Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: A meta-analysis

Impact of Fruit and Vegetable Incentive Programs on Food Insecurity, Fruit and Vegetable Consumption, and Health Outcomes: A Community Guide Systematic Review

INTRODUCTION

Food and nutrition security is crucial for health, but many U.S. households experience food insecurity. This systematic review conducted in support of the Community Preventive Services Task Force (CPSTF) examines the effectiveness of Fruit and Vegetable Incentive (FVI) programs in reducing food insecurity, increasing fruit and vegetable (FV) consumption, and improving health outcomes among households with lower incomes.

METHODS

Community Guide systematic review methods were applied. Studies were identified through a literature search (inception of each database to February 2023). U.S. studies were included if they evaluated programs offering participants financial incentives to purchase FV; were designed for or implemented among populations with lower incomes; reported health-related outcomes; and were published in English as peer-reviewed articles or government reports.

RESULTS

This review included 30 studies. Thirteen of 14 datapoints from 12 studies indicated FVI programs reduced household food insecurity. Twenty-one of 29 datapoints from 23 studies showed increased FV consumption. Programs providing incentives to participants at risk for or with diet-related health conditions improved blood glucose levels by a median of 0.64 percentage points.

DISCUSSION

Based on the review findings, CPSTF recommends FVI programs for populations with lower incomes to reduce household food insecurity, increase household FV consumption, and improve blood glucose levels in participants at risk for or with diet-related health conditions. Although the review did not find direct evidence of reducing health disparities, the CPSTF expects that these programs will improve health equity across the US by improving the affordability and accessibility of healthier foods for households with lower incomes.

The pattern of diabetic care and glycemic control among the ambulatory diabetic patients in tertiary care settings in Bangladesh

Diabetes mellitus is a major public health concern in Bangladesh. The pattern of diabetic care and control of blood sugar among diabetic patients are not well described. We assessed the pattern of diabetic care among ambulatory diabetic patients attending tertiary care hospitals in Bangladesh, and explored the relationship of glycemic control with behavioral and metabolic risks. Any patient 18 years and older attending the medicine outpatient department (OPD) at randomly selected three government tertiary hospitals in three divisions in Bangladesh were examined by hospital doctors. If a patient who was diagnosed as having diabetes and produced any medical document to support the diagnosis was recruited following an informed consent. Data on socio-demographic characteristics, diabetic care plan and behavioral risks, including tobacco use, physical activity, healthy diet (daily fruits and vegetable consumption) and salt intake were obtained from study participants by recall. Three milliliters of venous blood were tested to determine uncontrolled diabetes by measuring glycated hemoglobin (HbA1C > 7.0), and hyperlipidemia by measuring total cholesterol (> 200 mg/dL), high density lipoprotein/HDL (< 40 Mg/dL, low density lipoprotein/ LDL (> 200 mg/dL), and Triglyceride (> 160 mg/dL). A Total of 465 patients were enrolled. The Mean age was 49 years (SD:11) and 58% were women. Sixty percent patients were on a treatment plan of anti-diabetic drugs (drug), healthy diet (diet) and physical activity (PA), 13.3% diet and drug, 9.7% on drug only, 6.4%  on diet and PA, 3.9% on PA and drug, 1.3% on PA only and 0.9% on diet only. Two- third of the patients (68.6%) had uncontrolled diabetes, which was three times higher, if a patient had diabetes for more than five years than otherwise (OR: 3.31, 95% CI 2.06-5.33), two times higher if a patient did not consume fruits  (OR: 2.28, 1.34-3.87), or three times higher, if a patient did not consume vegetables (OR: 3.70, 95% CI 1.80-7.59) than otherwise, 78% higher, if a patient had taken extra salt in meal than otherwise (OR: 1.78, 95% CI 1.13-2.80) and nine times higher, if a patient had a raised total cholesterol level (> 200 mg/dL) than otherwise (OR: 9.60, 95% CI 2.60-35.40) and three times higher, if a patient had a raised LDL level compared than otherwise (OR: 3.33, 95% CI: 1.93-5.70). Diabetic patients seeking care at tertiary hospitals in Bangladesh follow diverse diabetic care plans and the majority of them do not have diabetes under control. Unhealthy dietary practice and hyperlipidemia among diabetic patients contribute to uncontrolled diabetes. Routine monitoring of blood glucose and enforcing lifestyle modifications could promote effective control of diabetes among diabetic patients in Bangladesh.

Beneficial Effects of a Freeze-Dried Kale Bar on Type 2 Diabetes Patients: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

BACKGROUND/OBJECTIVES

Type 2 diabetes (T2D) is one of the most common global diseases, with an ever-growing need for prevention and treatment solutions. Kale (Brassica oleracea L. var. acephala) offers a good source of fiber, minerals, bioavailable calcium, unsaturated fatty acids, prebiotic carbohydrates, vitamins, health-promoting secondary plant metabolites, as well as higher amounts of proteins and essential amino acids compared to other vegetables. The objective of this study was to investigate whether daily intake of freeze-dried kale powder can provide health benefits for T2D patients vs. placebo.

METHODS

This study was designed as a 12-week, blinded, randomized, controlled trial. Thirty T2D patients were randomly assigned to either a placebo bar (control) or a kale bar (intervention). Participants in the intervention group were instructed to consume three bars/day, each containing 26.25 g of freeze-dried kale (corresponding to approx. 341 g fresh kale/day). At baseline and 12 weeks, all participants underwent an oral glucose tolerance test (OGTT), 24 h blood pressure measurements, DEXA scans, and fasted blood samples were taken.

RESULTS

A significant reduction in HbA1c, insulin resistance, body weight, and calorie intake was observed in the intervention group compared to control. Positive trends were detected in fasted blood glucose and LDL-cholesterol for those in the kale intervention group. No significant differences were found in total body fat mass and area under the curve glucose 240 min OGTT.

CONCLUSIONS

Given the positive effects of high daily kale intake observed in this study, further research with a larger sample size is needed to better understand the health benefits of kale bars. This could potentially lead to new dietary recommendations for patients with T2D.

The Longitudinal Evidence on Social Ties and Fruit and Vegetable Intake among Aging Adults: A Systematic Review

CONTEXT

Social ties are associated with the mortality and morbidity of aging populations; however, the role of social ties in healthy eating practices or gender differences in this link is less understood.

OBJECTIVE

The objective of this study was to examine the longitudinal evidence for the impact of changes in social ties on fruit and vegetable (FV) intakes among aging adults, with attention to gender differences.

DATA SOURCES

Medline, Embase, Scopus, CINAHL, and ProQuest databases were searched until December 2022.

DATA EXTRACTION

Longitudinal studies evaluating changes in living arrangement, marital status, social network, or social participation and changes in FV intake among middle- and older-age adults were included. Data from the included studies were extracted using a standardized template and analyzed using a narrative approach.

DATA ANALYSIS

A total of 4956 titles were eligible after deduplication, and 75 full texts were screened. Seven studies met the inclusion criteria, and all examined marital transitions only. Five marital transitions were assessed: staying married, becoming widowed, becoming divorced, remaining unmarried, and becoming married. Both the quantity and variety of fruit and/or vegetables eaten were studied. Three of the included studies had only male or only female populations. The studies found that marital dissolution (divorce or widowhood), and remaining unmarried, were associated with reduced FV intakes in older women or men, compared with staying married. The associations were stronger in men than in women. Two studies showed that becoming married was associated with increased vegetable intakes, but 3 reported null results. The included studies were of medium quality.

CONCLUSIONS

There is a paucity of longitudinal research on whether changes in social ties are associated with changes in FV intakes among aging adults. This review showed that specific marital transitions may influence healthy eating habits, especially in older men. No evidence exists on whether changes in other social ties might alter healthy eating.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022365795.

Adherence to the dietary approaches to stop hypertension diet reduces the risk of diabetes mellitus: a systematic review and dose-response meta-analysis

BACKGROUND

Despite several epidemiological studies reporting a significant association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of diabetes mellitus, the results remain controversial. In this systematic review and meta-analysis, we aimed to summarize the existing evidence from published observational studies and evaluate the dose-response relationship between adherence to the DASH diet and diabetes mellitus risk.

METHODS

We performed a systematic search for relevant articles published up to September 2023 using electronic databases of PubMed, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). A random-effects model was applied to calculate the combined relative risks (RR) with 95% confidence intervals (CIs) for the highest compared to the lowest categories of DASH score in relation to diabetes mellitus risk. Heterogeneity among the included studies was assessed using the Cochran's Q test and I-squared (I2) statistic. Literature search, study selection, data extraction, and quality assessment were performed by two independent reviewers.

RESULTS

Fifteen studies involving 557,475 participants and 57,064 diabetes mellitus cases were eligible for our analyses. Pooled analyses from included studies showed that high adherence to the DASH diet was significantly associated with a reduced risk of diabetes mellitus (RR: 0.82; 95% CI: 0.76-0.90, P < 0.001). Moreover, the dose-response meta-analysis revealed a linear trend between adherence to the DASH diet and diabetes mellitus (RR:0.99; 95%CI: 0.97-1.02, Pdose-response = 0.546, Pnonlinearity = 0.701). Subgroup analyses further revealed a significant inverse association between adherence to the DASH diet and diabetes mellitus risk in case-control studies (RR: 0.65; 95%CI: 0.29-1.43, P < 0.001), with a marginal inverse association in cohort studies (RR:0.83; 95%CI: 0.76-0.91, P < 0.001). Additionally, we conducted analyses separately by comparison and found a significant inverse association between DASH diet and diabetes mellitus risk in T3 vs T1 comparison studies (RR = 0.74; 95%CI: 0.64-0.86, P = 0.012).

CONCLUSION

The findings of this study demonstrate a protective association between adherence to the DASH diet and risk of diabetes mellitus. However, further prospective cohort studies and randomized controlled trials are needed to validate these findings.

A diet-wide Mendelian randomization analysis: causal effects of dietary habits on type 2 diabetes

Background

Traditional clinical studies have indicated a link between certain food intakes and type 2 diabetes (T2D), but the causal relationships between different dietary habits and T2D remain unknown. Using Mendelian randomization (MR) approaches, we investigated the potential causal association between dietary habits and T2D risk.

Methods

We collected publicly available genome-wide association studies' summary statistics for 18 dietary habits from the UK Biobank and T2D data from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. We applied the inverse variance weighted (IVW) method, supplemented with the MR-Egger method, weighted median method (WMM), simple method, weighted mode, MR-Egger regression, and the MR pleiotropy residual sum and outlier test to determine whether a particular diet was causal for T2D.

Results

Reliable and robust MR estimates demonstrated that poultry intake has a causal effect on a higher risk of T2D (IVW: OR 6.30, 95% CI 3.573-11.11, p = 2.02e - 10; WMM: OR 5.479, 95% CI 0.2758-10.88, p = 1.19e - 06). Conversely, dried fruit intake (IVW: OR 0.380, 95% CI 0.237-0.608, p = 5.57e - 05; WMM: OR 0.450, 95% CI 0.321-0.630, p = 3.33e - 06) and cereal intake (IVW: OR 0.455, 95% CI 0.317-0.653, p = 1.924e - 05; WMM: OR 0.513, 95% CI 0.379-0.694, p = 1.514e - 05) were causally associated with T2D as protective factors. Sensitivity analyses confirmed the reliability and robustness of these findings.

Discussion

Our study established the causal effects of poultry intake, dried fruit intake, and cereal intake on T2D, identifying poultry intake as a risk factor and the other two as protective factors. Further research into potential mechanisms is required to validate these novel findings.

Fruit and vegetable consumption in diabetics patients: Effect of pender health promotion model (HPM) intervention

BACKGROUND

This study was aimed to investigate the effect of the intervention based on Pender's health promotion model (Pender's HPM) to improve the consumption of fruits and vegetables in diabetic patients.

MATERIALS AND METHODS

The present study was quasi-experiment community-based research conducted on 112 diabetic patients in Sirjan City. Eligible diabetic patients were randomly divided into two experimental and control groups. The data were collected by two questionnaires, Behavioral Risk Factor Surveillance System and the researcher-made based on Pender's HPM. In order to compare qualitative variables between two groups, Chi-square test was performed. P value <0.05 was considered significant.

RESULTS

The findings showed that there is a significant difference in the consumption of fruit juice in men and women (P value = 0.016). In this study, the perceived obstacles structure and interpersonal influences structure was effective on the consumption of vegetables and salad in diabetic patients before and after the educational intervention.

CONCLUSION

Perceived benefits and interpersonal and situational influencers are effective on the consumption of fruits and vegetables in diabetic people and health planners should design educational interventions in order to increase the consumption of fruits and vegetables in the target group by considering these effective determinants.

Skin Carotenoid Levels Are Associated with Demographic Factors, Body Size, and Fruit and Vegetable Intake in the Japanese Population

This study aimed to determine the association between demographic factors, body size, and fruit and vegetable intake in the general population, focusing on individuals with both low and high skin carotenoid levels. This cross-sectional study was conducted during the 14th National Convention on the Promotion of Food and Nutrition Education (2019) in Yamanashi, Japan (a rural area) and the Open House 2019 at the National Institute of Biomedical Innovation, Health, and Nutrition in Tokyo, Japan (an urban area). Skin carotenoid measurements were conducted, and the participants were asked to fill out a self-administered questionnaire. The study population consisted of 492 Japanese individuals aged ≥16 years. The odds ratios (ORs) for low skin carotenoid levels were elevated in males, those who were overweight, and those who almost never consumed or consumed only one vegetable dish/day. Conversely, the ORs were lower in those living in Yamanashi, aged 30-39 and ≥70 years, and those who consumed fruit ≥1 time/week. For high skin carotenoid levels, the ORs were higher among those aged ≥70 years, living in Yamanashi, and those who consumed fruit ≥1 time/day or ≥5 vegetable dishes/day. Demographic factors, body size, and habitual fruit and vegetable intake may serve as indicators of skin carotenoid levels.

Comparison of food intake pattern of diabetic patients and healthy individuals in a sample of Saudi population: a case-control study

BACKGROUND

There has been a significant rise in the number of individuals diagnosed with type 2 diabetes mellitus (T2DM), with the condition reaching epidemic proportions globally. This study examined the dietary pattern of a sample of Saudi Arabian adults with T2DM compared to control non-diabetics.

METHODS

Data from 414 participants, 207 control and 207 T2DM was analyzed. Anthropometric measurements, foods intake such as vegetables, fruits, whole grains, fried foods, sweetened juice, sweets, and pastries consumption as well as physical activity were obtained by an interview-survey.

RESULTS

The consumption of vegetables, green and leafy vegetables, starchy vegetables, fruits, proteins, and milk was significantly higher in the diabetics (p< 0.0001 for all and p<0.01 for starchy vegetables). Of the case group, 79.7% of them consumed whole-wheat bread while 54.6% of them consumed low fat milk (p<0.0001). There was a significant decrease in the percentage of cases who consumed discretionary foods and sweetened juices and soft drinks (24.1%), avoided sweets (75.8%) and pastries (37.1%), (p<0.0001). There were also significant increases in the percentages of participants who use healthy fat (as olive oil) in the case group (78.7%) (p<0.001). There was a significant increase in the percentage of diabetics who followed a diet to lose weight (15%) (p<0.05). The majority of the two study groups were physically inactive (control 95.2% & case 94.2%).

CONCLUSIONS

The results of this study provide insight on that diabetics generally follow a healthy diet, yet their engagement in physical activity may not be optimal.

Physiologic effects of the maqui berry (Aristotelia chilensis): a focus on metabolic homeostasis

The prevalence and socioeconomic impact of metabolic diseases is rapidly growing. The limited availability of effective and affordable treatments has fuelled interest in the therapeutic potential of natural compounds as they occur in selected food sources. These compounds might help to better manage the current problems of treatment availability, affordability, and adverse effects that, in combination, limit treatment duration and efficacy at present. Specifically, berries garnered interest given a strong epidemiological link between their consumption and improved metabolic functions, making the analysis of their phytochemical composition and the identification and characterization of biologically active ingredients an emerging area of research. In this regard, the present review focuses on the South American maqui berry Aristotelia chilensis, which has been extensively used by the indigenous Mapuche population for generations to treat a variety of disease conditions. An overview of the maqui plant composition precedes a review of pre-clinical and clinical studies that investigated the effects of maqui berries and their major components on metabolic homeostasis. The final part of the review highlights possible technologies to conserve maqui berry structural and functional integrity during passage through the small intestine, ultimately aiming to augment their systemic and luminal bioavailability and biological effects. The integration of the various aspects discussed herein can assist in the development of effective maqui-based therapies to benefit the growing population of metabolically compromised patients.

Diabetes Risk Reduction Diet and Colorectal Cancer Risk

BACKGROUND

Diabetes has been associated with colorectal cancer. We evaluated whether adherence to a diabetes risk reduction diet (DRRD) can favorably influence the risk of colorectal cancer.

METHODS

Data came from a multicentric Italian case-control study including 1,953 histologically confirmed colorectal cancer cases and 4,154 hospital controls admitted for acute nonneoplastic diseases. Diet was assessed through a validated and reproducible food frequency questionnaire. The DRRD score was computed assigning higher values for higher consumption of cereal fiber, fruit, coffee, nuts and a higher polyunsaturated/saturated fats ratio and for lower glycemic index and lower consumption of red/processed meat and sweetened beverages and fruit juices. The ORs and the corresponding 95% confidence intervals (CI) of colorectal cancer according to the DRRD score were obtained using logistic regression models adjusting for total energy intake and other major confounders.

RESULTS

The DRRD was inversely related to colorectal cancer risk. The ORs of colorectal cancer were 0.77 (95% CI, 0.67-0.89) for the third versus first score tertile (Ptrend < 0.001) and 0.92 (95% CI, 0.87-0.96) for a 3-point increment in the score. Inverse associations were observed for colon and rectal cancers and were consistent in strata of sex, age, and other major covariates.

CONCLUSIONS

A higher adherence to a DRRD was inversely associated with colorectal cancer risk.

IMPACT

Given the high incidence and mortality rates of colorectal cancer, adherence to a DRRD can have relevant prevention and public health implications.

Exploring the Causal Relationship Between Modifiable Exposures and Diabetes Mellitus: A Two-Sample Mendelian Randomization Analysis

Background Observational studies link lifestyle factors to diabetes, but confounding limits causal inference. This study employed Mendelian randomization (MR) to investigate the potential causal effects of major dietary, obesity, smoking, and physical activity exposures on diabetes risk. Methods A two-sample MR framework integrated FinnGen and United Kingdom Biobank (UKB) data. Genetic instruments for diet (fruits, vegetables, cheese), smoking (initiation, intensity, maternal), body mass index (BMI), and physical activity came from various consortia (n=64, 949-632, 802). Associations with diabetes odds were assessed using inverse-variance weighted analysis. Results Fruit and cheese intake and physical activity per standard deviation increase causally reduced diabetes risk in both cohorts. Conversely, smoking initiation, maternal smoking around birth, and BMI per standard deviation increase causally increased diabetes risk in both cohorts. Coffee increased diabetes risk only in FinnGen, whereas smoking intensity increased diabetes risk only in UKB. Conclusion This study provides robust evidence that modifiable lifestyle factors may have causal effects on diabetes risk. Fruit, cheese, and physical activity may protect against diabetes, whereas smoking, maternal smoking, and higher BMI appear to increase risk. Findings support public health interventions targeting diet, physical activity, smoking cessation, and healthy weight to combat the global diabetes epidemic.

Social desirability bias is related to children's energy intake in a laboratory test meal paradigm

Dietary intake is notoriously difficult to measure in children. Laboratory test meals address some of the methodological concerns of self-report methods, but may also be susceptible to social desirability bias, referring to the tendency for individuals to adjust their behaviors in order to be perceived more positively. The aim of the current study was to evaluate whether social desirability bias was associated with children's energy intake during a laboratory test meal, and whether this association varied by food type (total caloric intake, snack food intake, fruit/vegetable intake) and sex. A total of 82 children (M age = 9.45 ± 0.85; 50 % girls; 84.1 % rural; 85.4 % White) completed several surveys, including the Children's Social Desirability Scale and had their body composition measured. At lunchtime, they were granted access to a multi-array test meal (>5000 kcal). After adjusting for lean mass, fat mass, depressive symptoms, and parental food restriction, children who reported higher social desirability bias consumed fewer calories from snack foods (B = -11.58, p = .009, semi-partial correlation = -0.28). Boys with higher social desirability bias consumed less calories from fruits and vegetables (B = -6.47, p = .010, semi-partial correlation = -0.411); this association was not significant in girls. The desire to be perceived in a positive manner may influence children's eating behaviors in experimental paradigms. Replication studies with larger, more diverse pediatric samples are needed, as are strategies to reduce the effects of social desirability bias on test meal intake in order to enhance the validity of this dietary assessment approach.

Identifying diabetes risks among Indonesians: A cross-sectional study in a community setting

Background

There is an upward surge in diabetes patients worldwide, including in Indonesia, annually. Diabetes can lead to new diseases that burden patients' lives further. Nurses can reduce this problem by identifying people at risk of developing diabetes and educating them on how to prevent diabetes.

Objective

The study aimed to determine the risk of diabetes in the Indonesian population.

Methods

The descriptive research involved a sample of 1216 Indonesians living in North Sumatra Province. Participants were nondiabetic individuals selected using the convenience method from May to October 2020. This study utilized the Indonesian version of the Finnish Diabetes Risk Score (FINDRISC) tool and employed various statistical analyses, including frequencies, percentages, chi-square test, and Fisher's exact test.

Results

Of the total samples, 372 were males (30.6%), and 844 were females (69.4%). The risk of developing diabetes was classified as low (57.1%), slightly elevated (36.4%), moderate (5.3%), high (1.0%), and very high (0.2%). Only one of the eight risk factors that differed significantly between men and women was a history of elevated blood glucose levels, with a p-value of 0.02.

Conclusion

The study identified a portrait of the number and percentage of diabetes risk factors in a community setting in Indonesia. Nurses must provide education on diabetes prevention to not only members of the local community at the research site but also the general public, nationally and globally.

Effect of Blueberry Supplementation on a Diet-Induced Rat Model of Prediabetes-Focus on Hepatic Lipid Deposition, Endoplasmic Stress Response and Autophagy

Blueberries, red fruits enriched in polyphenols and fibers, are envisaged as a promising nutraceutical intervention in a plethora of metabolic diseases. Prediabetes, an intermediate state between normal glucose tolerance and type 2 diabetes, fuels the development of complications, including hepatic steatosis. In previous work, we have demonstrated that blueberry juice (BJ) supplementation benefits glycemic control and lipid profile, which was accompanied by an amelioration of hepatic mitochondrial bioenergetics. The purpose of this study is to clarify the impact of long-term BJ nutraceutical intervention on cellular mechanisms that govern hepatic lipid homeostasis, namely autophagy and endoplasmic reticulum (ER) stress, in a rat model of prediabetes. Two groups of male Wistar rats, 8-weeks old, were fed a prediabetes-inducing high-fat diet (HFD) and one group was fed a control diet (CD). From the timepoint where the prediabetic phenotype was achieved (week 16) until the end of the study (week 24), one of the HFD-fed groups was daily orally supplemented with 25 g/kg body weight (BW) of BJ (HFD + BJ). BW, caloric intake, glucose tolerance and insulin sensitivity were monitored throughout the study. The serum and hepatic lipid contents were quantified. Liver and interscapular brown and epidydimal white adipose tissue depots (iBAT and eWAT) were collected for histological analysis and to assess thermogenesis, ER stress and autophagy markers. The gut microbiota composition and the short-chain fatty acids (SCFAs) content were determined in colon fecal samples. BJ supplementation positively impacted glycemic control but was unable to prevent obesity and adiposity. BJ-treated animals presented a reduction in fecal SCFAs, increased markers of arrested iBAT thermogenesis and energy expenditure, together with an aggravation of HFD-induced lipotoxicity and hepatic steatosis, which were accompanied by the inhibition of autophagy and ER stress responses in the liver. In conclusion, despite the improvement of glucose tolerance, BJ supplementation promoted a major impact on lipid management mechanisms at liver and AT levels in prediabetic animals, which might affect disease course.

Prospective association between fruit and vegetable intake and the risk of type 2 diabetes amongst Chinese adults: the China Health and Nutrition Survey

This study aimed to prospectively explore the relationship between fruit and vegetable intake (FVI) and type 2 diabetes (T2D) risk amongst 13,175 Chinese adults. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of T2D events in relation to FVI. Results showed that the highest quintile of FVI was inversely associated with T2D risk in men (HR = 0.72, 95% CI: 0.50, 0.98) and women (HR = 0.74, 95% CI: 0.55, 0.97), whereas no such associations were observed between total vegetable intake and T2D in either men (HR = 0.92, 95% CI: 0.65, 1.26) or women (HR = 1.02, 95% CI: 0.77, 1.38). In addition, greater fruit intake was inversely associated with T2D risk in men (HR = 0.42, 95% CI: 0.28, 0.63) and women (HR = 0.64, 95% CI: 0.45, 0.90). Overall, FVI and total fruit intake were inversely associated with T2D risk amongst Chinese adults.

Nutrient patterns and risk of diabetes mellitus type 2: a case-control study

BACKGROUNDS

Although the significance of diet in preventing or managing diabetes complications is highlighted in current literature, there is insufficient evidence regarding the correlation between nutrient patterns and these complications. The objective of this case-control study is to investigate this relationship by analyzing the dietary intake of nutrients in participants with and without type 2 diabetes (T2D).

METHODS

A case-control study was conducted at the Tabriz Center of Metabolism and Endocrinology to investigate the relationship between nutrient patterns and type 2 diabetes (T2D). The study enrolled 225 newly diagnosed cases of T2D and 225 controls. The dietary intake of nutrients was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Principal component analysis using Varimax rotation was used to obtain nutrient patterns. Logistic regression analysis was performed to estimate the risk of T2D.

RESULTS

The participants' mean (SD) age and BMI were 39.8 (8.8) years and 27.8 (3.6) kg/m2, respectively. The results identified three major nutrient patterns. The first nutrient pattern was characterized by high consumption of sucrose, animal protein, vitamin E, vitamin B1, vitamin B12, calcium, phosphorus, zinc, and potassium. The second nutrient pattern included fiber, plant protein, vitamin D, Riboflavin, Vitamin B5, copper, and Magnesium. The third nutrient pattern was characterized by fiber, plant protein, vitamin A, riboflavin, vitamin C, calcium, and potassium. Individuals in the highest tertile of nutrient pattern 3 (NP3) had a lower risk of T2D compared to those in the lowest tertile after adjusting for confounders. The odds ratio was 0.52 with a 95% confidence interval of 0.30-0.89 and a P_trend of 0.039.

CONCLUSION

This study found that conforming to a nutrient pattern consisting of plant protein, vitamin C, vitamin A, vitamin B2, potassium, and calcium is linked to a lower likelihood of developing T2D.The initial results suggest that following a nutrient pattern that includes these nutrients may reduce the risk of T2D. However, further research is required to confirm the relationship between nutrient patterns and T2D.

Nutrition at the Intersection between Gut Microbiota Eubiosis and Effective Management of Type 2 Diabetes

Nutrition is one of the most influential environmental factors in both taxonomical shifts in gut microbiota as well as in the development of type 2 diabetes mellitus (T2DM). Emerging evidence has shown that the effects of nutrition on both these parameters is not mutually exclusive and that changes in gut microbiota and related metabolites such as short-chain fatty acids (SCFAs) and branched-chain amino acids (BCAAs) may influence systemic inflammation and signaling pathways that contribute to pathophysiological processes associated with T2DM. With this background, our review highlights the effects of macronutrients, carbohydrates, proteins, and lipids, as well as micronutrients, vitamins, and minerals, on T2DM, specifically through their alterations in gut microbiota and the metabolites they produce. Additionally, we describe the influences of common food groups, which incorporate varying combinations of these macronutrients and micronutrients, on both microbiota and metabolic parameters in the context of diabetes mellitus. Overall, nutrition is one of the first line modifiable therapies in the management of T2DM and a better understanding of the mechanisms by which gut microbiota influence its pathophysiology provides opportunities for optimizing dietary interventions.

Fruits and vegetables intake improves birth outcomes of women with gestational diabetes mellitus and hypertensive disorders of pregnancy

BACKGROUND

Disorders of pregnancy such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) have been associated with adverse birth outcomes. However, the ameliorating role of maternal nutrition in the relationship between disorders of pregnancy and adverse birth outcomes has received very little attention. We investigated the relationship between HDP and GDM, and adverse birth outcomes in a Ghanaian population and evaluated the effect modifying role of fruits and vegetables consumption in the relationship.

METHODS

We conducted a cross-sectional study among 799 mothers who had recently delivered singletons in the Cape Coast Metropolis, Ghana. Information on HDP, GDM and birth outcomes were retrieved from the maternal health book of the mothers. A food frequency questionnaire was used to assess fruits and vegetables intake during pregnancy. Modified Poisson regression was used to investigate the association between pregnancy disorders, and preterm birth (PTB) and low birth weight (LBW). Stratified analysis was used to assess the effect modifying role of fruits and vegetables consumption in the relationship.

RESULTS

The proportion of mothers with HDP and GDM was 11.3% and 7.5%, respectively. The proportion of the mothers with both conditions was 0.9%. The prevalence of PTB and LBW in the population was 27.9 and 7.3%, respectively. These disorders of pregnancy were associated with increased risk of PTB (Adjusted Prevalence Ration [APR] = 3.02; 95% CI: 2.42, 3.77) and LBW (APR = 5.32; 95% CI: 3.19, 8.88). In the stratified analysis, risk of PTB was higher among mothers classified in tertile I compared to mothers classified in tertiles II and III. For LBW, the risk increased with increasing fruits and vegetables consumption. The interaction p values were 0.0043 and 0.1604 for PTB and LBW, respectively.

CONCLUSIONS

We found mothers who were diagnosed with GDM and HDP to have increased risk of delivering a PTB and LBW baby. We also found fruits and vegetables consumption to modify the observed relationship. Mothers diagnosed with GDM and HDP should be advised during antenatal care visits to increase intake of fruits and vegetable consumption to help safeguard their health and that of the developing foetus.

Dietary Practices Among Type 2 Diabetes Patients Visiting a Non-communicable Disease (NCD) Clinic in a District of Western India: A Cross-Sectional Study

BACKGROUND AND AIMS

Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to find the perceptions of participants about the role of diet in controlling diabetes and to find the perception-practice gap among study participants.

METHODOLOGY

It was a hospital-based cross-sectional study conducted among 450 T2DM patients visiting the non-communicable disease (NCD) clinics of tertiary care hospitals and community health centres (CHCs) of the study district. Dietary practice was assessed using a modified UK Diabetes and Diet Questionnaire (UKDDQ), considering the food patterns in the study area. Statistical tests like chi-square and ordinal logistic regression were applied using Jamovi software for univariate and multivariate analyses.

RESULTS

The healthiest food choices were abstinence from alcohol consumption (100%), avoiding processed meat (92.21%), high-fibre breakfast (70.4%), and daily consumption of vegetables (68.2%). Improper dietary practices were regular sugary drinks (38%) and high-glycemic-index food items (22.4%). The mean (SD) of the composite score was 68.02 (8.7) and the median score (interquartile range (IQR)) was 69 (60-76). Tertile analysis of the composite score revealed that with the increase in age, patients were less likely to be in the intermediate or upper tertile score (β = -0.0219, p = 0.016). Being female (odds ratio (OR) =0.603, CI: 0.395-0.917, p = 0.019) and living in a three-generation family made the patients less likely to be in the upper tertile score.

CONCLUSION

Nearly half of the participants had an overall healthy score. Dietary practices were healthy among the participants of lower ages, males, and those living in nuclear and joint families. The highest perception-practice gap was seen for fruit and rice consumption.

Fruits and the Risk of Type 2 Diabetes: The Korean Genome and Epidemiology Study Cohort

BACKGROUND

To determine the association between type 2 diabetes mellitus and the consumption of various fruits.

METHODS

The Korean Genome And Epidemiology Study is an ongoing prospective longitudinal cohort study of community dwellers and participants (men and women, aged 40-69 years) recruited from the national health examinee registry of Korea. Their individual consumption habits for 12 different fruit types were recorded using food frequency questionnaires. The fruits were then divided into three groups according to their glycemic indexes and glycemic loads. Participants with extreme caloric intakes, pre-existing type 2 diabetes mellitus, chronic kidney diseases, chronic liver diseases, and ongoing cancer treatments were excluded. The incidence of type 2 diabetes in the cohort was identified through self-reporting and supplemented by glycated hemoglobin and fasting blood glucose levels.

RESULTS

A total of 2,549 cases of type 2 diabetes were documented during 283,033.8 person-years of follow-up. After adjusting for personal, lifestyle, and dietary risk factors for diabetes, the pooled hazard ratio of type 2 diabetes for every serving per week of total whole fruit consumption was 1.02 (95% confidence interval [CI], 0.99-1.06; P=0.2). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every serving per week were 0.94 (95% CI, 0.88-1.00; P=0.039) for bananas, and 0.90 (95% CI, 0.84-0.96; P<0.001) for grapes.

CONCLUSION

Our findings suggest associations between the consumption of certain fruits and the risk of developing type 2 diabetes. A greater consumption of grapes was significantly associated with a lower risk of type 2 diabetes in our cohort, but the total amount of fruit consumption was not associated with a reduced risk.

Total and different dietary fiber subtypes and the risk of all-cause, cardiovascular, and cancer mortality: a dose-response meta-analysis of prospective cohort studies

We aimed to conduct a comprehensive review of the association between dietary fiber and the risk of mortality. We did a systematic search in PubMed, Scopus, and Web of Science up to November 2022 to find prospective cohort studies of the relationship between total and subtypes of dietary fiber and the risk of all-cause, cardiovascular (CVD), and cancer mortality in the general population. The hazard ratios (HRs) and 95% CIs were calculated using a random-effects model. A total of 28 studies with 1 613 885 participants were included. Higher intake of total and subtypes of dietary fiber including cereal, vegetable, legume, soluble, and insoluble fiber, but not fruit fiber, was associated with a lower risk of all-cause mortality, with HRs ranging from 0.77 for insoluble fiber to 0.93 for legume fiber. Similar findings were observed for CVD mortality, where higher intake of total and all subtypes of dietary fiber was each associated with a lower risk. Higher intake of total, cereal, vegetable, and insoluble fiber was also associated with a lower risk of cancer mortality. No association was found between the intake of fruit, legume, and soluble fiber and cancer mortality. Dose-response meta-analyses suggested an inverse association between total fiber intake and the risk of all-cause, CVD, and cancer mortality. The certainty of evidence was rated moderate for the association of total fiber with all-cause, CVD, and cancer mortality. In conclusion, our findings highlight the potential advantages of consuming a wide range of dietary fiber subtypes against all-cause, CVD, and cancer mortality. Registry and registry number: PROSPERO (CRD42021226816).

Association of dietary phytochemical index with cardiometabolic risk factors

Objective(s): Cardio-metabolic risk factors are becoming a global health concern. To address this problem, one of the proposed ways is to focus on phytochemical-rich foods consumption. Therefore, we aimed to summarize the results of observational studies (cohorts, case-control, and cross-sectional) that investigated the association between dietary phytochemical index (PI) as a new index for evaluating phytochemical-rich food intake and various risk factors of cardio-metabolic disorders. Methods: We conducted a comprehensive systematic review through PubMed, Scopus, and Web of Science databases. The literature search was performed up to August 2021 with no publication year restriction on observational studies investigating the association between PI and cardiometabolic risk factors on adults and children. A random-effect meta-analysis was used. Results: Overall, 16 articles (cross-sectional, case-control, cohort) were eligible for this systematic review and 8 studies with 99771 participants were included in the meta-analysis. Random effect meta-analysis showed that adherence to higher dietary PI decrease the odds of abdominal obesity (OR: 0.73, 95% CI: 0.58, 0.88, I2: 84.90), generalized obesity (OR: 0.84, 95% CI: 0.69, 0.98, I2: 68.10), hypertriglyceridemia (OR: 0.81, 95% CI: 0.73, 0.89, I2: 0.00), hypertension (OR: 0.86, 95% CI: 0.73, 0.99, I2: 7.02), and MetS (OR: 0.79, 95% CI: 0.69, 0.88, I2: 84.90). However, results considering the associations between dietary PI with glycemic indices, and low high-density lipoprotein cholesterol (HDL-C) were not significant (p<0.05). Conclusion: Evidence showed adverse associations between dietary PI and some cardio-metabolic risk factors such as obesity, hypertriglyceridemia, hypertension and metabolic syndrome.

The Global Burden of Type 2 Diabetes Attributable to Dietary Risks: Insights from the Global Burden of Disease Study 2019

The Global Burden of Disease Study (GBD) 2019 reveals an increasing prevalence of Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. This study delves into the role of dietary risk factors across different demographic and socioeconomic groups. Utilizing data from the GBD 2019, it analyzes age-adjusted T2DM metrics-death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs)-stratified by age, sex, and region. The study employed Estimated Annual Percentage Changes (EAPCs) to track trends over time. The results show that in 2019, 26.07% of T2DM mortality and 27.08% of T2DM DALYs were attributable to poor diets, particularly those low in fruits and high in red and processed meats. There was a marked increase in both the death rate and DALY rate associated with dietary risks over this period, indicating the significant impact of dietary factors on the global T2DM landscape. Geographic variations in T2DM trends were significant, with regions like Southern Sub-Saharan Africa and Central Asia experiencing the most substantial increases in Age-Standardized Mortality Rate (ASMR) and Age-Standardized DALY Rate (ASDR). A positive correlation was noted between Socio-Demographic Index (SDI) and T2DM burden due to dietary risk factors. The study concludes that targeted public health initiatives promoting dietary changes could substantially reduce the global T2DM burden.

Association between a mediterranean lifestyle and Type 2 diabetes incidence: a prospective UK biobank study

BACKGROUND

There is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population.

METHODS

We used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40-69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) "Mediterranean food consumption", (b) "Mediterranean dietary habits", (c) "Physical activity, rest, social habits, and conviviality". Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders.

RESULTS

After a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82-0.99), 0.80 (0.72-0.89) and 0.70 (0.62-0.79) (p-trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes.

CONCLUSIONS

Higher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes.

The Influence of Grandparents on Children's Dietary Health: A Narrative Review

PURPOSE OF REVIEW

To examine and synthesise recent evidence on the role of grandparents in shaping children's dietary health.

RECENT FINDINGS

The influence of grandparents on children's dietary health was evident across studies. Grandparents frequently provide their grandchildren with meals and snacks, and engage in many of the same feeding practices used by parents. Although grandparents report providing their grandchildren with healthy foods, the provision of treat foods high in sugar or fat was a common finding. This provision led to family conflict, with the indulgent behaviours of grandparents seen by parents as a barrier to healthy eating. Grandparents are exerting significant influence on child dietary health. Efforts are needed to ensure these care providers are considered key stakeholders in the promotion of healthy eating and are targeted in policies and programs addressing children's diets. Research that determines how to best support grandparents to foster healthy behaviours in children is critical.

Investigating the relationship between lifestyle factors, family history, and diabetes mellitus in non-diabetic visitors to primary care centers

We investigated the risk levels associated with diabetes mellitus. They were assessed based on whether anyone in their family had a history of diabetes. The data collected are measurements of blood pressure, weight, height, and smoking habits, as well as physical activity and educational status. Based on the American Diabetes Association's (ADA) recommendations, the questionnaire included a diabetes risk assessment. The risk of diabetes was 76.3% among participants with a family history of diabetes. There is a 41.1% chance of diabetes among those participants whose fathers had diabetes, and a 39.3% chance of diabetes among those participants whose mothers had diabetes. Additionally, those participants who have siblings with diabetes were 24% at high risk for developing diabetes. The prevalence of the risk of having a family history of diabetes is higher in the women in the family (RR = 3.12; P = 0.0001) as compared to the men in the family (RR = 1.9; P = 0.0001). Risk of diabetes more in the male (1.13 times higher) in the current study based on the ADA scale. There is evidence that various factors, including lifestyle choices, physical attributes, and family history, influence the risk of developing diabetes in the current study. The results of the current study indicate that there is a strong association between patients with T2D and those who have a family history of diabetes. Considering Saudi Arabia's high diabetes risk, evidence-based lifestyle modifications are needed.

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Background. This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. Methods. This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D (N = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. Results. Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. Conclusion. T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses.

Highlights

More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes.Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities.The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.

High cereal fibre but not total fibre is associated with a lower risk of type 2 diabetes: Evidence from the Melbourne Collaborative Cohort Study

AIM

To assess the associations of total dietary fibre and fibre from different food sources (ie, cereal, fruit and vegetables) with the risk of diabetes.

MATERIALS AND METHODS

The Melbourne Collaborative Cohort Study enrolled 41 513 participants aged 40 to 69 years from 1990 to 1994. The first and second follow-ups were conducted in 1994 to 1998 and 2003 to 2007, respectively. Self-reported diabetes incidence was recorded at both follow-ups. We analysed data from 39 185 participants, with a mean follow-up of 13.8 years. The relationships between dietary fibre intake (total, fruit, vegetable and cereal fibre) and the incidence of diabetes were assessed using modified Poisson regression, adjusted for dietary, lifestyle, obesity, socioeconomic and other possible confounders. Fibre intake was categorized into quintiles.

RESULTS

At total of 1989 incident cases were identified over both follow-up surveys. Total fibre intake was not associated with diabetes risk. Higher intake of cereal fibre (P for trend = 0.003), but not fruit (P for trend = 0.3) and vegetable fibre (P for trend = 0.5), was protective against diabetes. For cereal fibre, quintile 5 versus quintile 1 showed a 25% reduction in diabetes risk (incidence risk ratio [IRR] 0.75, 95% confidence interval [CI] 0.63-0.88). For fruit fibre, only quintile 2 versus quintile 1 showed a 16% risk reduction (IRR 0.84, 95% CI 0.73-0.96). Adjustment for body mass index (BMI) and waist-to-hip ratio eliminated the association and mediation analysis showed that BMI mediated 36% of the relationship between fibre and diabetes.

CONCLUSION

Intake of cereal fibre and, to a lesser extent, fruit fibre, may reduce the risk of diabetes, while total fibre showed no association. Our data suggest that specific recommendations regarding dietary fibre intake may be needed to prevent diabetes.

The Endless World of Carotenoids-Structural, Chemical and Biological Aspects of Some Rare Carotenoids

Carotenoids are a large and diverse group of compounds that have been shown to have a wide range of potential health benefits. While some carotenoids have been extensively studied, many others have not received as much attention. Studying the physicochemical properties of carotenoids using electron paramagnetic resonance (EPR) and density functional theory (DFT) helped us understand their chemical structure and how they interact with other molecules in different environments. Ultimately, this can provide insights into their potential biological activity and how they might be used to promote health. In particular, some rare carotenoids, such as sioxanthin, siphonaxanthin and crocin, that are described here contain more functional groups than the conventional carotenoids, or have similar groups but with some situated outside of the rings, such as sapronaxanthin, myxol, deinoxanthin and sarcinaxanthin. By careful design or self-assembly, these rare carotenoids can form multiple H-bonds and coordination bonds in host molecules. The stability, oxidation potentials and antioxidant activity of the carotenoids can be improved in host molecules, and the photo-oxidation efficiency of the carotenoids can also be controlled. The photostability of the carotenoids can be increased if the carotenoids are embedded in a nonpolar environment when no bonds are formed. In addition, the application of nanosized supramolecular systems for carotenoid delivery can improve the stability and biological activity of rare carotenoids.

Characterization of Green and Yellow Papaya (Carica papaya) for Anti-Diabetic Activity in Liver and Myoblast Cells and Wound-Healing Activity in Fibroblast Cells

Obesity and diabetes, often characterized as "metabolic syndrome", have been recognized as two of the most important public health issues worldwide. The objective of the present research was to evaluate green and yellow papaya for anti-oxidation and anti-diabetic properties. Leaves, skin, pulp, and seed samples from papayas were freeze-dried and then extracted in water or 80% methanol. The extracts were used to determine total polyphenolic content and anti-oxidation activities, and to determine biological activities, including glucose uptake, Glut-2 expression, triglyceride reduction, and wound-healing activity. Our data demonstrated that methanol and water extracts of green and yellow papaya have similar concentrations of polyphenols in skin (10-20 mg/g dry powder), leaf (25-30 mg/g dry powder), and pulp (1-3 mg/g dry powder) fractions. However, both methanol and water extracts of seeds from yellow papaya have substantially higher concentrations of polyphenols compared to green papaya. Both water and methanol extracts of yellow papaya exhibited higher anti-oxidation activity compared to green papaya in skin (50-60%), pulp (200-300%), and seeds (10-800%). Old leaves also showed greater anti-oxidation activity (30-40%) compared to new leaves. Pulp extracts from both yellow and green papaya stimulated greater glucose uptake, but only pulp from green papaya stimulated glucose uptake in muscle cells. Similarly, pulp extract stimulated glucose transporter Glut-2 expression in liver cells. The skin, pulp, and seeds of green or yellow papaya showed triglyceride-lowering activity in liver cells by 60-80%, but samples taken from yellow papaya had a more potent effect. Seeds from both green and yellow papaya significantly stimulated the migration of fibroblasts in the wounded area by 2-2.5-fold compared to the untreated control. Consistent with these data, seeds from both green and yellow papaya also significantly stimulated collagen synthesis in fibroblast cells by almost 3-fold. In conclusion, our data indicate that different parts of papaya produce stimulatory effects on glucose uptake, Glut-2 expression, TG reduction, and wound-healing activities. This study concludes that different parts of the papaya can be beneficial for preventing diabetes and diabetes-related wound healing.

Berry Dietary Interventions in Metabolic Syndrome: New Insights

Metabolic Syndrome (MetS) is characterized by a group of dysmetabolic conditions, including abdominal obesity, dyslipidemia, glucose intolerance and/or insulin resistance, and hypertension. Generally, MetS is accompanied by an exacerbation of oxidative stress, inflammation, and vascular dysfunction. Increasing evidence suggests that berries and berry bioactives could play a potential role in the prevention and mitigation of the risk factors associated with MetS. The present systematic review summarizes the more recently available evidence deriving from human intervention studies investigating the effect of berries in subjects with at least three out of five MetS parameters. The PubMed, Scopus, and Embase databases were systematically searched from January 2010 until December 2022. A total of 17 human intervention trials met the inclusion criteria. Most of them were focused on blueberry (n = 6), cranberry (n = 3), and chokeberry (n = 3), while very few or none were available for the other berries. If considering MetS features, the main positive effects were related to lipid profile (low and high-density lipoproteins, cholesterol, and triglycerides) following blueberries and chokeberries, while conflicting results were documented for anthropometric parameters, blood pressure, and fasting blood glucose levels. Other markers analyzed within the studies included vascular function, oxidative stress, and inflammation. Here, the main positive effects were related to inflammation with a reduction in interleukin 6 and tumor necrosis factor-alpha following the intake of different berries. In conclusion, although limited, the evidence seems to support a potential role for berries in the modulation of lipid profile and inflammation in subjects with MetS. Furthermore, high-quality intervention trials are mandatory to demonstrate the role of berries in reducing risk factors for MetS and related conditions. In the future, such a demonstration could bring the adoption of berries as a potential dietary strategy to prevent/counteract MetS and related risk factors.

Partial substitution of red or processed meat with plant-based foods and the risk of type 2 diabetes

High consumption of red and processed meat has been associated with increased type 2 diabetes (T2D) risk. These kinds of diets are also environmentally unsustainable. We examined a modeled association between a partial substitution of red meat or processed meat with plant-based foods (legumes, vegetables, fruit, cereals, or a combination of these) and T2D risk among Finnish adults. We used pooled data from five Finnish cohorts (n = 41,662, 22% women, aged ≥ 25 years, 10.9 years median follow-up with 1750 incident T2D cases). Diet was assessed by a validated food frequency questionnaire. In the substitution models, 100 g/week of red meat or 50 g/week of processed meat were substituted with similar amounts of plant-based substitutes. Cohort-specific hazard ratios (HRs) were estimated by Cox proportional hazards multivariable model and pooled using a two-staged random-effects model. We observed small, but statistically significant, reductions in T2D risk in men when red or processed meat were partially substituted with fruits (red meat: HR 0.98, 95% CI 0.97-1.00, P = 0.049, processed meat: 0.99, 0.98-1.00, P = 0.005), cereals (red meat: 0.97, 0.95-0.99, P = 0.005, processed meat: 0.99, 0.98-1.00, P = 0.004) or combination of plant-based foods (only processed meat: 0.99, 0.98-1.00, P = 0.004) but not with legumes or vegetables. The findings of women were similar but not statistically significant. Our findings suggest that even small, easily implemented, shifts towards more sustainable diets may reduce T2D risk particularly in men.

COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income, Food-Insecure Households

OBJECTIVE

To examine the dietary behaviors of mothers from very low food security (VLFS) households following the availability of coronavirus disease 2019 (COVID-19) unemployment and Supplemental Nutrition Assistance Program benefits.

METHODS

Diet and food security status were obtained from 2,584 California mothers during Federal Fiscal Year 2020. Fruits, vegetables, and 100% fruit juice (FV100%FJ), sugar-sweetened beverages, and water intake, and Healthy Eating Index-2015 scores, were compared across 4 groups (before vs after COVID-19 benefits by VLFS vs non-VLFS households) with race/ethnicity and age as covariates.

RESULTS

Before COVID-19 benefits, VLFS was associated with fewer cups of FV100%FJ (P = 0.010), more fluid ounces of sugar-sweetened beverages (P = 0.004), and poorer diet quality (P = 0.003). After COVID-19 benefits, mothers from VLFS vs non-VLFS households reported similar dietary outcomes. VLFS mothers reported 0.96 (95% confidence interval, 0.53-1.38) more cups of FV100%FJ after COVID-19 benefits.

CONCLUSIONS AND IMPLICATIONS

Coronavirus disease 2019 benefits may have reduced dietary inequities among low-income families. Associations between increased Supplemental Nutrition Assistance Program and unemployment benefits and decreased costs associated with the negative health outcomes linked to food insecurity and poor diets would be of value.

Non-pharmacological management options for MAFLD: a practical guide

Lifestyle changes should be the main basis for any treatment for metabolic dysfunction-associated fatty liver disease (MAFLD), aiming to increase energy expenditure, reduce energy intake and improve the quality of nutrients consumed. As it is a multifactorial disease, approaches such as physical exercise, a better dietary pattern, and possible pharmacological intervention are shown to be more efficient when used simultaneously to the detriment of their applications. The main treatment for MAFLD is a lifestyle change consisting of diet, activity, exercise, and weight loss. The variables for training prescription such as type of physical exercise (aerobic or strength training), the weekly frequency, and the intensity most indicated for the treatment of MAFLD remain uncertain, that is, the recommendations must be adapted to the clinical conditions comorbidities, and preferences of each subject in a way individual. This review addresses recent management options for MAFLD including diet, nutrients, gut microbiota, and physical exercise.

Carotenoid and Tocopherol Profiling in 18 Korean Traditional Green Leafy Vegetables by LC-SIM-MS

Fruits and vegetables are a vital source of redox-active phytochemicals in the diet. Traditional green leafy vegetables (GLVs) are a rich source of carotenoids, dietary fiber, minerals, phenols, vitamins, and tocopherols and are commonly consumed in rural areas worldwide. In traditional Korean medicine, many GLVs are used to treat various ailments. However, data on the carotenoid and tocopherol content of many traditional GLVs consumed in the Republic of Korea are insufficient. The current work aims to compare the carotenoid and tocopherol profiles of 18 traditional GLVs by utilizing a single ion monitoring LC-MS approach to identify the potential GLVs for commercial cultivation and healthy diet formulations. Among the traditional GLVs investigated, (all-E)-lutein was the most abundant carotenoid, ranging from 44.4% in Glehnia littoralis to 52.1% in Heracleum moellendorffii. It was followed by (all-E)-violaxanthin and (all-E)-β-carotene. The highest contents of (all-E)-violaxanthin (75.6 µg/g FW), 9-Z-neoxanthin (48.4 µg/g FW), (all-E)-luteoxanthin (10.8 µg/g FW), (all-E)-lutein (174.1 µg/g FW), total xanthophylls (310.5 µg/g FW), (all-E)-β-carotene (69.6 µg/g FW), and total carotenoids (380.1 µg/g FW) were recorded in Pimpinella brachycarpa. Surprisingly, Taraxacum mongolicum also showed the highest contents of (all-E)-violaxanthin, (all-E)-lutein, and total carotenoids, which were statistically non-significant (p > 0.05, Tukey HSD) with P. brachycarpa. The highest concentration of (all-E)-zeaxanthin (14.4 µg/g FW) was recorded in Solidago virga-aurea. Among the studied herbs, 13.9 (H. moellendorffii)-133.6 µg/g FW (Toona sinensis) of α-tocopherol was recorded. Overall, the results suggest that P. brachycarpa and T. mongolicum are rich sources of carotenoids. On the other hand, T. sinensis is a rich source of α-tocopherol. These GLVs can be utilized in the diet to enhance the intake of health-beneficial carotenoids and α-tocopherol.

EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women

To improve the health of our planet and develop sustainable food policies, it is important to understand the health impact of a diet pattern that considers planetary and population health. We used data from the Mexican Teachers' Cohort (MTC) to estimate the association between the EAT-Lancet healthy reference diet (EAT-HRD) and type 2 diabetes (T2D) incidence. We included 74,671 women aged ≥25 years, free of T2D at baseline. A validated food frequency questionnaire (FFQ) was used to assess dietary intake. We created an EAT-HRD score based on 15 food groups recommended by the EAT-Lancet Commission (range from 0 to 15). T2D cases were identified through self-report and cross-linkage with clinical and administrative databases. We used Cox proportional hazards models to estimate the association between categories of the EAT-HRD score with T2D incidence. During a median follow-up of 2.16 y (IQR 1.8-4.3 y), we identified 3241 T2D incident cases. The median EAT-HRD score was 6 (IQR 5-7). In multivariable analyses, when comparing extreme categories, higher adherence to the EAT-HRD score was associated with lower T2D incidence (HR 0.90; 95% CI 0.75, 1.10), yet, the estimation was imprecise. Compared to those who did not meet the EAT-HRD recommendations, adhering to the red meat, legumes, and fish recommendations was associated with lower T2D incidence. Meeting the recommendation of dairy and added sugars was associated with an increased incidence of T2D. Higher adherence to a diet designed to promote environmental and human health may help prevent T2D incidence among women in a middle-income country.

The association of specific types of vegetables consumption with 10-year type II diabetes risk: Findings from the ATTICA cohort study

BACKGROUND

The present study aimed to investigate the association between vegetable consumption, in total as well as per type/category, and 10-year type-2 diabetes mellitus (T2DM) incidence.

METHODS

The ATTICA study was conducted during 2001-2012 in 3042 apparently healthy adults living in Athens area, Greece. A detailed biochemical, clinical, and lifestyle evaluation was performed; vegetable consumption (total, per type) was evaluated through a validated semi-quantitative food frequency questionnaire. After excluding those with no complete information of diabetes status or those lost at the 10-year follow-up, data from 1485 participants were used for the current analysis.

RESULTS

After adjusting for several participants' characteristics, including overall dietary habits, it was observed that participants consuming at least 4 servings/day of vegetables had a 0.42-times lower risk of developing T2DM (hazard ratio [HR] = 0.42; 95% confidence interval [CI] = 0.29-0.61); the benefits of consumption were greater in women (HR = 0.29; 95% CI = 0.16-0.53) compared to men (HR = 0.56; 95% CI = 0.34-0.92). Only 33% of the sample consumed vegetables 4 servings/day. The most significant associations were observed for allium vegetables in women and for red/orange/yellow vegetables, as well as for legumes in men.

CONCLUSIONS

The intake of at least 4 servings/day of vegetables was associated with a considerably reduced risk of T2DM, independently of other dietary habits; underlying the need for further elaboration of current dietary recommendations at the population level.

Exploring grandparents' receptivity to and preferences for a grandchild nutrition-focused intervention: A qualitative study

OBJECTIVE

Interventions promoting healthy eating in children typically overlook the critical role of grandparent caregivers. Utilising a co-design approach, this study (i) assessed the receptiveness of grandparents to a nutrition-focused resource aimed at promoting healthy eating in their grandchildren and (ii) explored grandparents' preferences for resource delivery and dissemination.

METHODS

Seventy-nine grandparents (58% female; mean age=69.37 years) who were secondary carers to a grandchild aged 3-12 years participated in one of 10 focus groups. Focus group transcripts were imported into NVivo for coding and semantic thematic analysis.

RESULTS

The vast majority of focus groups (n=9) were receptive to receiving a nutrition-focused resource. Participants indicated that such a resource should contain strategies that help grandparents promote healthy eating in their grandchildren rather than outline what grandchildren should be fed. A range of delivery (pamphlets, seminars and fridge magnets) and dissemination (online, email) methods were suggested.

CONCLUSIONS

A nutrition resource that equips grandparents with the strategies they need to promote healthy eating in their grandchildren would likely be welcomed.

IMPLICATIONS FOR PUBLIC HEALTH

Results provide program developers with the preliminary information required to tailor childhood lifestyle interventions to the needs of grandparents, thus helping increase acceptability and uptake.

Interactions between Bitter Taste Receptor Gene Variants and Dietary Intake Are Associated with the Incidence of Type 2 Diabetes Mellitus in Middle-Aged and Older Korean Adults

The relationship between the variants of bitter taste receptor gene TAS2R4, dietary intake, and incidence of type 2 diabetes mellitus (T2DM) remains unclear. Hence, we aimed to examine the association of TAS2R4 rs2233998 variants with T2DM incidence in middle-aged and older Korean adults to understand if their association was modulated by dietary intake. Data of the Ansan-Ansung cohort from the Korean Genome and Epidemiology Study were used in this study. A total of 4552 Korean adults aged 40-69 years with no history of T2DM or cancer at baseline were followed-up for 16 years. Dietary intake was assessed using a 103-item food frequency questionnaire, and new T2DM cases were defined based on the World Health Organization and International Diabetes Federation criteria. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for T2DM incidence. During the mean follow-up period of 11.97 years, 1082 (23.77%) new T2DM cases were identified. Women carrying the TT genotype of TAS2R4 rs2233998 exhibited 1.48 times higher incidence of T2DM (HR: 1.48; 95 CI: 1.13-1.93) than those carrying the CC genotype. TAS2R4 rs2233998 variants were positively associated with the incidence of T2DM among Korean women with high intakes of carbohydrates or sugars and low intakes of fruits or vegetables. TT carrier women in the highest tertile of carbohydrate or sugar intake exhibited an increased incidence of T2DM (HR: 2.08, 95% CI: 1.33-3.27 for carbohydrates; HR: 2.31, 95% CI: 1.53-3.51 for sugars) than CC carrier women. Women carrying the TT genotype in the lowest tertile exhibited an increased incidence of T2DM (HR: 1.55, 95% CI: 1.02-2.37 for vegetables; HR: 1.62, 95% CI: 1.06-2.48 for fruits) than women carrying the CC genotype in the highest tertile of vegetable or fruit consumption. However, no association was observed between TAS2R4 rs2233998 variants and dietary intake with T2DM incidence in Korean men. Our findings suggest that variants of TAS2R4 rs2233998 are associated with T2DM incidence, and their associations are strengthened by excessive intake of carbohydrates or sugars and inadequate intake of fruits or vegetables. Diet encompassing optimal intake of carbohydrates or sugars and high intake of fruits or vegetables may minimize the risk of developing T2DM.

Effect of Lycopene Intake on the Fasting Blood Glucose Level: A Systematic Review with Meta-Analysis

Lycopene is a lipophilic unsaturated carotenoid exhibiting a strong singlet oxygen-quenching ability. Herein, we investigated the effect of lycopene intake on the fasting blood glucose (FBG) level by conducting a systematic review and meta-analyses. We searched 15 databases (from the earliest date to June 2022 for PubMed or to August or September 2018 for the other databases) and included human interventional studies that assessed the effects of oral lycopene intake on FBG levels of participants ≥ 18 years of age. Three authors independently selected applicable studies and then assessed the study quality. Data were pooled as standardized mean difference (SMD) and analyzed by the random-effects model. Heterogeneity was assessed by I² statistics. A meta-analysis including 11 trial arms (n = 750) revealed a tendency towards a significant decrease in FBG level with not-important heterogeneity [SMD = -0.15 (95% CI: -0.31, 0.00), p = 0.05, I² = 9%]. Subgroup meta-analysis including two studies (n = 152) in type 2 diabetes patients revealed significantly decreased FBG levels with not-important heterogeneity [SMD = -0.37 (95% CI: -0.69, -0.05), p = 0.02, I² = 0%]. Most studies meeting the eligibility criteria had a moderate risk of bias. The funnel plot for FBG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake exerted an FBG-decreasing effect.

Profiling of Redox-Active Lipophilic Constituents in Leaf Mustard (Brassica juncea (L.) Czern.) Cultivars Using LC-MS and GC-MS

Leaf mustard is an important commercial and culinary vegetable. However, only limited information is available on the content and composition of the nutritionally important lipophilic constituents in these leaves. This research presents information on the contents and composition of carotenoids, tocols, phytosterols, and fatty acids in four cultivars of leaf mustard. The carotenoids and tocols were analyzed utilizing liquid chromatography (LC)-mass spectrometry (MS) with single ion monitoring (SIM), while phytosterols and fatty acids were analyzed using gas chromatography (GC)-MS and GC-flame ionization detection (FID), respectively. The LC-MS results revealed the dominance of (all-E)-lutein, within the range of 37.12 (cv. Asia Curled)-43.54% (cv. Jeok) of the total carotenoids. The highest amount of all of the individual carotenoids and total carotenoids (143.85 µg/g fresh weight; FW) were recorded in cv. Cheong. Among the studied leaf samples, 67.16 (cv. Asia Curled)-83.42 µg/g FW (cv. Cheong) of α-tocopherol was recorded. Among the phytosterols, β-sitosterol was the most dominant one among the studied mustard leaves, accounting for 80.42 (cv. Jeok)-83.14% (cv. Red frill) of the total phytosterols. The fatty acid analysis revealed the presence of a significant amount of rare hexadecatrienoic acid (C16:3n3) in the studied mustard leaves, which accounted for 27.17 (cv. Asia Curled)-32.59% (cv. Red frill) of the total fatty acids. Overall, the cv. Cheong represented the highest contents of carotenoids, tocols, and phytosterols. Moreover, cv. Red frill contains the highest amount of n-3 PUFAs and antioxidant compounds. Thus, these cultivars can be promoted in cuisines which can be eaten to obtain the highest health benefits.

Profiling of Nutritionally Vital Bioactive Compounds in Emerging Green Leafy Vegetables: A Comparative Study

Green leafy vegetables (GLVs), especially lettuce and spinach, are the key source of bioactive antioxidants in a diet. This research compared the contents and composition of lettuce and spinach bioactive compounds with emerging GLVs, moringa and fenugreek. Liquid chromatography (LC)-mass spectrometry (MS) with single ion monitoring (SIM) was used to examine carotenoids and tocols, while phytosterols were examined using gas chromatography (GC)-MS. Among the studied GLVs, the (all-E)-lutein was the most dominating carotenoid ranging between 31.3 (green/red lettuce)−45.3 % (fenugreek) of total carotenoids, followed by (all-E)-violaxanthin and (all-E)-β-carotene. Surprisingly, (all-E)-β-carotene, a provitamin A carotenoid, was the second most dominating carotenoid in moringa, accounting for 109.2 µg/g fresh weight (FW). Moreover, the significantly highest (p < 0.05; Tukey HSD) contents of total carotenoids (473.3 µg/g FW), α-tocopherol (83.7 µg/g FW), and total phytosterols (206.4 µg/g FW) were recorded in moringa. Therefore, moringa foliage may serve as an affordable source of nutritionally vital constituents in a diet.

Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. The evidence connecting dietary intake and DR is emerging, but uncertain. We conducted a systematic review to comprehensively summarize the current understanding of the associations between dietary consumption, DR and diabetic macular edema (DME). We systematically searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials between January 1967 to May 2022 for all studies investigating the effect of diet on DR and DME. Of the 4962 articles initially identified, 54 relevant articles were retained. Our review found that higher intakes of fruits, vegetables, dietary fibers, fish, a Mediterranean diet, oleic acid, and tea were found to have a protective effect against DR. Conversely, high intakes of diet soda, caloric intake, rice, and choline were associated with a higher risk of DR. No association was seen between vitamin C, riboflavin, vitamin D, and milk and DR. Only one study in our review assessed dietary intake and DME and found a risk of high sodium intake for DME progression. Therefore, the general recommendation for nutritional counseling to manage diabetes may be beneficial to prevent DR risk, but prospective studies in diverse diabetic populations are needed to confirm our findings and expand clinical guidelines for DR management.

KIDMED 2.0, An update of the KIDMED questionnaire: Evaluation of the psychometric properties in youth

BACKGROUND AND AIMS

As children and adolescents' eating patterns have changed over the last few years, researchers have found inconsistencies in the current questionnaires. Therefore, this research aims to (i) update the 2019 KIDMED questionnaire; and (ii) test the psychometric properties of this new questionnaire.

METHOD

A study with 419 children and adolescents in southwestern Spain was conducted in 2021. The new version of the KIDMED 2.0 was tested, which measures adherence to the Mediterranean diet through 16 items, of which 12 are positive, and 4 are negative. Content validation involved consultation with nutritionists, experts, and adolescents to assess whether the questionnaire was reliable and valid regarding dietary patterns associated with the Mediterranean diet. The expert assessment provided content validity indices for the clarity and representativeness of the questionnaire. Construct validity and test-retest reliability involved 419 students (M age = 14.40 ± 2.00) from southwestern Spain. Students responded twice (one week apart) to the KIDMED developed in the previous stage and completed a 7-day dietary record.

RESULTS

Regarding validity, results show a moderate agreement for 10 items (ranging between 0.21 and 0.47) of the KIDMED and the 7-day dietary record. Concerning Items 3, 4, 5, and 6, the agreement was slight (ranging between 0.08 and 0.17), whereas the agreement for Item 8 was low. Cohen's kappa showed that most items had moderate to substantial test-retest reliability. Also, kappa showed significant test-retest values for all items (p < 0.001).

CONCLUSION

The new version of the KIDMED 2.0 was shown to be a reliable and valid instrument to measure adherence to the Mediterranean diet in children and adolescents.

Dietary fibre intake and risk of prediabetes in China: results from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study

High dietary fibre intake has been associated with a lower risk of diabetes, but the association of dietary fibre with prediabetes is only speculative, especially in China, where the supportive data from prospective studies are lacking. This study aimed to examine the association between dietary fibre intake and risk of incident prediabetes among Chinese adults. We performed a prospective analysis in 18 085 participants of the Tianjin Chronic Low-grade Systemic Inflammation and Health cohort study who were free of diabetes, prediabetes, cancer and CVD at baseline. Dietary data were collected using a validated 100-item FFQ. Prediabetes was defined based on the American Diabetes Association diagnostic criteria. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI. During 63 175 person-years of follow-up, 4139 cases of incident prediabetes occurred. The multivariable HR of prediabetes for the highest v. lowest quartiles were 0·85 (95 % CI 0·75, 0·98) (P for trend = 0·02) for total dietary fibre, 0·84 (95 % CI 0·74, 0·95) (P for trend < 0·01) for soluble fibre and 1·05 (95 % CI 0·93, 1·19) (P for trend = 0·38) for insoluble fibre. Fibre from fruits but not from cereals, beans and vegetables was inversely associated with prediabetes. Our results indicate that intakes of total dietary fibre, soluble fibre and fibre derived from fruit sources were associated with a lower risk of prediabetes.

The Relationship of Physical Activity and Dietary Quality and Diabetes Prevalence in US Adults: Findings from NHANES 2011-2018

This study aimed to examine the relationship of physical activity and/or dietary quality and diabetes prevalence in the general population and within specific age groups. It was a cross-sectional study using 2011−2018 National Health and Nutrition Examination Survey and the US Department of Agriculture’s Food Patterns Equivalents data (n = 15,674). Physical activity was measured by Global Physical Activity questionnaire; dietary quality was analyzed using the Healthy Eating Index 2015; diabetes prevalence was determined by reported diagnosis and glycohemoglobin or fasting glucose. Data were analyzed using multiple logistic regression adjusted for demographic variables and weight status. Results revealed that although no statistically significant or non-substantial relationships were observed between dietary quality or physical activity and diabetes prevalence, respondents who did not meet physical activity recommendations regardless of dietary quality had a higher odds of diabetes prevalence than those who met physical activity recommendations and had a higher dietary quality (p < 0.05). In conclusion, meeting physical activity recommendations is an important protective factor for diabetes especially in combination with a higher quality diet. A healthy lifestyle appears to have the greater impact on diabetes prevention in middle-aged men and women.

Diet Quality and Biological Risk in a National Sample of Older Americans

Objectives: Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. Methods: We analyzed nationally representative data from 3734 older adults who participated in the Health and Retirement Study Venous Blood Study in 2016 and Health Care and Nutrition Survey in 2013. Results: Eleven out of 13 individual dietary components were associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. Discussion: Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, and fatty acids, while limiting consumption of sodium, added sugar, and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.

Dietary antioxidant consumption and the risk of type 2 diabetes in South Korean adults: a prospective cohort study based on the Health Examinees study

OBJECTIVES

Antioxidants are common dietary compounds with multiple health benefits. This study aimed to identify the association between dietary antioxidant consumption and the incidence of type 2 diabetes (T2D) mellitus (defined using the Korean Diabetes Association criteria) in South Korean adults.

DESIGN

Baseline and follow-up data from the Health Examinees (HEXA) study, a large-scale community-based genomic cohort study conducted in South Korea SETTING: A South Korean community.

PARTICIPANTS

A total of 20 594 participants, aged 40-79 years, who participated in the baseline and follow-up surveys of the HEXA study were included. After an average of 5 years of follow-up, there were 332 men and 360 women with T2D.

RESULTS

Participants with the highest total flavonoid consumption (Q5) had a lower risk of T2D (men: HR 0.63; 95% CI 0.42 to 0.93; p value for trend=0.0169; and women: HR 0.54; 95% CI 0.438 to 0.78; p value for trend=0.0001) than those with the lowest consumption (Q1). Dietary total antioxidant capacity was significantly inversely associated with the development of T2D mellitus in women participants alone (HR 0.58; 95% CI 0.40 to 0.83; p value for trend=0.0004). Stratified analyses according to age and body mass index (BMI) showed that dietary total flavonoid consumption and total antioxidant capacity had a negative association with the development of T2D in women aged >52 years and women with BMI >25 kg/m².

CONCLUSIONS

Dietary flavonoid consumption and total antioxidant capacity were associated with a lower risk of T2D in South Korean adults, especially in women aged >52 years and overweight. The findings of this study may provide reference data for the modification of dietary guidelines for South Koreans.