Fat nutrition and diet in childhood

This paper discusses the nutritional requirements for fat in infants and children in the light of the dietary alterations recently proposed by the Inter-Society Commission on Heart Disease Resources. It is not well known what the requirement for total fat and for serum cholesterol level during the first year of life should be. It is known that the only proved requirement for fat is linoleic acid, and that a logical fat intake would be that supplied by breast milk. 80% of American infants are fed with formulas which are not supplemented with the essential vitamin E. After infancy fat requirements change, and body stores are sufficient to insure against fatty acid deficiency. The dietary intake of American children is high in quantities of saturated fats and cholesterol, possibly leading to atherosclerosis later in life. The question is whether this cholesterogenic diet is harmful to all Americans or to a limited number of clinically discernible subjects, i.e., those children genetically predisposed to hyperlipoproteinimia. Such predisposition could be diagnosed at birth by screening of the umbilical cord blood, and checked again at school age and at adolescence. Thus, although limitation of a cholesterogenic diet to prevent obesity is reasonable, restricting cholestrogenic foods in everyone for the unproved distant goal of reducing atherosclerosis is dubious.     

Fat intake and food choices during weight reduction with diet, behavioural modification and a lipase inhibitor

OBJECTIVE: To study the composition of fat intake and fat-rich meals consumed during a trial in which obese subjects were treated with a lipase-inhibitor or placebo, with emphasis on food choices and eating hours. DESIGN: Patients were instructed to record all food and drink taken for four days prior to each dietician visit. The food diaries from all scheduled 15 treatment visits were analysed for nutritional content and composition and for temporal distribution. All meals containing 25 g of fat were defined as fat-rich. SUBJECTS: Twenty-eight women and six men, mean age 45.2 +/- 10.9 (SD) years with a mean body mass index of 37.3 +/- 3.3 (SD) kg m-2 at the beginning of the study. RESULTS: Fat intake, both as absolute weight and as energy % was generally higher in the placebo group but no significant trend over time could be seen. Fat rich meals were increased by 59% towards the end of the study. Most fat rich meals were eaten at lunch and dinner. Cooking fat, fatty sauces, meat dishes and cheese contributed to the major proportion of fat, both for placebo and drug treated subjects. No major changes were seen in food choice over time. CONCLUSION: A lipase inhibitor may affect the amount of fat ingested but does not seem to change major sources of fat. The typical fat-rich meal consumed by these subjects was a meat dish, consumed in the evening.     

Long-term diet modification and platelet activity

Platelet activity was assessed in a sub-sample of 56 participants in the MRC Diet and Reinfarction Trial (DART). Men whose diets contained a high ratio of polyunsaturated to saturated fatty acids (a P:S ratio of greater than 0.5) showed reduced secondary platelet aggregation to adenosine diphosphate (ADP) in platelet-rich plasma (PRP), and diminished platelet aggregation to ADP in whole blood. A trend of reduced secondary platelet aggregation to ADP with increasing dietary eicosapentaenoic acid was noted, but this was not statistically significant. The results of this study and the MRC Diet and Reinfarction Trial suggest a mediatory role for platelet activity in the relationship between diet and ischaemic heart disease.     

Behaviour modification in obese subjects with type 2 diabetes mellitus.

We have followed prospectively, 46 obese, type 2 diabetic patients for a 55-week period, in order to evaluate the efficiency of an educational programme based on behaviour modification to enhance weight loss and changes of other cardiovascular risk factors. No patient received pharmacological treatment during the study. At the end of the follow-up the patients obtained an average weight loss of 9.250 kg (range: 0.500-17.500 kg); the BMI was reduced from 34.2 +/- 0.8 kg/m2 to 30.6 +/- 1.1 kg/m2 (P less than 0.01); fasting serum glucose descended from 7.9 +/- 0.4 to 6.1 +/- 0.5 mM (P less than 0.05); SBP (systolic blood pressure) decreased from 145.7 +/- 3 to 126.4 +/- 5.1 mmHg (P less than 0.01); DBP (diastolic blood pressure) decreased from 83.5 +/- 2.5 to 65 +/- 2.6 mmHg (P less than 0.01); triglyceride levels were lowered from 164.5 +/- 12 to 109.7 +/- 10 mg/dl (P less than 0.01); HDL-cholesterol levels increased from 1.27 +/- 0.05 to 1.53 +/- 0.12 mM (P less than 0.01). Serum glucose 2 h after a 75 g glucose oral load decreased from 14.9 +/- 0.6 to 12.7 +/- 0.9 mM (P less than 0.05) on week 35 of follow-up. Twelve patients no longer presented a diabetic curve (8 normal oral glucose tolerance test (OGTT) curves, and 4 impaired glucose tolerance (IGT) curves). No significant changes in the parameters studied were obtained in the group of patients on conventional treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of type 2 diabetes prevention through diet modification in people with impaired glucose regulation: A population-based study

PurposeA few interventional studies to date have specifically assessed the association between dairy products and/or sugar consumption and the risk of type 2 diabetes mellitus (T2D) incidence. The aim of this study was to assess the effectiveness of diet modification in people with impaired glucose regulation (IGR) as defined by a glucose tolerance test (GTT).MethodsA quasi-experimental study design was used for this study. A total of 318 randomly selected 18-year-old or older participants from the rural area of the Kyiv region of Ukraine who had not been registered as T2D patients before underwent GTT between June 2013 and June 2017. For those who had been diagnosed with IGR, World Health Organization (WHO)/International Diabetes Federation criteria were used. Of 318 participants screened for T2D, 123 (74% of them females) were diagnosed with IGR. They were aged 18 to 79 years old with a median (Q_I – Q_III) age of 62 (52–68) years. They were repeatedly tested during the study and completed a questionnaire on average 2.8 (1.1) years (standard deviation [SD]), after they had received their lifestyle-based T2D prevention recommendations. In addition to basic recommendations, they were advised to consume approximately 200 g of low-fat dairy products and less than 25 g of sugar daily. Cases of screen-detected diabetes mellitus (SDDM) were diagnosed and reported as an outcome variable if a fast capillary blood glucose level reached 6.1 mmol/L and above. To define the association between implementation of recommendations and the risk of SDDM, the Cox proportional-hazards regression analysis was used.ResultsDuring the study observation period, 56 (45.5%) of 123 IGR-positive participants were recognized as SDDM cases. Those individuals with IGR (n = 111) who confirmed their adherence to preventive recommendations had a significantly lower risk of identifying SDDM, age- and gender-adjusted hazard ratio (HR) 0.26 (95% C?; 0.09–0.72). This effect appears to be related to the recommendation to reduce the daily intake of sugar to less than 25 g (n = 99), corresponding to age- and gender-adjusted HR 0.44 (95% C?; 0.2–0.99). We cannot prove that increasing consumption of dairy products, vegetables, and fruit or increased physical activity had similar effectiveness.ConclusionsAfter 2.8 years of follow-up, the individuals who are IGR-positive and who confirmed their adherence to lifestyle-based preventive recommendations had a significantly lower risk of identifying SDDM. This effect appears to be related to recommendations to reduce the daily intake of sugar to less than 25 g.     

High carbohydrate diet in the treatment of diabetes mellitus

Summary Restriction of carbohydrate in the diet of diabetics is widely advocated and practised in the Western Countries, but poses a special problem in the treatment of vegetarian diabetic patients in India, since cereals like wheat and rice constitute the major bulk of their diet. Drastic changes in the diet may be needed to curtail carbohydrate intake. 25 adult-onset diabetic patients were therefore allowed to eat their customary diet, and the control of their diabetes was studied. Restrictions were made only in the total caloric intake, where needed, by curtailing fats. The average carbohydrate consumption was 342 g, constituting 67% of the average total caloric intake. Prompt and adequate clinical and biochemical control of diabetes could be achieved by a moderate dose of oral hypoglycaemie agents or insulin, and maintained during their followup period of 6 months to 8 years without any difficulty despite their high carbohydrate intake. Avantages of such a diet are enumerated.

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Kohlenhydratreiche Diät in der Behandlung des Diabetes mellitus

Zusammenfassung Die Einschränkung der Kohlenhydrate in der Diät des Diabetikers wird in den Ländern des Westens viel empfohlen und geübt; sie bietet aber bei der Behandlung von diabetischen Vegetariern in Indien spezielle Probleme, da bei ihnen Getreideprodukte wie Weizen und Reis den überwiegenden Teil der Diät ausmachen. Eine Einschränkung der Kohlenhydratzufuhr würde daher bei diesen Patienten auf eine ausgesprochen drastische Umstellung der Diät hinauslaufen. Bei 25 Diabetikern vom Erwachsenen-Typ wurde daher die Einstellung des Diabetes kontrolliert, während sie ihre gewohnte Kost beibehielten. Soweit eine Kalorieneinschränkung erforderlich war, erfolgte sie durch Verringerung der Fettzufuhr. Der durchschnittliche Kohlenhydratverbrauch belief sich dabei auf 342 g, d.h. 70% der mittleren Kalorienaufnahme/Tag. Trotz der hohen KH-Zufuhr ließ sich bei diesen Patienten ohne Schwierigkeiten mit mittleren Dosen von oralen Antidiabetika oder Insulin eine gute Diabetes-Einstellung während der Untersuchungsperiode, die sieh über 1/2–8 Jahre ausdehnte, erzielen. Die Vorteile einer derartigen Diät werden aufgeführt.

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Alimentation riche en hydrates de carbone au cours du traitement du diabète sucré

Résumé La restriction des hydrates de carbone dans le régime des diabétiques est largement recommandée et pratiquée dans les pays occidentaux, mais pose un problème particulier dans le traitement des diabétiques végétariens en Inde, car les céréales telles que le blé et le riz constituent la majeure partie de leur régime. Des changements énergiques dans le régime peuvent être nécessaires pour diminuer la prise d'hydrates de carbone. 25 diabétiques adultes ont donc été autorisés à suivre leur régime habituel, et l'équilibre de leur diabète a été étudié. Les restrictions étaient faites seulement dans l'apport calorique total, quand cela était nécessaire, par réduction des matières grasses. La consommation moyenne d'hytrates de carbone était de 342 g, constituant 67% de l'apport calorique total moyen. Un bon contrôle clinique et biochimique du diabète pouvait être réalisé par l'administrationd'une dose modérée d'agents hypoglycémiants oraux ou d'insuline, et maintenu sans difficulté pendant la période d'observation allant de 6 mois à 8 ans, malgré l'apport élevé d'hydrates de carbone. Les avantages d'un tel régime sont énumérés.

     

Glycotoxins in the diet promote diabetes and diabetic complications

Oxidant stress underlies diabetes and diabetic complications, including cardiovascular, renal, and retinal disease. Advanced glycation end products (AGEs), or glycotoxins, are a significant contributor to oxidant stress in diabetes. The diet is a major, unrecognized source of AGEs. Importantly, reduction of dietary AGEs decreases circulating inflammatory markers in both diabetic patients and prediabetic patients and complications in animal models. This beneficial outcome requires only a 50% decrease in dietary AGEs, making this necessary intervention practical and inexpensive.     

Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus.

AIMS: To compare the effects of a high-carbohydrate (CHO) diet and a high-monounsaturated fatty acid (MUFA) diet on LDL oxidative resistance in free-living individuals with Type 2 diabetes mellitus. METHODS: Twenty-two men and women out-patients with Type 2 diabetes, with mean age 61 years and in fair metabolic control (HbA1c<8.0%), were enrolled at a university hospital lipid clinic in a randomized, crossover feeding trial comparing two isocaloric diets for 6 weeks each: CHO (fat, 28% energy) and MUFA (fat, 40% energy) based on virgin olive oil. Outcome measurements were changes in LDL susceptibility to oxidation, body weight, glycaemic control, and lipoprotein profiles. RESULTS: Planned and observed diets were well matched. Participants preferred the MUFA diet over the CHO diet. The lag time of conjugated diene formation during Cu2+-induced LDL oxidation was similar after the CHO and MUFA diets (36.4 +/- 12.2 min and 36.0 +/- 13.7 min, respectively). Body weight, glycaemic control, total triglycerides, and total, LDL- and HDL-cholesterol levels also were similar after the two diets. Compared with the CHO diet, the MUFA diet lowered VLDL-cholesterol by 35% (P=0.023) and VLDL triglyceride by 16% (P=0.016). CONCLUSIONS: Natural food-based high-CHO and high-MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes. A MUFA diet is a good alternative to high-CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance.     

Beneficial effect of a low glycaemic index diet in type 2 diabetes.

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well-controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol l-1 using a randomized, crossover design. Patients were given pre-weighed diets (59% energy as carbohydrate, 21% fat, and 24 g 1000-kcal-1 dietary fibre) for two 2-week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 +/- 108 (+/- SE) vs 204 +/- 112 mmol min l-1; p less than 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2-week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 +/- 0.12 vs 3.28 +/- 0.16 mmol l-1, p less than 0.05, and 5.5 +/- 0.4 vs 5.9 +/- 0.5 mmol l-1, p less than 0.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)