Randomized Nutrition Education Intervention to Improve Carbohydrate Counting in Adolescents with Type 1 Diabetes Study: Is More Intensive Education Needed?

BackgroundYouth with type 1 diabetes do not count carbohydrates accurately, yet it is an important strategy in blood glucose control.ObjectiveThe study objective was to determine whether a nutrition education intervention would improve carbohydrate counting accuracy and glycemic control.DesignWe conducted a randomized, controlled nutrition intervention trial that was recruited from February 2009 to February 2010.SubjectsYouth (12 to 18 years of age, n=101) with type 1 diabetes were screened to identify those with poor carbohydrate counting accuracy, using a previously developed carbohydrate counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n=66, age=15±3 years, 41 male, diabetes duration=6±4 years, hemoglobin A1c [HbA1c]=8.3%±1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90-minute class with a registered dietitian/certified diabetes educator and twice kept 3-day food records, which were used to review carbohydrate counting progress.Main outcome measuresCarbohydrate counting accuracy (measured as described) and HbA1c were evaluated at baseline and 3 months to determine the effectiveness of the intervention.Statistical analyses performedt Tests, Spearman correlations, and repeated measures models were used.ResultsAt baseline, carbohydrate content was over- and underestimated in 16 and 5 of 29 food items, respectively. When foods were presented as mixed meals, participants either significantly over- or underestimated 10 of the 9 meals and 4 snacks. After 3 months of follow-up, HbA1c decreased in both the intervention and control groups by ?0.19%±0.12% (P=0.12) and ?0.08%±0.11% (P=0.51), respectively; however, the overall intervention effect was not statistically significant for change in HbA1c or carbohydrate counting accuracy.ConclusionsMore intensive intervention might be required to improve adolescents' carbohydrate counting accuracy and nutrition management of type 1 diabetes. Additional research is needed to translate nutrition education into improved health outcomes.     

Hyperglycemia and Carotenoid Intake Are Associated with Serum Carotenoids in Youth with Type 1 Diabetes

BackgroundSerum carotenoids are commonly used as biomarkers of fruit and vegetable (F/V) intake in the general population. Although hyperglycemia induces oxidative stress, it is unknown whether this pathway is associated with lower serum carotenoid concentrations in individuals with type 1 diabetes. Consequently, the utility of serum carotenoids as markers of F/V intake in individuals with type 1 diabetes is unclear.ObjectiveThe study objectives were: 1) to investigate the relationship of glycemic control, oxidative stress, dietary carotenoid and F/V intake with serum carotenoid concentrations in youth with type 1 diabetes and 2) to determine whether glycemic control or oxidative stress moderates the association of carotenoid and F/V intake with serum carotenoids.DesignThe study was a secondary analysis of baseline data from youth with type 1 diabetes. Blood samples were drawn from youth with type 1 diabetes to assess carotenoids and markers of glycemic control (glycated hemoglobin and 1,5-anhydroglucitol); urine samples were used to assess oxidative stress (8-iso-prostaglandin F_2α); and 3-day diet records completed by families were used to determine F/V and carotenoid intake.Participants/settingThe study participants were youth with type 1 diabetes (n=136; age range: 8 to 16.9 years; diabetes duration ≥1 year; glycated hemoglobin: 5.8% to 11.9%) enrolled in a nutrition intervention trial from 2010 to 2013 at a tertiary diabetes center in Boston, MA.Main outcome measuresSerum carotenoids (total carotenoids and α-carotene, β-carotene, lycopene, β-cryptoxanthin, and lutein+zeaxanthin).Statistical analysisRegression analyses were used to estimate the association of glycemic control, oxidative stress, F/V and carotenoid intake with serum carotenoids, as well as the role of glycemic control and oxidative stress in moderating diet-serum carotenoid associations.ResultsGreater F/V intake (β=0.35, P<0.001) and carotenoid intake (β=0.28, P<0.01) were associated with higher total serum carotenoids, and no moderation by glycemic control or oxidative stress was observed. Greater hyperglycemia, as indicated by lower 1,5-anhydroglucitol (β=0.27, P<0.01), was related to lower serum carotenoids; however, glycated hemoglobin was not associated with serum carotenoids. 8-Iso-prostaglandin F2α was not associated with glycemic control or serum carotenoids.ConclusionsFindings support the validity of serum carotenoids as markers of F/V and carotenoid intake in youth with type 1 diabetes.     

Waist circumference is positively correlated with markers of inflammation and negatively with adiponectin in women with metabolic syndrome

The purpose of this study was to correlate biomarkers of metabolic syndrome (MetS), with markers of inflammation and macronutrient intake in 89 women (25-72 years) with MetS. We hypothesized that waist circumference (WC) would have the stronger correlations with inflammatory parameters and would correlate with carbohydrate intake. Values for WC (108.7 ± 11.1 cm) and plasma triglycerides (202.7 ± 52.1 mg/dL) were elevated, whereas plasma glucose levels varied from 66 to 179 mg/dL, with 42% of women having insulin resistance. Plasma levels of interleukin 6 (0.2-15.9 mg/L), tumor necrosis factor α (1.47-12.3 mg/L), and high-sensitivity C-reactive protein (0.06-3.08 mg/dL) varied widely, with most women being above values considered normal. Subjects had high intake of total sugar (92.3 ± 56.4 g/d), high glycemic index (59.8 ± 6.5), and glycemic load (127.2 ± 56.1), whereas dietary fiber (17.1 ± 9.1 g/d) was below recommended intake. Waist circumference was positively correlated with insulin (r = 0.275, P < .01) and with the inflammatory markers interleukin 6 (r = 0.307, P < .01) and tumor necrosis factor α (r = 0.228, P < .05) and negatively correlated with plasma adiponectin (r = −0.309, P < .0001). In addition, WC was positively correlated with total carbohydrate, added sugar, and glycemic load (P < .05) but not with fat or protein. These results are consistent with central obesity being a key marker of the inflammatory state, and they also suggest that carbohydrates, particularly those that are digested rapidly, contribute to increased risk of central obesity and development of MetS.     

Assessments of nutrient intake and metabolic profiles in Korean adolescents according to exercise regularity using data from the 2008 Korean National Health and Nutrition Examination Survey

The purpose of this study was to assess the metabolic profile and nutrient intake data in Korean adolescents according to exercise regularity using the forth Korean National Health and Nutrition Examination Survey from 2008 data. A total of 834 Korean adolescents (440 boys, 394 girls) aged 12 to 18 years were classified into exercising male (EM), non-exercising male (NM), exercising female (EF), and non-exercising female (NF) groups. EM exhibited significantly higher weight (P < 0.001), waist circumference (WC) (P < 0.01) and body mass index (BMI) (P < 0.001) than NM. EF showed significantly greater height (P < 0.01), weight (P<0.001), WC (P < 0.001), and BMI (P < 0.001) than NF. Although ratios of macronutrient intake were within the appropriate range in all groups, energy, riboflavin, vitamin C and calcium were assessed as in adequate by the nutritional adequacy ratio (NAR) in all groups. Moreover, EF and NF had inadequate intake of vitamin A and iron according to NAR, respectively. There were significant correlations between height and NAR protein (r = 0.249, P < 0.001), and mean adequacy ratio (MAR) (r = 0.177, P < 0.01), and between weight and NAR protein (r = 0.180, P < 0.01), and MAR(r = 0.136, P < 0.05) in EM. On the other hand, there were significant correlations between weight and NAR protein (r = 0.270, P < 0.01), WC and NAR protein (r = 0.271, P < 0.01), and BMI and NAR protein (r = 0.326, P < 0.01) in NM. There were significant correlations height and NAR Fe (r = 0.153, P < 0.05) in EF. However, there were no significant correlations between metabolic factors and nutritional adequacy in NF. Although we noted no significant differences in MAR between the groups, the exercising groups showed higher MAR values than the non-exercising groups. Therefore, practicing of ideal dietary behaviors appears to be induced through physical activity and regular exercise in Korean adolescents.     

Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes mellitus

Changes in the quality and quantity of carbohydrate foods may compromise nutrient intake in women with gestational diabetes mellitus (GDM). We hypothesized that glycemic index, glycemic load (GL), carbohydrate intake, grains, and cereal product consumption would be associated with nutrient adequacy. Eighty-two women with GDM (61% of Asian background, 34% whites) completed a 3-day food record following their routine group nutrition education session. Nutrient intakes were compared to Nutrient Reference Values (NRV) for Australia and New Zealand. Nutrient intake across energy-adjusted tertiles of glycemic index, GL, carbohydrate intake, and intake of grains and cereal products were assessed. The majority of women (66%-99%) did not meet the NRV for fiber, folate, vitamin D, iodine, and iron, and exceeded NRV for saturated fat and sodium. Higher dietary GL was associated with lower intakes of total, monounsaturated, and polyunsaturated fat; vitamin E; and potassium (all P < .001). Higher grain intake was not significantly associated with intake of any micronutrients. In Australian women with GDM, high dietary GL predicts greater risk of poor nutrition.     

Ratio of fat to energy intake independently associated with the duration of diabetes and total cholesterol levels in type 2 diabetes

The importance of dietary intake in the treatment of type 2 diabetes was emphasized. This study was performed to investigate the dietary intakes of Korean type 2 diabetes patients according to the treatment and duration of diabetes and to examine the relationships between their diet and serum lipid profiles. The subjects were 111 type 2 diabetic patients who were treated by medical nutrition therapy only, oral hypoglycemic agents (OHA), or insulin with medical nutrition therapy. Dietary intake was assessed by a registered dietitian using semi-quantitative food frequency questionnaires. Comparisons according to treatment type were made using covariance analyses. General linear models identified the independent effects of the different treatments after covarying for age, duration of diabetes, and 2-way interactions. There were no significant differences in age and BMI but was in duration of diabetes according to treatment type in these subjects. Carbohydrate to energy ratio was higher in the OHA group (P < 0.05), whereas the fat to energy ratio was higher in the insulin group for males (P < 0.05). Carbohydrate (R² = 0.24, P = 0.005) and fat (R² = 0.26, P = 0.02) to energy ratios were independently associated with the duration of diabetes after covarying for age, sex, treatment, and 2-way interactions. The levels of triglyceride (TG; R² = 0.32, P = 0.02) and total cholesterol (TC) were associated independently with energy intake and the carbohydrate (R² = 0.15, P = 0.02) and fat (R² = 0.15, P = 0.01) to energy ratios, respectively. The concern that the independent association of dietary intake with either duration of diabetes or dietary factors affects blood lipid levels could suggest that specific dietary recommendations may work better for identifiable groups of diabetes patients.     

Association between dietary carbohydrate,glycemic index,glycemic load,and the prevalence of obesity in Korean men and women

Intake of high–glycemic index (GI) food has been postulated to reduce satiety, resulting in an increased total energy intake and reduced access to body fat as fuel. Thus, we hypothesize that high dietary GI and glycemic load (GL) are associated with an increased prevalence of obesity in the Korean population. Dietary GI and GL were calculated for 933 Korean men and women based on dietary intake assessed by food frequency questionnaires and using a GI table developed from published GI databases in a cross-sectional design. Mean differences in dietary GL and carbohydrate intake between obese and nonobese men were statistically significant after adjusting for covariates (P = .027 and .021, respectively). High dietary GL and carbohydrate intake were negatively associated with the prevalence of obesity among men in a multivariate-adjusted logistic regression model (P for trend = .026 and .036, respectively). Statistically significant effects of dietary GI and GL on the prevalence of obesity among women were observed in a generalized linear model (P = .002 and .042, respectively) and a logistic regression model (P for trend < .001 and = .007, respectively), after adjusting for covariates. Women with higher dietary GI and GL were more likely to be obese, a result consistent with our hypothesis. However, an inverse association for dietary GL and carbohydrate and prevalence of obesity was found in men, suggesting that mechanisms contributing to the prevalence of obesity between sexes may be different.     

Obesity and its associations with hypertension and type 2 diabetes among Chinese adults age 40 years and over

AimTo investigate the prevalence of obesity in a Chinese community according to the World Health Organization recommended criteria for Asians in 2000 based on body mass index (BMI) and waist circumference (WC), and to examine the associations between obesity and the risk of hypertension and type 2 diabetes among adults age 40 years and over in Shanghai, China.MethodsA population-based survey was conducted in Youyi Community in Shanghai. Five thousand seventy-one subjects (1917 men and 3154 women) were included in this study. Standard questionnaires were used to collect baseline data of participants. Body weight, height, WC, blood pressure, and glucose in the blood were measured.ResultsThe prevalence of general obesity was 44.6% (46.4% for men and 43.6% for women) according to BMI and 36.1% (25.5% for men and 42.6% for women) for central obesity according to WC. The prevalence of obesity I was higher in men (41.6%) than in women (36.2%; χ² = 14.8, P < 0.05), although the rate was higher in women than in men for obesity II (7.4% versus 4.8%, χ² = 13.6, P < 0.01) or central obesity (42.6% versus 25.5%, χ² = 152.1, P < 0.01). Odds ratios of hypertension and type 2 diabetes were significantly higher in the obesity group compared with either the group with BMI 18.5–<23.0 kg/m² or the group with WC < 90 cm for men or <80 cm for women.ConclusionsAccording to the criteria of obesity for Asians, the prevalence of obesity among Chinese adults age 40 years and over in Shanghai is high. Subjects with obesity have a significantly higher risk of hypertension and type 2 diabetes.     

Food insecurity and food choices in rural older adults with diabetes receiving nutrition education via telemedicine

ObjectiveTo evaluate differences between rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, preparation, shopping, obesity, and glycemic control after receiving nutrition counseling through telemedicine.MethodsFood insecurity data were obtained by telephone survey (n = 74). Group differences for continuous variables were measured by t tests; categorical variables by Pearson chi-square tests.ResultsParticipants reporting mild food insecurity (23%) had higher body mass index (35.5 ± 7.1 kg/m² vs 30.5 ± 6.0 kg/m², P = .01) and lower household incomes (P = .03) and were more likely to consider cost of ingredients in food preparation compared to food-secure participants (P = .03). Most purchased fresh produce (97%) and considered the dietitian's advice when purchasing food. Both groups report similar adherence to dietitians' advice and had similar glycemic control.Conclusions and ImplicationsStrategies to address higher levels of obesity associated with food insecurity are needed.     

Comparison of Indices of Carbohydrate Quality and Food Sources of Dietary Fiber on Longitudinal Changes in Waist Circumference in the Framingham Offspring Cohort

The long-term impact of carbohydrate quality on abdominal weight gain is not fully understood. We aimed to examine the prospective relation of a carbohydrate quality index (CQI; defined by four criteria: dietary fiber, glycemic index, whole grain-to-total grain ratio, and solid-to-total carbohydrate ratio), total, cereal grain, vegetable, and fruit fiber, carbohydrate-to-total fiber ratio, and carbohydrate-to-cereal fiber ratio with changes in waist circumference (WC). Subjects were middle-aged to older, mostly white, participants in the Framingham Offspring cohort (n = 3101 subjects), with mean baseline age 54.9 ± 0.2 years (mean ± SE) and body mass index (BMI) 27.2 ± 0.1 kg/m². Food frequency questionnaire (FFQ), health, and lifestyle data were collected approximately every four years over a median total follow-up of 18 years. Repeated measure mixed models were used to estimate adjusted mean change in WC per four-year interval across quartiles of carbohydrate variables. In the most adjusted model, a higher CQI was marginally associated with a smaller increase in WC (2.0 ± 0.1 vs. 2.4 ± 0.1 cm in highest vs. lowest quartile, p-trend = 0.04). Higher ratios of carbohydrate-to-fiber and carbohydrate-to-cereal fiber were associated with greater increases in WC per four-year interval (2.6 ± 0.1 vs. 2.0 ± 0.1 cm, p-trend < 0.001, and 2.5 ± 0.1 vs. 2.1 ± 0.1 cm in highest versus lowest categories, p-trend = 0.007, respectively); whereas higher intake of total fiber (1.8 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001), cereal fiber (2.0 ± 0.1 vs. 2.5 ± 0.1 cm, p-trend = 0.001), and fruit fiber (2.0 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001) were associated with smaller increases in WC compared to lower intakes. There was a significant interaction between total fiber and total carbohydrate (as % of total energy intake). After stratification, the association between fiber intake and change in WC was not maintained in the context of a high carbohydrate diet. Better carbohydrate quality, primarily higher fiber intake and lower carbohydrate-to-fiber ratios, may help attenuate increases in abdominal adiposity over time.     

Multiple Indicators of Poor Diet Quality in Children and Adolescents with Type 1 Diabetes Are Associated with Higher Body Mass Index Percentile but not Glycemic Control

BackgroundDiet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied.ObjectiveTo evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile.DesignIn this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index.Participants/settingChildren and adolescents with type 1 diabetes ≥1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data.Statistical analysesAssociations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression.ResultsParticipants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4±11.0 (range=26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P=0.04) and whole-grain (P=0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P=0.01) and whole-grain (P=0.04) intake and NRF 9.3 score (P=0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses.ConclusionsData demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.     

Comparative Effectiveness of a Mindful Eating Intervention to a Diabetes Self-Management Intervention among Adults with Type 2 Diabetes: A Pilot Study

Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes. Diabetes self-management education (DSME) is an essential component of effective self-care. Yet, little research has compared the effect of mindful eating to DSME–based treatment. This study compared the impact of these two interventions in adults with type 2 diabetes mellitus. A prospective randomized controlled trial with two parallel interventions was used. Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more, body mass index (BMI) of 27 or more, and hemoglobin A1c (HbA1c) of 7% or more who were randomly assigned to a 3-month mindful eating (MB-EAT-D; n=27) or Smart Choices (SC) DSME–based (n=25) intervention. Follow-up occurred 3 months after intervention completion. Dietary intake, physical activity, weight, HbA1c and fasting plasma glucose, and fasting insulin were assessed using repeated measures analysis of variance with contrast analysis. There was no significant difference between groups in the change in weight or glycemia at study end. Significant difference occurred between groups in the change in dietary intake/1,000 kcal of trans fats, total fiber, and sugars (all P<0.05). Mean (± standard error) reduction in weight (?2.92±0.54 kg for SC vs ?1.53±0.54 kg for MB-EAT-D) and HbA1c (?0.67±0.24% for SC and ?0.83±0.24% for MB-EAT-D) were significant (P<0.01). Significant reduction in energy intake and glycemic load occurred (all P<0.0001) for both groups. Training in mindful eating and diabetes self-management facilitate improvement in dietary intake, modest weight loss, and glycemic control. The availability of effective treatments gives patients with diabetes choices in meeting their self-care needs.     

Food Insecurity and Dietary Intake among College Students with Unlimited Meal Plans at a Large,Midwestern University

BackgroundFood insecurity, a state of not being able to consistently access nutritious food due to financial constraints, has been associated with poor dietary intake among college students. The extent to which campus food resources contribute to this association is unknown.ObjectivesThis study examined the association between food insecurity and dietary intake in a sample of undergraduate students with unlimited meal plans and dining hall access at a large, public Midwestern university.DesignThe study design is cross-sectional. The data used are baseline data from a broader sugar-sweetened beverage intervention study that were collected using a Qualtrics survey prior to the intervention.Participants/settingThe sample consisted of 1033 undergraduate students recruited from 3 dining halls. The data were collected in November 2018.Main outcome measuresFood security was assessed using the 6-item Short Form Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute 26-item Dietary Screener Questionnaire and the Beverage Intake Questionnaire-15.Statistical analyses performedGeneralized linear regression models were used to examine differences in dietary intake by students’ food security status, adjusting for students’ sociodemographic characteristics.ResultsIn the sample, 14% of students were food-insecure. After adjusting for sociodemographic variables, food-insecure students reported 9% lower intake of fruits (P = 0.02), 9% lower intake of vegetables (P < 0.001), 10% higher intake of dairy (P = 0.002), 6% higher intake of total added sugars (P = 0.01), 10% higher intake of added sugars from sugar-sweetened beverages (P = 0.01), 4% higher intake of calcium (P = 0.01), and 4% lower intake of fiber (P = 0.01) compared with food-secure students. With respect to beverage intake, food-insecure students had 56% higher intake of total sugar-sweetened beverages (P = 0.002), which was driven by 185% higher intake of energy and sports drinks (P = 0.001), and 121% higher intake of sweetened teas (P = 0.001).ConclusionsDespite having identical food resources within campus dining halls, there were significant differences in the diets of college students by food security status.     

Paper-filtered coffee increases cholesterol and inflammation biomarkers independent of roasting degree: A clinical trial

ObjectiveThe aim of this study was to compare the effects of medium light roast (MLR) and medium roast (MR) paper-filtered coffee on cardiovascular risk factors in healthy volunteers.MethodsThis randomized crossover trial compared the effects of consuming three or four cups (150 mL) of MLR or MR coffee per day for 4 wk in 20 healthy volunteers. Plasma lipids, lipoprotein(a) (Lp[a]), total homocysteine, and endothelial dysfunction–related inflammation biomarkers, serum glycemic biomarkers, and blood pressure were measured at baseline and after each intervention.ResultsBoth roasts increased plasma total cholesterol, low-density lipoprotein-cholesterol, and soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations (10%, 12%, and 18% for MLR; 12%, 14%, and 14% for MR, respectively) (P < 0.05). MR also increased high-density lipoportein-cholesterol concentration by 7% (P = 0.003). Plasma fibrinogen concentration increased 8% after MR intake (P = 0.01), and soluble E-selectin increased 12% after MLR intake (P = 0.02). No changes were observed for Lp(a), total homocysteine, glycemic biomarkers, and blood pressure.ConclusionModerate paper-filtered coffee consumption may have an undesirable effect on plasma cholesterol and inflammation biomarkers in healthy individuals regardless of its antioxidant content.     

The relationship between malnutrition parameters and pressure ulcers in hospitals and nursing homes

ObjectivesPressure ulcers (PU) remain a major health care problem throughout the world. Although malnutrition is considered to be one of the intrinsic risk factors for PU, more evidence is needed to identify the exact relation between PU and malnutrition. This study aims to identify whether there exists a relationship between PU and malnutrition in hospitals and nursing homes.MethodsA cross-sectional study was performed in April 2007 in hospitals and nursing homes in Germany. PU were assessed using the Braden scale. Malnutrition was assessed by low body mass index (BMI), undesired weight loss, and insufficient nutritional intake.ResultsTwo thousand three hundred ninety-three patients from 29 nursing homes and 4067 patients from 22 hospitals participated in the study. PU in both hospital and nursing home patients were significantly (P < 0.01) related to undesired weight loss (5%–10%). Moreover low nutritional intake and low BMI (<18.5) were also significantly related to PU in hospitals and nursing homes.ConclusionThere is a significant relationship between malnutrition parameters like undesired weight loss, BMI < 18.5, and low nutritional intake and PU.     

Food Insecurity,Poor Diet Quality,and Obesity among Food Pantry Participants in Hartford,CT

ObjectiveExamine relationships between food security, diet quality, and body mass index (BMI) among food pantry users.MethodsConvenience sample of 212 food pantry clients in Hartford, CT from June, 2010 to May, 2011. Main outcomes included food security (United States Department of Agriculture module), fruit and vegetable consumption (Block Screener), and BMI (stadiometer and digital medical scale). Chi-square tests, Spearman correlations, and logistic regression models were analyzed.ResultsOver half of the sample (50.5%) had very low food security. Mean BMI was 29.5 kg/m². Age was positively associated with food security (P < .01). Food-secure participants were twice as likely to eat fruit, vegetables, and fiber as food-insecure participants (P = .04). Women were 4 times as likely to be obese as men (P < .01), yet food insecurity was not associated with obesity in this sample.Conclusions and ImplicationsEnsuring the nutritional adequacy of donated food is an important consideration for food donors and pantry staff.     

The gene–diet interaction,LPL PvuII and HindIII and carbohydrate,on the criteria of metabolic syndrome: KMSRI-Seoul Study

ObjectiveThe objective of this study was to investigate the effects of the interaction between lipoprotein lipase (LPL) PvuII and HindIII haplotypes and carbohydrate intakes on the components of metabolic syndrome (MetSyn) in Koreans.MethodsLPL PvuII and HindIII genotype, LPL mass, triglyceride, high-density lipoprotein cholesterol, blood pressure (BP), waist circumference (WC), insulin, and Homeostasis Model of Assessment - Insulin Resistance were determined using a cross-sectional design in 269 controls and 280 MetSyn patients.ResultsLPL mass was significantly lower in patients with PvuII and HindIII mutant alleles (P2 and H2) and decreased as the number of MetSyn components increased in all PvuII and HindIII haplotypes. Both LPL mass-adjusted WC and systolic BP (SBP) were positively associated with a ratio of percent energy from carbohydrate to percent energy from fat in individuals with P2H2 haplotype. After adjustment for age, sex, and LPL mass, the odds ratio (OR) for excessive WC was higher in carriers of P2H2 in the highest carbohydrate intake tertile compared with carriers of P1H1 in the lowest carbohydrate intake tertile (OR, 6.94; 95% confidence interval [CI], 1.39–34.62). Moreover, the OR for high SBP were higher in carriers of P1H2/P2H1 in the highest carbohydrate intake tertile (OR, 7.84; 95% CI, 1.79–34.46) and in carriers of P2H2 in the highest carbohydrate intake tertile (OR, 4.24; 95% CI, 1.16–15.48) than P1H1 carriers.ConclusionThis study suggests that P2H2 carriers in the highest carbohydrate intake tertile may be at risk for MetSyn because they had increased odds of excessive WC and high SBP.     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.