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Metabolic and Vascular Effect of the Mediterranean Diet. Int J Mol Sci 2019; 20:ijms20194716. [PMID: 31547615 PMCID: PMC6801699 DOI: 10.3390/ijms20194716] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022] Open
Abstract
Several studies indicated how dietary patterns that were obtained from nutritional cluster analysis can predict disease risk or mortality. Low-grade chronic inflammation represents a background pathogenetic mechanism linking metabolic risk factors to increased risk of chronic degenerative diseases. A Mediterranean diet (MeDi) style has been reported as associated with a lower degree of inflammation biomarkers and with a protective role on cardiovascular and cerebrovascular events. There is heterogeneity in defining the MedDiet, and it can, owing to its complexity, be considered as an exposome with thousands of nutrients and phytochemicals. Recently, it has been reported a novel positive association between baseline plasma ceramide concentrations and cardiovascular events and how adherence to a Mediterranean Diet-style may influence the potential negative relationship between elevated plasma ceramide concentrations and cardiovascular diseases (CVD). Several randomized controlled trials (RCTs) showed the positive effects of the MeDi diet style on several cardiovascular risk factors, such as body mass index, waist circumference, blood lipids, blood pressure, inflammatory markers and adhesion molecules, and diabetes and how these advantages of the MeDi are maintained in comparison of a low-fat diet. Some studies reported a positive effect of adherence to a Mediterranean Diet and heart failure incidence, whereas some recent studies, such as the PREDIMED study, showed that the incidence of major cardiovascular events was lower among those assigned to MeDi supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet. New studies are needed to better understand the molecular mechanisms, whereby the MedDiet may exercise its effects. Here, we present recent advances in understanding the molecular basis of MedDiet effects, mainly focusing on cardiovascular diseases, but also discussing other related diseases. We review MedDiet composition and assessment as well as the latest advances in the genomic, epigenomic (DNA methylation, histone modifications, microRNAs, and other emerging regulators), transcriptomic (selected genes and whole transcriptome), and metabolomic and metagenomic aspects of the MedDiet effects (as a whole and for its most typical food components). We also present a review of the clinical effects of this dietary style underlying the biochemical and molecular effects of the Mediterranean diet. Our purpose is to review the main features of the Mediterranean diet in particular its benefits on human health, underling the anti-inflammatory, anti-oxidant and anti-atherosclerotic effects to which new knowledge about epigenetic and gut-microbiota relationship is recently added.
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Wopereis S, Stroeve JHM, Stafleu A, Bakker GCM, Burggraaf J, van Erk MJ, Pellis L, Boessen R, Kardinaal AAF, van Ommen B. Multi-parameter comparison of a standardized mixed meal tolerance test in healthy and type 2 diabetic subjects: the PhenFlex challenge. GENES & NUTRITION 2017; 12:21. [PMID: 28861127 PMCID: PMC5576306 DOI: 10.1186/s12263-017-0570-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/08/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND A key feature of metabolic health is the ability to adapt upon dietary perturbations. Recently, it was shown that metabolic challenge tests in combination with the new generation biomarkers allow the simultaneous quantification of major metabolic health processes. Currently, applied challenge tests are largely non-standardized. A systematic review defined an optimal nutritional challenge test, the "PhenFlex test" (PFT). This study aimed to prove that PFT modulates all relevant processes governing metabolic health thereby allowing to distinguish subjects with different metabolic health status. Therefore, 20 healthy and 20 type 2 diabetic (T2D) male subjects were challenged both by PFT and oral glucose tolerance test (OGTT). During the 8-h response time course, 132 parameters were quantified that report on 26 metabolic processes distributed over 7 organs (gut, liver, adipose, pancreas, vasculature, muscle, kidney) and systemic stress. RESULTS In healthy subjects, 110 of the 132 parameters showed a time course response. Patients with T2D showed 18 parameters to be significantly different after overnight fasting compared to healthy subjects, while 58 parameters were different in the post-challenge time course after the PFT. This demonstrates the added value of PFT in distinguishing subjects with different health status. The OGTT and PFT response was highly comparable for glucose metabolism as identical amounts of glucose were present in both challenge tests. Yet the PFT reports on additional processes, including vasculature, systemic stress, and metabolic flexibility. CONCLUSION The PFT enables the quantification of all relevant metabolic processes involved in maintaining or regaining homeostasis of metabolic health. Studying both healthy subjects and subjects with impaired metabolic health showed that the PFT revealed new processes laying underneath health. This study provides the first evidence towards adopting the PFT as gold standard in nutrition research.
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Affiliation(s)
- Suzan Wopereis
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
| | | | - Annette Stafleu
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
| | | | | | - Marjan J. van Erk
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
| | - Linette Pellis
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
| | - Ruud Boessen
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
| | | | - Ben van Ommen
- TNO, Netherlands Institute for Applied Scientific Research, Zeist, The Netherlands
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Feng X, Chen L, Li N, Zhao Y, Han Q, Wang X, Wang W, Ma L, Zhao X. Metabolomics biomarker analysis of threatened abortion in polycystic ovary syndrome: a clinical discovery study. RSC Adv 2017. [DOI: 10.1039/c6ra27357b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In this study, using an advanced metabolomics platform based on UPLC-QTOF-MS, we found that pregnancy significantly altered the profile of metabolites in the plasma of women with PCOS.
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Affiliation(s)
- Xiaoling Feng
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Lu Chen
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Na Li
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Yan Zhao
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Qimao Han
- Department of Rheumatology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Xiaolin Wang
- Key Laboratory of Separation Science for Analytical Chemistry
- Dalian Institute of Chemical Physics
- Chinese Academy of Science
- Dalian 116023
- China
| | - Wei Wang
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Liping Ma
- Department of Gynecology
- First Affiliated Hospital
- Heilongjiang University of Chinese Medicine
- Harbin 150040
- China
| | - Xinjie Zhao
- Key Laboratory of Separation Science for Analytical Chemistry
- Dalian Institute of Chemical Physics
- Chinese Academy of Science
- Dalian 116023
- China
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Lifestyle Therapy in the Management of Cardiometabolic Risk: Diabetes Prevention, Hypertension, and Dyslipidemia. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Garvey WT. The conundrum of whole foods versus macronutrient composition in assessing effects on insulin sensitivity. Am J Clin Nutr 2015; 101:1109-10. [PMID: 25971718 PMCID: PMC4441816 DOI: 10.3945/ajcn.115.112292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W Timothy Garvey
- From the Department of Nutrition Sciences, University of Alabama at Birmingham, and the Birmingham Veterans Affairs Medical Center, Birmingham, AL.
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Abstract
With the diabetes epidemic reaching menacing proportions worldwide, there is an urgent need for the development of cost-efficient prevention strategies to be effective at the population level. Great potential in this direction lies in properly designed, large-scale dietary interventions. The macronutrient composition and the caloric content of our diet are major determinants of glucose homeostasis and there is a continuously growing list of foods, nutrients or individual compounds that have been associated with an increased or reduced incidence of diabetes mellitus. These include fat, carbohydrates, fibre, alcohol, polyphenols and other micronutrients or individual dietary compounds, which have been shown to either promote or prevent a progression towards a (pre-)diabetic state. This review aims to briefly summarize relevant epidemiological data linking foods to diabetes and to provide insights into the mechanisms through which these effects are mediated. These include improvement of insulin sensitivity or promotion of insulin resistance, regulation of inflammatory pathways, regulation of glucose transport and tissue glucose uptake, aggravation or attenuation of postprandial glycaemia/insulinaemia, interactions with hormonal responses and β-cell-dependent mechanisms.
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Affiliation(s)
- Theodoros Thomas
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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Effects on markers of inflammation and endothelial cell function of three ad libitum diets differing in type and amount of fat and carbohydrate: a 6-month randomised study in obese individuals. Br J Nutr 2011; 106:123-9. [PMID: 21320366 DOI: 10.1017/s0007114510005829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diet is important for the prevention of CVD, and diets high in MUFA might be more cardioprotective than low-fat diets. We hypothesise that inflammation and endothelial cell function will be improved most favourably by a high-MUFA diet compared with a low-fat diet. This was tested in a parallel randomised intervention trial on overweight individuals (aged 28·2 (SD 4·6) years) assigned to a diet moderate in the amount of fat (35-45% of energy; >20% of fat as MUFA; MUFA diet, n 39), a low-fat (20-30% of energy) diet (LF diet, n 43) or a control diet (35 % of energy as fat, n 24) for 6 months after weight loss. Protein constituted 10-20 % of energy in all diets. Food was provided free of charge. Fasting blood samples were collected before and after the intervention and analysed for C-reactive protein (CRP), IL-6, intercellular adhesion molecule, von Willebrand factor (vWF) and tissue factor pathway inhibitor. vWF concentrations tended to fall on the LF diet (4·78 (SD 16·44) %; P = 0·07). Concentrations of IL-6 were reduced by the MUFA (0·37 (SD 0·74) pg/ml; P < 0·01) and LF (0·47 (SD 0·69) pg/ml; P < 0·001) diets, and CRP was reduced on all diets (MUFA: 0·48 (SD 1·93) mg/l (P < 0·01); LF: 1·46 (SD 2·89) mg/l (P < 0·001); control: 1·20 (SD 1·97) mg/l (P < 0·01)). No significant differences were observed between changes induced by the different diets. Our findings suggest that in overweight subjects after weight loss, the MUFA and LF diets have similar long-term effects on inflammation and endothelial cell function.
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Gillingham LG, Harris-Janz S, Jones PJH. Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors. Lipids 2011; 46:209-28. [PMID: 21308420 DOI: 10.1007/s11745-010-3524-y] [Citation(s) in RCA: 311] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 12/21/2010] [Indexed: 01/12/2023]
Abstract
Over 50 years of research has sought to define the role dietary fat plays in cardiovascular disease (CVD) risk. Although optimal dietary fat quantity has been keenly pursued over past decades, attention has recently centered on the value of dietary fat quality. The purpose of the present review is to provide a critical assessment of the current body of evidence surrounding efficacy of dietary monounsaturated fatty acids (MUFA) for reduction of traditional risk factors defining metabolic syndrome (MetS) and CVD. Due to existing and emerging research on health attributes of MUFA rich diets, and to the low prevalence of chronic disease in populations consuming MUFA rich Mediterranean diets, national dietary guidelines are increasingly recommending dietary MUFA, primarily at the expense of saturated fatty acids (SFA). Consumption of dietary MUFA promotes healthy blood lipid profiles, mediates blood pressure, improves insulin sensitivity and regulates glucose levels. Moreover, provocative newer data suggest a role for preferential oxidation and metabolism of dietary MUFA, influencing body composition and ameliorating the risk of obesity. Mounting epidemiological and human clinical trial data continue to demonstrate the cardioprotective activity of the MUFA content of dietary fat. As the debate on the optimal fatty acid composition of the diet continues, the benefit of increasing MUFA intakes, particularly as a substitute for dietary SFA, deserves considerable attention.
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Affiliation(s)
- Leah G Gillingham
- Department of Human Nutritional Sciences, Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, 196 Innovation Drive, Winnipeg, MB, R3T 2N2, Canada
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Pérez-Jiménez F, Ruano J, Perez-Martinez P, Lopez-Segura F, Lopez-Miranda J. The influence of olive oil on human health: not a question of fat alone. Mol Nutr Food Res 2008; 51:1199-208. [PMID: 17879991 DOI: 10.1002/mnfr.200600273] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Olive oil is the most representative food in the traditional Mediterranean diet and its most important source of MUFA. The healthy benefits of MUFA-rich diets on plasma cholesterol levels, were the first to generate interest in this dietary model. In addition to the benefits conferred by its lipids, olive oil has other biological effects, some of them also related to MUFA. However, most recent studies have shown that there are a number of properties that depend on, or are potentiated by, the consumption of olive oil, such as virgin olive oil, that is rich in microcomponents. This foodstuff, thanks to its double set of benefits, thus tends to produce a better lipid profile and a less prothrombotic environment, promoting antioxidant and anti-inflammatory effects, with a greater endothelial protective capacity. In view of these effects, it would appear that when olive oil is the basic source of dietary alimentary fat it has a major antiatherogenic capacity, which is not shared to the same extent by other oils that are rich in oleic acid but lack its characteristic micronutrients.
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Affiliation(s)
- Francisco Pérez-Jiménez
- Lipids and Atherosclerosis Research Unit, Reina Sofia University Hospital, University of Córdoba, Ciber Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Spain.
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McClenaghan NH. Determining the relationship between dietary carbohydrate intake and insulin resistance. Nutr Res Rev 2007; 18:222-40. [DOI: 10.1079/nrr2005109] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Insulin resistance underlies type 2 diabetes, CVD and the metabolic syndrome, driven by changes in diet, lifestyle, energy over–consumption and obesity. Nutritional recommendations for insulin resistance remain an area of controversy, particularly the quantity and types of dietary carbohydrate. The present review gives an overview of insulin resistance, its relationship to impaired insulin secretion and the metabolic syndrome, research methodologies used to measure insulin action and the epidemiological and intervention studies on the relationship between dietary carbohydrate and insulin resistance. Epidemiological studies provide little evidence to suggest that total dietary carbohydrate predicts risk of type 2 diabetes, and high–carbohydrate, high–fibre diets with low–glycaemic index (GI) may even contribute to diabetes prevention. Despite inherent limitations associated with techniques used to measure insulin resistance and dietary assessment, most intervention studies reveal an increase in glucose tolerance or insulin sensitivity with high–carbohydrate, low–fat diets in non–diabetic and diabetic individuals. When energy is restricted the source or reduced content of carbohydrate does not appear to be as important as fat for body weight. Thus, low energy intake is key to weight loss and augmentation of insulin sensitivity. Given this, widespread adoption of popular low–carbohydrate high–fat diets highlights the necessity to evaluate dietary interventions regarding safety and metabolic effects. While current evidence supports FAO/WHO recommendations to maintain a high–carbohydrate diet with low–GI foods, the relationships between carbohydrate and insulin sensitivity remains an important research area. Emerging technologies should further enhance understanding of gene–diet interactions in insulin resistance, providing useful information for future nutrition policy decisions.
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Tierney AC, Roche HM. The potential role of olive oil-derived MUFA in insulin sensitivity. Mol Nutr Food Res 2007; 51:1235-48. [PMID: 17912722 DOI: 10.1002/mnfr.200700143] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Dietary fatty acids play an important role in the development of insulin resistance, the prelude to type 2 diabetes mellitus. This review addresses the potential role of olive oil-derived MUFA in insulin sensitivity, particularly how dietary fat interacts with insulin resistance looking at whole body metabolic measures, as well as molecular effects. The review focuses on the role of non-esterified fatty acids, fatty acid composition in vivo and dietary fat modification on insulin resistance in the metabolic syndrome. Particular emphasis is placed on the role of olive oil within the context of dietary modification to improve insulin sensitivity and for the prevention of the metabolic syndrome.
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Affiliation(s)
- Audrey C Tierney
- Nutrigenomics Research Group, School of Medicine, Institute of Molecular Medicine, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
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12
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Mukuddem-Petersen J, Stonehouse Oosthuizen W, Jerling JC, Hanekom SM, White Z. Effects of a high walnut and high cashew nut diet on selected markers of the metabolic syndrome: a controlled feeding trial. Br J Nutr 2007; 97:1144-53. [PMID: 17381974 DOI: 10.1017/s0007114507682944] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We investigated the effects of a high walnut diet and a high unsalted cashew nut diet on selected markers of the metabolic syndrome. In a randomized, parallel, controlled study design, sixty-four subjects having the metabolic syndrome (twenty-nine men, thirty-five women) with a mean age of 45 (sd 10) years and who met the selection criteria were all fed a 3-week run-in control diet. Hereafter, participants were grouped according to gender and age and then randomized into three groups receiving a controlled feeding diet including walnuts, or unsalted cashew nuts or no nuts for 8 weeks. Subjects were required to have lunch at the metabolic ward of the Nutrition Department of the North-West University (Potchefstroom Campus). Both the walnut and the unsalted cashew nut intervention diets had no significant effect on the HDL-cholesterol, TAG, total cholesterol, LDL-cholesterol, serum fructosamine, serum high-sensitivity C-reactive protein, blood pressure and serum uric acid concentrations when compared to the control diet. Low baseline LDL-cholesterol concentrations in the cashew nut group may have masked a possible nut-related benefit. Plasma glucose concentrations increased significantly (P = 0·04) in the cashew nut group compared to the control group. By contrast, serum fructosamine was unchanged in the cashew nut group while the control group had significantly increased (P = 0·04) concentrations of this short-term marker of glycaemic control. Subjects displayed no improvement in the markers of the metabolic syndrome after following a walnut diet or a cashew nut diet compared to a control diet while maintaining body weight.
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Affiliation(s)
- Janine Mukuddem-Petersen
- School of Computer, Mathematical and Statistical Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa.
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López-Miranda J, Badimon L, Bonanome A, Lairon D, Kris-Etherton PM, Mata P, Pérez-Jiménez F. Monounsaturated Fat and Cardiovascular Risk. Nutr Rev 2006. [DOI: 10.1111/j.1753-4887.2006.tb00259.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Pérez Martínez P, López-Miranda J, Delgado-Lista J, López-Segura F, Pérez Jiménez F. Aceite de oliva y prevención cardiovascular: más que una grasa. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS 2006. [DOI: 10.1016/s0214-9168(06)73688-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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McAuley K, Mann J. Thematic review series: Patient-Oriented Research. Nutritional determinants of insulin resistance. J Lipid Res 2006; 47:1668-76. [PMID: 16720893 DOI: 10.1194/jlr.r600015-jlr200] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interpreting the literature relating to the nutritional determinants of insulin resistance is complicated by the wide range of methods used to determine insulin sensitivity. Excess adiposity is unquestionably the most important determinant of insulin resistance, although the effect may be tempered by a relatively high proportion of lean body mass. Weight loss is associated with improved insulin sensitivity. Thus, diet-related factors that promote excessive energy intake may be regarded as promoters of insulin resistance. In the context of energy balance, diets characterized by high intakes of saturated fat and low intakes of dietary fiber are associated with reduced insulin sensitivity. Total fat intakes greater than the usually consumed range appear to promote insulin resistance, although the relative proportions of total fat and carbohydrate within the usual range appear unimportant. Monounsaturated fatty acids with a cis configuration and fiber-rich carbohydrate foods appear to be appropriate substitutes for saturated fatty acids and rapidly digested glycemic carbohydrates. In animal studies, n-3 unsaturated fatty acids have been shown to enhance insulin sensitivity and fructose and sucrose to increase insulin resistance. However, human data are limited. Large prospective studies currently being conducted should confirm the most appropriate macronutrient composition of diets for preventing and treating insulin resistance as well as establishing whether a range of candidate genes explains the variation in response to dietary change.
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Affiliation(s)
- Kirsten McAuley
- Edgar National Centre for Diabetes Research, University of Otago, Dunedin, New Zealand
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Abstract
PURPOSE OF REVIEW Insulin resistance increases the risk of cardiovascular disease and diabetes, and the risk of cardiovascular disease increases further once diabetes has developed. As insulin resistance is a precursor to diabetes, it is critically important to identify cost-effective means, such as dietary changes, by which to reduce insulin resistance. The purpose of this review is to evaluate recent findings concerning dietary composition and insulin resistance, with particular focus on low-fat diets compared with the currently popular low-carbohydrate diets. RECENT FINDINGS Recent findings indicate little support for the value of low-carbohydrate diets as therapies for insulin resistance. In contrast, the limited data available suggest that the higher fat content of typical low-carbohydrate diets may exacerbate insulin resistance in the long term. Preliminary data indicate that proteins from different sources may have differing effects on insulin resistance. Preliminary data also suggest the potential value of whole grains, fruits and vegetables in therapeutic diets to reduce insulin resistance. SUMMARY Current evidence supports the inclusion of whole grains, fruits and vegetables, and lean sources of animal proteins including low-fat dairy products in dietary therapies for insulin resistance. Those who wish to follow a low-carbohydrate diet should be encouraged to follow a new menu low in fat, and with most of the protein derived from plant sources.
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Affiliation(s)
- Dawn Colleen Schwenke
- Carl T. Hayden Veterans Affairs Medical Center, Arizona State University, 650 E. Indian School Road, RS 151, Phoenix, AZ 85012, USA.
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Mann JI, De Leeuw I, Hermansen K, Karamanos B, Karlström B, Katsilambros N, Riccardi G, Rivellese AA, Rizkalla S, Slama G, Toeller M, Uusitupa M, Vessby B. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 2004; 14:373-394. [PMID: 15853122 DOI: 10.1016/s0939-4753(04)80028-0] [Citation(s) in RCA: 305] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- J I Mann
- Edgar National Centre for Diabetes Research, Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand.
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Abstract
This article discusses the factors that contribute most to systolic and diastolic heart failure (HF): ischemic heart disease, hypertension,obesity, diabetes, and nephropathy. Diabetes often follows the insulin resistance syndrome in which obesity and hypertension are combined with dyslipidemia, and obesity is likely causal. Diabetes and hypertension are common causes of nephropathy, which in turn is a common precursor to HF. Insulin resistance, obesity,dyslipidemia, diabetes, and hypertension are risk factors for atherosclerotic coronary disease and left ventricular ischemia. Each is also a risk factor for diastolic dysfunction.
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Affiliation(s)
- David L Katz
- Yale University School of Medicine, Derby, CT 06418, USA.
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Lara-Castro C, Garvey WT. Diet, insulin resistance, and obesity: zoning in on data for Atkins dieters living in South Beach. J Clin Endocrinol Metab 2004; 89:4197-205. [PMID: 15356006 DOI: 10.1210/jc.2004-0683] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Insulin resistance is a central pathogenic factor for the metabolic syndrome and is associated with both generalized obesity and the accumulation of fat in the omental and intramyocellular compartments. In the context of the current obesity epidemic, it is imperative to consider diets in terms of their ability to both promote weight loss and ameliorate insulin resistance. Weight loss under any dietary formulation depends on hypocaloric intake, and only moderate weight loss (5-10%) is sufficient to augment insulin sensitivity. However, increments in insulin sensitivity may be more directly related to loss of intramyocellular or omental fat rather than loss of total body weight per se. The widespread acceptance of popular low-carbohydrate high-fat diets (e.g. Atkins Diet, Zone Diet, South Beach diet) further underscores the need to evaluate dietary interventions regarding their safety and metabolic effects. These high-fat diets have been shown to be safe in the short term; however, their long-term safety has not been established. With respect to insulin sensitivity, diets enriched in saturated fats can induce insulin resistance, whereas fat substitution with monounsaturated fats can enhance insulin sensitivity. On the other hand, high-fiber, high-carbohydrate diets comprised of foods with low caloric density can similarly be used for effective weight reduction and to ameliorate insulin resistance. Although some data suggest that low-glycemic index diets are most advantageous in this regard, these effects may have more to do with increments in dietary fiber than differences in available carbohydrates. Popular low-carbohydrate, high-fat diets are being fervently embraced as an alternative to challenging modifications in lifestyle and intentional calorie reduction. Current data do not support such unbridled enthusiasm for these diets, particularly in relationship to high-fiber, high-carbohydrate diets emphasizing intake of fresh vegetables and fruits. Long-term studies to determine the efficacy and safety of both popular and experimental diets are warranted.
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Affiliation(s)
- Cristina Lara-Castro
- Department of Nutrition Sciences, Webb 232, University of Alabama at Birmingham, 1675 University Boulevard, Birmingham, Alabama 35294-3360, USA
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Riccardi G, Giacco R, Rivellese AA. Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 2004; 23:447-56. [PMID: 15297079 DOI: 10.1016/j.clnu.2004.02.006] [Citation(s) in RCA: 432] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 02/16/2004] [Indexed: 11/24/2022]
Abstract
Insulin resistance is the pathogenetic link underlying the different metabolic abnormalities clustering in the metabolic syndrome. It can be induced by different environmental factors, including dietary habits. Consumption of energy-dense/high fat diets is strongly and positively associated with overweight that, in turn, deteriorates insulin sensitivity, particularly when the excess of body fat is located in abdominal region. Nevertheless the link between fat intake and overweight is not limited to the high-energy content of fatty foods; the ability to oxidize dietary fat is impaired in some individuals genetically predisposed to obesity. Insulin sensitivity is also affected by the quality of dietary fat, independently of its effects on body weight. Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition. A recent multicenter study (KANWU) has shown that shifting from a diet rich in saturated fatty acids to one rich in monounsaturated fat improves insulin sensitivity in healthy people while a moderate alpha-3 fatty acids supplementation does not affect insulin sensitivity. There are also other features of the metabolic syndrome that are influenced by different types of fat, particularly blood pressure and plasma lipid levels. Most studies show that alpha-3 fatty acids reduce blood pressure in hypertensive but not in normotensive subjects while shifting from saturated to monounsaturated fat intake reduces diastolic blood pressure. In relation to lipid abnormalities alpha-3 fatty acids reduce plasma triglyceride levels but in parallel, increase LDL cholesterol. Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals. In conclusion, there is evidence available in humans indicating that dietary fat quality influences insulin sensitivity and associated metabolic abnormalities. Therefore, prevention of the metabolic syndrome has to be targeted: (1) to correct overweight by reducing the energy density of the habitual diet (i.e., fat intake) and (2) to improve insulin sensitivity and associated metabolic abnormalities through a reduction of dietary saturated fat, partially replaced, when appropriate, by monounsaturated and polyunsaturated fats.
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Affiliation(s)
- G Riccardi
- Department of Clinical and Experimental Medicine, "FedericoII" University, Medical School, Via S Pansini 5, 80131, Napoli, Italy.
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Ros E. Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes. Am J Clin Nutr 2003; 78:617S-625S. [PMID: 12936956 DOI: 10.1093/ajcn/78.3.617s] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Whether low-fat, high-carbohydrate (CHO) diets or moderately high-fat, high-monounsaturated fatty acid (MUFA) diets are preferable for the treatment and prevention of diabetes has been a matter of debate. High-fat diets based on MUFA-rich oils or whole foods have been compared with high-CHO diets for effects on several cardiovascular risk outcomes in diabetic subjects. Early studies using metabolic diets with wide differences in total fat content (15-25% of energy) generally found a beneficial effect of MUFA diets on glycemic control and serum lipids. Recent studies using prescribed diets with a difference of </= 15% of energy in total fat between low-fat and high-MUFA diets show similar effects on glycemic profiles but still favor MUFA diets for effects on triacylglycerols and HDL cholesterol. It is unclear whether postprandial fat clearance is impaired by CHO diets and improved by MUFA diets, independent of effects on fasting triacylglycerol concentrations. Unless one diet contains abundant antioxidants, the 2 dietary approaches appear to have similar effects on LDL oxidation. Low-fat diets, however, are associated with atherogenic, dense LDL particles, while normal, buoyant LDL predominate with high-fat diets irrespective of fatty acid composition. Limited experimental evidence suggests that MUFA diets favorably influence blood pressure, coagulation, endothelial activation, inflammation, and thermogenic capacity. Energy-controlled high-MUFA diets do not promote weight gain and are more acceptable than low-fat diets for weight loss in obese subjects. Thus, there is good scientific support for MUFA diets as an alternative to low-fat diets for medical nutrition therapy in diabetes.
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Affiliation(s)
- Emilio Ros
- Lipid Clinic, Nutrition & Dietetics Service, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínico, University of Barcelona, Barcelona, Spain.
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Louheranta AM, Sarkkinen ES, Vidgren HM, Schwab US, Uusitupa MIJ. Association of the fatty acid profile of serum lipids with glucose and insulin metabolism during 2 fat-modified diets in subjects with impaired glucose tolerance. Am J Clin Nutr 2002; 76:331-7. [PMID: 12145003 DOI: 10.1093/ajcn/76.2.331] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Both the amount and quality of dietary fat can modify glucose and insulin metabolism. OBJECTIVE The objective was to examine the relation between serum lipid fatty acids and glucose metabolism before and after the consumption of a diet enriched in either monounsaturated (Mono diet) or polyunsaturated (Poly diet) fatty acids. DESIGN After consuming a high-saturated-fat run-in diet for 3 wk, 31 subjects with impaired glucose tolerance were randomly counseled to consume the Mono [40% fat; 11%, 19%, and 8% of energy as saturated, monounsaturated, and polyunsaturated fatty acids (S:M:P), respectively] or the Poly (34% fat; S:M:P of 11%:10%:10%) diet for 8 wk. Serum lipid fatty acids were measured, and an intravenous-glucose-tolerance test was performed at baseline and at 8 wk. RESULTS At baseline, a higher glucose effectiveness (S(G)) was associated with higher proportions of oleic (r = 0.57, P = 0.04) and alpha-linolenic (r = 0.64, P = 0.01) acids in phospholipids. An increase in the proportions of oleic and alpha-linolenic acids in phospholipids was associated with a decrease in fasting plasma glucose [r = -0.53 (P = 0.002) and r = -0.47 (P = 0.009), respectively]. An increase in the S(G) was associated with an increase in the proportion of oleic acid (r = 0.55, P = 0.004) and with a decrease in that of arachidonic acid (r = -0.40, P = 0.04) in phospholipids. CONCLUSIONS The beneficial changes in fasting plasma glucose and in the S(G) during the Mono diet were associated with alterations in the proportions of oleic, alpha-linolenic, and arachidonic acids in phospholipids.
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Refsgaard J, Thomsen C, Andreasen F, Gøtzsche O. Carvedilol does not alter the insulin sensitivity in patients with congestive heart failure. Eur J Heart Fail 2002; 4:445-53. [PMID: 12167382 DOI: 10.1016/s1388-9842(02)00035-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Congestive heart failure (CHF) has previously been shown to be associated with insulin resistance and hyperinsulinemia. A beneficial effect of the non-selective beta-blocker carvedilol has been demonstrated in patients with CHF. However, whether the drug affects the insulin sensitivity (S(i)) is unknown. AIMS To investigate whether treatment with carvedilol alters the S(i) in patients with CHF during a prospective, double-blinded, placebo-controlled study. METHODS AND RESULTS The patients were randomized to receive either carvedilol (n=29) or matched placebo (n=17). Insulin and glucose responses were measured during a 0.3 g/kg intravenous glucose tolerance test, and S(i) was calculated according to Bergman's Minimal Model. Baseline S(i) values correlated significantly with body mass index (r=-0.42, P=0.002), plasma urate (r=-0.42, P=0.002), plasma HDL-cholesterol (r=0.39, P=0.003), maximal oxygen uptake (r=0.35, P=0.009), plasma triglycerides (r=-0.34, P=0.01) and weight (r=-0.29, P=0.03). During the study the insulin sensitivity was unchanged in the carvedilol group compared with placebo (2.63+/-1.45 to 2.38+/-1.64 vs. 2.81+/-2.36 to 2.48+/-1.84x10(-4) min(-1)/mUl(-1), P=0.83). CONCLUSION Additional treatment with carvedilol is neutral with regard to influence the insulin sensitivity in patients with mild to moderate CHF.
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Affiliation(s)
- Jens Refsgaard
- Department of Cardiology and Medicine, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansensgade 2, Denmark.
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