The relationship among breakfast time, morningness-eveningness preference and body mass index in Type 2 diabetes

AIMS

Obesity is prevalent and related to poor outcomes in Type 2 diabetes. Evening preference and late meal times have been shown to be associated with obesity, but data are lacking in people with Type 2 diabetes. This study examined the relationship among meal timing, morningness-eveningness preference and BMI in Type 2 diabetes, using a mediation analysis.

METHODS

Some 210 non-shift workers with Type 2 diabetes participated in the study. Morningness-eveningness preference was assessed using a standard questionnaire, the Composite Scale of Morningness (CSM). Meal timing and daily calorie intake were obtained from 1-day food recall. A mediation analysis adjusting for relevant covariables was performed to explore whether morningness-eveningness had a direct effect on BMI, or whether the effect was mediated through the intermediate variable of meal timing.

RESULTS

Mean BMI was 28.4 ± 4.8 kg/m² . A higher BMI was associated with greater evening preference (P = 0.019), and non-significantly associated with late breakfast time (P = 0.053). BMI was not associated with other mealtimes or calorie intake. In addition, evening preference was associated with late breakfast time (P < 0.001). Mediation analysis revealed that breakfast time mediated the association between morningness-eveningness and BMI, i.e. morning preference (CSM ≥ 45) was associated with earlier breakfast time, and lower BMI by 0.37 kg/m² [coefficient = -0.365, 95% confidence intervals (CI): -0.877, -0.066), whereas the direct relationship between BMI and morningness-eveningness was non-significant.

CONCLUSIONS

Late breakfast time mediated the relationship between morningness-eveningness preference and BMI. These results suggest that circadian preference and meal timing are novel and possibly modifiable risk factors for obesity in Type 2 diabetes.

Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis

The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.

The efficacy of calcium supplementation alone in elderly Thai women over a 2-year period: a randomized controlled trial

Supplementation with elemental calcium 500 mg/day alone for 2 years is able to decrease bone turnover and is effective in retarding bone loss at lumbar spine and slowing bone loss at femoral neck in elderly Thai women who had low dietary calcium intake.

INTRODUCTION

Most elderly Thais have a total dietary calcium intake of less than the recommended amount. The aim of the study was to investigate the effect of calcium supplementation on bone mineral density and biochemical indices of bone remodeling in Thai postmenopausal women.

METHODS

Four hundred and four healthy postmenopausal women 60 years old or older without osteoporosis were recruited and conducted in a randomized, double-blinded, placebo-controlled trial. They were randomly given elementary calcium 500 mg/day or placebo for 2 years. Dietary calcium intake was calculated from the nutrient compositional analysis of the 3-day food records. Serum 25 hydroxyvitamin D was measured by radioimmunoassay and bone turnover markers were determined by electrochemiluminescence immunoassay.

RESULTS

The age of the subjects was 65.8 ± 4.4 years. All baseline characteristics of the subjects in the calcium-supplemented group and the placebo group were not statistically different. At the end of the study, significant decreases in serum C-terminal telopeptide of type I collagen and serum total procollagen type I amino terminal propeptide in the calcium-supplemented group were observed, while there was no change in the placebo group. In addition, plasma parathyroid hormone decreased, although not significantly, only in the calcium-supplemented group. Percent changes from baseline of lumbar spine (L2-L4) bone mineral density increased 2.76% in the calcium-supplemented group and 0.87% in the placebo group, whereas the percent changes from baseline of femoral neck decreased 0.21% in the calcium-supplemented group and 0.90% in the placebo group.

CONCLUSIONS

Calcium supplementation is necessary for the decrease of bone turnover and prevention of bone loss in Thai elderly women.

Use of a novel vitamin D bioavailability test demonstrates that vitamin D absorption is decreased in patients with quiescent Crohn's disease

BACKGROUND

Vitamin D deficiency is a common problem in patients with Crohn's disease (CD). The aim of this study was to determine the ability of normal subjects and patients with quiescent CD to absorb vitamin D(2) using a novel vitamin D bioavailability test. In addition, we evaluated whether the location of disease or previous surgery had any influence on the bioavailability of vitamin D(2) in CD patients.

METHODS

Ten normal subjects (50% female) and 37 CD patients with quiescent disease (51% female) were included in this study. Subjects who recently received any vitamin D(2) were excluded. The vitamin D bioavailability test was performed in all subjects. After a baseline blood draw, all subjects were then given a single 50,000 IU oral dose of vitamin D(2) in a capsule formulation and had their blood drawn 12 hours later to determine serum vitamin D(2), which reflected their vitamin D(2) absorption capacity.

RESULTS

Forty-two percent and 29% of CD patients were found to be either vitamin D-deficient (25-hydroxyvitamin D [25(OH)D] ≤20 ng/mL] or insufficient [25(OH)D 21-29 ng/mL], respectively. Twelve hours after ingesting 50,000 IU vitamin D(2) , vitamin D(2) levels rose from a baseline of 0.7 ± 0.7 ng/mL (mean ± SEM) to 49.8 ± 3.0 ng/mL in normal subjects. In CD patients, baseline vitamin D(2) levels rose from 0 ng/mL to 34.8 ± 2.8 ng/mL. CD patients had on average a 30% decrease in their ability to absorb vitamin D(2) (P = 0.01). Moreover, we found a wide variability of vitamin D(2) bioavailability in CD patients. Analysis of variance (ANOVA) revealed no statistical difference of vitamin D(2) bioavailability between patients in the CD subgroup stratified by the location of disease, the type of surgery, and receiving or not receiving surgery.

CONCLUSIONS

More than 70% of the patients with quiescent CD were vitamin D-deficient or insufficient. The ability to absorb vitamin D(2) in CD patients is unpredictable and the only way to determine this is to perform a vitamin D bioavailability test. Use of this test may guide clinicians in administering the appropriate therapeutic dose of vitamin D for treating vitamin D deficiency in patients with CD.