Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis

The effects of a plate model on the remission and need for hypoglycemic drugs of newly diagnosed type 2 diabetes in China: A randomized trial

To assess the effect of the plate model on the remission of diabetes and the demand for hypoglycemic drugs in China. We selected 456 participants with newly diagnosed type 2 diabetes and not required to take hypoglycemic drugs at baseline. The plate education model consists of three parts: a colored leaflet suitable for low literacy reading, regular medical visits and health education sessions. The primary outcomes were remission of diabetes and the time to first use of hypoglycemic drugs. The study was ended after 8.1 years of follow-up. The incidence of the using hypoglycemic drugs was 36.15 % in the plate model, and 75.54 % in the low-fat model (P < 0.001). The prevalence of any remission in plate model was 27.1 % (95 % CI 16.8-37.4 %) during the first 2 years, decreasing to 14.5 % (95 % CI 6.3-22.7 %) during year 4, to 10.1 % (95 % CI 4.4-15.8 %) during year 6, and to 9.6 % (95 % CI 5.3-13.9 %) during year 8, compared with 12.2 % (95 % CI 5.2-19.2 %) at year 2, 6.1 % (95 % CI 2.1-10.1 %) at year 4, 4.7 %(95 % CI 2.2-7.2 %) at year 6, and 2.6 % (95 % CI 1.1-4.2 %) at year 8 in the low-fat group. The HbA1c of plate group was significantly decreased at the endpoint (7.74 ± 0.45 % vs. 6.70 ± 0.46 %, P < 0.001). The plate model may significantly improve the remission rate of diabetes, delay the demand for diabetes drugs, more suitable for patients with low educational level, and reduce the long-term level of HbA1c.

Clinical trials registry

The study was registered at ChiCTR (www.chictr.org.cn) (ChiCTR1900027097).

High Versus Low Adherence to the Mediterranean Diet for Prevention of Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis

Diabetes mellitus type 2 (DMT-2) presents with a growing incidence, and its complications contribute mainly to cardiovascular disease and overall mortality. DMT-2 prevention and early stage management include lifestyle modification by adopting healthy eating patterns and increasing physical activity levels. The Mediterranean diet (MD) is associated with beneficial effects on human health and has been found effective for preventing and managing DMT-2. The purpose of this meta-analysis is to investigate whether the level of MD adherence plays a role in DMT-2 prevention and to what extent. A systematic literature search in PubMed, EMBASE, Web of Science Core Collection, Scopus, and Google Scholar databases was conducted until November 2022, and related observational studies fulfilling the eligibility criteria were included. The literature search concluded with 24 studies in the qualitative analysis and 23 studies in the quantitative analysis. Of those, 18 cohort studies were eligible for meta-analysis with hazard ratio as effect size and five studies providing odds ratio as effect size. The cohort studies included 248,140 participants with a mean follow-up of 10.8 years (3 to 22 years). Individuals with high adherence to MD presented an 11% and 18% decrease in risk and odds, respectively, of developing DMT-2 compared to those with low MD adherence (HR 0.89, 95%CI 0.83 to 0.95) and (OR 0.82, 95%CI 0.72 to 0.93). In studies where the follow-up was longer than 10 years, the 12% decrease in the risk of developing DMT-2 remained (HR 0.88 95%CI 0.84 to 0.92), whereas in studies where follow-up was less than 10 years, no difference between groups with different levels of adherence was found. Long-term high MD adherence is associated with a reduced risk of developing DMT-2, but further studies are needed to confirm these results.

Crop, Host, and Gut Microbiome Variation Influence Precision Nutrition: An Example of Blueberries

Epidemiological studies have shown associations between polyphenol-rich fruit intake and bone health, and preclinical studies have shown that blueberries improve bone health. To determine the genotype and dose of blueberries that are effective in ameliorating age-related bone loss, a multi-institutional team of investigators performed in vitro, preclinical, and clinical studies on blueberry varieties that differed in flavonoid profiles. Principal component analysis was used to select blueberry genotypes that varied in anthocyanin profiles. Total phenolic content did not predict the bioavailability of polyphenolic compounds in rats. A range in bioavailability was observed in individual polyphenolic compounds across genotypes. Both alpha and beta diversity analyses indicated that gut microbiome profiles varied with blueberry dose in rats. Additionally, the identification of specific taxa, such as Prevotellaceae_UCG-001 and Coriobacteriales, increasing after blueberry consumption adds to the mounting evidence of their role in polyphenol metabolism. All of the sources of variation can inform blueberry breeding practices to influence precision nutrition.

Association between a Mediterranean lifestyle and growth differentiation factor 15: The seniors ENRICA-2 cohort

BACKGROUND

Growth Differentiation Factor 15 (GDF-15) is a marker of inflammation and oxidative stress that has been associated with multiple age-related chronic diseases. Since lifestyle is key for preventing these adverse health outcomes, we examined the association between a Mediterranean lifestyle and GDF-15 serum concentrations in Spanish older adults.

METHODS

We used cross-sectional data from 2502 older adults participating in the Seniors ENRICA-2 cohort. Adherence to the Mediterranean lifestyle was assessed with the 27-item MEDLIFE index, divided into three blocks: 1) "Mediterranean food consumption, 2) Mediterranean dietary habits, 3) Physical activity, rest, social habits, and conviviality". Analyses of the association between the MEFLIFE index and GDF-15 concentrations were performed using multivariable linear regression models adjusting for the main potential confounders.

RESULTS

The MEDLIFE index was inversely associated with GDF-15. Compared with participants in the lowest quartile of the MEDLIFE score, GDF-15 mean percentage differences (95% CI) were -3.0% (-8.0, 2.3) for the second quartile, -8.7% (-13.0, -4.1) for the third quartile, and -10.1% (-15.0, -4.9) for the fourth quartile (p-trend<0.001). Block 3 of MEDLIFE, and particularly doing sufficient physical activity, adequate sleep duration, and participating in collective sports, was individually linked to lower concentrations of GDF-15. Results remained similar after excluding participants with cardiovascular disease, type 2 diabetes, or obesity.

CONCLUSIONS

A Mediterranean lifestyle was associated with reduced levels of GDF-15, suggesting that a combination of multiple lifestyles may be an integral approach to reduce chronic inflammation and disease burden in older adults.

Diet quality indices and their associations with all-cause mortality, CVD and type 2 diabetes mellitus: an umbrella review

Numerous observational studies have investigated associations between diet indices and health outcomes. Our aim was to systematically synthesise data that was previously summarised separately for each diet index in one umbrella review of all diet indices with sufficient evidence gained in systematic reviews and to assess the quality and strength of evidence for selected health outcomes. The MEDLINE, EMBASE and Scopus databases were systematically searched following the PRISMA guidelines through October 2021 for systematic reviews of observational studies investigating associations between adherence to diet indices and selected health outcomes (all-cause mortality, CVD incidence or mortality, type 2 diabetes mellitus incidence or mortality). Methodological quality and quality of evidence were assessed using the AMSTAR 2 and NutriGrade tools. The inclusion criteria were met by seven systematic reviews, entirely based on prospective cohort studies and reviewing five different diet indices - alternate healthy eating index (AHEI), dietary approaches to stop hypertension (DASH), dietary inflammatory index (DII), healthy eating index (HEI) and Mediterranean diet (MedDiet). All seven included systematic reviews showed that greater adherence to these diet indices reduces the risks of all-cause mortality, CVD incidence and mortality and type 2 diabetes mellitus incidence. Moderate meta-evidence was presented for AHEI and DASH for all outcomes, also for DII for all-cause mortality, CVD mortality and incidence, MedDiet for all-cause mortality and for HEI for CVD incidence and mortality. Our umbrella review provides further evidence for AHEI, DASH, DII and HEI diet indices to be used as predictors of selected health outcomes.

Evaluation of psychometric properties of dietary habits, lifestyle, food frequency consumption, and nutritional beliefs (KomPAN) questionnaire in Iranian adults

Background

Adherence to unhealthy dietary patterns is a major cause of overweight and obesity in adults. Therefore, it is recommended that assessment and modification of unhealthy lifestyle should be included in prevention programs. To achieve this goal, it is necessary to evaluate the status of dietary patterns in adults with valid and reliable tools. Thus, the aims of the present study were to translate the KomPAN questionnaire, evaluate its psychometric properties in Iranian adults and measure 4 dietary indices including high-saturated-fats-Diet-Index-8 (hSFDI-8), high-Sugar- Diet-Index-4 (hSDI-4), low-Glycaemic-Diet-Index-4 (LGIDI-4) and high- Glycaemic-Diet-Index-7 (hGIDI-7) based on 3 groups of body mass index (BMI) (BMI = 18.5-24.9, BMI = 25-29.9 and BMI ≥ 30), gender, educational level, income status, and age.

Methods

The KomPAN questionnaire included 4 scales nutrition beliefs (NB), lifestyle, food frequency consumption (FFC), dietary habits (DH) and after its translation from English into Persian, the psychometric properties of all 4 scales (face and content validity) were evaluated. For both FFC and NB scales, the construct validity was assessed through exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and convergent and discriminant validity, the internal consistency was evaluated using the Cronbach's alpha coefficient, McDonald's omega (Ω) and Theta coefficient (θ), as well as the stability was assessed via intraclass correlation coefficient (ICC). Cross-classification and Kappa statistics were evaluated for both DH and lifestyle scales. Then, 4 dietary indices were measured in terms of demographic variables.

Results

The cross-classification of DH (93.96%) and lifestyle (95.87%) scales indicated the percentage of correct classification in the test-retest scales. The Kappa statistic was >0.4 and its value was acceptable. The mean Kappa statistics were 0.734 and 0.865 for the DH and lifestyle scales, respectively. The fit indices showed that the two-factor construct of the FFC scale and the one-factor construct of the NB scale had a good and acceptable fit among the Iranian adults. The FFC and NB scales had acceptable internal consistency and stability.

Conclusion

It is recommended that other researchers use the KomPAN questionnaire to identify DH, FFC, NB and lifestyle as well as measure diet quality scores in the adult community.

A Posteriori dietary patterns, insulin resistance, and diabetes risk by Hispanic/Latino heritage in the HCHS/SOL cohort

Objective

We examined links among dietary patterns (DPs), insulin resistance (IR), and diabetes risk by heritage in the Hispanic Community Health Study/Study of Latinos.

Methods

Hispanics/Latinos of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American heritage aged 18–74 years and diabetes-free completed two 24 h dietary recalls at baseline (2008–2011) and provided 6-year follow-up data (2014–2017; n = 7774). We classified 6-year IR status [improved, unchanged (referent), worsened] using a 1-SD change in fasting insulin between visits and defined incident diabetes based on American Diabetes Association criteria. We derived heritage-specific DPs via principal factor analysis and estimated their associations with 6-year IR status (multinomial) and incident diabetes (binary) using complex survey-based logistic regression.

Results

Five overarching DPs based on high-loading foods were shared by two or more heritage groups: “Burger, Fries, & Soft Drinks”; “White Rice, Beans, & Red Meats”; “Fish & Whole Grains”; “Cheese & Sweets”; and “Stew & Corn”. Comparing highest-to-lowest DP quintiles, the Dominican “Burger, Fries, & Soft Drinks” and Cuban “White Rice, Beans, & Red Meats” DPs were associated with worsened 6-year IR status (log-odds: 2.35, 95% CI: 1.02, 3.68, P_trend = 0.037 and log-odds: 1.27, 95% CI: 0.49, 2.06, P_trend = 0.009, respectively). The Puerto Rican “Burger, Fries, & Soft Drinks” and the Central American “White Rice, Beans, & Red Meats” DPs were associated with greater diabetes incidence (OR: 3.00, 95% CI:1.50, 5.99 and OR: 2.41, 95% CI: 1.05, 5.50, respectively).

Conclusions

A diet characterized by higher intakes of burgers, fries, and soft drinks and another characterized by higher intakes of white rice, beans, and red meats may be adversely associated with IR and diabetes risk in some Hispanic/Latino heritage groups. Future work is needed to offer more heritage-specific dietary guidance for diabetes prevention in this population.

Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review

Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.

Food Insecurity and Cardiometabolic Markers: Results From the Study of Latino Youth

OBJECTIVES

Hispanic/Latino youth bear a disproportionate burden of food insecurity and poor metabolic outcomes, but research linking the two in this diverse population is lacking. We evaluated whether lower household and child food security (FS) were adversely associated with a metabolic syndrome (MetS) composite variable and clinically measured cardiometabolic markers: waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.

METHODS

This cross-sectional study included 1325 Hispanic/Latino youth aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth, a study of offspring of adults enrolled in the Hispanic Community Health Survey/Study of Latinos. Multivariable regression analyses were used to assess relationships between household FS (high, marginal, low, very low) and child FS (high, marginal, low/very low) status, separately, and our dependent variables, adjusting for participant age, sex, site, parental education, and poverty-income ratio.

RESULTS

For both FS measures, youth in the lowest FS category had significantly lower high-density lipoprotein cholesterol than those with high FS (household FS: -3.17, 95% confidence interval [CI]: -5.65 to -0.70, child FS: -1.81, 95% CI: -3.54 to -0.09). Low/very low versus high child FS was associated with greater fasting plasma glucose (β = 1.37, 95% CI: 0.08 to 2.65), triglycerides (β = 8.68, 95% CI: 1.75 to 15.61), and MetS expected log counts (β = 2.12, 95% CI: 0.02 to 0.45).

CONCLUSIONS

Lower FS is associated with unfavorable MetS-relevant cardiometabolic markers in Hispanic/Latino youth. These findings also support the use of a child-level versus a household-level measure to capture the health implications of food insecurity in this population.

What factors explain the much higher diabetes prevalence in Russia compared with Norway? Major sex differences in the contribution of adiposity

INTRODUCTION

Compared with many other countries Russia has a high prevalence of diabetes in men and women. However, contrary to what is found in most other populations, the risk is greater among women than men. The reasons for this are unclear.

RESEARCH DESIGN AND METHODS

Prevalence and risk factors for diabetes at ages 40-69 years were compared in two population-based studies: Know Your Heart (KYH) (Russia, 2015-2018, n=4121) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015-2016, n=17 649). Diabetes was defined by the level of glycated hemoglobin and/or self-reported diabetes and/or diabetes medication use. Marginal structural models were used to estimate the role of key risk factors for diabetes in differences between the studies.

RESULTS

Age-standardized prevalence of diabetes was higher in KYH compared with Tromsø 7 in men (11.6% vs 6.2%) and in women (13.2% vs 4.3%). Age-adjusted ORs for diabetes in KYH compared with Tromsø 7 were 2.01 (95% CI 1.68 to 2.40) for men and 3.66 (95% CI 3.13 to 4.26) for women. Adiposity (body mass index and waist circumference) explained none of this effect for men but explained 46.0% (39.6, 53.8) for women. Addition of smoking and C reactive protein, as further mediators, slightly increased the percentage explained of the difference between studies to 55.5% (46.5, 66.0) for women but only to 9.9% (-0.6, 20.8) for men.

CONCLUSIONS

Adiposity is a key modifiable risk factor that appears to explain half of the almost threefold higher female prevalence of diabetes in Russia compared with Norway, but none of the twofold male difference.

African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus

The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increasing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treatment with the appropriate type of insulin based on the meal patterns and lifestyle of the individual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient's habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.

Dietary patterns and depression risk in older adults: systematic review and meta-analysis

CONTEXT

Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations.

OBJECTIVE

The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults.

DATA SOURCES

Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design.

DATA EXTRACTION

Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed.

DATA ANALYSIS

Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78-0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity.

CONCLUSIONS

An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020169195.

A population-based survey for dietary patterns and prediabetes among 7555 Chinese adults in urban and rural areas in Jiangsu Province

Background: Prediabetes is an important public health problem concern globally, to which dietary patterns have shown varied effects. This study aims to analyze the relationship between dietary patterns and prediabetes in Chinese adults. Methods: A total of 7555 adults from Jiangsu province, China, were recruited using a stratified multistage cluster sampling method. Information on diet intake, demographic, blood glucose and other indices were collected by structured questionnaires. Four dietary patterns of Meat diet, Healthy diet, Traditional diet and Fried food with staple diet were identified using Principle Component Analysis and followingly divided into T1 - T4 groups according to their quartiles of factor scores. Multivariate logistic regression analysis was used to investigate the association between dietary patterns and prediabetes. Results: Healthy diet was found to be associated with the lowest prevalence of prediabetes (P < 0.05). Multivariate logistic regression analysis after adjusting the confounding factors demonstrated that the lowest odds ratio with prediabetes was associated with the third quartile (T3 group) of Healthy diet (Odds Ratio = 0.745, 95% Confidence Interval: 0.645–0.860, P < 0.01), compared with the lower quartile (T1 group). The Meat diet was a potential risk factor for the isolated IFG (Odds Ratio = 1.227, 95%Confidence Interval: 1.070–1.406, P-value<0.01) while Fried food with staple diet was positively linked to the presence of IFG combined with IGT (Odds Ratio = 1.735, 95% Confidence Interval: 1.184–2.543, P-value < 0.01). Conclusions: Dietary patterns rich in meat but low in fresh fruit, fresh vegetable, milk, and fish are positively associated with higher risk of prediabetes, particularly the IFG. Higher Healthy diet consumption was associated with significantly lower risk of prediabetes.

Reduction in Circulating Advanced Glycation End Products by Mediterranean Diet Is Associated with Increased Likelihood of Type 2 Diabetes Remission in Patients with Coronary Heart Disease: From the Cordioprev Study

SCOPE

It is hypothesized that decreased advanced glycation end products (AGEs) levels could affect type 2 diabetes mellitus (T2DM) remission in newly diagnosed patients through the consumption of two healthy diets.

METHODS AND RESULTS

Patients from CORDIOPREV study, all with previous cardiovascular events, with T2DM at the beginning of the study are included. Patients are randomized to a Mediterranean or a low-fat diet for five years. No different diabetes remission rates are found among diets. Serum methylglioxal (MG) and carboximethyllysine (CML), levels dietary AGE, as well as gene expression of AGER1 and RAGE are measured. Serum MG decreases only after the consumption of the Mediterranean diet. Moreover, a COX regression analysis shows that each SD decrease in the MG, occurring after the Mediterranean diet, increases the probability of T2DM remission with HR:2.56(1.02-6.25) and p = 0.046 and each SD increase in disposition index at baseline increases the probability of remission with HR:1.94(1.32-2.87) and p = 0.001.

CONCLUSIONS

It is demonstrated that the reduction of serum AGEs levels and the modulation of its metabolism, occurring after the consumption of a Mediterranean diet, might be involved in the molecular mechanism underlying the T2DM remission of newly diagnosed patients with coronary heart disease.

New Insights into Adipokines as Potential Biomarkers for Type-2 Diabetes Mellitus

A large number of studies have been focused on investigating serum biomarkers associated with risk or diagnosis of type-2 diabetes mellitus. In the last decade, promising studies have shown that circulating levels of adipokines could be used as a relevant biomarker for diabetes mellitus progression as well as therapeutic future targets. Here, we discuss the possible use of recently described adipokines, including apelin, omentin-1, resistin, FGF-21, neuregulin-4 and visfatin, as early biomarkers for diabetes. In addition, we also include recent findings of other well known adipokines such as leptin and adiponectin. In conclusion, further studies are needed to clarify the pathophysiological significance and clinical value of these biological factors as potential biomarkers in type-2 diabetes and related dysfunctions.

Fruit and Vegetable Intake and Risk of Posttransplantation Diabetes in Renal Transplant Recipients

OBJECTIVE

Posttransplantation diabetes mellitus (PTDM) contributes to risk for cardiovascular morbidity and mortality in renal transplant recipients (RTRs). In the general population, consumption of a diet containing few fruits and vegetables predisposes to type 2 diabetes. The role of diet as a potential modifiable risk factor for PTDM has not been explored. Our focus was to investigate the prospective associations of fruit and vegetable intake with risk of PTDM in stable RTRs.

RESEARCH DESIGN AND METHODS

We included 472 adult RTRs who had a functioning graft ≥1 year. Fruit and vegetable intake was assessed by using a 177-item food frequency questionnaire. PTDM was defined according the American Diabetes Association's diagnostic criteria for diabetes.

RESULTS

During 5.2 years of follow-up, 52 RTRs (11%) developed PTDM. Fruit intake was not associated with PTDM (hazard ratio [HR] 0.90 [95% CI 0.79-1.03] per ²log g/day; P = 0.13), whereas vegetable intake was inversely associated with PTDM (HR 0.77 [95% CI 0.63-0.94] per ²log g/day; P = 0.009). Mediation analyses revealed that ±50% of the association between vegetable intake and PTDM was mediated by variations in key components of the metabolic syndrome (i.e., HDL cholesterol, triglycerides, and waist circumference) as determined by the National Cholesterol Education Program's Adult Treatment Panel III Expert Panel.

CONCLUSIONS

In this study vegetable intake, but not fruit intake, was associated with lower risk of PTDM in RTRs, likely largely through beneficial effects on key components of the metabolic syndrome. These findings further support accumulating evidence that supports a recommendation of higher vegetable intake by RTRs.

Relationship between Dietary Patterns and Incidence of Type 2 Diabetes

Introduction

Increasing rate of type 2 diabetes (T2D) prevalence during the recent years has caused concern about significant risks for the public health. Dietary patterns have recently attracted great attention in the evaluation of the relationship between diet and health. In the present study, we investigated the relationship between the major identified dietary patterns and T2D.

Methods

In this matched case-control study, 315 individuals (125 newly diagnosed cases and 190 controls); 18-60 years of age were selected. A valid semiquantitative food frequency questionnaire was used to collect dietary intakes of individuals. Anthropometric characteristics and blood pressure were measured with standard instructions and body mass index and waist to hip ratio were calculated. Factor analysis was used to identify major dietary patterns. The relationship between major food patterns and T2D was assessed by logistic regression analysis.

Results

Two dietary patterns were identified: healthy and Western dietary patterns. The second tertile of the healthy dietary pattern had significantly association with decreased risk of T2D in the crude model (Odds ratios [OR]: 0.51, 95% Confidence interval [CI]: 0.29-0.9; P for trend = 0.018), Model II (OR: 0.5, 95% CI: 0.27-0.9; P for trend = 0.019), and Model III (OR: 0.56, 95% CI: 0.23-1.4 P for trend = 0.048). The inverse association of the second tertile of Western dietary pattern score with the T2D was significant in crude (OR: 9.25, 95% CI: 4.95-17.4; P for trend <0.001) and multivariable-adjusted model (OR: 16.65, 95% CI: 2.99-92.84; P for trend <0001).

Conclusions

Our study found an inverse relationship between adherence of healthy pattern and direct association with Western dietary pattern and the risk of T2D.

The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription

The Mediterranean diet originates in the food cultures of ancient civilizations which developed around the Mediterranean Basin and is based on the regular consumption of olive oil (as the main source of added fat), plant foods (cereals, fruits, vegetables, legumes, tree nuts, and seeds), the moderate consumption of fish, seafood, and dairy, and low-to-moderate alcohol (mostly red wine) intake, balanced by a comparatively limited use of red meat and other meat products. A few decades ago, the Mediterranean diet drew the attention of medical professionals by proving extended health benefits. The first reports ascertained cardiovascular protection, as multiple large-scale clinical studies, starting with Ancel Keys’ Seven Countries Study, showed a marked reduction of atherosclerotic clinical events in populations with a Mediterranean dietary pattern. Ensuing trials confirmed favorable influences on the risk for metabolic syndrome, obesity, type 2 diabetes mellitus, cancer, and neurodegenerative diseases. While its health benefits are universally recognized today by medical professionals, the present state of the Mediterranean diet is challenged by major difficulties in implementing this protective dietary pattern in other geographical and cultural areas and keeping it alive in traditional Mediterranean territories, also tainted by the unhealthy eating habits brought by worldwide acculturation.

Patient empowerment and the Mediterranean diet as a possible tool to tackle prediabetes associated with overweight or obesity: a pilot study

AIM

The objective of this study was to investigate the effect of implementation of short-term patient empowerment as applied to Mediterranean diet (MD) adherence on metabolic and anthropometric parameters in prediabetic overweight or obese subjects.

METHODS

The sample included 42 subjects with prediabetes, aged 18-75 years and with body mass index (BMI) > 25 kg/m², who received dietary advice on MD by nutritionists during session groups every 2 weeks for 4 months. Data on energy caloric intake and macronutrient consumption were collected using a 7-day food diary record. Adherence to MD was investigated through the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. No advice was given regarding caloric restriction and physical activity. At baseline and at the end of the study, each subject underwent anthropometric, metabolic, and nutritional assessments.

RESULTS

Approximately 40.5% of subjects had achieved restoration of normal glucose tolerance by the end of the study. Fasting plasma glucose, glycated hemoglobin (HbA1C), BMI, waist circumference, blood pressure, visceral adiposity index, triglycerides, and total and LDL cholesterol levels were significantly decreased, while HDL cholesterol had significantly increased by the end of the study. The subjects significantly increased adherence to MD, as assessed by the PREDIMED questionnaire at follow-up. A reduction of prevalence of the metabolic syndrome was also reported. Interestingly, the PREDIMED score correlated with HbA1C values at follow-up, after adjusting for BMI and total caloric intake.

CONCLUSIONS

Implementation of short-term patient empowerment as applied to MD adherence was shown to improve anthropometric and metabolic parameters in prediabetic overweight or obese subjects. This is of considerable importance, given that diet must be the cornerstone of treatment in patients at high risk of developing type 2 diabetes.

Differences in the interpretation of a modernized Mediterranean diet prescribed in intervention studies for the management of type 2 diabetes: how closely does this align with a traditional Mediterranean diet?

PURPOSE AND METHODS

Adherence to Mediterranean diet (MedDiet) is associated with the prevention and management of type 2 diabetes mellitus (T2DM). However, in intervention studies, there is discordance in the interpretation of a MedDiet. The purpose of this paper was to examine, synthesize, and develop a narrative review, exploring the qualitative differences in the interpretation of a modernized MedDiet prescribed as an intervention in clinical trials for the management of T2DM, and how closely this aligns with a traditional MedDiet. The 'traditional' MedDiet is often described as a dietary pattern high in unprocessed plant foods (fruits, vegetables, legumes, nuts, wholegrain cereals, and olive oil); moderate consumption of wine; low moderate in fish/shellfish; and an infrequent consumption of red meat, animal fats, vegetable oils, and processed foods.

RESULTS AND CONCLUSIONS

Synthesis of the reviewed literature demonstrates considerable variation in the qualitative interpretation of a MedDiet. We also identified inadequate reporting of MedDiet interventions, despite a number of studies referring to their intervention as a 'traditional' MedDiet. The majority of studies emphasized the same key dietary components and principles: an increased intake of vegetables, wholegrains, and the preferential consumption of white meat in substitute of red and processed meat and abundant use of olive oil. However, the reporting of specific dietary recommendations for fruit, legumes, nuts, bread, red wine, and fermentable dairy products were less consistent or not reported. Irrespective of the discordance in the interpretation of a MedDiet, a number of studies included in the present review reported improved glycaemic control and favorable cardiovascular outcomes with adherence to a Mediterranean-style diet. Nevertheless, greater clarity and depth of reporting amongst intervention studies is warranted for the refinement of a modernized MedDiet definition that is distinct from a prudent dietary pattern.

RNA-seq analysis of the transcriptome of the liver of cynomolgus monkeys with type 2 diabetes

Genetic and environmental factors such as high-fat diet are involved in the development of type 2 diabetes mellitus (T2DM). Cynomolgus monkey shares similar genetic makeup, tissue structures, physiology and metabolic function to human. This study aimed to establish T2DM model in cynomolgus monkey and compare expression profiles of hepatic genes and their associated pathways in normal cynomolgus monkeys and those with T2DM. We employed RNA-seq technique and identified 1451 differentially expressed genes (DEGs) with a false discovery rate (FDR) of 0.1% between normal and T2DM animals. KEGG pathway analysis revealed that DEGs were associated with 12 KEGG pathways (P < 0.05). Two of these pathways were associated with metabolism and five were related to immunity. Unexpected, we found ECM-receptor interaction pathway. In conclusion, our data suggest that three major pathways may be implicated in the development of T2DM, including steroid biosynthesis, immune response and ECM. Further characterization of these pathways may provide new targets for the prevention and therapy of T2DM.

Joint associations of dietary pattern and television viewing with CVD risk factors among urban men and women in China: a cross-sectional study

The purpose of this study was to investigate the joint associations of dietary pattern and television viewing with risk factors of CVD among urban adults in China. A community-based cross-sectional study was conducted among urban adults in Nanjing, China. Five dietary patterns were identified based on a FFQ. Television time was obtained from a standard questionnaire and further classified into two categories (≤7, >7 h/week). Multiple logistic regression was used to calculate the OR and 95 % CI for the separate and joint associations of dietary patterns and television viewing with CVD risk factors. Compared with other dietary patterns, participants who followed the healthy traditional pattern had a lower likelihood of abdominal obesity (AO) (OR 0·52; 95 % CI 0·41, 0·67). Participants watching television no more than 7 h/week presented a 19 and 21 % lower likelihood for hypertension (HT) and elevated total cholesterol (ETC) than those with television time >7 h/week. Individuals who had less television time and a healthy dietary pattern had a lower OR for the presence of AO (OR 0·48; 95 % CI 0·36, 0·65), HT (OR 0·71; 95 % CI 0·66, 0·77), ETC (OR 0·72; 95 % CI 0·57, 0·91) and elevated TAG (OR 0·76; 95 % CI 0·61, 0·95), compared with those who followed other dietary patterns and television time >7 h/week. In conclusion, both healthy traditional pattern and less television time are jointly associated with reduced levels of CVD risk factors. It has important public health implications regarding the precision prevention of CVD at population level.

Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

The consumption of sugars, particularly sugar-sweetened beverages (SSBs; beverages or drinks that contain added caloric sweeteners (ie, sucrose, high-fructose corn syrup, fruit juice concentrates), in European children and adolescents exceeds current recommendations. This is of concern because there is no nutritional requirement for free sugars, and infants have an innate preference for sweet taste, which may be modified and reinforced by pre- and postnatal exposures. Sugar-containing beverages/free sugars increase the risk for overweight/obesity and dental caries, can result in poor nutrient supply and reduced dietary diversity, and may be associated with increased risk of type 2 diabetes mellitus, cardiovascular risk, and other health effects. The term "free sugars," includes all monosaccharides/disaccharides added to foods/beverages by the manufacturer/cook/consumer, plus sugars naturally present in honey/syrups/unsweetened fruit juices and fruit juice concentrates. Sugar naturally present in intact fruits and lactose in amounts naturally present in human milk or infant formula, cow/goat milk, and unsweetened milk products is not free sugar. Intake of free sugars should be reduced and minimised with a desirable goal of <5% energy intake in children and adolescents aged ≥2 to 18 years. Intake should probably be even lower in infants and toddlers <2 years. Healthy approaches to beverage and dietary consumption should be established in infancy, with the aim of preventing negative health effects in later childhood and adulthood. Sugar should preferably be consumed as part of a main meal and in a natural form as human milk, milk, unsweetened dairy products, and fresh fruits, rather than as SSBs, fruit juices, smoothies, and/or sweetened milk products. Free sugars in liquid form should be replaced by water or unsweetened milk drinks. National Authorities should adopt policies aimed at reducing the intake of free sugars in infants, children and adolescents. This may include education, improved labelling, restriction of advertising, introducing standards for kindergarten and school meals, and fiscal measures, depending on local circumstances.

Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans

INTRODUCTION

The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs.

METHODS

Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016.

RESULTS

Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30.

CONCLUSIONS

A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity.

Metabolomics applied to diabetes-lessons from human population studies

The 'classical' distribution of type 2 diabetes (T2D) across the globe is rapidly changing and it is no longer predominantly a disease of middle-aged/elderly adults of western countries, but it is becoming more common through Asia and the Middle East, as well as increasingly found in younger individuals. This global altered incidence of T2D is most likely associated with the spread of western diets and sedentary lifestyles, although there is still much debate as to whether the increased incidence rates are due to an overconsumption of fats, sugars or more generally high-calorie foods. In this context, understanding the interactions between genes of risk and diet and how they influence the incidence of T2D will help define the causative pathways of the disease. This review focuses on the use of metabolomics in large cohort studies to follow the incidence of type 2 diabetes in different populations. Such approaches have been used to identify new biomarkers of pre-diabetes, such as branch chain amino acids, and associate metabolomic profiles with genes of known risk in T2D from large scale GWAS studies. As the field develops, there are also examples of meta-analysis across metabolomics cohort studies and cross-comparisons with different populations to allow us to understand how genes and diet contribute to disease risk. Such approaches demonstrate that insulin resistance and T2D have far reaching metabolic effects beyond raised blood glucose and how the disease impacts systemic metabolism.

Dietary Patterns and Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Prospective Studies

Background: Different methodologic approaches for constructing dietary patterns and differences in their composition limit conclusions on healthful patterns for diabetes prevention.Objective: We summarized evidence from prospective studies that examined associations of dietary patterns with type 2 diabetes by considering different methodologic approaches.Methods: The literature search (MEDLINE and Web of Science) identified prospective studies (cohorts or trials) that associated dietary patterns with diabetes incidence in nondiabetic and apparently healthy participants. We summarized evidence by meta-analyses and distinguished different methodologic approaches.Results: The search resulted in 48 articles comprising 16 cohorts. Adherence to the Mediterranean diet (RR for comparing extreme quantiles: 0.87; 95% CI: 0.82, 0.93), Dietary Approaches to Stop Hypertension (DASH) (RR: 0.81; 95% CI: 0.72, 0.92), and Alternative Healthy Eating Index (AHEI) (RR: 0.79; 95% CI: 0.69, 0.90) was associated with significant risk reductions of incident diabetes. Patterns from exploratory factor and principal component analyses characterized by red and processed meat, refined grains, high-fat dairy, eggs, and fried products ("mainly unhealthy") were positively associated with diabetes (RR: 1.44; 95% CI: 1.27, 1.62), whereas patterns characterized by vegetables, legumes, fruits, poultry, and fish ("mainly healthy") were inversely associated with diabetes (RR: 0.84; 95% CI: 0.77, 0.91). Reduced rank regression (RRR) used diabetes-related biomarkers to identify patterns. These patterns were characterized by high intakes of refined grains, sugar-sweetened soft drinks, and processed meat and were all significantly associated with diabetes risk.Conclusions: Our meta-analysis suggests that diets according to the Mediterranean diet, DASH, and AHEI have a strong potential for preventing diabetes, although they differ in some particular components. Exploratory dietary patterns were grouped based on concordant food groups and were significantly associated with diabetes risk despite single-component foods having limited evidence for an association. Still, they remain population-specific observations. Consistent positive associations with diabetes risk were observed for 3 RRR patterns.

The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis

AIMS/HYPOTHESIS

Levels of ideal cardiovascular health (ICH) and incident type 2 diabetes mellitus have not been examined in a multiethnic population. We assessed the total and race/ethnicity-specific incidence of diabetes based on American Heart Association (AHA) ICH components.

METHODS

Incident diabetes was assessed among 5341 participants in the Multi-Ethnic Study of Atherosclerosis without prevalent diabetes between 2002 and 2012. ICH components (total cholesterol, BP, dietary intake, tobacco use, physical activity and BMI) were assessed at baseline and participants were categorised as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 impact goals. We developed a scoring system based on the number of ICH components (0-1 'poor', 2-3 'intermediate', and ≥4 'ideal'). HRs were calculated using Cox models.

RESULTS

During a median follow-up of 11.1 years, we identified 587 cases of incident diabetes. After multivariable adjustment, participants with 2-3 and ≥4 ICH components vs 0-1 components had a 34% lower (HR 0.66; 95% CI 0.54, 0.80) and a 75% lower (HR 0.25; 95% CI 0.18, 0.35) diabetes incidence, respectively. There were significant differences by race/ethnicity: African-American and Hispanic-American participants with ≥4 ICH components had diabetes incidence rates per 1000 person-years of 5.6 (95% CI 3.1, 10.1) and 10.5 (95% CI 6.7, 16.4), respectively, compared with 2.2 (95% CI 1.3, 3.7) among non-Hispanic white Americans.

CONCLUSIONS/INTERPRETATION

Meeting an increasing number of AHA 2020 impact goals for dietary intake, physical activity, smoking, BP, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes with significant variation by race/ethnicity.

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Medical nutrition therapy constitutes an important lifestyle intervention in diabetes management. Several nutrition patterns have been effective in improving diabetes control, but there has been a debate about the optimal macronutrient composition in diabetes meal planning. For many years, the recommended diets for persons with and without diabetes were similar, i.e. heart-healthy and low in fat. For almost three decades, carbohydrates have been lauded, lipids demonized, and proteins considered of little importance. However, in the past few years, this concept has been questioned and reassessed. Modern nutritional recommendations for people with diabetes are headed towards individualization, but lack specific guidelines. Nutritional algorithms may help nutritionists in diabetes meal planning. This review aims to discuss: 1) the effects of the three major macronutrients (carbohydrates, proteins, and lipids) on glucose levels, 2) current recommendations for macronutrient intake for people with diabetes, and 3) specific parameters that need to be taken into consideration when determining the macronutrient composition for a person with diabetes, for example body mass index, degree of insulin resistance, HbA1c value, and lipid profile (especially triglycerides and HDL cholesterol). These aspects are analyzed in the context of the results of recent studies, especially randomized controlled trials (RCTs). Finally, we introduce an individualized nutritional concept that proposes carbohydrate over lipid restriction, substitution of SFAs with MUFAs and PUFAs, and adequate intake of dietary fiber, which are key factors in optimizing diabetes management.

Healthy and unhealthy dietary patterns are related to pre-diabetes: a case–control study

Pre-diabetes increases the risk of diabetes and CVD. Several studies have investigated the relationship between food intake and pre-diabetes morbidity, but the dietary patterns of pre-diabetes subjects were not taken into consideration. The aim of this study was to determine the relationship between dietary patterns and pre-diabetes. In this regard, 150 pre-diabetic subjects and 150 healthy controls, who attended the diabetes screening centre in Shahreza, Iran, were matched for age group and sex. The weight, height, waist circumference, physical activity, systolic and diastolic blood pressures, and blood glucose levels of all participants were measured. Dietary information was collected using a semi-quantitative FFQ. Using factor analysis, two dietary patterns were identified: the vegetables, fruits and legumes (VFL) dietary pattern and the sweet, solid fat, meat and mayonnaise (SSMM) dietary pattern. Multivariate logistic regression was used to assess the relationship between pre-diabetes and dietary patterns. After adjusting for age, education, physical activity, BMI and energy intake, the VFL dietary pattern was found to be negatively associated with lower pre-diabetes (OR 0·16; 95 % CI 0·10, 0·26). Furthermore, the SSMM dietary pattern was positively associated with pre-diabetes (OR 5·45; 95 % CI 3·22, 9·23). In conclusion, the VFL dietary pattern is inversely related to pre-diabetes, whereas the SSMM dietary pattern is associated with increased risk of pre-diabetes.

Dietary Patterns and Type 2 Diabetes Mellitus in a First Nations Community

BACKGROUND

Type 2 diabetes mellitus is a growing concern worldwide, particularly in Indigenous communities, which have undergone a marked nutrition transition characterized by reduced intakes of traditional foods and increased intakes of market foods. Few studies have assessed the relationships between differing dietary patterns and risk for type 2 diabetes in Indigenous communities in Canada. The objective of the study was to characterize dietary patterns using factor analysis (FA) and to relate these patterns to the incidence of type 2 diabetes after 10 years of follow up in a First Nations community in Ontario, Canada.

METHODS

We conducted a prospective analysis of 492 participants in the SLHDP who did not have diabetes at baseline (1993 to 1995) and were followed for 10 years. A food-frequency questionnaire was administered, and FA was used to identify patterns of food consumption. Multivariate logistic regression analyses determined associations of food patterns with incident type 2 diabetes, adjusting for sociodemographic and lifestyle confounders.

RESULTS

At follow up, 86 participants had developed incident type 2 diabetes. FA revealed 3 prominent dietary patterns: Balanced Market Foods, Beef and Processed Foods and Traditional Foods. After adjustment for age, sex, waist circumference, interleukin-6 and adiponectin, the Beef and Processed Foods pattern was associated with increased risk for incident type 2 diabetes (OR=1.38; 95% CI 1.02, 1.86). In contrast, the Balanced Market Foods and Traditional Foods Patterns were not significantly associated with type 2 diabetes.

CONCLUSIONS

Dietary interventions should encourage reduced consumption of unhealthful market foods, in combination with improvements in local food environments so as to increase access to healthful foods and reduce food insecurity in Indigenous communities.

Whole food approach for type 2 diabetes prevention

Diet is intimately associated with the risk of type 2 diabetes (T2D). Recently, attention has focused on the contributions of individual nutrients, food groups and eating patterns to the outcome of T2D. High consumption of coffee, whole grains, fruits and vegetables, and nuts are each independently associated with the reduced risk of T2D in high risk, glucose intolerant individuals. Experimental and clinical trials have given insight to the diverse mechanisms that may be responsible for the observed protective effects of certain foods on T2D, including nutrients, phytochemicals and dietary fiber, weight control, enhanced satiety and improvement in glucose tolerance and insulin sensitivity in diabetic patients. Elevated consumption of refined grains and sugar-sweetened beverages has shown to significantly elevate the risk of incident T2D. An overall healthy diet primarily comprising whole plant-based foods, together with regular physical activity and weight manage, could significantly reduce the risk of T2D. The present review consolidates current research and delineates major food groups shown to significantly influence risk of T2D. Documenting and quantifying the effects of diet on the outcome of T2D are of great scientific and public health importance as there is urgent need to implement dietary strategies to prevent and manage the outcome of T2D.

Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods

Beyond nutritional composition, food structure is increasingly recognized to play a role in food health potential, notably in satiety and glycemic responses. Food structure is also highly dependent on processing conditions. The hypothesis for this study is, based on a data set of 98 ready-to-eat foods, that the degree of food processing would correlate with the satiety index (SI) and glycemic response. Glycemic response was evaluated according to two indices: the glycemic index (GI) and a newly designed index, the glycemic glucose equivalent (GGE). The GGE indicates how a quantity of a certain food affects blood glucose levels by identifying the amount of food glucose that would have an effect equivalent to that of the food. Then, foods were clustered within three processing groups based on the international NOVA classification: (1) raw and minimally processed foods; (2) processed foods; and (3) ultra-processed foods. Ultra-processed foods are industrial formulations of substances extracted or derived from food and additives, typically with five or more and usually many (cheap) ingredients. The data were correlated by nonparametric Spearman's rank correlation coefficient on quantitative data. The main results show strong correlations between GGE, SI and the degree of food processing, while GI is not correlated with the degree of processing. Thus, the more food is processed, the higher the glycemic response and the lower its satiety potential. The study suggests that complex, natural, minimally and/or processed foods should be encouraged for consumption rather than highly unstructured and ultra-processed foods when choosing weakly hyperglycemic and satiating foods.

Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis

BACKGROUND

Previous cohort studies have shown that moderate alcohol consumption was associated with a lower risk of type 2 diabetes (T2D). However, whether these associations differ according to the characteristics of patients with T2D remains controversial.

OBJECTIVE

The purpose of this study was to explore and summarize the evidence on the strength of the association between alcohol consumption and the subsequent risk of T2D by using a dose-response meta-analytic approach.

DESIGN

We identified potential studies by searching the PubMed, Embase, and Cochrane Library databases up to 24 March 2015. Prospective observational studies that evaluated the relation between alcohol consumption and the risk of T2D and reported its effect estimates with 95% CIs were included.

RESULTS

Analyses were based on 706,716 individuals (275,711 men and 431,005 women) from 26 studies with 31,621 T2D cases. We detected a nonlinear relation between alcohol consumption and the risk of T2D, which was identified in all cohorts (P-trend < 0.001, P-nonlinearity < 0.001), in men (P-trend < 0.001, P-nonlinearity < 0.001), and in women (P-trend < 0.001, P-nonlinearity < 0.001). Compared with the minimal category of alcohol consumption, light (RR: 0.83; 95% CI: 0.73, 0.95; P = 0.005) and moderate (RR: 0.74; 95% CI: 0.67, 0.82; P < 0.001) alcohol consumption was associated with a lower risk of T2D. However, heavy alcohol consumption had little or no effect on subsequent T2D risk. Furthermore, the summary RR ratio (RRR; male to female) of the comparison between moderate alcohol consumption and the minimal alcohol categories for T2D was significantly higher, and the pooled RRR (current smoker to never smoker) of light alcohol consumption was significantly reduced.

CONCLUSIONS

Light and moderate alcohol consumption was associated with a lower risk of T2D, whereas heavy alcohol consumption was not related to the risk of T2D.

Effectiveness of the Complete Health Improvement Program in Reducing Risk Factors for Cardiovascular Disease in an Appalachian Population

CONTEXT

In 11 counties in Appalachian Ohio, the self-reported prevalence of diabetes mellitus (11.3%) is higher than the state (7.8%) or national (7.2%) average. Direct medical costs for diabetes in the United States are estimated at $176 billion annually. Indirect costs from disability, work loss, and premature death add up to another $69 billion.

OBJECTIVE

To determine the effectiveness of the Complete Health Improvement Program (CHIP) in reducing cardiovascular disease (CVD) risk factors in a sample of Appalachian participants with elevated fasting blood glucose (FBG) levels or a diagnosis of type 2 diabetes mellitus (T2DM).

METHODS

In a retrospective study, data from 6 CHIP cohorts conducted in Appalachian Ohio from 2011 to 2012 were combined and analyzed for short-term changes in CVD risk factors from baseline. This study focused on a subsample of the overall CHIP, whose participants had elevated FBG levels or T2DM. Statistical analysis was completed by calculating means and SDs and using paired t tests to compare differences in variables.

RESULTS

After the CHIP intervention, 110 participants with baseline elevated FBG levels showed notable reductions in FBG levels, total cholesterol, low-density lipoprotein cholesterol, body mass index, and systolic blood pressure (all P values <.001). Likewise, participants in the subsample with T2DM experienced reductions in all CVD risk factors (all P values <.05).

CONCLUSION

The CHIP lifestyle intervention was effective in reducing CVD risk factors in this Appalachian population with elevated FBG levels or with T2DM.

Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document

The relationship between the consumption of meat and health is multifaceted, and it needs to be analyzed in detail, with specific attention to the relevant differences that characterize the effects of the different meat types, as yet considered by only a limited literature. A variable but moderate energy content, highly digestible proteins (with low levels of collagen) of good nutritional quality, unsaturated lipids (mainly found in the skin and easily removed), B-group vitamins (mainly thiamin, vitamin B6, and pantothenic acid), and minerals (like iron, zinc, and copper) make poultry meat a valuable food. Epidemiological studies performed across the world, in highly diverse populations with different food preferences and nutritional habits, provide solid information on the association between poultry consumption, within a balanced diet, and good health. Consumption of poultry meat, as part of a vegetable-rich diet, is associated with a risk reduction of developing overweight and obesity, cardiovascular diseases, and type 2 diabetes mellitus. Also, white meat (and poultry in particular) is considered moderately protective or neutral on cancer risk. The relevance of poultry meat for humans also has been recognized by the UN Food and Agricultural Organization (FAO), who considers this widely available, relatively inexpensive food to be particularly useful in developing countries, where it can help to meet shortfalls in essential nutrients. Moreover, poultry meat consumption also contributes to the overall quality of the diet in specific ages and conditions (prior to conception, during pregnancy up to the end of breastfeeding, during growth, and in the geriatric age) and is suitable for those who have an increased need for calorie and protein compared to the general population.

Dietary patterns and the incidence of hyperglyacemia in China

OBJECTIVE

Epidemiological studies have examined associations between dietary patterns and the risk of type 2 diabetes. However, information on dietary patterns and the risk of type 2 diabetes in Chinese populations is scarce. The aim of the present study was to identify dietary patterns and examine their association with incident hyperglycaemia in Nanjing, China.

DESIGN

A community-based prospective cohort study. Dietary assessment was carried out using a validated eighty-seven-item FFQ. Dietary patterns were identified by exploratory factor analysis. Participants were categorized into tertiles of dietary factor score for each dietary pattern. The relationship between dietary patterns and hyperglycaemia risk was analysed using multivariable linear and Cox regression.

SETTING

Seven communities from two urban districts in Nanjing, China.

SUBJECTS

A total of 2900 of Chinese local residents aged 30 years or above, free of hyperglycaemia and other serious diseases, who participated in the baseline survey from June to September 2007 were followed up 3 years later from June to September 2010 for the development of hyperglycaemia. Fasting blood samples were collected at both baseline and 3-year follow-up surveys. Hyperglycaemia was defined as fasting plasma glucose concentration of ≥6·1 mmol/l or already taking oral hyperglycaemia agents for treatment of type 2 diabetes.

RESULTS

Five major dietary patterns were identified: (i) the 'condiments' pattern; (ii) the 'animal and plant protein' pattern; (iii) the 'healthy traditional' pattern; (iv) the 'fruits, eggs and juice' pattern; and (v) the 'alcohol, milk and tea' pattern. A total of 2093 (72·2 %) individuals completed the follow-up survey and the 3-year cumulative incidence of hyperglycaemia was 7·5 % (158/2093). A 1-unit increase in the score for the 'healthy traditional' pattern was associated with a decrease of 0·054 mmol/l in fasting plasma glucose (P=0·017), while a 1-unit increase in the 'fruits, eggs and juice' pattern score was associated with an increase of 0·050 mmol/l in fasting plasma glucose (P=0·023) by multivariable linear regression. For men, tertile 3 of the 'fruits, eggs and juice' pattern was associated with an 88 % greater risk (hazard ratio=1·88; 95 % CI 1·04, 3·54) of hyperglycaemia than tertile 1 of this pattern. Being in tertile 3 of the 'alcohol, milk and tea' pattern was associated with a 35 % greater risk (hazard ratio=1·35; 95 % CI 1·04, 2·16) relative to tertile 1 in women, while for the ''healthy traditional' pattern tertile 3 was associated with a 41 % lower risk (hazard ratio=0·59; 95 % CI 0·35, 0·99) compared with tertile 1. The 'condiments' and the 'animal and plant protein' patterns were not independently associated with hyperglycaemia.

CONCLUSIONS

Our findings suggest that modifying dietary patterns could reduce hyperglycaemia incidence in the mainland Chinese adult population.

Gut microbiota and Ma-Pi 2 macrobiotic diet in the treatment of type 2 diabetes

In the past 10 years the prevalence of type 2 diabetes mellitus (T2DM) has increased hugely worldwide, driven by a rise in the numbers of overweight and obese individuals. A number of diets have been shown to be effective for the management of T2DM: the Mediterranean diet, the vegetarian diet and the low-calorie diet. Results of studies clearly indicate, however, that the efficacy of these diets is not solely related to the biochemical structure of the individual nutrients they contain. This review discusses this point with reference to the potential role of the intestinal microbiota in diabetes. The macrobiotic Ma-Pi 2 diet is rich in carbohydrates, whole grains and vegetables, with no animal fat or protein or added sugar. In short- and medium-term trials conducted in patients with T2DM, the Ma-Pi 2 diet has been found to significantly improve indicators of metabolic control, including fasting blood glucose, glycosylated hemoglobin, the serum lipid profile, body mass index, body weight and blood pressure. The diet may also alter the gut microbiota composition, which could additionally affect glycemic control. As a result, the Ma-Pi 2 diet could be considered a valid additional short- to medium-term treatment for T2DM.

Prose Fiction as a Narrative Companion for a Vegetable Parenting Videogame

OBJECTIVE

The purpose of this research is to explore the capacity of story to connect to a health-related videogame, as well as the qualities that may increase efficacy by making the story compelling. Parents of 3-5-year-old children often report difficulty getting their children to eat vegetables, which are protective against chronic illnesses. Videogames may be vehicles for training parenting practices for successful vegetable consumption outcomes but often rely on stories to provide context and details. Unfortunately, storytelling may interrupt immersion and player agency. Delivering stories outside of gameplay may provide an understanding of game situations while maintaining immersion.

MATERIALS AND METHODS

Two companion storylines (one a romantic adventure and the other a suspenseful fantasy) were generated for a vegetable parenting game, "Mommio," targeting mothers of preschool children. Mothers of 3-5-year-old children (n=18) read both storylines and completed semistructured interviews.

RESULTS

Mothers preferred the romantic adventure, which featured strong characters, relatable issues, and an engaging plot. Most mothers were interested in playing the "Mommio" videogame after reading the stories.

CONCLUSIONS

Results suggest that it is possible for prose literature to both motivate gameplay and be an immersive narrative companion to, but separate from, games for health. This literature should include engaging, realistic stories and relatable strong characters.

Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Background

Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery.

Methods

The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/delivery.

Results

Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants.

Conclusions

Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0487-2) contains supplementary material, which is available to authorized users.

Fruit intake decreases risk of incident type 2 diabetes: an updated meta-analysis

Association between fruit intake and risk of type 2 diabetes is inconsistent. In this study, we performed a meta-analysis of all prospective cohort studies to clarify the association between fruit intake and risk of type 2 diabetes. Relevant studies were identified by searches of the PubMed and Embase databases up to November 2013. The summary relative risks of association were obtained using a fixed- or random-effects model. A total of nine prospective studies (403,259 participants, including 27,940 with incident type 2 diabetes) from seven publications were included in the meta-analysis of fruit intake and risk of type 2 diabetes. We found that individuals in the highest category of fruit intake had a reduced risk of type 2 diabetes (relative risk 0.92, 95 % confidence interval 0.86-0.97, p = 0.003) compared to those in the lowest category, with moderate evidence of between-study heterogeneity (I (2) = 37.6 %, p = 0.12). There was an evident non-linear association of fruit intake with type 2 diabetes (P for nonlinearity <0.001). A non-linear threshold of 200 g/day of fruit intake was identified and the risk of type 2 diabetes reduced by about 13 % at this cut-off. Our findings are consistent with diet recommendations to consume about 200 g/day of fruits to prevent type 2 diabetes.

Causes of type 2 diabetes in China

The prevalence of diabetes in China has increased substantially over recent decades, with more than 100 million people estimated to be affected by the disease presently. During this period there has been an increase in the rates of obesity and a reduction in physical activity. Many of the changes in lifestyle and diet are a result of increased economic development and urbanisation. In addition to an increasingly westernised diet, the traditional Chinese diet also plays a part, with the quantity and quality of rice intake linked to the risk of type 2 diabetes. Familial factors including inherited genetic variants are important, although differences in the genetic architecture suggest a different combination of genetic variants could be most relevant in Chinese when compared with Europeans. Recent advances have also emphasised the role of early life factors in the epidemic of diabetes and non-communicable diseases: maternal undernutrition, maternal obesity, and gestational diabetes are all linked to increased risk of diabetes in offspring. A mismatch between developmentally programmed biology and the modern environment is relevant for countries like China where there has been rapid economic transformation. Multisectoral efforts to address the risks will be needed at different stages throughout the lifecourse to reduce the burden of diabetes.

Management of NCD in low- and middle-income countries

Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified "best buys" it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases.

Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies

OBJECTIVE

To clarify and quantify the potential dose-response association between the intake of fruit and vegetables and risk of type 2 diabetes.

DESIGN

Meta-analysis and systematic review of prospective cohort studies.

DATA SOURCE

Studies published before February 2014 identified through electronic searches using PubMed and Embase.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Prospective cohort studies with relative risks and 95% CIs for type 2 diabetes according to the intake of fruit, vegetables, or fruit and vegetables.

RESULTS

A total of 10 articles including 13 comparisons with 24,013 cases of type 2 diabetes and 434,342 participants were included in the meta-analysis. Evidence of curve linear associations was seen between fruit and green leafy vegetables consumption and risk of type 2 diabetes (p=0.059 and p=0.036 for non-linearity, respectively). The summary relative risk of type 2 diabetes for an increase of 1 serving fruit consumed/day was 0.93 (95% CI 0.88 to 0.99) without heterogeneity among studies (p=0.477, I(2)=0%). For vegetables, the combined relative risk of type 2 diabetes for an increase of 1 serving consumed/day was 0.90 (95% CI 0.80 to 1.01) with moderate heterogeneity among studies (p=0.002, I(2)=66.5%). For green leafy vegetables, the summary relative risk of type 2 diabetes for an increase of 0.2 serving consumed/day was 0.87 (95% CI 0.81 to 0.93) without heterogeneity among studies (p=0.496, I(2)=0%). The combined estimates showed no significant benefits of increasing the consumption of fruit and vegetables combined.

CONCLUSIONS

Higher fruit or green leafy vegetables intake is associated with a significantly reduced risk of type 2 diabetes.

A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis

Our review and meta-analysis examined the association between a posteriori-derived dietary patterns (DPs) and risk of type 2 diabetes mellitus. MEDLINE and EMBASE were searched for articles published up to July 2012 and data were extracted by two independent reviewers. Overall, 19 cross-sectional, 12 prospective cohort, and two nested case-control studies were eligible for inclusion. Results from cross-sectional studies reported an inconsistent association between DPs and measures of insulin resistance and/or glucose abnormalities, or prevalence of type 2 diabetes. A meta-analysis was carried out on nine prospective cohort studies that had examined DPs derived by principle component/factor analysis and incidence of type 2 diabetes risk (totaling 309,430 participants and 16,644 incident cases). Multivariate-adjusted odds ratios were combined using a random-effects meta-analysis. Two broad DPs (Healthy/Prudent and Unhealthy/Western) were identified based on food factor loadings published in original studies. Pooled results indicated a 15% lower type 2 diabetes risk for those in the highest category of Healthy/Prudent pattern compared with those in the lowest category (95% CI 0.80 to 0.91; P<0.0001). Compared with the lowest category of Unhealthy/Western DP, those in the highest category had a 41% increased risk of type 2 diabetes (95% CI 1.32 to 1.52; P<0.0001). These results provide evidence that DPs are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.

Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial

BACKGROUND

The HealthValues Healthy Eating Programme is a standalone Internet-based intervention that employs a novel strategy for promoting behavior change (analyzing one's reasons for endorsing health values) alongside other psychological principles that have been shown to influence behavior. The program consists of phases targeting motivation (dietary feedback and advice, analyzing reasons for health values, thinking about health-related desires, and concerns), volition (implementation intentions with mental contrasting), and maintenance (reviewing tasks, weekly tips).

OBJECTIVE

The aim was to examine the effects of the program on consumption of fruit and vegetables, saturated fat, and added sugar over a 6-month period.

METHODS

A total of 82 females and 18 males were recruited using both online and print advertisements in the local community. They were allocated to an intervention or control group using a stratified block randomization protocol. The program was designed such that participants logged onto a website every week for 24 weeks and completed health-related measures. Those allocated to the intervention group also completed the intervention tasks at these sessions. Additionally, all participants attended laboratory sessions at baseline, 3 months, and 6 months. During these sessions, participants completed a food frequency questionnaire (FFQ, the Block Fat/Sugar/Fruit/Vegetable Screener, adapted for the UK), and researchers (blind to group allocation) measured their body mass index (BMI), waist-to-hip ratio (WHR), and heart rate variability (HRV).

RESULTS

Data were analyzed using a series of ANOVA models. Per protocol analysis (n=92) showed a significant interaction for fruit and vegetable consumption (P=.048); the intervention group increased their intake between baseline and 6 months (3.7 to 4.1 cups) relative to the control group (3.6 to 3.4 cups). Results also showed overall reductions in saturated fat intake (20.2 to 15.6 g, P<.001) and added sugar intake (44.6 to 33.9 g, P<.001) during this period, but there were no interactions with group. Similarly, there were overall reductions in BMI (27.7 to 27.3 kg/m(2), P=.001) and WHR (0.82 to 0.81, P=.009), but no interactions with group. The intervention did not affect alcohol consumption, physical activity, smoking, or HRV. Data collected during the online sessions suggested that the changes in fruit and vegetable consumption were driven by the motivational and maintenance phases of the program.

CONCLUSIONS

Results suggest that the program helped individuals to increase their consumption of fruit and vegetables and to sustain this over a 6-month period. The observed reduction in fat and sugar intake suggests that monitoring behaviors over time is effective, although further research is needed to confirm this conclusion. The Web-based nature of the program makes it a potentially cost-effective way of promoting healthy eating.