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| Title: |
Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial |
| Author(s): |
Geohas J, Daly A, Juturu V, Finch M, Komorowski JR. |
| BACKGROUND: The atherogenic index of plasma (AIP), defined as logarithm [log] of the ratio of plasma concentration of triglycerides to high-density lipoprotein (HDL) cholesterol, has recently been proposed as a predictive marker for plasma atherogenicity and is positively correlated with cardiovascular disease risk. The nutrient combination of chromium picolinate and biotin (CPB) has been previously shown to reduce insulin resistance and hyperglycemia in patients with type 2 diabetes (T2DM). METHODS: Thirty-six moderately obese subjects with T2DM and with impaired glycemic control were randomized to receive CPB or placebo in addition to their oral hyperglycemic agents for 4 weeks. Measurements of blood lipids (including ratio of triglycerides to HDL cholesterol), fructosamine, glucose, and insulin were taken at baseline and after 4 weeks. RESULTS: At the final visit, the active group had a significantly lower AIP compared to the placebo group (P < 0.05). A significant difference in triglyceride level (P < 0.02) and the ratio of low-density lipoprotein (LDL) to HDL cholesterol (P < 0.05) was also observed between the groups at the final visit. In the active group, the changes in urinary chromium levels were inversely correlated with the change in AIP (P < 0.05). Urinary chromium levels were significantly increased in the CPB group. In the CPB group, glucose levels decreased at 1 hour and 2 hours and glucose area under the curve and fructosamine level were significantly decreased. Ratios of total to HDL cholesterol, LDL to HDL cholesterol, and non-HDL to HDL cholesterol were significantly decreased between the treatments at final visit. No significant adverse events were observed in the CPB or placebo groups. CONCLUSIONS: These results suggest that the combination of chromium picolinate and biotin may be a valuable nutritional adjuvant therapy to reduce AIP and correlated CVD risk factors in people with T2DM. |
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Improvement of insulin sensitivity in patients with type 2 diabetes mellitus after oral administration of alpha-lipoic acid. |
| Author(s): |
Kamenova P. |
| BACKGROUND: Amelioration of insulin resistance could improve both glycaemic control and cardiovascular risk factors in patients with type 2 diabetes mellitus. Alpha-lipoic acid has been shown to improve insulin action after parenteral administration. OBJECTIVE: the aim of the study was to assess the effect of oral administration of alpha-lipoic acid on insulin sensitivity in patients with type 2 diabetes. DESIGN: twelve patients (mean+/-sD; age 52.9+/-9.9 yrs; body mass index 33.9+/-7.4 kg/m(2)) were treated with oral alpha-lipoic acid, 600 mg twice daily over a period of 4 weeks. twelve subjects with normal glucose tolerance served as a control group in terms of insulin sensitivity (Is). Is was measured by a 2h manual hyperinsulinaemic (insulin infusion rate-40 mU/m(2 )body surface area/min) euglycaemic (blood glucose kept at 5 mmol/l) clamp technique and expressed as a glucose disposal rate (M) and insulin sensitivity index (IsI). RESULTS: At the end of the treatment period, Is of diabetic patients was significantly increased: M from 3.202+/-1.898 to 5.951+/-2.705 mg/kg/min (mean+/-sD), p<0.01; and IsI from 4.706+/-2.666 to 7.673+/-3.559 mg/kg/min per mIU/l x 100 (mean+/-sD), p<0.05. the difference was not statistically significant between the Is of diabetic patients after alpha-lipoic acid therapy and control subjects. CONCLUSION: short-term oral alpha-lipoic acid treatment increases peripheral insulin sensitivity in patients with type 2 diabetes mellitus. |
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Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. |
| Author(s): |
Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. |
| BACKGROUND: Observational evidence suggests that having been breastfed in infancy may reduce the prevalence of type 2 diabetes in later life. OBJECTIVE: The objective was to examine the influence of initial breastfeeding on type 2 diabetes and blood glucose and insulin concentrations. DESIGN: A systematic review of published studies identified 1010 reports; 23 examined the relation between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Risk factors in infants were examined separately from those in children and adults. All estimates were pooled by using fixed-effect models; differences <0 and ratios <1 imply a beneficial effect of breastfeeding. RESULTS: Subjects who were breastfed had a lower risk of type 2 diabetes in later life than did those who were formula fed (7 studies; 76 744 subjects; odds ratio: 0.61; 95% CI: 0.44, 0.85; P = 0.003). Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than did those who were formula fed (6 studies; 4800 subjects; percentage difference: -3%; 95% CI: -8%, 1%; P = 0.13); no significant difference in fasting glucose concentrations was observed. Breastfed infants had lower mean preprandial blood glucose (12 studies; 560 subjects; mean difference: -0.17 mmol/L; 95% CI: -0.28, -0.05 mmol/L; P = 0.005) and insulin (7 studies; 291 subjects; mean difference: -2.86 pmol/L; 95% CI: -5.76, 0.04 pmol/L; P = 0.054) concentrations than did those who were formula fed. CONCLUSION: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy. |
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New Nordic nutrition recommendations 2004. Physical activity as important as good nourishing food |
| Author(s): |
Becker W. |
| The 4th edition of the Nordic Nutrition Recommendations (NNR 2004) now includes detailed recommendations on daily physical activity. For adults a minimum of 30 minutes of daily physical activity of moderate intensity and/or vigorous intensity is recommended. More physical activity (about 60 minutes daily) may be needed for prevention of weight gain. For children a minimum of 60 minutes of physical activity every day is recommended. As in the 3rd edition, a limitation of the intake of saturated plus trans fatty acids to about 10 % of the total energy intake (E%) and of the total fat intake to 30 E% is recommended. The intake of carbohydrates and dietary fibre should increase, while the intake of refined sugars should not exceed 10 E%. The 4th edition includes changes in the recommended intakes for e.g. vitamin A, D and C and for folate. |
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Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence. |
| Author(s): |
Pouwer F, Nijpels G, Beekman AT, Dekker JM, van Dam RM, Heine RJ, Snoek FJ. |
| AIMS: Evidence strongly suggests that depression is a common complication of Type 2 diabetes mellitus. However, there is considerable room to improve the effectiveness of pharmacological antidepressant agents, as in only 50-60% of the depressed subjects with diabetes does pharmacotherapy lead to remission of depression. The aim of the present paper was to review whether polyunsaturated fatty acids (PUFA) of the omega-3 family could be used for the prevention and treatment of depression in Type 2 diabetes. METHODS: MEDLINE database and published reference lists were used to identify studies that examined the associations between omega-3 PUFA and depression. To examine potential side-effects, such as on glycaemic control, studies regarding the use of omega-3 supplements in Type 2 diabetes were also reviewed. RESULTS: Epidemiological and clinical studies suggest that a high intake of omega-3 PUFA protects against the development of depression. There is also some evidence that a low intake of omega-3 is associated with an increased risk of Type 2 diabetes, but the results are less conclusive. Results from randomized controlled trials in non-diabetic subjects with major depression show that eicosapentaenoic acid is an effective adjunct treatment of depression in diabetes, while docosahexanoic acid is not. Moreover, consumption of omega-3 PUFA reduces the risk of cardiovascular disease and may therefore indirectly decrease depression in Type 2 diabetes, via the reduction of cardiovascular complications. CONCLUSIONS: Supplementation with omega-3 PUFA, in particular eicosapentaenoic acid, may be a safe and helpful tool to reduce the incidence of depression and to treat depression in Type 2 diabetes. Further studies are now justified to test these hypotheses in patients with Type 2 diabetes. |
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Comparison of the Effects of Vitamins and/or Mineral Supplementation on Glomerular and Tubular Dysfunction in Type 2 Diabetes. |
| Author(s): |
Farvid MS, Jalali M, Siassi F, Hosseini M. |
| OBJECTIVE: The present study was designed to assess the effect of magnesium plus zinc, vitamins C plus E, and a combination of these micronutrients on nephropathy indexes in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: In a randomized, double-blind, placebo-controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months: group M (n = 16), 200 mg Mg and 30 mg Zn; group V (n = 18), 200 mg vitamin C and 100 IU vitamin E; group MV (n = 17), minerals plus vitamins; and group P (n = 18), placebo. Urinary albumin excretion and N-acetyl-beta-d-glucosaminidase activity (NAG) in urine were determined at the beginning and at the end of the trial. Treatment effects were analyzed by general linear modeling. RESULTS: Results indicate that after 3 months of supplementation, levels of urinary albumin excretion decreased in the V and MV groups (P = 0.034 and P = 0.005, respectively). Urinary NAG activity did not significantly change in any treatment groups. Levels of systolic, diastolic, and mean blood pressure significantly decreased in the MV group (P = 0.008, P = 0.017, and P = 0.009, respectively). Also, combination of vitamin and mineral supplementation had significant effects in decreasing fasting serum glucose (P = 0.035) and malondialdehyde concentrations (P = 0.004) and in increasing HDL cholesterol and apolipoprotein A1 levels (P = 0.019). There was no significant change in the levels of these parameters in the other three groups. CONCLUSIONS: In conclusion, the results of the present study provide evidence for the effects of vitamins C and E and also combination of magnesium, zinc, and vitamins C and E supplementation on improvement of glomerular but not tubular renal function in type 2 diabetic patients. |
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Ascorbic Acid and Alpha Tocopherol Antioxidant Status of Type 2 Diabetes Mellitus Patients seen in Lagos. |
| Author(s): |
Dogun ES, Ajala MO. |
| Summary: This study was carried out with the aim of assessing the plasma status of ascorbic acid and alpha-tocopherol in Nigerian type 2 diabetes mellitus patients It was a cross sectional study, made up of 70 type 2 diabetes mellitus patients and 40 healthy controls. The plasma levels of vitamins C and E were measured, so also were the fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1C). Results showed significantly lower plasma levels of vitamin C and vitamin E in the patients, compared with the controls. The correlation studies between vitamins C and E on the one hand, versus (FPG) and HbA1c on the other hand were not contributory.The conclusion from this study, is that, there is a reduction in plasma levels of anti-oxidant vitamins C and E in type 2 DM but this does not have any particular relationship with the levels of FPG or HbA1C. Keywords: type 2 Dm, ascorbic Acid, alpha tocopherol antioxidant status. |
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Treatment for diabetic mononeuropathy with alpha-lipoic acid. |
| Author(s): |
Tankova T, Cherninkova S, Koev D. |
| Twenty-three diabetic patients -- 16 men and seven women (mean age: 50.7 +/- 17.4 years; mean duration of diabetes: 13.6 +/- 6.9 years) -- with diabetic mononeuropathy of the cranial nerves participated in the study. Four of them were with mononeuropathia multiplex and total ophthalmoplegia, affecting the oculomotor, trochlear and abducent nerves; 12 with paresis of the oculomotor nerve, one -- of the trochlear nerve and six -- of the abducent nerve. They were treated with alpha-lipoic acid (600 mg) for 10 days daily intravenously, thereafter one film tablet of 600 mg daily for 60 days. On the 10th day, we found significant improvement in the clinical signs of diabetic mononeuropathy - double vision, motility and position of the eyeball, ptosis of the upper eyelid and mydriasis. The mean period of oral treatment was 69.1 +/- 23.8 days, following the 10-day intravenous application of alpha-lipoic acid, and full recovery of the diabetic mononeuropathy was achieved with this therapeutic approach. Peripheral neuropathy was present in 17 patients (74%). On the 10th day, we established a decrease in total symptom score by an average of 2.7 +/- 1.4 points and by the end of the treatment period it was improved by 5.9 +/- 1.9 points (p = 0.04). On the 10th day, we found a decrease of 33% in foot pain and by the end of the second month, it fell by 65.5% (p < 0.0001). Vibration perception threshold was reduced in these patients at entry -- mean: 2.42 +/- 1.8 at the great toe, 2.89 +/- 1.8 at the first metatarsal and 3.65 +/- 1.7 at the medial malleolus. By the end of the second month, it reached mean 4.7 +/- 1.8 (p < 0.002) at the great toe, 4.92 +/- 2.1 (p = 0.004) at the first metatarsal and 5.3 +/- 1.4 (p < 0.01) at the medial malleolus. Cardiovascular autonomic neuropathy was present in two of the patients and there was improvement after treatment in the Ewing's tests -- Valsalva manoeuvre, deep-breathing test and lying-to-standing test. The results of our study demonstrate that alpha-lipoic acid appears to be an effective drug in the treatment for not only peripheral and autonomic diabetic neuropathy, but also diabetic mononeuropathy of the cranial nerves leading to full recovery of the patients. |
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Title:
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alpha-Lipoic acid prevents diabetes mellitus in diabetes-prone obese rats. |
| Author(s): |
Song KH, Lee WJ, Koh JM, Kim HS, Youn JY, Park HS, Koh EH, Kim MS, Youn JH, Lee KU, Park JY. |
| Several lines of evidence have suggested that triglyceride accumulation in skeletal muscle and pancreatic islets is causally related to type 2 diabetes mellitus. We recently showed that alpha-lipoic acid (ALA), a potent antioxidant and cofactor of mitochondrial respiratory enzymes, reduces body weight of rodents by suppressing food intake and increasing energy expenditure. We sought to determine if ALA can prevent the development of diabetes mellitus in obese Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Most (78%) untreated OLETF rats showed glycosuria at 40 weeks of age, but this was completely prevented by ALA. Compared with untreated OLETF rats, ALA reduced body weight and protected pancreatic beta-cells from destruction. ALA also reduced triglyceride accumulation in skeletal muscle and pancreatic islets. These results indicate that ALA prevents diabetes mellitus in obese diabetes-prone rats by reducing lipid accumulation in non-adipose tissue as well as in adipose tissue. |
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Title:
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Alpha-lipoic acid in the treatment of autonomic diabetic neuropathy (controlled, randomized, open-label study). |
| Author(s): |
Tankova T, Koev D, Dakovska L. |
| AIM: to evaluate the effect of alpha-lipoic acid in autonomic diabetic neuropathy in a controlled, randomized, open-label study. MATERIAL AND METHODS: 46 patients with type 1 diabetes and different forms of autonomic neuropathy, of mean age 38.1 +/- 12.5 years and mean duration of diabetes 16.8 +/- 8.9 years were treated with alpha-lipoic acid for 10 days 600mg daily iv, thereafter one film tablet of 600mg daily for 50 days. 29 type 1 diabetic patients with autonomic diabetic neuropathy, of mean age 40.2 +/- 9.3 years and mean duration of diabetes 15.4 +/- 7.9 years served as a control group. We have followed-up patients' complaints, Ewing's tests, laboratory parameters of oxidative stress. RESULTS: There was a significant improvement after treatment in the score for severity of cardiovascular autonomic neuropathy--from 6.43 +/- 0.9 to 4.24 +/- 1.8 (p<0.001), while in the control group it worsened from 6.18 +/- 1.3 to 6.52 +/- 0.9 (p>0.1). We found improvement in the Valsalva manoeuvre after treatment - from 1.05 +/- 0.04 to 1.13 +/- 0.08 (p<0.001); in the deep-breathing test -from 3.4 +/- 2.8 to 10.4 +/- 5.7 (p<0.001); and in the lying-to-standing test--from 0.99 +/- 0.01 to 1.01 +/- 0.02 (p>0.1), while in the control group there was no improvement. There was a beneficial effect of treatment on the change of systolic blood pressure at the lying-to-standing test--from 22.7 +/- 11.5 to 9.8 +/- 7.9 (p<0.001), while in the control group the change was 20.5 +/- 11.1 mmHg and 19.7 +/- 12.9 mmHg (p>0.1), respectively. We found improvement in diabetic enteropathy in six patients; in the complaints of dizziness, instability upon standing in six patients; in neuropathic edema of the lower extremities in four patients and in erectile dysfunction in four patients after treatment, while in the control group no change was reported in the symptoms and signs of autonomic neuropathy by the end of the follow-up period. There were changes in the laboratory parameters of oxidative stress after therapy--total serum antioxidant capacity increased from 20.42 +/- 1.8 to 22.96 +/- 2.3 microgH2O2/ml/min (p<0.05), serum SOD activity - from 269.8 +/- 31.1 to 319.8 +/- 29.IU/l (p=0.02) and erythrocyte SOD--from 0.89 +/- 0.10 to 1.11 +/- 0.09 U/gHb (p=0.04). CONCLUSION: Our results demonstrate that alpha-lipoic acid (Thiogamma) appears to be an effective drug in the treatment of the different forms of autonomic diabetic neuropathy. |
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Effect of long-term administration of alpha-lipoic acid on retinal capillary cell death and the development of retinopathy in diabetic rats. |
| Author(s): |
Kowluru RA, Odenbach S. |
| Oxidative stress is increased in the retina in diabetes, and it is considered to play an important role in the development of retinopathy. alpha-Lipoic acid, a thiol antioxidant, has been shown to have beneficial effects on polyneuropathy and on the parameters of oxidative stress in various tissues, including nerve, kidney, and retina. The purpose of this study was to examine the effect of alpha-lipoic acid on retinal capillary cell apoptosis and the development of pathology in diabetes. Retina was used from streptozotocin-induced diabetic rats receiving diets supplemented with or without alpha-lipoic acid (400 mg/kg) for 11 months of diabetes. Capillary cell apoptosis (by terminal transferase-mediated dUTP nick-end labeling) and formation of acellular capillaries were investigated in the trypsin-digested retinal microvessels. The effect of alpha-lipoic acid administration on retinal 8-hydroxy-2'deoxyguanosine (8-OHdG) and nitrotyrosine levels was determined by enzyme-linked immunosorbent assay. alpha-Lipoic acid administration for the entire duration of diabetes inhibited capillary cell apoptosis and the number of acellular capillaries in the retina, despite similar severity of hyperglycemia in the two diabetic groups (with and without alpha-lipoic acid). Retinal 8-OHdG and nitrotyrosine levels were increased by over twofold and 70%, respectively, in diabetes, and alpha-lipoic acid administration inhibited these increases. Our results demonstrate that the long-term administration of alpha-lipoic acid has beneficial effects on the development of diabetic retinopathy via inhibition of accumulation of oxidatively modified DNA and nitrotyrosine in the retina. alpha-Lipoic acid supplementation represents an achievable adjunct therapy to help prevent vision loss in diabetic patients. |
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Metabolic risk in early childhood: the EarlyBird Study. |
| Author(s): |
Wilkin TJ, Voss LD, Metcalf BS, Mallam K, Jeffery AN, Alba S, Murphy MJ. |
| OBJECTIVE:: For a decade or more, poor nutrition during gestation, expressed as low weight at birth, was held to be the factor responsible for insulin resistance later in life. Birth weights, however, are rising and insulin-resistant states, such as diabetes, faster still. Alternative explanations are needed for insulin resistance in contemporary society. This review cites data from the EarlyBird study on the relationships of insulin resistance and metabolic disturbance in early childhood. DESIGN:: EarlyBird is a nonintervention prospective cohort study that asks the question 'Which children develop insulin resistance, and why?' It is unique in taking serial blood samples from a young age with which to monitor the behaviour of insulin resistance and its metabolic correlates, and in its comprehensive assessment of factors known or thought to influence insulin resistance SUBJECTS:: In all, 307 randomly selected healthy school children at school entry (mean age 4.9 y) and at 12 and 24 months later. MEASUREMENTS:: In the children: Birth weight and, at each time point height, weight, body mass index (BMI, kg/m(2)), skinfolds at five sites, circumferences, resting energy expenditure, physical activity, body composition, heart rate variability, diet, HOMA-IR and HOMA-ISC, blood pressure, full blood count, haemoglobin and haematocrit, HbA1C, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, uric acid, IGF-1, gonadotrophins and SHBG. In their parents: At baseline height, weight, BMI, waist circumference, HOMA-IR and HOMA-ISC, full blood count, haematocrit, HbA1C, total cholesterol, HDL cholesterol, calculated LDL cholesterol, triglycerides, uric acid, gonadotrophins and SHBG. RESULTS:: Four observations are reported here: (1) There are clear correlations in contemporary children between insulin resistance and weight at 5 y, but none with birth weight. (2) Females throughout life are intrinsically more insulin resistant than males. (3) The substantial variation of physical activity among young children is attributable to the child, and not to his environment. (4) There is dissociation in young children between fatness and insulin resistance. CONCLUSION:: There is much yet to be learned about the development of obesity and insulin resistance in children. The notions of overnutrition and underactivity alone are too simplistic.International Journal of Obesity (2004) 28, S64-S69. doi:10.1038/sj.ijo.0802807. |
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Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial. |
| Author(s): |
Brinkworth GD, Noakes M, Parker B, Foster P, Clifton PM. |
| AIMS/HYPOTHESIS. This study compared the long-term weight loss and health outcomes at 1-year follow-up, after a 12-week intensive intervention consisting of two low-fat, weight-loss diets, which differed in protein content. METHODS. We randomly assigned 66 obese patients (BMI: 27-40 kg/m(2)) with Type 2 diabetes to either a low-protein (15% protein, 55% carbohydrate) or high-protein diet (30% protein, 40% carbohydrate) for 8 weeks of energy restriction (~6.7 MJ/day) and 4 weeks of energy balance. Subjects were asked to maintain the same dietary pattern for a further 12 months of follow-up. RESULTS. The study was completed by 38 of the subjects, with equal dropouts in each group. At Week 64, weight reductions against baseline were -2.2+/-1.1 kg (low protein) and -3.7+/-1.0 kg (high protein), p<0.01, with no diet effect. Fat mass was not different from baseline in either group. At Week 12, both diets reduced systolic and diastolic blood pressure by 6 and 3 mm Hg respectively, but blood pressure increased more with weight regain during follow-up in the low-protein group ( p |
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Title:
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Maternal plasma ascorbic Acid (vitamin C) and risk of gestational diabetes mellitus. |
| Author(s): |
Zhang C, Williams MA, Sorensen TK, King IB, Kestin MM, Thompson ML, Leisenring WM, Dashow EE, Luthy DA. |
| BACKGROUND: Antioxidants, particularly vitamin C (ascorbic acid), have the capacity to influence glucose tolerance. Modification of diet could reduce the likelihood of developing gestational diabetes mellitus. METHODS: In a prospective cohort study of pregnant women, we studied the association of maternal plasma ascorbic acid concentrations, measured at an average of 13 weeks' gestation, with subsequent risk of gestational diabetes. Maternal plasma ascorbic acid concentrations were determined using automated enzymatic procedures. Dietary vitamin C intake during the periconceptional period and early pregnancy was ascertained using a semiquantitative food frequency questionnaire. We fitted generalized linear models to derive estimates of relative risks and 95% confidence intervals (CIs). RESULTS: Approximately 4% (n = 33) of 755 women who completed pregnancy developed gestational diabetes mellitus. Plasma ascorbic acid concentrations were inversely associated with the risk of gestational diabetes (P for trend = 0.023). After adjusting for maternal age, race, prepregnancy adiposity, parity, family history of type 2 diabetes, and household income, women with plasma ascorbic acid <55.9 micromol/L (lowest quartile) experienced a 3.1-fold increased risk of gestational diabetes (95% CI = 1.0 - 9.7) compared with women whose concentrations were > or = 74.6 micromol/L (upper quartile). Women who consumed <70 mg vitamin C daily experienced a 1.8-fold increased risk of gestational diabetes compared with women who consumed higher amounts (95% CI = 0.8 - 4.4). CONCLUSIONS: If confirmed, our results raise the possibility that current efforts to encourage populations to consume diets rich in antioxidants, including vitamin C, could reduce the occurrence of gestational diabetes mellitus. |
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Title:
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Review of dietary recommendations for diabetes mellitus. |
| Author(s): |
Choudhary P. |
| Previous nutritional guidelines for people with diabetes focused on carbohydrate-based meal planning. Updated guidelines from Europe and North America reflect a more flexible approach to nutritional intervention. New aspects of these most recent recommendations include: (1) increased emphasis on the role of trained dietitians for educating people with diabetes; (2) greater individualization of dietary choices based on cultural, regional and personal preferences; (3) more flexibility for choosing between carbohydrate and monounsaturated fat consumption, but with limitations on intake of polyunsaturated fats (<10% of total energy); (4) broadened allowance of sucrose in the diet (up to 10% of total energy); and (5) greater recognition of physical activity as an important means to control weight and enhance general health. Expert guidelines vary regarding preferential intake of carbohydrates with lower glycemic indices. |
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A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the women's health study. |
| Author(s): |
Song Y, Manson JE, Buring JE, Liu S. |
| OBJECTIVE: The aim of this study was to prospectively assess the relation between red meat intake and incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS: Over an average of 8.8 years, we evaluated 37,309 participants in the Women's Health Study aged >/=45 years who were free of cardiovascular disease, cancer, and type 2 diabetes and completed validated semiquantitative food frequency questionnaires in 1993. RESULTS: During 326,876 person-years of follow-up, we documented 1,558 incident cases of type 2 diabetes. After adjusting for age, BMI, total energy intake, exercise, alcohol intake, cigarette smoking, and family history of diabetes, we found positive associations between intakes of red meat and processed meat and risk of type 2 diabetes. Comparing women in the highest quintile with those in the lowest quintile, the multivariate-adjusted relative risks (RRs) of type 2 diabetes were 1.28 for red meat (95% CI 1.07-1.53, P < 0.001 for trend) and 1.23 for processed meat intake (1.05-1.45, P = 0.001 for trend). Furthermore, the significantly increased diabetes risk appeared to be most pronounced for frequent consumption of total processed meat (RR 1.43, 95% CI 1.17-1.75 for >/=5/week vs. <1/month, P < 0.001 for trend) and two major subtypes, which were bacon (1.21, 1.06-1.39 for >/=2/week vs. <1/week, P = 0.004 for trend) and hot dogs (1.28, 1.09-1.50 for >/=2/week vs. <1/week, P = 0.003 for trend). These results remained significant after further adjustment for intakes of dietary fiber, magnesium, glycemic load, and total fat. Intakes of total cholesterol, animal protein, and heme iron were also significantly associated with a higher risk of type 2 diabetes. CONCLUSIONS: Our data indicate that higher consumption of total red meat, especially various processed meats, may increase risk of developing type 2 diabetes in women. |
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Title:
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Physical exercise enhances hepatic insulin signaling and inhibits phosphoenolpyruvate carboxykinase activity in diabetes-prone Psammomys obesus. |
| Author(s): |
Heled Y, Shapiro Y, Shani Y, Moran DS, Langzam L, Barash V, Sampson SR, Meyerovitch J. |
| We have shown that physical exercise enhances insulin sensitivity of skeletal muscle in diabetes-prone Psammomys-obesus. In this study, we examined the effect of physical exercise on the liver of these animals. Three groups of animals were exposed to a 4-week protocol; high-energy diet (CH), high-energy diet and exercising (EH), and low-energy diet (CL). Different groups were studied either in a fed state or after an overnight fast, 30 minutes after intraperitoneal (IP) injection of 1 U insulin. Hepatic phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase) activity was measured. Insulin signaling response was examined after insulin injection in the fast state by analyzing tyrosine phosphorylation of insulin receptor (IR) and the association between insulin receptor substrate-1 (IRS-1) and IRS-2 with phosphatidylinositol 3 kinase (PI3-K). After 4 weeks, none of the EH animals became diabetic, whereas all the CH animals became diabetic. PEPCK activity in the fed state was higher in the CH group compared with the CL and EH groups (480 +/- 28 nmol/min/mg protein, 280 +/- 30 nmol/min/mg protein, and 208 +/- 13 nmol/min/mg protein, respectively) (P <.02). G6Pase activity was higher in the CH and EH groups compared with the CL group (261 +/- 54 nmol/min/mg protein, 251 +/- 34 nmol/min/mg protein, and 75 +/- 32 nmol/min/mg protein, respectively) (P <.01). After insulin administration in the fast state, tyrosine phosphorylation of IR and association of IRS-2 with PI3-K were higher in the EH and CL groups than in the CH group. We conclude that exercise improves in vivo hepatic insulin sensitivity in diabetes-prone Psammomys-obesus. |
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Title:
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Wild ginseng prevents the onset of high-fat diet induced hyperglycemia and obesity in ICR mice. |
| Author(s): |
Yun SN, Moon SJ, Ko SK, Im BO, Chung SH. |
| Ginseng is a shade-loving perennial herb that is cultivated mainly in Korea, Japan, and China. The ginseng root has been used as a tonic remedy, and its antidiabetic activity has been demonstrated as early as 1920s. Although wild ginseng was anecdotally thought to be superior to cultivated ginseng as far as pharmacological properties were concerned, there have been no prior reports on the antidiabetic effect of wild ginseng. In this study, we investigated the preventative anti-diabetic and anti-obese effects of wild ginseng ethanol extract (WGEE). In the preventive experiment, WGEE co-administered with a high fat diet significantly inhibited body weight gain, fasting blood glucose, triglyceride, and free fatty acid levels in a dose dependent manner. WGEE-treated mice at doses of 250 and 500 mg/kg improved the insulin resistance index by 55% and 61% compared to the high fat diet (HFD) control, respectively. Diameters of white and brown adipocytes were also decreased by 62% and 46% in the WG500-treated group compared to those in HFD fed control mice. Taken together, WGEE has potential as a preventive agent for type 2 diabetes mellitus (and possibly obesity) and deserves clinical trial in the near future. |
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Title:
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Effects of Dietary Intake and Life Style on Bone Density in Patients with Diabetes mellitus Type 2. |
| Author(s): |
De Luis Roman DA, Aller R, Perez Castrillon JL, De Luis J, Gonzalez Sagrado M, Izaola O, Romero E, Escudero JC, Herreros V |
| Objective: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. Design: Cross-sectional study. Setting: Tertiary care hospital. Participants: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. Results: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 +/- 6.9 vs. 62.1 +/- 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 +/- 387 vs. 839 +/- 251 mg/day; p < 0.05) and zinc intake (9.23 +/- 3.5 vs. 13.3 +/- 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = -0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. Conclusions: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population. Copyright 2004 S. Karger AG, Basel |
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Title:
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The metabolic syndrome: An emerging health epidemic in women. |
| Author(s): |
Steinbaum SR. |
| The metabolic syndrome is a compilation of factors characterized by insulin resistance and the identification of 3 of the 5 criteria of abdominal obesity, elevated triglycerides, decreased high-density lipoprotein (HDL) level, elevated blood pressure, and elevated fasting plasma glucose. According to census data from 2000, these criteria have lead to the diagnosis of approximately 47 million Americans with the metabolic syndrome, correlating with the 61% increase in the incidence of obesity between 1991 and 2000. Insulin resistance occurs when target tissues cannot respond properly to normal concentrations of insulin. The results are hypercoagulability, endothelial dysfunction, inflammation, and eventually coronary artery disease. Treatment involves lifestyle modification, including diet and exercise, to treat obesity and prevent the development of diabetes. Patients who meet the criteria for the metabolic syndrome may also be treated with insulin-sparing and insulin-sensitizing medications that help to improve endothelial function, vascular reactivity, and vascular inflammation. Ultimately, treatment goals are to prevent cardiovascular disease by both altering the risk factors that are components of the syndrome, and treating the lifestyle issues inherent to the disease process, such as caloric restriction and increased physical activity. There are 2 million more women than men in the United States categorized as being obese, with the trend of obesity and diabetes increasing. In the last decade there has been a 74% increase in obesity, mostly in women. This epidemic needs to be understood and managed to prevent further morbidity and mortality owing to diabetes and cardiovascular disease. |
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Title:
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Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. |
| Author(s): |
Carnethon MR, Gidding SS, Nehgme R, Sidney S, Jacobs DR Jr, Liu K. |
| CONTEXT: Low cardiorespiratory fitness is an established risk factor for cardiovascular and total mortality; however, mechanisms responsible for these associations are uncertain. OBJECTIVE: To test whether low fitness, estimated by short duration on a maximal treadmill test, predicted the development of cardiovascular disease risk factors and whether improving fitness (increase in treadmill test duration between examinations) was associated with risk reduction. DESIGN, SETTING, AND PARTICIPANTS: Population-based longitudinal cohort study of men and women 18 to 30 years of age in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants who completed the treadmill examination according to the Balke protocol at baseline were followed up from 1985-1986 to 2000-2001. A subset of participants (n = 2478) repeated the exercise test in 1992-1993. MAIN OUTCOME MEASURES: Incident type 2 diabetes, hypertension, the metabolic syndrome (defined according to National Cholesterol Education Program Adult Treatment Panel III), and hypercholesterolemia (low-density lipoprotein cholesterol > or =160 mg/dL [4.14 mmol/L]). RESULTS: During the 15-year study period, the rates of incident diabetes, hypertension, the metabolic syndrome, and hypercholesterolemia were 2.8, 13.0, 10.2, and 11.7 per 1000 person-years, respectively. After adjustment for age, race, sex, smoking, and family history of diabetes, hypertension, or premature myocardial infarction, participants with low fitness (<20th percentile) were 3- to 6-fold more likely to develop diabetes, hypertension, and the metabolic syndrome than participants with high fitness (> or =60th percentile), all P<.001. Adjusting for baseline body mass index diminished the strength of these associations to 2-fold (all P<.001). In contrast, the association between low fitness and hypercholesterolemia was modest (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.7; P =.02) and attenuated to marginal significance after body mass index adjustment (P =.13). Improved fitness over 7 years was associated with a reduced risk of developing diabetes (HR, 0.4; 95% CI, 0.2-1.0; P =.04) and the metabolic syndrome (HR, 0.5; 95% CI, 0.3-0.7; P<.001), but the strength and significance of these associations was reduced after accounting for changes in weight. CONCLUSIONS: Poor fitness in young adults is associated with the development of cardiovascular disease risk factors. These associations involve obesity and may be modified by improving fitness. |
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Title:
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The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. |
| Author(s): |
Ametov AS, Barinov A, Dyck PJ, Hermann R, Kozlova N, Litchy WJ, Low PA, Nehrdich D, Novosadova M, O'Brien PC, Reljanovic M, Samigullin R, Schuette K, Strokov I, Tritschler HJ, Wessel K, Yakhno N, Ziegler D; SYDNEY Trial Study Group. |
| OBJECTIVE: Because alpha-lipoic acid (ALA), a potent antioxidant, prevents or improves nerve conduction attributes, endoneurial blood flow, and nerve (Na(+) K(+) ATPase activity in experimental diabetes and in humans and may improve positive neuropathic sensory symptoms, in this report we further assess the safety and efficacy of ALA on the Total Symptom Score (TSS), a measure of positive neuropathic sensory symptoms. RESEARCH DESIGN AND METHODS: Metabolically stable diabetic patients with symptomatic (stage 2) diabetic sensorimotor polyneuropathy (DSPN) were randomized to a parallel, double-blind study of ALA (600 mg) (n = 60) or placebo (n = 60) infused daily intravenously for 5 days/week for 14 treatments. The primary end point was change of the sum score of daily assessments of severity and duration of TSS. Secondary end points were sum scores of neuropathy signs (NIS), symptoms (NSC), attributes of nerve conduction, quantitative sensation tests (QSTs), and an autonomic test. RESULTS: At randomization, the groups were not significantly different by the criteria of metabolic control or neuropathic end points. After 14 treatments, the TSS of the ALA group had improved from baseline by an average of 5.7 points and the placebo group by an average of 1.8 points (P < 0.001). Statistically significant improvement from baseline of the ALA, as compared with the placebo group, was also found for each item of the TSS (lancinating and burning pain, asleep numbness and prickling), NIS, one attribute of nerve conduction, and global assessment of efficacy. CONCLUSIONS: Intravenous racemic ALA, a potent antioxidant, rapidly and to a significant and meaningful degree, improved such positive neuropathic sensory symptoms as pain and several other neuropathic end points. This improvement of symptoms was attributed to improved nerve pathophysiology, not to increased nerve fiber degeneration. Because of its safety profile and its effect on positive neuropathic sensory symptoms and other neuropathic end points, this drug appears to be a useful ancillary treatment for the symptoms of diabetic polyneuropathy. |
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Title:
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Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. |
| Author(s): |
Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R. |
| BACKGROUND: Use of multivitamin and mineral supplements is common among U.S. adults, yet few well-designed trials have assessed the reputed benefits. OBJECTIVE: To determine the effect of a daily multivitamin and mineral supplement on infection and well-being. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Primary care clinics at two medical centers in North Carolina. PARTICIPANTS: 130 community-dwelling adults stratified by age (45 to 64 years or >or=65 years) and presence of type 2 diabetes mellitus. INTERVENTION: Multivitamin and mineral supplement or placebo taken daily for 1 year. MEASUREMENTS: Incidence of participant-reported symptoms of infection, incidence of infection-associated absenteeism, and scores on the physical and mental health subscales of the Medical Outcomes Study 12-Item Short Form. RESULTS: More participants receiving placebo reported an infectious illness over the study year than did participants receiving multivitamin and mineral supplements (73% vs. 43%; P < 0.001). Infection-related absenteeism was also higher in the placebo group than in the treatment group (57% vs. 21%; P < 0.001). Participants with type 2 diabetes mellitus (n = 51) accounted for this finding. Among diabetic participants receiving placebo, 93% reported an infection compared with 17% of those receiving supplements (P < 0.001). Medical Outcomes Study 12-Item Short Form scores did not differ between the treatment and placebo groups. CONCLUSIONS: A multivitamin and mineral supplement reduced the incidence of participant-reported infection and related absenteeism in a sample of participants with type 2 diabetes mellitus and a high prevalence of subclinical micronutrient deficiency. A larger clinical trial is needed to determine whether these findings can be replicated not only in diabetic persons but also in any population with a high rate of suboptimal nutrition or potential underlying disease impairment. |
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Title:
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Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. |
| Author(s): |
Hu FB, Cho E, Rexrode KM, Albert CM, Manson JE. |
| BACKGROUND: Although several prospective cohort studies have found an inverse association between fish consumption and risk of coronary heart disease (CHD) or sudden cardiac death in the general population, limited data are available among diabetic patients. METHODS AND RESULTS: We examined prospectively the association between intake of fish and omega-3 fatty acids and risk of CHD and total mortality among 5103 female nurses with diagnosed type 2 diabetes but free of cardiovascular disease or cancer at baseline. Between 1980 and 1996 (45 845 person-years of follow-up), we documented 362 incident cases of CHD (141 CHD deaths and 221 nonfatal myocardial infarctions) and 468 deaths from all causes. Compared with women who seldom consumed fish (<1 serving/mo), the relative risks (RRs) (95% CI) of CHD adjusted for age, smoking, and other established coronary risk factors were 0.70 (0.48 to 1.03) for fish consumption 1 to 3 times per month, 0.60 (0.42 to 0.85) for once per week, 0.64 (0.42 to 0.99) for 2 to 4 times per week, and 0.36 (0.20 to 0.66) for 5 or more times per week (P for trend=0.002). Higher consumption of fish was also associated with a significantly lower total mortality (multivariate RR=0.48 [0.29 to 0.80] for > or =5 times per week [P for trend=0.005]). Higher consumption of long-chain omega-3 fatty acids was associated with a trend toward lower incidence of CHD (RR=0.69 [95% CI 0.47 to 1.03], P for trend=0.10) and total mortality (RR=0.63 [95% CI, 0.45 to 0.88], P for trend=0.02). CONCLUSIONS: A higher consumption of fish and long-chain omega-3 fatty acids was associated with a lower CHD incidence and total mortality among diabetic women. |
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Title:
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Urinary cadmium, impaired fasting glucose, and diabetes in the NHANES III. |
| Author(s): |
Schwartz GG, Il'yasova D, Ivanova A. |
| OBJECTIVE: Increasing rates of type 2 diabetes worldwide suggest that diabetes may be caused by environmental toxins. Cadmium is a widespread environmental pollutant that accumulates in the pancreas and exerts diabetogenic effects in animals. To test the hypothesis that exposure to cadmium is associated with impaired fasting glucose and type 2 diabetes, we examined the associations between urinary cadmium and the prevalence of impaired fasting glucose (prediabetes) and diabetes in the Third National Health and Nutrition Examination Survey (NHANES III). RESEARCH DESIGN AND METHODS: We analyzed data on 8,722 adults > or =40 years of age from the NHANES III (1988-1994), a cross-sectional health survey of a nationally representative sample of the noninstitutionalized civilian U.S. population. We studied urinary levels of cadmium (adjusted for urine creatinine) in relation to the prevalence of impaired fasting glucose and diabetes, using the criteria of the American Diabetes Association. RESULTS: After adjustment for age, ethnicity, sex, and BMI, the odds of impaired fasting glucose and diabetes increased dose-dependently with elevations in urinary cadmium from 0-0.99 to 1.00-1.99 and > or =2 micro g/g creatinine (impaired fasting glucose, odds ratio [OR] 1.48, 95% CI 1.21-1.82 and OR 2.05, 95% CI 1.42-2.95; diabetes, OR 1.24, 95% CI 1.06-1.45 and OR 1.45, 95% CI 1.07-1.97). CONCLUSIONS: In this large cross-sectional study, urinary cadmium levels are significantly and dose-dependently associated with both impaired fasting glucose and diabetes. These findings, which require confirmation in prospective studies, suggest that cadmium may cause prediabetes and diabetes in humans. |
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Title:
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Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects |
| Author(s): |
George B. Kudoloa, Sheryl Dorseya, Janet Blodgett |
| Enhanced platelet function, particularly in response to collagen, is a common occurrence in diabetes that increases the risk of cardiovascular disease. Ginkgo biloba extract is ingested primarily to improve mental focus but it possesses a blood-thinning potential, which has not been well characterized. This study was designed to compare the effect of ingesting G. biloba extract on platelet aggregation in platelet-rich plasma (PRP) and prostanoid urinary excretion in healthy volunteers and subjects with Type 2 diabetes mellitus (T2DM). Before and after ingesting 120 mg of standardized G. biloba extract for 3 months, platelet aggregation was studied in PRP and urinary metabolites of thromboxane B2 (TXB2) and prostacyclin (PGI2) were measured. In healthy volunteers (age, 42±11 years; BMI, 28.4±4.8 kg/m2; n=28), the ingestion of G. biloba extract significantly increased fasting insulin and C-peptide (10±4 vs. 12±6 U/ml, p<0.007 and 1.3±0.8 vs. 2.1±1.1 ng/ml, p<0.001, respectively) and significantly reduced collagen but not PAF-mediated platelet aggregation, converting 21 of 28 subjects with [COL+/EPI+] platelets to the [COL-/EPI+] phenotype. This was accompanied by a reduction of 11-dehydro-TXB2 from 12.4±6.1 to 10.3±6.1 ng/mg Cr (p<0.04) and PGI2 metabolites (2,3-dinor-6-keto-PGF1 and 6-keto-PGF1) from 2.2±0.8 to 1.8±0.8 ng/mg Cr (p<0.05). In the T2DM subjects (age, 54±8; BMI, 36.6±7.9 kg/m2; n=19), G. biloba ingestion did not affect pancreatic -cell function but significantly reduced platelet aggregation, converting 16 of 19 [COL+/EPI+] platelets to the [COL-/EPI+] phenotype. Unlike the healthy volunteers, this was not accompanied by a reduced urinary prostanoid excretion. G. biloba-induced reduction of both classes of prostanoid metabolites in healthy volunteers, but not in T2DM subjects, may suggest a nonselective inhibition of COX-1-mediated TXA2 in platelets and COX-2-mediated PGI2 production by the endothelial cells and perhaps platelet-enriched levels of arachidonic acid or COX-1 activity, or both, in T2DM subjects. |
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Title:
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Nut and peanut butter consumption and risk of type 2 diabetes in women. |
| Author(s): |
Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. |
| CONTEXT: Nuts are high in unsaturated (polyunsaturated and monounsaturated) fat and other nutrients that may improve glucose and insulin homeostasis. OBJECTIVE: To examine prospectively the relationship between nut consumption and risk of type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 83 818 women from 11 states in the Nurses' Health Study. The women were aged 34 to 59 years, had no history of diabetes, cardiovascular disease, or cancer, completed a validated dietary questionnaire at baseline in 1980, and were followed up for 16 years. MAIN OUTCOME MEASURE: Incident cases of type 2 diabetes. RESULTS: We documented 3206 new cases of type 2 diabetes. Nut consumption was inversely associated with risk of type 2 diabetes after adjustment for age, body mass index (BMI), family history of diabetes, physical activity, smoking, alcohol use, and total energy intake. The multivariate relative risks (RRs) across categories of nut consumption (never/almost never, or =5 times/week) for a 28-g (1 oz) serving size were 1.0, 0.92 (95% confidence interval [CI], 0.85-1.00), 0.84 (0.95% CI, 0.76-0.93), and 0.73 (95% CI, 0.60-0.89) (P for trend <.001). Further adjustment for intakes of dietary fats, cereal fiber, and other dietary factors did not appreciably change the results. The inverse association persisted within strata defined by levels of BMI, smoking, alcohol use, and other diabetes risk factors. Consumption of peanut butter was also inversely associated with type 2 diabetes. The multivariate RR was 0.79 (95% CI, 0.68-0.91; P for trend <.001) in women consuming peanut butter 5 times or more a week (equivalent to > or =140 g [5 oz] of peanuts/week) compared with those who never/almost never ate peanut butter. CONCLUSIONS: Our findings suggest potential benefits of higher nut and peanut butter consumption in lowering risk of type 2 diabetes in women. To avoid increasing caloric intake, regular nut consumption can be recommended as a replacement for consumption of refined grain products or red or processed meats. |
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