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Neyman A, Hannon TS. Low-Carbohydrate Diets in Children and Adolescents With or at Risk for Diabetes. Pediatrics 2023; 152:e2023063755. [PMID: 37718964 DOI: 10.1542/peds.2023-063755] [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] [Accepted: 07/27/2023] [Indexed: 09/19/2023] Open
Abstract
Carbohydrate restriction is increasingly popular as a weight loss strategy and for achieving better glycemic control in people with diabetes, including type 1 and type 2 diabetes. However, evidence to support low-carbohydrate diets in youth (children and adolescents 2-18 years of age) with obesity or diabetes is limited. There are no guidelines for restricting dietary carbohydrate consumption to reduce risk for diabetes or improve diabetes outcomes in youth. Thus, there is a need to provide practical recommendations for pediatricians regarding the use of low-carbohydrate diets in patients who elect to follow these diets, including those with type 1 diabetes and for patients with obesity, prediabetes, and type 2 diabetes. This clinical report will: Provide background on current dietary patterns in youth, describe how moderate-, low-, and very low-carbohydrate diets differ, and review safety concerns associated with the use of these dietary patternsReview the physiologic rationale for carbohydrate reduction in youth with type 1 diabetes and for youth with obesity, prediabetes, and type 2 diabetesReview the evidence for low-carbohydrate diets in the management of youth with type 1 diabetesReview the evidence for low-carbohydrate diets in the management of youth with obesity, prediabetes, and type 2 diabetesProvide practical information for pediatricians counseling families and youth on carbohydrate recommendations for type 1 diabetes and for obesity, prediabetes, and type 2 diabetes.
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Affiliation(s)
- Anna Neyman
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana
| | - Tamara S Hannon
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana
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Lewgood J, Oliveira B, Korzepa M, Forbes SC, Little JP, Breen L, Bailie R, Candow DG. Efficacy of Dietary and Supplementation Interventions for Individuals with Type 2 Diabetes. Nutrients 2021; 13:2378. [PMID: 34371888 PMCID: PMC8308746 DOI: 10.3390/nu13072378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of Type 2 diabetes (T2D) is increasing, which creates a large economic burden. Diet is a critical factor in the treatment and management of T2D; however, there are a large number of dietary approaches and a general lack of consensus regarding the efficacy of each. Therefore, the purpose of this narrative review is twofold: (1) to critically evaluate the effects of various dietary strategies on diabetes management and treatment, such as Mediterranean diet, plant-based diet, low-calorie and very low-calorie diets, intermittent fasting, low-carbohydrate and very low-carbohydrate diets, and low glycemic diets and (2) to examine several purported supplements, such as protein, branched-chain amino acids, creatine, and vitamin D to improve glucose control and body composition. This review can serve as a resource for those wanting to evaluate the evidence supporting the various dietary strategies and supplements that may help manage T2D.
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Affiliation(s)
- Jessica Lewgood
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
| | - Barbara Oliveira
- Okanagan Campus, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC V1V1V7, Canada; (B.O.); (J.P.L.)
| | - Marie Korzepa
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (M.K.); (L.B.)
| | - Scott C. Forbes
- Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, MB R7A6A9, Canada;
| | - Jonathan P. Little
- Okanagan Campus, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC V1V1V7, Canada; (B.O.); (J.P.L.)
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (M.K.); (L.B.)
| | - Robert Bailie
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
| | - Darren G. Candow
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
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Locatelli CAA, Mulvihill EE. Islet Health, Hormone Secretion, and Insulin Responsivity with Low-Carbohydrate Feeding in Diabetes. Metabolites 2020; 10:E455. [PMID: 33187118 PMCID: PMC7697690 DOI: 10.3390/metabo10110455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/25/2022] Open
Abstract
Exploring new avenues to control daily fluctuations in glycemia has been a central theme for diabetes research since the Diabetes Control and Complications Trial (DCCT). Carbohydrate restriction has re-emerged as a means to control type 2 diabetes mellitus (T2DM), becoming increasingly popular and supported by national diabetes associations in Canada, Australia, the USA, and Europe. This approval comes from many positive outcomes on HbA1c in human studies; yet mechanisms underlying their success have not been fully elucidated. In this review, we discuss the preclinical and clinical studies investigating the role of carbohydrate restriction and physiological elevations in ketone bodies directly on pancreatic islet health, islet hormone secretion, and insulin sensitivity. Included studies have clearly outlined diet compositions, including a diet with 30% or less of calories from carbohydrates.
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Affiliation(s)
- Cassandra A. A. Locatelli
- Energy Substrate Laboratory, The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, ON KIY 4W7, Canada;
- Department of Biochemistry, Microbiology and Immunology, The University of Ottawa, Faculty of Medicine, 451 Smyth Rd, Ottawa, ON K1H 8L1, Canada
| | - Erin E. Mulvihill
- Energy Substrate Laboratory, The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, ON KIY 4W7, Canada;
- Department of Biochemistry, Microbiology and Immunology, The University of Ottawa, Faculty of Medicine, 451 Smyth Rd, Ottawa, ON K1H 8L1, Canada
- Montreal Diabetes Research Centre CRCHUM-Pavillion R, 900 Saint-Denis-Room R08.414, Montreal, QC H2X 0A9, Canada
- Centre for Infection, Immunity and Inflammation, The University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada
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Fan R, Xu M, Wang J, Zhang Z, Chen Q, Li Y, Gu J, Cai X, Guo Q, Bao L, Li Y. Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients. Nutrients 2016; 8:nu8090560. [PMID: 27649232 PMCID: PMC5037545 DOI: 10.3390/nu8090560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 01/19/2023] Open
Abstract
Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.
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Affiliation(s)
- Rui Fan
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Meihong Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Junbo Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Qihe Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Ye Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Jiaojiao Gu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Xiaxia Cai
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Qianying Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Lei Bao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Yong Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
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Abstract
INTRODUCTION Low carbohydrate diets are again in the spotlight and have been identified as particularly appropriate for people with type 2 diabetes. There is confusion amongst both health professionals and people with diabetes about the suitability of these diets. This review aims to provide an overview of the latest evidence and to explore the role of low carbohydrate diets for people with type 2 diabetes. METHODS An electronic search of English language articles was performed using MEDLINE (2010-May 2015), EMBASE (2010-May 2015), and the Cochrane Central Register of Controlled Trials (2010-May 2015). Only randomized controlled trials comparing interventions evaluating reduced carbohydrate intake with higher carbohydrate intake in people with diagnosed type 2 diabetes were included. Primary outcomes included weight, glycated hemoglobin, and lipid concentrations. RESULTS Low carbohydrate diets in people with type 2 diabetes were effective for short-term improvements in glycemic control, weight loss, and cardiovascular risk, but this was not sustained over the longer term. Overall, low carbohydrate diets failed to show superiority over higher carbohydrate intakes for any of the measures evaluated including weight loss, glycemic control, lipid concentrations, blood pressure, and compliance with treatment. CONCLUSION Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.
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Affiliation(s)
- Pamela Dyson
- Churchill Hospital, University of Oxford, OCDEM, Oxford, UK.
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Pinilla AE, Barrera MDP, Sánchez AL, Mejía A. Factores de riesgo en diabetes mellitus y pie diabético: un enfoque hacia la prevención primaria. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70058-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Lushchak OV, Gospodaryov DV, Rovenko BM, Yurkevych IS, Perkhulyn NV, Lushchak VI. Specific Dietary Carbohydrates Differentially Influence the Life Span and Fecundity of Drosophila melanogaster. ACTA ACUST UNITED AC 2013; 69:3-12. [DOI: 10.1093/gerona/glt077] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mir PS, He ML, Travis G, Entz T, McAllister T, Marchand S, Schaefer A, Meadus J, Lepage P, Okine E, Dodson MV. Periodic 48 h feed withdrawal improves glucose tolerance in growing pigs by enhancing adipogenesis and lipogenesis. Nutr Metab (Lond) 2012; 9:10. [PMID: 22321818 PMCID: PMC3292934 DOI: 10.1186/1743-7075-9-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 02/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background Adipocyte numbers and peroxisome proliferators activated receptorγ (PPARγ) expression of retroperitoneal tissue increased while area under the curve (AUC) during the glucose tolerance test (GTT) was reduced in rats subjected to certain feed withdrawal (FW) regimens. Thus, using pigs as the experimental model, the hypothesis that FW regimens influence glucose tolerance by influencing fat cell function was evaluated with the objective of determining the effect of a single (FWx1; at age of 19 wk for 48 h) or periodic, multiple (FWx4; 24 h FW at 7 and 11 wk of age and 48 h FW at 15 and 19 wk of age) FW on AUC of glucose and insulin during the GTT relative to pigs that did not experience FW (Control). Methods Growth, body composition, adipocyte numbers, PPARγ expression, lipogenic potential as glucose uptake into fat of adipocytes of varying diameter in omental (OM) and subcutaneous (SQ) fat as affected by FW regimens were determined in pigs initiated into the study at 5 wk of age and fed the same diet, ad libitum. Results Blood glucose concentrations for prior to and 120 min post glucose meal tended to be lower (p = 0.105 and 0.097, respectively) in pigs in FW treatments. In OM fat; cell numbers, glucose Universal14C [U14C] incorporation into fat and rate of incorporation per 104 cells was greatest for cells with diameters of 90-119 μm. Pigs undergoing FWx4 tended to have greater (p = 0.0685; by 191%) number of adipocytes, increased (p = 0.0234) glucose U14C incorporation into adipocytes and greater (p = 0.0872) rate of glucose uptake into cells of 119-150 μm diameter than of cells from control or FWx1 pigs. Subcutaneous adipocyte numbers in 22-60 and 61-90 μm diameter ranges from pigs in FWx1 tended to be greater (p = 0.08 and 0.06, respectively) than for those in FWx4 treatment, yet PPARγ expression and total cell number were not affected by treatment. Conclusions Results suggest that FW regimens influence fat cell function or lipogenesis rather than number, affecting glucose metabolism and may have implications in drug-free control of metabolic syndrome symptoms.
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Affiliation(s)
- Priya S Mir
- Agriculture and Agri-food Canada Research Centre, 5403, 1st Ave S,, P,O, Box 3000, Lethbridge, AB T1J 4B1, Canada.
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Plotnikoff RC, Karunamuni ND, Johnson JA, Kotovych M, Svenson LW. Health-related behaviours in adults with diabetes: associations with health care utilization and costs. Canadian Journal of Public Health 2008. [PMID: 18615947 DOI: 10.1007/bf03405479] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary objective of this study was to examine whether physical activity, diet, and smoking behaviours are associated with health resource utilization and costs in the Canadian context. A secondary objective was to evaluate demographic and health behavioural characteristics of the participants of the study to assess the degree of respondent bias. METHODS Self-reported physical activity, diet and smoking status were obtained from a large population-based sample of adults with diabetes (N = 2311). Resource utilization and cost information was obtained by linking these data to the provincial government's administrative database. Multiple regression models examined predictors of resource utilization and costs for individuals with type 1 (T1D) and type 2 (T2D) diabetes separately. To assess the degree of responder bias, characteristics of individuals who consented to link data were compared with those who did not consent. RESULTS Various measures of health care utilization and costs were negatively associated with physical activity behaviour in both T1D and T2D groups. Ever having smoked cigarettes was associated with higher resource utilization in individuals with T2D when controlling for demographic and health variables. Significant differences in demographic and health behavioural characteristics of the participants who provided consent for data linkage and those who did not were also found. CONCLUSION These findings are of interest considering that PA is a critical but understudied component of individuals with diabetes, and this appears to be one of the first studies to directly examine the relationship between health-related behaviours and health care utilization and costs. The findings may be useful in guiding targeted health promotion programs for individuals with diabetes. The results also indicate that studies involving linkage of administrative and survey data could be over-represented by healthy individuals.
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Affiliation(s)
- Ronald C Plotnikoff
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB.
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Abstract
Diabetes mellitus is widely recognized as one of the leading causes of death and disability. While insulin insensitivity is an early phenomenon partly related to obesity, pancreatic beta-cell function declines gradually over time even before the onset of clinical hyperglycemia. Several mechanisms have been proposed to be responsible for insulin resistance, including increased non-esterified fatty acids, inflammatory cytokines, adipokines, and mitochondrial dysfunction, as well as glucotoxicity, lipotoxicity, and amyloid formation for beta-cell dysfunction. Moreover, the disease has a strong genetic component, although only a handful of genes have been identified so far. Diabetic management includes diet, exercise and combinations of antihyperglycemic drug treatment with lipid-lowering, antihypertensive, and antiplatelet therapy. Since many persons with type 2 diabetes are insulin resistant and overweight, nutrition therapy often begins with lifestyle strategies to reduce energy intake and increase energy expenditure through physical activity. These strategies should be implemented as soon as diabetes or impaired glucose homoeostasis (pre-diabetes) is diagnosed.
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Affiliation(s)
- George V Z Dedoussis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Str., 17671 Kallithea-Athens, Greece
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Abstract
PURPOSE OF REVIEW This review summarizes the current progress in disease classification, pathophysiology and management of diabetes mellitus with a special focus on treatment modalities and recommendations for the practicing anesthesiologist. RECENT FINDINGS The revised classification of diabetes mellitus emphasizes disease cause and eliminates any reference to age-of-onset and insulin therapy. Hyperglycemia has emerged as an important marker of outcome in the operating room. Intensive insulin therapy promises to reduce health risk in the surgical and critical care setting. Perioperative beta-blocker and statin therapy are likely to reduce cardiac morbidity and mortality in diabetic patients. Promotility therapy (with metoclopromide) intended to reduce the aspiration risk of diabetic gastroparesis is likely over-utilized and may only be indicated for diabetics with poor glucose control and high hemoglobin A1c levels. SUMMARY According to World Health Organization projections, anesthesiologists can expect to care for more diabetic patients than ever before. Diabetes and its associated complications present unique challenges to the perioperative physician. As biomedical research continues to unravel the genetic, cellular and molecular mechanisms of this complex metabolic disease, our specialty must be prominently involved in the design and testing of innovative treatments to protect the diabetic patient from the risks of surgery and anesthesia.
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Affiliation(s)
- Vivek K Moitra
- Division of Critical Care Medicine, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York, USA
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