1
|
López-Gómez JJ, Delgado García E, Primo-Martín D, Simón de la Fuente M, Gómez-Hoyos E, Jiménez-Sahagún R, Torres-Torres B, Ortolá-Buigues A, Gómez-Vicente B, Arenillas-Lara JF, De Luis Román DA. Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: a randomized controlled trial. Nutr Diabetes 2024; 14:34. [PMID: 38816400 PMCID: PMC11139872 DOI: 10.1038/s41387-024-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND/OBJECTIVES In patients with acute stroke, the presence of hyperglycaemia has been associated with higher morbidity and less neurological recovery. The aim of the study was to evaluate the impact of a diabetes specific enteral nutrition (EN) formula on glycaemia, comorbidities and mortality in patients admitted with a first episode of stroke who received complete EN. METHODS This was a prospective randomised controlled trial. Patients with acute stroke did not have diagnosis of diabetes mellitus and required nasogastric tube feeding. This study has been registered with code NCT03422900. The patients were randomised into two arms: an isocaloric isoprotein formula (control group (CG), 27 patients) vs a diabetes-specific formula (low glycaemic index carbohydrates, fibre (80% soluble) and higher lipid content) (experimental group (EG), 25 patients). Pre-EN blood glucose, hyperglycaemia during EN treatment, HbA1c, insulin use, oral route recovery, length of stay (LOS) and mortality at 30 days were collected. The complications of enteral nutrition during admission were collected as well. RESULTS 52 patients were included, 50% females, with an age of 77.44(11.48) years; 34 (65.4%) had ischaemic stroke, with a Rankin score of 0(0-2), and a National Institute of Health Stroke Scale (NIHSS) of 19 (15-22). In CG, there were more cases of hyperglycaemia on the 5th day post-NE (13(65%) vs7(35%), p < 0.01). CG showed an OR of 7.58(1.49-39.16) (p = 0.02) for the development of hyperglycaemia. There were no differences in LOS between groups (12(8.5) days vs 14(23) days, p = 0.19) or in the death rate (10(37%) vs 10(40%), p = 0.8), although differences were found in terms of oral route recovery (EG: 11(44%) patients vs CG: 5(18.5%) patients, p = 0.04) (OR (EG): 5.53(1.25-24.47); p = 0.02). CONCLUSIONS The use of a diabetes-specific enteral formula in non-diabetic patients admitted with acute stroke reduced the risk of developing hyperglycaemia and improved the rate of oral route recovery. Registered under ClinicalTrials.gov Identifier no. NCT03422900.
Collapse
Affiliation(s)
- Juan J López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain.
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain.
| | - Esther Delgado García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - David Primo-Martín
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
| | | | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres-Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Ana Ortolá-Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Gómez-Vicente
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
- Stroke Program, Department of Neurology, HCUV, Valladolid, Spain
| | - Juan F Arenillas-Lara
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
- Stroke Program, Department of Neurology, HCUV, Valladolid, Spain
| | - Daniel A De Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Universidad de Valladolid, Valladolid, Spain
| |
Collapse
|
2
|
Hamamah S, Iatcu OC, Covasa M. Nutrition at the Intersection between Gut Microbiota Eubiosis and Effective Management of Type 2 Diabetes. Nutrients 2024; 16:269. [PMID: 38257161 PMCID: PMC10820857 DOI: 10.3390/nu16020269] [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: 12/20/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Nutrition is one of the most influential environmental factors in both taxonomical shifts in gut microbiota as well as in the development of type 2 diabetes mellitus (T2DM). Emerging evidence has shown that the effects of nutrition on both these parameters is not mutually exclusive and that changes in gut microbiota and related metabolites such as short-chain fatty acids (SCFAs) and branched-chain amino acids (BCAAs) may influence systemic inflammation and signaling pathways that contribute to pathophysiological processes associated with T2DM. With this background, our review highlights the effects of macronutrients, carbohydrates, proteins, and lipids, as well as micronutrients, vitamins, and minerals, on T2DM, specifically through their alterations in gut microbiota and the metabolites they produce. Additionally, we describe the influences of common food groups, which incorporate varying combinations of these macronutrients and micronutrients, on both microbiota and metabolic parameters in the context of diabetes mellitus. Overall, nutrition is one of the first line modifiable therapies in the management of T2DM and a better understanding of the mechanisms by which gut microbiota influence its pathophysiology provides opportunities for optimizing dietary interventions.
Collapse
Affiliation(s)
- Sevag Hamamah
- Department of Basic Medical Sciences, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA 91766, USA;
| | - Oana C. Iatcu
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, 720229 Suceava, Romania
| | - Mihai Covasa
- Department of Basic Medical Sciences, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA 91766, USA;
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, 720229 Suceava, Romania
| |
Collapse
|
3
|
Chaiyakul S, Ketkham N, Chaichana C, Khumkhana N, Deekum W, Wongshaya P, Suwanmalai T, Hutchinson C, Pramyothin P. Effects of a novel rice-based diabetes-specific formula on postprandial glucose and gastrointestinal hormones: a double-blinded multi-arm randomized crossover trial. Front Endocrinol (Lausanne) 2023; 14:1141497. [PMID: 37293492 PMCID: PMC10244629 DOI: 10.3389/fendo.2023.1141497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction We developed a novel rice-based medical food for diabetes (MFDM) powder formula, using locally available ingredients in Thailand, which can potentially improve patient access to diabetes-specific formula (DSF) by reducing cost and improving availability. Purpose The goals of our studies were to 1) measure the glycemic index (GI) and glycemic load (GL) of the MFDM powder formula in healthy individuals, and 2) assess postprandial glucose, insulin, satiety, hunger, and gastrointestinal (GI) hormone responses in adults with prediabetes or early type 2 diabetes after consuming MFDM in comparison with a commercially available standard formula (SF) and a DSF. Methods In Study 1, glycemic responses were assessed using the area under the curve (AUC), which was used to calculate GI and GL. Study 2 was a double-blinded multi-arm randomized crossover trial enrolling participants with either prediabetes or type 2 diabetes of ≤6 years. At each study visit, participants consumed either MFDM, SF, or DSF which contained 25 g of carbohydrates. Hunger and satiety were assessed using a visual analog scale (VAS). Glucose, insulin, and GI hormones were assessed using AUC. Results All participants tolerated the MFDM well with no adverse events. In Study 1, the measured GI was 39 ± 6 (low GI) and GL was 11 ± 2 (medium GL). In Study 2, glucose and insulin responses were significantly lower after MFDM compared with SF (p-value<0.01 for both), however, those responses were similar between MFDM and DSF. MFDM suppressed hunger, promoted satiety, stimulated active GLP-1, GIP, and PYY, and suppressed active ghrelin although these changes were similar to SF and DSF. Conclusions MFDM had a low GI and a low-to-medium GL. In people with prediabetes or early type 2 diabetes, MFDM elicited reduced glucose and insulin responses when compared with SF. Rice-based MFDM may be an option for patients who are at risk for postprandial hyperglycemia. Clinical Trial Registration https://www.thaiclinicaltrials.org/show/TCTR20210731001, identifier TCTR20210731001; https://www.thaiclinicaltrials.org/show/TCTR20210730007, identifier TCTR20210730007.
Collapse
Affiliation(s)
- Supat Chaiyakul
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Narong Ketkham
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Chaichana
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nanta Khumkhana
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanjan Deekum
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakwuan Wongshaya
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thaniya Suwanmalai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carol Hutchinson
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Pornpoj Pramyothin
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
4
|
López-Gómez JJ, Gutiérrez-Lora C, Izaola-Jauregui O, Primo-Martín D, Gómez-Hoyos E, Jiménez-Sahagún R, De Luis-Román DA. Real World Practice Study of the Effect of a Specific Oral Nutritional Supplement for Diabetes Mellitus on the Morphofunctional Assessment and Protein Energy Requirements. Nutrients 2022; 14:4802. [PMID: 36432489 PMCID: PMC9692739 DOI: 10.3390/nu14224802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The prevalence of malnutrition in patients with diabetes mellitus is high. In these patients, monitoring nutritional intervention is complex. Aims: To evaluate the evolution in the nutritional status in patients with diabetes/prediabetes and malnutrition with a diabetes-specific enteral formula. Methods: Real-life study of one arm in 60 patients with diabetes and prediabetes, performing a dietary adaptation with diabetes-specific oral nutritional supplementation. A morphofunctional assessment was performed, consisting of intake assessment, anthropometry, body composition (bioimpedance and muscle ultrasound), handgrip strength and biochemical markers. The diagnosis of malnutrition was made using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The variables were measured at baseline and 3 months after starting the intervention. Results: The mean age was 67.13 (14.9) years. In total, 30 (50%) of the patients were women. Of the total, 60% of the patients had diabetes mellitus and 40% of the patients had prediabetes. The initial body mass index was 24.65 (5.35) kg/m2. It was observed that 80% of the patients had malnutrition, whereas after the intervention, the prevalence was 51.7% (p < 0.01). At the beginning of the study, 20% of the patients suffered from sarcopenia and after the intervention it was 16.7% (p = 0.19). Conclusions: Medical Nutrition Therapy with an adapted oral diet associated with diabetes-specific oral nutritional supplementation reduces malnutrition in patients at nutritional risk and disturbances of carbohydrate metabolism.
Collapse
Affiliation(s)
- Juan J. López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - Cristina Gutiérrez-Lora
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - David Primo-Martín
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| | - Daniel A. De Luis-Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
| |
Collapse
|