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Pantanetti P, Cangelosi G, Sguanci M, Morales Palomares S, Nguyen CTT, Morresi G, Mancin S, Petrelli F. Glycemic Control in Diabetic Patients Receiving a Diabetes-Specific Nutritional Enteral Formula: A Case Series in Home Care Settings. Nutrients 2024; 16:2602. [PMID: 39203739 PMCID: PMC11357306 DOI: 10.3390/nu16162602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/26/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND AND AIM In patients with Diabetes Mellitus (DM), Enteral Nutrition (EN) is associated with less hyperglycemia and lower insulin requirements compared to Parenteral Nutrition (PN). The primary aim of this study was to assess changes in glycemic control (GC) in DM patients on EN therapy. The secondary objectives included evaluating the impact of the specialized formula on various clinical parameters and the tolerability of the nutritional formula by monitoring potential gastrointestinal side effects. METHODS We report a case series on the effects of a Diabetes-Specific Formula (DSF) on GC, lipid profile (LP), and renal and hepatic function in a DM cohort receiving EN support. RESULTS Twenty-two DM subjects with total dysphagia (thirteen men, nine women) on continuous EN were observed. The use of a DSF in EN was associated with an improvement in glycemic indices across all patients studied, leading to a reduction in average insulin demand. No hospitalizations were reported during the study period. CONCLUSION The study demonstrated that the use of DSFs in a multi-dimensional home care management setting can improve glycemic control, reduce glycemic variability and insulin need, and positively impact the lipid profile of the DM cohort. The metabolic improvements were supported by the clinical outcomes observed.
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Affiliation(s)
- Paola Pantanetti
- Unit of Diabetology, Asur Marche–Area Vasta 4, 63900 Fermo, Italy; (P.P.); (G.C.)
| | - Giovanni Cangelosi
- Unit of Diabetology, Asur Marche–Area Vasta 4, 63900 Fermo, Italy; (P.P.); (G.C.)
| | - Marco Sguanci
- A.O. Polyclinic San Martino Hospital, Largo R. Benzi 10, 16132 Genova, Italy;
| | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy;
| | - Cuc Thi Thu Nguyen
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi 100000, Vietnam;
| | | | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Fabio Petrelli
- School of Pharmacy, Polo Medicina Sperimentale e Sanità Pubblica “Stefania Scuri”, Via Madonna delle Carceri 9, 62032 Camerino, Italy
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Guizar-Heredia R, Noriega LG, Rivera AL, Resendis-Antonio O, Guevara-Cruz M, Torres N, Tovar AR. A New Approach to Personalized Nutrition: Postprandial Glycemic Response and its Relationship to Gut Microbiota. Arch Med Res 2023; 54:176-188. [PMID: 36990891 DOI: 10.1016/j.arcmed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
A prolonged and elevated postprandial glucose response (PPGR) is now considered a main factor contributing for the development of metabolic syndrome and type 2 diabetes, which could be prevented by dietary interventions. However, dietary recommendations to prevent alterations in PPGR have not always been successful. New evidence has supported that PPGR is not only dependent of dietary factors like the content of carbohydrates, or the glycemic index of the foods, but is also dependent on genetics, body composition, gut microbiota, among others. In recent years, continuous glucose monitoring has made it possible to establish predictions on the effect of different dietary foods on PPGRs through machine learning methods, which use algorithms that integrate genetic, biochemical, physiological and gut microbiota variables for identifying associations between them and clinical variables with aim of personalize dietary recommendations. This has allowed to improve the concept of personalized nutrition, since it is now possible to recommend through these predictions specific dietary foods to prevent elevated PPGRs that are highly variable among individuals. Additional components that can enrich the predictive algorithms are findings of nutrigenomics, nutrigenetics and metabolomics. Thus, this review aims to summarize the evidence of the components that integrate personalized nutrition focused on the prevention of PPGRs, and to show the future of personalized nutrition by laying the groundwork for the development of individualized dietary management and its impact on the improvement of metabolic diseases.
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Lei L, Huang J, Zhang L, Hong Y, Hui S, Yang J. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors in overweight and obese adults: A meta-analysis of randomized controlled trials. Front Nutr 2022; 9:935234. [PMID: 36017224 PMCID: PMC9397119 DOI: 10.3389/fnut.2022.935234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background and aims Low-carbohydrate diets (LCD) and low-fat diets (LFD) have shown beneficial effects on the management of obesity. Epidemiological studies were conducted to compare the effects of the two diets. However, the results were not always consistent. This study aimed to conduct a meta-analysis to compare the long-term effects of LCD and LFD on metabolic risk factors and weight loss in overweight and obese adults. Methods We performed a systematic literature search up to 30 March, 2022 in PubMed, EMBASE, and Cochrane Library. The meta-analysis compared the effects of LCD (carbohydrate intake ≤ 40%) with LFD (fat intake < 30%) on metabolic risk factors and weight loss for ≥6 months. Subgroup analyses were performed based on participant characteristics, dietary energy intake, and the proportions of carbohydrates. Results 33 studies involving a total of 3,939 participants were included. Compared with participants on LFD, participants on LCD had a greater reduction in triglycerides (–0.14 mmol/L; 95% CI, –0.18 to –0.10 mmol/L), diastolic blood pressure (–0.87 mmHg; 95% CI, –1.41 to –0.32 mmHg), weight loss (–1.33 kg; 95% CI, –1.79 to –0.87 kg), and a greater increase in high-density lipoprotein cholesterol (0.07 mmol/L; 95% CI, 0.06 to 0.09 mmol/L) in 6–23 months. However, the decrease of total cholesterol (0.14 mmol/L; 95% CI, 0.07 to 0.20 mmol/L) and low-density lipoprotein cholesterol (0.10 mmol/L; 95% CI, 0.06 to 0.14 mmol/L) was more conducive to LFD in 6–23 months. There was no difference in benefits between the two diets after 24 months. Subgroup analyses showed no significant difference in the reduction of total cholesterol, low-density lipoprotein cholesterol, and blood pressure between the two diets in participants with diabetes, hypertension, or hyperlipidemia. Conclusion The results suggest that LCD and LFD may have specific effects on metabolic risk factors and weight loss in overweight and obese adults over 6 months. At 24 months, the effects on weight loss and improvement of metabolic risk factors were at least the same. These indicated that we might choose different diets to manage the overweight and obese subjects. However, the long-term clinical efficacy and effects of various sources of carbohydrates or fat in the two diets need to be studied in the future.
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Affiliation(s)
- Lifu Lei
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Huang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longlong Zhang
- Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Endocrinology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqin Hong
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suocheng Hui
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Research Center for Metabolic and Cardiovascular Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis. Clin Nutr 2020; 39:3273-3282. [DOI: 10.1016/j.clnu.2020.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
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A Tool to Explore Discrete-Time Data: The Time Series Response Analyser. Int J Sport Nutr Exerc Metab 2020; 30:374-381. [PMID: 32726749 DOI: 10.1123/ijsnem.2020-0150] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022]
Abstract
The analysis of time series data is common in nutrition and metabolism research for quantifying the physiological responses to various stimuli. The reduction of many data from a time series into a summary statistic(s) can help quantify and communicate the overall response in a more straightforward way and in line with a specific hypothesis. Nevertheless, many summary statistics have been selected by various researchers, and some approaches are still complex. The time-intensive nature of such calculations can be a burden for especially large data sets and may, therefore, introduce computational errors, which are difficult to recognize and correct. In this short commentary, the authors introduce a newly developed tool that automates many of the processes commonly used by researchers for discrete time series analysis, with particular emphasis on how the tool may be implemented within nutrition and exercise science research.
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Patel VN, Dijk G, Malarkey B, Brooke JR, Whelan K, MacLaughlin HL. Glycemic Response to a Renal-Specific Oral Nutritional Supplement in Patients With Diabetes Undergoing Hemodialysis: A Randomized Crossover Trial. JPEN J Parenter Enteral Nutr 2020; 45:267-276. [PMID: 32713006 DOI: 10.1002/jpen.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes and malnutrition are common in patients with kidney failure. We aimed to evaluate the postprandial glucose response to oral nutritional supplement drinks (ONSs) in patients with diabetes undergoing hemodialysis treatment. METHODS A randomized, single-blind crossover study was conducted in patients with diabetes, and requiring chronic hemodialysis. Patients consumed either a renal-specific ONS, macronutrient-matched ONS, or standard ONS on 3 separate study days, during dialysis, following an overnight fast. Blood was collected before and 15, 30, 45, 60, 90, 120, and 180 minutes post ingestion. Mean net incremental area under the curve (iAUC) and peak incremental blood glucose concentration were compared across conditions, using analyses of variance. RESULTS Consumption of the renal-specific ONS resulted in the lowest mean net iAUC (87.9 ± 169.0 mmol/L per 3 hours) compared with macronutrient-matched (188.0 ± 127.5 mmol/L per 3 hours) and standard ONS (199.5 ± 169.2 mmol/L per 3 hours) (F2,30 = 5.115, P = 0.012, partial n2 = 0.254). Pairwise comparisons demonstrated a mean difference of 100.1 mmol/L per 3 hours (95% CI, -2.8 to 202.9) in mean iAUC between the renal-specific ONS and macronutrient-matched ONS (P = 0.058). Peak blood glucose concentration, corrected for baseline, was significantly lower after the renal-specific ONS (1.40 ± 1.0 mmol/L) compared with both macronutrient-matched (2.02 ± 0.71 mmol/L, P = 0.036) and standard ONS (2.3 ± 1.06 mmol/L, P = 0.017). CONCLUSION A renal-specific ONS elicits a lower postprandial glucose response than either macronutrient-matched ONS or standard ONS in patients with diabetes during hemodialysis.
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Affiliation(s)
| | - Giulia Dijk
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK
| | - Bridget Malarkey
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jennifer R Brooke
- Department of Nutritional Sciences, King's College London, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Helen L MacLaughlin
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK.,Queensland University of Technology (QUT) School of Exercise and Nutrition Sciences, Brisbane, Australia
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Ingadottir AR, Bjorgvinsdottir EB, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Birgisdottir BE, Gislason T, Gunnarsdottir I. Effect of two different nutritional supplements on postprandial glucose response and energy- and protein intake in hospitalised patients with COPD: A randomised cross-over study. Clin Nutr 2019; 39:1085-1091. [PMID: 31064666 DOI: 10.1016/j.clnu.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Oral nutrition support is frequently used in treatment of malnutrition in patients with chronic obstructive pulmonary disease (COPD). Considering the use of corticoidsteroids in patients with COPD, little is known about the effect on postprandial glucose response and if they might interfere with glucose control. Our aims were to compare the effect of a liquid oral nutritional supplement (ONS) and semi solid inbetween meal snack (snack) on postprandial glucose and energy- and protein intake, and to compare the effect of timing of each intervention on postprandial glucose and energy- and protein intake. METHODS Patients with COPD (n = 17) admitted to the Department of Pulmonary Medicine, Iceland and defined as at low or medium nutritional risk (score 0-3) were recruited. In a randomised cross-over design, subjects consumed ONS or snack either in a fasting state (study 1) or following breakfast (study 2) and postprandial glucose responses were assessed at regular intervals for two hours (t = 15, t = 30, t = 45, t = 60, t = 90, t = 120 min). Energy- and protein intake was estimated using a validated plate diagram sheet. Wilcoxon Signed-Rank test was used to compare the two interventions. RESULTS In study 2, following breakfast, postprandial glucose was significantly higher after consuming ONS than the snack after 60 min (9.7 ± 2.4 mmol/L vs. 8.2 ± 3.2 mmol/L, p = 0.013 and 120 min 9.2 ± 3.2 mmol/L vs. 7.9 ± 2.4 mmol/L, p = 0.021, respectively). No difference was found in postprandial glucose concentrations between ONS and the snack when consumed after overnight fasting (study 1). No difference in energy or protein intake from hospital food was seen between supplement types neither in study 1 or 2. CONCLUSION Lower postprandial glucose concentrations were associated with the snack compared to ONS when taken after a meal compared to either type directly after overnight fasting. The clinical relevance of higher postprandial blood glucose after consuming a liquid ONS after breakfast compared with a semi solid snack needs to be studied further.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland.
| | - Eva Bjorg Bjorgvinsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health and Copenhagen University College, Copenhagen N, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, DK-2820, Gentofte, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | - C Elizabeth Weekes
- Department of Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; The Icelandic Gerontological Research Institute, Landspitali University Hospital & University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Bryndis Eva Birgisdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Huang YC, Wu BH, Chu YL, Chang WC, Wu MC. Effects of Tempeh Fermentation with Lactobacillus plantarum and Rhizopus oligosporus on Streptozotocin-Induced Type II Diabetes Mellitus in Rats. Nutrients 2018; 10:E1143. [PMID: 30135362 PMCID: PMC6163431 DOI: 10.3390/nu10091143] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022] Open
Abstract
The increased consumption of high fat-containing foods has been linked to the prevalence of obesity and abnormal metabolic syndromes. Rhizopus oligosporus, a fungus in the family Mucoraceae, is widely used as a starter for homemade tempeh. Although R. oligosporus can prevent the growth of other microorganisms, it grows well with lactic acid bacteria (LAB). Lactobacillus plantarum can produce β-glucosidase, which catalyzes the hydrolysis of glucoside isoflavones into aglycones (with greater bioavailability). Therefore, the development of a soybean-based functional food by the co-inoculation of R. oligosporus and L. plantarum is a promising approach to increase the bioactivity of tempeh. In this study, the ameliorative effect of L. plantarum in soy tempeh on abnormal carbohydrate metabolism in high-fat diet (HFD)-induced hyperglycemic rats was evaluated. The co-incubation of L. plantarum with R. oligosporus during soy tempeh fermentation reduced the homeostatic model assessment of insulin resistance, HbA1c, serum glucose, total cholesterol, triglyceride, free fatty acid, insulin, and low-density lipoprotein contents, and significantly increased the high-density lipoprotein content in HFD rats. It also increased the LAB counts, as well as the bile acid, cholesterol, triglyceride, and short-chain fatty acid contents in the feces of HFD rats. Our results suggested that the modulation of serum glucose and lipid levels by LAB occurs via alterations in the internal microbiota, leading to the inhibition of cholesterol synthesis and promotion of lipolysis. Tempeh, which was produced with both L. plantarum and R. oligosporus, might be a beneficial dietary supplement for individuals with abnormal carbohydrate metabolism.
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Affiliation(s)
- Ying-Che Huang
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
| | - Bo-Hua Wu
- Department of Food Science, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
| | - Yung-Lin Chu
- International Master's Degree Program in Food Science, International College, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
| | - Wen-Chang Chang
- Department of Food Science, National Chiayi University, Chiayi 60004, Taiwan.
| | - Ming-Chang Wu
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
- Department of Food Science, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
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Barazzoni R, Deutz N, Biolo G, Bischoff S, Boirie Y, Cederholm T, Cuerda C, Delzenne N, Leon Sanz M, Ljungqvist O, Muscaritoli M, Pichard C, Preiser J, Sbraccia P, Singer P, Tappy L, Thorens B, Van Gossum A, Vettor R, Calder P. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr 2017; 36:355-363. [DOI: 10.1016/j.clnu.2016.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
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Sanz-Paris A, Álvarez Hernández J, Ballesteros-Pomar MD, Botella-Romero F, León-Sanz M, Martín-Palmero Á, Martínez Olmos MÁ, Olveira G. Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia. Nutrition 2017; 41:58-67. [PMID: 28760429 DOI: 10.1016/j.nut.2017.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/03/2017] [Accepted: 02/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia who are receiving enteral nutrition (EN). METHODS A Delphi survey method using Grading Recommendations Assessment, Development and Evaluation criteria was utilized for evaluation of suitable studies. RESULTS In patients with diabetes or stress hyperglycemia who were on EN support, the following results were found: CONCLUSIONS: These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.
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Affiliation(s)
- Alejandro Sanz-Paris
- Unit of Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Julia Álvarez Hernández
- Section of Endocrinology and Nutrition, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - María D Ballesteros-Pomar
- Unit of Clinical Nutrition and Dietetics, Section of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain
| | | | - Miguel León-Sanz
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángela Martín-Palmero
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Hospital San Pedro, Logroño, Spain
| | - Miguel Ángel Martínez Olmos
- Unit of Clinical Nutrition and Dietetics, Service of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Olveira
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (Instituto de Salud Carlos III: CB07/08/0019), Spain
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Lansink M, Hofman Z, Genovese S, Rouws CHFC, Ceriello A. Improved Glucose Profile in Patients With Type 2 Diabetes With a New, High-Protein, Diabetes-Specific Tube Feed During 4 Hours of Continuous Feeding. JPEN J Parenter Enteral Nutr 2016; 41:968-975. [PMID: 26826263 DOI: 10.1177/0148607115625635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperglycemia frequently occurs in hospitalized patients receiving nutrition support. In this study, the effects of a new diabetes-specific formula (DSF) on glucose profile during 4 hours of continuous feeding and 4 hours after stopping feeding were compared with a standard formula (SF). MATERIALS AND METHODS In this randomized, controlled, double-blind, crossover study, ambulant, nonhospitalized patients with type 2 diabetes received the DSF or an isocaloric, fiber-containing SF via a nasogastric tube. After overnight fasting, the formula was continuously administered to the patients during 4 hours. Plasma glucose and insulin concentrations were determined during the 4-hour period and in the subsequent 4 hours during which no formula was provided. RESULTS During the 4-hour feeding period, DSF compared with SF resulted in a lower mean delta glucose concentration in the 3- to 4-hour period (0.3 ± 1.0 and 2.4 ± 1.5 mmol/L; P < .001). Also, the (delta) peak concentrations, (delta) mean concentrations, and incremental area under the curve (iAUC) for glucose and insulin were significantly lower during DSF compared with SF feeding (all comparisons: P < .001). Furthermore, fewer patients experienced hyperglycemia (>10 mmol/L) on DSF compared with SF (2 vs 11, P = .003, respectively). No differences in number of patients with hypoglycemia (<3.9 mmol/L) were observed. No significant differences in tolerance were observed. CONCLUSION Administration of a new, high-protein DSF during 4 hours of continuous feeding resulted in lower glucose and insulin levels compared with a fiber-containing SF in ambulant, nonhospitalized patients with type 2 diabetes. These data suggest that a DSF may contribute to lower glucose levels in these patients.
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Affiliation(s)
- Mirian Lansink
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Zandrie Hofman
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Stefano Genovese
- 2 Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, Sesto San Giovanni (MI), Italy
| | - Carlette H F C Rouws
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Antonio Ceriello
- 3 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,4 Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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12
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Comparison of two liquid nutritional supplements designed for patients with diabetes: Effect on glucose and insulin metabolism in healthy subjects. PHARMANUTRITION 2015. [DOI: 10.1016/j.phanu.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Ojo O, Brooke J. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review. Nutrients 2014; 6:5142-52. [PMID: 25412151 PMCID: PMC4245584 DOI: 10.3390/nu6115142] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 12/31/2022] Open
Abstract
The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education and Health, University of Greenwich, Avery Hill Road, Avery Hill Campus, London, SE9 2UG, UK.
| | - Joanne Brooke
- Faculty of Education and Health, University of Greenwich, Avery Hill Road, Avery Hill Campus, London, SE9 2UG, UK.
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Quilliot D, Malgras A, Paquot N, Ziegler O. Diabète et nutrition artificielle : principes de prise en charge. NUTR CLIN METAB 2013. [DOI: 10.1016/j.nupar.2013.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Abstract
Both glycemic control and adequate nutrition support impact the clinical outcome of hospitalized patients. Providing nutrition to malnourished patients using the enteral or parenteral route may increase the risk of hyperglycemia, especially in patients with diabetes. Hyperglycemia can be managed through the use of enteral tube feeds with reduced carbohydrate content or limiting the carbohydrate concentration in parenteral formulas. Judicious use of insulin or other glucose-lowering medications synchronized with appropriate nutrition support allows for optimal inpatient glycemic control.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, 55 East 34th Street, New York, NY 10016, USA.
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16
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Carles M, Quilliot D, Raucoules-Aimé M. La nutrition artificielle en periopératoire chez le patient diabétique. NUTR CLIN METAB 2010. [DOI: 10.1016/j.nupar.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Vaisman N, Lansink M, Rouws CH, van Laere KM, Segal R, Niv E, Bowling TE, Waitzberg DL, Morley JE. Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients. Clin Nutr 2009; 28:549-55. [PMID: 19501937 DOI: 10.1016/j.clnu.2009.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 04/24/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Assess longer-term (12 weeks) effects of a diabetes-specific feed on postprandial glucose response, glycaemic control (HbA1c), lipid profile, (pre)-albumin, clinical course and tolerance in diabetic patients. METHODS In this randomized, controlled, double-blind, parallel group study 25 type 2 diabetic patients on tube feeding were included. Patients received a soy-protein based, multi-fibre diabetes-specific feed or isocaloric, fibre-containing standard feed for 12 weeks, while continuing on their anti-diabetic medication. At the beginning, after 6 and 12 weeks, several (glycaemic) parameters were assessed. RESULTS The postprandial glucose response (iAUC) to the diabetes-specific feed was lower at the 1st assessment compared with the standard feed (p=0.008) and this difference did not change over time. HbA1c decreased over time in the diabetes-specific and not in the standard feed group (treatment*time:p=0.034): 6.9+/-0.3% (mean+/-SEM) at baseline vs. 6.2+/-0.4% at 12 weeks in the diabetes-specific group compared to 7.9+/-0.3% to 8.7+/-0.4% in the standard feed group. No significant treatment*time effect was found for fasting glucose, insulin, (pre-) albumin or lipid profile, except for increase of HDL in the diabetes-specific group. CONCLUSIONS The diabetes-specific feed studied significantly improved longer-term glycaemic control in diabetic patients. This was achieved in addition to on-going anti-diabetic medication and may affect clinical outcome.
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Affiliation(s)
- Nachum Vaisman
- Unit of Clinical Nutrition, Tel Aviv Sourasky Medical Center, Weizmanstreet 6, Tel Aviv, Israel.
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18
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Ceriello A, Lansink M, Rouws CHFC, van Laere KMJ, Frost GS. Administration of a new diabetes-specific enteral formula results in an improved 24h glucose profile in type 2 diabetic patients. Diabetes Res Clin Pract 2009; 84:259-66. [PMID: 19307037 DOI: 10.1016/j.diabres.2009.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 01/29/2009] [Accepted: 02/09/2009] [Indexed: 01/08/2023]
Abstract
AIMS Study the effect of several boluses of a new diabetes-specific formula (DSF) during the day on 24h glucose profile. METHODS In this randomized, controlled, double-blind, cross-over study 12 ambulatory type 2 diabetic patients were included. Subjects received a new DSF and an isocaloric standard fibre-containing formula (SF) while continuing their anti-diabetic medication. Subjects received 100% of their calculated daily energy requirements as bolus feeding every 3h (5 times/day, starting at 8.00 a.m.+/-1h). RESULTS Glucose profiles were significantly better after administration of DSF compared with SF determined as mean glucose concentration (+/-SEM) (8.7+/-0.5 versus 9.6+/-0.6 mmol/L, p<0.05 during 24h; 9.4+/-0.6 versus 10.7+/-0.6 mmol/L, p<0.001 during daytime) or as incremental area under the curve during daytime (-44%; p<0.05). Subjects receiving DSF experienced less hyperglycaemic time over 24h (-26%; p<0.05) and during daytime (-30%; p<0.05). Furthermore, lower individual and mean (delta) peak glucose levels were found (p<0.05). No clinically relevant differences in gastrointestinal tolerance were observed. CONCLUSIONS Using DSF resulted in significantly better 24h and postprandial glucose profiles than fibre-containing SF after bolus administration and may therefore help to improve glycaemic control in diabetic patients.
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Vanschoonbeek K, Lansink M, van Laere KMJ, Senden JMG, Verdijk LB, van Loon LJC. Slowly digestible carbohydrate sources can be used to attenuate the postprandial glycemic response to the ingestion of diabetes-specific enteral formulas. DIABETES EDUCATOR 2009; 35:631-40. [PMID: 19448045 DOI: 10.1177/0145721709335466] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to compare the glycemic and insulinemic responses following the ingestion of recently developed diabetes-specific enteral formulas versus a standard and a high-fat formula. METHODS Fifteen type 2 diabetes patients were selected to participate in a randomized, double-blind, crossover study. Two enteral formulas (47 energy percent [En%] carbohydrate, 34En% fat, and 4 g fiber/200 mL) were defined with either isomaltulose (formula 1) or sucromalt (formula 2) as the main carbohydrate source. For comparison, an isoenergetic diabetes-specific, high-fat (33En% carbohydrate, 50En% fat, 2.9 g fiber/200 mL) and a standard formula (55En% carbohydrate, 30En% fat, 2.8 g fiber/200 mL) were tested. RESULTS Ingestion of formulas 1 and 2 and the high-fat formula resulted in an attenuated blood glucose response when compared with the standard formula (P < .05). In accordance, peak plasma glucose concentrations were significantly lower when compared with the standard formula (189 +/- 3.6 mg/dL [10.5 +/- 0.2 mmol/L], 196.2 +/- 3.6 mg/dL [10.9 +/- 0.2 mmol/L], 187.2 +/- 3.6 mg/dL [10.4 +/- 0.2 mmol/L], and 237.6 +/- 3.6 mg/dL [13.2 +/- 0.2 mmol/L], respectively). Plasma insulin responses were lower after consumption of the newly developed and high-fat formulas. Ingestion of the high-fat formula resulted in a greater postprandial triglyceride response (P < .05). CONCLUSIONS Diabetes-specific enteral formulas rich in slowly digestible carbohydrate sources can be equally effective in attenuating the postprandial blood glucose response as low-carbohydrate, high-fat enteral formulas without elevating the plasma triglyceride response.
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Affiliation(s)
- K Vanschoonbeek
- The Departments of Human Biology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands (Dr Vanschoonbeek, Dr van Loon)
| | - M Lansink
- Danone Research, Centre for Specialised Nutrition, Wageningen, the Netherlands (Dr Lansink, Dr van Laere)
| | - K M J van Laere
- Danone Research, Centre for Specialised Nutrition, Wageningen, the Netherlands (Dr Lansink, Dr van Laere)
| | - J M G Senden
- Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands (Mr Senden, Mr Verdijk, Dr van Loon)
| | - L B Verdijk
- Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands (Mr Senden, Mr Verdijk, Dr van Loon)
| | - L J C van Loon
- The Departments of Human Biology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands (Dr Vanschoonbeek, Dr van Loon),Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands (Mr Senden, Mr Verdijk, Dr van Loon)
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Widlicka A. Enteral nutrition in the cardiothoracic intensive care unit: challenges and considerations. Nutr Clin Pract 2008; 23:510-20. [PMID: 18849556 DOI: 10.1177/0884533608323422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is a common preexisting condition among hospitalized patients. Acute myocardial infarction and cardiac surgery account for 2 of the most common reasons patients are admitted to the intensive care unit. Determining how and when to feed these patients is a constant challenge presented to nutrition support practitioners. Enteral nutrition has emerged as the preferred route of feeding particularly in critical illness. By providing enteral nutrition instead of parenteral nutrition, the natural physiologic pathway is being followed and gut immunity preserved. However, obstacles such as upper gastrointestinal intolerance, hypoperfusion vasopressor support, and glycemic control make the task of initiating feeds a challenge. Once a patient has successfully tolerated feeds, the nutrition support clinician must still determine how much to feed and if specialty formulas such as those containing omega-3 fatty acids are beneficial for their patient. The purpose of this review is to present recent research on the feeding challenges in the critical care population with a focus on the cardiothoracic population and an emphasis on improving patient outcomes.
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Affiliation(s)
- Annie Widlicka
- University of Chicago Medical Center, Department of Nutrition Services, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
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21
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Pohl M, Mayr P, Mertl-Roetzer M, Lauster F, Haslbeck M, Hipper B, Steube D, Tietjen M, Eriksen J, Rahlfs VW. Glycemic Control in Patients With Type 2 Diabetes Mellitus With a Disease-Specific Enteral Formula: Stage II of a Randomized, Controlled Multicenter Trial. JPEN J Parenter Enteral Nutr 2008; 33:37-49. [DOI: 10.1177/0148607108324582] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marcus Pohl
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Peter Mayr
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Marion Mertl-Roetzer
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Frank Lauster
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Manfred Haslbeck
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Beate Hipper
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Diethard Steube
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Monika Tietjen
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Jan Eriksen
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
| | - Volker W. Rahlfs
- From the Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany; Diabetology, Health Care Center, Stockach, Germany; Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; Diabetes Research Institute, Munich, Germany; Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany; Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; Fresenius Kabi, Bad Homburg, Germany; Department of Internal Medicine, Herning
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Magnoni D, Rouws CHFC, Lansink M, van Laere KMJ, Campos AC. Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients. Diabetes Res Clin Pract 2008; 80:75-82. [PMID: 18067986 DOI: 10.1016/j.diabres.2007.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. METHODS Forty patients participated in this randomised, controlled, double-blind, parallel-group study. Subjects consumed 2 x 200 ml of diabetes-specific ONS (Diasip) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. RESULTS Postprandial glucose responses (incremental area under curve) (p<0.01) and delta postprandial peak glucose concentration (p<0.01) were significantly lower in the diabetes-specific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose (p=0.074, t=0 week vs. t=12 weeks) and delta postprandial peak plasma glucose concentration (p<0.05, t=0 week vs. t=12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. CONCLUSIONS These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.
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Affiliation(s)
- Daniel Magnoni
- Instituto Dante Pazzanese de Cardiologia, Rua Carlos Sampaio 304, cj 31 CEP 01333 020 São Paulo, Brazil
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23
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Beneficial effects of a diabetes specific formula on insulin sensitivity and free fatty acid in patients with type 2 diabetes mellitus. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200804020-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health--a systematic review and meta-analysis: the database, study characteristics, and macronutrient intakes. Am J Clin Nutr 2008; 87:223S-236S. [PMID: 18175762 DOI: 10.1093/ajcn/87.1.223s] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reduction of dietary glycemic response has been proposed as a means of reducing the risk of diabetes and coronary heart disease. Its role in health maintenance and management, alongside unavailable carbohydrate (eg, fiber), is incompletely understood. OBJECTIVE We aimed to assess the evidence relating the glycemic impact of foods to a role in health maintenance and management of disease. DESIGN We searched the literature for relevant controlled dietary intervention trials on glycemic index (GI) according to inclusion and exclusion criteria, extracted the data to a database, and synthesized the evidence via meta-analyses and meta-regression models. RESULTS Among literature to January 2005, 45 relevant publications were identified involving 972 subjects with good health or metabolic disease. With small reductions in GI (<10 units), increases in available carbohydrate, energy, and protein intakes were found in all studies combined. Falling trends in energy, available carbohydrate, and protein intakes then occurred with progressive reductions in GI. Fat intake was essentially unchanged. Unavailable carbohydrate intake was generally higher for intervention diets but showed no trend with GI (falling or rising). Among studies reporting on GI, variation in glycemic load was approximately equally explained by variation in GI and variation in available carbohydrate intake. An exchange of available and unavailable carbohydrate (approximately 1 g/g) was evident in these studies. CONCLUSIONS Among GI studies, observed reductions in glycemic load are most often not solely due to substitution of high for low glycemic carbohydrate foods. Available carbohydrate intake is a confounding factor. The role of unavailable carbohydrate remains to be accounted for.
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Affiliation(s)
- Geoffrey Livesey
- Independent Nutrition Logic, Wymondham, Norfolk, United Kingdom.
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25
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Diabetes specific tube feed results in improved glycaemic and triglyceridaemic control during 6h continuous feeding in diabetes patients. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eclnm.2007.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Whelan K, Efthymiou L, Judd PA, Preedy VR, Taylor MA. Appetite during consumption of enteral formula as a sole source of nutrition: the effect of supplementing pea-fibre and fructo-oligosaccharides. Br J Nutr 2006; 96:350-6. [PMID: 16923230 DOI: 10.1079/bjn20061791] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Liquid enteral formulas are commonly used as a sole source of nutritional support of patients in hospital and community settings. Their effect on appetite has important consequences for dietary management of such patients and is likely to be affected by the formula composition. The aim of the present study was to compare appetite within healthy subjects consuming both a standard formula and one supplemented with pea-fibre (10 g/l) and fructo-oligosaccharide (FOS; 5 g/l) as a sole source of nutrition. Eleven healthy subjects consumed a standard formula or a pea-fibre/FOS formula as a sole source of nutrition for 14 d in a double-blind, cross-over trial. Appetite was recorded using standard 100 mm lines anchored at each end by a phrase denoting the most extreme appetite sensation. Consumption of the pea-fibre/FOS formula resulted in higher mean fullness (46 v. 37 mm, P=0.035), minimum fullness (13 v. 9 mm, P=0.024) and minimum satiety (12 v. 8 mm, P=0.012) compared to the standard formula. As there were no differences in macronutrient intake between formulas, these differences are likely to be due to supplementation with pea-fibre and FOS. The effect on appetite of the composition of an enteral formula, both with respect to nutrient content and functional components such as pea-fibre and FOS, may be an important aspect to consider in the dietary management of patients consuming enteral formula as a sole source of nutrition.
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Affiliation(s)
- Kevin Whelan
- Nutritional Sciences Research Division, King's College London, 150 Stamford Street, London SE1 9NH, UK.
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27
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Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Papakonstantinou E, Zampelas A, Stefanadis C. The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study. Rev Diabet Stud 2006; 2:208-15. [PMID: 17491696 PMCID: PMC1783563 DOI: 10.1900/rds.2005.2.208] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Diet has long been associated with a risk of insulin resistance and poor glycemic control. We sought to investigate the association between food groups and indices of glycemic control in adults without type 2 diabetes and cardiovascular disease. METHODS During 2001 - 2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) without evidence of cardiovascular disease from the Attica area of Greece. Of them, 118 men and 92 women were excluded from the present analysis due to a history of diabetes mellitus (type 2). Fasting blood glucose and insulin levels were measured, while dietary habits were evaluated through a semi-quantitative food frequency questionnaire. RESULTS Red meat consumption was positively associated with hyperglycemia (p = 0.04), hyperinsulinemia (p = 0.04), and HOMA levels (p = 0.03), even after adjusting for BMI and various other potential confounders. The intake of fruits, vegetables, legumes, yogurt and other dairy products was not associated with levels of glycemic control indices. CONCLUSIONS A higher consumption of red meat and its products may aggravate hyperinsulinemia and insulin resistance in non-diabetic people.
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Affiliation(s)
- Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, Harokopio University, 46 Paleon Polemiston St., 166 74 Attica, Athens, Greece.
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Elia M, Ceriello A, Laube H, Sinclair AJ, Engfer M, Stratton RJ. Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care 2005; 28:2267-79. [PMID: 16123506 DOI: 10.2337/diacare.28.9.2267] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible. RESULTS A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58-1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86-2.32]; two RCTs), and glucose area under curve (by 7.96 mmol.l(-1).min(-1) [2.25-13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26-71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas. CONCLUSIONS This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.
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Affiliation(s)
- Marinos Elia
- Institute of Human Nutrition, University of Southampton, Southampton General Hospital, MP 113 F Level, Tremona Road, Southampton, SO16 6YD, UK.
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30
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Pohl M, Mayr P, Mertl-Roetzer M, Lauster F, Lerch M, Eriksen J, Haslbeck M, Rahlfs VW. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial. Eur J Clin Nutr 2005; 59:1221-32. [PMID: 16077745 DOI: 10.1038/sj.ejcn.1602232] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the effects of long-term treatment with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), in comparison with a standard formula, on glycaemic control in tube-fed type II diabetic patients. DESIGN Randomised, double-blind, controlled, multi-centre trial. SETTING Early rehabilitation centres, primary care and nursing facilities. SUBJECTS A total of 78 patients with insulin-treated type II diabetes with HbA(1C) > or =7.0% and/or fasting blood glucose >6.66 mmol/l, who required enteral tube feeding due to neurological dysphagia. INTERVENTIONS Patients received 113 kJ (27 kcal)/kg of body weight of either test feed or an isoenergetic, isonitrogenous enteral formula (control) for 12 weeks. Glycaemic control (total daily insulin dosage (IU), fasting blood glucose, and HbA(1C)) and gastrointestinal tolerance were monitored daily. RESULTS After 12 weeks, median values for changes from baseline were as follows (test group vs control group, 'data as available' analysis): total daily IUs -6.0 vs 0.0 (P=0.0024), fasting blood glucose (mmol/l) -1.59 vs -0.08 (P=0.0068); HbA(1C) (%) -0.8 vs 0.0 (P=0.0016). Both formulas were tolerated comparably. CONCLUSIONS This study indicates that in tube-fed insulin-treated type II diabetic patients, the new low-carbohydrate, high MUFA formula results in a more effective glycaemic control than the standard diet, while being comparable in safety.
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Affiliation(s)
- M Pohl
- Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany.
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Sanz París A, Barragán Angulo A, Albero Gamboa R. Evidencias clínicas sobre el soporte nutricional en el paciente diabético: revisión sistemática. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1575-0922(05)74653-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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