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Minari TP, Tácito LHB, Yugar LBT, Ferreira-Melo SE, Manzano CF, Pires AC, Moreno H, Vilela-Martin JF, Cosenso-Martin LN, Yugar-Toledo JC. Nutritional Strategies for the Management of Type 2 Diabetes Mellitus: A Narrative Review. Nutrients 2023; 15:5096. [PMID: 38140355 PMCID: PMC10746081 DOI: 10.3390/nu15245096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Thinking about greater adherence to dietary planning, it is extremely important to be aware of all nutritional strategies and dietary prescriptions available in the literature, and of which of them is the most efficient for the management of T2DM. METHODS A search was carried out in 2023 for randomized clinical trials, systematic reviews, meta-analyses, and guidelines in the following databases: Pubmed, Scielo, Web of Science, CrossRef and Google Scholar. In total, 202 articles were collected and analyzed. The period of publications was 1983-2023. RESULTS There is still no consensus on what the best nutritional strategy or ideal dietary prescription is, and individuality is necessary. In any case, these references suggest that Mediterranean Diet may of greater interest for the management of T2DM, with the following recommended dietary prescription: 40-50% carbohydrates; 15-25% proteins; 25-35% fats (<7% saturated, 10% polyunsaturated, and 10% monounsaturated); at least 14 g of fiber for every 1000 kcal consumed; and <2300 mg sodium. CONCLUSIONS Individuality is the gold standard for dietary prescriptions, however, the Mediterranean diet with low levels of carbohydrates and fats seems to be the most promising strategy for the management of T2DM.
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Affiliation(s)
- Tatiana Palotta Minari
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Lúcia Helena Bonalume Tácito
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | | | - Sílvia Elaine Ferreira-Melo
- Cardiovascular Pharmacology & Hypertension Laboratory, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Carolina Freitas Manzano
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Antônio Carlos Pires
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Heitor Moreno
- Cardiovascular Pharmacology & Hypertension Laboratory, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - José Fernando Vilela-Martin
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Luciana Neves Cosenso-Martin
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Juan Carlos Yugar-Toledo
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
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Amorim MMA, Souza AHD, Coelho AK. Competences for self-care and self-control in diabetes mellitus type 2 in primary health care. World J Diabetes 2019; 10:454-462. [PMID: 31523381 PMCID: PMC6715572 DOI: 10.4239/wjd.v10.i8.454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/05/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
The purpose of the guidelines of self-care and self-control of type 2 diabetes mellitus proposed by the Brazilian Ministry of Health is to strengthen and qualify users and health care professionals through the integrality and longitudinality of care with this disease. This article aims to present the self-care and self-control of people with type 2 diabetes mellitus in objective terms, taking into account the current recommen-dations based on scientific evidence and also from the subjective point of view, that is, emphasizing the aspects related to experience and subjectivity of these people. Next, we present the essential skills for self-care and self-control of users and professionals working in primary health care.
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Affiliation(s)
| | - Alessandra Hugo de Souza
- Programa de Pós graduação em Biologia de Vertebrados, Pontificia Universidade Católica de Minas Gerais, Belo Horizonte 30535901, Brazil
| | - Adriana Keller Coelho
- Geriatric Unit, Hospital do Instituto de Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte 3010110, Brazil
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Ferreira SRG, Chiavegatto Filho ADP, Lebrão ML, Duarte YADO, Laurenti R. Cardiometabolic diseases. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 21Suppl 02:e180008. [PMID: 30726353 DOI: 10.1590/1980-549720180008.supl.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/15/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiometabolic diseases are prevalent in populations and are among the leading causes of death. Objective: This sub-study of the Health, Well-being and Aging (SABE) study describes the self-reported prevalence of diabetes mellitus (DM), hypertension, and atherosclerotic cardiovascular disease (CVD) for its three waves (2000, 2006, and 2010). It also analyses the associations with selected risk factors. METHODS Logistic regression models were performed. RESULTS Predominance of women and average age (68 years) were maintained in all the waves. During the period, there was a general tendency of increasing prevalence of hypertension (53.1 to 66.7%), DM (16.7 to 25.0%), and CVD (23.0 to 27.2%); and stabilization of the CVD prevalence rate occurred only from 2006 to 2010. Women, with body mass index (BMI) > 27 kg/m2, and ex-smokers had consistently higher risk of self-reported hypertension across the three waves. BMI >27kg/m2 was also associated with a higher probability of DM in the three waves, whereas with ex-smokers this occurred only in 2010. Ex-smokers presented higher risk of CVD in all the waves, but not excess weight. Wave pairs were analyzed to test changes in prevalence, and it was found a significant increase in diseases rates across the years. CONCLUSION In summary, self-reported DM, hypertension, and CVD had high prevalence rates for participants of SABE Study, in São Paulo. The association of elevated BMI with cardiometabolic diseases suggests that body adiposity might favor their occurrence, although the study design does not guarantee a cause and effect relationship. Increased rates of affected individuals from the first to the third wave may reflect improvement in diagnostic conditions and/or control of these diseases' mortality during that period.
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Affiliation(s)
| | | | - Maria Lúcia Lebrão
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Ruy Laurenti
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
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Branoff JD, Jiroutek MR, Kelly CR, Huma S, Sutton BS. A Retrospective Cross-sectional Analysis of Health Education Disparities in Patients With Diabetes Using Data From the National Ambulatory Medical Care Survey. DIABETES EDUCATOR 2017; 43:125-134. [DOI: 10.1177/0145721716685408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to determine if there was an association between receipt of diet/nutrition, exercise, and weight loss education in adult patients with a primary diagnosis of diabetes with various demographic and socioeconomic variables using data from the National Ambulatory Medical Care Survey (NAMCS) for the years 2008 to 2011. Methods This retrospective, cross-sectional, observational study design included patients ≥ 18 years of age with diabetes in the NAMCS between 2008 and 2011, inclusive. A series of weighted multivariable logistic regression models was constructed to evaluate predictors of diet/nutrition, exercise, and weight loss education. Odds ratios and 95% confidence intervals were reported. Results Among patients included in this study (n = 3027), 35.6% received diet/nutrition education, 21.8% received exercise education, and 13.6% received weight loss education. From the multivariable analyses, visits using “other” payment type, visits with Medicaid, and visits occurring in non-Metropolitan Statistical Areas were significantly less likely to receive diet/nutrition education; visits using other payment type, visits in non-Metropolitan Statistical Areas, and visits by those ≥ 65 and 45-64 years of age were significantly less likely to receive exercise education. No significant disparities in the receipt of weight loss education were found. Conclusion These findings indicate that although only approximately one third or fewer patients diagnosed with diabetes were receiving diet/nutrition, exercise, or weight loss education, there appeared to be limited disparities among the groups studied. Education rates appear to be trending upward over time, to be slightly improved as compared with previous studies, and to include fewer disparities.
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Affiliation(s)
- Janelle D. Branoff
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA (Mrs Branoff, Dr Jiroutek, Mrs Kelly, Ms Huma, Dr Sutton)
| | - Michael R. Jiroutek
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA (Mrs Branoff, Dr Jiroutek, Mrs Kelly, Ms Huma, Dr Sutton)
| | - Chloe R. Kelly
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA (Mrs Branoff, Dr Jiroutek, Mrs Kelly, Ms Huma, Dr Sutton)
| | - Sadia Huma
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA (Mrs Branoff, Dr Jiroutek, Mrs Kelly, Ms Huma, Dr Sutton)
| | - Beth S. Sutton
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA (Mrs Branoff, Dr Jiroutek, Mrs Kelly, Ms Huma, Dr Sutton)
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de Almeida-Pititto B, Dias ML, de Moraes ACF, Ferreira SRG, Franco DR, Eliaschewitz FG. Type 2 diabetes in Brazil: epidemiology and management. Diabetes Metab Syndr Obes 2015; 8:17-28. [PMID: 25609989 PMCID: PMC4298341 DOI: 10.2147/dmso.s72542] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the most important epidemic diseases in the world this century, and accounts for 90% of cases of diabetes globally. Brazil is one of the most important examples of the alarming picture of T2DM in emergent societies, being the country with the fourth largest number of people with diabetes. The aim of this paper is to review the literature on diabetes in Brazil, specifically looking at the epidemiology and management of T2DM. A literature search was conducted using PubMed and LILACS to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government, World Health Organization, and International Diabetes Federation were also reviewed.
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Affiliation(s)
| | - Monike Lourenço Dias
- Department of Endocrinology, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Sandra RG Ferreira
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
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Choudhary M, Kochhar A, Sangha J. Hypoglycemic and hypolipidemic effect of Aloe vera L. in non-insulin dependent diabetics. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2014; 51:90-6. [PMID: 24426052 PMCID: PMC3857397 DOI: 10.1007/s13197-011-0459-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 05/28/2011] [Accepted: 07/05/2011] [Indexed: 11/30/2022]
Abstract
Ninety non-insulin dependent diabetic subjects were selected from Punjab Agricultural University and Civil hospitals of Ludhiana. The selected subjects were divided into three groups viz. Group I, II and III having thirty subjects each. The subjects of group I were not given any treatment. The subjects of group II and III were supplemented with 100 mg and 200 mg of Aloe vera L. gel powder respectively for a period of 3 months and supplementation was continued along with nutrition counselling for the next 3 months. The nutrition education was given for 3 months after 15 days interval to the subjects of group II and III through individual and group contact. The blood glucose and lipid profile were analyzed. The blood pressure of the subjects was also measured. It was seen that there was a significant (p ≤ 0.01) reduction in fasting blood glucose level by 11.4% and 15.4% and post prandial glucose level 18.5% and 27.8% in the subjects of group II and III respectively after the study. Significant (p ≤ 0.01) reduction in total cholesterol 8.6% and 10.1%, triglycerides 9.6% and 12.2%, low density lipoprotein cholesterol (LDL-C) 12.8% and 14.6%, very low density lipoprotein cholesterol (VLDL-C) 9.6% and 12.2% and an increase in high density lipoprotein cholesterol (HDL-C) 7.3% and 9.4% was observed in the subjects of group II and III respectively. The ratio of total cholesterol to HDL-C reduced from 5.6 to 4.8 and 6.1 to 5.0 and LDL-C to HDL-C from 3.7 to 3.0 and 4.1 to 3.1 in the subjects of group II and III respectively after the study. There was also a significant decrease (p ≤ 0.01) in the blood pressure of the subjects of group II and III and a non significant decrease (p ≤ 0.01) was seen in the subjects of group I. With the intervention of Aloe vera L., significant reduction was observed in blood glucose, lipid profile and blood pressure of the diabetic patients.
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Affiliation(s)
- Monika Choudhary
- Department of Food and Nutrition, College of Home Science, Punjab Agricultural University, Ludhiana, 141 004 India
| | - Anita Kochhar
- Department of Food and Nutrition, College of Home Science, Punjab Agricultural University, Ludhiana, 141 004 India
| | - Jaswinder Sangha
- Department of Food and Nutrition, College of Home Science, Punjab Agricultural University, Ludhiana, 141 004 India
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Almeida-Pititto BD, Griffin SJ, Sharp SJ, Hirai AT, Gimeno SGA, Ferreira SRG. A behavioral intervention in a cohort of Japanese-Brazilians at high cardiometabolic risk. Rev Saude Publica 2012; 46:602-9. [PMID: 22735273 DOI: 10.1590/s0034-89102012005000045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, p<0.001], systolic blood pressure [-4.6(17.9) vs. 1.8(4.3) mmHg per year, p<0.001], 2-hour plasma glucose [-1.2(2.1) vs. -0.2(0.6) mmol/L per year, p<0.001], LDL-cholesterol [-0.3(0.9) vs. -0.1(0.2) mmol/L per year, p<0.001] and Framingham coronary heart disease risk score [-0.25(3.03) vs. 0.11(0.66) per year, p=0.02] but not in triglycerides [0.2(1.6) vs. 0.1(0.42) mmol/L per year, p<0.001], and fasting insulin level [1.2(5.8) vs. -0.7(2.2) IU/mL per year, p<0.001] compared with the pre-intervention period. Significant reductions in the prevalence of impaired fasting glucose/impaired glucose tolerance and diabetes were seen during the intervention (from 58.4% to 35.4%, p<0.001; and from 30.1% to 21.7%, p= 0.004, respectively). CONCLUSIONS A one-year community-based health promotion program brings cardiometabolic benefits in a high-risk population of Japanese-Brazilians.
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Affiliation(s)
- Bianca de Almeida-Pititto
- Departamento de Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
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Almeida-Pititto B, Hirai AT, Sartorelli DS, Harima HA, Gimeno SGA, Ferreira SRG. Predictive factors of non-deterioration of glucose tolerance following a 2-year behavioral intervention. Diabetol Metab Syndr 2010; 2:52. [PMID: 20673337 PMCID: PMC2919448 DOI: 10.1186/1758-5996-2-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 07/30/2010] [Indexed: 11/28/2022] Open
Abstract
AIM To identify predictive factors associated with non-deterioration of glucose metabolism following a 2-year behavioral intervention in Japanese-Brazilians. METHODS 295 adults (59.7% women) without diabetes completed 2-year intervention program. Characteristics of those who maintained/improved glucose tolerance status (non-progressors) were compared with those who worsened (progressors) after the intervention. In logistic regression analysis, the condition of non-progressor was used as dependent variable. RESULTS Baseline characteristics of non-progressors (71.7%) and progressors were similar, except for the former being younger and having higher frequency of disturbed glucose tolerance and lower C-reactive protein (CRP). In logistic regression, non-deterioration of glucose metabolism was associated with disturbed glucose tolerance - impaired fasting glucose or impaired glucose tolerance - (p < 0.001) and CRP levels </= 0.04 mg/dL (p = 0.01), adjusted for age and anthropometric variables. Changes in anthropometry and physical activity and achievement of weight and dietary goals after intervention were similar in subsets that worsened or not the glucose tolerance status. CONCLUSION The whole sample presented a homogeneous behavior during the intervention. Lower CRP levels and diagnosis of glucose intolerance at baseline were predictors of non-deterioration of the glucose metabolism after a relatively simple intervention, independent of body adiposity.
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Affiliation(s)
- Bianca Almeida-Pititto
- Department of Nutrition, School of Public Health, University of Sao Paulo-Av. Dr. Arnaldo, 715, CEP 01246-904, São Paulo-SP, Brazil
| | - Amélia T Hirai
- Department of Preventive Medicine, Federal University of Sao Paulo-Rua Borges Lagoa, 564, cj. 81/82, Vila Clementino CEP 04038-000, São Paulo, SP, Brazil
| | - Daniela S Sartorelli
- Department of Social Medicine, University of Sao Paulo-Rua Onze de Agosto, 798 apto. 81, Campos Elíseos, CEP 14085-030, Ribeirão Preto, SP, Brazil
| | - Helena A Harima
- Department of Preventive Medicine, Federal University of Sao Paulo-Rua Borges Lagoa, 564, cj. 81/82, Vila Clementino CEP 04038-000, São Paulo, SP, Brazil
| | - Suely GA Gimeno
- Department of Preventive Medicine, Federal University of Sao Paulo-Rua Borges Lagoa, 564, cj. 81/82, Vila Clementino CEP 04038-000, São Paulo, SP, Brazil
| | - Sandra RG Ferreira
- Department of Nutrition, School of Public Health, University of Sao Paulo-Av. Dr. Arnaldo, 715, CEP 01246-904, São Paulo-SP, Brazil
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Pimentel GD, Portero-McLellan KC, Oliveira EP, Spada APM, Oshiiwa M, Zemdegs JCS, Barbalho SM. Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Nutr Res 2010; 30:186-90. [PMID: 20417879 DOI: 10.1016/j.nutres.2010.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 02/22/2010] [Accepted: 03/12/2010] [Indexed: 12/24/2022]
Abstract
The aim of this study was to evaluate the effects of a nutrition education program (NEP) on anthropometric, dietetic, and metabolic parameters in high-risk subjects for type 2 diabetes mellitus. Fifty-one participants, both sexes, were randomly assigned to either the control (58.8%) or the intervention (NEP) group. The intervention group received frequent individual and group nutritional counseling from a team of nutritionists. Participants were assessed at baseline (M0) and after 12 months (M1) for anthropometric, dietetic, and metabolic parameters. The hypothesis was that high-risk subjects for type 2 diabetes mellitus participating in NEP would show an improvement in these parameters. At M1, the intervention group showed a significant decline in body weight (-3.4%), body mass index (-5.7%), cholesterol intake (-49.5%), fasting glycemia (-14.0%), fasting insulin (-9.0%), postprandial glycemia (-21.0%), postprandial insulin (-71.0%), total serum cholesterol (-23.0%), and glycated hemoglobin (-24.0%). A decrease in energy intake (5%, P = .06) and low-density lipoprotein cholesterol (25%, P = .07) was observed in the interventional group, although it did not reach statistical significance. In contrast, the control group presented a significantly higher energy intake (19%, P = .04) and a nonsignificant increase in consumption of all macronutrients. The long-term NEP was found to improve anthropometric, dietary, and metabolic parameters in high-risk subjects for type 2 diabetes mellitus.
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Affiliation(s)
- Gustavo D Pimentel
- Department of Physiology, Federal University of Sao Paulo (UNIFESP), São Paulo/SP, Brazil.
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Nutritional intervention programme among a Japanese-Brazilian community: procedures and results according to gender. Public Health Nutr 2010; 13:1453-61. [DOI: 10.1017/s1368980010000935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo describe the results of a nutritional intervention programme among Japanese-Brazilians according to gender.DesignA non-controlled experimental study.SettingThe research included three points of clinical, nutritional and physical activity evaluation: at baseline (in 2005), after the first year and at the end of the second year (in 2007). The paired Student t test and multiple linear regression analysis were used to evaluate changes in the subjects’ profile (clinical, nutritional and physical activity variables).SubjectsJapanese-Brazilians (n 575) of both genders, aged over 30 years.ResultsWe verified statistically significant reductions in body weight (0·9 kg), waist circumference (2·9 cm), blood pressure, fasting blood glucose (>3 mg/dl) and total cholesterol (>20 mg/dl) and its fractions, in both genders. We also found reductions in intake of energy (among men), protein (among women) and fat (both genders) and increases in intake of total fibre (among women) and carbohydrate (among men).ConclusionsThe intervention programme indicated meaningful benefits for the intervention subjects, with changes in their habits that led to a ‘healthier’ lifestyle positively impacting their nutritional and metabolic profile.
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Sartorelli DS, Damião R, Chaim R, Hirai A, Gimeno SGA, Ferreira SRG. Dietary omega-3 fatty acid and omega-3: omega-6 fatty acid ratio predict improvement in glucose disturbances in Japanese Brazilians. Nutrition 2009; 26:184-91. [PMID: 19647413 DOI: 10.1016/j.nut.2009.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 03/17/2009] [Accepted: 03/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We investigated whether lifestyle-induced changes in dietary fat quality are related to improvements on glucose metabolism disturbances in Japanese Brazilians at high risk of type 2 diabetes. METHODS One hundred forty-eight first- and second-generation subjects with impaired glucose tolerance or impaired fasting glycemia who attended a lifestyle intervention program for 12 mo were studied in the city of Bauru, State of São Paulo, Brazil. Dietary fatty acid intakes at baseline and after 12 mo were estimated using three 24-h recalls. The effect of dietary fat intake on glucose metabolism was investigated by multiple logistic regression models. RESULTS At baseline, mean +/- standard deviation age and body mass index were 60+/-11 y and 25.5+/-4.2kg/m(2), respectively. After 12 mo, 92 subjects had normal plasma glucose levels and 56 remained in prediabetic conditions. Using logistic regression models adjusted for age, gender, generation, basal intake of explanatory nutrient, energy intake, physical activity, and waist circumference, the odds ratios (95% confidence intervals) for reversion to normoglycemia were 3.14 (1.22-8.10) in the second tertile of total omega-3 fatty acid, 4.26 (1.34-13.57) in the second tertile of eicosapentaenoic acid, and 2.80 (1.10-7.10) in the second tertile of linolenic acid. Similarly, subjects in the highest tertile of omega-3:omega-6 fatty acid ratio showed a higher chance of improving glucose disturbances (2.51, 1.01-6.37). CONCLUSIONS Our findings support the evidence of an independent protective effect of omega-3 fatty acid and of a higher omega-3:omega-6 fatty acid ratio on the glucose metabolism of high-risk individuals.
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Affiliation(s)
- Daniela S Sartorelli
- Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Sartorelli DS, Franco LJ, Cardoso MA. High intake of fruits and vegetables predicts weight loss in Brazilian overweight adults. Nutr Res 2009; 28:233-8. [PMID: 19083413 DOI: 10.1016/j.nutres.2008.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 01/04/2008] [Accepted: 02/04/2008] [Indexed: 10/22/2022]
Abstract
To determine whether changes in dietary intakes predict weight loss, we studied 80 overweight adults who attended a nutritional counseling program during 6 months of follow-up at a primary health care center in Brazil. Habitual diet was assessed using a validated food frequency questionnaire at baseline and after 6 months. The mean age (+/-SD) of the participants was 46.5 +/- 9.5 years, and their mean body mass index was 29 +/- 3 kg/m(2) at baseline. After 6 months, the differences in body weight and fruit/vegetable intake were -1.4 +/- 3 kg and +/-109 +/- 320 g daily, respectively. Using multiple linear regression models adjusted for age, sex, changes in walking time, and total energy intake, the increased intake of dietary fiber from fruits/vegetables was associated with a greater weight loss (beta1 [95% confidence interval (CI)] = -0.180 [-0.269, -0.091]) after 6 months of follow-up. Similar results were observed for increased intake of vegetables (beta1 [95% CI] = -0.00497 [-0.008, -0.002]) and fruits (beta1 [95% CI] = -0.00290 [-0.005, -0.001]) as predictors of weight loss. The increase of 100 g/d of vegetables and fruits represented a body weight loss of 500 and 300 g after 6 months, respectively (P < .05). Our findings support the relevance of increased intakes of fruits and vegetables that may help avoid weight gain in overweight adults.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, SP 14049-900, Brazil.
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Schwarz PEH, Schwarz J, Schuppenies A, Bornstein SR, Schulze J. Development of a diabetes prevention management program for clinical practice. Public Health Rep 2007; 122:258-63. [PMID: 17357369 PMCID: PMC1820432 DOI: 10.1177/003335490712200216] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter E H Schwarz
- Department of Internal Medicine, Carl Gustav Carus Medical School, Dresden University of Technology, Germany
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Sartorelli DS, Cardoso MA. [Association between dietary carbohydrates and type 2 diabetes mellitus: epidemiological evidence]. ACTA ACUST UNITED AC 2007; 50:415-26. [PMID: 16936981 DOI: 10.1590/s0004-27302006000300003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 03/21/2006] [Indexed: 12/15/2022]
Abstract
The prevalence of type 2 diabetes has been escalating throughout the world and usual food consumption is regarded as one of the most important environmental determinants for chronic diseases. Thus, the role of type and quality of carbohydrates on the etiology of type 2 diabetes is still poorly understood. The present review discusses the available epidemiological evidence regarding the effect of the type and source of carbohydrate of the usual diet and the risk of type 2 diabetes in adults. Although epidemiological investigations support the hypothesis for a potential risk effect of high glycemic index and low fiber content diets for diabetes, the results are controversial and the benefit may be related to the magnesium content of the structure of the grains, suggesting the relevance of taking into account the food sources instead of nutrients on investigations of diet and risk of chronic diseases. The available evidence suggests that eating a diet rich in whole grain cereals and vegetables and low in refined grains, sucrose and fructose contents is beneficial in the prevention of diabetes. Thus, more clinical trials are required to support the associations and establish biologically plausible pathways.
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Affiliation(s)
- Daniela S Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Av. Bandeirantes 3900, 14049-900 Ribeirão Preto, SP.
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Sartorelli DS, Franco LJ, Cardoso MA. Intervenção nutricional e prevenção primária do diabetes mellitus tipo 2: uma revisão sistemática. CAD SAUDE PUBLICA 2006; 22:7-18. [PMID: 16470278 DOI: 10.1590/s0102-311x2006000100002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O diabetes mellitus tipo 2 pode ser considerado um dos principais problemas de saúde pública no mundo atual. A prevalência crescente em diversos países e o difícil controle metabólico dos indivíduos com a doença em evolução justificam o estudo de estratégias para prevenção primária do diabetes mellitus tipo 2. Ensaios clínicos aleatorizados controlados recentes sugerem um impacto importante da intervenção nutricional na redução do risco de desenvolvimento de diabetes mellitus tipo 2 entre indivíduos portadores de fatores de risco. O presente artigo de revisão descreve o impacto de programas de intervenção no estilo de vida em ensaios clínicos aleatorizados controlados para a prevenção primária do diabetes mellitus tipo 2.
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Ferreira SRG, Almeida BD, Siqueira AFA, Khawali C. Intervenções na prevenção do diabetes mellitus tipo 2: é viável um programa populacional em nosso meio? ACTA ACUST UNITED AC 2005; 49:479-83. [PMID: 16358074 DOI: 10.1590/s0004-27302005000400003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A crescente prevalência de diabetes mellitus (DM) em países em desenvolvimento, associada à facilidade de se identificar indivíduos de alto risco para a doença, tornam interessante a idéia de se introduzir medidas que visem à prevenção da doença. Vários estudos comprovam os benefícios de mudanças no estilo de vida em prevenir ou retardar a progressão da tolerância à glicose diminuída para o DM. A revisão destes estudos mostra que é possível reduzir em 50 a 60% a incidência de DM intervindo-se no estilo de vida destes indivíduos, resultado superior ao obtido naqueles que, até o momento, utilizaram medidas farmacológicas com o mesmo objetivo. Apesar da eficácia destas simples medidas de prevenção por meio de mudanças no estilo de vida, estas são de difícil aderência e implementação em comunidades. Em nosso meio, são necessários estudos para avaliar as dificuldades de se implantar um programa nacional de prevenção de DM e outras doenças relacionadas ao estilo de vida em brasileiros de alto risco.
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Affiliation(s)
- Sandra R G Ferreira
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP.
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