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Fotouhi Ardakani A, Anjom-Shoae J, Sadeghi O, Marathe CS, Feinle-Bisset C, Horowitz M. Association between total, animal, and plant protein intake and type 2 diabetes risk in adults: A systematic review and dose-response meta-analysis of prospective cohort studies. Clin Nutr 2024; 43:1941-1955. [PMID: 39032197 DOI: 10.1016/j.clnu.2024.07.001] [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: 12/26/2023] [Revised: 06/04/2024] [Accepted: 07/03/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND AND AIMS While clinical studies indicate that dietary protein may benefit glucose homeostasis in type 2 diabetes (T2D), the impact of dietary protein, including whether the protein is of animal or plant origin, on the risk of T2D is uncertain. We conducted a systematic review and meta-analysis to evaluate the associations of total, animal, and plant protein intakes with the risk of T2D. METHODS A systematic search was performed using multiple data sources, including PubMed/Medline, ISI Web of Science, Scopus, and Google Scholar, with the data cut-off in May 2023. Our selection criteria focused on prospective cohort studies that reported risk estimates for the association between protein intake and T2D risk. For data synthesis, we calculated summary relative risks and 95% confidence intervals for the highest versus lowest categories of protein intake using random-effects models. Furthermore, we conducted both linear and non-linear dose-response analyses to assess the dose-response associations between protein intake and T2D risk. RESULTS Sixteen prospective cohort studies, involving 615,125 participants and 52,342 T2D cases, were identified, of which eleven studies reported data on intake of both animal and plant protein. Intakes of total (pooled effect size: 1.14, 95% CI: 1.04-1.24) and animal (pooled effect size: 1.18, 95% CI: 1.09-1.27) protein were associated with an increased risk of T2D. These effects were dose-related - each 20-g increase in total or animal protein intake increased the risk of T2D by ∼3% and ∼7%, respectively. In contrast, there was no association between intake of plant protein and T2D risk (pooled effect size: 0.98, 95% CI: 0.89-1.08), while replacing animal with plant protein intake (per each 20 g) was associated with a reduced risk of T2D (pooled effect size: 0.80, 95% CI: 0.76-0.84). CONCLUSIONS Our findings indicate that long-term consumption of animal, but not plant, protein is associated with a significant and dose-dependent increase in the risk of T2D, with the implication that replacement of animal with plant protein intake may lower the risk of T2D.
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Affiliation(s)
- Amirmahdi Fotouhi Ardakani
- Student Research Committee, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran; Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Anjom-Shoae
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, Australia
| | - Omid Sadeghi
- Nutrition and Food Security Research Centre and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Chinmay S Marathe
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
| | - Christine Feinle-Bisset
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
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Mensink M. Dietary protein, amino acids and type 2 diabetes mellitus: a short review. Front Nutr 2024; 11:1445981. [PMID: 39114126 PMCID: PMC11305142 DOI: 10.3389/fnut.2024.1445981] [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: 06/08/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024] Open
Abstract
Diabetes is a widespread metabolic disorder and results from insulin resistance and impaired insulin secretion. Modifiable factors like diet, physical activity, and body weight play crucial roles in diabetes prevention, with targeted interventions reducing diabetes risk by about 60%. High-protein consumption, above the recommended intake of 0.8 g/kg body weight per day, have often explored in relation to diabetes risk. However, the relationship between dietary protein and diabetes is multifaceted. Observational studies have linked high total and animal protein intake to an increased risk of type 2 diabetes, particularly in obese women. Elevated levels of branched-chain amino acids (BCAA), which can result from dietary intake, protein breakdown, as well as an impaired catabolism, are strong predictors of cardiometabolic risk and insulin resistance. With several mechanism linking BCAA to insulin resistance. On the other hand, intervention studies suggest that high-protein diets can support weight loss and improve cardiometabolic risk factors. However, the impact on insulin sensitivity and glucose homeostasis is not straightforward. Proteins and amino acids stimulate both insulin and glucagon secretion, influencing glucose levels, but chronic effects remain uncertain. This short narrative review aims to provide an update on the relationship between increased dietary protein intake, amino acids, insulin resistance and type 2 diabetes, and to describe protein recommendations for type 2 diabetes.
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Affiliation(s)
- Marco Mensink
- Division of Human Nutrition and Health, Chair Group Nutritional Biology, Wageningen University & Research, Wageningen, Netherlands
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Silva JCDE, Anghinoni ICAB, Gomes MB. Plant-Based Food for the Prevention of Type 2 Diabetes: Scoping Review. Nutrients 2024; 16:1671. [PMID: 38892604 PMCID: PMC11175055 DOI: 10.3390/nu16111671] [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: 04/17/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) is a chronic condition with growing worldwide prevalence. Besides genetic factors, a sedentary lifestyle, excess weight, and inadequate eating habits, characterized by an excess intake of refined carbohydrates and ultra-processed foods, are contributing factors for the development of the disease. In this scenario, promoting a plant-based diet, and limiting animal product consumption while increasing the intake of vegetables, concurrently with healthy lifestyle habits, is a promising strategy to prevent T2DM. This scoping review, carried out between 2017 and 2022, aimed to gather evidence substantiating the benefits of a plant-based diet in T2DM prevention, considering different eating patterns, such as vegetarian, vegan, Mediterranean, and DASH diets. Several studies demonstrate a significant reduction in T2DM incidence among individuals adopting plant-based eating patterns or emphasizing healthy plant-based food alongside decreased intake or exclusion of animal-based foods. There are still no robust data regarding plant-based diets and the prevention of diabetes without loss in body weight. Hence, prospective studies in plant-based diets with weight control are needed. Nevertheless, adopting plant-based diets appears to induce significant weight loss, which is crucial in an obesity-endemic context. Thus, embracing plant-based diets, along with healthy habits, emerges as a relevant strategy in obesity and T2DM prevention.
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Affiliation(s)
| | | | - Marília Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Vila Isabel, Rio de Janeiro 20551-030, RJ, Brazil;
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Matsuda K, Nagano N, Nakazaki K, Katayama D, Tokunaga W, Okuda K, Shimizu S, Aoki R, Fuwa K, Shirai K, Fujioka K, Morioka I. Amelioration of Insulin Resistance by Whey Protein in a High-Fat Diet-Induced Pediatric Obesity Male Mouse Model. Nutrients 2024; 16:1622. [PMID: 38892554 PMCID: PMC11174045 DOI: 10.3390/nu16111622] [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: 04/22/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
This study examined whey protein's impact on insulin resistance in a high-fat diet-induced pediatric obesity mouse model. Pregnant mice were fed high-fat diets, and male pups continued this diet until 8 weeks old, then were split into high-fat, whey, and casein diet groups. At 12 weeks old, their body weight, fasting blood glucose (FBG), blood insulin level (IRI), homeostatic model assessment for insulin resistance (HOMA-IR), liver lipid metabolism gene expression, and liver metabolites were compared. The whey group showed significantly lower body weight than the casein group at 12 weeks old (p = 0.034). FBG was lower in the whey group compared to the high-fat diet group (p < 0.01) and casein group (p = 0.058); IRI and HOMA-IR were reduced in the whey group compared to the casein group (p = 0.02, p < 0.01, p < 0.01, respectively). The levels of peroxisome proliferator-activated receptor α and hormone-sensitive lipase were upregulated in the whey group compared to the casein group (p < 0.01, p = 0.03). Metabolomic analysis revealed that the levels of taurine and glycine, both known for their anti-inflammatory and antioxidant properties, were upregulated in the whey group in the liver tissue (p < 0.01, p < 0.01). The intake of whey protein was found to improve insulin resistance in a high-fat diet-induced pediatric obesity mouse model.
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Affiliation(s)
- Kengo Matsuda
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Kimitaka Nakazaki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Daichi Katayama
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Wataru Tokunaga
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Koh Okuda
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Shoichi Shimizu
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Ryoji Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Kazumasa Fuwa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
| | - Keisuke Shirai
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.S.); (K.F.)
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.S.); (K.F.)
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 173-8610, Japan; (K.M.); (K.N.); (D.K.); (W.T.); (K.O.); (S.S.); (R.A.); (K.F.); (I.M.)
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Luo T, Chen H, Wei H, Yang Y, Wei F, Chen W. Dietary protein in early pregnancy and gestational diabetes mellitus: a prospective cohort study. Endocrine 2024; 83:357-367. [PMID: 37721649 DOI: 10.1007/s12020-023-03517-1] [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: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE The relationship between dietary protein intake and the risk of gestational diabetes mellitus (GDM) remains inconsistent and unclear. Here, we examined the correlation between the various sources of protein intake among Chinese pregnant women and GDM. METHODS This prospective cohort study included 1060 pregnant women at 6-13+6 weeks of gestation from Guangdong Provincial Hospital for Women and Children, South China. The participants' intake of dietary protein was assessed using a validated quantitative food frequency questionnaire during the early trimester. GDM was diagnosed via an oral glucose tolerance test performed at 24-28 gestational weeks. Logistic regression analysis was used to evaluate the association between dietary protein intake during pregnancy and GDM. Furthermore, we applied restricted cubic splines to determine their linear relationship. RESULTS About 26.3% (n = 279) of pregnant women were diagnosed with GDM. Animal protein intake was revealed to have a positive correlation with GDM risk (Q4 vs. Q1: OR, 2.78; 95% CI, 1.46-5.34; P = 0.015), whereas high intake levels of dietary plant protein were linked to reduced GDM risk (Q4 vs. Q1: OR, 0.43; 95% CI, 0.25-0.73). In stratified analysis, the relationship between protein and GDM was stronger during early pregnancy in women with obesity. However, total protein intake did not show a significant association with GDM. CONCLUSIONS Our study findings suggest that a plant protein-based diet was associated with reduced GDM risk, whereas the dietary intake of animal protein was positively associated with GDM risk among Chinese women during early pregnancy.
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Affiliation(s)
- Tingyu Luo
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510000, China
| | - Hongyan Chen
- Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, 518000, China
| | - Huixin Wei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510000, China
| | - Yiling Yang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510000, China
| | - Fengxiang Wei
- Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, 518000, China
| | - Weiqiang Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510000, China.
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Kim J, Lim KH. Prognostic Factors for Hyperglycemia in Patients Receiving Chemotherapy. Cancer Nurs 2023:00002820-990000000-00193. [PMID: 37991472 DOI: 10.1097/ncc.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Approximately 10% to 30% of patients who receive chemotherapy experience hyperglycemia, which can affect the adverse reactions and treatment efficacy of chemotherapy. However, there is a paucity of research to explore the factors affecting hyperglycemia and include them in nursing interventions. OBJECTIVE The aim of this study was to understand the prognostic factors of hyperglycemia in cancer patients on chemotherapy. METHODS This retrospective, descriptive study included 134 adult patients with cancer receiving chemotherapy at Keimyeng University Dongsan Hospital in Daegu between July 1, 2021, and March 31, 2022. Data were analyzed using frequency, percentage, average, and standard deviation statistics and compared by t test, χ2 test, and logistic regression analysis. RESULTS Logistic regression analysis revealed that sex (male) (95% confidence interval [CI], 7.24-745.49; odds ratio [OR], 73.48); education (95% CI, 4.02-201.59; OR, 28.46); exercise durations of 30 to 60 minutes (95% CI, 0.00-0.06; OR, 0.01), 60 to 90 minutes (95% CI, 0.00-0.05, OR = 0.01), and ≥90 minutes (95% CI, 0.00-0.42; OR, 0.03); exercise amount ≥ 2000 kcal/wk (95% CI, 0.01-0.77; OR, 0.06); and daily fat (95% CI, 1.02-1.14; OR, 1.08), protein (95% CI, 0.82-0.95; OR, 0.88), and seaweed (95% CI, 0.85-0.99; OR, 0.92) intake were significant predictors of hyperglycemia. CONCLUSION The prognostic factors of hyperglycemia should be included in nursing interventions to prevent and manage hyperglycemia, which in turn may help reduce adverse reactions related to chemotherapy and improve treatment efficacy. IMPLICATIONS FOR PRACTICE To prevent and manage hyperglycemia in patients on chemotherapy, prognostic factors, including exercise and protein, fat, and seaweed consumption, should be considered in nursing interventions. Particularly, in men and patients with low education levels who are at a high risk of hyperglycemia, nursing interventions for diet and exercise should be individualized.
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Affiliation(s)
- Jiyeong Kim
- Author Affiliations: College of Nursing (Ms Kim) and Department of Nursing (Dr Lim), Keimyung University, Daegu, South Korea
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Neuenschwander M, Stadelmaier J, Eble J, Grummich K, Szczerba E, Kiesswetter E, Schlesinger S, Schwingshackl L. Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies. BMC Med 2023; 21:404. [PMID: 37968628 PMCID: PMC10652524 DOI: 10.1186/s12916-023-03093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis. METHODS We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach. RESULTS In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality. CONCLUSIONS Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.
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Affiliation(s)
- Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Eble
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Edyta Szczerba
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany.
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lee ER, Park S, Lee SK, Hong HG. Quantile forward regression for high-dimensional survival data. LIFETIME DATA ANALYSIS 2023; 29:769-806. [PMID: 37393569 DOI: 10.1007/s10985-023-09603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/17/2023] [Indexed: 07/04/2023]
Abstract
Despite the urgent need for an effective prediction model tailored to individual interests, existing models have mainly been developed for the mean outcome, targeting average people. Additionally, the direction and magnitude of covariates' effects on the mean outcome may not hold across different quantiles of the outcome distribution. To accommodate the heterogeneous characteristics of covariates and provide a flexible risk model, we propose a quantile forward regression model for high-dimensional survival data. Our method selects variables by maximizing the likelihood of the asymmetric Laplace distribution (ALD) and derives the final model based on the extended Bayesian Information Criterion (EBIC). We demonstrate that the proposed method enjoys a sure screening property and selection consistency. We apply it to the national health survey dataset to show the advantages of a quantile-specific prediction model. Finally, we discuss potential extensions of our approach, including the nonlinear model and the globally concerned quantile regression coefficients model.
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Affiliation(s)
- Eun Ryung Lee
- Department of Statistics, Sungkyunkwan University, Seoul, 03063, Korea
| | - Seyoung Park
- Department of Statistics, Sungkyunkwan University, Seoul, 03063, Korea
| | - Sang Kyu Lee
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, 48823, USA
- Biostatistics Branch, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Hyokyoung G Hong
- Biostatistics Branch, National Cancer Institute, Bethesda, MD, 20892, USA.
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Basiri R, Seidu B, Rudich M. Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies. Nutrients 2023; 15:4226. [PMID: 37836510 PMCID: PMC10574484 DOI: 10.3390/nu15194226] [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: 07/14/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Across the world, diabetes, depression, and anxiety symptoms have gained widespread recognition as significant public health issues. Recent research has unveiled a mutually influential relationship between diabetes and these two mental health conditions, where each disorder impacts the course and outcomes of the others. The role of nutrition emerges as pivotal in preventing and treating depression, anxiety, and diabetes. A thorough literature review was undertaken to investigate the reciprocal effects between anxiety, depression, and diabetes, including their impact on the development and severity of each condition. Additionally, the effects of nutrition on the prevention and management of depression, anxiety, diabetes, and related complications in at-risk individuals were assessed. Our findings show that mental disorders, such as depression and anxiety, increase the risk of developing type 2 diabetes and are associated with poorer glycemic control, increased diabetes-related complications, and higher mortality rates. Conversely, diabetes is also linked with an increased risk of developing depression and anxiety. The biological, psychological, and social factors that contribute to the comorbidity between these two conditions are complex and multifaceted. Therefore, an integrated approach to the management of both conditions is critical for improving patient outcomes and reducing the overall burden of disease. Nutritional interventions should be utilized to reduce the risk of diabetes in patients with anxiety and depression as well as enhance mental health in patients with diabetes.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
| | - Blessing Seidu
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
| | - Mark Rudich
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
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Dong Z, Richie JP, Gao X, Al-Shaar L, Nichenametla SN, Shen B, Orentreich D. Cumulative Consumption of Sulfur Amino Acids and Risk of Diabetes: A Prospective Cohort Study. J Nutr 2022; 152:2419-2428. [PMID: 36774108 DOI: 10.1093/jn/nxac172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/17/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cross-sectional studies have suggested that consumption of sulfur amino acids (SAAs), including methionine and cysteine, is associated with a higher risk of type 2 diabetes (T2D) in humans and with T2D-related biomarkers in animals. But whether higher long-term SAA intake increases the risk of T2D in humans remains unknown. OBJECTIVES We aimed to investigate the association between long-term dietary SAA intake and risk of T2D. METHODS We analyzed data collected from 2 different cohorts of the Framingham Heart Study, a long-term, prospective, and ongoing study. The Offspring cohort (1991-2014) included participants from fifth through ninth examinations, and the Third-Generation cohort (2002-2011) included participants from first and second examinations. After excluding participants with a clinical history of diabetes, missing dietary data, or implausible total energy intake, 3222 participants in the Offspring cohort and 3205 participants in the Third-Generation cohort were included. Dietary intake was assessed using a validated FFQ. The relations between energy-adjusted total SAA (methionine and cysteine) intake or individual SAA intake (in quintiles) and risk of incident T2D were estimated via Cox proportional hazards models after adjusting for dietary and nondietary risk factors. Associations across the 2 cohorts were determined by direct combination and meta-analysis. RESULTS During the 23 y of follow-up, 472 participants reported a new diagnosis of T2D in the 2 cohorts. In the meta-analysis, the HRs of T2D comparing the highest with the lowest intake of total SAAs, methionine, and cysteine were 1.8 (95% CI: 1.3, 2.5), 1.7 (95% CI: 1.2, 2.3), and 1.4 (95% CI: 1.0, 2.1), respectively. The association of SAA intake with T2D was attenuated after adjusting animal protein intake in sensitivity analyses. CONCLUSIONS Our findings show that excess intake of SAAs is associated with higher risk of T2D. Dietary patterns that are low in SAAs could help in preventing T2D.
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Affiliation(s)
- Zhen Dong
- Orentreich Foundation for the Advancement of Science, Inc, Cold Spring, NY, USA.
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Biyi Shen
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Orentreich
- Orentreich Foundation for the Advancement of Science, Inc, Cold Spring, NY, USA
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11
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Wu J. Emerging sources and applications of alternative proteins: An introduction. ADVANCES IN FOOD AND NUTRITION RESEARCH 2022; 101:1-15. [PMID: 35940701 DOI: 10.1016/bs.afnr.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Food protein is an essential macronutrient. Even though daily per capita supply of protein has increased globally from 61g in 1961 to 81g in 2013, and most people in the developed world have sufficient protein intake from their diets, however, protein deficiencies continue to be pervasive globally. Protein deficiency is the single major factor responsible for impaired growth and suboptimal health worldwide. Animal proteins are high quality and contain adequate and balanced amino acids, animal protein production however is inefficient and resource intensive. Alternative proteins are expected to provide the solution to meet the growing protein demand within the environmental limits. Alternative proteins include proteins from plants (i.e., grains, legumes, pulse, and nuts), fungus (i.e., mushrooms), algae, insects and cultured (lab-grown) meat that can be used to replace conventional animal proteins. Major concerns for human consumption of alternative proteins are inferior organoleptic properties, consumer acceptability, affordability, and sustainability. There is a need to develop culturally diversified alternative proteins to mitigate global protein malnutrition. Food proteins are also found applications in biomaterials and as a source of bioactive peptides.
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Affiliation(s)
- Jianping Wu
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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12
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Gao M, Jebb SA, Aveyard P, Ambrosini GL, Perez-Cornago A, Papier K, Carter J, Piernas C. Associations Between Dietary Patterns and Incident Type 2 Diabetes: Prospective Cohort Study of 120,343 UK Biobank Participants. Diabetes Care 2022; 45:1315-1325. [PMID: 35299247 DOI: 10.2337/dc21-2258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify dietary patterns (DPs) characterized by a set of nutrients of concern and their association with incident type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS A total of 120,343 participants from the U.K. Biobank study with at least two 24 h dietary assessments were studied. Reduced rank regression was used to derive DPs explaining variability in energy density, free sugars, saturated fat, and fiber intakes. We investigated prospective associations with T2D using Cox proportional hazard models. RESULTS Over 8.4 years of follow-up from the latest dietary assessment, 2,878 participants developed T2D. Two DPs were identified that jointly explained a total of 63% variation in four nutrients. DP1 was characterized by high intakes of chocolate and confectionery, butter, low-fiber bread, and sugars and preserves, and low intakes of fruits and vegetables. DP1 was linearly associated with T2D in multivariable models without BMI adjustment (per z score, hazard ratio [HR] 1.11 [95% CI 1.08-1.14]) and after BMI adjustment (HR 1.09 [95% CI 1.06-1.12]). DP2 was characterized by high intakes of sugar-sweetened beverages, fruit juice, table sugars and preserves, and low intakes of high-fat cheese and butter, but showed no clear association with T2D. There were significant interactions between both DPs and age, with increased risks among younger people in DP1 (HR 1.13 [95% CI 1.09-1.18]) and DP2 (HR 1.10 [95% CI 1.05-1.15]), as well as with DP1 and BMI, with increased risks among people with obesity (HR 1.11 [95% CI 1.07-1.16]). CONCLUSIONS A DP characterized by high intakes of chocolate and confectionery, butter, low-fiber bread, and added sugars, and low in fresh fruits and vegetables intake is associated with a higher incidence of T2D, particularly among younger people and those with obesity.
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Affiliation(s)
- Min Gao
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, U.K
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, U.K
| | - Gina L Ambrosini
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Jennifer Carter
- Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
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13
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Gurugubelli VS, Fang H, Shikany JM, Balkus SV, Rumbut J, Ngo H, Wang H, Allison JJ, Steffen LM. A review of harmonization methods for studying dietary patterns. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 23:100263. [PMID: 35252528 PMCID: PMC8896407 DOI: 10.1016/j.smhl.2021.100263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Data harmonization is the process by which each of the variables from different research studies are standardized to similar units resulting in comparable datasets. These data may be integrated for more powerful and accurate examination and prediction of outcomes for use in the intelligent and smart electronic health software programs and systems. Prospective harmonization is performed when researchers create guidelines for gathering and managing the data before data collection begins. In contrast, retrospective harmonization is performed by pooling previously collected data from various studies using expert domain knowledge to identify and translate variables. In nutritional epidemiology, dietary data harmonization is often necessary to construct the nutrient and food databases necessary to answer complex research questions and develop effective public health policy. In this paper, we review methods for effective data harmonization, including developing a harmonization plan, which common standards already exist for harmonization, and defining variables needed to harmonize datasets. Currently, several large-scale studies maintain harmonized nutrient databases, especially in Europe, and steps have been proposed to inform the retrospective harmonization process. As an example, data harmonization methods are applied to several U.S longitudinal diet datasets. Based on our review, considerations for future dietary data harmonization include user agreements for sharing private data among participating studies, defining variables and data dictionaries that accurately map variables among studies, and the use of secure data storage servers to maintain privacy. These considerations establish necessary components of harmonized data for smart health applications which can promote healthier eating and provide greater insights into the effect of dietary patterns on health.
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Affiliation(s)
| | - Hua Fang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
- Corresponding author. Tel.: +0-508-910-6411;
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, 35294, Alabama, USA
| | - Salvador V Balkus
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Joshua Rumbut
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Hieu Ngo
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Honggang Wang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, 55455, Minnesota, USA
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14
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Langyan S, Yadava P, Khan FN, Dar ZA, Singh R, Kumar A. Sustaining Protein Nutrition Through Plant-Based Foods. Front Nutr 2022; 8:772573. [PMID: 35118103 PMCID: PMC8804093 DOI: 10.3389/fnut.2021.772573] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
Proteins are essential components of the human diet. Dietary proteins could be derived from animals and plants. Animal protein, although higher in demand, is generally considered less environmentally sustainable. Therefore, a gradual transition from animal- to plant-based protein food may be desirable to maintain environmental stability, ethical reasons, food affordability, greater food safety, fulfilling higher consumer demand, and combating of protein-energy malnutrition. Due to these reasons, plant-based proteins are steadily gaining popularity, and this upward trend is expected to continue for the next few decades. Plant proteins are a good source of many essential amino acids, vital macronutrients, and are sufficient to achieve complete protein nutrition. The main goal of this review is to provide an overview of plant-based protein that helps sustain a better life for humans and the nutritional quality of plant proteins. Therefore, the present review comprehensively explores the nutritional quality of the plant proteins, their cost-effective extraction and processing technologies, impacts on nutrition, different food wastes as an alternative source of plant protein, and their environmental impact. Furthermore, it focuses on the emerging technologies for improving plant proteins' bioavailability, digestibility, and organoleptic properties, and highlights the aforementioned technological challenges for future research work.
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Affiliation(s)
- Sapna Langyan
- Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, Pusa, New Delhi, India
| | - Pranjal Yadava
- Division of Plant Physiology, Indian Agricultural Research Institute, Pusa, New Delhi, India
| | | | - Zahoor A. Dar
- Dryland Agricultural Research Station, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - Renu Singh
- Division of Plant Physiology, Indian Agricultural Research Institute, Pusa, New Delhi, India
| | - Ashok Kumar
- Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, Pusa, New Delhi, India
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15
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Brand-Miller JC, Raben A. Editorial: FIN Special Issue on PREVIEW. Front Nutr 2022; 8:811541. [PMID: 35004829 PMCID: PMC8727356 DOI: 10.3389/fnut.2021.811541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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16
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Drummen M, Adam TC, Macdonald IA, Jalo E, Larssen TM, Martinez JA, Handjiev-Darlenska T, Brand-Miller J, Poppitt SD, Stratton G, Pietiläinen KH, Taylor MA, Navas-Carretero S, Handjiev S, Muirhead R, Silvestre MP, Swindell N, Huttunen-Lenz M, Schlicht W, Lam T, Sundvall J, Raman L, Feskens E, Tremblay A, Raben A, Westerterp-Plantenga MS. Associations of changes in reported and estimated protein and energy intake with changes in insulin resistance, glycated hemoglobin, and BMI during the PREVIEW lifestyle intervention study. Am J Clin Nutr 2021; 114:1847-1858. [PMID: 34375397 PMCID: PMC8574694 DOI: 10.1093/ajcn/nqab247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Observed associations of high-protein diets with changes in insulin resistance are inconclusive. OBJECTIVES We aimed to assess associations of changes in both reported and estimated protein (PRep; PEst) and energy intake (EIRep; EIEst) with changes in HOMA-IR, glycated hemoglobin (HbA1c), and BMI (in kg/m2), in 1822 decreasing to 833 adults (week 156) with overweight and prediabetes, during the 3-y PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) study on weight-loss maintenance. Eating behavior and measurement errors (MEs) of dietary intake were assessed. Thus, observational post hoc analyses were applied. METHODS Associations of changes in EIEst, EIRep, PEst, and PRep with changes in HOMA-IR, HbA1c, and BMI were determined by linear mixed-model analysis in 2 arms [high-protein-low-glycemic-index (GI) diet and moderate-protein-moderate-GI diet] of the PREVIEW study. EIEst was derived from energy requirement: total energy expenditure = basal metabolic rate × physical activity level; PEst from urinary nitrogen, and urea. MEs were calculated as [(EIEst - EIRep)/EIEst] × 100% and [(PRep - PEst)/PEst] × 100%. Eating behavior was determined using the Three Factor Eating Questionnaire, examining cognitive dietary restraint, disinhibition, and hunger. RESULTS Increases in PEst and PRep and decreases in EIEst and EIRep were associated with decreases in BMI, but not independently with decreases in HOMA-IR. Increases in PEst and PRep were associated with decreases in HbA1c. PRep and EIRep showed larger changes and stronger associations than PEst and EIEst. Mean ± SD MEs of EIRep and PRep were 38% ± 9% and 14% ± 4%, respectively; ME changes in EIRep and En% PRep were positively associated with changes in BMI and cognitive dietary restraint and inversely with disinhibition and hunger. CONCLUSIONS During weight-loss maintenance in adults with prediabetes, increase in protein intake and decrease in energy intake were not associated with decrease in HOMA-IR beyond associations with decrease in BMI. Increases in PEst and PRep were associated with decrease in HbA1c.This trial was registered at clinicaltrials.gov as NCT01777893.
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Affiliation(s)
- Mathijs Drummen
- Department of Nutrition and Movement Sciences, NUTRIM—School of Nutrition and Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM—School of Nutrition and Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands
| | - Ian A Macdonald
- MRC/Arthritis Research UK (ARUK) Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise, and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Division of Physiology, Pharmacology, and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Thomas M Larssen
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - J Alfredo Martinez
- Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN),
Madrid, Spain,IdisNA Institute for Health Research, Pamplona, Spain,Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM + CSIC, Madrid, Spain
| | | | - Jennie Brand-Miller
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gareth Stratton
- Applied Sports Technology, Exercise, and Medicine (A-STEM), College of Engineering Research Centre, Swansea University, Swansea, United Kingdom
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Obesity Center, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Moira A Taylor
- MRC/Arthritis Research UK (ARUK) Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise, and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Division of Physiology, Pharmacology, and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Santiago Navas-Carretero
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain,IdisNA Institute for Health Research, Pamplona, Spain,Centre for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Roslyn Muirhead
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand,Center for Research in Health Technologies and Services (CINTESIS), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Nils Swindell
- Applied Sports Technology, Exercise, and Medicine (A-STEM), College of Engineering Research Centre, Swansea University, Swansea, United Kingdom
| | - Maija Huttunen-Lenz
- Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,Institute of Nursing Science, Schwäbisch Gmünd University of Education, Schwäbisch Gmünd, Germany
| | - Wolfgang Schlicht
- Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | - Jouko Sundvall
- Biochemistry Laboratory, Forensic Toxicology Unit, Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Laura Raman
- Biochemistry Laboratory, Forensic Toxicology Unit, Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Angelo Tremblay
- Department of Kinesiology, Laval University, Quebec City, Quebec, Canada
| | - Anne Raben
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark,Steno Diabetes Center, Copenhagen, Denmark
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17
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Hruby A, Jacques PF. Protein Intake and Human Health: Implications of Units of Protein Intake. Adv Nutr 2021; 12:71-88. [PMID: 32879937 PMCID: PMC7850043 DOI: 10.1093/advances/nmaa097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Understanding the health effects of protein intake is bedeviled by a number of factors, including protein quality and source. In addition, different units, including grams, grams per kilogram body weight (g/kg BW), and percent energy, may contribute to confusion about protein's effects on health, especially BW-based units in increasingly obese populations. We aimed to review the literature and to conduct a modeling demonstration of various units of protein intake in relation to markers of cardiometabolic health. Data from the Framingham Heart Study Offspring (n = 1847; 60.3 y; 62.5% women) and Third Generation (n = 2548; 46.2 y; 55.3% women) cohorts and the NHANES 2003-04 (n = 1625; 46.2 y; 49.7% women) and 2005-06 (n = 1347; 43.7 y; 49.5% women) cycles were used to model cross-sectional associations between 7 protein units (grams, percent energy, g/kg ideal BW, g/kg actual BW, BW-adjusted g/kg actual BW, g/kg lean BW, and g/kg fat-free BW) and 9 cardiometabolic outcomes (fasting glucose, systolic and diastolic blood pressure, total and HDL cholesterol, triglycerides, BMI, waist circumference, and estimated glomerular filtration rate). The literature review indicated the use of myriad units of protein intake, with differential results on cardiometabolic outcomes. The modeling demonstration showed units expressed in BW were confounded by BW, irrespective of outcome. Units expressed in grams, percent energy, and ideal BW showed similar results, with or without adjustment for body size. After adjusting for BW, results of units expressed in BW aligned with results of grams, percent energy, and ideal BW. In conclusion, protein intake in cardiometabolic health appears to depend on protein's unit of expression. Authors should be specific about the use of WHO (g/kg ideal BW) compared with US (g/kg actual BW) units, and ideally use gram or percent energy in observational studies. In populations where overweight/obesity are prevalent, intake based on actual BW should be reevaluated.
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Affiliation(s)
- Adela Hruby
- Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
| | - Paul F Jacques
- Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
- Nutritional Epidemiology, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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18
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Raben A, Vestentoft PS, Brand‐Miller J, Jalo E, Drummen M, Simpson L, Martinez JA, Handjieva‐Darlenska T, Stratton G, Huttunen‐Lenz M, Lam T, Sundvall J, Muirhead R, Poppitt S, Ritz C, Pietiläinen KH, Westerterp‐Plantenga M, Taylor MA, Navas‐Carretero S, Handjiev S, McNarry MA, Hansen S, Råman L, Brodie S, Silvestre MP, Adam TC, Macdonald IA, San‐Cristobal R, Boyadjieva N, Mackintosh KA, Schlicht W, Liu A, Larsen TM, Fogelholm M. The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes. Diabetes Obes Metab 2021; 23:324-337. [PMID: 33026154 PMCID: PMC8120810 DOI: 10.1111/dom.14219] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022]
Abstract
AIM To compare the impact of two long-term weight-maintenance diets, a high protein (HP) and low glycaemic index (GI) diet versus a moderate protein (MP) and moderate GI diet, combined with either high intensity (HI) or moderate intensity physical activity (PA), on the incidence of type 2 diabetes (T2D) after rapid weight loss. MATERIALS AND METHODS A 3-year multicentre randomized trial in eight countries using a 2 x 2 diet-by-PA factorial design was conducted. Eight-week weight reduction was followed by a 3-year randomized weight-maintenance phase. In total, 2326 adults (age 25-70 years, body mass index ≥ 25 kg/m2 ) with prediabetes were enrolled. The primary endpoint was 3-year incidence of T2D analysed by diet treatment. Secondary outcomes included glucose, insulin, HbA1c and body weight. RESULTS The total number of T2D cases was 62 and the cumulative incidence rate was 3.1%, with no significant differences between the two diets, PA or their combination. T2D incidence was similar across intervention centres, irrespective of attrition. Significantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycaemia was lowest in HP-HI (11.9%) compared with the other three groups (20.0%-21.0%, P < .05). There were no group differences in body weight change (-11% after 8-week weight reduction; -5% after 3-year weight maintenance) or in other secondary outcomes. CONCLUSIONS Three-year incidence of T2D was much lower than predicted and did not differ between diets, PA or their combination. Maintaining the target intakes of protein and GI over 3 years was difficult, but the overall protocol combining weight loss, healthy eating and PA was successful in markedly reducing the risk of T2D. This is an important clinically relevant outcome.
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Affiliation(s)
- Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Pia Siig Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Jennie Brand‐Miller
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Elli Jalo
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
| | - Mathjis Drummen
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Liz Simpson
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreMRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - J. Alfredo Martinez
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN)MadridSpain
- IdisNA Instituto for Health ResearchPamplonaSpain
- Precision Nutrition and Cardiometabolic Health Program. IMDEA‐Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSICMadridSpain
| | | | - Gareth Stratton
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | - Maija Huttunen‐Lenz
- Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
- Institute of Nursing ScienceUniversity of Education Schwäbisch GmündSchwäbisch GmündGermany
| | - Tony Lam
- NetUnion sarlLausanneSwitzerland
| | - Jouko Sundvall
- Department of Government Services, Forensic Toxicology Unit, Biochemistry LaboratoryNational Institute for Health and WelfareHelsinkiFinland
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Sally Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of MedicineUniversity of Helsinki and Obesity Centre, Endocrinology, Abdominal Center, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Margriet Westerterp‐Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Moira A. Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreNational Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - Santiago Navas‐Carretero
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN)MadridSpain
- IdisNA Instituto for Health ResearchPamplonaSpain
| | - Svetoslav Handjiev
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Melitta A. McNarry
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | - Sylvia Hansen
- Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Laura Råman
- Department of Government Services, Forensic Toxicology Unit, Biochemistry LaboratoryNational Institute for Health and WelfareHelsinkiFinland
| | - Shannon Brodie
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Marta P. Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
- CINTESIS ‐ Centro de Investigação em Tecnologias e Serviços de Saúde NOVA Medical SchoolNOVA University of LisbonLisbonPortugal
| | - Tanja C. Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Ian A. Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreMRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - Rodrigo San‐Cristobal
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Precision Nutrition and Cardiometabolic Health Program. IMDEA‐Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSICMadridSpain
| | - Nadka Boyadjieva
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Kelly A. Mackintosh
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | | | - Amy Liu
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
| | - Thomas M. Larsen
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Mikael Fogelholm
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
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19
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Poppitt SD. Cow's Milk and Dairy Consumption: Is There Now Consensus for Cardiometabolic Health? Front Nutr 2020; 7:574725. [PMID: 33364249 PMCID: PMC7753100 DOI: 10.3389/fnut.2020.574725] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Cow's milk and dairy products derived from this complex food source have long been proposed as beneficial to human health, yet underlying clinical evidence of direct benefit continues to raise controversy. Limited evidence supports positive cardiometabolic effects of a number of dairy macro- and micronutrient components including whey protein and casein, unsaturated fats, milk fat globule membrane (MFGM) and polar phospholipids, vitamin D and calcium, in addition to non-bovine components including bacterial and yeast probiotics. More controversial remain lipid components trans fats, including trans vaccenic acid, trans palmitoleic acid, and conjugated cis trans linoleic acid (CLA), plus medium-chain and odd-chain dairy fats. New evidence is rapidly identifying multiple pathways by which these dairy nutrients may effect health. Processing, including fermentation and homogenization, may also have positive effects. Conversely, the high saturated fat content of dairy has long raised concern, aligned with international guidelines to minimize dietary intake of animal-origin saturated fatty acids (SFA) to achieve better cardiometabolic health. However, led in part by observational studies and meta-analyses showing dairy to have no or even an inverse association with cardiometabolic health, evidence from randomized controlled trials (RCTs) has been scrutinized over the last 5 years, and focus on low-fat dairy has been challenged. Recent evidence supports the hypothesis that adverse effects of SFAs on metabolic health may be ameliorated when these fats are consumed within a complex matrix such as milk, cheese or yogurt, and that dairy food categories may influence outcomes as much as total fat content. For example, yogurt and high-fat, high-SFA cheese have a negative association with risk of type 2 diabetes (T2D) in many, not all, published trials. However, large sample dairy RCTs of long duration with CVD or T2D incidence as primary endpoints are lacking. This is a clear research gap, with these clinical studies required if a causative link between dairy and improved cardiometabolic health is to be confirmed and in turn promoted through dietary guidelines. Current advisories from national guidance groups such as American Heart Association (AHA) and European Society of Cardiology (ESC) continue to promote consumption of low-fat dairy products, whilst liquid milk and yogurt remain part of nutrition guidelines from joint American Diabetes Association (ADA)/European Association for Study of Diabetes (EASD) reports, and as part of a "no-one-size-fits-all" answer to diet and T2D by the ADA in their most recent 2019 Consensus Report.
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Affiliation(s)
- Sally D. Poppitt
- Human Nutrition Unit, Department of Medicine, School of Biological Sciences, University of Auckland, Auckland, New Zealand
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20
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Medical nutrition therapy and dietary counseling for patients with diabetes-energy, carbohydrates, protein intake and dietary counseling. Diabetol Int 2020; 11:224-239. [PMID: 32802703 DOI: 10.1007/s13340-020-00437-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 12/11/2022]
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21
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Greenberg JA. Adjusting nutrition intake exposure variables for body weight. Am J Clin Nutr 2019; 110:1511. [PMID: 31788691 DOI: 10.1093/ajcn/nqz223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- James A Greenberg
- From the Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY, USA
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22
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Ibsen DB, Jakobsen MU, Overvad K. Statistical models in nutritional epidemiology: more focus on the interpretation and argumentation for variable selection. Am J Clin Nutr 2019; 110:1510. [PMID: 31788692 DOI: 10.1093/ajcn/nqz219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Daniel B Ibsen
- From the Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Marianne U Jakobsen
- National Food Institute, Division for Diet, Disease Prevention and Toxicology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Kim Overvad
- From the Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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23
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Dietary habits contribute to define the risk of type 2 diabetes in humans. Clin Nutr ESPEN 2019; 34:8-17. [DOI: 10.1016/j.clnesp.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022]
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24
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Brouwer-Brolsma EM, Raben A, Feskens EJM. Reply to J Greenberg and D Ibsen et al. Am J Clin Nutr 2019; 110:1512. [PMID: 31788694 DOI: 10.1093/ajcn/nqz221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Elske M Brouwer-Brolsma
- From the Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Edith J M Feskens
- From the Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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25
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Abstract
AbstractDietary protein insufficiency has been linked to excessive TAG storage and non-alcoholic fatty liver disease (NAFLD) in developing countries. Hepatic TAG accumulation following a low-protein diet may be due to altered peroxisomal, mitochondrial and gut microbiota function. Hepatic peroxisomes and mitochondria normally mediate metabolism of nutrients to provide energy and substrates for lipogenesis. Peroxisome biogenesis and activities can be modulated by odd-chain fatty acids (OCFA) and SCFA that are derived from gut bacteria, for example, propionate and butyrate. Also produced during amino acid metabolism by peroxisomes and mitochondria, propionate and butyrate concentrations correlate inversely with risk of obesity, insulin resistance and NAFLD. In this horizon-scanning review, we have compiled available evidence on the effects of protein malnutrition on OCFA production, arising from loss in mitochondrial, peroxisomal and gut microbiota function, and its association with lipid accumulation in the liver. The methyl donor amino acid composition of dietary protein is an important contributor to liver function and lipid storage; the presence and abundance of dietary branched-chain amino acids can modulate the composition and metabolic activity of the gut microbiome and, on the other hand, can affect protective OCFA and SCFA production in the liver. In preclinical animal models fed with low-protein diets, specific amino acid supplementation can ameliorate fatty liver disease. The association between low dietary protein intake and fatty liver disease is underexplored and merits further investigation, particularly in vulnerable groups with dietary protein restriction in developing countries.
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26
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Hoyas I, Leon-Sanz M. Nutritional Challenges in Metabolic Syndrome. J Clin Med 2019; 8:E1301. [PMID: 31450565 PMCID: PMC6780536 DOI: 10.3390/jcm8091301] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
Metabolic Syndrome (MetS) is a combination of risk factors for the development of cardiovascular disease (CVD) and type 2 diabetes. Different diagnostic criteria were proposed, but a consensus was reached in 2009 based on values of waist circumference, blood pressure, fasting glycemia, triglycerides, and high-density lipoprotein (HDL)-cholesterol levels. The main underlying etiologic factor is insulin resistance. The quality and quantity of individual macronutrients have an influence on the development and resolution of this syndrome. However, the main treatment goal is weight loss and a decrease in insulin resistance. A controlled energy dietary recommendation, together with moderate levels of physical activity, may positively change the parameters of MetS. However, there is no single dietary or exercise prescription that works for all patients. Dietary patterns such as Mediterranean-style, dietary approaches to stop hypertension (DASH), low-carbohydrate, and low-fat diets can ameliorate insulin resistance and MetS. Long-term adherence to a healthy lifestyle is key in assuring that individuals significantly reduce the risk of CVD and diabetes mellitus.
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Affiliation(s)
- Irene Hoyas
- Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, 28041 Madrid, Spain
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