississippi State University, Starkville, Mississippi
| | - Brent J Fountain
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi
| | - Richard J Bloomer
- School of Health Studies, The University of Memphis, Memphis, Tennessee; and
| | - Matthew B Butawan
- School of Health Studies, The University of Memphis, Memphis, Tennessee; and
| | - Matthew J McAllister
- Department of Health and Human Performance, Metabolic & Applied Physiology Lab, Texas State University, San Marcos, Texas
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44
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Goldenberg JZ, Day A, Brinkworth GD, Sato J, Yamada S, Jönsson T, Beardsley J, Johnson JA, Thabane L, Johnston BC. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021; 372:m4743. [PMID: 33441384 PMCID: PMC7804828 DOI: 10.1136/bmj.m4743] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. DESIGN Systematic review and meta-analysis. DATA SOURCES Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. STUDY SELECTION Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. DATA EXTRACTION Primary outcomes were remission of diabetes (HbA1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA1c, fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. RESULTS Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I2=58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. CONCLUSIONS On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020161795.
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Affiliation(s)
- Joshua Z Goldenberg
- Department of Nutrition, Texas A&M University, College Station, TX, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Sydney, NSW, Australia
| | - Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Yamada
- Diabetes Center, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Tommy Jönsson
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Malmö, Sweden
| | | | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Bradley C Johnston
- Department of Nutrition, Texas A&M University, College Station, TX, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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45
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Delgado J, Ansorena D, Van Hecke T, Astiasarán I, De Smet S, Estévez M. Meat lipids, NaCl and carnitine: Do they unveil the conundrum of the association between red and processed meat intake and cardiovascular diseases?_Invited Review. Meat Sci 2021; 171:108278. [DOI: 10.1016/j.meatsci.2020.108278] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
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46
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Waldman HS, McAllister MJ. Exogenous Ketones as Therapeutic Signaling Molecules in High-Stress Occupations: Implications for Mitigating Oxidative Stress and Mitochondrial Dysfunction in Future Research. Nutr Metab Insights 2020; 13:1178638820979029. [PMID: 33354110 PMCID: PMC7734540 DOI: 10.1177/1178638820979029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
High-stress occupations (ie, firefighters, military personnel, police officers, etc.) are often plagued by cardiometabolic diseases induced by exposure to chronic stressors. Interrupted sleep cycles, poor dietary patterns, lack of physical activity, and smoke exposure along with simultaneous psychological stressors promote chronic low-grade inflammation and excessive oxidative stress. Collectively, these data suggest that practical interventions which might mitigate the underlying pathologies of these cardiometabolic diseases are warranted. Ketones, specifically R-βHB, modulates intracellular signaling cascades such as the cellular redox ratios of NAD+/NADH, the activity of NAD dependent deacetylases SIRT1 and SIRT3, and promotes a robust mitochondrial environment which favors reductions in oxidative stress and inflammation. To date, the literature examining R-βHB as a signaling metabolite has mostly been performed from endogenous R-βHB production achieved through nutritional ketosis or cell culture and mouse models using exogenous R-βHB. To the authors knowledge, only 1 study has attempted to report on the effects of exogenous ketones and the mitigation of oxidative stress/inflammation. Therefore, the scope of this review is to detail the mechanisms of R-βHB as a signaling metabolite and the role that exogenous ketones might play in mitigating diseases in individuals serving in high-stress occupations.
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Affiliation(s)
- Hunter S Waldman
- Human Performance Lab, Department of Kinesiology, University of North Alabama, Florence, AL, USA
| | - Matthew J McAllister
- Metabolic and Applied Physiology Lab, Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
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47
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Cipryan L, Dostal T, Plews DJ, Hofmann P, Laursen PB. Adiponectin/leptin ratio increases after a 12-week very low-carbohydrate, high-fat diet, and exercise training in healthy individuals: A non-randomized, parallel design study. Nutr Res 2020; 87:22-30. [PMID: 33596508 DOI: 10.1016/j.nutres.2020.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/16/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate the effect of a 12-week very low-carbohydrate, high-fat (VLCHF) diet and exercise on biomarkers of inflammation in healthy individuals. Since the anti-inflammatory effects of a ketogenic diet have been established, we hypothesized that the VLCHF diet, along with exercise, would have an additional favorable effect on biomarkers of inflammation. Twenty-four healthy individuals were allocated to the VLCHF diet (VLCHF: N = 12, age 25.3 ± 2.0 years, body mass 66.7 ± 9.8 kg, fat mass 21.5% ± 4.9%), or habitual diet (HD: N = 12, age 23.9 ± 3.8 years, body mass 72.7 ± 15.0 kg, fat mass 23.4 ± 8.4 %) group. Biomarkers of inflammation (adiponectin, leptin, and high-sensitive interleukin-6 [hs-IL-6]) and substrate metabolism (glycated hemoglobin, fasting glucose, triacylglycerides, and cholesterol) were analyzed from blood at baseline and after 12 weeks. The adiponectin-leptin ratio significantly increased in the VLCHF group after the intervention period (ES [95% CL]: -0.90 [-0.96, -0.77], P ≤ .001, BF10 = 22.15). The adiponectin-leptin ratio changes were associated with both a significant increase in adiponectin (-0.79 [-0.91, -0.54], P ≤ .001, BF10 = 9.43) and a significant decrease in leptin (0.58 [0.19, 0.81], P = .014, BF10 = 2.70). There was moderate evidence of changes in total cholesterol (-1.15 [-2.01, -0.27], P = .010, BF10 = 5.20), and LDL cholesterol (-1.12 [-2.01, -0.21], P = .016, BF10 = 4.56) in the VLCHF group. Body weight (kg) and fat mass (%) decreased in the VLCHF group by 5.4% and 14.9%, respectively. We found that in healthy young individuals, consuming a VLCHF diet while performing regular exercise over a 12-week period produced favorable changes in body weight and fat mass along with beneficial changes in serum adiponectin and leptin concentrations. These data support the use of a VLCHF diet strategy for the primary prevention of chronic diseases associated with systemic low-grade inflammation.
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Affiliation(s)
- Lukas Cipryan
- Department of Human Movement Studies and Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic.
| | - Tomas Dostal
- Department of Human Movement Studies and Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic.
| | - Daniel J Plews
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand.
| | - Peter Hofmann
- Institute of Human Movement Science, Sport and Health; Exercise Physiology, Training and Training Therapy Research Group, University of Graz, Graz, Austria.
| | - Paul B Laursen
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand.
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48
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Neves GS, Lunardi MS, Lin K, Rieger DK, Ribeiro LC, Moreira JD. Ketogenic diet, seizure control, and cardiometabolic risk in adult patients with pharmacoresistant epilepsy: a review. Nutr Rev 2020; 79:931-944. [PMID: 33230563 DOI: 10.1093/nutrit/nuaa112] [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] [Indexed: 01/01/2023] Open
Abstract
Pharmacoresistant epilepsy causes serious deleterious effects on the patient's health and quality of life. For this condition, a ketogenic diet (KD) is a treatment option. The KD is a general term for a set of diets that contain high amounts of fat and low content of carbohydrates. The most prominent KD treatments are classical KD (4:1 ratio of fat to carbohydrate), modified Atkins diet (2:1 to 1:1 ratio), medium-chain triglycerides KD (with medium-chain triglyceride as a part of the fat content), and low glycemic index KD (using low glycemic carbohydrates). KD has been widely prescribed for children with epilepsy but not for adult patients. One of the main concerns about adult use of KD is its cardiovascular risk associated with high-fat and cholesterol intake. Therefore, this narrative review provides comprehensive information of the current literature on the effects of KD on lipid profile, glycemic-control biomarkers, and other cardiometabolic risk factors in adult patients with pharmacoresistant epilepsy.
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Affiliation(s)
- Gabriela S Neves
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Mariana S Lunardi
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Débora Kurrle Rieger
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Letícia C Ribeiro
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Júlia D Moreira
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
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49
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Miller VJ, LaFountain RA, Barnhart E, Sapper TS, Short J, Arnold WD, Hyde PN, Crabtree CD, Kackley ML, Kraemer WJ, Villamena FA, Volek JS. A ketogenic diet combined with exercise alters mitochondrial function in human skeletal muscle while improving metabolic health. Am J Physiol Endocrinol Metab 2020; 319:E995-E1007. [PMID: 32985255 DOI: 10.1152/ajpendo.00305.2020] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Animal data indicate that ketogenic diets are associated with improved mitochondrial function, but human data are lacking. We aimed to characterize skeletal muscle mitochondrial changes in response to a ketogenic diet combined with exercise training in healthy individuals. Twenty-nine physically active adults completed a 12-wk supervised exercise program after self-selection into a ketogenic diet (KD, n = 15) group or maintenance of their habitual mixed diet (MD, n = 14). Measures of metabolic health and muscle biopsies (vastus lateralis) were obtained before and after the intervention. Mitochondria were isolated from muscle and studied after exposure to carbohydrate (pyruvate), fat (palmitoyl-l-carnitine), and ketone (β-hydroxybutyrate+acetoacetate) substrates. Compared with MD, the KD resulted in increased whole body resting fat oxidation (P < 0.001) and decreased fasting insulin (P = 0.019), insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR), P = 0.022], and visceral fat (P < 0.001). The KD altered mitochondrial function as evidenced by increases in mitochondrial respiratory control ratio (19%, P = 0.009), ATP production (36%, P = 0.028), and ATP/H2O2 (36%, P = 0.033) with the fat-based substrate. ATP production with the ketone-based substrate was four to eight times lower than with other substrates, indicating minimal oxidation. The KD resulted in a small decrease in muscle glycogen (14%, P = 0.035) and an increase in muscle triglyceride (81%, P = 0.006). These results expand our understanding of human adaptation to a ketogenic diet combined with exercise. In conjunction with weight loss, we observed altered skeletal muscle mitochondrial function and efficiency, an effect that may contribute to the therapeutic use of ketogenic diets in various clinical conditions, especially those associated with insulin resistance.
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Affiliation(s)
- Vincent J Miller
- OSU Interdisciplinary PhD Program in Nutrition, Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | | | - Emily Barnhart
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Teryn S Sapper
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Jay Short
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - W David Arnold
- Department of Neurology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Parker N Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | | | - Madison L Kackley
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Frederick A Villamena
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, Ohio
| | - Jeff S Volek
- OSU Interdisciplinary PhD Program in Nutrition, Department of Human Sciences, The Ohio State University, Columbus, Ohio
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
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50
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Keith L, Seo CA, Rowsemitt C, Pfeffer M, Wahi M, Staggs M, Dudek J, Gower B, Carmody M. Ketogenic diet as a potential intervention for lipedema. Med Hypotheses 2020; 146:110435. [PMID: 33303304 DOI: 10.1016/j.mehy.2020.110435] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.
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Affiliation(s)
- L Keith
- The Lipedema Project, Boston, MA, USA; Lipedema Simplified, Boston, MA, USA.
| | - C A Seo
- The Lipedema Project, Boston, MA, USA; Lipedema Simplified, Boston, MA, USA
| | - C Rowsemitt
- Lipedema Simplified, Boston, MA, USA; Comprehensive Weight Management, Templeton, CA and Providence, RI, USA; The Lipedema Project: Medical Advisory Board, Boston, MA, USA
| | - M Pfeffer
- Lipedema Simplified, Boston, MA, USA; The Lipedema Project: Medical Advisory Board, Boston, MA, USA; I Choose Health, Metung, Australia
| | - M Wahi
- DethWench Professional Services, Boston, MA, USA
| | - M Staggs
- Lipedema Simplified, Boston, MA, USA
| | - J Dudek
- The Lipedema Project: Medical Advisory Board, Boston, MA, USA; SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - B Gower
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, AL, USA
| | - M Carmody
- Harvard Medical School, Boston, MA, USA
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