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Dinesh S, Sharma S, Chourasiya R. Therapeutic Applications of Plant and Nutraceutical-Based Compounds for the Management of Type 2 Diabetes Mellitus: A Narrative Review. Curr Diabetes Rev 2024; 20:e050523216593. [PMID: 37151065 DOI: 10.2174/1573399819666230505140206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 05/09/2023]
Abstract
Diabetes mellitus is a condition caused by a deficiency in insulin production or sensitivity that is defined by persistent hyperglycemia as well as disturbances in glucose, lipid, and protein metabolism. Uncurbed diabetes or incessant hyperglycemic condition can lead to severe complications, including renal damage, visual impairment, cardiovascular disease, neuropathy, etc., which promotes diabetes-associated morbidity and mortality rates. The therapeutic management of diabetes includes conventional medications and nutraceuticals as complementary therapies. Nutraceuticals are bioactive compounds derived from food sources that have health-promoting properties and are instrumental in the management and treatment of various maladies. Nutraceuticals are clinically exploited to tackle DM pathogenesis, and the clinical evidence suggests that nutraceuticals can modulate biochemical parameters related to diabetes pathogenesis and comorbidities. Hypoglycemic medicines are designed to mitigate DM in traditional medicinal practice. This review intends to emphasize and comment on the various therapeutic strategies available to manage this chronic condition, conventional drugs, and the potential role of nutraceuticals in managing the complexity of the disease and reducing the risk of complications. In contrast to conventional antihyperglycemic drugs, nutraceutical supplements offer a higher efficacy and lesser adverse effects. To substantiate the efficacy and safety of various functional foods in conjunction with conventional hypoglycemic medicines, additional data from clinical studies are required.
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Affiliation(s)
- Susha Dinesh
- Department of Bioinformatics, BioNome, Bengaluru, 560043, India
| | - Sameer Sharma
- Department of Bioinformatics, BioNome, Bengaluru, 560043, India
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Pappe CL, Peters B, Dommisch H, Woelber JP, Pivovarova-Ramich O. Effects of reducing free sugars on 24-hour glucose profiles and glycemic variability in subjects without diabetes. Front Nutr 2023; 10:1213661. [PMID: 37850088 PMCID: PMC10577299 DOI: 10.3389/fnut.2023.1213661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
Background The Western diet, especially beverages and high processed food products, is high in sugars which are associated with the development of obesity and diabetes. The reduction of refined carbohydrates including free and added sugars improves glycemic control in individuals with diabetes, but the data regarding effects in subjects without diabetes are limited. Objective This study aimed to evaluate the effects of reducing free sugar intake on 24-h glucose profiles and glycemic variability using continuous glucose monitoring (CGM). Methods In the randomized controlled study, 21 normal weight and overweight/obese subjects (BMI 18-40 kg/m2) without diabetes were assigned to a 4-week reduced-sugar (RS) diet or control diet after a 2-week baseline phase. During the baseline phase, all participants were advised not to change their habitual diet. During the intervention phase, RS participants were asked to avoid added sugar and white flour products, whereas participants of the control group were requested to proceed their habitual diet. Anthropometric parameters and HbA1c were assessed before and at the end of the intervention phase. Interstitial glucose was measured using continuous glucose monitoring (CGM), and the food intake was documented by dietary records for 14 consecutive days during the baseline phase and for the first 14 consecutive days during the intervention phase. Mean 24-h glucose as well as intra- and inter-day indices of glucose variability, i.e., standard deviation (SD) around the sensor glucose level, coefficient of variation in percent (CV), mean amplitude of glucose excursions (MAGE), continuous overlapping net glycemic action (CONGA), and mean absolute glucose (MAG), were calculated for the baseline and intervention phases. Results During the intervention, the RS group decreased the daily intake of sugar (i.e., -22.4 ± 20.2 g, -3.28 ± 3.61 EN %), total carbohydrates (-6.22 ± 6.92 EN %), and total energy intake (-216 ± 108 kcal) and increased the protein intake (+2.51 ± 1.56 EN %) compared to the baseline values, whereby this intervention-induced dietary changes differed from the control group. The RS group slightly reduced body weight (-1.58 ± 1.33 kg), BMI, total fat, and visceral fat content and increased muscle mass compared to the baseline phase, but these intervention-induced changes showed no differences in comparison with the control group. The RS diet affected neither the 24-h mean glucose levels nor intra- and inter-day indices of glucose variability, HbA1c, or diurnal glucose pattern in the within- and between-group comparisons. Conclusion The dietary reduction of free sugars decreases body weight and body fat which may be associated with reduced total energy intake but does not affect the daily mean glucose and glycemic variability in individuals without diabetes. Clinical trial registration German Clinical Trials Register (DRKS); identifier: DRKS00026699.
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Affiliation(s)
- Christina Laeticia Pappe
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beeke Peters
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
| | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Periodontology, Health Science Center, University of Washington, Seattle, WA, United States
| | - Johan Peter Woelber
- Policlinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Olga Pivovarova-Ramich
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Hall B, Żebrowska A, Sikora M, Siatkowski S, Robins A. The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study. Nutrients 2023; 15:3749. [PMID: 37686781 PMCID: PMC10490106 DOI: 10.3390/nu15173749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Type 1 diabetes (T1D) is associated with hyperglycaemia-induced hypoxia and inflammation. This study assessed the effects of a single bout of high-intensity interval exercise (HIIE) on glycaemia (BG) and serum level of pro-inflammatory cytokines, and an essential mediator of adaptive response to hypoxia in T1D patients. The macronutrient intake was also evaluated. Nine patients suffering from T1D for about 12 years and nine healthy individuals (CG) were enrolled and completed one session of HIIE at the intensity of 120% lactate threshold with a duration of 4 × 5 min intermittent with 5 min rests after each bout of exercise. Capillary and venous blood were withdrawn at rest, immediately after and at 24 h post-HIIE for analysis of BG, hypoxia-inducible factor alpha (HIF-1α), tumour necrosis factor alpha (TNF-α) and vascular-endothelial growth factor (VEGF). Pre-exercise BG was significantly higher in the T1D patients compared to the CG (p = 0.043). HIIE led to a significant decline in T1D patients' BG (p = 0.027) and a tendency for a lower BG at 24 h post-HIIE vs. pre-HIIE. HIF-1α was significantly elevated in the T1D patients compared to CG and there was a trend for HIF-1α to decline, and for VEGF and TNF-α to increase in response to HIIE in the T1D group. Both groups consumed more and less than the recommended amounts of protein and fat, respectively. In the T1D group, a tendency for a higher digestible carbohydrate intake and more frequent hyperglycaemic episodes on the day after HIIE were observed. HIIE was effective in reducing T1D patients' glycaemia and improving short-term glycaemic control. HIIE has the potential to improve adaptive response to hypoxia by elevating the serum level of VEGF. Patients' diet and level of physical activity should be screened on a regular basis, and they should be educated on the glycaemic effects of digestible carbohydrates.
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Affiliation(s)
- Barbara Hall
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Aleksandra Żebrowska
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Marcin Sikora
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland;
| | - Anna Robins
- School of Health and Society, University of Salford, Allerton Building, 43 Crescent, Salford M5 4WT, UK;
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Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, Hosseini Y, Jibril AT, Shahinfar H, Mirrafiei A, Hosseini F, Bidar SS. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:40-56. [PMID: 35537861 DOI: 10.1093/ajcn/nqac066] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Carbohydrate restriction is effective for type 2 diabetes management. OBJECTIVES We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes. METHODS We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake. RESULTS Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%-65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, -0.20%; 95% CI, -0.27% to -0.13%), FPG (MD, -0.34 mmol/L; 95% CI, -0.56 to -0.12 mmol/L), and body weight (MD, -1.44 kg; 95% CI, -1.82 to -1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%. CONCLUSIONS Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.
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Affiliation(s)
- Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Jabbarzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliyu Tijen Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Mirrafiei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab- Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Wheatley SD, Deakin TA, Arjomandkhah NC, Hollinrake PB, Reeves TE. Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes-A Narrative Review. Front Nutr 2021; 8:687658. [PMID: 34336909 PMCID: PMC8319397 DOI: 10.3389/fnut.2021.687658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023] Open
Abstract
Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.
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Affiliation(s)
| | | | - Nicola C Arjomandkhah
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
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Oliveira CLP, Boulé NG, Berg A, Sharma AM, Elliott SA, Siervo M, Ghosh S, Prado CM. Consumption of a High-Protein Meal Replacement Leads to Higher Fat Oxidation, Suppression of Hunger, and Improved Metabolic Profile After an Exercise Session. Nutrients 2021; 13:E155. [PMID: 33466462 PMCID: PMC7824960 DOI: 10.3390/nu13010155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to compare the impact of a high-protein meal replacement (HP-MR) versus a control (CON) breakfast on exercise metabolism. In this acute, randomized controlled, cross-over study, participants were allocated into two isocaloric arms: (a) HP-MR: 30% carbohydrate, 43% protein, and 27% fat; (b) CON: 55% carbohydrate, 15% protein, and 30% fat. Following breakfast, participants performed a moderate-intensity aerobic exercise while inside a whole-body calorimetry unit. Energy expenditure, macronutrient oxidation, appetite sensations, and metabolic blood markers were assessed. Forty-three healthy, normal-weight adults (24 males) participated. Compared to the CON breakfast, the HP-MR produced higher fat oxidation (1.07 ± 0.33 g/session; p = 0.003) and lower carbohydrate oxidation (-2.32 ± 0.98 g/session; p = 0.023) and respiratory exchange ratio (-0.01 ± 0.00; p = 0.003) during exercise. After exercise, increases in hunger were lower during the HP-MR condition. Changes in blood markers from the fasting state to post-exercise during the HP-MR condition were greater for insulin, peptide tyrosine-tyrosine, and glucagon-like peptide 1, and lower for low-density lipoprotein cholesterol, triglyceride, and glycerol. Our primary findings were that an HP-MR produced higher fat oxidation during the exercise session, suppression of hunger, and improved metabolic profile after it.
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Affiliation(s)
- Camila L. P. Oliveira
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.L.P.O.); (S.A.E.)
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Normand G. Boulé
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Aloys Berg
- Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany;
| | - Arya M. Sharma
- Division of Endocrinology & Metabolism, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Sarah A. Elliott
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.L.P.O.); (S.A.E.)
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Mario Siervo
- School of Life Sciences, Division of Physiology, Pharmacology and Neuroscience, University of Nottingham, Nottingham NG7 2UH, England, UK;
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Carla M. Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.L.P.O.); (S.A.E.)
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Yang J, Park HJ, Hwang W, Kim TH, Kim H, Oh J, Cho MS. Changes in the glucose and insulin responses according to high-protein snacks for diabetic patients. Nutr Res Pract 2020; 15:54-65. [PMID: 33542792 PMCID: PMC7838472 DOI: 10.4162/nrp.2021.15.1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to develop healthy, appetizing high-protein snacks with enhanced isolated soy protein for diabetic patients and determine the blood glucose and insulin response after being consumed by these patients. MATERIALS/METHODS Thirty adult patients aged between 30 and 75 years, with a ≤ 10-year history of type 2 diabetes and hemoglobin A1c of < 7.5%, were enrolled in this study. They made 3 clinical visits at one-week intervals. The control group consumed 50 g carbohydrates (white bread), whereas the test groups consumed high-protein grain (HP_G) or high-protein chocolate (HP_C) after an 8-hrs fast. Blood (2 cm3) was drawn at 15, 30, 45, 60, 90, and 120 min before and after consumption to analyze the blood glucose and insulin concentrations. RESULTS Compared to the commercial snacks, the developed high-protein snacks had below-average calorie, carbohydrate, and fat content and a 2.5-fold higher protein content. In diabetic patients who consumed these snacks, the postprandial blood glucose increased between 15 min and 2 h after consumption, which was significantly slower than the time taken for the blood glucose to increase in the patients who consumed the control food product (P < 0.001). Insulin secretion was significantly lower at 45 min after consumption (P < 0.05), showing that the high-protein snacks did not increase the blood glucose levels rapidly. The incremental area under the curve (iAUC), which indicated the degree of blood sugar and insulin elevation after food intake, was higher in the control group than the groups given the 2 developed snacks (P < 0.001), and there was no significant difference in insulin secretion. CONCLUSIONS The results of the postprandial blood glucose and insulin response suggest that high-protein snacks are potential convenient sources of high-quality protein and serve as a healthier alternative for patients with type 2 diabetes, who may have limited snack product choices. Such snacks may also provide balanced nutrition to pre-diabetic and obese individuals.
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Affiliation(s)
- Junyoung Yang
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Hae Jin Park
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Wonsun Hwang
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Tae Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, Seoul 02053, Korea
| | - Hyeonmok Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, Seoul 02053, Korea
| | - Jieun Oh
- College of Science & Industry Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Mi Sook Cho
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
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Jin SM, Ahn J, Park J, Hur KY, Kim JH, Lee MK. East Asian diet-mimicking diet plan based on the Mediterranean diet and the Dietary Approaches to Stop Hypertension diet in adults with type 2 diabetes: A randomized controlled trial. J Diabetes Investig 2020; 12:357-364. [PMID: 32772491 PMCID: PMC7926224 DOI: 10.1111/jdi.13384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022] Open
Abstract
Aims/Introduction Using an investigational diet plan based on the Mediterranean diet and the Dietary Approaches to Stop Hypertension diet comprised of substitute ingredients that mimic the average East Asian diet, this study assessed the glycemic benefits in comparison with a food exchange system‐based diet in established type 2 diabetes patients. Materials and Methods This was a 12‐week, open‐label randomized clinical trial carried out among 60 Korean adults with type 2 diabetes having a median body mass index of 23.5 kg/m2. Glycemic benefits in the investigational diet (group A) were compared with those obtained with a food exchange system‐based diet, either in the form of ready meals provided to participants (group B) or not (group C). The primary end‐point was changes in glycated hemoglobin from baseline to week 12. Results Changes in glycated hemoglobin (%) from baseline to week 12 were −0.97 ± 0.97 in group A (vs group B, P = 0.085 in the full analysis set, and P = 0.028 in the per‐protocol set; vs group C, P = 0.030 in the full analysis set and P = 0.020 in the per‐protocol set), −0.51 ± 0.65 in group B (vs group C, P > 0.05 in the full analysis set and the per‐protocol set), and −0.36 ± 0.74 in group C. Decreases from baseline in body mass index, waist circumference and blood pressure were greater in group A than in group C. Conclusion With the provision of ready meals, the glycemic benefits of the investigational diet plan were demonstrable over a self‐prepared food exchange system‐based diet in Korean adults with established type 2 diabetes.
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Affiliation(s)
- Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Myongji Hospital, Goyang, Korea
| | - Jiyun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea
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The Effects of Different Quantities and Qualities of Protein Intake in People with Diabetes Mellitus. Nutrients 2020; 12:nu12020365. [PMID: 32019211 PMCID: PMC7071151 DOI: 10.3390/nu12020365] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 12/20/2022] Open
Abstract
The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m2. Patients with a GFR <60 mL/min/1.73 m2 did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.
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Pivovarova-Ramich O, Markova M, Weber D, Sucher S, Hornemann S, Rudovich N, Raila J, Sunaga-Franze D, Sauer S, Rohn S, Pfeiffer AFH, Grune T. Effects of diets high in animal or plant protein on oxidative stress in individuals with type 2 diabetes: A randomized clinical trial. Redox Biol 2020; 29:101397. [PMID: 31926623 PMCID: PMC6909130 DOI: 10.1016/j.redox.2019.101397] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022] Open
Abstract
High-protein diet is a promising strategy for diabetes treatment supporting body weight control, improving glycaemic status, cardiovascular risk factors and reducing liver fat. Here, we investigated effects of diets high in animal (AP) or plant (PP) protein on oxidative stress and antioxidant status in individuals with type 2 diabetes (T2DM). 37 obese individuals (age 64.3 ± 1.0 years) with T2DM were randomized to an isocaloric diet (30 energy(E)% protein, 30 E% fat and 40 E% carbohydrates) rich in AP or PP for 6 weeks. Markers of oxidative and nitrosative stress and antioxidant status in plasma and nitrate/nitrite levels in urine were assessed. Gene expression in subcutaneous adipose tissue (SAT) was analysed by RNA-Seq and real-time PCR. Both AP and PP diets similarly reduced plasma levels of malondialdehyde (PAP = 0.003, PPP = 1.6 × 10-4) and protein carbonyls (PAP = 1.2 × 10-4, PPP = 3.0 × 10-5) over 6 weeks. Nitrotyrosine (NT) increased upon both AP and PP diets (PAP = 0.005, PPP = 0.004). SAT expression of genes involved in nitric oxide (NO) and oxidative stress metabolism and urine NO metabolite (nitrate/nitrite) levels were not changed upon both diets. Plasma levels of carotenoids increased upon PP diet, whereas retinol, alpha- and gamma-tocopherol slightly decreased upon both diets. AP and PP diets similarly improve oxidative stress but increase nitrosative stress markers in individuals with T2DM. Mechanisms of the NT regulation upon high-protein diets need further investigation.
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Affiliation(s)
- Olga Pivovarova-Ramich
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Reseach Group Molecular Nutritional Medicine, Dept. of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, Berlin, Germany.
| | - Mariya Markova
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Daniela Weber
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany; Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Stephanie Sucher
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Silke Hornemann
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Natalia Rudovich
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, Berlin, Germany; Division of Endocrinology and Diabetes, Department of Internal Medicine, Spital Bülach, Bülach, Switzerland
| | - Jens Raila
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Daniele Sunaga-Franze
- Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Society, Berlin, Germany and Berlin Institute of Health, Berlin, Germany
| | - Sascha Sauer
- Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Society, Berlin, Germany and Berlin Institute of Health, Berlin, Germany
| | - Sascha Rohn
- Institute for Food and Environmental Research e.V, Bad Belzig, Germany; Institute of Food Chemistry, Hamburg School of Food Science, University of Hamburg, Hamburg, Germany
| | - Andreas F H Pfeiffer
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, Berlin, Germany
| | - Tilman Grune
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany; Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
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11
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Shapira N. The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet. Nutrients 2019; 11:E2373. [PMID: 31590352 PMCID: PMC6835480 DOI: 10.3390/nu11102373] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/31/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.
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12
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Markova M, Koelman L, Hornemann S, Pivovarova O, Sucher S, Machann J, Rudovich N, Thomann R, Schneeweiss R, Rohn S, Pfeiffer AFH, Aleksandrova K. Effects of plant and animal high protein diets on immune-inflammatory biomarkers: A 6-week intervention trial. Clin Nutr 2019; 39:862-869. [PMID: 30967307 DOI: 10.1016/j.clnu.2019.03.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/13/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Pro-inflammatory biomarkers are well-established contributors to insulin resistance and represent valid targets for diabetes management and prevention. Yet, little is known whether nutrition could play a role in modulating various aspects of immune-inflammatory responses. Our aim is to assess the effect of isocaloric animal and plant protein dietary interventions on selected biomarkers representing various immune-inflammatory pathways. METHODS We enrolled 37 participants with type 2 diabetes (age 64 ± 6 years, body mass index 30.2 ± 3.6 kg/m2, glycated hemoglobin 7.0 ± 0.6%) who underwent an either high-animal protein (AP) or high-plant protein (PP) diet (30 E% protein, 40 E% carbohydrates, 30 E% fat) for 6-weeks. Clinical examinations were performed at beginning and end of the study. Levels of pro-inflammatory adipokines [chemerin, progranulin], cytokines [tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), soluble urokinase-type plasminogen activator receptor (suPAR), transforming growth factor beta 1 (TGF-β1)], and proteins [calprotectin, lactoferrin and growth differentiation factor 15 (GDF-15)] were determined in blood serum using enzyme-linked immunosorbent assay. RESULTS Chemerin and progranulin concentrations decreased following AP and PP diets. TGF-β1 increased in AP and decreased in PP, whereas calprotectin increased in PP and decreased in AP. No statistically significant differences in the concentrations of IL-6, TNF-α, suPAR, lactoferrin and GDF-15 could be seen in either of the protein diet arms. CONCLUSIONS These results suggest that both AP and PP diets may effectively reduce the levels of the pro-inflammatory adipokines chemerin and progranulin. The effects on the additional immune-inflammatory biomarkers seem to be more complex. CLINICAL TRIAL REGISTRY NUMBER NCT02402985 (ww.clinicaltrials.gov).
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Affiliation(s)
- Mariya Markova
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany.
| | - Liselot Koelman
- Senior Scientist Group Nutrition, Immunity and Metabolism, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Silke Hornemann
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany
| | - Olga Pivovarova
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany; Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Stephanie Sucher
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany
| | - Juergen Machann
- University of Tübingen, Experimental Radiology, Tübingen, Germany
| | - Natalia Rudovich
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany; Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany; Division of Endocrinology and Diabetology, Clinic of Internal Medicine, Hospital of Buelach, Buelach, Switzerland
| | - Ralph Thomann
- Institut für Getreideverarbeitung GmbH, Nuthetal, Germany
| | | | - Sascha Rohn
- Institute for Food and Environmental Research, Nuthetal, Germany; Institute of Food Chemistry, Hamburg School of Food Science, University of Hamburg, Hamburg, Germany
| | - Andreas F H Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Germany; Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Krasimira Aleksandrova
- Senior Scientist Group Nutrition, Immunity and Metabolism, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Potsdam, Germany.
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13
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Postprandial Glycaemic, Hormonal and Satiety Responses to Rice and Kiwifruit Preloads in Chinese Adults: A Randomised Controlled Crossover Trial. Nutrients 2018; 10:nu10081110. [PMID: 30126094 PMCID: PMC6116117 DOI: 10.3390/nu10081110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022] Open
Abstract
Controlling postprandial glycaemia helps to prevent and manage non-communicable diseases. One strategy in controlling glycaemia may be to consume meals in two parts; a preload, followed by the remainder of the meal. Our aim was to test preloading a rice meal given for breakfast and lunch on different days, either by splitting the meal (rice preload followed by rice meal) or by using kiwifruit as a preload compared with consuming the rice meal in one sitting. Primary outcomes were glycaemic and insulinaemic responses with secondary outcomes of other hormonal responses, subjective satiety, and subsequent energy intake. Following breakfast, postprandial glycaemic peak concentration was 0.9 (95% CI: 0.2, 1.6) mmol/L lower for the kiwifruit preload compared with the rice meal eaten in one sitting. Following lunch, glycaemic peak concentrations were 1.0 (0.7, 1.4) and 1.1 (0.5, 1.7) mmol/L lower for the rice-split and kiwifruit preload compared with the rice meal alone, respectively. Postprandial insulinaemia area-under-the-curve was 1385 (87, 2684) mU/L·min less for the kiwifruit preload compared with the rice-split. There were no differences among treatments for subsequent energy intake. Meal splitting is useful for lowering postprandial glycaemia, and replacing part of a meal with kiwifruit may help with insulin efficiency without detriment to subsequent energy intake.
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14
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Markova M, Hornemann S, Sucher S, Wegner K, Pivovarova O, Rudovich N, Thomann R, Schneeweiss R, Rohn S, Pfeiffer AFH. Rate of appearance of amino acids after a meal regulates insulin and glucagon secretion in patients with type 2 diabetes: a randomized clinical trial. Am J Clin Nutr 2018; 108:279-291. [PMID: 29982277 DOI: 10.1093/ajcn/nqy100] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/23/2018] [Indexed: 01/05/2023] Open
Abstract
Background Meal composition regulates the postprandial response of pancreatic and gastrointestinal hormones and plays an important role in patients with type 2 diabetes (T2D). Proteins have glucagon and insulinotropic effects, which may differ depending on amino acid composition, form of intake, and rate of digestibility and absorption. Objective The aim of this study was to test effects of isolated pea protein-based (PP) compared with casein protein-based (CP) meals differing in amino acid compositions on endocrine responses to meal tolerance tests (MTTs) in patients with T2D. Design Thirty-seven individuals with T2D [mean ± SD age: 64 ± 6 y; mean ± SD body mass index (kg/m2): 30.2 ± 3.6; mean ± SD glycated hemoglobin: 7.0% ± 0.6%] were randomly assigned to receive either high-animal-protein (∼80% of total protein) or high-plant-protein (∼72% of total protein) diets (30% of energy from protein, 40% of energy from carbohydrate, 30% of energy from fat) for 6 wk. MTTs were performed at study onset and after 6 wk. Participants received standardized high-protein (30% of energy) meals 2 times/d containing either CP-rich (∼85% wt:wt) or PP-rich (∼95% wt:wt) foods. Results The CP and PP meals produced differences in insulin, C-peptide, glucagon, and glucose-dependent insulinotropic peptide (GIP) release. Total areas under the curve after CP were significantly lower than after the PP lunch by 40% for insulin and 23% for glucagon. Indexes of insulin sensitivity and secretion were significantly improved for the second CP MTT. This was accompanied by differential rates of appearance of amino acids. The ingestion of PP resulted in significant increases in amino acids after both meals, with a decline between meals. By contrast, CP intake resulted in increases in most amino acids after breakfast, which remained elevated but did not increase further after lunch. Conclusions PP elicits greater postprandial increases in glucagon than does CP and consequently requires higher insulin to control glucose metabolism, which appears to be related to the rate of amino acid appearance. The metabolic impact of protein quality could be used as a strategy to lower insulin needs in patients with T2D. This trial was registered at www.clinicaltrials.gov as NCT02402985.
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Affiliation(s)
- Mariya Markova
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Silke Hornemann
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Stephanie Sucher
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Katrin Wegner
- Institute of Food Chemistry, Hamburg School of Food Science, University of Hamburg, Hamburg, Germany
| | - Olga Pivovarova
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
- Department of Endocrinology, Diabetes, and Nutrition, Charité University Medicine, Berlin, Germany
| | - Natalia Rudovich
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
- Department of Endocrinology, Diabetes, and Nutrition, Charité University Medicine, Berlin, Germany
- Division of Endocrinology and Diabetology, Clinic of Internal Medicine, Hospital of Buelach, Buelach, Switzerland
| | - Ralph Thomann
- Institut für Getreideverarbeitung GmbH, Nuthetal, Germany
| | | | - Sascha Rohn
- Institute of Food Chemistry, Hamburg School of Food Science, University of Hamburg, Hamburg, Germany
- Institute for Food and Environmental Research, Nuthetal, Germany
| | - Andreas F H Pfeiffer
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
- Department of Endocrinology, Diabetes, and Nutrition, Charité University Medicine, Berlin, Germany
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15
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Wang B, Smyl C, Chen CY, Li XY, Huang W, Zhang HM, Pai VJ, Kang JX. Suppression of Postprandial Blood Glucose Fluctuations by a Low-Carbohydrate, High-Protein, and High-Omega-3 Diet via Inhibition of Gluconeogenesis. Int J Mol Sci 2018; 19:E1823. [PMID: 29933567 PMCID: PMC6073393 DOI: 10.3390/ijms19071823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022] Open
Abstract
Hyperglycemia significantly contributes to the development and progression of metabolic diseases. Managing postprandial blood glucose fluctuations is of particular importance for patients with hyperglycemia, but safe and effective means of reducing blood glucose levels are still lacking. Five diets with varying macronutrient ratios and omega-3 fatty acid amounts were tested for their blood glucose-lowering effects in male C57BL/6J mice. The diets with potent blood glucose-lowering effects were further investigated for their underlying mechanisms and their beneficial effects on hyperglycemia models. Mice given the low-carbohydrate, high-protein, and high-omega-3 (LCHP+3) diet exhibited a rapid reduction of the blood glucose levels that remained consistently low, regardless of feeding. These effects were associated with reduced amino acid gluconeogenesis, due to the inhibition of hepatic alanine transaminase (ALT). Furthermore, the LCHP+3 intervention was effective in reducing the blood glucose levels in several disease conditions, including type 1 diabetes mellitus, hormone-induced hyperglycemia, and diet-induced metabolic syndrome. Our findings identify the LCHP+3 diet as a potent blood glucose-lowering diet that suppresses postprandial blood glucose fluctuations through the inhibition of gluconeogenesis and may have great clinical utility for the management of metabolic diseases with hyperglycemia.
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Affiliation(s)
- Bin Wang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
| | - Christopher Smyl
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Chih-Yu Chen
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Xiang-Yong Li
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Wei Huang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
- Biomedical Analysis Center, Third Military Medical University, Chongqing 400038, China.
| | - Hong-Man Zhang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Victor J Pai
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Jing X Kang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
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16
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Laeger T, Castaño-Martinez T, Werno MW, Japtok L, Baumeier C, Jonas W, Kleuser B, Schürmann A. Dietary carbohydrates impair the protective effect of protein restriction against diabetes in NZO mice used as a model of type 2 diabetes. Diabetologia 2018; 61:1459-1469. [PMID: 29550873 PMCID: PMC6449005 DOI: 10.1007/s00125-018-4595-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Low-protein diets are well known to improve glucose tolerance and increase energy expenditure. Increases in circulating fibroblast growth factor 21 (FGF21) have been implicated as a potential underlying mechanism. METHODS We aimed to test whether low-protein diets in the context of a high-carbohydrate or high-fat regimen would also protect against type 2 diabetes in New Zealand Obese (NZO) mice used as a model of polygenetic obesity and type 2 diabetes. Mice were placed on high-fat diets that provided protein at control (16 kJ%; CON) or low (4 kJ%; low-protein/high-carbohydrate [LP/HC] or low-protein/high-fat [LP/HF]) levels. RESULTS Protein restriction prevented the onset of hyperglycaemia and beta cell loss despite increased food intake and fat mass. The effect was seen only under conditions of a lower carbohydrate/fat ratio (LP/HF). When the carbohydrate/fat ratio was high (LP/HC), mice developed type 2 diabetes despite the robustly elevated hepatic FGF21 secretion and increased energy expenditure. CONCLUSION/INTERPRETATION Prevention of type 2 diabetes through protein restriction, without lowering food intake and body fat mass, is compromised by high dietary carbohydrates. Increased FGF21 levels and elevated energy expenditure do not protect against hyperglycaemia and type 2 diabetes per se.
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Affiliation(s)
- Thomas Laeger
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Teresa Castaño-Martinez
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Martin W Werno
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Lukasz Japtok
- Department of Toxicology, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Christian Baumeier
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Wenke Jonas
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Burkhard Kleuser
- Department of Toxicology, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Annette Schürmann
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
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17
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Yamada T, Matsuzaki M, Tanaka A. Increase in insulin secretion and decrease in muscle degradation by fat-free milk intake are attenuated by physical exercise. Clin Chim Acta 2018; 484:21-25. [PMID: 29752915 DOI: 10.1016/j.cca.2018.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Protein intake, particularly branched chain amino acids (BCAAs), and exercise have opposing actions on insulin secretion, but the same action on protein anabolism. We examined the effects of BCAA-rich fat-free milk intake and/or exercise on levels of insulin secretion and indices related to muscle protein metabolism in order to assess the potency of dietary and exercise therapies against metabolic and locomotive disorders. METHODS Eight adult female volunteers participated in all four 24 h experiments; control diet intake with or without exercise, and fat-free milk-containing diet intake with or without exercise. Fat-free milk was replaced with one-sixth of all foods in the control diet. Exercise was set at an equal-energy level as fat-free milk. Urine and fasting blood samples were collected for each experiment. RESULTS Urinary C-peptide immunoreactivity excretion and serum insulin levels were significantly higher, but urinary 3-methyl-histidine excretion levels were significantly lower with low urinary adrenaline and dopamine excretion in the fat-free milk-containing diet than in the control diet. These findings were reduced by exercise with high urinary adrenaline and noradrenaline excretion. CONCLUSIONS BCAA-rich fat-free milk intake enhanced insulin secretion and suppressed muscle protein degradation, but these effects are attenuated by exercise accompanied with increase in catecholamine secretion.
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Affiliation(s)
- Tetsuo Yamada
- Department of Nutrition and Dietetics, Kanto Gakuin University, Yokohama, Japan.
| | - Masami Matsuzaki
- Department of Nutrition and Dietetics, Kanto Gakuin University, Yokohama, Japan
| | - Akira Tanaka
- Laboratory of Clinical Nutrition and Medicine, Kagawa Nutrition University, Sakado, Japan
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18
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Shafaeizadeh S, Muhardi L, Henry CJ, van de Heijning BJM, van der Beek EM. Macronutrient Composition and Food Form Affect Glucose and Insulin Responses in Humans. Nutrients 2018; 10:E188. [PMID: 29419785 PMCID: PMC5852764 DOI: 10.3390/nu10020188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023] Open
Abstract
Glycaemic index (GI) is used as an indicator to guide consumers in making healthier food choices. We compared the GI, insulin index (II), and the area under the curve for blood glucose and insulin as glucose (GR) and insulin responses (IR) of a newly developed liquid nutritional formula with one commercially available liquid product with different types of carbohydrates. We then evaluated the glucose and insulin responses of two test foods with comparable energy density and protein percentage but presented in different food forms (liquid vs. solid). Fourteen healthy women participated in the study. GI, II, GR, and IR were assessed after (independent) consumption of two liquid products and a solid breakfast meal. The two liquid foods showed comparable GI, whilst the liquid form appeared to produce lower median GI (25 vs. 54), and II (52 vs. 98) values compared to the solid breakfast (p < 0.02). The median GR and IR for solid breakfast were respectively 44% and 45% higher compared to the liquid product (p < 0.02). Liquid formulas with different carbohydrate qualities produced comparable glucose responses, while foods with comparable energy density and protein percentage but different food form elicited differential effects on GI, II, GR, and IR. Nutrient quality and food form need to be taken into consideration when developing low GI products to manage glycaemic responses.
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Affiliation(s)
- Shila Shafaeizadeh
- Nutricia Research, Matrix Building #05-01b, 30 Biopolis Street, Singapore 138671, Singapore.
| | - Leilani Muhardi
- Danone Early Life Nutrition, Cyber 2 Tower, 15th Floor, Jl. HR. Rasuna Said #X-5 No. 13, South Jakarta 12950, Indonesia.
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), and National University Health System, Centre for Translational Medicine, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore 117599, Singapore.
- Department of Biochemistry, National University of Singapore, 8 Medical Drive, Singapore 117596, Singapore.
| | | | - Eline M van der Beek
- Nutricia Research, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands.
- Department of Pediatrics, University Medical Centre Groningen, CA84, Room Y2.115, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Shafique M, Russell S, Murdoch S, Bell JD, Guess N. Dietary intake in people consuming a low-carbohydrate diet in the UK Biobank. J Hum Nutr Diet 2017; 31:228-238. [PMID: 29235157 DOI: 10.1111/jhn.12527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low-carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced-carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories. METHODS In the present cross-sectional study, the dietary and nutrient intake collected via up to five consecutive 24-h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46-79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut-offs to define the low-carbohydrate group (<130 g day-1 ; n = 1953 versus ≥225 g day-1 , n = 113 036) were also used. RESULTS Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high-sugar, high-fat snacks [median 6.0, interquartile range (IQR) = 2.0-11.0 and median 6.0, IQR = 3.0-11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0-2.8 and median 1, IQR = 0-3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio-economic status, most differences remained. CONCLUSIONS Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.
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Affiliation(s)
- M Shafique
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - S Russell
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - S Murdoch
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - J D Bell
- Department of Life Sciences, Research Centre for Optimal Health, University of Westminster, London, UK
| | - N Guess
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK.,Department of Medicine, Imperial College London, London, UK
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Dietary Protein Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients 2017; 9:nu9090982. [PMID: 28878172 PMCID: PMC5622742 DOI: 10.3390/nu9090982] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023] Open
Abstract
Recently, some studies have focused on the relationship between dietary protein intake and the risk of type 2 diabetes mellitus (T2DM), but the conclusions have been inconsistent. Therefore, in this paper, a systematic review and meta-analysis of cohort studies regarding protein consumption and T2DM risk are conducted in order to present the association between them. We searched the PubMed and Embase databases for cohort studies on dietary protein, high-protein food consumption and risk of T2DM, up to July 2017. A summary of relative risks was compiled by the fixed-effect model or random-effect model. Eleven cohort studies regarded protein intake and T2DM (52,637 cases among 483,174 participants). The summary RR and 95% CI (Confidence Interval) of T2DM was 1.12 (1.08–1.17) in all subjects, 1.13 (1.04–1.24) in men, and 1.09 (1.04–1.15) in women for total protein; 1.14 (1.09–1.19) in all subjects, 1.23 (1.09–1.38) in men, and 1.11 (1.03–1.19) in women for animal protein; 0.96 (0.88–1.06) in all subjects, 0.98 (0.72–1.34) in men, and 0.92 (0.86–0.98) in women for plant protein. We also compared the association between different food sources of protein and the risk of T2DM. The summary RR (Relative Risk) and 95% CI of T2DM was 1.22 (1.09–1.36) for red meat, 1.39 (1.29–1.49) for processed meat, 1.03 (0.89–1.17) for fish, 1.03 (0.64–1.67) for egg, 0.89 (0.84–0.94) for total dairy products, 0.87 (0.78–0.96) for whole milk, 0.83 (0.70–0.98) for yogurt, 0.74 (0.59–0.93) in women for soy. This meta-analysis shows that total protein and animal protein could increase the risk of T2DM in both males and females, and plant protein decreases the risk of T2DM in females. The association between high-protein food types and T2DM are also different. Red meat and processed meat are risk factors of T2DM, and soy, dairy and dairy products are the protective factors of T2DM. Egg and fish intake are not associated with a decreased risk of T2DM. This research indicates the type of dietary protein and food sources of protein that should be considered for the prevention of diabetes.
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Sato J, Kanazawa A, Makita S, Hatae C, Komiya K, Shimizu T, Ikeda F, Tamura Y, Ogihara T, Mita T, Goto H, Uchida T, Miyatsuka T, Takeno K, Shimada S, Ohmura C, Watanabe T, Kobayashi K, Miura Y, Iwaoka M, Hirashima N, Fujitani Y, Watada H. A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control. Clin Nutr 2017; 36:992-1000. [DOI: 10.1016/j.clnu.2016.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/03/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
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Amankwaah AF, Sayer RD, Wright AJ, Chen N, McCrory MA, Campbell WW. Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults. Nutrients 2017; 9:nu9040352. [PMID: 28368334 PMCID: PMC5409691 DOI: 10.3390/nu9040352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
Abstract
Dietary protein and fiber independently influence insulin-mediated glucose control. However, potential additive effects are not well-known. Men and women (n = 20; age: 26 ± 5 years; body mass index: 26.1 ± 0.2 kg/m2; mean ± standard deviation) consumed normal protein and fiber (NPNF; NP = 12.5 g, NF = 2 g), normal protein and high fiber (NPHF; NP = 12.5 g, HF = 8 g), high protein and normal fiber (HPNF; HP = 25 g, NF = 2 g), or high protein and fiber (HPHF; HP = 25 g, HF = 8 g) breakfast treatments during four 2-week interventions in a randomized crossover fashion. On the last day of each intervention, meal tolerance tests were completed to assess postprandial (every 60 min for 240 min) serum glucose and insulin concentrations. Continuous glucose monitoring was used to measure 24-h interstitial glucose during five days of the second week of each intervention. Repeated-measures ANOVA was applied for data analyses. The HPHF treatment did not affect postprandial glucose and insulin responses or 24-h glucose total area under the curve (AUC). Higher fiber intake reduced 240-min insulin AUC. Doubling the amount of protein from 12.5 g to 25 g/meal and quadrupling fiber from 2 to 8 g/meal at breakfast was not an effective strategy for modulating insulin-mediated glucose responses in these young, overweight adults.
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Affiliation(s)
- Akua F Amankwaah
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.
- Department of Public Health Sciences, College of Health Science, California Baptist University, Riverside, CA 92504, USA.
| | - R Drew Sayer
- Anschutz Health and Wellness Center, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Amy J Wright
- Department of Public Health Sciences, College of Health Science, California Baptist University, Riverside, CA 92504, USA.
| | - Ningning Chen
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA.
| | - Megan A McCrory
- Department of Health Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA 02215, USA.
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.
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Absence of Role of Dietary Protein Sensing in the Metabolic Benefits of Duodenal-Jejunal Bypass in the Mouse. Sci Rep 2017; 7:44856. [PMID: 28332577 PMCID: PMC5362960 DOI: 10.1038/srep44856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/14/2017] [Indexed: 02/04/2023] Open
Abstract
Roux-en-Y gastric bypass (RYGB) induces remission or substantial improvement of type 2 diabetes mellitus (T2D) but underlying mechanisms are still unclear. The beneficial effects of dietary proteins on energy and glucose homeostasis are mediated by the antagonist effects of peptides toward mu-opioid receptors (MORs), which are highly expressed in the distal gut. We hypothesized that the beneficial effects of RYGB could depend at least in part on the interaction of peptides from food with intestinal MORs. Duodenal-jejunal bypass (DJB) was performed in obese and lean wild-type (WT) or MOR deficient (MOR−/−) mice. Food intake and body weight was monitored daily during 3 weeks. Glucose homeostasis was assessed from glucose and insulin tolerance tests. In obese WT and MOR−/− mice, DJB induced a rapid and sustained weight loss partly independent of food intake, and a rapid improvement in glycaemic parameters. Weight loss was a major determinant of the improvements observed. In lean WT and MOR−/− mice, DJB had no effect on weight loss but significantly enhanced glucose tolerance. We found that MORs are not essential in the metabolic beneficial effects of DJB, suggesting that protein sensing in the distal gut is not a link in the metabolic benefits of gastric surgery.
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Shukla AP, Andono J, Touhamy SH, Casper A, Iliescu RG, Mauer E, Shan Zhu Y, Ludwig DS, Aronne LJ. Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes. BMJ Open Diabetes Res Care 2017; 5:e000440. [PMID: 28989726 PMCID: PMC5604719 DOI: 10.1136/bmjdrc-2017-000440] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are limited data regarding the timing of carbohydrate ingestion during a meal and postprandial glucose regulation. METHODS Sixteen subjects with type 2 diabetes mellitus (T2DM) consumed the same meal on 3 days in random order: carbohydrate first, followed 10 min later by protein and vegetables; protein and vegetables first, followed 10 min later by carbohydrate; or all components together. Blood was sampled for glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucagon measurements at baseline (just before meal ingestion) and subsequently at 30 min intervals up to 180 min. RESULTS The incremental areas under the curve for glucose (iAUC0-180) and incremental glucose peaks were 53% and 54% lower, respectively, when carbohydrate was consumed last compared with carbohydrate consumed first (3124.7±501.2 vs 6703.5±904.6 mg/dL×180min, p<0.001; 34.7±4.1 vs 75.0±6.5 mg/dL, p<0.001) and 44% and 40% lower, respectively, compared with the all components together condition (3124.7±501.2 vs 5587.1±828.7 mg/dL×180min, p=0.003; 34.7±4.1 vs 58.2±5.9 mg/dL, p<0.001). Postprandial insulin excursions were lower (iAUC0-180: 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC0-180: 3487.56±327.7 vs 2519.11±494.8 pg/mL×min, p=0.019) following the carbohydrate-last meal order compared with carbohydrate first. CONCLUSION The carbohydrate-last meal pattern may be an effective behavioral strategy to improve postprandial glycemia.
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Affiliation(s)
- Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
| | - Jeselin Andono
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
- Institute of Human Nutrition, Columbia University, New York, USA
| | - Samir H Touhamy
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
- Institute of Human Nutrition, Columbia University, New York, USA
| | - Anthony Casper
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
| | - Radu G Iliescu
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, USA
| | - Yuan Shan Zhu
- Department of Medicine, Clinical and Translational Science Center, Weill Cornell Medical College, New York, USA
| | - David S Ludwig
- The New Balance Foundation Obesity Prevention Center, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
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Abstract
Asians typically consume carbohydrate-rich and high-glycaemic-index diets that have been associated with an increased risk of developing type 2 diabetes. Rice is rarely eaten alone such that it is of interest to investigate the effects of co-ingesting different protein-rich meals with rice on insulin and glycaemic response. This study had a randomised, controlled, non-blind, cross-over design in which fifteen healthy Chinese male participants were required to come on non-consecutive days. Five rice-based test meals were served: rice alone (control), rice with fish (RWF), rice with egg white (RWE), rice with soya beancurd (taukwa) (RWT) and rice with chicken (RWC). The control meal consisted of 50 g of available carbohydrate, whereas all other test meals contained additional 25 g of protein. RWT was the only meal that showed significantly lower glucose response when compared with the control (P<0·05). RWF and RWE had significantly higher insulin response, but no significant increase was observed in RWT and RWC when compared with the control (P<0·05). RWT and RWF showed significantly higher glucagon secretion as compared with the control (P<0·05). The four test meals studied showed varying effects, with RWT showing the greatest reduction in glycaemic response. Therefore, the ingestion of soya beancurd with rice may have a direct impact on reducing the risk in Asians transiting from being pre-diabetics to diabetics.
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Shrestha A, Müllner E, Poutanen K, Mykkänen H, Moazzami AA. Metabolic changes in serum metabolome in response to a meal. Eur J Nutr 2015; 56:671-681. [PMID: 26658764 DOI: 10.1007/s00394-015-1111-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/22/2015] [Indexed: 01/11/2023]
Abstract
PURPOSE The change in serum metabolic response from fasting state to postprandial state provides novel insights into the impact of a single meal on human metabolism. Therefore, this study explored changes in serum metabolite profile after a single meal. METHODS Nineteen healthy postmenopausal women with normal glucose tolerance participated in the study. They received a meal consisting of refined wheat bread (50 g carbohydrates, 9 g protein, 4.2 g fat and 2.7 g dietary fibre), 40 g cucumber and 300 mL noncaloric orange drink. Blood samples were collected at fasting and five postprandial time points. Metabolic profile was measured by nuclear magnetic resonance and targeted liquid chromatography-mass spectrometry. Changes over time were assessed with multivariate models and ANOVA, with baseline as control. RESULTS The metabolomic analyses demonstrated alterations in phospholipids, amino acids and their breakdown products, glycolytic products, acylcarnitines and ketone bodies after a single meal. More specifically, phosphatidylcholines, lysophosphatidylcholines and citrate displayed an overall declining pattern, while leucine, isoleucine, methionine and succinate increased initially but declined thereafter. A sharp decline in acylcarnitines and ketone bodies and increase in glycolytic products postprandially suggest a switch in the body's energy source from β-oxidation to glycolysis. Moreover, individuals with relatively high postprandial insulin responses generated a higher postprandial leucine responses compared to participants with lower insulin responses. CONCLUSIONS The study demonstrated complex changes from catabolic to anabolic metabolism after a meal and indicated that the extent of postprandial responses is different between individuals with high and low insulin response.
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Affiliation(s)
- Aahana Shrestha
- Department of Chemistry and Biotechnology, Swedish University of Agricultural Sciences, P.O. Box 7015, 75007, Uppsala, Sweden
| | - Elisabeth Müllner
- Department of Chemistry and Biotechnology, Swedish University of Agricultural Sciences, P.O. Box 7015, 75007, Uppsala, Sweden.
| | - Kaisa Poutanen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, 70211, Kuopio, Finland.,VTT Technical Research Centre of Finland, Tietotie 2, P.O. Box 1000, 02044, Espoo, Finland
| | - Hannu Mykkänen
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, 70211, Kuopio, Finland
| | - Ali A Moazzami
- Department of Chemistry and Biotechnology, Swedish University of Agricultural Sciences, P.O. Box 7015, 75007, Uppsala, Sweden
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Provenza FD, Meuret M, Gregorini P. Our landscapes, our livestock, ourselves: Restoring broken linkages among plants, herbivores, and humans with diets that nourish and satiate. Appetite 2015; 95:500-19. [DOI: 10.1016/j.appet.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/25/2015] [Accepted: 08/01/2015] [Indexed: 02/06/2023]
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Bell KJ, Bao J, Petocz P, Colagiuri S, Brand-Miller JC. Validation of the food insulin index in lean, young, healthy individuals, and type 2 diabetes in the context of mixed meals: an acute randomized crossover trial. Am J Clin Nutr 2015; 102:801-6. [PMID: 26354547 DOI: 10.3945/ajcn.115.112904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Food Insulin Index (FII) is a novel classification of single foods based on insulin responses in healthy subjects relative to an isoenergetic reference food. OBJECTIVE Our aim was to compare day-long responses to 2 nutrient-matched diets predicted to have either high or low insulin demand in healthy controls and individuals with type 2 diabetes (T2DM). DESIGN Twenty adults (10 healthy adults and 10 adults with T2DM) were recruited. On separate mornings, subjects consumed either a high- or low-FII diet in random order. Diets consisted of 3 consecutive meals (breakfast, morning tea, and lunch), matched for macronutrients, fiber, and glycemic index (GI), but with 2-fold difference in insulin demand as predicted by the FII of the component foods. Postprandial glycemia and insulinemia were measured in capillary plasma at regular intervals over 8 h. RESULTS As predicted by their GI, there were no differences in glycemic responses between the 2 diets in either group (mean ± SEM; healthy: 6.2 ± 0.2 compared with 6.1 ± 0.1 mmol/L · min, P = 0.429; T2DM: 9.9 ± 1.3 compared with 10.3 ± 1.6 mmol/L · min, P = 0.485). Compared with the high-FII diet, mean postprandial insulin response over 8 h was 53% lower with the low-FII diet in healthy subjects (mean ± SEM; incremental AUCinsulin 31,900 ± 4100 pmol/L · min compared with 68,100 ± 11,400 pmol/L · min, P = 0.003) and 41% lower in subjects with T2DM (mean ± SEM; incremental AUCinsulin 11,000 ± 1800 pmol/L · min compared with 18,700 ± 3100 pmol/L · min, P = 0.018). Incremental AUCinsulin was statistically significantly different between diets when groups were combined (P = 0.001). CONCLUSIONS The FII algorithm may be a useful tool for reducing postprandial hyperinsulinemia in T2DM, thereby potentially improving insulin resistance and β-cell function. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12611000654954.
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Affiliation(s)
- Kirstine J Bell
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, and the School of Molecular Bioscience, University of Sydney, Sydney, Australia, and
| | - Jiansong Bao
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, and the School of Molecular Bioscience, University of Sydney, Sydney, Australia, and
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, and the School of Molecular Bioscience, University of Sydney, Sydney, Australia, and
| | - Jennie C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, and the School of Molecular Bioscience, University of Sydney, Sydney, Australia, and
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Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care 2015; 38:e98-9. [PMID: 26106234 PMCID: PMC4876745 DOI: 10.2337/dc15-0429] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, New York, NY
| | - Radu G Iliescu
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, New York, NY
| | - Catherine E Thomas
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, New York, NY
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, New York, NY
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Whitham D. Nutrition for the prevention and treatment of chronic kidney disease in diabetes. Can J Diabetes 2014; 38:344-8. [PMID: 25201774 DOI: 10.1016/j.jcjd.2014.07.222] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 02/01/2023]
Abstract
The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Controversy has existed regarding the clinical significance of a protein-controlled diet, not to mention the ideal recommended intake in view of the benefits and risks. Furthermore, the level of CKD with which to implement dietary changes should also be considered. This review seeks to provide guidance and clarity concerning the nutritional management of CKD in diabetes.
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Affiliation(s)
- Dana Whitham
- Diabetes Comprehensive Care Program, St Michael's Hospital, Toronto, Ontario, Canada.
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Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial. Eur J Clin Nutr 2013; 67:990-5. [DOI: 10.1038/ejcn.2013.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 02/01/2023]
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Blaak EE, Antoine JM, Benton D, Björck I, Bozzetto L, Brouns F, Diamant M, Dye L, Hulshof T, Holst JJ, Lamport DJ, Laville M, Lawton CL, Meheust A, Nilson A, Normand S, Rivellese AA, Theis S, Torekov SS, Vinoy S. Impact of postprandial glycaemia on health and prevention of disease. Obes Rev 2012; 13:923-84. [PMID: 22780564 PMCID: PMC3494382 DOI: 10.1111/j.1467-789x.2012.01011.x] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/11/2012] [Accepted: 04/27/2012] [Indexed: 12/11/2022]
Abstract
Postprandial glucose, together with related hyperinsulinemia and lipidaemia, has been implicated in the development of chronic metabolic diseases like obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this review, available evidence is discussed on postprandial glucose in relation to body weight control, the development of oxidative stress, T2DM, and CVD and in maintaining optimal exercise and cognitive performance. There is mechanistic evidence linking postprandial glycaemia or glycaemic variability to the development of these conditions or in the impairment in cognitive and exercise performance. Nevertheless, postprandial glycaemia is interrelated with many other (risk) factors as well as to fasting glucose. In many studies, meal-related glycaemic response is not sufficiently characterized, or the methodology with respect to the description of food or meal composition, or the duration of the measurement of postprandial glycaemia is limited. It is evident that more randomized controlled dietary intervention trials using effective low vs. high glucose response diets are necessary in order to draw more definite conclusions on the role of postprandial glycaemia in relation to health and disease. Also of importance is the evaluation of the potential role of the time course of postprandial glycaemia.
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Affiliation(s)
- E E Blaak
- Department of Human Biology, School of Nutrition & Toxicology Research and Metabolism (NUTRIM), Maastricht UniversityMaastricht, the Netherlands
| | | | - D Benton
- Department of Psychology, University of SwanseaWales, UK
| | - I Björck
- Division of Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Lund UniversityLund, Sweden
| | - L Bozzetto
- Department of Clinical and Experimental Medicine, University Federico IINaples, Italy
| | - F Brouns
- Department of Human Biology, School of Nutrition & Toxicology Research and Metabolism (NUTRIM), Maastricht UniversityMaastricht, the Netherlands
| | - M Diamant
- Diabetes Center, Department of Internal Medicine, VU University Medical CenterAmsterdam, the Netherlands
| | - L Dye
- Institute of Psychological Sciences, University of LeedsLeeds, UK
| | - T Hulshof
- Kellogg EuropeDen Bosch, the Netherlands
| | - J J Holst
- Department of Biomedical Sciences and Novo Nordisk Foundation Centre of Basic Metabolic Research, University of CopenhagenCopenhagen, Denmark
| | - D J Lamport
- Institute of Psychological Sciences, University of LeedsLeeds, UK
| | - M Laville
- Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Center for European Nutrition, Safety and Health, Centre Hospitalier Lyon SudLyon, France
| | - C L Lawton
- Institute of Psychological Sciences, University of LeedsLeeds, UK
| | | | - A Nilson
- Division of Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Lund UniversityLund, Sweden
| | - S Normand
- Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Center for European Nutrition, Safety and Health, Centre Hospitalier Lyon SudLyon, France
| | - A A Rivellese
- Department of Clinical and Experimental Medicine, University Federico IINaples, Italy
| | - S Theis
- Südzucker/BENEO GroupObrigheim, Germany
| | - S S Torekov
- Department of Biomedical Sciences and Novo Nordisk Foundation Centre of Basic Metabolic Research, University of CopenhagenCopenhagen, Denmark
| | - S Vinoy
- Kraft Foods, R&D Centre, Nutrition DepartmentSaclay, France
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Gögebakan Ö, Kohl A, Osterhoff MA, van Baak MA, Jebb SA, Papadaki A, Martinez JA, Handjieva-Darlenska T, Hlavaty P, Weickert MO, Holst C, Saris WH, Astrup A, Pfeiffer AF. Effects of Weight Loss and Long-Term Weight Maintenance With Diets Varying in Protein and Glycemic Index on Cardiovascular Risk Factors. Circulation 2011; 124:2829-38. [PMID: 22104550 DOI: 10.1161/circulationaha.111.033274] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background—
We sought to separately examine the effects of either weight loss or diets varying in protein content and glycemic index without further changes in body weight on cardiovascular risk factors within the Diet, Obesity, and Genes study (DiOGenes).
Methods and Results—
DiOGenes is a pan-European controlled dietary intervention study in 932 overweight adults who first lost body weight on an 8-week low-calorie diet and were then randomized to 1 of 5 ad libitum diets for 26 weeks. The diets were either high or low protein or high or low glycemic index in 4 combinations or control. Weight loss (−11.23 kg; 95% confidence interval, −11.54 to −10.92;
P
<0.001) reduced high-sensitivity C-reactive protein (−1.15 mg/L; 95% confidence interval, −1.30 to −0.41;
P
<0.001), low- and high-density lipoprotein cholesterol, triglycerides, and blood pressure. During the 26-week weight maintenance period in the intention-to-treat analysis, the further decrease of high-sensitivity C-reactive protein blood levels was −0.46 mg/L greater (95% confidence interval, −0.79 to −0.13) in the groups assigned to low-glycemic-index diets than in those on high-glycemic-index diets (
P
<0.001). Groups on low-protein diets achieved a −0.25 mg/L greater reduction in high-sensitivity C-reactive protein (95% confidence interval, −0.59 to −0.17) than those on high-protein diets (
P
<0.001), whereas lipid profiles and blood pressure were not differently affected.
Conclusions—
This large-scale intervention study clearly separates weight loss from dietary composition–related effects. Low-glycemic-index carbohydrates and, to a lesser extent, low-protein intake may specifically reduce low-grade inflammation and associated comorbidities in overweight/obese adults.
Clinical Trial Registration—
http://www.clinicaltrials.gov
. Unique identifier: NCT00390637.
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Affiliation(s)
- Özlem Gögebakan
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Angela Kohl
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Martin A. Osterhoff
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Marleen A. van Baak
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Susan A. Jebb
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Angeliki Papadaki
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - J. Alfredo Martinez
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Teodora Handjieva-Darlenska
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Petr Hlavaty
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Martin O. Weickert
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Claus Holst
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Wim H.M. Saris
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Arne Astrup
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
| | - Andreas F.H. Pfeiffer
- From the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, and Department of Endocrinology, Diabetes, and Nutrition, Charité Universitätsmedizin, Berlin, Germany (Ö.G., A.K., M.A.O., M.O.W., A.F.H.P.); NUTRIM School for Nutrition, Toxicology, and Metabolism, Department of Human Biology, Maastricht University Medical Centre, Maastricht, Netherlands (M.A.v.B., W.H.M.S.); Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory,
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34
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Mithieux G. Brain, liver, intestine: a triumvirate to coordinate insulin sensitivity of endogenous glucose production. DIABETES & METABOLISM 2010; 36 Suppl 3:S50-3. [DOI: 10.1016/s1262-3636(10)70467-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee. Nutrition 2010; 26:915-24. [DOI: 10.1016/j.nut.2010.08.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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36
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Delaere F, Magnan C, Mithieux G. Hypothalamic integration of portal glucose signals and control of food intake and insulin sensitivity. DIABETES & METABOLISM 2010; 36:257-62. [PMID: 20561808 DOI: 10.1016/j.diabet.2010.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 11/18/2022]
Abstract
Glycolysis is an essential metabolic function that lies at the core of any cellular life. Glucose homoeostasis is, thus, a crucial physiological function of living organisms. A system of plasma glucose-sensing in the portal vein plays a key role in this homoeostasis. Connected to the hypothalamus via the peripheral nervous system, the system allows the body to adapt its response to any variation of portal glycaemia. The hypothalamus controls food intake (exogenous glucose supply) and hepatic glycogenolysis (endogenous glucose supply). Intestinal gluconeogenesis, via the release of glucose into the portal vein, plays a key role in the control of hunger and satiety, and of endogenous glucose production through the modulation of liver insulin sensitivity. The induction of intestinal gluconeogenesis provides a physiological explanation for the satiety effects induced by protein-enriched diets. In particular, the influence of protein-enriched diets on the hypothalamus is comparable to the activation observed after glucose infusion into the portal vein. The induction of intestinal gluconeogenesis also offers an explanation for the early improvement in glycaemia control observed in obese diabetic patients treated by gastric-bypass surgery. In addition to intestinal gluconeogenesis, a number of gastrointestinal hormones involved in the control of food intake exert their effects, at least in part, via the peripheral afferent nervous system. These data emphasize the importance of the gut-brain axis in the understanding and treatment of obesity and type 2 diabetes.
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Affiliation(s)
- F Delaere
- Inserm U855, Institut national de la santé et de recherche médicale, faculté de médecine Laennec, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
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37
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Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Iraklianou S, Berdanier CD, Zampelas A. A high protein low fat meal does not influence glucose and insulin responses in obese individuals with or without type 2 diabetes. J Hum Nutr Diet 2010; 23:183-9. [PMID: 20113388 DOI: 10.1111/j.1365-277x.2009.01020.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND When substituted for carbohydrate in a meal, dietary protein enhances glycaemic control in subjects with type 2 diabetes (DM2). It is unknown whether the effect is a result of increased protein or reduced carbohydrate. The present study aimed to compare the effects of two meals differing in protein to fat ratios on post-prandial glucose and insulin responses. METHODS This was a crossover, blind study in which obese subjects with (n = 23) and without (n = 26) DM2 consumed two meals in random order with equal amounts of energy (3.1 MJ, 741 kcal), fibre and carbohydrates and a 1-week washout period. Meals were a high protein, low fat (30% protein, 51% carbohydrates, 19% fat) meal and a low protein, high fat (15% protein, 51% carbohydrates, 34% fat) meal. Subjects were matched for age and body mass index. Plasma glucose and insulin were measured at fasting, 30, 60, 90, 120 min post-prandially. Insulin resistance and insulin sensitivity were assessed. RESULTS There was no significant meal effect on glucose and insulin responses within groups. Glucose response was higher in diabetic (120 min 11 +/- 0.7 mmol L(-1)) compared to nondiabetic (120 min 5 +/- 0.2; P < 0.001) subjects. Diabetic subjects had significantly higher insulin resistance (P < 0.001) and lower insulin sensitivity (P < 0.001) than nondiabetics. Although peak insulin levels, 60 min post-prandially, did not differ between groups (81 +/- 9 pmol L(-1) for diabetic versus 79 +/- 7 pmol L(-1) for nondiabetic subjects), they were achieved much later, 90 min post-prandially, in diabetic, (99 +/- 8 pmol L(-1)) compared to nondiabetic (63 +/- 7 pmol L(-1), P = 0.002) subjects. CONCLUSIONS Manipulating protein to fat ratio in meals does not affect post-prandial plasma blood glucose or insulin responses in obese people with and without DM2.
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Affiliation(s)
- E Papakonstantinou
- Department of Dietetics and Nutrition Sciences, Harokopio University, Athens, Greece
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38
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Pillot B, Soty M, Gautier-Stein A, Zitoun C, Mithieux G. Protein feeding promotes redistribution of endogenous glucose production to the kidney and potentiates its suppression by insulin. Endocrinology 2009; 150:616-24. [PMID: 18845639 DOI: 10.1210/en.2008-0601] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to assess in rats the effect of protein feeding on the: 1) distribution of endogenous glucose production (EGP) among gluconeogenic organs, and 2) repercussion on the insulin sensitivity of glucose metabolism. We used gene expression analyses, a combination of glucose tracer dilution and arteriovenous balance to quantify specific organ release, and hyperinsulinemic euglycemic clamps to assess EGP and glucose uptake. Protein feeding promoted a dramatic induction of the main regulatory gluconeogenic genes (glucose-6 phosphatase and phosphoenolpyruvate carboxykinase) in the kidney, but not in the liver. As a consequence, the kidney glucose release was markedly increased, compared with rats fed a normal starch diet. Protein feeding ameliorated the suppression of EGP by insulin and the sparing of glycogen storage in the liver but had no effect on glucose uptake. Combined with the previously reported induction of gluconeogenesis in the small intestine, the present work strongly suggests that a redistribution of glucose production among gluconeogenic organs might occur upon protein feeding. This phenomenon is in keeping with the improvement of insulin sensitivity of EGP, most likely involving the hepatic site. These data shed a new light on the improvement of glucose tolerance, previously observed upon increasing the amount of protein in the diet, in type 2 diabetic patients.
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Affiliation(s)
- Bruno Pillot
- Institut National de la Santé et de la Recherche Médicale, Unité 855 and Université de Lyon, Lyon, France
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39
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Vidurrizaga-De Amezaga CA, Zulet MA, Marti A, Martinez-Gonzalez MA, Martinez JA. The Mediterranean food pattern: a good recipe for patients with the metabolic syndrome. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2008. [DOI: 10.1007/s12349-008-0001-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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40
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Mithieux G. [Intestinal metabolism and control of the appetite: from genes to diseases]. ANNALES D'ENDOCRINOLOGIE 2008; 69:112-115. [PMID: 18430407 DOI: 10.1016/j.ando.2008.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- G Mithieux
- INSERM U855, UCBL Lyon-1, institut fédératif de recherche Lyon-Est, rue Guillaume-Paradin, Lyon cedex 08, France.
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41
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Fujio J, Kushiyama A, Sakoda H, Fujishiro M, Ogihara T, Fukushima Y, Anai M, Horike N, Kamata H, Uchijima Y, Kurihara H, Asano T. Regulation of gut-derived resistin-like molecule beta expression by nutrients. Diabetes Res Clin Pract 2008; 79:2-10. [PMID: 17936398 DOI: 10.1016/j.diabres.2007.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 02/19/2007] [Accepted: 04/16/2007] [Indexed: 11/21/2022]
Abstract
Resistin was initially identified as a protein, secreted by adipocytes, which inhibits insulin action and adipose differentiation. The three proteins homologous to resistin were identified and given the names resistin-like molecules (RELM) alpha, beta and gamma. Resistin and RELMalpha are abundantly expressed in adipose, but RELMbeta and RELMgamma are secreted mainly from the gut. Since nutrient composition greatly affects insulin sensitivity, we investigated the regulatory effects of various nutritional factors in food on the expressions of resistin family proteins. First, mice were given diets with different nutritional compositions (high-carbohydrate, high-protein and high-fat) for 2 weeks. RELMbeta mRNA expression in the intestines was markedly suppressed by the high-protein and high-carbohydrate diets, while slightly but not significantly upregulated by the high-fat diet. In the epididymal fat, resistin expression was unchanged, while RELMalpha expression was markedly decreased by the high-carbohydrate diet. Taking into consideration that humans have neither RELMalpha nor RELMgamma, our subsequent studies focused on RELMbeta expression. We used the human colon cancer cell line LS174T. Treatments with insulin and TNFalpha as well as stearic acid, a saturated free fatty acid, upregulated RELMbeta expression, while d-glucose downregulated RELMbeta. These results suggest RELMbeta expression to be regulated directly by nutrients such as glucose and saturated free fatty acids including stearic acid, as well as by hormones including insulin and TNFalpha. These regulations may play an important role in the nutrient-associated induction of insulin resistance.
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Affiliation(s)
- Junko Fujio
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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42
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NOAKES M, KEOGH J, CLIFTON P. Obesity and type 2 diabetes mellitus. Nutr Diet 2007. [DOI: 10.1111/j.1747-0080.2007.00205.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manders RJF, Praet SFE, Vikström MH, Saris WHM, van Loon LJC. Protein hydrolysate co-ingestion does not modulate 24 h glycemic control in long-standing type 2 diabetes patients. Eur J Clin Nutr 2007; 63:121-6. [PMID: 17717533 DOI: 10.1038/sj.ejcn.1602891] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluate the efficacy of protein hydrolysate co-ingestion as a dietary strategy to improve blood glucose homeostasis under free-living conditions in long-standing type 2 diabetes patients. METHODS A total of 13 type 2 diabetes patients were enrolled in a randomized, double-blind cross-over design and studied on two occasions for 40 h under strict dietary standardization but otherwise normal, free-living conditions. In one trial, subjects ingested a protein hydrolysate (0.4 g kg(-1) bw casein hydrolysate, PRO) with every main meal. In the other trial, a placebo was ingested (PLA). Blood glucose concentrations were assessed by continuous glucose monitoring. RESULTS Average 24 h glucose concentrations were similar between the PLA and the PRO trials (8.9 +/- 0.8 vs 9.2 +/- 0.7 mmol l(-1), respectively). Hyperglycemia (glucose concentrations >10 mmol l(-1)) was experienced 34 +/- 9% of the time (8 +/- 2 h per 24 h) in the PLA trial. Protein hydrolysate co-ingestion with each main meal (PRO) did not reduce the prevalence of hyperglycemia (39 +/- 10%, 9 +/- 2 h per 24 h; P=0.2). CONCLUSION Co-ingestion of a protein hydrolysate with each main meal does not improve glucose homeostasis over a 24 h period in long-standing type 2 diabetes patients.
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Affiliation(s)
- R J F Manders
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands.
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44
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Abstract
PURPOSE OF REVIEW Recent randomized controlled trials examining diets of varying carbohydrate composition recommended for people with diabetes and cardiovascular disease and those at risk are summarized. RECENT FINDINGS Severe carbohydrate restriction results in appreciable initial weight loss and improvement in risk factors. After a year, however, the beneficial effects are equal to or less than those achieved on conventional alternatives. Some people develop elevations of LDL cholesterol. Modest carbohydrate restriction with relatively high intakes of cis-unsaturated fatty acids and protein is acceptable to many people and is more likely to produce sustained benefit in terms of weight loss and cardiovascular risk indicators. SUMMARY Diets involving moderate carbohydrate restriction are suitable alternatives to high-carbohydrate, high-fibre diets for weight loss and reduction of cardiovascular disease and diabetes risk, as well as to treat individuals with the conditions. As such diets are generally high in protein and unsaturated fatty acids, they are not recommended for those with established or incipient nephropathy. High-carbohydrate, high-fibre diets remain appropriate for use in all those situations, provided carbohydrate is derived principally from minimally processed wholegrain breads and cereals and intact vegetables and fruit. Lower carbohydrate options may be preferable for markedly insulin-resistant individuals.
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Affiliation(s)
- Jim Mann
- Edgar National Centre for Diabetes Research, University of Otago, Dunedin, New Zealand.
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45
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Abstract
In healthy individuals, blood glucose levels in the fasting state are maintained by the continuous basal-level insulin secretion. After a meal, the rise in postprandial glucose (PPG) is controlled by the rapid pancreatic release of insulin, stimulated by both glucose and the intestinal production of the incretins glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1. In diabetic individuals, postprandial insulin secretion is insufficient to suppress an excessive rise in PPG. There is increasing evidence that elevated PPG exerts a more deleterious effect on the vascular system than elevation of fasting plasma glucose. In particular, individuals with normal fasting plasma glucose but impaired glucose tolerance have significantly increased risk of cardiovascular events. With the recognition of the importance of PPG and the availability of new pharmacologic options, management of diabetes will shift to greater attention to PPG levels. The prototype for such an approach is in the treatment of gestational diabetes and diabetic pregnancies where PPG is the primary target of efforts at glycemic control. These efforts have been extremely successful in improving the outlook for diabetic pregnant women. There are many approaches to reduction of PPG; dietary management and promotion of exercise are very effective. Sulfonylureas, meglitinides, metformin, thiazolidinediones, and disaccharidase inhibitors all counteract PPG elevation. The development of glucagon-like peptide 1 agonists such as exendin and dipeptidyl peptidase IV inhibitors such as vildagliptin offers a new approach to suppression of PPG elevation. New semisynthetic insulin analogues permit a more aggressive response to postprandial glucose elevation, with lower risk of hypoglycemia, than with regular insulin. Inhaled insulin also has a rapid onset of action and offers benefits in PPG control. It is proposed that an aggressive treatment approach focusing on PPG, similar to the current standards for diabetic pregancies, be directed at individuals with diabetes and impaired glucose tolerance.
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46
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Abstract
PURPOSE OF REVIEW Despite the proven efficacy of the established high-carbohydrate diets for treatment and prevention of obesity and type 2 diabetes, alternative diets including high-protein, high-fat, low-carbohydrate diets have become increasingly popular. The purpose of this review is to discuss potential effects of increased protein intake on glucose metabolism and body weight. RECENT FINDINGS Recent intervention trials revealed that, in the short-term, the intake of proteins at the expense of carbohydrates increases satiety and thereby lowers intake of calories. High protein intake augments prandial insulin secretion and might thereby improve glycaemic control in type 2 diabetic patients. On the other hand, epidemiological studies suggest that chronic high dietary protein intake is associated with increased incidence of type 2 diabetes. Furthermore, a short-term increase in plasma amino acid concentrations has been shown to directly induce insulin resistance in skeletal muscle and stimulate endogenous glucose production. SUMMARY Dietary proteins and amino acids are potent modulators of glucose metabolism and might also affect satiety and energy intake. However, due to the lack of well-controlled long-term studies the optimal macronutrient composition for treatment and prevention of obesity and type 2 diabetes is not known.
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Affiliation(s)
- Miriam Promintzer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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47
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Gannon MC, Nuttall FQ. Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006; 3:16. [PMID: 16556307 PMCID: PMC1475800 DOI: 10.1186/1743-7075-3-16] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Accepted: 03/23/2006] [Indexed: 01/08/2023] Open
Abstract
Background Over the past several years our research group has taken a systematic, comprehensive approach to determining the effects on body function (hormonal and non-hormonal) of varying the amounts and types of proteins, carbohydrates and fats in the diet. We have been particularly interested in the dietary management of type 2 diabetes. Our objective has been to develop a diet for people with type 2 diabetes that does not require weight loss, oral agents, or insulin, but that still controls the blood glucose concentration. Our overall goal is to enable the person with type 2 diabetes to control their blood glucose by adjustment in the composition rather than the amount of food in their diet. Methods This paper is a brief summary and review of our recent diet-related research, and the rationale used in the development of diets that potentially are useful in the treatment of diabetes. Results We determined that, of the carbohydrates present in the diet, absorbed glucose is largely responsible for the food-induced increase in blood glucose concentration. We also determined that dietary protein increases insulin secretion and lowers blood glucose. Fat does not significantly affect blood glucose, but can affect insulin secretion and modify the absorption of carbohydrates. Based on these data, we tested the efficacy of diets with various protein:carbohydrate:fat ratios for 5 weeks on blood glucose control in people with untreated type 2 diabetes. The results were compared to those obtained in the same subjects after 5 weeks on a control diet with a protein:carbohydrate:fat ratio of 15:55:30. A 30:40:30 ratio diet resulted in a moderate but significant decrease in 24-hour integrated glucose area and % total glycohemoglobin (%tGHb). A 30:20:50 ratio diet resulted in a 38% decrease in 24-hour glucose area, a reduction in fasting glucose to near normal and a decrease in %tGHb from 9.8% to 7.6%. The response to a 30:30:40 ratio diet was similar. Conclusion Altering the diet composition could be a patient-empowering method of improving the hyperglycemia of type 2 diabetes without weight loss or pharmacologic intervention.
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Affiliation(s)
- Mary C Gannon
- Metabolic Research Laboratory and Section of Endocrinology, Metabolism & Nutrition, VA Medical Center, Minneapolis, MN, USA
- Department of Food Science & Nutrition, University of Minnesota, USA
- Department of Medicine, University of Minnesota, USA
| | - Frank Q Nuttall
- Metabolic Research Laboratory and Section of Endocrinology, Metabolism & Nutrition, VA Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, USA
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48
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Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005; 2:31. [PMID: 16288655 PMCID: PMC1323303 DOI: 10.1186/1743-7075-2-31] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 11/16/2005] [Indexed: 12/20/2022] Open
Abstract
Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO. We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO restriction might thus provide a new experimental criterion for MetS in the face of on-going controversy about a useful definition. As a guide to future research, the idea that control of insulin metabolism by CHO intake is, to a first approximation, the underlying mechanism in MetS is a testable hypothesis.
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Affiliation(s)
- Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269-1110 USA
| | - Richard D Feinman
- Department of Biochemistry, SUNY Downstate Medical Center, Brooklyn, NY 11203 USA
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49
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Abstract
Despite its high prevalence and severe complications, the aetiology of the primary defects leading to Type 2 diabetes mellitus remain unknown. In addition to polygenic predisposition, environmental factors including dietary behaviour are increasingly recognized as being of crucial importance for the development of this disease. This strongly supports the concept that nutrient excess leading to increased availability of substrates adversely influences whole-body metabolic regulation and plays a major role in the development of type 2 diabetes. We have shown previously that a short-term increase in free fatty acid availability impairs glucose metabolism in liver and skeletal muscle. Despite the widespread interest in protein-rich diets, the effects of plasma amino acid elevation on human glucose metabolism have not yet been studied in detail. This editorial summarizes recent advances in the identification of mechanisms responsible for amino acid-dependent modulation of glucose metabolism in liver and skeletal muscle in vivo.
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