Underreporting of food intake in obese diabetic and nondiabetic patients

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial

BACKGROUND

Clinical guidelines recommend basic carbohydrate counting (BCC), or similar methods to improve carbohydrate estimation skills and to strive for higher consistency in carbohydrate intake potentially improving glycaemic control. However, evidence for this approach in type 2 diabetes (T2D) is limited.

OBJECTIVE

To examine the efficacy of a structured education program in BCC as add-on to standard dietary care on glycaemic control in individuals with T2D.

METHODS

The BCC Study was a randomized, controlled, open-label, parallel-group trial. Individuals with T2D aged 18-75 years with glycated haemoglobin A1c (HbA1c) 53-97 mmol/mol (7.0-11.0%) were randomly assigned (1:1) to BCC or standard dietary care. The primary outcomes were differences in changes in HbA1c or glycaemic variability (calculated as mean amplitude of glycaemic excursions [MAGE]) between groups after six months of intervention.

RESULTS

Between September 2018 and July 2021, 48 participants were randomly assigned, 23 to BCC and 25 to standard dietary care. Seven participants did not receive the allocated intervention. From a baseline-adjusted mean of 65 mmol/mol (95% CI 62-68 [8.1%, 7.8-8.4]), HbA1c changed by -5 mmol/mol (-8 to -1 [-0.5%, -0.7 to -0.1]) in BCC and -3 mmol/mol (-7 to 1 [-0.3%, -0.6 to 0.1]) in standard care with an estimated treatment effect of -2 mmol/mol (-7 to 4 [-0.2%, -0.6 to 0.4]); p = 0.554. From a baseline-adjusted mean of 4.2 mmol/l (3.7 to 4.8), MAGE changed by -16% (-33 to 5) in BCC and by -3% (-21 to 20) in standard care with an estimated treatment effect of -14% (-36 to 16); p = 0.319. Only median carbohydrate estimation error in favour of BCC (estimated treatment difference -55% (-70 to -32); p < 0.001) remained significant after multiple testing adjustment.

CONCLUSIONS

No glycaemic effects were found but incorporating BCC as a supplementary component to standard dietary care led to improved skills in estimating carbohydrate intake among individuals with T2D.

Analysis of dietary behavior and intake related to glycemic control in patients with type 2 diabetes aged 30 years or older in Korea: Utilizing the 8th Korea National Health and Nutrition Examination Survey (2019-2021)

BACKGROUND/OBJECTIVES

Over the past 10 yrs, the prevalence of diabetes in Korea has continued to incline, and the importance of lifestyle modification to manage diabetes has been highlighted. For patients with diabetes, carbohydrate intake reduction is effective in improving glycemic control; thus, we aimed to analyze the effect of carbohydrate intake ratio and suggest an appropriate carbohydrate intake ratio.

SUBJECTS/METHODS

Using the 8th Korea National Health and Nutrition Examination Survey (2019-2021), we analyzed the data including participants aged 30 yrs or older with diabetes, and they were stratified into good and poor glycemic control groups. To analyze the correlation between the dietary behavior characteristics of participants with diabetes and the carbohydrate intake ratio, sociodemographic characteristics, dietary behavior, and health behavior were adjusted, and multivariate logistic regression analysis was conducted to present the adjusted odds ratio and 95% confidence interval (CI).

RESULTS

In the unadjusted crude model, when carbohydrate intake ratio in total energy intake increased by 1%, the likelihood of poor glycemic control increased by 1.007-fold (95% CI, 0.998-1.016; P = 0.121). In model 1, which uses age and sex as adjustment variables, an increase of up to 1.011-fold was possible (95% CI, 1.001-1.021; P = 0.008). In model 2, which added variables such as diabetes duration, frequency of fruit consumption, frequency of lunch and, frequency of dinner, the risk of poor glycemic control increased by 1.010-fold as the carbohydrate intake ratio increased (95% CI, 0.998-1.022; P < 0.001).

CONCLUSION

This study confirmed that as the ratio of carbohydrate intake to total energy intake increases the likelihood of poor glycemic control also increases in patients with diabetes. Therefore, to improve glycemic control in patients with diabetes, controlling the carbohydrate intake may be helpful.

Poorly controlled glycemia and worse beta cell function associate with higher resting and total energy expenditure in adults with obesity and type 2 diabetes: A doubly labeled water study

BACKGROUND

Some studies comparing persons with and without type 2 diabetes (T2DM) show no difference in resting energy expenditure (REE). However, the degree of glycemic control may be a crucial factor in determining energy requirements. Few studies have employed the doubly labeled water (DLW) method in persons with T2DM to objectively measure daily energy expenditure.

AIMS

To determine relationships between glycemia, body composition, and energy expenditure in adults with obesity and T2DM. We hypothesized that worse hyperglycemia, insulin resistance, and beta cell function would associate with higher resting and total energy expenditure (TEE).

METHODS

Two cohorts age 31-50 years were included: 78 with obesity and T2DM, 19 with normal weight and no chronic disease. Baseline data from clinical biomarkers, intravenous glucose tolerance tests, DXA and MRI for body composition, and dietary intakes were used in multivariable regression models to predict REE and TEE. Additionally, comparisons were made by categorizing participants as having controlled or uncontrolled glycemia based on glucose levels ≥175 mg/dL.

RESULTS

REE was higher in participants with T2DM by 534.08 ± 74.35 kcal/d (p < 0.001). Higher fasting glucose and HbA1C levels associated with higher TEE. Abdominal SAT and VAT were also predictors in regression models accounting for 76 % of the variance in REE and 89 % of TEE. Participants with uncontrolled glycemia had 22 % higher adipose/lean ratio, two-fold higher VAT/SAT ratio, 21 % higher HOMA-IR score, and worse beta cell function (mean difference in HOMA2-%β of 74.09 ± 14.01, p < 0.001) than those with controlled glycemia. Both REE and TEE were significantly higher in uncontrolled glycemia, difference in REE of 154.17 ± 96.28 kcals/day (p = 0.04) and difference in TEE of 480.64 ± 215.45 kcals/day (p = 0.03).

CONCLUSIONS

Poor beta cell function and uncontrolled glycemia associate with higher REE and TEE in persons with obesity and T2DM. This study is registered with clinicaltrials.gov identifier: NCT01239550.

Sleep duration and food intake in people with type 2 diabetes mellitus and factors affecting confectionery intake

AIMS/INTRODUCTION

We carried out a cross-sectional study of people with type 2 diabetes mellitus to elucidate the association between sleep duration and food intake.

MATERIALS AND METHODS

Overall, 2,887 participants with type 2 diabetes mellitus (mean age 63.0 years; 61.1% men; mean glycated hemoglobin level 7.5%) were included in this study. The participants' self-reported dietary habits and sleep duration were evaluated using a brief self-administered dietary history questionnaire and Pittsburgh Sleep Quality Index, respectively. The participants were categorized into the following four groups based on sleep duration: <6, 6-6.9, 7-7.9 (reference) and ≥8 h.

RESULTS

No significant differences were observed between the groups regarding energy intake (kcal/day), absolute intake (g/day) or relative intake (% energy) of carbohydrates, total fat, proteins and fibers. However, confectionery intake was higher in the <6 h group and lower in the ≥8 h group than in the reference group after adjustment for confounding factors. In multivariate analysis, sleep durations <6 h and ≥8 h significantly correlated with increased (95% confidence interval 0.55 to 3.6; P = 0.0078) and decreased (95% confidence interval -4.0 to -0.32; P = 0.021) confectionery intake, respectively. Confectionery intake was positively correlated with female sex, glycated hemoglobin level and dyslipidemia, whereas it was negatively correlated with alcohol consumption and current smoking status.

CONCLUSIONS

Short sleep duration is associated with high confectionery intake in people with type 2 diabetes mellitus; this might disturb their glycemic control. Therefore, short sleepers with type 2 diabetes mellitus could improve their glycemic control by avoiding confectionery intake and maintaining adequate sleep duration.

Differences in Dietary Intake Exist among U.S. Adults by Diabetic Status Using NHANES 2009–2016

The objective was to determine the most frequently consumed food items, food subcategories, and food categories, and those that contributed most to total energy intake for the group of U.S. adults reporting taking insulin, those with type 2 diabetes (T2D) not taking insulin, and those without diabetes. Laboratory tests and questionnaires of the National Health and Nutrition Examination Survey 2009–2016 classified 774 participants reporting taking insulin, 2758 participants reporting T2D not taking insulin, and 17,796 participants without diabetes. Raw and weighted frequency and energy contributions of each food item, food subcategory, and food category were calculated and ranked. Comparisons among groups by broad food category used the Rao–Scott modified chi-square test. Soft drinks ranked as the 8th and 6th most consumed food subcategory of participants with T2D not taking insulin and those without diabetes, and contributed 5th and 2nd most to energy, respectively. The group reporting taking insulin is likely to consume more protein foods and less soft drink compared to the other two groups. Lists of the most frequently reported foods and foods contributing most to energy may be helpful for nutrition education, prescribing diets, and digital-based dietary assessment for the group reporting taking insulin.

Impact of Eating Speed on Muscle Mass in Older Patients With Type 2 Diabetes: A Prospective Study of KAMOGAWA–DM Cohort

Background and Aims

Maintenance of muscle mass is important for sarcopenia prevention. However, the effect of eating speed, especially fast, normal, or slow speed, on muscle mass changes remains unclear. Therefore, the purpose of this prospective study was to investigate the effect of eating speed on muscle mass changes in patients with type 2 diabetes (T2DM).

Methods

This study included 284 patients with T2DM. Based on a self–reported questionnaire, participants were classified into three groups: fast–, normal–, and slow–speed eating. Muscle mass was assessed using a multifrequency impedance body composition analyzer, and skeletal muscle mass (SMI) decrease (kg/m²/year) was defined as [baseline SMI (kg/m²)–follow–up SMI (kg/m²)] ÷ follow–up duration (year). The rate of SMI decrease (%) was defined as [SMI decrease (kg/m²/year) ÷ baseline SMI (kg/m²)] × 100.

Results

The proportions of patients with fast–, normal–, and slow–speed eating were, respectively, 50.5%, 42.9%, and 6.6% among those aged <65 years and 40.4%, 38.3%, and 21.3% among those aged ≥65 years. In patients aged ≥65 years, the rate of SMI decrease in the normal (0.85 [95% confidence interval, CI: −0.66 to 2.35]) and slow (0.93 [95% CI −0.61 to 2.46]) speed eating groups was higher than that in the fast speed eating group (−1.08 [95% CI −2.52 to 0.36]). On the contrary, there was no difference in the rate of SMI decrease among the groups in patients aged <65 years. Compared with slow speed eating, the adjusted odds ratios of incident muscle loss [defined as rate of SMI decrease (%) ≥0.5%] due to fast– and normal–speed eating were 0.42 (95% CI 0.18 to 0.98) and 0.82 (95% CI 0.36 to 2.03), respectively.

Conclusion

Slow–speed eating is associated with a higher risk of muscle mass loss in older patients with T2DM.

Dietary changes based on food purchase patterns following a type 2 diabetes diagnosis

OBJECTIVE

The study explores whether type 2 diabetes (T2D) diagnosis affects food consumption patterns in line with the dietary recommendations provided to individuals in relation to a diagnosis.

DESIGN

Based on detailed food purchase data, we explore which dietary changes are most common following a T2D diagnosis. Changes are investigated for several energy-adjusted nutrients and food groups and overall adherence to dietary guidelines.

SETTING

We use data on diagnosis of T2D and hospitalisation in relation to T2D for a sample of adult Danes registered in the official patient register. This is combined with detailed scanner data on food purchases, which are used as a proxy for dietary intake.

PARTICIPANTS

We included 274 individuals in Denmark who are diagnosed during their participation in a consumer panel where they report their food purchases and 16 395 individuals who are not diagnosed.

RESULTS

Results suggest some changes in dietary composition following diagnosis, as measured by a Healthy Eating Index and for specific food groups and nutrients, although the long-term effects are limited. Socio-economic characteristics are poor predictors of dietary changes following diagnosis. Change in diet following diagnosis vary with the pre-diagnosis consumption patterns, where individuals with relatively unhealthy overall diets prior to diagnosis improve overall healthiness more compared to individuals with relatively healthy diets prior to diagnosis.

CONCLUSIONS

Adherence to dietary advice is low, on average, but there is large variation in behavioural change between the diagnosed individuals. Our results stress the difficulty for diagnosed individuals to shift dietary habits, particularly in the long term.

Relative validity and reproducibility of food frequency questionnaire for individuals on hemodialysis (NUGE-HD study)

INTRODUCTION

Adequate assessment of food intake is essential to establish the magnitude and direction of the relationship of food, nutrients, and bioactive compounds with clinical outcomes of individuals in hemodialysis. We evaluated the relative validity and reproducibility of a specific food frequency questionnaire for individuals on hemodialysis (FFQ-HD).

METHODS

Eighty-two participants (57.3% male, 57.5 ± 14.4 years) from the open cohort Nutrition and Genetics in Hemodialysis Outcomes participated in this study. The relative validity of the FFQ-HD was assessed using the mean of two 24-h food recall (24hR) adjusted for within-subject variability as a reference method. We also performed Pearson correlations, and agreement between tertile, kappa statistics, and Bland-Altman scatter plots were validated. Reproducibility was assessed after 1 year using intraclass correlation coefficient (ICC).

FINDINGS

Daily energy intake was not different between FFQ-HD and 24hR (mean difference of 50.1 kcal). Intake of protein, linolenic acid, fiber, phosphorus, potassium, sodium, calcium, and sugar showed a moderate correlation (r between 0.4 and 0.5) among instruments, while mean correlation coefficient was r = 0.38 to food group intake. Bland-Altman plots showed good agreement for micronutrients, phosphorus, sodium, and potassium and for the groups "flour, bread, and pasta" and "processed, canned meat, salts, and seasonings". The reproducibility of FFQ-HD for nutrients and food groups was satisfactory, reaching a maximum ICC of 0.72 and 0.59, respectively.

DISCUSSION

The FFQ-HD showed moderate validity and reproducibility for calories, nutrients, and food groups of clinical and nutritional interest for HD subjects so that it can be a useful tool in epidemiological studies in this population.

Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)-a cross-sectional study

OBJECTIVES

Diabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia.

SETTING

The Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities.

PARTICIPANTS

Between June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes.

RESULTS

The overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes.

CONCLUSIONS

Diabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.

Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes: a randomized controlled trial

PURPOSE

This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A tertiary hospital outpatient adults (40-70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments).

RESULTS

Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months.

CONCLUSIONS

NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation.

TRIAL REGISTRATION

ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.

Energy Expenditure in Free-Living Japanese People with Obesity and Type 2 Diabetes, Measured Using the Doubly-Labeled Water Method

We determined the total energy expenditure (TEE) of healthy overweight or obese people, and those with impaired glucose tolerance and/or impaired fasting glycemia (IGT/IFG), or type 2 diabetes (T2DM) using the doubly-labeled water method. As a second purpose, we compared the measured TEE with the target energy intake recommended in the treatment guidelines for diabetes. The participants were normal glucose tolerance (NGT), and IGT/IFG (n=11) and T2DM (n=9) patients, who were 50-59 y and had a body mass index >25 kg/m². The median TEE/body mass (BM) values were 32.6, 33.3, and 34.4 kcal/kg BM and the TEE/target BM values (target BM: BM at a BMI of 22 kg/m²) were 43.7, 50.2, and 46.5 kcal/kg target BM for each group, respectively, and did not differ significantly among them. Obese Japanese participants with T2DM in this study had lower TEE/BM than previously studied in non-obese participants with T2DM. In IGT/IFG or T2DM patients, if 30 kcal/kg target BM was used as the energy coefficient, on the basis of the treatment guidelines, the difference between TEE and the target energy intake would be -1,174±552 kcal (-38±11%). When 35 kcal/kg target BM was used as the energy coefficient, the difference between TEE and the target energy intake would be -877±542 kcal (-27±13%). Thus, the energy coefficients used to estimate target energy intake during lifestyle modification in obese/overweight patients with T2DM are considered to be quite low during the first step of diet therapy.

Energy Requirements for Older Patients with Type 2 Diabetes: A Narrative Review of the Current Findings and Future Tasks

Aging patients with type 2 diabetes (T2DM) have a high risk of frailty and disability. This narrative review summarizes the current findings and future tasks regarding the following issues: (1) the optimum body mass index (BMI) target for patients with T2DM, (2) energy expenditure and requirements of patients with T2DM, and (3) the significance of low-intensity physical activity (LPA) as a key determinant of total energy expenditure (TEE) among the older population. While weight reduction is associated with an improvement in glycemic control, an increased risk of mortality as well as disability related to unhealthy BMI must also be considered, especially in older patients. The optimum BMI range and energy requirements for maintaining a healthy BMI should be identified. Limited evidence has shown that the TEE measured using the doubly labeled water method in patients with T2DM did not differ from that of subjects without diabetes, suggesting that the energy requirement data of subjects without diabetes may be applicable to these populations. LPA is one of the determinants of variability in the energy requirements of older patients with T2DM, and the beneficial effects of increasing LPA on nutritional intake and frailty prevention should be investigated further.

Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status

BACKGROUND

This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated.

RESULTS

In 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes.

CONCLUSION

The high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.

The quality of dietary carbohydrate and fat is associated with better metabolic control in persons with type 1 and type 2 diabetes

Background

Diet quality is generally poor in persons with diabetes and it is unknown whether this is associated with worse glycaemic control and atherogenic lipid profile. The aim was to examine diet quality in relation to important markers of metabolic control in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D).

Methods

The study was cross-sectional and included 423 (49% females) persons with T1D and 339 (29% females) persons with T2D recruited from an outpatient diabetes clinic in Denmark. Data were collected from July 2014 to January 2015. Diet quality was assessed with a food frequency questionnaire to examine eight key dietary components (carbohydrates, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, added sugar, dietary fibre, fruit and vegetables). Clinical data assessing metabolic control (haemoglobin A1c (HbA1c), total cholesterol (total C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic and diastolic blood pressure and body mass index were extracted from the electronic medical records.

Results

In T1D, higher intake of carbohydrates and added sugar was associated with higher HbA1c; higher fruit intake was associated with lower total C and LDL-C; and higher intake of carbohydrates and dietary fibre was associated with lower HDL-C. In T2D, higher intake of saturated fat was associated with higher total C; higher intake of added sugar was associated with higher LDL-C; and higher intake of polyunsaturated fat was associated with higher diastolic blood pressure.

Conclusions

In Danish adults with T1D and T2D, both the total intake and the quality of carbohydrates and fat were associated with an unfavourable glucose regulation and lipid profile. Thus, our findings support a constant focus on diet and emphasise the need for dietary support in people with diabetes to improve diet quality, metabolic control and possibly reduce cardiovascular risk.

Under-reporting of the energy intake in patients with type 2 diabetes

BACKGROUND

In patients with type 2 diabetes mellitus (DM), an accurate assessment of food intake is essential for clinical nutritional management. Tools such as the food frequency questionnaire (FFQ) and 24-h food record (24HR) identify dietary habits in support of dietary planning. However, it is possible that these tools have reporting errors with respect to assessing food intake, particularly energy intake (EI).

METHODS

A cross-sectional study was conducted in patients with type 2 DM. EI was assessed by the FFQ and 24HR tools. Resting energy expenditure (REE) was measured by indirect calorimetry. Data were analysed using a kappa test, t-test and Spearman's correlation coefficients. Under-reporting was assessed using the EI/REE ratio. Patients with values <1.18 and <1.10 for FFQ and 24HR, respectively, were considered as under-reporting.

RESULTS

We evaluated 55 patients [mean (SD) 62.7 (5.3) years old, duration of diabetes 11.2 (7.3) years, 52.7% female]. The mean (SD) EI assessed by FFQ was 1797.7 (641.3) and as assessed by 24HR was 1624 (484.8) kcal day^-1 . The mean (SD) REE was 1641.3 (322.3) kcal day^-1 . The mean (SD) ratios FFQ/REE and 24HR/REE were 1.11 (0.38) and 1.01 (0.30), respectively. The tools showed a moderate agreement for under-reporting of EI (kappa = 0.404; P = 0.003). Moderate and positive correlations between REE were observed with FFQ (r = 0.321; P = 0.017) and 24HR (r = 0.364; P = 0.006). According to the tools, the under-reporting was observed in approximately 65% of patients.

CONCLUSIONS

The majority of patients with type 2 DM under-reported their calorie intake, as assessed by FFQ and 24HR. REE showed a positive correlation with both tools.

Impact of obesity on underreporting of energy intake in type 2 diabetic patients: Clinical Evaluation of Energy Requirements in Patients with Diabetes Mellitus (CLEVER-DM) study

BACKGROUND & AIMS

Although accurate assessment of energy intake (EI) is critical in diabetes care, underreporting of EI on dietary records (DR) is often an issue. However, few studies have examined EI with doubly labeled water (DLW) in patients with diabetes mellitus. We aimed to investigate the impact of sex and obesity on the dissociation of DR from total energy expenditure (TEE) evaluated with DLW in patients with type 2 diabetes.

METHODS

Fifty-two patients with type 2 diabetes aged 60-79 years were enrolled for the Clinical Evaluation of Energy Requirements in Patients with Diabetes Mellitus (CLEVER-DM) study at a single university hospital. TEE was measured over 14 days by the DLW method as standard. EI was calculated by assessment of 3-day DR by registered dietitians.

RESULTS

The mean difference between EI and TEE was 238 ± 412 kcal/day (~10% of TEE). Neither EI nor TEE was significantly different between obese (body mass index (BMI) ≥25 kg/m²) and non-obese (BMI <25 kg/m²) patients. There was a negative correlation between EI/TEE ratio and BMI in women (R = -0.437, P = 0.033) but not in men (R = -0.174, P = 0.377). There was a significant difference in EI/TEE ratio between obese and non-obese patients among women (0.85 ± 0.15 vs. 1.01 ± 0.21, P = 0.045) but not men (0.85 ± 0.20 vs. 0.87 ± 0.17, P = 0.79).

CONCLUSIONS

EI calculated by 3-day DR may underestimate habitual intake, which is assumed to be equal to TEE measured by the DLW method except in non-obese women with diabetes.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000023051.

Acute Hyperenergetic, High-Fat Feeding Increases Circulating FGF21, LECT2, and Fetuin-A in Healthy Men

BACKGROUND

Hepatokines such as fibroblast growth factor 21 (FGF21), leukocyte cell-derived chemotaxin 2 (LECT2), fetuin-A, fetuin-B, and selenoprotein P (SeP) are liver-derived proteins that are modulated by chronic energy status and metabolic disease. Emerging data from rodent and cell models indicate that hepatokines may be sensitive to acute nutritional manipulation; however, data in humans are lacking.

OBJECTIVE

The aim was to investigate the influence of hyperenergetic, high-fat feeding on circulating hepatokine concentrations, including the time course of responses.

METHODS

In a randomized, crossover design, 12 healthy men [mean ± SD: age, 24 ± 4 y; BMI (kg/m2), 24.1 ± 1.5] consumed a 7-d hyperenergetic, high-fat diet [HE-HFD; +50% energy, 65% total energy as fat (32% saturated, 26% monounsaturated, 8% polyunsaturated)] and control diet (36% total energy as fat), separated by 3 wk. Whole-body insulin sensitivity was assessed before and after each diet using oral-glucose-tolerance tests. Fasting plasma concentrations of FGF21 (primary outcome), LECT2, fetuin-A, fetuin-B, SeP, and related metabolites were measured after 1, 3, and 7 d of each diet. Hepatokine responses were analyzed using 2-factor repeated-measures ANOVA and subsequent pairwise comparisons.

RESULTS

Compared with the control, the HE-HFD increased circulating FGF21 at 1 d (105%) and 3 d (121%; P ≤ 0.040), LECT2 at 3 d (17%) and 7 d (32%; P ≤ 0.004), and fetuin-A at 7 d (7%; P = 0.028). Plasma fetuin-B and SeP did not respond to the HE-HFD. Whole-body insulin sensitivity was reduced after the HE-HFD by 31% (P = 0.021).

CONCLUSIONS

Acute high-fat overfeeding augments circulating concentrations of FGF21, LECT2, and fetuin-A in healthy men. Notably, the time course of response varies between proteins and is transient for FGF21. These findings provide further insight into the nutritional regulation of hepatokines in humans and their interaction with metabolic homeostasis. This study was registered at clinicaltrials.gov as NCT03369145.

Dietary habits and adherence to dietary recommendations in patients with type 1 and type 2 diabetes compared with the general population in Denmark

OBJECTIVES

The aim of the present study was to examine dietary habits and adherence to dietary recommendations in adult patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with the general population in Denmark.

METHODS

The study was cross-sectional and included 426 patients with T1D and 348 patients with T2D recruited from an outpatient diabetes clinic in the capital region of Denmark. Dietary habits were assessed by a food frequency questionnaire and compared with dietary data from 2,899 participants without diabetes from the Danish National Survey of Dietary Habits and Physical Activity.

RESULTS

Patients with diabetes had a 20-50% lower intake of added sugar and alcohol, and a 10-20% higher intake of fibre and vegetables compared with the general population (p<0.001 for all). Patients with T2D had a 37% lower intake of alcohol compared with T1D (p<0.001). Adherence to dietary recommendations (e.g. fibre, saturated fat, vegetables, fruit and fish) were low in all groups but lowest in the general population.

CONCLUSION

The Danish diet is too high in saturated fat and too low in dietary fibre, vegetable, fruit and fish compared to dietary recommendations in both patients with diabetes and the general population. However, our data demonstrate that patients with diabetes consume a healthier diet compared to the general population: Limiting the intake of added sugar and alcohol, and increasing the intake of vegetables and dietary fibre.

Daily consumption of fruit-flavored yoghurt enriched with vitamins B contributes to lower energy intake and body weight reduction, in type 2 diabetic patients: a randomized clinical trial

Fruit-yoghurt enriched with vitamins B promotes body weight reduction and improves vitamin B status and homocysteine levels in T2DM patients.

Total energy expenditure is comparable between patients with and without diabetes mellitus: Clinical Evaluation of Energy Requirements in Patients with Diabetes Mellitus (CLEVER-DM) Study

OBJECTIVE

Assessment of total energy expenditure (TEE) is essential for appropriate recommendations regarding dietary intake and physical activity in patients with and without diabetes mellitus (DM). However, few reports have focused on TEE in patients with DM, particularly in Asian countries. Therefore, we evaluated TEE in Japanese patients with DM using the doubly labeled water (DLW) method and physical activity level (PAL).

RESEARCH DESIGN AND METHODS

In this cross-sectional observational study, we evaluated 52 patients with type 2 DM and 15 patients without DM. Free-living TEE was measured over 12-16 days by the DLW method, and PAL was calculated as TEE divided by the basal metabolic rate (BMR) as assessed by indirect calorimetry. The equivalence margin was defined as 5 kcal/kg/day.

RESULTS

The numbers of patients with DM treated with insulin, oral antidiabetic drugs, and diet were 18 (34.6%), 20 (38.5%), and 14 (26.9%), respectively. The mean±SD level of glycated hemoglobin was 6.9%±0.8% and 5.5%±0.3% in the DM and non-DM group, respectively (p<0.001). The mean body mass index was 23.3±3.0 and 22.7±2.1 kg/m² in the DM and non-DM group, respectively. The mean TEE per kilogram body weight adjusted for sex and age was 36.5 kcal/kg/day and 37.5 kcal/kg/day in the DM and non-DM group, respectively, with no significant difference (mean difference, -1.0 kcal/kg/day; 95% CI -4.2 to 2.3 kcal/kg/day). The BMR tended to be higher in the DM than in the non-DM group (mean difference, 33 kcal/day; 95% CI, -15 to 80 kcal/day). The mean PAL adjusted for sex and age was 1.71 and 1.81 in the DM and non-DM group, respectively, without a significant difference (mean difference, -0.10; 95% CI -0.21 to 0.01).

CONCLUSION

TEE was comparable between Japanese patients with and without DM.

TRIAL REGISTRATION NUMBER

UMIN000023051.

Evaluation of Pictorial Dietary Assessment Tool for Hospitalized Patients with Diabetes: Cost, Accuracy, and User Satisfaction Analysis

Although nutritional screening and dietary monitoring in clinical settings are important, studies on related user satisfaction and cost benefit are still lacking. This study aimed to: (1) elucidate the cost of implementing a newly developed dietary monitoring tool, the Pictorial Dietary Assessment Tool (PDAT); and (2) investigate the accuracy of estimation and satisfaction of healthcare staff after the use of the PDAT. A cross-over intervention study was conducted among 132 hospitalized patients with diabetes. Cost and time for the implementation of PDAT in comparison to modified Comstock was estimated using the activity-based costing approach. Accuracy was expressed as the percentages of energy and protein obtained by both methods, which were within 15% and 30%, respectively, of those obtained by the food weighing. Satisfaction of healthcare staff was measured using a standardized questionnaire. Time to complete the food intake recording of patients using PDAT (2.31 ± 0.70 min) was shorter than when modified Comstock (3.53 ± 1.27 min) was used (p < 0.001). Overall cost per patient was slightly higher for PDAT (United States Dollar 0.27 ± 0.02) than for modified Comstock (USD 0.26 ± 0.04 (p < 0.05)). The accuracy of energy intake estimated by modified Comstock was 10% lower than that of PDAT. There was poorer accuracy of protein intake estimated by modified Comstock (<40%) compared to that estimated by the PDAT (>71%) (p < 0.05). Mean user satisfaction of healthcare staff was significantly higher for PDAT than that for modified Comstock (p < 0.05). PDAT requires a shorter time to be completed and was rated better than modified Comstock.

Association between dairy intake, lipids and vascular structure and function in diabetes

AIM

To determine lipid species that change in response to a change in dairy consumption. In addition, to investigate whether dairy associated lipid species are correlated with changes in measures of vascular structure and function.

METHODS

A 12-mo randomised controlled trial was conducted to determine the effect of increased consumption of fruit, vegetables and dairy, compared to usual diet, on measures of vascular structure and function in adults with type 1 and type 2 diabetes (n = 108). This paper comprises post-hoc analyses investigating the relationship between dairy intake, serum lipid species and vascular health. Central and peripheral blood pressure, carotid femoral pulse wave velocity, augmentation index, serum lipid species and dietary intake were measured at baseline and 3-mo. Common carotid artery intima media thickness was measured at baseline and 12-mo.

RESULTS

Serum lipid species [lysophosphatidylcholine (LPC) 14:0, LPC 15:0, LPC 16:1, phosphatidylcholine (PC) 29:0 PC 30:0, PC 31:0 and cholesterol ester (CE) 14:0] were associated with the change in full fat dairy consumption (rho 0.19-0.25; P < 0.05). The 3-mo change in some lipids was positively associated with the 3-mo change in central systolic [LPC 14:0 (rho 0.30; P = 0.007), PC 30:0 (rho 0.28; P = 0.010)] and diastolic blood pressure [LPC 14:0 (rho 0.32; P = 0.004), LPC 15:0 (rho 0.23; P = 0.04), LPC 16:1 (rho 0.23; P = 0.035), PC 29:0 (rho 0.28; P = 0.01), PC 30:0 (rho 0.36; P = 0.001), PC 31:0 (rho 0.30; P = 0.007)] and 12-mo change in common carotid artery intimal medial thickness [CE 14:0 (rho 0.22; P = 0.02)]. Pulse wave velocity and augmentation index were unrelated to dairy and lipid species.

CONCLUSION

An increase in dairy associated lipids appears to be associated with an increase in blood pressure and common carotid intimal medial thickness.

Short-term, high-fat overfeeding impairs glycaemic control but does not alter gut hormone responses to a mixed meal tolerance test in healthy, normal-weight individuals

Obesity is undoubtedly caused by a chronic positive energy balance. However, the early metabolic and hormonal responses to overeating are poorly described. This study determined glycaemic control and selected gut hormone responses to nutrient intake before and after 7 d of high-fat overfeeding. Nine healthy individuals (five males, four females) performed a mixed meal tolerance test (MTT) before and after consuming a high-fat (65 %), high-energy (+50 %) diet for 7 d. Measurements of plasma glucose, NEFA, acylated ghrelin, glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP) and serum insulin were taken before (fasting) and at 30-min intervals throughout the 180-min MTT (postprandial). Body mass increased by 0·79 (sem 0·14) kg after high-fat overfeeding (P<0·0001), and BMI increased by 0·27 (sem 0·05) kg/m2 (P=0·002). High-fat overfeeding also resulted in an 11·6 % increase in postprandial glucose AUC (P=0·007) and a 25·9 % increase in postprandial insulin AUC (P=0·005). Acylated ghrelin, GLP-1 and GIP responses to the MTT were all unaffected by the high-fat, high-energy diet. These findings demonstrate that even brief periods of overeating are sufficient to disrupt glycaemic control. However, as the postprandial orexigenic (ghrelin) and anorexigenic/insulintropic (GLP-1 and GIP) hormone responses were unaffected by the diet intervention, it appears that these hormones are resistant to short-term changes in energy balance, and that they do not play a role in the rapid reduction in glycaemic control.

A Substance Called Food: Long-Term Psychodynamic Group Treatment for Compulsive Overeating

Obesity has proven difficult to treat. Many approaches neglect to address the deep-rooted underlying psychological issues. This paper describes a psychodynamically oriented approach to treating compulsive overeating as an addiction. Common to all addictions is a compulsion to consume a substance or engage in a behavior, a preoccupation with using behavior and rituals, and a lifestyle marked by an inability to manage the behavior and its harmful consequences. The approach represents a shift away from primarily medical models of intervention to integrated models focusing on the psychological underpinnings of obesity. Long-term psychodynamic group psychotherapy is recommended as a primary treatment.

Controlling type-2 diabetes by inclusion of Cr-enriched yeast bread in the daily dietary pattern: a randomized clinical trial

PURPOSE

Chromium (Cr)-enriched yeast supplementation to whole wheat bread (WWCrB) has been shown to ameliorate postprandial glycemic response in healthy subjects. The present study investigates the long-term benefit of WWCrB consumption for patients with type-2 diabetes mellitus (T2DM).

METHODS

Thirty patients with T2DM were randomly assigned to a group receiving WWCrB or the plain whole wheat bread (WWB) group. Plasma glucose, insulin, glycosylated hemoglobin (HbA_1c) and insulin resistance were determined, and oral glucose tolerance test (OGTT) was performed at the beginning and the end of the dietary intervention, which lasted for 12 weeks. Biochemical parameters related to the disease, markers of inflammation as well as body weight and energy balance were examined.

RESULTS

At the end of the study, subjects of WWCrB group exerted lower levels of glucose, insulin and HbA_1c and improved insulin resistance (P < 0.05 against before treatment). Area under the glucose curve attained during OGTT decreased after the intervention (28,117.5 ± 1266.4 vs. 31,588.5 ± 1187.5 mg min/dL before treatment, P < 0.05) with significantly lower values of glucose concentration at 0 and 60 min. A significant reduction in body weight and systolic blood pressure (SBP) was observed (P < 0.05 against before treatment). Markers of inflammation and lipid profiles were not affected by WWCrB consumption.

CONCLUSIONS

Inclusion of WWCrB in the daily dietary pattern of diabetic patients resulted in improvement of glucose tolerance and insulin resistance, significant reduction in HbA_1c, weight loss and lower SBP. Patients with inadequate glycemic control may benefit from the consumption of WWCrB.

Assessment of mineral intake in the diets of Polish postmenopausal women in relation to their BMI-the RAC-OST-POL study : Mineral intake in relation to BMI

BACKGROUND

The diets of postmenopausal women in Western countries tend to be deficient in minerals, even if the energy value is at the recommended level. The objective of the presented population-based cohort study was to assess the intake of minerals (sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper) in the diets of women aged above 55 years and to analyse the relations between BMI and mineral intake in this group.

METHODS

The study was conducted in a group of 406 women who were randomly recruited from the general population of those aged above 55 years. The main outcome measures included BMI, reported sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper intake assessed by dietary record (conducted during two typical, non-consecutive days). The distribution was verified with the use of the Shapiro-Wilk test. The comparison between groups was conducted using ANOVA with the LSD post hoc test or Kruskal-Wallis ANOVA with multiple comparisons. A comparison of satisfying nutritional needs was conducted using the chi-square test.

RESULTS

Normal body weight individuals were characterised by lower sodium intake per 1000 kcal of diet than obese class II and III individuals (BMI ≥ 35.0 kg/m(2)). Overweight individuals were characterised by lower potassium and magnesium intake per 1000 kcal of diet than obese class I individuals (BMIϵ < 30.0; 35.0 kg/m(2)). The majority of individuals was characterised by insufficient potassium, calcium and magnesium intake. No differences in satisfying nutritional needs between BMI groups were observed for all minerals.

CONCLUSIONS

Following an improperly balanced diet was observed in the group of postmenopausal female individuals analysed. It was stated that the daily intake of all the assessed minerals was not BMI-dependent for the postmenopausal female individuals, but the nutrient density of diet (for sodium, potassium and magnesium) was associated with BMI.

Changes in fruit, vegetable and juice consumption after the diagnosis of type 2 diabetes: a prospective study in men

Given the importance of prevention of complications in type 2 diabetes (T2D), we aimed to examine changes over time in consumption of fruits, vegetables and juice among men who were diagnosed with T2D in comparison with men without diabetes. The prospective Cohort of Swedish Men, aged 45-79 years in 1997, was used to examine changes in diet after diagnosis of T2D. Dietary intake was assessed using FFQ in 1997 and 2009. In all, 23 953 men who were diabetes free at baseline (1997) and completed both FFQ were eligible to participate in the study. Diagnosis of T2D was reported by subjects and ascertained through registers. Multivariable linear mixed models were used to examine changes in mean servings/week over time. In total, 1741 men developed T2D during the study period. Increased consumption of vegetables and fruits was observed among those who developed T2D (equivalent to 1·6 servings/week, 95 % CI 1·08, 2·03) and men who remained diabetes free (0·7 servings/week, 95 % CI 0·54, 0·84). Consumption of juice decreased by 0·6 servings/week (95 % CI -0·71, -0·39) among those who developed T2D and increased by 0·1 servings/week (95 % CI 0·05, 0·15) in those who were diabetes free. Changes over time and between groups were statistically significant. Although improvements in diet were observed, only 36 % of those with T2D and 35 % of those without diabetes consumed ≥5 servings of fruits and vegetables/d in 2009.

The effect of under-reporting of energy intake on dietary patterns and on the associations between dietary patterns and self-reported chronic disease in women aged 50–69 years

The aim of this cross-sectional study was to investigate whether under-reporting of energy intake affects derived dietary patterns and the association between dietary patterns and self-reported chronic disease. Diets of 6204 women aged 50–69 years participating in the Norwegian Breast Cancer Screening Program were assessed using a 253-item FFQ. We identified dietary patterns using principal component analysis. According to the revised Goldberg cut-off method, women with a ratio of reported energy intake:estimated BMR<1·10 were classified as low energy reporters (n 1133, 18 %). We examined the associations between dietary patterns and self-reported chronic diseases by log-binomial regression, and the results are presented as prevalence ratios (PR) and CI. ‘Prudent’, ‘Western’ and ‘Continental’ dietary patterns were identified among all reporters and plausible reporters. The PR expressing the associations between the ‘Western’ and ‘Prudent’ dietary pattern scores and self-reported chronic diseases were consistently highest among plausible reporters except for joint/muscle/skeletal disorders. The largest difference in PR among plausible v. all reporters was found for the association between the ‘Prudent’ pattern and diabetes (PR for highest v. lowest tertile: PRall reporters 2·16; 95 % CI 1·50, 3·13; Ptrend<0·001; PRplausible reporters 2·86; 95 % CI 1·81, 4·51; Ptrend<0·001). In conclusion, our results suggest that under-reporting can result in systematic error that can affect the association between dietary pattern and disease. In studies of dietary patterns, investigators ought to consider reporting effect estimates both for all individuals and for plausible reporters.

Effects of sardine-enriched diet on metabolic control, inflammation and gut microbiota in drug-naïve patients with type 2 diabetes: a pilot randomized trial

BACKGROUND

Nutrition therapy is the cornerstone of treating diabetes mellitus. The inclusion of fish (particularly oily fish) at least two times per week is recommended by current international dietary guidelines for type 2 diabetes. In contrast to a large number of human studies examining the effects of oily fish on different cardiovascular risk factors, little research on this topic is available in patients with type 2 diabetes. The aims of this pilot study were to investigate the effects of a sardine-enriched diet on metabolic control, adiponectin, inflammatory markers, erythrocyte membrane fatty acid (EMFA) composition, and gut microbiota in drug-naïve patients with type 2 diabetes.

METHODS

35 drug-naïve patients with type 2 diabetes were randomized to follow either a type 2 diabetes standard diet (control group: CG), or a standard diet enriched with 100 g of sardines 5 days a week (sardine group: SG) for 6 months. Anthropometric, dietary information, fasting glycated hemoglobin, glucose, insulin, adiponectin, inflammatory markers, EMFA and specific bacterial strains were determined before and after intervention.

RESULTS

There were no significant differences in glycemic control between groups at the end of the study. Both groups decreased plasma insulin (SG: -35.3%, P = 0.01, CG: -22.6%, P = 0.02) and homeostasis model of assessment--insulin resistance (HOMA-IR) (SG: -39.2%, P = 0.007, CG: -21.8%, P = 0.04) at 6-months from baseline. However only SG increased adiponectin in plasma compared to baseline level (+40.7%, P = 0.04). The omega-3 index increased 2.6% in the SG compared to 0.6% in the CG (P = 0.001). Both dietary interventions decreased phylum Firmicutes (SG and CG: P = 0.04) and increased E. coli concentrations (SG: P = 0.01, CG: P = 0.03) at the end of the study from baseline, whereas SG decreased Firmicutes/Bacteroidetes ratio (P = 0.04) and increased Bacteroides-Prevotella (P = 0.004) compared to baseline.

CONCLUSIONS

Although enriching diet with 100 g of sardines 5 days a week during 6 months to a type 2 diabetes standard diet seems to have neutral effects on glycemic control in drug-naïve patients with type 2 diabetes, this nutritional intervention could have beneficial effects on cardiovascular risk. Furthermore, both dietary interventions decreased HOMA-IR and altered gut microbiota composition of drug-naïve patients with type 2 diabetes.

TRIAL REGISTRATION

Trial number and name of the registry: NCT02294526, ClinicalTrials.gov.

Dietary intake in adults with type 1 and type 2 diabetes: validation of the Dietary Questionnaire for Epidemiological Studies version 2 FFQ against a 3-d weighed food record and 24-h urinalysis

The Dietary Questionnaire for Epidemiological Studies version 2 (DQES v2) FFQ has not been validated in adults with diabetes. The aim was to determine the agreement between the DQES v2 FFQ and a 3-d weighed food record (WFR) and 24-h urinalysis in adults with type 1 and type 2 diabetes. The DQES v2 FFQ and a 3-d WFR were completed on one occasion for measurement of food and nutrient intake. A 24-h urine sample was provided for measurement of Na and K excretion. Participants were sixty-seven adults with type 1 and type 2 diabetes recruited from the community. Nutrient intake reported in the FFQ was within 20 % of the corresponding intake level reported in the WFR for the majority of nutrients. However, the 95 % limits of agreement showed large variation at an individual level between the two methods. There was a weak to moderate correlation between nutrient intake measured using the two methods and a moderate to high correlation for food intake. Quintile analysis showed that for the majority of foods and nutrients >60 % of participants were ranked within 1 quintile of the WFR ranking. The weighted κ values showed slight to moderate agreement between the two methods. Na intake was under-estimated in the FFQ by 25 % and K intake was over-estimated by 5 % compared with the 24-h urinalysis. In adults with type 1 and type 2 diabetes, it is appropriate to use the DQES v2 FFQ to measure food and nutrient intake at a group level.

Evaluation of a Mobile Phone Image-Based Dietary Assessment Method in Adults with Type 2 Diabetes

Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM), in adults with type 2 diabetes mellitus (T2DM). Criterion validity was determined by comparing energy intake (EI) with total energy expenditure (TEE) measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR). Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m²) participated. Compared to TEE, mean EI (MJ/day) was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57), carbohydrate (g/day) (r = 0.63, p < 0.05), protein (g/day) (r = 0.78, p < 0.01) and alcohol (g/day) (r_s = 0.85, p < 0.01), with a weaker relationship for fat (g/day) (r = 0.24). Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC) = 0.77–0.99) was lower when compared with the 3-day WFR (ICC = 0.82–0.99). These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.

Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial

Objective

To evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA1c), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus.

Design

A randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2–2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic).

Setting

Two community health centres, Moretele sub-district (North West Province), South Africa.

Subjects

Adults (aged 40–70 years) with type 2 diabetes, HbA1c ≥8 %.

Results

Differences in HbA1c (primary outcome) were −0·64 % (P=0·15) at 6 months and −0·63 % (P=0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P=0·005) at 6 months and 9·9 v. 11·9 servings/d (P=0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P=0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed.

Conclusions

Nutrition education was not efficacious on HbA1c; however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.

Correlations among obesity-associated gene polymorphisms, body composition, and physical activity in patients with type 2 diabetes mellitus

CONTEXT

Various studies have focused on the correlation between β2-adrenergic receptor (β2AR), the β3-adrenergic receptor (β3AR), and the uncoupling protein 1 (UCP1) polymorphisms and obesity in patients with type 2 diabetes mellitus (T2DM).

AIMS

We examined the correlation between these polymorphisms and body composition variables and between body composition and lifestyle variables in Japanese T2DM patients.

MATERIALS AND METHODS

Of the 48, T2DM outpatients in Kanagawa prefecture recruited for participation, 32 (6 men and 26 women) met the study criteria and were enrolled. Obesity-related gene polymorphisms were identified in 3 genes β3AR, UCP1, and β2AR using the SMart amplification process. Body composition variables were measured using a body composition analyzer. Data regarding food and nutrient consumption, family history, and lifestyle factors were collected via administration of questionnaires.

RESULTS

Because significant differences in body composition variables were found between men and women, statistical analysis was performed with data from the 25 female subjects only. On the basis of results of genetic testing, the subjects were divided into genotype groups for two-group and three-group comparison. The β3AR, UCP1, and β2AR polymorphisms and body composition significantly correlated with the percentage of subcutaneous fat in both arms as compared with the wild type or hetero groups with β3AR polymorphisms. However, physical activity correlated with several body composition variables.

CONCLUSIONS

These results suggest that obesity in T2DM patients is not the result of presence of an obesity-related gene polymorphism but rather the absence of daily physical activity.

A method for neighborhood-level surveillance of food purchasing

Added sugar, particularly in carbonated soft drinks (CSDs), represents a considerable proportion of caloric intake in North America. Interventions to decrease the intake of added sugar have been proposed, but monitoring their effectiveness can be difficult due to the costs and limitations of dietary surveys. We developed, assessed the accuracy of, and took an initial step toward validating an indicator of neighborhood-level purchases of CSDs using automatically captured store scanner data in Montreal, Canada, between 2008 and 2010 and census data describing neighborhood socioeconomic characteristics. Our indicator predicted total monthly neighborhood sales based on historical sales and promotions and characteristics of the stores and neighborhoods. The prediction error for monthly sales in sampled stores was low (2.2%), and we demonstrated a negative association between predicted total sales and median personal income. For each $10,000 decrease in median personal income, we observed a fivefold increase in predicted monthly sales of CSDs. This indicator can be used by public health agencies to implement automated systems for neighborhood-level monitoring of an important upstream determinant of health. Future refinement of this indicator is possible to account for factors such as store catchment areas and to incorporate nutritional information about products.

High saturated-fat and low-fibre intake: a comparative analysis of nutrient intake in individuals with and without type 2 diabetes

OBJECTIVE

The aim of dietary modification, as a cornerstone of type 2 diabetes (T2DM) management, is to optimise metabolic control and overall health. This study describes food and nutrient intake in a sample of adults with T2DM, and compares this to recommendations, and to intake in age, sex, body mass index (BMI) and social-class matched adults without T2DM.

DESIGN

A cross-sectional analysis of food and nutrient intake in 124 T2DM individuals (64% male; age 57.4±5.6 years, BMI 32.5±5.8 kg m(-2)) and 124 adults (age 57.4±7.0 years, BMI 31.2±5.0 kg m(-2)) with no diabetes (ND) was undertaken using a 4-day semiweighed food diary. Biochemical and anthropometric variables were also measured.

RESULTS

While reported energy intake was similar in T2DM vs ND (1954 vs 2004 kcal per day, P=0.99), T2DM subjects consumed more total-fat (38.8% vs 35%, P0.001), monounsaturated-fat (13.3% vs 12.2%; P=0.004), polyunsaturated-fat (6.7% vs 5.9%; P<0.001) and protein (18.6% vs 17.5%, P0.01). Both groups exceeded saturated-fat recommendations (14.0% vs 13.8%). T2DM intakes of carbohydrate (39.5% vs 42.9%), non-milk sugar (10.4% vs 15.0%) and fibre (14.4 vs 18.9 g) were significantly lower (P<0.001). Dietary glycaemic load (GL) was also lower in T2DM (120.8 vs 129.2; P=0.02), despite a similar glycaemic index (59.7 vs 60.1; P=0.48). T2DM individuals reported consuming significantly more wholemeal/brown/wholegrain breads, eggs, oils, vegetables, meat/meat products, savoury snacks and soups/sauces and less white breads, breakfast cereals, cakes/buns, full-fat dairy, chocolate, fruit juices, oily fish and alcohol than ND controls.

CONCLUSION

Adults with T2DM made different food choices to ND adults. This resulted in a high saturated-fat diet, with a higher total-fat, monounsaturated-fat, polyunsaturated-fat and protein content and a lower GL, carbohydrate, fibre and non-milk sugar content. Dietary education should emphasise and reinforce the importance of higher fibre, fruit, vegetable and wholegrain intake and the substitution of monounsaturated for saturated-fat sources, in energy balanced conditions.

Lifestyle factors and mortality risk in individuals with diabetes mellitus: are the associations different from those in individuals without diabetes?

AIMS/HYPOTHESIS

Thus far, it is unclear whether lifestyle recommendations for people with diabetes should be different from those for the general public. We investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes.

METHODS

Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Joint Cox proportional hazard regression models of people with and without diabetes were built for the following lifestyle factors in relation to overall mortality risk: BMI, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking. Likelihood ratio tests for heterogeneity assessed statistical differences in regression coefficients.

RESULTS

Multivariable adjusted mortality risk among individuals with diabetes compared with those without was increased, with an HR of 1.62 (95% CI 1.51, 1.75). Intake of fruit, legumes, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk. These associations were significantly different in magnitude from those in diabetes-free individuals, but directions were similar. No differences between people with and without diabetes were detected for the other lifestyle factors.

CONCLUSIONS/INTERPRETATION

Diabetes status did not substantially influence the associations between lifestyle and mortality risk. People with diabetes may benefit more from a healthy diet, but the directions of association were similar. Thus, our study suggests that lifestyle advice with respect to mortality for patients with diabetes should not differ from recommendations for the general population.

Characteristics of energy intake under-reporting in French adults

Energy intake under-reporting (UR) is a concern in nutritional epidemiological studies, as it may distort the relationships between dietary habits and health. Although UR is known to be associated with certain characteristics, few studies have investigated them in France. Therefore, the goal of the present study was to assess the prevalence and characteristics of UR in French adults. UR was defined according to Goldberg's classification. A sample of 1567 adults was drawn from the nationally representative French dietary survey (Individuelle Nationale des Consommations Alimentaires 2 2006-7). Food intake (7 d record), dietary habits, socio-economic status, region of residence, sedentary behaviour and weight perception variables were assessed. Multivariate logistic regression was used to investigate the associations between UR and a number of covariates. The overall prevalence of UR was 22.5%, similar in men and women. In both sexes, UR was positively associated with overweight and protein intake and inversely associated with age. In women, UR was associated with eating lunch in the office, poor perception of diet quality and sedentary behaviour and was inversely associated with educational level, residence in the Paris region, cereal product intake and eating lunch in a friend's or family member's home. In men, UR was positively associated with a history of slimming and inversely associated with dairy product intake and eating lunch at a staff canteen. In conclusion, UR is prevalent in French adults and is associated with several different characteristics. It is important to take account of UR when investigating diet-disease associations in adults.

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

Background

A number of dietary quality indices (DQIs) have been developed to assess the quality of dietary intake. Analysis of the intake of individual nutrients does not reflect the complexity of dietary behaviours and their association with health and disease. The aim of this study was to determine the dietary quality of individuals with type 2 diabetes mellitus (T2DM) using a variety of validated DQIs.

Methods

In this cross-sectional analysis of 111 Caucasian adults, 65 cases with T2DM were recruited from the Diabetes Day Care Services of St. Columcille’s and St. Vincent’s Hospitals, Dublin, Ireland. Forty-six controls did not have T2DM and were recruited from the general population. Data from 3-day estimated diet diaries were used to calculate 4 DQIs.

Results

Participants with T2DM had a significantly lower score for consumption of a Mediterranean dietary pattern compared to the control group, measured using the Mediterranean Diet Score (Range 0–9) and the Alternate Mediterranean Diet Score (Range 0–9) (mean ± SD) (3.4 ± 1.3 vs 4.8 ± 1.8, P < 0.001 and 3.3 ± 1.5 vs 4.2 ± 1.8, P = 0.02 respectively). Participants with T2DM also had lower dietary quality than the control population as assessed by the Healthy Diet Indicator (Range 0–9) (T2DM; 2.6 ± 2.3, control; 3.3 ± 1.1, P = 0.001). No differences between the two groups were found when dietary quality was assessed using the Alternate Healthy Eating Index. Micronutrient intake was assessed using the Micronutrient Adequacy Score (Range 0–8) and participants with T2DM had a significantly lower score than the control group (T2DM; 1.6 ± 1.4, control; 2.3 ± 1.4, P = 0.009). When individual nutrient intakes were assessed, no significant differences were observed in macronutrient intake.

Conclusion

Overall, these findings demonstrate that T2DM was associated with a lower score when dietary quality was assessed using a number of validated indices.

Relation between energy intake and glycemic control in physically active young adults with type 1 diabetes

OBJECTIVES

To examine the relationships between daily energy expenditure, energy intake and glycemic control in young adults with type 1 diabetes.

DESIGN

Cross-sectional study.

METHODS

Energy expenditure (kcal kg(-1)d(-1)) and duration of participation in physical activity were measured from a 3-d activity diary and categorized according to their intensity on a 1-9 scale. Energy intake was measured by a 3-d food record. Glycemic control was measured using the HbA1c.

RESULTS

Energy expenditure and intake were assessed in 35 young adults with type 1 diabetes (age: 28 ± 7 years). Participants with higher energy expenditure from moderate to intense physical activity (categories 6-9) presented higher proportion of energy intake derived from carbohydrate and lower proportion of lipids in the diet with significantly higher HbA(1c) values (7.3 ± 1.0% vs 6.7 ± 0.6%).

CONCLUSIONS

These results suggest that highly physically active individuals with type 1 diabetes consume more carbohydrates than lipids, a strategy that may affect their glycemic control. Further studies are needed to develop interventions to improve glycemic control in highly active individuals with type 1 diabetes.

Nutrition and the circadian timing system

Life on earth has evolved under the daily rhythm of light and dark. Consequently, most creatures experience a daily rhythm in food availability. In this review, we first introduce the mammalian circadian timing system, consisting of a central clock in the suprachiasmatic nucleus (SCN) and peripheral clocks in various metabolic tissues including liver, pancreas, and intestine. We describe how peripheral clocks are synchronized by the SCN and metabolic signals. Second, we review the influence of the circadian timing system on food intake behavior, activity of the gastrointestinal system, and several aspects of glucose and lipid metabolism. Third, the circadian control of digestion and metabolism may have important implications for several aspects of food intake in humans. Therefore, we review the human literature on health aspects of meal timing, meal frequency, and breakfast consumption, and we describe the potential implications of the clock system for the timing of enteral tube feeding and parenteral nutrition. Finally, we explore the connection between type 2 diabetes and the circadian timing system. Although the past decade has provided exciting knowledge about the reciprocal relation between biological clocks and feeding/energy metabolism, future research is necessary to further elucidate this fascinating relationship in order to improve human health.

Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus

BACKGROUND

Dietary fiber, carbohydrate quality and quantity are associated with mortality risk in the general population. Whether this is also the case among diabetes patients is unknown.

OBJECTIVE

To assess the associations of dietary fiber, glycemic load, glycemic index, carbohydrate, sugar, and starch intake with mortality risk in individuals with diabetes.

METHODS

This study was a prospective cohort study among 6,192 individuals with confirmed diabetes mellitus (mean age of 57.4 years, and median diabetes duration of 4.4 years at baseline) from the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline (1992-2000) with validated dietary questionnaires. Cox proportional hazards analysis was performed to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality, while adjusting for CVD-related, diabetes-related, and nutritional factors.

RESULTS

During a median follow-up of 9.2 y, 791 deaths were recorded, 306 due to CVD. Dietary fiber was inversely associated with all-cause mortality risk (adjusted HR per SD increase, 0.83 [95% CI, 0.75-0.91]) and CVD mortality risk (0.76[0.64-0.89]). No significant associations were observed for glycemic load, glycemic index, carbohydrate, sugar, or starch. Glycemic load (1.42[1.07-1.88]), carbohydrate (1.67[1.18-2.37]) and sugar intake (1.53[1.12-2.09]) were associated with an increased total mortality risk among normal weight individuals (BMI≤25 kg/m(2); 22% of study population) but not among overweight individuals (P interaction≤0.04). These associations became stronger after exclusion of energy misreporters.

CONCLUSIONS

High fiber intake was associated with a decreased mortality risk. High glycemic load, carbohydrate and sugar intake were associated with an increased mortality risk in normal weight individuals with diabetes.

Zinc deficiency: a frequent and underestimated complication after bariatric surgery

BACKGROUND

Although zinc deficiency is common after bariatric surgery, its incidence is underestimated. The objective was to monitor zinc and nutritional status before and 6, 12 and 24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y gastric bypass), sleeve gastrectomy and biliopancreatic diversion with duodenal switch (DS) in patients receiving systematised nutritional care.

METHODS

Data for 324 morbidly obese patients (mean body mass index 46.2 ± 7.3 kg/m(2)) were reviewed retrospectively. The follow-up period was 6 months for 272 patients, 12 months for 175, and 24 months for 70. Anthropometric, dietary and serum albumin, prealbumin, zinc, iron and transferrin saturation measures were determined at each timepoint.

RESULTS

Nine percent of patients had zinc deficiency pre-operatively. Zinc deficiency was present in 42.5% of the population at M12 and then remained stable. Zinc deficiency was significantly more frequent after DS, with a prevalence of 91.7% at M12. Between M0 and M6, variation in plasma prealbumin, surgery type and zinc supplementation explained 27.2% of the variance in plasma zinc concentration. Surgery type explained 22.1% of this variance between M0 and M24. Mean supplemental zinc intake was low (22 mg/day). The percentage of patients taking zinc supplementation at M6, M12 and M24 was 8.9%, 20.6% and 29%, respectively.

CONCLUSIONS

Reduced protein intake, impaired zinc absorption and worsening compensatory mechanisms contribute to zinc deficiency. The mechanisms involved differ according to the type of surgery and time since surgery. Zinc supplementation is necessary early after bariatric surgery, but this requirement is often underestimated or is inadequate.

Enhanced weight loss with protein-enriched meal replacements in subjects with the metabolic syndrome

BACKGROUND

The objective of this study was to investigate the effects of a protein-rich diet in comparison with a conventional protein diet on weight loss, weight maintenance, and body composition in subjects with the metabolic syndrome.

METHODS

Obese subjects received instructions for an energy-restricted diet with a calorie deficit of 500 kcal/day and were randomly assigned to either high-protein (1.34 g/kg body weight) or conventional protein (0.8 g/kg body weight) diets for 12 months. Protein-enriched meal replacements were used to enrich one arm of the diet with protein throughout the study. In all, 67% of the participants completed the 1-year study.

RESULTS

Subjects following the high-protein diet lost more body weight and more fat mass compared with those on the conventional protein diet, whereas the loss of fat-free mass was similar in both diet groups. Biochemical parameters associated with the metabolic syndrome improved in both diet groups. Improvements were modestly greater in subjects with the high-protein diet. After 12 months of treatment, 64.5% of the subjects in the high-protein diet group and 34.8% of the subjects in the conventional diet group no longer met three or more of the criteria for having the metabolic syndrome.

CONCLUSIONS

Individuals with the metabolic syndrome achieved significant weight loss while preserving fat-free mass when treated with an energy-restricted, high-protein diet that included nutrient-dense meal replacements, as compared with the results for conventional protein intake. An intervention with a protein-enriched diet may have advantages for the management of the metabolic syndrome.

Prevalence of daily hyperglycemia in obese type 2 diabetic men compared with that in lean and obese normoglycemic men: effect of consumption of a sucrose-containing beverage

BACKGROUND

Hyperglycemia forms a direct and independent risk factor for the development of cardiovascular comorbidities in type 2 diabetes. Consumption of sucrose-sweetened soft drinks might further increase the prevalence of hyperglycemic episodes.

OBJECTIVE

The objective was to assess glycemic control in type 2 diabetic subjects and healthy lean and obese control subjects under strict dietary standardization but otherwise free-living conditions, with and without the consumption of soft drinks.

DESIGN

Obese type 2 diabetic men (n = 11) and lean (n = 10) and obese (n = 10) normoglycemic male control subjects participated in a randomized crossover study. The subjects were provided with a standardized diet in 2 periods, during which they consumed 250 mL water with or without (control) sucrose (37.5 g) 2 h after breakfast and lunch. Blood glucose concentrations were assessed by continuous glucose monitoring.

RESULTS

In the type 2 diabetic subjects, the mean 24-h glucose concentrations were significantly elevated (9.1 +/- 0.6 mmol/L), and hyperglycemia (glucose >10 mmol/L) was evident over 33 +/- 8% (8 +/- 2 h) of a 24-h period (P < 0.01). Hyperglycemia was rarely present in the normoglycemic lean and obese control subjects (5 +/- 2%/24 h for both). Consumption of 75 g sucrose, equivalent to 2 cans of a soft drink, did not further augment the prevalence of hyperglycemia throughout the day in any group.

CONCLUSIONS

Type 2 diabetic subjects taking oral blood glucose-lowering medication experience hyperglycemia during most of the daytime. Moderate consumption of sucrose-sweetened beverages does not further increase the prevalence of hyperglycemia in type 2 diabetic subjects or in normoglycemic lean or obese men.

Action for Health in Diabetes (Look AHEAD) trial: baseline evaluation of selected nutrients and food group intake

BACKGROUND

Little has been reported regarding food and nutrient intake in individuals diagnosed with type 2 diabetes, and most reports have been based on findings in select groups or individuals who self-reported having diabetes.

OBJECTIVE

To describe the baseline food and nutrient intake of the Look AHEAD (Action for Health in Diabetes) trial participants, compare participant intake to national guidelines, and describe demographic and health characteristics associated with food group consumption.

METHODS

The Look AHEAD trial is evaluating the effects of a lifestyle intervention (calorie control and increased physical activity for weight loss) compared with diabetes support and education on long-term cardiovascular and other health outcomes. Participants are 45 to 75 years old, overweight or obese (body mass index [BMI] > or = 25), and have type 2 diabetes. In this cross-sectional analysis, baseline food consumption was assessed by food frequency questionnaire from 2,757 participants between September 2000 and December 2003.

STATISTICAL ANALYSIS

Descriptive statistics were used to summarize intake by demographic characteristics. Kruskal-Wallis tests assessed univariate effects of characteristics on consumption. Multiple linear regression models assessed factors predictive of intake. Least square estimates were based on final models, and logistic regression determined factors predictive of recommended intake.

RESULTS

Ninety-three percent of the participants exceeded the recommended percentage of calories from fat, 85% exceeded the saturated fat recommendation, and 92% consumed too much sodium. Also, fewer than half met the minimum recommended servings of fruit, vegetables, dairy, and grains.

CONCLUSIONS

These participants with pre-existing diabetes did not meet recommended food and nutrition guidelines. These overweight adults diagnosed with diabetes are exceeding recommended intake of fat, saturated fats, and sodium, which may contribute to increasing their risk of cardiovascular disease and other chronic diseases.

The prevalence of abnormal eating behaviour in a representative sample of the French diabetic population

AIM

To assess the relationship between abnormal eating behaviour (AEB) and diabetes in a sample of French adult patients with type 1 (T1D) and type 2 (T2D) diabetes.

METHODS

Ninety-four consecutively recruited patients self-completed a series of validated questionnaires.

RESULTS

Over one-fourth of men with T1D (26%) or T2D (27%) and 11% of female T2D patients reported consistent and pathological overeating or binge-eating during the previous six months. Glycaemic control in these T1D patients was poorer than in T1D patients defined as normal eaters (NORM) (11.9% versus 9.6%), but did not reach statistical significance (P=0.08), and no significant difference was observed in the T2D group (P=0.61) either. T2D patients reported being markedly more restrained when eating than did the T1D patients (P=0.002), and their restraint increased along with their BMI (P<0.001). Patients who overate or binged also reported greater general hunger (P=0.02) and disinhibition (P=0.003) than did the NORM patients.

CONCLUSION

AEB is present in French diabetic patients at levels that are probably higher than among the general population. These results highlight the need for: (1) greater awareness among diabetes clinicians of the problem; (2) regular screening of diabetic patients for AEB; and (3) adaptation of therapeutic and dietary recommendations for this patient subgroup.

Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population

We examined the associations of intake of vegetables, legumes and fruit with all-cause and cause-specific mortality in a population with prevalent diabetes in Europe. A cohort of 10,449 participants with self-reported diabetes within the European Prospective Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables, legumes, and fruit were assessed at baseline between 1992 and 2000 using validated country-specific questionnaires. A total of 1346 deaths occurred. Multivariate relative risks (RR) for all-cause mortality were estimated in Cox regression models and RR for cause-specific mortality were derived in a competing risk model. An increment in intake of total vegetables, legumes, and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [95% CI 0.90-0.98]. Analyzed separately, vegetables and legumes were associated with a significantly reduced risk, whereas nonsignificant inverse associations for fruit intake were observed. Cardiovascular disease (CVD) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables, legumes, and fruit (RR 0.88 [95% CI 0.81-0.95] and 0.90 [0.82-0.99], respectively) but not cancer mortality (1.08 [0.99-1.17]). Intake of vegetables, legumes, and fruit was associated with reduced risks of all-cause and CVD mortality in a diabetic population. The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruits.

Is a failure to recognize an increase in food intake a key to understanding insulin-induced weight gain?

The present study aimed to assess the contribution of energy intake to positive energy balance and weight gain with insulin therapy. Changes in energy intake (self-report and weighed food intake), dietary behavior (auto-questionnaires), resting energy expenditure (REE) (indirect calorimetry), physical activity (accelerometry), and glucosuria were monitored over the first 6 months of insulin therapy in 46 diabetic adults. No change in REE, activity, or glucosuria could explain weight gain in the type 1 (4.1 +/- 0.6 kg, P < 0.0001) or type 2 (1.8 +/- 0.8 kg, P = 0.02) diabetic groups. An increase in energy intake provides the most likely explanation for weight gain with insulin. However, it is not being recognized because of significant underestimation of self-reported food intake, which appears to be associated with increased dietary restraint.