Lifestyle changes through the use of delivered meals and dietary counseling in a single-blind study. The STYLIST study

A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): −0.24 mmol/L, 95% confidence intervals (CIs): −0.40 to −0.09), TC (WMD: −0.31 mmol/L, 95% CIs: −0.49 to −0.13), LDL (WMD: −0.39 mmol/L, 95% CIs: −0.61 to −0.16) and FBS (WMD: −0.69 mmol/L, 95% CIs: −0.99 to −0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Weight Management Interventions for Adults With Overweight or Obesity: An Evidence Analysis Center Scoping Review

The objectives of this evidence scoping review were to identify and characterize studies investigating weight management interventions provided by a registered dietitian nutritionist or international equivalent (RDN) among adults with overweight or obesity. A medical librarian conducted an electronic literature search in 6 databases-MEDLINE (Ovid), Embase (Ovid), PyscINFO (Ovid), Cochrane CENTRAL (Ovid), Cochrane Database of Systematic Reviews (Ovid), and CINAHL (Ebsco). Except for narrative review, gray literature, and case study or report, all types of peer-reviewed articles published between January 2008 and April 26, 2019 were eligible. Two content advisors, who are experts in adult weight management, guided the process and reviewed the search plan and findings. The literature search resulted in 30,551 records with 16 additional records identified through other sources. A total of 29,756 records were excluded during the first round of screening due to duplication or irrelevancy. Of the 811 full-text articles that were screened, 139 met the criteria and were included. Approximately 51% and 43% of the studies were conducted in the community setting and in the United States or Canada, respectively. Over 97% of the studies were clinical or quasi-experimental trials. A total of 6 different intervention delivery modes were reported, which resulted in 22 combinations of the modes of delivery. RDNs delivered the weight management intervention (especially the nutrition component) in all studies, but some (61%) also involved an interdisciplinary team to deliver other components of the intervention. The average length of the intervention was about 10 months with a follow-up that ranged from 0 to 9 years. The commonly reported outcomes were anthropometrics, endocrine, and cardiovascular measures; dietary intake; and physical activity. Based on the scoping review, there were systematic reviews and evidence-based practice guidelines on weight management interventions but none of them met the a priori inclusion or exclusion criteria. Therefore, it would be beneficial to conduct a systematic review and develop an evidence-based practice guideline on adult weight management interventions provided by an RDN to guide practitioners and to evaluate their effects on health and nutrition-related outcomes.

Searching for optimal blood pressure targets in type 2 diabetic patients with coronary artery disease

BACKGROUND

Controversies exist regarding the optimal blood pressure (BP) level that is safe and provides cardiovascular protection in patients with type 2 diabetes mellitus (T2DM) and coexistent coronary artery disease. Several new glucose-lowering agents have been found to lower BP as well, making the interaction between BP and T2DM even more complex.

METHODS

With the reference to recent literature, this review article describes the potential mechanisms of increased risk of hypertension in T2DM and outlines the possible optimal BP levels based upon recommendations on the management of hypertension by the current guidelines, in combination with our research findings, for type 2 diabetic patients with coronary artery disease.

RESULTS

The development of hypertension in T2DM involves multiple processes, including enhanced sympathetic output, inappropriate activation of renin-angiotensin- aldosterone system, endothelial dysfunction induced through insulin resistance, and abnormal sodium handling by the kidney. Both AGE-RAGE axis and adipokine dysregulation activate intracellular signaling pathways, increase oxidative stress, and aggravate vascular inflammation. Pancreatic β-cell specific microRNAs are implicated in gene expression and diabetic complications. Non-pharmacological intervention with lifestyle changes improves BP control, and anti-hypertensive medications with ACEI/ARB, calcium antagonists, β-blockers, diuretics and new hypoglycemic agent SGLT2 inhibitors are effective to decrease mortality and prevent major adverse cardiovascular events. For hypertensive patients with T2DM and stable coronary artery disease, control of BP < 130/80 mmHg but not < 120/70 mmHg is reasonable, whereas for those with chronic total occlusion or acute coronary syndromes, an ideal BP target may be somewhat higher (< 140/90 mmHg). Caution is advised with aggressive lowering of diastolic BP to a critical threshold (< 60 mmHg).

CONCLUSIONS

Hypertension and T2DM share certain similar aspects of pathophysiology, and BP control should be individualized to minimize adverse events and maximize benefits especially for patients with T2DM and coronary artery disease.

Efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs on glycemic and periodontal status among DM patients

Purpose

A global trend of type 2 diabetes prevalence is rising. Preventing and managing of systemic and dental complications is crucial to decrease negative effects on glycemic control. The purpose of this paper is to estimate the efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs to decrease glycemic level and improve periodontal status in patients with type 2 diabetes.

Design/methodology/approach

Health Center 54 conducted randomized controlled trial among 192 patients (96 intervention and 96 control) from February to August 2018. Group education for lifestyle modification, individual oral hygiene instruction and lifestyle counseling by motivational interviewing was provided to the intervention group at baseline. Motivation of lifestyle modification every month by multimedia was also provided to the intervention group. The usual program was provided to the control group. At baseline and a six-month follow-up, glycemic level and periodontal status were assessed from participants. Data were analyzed by descriptive statistic, t-test, χ2 test, Fisher’s exact test, Repeated measure ANOVA and multiple linear regression.

Findings

Glycemic level and periodontal status were lower in the intervention group than the control group at the sixth-month followed up with statistical significances. Glycemic level and periodontal status had negatively correlated to intervention group with statistically significant.

Originality/value

Brief-LCDC Program which incorporated lifestyle modification and oral health care had efficacious to decrease glycemic level and improve periodontal status in patients with type 2 diabetes. Early prevention program by Brief-LCDC Program is crucial to prevent dental complications.

Dietary Approaches for Japanese Patients with Diabetes: A Systematic Review

This study aimed to elucidate the effect of an energy restricted and carbohydrate restricted diet on the management of Japanese diabetes patients. Several databases including MEDLINE, EMBASE, and the Japan Medical Abstracts Society were searched for relevant articles published prior to June 2017. The articles identified were systematically reviewed. We identified 286 articles on an energy restricted diet, assessed seven and included two studies in our review. On a carbohydrate restricted diet, 75 articles were extracted, seven articles assessed and three included in the review, of which two were the studies that were selected for the energy restricted diet group, since they compared energy restricted diets with carbohydrate restricted diets. All selected studies were on Japanese patients with type 2 diabetes. No studies for type 1 diabetes were found in our search. Two randomized controlled trials on an energy restricted diet were also included in the three studies for a carbohydrate restricted diet. All the three randomized controlled trials showed better glucose management with the carbohydrate restricted diet. Our study revealed that there is very little evidence on diets, particularly in Japanese patients with diabetes, and that the energy restricted diet, which has been recommended by the Japan Diabetes Society in the sole dietary management approach, is not supported by any scientific evidence. Our findings suggest that the carbohydrate restricted diet, but not the energy restricted diet, might have short term benefits for the management of diabetes in Japanese patients. However, since our analysis was based on a limited number of small randomized controlled trials, large scale and/or long term trials examining the dietary approaches in these patients are needed to confirm our findings.

Glycated albumin: from biochemistry and laboratory medicine to clinical practice

This review summarizes current knowledge about glycated albumin. We review the changes induced by glycation on the properties of albumin, the pathological implications of high glycated albumin levels, glycated albumin quantification methods, and the use of glycated albumin as a complementary biomarker for diabetes mellitus diagnosis and monitoring and for dealing with long-term complications. The advantages and limits of this biomarker in different clinical settings are also discussed.

The Impact of Gender and Protein Intake on the Success of Weight Maintenance and Associated Cardiovascular Risk Benefits, Independent of the Mode of Food Provision: The DiOGenes Randomized Trial

OBJECTIVE

Maintenance of weight loss and associated cardiovascular benefits after following energy-restricted diets is still a challenging field, and thorough investigation is needed. The present research aimed to determine the role of protein and gender in relation to two different intervention models related to food supply, in a weight maintenance trial.

SUBJECTS AND METHODS

The DiOGenes trial was a long-term, multicenter, randomized, dietary intervention study, conducted in eight European countries (Clinical Trials.gov, NCT00390637), focusing on assessing the effectiveness of weight maintenance over 6 months. This secondary analysis intended to evaluate the different benefits for weight maintenance and cardiometabolic markers of two dietary advice delivery models: "shop + instruction intervention" vs "instruction-alone intervention," which were further categorized for gender and macronutrient intake.

RESULTS

The weight maintenance intervention based on different macronutrient intake showed, independently of the advice delivery model, in both sexes that higher protein consumption was more effective for weight stability, showing better results in obese women (low protein: 1.65 kg in males and 0.73 Kg in females vs high protein: 1.45 kg in males and -0.93 Kg in females) . Measurements concerning cardiovascular risk markers from subjects on both structured models produced similar trends in the subsequent follow-up period, with a lower rebound in women for most of the markers analyzed.

CONCLUSION

The reported dietary benefits for weight sustainability should be ascribed to the macronutrient distribution (higher protein diets) rather than to the structured mode of delivery. Higher weight regain in males was noted, as well as a metabolic divergence attributable to the sex, with a better biochemical outcome in women.

Effectiveness of lifestyle change plus dental care program in improving glycemic and periodontal status in aging patients with diabetes: a cluster, randomized, controlled trial

BACKGROUND

Currently, there is an increased prevalence of diabetes mellitus among the aging adult population. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in patients with diabetes are essential. The objective of this study is to assess the effectiveness of the lifestyle change plus dental care (LCDC) program to improve glycemic and periodontal status in aging patients with diabetes.

METHODS

A cluster, randomized, controlled trial was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to April 2014. Sixty-six patients with diabetes per health center were included. At baseline, the intervention group attended 20-minute lifestyle and oral health education, individual lifestyle counseling, application of a self-regulation manual, and individual oral hygiene instruction. At month 3, the intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-minute educational video. The control group received a routine program. Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status. Data were analyzed by using descriptive statistic, χ(2) test, Fisher exact test, t test, and repeated-measures analysis of variance.

RESULTS

After the 6-month follow-up, participants in the intervention group had significantly lower glycated hemoglobin, fasting plasma glucose, plaque index, gingival index, probing depth, and attachment loss when compared with the control group.

CONCLUSION

The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes.

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. The purpose of this study was to conduct a comprehensive and systematic review of all studies related to home-delivered meals in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword "Meal" was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce.

Effectiveness of lifestyle change plus dental care (LCDC) program on improving glycemic and periodontal status in the elderly with type 2 diabetes

Background

Currently, there is an increased prevalence of diabetes mellitus among the elderly. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in diabetic patients is essential. The purpose of the present study is to assess the effectiveness of a Lifestyle Change plus Dental Care (LCDC) program to improve glycemic and periodontal status in the elderly with type 2 diabetes.

Methods

A quasi-experimental study was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to January 2014. 66 diabetic patients per health center were included. At baseline, the intervention group attended a 20 minute lifestyle and oral health education program, individual lifestyle counseling using motivational interviewing (MI), application of self regulation manual, and individual oral hygiene instruction. The intervention group received booster education every visit by viewing a 15 minute educational video. The control group received a routine program. Participants were assessed at baseline and 3 month follow up for glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), periodontal status, knowledge, attitude and practice of oral health and diabetes mellitus. Data were analyzed by using descriptive statistic, Chi-square test, Fisher’s exact test, t-test, and multiple linear regression.

Results

After the 3 month follow up, a multiple linear regression analysis showed that the intervention group was significantly negatively correlated in both glycemic and periodontal status. Participants in the intervention group had significantly lower glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), plaque index score, gingival index score, pocket depth, clinical attachment level (CAL), and percentage of bleeding on probing (BOP) when compared to the control group.

Conclusions

The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in the elderly with type 2 diabetes.

Trial registration

ClinicalTrials.in.th: TCTR20140602001.

Type 2 diabetes mellitus and hypertension: an update

Patients with hypertension and type 2 diabetes are at increased risk of cardiovascular and chronic renal disease. Factors involved in the pathogenesis of both hypertension and type 2 diabetes include inappropriate activation of the renin-angiotensin-aldosterone system, oxidative stress, inflammation, impaired insulin-mediated vasodilatation, augmented sympathetic nervous system activation, altered innate and adaptive immunity, and abnormal sodium processing by the kidney. The renin-angiotensin-aldosterone system blockade is a key therapeutic strategy in the treatment of hypertension in type 2 diabetes. Emerging therapies for resistant hypertension as often exists in patients with diabetes, include renal denervation and carotid body denervation.

Associations between the consumption of different kinds of seafood and out-of-hospital cardiac arrests of cardiac origin in Japan

BACKGROUND

Prospective cohort studies have shown that seafood consumption is inversely related to fatal coronary heart disease, sudden cardiac death and stroke. We studied whether the kind of seafood consumed in addition to seafood consumption per se is associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin.

METHODS AND RESULTS

We compared the average consumption of different kinds of seafood and other risk factors to the average incidence of age-adjusted OHCA (660,672 cases of OHCA: 55.2% of cardiac origin and 44.8% of non-cardiac origin) between 2005 and 2010 in the 47 prefectures of Japan. There were many significant correlations between the incidence of age-adjusted OHCA of cardiac origin (ad-OHCA-CO) and the consumption of many kinds of seafood, but not the total consumption of seafood. The consumption of horse mackerel (r = - 0.568, p < 0.0001) and saury (r = 0.607, p < 0.0001) showed the highest negative and positive correlations, respectively, with the age-adjusted incidence of ad-OHCA-CO.

CONCLUSIONS

In Japan, the consumption of different kinds of seafood may be an important factor in OHCA of cardiac origin. Thus, dietary habits with regard to seafood may play a role in OHCA of cardiac origin, however, the question of whether to eat fish in general or instead to eat certain kinds of fish is still unclear.