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Bazyar H, Zare Javid A, Ahangarpour A, Zaman F, Hosseini SA, Zohoori V, Aghamohammadi V, Yazdanfar S, Ghasemi Deh Cheshmeh M. The effects of rutin supplement on blood pressure markers, some serum antioxidant enzymes, and quality of life in patients with type 2 diabetes mellitus compared with placebo. Front Nutr 2023; 10:1214420. [PMID: 37599700 PMCID: PMC10435270 DOI: 10.3389/fnut.2023.1214420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background This trial aimed to investigate the effects of rutin supplement in type 2 diabetes mellitus (T2DM) patients. Methods In this trial with a double-blind and controlled design, fifty patients were randomly divided into intervention (n = 25) and control groups (n = 25) and were treated with 1 g of rutin or placebo for three months, respectively. At the baseline and end of the intervention, mean arterial pressure (MAP), heart rate (HR), pulse pressure (PP), systolic and diastolic blood pressure (SBP and DBP), serum levels of antioxidant enzymes, such as catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase (SOD) and quality of life (QOL) parameters, were evaluated. Results Rutin consumption caused a significant reduction in SBP, DBP, PP, MAP, and HR, with a significant increase in SOD, CAT, and GPx and some QOL parameters (emotional limitations, energy and freshness, mental health, social performance, and general health) compared with baseline (p for all <0.05). Also, the mean changes of emotional limitations, energy and freshness, mental health, and general health (unadjusted p for all <0.05) and GPX and SOD (adjusted p for all <0.05) were significantly higher in the rutin group compared with the placebo group. Although, in the supplement group compared with the placebo group, the mean changes of SBP, DBP, MAP, PP, and HR were significantly lower (adjusted p for all <0.05). Conclusion Rutin consumption improved blood pressure, the levels of antioxidant enzymes, and QOL in patients with T2DM.
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Affiliation(s)
- Hadi Bazyar
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
- Student Research Committee, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Ahmad Zare Javid
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Akram Ahangarpour
- Department of Physiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ferdows Zaman
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Ahmad Hosseini
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vida Zohoori
- Teesside University, Middlesbrough, United Kingdom
| | | | - Shima Yazdanfar
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Nouripour F, Mazloom Z, Fararouei M, Zamani A. Effect of protein and carbohydrate distribution among meals on quality of life, sleep quality, inflammation, and oxidative stress in patients with type 2 diabetes: A single-blinded randomized controlled trial. Food Sci Nutr 2021; 9:6176-6185. [PMID: 34760248 PMCID: PMC8565242 DOI: 10.1002/fsn3.2570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/OBJECTIVES Patients with diabetes mellitus have a lower quality of life and sleep compared with healthy individuals. Nutrition therapy has an important role in the management of diabetes and can improve inflammation and quality of life in patients with diabetes. The present study aimed to evaluate the effect of high-protein versus high-carbohydrate intake during evening meal on quality of life, sleep quality, inflammation, and oxidative stress in subjects with type 2 diabetes. SUBJECTS/METHODS This is a 10-week randomized controlled trial. 96 adult patients with type 2 diabetes were assigned into one of the following three groups: standard evening meal (ST), high-carbohydrate evening meal (HC), and high-protein evening meal (HP). The effect of these diets was examined on high-sensitivity C-reactive protein, malondialdehyde, quality of life, and sleep quality. RESULTS Sleep quality improved significantly in all groups (p < .05). The quality of life and high-sensitivity C-reactive protein improved in all groups except for the HP group (p < .05). Serum malondialdehyde level did not change significantly throughout the study (p > .05). CONCLUSIONS Small manipulation of protein and carbohydrate distribution among the meals might not affect sleep quality. A diet with an even distribution of macronutrients among the meals or with a higher percentage of carbohydrates in the evenings can improve the quality of life and reduce inflammation in patients with type 2 diabetes, while a diet with a higher percentage of protein in the evenings may not improve it.
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Affiliation(s)
- Fatemeh Nouripour
- Department of Clinical NutritionSchool of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Zohreh Mazloom
- Department of Clinical NutritionSchool of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Mohammad Fararouei
- Department of EpidemiologySchool of HealthShiraz University of Medical SciencesShirazIran
| | - Ali Zamani
- Department of Internal medicineSchool of Medicine, Endocrinology and Metabolism Research CenterShiraz University of Medical SciencesShirazIran
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Shah SZA, Karam JA, Zeb A, Ullah R, Shah A, Haq IU, Ali I, Darain H, Chen H. Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther 2021; 12:707-732. [PMID: 33547579 PMCID: PMC7947168 DOI: 10.1007/s13300-021-01005-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Exercise is considered a cornerstone in achieving an optimized blood glucose level and reducing body weight, body mass index (BMI), and waist circumference. This study aimed to investigate and quantitatively summarize the literature regarding the therapeutic effects of exercise and general physical activity on glycemic control. METHODS A systematic review and meta-analysis of the literature on the therapeutic effects of exercise on glycemic control in patients with type 2 diabetes mellitus (type 2 DM) were conducted using electronic databases. Studies with an exercise intervention lasting more than 8 weeks were included. Both qualitative and quantitative analyses were performed. Qualitative data were presented narratively in table form. Quantitative analysis was performed using a random-effects model with a 95% confidence interval and a significance level of 0.05. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk of bias. RESULTS A total of 21,559 articles were identified through different databases. Out of 21559 studies, only 32 randomized controlled trials were deemed eligible for inclusion in this study. The average exercise session was 45.15 min, while the average follow-up duration was 21.94 weeks. The mean exercise frequency according to our findings was 3.25 days/week. Almost all the studies reported decreases in glycated hemoglobin (HbA1c; P < 0.0001), fasting blood glucose (P = 0.03), BMI (P = 0.04), and waist circumference (P = 0.007) after the exercise intervention. CONCLUSION Exercise plays an important role in optimizing glycemic control and improving quality of life (QoL), BMI, and waist circumference in type 2 DM patients. Exercise could be a safe adjunct therapy to medical treatments in these patients. REGISTRATION PROSPERO: CRD42020210816.
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Affiliation(s)
- Sayed Z A Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jawad A Karam
- Department of applied exercise science, Concordia University Chicago, 7400 Augusta St., River Forest, IL, 60305, United States
| | - Alam Zeb
- School of Health Sciences, Peshawar, Pakistan
| | - Rafi Ullah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Arif Shah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Ijaz Ul Haq
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Iftikhar Ali
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Haider Darain
- Institute of Physical Medicine and Rehabilitation Sciences, Khyber Medical University, Hayatabad, Peshawar, Pakistan
| | - Hong Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Martenstyn J, King M, Rutherford C. Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review. J Behav Med 2020; 43:873-891. [PMID: 32060765 DOI: 10.1007/s10865-020-00140-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
Abstract
Previous reviews explored weight loss-induced metabolic changes in overweight and obese adults with type 2 diabetes (T2D) but did not report on the impact on patient-reported outcomes (PROs). This systematic review investigated the effect of weight loss interventions on weight loss and PROs in overweight and obese adults with T2D. We searched three electronic databases from inception to March 2018 for randomised controlled trials (RCTs) of weight loss interventions in overweight and obese (according to BMI) adults aged ≥ 18 years reporting changes in PROs from baseline to at least one follow-up assessment during or post-intervention. One reviewer screened abstracts, performed data extraction, and conducted the narrative synthesis, with 25% cross-checking by a second reviewer. We extracted data relating to sample characteristics, intervention and comparison conditions, weight loss, and change in PROs. We identified 540 papers of which 23 met eligibility reporting on 19 RCTs. Four types of interventions (diet, surgery, pharmacological, and multi-component lifestyle interventions) significantly reduced weight. Weight loss was consistently associated with improvements in sexual and physical function across all intervention types, with diet and multi-component lifestyle interventions producing more substantial improvements than surgical or pharmacological interventions. Findings for other PROs, such as HRQOL and depressive symptoms, were inconsistent across studies and intervention types. The four weight loss interventions can be prescribed to engender weight loss in overweight and obese adults with T2D, with multi-component lifestyle interventions generating substantial improvements in physical and sexual function, perhaps due to the potency of exercise in improving PROs.
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Affiliation(s)
- Jordan Martenstyn
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia
| | - Madeleine King
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- School of Psychology, Quality of Life Office, Level 6, Chris O' Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia.
- Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia.
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Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet 2019; 118:343-353. [PMID: 29389511 DOI: 10.1016/j.jand.2017.11.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 01/03/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.
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Kloecker DE, Zaccardi F, Baldry E, Davies MJ, Khunti K, Webb DR. Efficacy of low- and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies. Diabetes Obes Metab 2019; 21:1695-1705. [PMID: 30924575 DOI: 10.1111/dom.13727] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022]
Abstract
AIMS To review systematically and quantify the weight loss achieved through low- (LEDs) and very-low-energy diets (VLEDs) in people with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Studies reporting the effects of diet-only interventions of up to 1600 kcal/d in people with T2DM were searched in MEDLINE, EMBASE and CINAHL up to July 2018. Changes in the primary (body weight and body mass index [BMI]) and secondary outcomes (glycated haemoglobin, blood lipids) according to energy restriction and duration of diet were modelled using restricted cubic splines. RESULTS Forty-four studies (3817 participants) were included. The overall quality of the evidence was moderate and limited to short-term interventions up to 4 months. Baseline mean weight and BMI were 92.1 kg and 36.6 kg/m2 . VLEDs of 400 kcal/d led to 5.4% weight loss at 2 weeks, increasing to 17.9% at 3 months. More modest reductions of 7.3% were observed on LEDs of 1200 kcal/d and 2.0% on 1600 kcal/d after 3 months. No clear patterns emerged for secondary outcomes. Publication bias was significant for primary outcomes. CONCLUSIONS Through modelling, we were able to describe effective dietary deficit strategies to achieve weight reduction up to 4 months in people with T2DM. High-quality studies are required to further support clinical practice with evidence-based dietary interventions.
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Affiliation(s)
- David E Kloecker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Emma Baldry
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester General Hospital, Leicester, UK
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- National Institute for Health Research, Biomedical Research Centre, Leicester, UK
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Psychological well-being and marital satisfaction in response to weight loss after bariatric surgery. Surg Today 2019; 49:435-442. [PMID: 30600395 DOI: 10.1007/s00595-018-1750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare the marital satisfaction (MS) and psychological well-being (PWB) of men and women before and after bariatric surgery for obesity. METHODS The subjects of this prospective observational study were obese patients who underwent bariatric surgery. MS and PWB were assessed before, and 6 months after the surgery, using specific scales for MS and PWB. RESULTS The correlation matrix showed that age was not correlated with any of the scores from the PWB scales, and only with the total MS scores of men (P < 0.05). The pre-surgical BMI-post-surgical BMI (ΔBMI) was correlated negatively and significantly with the post-surgical total MS, especially for women, but it was not correlated with the sexual satisfaction of either gender. The score of positive interpersonal relationships was negatively correlated with the ΔBMI, especially for women (P < 0.05), whereas personal improvement was positively correlated for men (P < 0.05). There was also a significant correlation between ΔBMI and purpose in life for both genders. Post-surgical ΔBMIs were not associated with the other two indicators of PWB, namely, autonomy and environmental mastery for both genders. CONCLUSIONS For women, weight loss after bariatric surgery seemed to improve PWB and MS when assessed 6 months post-operatively; however, the psychiatric assessment of patients before and after the surgery is crucial.
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Billings LK, Handelsman Y, Heile M, Schneider D, Wyne K. Health-Related Quality of Life Assessments with Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes Mellitus. J Manag Care Spec Pharm 2018; 24:S30-S41. [PMID: 30156447 PMCID: PMC10408424 DOI: 10.18553/jmcp.2018.24.9-a.s30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Type 2 diabetes (T2DM) is associated with significant impairment in health-related quality of life (HRQoL). A patient-centered collaborative approach is recommended to optimize clinical outcomes, including HRQoL, in this patient population. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide effective glycemic control and have demonstrated beneficial effects on HRQoL and treatment satisfaction. Available once-weekly GLP-1 RAs may offer enhanced convenience compared with daily GLP-1 RAs and include exenatide extended-release (ER), dulaglutide, and semaglutide. This article reviews the impact of once-weekly GLP-1 RAs on HRQoL and treatment satisfaction in patients with T2DM. Compared with oral antihyperglycemic drugs, insulin, and daily GLP-1 RAs, once-weekly GLP-1 RAs offer benefits with regard to HRQoL and treatment satisfaction. These benefits appear to be largely mediated by relative drug effects on glycemic control, weight, and hypoglycemia. While there was not an overall class benefit of once-weekly GLP-1 RAs compared with daily GLP-1 RAs on HRQoL and treatment satisfaction, results suggested that once-weekly GLP-1 RAs may enhance certain elements of treatment satisfaction and increase willingness to continue treatment. In 2 studies comparing once-weekly GLP-1 RAs with each other, semaglutide produced significantly greater improvement in overall treatment satisfaction compared with exenatide ER but not dulaglutide. Once-weekly GLP-1 RAs represent an effective and convenient treatment option that may potentially increase treatment satisfaction and enhance adherence, contributing to improved health outcomes. DISCLOSURES This supplement was funded by Novo Nordisk. Billings reports personal fees from Dexcom, Novo Nordisk, and Sanofi. Handelsman reports research grants from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Grifols, Janssen, Lexicon, Merck, Novo Nordisk, Regeneron, and Sanofi; speaker fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, Merck, Novo Nordisk, Regeneron, and Sanofi; and has served in advisory capacity to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Intarcia, Janssen, Lilly, Merck, Merck-Pfizer, Novo Nordisk, Regeneron, and Sanofi. Heile reports speaker fees from and has served as advisor to Novo Nordisk. Schneider reports advisory board fees from Intarcia, Lilly, and Novo Nordisk. Wyne has nothing to disclose.
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Affiliation(s)
| | | | | | - Doron Schneider
- 4 Jefferson Health at Abington Hospital, Abington, Pennsylvania
| | - Kathleen Wyne
- 5 The Ohio State University Wexner Medical School, Columbus
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Murphy KJ. Comparison of two low-fat diets, differing in protein and carbohydrate, on psychological wellbeing in adults with obesity and type 2 diabetes: a randomised clinical trial. Nutr J 2018; 17:62. [PMID: 29907153 PMCID: PMC6004092 DOI: 10.1186/s12937-018-0367-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Although higher-protein diets (HP) can assist with weight loss and glycemic control, their effect on psychological wellbeing has not been established. The objective of this study was to compare the effects of a HP and a higher-carbohydrate diet (HC), combined with regular exercise, on psychological wellbeing both during weight loss (WL) and weight maintenance phases (WM). Methods In a parallel RCT, 61 adults with T2D (mean ± SD: BMI 34.3 ± 5.1 kg/m2, aged 55 ± 8 years) consumed a HP diet (29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%), with moderate intensity exercise, for 12 weeks of WL and 12 weeks of WM. Secondary data evaluating psychological wellbeing was assessed using: Problems Areas in Diabetes (PAID); Diabetes-39 Quality of Life (D-39); Short Form Health Survey (SF-36); Perceived Stress Scale-10 (PSS-10) and the Leeds Sleep Evaluation Questionnaire (LSEQ) at Weeks 0, 12 and 24 and evaluated with mixed models analysis. Results Independent of diet, improvements for PAID; D-39 diabetes control; D-39 severity of diabetes; SF-36 physical functioning and SF-36 general health were found following WL (d = 0.30 to 0.69, P ≤ 0.04 for all) which remained after 12 weeks of WM. SF-36 vitality improved more in the HP group (group x time interaction P = 0.03). Associations were seen between HbA1c and D-39 severity of diabetes rating (r = 0.30, P = 0.01) and SF-36 mental health (r = − 0.32, P = 0.003) and between weight loss and PAID (r = 0.30, P = 0.01). Conclusion Several improvements in diabetes-related and general psychological wellbeing were seen similarly for both diets following weight loss and a reduction in HbA1c with most of these improvements remaining when weight loss was sustained for 12 weeks. A HP diet may provide additional increases in vitality. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000008729) on 4 January 2013.
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Affiliation(s)
- Nerylee Ann Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Kathryn Ann Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Jonathan David Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Grant David Brinkworth
- Commonwealth Scientific and Industrial Research Organization - Health and Biosecurity, PO Box 10041, Adelaide, SA, 5000, Australia
| | - Alison Mary Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organization - Health and Biosecurity, PO Box 10041, Adelaide, SA, 5000, Australia
| | - Karen Joy Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Booth AO, Wang X, Turner AI, Nowson CA, Torres SJ. Diet-Induced Weight Loss Has No Effect on Psychological Stress in Overweight and Obese Adults: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2018; 10:E613. [PMID: 29757978 PMCID: PMC5986493 DOI: 10.3390/nu10050613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
The effect of weight loss on psychological stress is unknown. The study aimed to investigate the effect of diet-induced weight loss in overweight and obese adults on psychological measures of stress through a meta-analysis of randomized controlled trials (RCTs). Databases including Medline Complete, Embase and PsycINFO were searched up to February 2018 for diet-induced weight loss RCTs, which included self-reported assessment of psychological stress. The mean difference between the intervention and control group of changes in stress (intervention-baseline) was used. Ten RCTs were included with 615 participants (502 women, age range 20⁻80 years). Overall, there was no change in stress (mean difference -0.06, 95% CI: -0.17, 0.06, p = 0.33) and no change in the five studies with a significant reduction in weight in the intervention group compared to a control group that lost no weight (mean difference in weight -3.9 Kg, 95% CI: -5.51, -2.29, p < 0.0001; mean difference in stress 0.04, 95% CI: -0.17, 0.25, p = 0.71). For all analyses, there was low heterogeneity. The benefits of weight loss for those who are overweight and obese do not appear to either increase or reduce psychological stress at the end of the weight loss period.
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Affiliation(s)
- Alison O Booth
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
| | - Xiaodan Wang
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
| | - Anne I Turner
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
| | - Susan J Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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El Karib AO, Al-Ani B, Al-Hashem F, Dallak M, Bin-Jaliah I, El-Gamal B, Bashir SO, Eid RA, Haidara MA. Insulin and vanadium protect against osteoarthritis development secondary to diabetes mellitus in rats. Arch Physiol Biochem 2016; 122:148-54. [PMID: 26939846 DOI: 10.3109/13813455.2016.1159698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Diabetic complications such as cardiovascular disease and osteoarthritis (OA) are among the common public health problems. The effect of insulin on OA secondary to diabetes has not been investigated before in animal models. Therefore, we sought to determine whether insulin and the insulin-mimicking agent, vanadium can protect from developing OA in diabetic rats. METHODS Type 1 diabetes mellitus (T1DM) was induced in Sprague-Dawley rats and treated with insulin and/or vanadium. Tissues harvested from the articular cartilage of the knee joint were examined by scanning electron microscopy, and blood samples were assayed for oxidative stress and inflammatory biomarkers. RESULTS Eight weeks following the induction of diabetes, a profound damage to the knee joint compared to the control non-diabetic group was observed. Treatment of diabetic rats with insulin and/or vanadium differentially protected from diabetes-induced cartilage damage and deteriorated fibrils of collagen fibers. The relative biological potencies were insulin + vanadium >> insulin > vanadium. Furthermore, there was about 2- to 5-fold increase in TNF-α (from 31.02 ± 1.92 to 60.5 ± 1.18 pg/ml, p < 0.0001) and IL-6 (from 64.67 ± 8.16 to 338.0 ± 38.9 pg/ml, p < 0.0001) cytokines and free radicals measured as TBARS (from 3.21 ± 0.37 to 11.48 ± 1.5 µM, p < 0.0001) in the diabetic group, which was significantly reduced with insulin and or vanadium. Meanwhile, SOD decreased (from 17.79 ± 8.9 to 8.250.29, p < 0.0001) and was increased with insulin and vanadium. The relative potencies of the treating agents on inflammatory and oxidative stress biomarkers were insulin + vanadium >> insulin > vanadium. CONCLUSION The present study demonstrates that co-administration of insulin and vanadium to T1DM rats protect against diabetes-induced OA possibly by lowering biomarkers of inflammation and oxidative stress.
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Affiliation(s)
| | | | | | | | | | | | | | - Refaat A Eid
- c Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia , and
| | - Mohamed A Haidara
- a Department of Physiology
- d Department of Physiology , Kasr al-Aini Faculty of Medicine, Cairo University , Cairo , Egypt
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Dye L, Chadwick H, Murphy KJ. A randomised trial comparing low-fat diets differing in carbohydrate and protein ratio, combined with regular moderate intensity exercise, on glycaemic control, cardiometabolic risk factors, food cravings, cognitive function and psychological wellbeing in adults with type 2 diabetes: Study protocol. Contemp Clin Trials 2015; 45:217-225. [PMID: 26546883 DOI: 10.1016/j.cct.2015.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypocaloric low-fat diets, high in protein with moderate carbohydrate (HP) can enhance weight loss, improve glycaemic control and improve cardiometabolic health risk factors in type 2 diabetes mellitus (T2DM). However, it is unclear whether the metabolic benefits observed during weight loss are sustained during energy-balance and weight maintenance. Furthermore, there is a lack of evidence regarding the effect of HP diets on food cravings, cognitive function and psychological wellbeing in T2DM, despite carbohydrate food cravings, cognitive impairment and depression being associated with hyperglycaemia. METHODS/DESIGN Overweight/obese adults with T2DM were randomised to consume either a HP diet (n=32, ~32% protein, 33% carbohydrate, 30% fat) or a higher-carbohydrate diet (HC, n=29, ~22% protein, 51% carbohydrate, 22% fat) for 24 weeks with 30 min of moderate intensity exercise five days/week for the study duration. There were 2 phases: a 12 week weight loss phase followed by a 12 week weight maintenance phase. Primary outcome was glycaemic control (glycosylated haemoglobin; HbA1c). Secondary outcomes were cardiometabolic risk factors (body composition, fasting blood pressure, blood lipids, glucose, insulin and C-reactive protein), food cravings, cognitive function (memory; psychomotor and executive function and psychological well-being. Outcomes were measured at baseline and the end of each 12-week intervention phase. Data will be analysed as intention-to-treat using linear mixed effects models. CONCLUSION This study will examine the effects of two dietary interventions on health outcomes in T2DM during weight loss and notably following weight maintenance where there is a paucity of evidence.
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Affiliation(s)
- Nerylee Ann Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Kathryn Ann Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Jonathan David Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Grant David Brinkworth
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Alison Mary Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Manny Noakes
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Helen Chadwick
- School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Karen Joy Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Pirmoradi L, Noorafshan A, Safaee A, Dehghani GA. Quantitative Assessment of Proliferative Effects of Oral Vanadium on Pancreatic Islet Volumes and Beta Cell Numbers of Diabetic Rats. IRANIAN BIOMEDICAL JOURNAL 2015; 20:18-25. [PMID: 26459400 PMCID: PMC4689278 DOI: 10.7508/ibj.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Oral vanadyl sulfate (vanadium) induces normoglycemia, proliferates beta cells and prevents pancreatic islet atrophy in streptozotocin-induced diabetic rats. Soteriological method is used to quantitate the proliferative effects of vanadium on beta-cell numbers and islet volumes of normal and diabetic rats. Methods: Adult male Sprague-Dawley rats were made diabetic with intravenous streptozotocin injection (40 mg/kg). Normal and diabetic rats were divided into four groups. While control normal and diabetic (CD) groups used water, vanadium-treated normal (VTN) and diabetic (VTD) groups used solutions containing vanadyl sulfate (0.5-1 mg/mL, VOSO4+5H2O). Tail blood samples were used to measure blood glucose (BG) and plasma insulin. Two months after treatment, rats were sacrificed, pancreata prepared, and stereology method was used to quantitatively evaluate total beta cell numbers (TBCN) and total islet volumes (TISVOL). Results: Normoglycemia persisted in VTN with significantly decreased plasma insulin (0.190.08 vs. 0.970.27 ng/dL, P<0.002). The respective high BG (53249 vs. 14446 mg/dL, P<0.0001) and reduced plasma insulin (0.260.15 vs. 0.540.19 ng/dL, P<0.002) seen in CD were reversed in VTD during vanadium treatment or withdrawal. While the induction of diabetes, compared to their control, significantly decreased TISVOL (1.90.2 vs. 3.030.6 mm3, P<0.003) and TBCN (0.990.1 vs. 3.20.2 x 106, P<0.003), vanadium treatment significantly increased TISVOL (2.90.8 and 4.071.0 mm3, P<0.003) and TBCN (1.50.3 and 3.80.6 x 106, P<0.03). Conclusion: Two-month oral vanadium therapy in STZ-diabetic rats ameliorated hyperglycemia by partially restoring plasma insulin. This action was through proliferative actions of vanadium in preventing islet atrophy by increasing beta-cell numbers.
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Affiliation(s)
- Leila Pirmoradi
- Dept. of Physiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Noorafshan
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Akbar Safaee
- Dept. of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Abbas Dehghani
- Dept. of Physiology, Shiraz University of Medical Sciences, Shiraz, Iran.,Endocrine and Metabolism Research Center, Nemazi hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Osama AJ, Shehab AEK. Psychological wellbeing and biochemical modulation in response to weight loss in obese type 2 diabetes patients. Afr Health Sci 2015; 15:503-12. [PMID: 26124797 PMCID: PMC4480496 DOI: 10.4314/ahs.v15i2.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Obesity in type 2 diabetes patients is a serious health issue by itself; it is also associated with other health problems including psychiatric illnesses. The psychological effects of dieting and weight loss have been a matter of controversy in the field of obesity management. OBJECTIVE The aim of this study was to compare the impact of weight loss because of aerobic exercise training and dietary measures on psychological wellbeing and biochemical modulation in obese type 2 diabetes patients. MATERIAL AND METHODS One hundred obese type 2 diabetes patients of both sexes participated in this study, and were included into two equal groups. The first group (A) received aerobic exercise training, three sessions per week for three months combined with dietary measures. The second group (B) received no training intervention for three months. RESULTS There was a significant decrease in body mass index (BMI), leptin, total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), triglycerides(TG), homeostasis model assessment-insulin resistance- index (HOMA-IR) , beck depression inventory (BDI ) & profile of mood states(POMS) and increase in high density lipoprotein cholesterol (HDL-c) & Rosenberg self-esteem scale (RSES) of group (A) after treatments, but the changes of group (B) were not significant. Moreover, there were significant differences between mean levels of the investigated parameters of group (B) and group (A) at the end of the study. CONCLUSION Physical training and dietary measures can be used as methods of choice for psychological wellbeing and biochemical modulation in obese type 2 diabetes patients.
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Affiliation(s)
- Al-Jiffri Osama
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University
| | - Abd El-Kader Shehab
- Department of Physical therapy, Faculty of Applied Medical Sciences, King Abdulaziz University
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Hammond D, Williams RW, Juj K, O'Connell S, Isherwood G, Hammond N. Weight loss in orthognathic surgery: a clinical study. J Orthod 2015; 42:220-8. [PMID: 25904194 DOI: 10.1179/1465313314y.0000000130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To analyse weight change, body composition change and Body Mass Index change in patients undergoing orthognathic surgery. DESIGN A service evaluation was undertaken in orthognathic patients pre-operatively and at 4 weeks post-surgery. SETTING Queen Elizabeth Hospital Birmingham outpatient department. SUBJECTS Thirty-one patients scheduled for single- or two-jaw orthognathic surgery and rigid internal fixation. METHODS Immediately pre-operatively and at 4 weeks post-surgery the following information was gathered: (1) patient height; (2) patient weight (kg); (3) Patient Body Mass Index; and (4) patient body fat percentage. RESULTS In the 4-week post-operative period, the average weight loss was -4·96 kg (range: -9·6 to +3·0 kg), with a body fat reduction of -3·07% (range: -5·80% to +2·30%) and an average reduction in Body Mass Index of -1·63 (range: -3·4 to +0·8). There was no statistically significant difference in weight loss (P = 0·1562) or body fat composition change (P = 0·2391) between single- or two-jaw surgery. There was no statistically significant difference in weight loss (P = 0·4858) or body fat composition change (P = 0·5321) between male and female patients. CONCLUSIONS Weight loss observed was similar to that reported in studies using inter-maxillary fixation. Closer psychological and dietetic support is needed for patients who have a low normal or underweight Body Mass Index. Better and more bespoke tailored Oral Nutritional Supplementation must be provided for all orthognathic surgery patients to potentially reduce this significant weight loss.
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Wycherley TP, Clifton PM, Noakes M, Brinkworth GD. Weight loss on a structured hypocaloric diet with or without exercise improves emotional distress and quality of life in overweight and obese patients with type 2 diabetes. J Diabetes Investig 2014; 5:94-8. [PMID: 24843744 PMCID: PMC4025227 DOI: 10.1111/jdi.12120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate the effects of a caloric restricted weight loss program with or without supervised resistance exercise training (EX) on diabetes-related emotional distress and quality of life (QOL) in overweight and obese patients with type 2 diabetes. MATERIALS AND METHODS In a parallel design, 106 men and women with type 2 diabetes were randomized to a prescriptive 16-week caloric restricted diet (D; 6,000-7,000 kJ/day), with (n = 65) or without (n = 41) EX (three times per week). Bodyweight, glycated hemoglobin, diabetes-specific emotional distress (Problem Areas in Diabetes [PAID] questionnaire) and QOL (Diabetes-39 [D-39] questionnaire) was assessed pre- and post-intervention. RESULTS A total of 84 participants completed the study (D n = 33, D + EX n = 51). Weight loss was significantly greater in D + EX compared with D (-11.4 ± 5.8 vs -8.8 ± 5.8 kg, P = 0.04 time × diet). Overall, there were significant improvements in glycated hemoglobin, PAID total score and the D-39 dimensions of 'diabetes control', 'anxiety and worry', 'sexual functioning', 'energy and mobility', 'overall rating of QOL' and 'severity of diabetes' (P ≤ 0.01 for time). The D-39 dimension, 'social burden', did not change (P = 0.07 for time). There was no difference between groups in the response for any of these variables (P ≥ 0.10). CONCLUSION A structured caloric restricted diet with or without EX improves emotional distress and QOL in overweight and obese patients with type 2 diabetes. This trial was registered with Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTR No: ACTRN12608000206325).
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Affiliation(s)
- Thomas Philip Wycherley
- Division of Health SciencesSansom Institute for Health ResearchUniversity of South AustraliaAdelaideSAAustralia
| | | | - Manny Noakes
- Preventative Health FlagshipCommonwealth Scientific and Industrial Research Organisation – Animal, Food and Health SciencesAdelaideSAAustralia
| | - Grant David Brinkworth
- Preventative Health FlagshipCommonwealth Scientific and Industrial Research Organisation – Animal, Food and Health SciencesAdelaideSAAustralia
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