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Mozaffari H, Madani Civi R, Askari M, Lee C, Wong E, Wong C, Conklin AI. The impact of food-based dietary strategies on achieving type 2 diabetes remission: A systematic review. Diabetes Metab Syndr 2024; 18:103096. [PMID: 39163706 DOI: 10.1016/j.dsx.2024.103096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/27/2024] [Accepted: 08/03/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVE Conventional wisdom once asserted that diabetes was irreversible. However, contemporary research indicates that dietary changes may contribute to achieving diabetes remission in persons with type 2 diabetes (T2D). We aimed to determine the effectiveness of food-based dietary approaches for T2D remission. METHODS We systematically searched Medline, EMBASE, and Web of Science, along with exploring grey literature, to identify longitudinal studies. Data extraction and quality assessment adhered to predetermined criteria, and the results of the included studies were analyzed using a narrative synthesis and graphical display. RESULTS We included 52 original studies-40 % were rated as low-risk of bias. Overall, studies showed the low-carbohydrate Mediterranean diet (LCMD), compared to a low-fat diet, was more effective for achieving T2D remission in newly diagnosed patients who also had a weight loss of up to 6 kg. Compared to both the traditional Mediterranean diet and the American Diabetic Association diet, the LCMD was also more effective at diabetes remission for persons with T2D with any duration of diabetes; however, more substantial weight loss of 8 kg was required. Other diets that appeared effective for T2D remission included low-calorie diets and diets high in plant protein sources. Less weight loss was needed to achieve remission on plant-based diets than a low-calorie diet and low-carbohydrate diet. CONCLUSIONS Diets high in plant protein sources may support T2D remission, particularly among newly diagnosed patients. For patients with a duration of over 2 years, the combination of plant-based diets with greater weight loss should be considered to induce remission.
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Affiliation(s)
- Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | - Rana Madani Civi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Mohammadreza Askari
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Clover Lee
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | - Emily Wong
- Faculty of Sciences, University of British Columbia, Vancouver, Canada
| | - Cheryl Wong
- Faculty of Arts, University of British Columbia, Vancouver, Canada
| | - Annalijn I Conklin
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Centre for Advancing Health Outcomes (formerly CHÉOS), Providence Healthcare Research Institute, St. Paul's Hospital, Vancouver, Canada.
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Kopp LHP, Søgaard-Hansen CM, Zachhau KM, Bastkjær RM, Andersen BV, Budtz-Jørgensen E, Byrne DV, Chaaban N, Holst JJ, Klindt TB, Magkos F, Ozenne B, Samkani A, Skytte MJ, Madsbad S, Krarup T, Thomsen MN. Effects of a carbohydrate-reduced high-protein diet delivered with meal kits to Danish people with type 2 diabetes: protocol for a 12-month randomised controlled trial. BMJ Open 2024; 14:e084686. [PMID: 39142677 PMCID: PMC11331900 DOI: 10.1136/bmjopen-2024-084686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/16/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION The cornerstone in the management of type 2 diabetes (T2D) is lifestyle modification including a healthy diet, typically one in which carbohydrate provides 45%-60% of total energy intake (E%). Nevertheless, systematic reviews and meta-analyses of trials with low carbohydrate diets (which are increased in protein and/or fat) for T2D have found improved glycaemic control in the first months relative to comparator diets with higher carbohydrate content. Studies lasting ≥1 year are inconclusive, which could be due to decreased long-term dietary adherence. We hypothesise that glucometabolic benefits can be achieved following 12 months of carbohydrate-restricted dieting, by maximising dietary adherence through delivery of meal kits, containing fresh, high-quality ingredients for breakfast, dinner and snacks, combined with nutrition education and counselling. METHODS AND ANALYSIS This protocol describes a 12-month investigator-initiated randomised controlled, open-label, superiority trial with two parallel groups that will examine the effect of a carbohydrate-reduced high-protein (CRHP) diet compared with a conventional diabetes (CD) diet on glucometabolic control (change in glycated haemoglobin being the primary outcome) in 100 individuals with T2D and body mass index (BMI) >25 kg/m2. Participants will be randomised 1:1 to receive either the CRHP or the CD diet (comprised 30/50 E% from carbohydrate, 30/17 E% from protein and 40/33 E% from fat, respectively) for 12 months delivered as meal kits, containing foods covering more than two-thirds of the participants' estimated daily energy requirements for weight maintenance. Adherence to the allocated diets will be reinforced by monthly sessions of nutrition education and counselling from registered clinical dietitians. ETHICS AND DISSEMINATION The trial has been approved by the National Committee on Health Research Ethics of the Capital Region of Denmark. The trial will be conducted in accordance with the Declaration of Helsinki. Results will be submitted for publication in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05330247. PROTOCOL VERSION The trial protocol was approved on 9 March 2022 (study number: H-21057605). The latest version of the protocol, described in this manuscript, was approved on 23 June 2023.
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Affiliation(s)
- Luise H P Kopp
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | - Karen M Zachhau
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Rasmus M Bastkjær
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | | | - Derek V Byrne
- Department of Food Science, Aarhus University, Aarhus, Denmark
| | - Nora Chaaban
- Department of Food Science, Aarhus University, Aarhus, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Trine B Klindt
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- Neurobiology Research Unit and BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Amirsalar Samkani
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Mads J Skytte
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thure Krarup
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mads N Thomsen
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Tsuruta H, Sugahara S, Kume S. Nutrient quality in dietary therapy for diabetes and diabetic kidney disease. J Diabetes Investig 2024; 15:973-981. [PMID: 38591876 PMCID: PMC11292394 DOI: 10.1111/jdi.14208] [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: 12/27/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Dietary therapy is crucial for diabetes care with the aim of preventing the onset and progression of diabetes and its complications. The traditional approach to dietary therapy for diabetes has primarily focused on restricting the intake of the three major nutrients and rigorously controlling blood glucose levels. However, advancements in nutritional science have shown that within the three major nutrients - carbohydrates, proteins and lipids - there exist multiple types, each with distinct impacts on type 2 diabetes and its complications, sometimes even showing conflicting effects. In light of this, the present review shifts its focus from the quantity to the quality of the three major nutrients. It aims to provide an overview of how the differences in nutrient quality can influence onset and progression of type 2 diabetes and diabetic kidney disease, highlighting the diverse effects and, at times, contradictory impacts associated with each nutrient type.
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Affiliation(s)
- Hiroaki Tsuruta
- Department of MedicineShiga University of Medical ScienceOtsuShigaJapan
| | - Sho Sugahara
- Department of MedicineShiga University of Medical ScienceOtsuShigaJapan
| | - Shinji Kume
- Department of MedicineShiga University of Medical ScienceOtsuShigaJapan
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Conlin PR, Burke BV, Hobbs C, Hurren KM, Lang AE, Morrison JW, Spacek L, Steil EN, Watts SA, Weinreb JE, Pogach LM. Management of Type 2 Diabetes Mellitus: Synopsis of the Department of Veterans Affairs and Department of Defense Clinical Practice Guideline. Mayo Clin Proc 2024; 99:S0025-6196(24)00210-6. [PMID: 39093266 DOI: 10.1016/j.mayocp.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/04/2024]
Abstract
The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes. This was the product of a multidisciplinary guideline development committee composed of clinicians from both the VA and the DoD and was overseen by the VA/DoD Evidence Based Practice Work Group. The development process conformed to the standards for trustworthy guidelines as established by the National Academy of Medicine. The guideline development committee developed 12 key questions to guide an evidence synthesis. An independent third party identified relevant randomized controlled trials and systematic reviews that were published from January 2016 through April 2022. This evidence synthesis served as the basis for drafting recommendations. Twenty-six recommendations were generated and rated by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Two algorithms were developed to guide clinical decision-making. This synopsis summarizes key aspects of the VA/DoD Clinical Practice Guideline for diabetes in 5 areas: prediabetes, screening for co-occurring conditions, diabetes self-management education and support, glycemic treatment goals, and pharmacotherapy. The guideline is designed to help clinicians and patients make informed treatment decisions to optimize health outcomes and quality of life and to align with patient-centered goals of care.
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Affiliation(s)
- Paul R Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA.
| | - Brian V Burke
- Department of Veterans Affairs Medical Center, Dayton, OH
| | | | - Kathryn M Hurren
- Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA
| | | | - Lance Spacek
- Department of Veterans Affairs South Texas Healthcare System, San Antonio, TX
| | - Evan N Steil
- Medical Readiness Command-Europe, Sembach, Germany
| | - Sharon A Watts
- Office of Nursing Service, Department of Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Jane E Weinreb
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Leonard M Pogach
- Specialty Care Program Office, Department of Veterans Affairs, Washington, DC
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Ambrož M, de Vries ST, Buitenhuis G, Frost J, Denig P. Willingness of people with type 2 diabetes to engage in healthy eating, physical activity and medication taking. Prim Care Diabetes 2024; 18:347-355. [PMID: 38575398 DOI: 10.1016/j.pcd.2024.03.006] [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: 10/03/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
AIM To assess the willingness of people with type 2 diabetes (T2D) to engage in healthy eating, physical activity and medication taking, and explore associated patient factors. METHODS Online survey among recently diagnosed T2D patients recruited in the Netherlands and the United Kingdom (UK). Patient factors included general factors and behaviour-specific beliefs. Logistic regression analyses and explorative comparisons were conducted. RESULTS Overall, 48% of 67 patients were willing to engage in all three management options, whereas 6% were not willing to follow any of them. 73% were willing to manage T2D with healthy eating, 73% with physical activity, and 72% with medication. Country of recruitment was significantly associated with willingness for healthy eating, with higher willingness among Dutch participants. Beliefs surrounding capability, opportunity, and motivation were significantly associated with willingness to engage in physical activity and medication taking. Many beliefs were similar regardless of willingness but those willing to engage in physical activity perceived less barriers and those willing to take medication had more positive and less negative outcome beliefs than those not willing. CONCLUSIONS Willingness to engage in all management options was limited among recently diagnosed patients, and partly associated with behaviour-specific patient beliefs.
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Affiliation(s)
- Martina Ambrož
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Goya Buitenhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Julia Frost
- Department of Health and Community Sciences, College of Medicine and Health, University of Exeter, UK
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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van den Burg EL, Schoonakker MP, Korpershoek B, Sommeling LE, Sturm CA, Lamb HJ, Pijl H, Numans ME, Adriaanse MA, van Peet PG. Self-initiated lifestyle changes during a fasting-mimicking diet programme in patients with type 2 diabetes: a mixed-methods study. BMC PRIMARY CARE 2024; 25:148. [PMID: 38698355 PMCID: PMC11067095 DOI: 10.1186/s12875-024-02405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Lifestyle changes, especially regarding diet quality and physical activity, are important in the management of type 2 diabetes (T2D). This mixed-methods study explores self-initiated lifestyle changes in patients with T2D who followed a periodic fasting-mimicking diet (FMD). METHODS Quantitative data were obtained from the Fasting In diabetes Treatment trial (November 2018 to August 2021) in which 100 participants with T2D, using metformin only or no medication, were randomised to receive a monthly 5-day FMD for twelve months next to usual care, or usual care only. Diet quality and physical activity questionnaires were completed at baseline, six and twelve months. Changes over time were analysed using linear mixed models. Focus groups were organized with FMD participants to explore experiences regarding self-initiated lifestyle changes. The qualitative data was analysed using the Theoretical Domains Framework. RESULTS Questionnaires were available from 49 FMD participants and 43 controls. No differences in diet quality were found. Total physical activity in the FMD participants changed from 34.6 to 38.5 h per week (h/wk) from baseline to twelve months, while in controls it changed from 34.9 to 29.0 h/wk (between group difference, p = 0.03). In six focus groups with FMD participants (n = 20), individual participants perceived the FMD as an encouragement for (minor) lifestyle changes. There were no barriers to behaviour change related to the FMD. Important facilitators of healthy behaviour were an increase in awareness of the impact of lifestyle on health (knowledge), better physical fitness (physical) and health improvement (reinforcement). Facilitators unrelated to the FMD included family support (social influences) and opportunities in the neighbourhood (environmental context and resources), while barriers unrelated to the FMD were experiencing health problems (physical) and social events (social influences). CONCLUSIONS Using an FMD for five consecutive days per month did not affect diet quality in between FMD periods in quantitative analysis, but increased the number of hours per week spent on physical activity. Qualitative analysis revealed self-initiated improvements in both diet quality and physical activity in individual participants using an FMD. Healthcare professionals could use an FMD programme as a 'teachable moment' to stimulate additional lifestyle changes. TRIAL REGISTRATION ClinicalTrials.gov; NCT03811587. Registered 22 January 2019.
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Affiliation(s)
- Elske L van den Burg
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Marjolein P Schoonakker
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Bregje Korpershoek
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Lara E Sommeling
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Carlijn A Sturm
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Hanno Pijl
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Marieke A Adriaanse
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
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Short E, Selig JP, Felix HC, Painter J, McElfish PA, Rowland B, Ammerman AS, Bounds K, Henske J, Hudson JS, Li J, Young SG, Long CR. Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol. Contemp Clin Trials 2024; 140:107491. [PMID: 38458560 PMCID: PMC11065573 DOI: 10.1016/j.cct.2024.107491] [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: 06/26/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION NCT04876053.
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Affiliation(s)
- Eliza Short
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jacob Painter
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK, Chapel Hill, NC 27599, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Christopher R Long
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
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Şahin Bayram S. A Narrative Review of the Significance of Popular Diets in Diabetes Mellitus Management. Cureus 2024; 16:e61045. [PMID: 38800782 PMCID: PMC11127507 DOI: 10.7759/cureus.61045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 05/29/2024] Open
Abstract
Diabetes mellitus is a collection of metabolic disorders marked by elevated levels of glucose in the blood due to irregularities in the generation or functioning of insulin. Medical nutrition therapy and weight loss are crucial elements in the management of diabetes and the prevention of complications. Several diets have become popular over time for the goal of achieving weight loss, but their popularity has declined due to a lack of reliable scientific evidence. This study classifies popular diets into three categories: diets that manage the composition of macronutrients, diets that restrict specific foods or food groups, and diets that manipulate meal timing. The review includes research studies that investigated the effects of popular diets on the prevention, management, and complications of diabetes. It is clear that different popular diets can have positive effects on both preventing and treating diabetes and preventing and treating complications related to diabetes. However, it is not practical to determine which diet is the most effective option for preventing or controlling diabetes. Thus, the main focus should be on common underlying factors that support well-being, such as decreasing the intake of refined grains and added sugar, choosing non-starchy vegetables, and giving priority to whole foods over processed foods whenever possible, until there is stronger evidence supporting the specific benefits of different dietary patterns.
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Zheng X, Zhang W, Wan X, Lv X, Lin P, Si S, Xue F, Wang A, Cao Y. The effects of Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes: a meta-analysis. BMC Nutr 2024; 10:59. [PMID: 38641818 PMCID: PMC11027355 DOI: 10.1186/s40795-024-00836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/31/2024] [Indexed: 04/21/2024] Open
Abstract
To explore the impact of the Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes(T2D) by a meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrance Library, EMBASE and four Chinese databases to identify RCTs that compared the Mediterranean diet with control diets in patients with T2D up to December 2021. The Risk of Bias of the included studies was assessed using the version 2 of the Cochrane risk-of-bias tools for randomized trials (ROB 2). Seven RCTs with 1371 patients met the eligibility criteria and entered into the meta-analysis. Compared to control diets, the beneficial effects of Mediterranean diet were not statistically significant in high-density lipoprotein (MD = 2.33; 95% CI: -0.27 to 4.92), low-density lipoprotein (MD = -2.34; 95% CI -5.67 to 0.99) and total cholesterol (MD = 2.60; 95% CI: -0.95 to 6.15). But Mediterranean diet led to reduce the level of diastolic blood pressure (MD = -1.20; 95% CI: -2.21 to -0.19) and systolic blood pressure (MD = -4.17; 95% CI: -7.12 to -1.22). Meanwhile, Mediterranean diet showed beneficial effects in glycemic control (HbA1[%]: MD = -0.39, 95% CI: -0.58 to -0.20; fasting plasma glucose: MD = -15.12, 95% CI: -24.69 to -5.55) and weight loss (BMI: MD = -0.71, 95% CI: -1.30 to -0.78; WC: MD = -1.69; 95% CI: -3.35 to -0.02) compared to the control diets. The meta-analysis presented evidence supporting the beneficial effects of the Mediterranean diet on blood pressure, glycemic control, and weight loss. However, the impact of the Mediterranean diet on the lipid profile was not found to be significant, warranting further verification. This Meta-analysis was registered on the INPLASY website (Registration number: INPLASY 202160096).
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Affiliation(s)
- Xing Zheng
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Wenwen Zhang
- Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Xiaojuan Wan
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, 225000, P. R. China
| | - Xiaoyan Lv
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Peng Lin
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Shucheng Si
- Institute for Medical Dataology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Fuzhong Xue
- Institute for Medical Dataology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China
| | - Aijun Wang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Yingjuan Cao
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China.
- Theory & Practice Innovation Research Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P. R. China.
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Slebe R, Wenker E, Schoonmade LJ, Bouman EJ, Blondin DP, Campbell DJT, Carpentier AC, Hoeks J, Raina P, Schrauwen P, Serlie MJ, Stenvers DJ, de Mutsert R, Beulens JWJ, Rutters F. The effect of preprandial versus postprandial physical activity on glycaemia: Meta-analysis of human intervention studies. Diabetes Res Clin Pract 2024; 210:111638. [PMID: 38548105 DOI: 10.1016/j.diabres.2024.111638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
This meta-analysis aims to investigate the effect of preprandial physical activity (PA) versus postprandial PA on glycaemia in human intervention studies. Medline and Embase.com were searched until February 2023 for intervention studies in adults, directly comparing preprandial PA versus postprandial PA on glycaemia. Studies were screened using ASReview (34,837) and full texts were read by two independent reviewers (42 full text, 28 included). Results were analysed using pooled mean differences in random-effects models. Studies were either acute response studies (n = 21) or Randomized Controlled Trials (RCTs) over multiple weeks (n = 7). In acute response studies, postprandial outcomes followed the expected physiological patterns, and outcomes measured over 24 h showed no significant differences. For the RCTs, glucose area under the curve during a glucose tolerance test was slightly, but not significantly lower in preprandial PA vs postprandial PA (-0.29 [95 %CI:-0.66, 0.08] mmol/L, I2 = 64.36 %). Subgroup analyses (quality, health status, etc.) did not significantly change the outcomes. In conclusion, we found no differences between preprandial PA versus postprandial PA on glycaemia both after one PA bout as well as after multiple weeks of PA. The studies were of low to moderate quality of evidence as assessed by GRADE, showed contradictive results, included no long-term studies and used various designs and populations. We therefore need better RCTs, with more similar designs, in larger populations and longer follow-up periods (≥12 weeks) to have a final answer on the questions eat first, then exercise, or the reverse?
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Affiliation(s)
- Romy Slebe
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1089a, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands.
| | - Eva Wenker
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1089a, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Emma J Bouman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1089a, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Denis P Blondin
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; Department of Medicine, Division of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada
| | - David J T Campbell
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada; Department of Cardiac Sciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - André C Carpentier
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; Department of Medicine, Division of Endocrinology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada
| | - Joris Hoeks
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Schrauwen
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Dirk Jan Stenvers
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joline W J Beulens
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1089a, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1089a, Amsterdam, the Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
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11
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Skurk T, Bosy-Westphal A, Grünerbel A, Kabisch S, Keuthage W, Kronsbein P, Müssig K, Nussbaumer H, Pfeiffer AFH, Simon MC, Tombek A, Weber KS, Rubin D. Dietary Recommendations for Persons with Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2024; 132:182-215. [PMID: 38286422 DOI: 10.1055/a-2166-6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Thomas Skurk
- ZIEL Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | | | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Peter Kronsbein
- Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach Campus, Mönchengladbach, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Centre Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany
- Vivantes Humboldt Hospital, Berlin, Germany
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12
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Peng Y, Zhong Z, Huang C, Wang W. The effects of popular diets on bone health in the past decade: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1287140. [PMID: 38665424 PMCID: PMC11044027 DOI: 10.3389/fendo.2023.1287140] [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: 09/01/2023] [Accepted: 11/14/2023] [Indexed: 04/28/2024] Open
Abstract
Bone health encompasses not only bone mineral density but also bone architecture and mechanical properties that can impact bone strength. While specific dietary interventions have been proposed to treat various diseases such as obesity and diabetes, their effects on bone health remain unclear. The aim of this review is to examine literature published in the past decade, summarize the effects of currently popular diets on bone health, elucidate underlying mechanisms, and provide solutions to neutralize the side effects. The diets discussed in this review include a ketogenic diet (KD), a Mediterranean diet (MD), caloric restriction (CR), a high-protein diet (HP), and intermittent fasting (IF). Although detrimental effects on bone health have been noticed in the KD and CR diets, it is still controversial, while the MD and HP diets have shown protective effects, and the effects of IF diets are still uncertain. The mechanism of these effects and the attenuation methods have gained attention and have been discussed in recent years: the KD diet interrupts energy balance and calcium metabolism, which reduces bone quality. Ginsenoside-Rb2, metformin, and simvastatin have been shown to attenuate bone loss during KD. The CR diet influences energy imbalance, glucocorticoid levels, and adipose tissue, causing bone loss. Adequate vitamin D and calcium supplementation and exercise training can attenuate these effects. The olive oil in the MD may be an effective component that protects bone health. HP diets also have components that protect bone health, but their mechanism requires further investigation. In IF, animal studies have shown detrimental effects on bone health, while human studies have not. Therefore, the effects of diets on bone health vary accordingly.
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Affiliation(s)
- Yue Peng
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zikang Zhong
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
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13
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Heidarzadeh-Esfahani N, Darbandi M, Khamoushi F, Najafi F, Soleimani D, Moradi M, Shakiba E, Pasdar Y. Association of plant-based dietary patterns with the risk of type 2 diabetes mellitus using cross-sectional results from RaNCD cohort. Sci Rep 2024; 14:3814. [PMID: 38360842 PMCID: PMC10869829 DOI: 10.1038/s41598-024-52946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is increasing in middle- and low-income countries, and this disease is a burden on public health systems. Notably, dietary components are crucial regulatory factors in T2DM. Plant-based dietary patterns and certain food groups, such as whole grains, legumes, nuts, vegetables, and fruits, are inversely correlated with diabetes incidence. We conducted the present study to determine the association between adherence to a plant-based diet and the risk of diabetes among adults. We conducted a cross-sectional, population-based RaNCD cohort study involving 3401 men and 3699 women. The plant-based diet index (PDI) was developed using a 118-item food frequency questionnaire (FFQ). Logistic regression models were used to evaluate the association between the PDI score and the risk of T2DM. A total of 7100 participants with a mean age of 45.96 ± 7.78 years were analysed. The mean PDI scores in the first, second, and third tertiles (T) were 47.13 ± 3.41, 54.44 ± 1.69, and 61.57 ± 3.24, respectively. A lower PDI was significantly correlated with a greater incidence of T2DM (T1 = 7.50%, T2 = 4.85%, T3 = 4.63%; P value < 0.001). Higher PDI scores were associated with significantly increased intakes of fibre, vegetables, fruits, olives, olive oil, legumes, soy products, tea/coffee, whole grains, nuts, vitamin E, vitamin C, and omega-6 fatty acids (P value < 0.001). After adjusting for confounding variables, the odds of having T2DM were significantly lower (by 30%) at T3 of the PDI than at T1 (OR = 0.70; 95% CI = 0.51, 0.96; P value < 0.001). Our data suggest that adhering to plant-based diets comprising whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee can be recommended today to reduce the risk of T2DM.
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Affiliation(s)
- Neda Heidarzadeh-Esfahani
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Ala Cancer Control and Prevention Centre, Isfahan, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Firoozeh Khamoushi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Davood Soleimani
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Moradi
- Internal Medicine Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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14
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Currenti W, Losavio F, Quiete S, Alanazi AM, Messina G, Polito R, Ciolli F, Zappalà RS, Galvano F, Cincione RI. Comparative Evaluation of a Low-Carbohydrate Diet and a Mediterranean Diet in Overweight/Obese Patients with Type 2 Diabetes Mellitus: A 16-Week Intervention Study. Nutrients 2023; 16:95. [PMID: 38201924 PMCID: PMC10781045 DOI: 10.3390/nu16010095] [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: 10/31/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The worldwide prevalence of type 2 diabetes mellitus (T2DM) and obesity has been steadily increasing over the past four decades, with projections indicating a significant rise in the number of affected individuals by 2045. Therapeutic interventions in T2DM aim to control blood glucose levels and reduce the risk of complications. Dietary and lifestyle modifications play a crucial role in the management of T2DM and obesity. While conventional medical nutritional therapy (MNT) often promotes a high-carbohydrate, low-fat Mediterranean diet as an elective treatment, low-carbohydrate diets (LCDs), specifically those restricting carbohydrate intake to less than 130 g/day, have gained popularity due to their multifaceted benefits. Scientific research supports the efficacy of LCDs in improving glycemic control, weight loss, blood pressure, lipid profiles, and overall quality of life. However, sustaining these benefits over the long term remains challenging. This trial aimed to compare the effects of a Mediterranean diet vs. a low-carbohydrate diet (carbohydrate intake < 130 g/day) on overweight/obese patients with T2DM over a 16-week period. The study will evaluate the differential effects of these diets on glycemic regulation, weight reduction, lipid profile, and cardiovascular risk factors. METHODS The study population comprises 100 overweight/obese patients with poorly controlled T2DM. Anthropometric measurements, bioimpedance analysis, and blood chemistry assessments will be conducted at baseline and after the 16-week intervention period. Both dietary interventions were hypocaloric, with a focus on maintaining a 500 kcal/day energy deficit. RESULTS After 16 weeks, both diets had positive effects on various parameters, including weight loss, blood pressure, glucose control, lipid profile, and renal function. However, the low-carbohydrate diet appears to result in a greater reduction in BMI, blood pressure, waist circumference, glucose levels, lipid profiles, cardiovascular risk, renal markers, and overall metabolic parameters compared to the Mediterranean diet at the 16-week follow up. CONCLUSIONS These findings suggest that a low-carbohydrate diet may be more effective than a Mediterranean diet in promoting weight loss and improving various metabolic and cardiovascular risk factors in overweight/obese patients with T2DM. However, it is important to note that further research is needed to understand the clinical implications and long-term sustainability of these findings.
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Affiliation(s)
- Walter Currenti
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Francesca Losavio
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (F.L.); (G.M.); (R.P.); (F.C.); (R.I.C.)
| | - Stefano Quiete
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Amer M. Alanazi
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (F.L.); (G.M.); (R.P.); (F.C.); (R.I.C.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (F.L.); (G.M.); (R.P.); (F.C.); (R.I.C.)
| | - Fabiana Ciolli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (F.L.); (G.M.); (R.P.); (F.C.); (R.I.C.)
| | - Raffaela Simona Zappalà
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Raffaele Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (F.L.); (G.M.); (R.P.); (F.C.); (R.I.C.)
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15
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Sánchez-García JC, Saraceno López-Palop I, Piqueras-Sola B, Cortés-Martín J, Mellado-García E, Muñóz Sánchez I, Rodríguez-Blanque R. Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence. J Clin Med 2023; 13:37. [PMID: 38202044 PMCID: PMC10779518 DOI: 10.3390/jcm13010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (E.M.-G.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | | | - Beatriz Piqueras-Sola
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (E.M.-G.); (R.R.-B.)
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (E.M.-G.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Elena Mellado-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (E.M.-G.); (R.R.-B.)
- Costa del Sol Health District, 29640 Fuengirola, Spain
| | | | - Raquel Rodríguez-Blanque
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (E.M.-G.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- San Cecilio University Hospital, 18071 Granada, Spain
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16
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Senn MK, Goodarzi MO, Ramesh G, Allison MA, Graff M, Young KL, Talavera GA, McClain AC, Garcia TP, Rotter JI, Wood AC. Associations between avocado intake and measures of glucose and insulin homeostasis in Hispanic individuals with and without type 2 diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Nutr Metab Cardiovasc Dis 2023; 33:2428-2439. [PMID: 37798236 PMCID: PMC10842938 DOI: 10.1016/j.numecd.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS To investigate associations between avocado intake and glycemia in adults with Hispanic/Latino ancestry. METHODS AND RESULTS The associations of avocado intake with measures of insulin and glucose homeostasis were evaluated in a cross-sectional analysis of up to 14,591 Hispanic/Latino adults, using measures of: average glucose levels (hemoglobin A1c; HbA1c), fasting glucose and insulin, glucose and insulin levels after an oral glucose tolerance test (OGTT), and calculated measures of insulin resistance (HOMA-IR, and HOMA-%β), and insulinogenic index. Associations were assessed using multivariable linear regression models, which controlled for sociodemographic factors and health behaviors, and which were stratified by dysglycemia status. In those with normoglycemia, avocado intake was associated with a higher insulinogenic index (β = 0.17 ± 0.07, P = 0.02). In those with T2D (treated and untreated), avocado intake was associated with lower hemoglobin A1c (HbA1c; β = -0.36 ± 0.21, P = 0.02), and lower fasting glucose (β = -0.27 ± 0.12, P = 0.02). In the those with untreated T2D, avocado intake was additionally associated with HOMA-%β (β = 0.39 ± 0.19, P = 0.04), higher insulin values 2-h after an oral glucose load (β = 0.62 ± 0.23, P = 0.01), and a higher insulinogenic index (β = 0.42 ± 0.18, P = 0.02). No associations were observed in participants with prediabetes. CONCLUSIONS We observed an association of avocado intake with better glucose/insulin homeostasis, especially in those with T2D.
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Affiliation(s)
- MacKenzie K Senn
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue Houston, TX 77030, USA; The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gautam Ramesh
- School of Medicine, University of California, La Jolla, San Diego, CA 92037, USA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California, La Jolla, San Diego, CA 92037, USA
| | - Mariaelisa Graff
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kristin L Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA
| | - Tanya P Garcia
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue Houston, TX 77030, USA.
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17
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Rondanelli M, Barrile GC, Cavioni A, Donati P, Genovese E, Mansueto F, Mazzola G, Patelli Z, Pirola M, Razza C, Russano S, Sivieri C, Tartara A, Valentini EM, Perna S. A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices. Nutrients 2023; 15:4943. [PMID: 38068801 PMCID: PMC10707766 DOI: 10.3390/nu15234943] [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: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
In 2019, "Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report" was published. This consensus report, however, did not provide an easy way to illustrate to subjects with prediabetes (SwPs) how to follow a correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of SwPs and to provide a food pyramid for this population. The pyramid built shows that everyday consumption should consist of: whole-grain bread or potatoes eaten with their skins (for fiber and magnesium) and low glycemic index carbohydrates (GI < 55%) (three portions); fruit and vegetables (5 portions), in particular, green leafy vegetables (for fiber, magnesium, and polyphenols); EVO oil (almost 8 g); nuts (30 g, in particular, pistachios and almonds); three portions of dairy products (milk/yogurt: 300-400 g/day); mineral water (almost 1, 5 L/day for calcium intake); one glass of wine (125 mL); and three cups of coffee. Weekly portions should include fish (four portions), white meat (two portions), protein plant-based food (four portions), eggs (egg portions), and red/processed meats (once/week). At the top of the pyramid, there are two pennants: a green one means that SwPs need some personalized supplementation (if daily requirements cannot be satisfied through diet, vitamin D, omega-3, and vitamin B supplements), and a red one means there are some foods and factors that are banned (simple sugar, refined carbohydrates, and a sedentary lifestyle). Three to four times a week of aerobic and resistance exercises must be performed for 30-40 min. Finally, self-monitoring innovative salivary glucose devices could contribute to the reversion of prediabetes to normoglycemia.
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Affiliation(s)
- Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Gaetan Claude Barrile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Alessandro Cavioni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Paolo Donati
- AICUBE srl, 20090 Trezzano sul Naviglio, Italy; (P.D.); (S.R.)
| | - Elisa Genovese
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Francesca Mansueto
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Giuseppe Mazzola
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Zaira Patelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Martina Pirola
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Claudia Razza
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Stefano Russano
- AICUBE srl, 20090 Trezzano sul Naviglio, Italy; (P.D.); (S.R.)
| | - Claudia Sivieri
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Alice Tartara
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Eugenio Marzio Valentini
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Simone Perna
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, University of Milan, 20133 Milan, Italy;
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18
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Liu N, Heng C, Cui Y, Wu D, Li L, Bai M, Guo Y, Wang W, Zhang Y. Investigating the relationship between inhibitory control and dietary adherence among patients with type 2 diabetes mellitus based on subjective and objective measures. Nutr Diabetes 2023; 13:23. [PMID: 37989739 PMCID: PMC10663600 DOI: 10.1038/s41387-023-00252-4] [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: 11/20/2022] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Dietary management has been recommended as the cornerstone of type 2 diabetes mellitus (T2DM) management. However, low adherence to dietary recommendations has been identified in both developed and developing countries. Previous research suggests that inhibitory control influences eating behavior, but few studies have been conducted in patients with T2DM. Thus, we aimed to explore the relationship between inhibitory control and dietary adherence among patients with T2DM. METHODS A total of 393 patients with T2DM from the endocrinology departments of three tertiary hospitals in China were enrolled by the convenience sampling method. Dietary adherence was measured by the Dietary Behavior Adherence Scale for Patients with Type 2 Diabetes Mellitus. Additionally, inhibitory control was subjectively measured by the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) and objectively assessed by the stop signal task (SST) and the Stroop task. The relationship between inhibitory control and dietary adherence was analyzed using Pearson correlation analysis and hierarchical regression analysis. RESULTS Subjectively measured inhibitory control had a significant predictive effect for dietary adherence after controlling for demographic and clinical variables. Adding the inhibitory control variable to the regression equation resulted in the following values: overall model F (19, 373) = 7.096, p < 0.001, increase in R2 value by 0.069, change in F (1, 373) = 35.219, p < 0.001. Similarly, the performance of the Stroop task had a significant predictive effect for dietary adherence to some foods, i.e., carbohydrate and fat. Adding the Stroop effect variable to the regression equation resulted in the following values: overall model F (19, 81) = 2.848, p = 0.005, increase in R2 value by 0.060, change in F (1, 81) = 8.137, p = 0.006. CONCLUSIONS Inhibitory control was a predictor of dietary adherence in patients with T2DM. Future interventions should investigate whether inhibitory control training results in the improvement of dietary adherence in patients with T2DM.
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Affiliation(s)
- Na Liu
- Department of Nursing, Air Force Medical University, Xi'an, China
| | - Chunni Heng
- Department of Endocrinology, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yi Cui
- Department of Nursing, Air Force Medical University, Xi'an, China
| | - Di Wu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Ling Li
- Department of Endocrinology, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Mengge Bai
- Department of Endocrinology, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yanxue Guo
- Department of Endocrinology, the Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen Wang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Yinling Zhang
- Department of Nursing, Air Force Medical University, Xi'an, China.
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19
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Song S, Shon J, Yang WR, Kang HB, Kim KH, Park JY, Lee S, Baik SY, Lee KR, Park YJ. Short-Term Effects of Weight-Loss Meal Replacement Programs with Various Macronutrient Distributions on Gut Microbiome and Metabolic Parameters: A Pilot Study. Nutrients 2023; 15:4744. [PMID: 38004139 PMCID: PMC10675061 DOI: 10.3390/nu15224744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
It has emerged the gut microbiome is crucially linked to metabolic health and obesity. Macronutrient distribution has been discussed as a key parameter in weight-loss programs, but little is known about its impact on the gut microbiome. We investigated the effects of weight-loss meal replacement programs with different macronutrient ratios on the gut microbiota and metabolic parameters in subjects with overweight and obesity. Three low-calorie meal replacement programs with different ratios of carbohydrates, proteins, and lipids were designed: a balanced diet (Group B, 60:15:30), a high-lipid-low-carbohydrate diet (Group F, 35:20:55), and a protein-enriched diet (Group P, 40:25:35). Sixty overweight or obese participants were provided with the meals twice daily for 3 weeks. In all groups, diet intervention resulted in reduced body weight and BMI. The relative abundance of Bacteroidetes and Firmicutes phyla decreased and increased, respectively, which increased the Firmicutes/Bacteroidetes (F/B) ratio in all subjects, particularly in Groups B and P. Alpha- and beta-diversity were augmented at the phylum level in Group P. In conclusion, short-term interventions with weight-loss meal replacement programs increased butyrate-producing bacteria and the F/B ratio. Moreover, the protein-enriched diet significantly increased alpha- and beta-diversity compared to the balanced diet and the high-lipid-low-carbohydrate diet.
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Affiliation(s)
- Seungmin Song
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Jinyoung Shon
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Woo-ri Yang
- Hyundai Greenfood Greating Laboratory, Yongin-si 16827, Republic of Korea
| | - Han-Bit Kang
- Hyundai Greenfood Greating Laboratory, Yongin-si 16827, Republic of Korea
| | - Keun-Ha Kim
- Hyundai Greenfood Greating Laboratory, Yongin-si 16827, Republic of Korea
| | - Ju-Yeon Park
- Hyundai Greenfood Greating Laboratory, Yongin-si 16827, Republic of Korea
| | - Sanghoo Lee
- SCL Healthcare Inc., Yongin-si 16954, Republic of Korea
| | - Sae Yun Baik
- Hanaro Medical Foundation, Seoul 03159, Republic of Korea
| | - Kyoung-Ryul Lee
- SCL Healthcare Inc., Yongin-si 16954, Republic of Korea
- Hanaro Medical Foundation, Seoul 03159, Republic of Korea
| | - Yoon Jung Park
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
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20
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Szczerba E, Barbaresko J, Schiemann T, Stahl-Pehe A, Schwingshackl L, Schlesinger S. Diet in the management of type 2 diabetes: umbrella review of systematic reviews with meta-analyses of randomised controlled trials. BMJ MEDICINE 2023; 2:e000664. [PMID: 38027413 PMCID: PMC10649708 DOI: 10.1136/bmjmed-2023-000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
Objective To systematically summarise and evaluate the existing evidence on the effect of diet on the management of type 2 diabetes and prevention of complications. Design Umbrella review of systematic reviews with meta-analyses of randomised controlled trials. Data sources PubMed, Embase, Epistemonikos, and Cochrane, from inception up to 5 June 2022. Eligibility criteria for selecting studies Systematic reviews with meta-analyses of randomised controlled trials reporting summary effect estimates on the effect of diet on any health outcome in populations with type 2 diabetes were included in the review. Only meta-analyses with randomised controlled trials with the duration of at least 12 weeks were eligible for inclusion. Summary data were extracted by two investigators independently. Summary effect estimates with 95% confidence intervals were recalculated with a random effects model if the information provided was insufficient. Methodological quality was assessed with the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool and the certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach. Results 88 publications with 312 meta-analyses of randomised controlled trials were included. Methodological quality was high to moderate in 23% and low to very low in 77% of the included publications. A high certainty of evidence was found for the beneficial effects of liquid meal replacement on reducing body weight (mean difference -2.37 kg, 95% confidence interval -3.30 to -1.44; n=9 randomised controlled trials included in the meta-analysis) and body mass index (-0.87, -1.32 to -0.43; n=8 randomised controlled trials), and of a low carbohydrate diet (<26% of total energy) on levels of haemoglobin A1c (-0.47%, -0.60% to -0.34%; n=17 randomised controlled trials) and triglycerides (-0.30 mmol/L, -0.43 to -0.17; n=19 randomised controlled trials). A moderate certainty of evidence was found for the beneficial effects of liquid meal replacement, plant based, Mediterranean, high protein, low glycaemic index, and low carbohydrate diets (<26% total energy) on various cardiometabolic measures. The remaining results had low to very low certainty of evidence. Conclusions The evidence indicated that diet has a multifaceted role in the management of type 2 diabetes. An energy restricted diet can reduce body weight and improve cardiometabolic health. Beyond energy restriction, dietary approaches such as plant based, Mediterranean, low carbohydrate (<26% total energy), or high protein diets, and a higher intake of omega 3 fatty acids can be beneficial for cardiometabolic health in individuals with type 2 diabetes. Systematic review registration PROSPERO CRD42021252309.
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Affiliation(s)
- Edyta Szczerba
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
| | - Janett Barbaresko
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Tim Schiemann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
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21
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Jin P, Wang X, Li A, Dong H, Ji M. Time Perspective, Dietary Behavior, and Glycemic Control in Patients With Type 2 Diabetes. Nurs Res 2023; 72:462-470. [PMID: 37733643 DOI: 10.1097/nnr.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Dietary behavior is a key component in the self-management of patients with Type 2 diabetes (T2DM), as it is essential for glycemic control and preventing diabetic complications. However, it is challenging for patients with diabetes to make sustainable dietary behavior changes and achieve long-term optimal glycemic control. OBJECTIVES Dietary behavior changes involve present efforts to achieve future benefits. The primary aim of this study was to investigate the relationships among time perspective, dietary behaviors, and health outcomes in patients with T2DM. Based on the temporal self-regulation theory and previous research, the secondary aim of the study was to explore how time perspective influences dietary behaviors. METHODS Following convenient sampling ( N = 329), a cross-sectional study was conducted in patients with T2DM between November 2021 and October 2022. Data were collected using self-reported questionnaires and the retrieval of clinical information from medical records. Hierarchical regression and path analysis were used to explore the relationships among study variables. RESULTS Our analyses showed that a future-oriented time perspective was associated with better dietary behavior but was not significantly related to hemoglobin A1c. Hierarchical regression analysis also demonstrated that having a more future-oriented time perspective was associated with healthier dietary behavior after controlling covariates. Based on the theory and path analysis, there was an indirect effect of future time perspective on dietary behavior through self-control capacity and intention. DISCUSSION The study reveals that a future-oriented time perspective can promote healthier dietary behavior when providing care for patients with T2DM. As a theoretical framework, the temporal self-regulation theory offers references for researchers and clinicians to take into consideration patients' time perspectives and their intentions and self-control capacity when developing interventional programs to improve dietary behaviors.
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22
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Santos CFDS, Santos BDC, de Carvalho GB, Oliveira JDS, Santos CB, Reis AR, Santos RKF, Brandão-Lima PN, da Costa SSL, Dos Santos SH, Rocha VDS, Pires LV. Magnesium Status and Dietary Patterns Associated with Glycemic Control in Individuals with Type 2 Diabetes Mellitus. Biol Trace Elem Res 2023; 201:5152-5161. [PMID: 36807884 DOI: 10.1007/s12011-023-03601-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 02/20/2023]
Abstract
Hypomagnesemia and unhealthy eating patterns are associated with poor glycemic control in individuals with type 2 diabetes mellitus (T2DM). This study aimed to associate magnesium status and dietary patterns with glycemic control in T2DM individuals. This cross-sectional study included 147 individuals with T2DM, aged between 19 and 59 years, of both sexes, residents in Sergipe/Brazil. The BMI, waist circumference, %body fat, plasma magnesium, serum glucose, insulin, %HbA1c, triacylglycerol, total cholesterol, LDL-c, and HDL-c were analyzed. Eating patterns were identified using a 24-h recall method. Logistic regression models were used to verify the association of magnesium status and dietary patterns with markers of glycemic control by adjusting for sex, age, time of T2DM diagnosis, and BMI. A P value < 0.05 was considered significant. Magnesium deficiency increased the chance of elevated %HbA1c by 5.893-fold (P = 0.041). Three main dietary patterns were identified: mixed (MDP), unhealthy (UDP), and healthy (HDP). UDP also increased the chance of elevated %HbA1c levels (P = 0.034). T2DM individuals' who presented magnesium deficiency had a higher chance of elevated %HbA1c levels (8.312-fold) and those in the lowest quartile (Q) of the UDP (Q1: P = 0.007; Q2: P = 0.043) had a lower chance of elevated %HbA1c levels. However, the lower quartiles of the HDP were associated with a greater chance of alterations in the %HbA1c level (Q1: P = 0.050; Q2: P = 0.044). No association was observed between MDP and the variables studied. Magnesium deficiency and UDP were associated with a higher chance of inadequate glycemic control in T2DM individuals.
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Affiliation(s)
- Cinthia Fontes da Silva Santos
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Beatriz da Cruz Santos
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Gabrielli Barbosa de Carvalho
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
- Nutrition in Public Health Post-Graduation Program, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Juliana de Souza Oliveira
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Cynthia Batista Santos
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Aline Rocha Reis
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Ramara Kadija Fonseca Santos
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
| | - Paula Nascimento Brandão-Lima
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil
- Nutrition in Public Health Post-Graduation Program, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Samir Hipólito Dos Santos
- Chemistry Post-Graduation Program, Chemistry Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Liliane Viana Pires
- Nutrition Sciences Post-Graduation Program, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, Marechal Rondon Avenue, S/n - Jardim Rosa Elze, ZIP: 49100-000, São Cristóvão, Sergipe, Brazil.
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23
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Mesinovic J, Fyfe JJ, Talevski J, Wheeler MJ, Leung GK, George ES, Hunegnaw MT, Glavas C, Jansons P, Daly RM, Scott D. Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies. Diabetes Metab J 2023; 47:719-742. [PMID: 37709502 PMCID: PMC10695715 DOI: 10.4093/dmj.2023.0112] [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: 04/14/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.
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Affiliation(s)
- Jakub Mesinovic
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Jackson J. Fyfe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jason Talevski
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
- School of Rural Health, Monash University, Warragul, Australia
| | - Michael J. Wheeler
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Gloria K.W. Leung
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Melkamu T. Hunegnaw
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Costas Glavas
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Paul Jansons
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Robin M. Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Ruiz-Tovar J, Llavero C, Fernandez-Contreras ME. Effect of Lactobacillus kefiri, in Conjunction with PENS T6 and a Hypocaloric Diet, on Weight Loss, Hypertension and Laboratory Glycemic and Lipid Profile. Nutrients 2023; 15:4549. [PMID: 37960202 PMCID: PMC10649111 DOI: 10.3390/nu15214549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
The pathogenesis of obesity has been linked to alterations in gut microorganisms. The aim of this study was to investigate the effect of Lactobacillus kefiri, together with PENS T6 and a hypocaloric diet, on weight loss, hypertension and laboratory glycemic and lipid profile. A prospective non-randomized study was conducted involving adult patients with a body mass index (BMI) > 30 kg/m2. Patients were divided into two groups: those undergoing PENS-T6 and hypocaloric diet (PENS-Diet Group) and those undergoing the same PENS-T6 scheme and hypocaloric diet, but additionally receiving probiotics including Lactobacillus kefiri (PENS-Diet + L. kefiri Group). Weight loss was assessed at the end of the treatment, and analytical glycemic and lipid profile, and microbiological analysis of feces were performed before and after treatment. The addition of Lactobacillus kefiri to PENS T6 and a low-calorie diet, increases weight loss and further improves the glycemic and lipid profile. L. kefiri also causes a further improvement in obesity-associated dysbiosis, mainly by increasing the muconutritive (Akkermansia muciniphila) and regulatory (Bifidobacterium spp.) microbiome, and the Phylum Bacteroidetes (Prevotella spp.) and decreasing the Firmicutes/Bacteroidetes ratio.
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Affiliation(s)
- Jaime Ruiz-Tovar
- EUEF San Juan de Dios, Universidad Pontificia de Comillas, 28036 Madrid, Spain
- Garcilaso Clinic, 28010 Madrid, Spain;
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Karki A, Vandelanotte C, Khalesi S, Dahal P, Rawal LB. The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0293028. [PMID: 37844107 PMCID: PMC10578590 DOI: 10.1371/journal.pone.0293028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs. METHODS Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis. RESULTS Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence. CONCLUSION The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.
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Affiliation(s)
- Ashmita Karki
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Saman Khalesi
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
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26
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Pappe CL, Peters B, Dommisch H, Woelber JP, Pivovarova-Ramich O. Effects of reducing free sugars on 24-hour glucose profiles and glycemic variability in subjects without diabetes. Front Nutr 2023; 10:1213661. [PMID: 37850088 PMCID: PMC10577299 DOI: 10.3389/fnut.2023.1213661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
Background The Western diet, especially beverages and high processed food products, is high in sugars which are associated with the development of obesity and diabetes. The reduction of refined carbohydrates including free and added sugars improves glycemic control in individuals with diabetes, but the data regarding effects in subjects without diabetes are limited. Objective This study aimed to evaluate the effects of reducing free sugar intake on 24-h glucose profiles and glycemic variability using continuous glucose monitoring (CGM). Methods In the randomized controlled study, 21 normal weight and overweight/obese subjects (BMI 18-40 kg/m2) without diabetes were assigned to a 4-week reduced-sugar (RS) diet or control diet after a 2-week baseline phase. During the baseline phase, all participants were advised not to change their habitual diet. During the intervention phase, RS participants were asked to avoid added sugar and white flour products, whereas participants of the control group were requested to proceed their habitual diet. Anthropometric parameters and HbA1c were assessed before and at the end of the intervention phase. Interstitial glucose was measured using continuous glucose monitoring (CGM), and the food intake was documented by dietary records for 14 consecutive days during the baseline phase and for the first 14 consecutive days during the intervention phase. Mean 24-h glucose as well as intra- and inter-day indices of glucose variability, i.e., standard deviation (SD) around the sensor glucose level, coefficient of variation in percent (CV), mean amplitude of glucose excursions (MAGE), continuous overlapping net glycemic action (CONGA), and mean absolute glucose (MAG), were calculated for the baseline and intervention phases. Results During the intervention, the RS group decreased the daily intake of sugar (i.e., -22.4 ± 20.2 g, -3.28 ± 3.61 EN %), total carbohydrates (-6.22 ± 6.92 EN %), and total energy intake (-216 ± 108 kcal) and increased the protein intake (+2.51 ± 1.56 EN %) compared to the baseline values, whereby this intervention-induced dietary changes differed from the control group. The RS group slightly reduced body weight (-1.58 ± 1.33 kg), BMI, total fat, and visceral fat content and increased muscle mass compared to the baseline phase, but these intervention-induced changes showed no differences in comparison with the control group. The RS diet affected neither the 24-h mean glucose levels nor intra- and inter-day indices of glucose variability, HbA1c, or diurnal glucose pattern in the within- and between-group comparisons. Conclusion The dietary reduction of free sugars decreases body weight and body fat which may be associated with reduced total energy intake but does not affect the daily mean glucose and glycemic variability in individuals without diabetes. Clinical trial registration German Clinical Trials Register (DRKS); identifier: DRKS00026699.
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Affiliation(s)
- Christina Laeticia Pappe
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beeke Peters
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
| | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Periodontology, Health Science Center, University of Washington, Seattle, WA, United States
| | - Johan Peter Woelber
- Policlinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Olga Pivovarova-Ramich
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Arimoto M, Yamamoto Y, Imaoka W, Kuroshima T, Toragai R, Nakamura M, Ito Y, Ai M. Small Dense Low-Density Lipoprotein Cholesterol Levels in Breakfast Skippers and Staple Foods Skippers. J Atheroscler Thromb 2023; 30:1376-1388. [PMID: 36878535 PMCID: PMC10564629 DOI: 10.5551/jat.64024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 03/08/2023] Open
Abstract
AIMS Skipping breakfast is known as a cardiovascular disease (CVD) risk. Recently, eating and dietary patterns have been varied in many countries, however, the mechanisms of promoting CVD are still unclear. Our goal was to assess the effects of eating and dietary patterns on CVD risk factors, with a focus on lipid parameters including serum concentration of small dense low-density lipoprotein cholesterol (sdLDL-C). METHODS Subjects consisted of 27,997 Japanese men and women, who had medical check-up. Lipid parameters including sdLDL-C levels in breakfast skippers were compared with those in breakfast eaters. Lipid parameters in staple foods skippers were also compared with those in staple foods eaters. RESULTS Breakfast skippers had significantly (p<0.01) higher serum levels of median sdLDL-C than breakfast eaters in both genders (34.7 versus 32.0 mg/dL in men, 25.4 versus 24.9 mg/dL in women, respectively), and the same was true for sdLDL-C/LDL-C ratio (0.276 versus 0.260 in men, 0.218 versus 0.209 in women, respectively). Similarly, staple foods skippers had significantly higher sdLDL-C level than staple foods eaters in both genders (34.1 versus 31.6 mg/dL in men, 25.8 versus 24.7 mg/dL in women), and the same went for sdLDL-C/LDL-C ratio (0.278 versus 0.256 in men, 0.215 versus 0.208 mg/dL in women, respectively). CONCLUSION Our data indicate that both skipping breakfast and having meals without staple foods increase serum sdLDL-C concentration and cause unfavorable lipid profiles, and then may promote CVD. These finding provide evidence for the importance of having breakfast and meals with staple foods for preventing CVD.
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Affiliation(s)
- Masako Arimoto
- Department of Insured Medical Care Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasushi Yamamoto
- Kansai Occupational Health Association, ACTY Health Evaluation Center, Osaka, Japan
| | - Wataru Imaoka
- Kansai Occupational Health Association, ACTY Health Evaluation Center, Osaka, Japan
| | - Toshio Kuroshima
- Kansai Occupational Health Association, Senri LC Health Evaluation Center, Osaka, Japan
| | - Ryoko Toragai
- Kansai Occupational Health Association, Senri LC Health Evaluation Center, Osaka, Japan
| | - Marie Nakamura
- Department of Insured Medical Care Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Koshigaya Laketown Clinic, Saitama, Japan
| | - Yasuki Ito
- Vaccine & Diagnostics R&D department, Denka Company Ltd., Niigata, Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Attaye I, Lassen PB, Adriouch S, Steinbach E, Patiño-Navarrete R, Davids M, Alili R, Jacques F, Benzeguir S, Belda E, Nemet I, Anderson JT, Alexandre-Heymann L, Greyling A, Larger E, Hazen SL, van Oppenraaij SL, Tremaroli V, Beck K, Bergh PO, Bäckhed F, ten Brincke SP, Herrema H, Groen AK, Pinto-Sietsma SJ, Clément K, Nieuwdorp M. Protein supplementation changes gut microbial diversity and derived metabolites in subjects with type 2 diabetes. iScience 2023; 26:107471. [PMID: 37599833 PMCID: PMC10432813 DOI: 10.1016/j.isci.2023.107471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
High-protein diets are promoted for individuals with type 2 diabetes (T2D). However, effects of dietary protein interventions on (gut-derived) metabolites in T2D remains understudied. We therefore performed a multi-center, randomized-controlled, isocaloric protein intervention with 151 participants following either 12-week high-protein (HP; 30Energy %, N = 78) vs. low-protein (LP; 10 Energy%, N = 73) diet. Primary objectives were dietary effects on glycemic control which were determined via glycemic excursions, continuous glucose monitors and HbA1c. Secondary objectives were impact of diet on gut microbiota composition and -derived metabolites which were determined by shotgun-metagenomics and mass spectrometry. Analyses were performed using delta changes adjusting for center, baseline, and kidney function when appropriate. This study found that a short-term 12-week isocaloric protein modulation does not affect glycemic parameters or weight in metformin-treated T2D. However, the HP diet slightly worsened kidney function, increased alpha-diversity, and production of potentially harmful microbiota-dependent metabolites, which may affect host metabolism upon prolonged exposure.
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Affiliation(s)
- Ilias Attaye
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Pierre Bel Lassen
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
- Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Solia Adriouch
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Emilie Steinbach
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Rafael Patiño-Navarrete
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Mark Davids
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Rohia Alili
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Flavien Jacques
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Sara Benzeguir
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Eugeni Belda
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
| | - Ina Nemet
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA
- Center for Microbiome & Human Health, Cleveland Clinic, Cleveland, OH, USA
| | - James T. Anderson
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA
- Center for Microbiome & Human Health, Cleveland Clinic, Cleveland, OH, USA
| | | | - Arno Greyling
- Unilever Foods Innovation Centre, Wageningen, the Netherlands
| | - Etienne Larger
- Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Stanley L. Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA
- Center for Microbiome & Human Health, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH, USA
| | - Sophie L. van Oppenraaij
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Valentina Tremaroli
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Katharina Beck
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Per-Olof Bergh
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Fredrik Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden
| | - Suzan P.M. ten Brincke
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Hilde Herrema
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Albert K. Groen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics), Paris, France
- Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
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Jing T, Zhang S, Bai M, Chen Z, Gao S, Li S, Zhang J. Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients 2023; 15:3156. [PMID: 37513574 PMCID: PMC10384204 DOI: 10.3390/nu15143156] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Dietary patterns play a critical role in diabetes management, while the best dietary pattern for Type 2 diabetes (T2DM) patients is still unclear. The aim of this network meta-analysis was to compare the impacts of various dietary approaches on the glycemic control of T2DM patients. METHODS Relevant studies were retrieved from PubMed, Embase, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL), and other additional records (1949 to 31 July 2022). Eligible RCTs were those comparing different dietary approaches against each other or a control diet in individuals with T2DM for at least 6 months. We assessed the risk of bias of included studies with the Cochrane risk of bias tool and confidence of estimates with the Grading of Recommendations Assessment, Development, and Evaluation approach for network meta-analyses. In order to determine the pooled effect of each dietary approach relative to each other, we performed a network meta-analysis (NMA) for interventions for both HbA1c and fasting glucose, which enabled us to estimate the relative intervention effects by combing both direct and indirect trial evidence. RESULTS Forty-two RCTs comprising 4809 patients with T2DM were included in the NMA, comparing 10 dietary approaches (low-carbohydrate, moderate-carbohydrate, ketogenic, low-fat, high-protein, Mediterranean, Vegetarian/Vegan, low glycemic index, recommended, and control diets). In total, 83.3% of the studies were at a lower risk of bias or had some concerns. Findings of the NMA revealed that the ketogenic, low-carbohydrate, and low-fat diets were significantly effective in reducing HbA1c (viz., -0.73 (-1.19, -0.28), -0.69 (-1.32, -0.06), and -1.82 (-2.93, -0.71)), while moderate-carbohydrate, low glycemic index, Mediterranean, high-protein, and low-fat diets were significantly effective in reducing fasting glucose (viz., -1.30 (-1.92, -0.67), -1.26 (-2.26, -0.27), -0.95 (-1.51, -0.38), -0.89 (-1.60, -0.18) and -0.75 (-1.24, -0.27)) compared to a control diet. The clustered ranking plot for combined outcomes indicated the ketogenic, Mediterranean, moderate-carbohydrate, and low glycemic index diets had promising effects for controlling HbA1c and fasting glucose. The univariate meta-regressions showed that the mean reductions of HbA1c and fasting glucose were only significantly related to the mean weight change of the subjects. CONCLUSIONS For glycemic control in T2DM patients, the ketogenic diet, Mediterranean diet, moderate-carbohydrate diet, and low glycemic index diet were effective options. Although this study found the ketogenic diet superior, further high-quality and long-term studies are needed to strengthen its credibility.
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Affiliation(s)
- Tiantian Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Shunxing Zhang
- Department of Global Public Health/Media, Culture, and Communication, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10016, USA
| | - Mayangzong Bai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Zhongwan Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Sihan Gao
- School of Public Health, University of Washington Seattle Campus, Seattle, WA 98105, USA
| | - Sisi Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Jing Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
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Markussen LT, Kivelä J, Lindström J, Ashrafi RA, Heinonen S, Koivusalo S, Meinilä J. Short-term effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes - the eMOM pilot study. BMC Nutr 2023; 9:87. [PMID: 37452403 PMCID: PMC10349459 DOI: 10.1186/s40795-023-00744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The optimal nutritional treatment for gestational diabetes (GDM) is still a matter of debate. With increasing rates of GDM and potential negative consequences for the health of mother and child, the best treatment should be established. The Nordic diet with emphasis on plant-based protein show promising health outcomes in other populations but has yet to be investigated in GDM population. The aim of this study, which is part of the "Effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes" (eMOM) pilot study was to compare the short-term effects of healthy Nordic diet (HND) and the currently recommended moderate restriction of carbohydrates diet (MCRD) on glucose and lipid metabolism in women with GDM. METHODS This was a randomized crossover where each of the diet interventions (HND and MCRD) were consumed for 3 days with a 3-day wash-out period in between. In total, 42 pregnant women diagnosed with GDM (< 29 + 0 gestational week) were randomized. Glucose data was collected by continuous glucose monitors (CGM, Freestyle Libre®, Abbott, USA) worn for 14 days, and participants gave blood samples before and after diet interventions. The primary outcome was time spent in glucose target range (TIR, < 7.8 mmol/L). TIR, 3-day mean tissue glucose as well as changes in fasting glucose, homeostatic model of insulin resistance (HOMA-IR) and blood lipids were analyzed with paired samples statistical analyses. RESULTS Thirty-six women with complete 14 days CGM data were analyzed. Both diet interventions produced a high degree of TIR (99% SD 1.8), without a difference between the diets (p = 0.727). The 3-day mean glucose was significantly lower in HND than in MCRD (p = 0,049). Fasting insulin (p = 0,034), insulin resistance (p = 0,030), total and LDL cholesterol (p = 0,023 and 0,008) reduced more in the MCRD diet than the HND. NS differences in any other measure of CGM or blood tests. CONCLUSIONS HND and MCRD did not differ in terms of their short-term effect on TIR. A larger study with sufficient power is needed to confirm the differences in short-term mean glucose, insulin resistance and lipid metabolism. TRIAL REGISTRATION Registered in clinicaltrials.gov (21/09/2018, NCT03681054).
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Affiliation(s)
- Lisa Torsdatter Markussen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
- Department of IT Management, Helsinki University Hospital, Tukholmankatu 8, Biomedicum 2C, Helsinki, 00029 HUS, Finland.
| | - Jemina Kivelä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jaana Lindström
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Reza A Ashrafi
- Department of Computer Science, Aalto University, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Saila Koivusalo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital and Turku University, Turku, Finland
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Bryl A, Mrugacz M, Falkowski M, Zorena K. A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy. Int J Mol Sci 2023; 24:11145. [PMID: 37446322 DOI: 10.3390/ijms241311145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
The Mediterranean diet is recognized as one of the healthiest available dietary patterns. This perception results from its beneficial effects on the cardiovascular system and, also, on hypertension, diabetes, and cancer compared with other diets. Its impact on the course of diabetes is assessed in the available scientific literature; however, little information is available about its impact on diabetic retinopathy. The MD is characterized mainly by the consumption of fish, seafood, foods of plant origin, and fresh fruit and vegetables. It is also recommended to consume legumes, which are a source of folic acid, magnesium, iron, and dietary fiber. High consumption of nuts and unrefined grains is also recommended in the MD. Marine fish provide polyunsaturated acids from the omega-3 group. Olive oil plays a very important role, especially olive oil obtained from mechanical pressing. Additionally, olive oil contains vitamins E, K, and polyphenols. Polyphenols, which are present in a diverse range of vegetables, fruits, and seeds, have the ability to decrease oxidative stress, inflammation, and insulin resistance. Resveratrol is naturally found in grape skins and seeds, as well as in peanuts and berries, and is a constituent of red wine. Resveratrol can inhibit increased vascular leakage and loss of pericytes and regulate the level of VEGF protein in the retina, thus inhibiting the development of DR. Consumption of fruits, vegetables, fish, and olive oil may be correlated with a lower risk of diabetic retinopathy. This paper presents the definition of the Mediterranean diet and its influence on the course of diabetes and diabetic retinopathy.
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Affiliation(s)
- Anna Bryl
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Mariusz Falkowski
- PhD Studies, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental Microbiology, Medical University of Gdansk, 80-211 Gdansk, Poland
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Richardson LA, Basu A, Chien LC, Alman AC, Snell-Bergeon JK. Longitudinal Associations of Healthy Dietary Pattern Scores with Coronary Artery Calcification and Pericardial Adiposity in United States Adults with and without Type 1 Diabetes. J Nutr 2023; 153:2085-2093. [PMID: 37187353 PMCID: PMC10375506 DOI: 10.1016/j.tjnut.2023.05.016] [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: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Pericardial adipose tissue volume (PAT) and coronary artery calcification (CAC) are prognostic indicators for future cardiovascular events; however, no studies have assessed the long-term associations of adherence to dietary patterns (DPs) with PAT and CAC in adults with and without type 1 diabetes (T1D). OBJECTIVES We investigated the longitudinal associations of the Mediterranean Diet (MedDiet) and Dietary Approaches to Stop Hypertension (DASH) diet with PAT and CAC progression in adults with and without T1D. METHODS The Coronary Artery Calcification in Type 1 Diabetes (CACTI) study is a population-based, prospective study of 652 T1D and 764 nondiabetic mellitus (nonDM) (19-56 y) participants that began in 2000-2002 with follow-up visits in 2003-2004 and 2006-2007. At each visit, food frequency questionnaires were collected and used to develop adherence scores for the MedDiet and DASH diets. PAT and CAC were measured at each visit using electron beam computed tomography. CAC progression was defined as a ≥2.5 mm square root-transformed volume. Mixed effect models were used to conduct statistical analyses. RESULTS Combined models found a significant-0.09 cm3 (95% CI: -0.14, -0.03; P = 0.0027) inverse association in PAT for every 1-point increase in the MedDiet score and a significant-0.26 cm3 (95% CI: -0.38, -0.14; P < 0.0001) inverse association in PAT for every 1-point increase in the DASH score. In combined models, the DPs were not significantly associated with lower odds of CAC progression; however, both DPs had significant interactions by diabetes status for CAC. Only the DASH diet was associated with lower odds of CAC progression in the nonDM group (OR: 0.96; 95% CI: 0.93, 0.99; P = 0.0224). CONCLUSIONS These data suggest that the DPs are associated with lower PAT, which may reduce future cardiovascular events. The DASH diet may be beneficial for lower odds of CAC progression in those without T1D.
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Affiliation(s)
- Leigh Ann Richardson
- Department of Epidemiology and Biostatistics, University of Nevada at Las Vegas, Las Vegas, NV, United States
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada at Las Vegas, Las Vegas, NV, United States.
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada at Las Vegas, Las Vegas, NV, United States
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
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Pradeepa R, Shreya L, Anjana RM, Jebarani S, Venkatesan U, Kamal Raj N, Swami OC, Mohan V. Sex-Based Differences in Clinical Profile and Complications among Individuals with Type 2 Diabetes Seen at a Private Tertiary Diabetes Care Centre in India. Healthcare (Basel) 2023; 11:healthcare11111634. [PMID: 37297774 DOI: 10.3390/healthcare11111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
This study aimed to compare the clinical and biochemical profiles as well as the complications in males and females with type 2 diabetes (T2DM) presenting to a private tertiary diabetes care centre in India. This is a retrospective study, conducted between 1 January 2017 and 31 December 2019, and included 72,980 individuals with T2DM, aged ≥ 18 years (age and sex-matched-males-36,490; females-36,490). Anthropometric measurements, blood pressure, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), glycated haemoglobin (HbA1c), lipids, urea, and creatinine were measured. Retinopathy was screened using retinal photography, neuropathy using biothesiometry, nephropathy measuring urinary albumin excretion, peripheral vascular disease (PVD) using Doppler, and coronary artery disease (CAD) based on the history of myocardial infarction and/or drug treatment for CAD and/or electrocardiographic changes. Obesity (73.6% vs. 59.0%) rates were significantly higher in females compared to males. FPG, PPPG, and HbA1c were higher among younger age groups among both sexes, with males having higher values compared to females. However, after the age of 44 years, control of diabetes was worse among females. In addition, only 18.8% of the females achieved glycemic control (HbA1c < 7%) compared to 19.9% in males (p < 0.001). Males had higher prevalence of neuropathy (42.9% vs. 36.9%), retinopathy (36.0% vs. 26.3%), and nephropathy (25.0% vs. 23.3%) compared to females. Males had 1.8- and 1.6-times higher risk of developing CAD and retinopathy compared to females. Hypothyroidism (12.5% vs. 3.5%) and cancers (1.3% vs. 0.6%) were significantly higher in females compared to males. In this large sample of T2DM seen at a chain of private tertiary diabetes centres, females had higher prevalence of metabolic risk factors and poorer diabetes control compared to males, emphasizing the need for better control of diabetes in females. However, males had higher prevalence of neuropathy, retinopathy, nephropathy, and CAD compared to females.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
| | - Lal Shreya
- Emcure Pharmaceuticals Ltd., Pune 411057, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
| | - Saravanan Jebarani
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
| | - Nithyanantham Kamal Raj
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 600086, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai 600086, India
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Salvia MG, Quatromoni PA. Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100034. [PMID: 39035058 PMCID: PMC11256231 DOI: 10.1016/j.ajmo.2023.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/15/2023] [Indexed: 07/23/2024]
Abstract
Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.
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Affiliation(s)
- Meg G. Salvia
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Paula A. Quatromoni
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
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Luo J, Tao Y, Xu Y, Yang L, Zhang H, Chen Y, Liu X, Zhang Y, Lan R, Chen Y, Liu B, Deng T. Global comparison of the effect of non-pharmacological interventions on glycemic control in patients with type 2 diabetes: A network meta-analysis from 107 randomized controlled trials. J Diabetes Complications 2023; 37:108518. [PMID: 37267719 DOI: 10.1016/j.jdiacomp.2023.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of non-pharmacological interventions (NPIs) on glycemic control in patients with type 2 diabetes (T2D) and to provide guidance for clinical healthcare-giver. DESIGN Network meta-analysis (NMA). SETTING AND PARTICIPANTS Randomized controlled trials comparing the effect of NPIs with usual care, waitlist, or other NPIs on glycemic control in patients with T2D. METHODS This NMA was guided by frequentist framework. PubMed, Embase, the Cochrane Library Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, and Web of Science were searched from their inception until January 2023. The primary outcome was HbA1c and secondary outcomes were cardiovascular risk scores and related psychosocial scores. Mean differences and standardized mean differences were pooled using NMA. Study quality was assessed with the Confidence in Network Meta-analysis. RESULTS A total of 107 studies (10,496 participants) were included. The median sample size of the included studies was 64 (range, 10-563) and the median duration was 3 months (range, 1-24). Compared to usual care, all NPIs except acupuncture (MD: -0.28; 95 % CI: -1.02, 0.26) and psychological therapy (MD: -0.29; 95 % CI: -0.66, 0.08) showed significantly differences in improving glycemic control in patients with T2D. And according to the results of surface under the cumulative ranking analysis and Cluster ranking, meditation therapy was considered to the best choice when balancing the efficacy of glycemic control with self-efficacy and diabetes related problems, while nutrition therapy was considered to the best choice when balancing quality of life with risk of cardiovascular complications. CONCLUSIONS These findings validate the efficacy of NPIs for glycemic control in patients with T2D and suggest that healthcare-giver should consider both the efficacy of interventions and the psychosocial needs of patients when developing NPIs programs.
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Affiliation(s)
- Jingsong Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yanmin Tao
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yaxin Xu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Tongji University, Shanghai 200000, China
| | - Liping Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Han Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yufei Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xingting Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yunwu Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Ruixi Lan
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yuxin Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Beijia Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Tingting Deng
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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Westerman KE, Walker ME, Gaynor SM, Wessel J, DiCorpo D, Ma J, Alonso A, Aslibekyan S, Baldridge AS, Bertoni AG, Biggs ML, Brody JA, Chen YDI, Dupuis J, Goodarzi MO, Guo X, Hasbani NR, Heath A, Hidalgo B, Irvin MR, Johnson WC, Kalyani RR, Lange L, Lemaitre RN, Liu CT, Liu S, Moon JY, Nassir R, Pankow JS, Pettinger M, Raffield LM, Rasmussen-Torvik LJ, Selvin E, Senn MK, Shadyab AH, Smith AV, Smith NL, Steffen L, Talegakwar S, Taylor KD, de Vries PS, Wilson JG, Wood AC, Yanek LR, Yao J, Zheng Y, Boerwinkle E, Morrison AC, Fornage M, Russell TP, Psaty BM, Levy D, Heard-Costa NL, Ramachandran VS, Mathias RA, Arnett DK, Kaplan R, North KE, Correa A, Carson A, Rotter JI, Rich SS, Manson JE, Reiner AP, Kooperberg C, Florez JC, Meigs JB, Merino J, Tobias DK, Chen H, Manning AK. Investigating Gene-Diet Interactions Impacting the Association Between Macronutrient Intake and Glycemic Traits. Diabetes 2023; 72:653-665. [PMID: 36791419 PMCID: PMC10130485 DOI: 10.2337/db22-0851] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Few studies have demonstrated reproducible gene-diet interactions (GDIs) impacting metabolic disease risk factors, likely due in part to measurement error in dietary intake estimation and insufficient capture of rare genetic variation. We aimed to identify GDIs across the genetic frequency spectrum impacting the macronutrient-glycemia relationship in genetically and culturally diverse cohorts. We analyzed 33,187 participants free of diabetes from 10 National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine program cohorts with whole-genome sequencing, self-reported diet, and glycemic trait data. We fit cohort-specific, multivariable-adjusted linear mixed models for the effect of diet, modeled as an isocaloric substitution of carbohydrate for fat, and its interactions with common and rare variants genome-wide. In main effect meta-analyses, participants consuming more carbohydrate had modestly lower glycemic trait values (e.g., for glycated hemoglobin [HbA1c], -0.013% HbA1c/250 kcal substitution). In GDI meta-analyses, a common African ancestry-enriched variant (rs79762542) reached study-wide significance and replicated in the UK Biobank cohort, indicating a negative carbohydrate-HbA1c association among major allele homozygotes only. Simulations revealed that >150,000 samples may be necessary to identify similar macronutrient GDIs under realistic assumptions about effect size and measurement error. These results generate hypotheses for further exploration of modifiable metabolic disease risk in additional cohorts with African ancestry. ARTICLE HIGHLIGHTS We aimed to identify genetic modifiers of the dietary macronutrient-glycemia relationship using whole-genome sequence data from 10 Trans-Omics for Precision Medicine program cohorts. Substitution models indicated a modest reduction in glycemia associated with an increase in dietary carbohydrate at the expense of fat. Genome-wide interaction analysis identified one African ancestry-enriched variant near the FRAS1 gene that may interact with macronutrient intake to influence hemoglobin A1c. Simulation-based power calculations accounting for measurement error suggested that substantially larger sample sizes may be necessary to discover further gene-macronutrient interactions.
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Affiliation(s)
- Kenneth E. Westerman
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
| | - Maura E. Walker
- Department of Medicine, Section of Preventive Medicine, Boston University School of Medicine, Boston, MA
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Sheila M. Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Wessel
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
- Diabetes Translational Research Center, Indiana University, Indianapolis, IN
| | - Daniel DiCorpo
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Jiantao Ma
- Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Abigail S. Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary L. Biggs
- Department of Biostatistics, University of Washington, Seattle, WA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Joseé Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Natalie R. Hasbani
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Adam Heath
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Bertha Hidalgo
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Rita R. Kalyani
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leslie Lange
- Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Internal Medicine, University of Washington, Seattle, WA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Evans Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, MA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Boston, MA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rami Nassir
- Department of Pathology, School of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mackenzie K. Senn
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Albert V. Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
- Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, WA
| | - Lyn Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Sameera Talegakwar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Paul S. de Vries
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - James G. Wilson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Alexis C. Wood
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Lisa R. Yanek
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Alanna C. Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Miriam Fornage
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Tracy P. Russell
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Daniel Levy
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Nancy L. Heard-Costa
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Vasan S. Ramachandran
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Evans Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, MA
| | - Rasika A. Mathias
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Donna K. Arnett
- College of Public Health, University of Kentucky, Lexington, KY
| | - Robert Kaplan
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA
| | - Kari E. North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adolfo Correa
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS
| | - April Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Stephen S. Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | | | | | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jose C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - James B. Meigs
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jordi Merino
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Han Chen
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Center for Precision Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Alisa K. Manning
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
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Michaelidou M, Pappachan JM, Jeeyavudeen MS. Management of diabesity: Current concepts. World J Diabetes 2023; 14:396-411. [PMID: 37122433 PMCID: PMC10130896 DOI: 10.4239/wjd.v14.i4.396] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/15/2023] [Accepted: 03/20/2023] [Indexed: 04/12/2023] Open
Abstract
The global prevalence of obesity is increasing rapidly with an exponential rise in incidence of type 2 diabetes mellitus in recent years. ‘Diabesity’, the term coined to show the strong interlink between obesity and diabetes, is the direct cons-equence of the obesity pandemic, and poses significant challenges in the management of the disease. Without addressing the clinical and mechanistic complications of obesity such as metabolic-associated fatty liver disease and obstructive sleep apnoea, a rational management algorithm for diabesity cannot be developed. Several classes of anti-diabetic medications including insulins, sulphonylureas, thiazolidinediones and meglitinides are associated with the risk of weight gain and may potentially worsen diabesity. Therefore, appropriate selection of antidiabetic drug regimen is crucial in the medical management of diabesity. The role of non-pharmacological measures such as dietary adjustments, exercise interventions and bariatric procedures should also be emphasised. Unfortunately, the importance of appropriate and optimal management of diabesity is often overlooked by medical professionals when achieving adequate glycemic control which results in inappropriate management of the disease and its complications. This review provides a narrative clinical update on the evidence behind the management of diabesity.
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Affiliation(s)
- Maria Michaelidou
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Mohammad Sadiq Jeeyavudeen
- Department of Endocrinology & Metabolism, University Hospitals of Edinburgh, Edinburgh EH16 4SA, United Kingdom
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Cohen CC, Perng W, Sauder KA, Shapiro ALB, Starling AP, Friedman C, Felix JF, Küpers LK, Moore BF, Hébert JR, Shivappa N, Scherzinger A, Sundaram SS, Shankar K, Dabelea D. Maternal Diet Quality During Pregnancy and Offspring Hepatic Fat in Early Childhood: The Healthy Start Study. J Nutr 2023; 153:1122-1132. [PMID: 36796482 PMCID: PMC10196613 DOI: 10.1016/j.tjnut.2023.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Overnutrition in utero may increase offspring risk of nonalcoholic fatty liver disease (NAFLD), but the specific contribution of maternal diet quality during pregnancy to this association remains understudied in humans. OBJECTIVES This study aimed to examine the associations of maternal diet quality during pregnancy with offspring hepatic fat in early childhood (median: 5 y old, range: 4-8 y old). METHODS Data were from 278 mother-child pairs in the longitudinal, Colorado-based Healthy Start Study. Multiple 24-h recalls were collected from mothers during pregnancy on a monthly basis (median: 3 recalls, range: 1-8 recalls starting after enrollment), and used to estimate maternal usual nutrient intakes and dietary pattern scores [Healthy Eating Index-2010 (HEI-2010), Dietary Inflammatory Index (DII), and Relative Mediterranean Diet Score (rMED)]. Offspring hepatic fat was measured in early childhood by MRI. Associations of maternal dietary predictors during pregnancy with offspring log-transformed hepatic fat were assessed using linear regression models adjusted for offspring demographics, maternal/perinatal confounders, and maternal total energy intake. RESULTS Higher maternal fiber intake and rMED scores during pregnancy were associated with lower offspring hepatic fat in early childhood in fully adjusted models [Back-transformed β (95% CI): 0.82 (0.72, 0.94) per 5 g/1000 kcal fiber; 0.93 (0.88, 0.99) per 1 SD for rMED]. In contrast, higher maternal total sugar and added sugar intakes, and DII scores were associated with higher offspring hepatic fat [Back-transformed β (95% CI): 1.18 (1.05, 1.32) per 5% kcal/d added sugar; 1.08 (0.99, 1.18) per 1 SD for DII]. Analyses of dietary pattern subcomponents also revealed that lower maternal intakes of green vegetables and legumes and higher intake of "empty calories" were associated with higher offspring hepatic fat in early childhood. CONCLUSIONS Poorer maternal diet quality during pregnancy was associated with greater offspring susceptibility to hepatic fat in early childhood. Our findings provide insights into potential perinatal targets for the primordial prevention of pediatric NAFLD.
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Affiliation(s)
- Catherine C Cohen
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L B Shapiro
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne P Starling
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Chloe Friedman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Leanne K Küpers
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brianna F Moore
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nitin Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Ann Scherzinger
- Department of Radiology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shikha S Sundaram
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kartik Shankar
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Dominguez LJ, Veronese N, Di Bella G, Cusumano C, Parisi A, Tagliaferri F, Ciriminna S, Barbagallo M. Mediterranean diet in the management and prevention of obesity. Exp Gerontol 2023; 174:112121. [PMID: 36792040 DOI: 10.1016/j.exger.2023.112121] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
The current pandemic of obesity represents a major global public health problem, mainly due to its association with chronic non-communicable disabling conditions and with increased mortality. Population aging increases the chances of non-communicable chronic diseases allowing a longer exposure to risk factors for these disabling conditions. Obesity is a major risk factor contributing to pathological aging. Numerous epidemiological studies have shown that the risk of death due to cardiovascular disease and cancer increases progressively as overweight and obesity rise. Nutrition research is now focused on the effects of combinations of foods in dietary patterns instead of those of single nutrients or foods. The dietary model with the largest body of evidence of health benefit is that traditionally followed by inhabitants of some Mediterranean countries. There is evidence confirming the inverse association of adhering to Mediterranean diet with overweight and obesity. Four meta-analyses of randomized controlled trials, including up to 16 trials, have shown a greater reduction of body weight and BMI with MedDiet compared to other diets, while a meta-analysis of 7 prospective cohort studies, found a reduced risk of becoming obese and gaining weight over time associated with a higher adherence to MedDiet. This narrative review examines studies reporting inverse associations of a higher adherence to the MedDiet with overweight/obesity and with age-associated chronic diseases related to obesity.
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Affiliation(s)
- Ligia J Dominguez
- Faculty of Medicine and Surgery, "Kore" University of Enna, Enna, Italy; Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Giovanna Di Bella
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Claudia Cusumano
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Angela Parisi
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Federica Tagliaferri
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Stefano Ciriminna
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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Oda K, Anno T, Ogawa N, Kimura Y, Kawasaki F, Kaku K, Kaneto H, Takemasa M, Sasano M. Impact of nutritional guidance on various clinical parameters in patients with moderate obesity: A retrospective study. Front Nutr 2023; 10:1138685. [PMID: 37006919 PMCID: PMC10060631 DOI: 10.3389/fnut.2023.1138685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
ContextThis study aims to investigate whether there is adequate provision of nutritional guidance through interventions by registered dietitians, especially for patients with moderate obesity. This is particularly important as such interventions may prove to be more effective for Japanese patients.MethodsIn Japan, since there is a system of nutritional guidance with a registered dietitian for patients with a BMI over 30 kg/m2, we recruited 636 patients with obesity who had a BMI over 30 kg/m2 admitted to the Kawasaki Medical School General Medical Center between April 2018 and March 2020 through a review of their medical records. Second, we recruited 153 patients who underwent a blood examination before receiving nutritional guidance and at least one time every 3 to 6 months thereafter after receiving it. We aimed to evaluate whether continued nutritional guidance and follow-up interventions for patients with obesity were effective. We compared the BMI and metabolic markers of the patients who received nutritional guidance from a registered dietitian against those who did not.ResultsA total of 636 patients with obesity who have a BMI over 30 kg/m2 were included in this study. A total of 164 patients with obesity received nutritional guidance from a registered dietitian at least one time, but 472 patients did not. Most interventions on nutritional guidance conducted by a registered dietitian were ordered from internal medicine (81.1%). However, internal medicine was the most common department that did not perform these interventions; however, less than half of the (49.2%) received them. In the second analysis, we compared two groups of patients with obesity. The first group (n = 70) who underwent blood examinations received nutritional guidance from a registered dietitian, while the second group (n = 54) did not receive such guidance. We found that there was no significant difference in body weight and BMI between the two groups of patients. We observed a significant decrease in dyslipidemia-associated metabolic markers among the patients who received nutritional guidance compared to those who did not [total cholesterol, −9.7 ± 29.3 vs. 2.3 ± 22.0 mg/dL (p = 0.0208); low-density lipoprotein cholesterol, −10.4 ± 30.5 vs. −2.0 ± 51.0 mg/dL (p = 0.0147), respectively]. Other metabolic markers also tended to decrease, although they did not reach statistical significance.ConclusionIt is rare for patients with only obesity to receive nutritional guidance. However, when nutritional guidance from a registered dietitian is provided, improvements in BMI and metabolic parameters can be expected.
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Affiliation(s)
- Kayoko Oda
- Department of Nutrition, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Nozomi Ogawa
- Department of Nutrition, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Yukiko Kimura
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Mutsuko Takemasa
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Miyori Sasano
- Department of Nutrition, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
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Yera R, Alzahrani AA, Martínez L, Rodríguez RM. A Systematic Review on Food Recommender Systems for Diabetic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4248. [PMID: 36901271 PMCID: PMC10001611 DOI: 10.3390/ijerph20054248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Recommender systems are currently a relevant tool for facilitating access for online users, to information items in search spaces overloaded with possible options. With this goal in mind, they have been used in diverse domains such as e-commerce, e-learning, e-tourism, e-health, etc. Specifically, in the case of the e-health scenario, the computer science community has been focused on building recommender systems tools for supporting personalized nutrition by delivering user-tailored foods and menu recommendations, incorporating the health-aware dimension to a larger or lesser extent. However, it has been also identified the lack of a comprehensive analysis of the recent advances specifically focused on food recommendations for the domain of diabetic patients. This topic is particularly relevant, considering that in 2021 it was estimated that 537 million adults were living with diabetes, being unhealthy diets a major risk factor that leads to such an issue. This paper is centered on presenting a survey of food recommender systems for diabetic patients, supported by the PRISMA 2020 framework, and focused on characterizing the strengths and weaknesses of the research developed in this direction. The paper also introduces future directions that can be followed in the next future, for guaranteeing progress in this necessary research area.
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Affiliation(s)
- Raciel Yera
- Computer Science Department, University of Jaén, 23007 Jaén, Spain
- Computer Science Department, University of Ciego de Ávila, Ciego de Ávila 65100, Cuba
| | - Ahmad A. Alzahrani
- Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Luis Martínez
- Computer Science Department, University of Jaén, 23007 Jaén, Spain
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Caffeine and the Risk of Diabetic Retinopathy in Type 2 Diabetes Mellitus: Findings from Clinical and Experimental Studies. Nutrients 2023; 15:nu15051169. [PMID: 36904168 PMCID: PMC10005220 DOI: 10.3390/nu15051169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
The aim of this study was to assess the potential benefits of caffeine intake in protecting against the development of diabetic retinopathy (DR) in subjects with type 2 diabetes (T2D). Furthermore, we tested the effect of topical administration of caffeine on the early stages of DR in an experimental model of DR. In the cross-sectional study, a total of 144 subjects with DR and 147 individuals without DR were assessed. DR was assessed by an experienced ophthalmologist. A validated food frequency questionnaire (FFQ) was administered. In the experimental model, a total of 20 mice were included. One drop (5 μL) of caffeine (5 mg/mL) (n = 10) or vehicle (5 μL PBS, pH 7.4) (n = 10) was randomly administered directly onto the superior corneal surface twice daily for two weeks in each eye. Glial activation and retinal vascular permeability were assessed using standard methods. In the cross-sectional study in humans, the adjusted-multivariable model showed that a moderate and high (Q2 and Q4) caffeine intake had a protective effect of DR (odds ratio (95% confidence interval) = 0.35 (0.16-0.78); p = 0.011 and 0.35 (0.16-0.77); p = 0.010, respectively). In the experimental model, the administration of caffeine did not improve either reactive gliosis or retinal vascular permeability. Our results suggest a dose-dependent protective effect of caffeine in the development of DR, while the potential benefits of antioxidants in coffee and tea should also be considered. Further research is needed to establish the benefits and mechanisms of caffeinated beverages in the development of DR.
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Mirzababaei A, Abaj F, Hajishizari S, Bahrampour N, Noori S, Barekzai AM, Hosseininasab D, Clark CCT, Mirzaei K. The association of dietary approaches to stop hypertension (DASH) with the odds of diabetic nephropathy and metabolic markers in women: a case-control study. BMC Womens Health 2023; 23:63. [PMID: 36782160 PMCID: PMC9926721 DOI: 10.1186/s12905-022-02140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/20/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES Epidemiologic studies have reported that diet is associated with diabetes and its complications through different pathways. We sought to examine the associations between the Dietary Approaches to Stop Hypertension (DASH) diet and the odds of diabetic nephropathy (DN) developing in Iranian women with existing type 2 diabetes. METHODS In this case-control study, 105 women with DN and 105 controls, matched for age and diabetes duration, were selected from the Kowsar Diabetes Clinic in Semnan, Iran. DASH, estimated using dietary intake, was assessed using a validated and reliable food frequency questionnaire with 147 items. Anthropometric measurements were assessed for all subjects. Logistic regression was performed to examine the association between DASH and the odds of developing DN. RESULTS After controlling for potential confounders, subjects in the highest intake of DASH diet adherence have 84% lower odds of DN, compared to those with the lowest intake (OR = 0.16, 95% CI = 0.07-0.34, P < 0.001). Among DASH diet subcategories, intakes of vegetables (80%), fruits (88%), nuts and legumes (87%), and low-fat dairy (73%) decreased the risk of DN after adjustment for confounders (P < 0.001). CONCLUSIONS This study showed that the DASH diet is associated with lower odds of DN development in women with type 2 diabetes.
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Affiliation(s)
- Atieh Mirzababaei
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Faezeh Abaj
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Sara Hajishizari
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Niki Bahrampour
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sahar Noori
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ahmad Mujtaba Barekzai
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Dorsa Hosseininasab
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran. .,Food Microbiology Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Whiteley C, Benton F, Matwiejczyk L, Luscombe-Marsh N. Determining Dietary Patterns to Recommend for Type 2 Diabetes: An Umbrella Review. Nutrients 2023; 15:nu15040861. [PMID: 36839218 PMCID: PMC9958769 DOI: 10.3390/nu15040861] [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: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Some specific dietary patterns improve glycaemic levels and cardiovascular risk factors better than others. We aimed to identify the most effective dietary patterns using a food-focused approach to improve blood glucose management (primary outcome) and cardiovascular risk factors (secondary outcome) in people with type 2 diabetes. An umbrella review was conducted comparing dietary patterns for the management of these outcomes. Studies published between 2012 and 2022 were identified using PubMed Central, ProQuest, Web of Science, and the Cochrane Database of Systematic Reviews. Thirty systematic reviews met the inclusion criteria. Twenty-two of thirty reviews quantitated (via meta-analyses of over 212 randomised control trials) the effect size of different dietary patterns. Twelve reviews found Low-carbohydrate (LC), Mediterranean (M), Plant-based (PB), and/or Low-glycaemic Index (LGI) diets reduced HbA1c moderately more than control diets (typically a high-carbohydrate, low-fat diet) (i.e., LC: -0.1 to -0.5%; M: -0.3 to -0.5%; PB: -0.2 to -0.4%; LGI -0.2 to -0.5%; all p-value < 0.01). We conclude that Low-carbohydrate, Mediterranean, Plant-based, and Low-glycaemic Index dietary patterns are all clinically effective for people with type 2 diabetes as alternatives to high-carbohydrate, low-fat diets typically used for managing glycaemic levels and CVD risk. However, quality evidence about the sustainability of effects and safety remains limited, warranting future research.
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Affiliation(s)
- Cathryn Whiteley
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
| | - Fiona Benton
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
| | - Louisa Matwiejczyk
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Natalie Luscombe-Marsh
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
- Correspondence: ; Tel.: +61-08-8354-5803
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Turner-McGrievy GM, Wilson MJ, Carswell J, Okpara N, Aydin H, Bailey S, Davey M, Hutto B, Wilcox S, Friedman DB, Sarzynski MA, Liese AD. A 12-Week Randomized Intervention Comparing the Healthy US, Mediterranean, and Vegetarian Dietary Patterns of the US Dietary Guidelines for Changes in Body Weight, Hemoglobin A1c, Blood Pressure, and Dietary Quality among African American Adults. J Nutr 2023; 153:579-587. [PMID: 36894249 PMCID: PMC10196600 DOI: 10.1016/j.tjnut.2022.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The US Dietary Guidelines (USDG) form the basis of nutrition guidelines, but the research informing the 3 USDG dietary patterns (Healthy US-Style [H-US], Mediterranean [Med], and vegetarian [Veg]) has been drawn largely from observational studies among White populations. OBJECTIVES The Dietary Guidelines 3 Diets study was a 3-arm, 12-wk randomly assigned intervention among African American (AA) adults at risk of type 2 diabetes mellitus that tested the 3 USDG dietary patterns. METHODS The AAs (ages 18-65 y, BMI 25-49.9 kg/m2, and BMI was measured in kg/m2) with ≥3 type 2 diabetes mellitus risk factors were recruited. Weight, HbA1c, blood pressure, and dietary quality (healthy eating index [HEI]) were collected at baseline and 12 wk. In addition, participants attended weekly online classes that were designed using material from the USDG/MyPlate. Repeated measures, mixed models with maximum likelihood estimation, and robust computation of standard errors were tested. RESULTS Of the 227 participants screened, 63 were eligible (83% female; age 48.0 ± 10.6 y, BMI 35.9 ± 0.8 kg/m2) and randomly assigned to the Healthy US-Style Eating Pattern (H-US) (n = 21, 81% completion), healthy Mediterranean-style eating pattern (Med) (n = 22, 86% completion), or healthy vegetarian eating pattern (Veg) (n = 20, 70% completion) groups. Within-group, but not between groups, weight loss was significant (-2.4 ± 0.7 kg H-US, -2.6 ± 0.7 kg Med, -2.4 ± 0.8 kg Veg; P = 0.97 between group). There was also no significant difference between groups for changes in HbA1c (0.03 ± 0.05% H-US, -0.10 ± 0.05% Med, 0.07 ± 0.06% Veg; P = 0.10), systolic BP (-5.5 ± 2.7 mmHg H-US, -3.2 ± 2.5 mmHg Med, -2.4 ± 2.9 mmHg Veg; P = 0.70), diastolic blood pressure (-5.2 ± 1.8 mmHg H-US, -2.0 ± 1.7 mmHg Med, -3.4 ± 1.9 mmHg Veg; P = 0.41), or HEI (7.1 ± 3.2 H-US, 15.2 ± 3.1 Med, 4.6 ± 3.4 Veg; P = 0.06). Post hoc analyses showed that the Med group had significantly greater improvements in HEI compared to the Veg group (difference = -10.6 ± 4.6; 95% CI: -19.7, -1.4; P = 0.02). CONCLUSIONS The present study demonstrates that all 3 USDG dietary patterns lead to significant weight loss among AA adults. However, none of the outcomes were significantly different between groups. This trial was registered at clinicaltrials.gov as NCT04981847.
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Affiliation(s)
- Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Mary J Wilson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jessica Carswell
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Halide Aydin
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shiba Bailey
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Marty Davey
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Liu X, He M, Gan X, Yang Y, Hou Q, Hu R. The Effects of Six Weeks of Fasted Aerobic Exercise on Body Shape and Blood Biochemical Index in Overweight and Obese Young Adult Males. J Exerc Sci Fit 2023; 21:95-103. [PMID: 36447628 PMCID: PMC9674552 DOI: 10.1016/j.jesf.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/OBJECTIVE The effects of fasted aerobic exercise on body composition and whether it causes adverse effects remain controversial. This study was to compare the effects of fasted and non-fasted aerobic exercise on body shape and blood biochemical indexes in overweight and obese young adult males, and observe whether FAE triggers adverse reactions. METHODS Thirty overweight and obese young adult males were randomly divided into fasted aerobic exercise (FAE) group, non-fasted aerobic exercise (NFAE) group, and control group. They were subjected to indoor treadmill intervention five days a week combined with diet control for six weeks. The FAE group had breakfast 0.5 h after exercise, and the NFAE group exercised 1 h after breakfast. Both groups filled out adverse reaction questionnaires during exercise, and the control group did not have any intervention. Height, weight, body mass index (BMI), and body fat percentage of the three groups of subjects before and after the experiment were measured by the GAIA KIKO bio-resistance antibody composition analyzer in Korea; waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were measured by the tape measure method; fasting plasma glucose (FPG), fasting insulin (FINs), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein (VLDL), and HDL-C/LDL-C were measured by Roche C8000 automatic biochemical analysis instrument. RESULTS Weight, BMI, body fat percentage, WC, HC, WHR, WHtR, TG, TC, LDL-C and VLDL decreased very significantly (P < 0.01) in the FAE and NFAE groups after the 6-week experiment. The decrease in FINS was significant in the FAE group (P < 0.05) and the decrease in HDL-C was very significant in the NFAE group (P < 0.01). There was no significant difference in the frequency of adverse reactions between two groups (P > 0.05). CONCLUSION Six-week FAE and NFAE significantly improved body shape in overweight and obese young adult males, while FAE significantly reduced fasting insulin levels and increased tissue cell sensitivity to insulin. And compared to NFAE, 30 min of FAE in the morning did not increase adverse effects.
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Affiliation(s)
- Xiaolong Liu
- Sports Medicine Laboratory, Guangxi Normal University, Guilin, 541006, Guangxi, China
- Rehabilitation Institute, Guilin Life and Health Career Technical College, Guilin, 541100, Guangxi, China
| | - Mengxiao He
- Key Laboratory of Human Sports Science, Xinjiang Normal University, Urumqi, 830054, Xinjiang, China
- Department of Physical Education and Health, Guilin College, Guilin, 541006, Guangxi, China
| | - Xiaoli Gan
- College of Foreign Studies, Guangxi Normal University, Guilin, 541006, Guangxi, China
| | - Yang Yang
- Department of Sports Science, Shanghai Institute of Physical Education, Shanghai, 200438, China
| | - Qin Hou
- Department of Gastroenterology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Rongbo Hu
- Chair of Building Realization and Robotics, Technical University of Munich, Munich, 80333, Germany
- Corresponding author. Chair of Building Realization and Robotics, Technical University of Munich, Munich, 80333, Germany.
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Khorasaniha R, Olof H, Voisin A, Armstrong K, Wine E, Vasanthan T, Armstrong H. Diversity of fibers in common foods: Key to advancing dietary research. Food Hydrocoll 2023. [DOI: 10.1016/j.foodhyd.2023.108495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Li Y, Yu L, Liu Z, Jia S, Man Q, Zhu Q, Li C, Yang Y, Liu B, Zhang J. Dietary Pattern Associated with the Risk of Poor Glycemic Control in Chinese Diabetic Adults: Results from the China Nutrition and Health Surveillance 2015-2017 Survey. Nutrients 2022; 15:nu15010056. [PMID: 36615714 PMCID: PMC9824526 DOI: 10.3390/nu15010056] [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: 11/20/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
The present study was conducted to investigate the nutrition status of dietary patterns and the association between dietary patterns and the risk of poor glycemic control in Chinese diabetics. The relevant data was collected from the China Nutrition and Health Surveillance 2015-2017 survey, which is a national cross-sectional surveillance program. A total of 2031 participants were included in the present statistical analysis. Food consumption was assessed through a validated and standard food frequency questionnaire. Dietary patterns were derived with reduced rank regression using hemoglobin A1c. Diabetes was diagnosed by medical institutions, glycemic control was defined as hemoglobin A1c less than 7%, poor glycemic control was defined as hemoglobin A1c greater than 7%. A multiple-variable-adjusted logistic regression, including age, living area, income level, educational attainment, body mass index, occupational physical activity, energy intake, current smoking status, current drinking status, diabetic medication use, insulin use, following diabetic diets, increased exercise, and glucose monitoring, was adjusted to explore the association between dietary patterns and the risk of poor glycemic control in diabetes. Two gender-specific dietary patterns have an increased risk of poor glycemic control and are characterized by a low intake of freshwater fish, poultry, and fruits. For male participants, the dietary pattern was characterized by a high intake of wheat and its products, a low intake of vegetables, corn and its products, shrimp and crab, and beans (Q4 vs. Q1, OR = 2.69, 95% CI: 1.76 to 4.10). For female participants, the dietary pattern was characterized by a low intake of snacks and nuts, and algae and mushroom (Q4 vs. Q1, OR = 2.18, 95% CI: 1.48 to 3.20).
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Affiliation(s)
- Yuqian Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lianlong Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Shandong Center for Disease Control and Prevention, Jinan 250014, China
| | - Zhen Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shanshan Jia
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qingqing Man
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qianrang Zhu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Cheng Li
- Department of Clinical Nutrition, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yuxiang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Beibei Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence:
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Self-Reported Dietary Management Behaviors and Dietary Intake among Chinese Adults with Diabetes: A Population-Based Study. Nutrients 2022; 14:nu14235178. [PMID: 36501208 PMCID: PMC9740534 DOI: 10.3390/nu14235178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Few studies have analyzed the implementation of dietary management in Chinese adults with diabetes. Thus, we assessed and compared dietary intake and diet quality between diabetic patients with and without dietary management behaviors (DPDM vs. NDPDM), and evaluated the adherence to dietary guidelines in both groups of patients. The data were obtained from the 2002, 2010-2013, and 2015 China National Nutrition Survey. A total of 69,583, 67,177, and 96,631 subjects participated in the 2002, 2010-2013, and 2015 survey rounds, respectively. The dietary intake data were measured using 3-day 24 h dietary recalls and weighed records of household condiments. The China Healthy Diet Index (CHDI) was used to evaluate diet quality. The study included 6229 patients with diabetes, of which 78% had dietary management behaviors. The diabetic patients with dietary management behaviors showed higher percentages of energy from high-quality carbohydrates, animal protein, saturated fatty acids, and unsaturated fatty acids and lower percentages from low-quality carbohydrates and plant protein than NDPDM. The diabetic patients with dietary management behaviors also had lower intakes of cereals and tubers and higher intakes of vegetables than NDPDM. The total CHDI score of DPDM was higher than NDPDM (56.3 ± 12.7 vs. 54.1 ± 12.3). The proportion of DPDM meeting the recommended intake for different food items ranged from 3.3% to 42.8% and from 3.0% to 39.2% in NDPDM. The diabetic patients with dietary management behaviors showed better adherence to dietary guidelines and higher diet quality scores than NDPDM, while the overall adherence was poor in both groups of patients. Our findings suggested that measures are needed to promote and refine dietary management behaviors, which can help to improve disease management in diabetic patients.
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Lin YH, Lin CH, Huang YY, Chen HY, Tai AS, Fu SC, Hsieh SH, Sun JH, Chen ST, Lin SH. Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen. Eur J Med Res 2022; 27:273. [PMID: 36463197 PMCID: PMC9719195 DOI: 10.1186/s40001-022-00892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM). METHODS Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed. RESULTS Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime. CONCLUSION A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.
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Affiliation(s)
- Yi-Hsuan Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Chia-Hung Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yao Huang
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Hsin-Yun Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - An-Shun Tai
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Shih-Chen Fu
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Sheng-Hwu Hsieh
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Jui-Hung Sun
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Szu-Tah Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Sheng-Hsuan Lin
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
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