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Badrooj N, Jayedi A, Shab-Bidar S. Comparative effects of different macronutrient compositions for type 2 diabetes management: a systematic review and network meta-analysis of randomized trials. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2025; 44:108. [PMID: 40200364 PMCID: PMC11977911 DOI: 10.1186/s41043-025-00818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 03/06/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND To assess and rank the comparative effects of different exact macronutrient compositions for type 2 diabetes management rather than examining single macronutrients or as a dietary pattern. METHODS PubMed, Scopus, and Cochrane Library Central Register of Controlled Trials were searched. Randomized controlled trials were included. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95% credible intervals (CrIs). The certainty of evidence was rated using the GRADE approach. RESULTS 80 trials with 9232 patients with type 2 diabetes were included in the network meta-analysis. A very low-carbohydrate, high-protein, and calorie-restricted diet had the greatest effect on reducing HbA1c (range of mean difference: - 1.0% to - 1.79%), weight (range of mean difference: -5.83 kg to -10.96 kg), and FPG (range of mean difference: - 2.20 mmol/L to - 2.88 mmol/L) at 6-month follow-up, but at 12-month follow-up, the effect remained only for HbA1c (range of mean difference: - 1.25% to - 1.30%) and FPG (range of mean difference: - 1.21 mmol/L to - 1.27 mmol/L). For weight loss in 12-month follow-up, the low-carbohydrate, high-protein diet was probably the most effective approach (range of mean difference: - 10.05 kg to - 14.52 kg). The best dietary approach to reduce LDL at 6-month follow-up was a low carbohydrate, high protein, calorie-restricted diet (range of mean difference: - 0.49 mmol/L to - 0.59 mmol/L) and at 12-month follow-up, a moderate carbohydrate, standard protein, calorie-restricted diet was effective in reducing LDL (mean difference: - 0.87 mmol/L, 95%CrI - 1.55 to - 0.16). CONCLUSIONS A very low carbohydrate, high protein, calorie-restricted diet can be an effective dietary composition in managing diabetes, but milder dietary carbohydrate restriction for weight loss in the long-term, and improving lipid profiles is needed.
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Affiliation(s)
- Negin Badrooj
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran
| | - Ahmad Jayedi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran.
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Hanick CJ, Berg KJ, Garvey WT, Goss AM, Steger FL, Richman JS, Peterson CM. Study protocol, menu design, and rationale for a study testing the effects of a whole fruit-rich diet on glycemic control, liver fat, pancreatic fat, and cardiovascular health in adults with type 2 diabetes. Nutr Res 2025; 135:82-100. [PMID: 39978247 DOI: 10.1016/j.nutres.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 01/22/2025] [Accepted: 01/22/2025] [Indexed: 02/22/2025]
Abstract
Dietary interventions such as very-low-calorie diets and low-carbohydrate diets can improve glycemic control and even induce type 2 diabetes (T2D) remission. However, less is known about the effects of carbohydrate-rich whole foods, such as whole fruit, in people with T2D. Therefore, the aim of this pilot study is to investigate the effects of a whole fruit-rich diet on glycemic control, ectopic fat, and cardiovascular risk factors in adults with T2D. In this pilot study, sixteen adults aged 20 to 70 years with insulin-independent T2D for ≤6 years will complete a 12-week controlled-feeding intervention while maintaining their weight. During the ramp-up phase (weeks 1-4), participants progressively consume more whole fruit. During weeks 5 to 12, participants eat a fruit-rich Mediterranean diet providing 50% of calories as whole fruit (∼16.4 servings/day). All outcomes are measured at weeks 0, 4, and 12. The primary outcome is glycemic control, assessed hierarchically by whether participants achieve nondiabetic glucose concentrations without antihyperglycemic medications; the total dose of antihyperglycemic medications; mean glucose during a three-hour oral glucose tolerance test; and mean 24-hour glucose from continuous glucose monitoring. Secondary outcomes include intrahepatic lipid, pancreatic fat, blood pressure, heart rate, and serum lipids. We hypothesize that a fruit-rich diet will improve glycemic control, reduce the need for antihyperglycemic medications, decrease ectopic fat, and improve cardiovascular risk factors. This novel study will help determine the effects of a whole fruit-rich diet on glycemic control and liver fat and whether diabetes remission may be possible without losing weight. This study was registered at ClinicalTrials.gov (NCT03758742).
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Affiliation(s)
- Cody J Hanick
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly J Berg
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy M Goss
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Felicia L Steger
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Endocrinology, Metabolism, & Genetics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joshua S Richman
- Division of Gastrointestinal Surgery, UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney M Peterson
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
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Wellmann IA, Ayala LF, Valley TM, Irazola V, Huffman MD, Heisler M, Rohloff P, Donis R, Palacios E, Ramírez-Zea M, Flood D. Evaluating the World Health Organization's Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala. Glob Heart 2025; 20:9. [PMID: 39896314 PMCID: PMC11784498 DOI: 10.5334/gh.1397] [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] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 01/15/2025] [Indexed: 02/04/2025] Open
Abstract
Background The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. Methods We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach. Results The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: -1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively. Conclusions Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.
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Affiliation(s)
- Irmgardt Alicia Wellmann
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Luis Fernando Ayala
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Taryn M. Valley
- Department of Anthropology, University of Wisconsin-Madison, Madison, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mark D. Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham, and Women’s Hospital, Boston, Massachusetts, USA
| | - Rocío Donis
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer Ministry of Health, Guatemala City, Guatemala
| | - Eduardo Palacios
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer Ministry of Health, Guatemala City, Guatemala
| | - Manuel Ramírez-Zea
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - David Flood
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Indigenous Health Research, Wuqu’Kawoq, Tecpán, Guatemala
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Salim J, Tandy S, Puspitasari G. A systematic review, ANCOVA meta-analysis, and meta-regression of clinical trials: Orlistat and body mass index of overweight and obese patients. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2024; 17:263-277. [DOI: 10.1177/1973798x241289779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2025]
Abstract
Background: Obesity or overfat (i.e., excessive fat accumulation in the host) contributes to cerebrocardiovascular and other diseases. Orlistat is a good obesity medication, unlike other drugs that have higher cardiac toxicity. It reversibly inhibits pancreatic and gastric lipases, and improves oxysterol metabolism. This study summarizes and elaborates the impact of orlistat on BMI in overweight and obese adult patients. Methods: All authors systematically searched and retrieved 288 controlled trial articles on orlistat and BMI from three databases, two registries, and citation searches using specific keywords. The quality and bias risks were determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), Risk of Bias in Non-Randomized Study (ROBINS-I), and modified Jadad scale. R version 4.2.2 software calculated the effect size and the analysis of covariance (ANCOVA) effect, and subsequently analyzed using metafor. Results: This novel meta-analysis included 114 studies with 24,600 overweight or obese participants. We showed that orlistat substantially reduced BMI (mean difference −0.78 [−0.94, −0.63], p < 0.0001; I2 = 90.19%, pheterogeneity < 0.0001). Similarly, meta-regression showed a significant impact of orlistat daily dose (ß = −0.0019), yet not for duration (ß = −0.0024) and location (ß = −0.8591, −0.0190). Conclusion: Orlistat has the capacity to reduce BMI in overweight and obese individuals. Medical practitioners shall prescribe orlistat as a BMI lowering agent to complement other intervention in those patients
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Affiliation(s)
- Jonathan Salim
- Kalideres District General Hospital, West Jakarta, Indonesia
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | - Sutiono Tandy
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
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Koller OG, Andrade TFDCS, Machado ABC, Polet JP, Riboldi BP, Rodrigues CCR, de Almeida JC. Exploring the interplay between emotional attitudes towards diabetes, eating behaviour and glycaemic control in patients with type 2 diabetes mellitus. Public Health Nutr 2024; 27:e237. [PMID: 39440420 PMCID: PMC11645113 DOI: 10.1017/s1368980024002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 09/20/2024] [Accepted: 10/09/2024] [Indexed: 10/25/2024]
Abstract
OBJECTIVE This study aimed to assess the association between emotional attitudes towards diabetes, eating behaviour styles and glycaemic control in outpatients with type 2 diabetes. DESIGN Observational study. SETTING Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil. PARTICIPANTS Ninety-one outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behaviour styles and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages and glycated Hb (HbA1c) values. Patients were categorised based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests. RESULTS At baseline, no differences were observed in the proportion of patients with good glycaemic control, eating behaviour styles and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycaemic control compared with the reference group (OR = 3·47; 95 % CI = 1·12, 10·75), after adjusting for diabetes duration, sex and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution. CONCLUSIONS Patients with a positive attitude towards diabetes showed a greater reduction in HbA1c levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.
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Affiliation(s)
- Olívia Garbin Koller
- Post-graduate Program in Nutrition, Food and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Jessica Pinto Polet
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition Division, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bárbara Pelicioli Riboldi
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cíntia Corte Real Rodrigues
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jussara Carnevale de Almeida
- Post-graduate Program in Nutrition, Food and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 1 andar do bloco A, Porto Alegre PO 90035-003, Brazil
- Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gower BA, Goss AM, Yurchishin ML, Deemer SE, Sunil B, Garvey WT. Effects of a Carbohydrate-Restricted Diet on β-Cell Response in Adults With Type 2 Diabetes. J Clin Endocrinol Metab 2024:dgae670. [PMID: 39436786 DOI: 10.1210/clinem/dgae670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Indexed: 10/25/2024]
Abstract
CONTEXT β-Cell response to glucose is compromised in individuals with type 2 diabetes (T2D), possibly due in part to excessive carbohydrate consumption. OBJECTIVE This study was conducted to determine if a eucaloric carbohydrate-restricted (CR) diet (∼9% energy from carbohydrate, 65% energy from fat), compared to a eucaloric higher carbohydrate (HC) diet (∼55% energy from carbohydrate, 20% energy from fat), would improve β-cell response to glucose in participants with T2D. METHODS Participants were 57 African American and European American adults with T2D not using insulin. Medications were discontinued 1 to 2 weeks prior to baseline testing. A hyperglycemic clamp was used to assess the acute (first-phase) and maximal (arginine-stimulated) C-peptide response to glucose at baseline and after 12 weeks of controlled diet therapy (all food provided). An oral glucose tolerance test (OGTT) was used to assess the disposition index (DI). RESULTS At 12 weeks, a statistically significant effect of diet was observed on acute C-peptide response (2-fold greater with the CR diet; P < .01). For maximal C-peptide, a significant effect of diet was observed (22% greater with the CR diet; P < .05), as was a significant diet-by-race interaction (P < .05), indicating that the diet effect was specific to European Americans (48% greater with the CR diet; P < .01). OGTT results showed a significant effect of diet on DI at 12 weeks (32% greater with the CR diet; P < .05). CONCLUSION These results suggest that a eucaloric CR diet has beneficial effects on β-cell function in patients with mild T2D.
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Affiliation(s)
- Barbara A Gower
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Amy M Goss
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Marian L Yurchishin
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah E Deemer
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Bhuvana Sunil
- Division of Pediatric Endocrinology, Children's of Alabama, Birmingham, AL 35294, USA
| | - William T Garvey
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Wellmann IA, Ayala LF, Valley TM, Irazola V, Huffman MD, Heisler M, Rohloff P, Donis R, Palacios E, Ramírez-Zea M, Flood D. Evaluating the World Health Organization's HEARTS Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.10.07.24315061. [PMID: 39417146 PMCID: PMC11483012 DOI: 10.1101/2024.10.07.24315061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Background The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. Methods We conducted a single-arm pilot implementation trial over 6 months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrollment and retention. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rate. Results The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. M treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P<0.001) and 3.5 (95% CI: -1.6 to 8.7; P=0.17) patients per month for hypertension and diabetes, respectively. Conclusions Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.
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Affiliation(s)
- Irmgardt Alicia Wellmann
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Luis Fernando Ayala
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Taryn M. Valley
- Department of Anthropology, University of Wisconsin-Madison, Madison, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mark D. Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Rocío Donis
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer. Ministry of Health, Guatemala City, Guatemala
| | - Eduardo Palacios
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer. Ministry of Health, Guatemala City, Guatemala
| | - Manuel Ramírez-Zea
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - David Flood
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
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Luong TV, Pedersen MGB, Abild CB, Lauritsen KM, Kjærulff MLG, Møller N, Gormsen LC, Søndergaard E. A 3-Week Ketogenic Diet Increases Skeletal Muscle Insulin Sensitivity in Individuals With Obesity: A Randomized Controlled Crossover Trial. Diabetes 2024; 73:1631-1640. [PMID: 39052652 PMCID: PMC11417439 DOI: 10.2337/db24-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
A ketogenic diet (KD) can induce weight loss and improve glycemic regulation, potentially reducing the risk of type 2 diabetes development. To elucidate the underlying mechanisms behind these beneficial effects of a KD, we investigated the impact of a KD on organ-specific insulin sensitivity (IS) in skeletal muscle, liver, and adipose tissue. We hypothesized that a KD would increase IS in skeletal muscle. The study included 11 individuals with obesity who underwent a randomized, crossover trial with two 3-week interventions: 1) a KD and 2) a standard diet. Skeletal muscle IS was quantified as the increase in glucose disposal during a hyperinsulinemic-euglycemic clamp (HEC). Hepatic IS and adipose tissue IS were quantified as the relative suppression of endogenous glucose production (EGP) and the relative suppression of palmitate flux during the HEC. The KD led to a 2.2-kg weight loss and increased insulin-stimulated glucose disposal, whereas the relative suppression of EGP during the HEC was similar. In addition, the KD decreased insulin-mediated suppression of lipolysis. In conclusion, a KD increased skeletal muscle IS in individuals with obesity. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Thien Vinh Luong
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Glavind Bülow Pedersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mette Louise Gram Kjærulff
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Møller
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Søndergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Ghasemi P, Jafari M, Maskouni SJ, Hosseini SA, Amiri R, Hejazi J, Chambari M, Tavasolian R, Rahimlou M. Impact of very low carbohydrate ketogenic diets on cardiovascular risk factors among patients with type 2 diabetes; GRADE-assessed systematic review and meta-analysis of clinical trials. Nutr Metab (Lond) 2024; 21:50. [PMID: 39030553 PMCID: PMC11264514 DOI: 10.1186/s12986-024-00824-w] [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: 12/01/2023] [Accepted: 07/08/2024] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVE This study was designed to evaluate the impact of VLCKD on cardiovascular risk factors in patients with T2DM. METHODS Until March 2024, extensive searches were conducted on PubMed, Scopus, Web of Science, Embase, and other relevant databases. The purpose was to identify clinical trials examining the impact of VLCKD on glycemic control, lipid profile, and blood pressure. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method was used to assess the evidence's degree of certainty. RESULTS Our initial search found a total of 2568 records and finally 29 trials were included in final analysis. Our results showed that adherence from VLCKD led to significant reduction in fasting blood sugar (WMD= -11.68 mg/dl; 95% CI: -18.79, -4.56; P = 0.001), HbA1c (WMD= -0.29; 95% CI: -0.44, -0.14; P < 0.001), HOMA-IR(WMD= -0.71; 95% CI: -1.14, -0.29; P = 0.001), insulin (WMD= -1.45; 95% CI: -2.54, -0.36; P = 0.009), triglyceride (WMD= -17.95; 95% CI: -26.82, -9.07; P < 0.001), systolic blood pressure (WMD= -2.85, 95% CI: -4.99, -0.71; P = 0.009) and diastolic blood pressure (WMD= -1.40; 95% CI: -2.66, -0.13; P = 0.03). We also found a significant increase in high-density lipoprotein (HDL) level after adherence from VLCKD diet (WMD = 3.93, 95% CI: 2.03, 5.84; P = 0.000). We couldn't find any significant differences between groups in term of LDL and total cholesterol levels. CONCLUSION People following a VLCKD experience a more significant improvement in cardiovascular risk factors when compared to individuals on control diets.
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Affiliation(s)
- Parisa Ghasemi
- Research Committee, Medical School, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Jafari
- Department of Exercise physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Saber Jafari Maskouni
- Department of nutrition, School of Public health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Seyed Ahmad Hosseini
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roksaneh Amiri
- Mofid Childrens Hospital Clinical Research Development Unit, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Jalal Hejazi
- Department of Nutrition, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahla Chambari
- Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Ronia Tavasolian
- Department of Nutrition, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.
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10
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Amini MR, Askarpour M, Ghalandari H, Gholizadeh M, Pouraram H. Effect of ketogenic diet on blood pressure: A GRADE-Assessed systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2024; 34:823-837. [PMID: 38310076 DOI: 10.1016/j.numecd.2023.12.004] [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: 07/10/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 02/05/2024]
Abstract
AIMS Cardiovascular diseases (CVDs) are major causes of mortality around the world. High blood pressure (BP) or hypertension is one of the most significant predisposing factors to CVDs. Ketogenic diets (KDs) have been the center of attention for their possible health benefits. The aim of this analysis is to study the impact of KDs on BP through the existing literature. DATA SYNTHESIS We investigated the impact of KDs on systolic and diastolic blood pressures (SBP and DBP) conducted in the format of randomized controlled trials (RCTs). Four online databases (PubMed/Medline, SCOPUS, Cochrane Library, and Google Scholar) were searched from inception up to November 2022. Subgroup analyses were carried out to find the sources of heterogeneities. Twenty-three RCTs with 1664 participants were identified. KDs did not exert any significant impacts on SBP (WMD: -0.87 mmHg, 95% CI: -2.05, 0.31) nor DBP (WMD: -0.11 mmHg, 95% CI -1.14, 0.93). Subgroup analyses did not reveal any further information. Also, non-linear dose-response analysis could not detect any associations between the percentage of calorie intake from fat in the KD format and BP levels. CONCLUSION KDs do not seem to be effective in improving BP. Nonetheless, further investigations are recommended to examine the proportion of fat intake needed to induce favorable clinical impacts.
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Affiliation(s)
- Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Moein Askarpour
- Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Ghalandari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Gholizadeh
- Department of Clinical Nutrition, Faculty of Nutrition Sciences and Food Industries, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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11
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Galali Y, Zebari SMS, Aj. Jabbar A, Hashm Balaky H, Sadee BA, Hassanzadeh H. The impact of ketogenic diet on some metabolic and non-metabolic diseases: Evidence from human and animal model experiments. Food Sci Nutr 2024; 12:1444-1464. [PMID: 38455178 PMCID: PMC10916642 DOI: 10.1002/fsn3.3873] [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: 08/24/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024] Open
Abstract
The ketogenic diet (KD) is recognized as minimum carbohydrate and maximum fat intakes, which leads to ketosis stimulation, a state that is thought to metabolize fat more than carbohydrates for energy supply. KD has gained more interest in recent years and is for many purposes, including weight loss and managing serious diseases like type 2 diabetes. On the other hand, many believe that KD has safety issues and are uncertain about the health drawbacks. Thus, the outcomes of the effect of KD on metabolic and non-metabolic disease remain disputable. The current narrative review aims to evaluate the effect of KD on several diseases concerning the human health. To our best knowledge, the first report aims to investigate the efficacy of KD on multiple human health issues including type 2 diabetes and weight loss, cardiovascular disease, kidney failure and hypertension, non-alcoholic fatty liver, mental problem, oral health, libido, and osteoporosis. The literature searches were performed in Databases, PubMed, Scopus, and web of Science looking for both animal and human model designs. The results heterogeneity seems to be explained by differences in diet composition and duration. Also, the available findings may show that proper control of carbohydrates, a significant reduction in glycemic control and glycated hemoglobin, and weight loss by KD can be an approach to improve diabetes and obesity, hypertension, non-alcoholic fatty liver, PCOS, libido, oral health, and mental problem if isocaloric is considered. However, for some other diseases like cardiovascular disease and osteoporosis, more robust data are needed. Therefore, there is robust data to support the notion that KD can be effective for some metabolic and non-metabolic diseases but not for all of them. So they have to be followed cautiously and under the supervision of health professionals.
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Affiliation(s)
- Yaseen Galali
- Food Technology DepartmentCollege of Agricultural Engineering Sciences, Salahaddin University‐ErbilErbilIraq
| | - Salih M. S. Zebari
- Department of Nutrition and DieteticsCihan University‐ErbilErbilIraq
- Animal Resource DepartmentCollege of Agricultural Engineering Sciences, Salahaddin University‐ErbilErbilIraq
| | - Ahmed Aj. Jabbar
- Department of Medical Laboratory TechnologyErbil Technical Health and Medical College, Erbil Polytechnic UniversityErbilIraq
| | - Holem Hashm Balaky
- General Science Department, Faculty of EducationSoran UniversityErbilIraq
- Mergasor Technical InstituteErbil Polytechnic UniversityErbilIraq
| | - Bashdar Abuzed Sadee
- Food Technology DepartmentCollege of Agricultural Engineering Sciences, Salahaddin University‐ErbilErbilIraq
- Department of Nutrition and DieteticsCihan University‐ErbilErbilIraq
| | - Hamed Hassanzadeh
- Department of Food Science and Technology, Faculty of Para‐veterinaryIlam UniversityIlamIran
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12
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Szendi K, Murányi E, Hunter N, Németh B. Methodological Challenges and Confounders in Research on the Effects of Ketogenic Diets: A Literature Review of Meta-Analyses. Foods 2024; 13:248. [PMID: 38254549 PMCID: PMC10814162 DOI: 10.3390/foods13020248] [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: 12/04/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Several meta-analyses have found a positive association between a popular type of "fad diet", ketogenic diets, and their effect on anthropometric and blood parameters. However, the non-specific inclusion criteria for meta-analyses may lead to incorrect conclusions. The aim of this literature review is to highlight the main confounders and methodological pitfalls of meta-analyses on ketogenic diets by inspecting the presence of key inclusion criteria. The PubMed, Embase, and Web of Science databases and the Cochrane Database of Systematic Reviews were searched for meta-analyses. Most meta-analyses did not define the essential parameters of a ketogenic diet (i.e., calories, macronutrient ratio, types of fatty acids, ketone bodies, etc.) as inclusion criteria. Of the 28 included meta-analyses, few addressed collecting real, re-measured nutritional data from the ketogenic diet and control groups in parallel with the pre-designed nutritional data. Most meta-analyses reported positive results in favor of ketogenic diets, which can result in erroneous conclusions considering the numerous methodological pitfalls and confounders. Well-designed clinical trials with comparable results and their meta-analyses are needed. Until then, medical professionals should not recommend ketogenic diets as a form of weight loss when other well-known dietary options have been shown to be healthy and effective.
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Affiliation(s)
- Katalin Szendi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
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13
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Su S, Ji X, Li T, Teng Y, Wang B, Han X, Zhao M. The changes of cardiac energy metabolism with sodium-glucose transporter 2 inhibitor therapy. Front Cardiovasc Med 2023; 10:1291450. [PMID: 38124893 PMCID: PMC10731052 DOI: 10.3389/fcvm.2023.1291450] [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: 09/09/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Background/aims To investigate the specific effects of s odium-glucose transporter 2 inhibitor (SGLT2i) on cardiac energy metabolism. Methods A systematic literature search was conducted in eight databases. The retrieved studies were screened according to the inclusion and exclusion criteria, and relevant information was extracted according to the purpose of the study. Two researchers independently screened the studies, extracted information, and assessed article quality. Results The results of the 34 included studies (including 10 clinical and 24 animal studies) showed that SGLT2i inhibited cardiac glucose uptake and glycolysis, but promoted fatty acid (FA) metabolism in most disease states. SGLT2i upregulated ketone metabolism, improved the structure and functions of myocardial mitochondria, alleviated oxidative stress of cardiomyocytes in all literatures. SGLT2i increased cardiac glucose oxidation in diabetes mellitus (DM) and cardiac FA metabolism in heart failure (HF). However, the regulatory effects of SGLT2i on cardiac FA metabolism in DM and cardiac glucose oxidation in HF varied with disease types, stages, and intervention duration of SGLT2i. Conclusion SGLT2i improved the efficiency of cardiac energy production by regulating FA, glucose and ketone metabolism, improving mitochondria structure and functions, and decreasing oxidative stress of cardiomyocytes under pathological conditions. Thus, SGLT2i is deemed to exert a benign regulatory effect on cardiac metabolic disorders in various diseases. Systematic review registration https://www.crd.york.ac.uk/, PROSPERO (CRD42023484295).
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Affiliation(s)
- Sha Su
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiang Ji
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Tong Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yu Teng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Baofu Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowan Han
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Department of Cardiology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Mingjing Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
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14
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Choy KYC, Louie JCY. The effects of the ketogenic diet for the management of type 2 diabetes mellitus: A systematic review and meta-analysis of recent studies. Diabetes Metab Syndr 2023; 17:102905. [PMID: 38006799 DOI: 10.1016/j.dsx.2023.102905] [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: 07/31/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To systematically review the effects of the ketogenic diet on glycaemic control, body weight, cardiovascular risk factors, and liver and kidney function in patients with type 2 diabetes. METHODS PubMed, MEDLINE, Embase, Cochrane Library and CINAHL were searched for randomised controlled trials published between 2001 and 2021 that compared the ketogenic diet to a control diet for effects on glycaemic control, body weight, cardiovascular risk factors, liver and renal function markers in adults with type 2 diabetes for >14 days. Meta-analyses using fixed or random effects models were conducted. RESULTS Nineteen reports from 11 randomised controlled trials were included. Compared to the control, the ketogenic diet showed no significant difference in changes in glycaemic control or body weight, but greater increases in HDL (standardised mean difference 0.19; 95%CI 0.02-0.37; I2 = 0 %; moderate-quality evidence) and greater reductions in triglycerides (standardised mean difference -0.41; 95%CI -0.64 to -0.18; I2 = 0 %; low-quality evidence). CONCLUSIONS The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.
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Affiliation(s)
- Kimberley Yu Ching Choy
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.
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15
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Khemka S, Reddy A, Garcia RI, Jacobs M, Reddy RP, Roghani AK, Pattoor V, Basu T, Sehar U, Reddy PH. Role of diet and exercise in aging, Alzheimer's disease, and other chronic diseases. Ageing Res Rev 2023; 91:102091. [PMID: 37832608 PMCID: PMC10842571 DOI: 10.1016/j.arr.2023.102091] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by memory loss and multiple cognitive impairments. Genetic mutations cause a small proportion (1-2%) of early-onset AD, with mutations in amyloid precursor protein (APP), presenilin 1 (PS1) and presenilin 2 (PS2). Major contributing factors of late-onset AD are ApoE4 genotype, traumatic brain injury, diabetes, obesity, hypertension, cardiovascular conditions, in addition to lifestyle factors, such as unhealthy diet and lack of physical exercise. Disease progression can be delayed and/or prevented to a greater extent by adopting healthy lifestyle with balanced and antioxidant enriched diet and daily exercise. The interaction and interplay of diet, exercise, age, and pharmacological interventions holds a crucial role in the progression, pathogenesis and management of AD and its comorbidities, including diabetes, obesity, hypertension and cardiovascular conditions. Antioxidant enriched diet contributes to brain health, glucose control, weight management, and cardiovascular well-being. Regular exercise removes toxins including free radicals and enhances insulin sensitivity, and supports cardiovascular function. In the current article, we discussed, the role of diet, and exercise in aging, AD and other conditions including diabetes, obesity, hypertension, cardiovascular conditions. This article also highlights the impact of medication, socioeconomic and lifestyle factors, and pharmacological interventions. These aspects were discussed in different races and ethnic groups in Texas, and the US.
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Affiliation(s)
- Sachi Khemka
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Aananya Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Lubbock High School, Lubbock, TX 79401, USA
| | - Ricardo Isaiah Garcia
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Micheal Jacobs
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Biology, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Ruhananhad P Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Lubbock High School, Lubbock, TX 79401, USA
| | - Aryan Kia Roghani
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Frenship High School, Lubbock, TX 79382, USA
| | - Vasanthkumar Pattoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; University of South Florida, Tampa, FL 33620, USA
| | - Tanisha Basu
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department pf Speech, Language and Hearing Services, School Health Professions, Texas Tech University Healthy Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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16
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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: 13] [Impact Index Per Article: 6.5] [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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Luong TV, Nielsen EN, Falborg L, Kjærulff MLG, Tolbod LP, Søndergaard E, Møller N, Munk OL, Gormsen LC. Intravenous and oral whole body ketone dosimetry, biodistribution, metabolite correction and kinetics studied by (R)-[1- 11C]β-hydroxybutyrate ([ 11C]OHB) PET in healthy humans. EJNMMI Radiopharm Chem 2023; 8:12. [PMID: 37314530 DOI: 10.1186/s41181-023-00198-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/11/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Ketones are increasingly recognized as an important and possibly oxygen sparing source of energy in vital organs such as the heart, the brain and the kidneys. Drug treatments, dietary regimens and oral ketone drinks designed to deliver ketones for organ and tissue energy production have therefore gained popularity. However, whether ingested ketones are taken up by various extra-cerebral tissues and to what extent is still largely unexplored. It was therefore the aim of this study to use positron emission tomography (PET) to explore the whole body dosimetry, biodistribution and kinetics of the ketone tracer (R)-[1-11C]β-hydroxybutyrate ([11C]OHB). Six healthy subjects (3 women and 3 men) underwent dynamic PET studies after both intravenous (90 min) and oral (120 min) administration of [11C]OHB. Dosimetry estimates of [11C]OHB was calculated using OLINDA/EXM software, biodistribution was assessed visually and [11C]OHB tissue kinetics were obtained using an arterial input function and tissue time-activity curves. RESULTS Radiation dosimetry yielded effective doses of 3.28 [Formula: see text]Sv/MBq (intravenous administration) and 12.51 [Formula: see text]Sv/MBq (oral administration). Intravenous administration of [11C]OHB resulted in avid radiotracer uptake in the heart, liver, and kidneys, whereas lesser uptake was observed in the salivary glands, pancreas, skeletal muscle and red marrow. Only minimal uptake was noted in the brain. Oral ingestion of the tracer resulted in rapid radiotracer appearance in the blood and radiotracer uptake in the heart, liver and kidneys. In general, [11C]OHB tissue kinetics after intravenous administration were best described by a reversible 2-tissue compartmental model. CONCLUSION The PET radiotracer [11C]OHB shows promising potential in providing imaging data on ketone uptake in various physiologically relevant tissues. As a result, it may serve as a safe and non-invasive imaging tool for exploring ketone metabolism in organs and tissues of both patients and healthy individuals. Trial registration Clinical trials, NCT0523812, Registered February 10th 2022, https://clinicaltrials.gov/ct2/show/NCT05232812?cond=NCT05232812&draw=2&rank=1 .
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Affiliation(s)
- Thien Vinh Luong
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Erik Nguyen Nielsen
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Lise Falborg
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Mette Louise Gram Kjærulff
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Niels Møller
- Medical/Steno Aarhus Research Laboratory, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, 8200, Aarhus N, Denmark
| | - Ole Lajord Munk
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Real Rodrigues CC, Riboldi BP, Rodrigues TDC, Sarmento RA, Antonio JP, de Almeida JC. Association of Eating Patterns and Diabetic Kidney Disease in Type 2 Diabetes: A Cross-Sectional Study. J Ren Nutr 2023; 33:261-268. [PMID: 36270481 DOI: 10.1053/j.jrn.2022.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/03/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The aim of this cross-sectional study was to evaluate the relationship between eating patterns and diabetic kidney disease in patients with type 2 diabetes. METHODS Outpatients underwent clinical and nutritional evaluation. Dietary information was obtained through a validated quantitative food frequency questionnaire, and eating patterns were identified by cluster analysis. Diabetic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or persistently elevated urinary albumin concentration (albuminuria ≥ 14 mg/L). Procedures involving patients were approved by the Hospital's Ethics Committee. Patients with type 2 diabetes treated at university hospital and tertiary referral center, southern Brazil. RESULTS A total of 329 patients were evaluated: mean age 62 ± 10 years, body mass index 30.9 ± 4.2 kg/m2, glycated hemoglobin 8.7% ± 2.0, and 10 (5 to 19) years of diabetes duration. Four eating patterns were identified based on cluster analysis: healthy= dairy products, fruits, and vegetables; snacks= dairy products, whole breads, vegetables, and low-calorie products; processed foods= refined carbohydrates and processed meat, and red meat= red meat. Poisson regression models confirmed that snack eaters (PR = 1.48, 95% CI 1.10, 1.99; P = .010) and red meat eaters (PR = 1.93, 95% CI 1.29, 2.89; P = .001) were associated with diabetic kidney disease. CONCLUSION In this sample of outpatients with type 2 diabetes, the patterns of snacks and red meat were associated with diabetic kidney disease as compared to a healthy pattern.
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Affiliation(s)
- Cíntia Corte Real Rodrigues
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Bárbara Pelicioli Riboldi
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Ticiana da Costa Rodrigues
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Roberta Aguiar Sarmento
- Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Peçanha Antonio
- Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Jussara Carnevale de Almeida
- Graduate Medical Sciences Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
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19
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Hansen CD, Gram-Kampmann EM, Hansen JK, Hugger MB, Madsen BS, Jensen JM, Olesen S, Torp N, Rasmussen DN, Kjærgaard M, Johansen S, Lindvig KP, Andersen P, Thorhauge KH, Brønd JC, Hermann P, Beck-Nielsen H, Detlefsen S, Hansen T, Højlund K, Thiele MS, Israelsen M, Krag A. Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease : A Randomized Controlled Trial. Ann Intern Med 2023; 176:10-21. [PMID: 36508737 DOI: 10.7326/m22-1787] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM), and the effect on nonalcoholic fatty liver disease (NAFLD) has not been investigated. OBJECTIVE To investigate the effect of a calorie-unrestricted LCHF diet, with no intention of weight loss, on T2DM and NAFLD compared with a high-carbohydrate, low-fat (HCLF) diet. DESIGN 6-month randomized controlled trial with a 3-month follow-up. (ClinicalTrials.gov: NCT03068078). SETTING Odense University Hospital in Denmark from November 2016 until June 2020. PARTICIPANTS 165 participants with T2DM. INTERVENTION Two calorie-unrestricted diets: LCHF diet with 50 to 60 energy percent (E%) fat, less than 20E% carbohydrates, and 25E% to 30E% proteins and HCLF diet with 50E% to 60E% carbohydrates, 20E% to 30E% fats, and 20E% to 25E% proteins. MEASUREMENTS Glycemic control, serum lipid levels, metabolic markers, and liver biopsies to assess NAFLD. RESULTS The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A1c (mean difference in change, -6.1 mmol/mol [95% CI, -9.2 to -3.0 mmol/mol] or -0.59% [CI, -0.87% to -0.30%]) and lost more weight (mean difference in change, -3.8 kg [CI, -6.2 to -1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up. LIMITATION Open-label trial, self-reported adherence, unintended weight loss, and lack of adjustment for multiple comparisons. CONCLUSION Persons with T2DM on a 6-month, calorie-unrestricted, LCHF diet had greater clinically meaningful improvements in glycemic control and weight compared with those on an HCLF diet, but the changes were not sustained 3 months after intervention. PRIMARY FUNDING SOURCE Novo Nordisk Foundation.
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Affiliation(s)
- Camilla Dalby Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Eva-Marie Gram-Kampmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Johanne Kragh Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Mie Balle Hugger
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Bjørn Stæhr Madsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Jane Møller Jensen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Sara Olesen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Nikolaj Torp
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Ditlev Nytoft Rasmussen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Maria Kjærgaard
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Stine Johansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Katrine Prier Lindvig
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense SV, Denmark (K.P.L.)
| | - Peter Andersen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Katrine Holtz Thorhauge
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Jan Christian Brønd
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (J.C.B.)
| | - Pernille Hermann
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark (P.H.)
| | - Henning Beck-Nielsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Sönke Detlefsen
- Institute of Clinical Research, University of Southern Denmark, and Department of Pathology, Odense University Hospital, Odense, Denmark (S.D.)
| | - Torben Hansen
- Novo Nordisk Foundation, Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark (T.H.)
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark (E.M.G., H.B., K.H.)
| | - Maja Sofie Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (C.D.H., M.B.H., N.T., M.K., S.J., K.H.T., M.S.T.)
| | - Mads Israelsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark (J.K.H., B.S.M., J.M.J., S.O., D.N.R., P.A., M.I.)
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark (A.K.)
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20
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Parry‐Strong A, Wright‐McNaughton M, Weatherall M, Hall RM, Coppell KJ, Barthow C, Krebs JD. Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2022; 24:2431-2442. [PMID: 36064937 PMCID: PMC9826205 DOI: 10.1111/dom.14837] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
AIM Very low carbohydrate/ketogenic diets (VLC/KDs) are popular but their role in managing pre-diabetes and type 2 diabetes (T2D) is uncertain. This study uses a systematic review and meta-analysis of randomized controlled trials to estimate the effect of these diets in this population. MATERIALS AND METHODS A systematic review identified randomized controlled trials of at least 6 months duration comparing efficacy and safety of VLC/KDs (≤50 g carbohydrate or ≤10% total energy from carbohydrate per day) with a control diet (carbohydrate above the VLC/KD threshold) in adults with pre-diabetes or T2D. The primary outcome variable was glycated haemoglobin (HbA1c) after 12 months. The meta-analysis method was inverse variance weighting of mean values for continuous variables. RESULTS Key word searches identified 2290 studies; 2221 were not in scope. A full text review of 69 studies identified eight meeting inclusion criteria; in total, it involved 606 participants. Six studies reported HbA1c (%) at 12 months; four as change from baseline with a fixed effects estimate (95% confidence interval): VLC/KD minus control of 0.01% (-0.22 to 0.25), p = .91; and two as change from baseline: -0.65% (-0.99; -0.31) [-7.1 mmol/mol (-10.8; -3.4)], p < .001. Serum triglycerides were lower with VLC/KD versus control: -0.28 mmol/L (-0.44 to -0.11), p < .001. High-density lipoprotein was higher with an estimate of 0.04 mmol/L (0.01 to 0.08), p = .03, in the five studies reporting 12-month summary data. CONCLUSIONS A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited. More well-designed studies are required to provide certain evidence.
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Affiliation(s)
- Amber Parry‐Strong
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Morag Wright‐McNaughton
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Mark Weatherall
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Rosemary M. Hall
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Kirsten J. Coppell
- Department of Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Christine Barthow
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Jeremy D. Krebs
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
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21
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A Health Care Professional Delivered Low Carbohydrate Diet Program Reduces Body Weight, Haemoglobin A1c, Diabetes Medication Use and Cardiovascular Risk Markers-A Single-Arm Intervention Analysis. Nutrients 2022; 14:nu14204406. [PMID: 36297093 PMCID: PMC9609895 DOI: 10.3390/nu14204406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
This study examined the effectiveness of a health care professional delivered low-carbohydrate diet program (Diversa Health Program) aiming to improve obesity/type-2-diabetes management for people living in Australia. 511 adults (Age:57.1 ± 13.7 [SD] yrs) who participated between January 2017−August 2021 for ≥30 days with pre-post data collected for ≥1 key outcome variable (body weight and HbA1c) were included in the analysis. Average participation duration was 218 ± 207 days with 5.4 ± 3.9 reported consultation visits. Body weight reduced from 92.3 ± 23.0 to 86.3 ± 21.1 kg (n = 506, p < 0.001). Weight loss was 0.9 ± 2.8 kg (1.3%), 4.5 ± 4.3 kg (5.7%) and 7.9 ± 7.2 kg (7.5%), respectively, for those with a classification of normal weight (n = 67), overweight (n = 122) and obese (n = 307) at commencement. HbA1c reduced from 6.0 ± 1.2 to 5.6 ± 0.7% (n = 212, p < 0.001). For members with a commencing HbA1c of <5.7% (n = 110), 5.7−6.4% (n = 55), and ≥6.5% (n = 48), HbA1c reduced −0.1 ± 0.2%, −0.3 ± 0.3%, and −1.4 ± 1.3%, respectively. For members with a commencing HbA1c ≥6.5%, 90% experienced a HbA1c reduction and 54% achieved a final HbA1c < 6.5%. With inclusion and exclusion of metformin, respectively, 124 and 82 diabetes medications were prescribed to 63 and 42 members that reduced to 82 and 35 medications prescribed to 51 and 26 members at final visit. A health care professional delivered low-carbohydrate diet program can facilitate weight loss and improve glycaemic control with greatest improvements and clinical relevance in individuals with worse baseline parameters.
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22
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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23
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Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, Hosseini Y, Jibril AT, Shahinfar H, Mirrafiei A, Hosseini F, Bidar SS. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:40-56. [PMID: 35537861 DOI: 10.1093/ajcn/nqac066] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Carbohydrate restriction is effective for type 2 diabetes management. OBJECTIVES We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes. METHODS We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake. RESULTS Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%-65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, -0.20%; 95% CI, -0.27% to -0.13%), FPG (MD, -0.34 mmol/L; 95% CI, -0.56 to -0.12 mmol/L), and body weight (MD, -1.44 kg; 95% CI, -1.82 to -1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%. CONCLUSIONS Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.
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Affiliation(s)
- Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Jabbarzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliyu Tijen Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Mirrafiei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab- Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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24
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Sagalla N, Yancy WS, Edelman D, Jeffreys AS, Coffman CJ, Voils CI, Alexopoulos AS, Maciejewski ML, Dar M, Crowley MJ. Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes. Chronic Illn 2022; 18:398-409. [PMID: 33100020 PMCID: PMC8995079 DOI: 10.1177/1742395320968627] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS In this secondary analysis of a randomized trial in patients with obesity and uncontrolled type 2 diabetes, multivariable logistic regression was used to evaluate associations between several clinical factors (measured with survey questionnaires at study baseline) and self-reported non-adherence to insulin and non-insulin medications. RESULTS Among 263 patients, reported non-adherence was 62% (52% for insulin, 55% for non-insulin medications). Reported non-adherence to non-insulin medications was less likely in white versus non-white patients (odds ratio (OR) = 0.42; 95%CI: 0.22,0.80) and with each additional medication taken (OR = 0.75; 95%CI: 0.61,0.93). Non-adherence to non-insulin medications was more likely with each point increase in a measure of diabetes medication intensity (OR = 1.43; 95%CI: 1.01,2.03), the Problem Areas in Diabetes (PAID) score (OR = 1.06; 95%CI: 1.02,1.12), and in men versus women (OR = 3.03; 95%CI: 1.06,8.65). For insulin, reporting non-adherence was more likely (OR = 1.02; 95%CI: 1.00,1.04) with each point increase in the PAID. DISCUSSION Despite similar overall rates of reported non-adherence to insulin and non-insulin medications, factors associated with reported non-adherence to each medication type differed. These findings may help tailor approaches to supporting adherence in patients using different types of diabetes medications.
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Affiliation(s)
- Nicole Sagalla
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA.,Duke Diet and Fitness Center, Durham, USA
| | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA.,Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA
| | - Moahad Dar
- Division of Endocrinology and Metabolism, East Carolina University, Greenville, USA.,Greenville Veterans Affairs Health Care Center, Greenville, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
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25
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Zaki HA, Iftikhar H, Bashir K, Gad H, Samir Fahmy A, Elmoheen A. A Comparative Study Evaluating the Effectiveness Between Ketogenic and Low-Carbohydrate Diets on Glycemic and Weight Control in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e25528. [PMID: 35800806 PMCID: PMC9246466 DOI: 10.7759/cureus.25528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Diabetes mellitus (DM) has become a worldwide public health burden and a significant cause of motility and morbidity. The most common type of diabetes is type 2 diabetes, which is estimated to have a prevalence of one in every ten adults living with diabetes in the United States. The risk factors for type 2 diabetes are obesity and being overweight. Therefore, the primary strategy used to manage type 2 diabetes is weight loss. Different measures, such as dietary therapies and physical training, have been used to manage type 2 diabetes through weight and glycemic control. The dietary therapies used to manage type 2 diabetes are ketogenic and low-carbohydrate diets. Despite studies showing that both ketogenic and low-carbohydrate diets significantly impact weight and glycemic control, the difference between the two diets has not been fully established. Therefore, this systematic review has demonstrated and compared the effectiveness of ketogenic and low-carbohydrate diets on glycemic and weight control. The literature search was conducted on five electronic databases, PubMed, ScienceDirect, Embase, Web of Science, and Google Scholar, from 2000 to 2022. Specified keywords related to the ketogenic diet (KD), low carbohydrates, and type 2 diabetes were used to search for relevant and original articles. The identified articles were analyzed using the eligibility criteria before they were included in the study. The eligibility criteria yielded 15 studies that were included in this systematic review. The results obtained by conducting a meta-analysis showed that low-carbohydrates had a greater reduction in the HbA1c than other diets (standardized mean difference [SMD]: -0.27%; 95% CI; -0.60%, 0.07%: P = 0.008, I2 = 66%). Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001). The results also show that the KD significantly impacts weight loss than control diets. The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet. Therefore, we can summarize that the KD is a more effective dietary therapy. However, there is a need to balance the weight loss and glycemic control benefits obtained from the KD with the increased cardiovascular risks for patients with type 2 diabetes.
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Chen CY, Huang WS, Ho MH, Chang CH, Lee LT, Chen HS, Kang YD, Chie WC, Jan CF, Wang WD, Tsai JS. The potential prolonged effect at one-year follow-up after 18-month randomized controlled trial of a 90 g/day low-carbohydrate diet in patients with type 2 diabetes. Nutr Diabetes 2022; 12:17. [PMID: 35397622 PMCID: PMC8994754 DOI: 10.1038/s41387-022-00193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/12/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To evaluate the effect at a one-year follow-up after an 18-month randomized controlled trial (RCT) of 90 gm/day low-carbohydrate diet (LCD) in type 2 diabetes. Research design and methods Eighty-five poorly controlled type 2 diabetic patients with an initial HbA1c ≥ 7.5% who have completed an 18-month randomized controlled trial (RCT) on 90 g/day low-carbohydrate diet (LCD) were recruited and followed for one year. A three-day weighted food record, relevant laboratory tests, and medication effect score (MES) were obtained at the end of the previous trial and one year after for a total of 30 months period on specific diet. Results 71 (83.5%) patients completed the study, 35 were in TDD group and 36 were in LCD group. Although the mean of percentage changes in daily carbohydrate intake was significantly lower for those in TDD group than those in LCD group (30.51 ± 11.06% vs. 55.16 ± 21.79%, p = 0.0455) in the period between 18 months and 30 months, patients in LCD group consumed significantly less amount of daily carbohydrate than patients in TDD group (131.8 ± 53.9 g vs. 195.1 ± 50.2 g, p < 0.001). The serum HbA1C, two-hour serum glucose, serum alanine aminotransferase (ALT), and MES were also significantly lower for the LCD group patients than those in the TDD group (p = 0.017, p < 0.001, p = 0.017, and p = 0.008 respectively). The mean of percentage changes of HbA1C, fasting serum glucose, 2 h serum glucose, as well as serum cholesterol, triglyceride, low-density lipoprotein, ALT, creatinine, and urine microalbumin, however, were not significantly different between the two groups (p > 0.05). Conclusions The one-year follow-up for patients on 90 g/d LCD showed potential prolonged and better outcome on glycaemic control, liver function and MES than those on TDD for poorly controlled diabetic patients.
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Affiliation(s)
- Chin-Ying Chen
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan.
| | - Wei-Sheng Huang
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Ming-Hua Ho
- Department of Dietetics, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Heng-Shuen Chen
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Yow-Der Kang
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chyi-Feng Jan
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Wei-Dean Wang
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
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Luong TV, Abild CB, Bangshaab M, Gormsen LC, Søndergaard E. Ketogenic Diet and Cardiac Substrate Metabolism. Nutrients 2022; 14:nu14071322. [PMID: 35405935 PMCID: PMC9003554 DOI: 10.3390/nu14071322] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023] Open
Abstract
The ketogenic diet (KD) entails a high intake of fat, moderate intake of protein, and a very limited intake of carbohydrates. Ketogenic dieting has been proposed as an effective intervention for type 2 diabetes and obesity since glycemic control is improved and sustained weight loss can be achieved. Interestingly, hyperketonemia is also associated with beneficial cardiovascular effects, possibly caused by improved cardiac energetics and reduced oxygen use. Therefore, the KD has the potential to both treat and prevent cardiovascular disease. However, the KD has some adverse effects that could counteract the beneficial cardiovascular properties. Of these, hyperlipidemia with elevation of triglycerides and LDL cholesterol levels are the most important. In addition, poor diet adherence and lack of knowledge regarding long-term effects may also reduce the broader applicability of the KD. The objective of this narrative review is to provide insights into the KD and its effects on myocardial ketone body utilization and, consequently, cardiovascular health.
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Affiliation(s)
- Thien Vinh Luong
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Blvd. 165, 8200 Aarhus, Denmark; (T.V.L.); (L.C.G.)
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus, Denmark; (C.B.A.); (M.B.)
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus, Denmark; (C.B.A.); (M.B.)
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Maj Bangshaab
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus, Denmark; (C.B.A.); (M.B.)
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Blvd. 165, 8200 Aarhus, Denmark; (T.V.L.); (L.C.G.)
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Esben Søndergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus, Denmark; (C.B.A.); (M.B.)
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
- Correspondence: ; Tel.: +45-28730943
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28
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McDiarmid S, Harvie M, Johnson R, Vyas A, Aglan A, Moran J, Ruane H, Hulme A, Sellers K, Issa BG. Manchester Intermittent versus Daily Diet App Study (MIDDAS): A pilot randomized controlled trial in patients with type 2 diabetes. Diabetes Obes Metab 2022; 24:432-441. [PMID: 34726317 DOI: 10.1111/dom.14592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/20/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
AIMS To test the feasibility and potential efficacy of remotely supported intermittent low-energy diets (ILEDs) and continuous low-energy diets (CLEDs) in people with type 2 diabetes (T2D) and the feasibility of a randomized controlled trial comparing the two approaches. MATERIALS AND METHODS Seventy-nine adults with overweight/obesity and T2D (≤8 years duration) were randomized 1:1 to CLED (8 weeks/56 days of daily Optifast 820 kcal (3430 kJ) diet) or isoenergetic ILED (2 days of Optifast and 5 days of a Mediterranean diet/week for 28 weeks). Weight maintenance/continued weight loss was undertaken for the remainder of the 52 weeks. Both groups received frequent telephone or the Oviva app support. Feasibility outcomes included study uptake, retention, app usage, dietary adherence, weight loss and change in glycated haemoglobin (HbA1c) at 52 weeks. RESULTS We enrolled 39 ILED and 40 CLED participants and 27 (69%) ILED and 30 CLED (75%) attended the 52-week follow-up. Eighty-nine per cent (70 of 79) started using the app and 86% (44 of 51) still used the app at 52 weeks. Intention-to-treat analysis at 52 weeks showed percentage weight loss was mean (95% confidence interval) -5.4% (-7.6, -3.1%) for ILED and -6.0% (-7.9, -4.0%) for CLED. HbA1c <48 mmol/mol was achieved in 42% of both groups. Mean (95% confidence interval) changes in the T2D medication effect score were 0.0008 (-0.3, 0.3) for ILED and -0.5 (-0.8, -0.3) for CLED. CONCLUSION The study shows the feasibility and potential efficacy of remotely delivered ILED and CLED programmes for weight loss and HbA1c reduction, and the feasibility of a randomized controlled trial comparing the two approaches.
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Affiliation(s)
- Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Rhona Johnson
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Avni Vyas
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azza Aglan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jacqui Moran
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Basil G Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
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Shah AS, Nadeau KJ, Dabelea D, Redondo MJ. Spectrum of Phenotypes and Causes of Type 2 Diabetes in Children. Annu Rev Med 2022; 73:501-515. [PMID: 35084995 PMCID: PMC9022328 DOI: 10.1146/annurev-med-042120-012033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several factors, including genetics, family history, diet, physical activity, obesity, and insulin resistance in puberty, appear to increase the risk of type 2 diabetes in youth. Youth-onset type 2 diabetes is often thought of as a single entity but rather exists as a spectrum of disease with differences in presentation, metabolic characteristics, clinical progression, and complication rates. We review what is currently known regarding the risks associated with developing type 2 diabetes in youth. Additionally, we focus on the spectrum of phenotypes of pediatric type 2 diabetes, discuss the pathogenic underpinnings and potential therapeutic relevance of this heterogeneity, and compare youth-onset type 2 diabetes with type 1 diabetes and adult-onset type 2 diabetes. Finally, we highlight knowledge gaps in prediction and prevention of youth-onset type 2 diabetes.
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Affiliation(s)
- Amy S. Shah
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio 45229, USA
| | - Kristen J. Nadeau
- Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Department of Epidemiology, and Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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30
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Effects of 6-month episodic future thinking training on delay discounting, weight loss and HbA1c changes in individuals with prediabetes. J Behav Med 2022; 45:227-239. [PMID: 35006500 PMCID: PMC8744570 DOI: 10.1007/s10865-021-00278-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022]
Abstract
People with prediabetes are at risk for type 2 diabetes. They may discount the future delay discounting (DD), and not engage in preventive health behaviors. Episodic future thinking (EFT) can reduce DD when future scenarios are cued, but research is needed to assess long-term effects of EFT and when EFT is not cued. This study tested EFT training compared to control for people with prediabetes enrolled in a 6-month weight loss program on DD, weight, HbA1c, and physical activity. Results showed a reliable EFT effect on reducing DD in cued (p = 0.0035), and uncued DD tasks (p = 0.048), and significant overall changes in weight (p < 0.001), HbA1c (p, 0.001) and physical activity (p = 0.003), but no significant differences in these outcomes by group (p’s > 0.05). Sixty-eight percent of the sample ended below the prediabetes HbA1c range. These results suggest that DD can be modified over extended periods, and the effects of EFT can be observed without EFT cues. However, these data do not suggest that changes in weight, HbA1c or physical activity were due to EFT training. The study was initiated before the COVID-19 pandemic which provided the opportunity to compare differences for people treated in-person or remotely. Analyses showed no differences in DD, weight, HBA1c or physical activity outcomes were observed between in-person and remote treatment, suggesting telehealth is a scalable approach to treating prediabetes.
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31
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Kumar NK, Merrill JD, Carlson S, German J, Yancy WS. Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review. Diabetes Metab Syndr Obes 2022; 15:477-498. [PMID: 35210797 PMCID: PMC8863186 DOI: 10.2147/dmso.s292742] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.
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Affiliation(s)
- Nitya Kalyani Kumar
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
- Correspondence: Nitya Kalyani Kumar, 30 Duke Medicine Circle Clinic 1A, Durham, NC, 27710, USA, Email
| | - Jennifer D Merrill
- Division of Endocrinology, Diabetes, & Metabolism, Ohio State University, Columbus, OH, USA
| | - Scott Carlson
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - William S Yancy
- Duke Lifestyle and Weight Management Center and Division of General Medicine, Duke University, Durham, NC, USA
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32
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Alexopoulos AS, Yancy WS, Edelman D, Coffman CJ, Jeffreys AS, Maciejewski ML, Voils CI, Sagalla N, Barton Bradley A, Dar M, Mayer SB, Crowley MJ. Clinical associations of an updated medication effect score for measuring diabetes treatment intensity. Chronic Illn 2021; 17:451-462. [PMID: 31653175 PMCID: PMC7182482 DOI: 10.1177/1742395319884096] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effect score to account for newer agents and explored associations between medication effect score and patient-level clinical factors. METHODS Cross-sectional analysis of baseline data from a randomized controlled trial involving 263 Veterans with type 2 diabetes and hemoglobin A1c levels ≥8.0% (≥7.5% if under age 50). Medication effect score was calculated for all patients at baseline, alongside additional measures including demographics, comorbid illnesses, hemoglobin A1c, and self-reported psychosocial factors. We used multivariable regression to explore associations between baseline medication effect score and patient-level clinical factors. RESULTS Our sample had a mean age of 60.7 (SD = 8.2) years, was 89.4% male, and 57.4% non-White. Older age and younger onset of diabetes were associated with a higher medication effect score, as was higher body mass index. Higher medication effect score was significantly associated with medication nonadherence, although not with hemoglobin A1c, self-reported hypoglycemia, diabetes-related distress, or depression. DISCUSSION We observed several expected associations between an updated medication effect score and patient-level clinical factors. These associations support the medication effect score as an appropriate measure of diabetes regimen intensity in clinical and research contexts.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Diet and Fitness Center, Durham, NC, USA
| | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Nicole Sagalla
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - Anna Barton Bradley
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, VA, USA
| | - Moahad Dar
- Division of Endocrinology and Metabolism, East Carolina University, Greenville NC, USA.,Greenville Veterans Affairs Health Care Center, Greenville, NC, USA
| | - Stéphanie B Mayer
- Hunter Holmes McGuire Veterans Affairs Medical Center, Division of Endocrinology and Metabolism, Richmond, VA, USA.,Virginia Commonwealth University, Division of Endocrinology and Metabolism, Richmond, VA, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
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33
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Sandhu SA, Angel CA, Campbell KL, Hickman IJ, MacLaughlin HL. Standardised Outcome Reporting for the Nutrition Management of Complex Chronic Disease: A Rapid Review. Nutrients 2021; 13:3388. [PMID: 34684389 PMCID: PMC8538850 DOI: 10.3390/nu13103388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022] Open
Abstract
Individuals with coexisting chronic diseases or with complex chronic disease are among the most challenging and costly patients to treat, placing a growing demand on healthcare systems. Recommending effective treatments, including nutrition interventions, relies on standardised outcome reporting from randomised controlled trials (RCTs) to enable data synthesis. This rapid review sought to determine how the scope and consistency of the outcomes reported by RCTs investigating nutrition interventions for the management of complex chronic disease compared to what is recommended by the core outcome sets (COS) for individual disease states. Peer-reviewed RCTs published between January 2010 and July 2020 were systematically sourced from PubMed, CINAHL and Embase, and COS were sourced from the International Consortium for Health Outcomes Measurements (ICHOM) and the Core Outcome Measures in Effectiveness Trials (COMET) database. A total of 45 RCTs (43 studies) and 7 COS were identified. Outcomes were extracted from both the RCTs and COS and were organised using COMET Taxonomy Core Areas. A total of 66 outcomes and 439 outcome measures were reported by the RCTs. The RCTs demonstrated extensive outcome heterogeneity, with only five outcomes (5/66, 8%) being reported with relative consistency (cited by ≥50% of publications). Furthermore, the scope of the outcomes reported by studies was limited, with a notable paucity of patient-reported outcomes. Poor agreement (25%) was observed between the outcomes reported in the RCTs and those recommended by the COS. This review urges greater uptake of the existing COS and the development of a COS for complex chronic disease to be considered so that evidence can be better synthesised regarding effective nutrition interventions.
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Affiliation(s)
- Savita A Sandhu
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Chloe A Angel
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane 4029, Australia;
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane 4102, Australia;
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
- Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
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Wang X, Li Q, Liu Y, Jiang H, Chen W. Intermittent fasting versus continuous energy-restricted diet for patients with type 2 diabetes mellitus and metabolic syndrome for glycemic control: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2021; 179:109003. [PMID: 34391831 DOI: 10.1016/j.diabres.2021.109003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/20/2021] [Accepted: 08/10/2021] [Indexed: 12/21/2022]
Abstract
AIMS To compare the safety of intermittent fasting (IF) with that of continuous energy-restricted diets (CERD) in patients with T2DM and metabolic syndrome who were overweight or obese and assess their effects on glycemic control and weight loss. MATERIALS AND METHODS We searched MEDLINE (Ovid), Embase, and SINOMED databases up to September 13, 2020. The major outcome was glycemic control and secondary outcomes were change in weight, fasting insulin, and lipid profile. RESULTS Of 84 retrieved studies, 5 met our inclusion criteria. Of these, four studies comprising 355 participants were included in the meta-analysis. Based on changes in HbA1c (-0.06, 95% confidence interval [CI] -0.27 to 0.16) and fasting plasma glucose (-0.27, 95% CI -0.76 to 0.22), IF and CERD had similar effects on glycemic control. Moreover, IF had a better effect on weight loss (-1.70, 95% CI -3.28 to -0.11 kg). Patients in both groups experienced similar improvements in fasting insulin and lipid profile as well as similar hypoglycemic events. CONCLUSIONS IF is a safe diet pattern and could be implemented for patients with T2DM or metabolic syndrome. Further studies with a larger sample size are needed to verify the effectiveness and safety of IF in patients with T2DM.
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Affiliation(s)
- Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing Dong cheng District, Beijing 100730, China
| | - Qifei Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing Dong cheng District, Beijing 100730, China
| | - Yan Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing Dong cheng District, Beijing 100730, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu 610072, Sichuan Province, China; Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu 610072, Sichuan Province, China; Department of Acute Care Surgery, Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu 610072, Sichuan Province, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai fu yuan Wang fu jing Dong cheng District, Beijing 100730, China.
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35
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Wheatley SD, Deakin TA, Arjomandkhah NC, Hollinrake PB, Reeves TE. Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes-A Narrative Review. Front Nutr 2021; 8:687658. [PMID: 34336909 PMCID: PMC8319397 DOI: 10.3389/fnut.2021.687658] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023] Open
Abstract
Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.
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Affiliation(s)
| | | | - Nicola C Arjomandkhah
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
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36
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McDiarmid S, Harvie M, Johnson R, Vyas A, Aglan A, Moran J, Ruane H, Hulme A, Sellers K, Issa B. Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e21116. [PMID: 33739297 PMCID: PMC8088860 DOI: 10.2196/21116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. OBJECTIVE This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. METHODS A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. RESULTS A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. CONCLUSIONS The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21116.
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Affiliation(s)
- Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rhona Johnson
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Avni Vyas
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Azza Aglan
- Greater Manchester Mental Health Foundation Trust, Manchester, United Kingdom
| | - Jacqui Moran
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Basil Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Chao AM, Quigley KM, Wadden TA. Dietary interventions for obesity: clinical and mechanistic findings. J Clin Invest 2021; 131:140065. [PMID: 33393504 PMCID: PMC7773341 DOI: 10.1172/jci140065] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dietary modification is central to obesity treatment. Weight loss diets are available that include various permutations of energy restriction, macronutrients, foods, and dietary intake patterns. Caloric restriction is the common pathway for weight reduction, but different diets may induce weight loss by varied additional mechanisms, including by facilitating dietary adherence. This narrative Review of meta-analyses and select clinical trials found that lower-calorie diets, compared with higher-calorie regimens, reliably induced larger short-term (<6 months) weight losses, with deterioration of this benefit over the long term (>12 months). Few significant long-term differences in weight loss were observed for diets of varying macronutrient composition, although some regimens were found to have short-term advantages (e.g., low carbohydrate versus low fat). Progress in improving dietary adherence, which is critical to both short- and long-term weight loss, could result from greater efforts to identify behavioral and metabolic phenotypes among dieters.
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Affiliation(s)
- Ariana M. Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kerry M. Quigley
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Han Y, Cheng B, Guo Y, Wang Q, Yang N, Lin P. A Low-Carbohydrate Diet Realizes Medication Withdrawal: A Possible Opportunity for Effective Glycemic Control. Front Endocrinol (Lausanne) 2021; 12:779636. [PMID: 34970224 PMCID: PMC8713744 DOI: 10.3389/fendo.2021.779636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/19/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Multiple studies have confirmed that diet restrictions can effectively realize glycemic control and reduce metabolic risks in patients with type 2 diabetes mellitus (T2DM). In 2018, the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) stated that individuals can select a low-carbohydrate diet (LCD) according to their needs and preferences. Owing to the influence of Chinese traditional eating habits, only a small portion of patients in China have achieved their blood glucose goals. As a result, the Chinese government will incur huge expenditures. METHOD This study recruited 134 T2DM participants and randomly assigned them to the LCD group (n = 67) or the low-fat diet (LFD) group (n = 67). All of the patients had a fixed amount of exercise and were guided by clinicians. After a period of dietary washout, all of the patients received corresponding dietary education according to group. The follow-up time was 6 months. The indicators for anthropometry, glycemic control, and medication application parameters were collected and compared between the two groups. RESULTS There were 121 participants who finally entered the study. The proportions of calories from three major nutrients the participants consumed met the requirements of LCD and LFD. Compared with baseline, the pre-postdifferences of body weight, BMI, and several other indicators were significant except for dosages of insulin used in the LCD group and MES in the LFD group. After the intervention, body weight, body weight index (BMI), fasting blood glucose (FBG), postprandial 2-h blood glucose (PPG), and glycosylated hemoglobin (HbA1c) levels in the LCD group decreased significantly (p < 0.05) compared with the LFD group. The number of patients using lipid-lowering agents was significant higher in the LCD group and lower in the LFD group. However, there was no significant difference between the two groups for antihypertensive, hormone-replacement, and other agents. CONCLUSIONS The LCD diet can decrease body weight, glycemic levels, MES, and lipid-lowering agents more than the LFD diet, thus decreasing cost burden in Chinese patients with T2DM. Strict diet control and monitoring are the keys to managing diabetes.
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Affiliation(s)
- Yuxin Han
- Department of Endocrinology and Metabolism, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bingfei Cheng
- Department of Endocrinology and Metabolism, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanjun Guo
- Department of Endocrinology and Metabolism, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing Wang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nailong Yang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Nailong Yang, ; Peng Lin,
| | - Peng Lin
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Nailong Yang, ; Peng Lin,
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Nasser S, Vialichka V, Biesiekierska M, Balcerczyk A, Pirola L. Effects of ketogenic diet and ketone bodies on the cardiovascular system: Concentration matters. World J Diabetes 2020; 11:584-595. [PMID: 33384766 PMCID: PMC7754168 DOI: 10.4239/wjd.v11.i12.584] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Ketone bodies have emerged as central mediators of metabolic health, and multiple beneficial effects of a ketogenic diet, impacting metabolism, neuronal pathologies and, to a certain extent, tumorigenesis, have been reported both in animal models and clinical research. Ketone bodies, endogenously produced by the liver, act pleiotropically as metabolic intermediates, signaling molecules, and epigenetic modifiers. The endothelium and the vascular system are central regulators of the organism’s metabolic state and become dysfunctional in cardiovascular disease, atherosclerosis, and diabetic micro- and macrovascular complications. As physiological circulating ketone bodies can attain millimolar concentrations, the endothelium is the first-line cell lineage exposed to them. While in diabetic ketoacidosis high ketone body concentrations are detrimental to the vasculature, recent research revealed that ketone bodies in the low millimolar range may exert beneficial effects on endothelial cell (EC) functioning by modulating the EC inflammatory status, senescence, and metabolism. Here, we review the long-held evidence of detrimental cardiovascular effects of ketoacidosis as well as the more recent evidence for a positive impact of ketone bodies—at lower concentrations—on the ECs metabolism and vascular physiology and the subjacent cellular and molecular mechanisms. We also explore arising controversies in the field and discuss the importance of ketone body concentrations in relation to their effects. At low concentration, endogenously produced ketone bodies upon uptake of a ketogenic diet or supplemented ketone bodies (or their precursors) may prove beneficial to ameliorate endothelial function and, consequently, pathologies in which endothelial damage occurs.
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Affiliation(s)
- Souad Nasser
- Carmen Laboratory, INSERM Unit 1060—Lyon 1 University, Pierre Benite 69310, France
| | - Varvara Vialichka
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
- The University of Lodz Doctoral School of Exact and Natural Sciences, Lodz 90-237, Poland
| | - Marta Biesiekierska
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
| | - Aneta Balcerczyk
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
| | - Luciano Pirola
- Carmen Laboratory, INSERM Unit 1060—Lyon 1 University, Pierre Benite 69310, France
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Effect of a 90 g/day low-carbohydrate diet on glycaemic control, small, dense low-density lipoprotein and carotid intima-media thickness in type 2 diabetic patients: An 18-month randomised controlled trial. PLoS One 2020; 15:e0240158. [PMID: 33017456 PMCID: PMC7535044 DOI: 10.1371/journal.pone.0240158] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022] Open
Abstract
Aim This study explored the effect of a moderate (90 g/d) low-carbohydrate diet (LCD) in type 2 diabetes patients over 18 months. Methods Ninety-two poorly controlled type 2 diabetes patients aged 20–80 years with HbA1c ≥7.5% (58 mmol/mol) in the previous three months were randomly assigned to a 90 g/d LCD r traditional diabetic diet (TDD). The primary outcomes were glycaemic control status and change in medication effect score (MES). The secondary outcomes were lipid profiles, small, dense low-density lipoprotein (sdLDL), serum creatinine, microalbuminuria and carotid intima-media thickness (IMT). Results A total of 85 (92.4%) patients completed 18 months of the trial. At the end of the study, the LCD and TDD group consumed 88.0±29.9 g and 151.1±29.8 g of carbohydrates, respectively (p < 0.05). The 18-month mean change from baseline was statistically significant for the HbA1c (-1.6±0.3 vs. -1.0±0.3%), 2-h glucose (-94.4±20.8 vs. -18.7±25.7 mg/dl), MES (-0.42±0.32 vs. -0.05±0.24), weight (-2.8±1.8 vs. -0.7±0.7 kg), waist circumference (-5.7±2.7 vs. -1.9±1.4 cm), hip circumference (-6.1±1.8 vs. -2.9±1.7 cm) and blood pressure (-8.3±4.6/-5.0±3 vs. 1.6±0.5/2.5±1.6 mmHg) between the LCD and TDD groups (p<0.05). The 18-month mean change from baseline was not significantly different in lipid profiles, sdLDL, serum creatinine, microalbuminuria, alanine aminotransferase (ALT) and carotid IMT between the groups. Conclusions A moderate (90 g/d) LCD showed better glycaemic control with decreasing MES, lowering blood pressure, decreasing weight, waist and hip circumference without adverse effects on lipid profiles, sdLDL, serum creatinine, microalbuminuria, ALT and carotid IMT than TDD for type 2 diabetic patients.
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Guo Y, Wang X, Jia P, You Y, Cheng Y, Deng H, Luo S, Huang B. Ketogenic diet aggravates hypertension via NF-κB-mediated endothelial dysfunction in spontaneously hypertensive rats. Life Sci 2020; 258:118124. [PMID: 32702443 DOI: 10.1016/j.lfs.2020.118124] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
AIMS Ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome. However, the effects of KD on hypertension have not been well investigated. The present study aimed to investigate the effects and underling mechanisms of KD on hypertension in spontaneously hypertensive rats (SHRs). MATERIALS AND METHODS SHRs were subjected to normal diet or KD for 4 weeks, starting at the age of 10 weeks. Then, the blood pressure and vascular function were assessed. Next, the eNOS expression, inflammatory factors and relative signaling pathway were examined. Human umbilical vein endothelial cells were used to investigate the underlying mechanism account for the effect of ketone on inflammation and eNOS expression. KEY FINDINGS Compared with the normal diet, KD was indicated to aggravate hypertension and impaire endothelium-dependent relaxation in mesenteric arteries of SHRs. eNOS and CD31 expression in mesenteric arteries were also significantly suppressed by KD. In addition, KD markedly increased the activation of NF-κB pathway and the expression of IL1-β and TNF-α. In vitro, results showed that inhibition of NF-κB could rescue the adverse effects of ketone body and TGF-β on eNOS expression and inflammation response. SIGNIFICANCE Our study indicated that KD impaired endothelium-dependent relaxation in mesenteric arteries and aggravated the development of hypertension in SHRs, suggesting that it should be more cautious to apply KD into clinical application in hypertensive individuals.
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Affiliation(s)
- Yongzheng Guo
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiaowen Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ping Jia
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yuehua You
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu Cheng
- Institute of Life Science, Chongqing Medical University, Chongqing 400016, China
| | - Hongpei Deng
- Institute of Life Science, Chongqing Medical University, Chongqing 400016, China
| | - Suxin Luo
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Bi Huang
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Smith ES, Smith HA, Betts JA, Gonzalez JT, Atkinson G. A Systematic Review and Meta-Analysis Comparing Heterogeneity in Body Mass Responses Between Low-Carbohydrate and Low-Fat Diets. Obesity (Silver Spring) 2020; 28:1833-1842. [PMID: 32959516 DOI: 10.1002/oby.22968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/23/2020] [Accepted: 06/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE An important notion in personalized medicine is that there is clinically relevant treatment response heterogeneity. Low-carbohydrate (CHO) and low-fat diets are widely adopted to reduce body mass. To compare individual differences in responses between two dietary interventions, a formal statistical comparison of response variances between study arms in a randomized controlled trial (RCT) is crucial. METHODS The change in variances in RCTs for the body mass responses to low-CHO dietary interventions versus change variances for the low-fat groups (typically considered as the comparator intervention) were compared. A literature search identified relevant RCTs (n = 25; 3,340 participants). The means and SDs of body mass change in low-CHO and low-fat study arms were extracted to calculate the variances of individual responses. These were meta-analyzed in a random-effects model and converted to the SD for individual responses. RESULTS The pooled SD for individual responses for body mass was 1.4 kg (95% CI: -1.1 to 2.3) with a wide 95% prediction interval of -6.3 to 10.4 kg. CONCLUSIONS Evidence is insufficient to suggest the response heterogeneity to low-CHO diets differs from that observed with low-fat diets.
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Affiliation(s)
- Eleanor S Smith
- Department for Health, University of Bath, Bath, UK
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | | | | | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Affiliation(s)
- Pamela Dyson
- OCDEM, Oxford University NHS Foundation Trust, Oxford, UK; and NIHR Biomedical Research Centre Oxford UK
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44
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Goss AM, Dowla S, Pendergrass M, Ashraf A, Bolding M, Morrison S, Amerson A, Soleymani T, Gower B. Effects of a carbohydrate-restricted diet on hepatic lipid content in adolescents with non-alcoholic fatty liver disease: A pilot, randomized trial. Pediatr Obes 2020; 15:e12630. [PMID: 32128995 DOI: 10.1111/ijpo.12630] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/11/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common form of liver disease among adolescents in industrialized countries. While lifestyle intervention remains the hallmark treatment for NAFLD, the most effective dietary strategy to reverse NAFLD in children is unknown. OBJECTIVE The objective of this study was to determine the effects of a moderately CHO-restricted diet (CRD) vs fat-restricted diet (FRD) in adolescents with NAFLD on reduction in liver fat and insulin resistance. METHODS Thirty-two children/adolescents (age 9-17) with obesity and NAFLD were randomized to a CRD (<25:25:>50% energy from CHO:protein:fat) or FRD (55:25:20) for 8 weeks. Caloric intakes were calculated to be weight maintaining. Change in hepatic lipid content was measured via magnetic resonance imaging, body composition via dual energy X ray absorptiometry and insulin resistance via a fasting blood sample. RESULTS Change in hepatic lipid did not differ with diet, but declined significantly (-6.0 ± 4.7%, P < .001 only within the CRD group. We found significantly greater decreases in insulin resistance (HOMA-IR, <.05), abdominal fat mass (P < .01) and body fat mass (P < .01) in response to the CRD vs FRD. CONCLUSION These findings suggest that consumption of a moderately CHO-restricted diet may result in decreased hepatic lipid as well as improvements in body composition and insulin resistance in adolescents with NAFLD even in the absence of intentional caloric restriction. Larger studies are needed to determine whether a CHO-restricted diet induces change in hepatic lipid independent of change in body fat.
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Affiliation(s)
- Amy M Goss
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shima Dowla
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - May Pendergrass
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ambika Ashraf
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark Bolding
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shannon Morrison
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alesha Amerson
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Taraneh Soleymani
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Merrill JD, Soliman D, Kumar N, Lim S, Shariff AI, Yancy WS. Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes. Diabetes Spectr 2020; 33:133-142. [PMID: 32425450 PMCID: PMC7228825 DOI: 10.2337/ds19-0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.
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Affiliation(s)
- Jennifer D. Merrill
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Diana Soliman
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Nitya Kumar
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Sooyoung Lim
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Afreen I. Shariff
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - William S. Yancy
- Duke Diet and Fitness Center, Department of Medicine, Duke University Health System, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
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Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev 2020; 16:220-229. [PMID: 29879890 PMCID: PMC7516333 DOI: 10.2174/1573399814666180608074510] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes (DM) in children is disturbingly increasing in parallel with the increasing childhood obesity. Better knowledge regarding the pathophysiology of type 2 DM in children is paramount to devise an effective management plan. OBJECTIVE Discuss the pathophysiology of type 2 DM in children and adolescents. METHODS AND RESULTS This is a comprehensive review of the literature on this topic. Type 2 DM in childhood is viewed as a continuum of insulin resistance (IR) which is determined by an underlying genetic predisposition, intrauterine environment, excessive food consumption, continued rapid weight gain, and poor lifestyle. Besides IR, this is compounded by multiple metabolic defects including β-cell dysfunction and inadequate insulin secretion, α-cell dysfunction, hyperglucagonemia and increased hepatic glucose production, lipotoxicity, inflammation, deficiencies in incretin production and action, and increased renal glucose reabsorption. The confluence of genetic and environmental factors underscores the complexity in disease progression. CONCLUSION A consistent single risk factor for type 2 DM is obesity and related IR and therefore it is essential to curtail the progression of obesity. It is important to investigate the role of stringent dietary and nutritional approaches, medications that enhance β-cell function and insulin sensitivity.
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Affiliation(s)
- Badhma Valaiyapathi
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ambika P. Ashraf
- Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, USA
- Address correspondence to this author at the Department Pediatric Endocrinology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; Tel: 205 638 9107, Fax: 205 638 9821; E-mail:
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Turton J, Brinkworth GD, Field R, Parker H, Rooney K. An evidence-based approach to developing low-carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods. Diabetes Obes Metab 2019; 21:2513-2525. [PMID: 31347236 DOI: 10.1111/dom.13837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/06/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
AIM To identify core diet and delivery components of low-carbohydrate (CHO) diets that have demonstrated efficacy for type 2 diabetes (T2D) management. MATERIALS AND METHODS MEDLINE, Pre-MEDLINE, EMBASE, CINAHL and the Cochrane Library of Controlled Trials databases were systematically searched from inception until August 18, 2018. Primary intervention studies of low-CHO diets (≤130 g/d or 26% total energy intake [TEI]) were included. Content analysis was performed on the low-CHO diet protocols classified as safe and effective for T2D management. RESULTS A total of 41 studies published between 1963 and 2018 were included, of which 40 were classified as safe and effective for inclusion in the primary analysis. Thirteen studies (13/40) were on very-low-CHO diets (<50 g/d), 14/40 included low-CHO diets (≤130 g/d or 26% TEI), and 13/40 were adapted according to participant progress. Thirty-one studies reported a total energy prescription, of which 18/31 encouraged ad libitum intakes. Twenty studies reported a prescribed dietary fat amount, of which 18/20 were unrestricted or high-fat (>35% TEI). Twenty-six studies reported a prescribed dietary protein amount, of which 22 were unrestricted or were high-protein (>25% TEI). The types of dietary CHO, fat and protein recommended were predominantly whole foods. Common delivery methods reported were dietician and/or physician involvement, moderate to high frequency of contact (≥1 session/month) and use of participant self-monitoring. CONCLUSIONS Multiple approaches for developing and delivering a low-CHO diet intervention for T2D management are safe and effective. A comprehensive set of core dietary components to consider in the formulation of low-CHO diet protocols were identified for use in clinical practice and to inform evidence-based guidelines for T2D management.
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Affiliation(s)
- Jessica Turton
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia
| | | | - Rowena Field
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Parker
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kieron Rooney
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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Effect of liquid ubiquinol supplementation on glucose, lipids and antioxidant capacity in type 2 diabetes patients: a double-blind, randomised, placebo-controlled trial. Br J Nutr 2019; 120:57-63. [PMID: 29936921 DOI: 10.1017/s0007114518001241] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ubiquinone is a lipid antioxidant, and a novel liquid ubiquinol (a hydro-soluble, reduced form of coenzyme Q10) supplement was recently developed. The purpose of this study was to examine the levels of glucose, lipids and antioxidant capacity of type 2 diabetes patients after liquid ubiquinol supplementation. This study was designed as a randomised, double-blind, placebo-controlled trial. In all, fifty participants were randomly assigned to a placebo (n 25) or liquid ubiquinol (100 mg/d, n 25) group, and the intervention lasted for 12 weeks. Plasma coenzyme Q10, glucose homoeostasis parameters, lipid profiles, oxidative stress and antioxidative enzyme activities were measured during the study. After 12 weeks of supplementation, glyco Hb (HbA1c) value was significantly decreased in the liquid ubiquinol group (P=0·03), and subjects in the liquid ubiquinol group had significantly lower anti-glycaemic medication effect scores (MES) compared with those in the placebo group (P=0·03). The catalase (P<0·01) and glutathione peroxidase (P=0·03) activities were increased significantly after supplementation. Plasma coenzyme Q10 was correlated with the insulin level (P=0·05), homoeostatic model assessment-insulin resistance (P=0·07), quantitative insulin sensitivity check index (P=0·03) and the anti-hyperglycaemic agents' MES (P=0·03) after supplementation. Lipid profiles did not change after supplementation; however, the subjects in the placebo group had a significantly lower level of HDL-cholesterol after 12 weeks of intervention. In conclusion, oral intake of 100 mg/d liquid ubiquinol might benefit type 2 diabetes patients by increasing antioxidant enzyme activity levels, reducing HbA1c levels and maintaining HDL-cholesterol levels.
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Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes. J Gen Intern Med 2019; 34:1174-1183. [PMID: 30963440 PMCID: PMC6614233 DOI: 10.1007/s11606-019-04894-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/12/2018] [Accepted: 01/22/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. RESEARCH DESIGN AND METHODS This randomized controlled trial (n = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. RESULTS At 6 months, A1c decreased significantly more in the intervention group than the control group (- 0.76 vs - 0.21%, p = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months - 0.63 intervention vs - 0.45 control, p = 0.52). There was a decrease in A1c over 18 months in both the intervention (β = - 0.026, p = 0.003) and the comparison arm (β = - 0.018, p = 0.048) but no difference in trend (p = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p = 0.002) and diet quality (4.0 vs - 0.5 point change, p = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p < 0.05) at 12 months. CONCLUSIONS The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months. NIH TRIAL REGISTRY NUMBER NCT01901952.
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Davis BC, Jamshed H, Peterson CM, Sabaté J, Harris RD, Koratkar R, Spence JW, Kelly JH. An Intensive Lifestyle Intervention to Treat Type 2 Diabetes in the Republic of the Marshall Islands: Protocol for a Randomized Controlled Trial. Front Nutr 2019; 6:79. [PMID: 31231656 PMCID: PMC6560078 DOI: 10.3389/fnut.2019.00079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The Republic of the Marshall Islands has the highest prevalence of type 2 diabetes (T2D) in the world, with the country's rapid rise of T2D attributed to its reliance on imported and refined foods laden with salt, sugar, and fat. As much as lifestyle factors can increase the risk of T2D, they can also reverse or treat the disease, with multiple studies demonstrating that plant-based diets and/or moderate exercise improve glycemic control and cardiovascular risk factors in T2D patients. Objective: We therefore tested the hypothesis that a community-based, intensive, plant-rich lifestyle intervention with exercise is more effective for treating and managing T2D in the Republic of the Marshall Islands than the standard of diabetes care. Methods: Building on a successful lifestyle program used at the Guam Seventh-day Adventist Clinic, we conducted a randomized controlled trial to test the effectiveness of an intensive lifestyle intervention involving a plant-rich diet and moderate exercise or the standard of care in T2D patients for 24 weeks. In this manuscript, we describe the clinical trial protocol, including the rationale, design, and methods of the clinical trial and the lifestyle program. The lifestyle intervention included a step-wise, intensive 12-week program of counseling and instruction on healthy eating, exercise, and stress management. The prescribed diet focused on high-fiber, whole plant foods, with foods grouped into a four-tiered system. The lifestyle intervention also involved hands-on cooking classes, meals prepared for participants, and group exercise classes—all tailored to be culturally appropriate. The study's main endpoints were glycemic control and cardiovascular disease risk factors. Discussion: The present study is the first randomized clinical trial conducted in the Republic of the Marshall Islands and the first lifestyle intervention trial conducted in Micronesia. The results of this study will help guide future medical care for indigenous populations in the Pacific Islands and will also shed light on how to effectively design and deliver intensive lifestyle interventions to treat and manage diabetes. Clinical Trials Registration:www.ClinicalTrials.gov; identifier NCT03862963
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Affiliation(s)
- Brenda C Davis
- Brenda Davis Nutrition Consultation Services, Kelowna, BC, Canada
| | - Humaira Jamshed
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Courtney M Peterson
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joan Sabaté
- School of Public Health, Center for Nutrition, Lifestyle, and Disease Prevention, Loma Linda University, Loma Linda, CA, United States
| | - Ralph D Harris
- The Meridian Senior Retirement Center, San Marcos, CA, United States
| | - Rohit Koratkar
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - John H Kelly
- Department of Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, United States.,Black Hills Lifestyle Medicine Center, Hermosa, SD, United States
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