1
|
Vitale M, Masulli M, Rivellese AA, Babini AC, Boemi M, Bonora E, Buzzetti R, Ciano O, Cignarelli M, Cigolini M, Clemente G, Citro G, Corsi L, Dall'Aglio E, Del Prato S, Di Cianni G, Dolci MA, Giordano C, Iannarelli R, Iovine C, Lapolla A, Lauro D, Leotta S, Mazzucchelli C, Montani V, Perriello G, Romano G, Romeo F, Santarelli L, di Cola RS, Squatrito S, Tonutti L, Trevisan R, Turco AA, Zamboni C, Riccardi G, Vaccaro O. Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes-The TOSCA.IT Study. Eur J Nutr 2015; 55:1645-51. [PMID: 26303195 DOI: 10.1007/s00394-015-0983-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The optimal macronutrient composition of the diet for the management of type 2 diabetes is debated, particularly with regard to the ideal proportion of fat and carbohydrates. The aim of the study was to explore the association of different proportions of fat and carbohydrates of the diet-within the ranges recommended by different guidelines-with metabolic risk factors. METHODS We studied 1785 people with type 2 diabetes, aged 50-75, enrolled in the TOSCA.IT Study. Dietary habits were assessed using a validated food-frequency questionnaire (EPIC). Anthropometry, fasting lipids, HbA1c and C-reactive protein (CRP) were measured. RESULTS Increasing fat intake from <25 to ≥35 % is associated with a significant increase in LDL-cholesterol, triglycerides, HbA1c and CRP (p < 0.05). Increasing carbohydrates intake from <45 to ≥60 % is associated with significantly lower triglycerides, HbA1c and CRP (p < 0.05). A fiber intake ≥15 g/1000 kcal is associated with a better plasma lipids profile and lower HbA1c and CRP than lower fiber consumption. A consumption of added sugars of ≥10 % of the energy intake is associated with a more adverse plasma lipids profile and higher CRP than lower intake. CONCLUSIONS In people with type 2 diabetes, variations in the proportion of fat and carbohydrates of the diet, within the relatively narrow ranges recommended by different nutritional guidelines, significantly impact on the metabolic profile and markers of low-grade inflammation. The data support the potential for reducing the intake of fat and added sugars, preferring complex, slowly absorbable, carbohydrates.
Collapse
Affiliation(s)
- M Vitale
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - M Masulli
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A C Babini
- Diabetology, Infermi Hospital, Rimini, Italy
| | - M Boemi
- UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy
| | - E Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - R Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | - O Ciano
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - M Cignarelli
- Division of Endocrinology and Metabolism, University of Foggia, Foggia, Italy
| | - M Cigolini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - G Clemente
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - G Citro
- UO Endocrinologia e Diabetologia, ASP, Potenza, Italy
| | - L Corsi
- SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy
| | - E Dall'Aglio
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - S Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - M A Dolci
- UO Diabetologia, USL 1, Massa e Carrara, Italy
| | - C Giordano
- Endocrinology and Metabolic Diseases, University of Palermo, Palermo, Italy
| | - R Iannarelli
- UO Diabetologia, Ospedale San Salvatore, L'Aquila, Italy
| | - C Iovine
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A Lapolla
- Department of Medicine, University of Padova, Padova, Italy
| | - D Lauro
- Department of Internal Medicine, Tor Vergata University, Rome, Italy
| | - S Leotta
- Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy
| | - C Mazzucchelli
- Department of Internal Medicine, University of Genova, IRCCS San Martino, Genova, Italy
| | - V Montani
- UOSD, Presidio Ospedaliero di Atri, Atri, Italy
| | - G Perriello
- MISEM, University of Perugia, Perugia, Italy
| | - G Romano
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - F Romeo
- Diabetologia, ASL Torino 5, Torino, Italy
| | - L Santarelli
- Presidio Ospedaliero di Lanciano, Lanciano, Italy
| | - R Schiano di Cola
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - S Squatrito
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - L Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU "S. Maria della Misericordia", Udine, Italy
| | - R Trevisan
- Endocrinology and Diabetes Unit, AO Papa Giovanni XXIII, Bergamo, Italy
| | - A A Turco
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - C Zamboni
- Unità Operativa di Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale "S. Anna", Ferrara, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - O Vaccaro
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
| |
Collapse
|
2
|
Bianchi C, Miccoli R, Bonadonna RC, Giorgino F, Frontoni S, Faloia E, Marchesini G, Dolci MA, Alviggi L, Gnasso A, Consoli A, Cavalot F, Cavallo MG, Leonetti F, Giaccari A, Del Prato S. Metabolic syndrome in subjects at high risk for type 2 diabetes: the genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study. Nutr Metab Cardiovasc Dis 2011; 21:699-705. [PMID: 21291660 DOI: 10.1016/j.numecd.2010.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 03/17/2010] [Accepted: 03/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM We evaluated the relationship between insulin resistance (IR) and insulin secretion with the metabolic syndrome (MS) in 885 subjects (377 men/508 women, age 49±11 years, BMI 29±5.2kgm(-2)) at risk of diabetes enrolled in the genetics, pathophysiology and evolution of type 2 diabetes (GENFIEV) study. METHODS AND RESULTS All subjects underwent a 75-g oral glucose tolerance test (OGTT) for the estimation of plasma levels of glucose and C-peptide, as well as fasting insulin and lipid profile. IR was arbitrarily defined as HOMA-IR value above the 75th centile of normal glucose tolerance (NGT) subjects. Overall MS prevalence (National Cholesterol Treatment Panel-Adult Treatment Panel (NCEP-ATPIII) criteria) was 33%, 19% in subjects with NGT, 42% in impaired fasting glucose (IFG), 34% in impaired glucose tolerance (IGT), 74% in IFG+IGT subjects, and 56% in newly diagnosed diabetic patients. Prevalence was slightly higher with IDF criteria. MS prevalence was >50% in subjects with 2h glucose >7.8mmoll(-1), independently of fasting plasma glucose. IR prevalence was higher in subjects with MS than in those without (63% vs. 23%; p<0.0001) and increased from 54% to 73% and 88% in the presence of three, four or five traits, respectively. IR occurred in 42% of subjects with non-diabetic alterations of glucose homeostasis, being the highest in those with IFG+IGT (IFG+IGT 53%, IFG 45%, IGT 38%; p<0.0001). Individuals with MS were more IR irrespective of glucose tolerance (p<0.0001) with no difference in insulinogenic index. Hypertriglyceridaemia (OR: 3.38; Confidence Interval, CI: 2.294.99), abdominal obesity (3.26; CI: 2.18-4.89), hyperglycaemia (3.02; CI: 1.80-5.07) and hypertension (1.69; CI: 1.12-2.55) were all associated with IR. CONCLUSIONS These results show that in subjects with altered glucose tolerance (in particular IFG+IGT) MS prevalence is high and is generally associated to IR. Some combinations of traits of MS may significantly contribute to identify subjects with IR.
Collapse
Affiliation(s)
- C Bianchi
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|