A new approach to the study of diet and risk of type 2 diabetes

The Metabolic Benefits of Menopausal Hormone Therapy Are Not Mediated by Improved Nutritional Habits. The OsteoLaus Cohort

Menopause alters body composition by increasing fat mass. Menopausal hormone therapy (MHT) is associated with decreased total and visceral adiposity. It is unclear whether MHT favorably affects energy intake. We aimed to assess in the OsteoLaus cohort whether total energy intake (TEI) and/or diet quality (macro- and micronutrients, dietary patterns, dietary scores, dietary recommendations)—evaluated by a validated food frequency questionnaire—differ in 839 postmenopausal women classified as current, past or never MHT users. There was no difference between groups regarding TEI or consumption of macronutrients. After multivariable adjustment, MHT users were less likely to adhere to the unhealthy pattern ‘fat and sugar: Current vs. never users [OR (95% CI): 0.48 (0.28–0.82)]; past vs. never users [OR (95% CI): 0.47 (0.27–0.78)]. Past users exhibited a better performance in the revised score for Mediterranean diet than never users (5.00 ± 0.12 vs. 4.63 ± 0.08, p < 0.04). Differences regarding compliance with dietary recommendations were no longer significant after adjustment for covariates. Overall, these results argue against a major role of TEI and diet quality as possible mediators of the MHT metabolic benefits. Future research on this relationship should focus on other potential targets of MHT, such as resting energy expenditure and physical activity.

Socio-demographic and lifestyle determinants of dietary patterns in French-speaking Switzerland, 2009-2012

Background

Food intake is a complex behaviour which can be assessed using dietary patterns. Our aim was to characterize dietary patterns and associated factors in French-speaking Switzerland.

Methods

Cross-sectional study conducted between 2009 and 2012 in the city of Lausanne, Switzerland, including 4372 participants (54% women, 57.3 ± 10.3 years). Food consumption was assessed using a validated food frequency questionnaire. Dietary patterns were assessed by principal components analysis.

Results

Three patterns were identified: “Meat & fries”; “Fruits & Vegetables” and “Fatty & sugary”. The “Meat & fries” pattern showed the strongest correlations with total and animal protein and cholesterol carbohydrates, dietary fibre and calcium. The “Fruits & Vegetables” pattern showed the strongest correlations with dietary fibre, carotene and vitamin D. The “Fatty & sugary” pattern showed the strongest correlations with total energy and saturated fat. On multivariate analysis, male gender, low educational level and sedentary status were positively associated with the “Meat & fries” and the “Fatty & sugary” patterns, and negatively associated with the “Fruits & Vegetables” pattern. Increasing age was inversely associated with the “Meat & fries” pattern; smoking status was inversely associated with the “Fruits & Vegetables” pattern. Being born in Portugal or Spain was positively associated with the “Meat & fries” and the “Fruits & Vegetables” patterns. Increasing body mass index was positively associated with the “Meat & fries” pattern and inversely associated with the “Fatty & sugary” pattern.

Conclusions

Three dietary patterns, one healthy and two unhealthy, were identified in the Swiss population. Several associated modifiable behaviours were identified; the information on socio- demographic determinants allows targeting of the most vulnerable groups in the context of public health interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5045-1) contains supplementary material, which is available to authorized users.

Maternal Dietary Patterns and Gestational Diabetes Risk: A Case-Control Study

BACKGROUND

Maternal dietary patterns play an important role in the progress of gestational diabetes mellitus (GDM). The aim of the present study was to explore this association.

METHOD

A total of 388 pregnant women (122 case and 266 control) were included. Dietary intake were collected using a food frequency questionnaire (FFQ). GDM was diagnosed using a 100-gram, 3-hour oral glucose tolerance test. Dietary pattern was identified by factor analysis. To investigate the relation between each of the independent variables with gestational diabetes, the odds ratio (OR) was calculated.

RESULTS

Western dietary pattern was high in sweets, jams, mayonnaise, soft drinks, salty snacks, solid fat, high-fat dairy products, potatoes, organ meat, eggs, red meat, processed foods, tea, and coffee. The prudent dietary pattern was characterized by higher intake of liquid oils, legumes, nuts and seeds, fruits and dried fruits, fish and poultry whole, and refined grains. Western dietary pattern was associated with increased risk of gestational diabetes mellitus before and after adjustment for confounders (OR = 1.97, 95% CI: 1.27-3.04, OR = 1.68, 95% CI: 1.04-2.27). However, no significant association was found for a prudent pattern.

CONCLUSION

These findings suggest that the Western dietary pattern was associated with an increased risk of GDM.

Vegetarian diets and incidence of diabetes in the Adventist Health Study-2

AIM

To evaluate the relationship of diet to incident diabetes among non-Black and Black participants in the Adventist Health Study-2.

METHODS AND RESULTS

Participants were 15,200 men and 26,187 women (17.3% Blacks) across the U.S. and Canada who were free of diabetes and who provided demographic, anthropometric, lifestyle and dietary data. Participants were grouped as vegan, lacto ovo vegetarian, pesco vegetarian, semi-vegetarian or non-vegetarian (reference group). A follow-up questionnaire after two years elicited information on the development of diabetes. Cases of diabetes developed in 0.54% of vegans, 1.08% of lacto ovo vegetarians, 1.29% of pesco vegetarians, 0.92% of semi-vegetarians and 2.12% of non-vegetarians. Blacks had an increased risk compared to non-Blacks (odds ratio [OR] 1.364; 95% confidence interval [CI], 1.093-1.702). In multiple logistic regression analysis controlling for age, gender, education, income, television watching, physical activity, sleep, alcohol use, smoking and BMI, vegans (OR 0.381; 95% CI 0.236-0.617), lacto ovo vegetarians (OR 0.618; 95% CI 0.503-0.760) and semi-vegetarians (OR 0.486, 95% CI 0.312-0.755) had a lower risk of diabetes than non-vegetarians. In non-Blacks vegan, lacto ovo and semi-vegetarian diets were protective against diabetes (OR 0.429, 95% CI 0.249-0.740; OR 0.684, 95% CI 0.542-0.862; OR 0.501, 95% CI 0.303-0.827); among Blacks vegan and lacto ovo vegetarian diets were protective (OR 0.304, 95% CI 0.110-0.842; OR 0.472, 95% CI 0.270-0.825). These associations were strengthened when BMI was removed from the analyses.

CONCLUSION

Vegetarian diets (vegan, lacto ovo, semi-) were associated with a substantial and independent reduction in diabetes incidence. In Blacks the dimension of the protection associated with vegetarian diets was as great as the excess risk associated with Black ethnicity.

What do review papers conclude about food and dietary patterns?

Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways. Therefore, associations between single nutrients and chronic disease may be difficult to identify and interpret, but when dietary patterns (DPs) are examined the combination of many food factors will be considered. An explorative literature search of published review articles was conducted to obtain a fuller understanding of current DPs in epidemiological research, to discuss pros and cons of DPs in nutrition research, and to identify results of studies linking DPs to chronic disease risk in adults. Randomized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits. Systematic reviews of feeding trials and prospective population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs. However, to date only a few review articles of DP studies have followed a systematic process using independent reviewers with strict inclusion, exclusion, and study quality criteria. Diets with plenty of plants foods, fish, and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases. In contrast, Western-type DPs with food products low in essential nutrients and high in energy, like sugar-sweetened beverages, sweets, refined cereals and solid fats (e.g. butter), and high in red and processed meats, are associated with adverse health effects. An emphasis on high-quality original research, and systematic reviews following a structured process to objectively select and judge studies, is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease.

Dietary Recommendations for the Prevention of Type 2 diabetes: What Are They Based on?

Introduction. Type 2 diabetes is increasing in all populations and all age groups across the world. Areas undergoing rapid westernisation and rapid nutrition transition are seeing the greatest increases in prevalence suggesting that environmental factors are important. Studies from around the world have shown that dietary modification for the prevention of T2DM can be successful; however which dietary factors are important remains to be fully elucidated. The WHO, ADA, and Diabetes UK have developed guidelines for the prevention of T2DM even though the WHO states that data from lifestyle modification programmes does not allow for the disentanglement of dietary factors. Aim of Review. The aim of this focused review is to evaluate the current dietary recommendations for the prevention of T2DM. In addition we aim to explore the available evidence from both observation studies and clinical trials to determine whether these recommendations are appropriate.

Avaliação dos marcadores de consumo alimentar do VIGITEL (2007-2009)

OBJETIVO: Avaliar as questões marcadoras de consumo alimentar do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico e sua evolução temporal. MÉTODOS: Foram avaliados 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 - 2009. Os marcadores de consumo alimentar foram descritos a partir da frequência de consumo de frutas, hortaliças, feijão, leite integral e desnatado, refrigerante normal e diet/light, e consumo de gordura aparente das carnes e a pele do frango. Avaliou-se a evolução temporal desses marcadores e, adicionalmente, testou-se a elaboração de um escore de alimentação saudável e a identificação de padrões alimentares por meio da análise de cluster. RESULTADOS: Observou-se aumento estatisticamente significativo nas frequências de consumo de feijão, leite integral e refrigerante normal e diminuição no consumo de leite desnatado. Mesmo com aumento de 11 para 13% de indivíduos que referiram consumir feijão diariamente, esses percentuais são baixos; assim como o consumo recomendado de 3 porções de frutas e 3 porções de hortaliças por dia, que foi referido por menos de 15% da população em todos os anos, com queda de 5 para 3% para as hortaliças. O refrigerante não diet foi o item com maior aumento no consumo, passando de 60 para 67%. Os itens avaliados apresentaram fraca correlação e não configuram um constructo único de alimentação saudável. CONCLUSÃO: A qualidade da dieta dos brasileiros tem piorado e é necessária melhor qualificação dos marcadores alimentares considerados de risco para doenças crônicas não-transmissíveis.

Association Between Muscle Mass, Leg Strength, and Fat Mass With Physical Function in Older Adults: Influence of Age and Sex

Objective: The purposes of this study were to determine the relationship between muscle mass, muscle strength, muscle quality, and fat mass with a composite measure of physical function in older adults, and to determine whether these relations differed by age and sex. Method: Participants consisted of 1280 adults aged ≥ 55 yr from the NHANES study. Reduced rank regression was used to identify patterns of muscle mass, muscle strength, muscle quality, and fat mass related to physical function. Results: A single relevant pattern emerged that included leg strength and fat mass as predictors of the 7 physical function variables. The leg strength loading was significantly greater than the fat mass loading in men and women aged 55-64 and ≥75, and differed between sexes. Conclusion: Leg strength and fat mass best predict physical function in older adults and the relative importance varies according to age and sex.

A comparison of three statistical methods applied in the identification of eating patterns

This work aimed to compare the results of three statistical methods applied in the identification of dietary patterns. Data from 1,009 adults between the ages of 20 and 65 (339 males and 670 females) were collected in a population-based cross-sectional survey in the Metropolitan Region of Rio de Janeiro, Brazil. Information on food consumption was obtained using a semi-quantitative food frequency questionnaire. A factor analysis, cluster analysis, and reduced rank regression (RRR) analysis were applied to identify dietary patterns. The patterns identified by the three methods were similar. The factor analysis identified "mixed", "Western", and "traditional" eating patterns and explained 35% of the data variance. The cluster analysis identified "mixed" and "traditional" patterns. In the RRR, the consumption of carbohydrates and lipids were included as response variables and again "mixed" and "traditional" patterns were identified. Studies comparing these methods can help to inform decisions as to which procedures best suit a specific research scenario.

Prevalence of the metabolic syndrome among rural original adults in NingXia, China

BACKGROUND

Metabolic syndrome (MS) is combination of medical disorders that increase people's risk for cardiovascular disease and diabetes mellitus. Little data exists on the prevalence of MS of rural original adults in Ningxia of China.

METHODS

A cross-sectional survey method was used and the participants were interviewed by trained health workers under a structured questionnaire in rural of Ningxia in 2008. The number of research subjects was 1612. MS was defined by International Diabetes Federation IDF (2005).

RESULTS

The age-adjusted prevalence of the metabolic syndrome was 11.8%, whereas ethnic-specific prevalence was 10.3% in Han ethnic group and 13.7% in Hui ethnic group. Components of MS and MS were more common in Hui ethnic group than Han ethnic group. The mean levels and prevalence of abnormal value increased with increasing age in both ethnic groups (Cochran-Artimage test for trend, Hui ethnic group P < 0.05, Han ethnic group P < 0.01).

CONCLUSIONS

The prevalence of MS was high in rural residents' adults in Ningxia. Clustering of MS components and MS was increased with age. The components of MS have big differences among different ethnic groups.

Development and validation of a semi-quantitative food frequency questionnaire to assess diets of korean type 2 diabetic patients

Background

Our aim was to assess the validity of a semi-quantitative food frequency questionnaire (FFQ) by comparison with the 3-day diet record (DR) in patients with type 2 diabetes.

Methods

Eighty five type 2 diabetic patients (aged 33 to 70 years) from the Korean National Diabetes Program (KNDP) completed 3-day DR and FFQ. The FFQ was designed to reflect the eating pattern of Korean type 2 diabetic patients, and was based on the 2003 Korean National Health and Nutrition Examination Survey. The FFQ consists of 85 food items and 12 food groups. The validity of FFQ was assessed by comparison with the 3-day DR.

Results

The mean age was 49 ± 10 years. Clinical characteristic including body weight, diabetic duration, and HbA1c were not different from the total cohort subjects (n = 1,478). There were no significant differences in the mean intake of protein, fat and calcium estimated by the FFQ and the 3-day DR. Energy and carbohydrate estimated by the FFQ were higher than those estimated by the 3-day DR. The correlation coefficient was highest for energy (r = 0.740; P < 0.00) and lowest for iron (r = 0.269; P < 0.05). The Kappa values for energy, carbohydrate, protein, fat and calcium were 0.54, 0.37, 0.36, 0.46, and 0.19, respectively.

Conclusion

The FFQ is a reasonable instrument for assessing the intake of most macronutrients in Korean type 2 diabetes, although careful consideration is required for the food groups and nutrients for which the FFQ had low validity.

Dietary patterns and the risk of mortality: impact of cardiorespiratory fitness

BACKGROUND

While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness.

METHODS

This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values.

RESULTS

One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, non-whole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02-1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively.

CONCLUSION

In this study the association between diet and overall mortality was, in large part, confounded by fitness.