Dietary quality in a sample of adults with type 2 diabetes mellitus in Ireland; a cross-sectional case control study

Dietary amino acid patterns and cardiometabolic risk factors among subjects with obesity; a cross-sectional study

BACKGROUND

The prevalence of obesity is a growing global public health concern. Certain dietary amino acids have been shown to have a potential therapeutic role in improving metabolic syndrome parameters and body composition in individuals with obesity. However, some amino acids have been linked to an increased risk of cardiometabolic disorders. This cross-sectional study aims to investigate the association between dietary amino acid patterns and cardiometabolic risk factors in individuals with obesity.

METHODS

This cross-sectional study included 335 participants with obesity (57.9% males and 41.5% females) from Tabriz and Tehran, Iran. The participants were between the ages of 20-50, with a body mass index (BMI) of 30 kg/m2 or higher, and free from certain medical conditions. The study examined participants' general characteristics, conducted anthropometric assessments, dietary assessments, and biochemical assessments. The study also used principal component analysis to identify amino acid intake patterns and determined the association between these patterns and cardiometabolic risk factors in individuals with obesity.

RESULTS

Upon adjusting for potential confounders, the study found that individuals in the third tertiles of pattern 1 and 2 were more likely to have lower LDL levels (OR = 0.99 and 95% CI (0.98-0.99)) for both. Additionally, a significant decrease in total cholesterol was observed in the third tertiles of pattern 2 in model II (OR = 0.99, 95% CI (0.98-0.99)). These findings suggest a potential cardioprotective effect of these amino acid patterns in managing cardiometabolic risk factors in individuals with obesity.

CONCLUSIONS

This study found that two identified amino acid patterns were associated with lower serum LDL and total cholesterol levels, while a third pattern was associated with higher serum triglycerides. The specific amino acids contributing to these patterns highlight the importance of targeted dietary interventions in managing cardiometabolic risk factors in individuals with obesity.

A Mediterranean-Style Diet Improves the Parameters for the Management and Prevention of Type 2 Diabetes Mellitus

Background and Objectives: Type 2 diabetes mellitus (T2DM) is a chronic condition recognized as the inability to maintain glucose homeostasis, typically presenting with insulin resistance and systemic inflammation. With the prevalence of T2DM and major risk factors, such as prediabetes and obesity, increasing each year, the need to address risk factor reduction strategies is crucial. Materials and Methods: Twenty-two men and women, overweight-to-obese adults (BMI mean: 26.1-31.6) (age range mean: 44.6-51.8) with T2DM, indicators of prediabetes, or who were metabolically healthy, participated in Cal Poly's Nutrition and Exercise in Type 2 Diabetes (CPNET) study. There were no significant differences in terms of age, BMI, or sex distribution among the groups at the baseline. This study's protocol included following a Mediterranean-style diet, the daily consumption of a high-quality whey protein supplement, and physical activity recommendations for 16 weeks. Body composition data, via dual-energy X-ray absorptiometry (DXA), and fasting blood samples were collected at the baseline and following the intervention. Due to restrictions associated with the outbreak of the COVID-19 pandemic, only 13 of the 22 participants who started this study were able to return for the second data collection to complete this study following the 16-week intervention. Results: The prediabetic and T2DM groups exhibited reductions in their fasting plasma glucose (12.0 mg/dL reduction in the prediabetic group; 19.6 mg/dL reduction in the T2DM group) to that of normal and prediabetic levels, respectively, while the T2DM group also demonstrated improvement in their hemoglobin A1c (reduced from 6.8% to 6.0%) to prediabetic levels. Additionally, the metabolically healthy, overweight group exhibited significant improvements in adiposity, while the obese prediabetic and T2DM groups showed non-significant improvements in all the measured metrics of body composition. No significant changes were observed in the inflammatory biomarkers (p-values ranged from 0.395 to 0.877). Conclusions: Collectively, our results suggest that adherence to a well-balanced, nutritious diet and activity may improve the parameters of glycemic control and provide benefits to body composition that help to manage and prevent the development of T2DM. Our study was able to yield significant findings signifying that the effects of a Mediterranean-style diet are observed even for a more conservative sample size.

Investigation of the association between habitual dietary FODMAP intake, metabolic parameters, glycemic status, and anthropometric features among apparently healthy overweight and obese individuals

BACKGROUND

The predisposition of humans to metabolic syndrome is affected by many factors, including diet and lifestyle. Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are a set of carbohydrates that are fermented by gut microbiota. In animal studies, supplementation with FODMAP-rich diets as prebiotics can alter body composition and gut microbiota. This study evaluates any relationship between FODMAP and metabolic syndrome risk factors among adults with metabolic syndrome in Iran.

METHODS

This cross-sectional study is based on sociodemographic information from 347 overweight and obese participants selected from outpatient clinics through public declaration. Participants body composition and anthropometric measures were also determined. A validated Food Frequency Questionnaire (FFQ) with 168 questions was used to collect dietary data. Biochemical parameters, including serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), and insulin levels, were determined by enzymatic methods. In addition, the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated.

RESULTS

In moderate FODMAP and low FODMAP groups, lower waist-to-hip ratio (WHR) and higher fat-free mass (FFM) were achieved in higher tertiles. In high FODMAP groups, higher systolic blood pressure (SBP) was shown in the higher tertile (P < 0.05). Higher insulin, HOMA-IR, and lower QUICKI in the second tertile of the high FODMAP group were also observed.

CONCLUSION

Findings of this study highlight the potential role of FODMAP in managing metabolic syndrome and open a new field of research.

Dietary insulin index and load and cardiometabolic risk factors among people with obesity: a cross-sectional study

BACKGROUND

The hypothesis of the effect of the insulinogenic effects of diet on the development of cardiometabolic disorders has been suggested, but limited data are available for adults with obesity. This study aimed to determine the association of dietary insulin index (DII) and dietary insulin load (DIL) with cardiometabolic risk factors among Iranian adults with obesity.

METHODS

The study was conducted with a total of 347 adults aged 20-50 years in Tabriz, Iran. Usual dietary intake was assessed through a validated 147-item food frequency questionnaire (FFQ). DIL was computed using published food insulin index (FII) data. DII was calculated by dividing DIL by the total energy intake of each participant. Multinational logistic regression analysis was performed to evaluate the association between DII and DIL and cardiometabolic risk factors.

RESULTS

Mean age of participants was 40.78 ± 9.23 y, and mean body mass index (BMI) was 32.62 ± 4.80 kg/m2. Mean of DII and DIL was 73.15 ± 37.60 and 196,242 ± 100,181. Participants with higher DII had higher BMI, weight, waist circumference (WC), and blood concentrations of triglyceride (TG) and Homeostasis model assessment insulin resistance index (HOMA-IR) (P < 0.05). After taking potential confounders into account, DIL was positively associated with MetS (OR: 2.58; 95% CI: 1.03-6.46), and high blood pressure (OR: 1.61; 95% CI: 1.13-6.56). Moreover, after adjustment for potential confounders, moderate DII was associated with increased odds of MetS (OR: 1.54, 95% CI: 1.36-4.21), high TG (OR, 1.25; 95% CI, 1.17-5.02), and high blood pressure (OR: 1.88; 95% CI: 1.06-7.86).

CONCLUSION

This population-based study revealed that adults with higher DII and DIL associated with cardiometabolic risk factors and consequently, replacement of high with low DII and DIL may have reduce the risk of cardiometabolic disorders. Further studies with longitudinal design are required to confirm these findings.

Association between plant-based diets and metabolic syndrome in obese adults from Iran: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is a common chronic disease with several complications. Given that, studies on the association of plant-based diet indices (PDIs) with risk of MetS among adults with obesity, are limited, we aimed to examine the association between PDIs (including overall PDI, healthy PDI (hPDI), unhealthy PDI (uPDI)) and MetS in Iranian adults with obesity.

METHODS

In Tabriz, Iran, a total of 347 adults between the ages of 20 and 50 participated in this cross-sectional research study. We created an overall PDI, hPDI, and uPDI from validated semi-quantitative food-frequency questionnaire (FFQ) data. To investigate the association between hPDI, overall PDI, uPDI, and MetS and its components, a binary logistic regression analysis was performed.

RESULTS

The average age was 40.78 ± 9.23 years, and the average body mass index was 32.62 ± 4.80 kg/m². There was no significant association between overall PDI (OR: 0.87; 95% CI: 0.54-1.47), hPDI (OR: 0.82; 95% CI: 0.48-1.40), and uPDI (OR: 0.83; 95% CI: 0.87-2.46) with MetS, even after adjustment for confounders. Moreover, our findings showed that participants with the highest adherence to uPDI had a higher chance of hyperglycemia (OR: 2.50; 95% CI: 1.13-5.52). Also, this association was significant in the first (OR: 2.51; 95% CI: 1.04-6.04) and second (OR: 2.58; 95% CI: 1.05-6.33) models, after controlling for covariates. However, in both adjusted and crude models, we did not find a significant association between hPDI and PDI scores and MetS components such as high triglyceride, high waist circumference, low High-density lipoprotein cholesterol, raised blood pressure, and hyperglycemia. Moreover, those in the top tertile of uPDI had higher fasting blood sugar and insulin levels when compared with those in the first tertile, and subjects in the last tertile of hPDI compared with participants in the first tertile had lower weight, waist-to-hip ratio, and fat-free mass.

CONCLUSION

We found a direct significant association between uPDI and odds of hyperglycemia in the whole population of study. Future large-scale, prospective studies on PDIs and the MetS are necessary to confirm these findings.

The association between healthy lifestyle score and risk of metabolic syndrome in Iranian adults: a cross-sectional study

BACKGROUND

Lifestyle risk factors, such as obesity, physical inactivity, smoking, and having an unhealthy diet are significantly associated to the risk of developing metabolic diseases such as type 2 diabetes, insulin resistance, and metabolic syndrome (MetS). Consequently, it is important to examine multiple lifestyle risk factors instead of single ones. Moreover, the combined effects of these factors on risk of MetS are not fully investigated. This study investigated the relationship between HLS and MetS and its components among apparently healthy adults living in Tabriz-Iran.

METHODS

This cross-sectional study includes 347 apparently healthy adults aged 20-50. To assess healthy lifestyle, four habits were used to examine HLS: physical activity (PA), smoking, healthy eating index-2015 (HEI-2015), and body mass index (BMI). Smoking status, PA, and dietary intakes (147-item) of study participants were evaluated using valid questionnaires. The lifestyle score ranged from zero (non-healthy) to four (most healthy) points. Binary logistic regression with adjusted models was used to examine the association of HLS and MetS, and its components. P < 0.05 was considered statistically significant.

RESULTS

In the current study, the average age and BMI of study participants were 40.78 ± 9.23 years old and 29.23 ± 5.97 kg/m², respectively. Participants in the highest quartile of HLS had significantly lower waist circumference (WC), BMI, weight, and had less fasting blood sugar (FBS), and triglyceride (TG) compared to the lowest quartile of HLS. Individuals in the second quartile of HLS had 24% greater odds for having MetS compared with those in the first quartile (adjusted OR: 1.24; 95% CI: 1.05-2.66). A significant reduction in hyperglycemia (adjusted OR: 0.85, 95% CI: 0.55-0.96) and high TG (adjusted OR: 0.83; 95% CI: 0.55-0.93) risk was also observed in the highest category of HLS compared to the lowest category. Moreover, after taking potential confounders into account, low score of HLS was associated with increased odds of MetS in women (adjusted OR: 1.32; 95% CI: 1.03-2.91).

CONCLUSION

The results showed that the lowest adherence to HLS was associated with higher odds MetS in women, after adjusting for all covariates. Moreover, adherence to a healthy lifestyle was related to lower odds of hyperglycemia and high TG in Iranian adults. To confirm these results, prospective studies are required.

Macronutrient intake: Hormonal controls, pathological states, and methodological considerations

A plethora of studies to date has examined the roles of feeding-related peptides in the control of food intake. However, the influence of these peptides on the intake of particular macronutrient constituents of food - carbohydrate, fat, and protein - has not been as extensively addressed in the literature. Here, the roles of several feeding-related peptides in controlling macronutrient intake are reviewed. Next, the relationship between macronutrient intake and diseases including diabetes mellitus, obesity, and eating disorders are examined. Finally, some key considerations in macronutrient intake research are discussed. We hope that this review will shed light onto this underappreciated topic in ingestive behavior research and will help to guide further scientific investigation in this area.

Interplay between fatty acid desaturase2 (FADS2) rs174583 genetic variant and dietary antioxidant capacity: cardio-metabolic risk factors in obese individuals

OBJECTIVE

Polymorphisms of the fatty acid desaturase (FADS) gene cluster have been associated with obesity and its-related consequences. This cross-sectional study aimed to investigate whether the adherence to dietary non-enzymatic antioxidant capacity (NEAC), reflecting the antioxidant potential of the whole diet, modifies the association of FADS2 rs174583 polymorphism with cardio-metabolic risk factors in obese adults.

METHODS

The present study included 347 healthy obese adults (aged 20-50 years). Dietary NEAC was assessed by a validated food frequency questionnaire with 147 items and estimated through total radical-trapping antioxidant parameters (TRAP), oxygen radical absorbance capacity (ORAC), and ferric reducing ability of plasma (FRAP) with the use of published databases. FADS2 rs174583 polymorphism was characterized using PCR-RFLP. ANCOVA multivariate interaction model was used to analyze gene-diet interactions.

RESULTS

after adjustment for the confounding variables (age, physical activity, SES and WC), this study showed significant interactions between rs174583 polymorphism and adherence to dietary ORAC on the serum cholesterol (P _Interaction = 0.029), LDL-C (P _Interaction = 0.025) and HDL-C levels (P _Interaction = 0.049) among the male group; minor allele carriers who had the highest adherence to the NEAC (ORAC) showed a better metabolic profile (lower TG and LDL-C and higher HDL-C) (P < 0.05). Among women, the dietary ORAC-rs174583 interactions were statistically significant for the serum insulin concentration (P _Interaction = 0.020), QUICKI (P _Interaction = 0.023) and HOMA-IR (P _Interaction = 0.017); the highest QUICKI and the lowest HOMA-IR and serum insulin levels were observed in the CC homozygote carriers with the moderate compliance with the dietary ORAC (P < 0.05). In addition, the dietary TRAP modified the association between FADS2 variant and change in LDL-C levels (P _Interaction = 0.037); the homozygous wild-type (CC) women who placed in the top tertile of TRAP had significantly the lowest LDL-C levels than those in the second tertile (P < 0.05).

CONCLUSION

These data indicate that the FADS2 rs174583 polymorphism interacts with the dietary NEAC to influence cardio-metabolic risk factors in obese subjects. Replication in prospective cohort studies among other populations is required to confirm the results of our study.

The Interaction Between Fatty Acid Desaturase-2 (FADS2) rs174583 Genetic Variant and Dietary Quality Indices (DASH and MDS) Constructs Different Metabolic Phenotypes Among Obese Individuals

Background and Aim: Genetic variation in fatty acid desaturases (FADS) has previously been linked to several diet-related diseases. We aimed to determine whether the FADS2 rs174583 variant interacts with the Dietary Approach to Stop Hypertension (DASH) score and Mediterranean dietary score (MDS) to influence cardio-metabolic risk factors among obese adults. Methods: This cross-sectional study was performed among 347 apparently healthy obese adults (aged 20-50 years). Dietary quality indicator scores (DASH and MDS) were generated using a validated 147-item Food Frequency Questionnaire (FFQ). The FADS2 rs174583 variant was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The gene-diet interaction was analyzed by the ANCOVA multivariate interaction model. Results: A significant interaction was observed between rs174583 and adherence to the DASH score in relation to serum triglyceride (TG) concentration among the female group (P Interaction = 0.046); CT-genotype carriers who were assigned to the second tertile of DASH compared with those in the first tertile had a lower TG level (P < 0.05). Another significant interaction was revealed between adherence to MDS score and rs174583 polymorphism on serum glucose levels (P Interaction = 0.044); the lowest mean of glucose level was observed in homozygous minor subjects (TT) in the third tertile of MDS, in comparison with other tertiles of this dietary index (P < 0.05). There was a similar significant interaction between DASH and rs174583 in relation to diastolic blood pressure (P Interaction = 0.038) among the male group. Additionally, a significant positive association was found between TT genotype and odds of having high TG both in the crude (OR, 3.21; 95% CI, 1.02-10.14) and adjusted (OR, 3.58; 95% CI, 1.07-11.97) models, taking into account different confounders. Conclusion: Adherence to the dietary quality indicators (DASH and MDS) modified the relationship between FADS2 rs174583 polymorphism and cardio-metabolic risk factors in obese subjects. Prospective cohort studies are needed to confirm the results of our study.

Dietary Association with Glycemic Status Among Adults Clinically Diagnosed with Type 2 Diabetes in Malawi

We elucidated diet and its association with glycemic status among adults clinically diagnosed with type 2 diabetes mellitus (T2DM) through across-sectional study in Malawi. Glycosylated hemoglobin (A1C) and dietary intakes were assessed. Consumption of cereals, roots, and tubers and sweet, sugary food, including sweetened beverages, was significantly higher among participants with A1C≥8%. Fruit and vegetable intake were disproportionately low overall. Consuming adiet high in carbohydrates (OR: 1.167; CI = 1.107-1.231; p < .001) and having <3 meals/day (OR: 2.680; CI = 1.445-4.970; p = .002) were both associated with A1C≥8%. Therefore, dietary interventions for T2DM focusing on carbohydrate counting, total dietary quality, and meal planning are needed in Malawi.

Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet

The aim of this study was to assess the dietary pattern (i.e., Mediterranean Diet (MedDiet) and healthy eating) in people with type 2 diabetes (T2D) compared with those without diabetes. In addition, we explored clinical factors associated with the dietary pattern. This cross-sectional study was performed with a sample of 476 participants (238 with T2D and 238 participants without diabetes, matched for age and sex). The alternate Mediterranean Diet (aMED) score and the alternate Healthy Eating Index (aHEI) were calculated. Statistical analysis included comparison between groups and multivariable models. Participants with T2D showed higher aMED and aHEI scores (mean (SD): 4.3 (1.5) and 43.9 (6.5), respectively) in comparison with the control group (3.5 (1.8) and 39.4 (7.4), respectively; p < 0.001). In addition, a higher proportion of participants with T2D in higher tertiles of aMED (21.8%) and aHEI (39.9%) was observed compared with participants without diabetes (11.3% for the aMED, and 19.3% for the aHEI; p < 0.001). The adjusted multivariable analysis revealed that T2D (p < 0.001), increasing age (p = 0.006 and p = 0.030, respectively), and physical activity (p = 0.009) were positively associated with higher aMED and aHEI scores. Dyslipidemia and female gender were positively associated with aMED and aHEI (p = 0.031 and p < 0.001, respectively). The specific multivariable analysis for the group with T2D yielded a positive association of age (p < 0.001) and dyslipidemia (p = 0.021) with aMED. Regarding the aHEI, only female gender was positively related with this score in diabetes participants (p = 0.025). Participants with T2D showed a higher adherence to the MedDiet and a healthier eating pattern.

Diabetes-related nutrition knowledge and dietary adherence in patients with Type 2 diabetes mellitus: A mixed-methods exploratory study

Aim:

The aim of the study is to gain insights into the relationship between diabetes-related nutrition knowledge (DRNK) and diet quality in Singapore.

Methods:

Forty-two participants were recruited from a tertiary hospital. DRNK and diet quality were ascertained with the DRNK questionnaire and Alternate Healthy Eating Index 2010, respectively. Twenty-one semi-structured interviews of perceived barriers and enablers to adherence to dietary guidelines were audio recorded, transcribed and analysed.

Results:

Participants had a poor mean percentage DRNK score of 39.7% (±17.7) and diet quality of 54.2% (±9.4). Pearson’s correlation tests revealed no correlation between DRNK and diet quality ( r –0.29; p=0.065) but suggest a moderate positive correlation between DRNK and psychosocial self-efficacy ( r 0.41; p=0.008). Thematic analysis revealed six barriers (obesogenic environment; lack of time; conflict between advice and personal values; stress from external sources; lack of personal motivation; gaps in DRNK) and four enablers (personal motivation to improve condition; fear of T2DM complications; sufficient DRNK; presence of social support) to adherence to dietary guidelines.

Conclusion:

DRNK may not correlate with adherence to dietary guidelines; multiple mediating factors are identified when translating DRNK to practice.

Dietary Micronutrient Intake of Participants in a "Partners Together in Health" Cardiac Rehabilitation Intervention

PURPOSE

Current guidelines for cardiovascular health emphasize a "dietary pattern" approach that could be expected to increase intakes of micronutrients in addition to altering the macronutrient profile. However, the effect of interventions such as cardiac rehabilitation on the micronutrient quality of the diet has not been evaluated. Therefore, the goal of this study was to investigate changes in micronutrient intake of cardiac rehabilitation participants over time.

METHODS

This was a secondary analysis of data from a randomized clinical trial that assessed the effects of the Partners Together in Health intervention on physical activity and healthy eating behaviors. The intake of 9 micronutrients important in cardiovascular health was assessed using 3-d food records. A micronutrient adequacy score was evaluated at 3 time points (baseline, 3 and 6 mo). Changes over time in micronutrient intake were assessed using a general linear model.

RESULTS

Sixty-eight participants who were enrolled in the Partners Together in Health interventional trial completed the study. There was no significant difference in the mean micronutrient score at any time point. Intake of individual micronutrients did not improve over the 6-mo time frame with the exception of vitamin E, (8.7 mg vs 6.5 mg for at 6 vs 3 mo, P = .02). The proportion of participants with intakes meeting the Dietary Recommended Intake for each nutrient also remained the same over time.

CONCLUSION

Although cardiac rehabilitation programs may be effective in altering the macronutrient composition, improvements to overall diet quality may be tempered by a lack of improvement in intake of micronutrients.

Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study)

The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes (T2DM). Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD, diet quality and biomedical parameters. The EMID study is a randomized and controlled clinical trial with two parallel groups and a 12-month follow-up period. The study included 204 subjects between 25–70 years with T2DM. The participants were randomized into intervention group (IG) and control group (CG). Both groups received brief advice about healthy eating and physical activity. The IG participants additionally took part in a food workshop, five walks and received a smartphone application for three months. The population studied had a mean age of 60.6 years. At the 3-month follow-up visit, there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points, compared to the baseline visit, respectively, in favour of the IG. This tendency of the improvement was maintained, in favour of the IG, at the 12-month follow-up visit. In conclusion, the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM.

Dietary quality of predominantly traditional diets is associated with blood glucose profiles, but not with total fecal Bifidobacterium in Indonesian women

Background

A high quality modern diet is associated with reduced risk of metabolic disease and diabetes. However, it remains unclear whether the quality of predominantly traditional ethnic diets is associated with such conditions. Moreover, the relationship between dietary quality and microbiota, a potential mediator of metabolic disease, has not been studied.

Objective

We investigated the relationship of dietary quality of traditional ethnic diets in Indonesia with fasting blood glucose (FBG), HbA1c, and the number of fecal Bifidobacterium.

Design

A cross-sectional study was conducted in selected districts with predominantly animal- or plant-based traditional diets of West Sumatera and West Java provinces, respectively. A total of 240 apparently healthy women aged 19–50 years were randomly selected from 360 women screened by a cluster sampling design. Dietary quality was assessed by 2-day repeated 24-hour food recall, and scored using the Healthy Eating Index (HEI) 2010. FBG was quantified with the enzymatic colorimetric method, and HbA1c by using hexokinase and high-performance liquid chromatography, and total fecal Bifidobacterium by real-time quantitative polymerase chain reaction.

Results

The HEI scores of 99% of women were <51, indicating a low-quality diet. In adjusted multivariate regression, HEI was inversely associated with FBG (ß = -0.403; 95% CI = -0.789 to -0.016; p = 0.041) and HbA1c (ß = -0.018; 95% CI = -0.036 to 0.000; p = 0.048) but was not significantly associated with total levels of Bifidobacterium (ß = -0.007, p = 0.275). Bifidobacterium count was not significantly associated with either FBG or HbA1c levels.

Conclusion

Low dietary quality is clearly associated with risk of increased markers of blood glucose. However, any mediating role of Bifidobacterium between dietary quality and glucose outcomes was not apparent. Innovative interventions for healthy eating should be implemented to increase dietary quality of populations transitioning from predominantly traditional to modern diets, to reduce the risk of diabetes, especially in women.

Dietary intake by food group of individuals with type 2 diabetes mellitus: A systematic review

AIMS

To synthesize peer-reviewed literature that investigates the dietary intake by food group of individuals with type 2 diabetes mellitus (T2DM) and compare intakes to national and international dietary guidelines.

METHODS

Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Sciences) were searched for studies that investigated the dietary intake of adults (≥18 years) with T2DM using the five main food groups (fruit, vegetables, dairy, grains and meat/meat alternatives). Food group intake in serves was compared against national guidelines and fruit and vegetable intake in grams was compared against the World Health Organization (WHO) guidelines.

RESULTS

After screening 13,662 publications, 11 studies were included. All reported cross-sectional data. Majority of participants were consuming less than the recommended serves of fruit, vegetables, grains and dairy and were meeting or exceeding the recommended serves for meat/meat alternatives. Two of six studies reported fruit and vegetable recommendations were being met, two reported dairy recommendations were being met and two reported grain recommendations were being met. Of the five studies reporting intake in grams, four met the WHO minimum intake for fruit and vegetables.

CONCLUSIONS

Individuals with T2DM do not comply with food group recommendations; particularly for fruit, vegetables, dairy and grains. Longitudinal research is required to better understand how food group intake changes over time after diagnosis.

Diet quality and therapeutic targets in patients with type 2 diabetes: evaluation of concordance between dietary indexes

Background

This study aimed to evaluate the concordance between two dietary indexes, the Healthy Eating Index (HEI) and the Diabetes Healthy Eating Index (DHEI), in evaluating diet quality and its possible association with therapeutic targets in patients with type 2 diabetes.

Methods

Cross-sectional study of outpatients with type 2 diabetes mellitus treated at a university hospital. Dietary information was obtained from a quantitative food frequency questionnaire (previously validated for use in patients with type 2 diabetes) and converted into daily intakes. Diet quality was assessed using two dietary indexes: HEI (12 components, nine food groups and three moderation components) and DHEI (10 components, six food groups, three nutrient groups, and one for variety of diet). In both indexes, the sum of the scores for each component yields an overall score converted on a scale from 0 to 100%; diet quality is subsequently ranked as low (<51%), needing improvement (51–80%), or high (>80%). Patients underwent clinical and laboratory assessment. Those with fasting blood glucose values 70–130 mg/dL, A1c < 7%, total cholesterol <200 mg/dL, LDL-cholesterol <100 mg/dL, and triglycerides <150 mg/dL were considered to meet therapeutic targets. All analyses were conducted in PASW Statistics 18.0, and p < 0.05 deemed significant.

Results

We analyzed 148 patients with type 2 diabetes (73% white, mean age 63.2 ± 9.4 years, median diabetes duration 10 [IQR 5–19] years, mean A1c% 8.4 ± 2.0%, and mean BMI 30.5 ± 4.2 kg/m²). Mean energy intake was 2114 ± 649 kcal/day. DHEI scores were 17.0 (95%CI -6.8 to 41.0) points lower than HEI scores (55.9 ± 14.2% vs. 72.9 ± 10.7%, respectively; P < 0.001), suggesting there is no agreement (Bland-Altman method), and the Pearson correlation coefficient was 0.55 (P < 0.001). More patients were classified as having a low-quality diet by the DHEI than by the HEI (38.5% vs. 1.4%; P < 0.001). A higher proportion of patients (35.7%) with out-of-target total cholesterol levels had a low-quality diet evaluated by the DHEI (P = 0.03). We did not find associations between overall score of HEI and therapeutic targets.

Conclusions

In its intended population of patients with type 2 diabetes, the DHEI seems to be a more rigorous tool to evaluate association between diet quality and changes in metabolic parameters.

Electronic supplementary material

The online version of this article (10.1186/s12937-017-0296-8) contains supplementary material, which is available to authorized users.

Risk factors for type 2 diabetes mellitus among out-patients in Ho, the Volta regional capital of Ghana: a case-control study

Background

The prevalence of type 2 diabetes mellitus in developing countries like Ghana continues to rise. This study seeks to assess the risk factors of type 2 diabetes mellitus in a Ghanaian setting. An unmatched case–control study among patients receiving care at the out-patient departments of the two major hospitals in the Ho Municipality. Patients diagnosed with type 2 diabetes mellitus were recruited. Appropriate controls with similar ages who were also patients receiving care at the out-patient department of these hospitals were recruited. Both cases and controls were administered a questionnaire that comprises of standardized and validated tools. These tools include WHO STEPs instrument, general practice physical activity questionnaire and rapid eating and activity assessment for patients. Additionally, the research participants were made to undergo physical examinations for weight, height, waist circumference and laboratory testing of fasting venous blood to assess the biochemical factors of interest namely fasting blood glucose and fasting lipids. Analysis of data was done using STATA version 11.

Results

A total of 136 (48 cases and 88 controls) participants of which 95 [39 (81.25%) cases and 56 (63.64%) controls] respondents underwent laboratory testing for fasting blood glucose and fasting blood lipid (total cholesterol, HDL cholesterol and triglycerides). Participants were aged between 35 and 62 years. This study reveals a number of risk factors for type 2 diabetes mellitus. Individuals in the middle socio-economic class have a greater risk of developing type 2 diabetes mellitus with an OR of 5.03 (p < 0.003; 95% CI 1.71–14.74). Eating large quantities/servings of fruits per seating provides protection against development of type 2 diabetes mellitus. A low physical activity level is a valid determinant of type 2 diabetes mellitus irrespective of body mass index, socio-economic level or place of residence.

Conclusions

Individuals within the middle socio-economic level, who are physically inactive and do not consume large amounts of fruit are at greatest risk of developing type 2 diabetes mellitus. Living in a rural setting is attendant with high levels of physical activity this tends to protect rural residents from type 2 diabetes mellitus. Physical activity level confounds the relationship between place of residence and development of type 2 diabetes mellitus. Local policies should be realigned to attract individual of the middle socio-economic level to live in rural areas where they are more likely to be both physically active and consume more fruits thus averting the risks of developing T2DM.

Relative validity of a 2-day 24-hour dietary recall compared with a 2-day weighed dietary record among adults in South China

AIM

To determine the relative validity of a 2-day 24-hour dietary recall (HR) designed to assess energy and nutrient intake among Chinese adults compared with a 2-day weighed dietary record (WD).

METHODS

Data were obtained from an ongoing population-based, prospective cohort study of adults aged 18-65 years in South China. A total of 41 adults completing a HR and a WD within 14 days were included in the present analysis. Estimations of individual mean differences, Spearman's correlation coefficients, cross-classifications and Bland-Altman plots were used to assess the agreement between the intakes of energy and 18 nutrients obtained from the HR and the WD.

RESULTS

With the exception of total fat, saturated fatty acids, thiamine, potassium and magnesium, the energy and nutrient intakes between the HR and WD showed no significant differences. All dietary intakes that were evaluated by the HR were correlated significantly with the dietary intake from the WD (de-attenuated correlation coefficients ranged from 0.10 to 0.87). The proportion of participants classified into quartiles correctly ranged from 61% for tocopherol intake to 90% for energy intake. The weighted k values ranking the participants ranged from 0.11 for tocopherol intake to 0.41 for the intakes of energy and calcium. The Bland-Altman plots showed moderate/good agreement among all the dietary intakes that were estimated from the HR and WD, except for total fat.

CONCLUSIONS

This study suggests that an HR could be a valid tool for estimating the energy and nutrient intakes among adults in South China at the group level.

Relationship between dietary patterns and risk factors for cardiovascular disease in patients with type 2 diabetes mellitus: a cross-sectional study

Background

While some dietary patterns are associated with the incidence of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), the relationship between dietary pattern and risk factors for CVD in patients with T2DM remains to be clarified. The aim of this study was to identify dietary patterns and investigate the relationship between dietary patterns and potential risk factors for CVD in patients with T2DM.

Methods

The study participants comprised 726 Japanese T2DM outpatients free of history of CVD. Life styles were analyzed using self-reported questionnaires. The relationship between dietary patterns, identified by factor analysis, and potential risk factors for CVD was investigated by linear and logistic regression analyses.

Results

Six dietary patterns were identified by factor analysis. Especially, three dietary patterns were associated with risk factors for CVD. The “Seaweeds, Vegetables, Soy products and Mushrooms” pattern, characterized by high consumption of seaweeds, soy products and mushrooms, was associated with lower use of diabetes medication and healthier lifestyles. The “Noodle and Soup” pattern, characterized by high consumption of noodle and soup was associated with higher body mass index, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase and triglyceride levels. The “Fruit, Dairy products and Sweets” pattern was associated with lower γ-glutamyl transpeptidase levels, blood pressure, albuminuria and brachial-ankle pulse wave velocity.

Conclusions

The findings suggested that dietary patterns correlated with risk factors for CVD in T2DM patients.

Salt Restriction in Diabetes

There are no long-term interventions examining the effects of salt reduction in people with diabetes, and these are urgently required. Sodium reduction is controversial as it appears that an intake below 2.5 g and above 6 g/day of salt is associated with increased cardiovascular disease risk. However, pre-existing illness leading to a lower salt intake may confound the findings. Only a few studies have prospectively collected data on the sodium intake and excretion of people with diabetes and examined hard end points. In addition, future studies need to collect more data on food intake as well as coexistent illnesses to address potential confounding. The World Health Organization recommends a reduction to less than 5 g/day salt in adults. Given that the available evidence suggests that the salt intake of people with type 2 diabetes is generally well above 6 g/day it seems reasonable to ensure individuals with diabetes have an intake below 6 g/day. However, such recommendations need to be individualized.

Relationship between dietary pattern and cognitive function in elderly patients with type 2 diabetes mellitus

OBJECTIVE

To analyse the relationships between dietary patterns and cognitive function in elderly patients with type 2 diabetes mellitus (T2DM).

METHODS

Patients with T2DM completed a 3-day dietary record and Mini-mental State Examination (MMSE). Dietary patterns were identified by factor analysis.

RESULTS

The study included 73 patients and identified five dietary patterns, one of which was characterized by high loading for vegetables and fish. A higher consumption of vegetables and fish was significantly associated with improved MMSE score (unadjusted model, model adjusted for age and sex, and model adjusted for age, sex, education, diabetic nephropathy and alcohol consumption), and decreased prevalence of suspected mild dementia (unadjusted model, model adjusted for age and sex).

CONCLUSIONS

A high score in the vegetables and fish dietary pattern was associated with high MMSE score and low prevalence of suspected mild dementia in elderly patients with T2DM.

Uptake of Dietary Sodium Restriction by Overweight and Obese Patients After Cardiac Revascularization

PURPOSE

High sodium intake increases the risk of cardiovascular diseases. Cardiac patients are recommended a daily sodium restriction of ≤1,500 mg. The purpose of this article is to describe daily sodium intake and sodium restriction adherence and its correlates in cardiac rehabilitation (CR) program participants following cardiac revascularizations.

DESIGN

This is a descriptive correlational study.

METHODS

A subanalysis was performed using the data collected from a randomized controlled trial to determine the effect of a 12-week weight management intervention.

FINDINGS

The average daily sodium intake was 3,020 mg ± 1,134 at baseline, 4,047 mg ±1,517 at 4 months, and 4,399 mg ± 1,722 at 6 months. The adherence rates were 4.8% at baseline and zero at 4 and 6 months. The factors influencing daily sodium intake were identified.

CONCLUSION

The CR program participants failed to adhere to the sodium restriction guidelines.

CLINICAL RELEVANCE

Rehabilitation nurses need to identify effective strategies to educate CR participants and their family members regarding dietary sodium adherence in CR participants.

Dietary quality in people with type 1 and type 2 diabetes compared to age, sex and BMI matched controls

A case-control analysis involving 98 individuals with diabetes and 98 age, sex and BMI matched controls was conducted to determine dietary quality and adherence to dietary recommendations. Diet quality was comparable and intake of fat, saturated fat, fibre, fruit and vegetables did not meet recommendations in both groups.

Lifestyle factors associated with type 2 diabetes and use of different glucose-lowering drugs: cross-sectional study

Aims

To examine the lifestyle profile among persons with and without Type 2 diabetes mellitus (DM) and among users of different glucose-lowering drugs.

Methods

We used questionnaire data from a Danish health survey and identified presence of Type 2 DM and use of medications through medical databases. We calculated age- and gender-standardized prevalence ratios (PRs) of lifestyle factors according to Type 2 DM and different glucose-lowering drugs.

Results

Of 21,637 survey participants aged 25–79 years, 680 (3%) had Type 2 DM (median age 63 years) with a median diabetes duration of 5 years. Participants with Type 2 DM had a substantially higher prevalence of obesity (36% vs. 13%, PR: 3.1, 95% confidence interval (CI): 2.8–3.6), yet more reported to eat a very healthy diet (25% vs. 21%, PR: 1.2, 95% CI: 1.0–1.4) and to exercise regularly (67% vs. 53%, PR: 1.3, 95% CI: 1.2–1.4). Also, fewer were current smokers or had high alcohol intake. When compared with metformin users, obesity was substantially less prevalent in users of sulfonylurea (PR: 0.5, 95% CI: 0.4–0-8), and insulin and analogues (PR: 0.4, 95% CI: 0.3–0.7). Tobacco smoking was more prevalent in sulfonylurea users (PR: 1.4, 95% CI: 0.9–2.1) compared with metformin users. We found no material differences in physical exercise, diet or alcohol intake according to type of glucose-lowering drug.

Conclusions

Type 2 DM patients are substantially more obese than other individuals, but otherwise report to have a healthier lifestyle. Metformin use is strongly associated with obesity, whereas sulfonylurea use tends to be associated with tobacco smoking.