Dietary micronutrient adequacies and adherence to the Mediterranean diet in a population of older adults with type 2 diabetes: A cross-sectional study

BACKGROUND AND AIMS

There are few data on micronutrient intake in older adults with type 2 diabetes (T2D) and their adherence to the Mediterranean diet, a dietary pattern rich in micronutrients. In this cross-sectional study, we evaluated the prevalence of adequacy in micronutrient intake according to the recommendations, and the adherence to the Mediterranean diet in older adults with T2D.

METHODS

One hundred thirty-eight patients (47 women and 91 men) with T2D aged over 65 years were included. Dietary habits were assessed by three 24-h dietary recalls. The micronutrient intake, expressed as mean daily intake, and adequacy were compared with the dietary recommendations proposed by the Italian Society of Human Nutrition (LARN) and the European Food Safety Agency (EFSA). Adherence to the Mediterranean diet was evaluated by the MEDI-quest score.

RESULTS

An extremely low proportion of participants (∼1%) adhered to the recommendations for potassium and vitamin D intake. A low proportion of participants adhered to the recommendations for calcium (∼23%), magnesium (∼16%), selenium (∼17%), vitamin E (∼14%), riboflavin (∼28%), vitamin B6 (∼29%), folate (∼25%), and niacin (∼27%) intake. More than 60% of the population adhered to the recommendations for iron, copper, vitamin A and B12 intake. Only 53% of the population showed high adherence to the Mediterranean diet.

CONCLUSIONS

Our data indicate that a very low proportion of older adults with T2D meet the recommendations for ten micronutrients (calcium, potassium, magnesium, selenium, vitamin D, vitamin E, riboflavin, vitamin B6, folate, and niacin) with an unsatisfactory adherence to the Mediterranean diet. Nutritional approaches aimed at favoring adherence to dietary recommendations and increasing the consumption of foods rich in micronutrients should be implemented in older adults.

Risk of Sarcopenia and Associated Factors in Older Adults with Type 2 Diabetes: An Exploratory Cross-Sectional Study

BACKGROUND

Evidence on the risk of sarcopenia and associated factors in older adults with type 2 diabetes (T2D) is lacking. We evaluate (1) the proportion of patients at risk of sarcopenia in older adults with T2D; and (2) the factors associated with the risk of sarcopenia.

METHODS

We conducted a cross-sectional study on T2D patients over 65 years referred to our outpatient clinic and who carried out the yearly complication assessment visit. Eligible patients were administered questionnaires during phone interviews for the risk evaluation of sarcopenia (SARC-F), the risk evaluation of malnutrition (Mini Nutritional Assessment Short Form (MNA^®-SF)), the adherence to the Mediterranean diet (MEDI-quest), and the evaluation of physical activity (the International Physical Activity Questionnaire short form).

RESULTS

A total of 138 patients were included in the study, and 12 patients (8.7% (95% CI 4.6-14.7)) were at risk of sarcopenia. The mean SARC-F score was significantly higher in women compared with men (2.1 ± 1.8 vs. 0.9 ± 1.4, respectively; p < 0.001). The majority of patients identified at risk of sarcopenia compared with those not at risk were women (75% vs. 30%, respectively; p = 0.003), had a higher proportion of neuropathy (50% vs. 19%, respectively; p = 0.027), a lower mean MNA^®-SF score (11.6 ± 1.5 vs. 13.0 ± 1.4, respectively; p = 0.001), a lower mean MEDI-quest score (5.2 ± 1.5 vs. 5.9 ± 1, respectively; p = 0.037), and were more inactive (92% vs. 61%, respectively; p = 0.032).

CONCLUSIONS

In a sample of older adults with T2D, the risk of sarcopenia was identified in 8.7% (95% CI: 4.6-14.7) of the sample, and the main factors associated were female gender, neuropathy, a lower MNA^®-SF score, low adherence to the Mediterranean diet, and low physical activity.

Legume Consumption and Blood Pressure Control in Individuals with Type 2 Diabetes and Hypertension: Cross-Sectional Findings from the TOSCA.IT Study

BACKGROUND

Our aims were to evaluate the relationship of habitual legume consumption with blood pressure (BP) control in a large cohort of people with T2D and hypertension, and to investigate whether specific nutritional components of legumes or other foods may contribute to regulate BP levels.

METHODS

We studied 1897 participants with T2D and hypertension. Dietary habits were assessed through a validated food frequency questionnaire. Sex-specific quartiles of legume consumption were created.

RESULTS

Higher legume consumption was associated with a lower intake of energy, carbohydrates, glycaemic load, alcohol, and sodium, and a significantly greater intake of proteins, fat, monounsaturated, polyunsaturated, fibre, potassium, and polyphenols. Significantly lower systolic and diastolic BP values were observed in the highest vs. lowest quartile of legume consumption (132.9 ± 6.7 vs. 137.3 ± 7.0 mmHg, p < 0.001; 78.9 ± 4.1 vs. 81.0 ± 4.2 mmHg, p = 0.002; respectively), as well as the proportion of people meeting the treatment targets (61.3% vs. 37.4% and 71.3% vs. 52.4%, respectively, p < 0.01). This association was independent from other foods whose consumption is associated with the high legume intake.

CONCLUSIONS

In people with T2D and hypertension, three servings of legumes per week are associated with significantly better BP control. This gives further support to current dietary guidelines in recommending the frequent consumption of legumes, as a "ready-to-use" dietary strategy to achieve optimal BP control.

Nutritional management of glycogen storage disease type III: a case report and a critical appraisal of the literature

Glycogen storage disease Type III (GSD III) is an autosomal recessive disease due to the deficiency of the debranching enzyme, which has two main consequences: a reduced availability of glucose due to the incomplete degradation of glycogen, and the accumulation of abnormal glycogen in liver and cardiac/skeletal muscle. The role of dietary lipid manipulations in the nutritional management of GSD III is still debated. A literature overview shows that low-carbohydrate (CHO) / high-fat diets may be beneficial in reducing muscle damage. We present a 24-year GSD IIIa patient with severe myopathy and cardiomyopathy in whom a gradual shift from a high-CHO diet (61% total energy intake), low-fat (18%), high-protein (21%) to a low-CHO (32 %) high-fat (45%) / high-protein (23%) diet was performed. CHO was mainly represented by high-fiber, low glycemic index food, and fat consisted prevalently of mono and polyunsaturated fatty acids. After a 2-year follow-up, all biomarkers of muscle and heart damage markedly decreased (by 50-75%), glucose levels remained within the normal range and lipid profile was unchanged. At echocardiography, there was an improvement in geometry and left ventricular function. A low -CHO, high-fat, high-protein diet seems to be safe, sustainable and effective in reducing muscle damage without worsening cardiometabolic profile in GSDIIIa. This dietary approach could be started as early as possible in GSD III displaying skeletal/cardiac muscle disease in order to prevent/minimize organ damage.

Performance of 2019 ESC risk classification and the Steno type 1 risk engine in predicting cardiovascular events in adults with type 1 diabetes: A retrospective study

AIMS

The study compares the performance of the European Society of Cardiology (ESC) risk criteria and the Steno Type 1 Risk Engine (ST1RE) in the prediction of cardiovascular (CV) events.

METHODS

456 adults with type 1 diabetes (T1D) were retrospectively studied. During 8.5 ± 5.5 years of observation, twenty-four patients (5.2%) experienced a CV event. The predictive performance of the two risk models was evaluated by classical metrics and the event-free survival analysis.

RESULTS

The ESC criteria show excellent sensitivity (91.7%) and suboptimal specificity (64.4 %) in predicting CV events in the very high CV risk group, but a poor performance in the high/moderate risk groups. The ST1RE algorithm shows a good predictive performance in all CV risk categories. Using ESC classification, the event-free survival analysis shows a significantly higher event rate in the very high CV risk group compared to the high/moderate risk group (p < 0.0019). Using the ST1RE algorithm, a significant difference in the event-free survival curve was found between the three CV risk categories (p < 0.0001).

CONCLUSIONS

In T1D the ESC classification has a good performance in predicting CV events only in those at very high CV risk, whereas the ST1RE algorithm has a good performance in all risk categories.

The Impact of Glucose-Lowering Drugs on Sarcopenia in Type 2 Diabetes: Current Evidence and Underlying Mechanisms

The age-related decrease in skeletal muscle mass together with the loss of muscle power and function is defined sarcopenia. Mounting evidence suggests that the prevalence of sarcopenia is higher in patients with type 2 diabetes mellitus (T2DM), and different mechanisms may be responsible for this association such as impaired insulin sensitivity, chronic hyperglycemia, advanced glycosylation end products, subclinical inflammation, microvascular and macrovascular complications. Glucose-lowering drugs prescribed for patients with T2DM might impact on these mechanisms leading to harmful or beneficial effect on skeletal muscle. Importantly, beyond their glucose-lowering effects, glucose-lowering drugs may affect per se the equilibrium between protein anabolism and catabolism through several mechanisms involved in skeletal muscle physiology, contributing to sarcopenia. The aim of this narrative review is to provide an update on the effects of glucose-lowering drugs on sarcopenia in individuals with T2DM, focusing on the parameters used to define sarcopenia: muscle strength (evaluated by handgrip strength), muscle quantity/quality (evaluated by appendicular lean mass or skeletal muscle mass and their indexes), and physical performance (evaluated by gait speed or short physical performance battery). Furthermore, we also describe the plausible mechanisms by which glucose-lowering drugs may impact on sarcopenia.

Uncooked cornstarch for the prevention of hypoglycemic events

Hypoglycemia is a pathological condition characterized by a low plasma glucose concentration associated with typical autonomic and/or neuroglycopenic symptoms, and resolution of these symptoms with carbohydrate consumption. Hypoglycemia is quite common in clinical practice, particularly in insulin-treated patients with diabetes and in other inherited or acquired conditions involving the regulation of glucose metabolism. Beyond symptoms that might strongly affect the quality of life, hypoglycemia can lead to short- and long-term detrimental consequences for health. Hypoglycemia can be prevented by appropriate changes in dietary habits or by relevant modifications of the drug treatment. Several dietary approaches based on the intake of various carbohydrate foods have been tested for hypoglycemia prevention; among them uncooked cornstarch (UCS) has demonstrated a great efficacy. In this narrative review, we have summarized the current evidence on the UCS usefulness in some conditions characterized by high hypoglycemic risk, focusing on some inherited diseases -i.e. glycogen storage diseases and other rare disorders - and acquired conditions such as type 1 diabetes, postprandial hypoglycemia consequent to esophageal-gastric or bariatric surgery, and insulin autoimmune syndrome. We also considered the possible role of UCS during endurance exercise performance. Lastly, we have discussed the dose requirement, the side effects, the limitations of UCS use, and the plausible mechanisms by which UCS could prevent hypoglycemia.

Dietary inflammatory index score, glucose control and cardiovascular risk factors profile in people with type 2 diabetes

We examined the relationships between the dietary inflammatory index (DII^®), dietary habits and cardiovascular risk factor profiles in people with type 2 diabetes mellitus (T2DM). Energy-adjusted DII (E-DII™) scores were calculated from a Food Frequency Questionnaire in 2568 T2DM patients from different parts of Italy. Analyses were conducted according to quartiles of sex-specific E-DII scores. Higher, more pro-inflammatory, (quartile 4) E-DII scores were associated with overall poor quality of the diet characterised by higher content of refined carbohydrates, added sugars, saturated fat and cholesterol and lower unsaturated fat, fibre and polyphenols compared to quartile 1. Higher E-DII scores also were associated with higher waist circumference (105.4 vs. 103.5 cm; p = 0.002), triglycerides (154.6 vs. 146.1 mg/dL; p = 0.005), diastolic blood pressure (80.05 vs. 78.6 mmHg; p = 0.04) and lower HDL-cholesterol (45.3 vs. 47.4 mg/dL; p = 0.04). In conclusion, E-DII is a potent marker of overall quality of the diet and is associated with an unfavourable cardiovascular risk factor profile.

The combination of UCP3-55CT and PPARγ2Pro12Ala polymorphisms affects BMI and substrate oxidation in two diabetic populations

BACKGROUND AND AIM

To evaluate the combined contribution of UCP3-55CT and PPARγ2 Pro12Ala polymorphisms as correlates of BMI, energy expenditure (REE) and substrate oxidation in people with type 2 diabetes.

METHODS AND RESULTS

Two independent population with type 2 diabetes were studied: population A, n = 272; population B, n = 269. Based on both UCP3 and PPARγ2 genotypes three groups were created. Carriers of the PPARγ2 Pro12Ala in combination with the CC genotype of UCP3 (ProAla/CC, group 1); carriers of only one of these genotypes (either CC/ProPro or CT-TT/ProAla, group 2); people with neither variants (CT-TT/ProPro, group 3). In both populations BMI (kg/m(2)) was highest in group 1, intermediate in group 2 and lowest in group 3, independent of energy intake (i.e 35.3 ± 6.7 vs 33.4 ± 5.4 vs 31.8 ± 3, p < 0.02, population A; 32.4 ± 4.2 vs 31.7 ± 3.8 vs 30.1 ± 2.7; p < 0.03, population B). People with the ProAla/CC genotype (group 1) showed similar REE, but lower lipid oxidation (10.9 vs 13.9 g/kg fat free mass/day; p = 0.04) and higher carbohydrate oxidation (23.6 vs 15.6 g/kg fat free mass/day; p = 0.02) than carriers of other genotypes.

CONCLUSIONS

The combination of UCP3-55 CC and PPARγ2 Pro12Ala genotypes is associated with significantly higher BMI than other PPARγ2-UCP3 genotype combinations, partly due to a reduced ability in lipids oxidation. The relative importance of these mechanism(s) may be different in non diabetic people.