Effects of 12-week supplementation of <Emphasis Type="Italic">Citrus bergamia</Emphasis> extracts-based formulation CitriCholess on cholesterol and body weight in older adults with dyslipidemia: a randomized,double-blind,placebo-controlled trial

Backgrounds

Recent experiments suggest that Citrus bergamia extracts could benefit people with dyslipidemia and obesity but this needs to be further validated.

Methods

A total of 98 people age-matched older adults (65 years) with elevated blood lipids were enrolled to receive 12-week supplementation of a Citrus bergamia extracts-based formulation (CitriCholess)(n?=?48) and placebo (n?=?50).

Results

No group differences were found in baseline bodyweight, body mass index (BMI), blood cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and glucose levels. CitriCholess supplementation resulted in lower levels than placebo in TG (1.83?±?0.92 vs. 1.95?±?1.34 mmol/L, P?=?0.612), TC (5.14?±?0.98 vs. 5.44?±?0.77 mmol/L, P?=?0.097), and LDL-C (3.13?±?0.74 vs. 3.43?±?0.62 mmol/L, P?=?0.032). Compared to placebo, CitriCholess also resulted in greater reductions in body weight (?0.604?±?0.939 vs. 0.06?±?0.74 kg, P?<?0.01), waist circumferences (?0.60?±?1.349 cm vs. -0.16?±?1.503 cm, P?<?0.01) and BMI (?0.207?±?0.357 vs. 0.025?±?0.274, P?<?0.01). Additionally, females had a significantly higher level of HDL-C than males. TC was significantly correlated with LDL-C, and to a less degree, with TG. TG was inversely correlated with HDL-C. Body weight and waist circumference were negatively correlated with HDL-C and positively correlated with glucose.

Conclusion

12-week supplementation of CitriCholess could benefit lipid metabolism and weight management in old adults with dyslipidemia.

     

Effects of 12-week supplementation of marine Omega-3 PUFA-based formulation Omega3Q10 in older adults with prehypertension and/or elevated blood cholesterol

Backgrounds

To study the effects of supplementation of a marine omega-3 poly-unsaturated fatty acids (n3-PUFA) formulation (Omega3Q10) in older adults with hypertension and/or hypercholesterolemia.

Methods

A total of 97 people were enrolled to receive 12-week supplementation of either Omega3Q10 (n?=?48) or soybean oil (n?=?49). Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and hypertension-related symptoms were determined before and after the supplementation.

Results

There were no baseline differences between the two groups. Omega3Q10 supplementation significantly reduced diastolic blood pressure (DBP) (from 81.6?±?5.3 mmHg to 79.3?±?5.2 mmHg, P?<?0.05). Blood concentrations of TC and LDL-C decreased significantly and blood HDL-C level increased significantly after 12 weeks of Omega3Q10 (5.5?±?0.7 vs. 5.3?±?0.5, P?<?0.05; 3.7?±?0.8 vs. 3.3?±?0.6, P?<?0.05; 1.2?±?0.6 vs. 1.3?±?0.5, P?<?0.05, respectively) and soybean oil supplementation (5.7?±?0.8 vs. 5.6?±?0.7, P?<?0.05; 3.6?±?0.7 vs. 3.4?±?0.8, P?<?0.05; 1.0?±?0.8 vs. 1.2?±?0.7, P?<?0.05, respectively) but no group differences were found. A significantly greater proportion of the people in the Omega3Q10 group became free from headache and palpitations & chest tightness symptoms after the 12-week supplementation compared to that of the soybean oil group (95.5% vs. 71.4%, P?<?0.01; 95.8 vs. 75.5%, P?<?0.01, respectively).

Conclusion

12-week supplementation of Fish oil-based PUFA appear to be more effective in improving DBP and hypertension-related symptoms than soybean oil in old adults with hypertension and hypercholesterolemia although both supplementation improved TC, LDL-C and HDL-C concentrations.

     

Maximal tachycardia and high cardiac strain during night shifts of emergency physicians

Purpose

To compare tachycardia and cardiac strain between 24-hour shifts (24hS) and 14-hour night shifts (14hS) in emergency physicians (EPs), and to investigate key factors influencing tachycardia and cardiac strain.

Methods

We monitored heart rate (HR) with Holter-ECG in a shift-randomized trial comparing a 24hS, a 14hS, and a control day, within a potential for 19 EPs. We also measured 24-h HR the third day (D3) after both shifts. We measured perceived stress by visual analog scale and the number of life-and-death emergencies.

Results

The 17 EPs completing the whole protocol reached maximal HR (180.9?±?6.9 bpm) during both shifts. Minutes of tachycardia?>100 bpm were higher in 24hS (208.3?±?63.8) than in any other days (14hS: 142.3?±?36.9; D3/14hS: 64.8?±?31.4; D3/24hS: 57.6?±?19.1; control day: 39.2?±?11.6 min, p?<?.05). Shifts induced a cardiac strain twice higher than in days not involving patients contact. Each life-and-death emergency enhanced 26 min of tachycardia?≥100 bpm (p?<?.001), 7 min?≥?110 bpm (p?<?.001), 2 min?≥?120 bpm (p?<?.001) and 19 min of cardiac strain?≥30% (p?=?.014). Stress was associated with greater duration of tachycardia?≥100, 110 and 120 bpm, and of cardiac strain?≥30% (p?<?.001).

Conclusion

We demonstrated several incidences of maximal HR during shifts combined with a high cardiac strain. Duration of tachycardia were the highest in 24hS and lasted several hours. Such values are comparable to those of workers exposed to high physical demanding tasks or heat. Therefore, we suggest that EPs limit their exposure to 24hS. We, furthermore, demonstrated benefits of HR monitoring for identifying stressful events. ClinicalTrials.gov identifier: NCT01874704.

     

The impact of communicating cardiovascular risk in type 2 diabetics on patient risk perception,diabetes self-care,glycosylated hemoglobin,and cardiovascular risk

Aim

This study aims to investigate the effect of a cardiovascular risk (CVR) communication intervention on the accuracy of CVR perception, diabetes self-care (DSC), glycosylated hemoglobin percent (HbA1c%), and CVR in patients with type 2 diabetes mellitus (T2DM).

Subject and methods

A randomized controlled trial was performed in T2DM patients attending the family medicine outpatient clinic in Suez Canal University Hospital, Ismailia. The intervention group (n?=?107) received a comprehensive CVR communication. Control subjects (n?=?107) received the standard usual care. The outcome measures were: accuracy of risk perception, DSC, HbA1c%, and CVR scores. Patients were investigated at baseline and 3 months after the intervention. Differences between arms were assessed using chi-square and Student's t-test, and within-group differences were assessed using the paired t-test and McNemar’s test.

Results

After the intervention, the accuracy rate of risk perception was significantly improved (from 44.9 % to 89.7 %) in the intervention group with excellent improvement in agreement between perceived and objective risk (kappa?±?SE 83.7?±?4.4 %, p?<?0.000). Diabetes self-care sum scale scores and HbA1c% showed statistically significant improvements for within-intervention group comparisons and between groups after the intervention (p?<?0.000). Cardiovascular risk scores showed minimal, not statistically significant improvement in both groups.

Conclusion

Our intervention significantly improved CVR perception, DSC, and HbA1c% in patients with T2DM. Further research is needed to investigate the effectiveness of applying more complex and longer lifestyle interventions and to confirm the credibility and sustainability of improvement.

     

Unexpected profile of sphingolipid contents in blood and bone marrow plasma collected from patients diagnosed with acute myeloid leukemia

Background

Impaired apoptotic pathways in leukemic cells enable them to grow in an uncontrolled way. Moreover, aberrations in the apoptotic pathways are the main factor of leukemic cells drug resistance.

Methods

To assess the presence of potential abnormalities that might promote dysfunction of leukemic cells growth, HPLC system was used to determine sphingosine (SFO), sphinganine (SFA), sphingosine-1-phosphate (S1P) and ceramide (CER) concentration in the blood collected from patients diagnose with acute myeloblastic leukemia (AML; n?=?49) and compare to values of control (healthily) group (n?=?51). Additionally, in AML group concentration of SFO, SFA, S1P and CER was determined in bone marrow plasma and compared to respective values in blood plasma. The concentration of S1P and CER binding protein – plasma gelsolin (GSN) was also assessed in collected samples using immunoblotting assay.

Results

We observed that in AML patients the average SFO, SFA and CER concentration in blood plasma was significantly higher (p?<?0.001) compare to control group, when blood plasma S1P concentration was significantly lower (p?<?0.001). At the same time the CER/S1P ratio in AML patient (44.5?±?19.4) was about 54% higher compare to control group (20.9?±?13.1). Interestingly the average concentration of S1P in blood plasma (196?±?13 pmol/ml) was higher compare to its concentration in plasma collected from bone marrow (154?±?21 pmol/ml).

Conclusions

We hypothesize that changes in profile of sphingolipids concentration and some of their binding protein partners such as GSN in extracellular environment of blood and bone marrow cells in leukemic patients can be targeted to develop new AML treatment method(s).

     

Decreased lipogenesis-promoting factors in adipose tissue in postmenopausal women with overweight on a Paleolithic-type diet

Purpose

We studied effects of diet-induced postmenopausal weight loss on gene expression and activity of proteins involved in lipogenesis and lipolysis in adipose tissue.

Methods

Fifty-eight postmenopausal women with overweight (BMI 32.5?±?5.5) were randomized to eat an ad libitum Paleolithic-type diet (PD) aiming for a high intake of protein and unsaturated fatty acids or a prudent control diet (CD) for 24 months. Anthropometry, plasma adipokines, gene expression of proteins involved in fat metabolism in subcutaneous adipose tissue (SAT) and lipoprotein lipase (LPL) activity and mass in SAT were measured at baseline and after 6 months. LPL mass and activity were also measured after 24 months.

Results

The PD led to improved insulin sensitivity (P?<?0.01) and decreased circulating triglycerides (P?<?0.001), lipogenesis-related factors, including LPL mRNA (P?<?0.05), mass (P?<?0.01), and activity (P?<?0.001); as well as gene expressions of CD36 (P?<?0.05), fatty acid synthase, FAS (P?<?0.001) and diglyceride acyltransferase 2, DGAT2 (P?<?0.001). The LPL activity (P?<?0.05) and gene expression of DGAT2 (P?<?0.05) and FAS (P?<?0.05) were significantly lowered in the PD group versus the CD group at 6 months and the LPL activity (P?<?0.05) remained significantly lowered in the PD group compared to the CD group at 24 months.

Conclusions

Compared to the CD, the PD led to a more pronounced reduction of lipogenesis-promoting factors in SAT among postmenopausal women with overweight. This could have mediated the favorable metabolic effects of the PD on triglyceride levels and insulin sensitivity.

     

Quality of life and stability of tooth color change at three months after dental bleaching

Purpose

Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients’ aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique.

Methods

The patients were randomly divided into two groups according to the bleaching agent used: G1?=?hydrogen peroxide 35% (n?=?25) and G2?=?carbamide peroxide 37% (n?=?25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires.

Results

The color change (ΔE) values at 1 month were G1?=?16.80?±?6.07 and G2?=?14.09?±?4.83. These values remained stable until the third month after treatment (p?>?0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p?<?0.05). This status was maintained through the third month after treatment.

Conclusions

Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

     

Lifestyle health risk factors and multiple non-communicable diseases among the adult population in India: a cross-sectional study

Aim

This article investigated the relationship between lifestyle factors and the co-occurrence of multiple chronic non-communicable diseases (NCDs).

Subjects and methods

Cross-sectional analysis of results from the World Health Organization Study on Global Ageing and Adult Health (WHO SAGE) was conducted in India in 2007. Subjects were aged 18 years and older. Multiple NCD morbidity was measured by a simple count of self-reported chronic NCDs from a list of nine. Five lifestyle risk factors were evaluated: (1) tobacco use, (2) alcohol consumption, (3) fruit and vegetable consumption, (4) physical activity, and (5) body mass index (BMI). Each lifestyle risk factor was given a score of 1 (unhealthy) if the recommended behavioral targets were not achieved and 0 otherwise. The combined effect of unhealthy lifestyle was evaluated using the total sum of scores.

Results

The overall mean number ± SD of unhealthy lifestyle factors in the study population was 2.3?±?1.14. Individually, the likelihood of reporting multiple chronic NCDs was greater among adults with low or high BMI (1.35, p?<?0.05), alcohol consumption (1.36, p?<?0.10), low intake of fruits and vegetables (1.05, p?<?0.10), and tobacco users (1.62, p?<?0.01). When combined, the risk of reporting multiple NCDs increased significantly with the increased exposure to the number of unhealthy lifestyle factors.

Conclusion

The present study provides support to the association of lifestyle factors and multiple NCD morbidity. Accumulation of a greater number of unhealthy lifestyle factors progressively increased the likelihood of suffering from multiple NCDs among adults in India.

     

Effects of a 9-month resistance training intervention on quality of life,sense of coherence,and depressive symptoms in older adults: randomized controlled trial

Purpose

(1) To determine the effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults, and (2) to compare effects between different training frequencies.

Methods

Men and women aged 65–75 (N?=?106) were randomized to four groups according to training frequency: training groups RT1 (n?=?26), RT2 (n?=?27), and RT3 (n?=?28) and non-training control group (n?=?25). All training groups attended supervised resistance training twice a week for 3 months. For the following 6 months, they continued training with different frequencies (1, 2 or 3 times per week). Psychological functioning was measured by quality of life (WHOQOL-Bref), sense of coherence (Antonovsky’s SOC-13), and depressive symptoms (Beck’s Depression Inventory II). Measurements were conducted at baseline and 3 and 9 months after baseline. The effects of the intervention were analyzed using generalized estimating equations (GEE).

Results

After 3 months, there was an intervention effect on environmental quality of life (group?×?time p?=?.048). Between 3 and 9 months, environmental quality of life decreased among RT1 compared to RT2 and RT3 (group?×?time p?=?.025). Between baseline and 9 months, environmental quality of life increased in RT2 compared to all other groups (group?×?time p?=?.011). Sense of coherence increased in RT2 compared to the control group and RT3 (group?×?time p?=?.032).

Conclusion

Resistance training is beneficial for environmental quality of life and sense of coherence. Attending resistance training twice a week seems to be the most advantageous for these aspects of psychological functioning.

     

Physical activity of German children during different segments of the school day

Aim

This study objectively investigated the amount and intensity of German primary school children’s physical activity (PA) during different segments of the school day and explored the contribution of physical education (PE) and break times to daily moderate to vigorous PA (MVPA).

Subject and methods

PA of 294 children (7.1?±?0.7 years, 48 % male) was objectively measured for 6 days using Actiheart®. Based on children’s timetables, break times and PE periods were determined and PA was calculated individually and subsequently classified in light (1.5–3 MET), moderate (3–6 MET) and vigorous (>6 MET) intensities. Weight status was determined during a school visit.

Results

Children spent 133?±?61 min in MVPA; on weekdays, this amount increased significantly (141?±?66 min, p?≤?0.01). 45.9 % of children reached physical activity guidelines of 60 min of MVPA daily, with boys achieving this goal significantly more often than girls (65.6 vs. 28.7 %, respectively; p?≤?0.01). PE lessons and break times accounted for 15?±?13 min (12.7 %) and 7?±?6 min (5.8 %) of daily MVPA, respectively. On days with PE, children spent 144?±?68 min in MVPA, whereas on days without PE, this time decreased significantly to 122?±?63 min (p?≤?0.01).

Conclusion

The findings suggest that segments such as PE lessons and morning breaks are important sources for MVPA for boys and girls. This should therefore be considered for policies, timetables and curriculums in order to offer sufficient opportunities for children to be physically active during the school day.

     

Impact of care at foster homes on the health-related quality of life of HIV-infected children and adolescents: a cross-sectional study from India

Purpose

To assess the impact of care at foster homes on the health-related quality of life (HRQOL) of children living with HIV (CLHIV), attending a referral ART Centre, and to compare their HRQOL with children living in their own homes.

Methods

A cross-sectional study was conducted in 144 CLHIV between 5 and 18 years of age, attending a referral ART Centre in South India to assess their HRQOL using the standard PedsQL? 4.0 questionnaire. Data were then analysed to compare the HRQOL of children living in foster homes to those children living in their own homes. The child report and the parent proxy-report on the child’s HRQOL were also compared to see for any differences in their perspectives.

Results

56.25% CLHIV were brought up in different foster homes. In the child’s self-report, the mean HRQOL was higher for children living in foster homes [physical score (76.54?±?12.40), psychosocial score (71.41?±?12.40) and total score (73.20?±?11.13)] when compared to children living in their own homes [physical score (75.09?±?14.76), psychosocial score (70.60?±?13.48) and total score (72.17?±?12.00)]. There was no statistically significant difference in the HRQOL between these two groups (p?>?0.05). In the parent proxy-report also, there was no statistically significant difference in the HRQOL in all the three scores. The child self-report depicted a significantly higher HRQOL in all the domains compared to the parent proxy-report (p?<?0.05).

Conclusions

HRQOL of children living in foster homes is at par with the quality of life enjoyed by children living in their own homes. Foster care manages to provide a reasonable HRQOL in CLHIV, and has become an inseparable component of quality health care delivery for these children.

     

Relationships between hydration biomarkers and total fluid intake in pregnant and lactating women

Introduction

Previous research established significant relationships between total fluid intake (TFI) and urinary biomarkers of the hydration process in free-living males and females; however, the nature of this relationship is not known for pregnant (PREG) and lactating (LACT) women.

Purpose

To determine the relationship between urinary and hematological hydration biomarkers with TFI in PREG and LACT.

Methods

Eighteen PREG/LACT (age: 31 ± 3 years, pre-pregnancy BMI: 24.26 ± 5.85 kg m^?2) collected 24-h urine samples, recorded TFI, and provided a blood sample at 5 time points (15 ± 2, 26 ± 1, 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation); 18 pair-matched non-pregnant (NP), non-lactating (NL) women (age: 29 ± 4 years, BMI: 24.1 ± 3.7 kg m^?2) provided samples at similar time intervals. Twenty-four-hour urine volume (U _VOL), osmolality (U _OSM), specific gravity (U _SG), and color (U _COL) were measured. Hematocrit, serum osmolality (S _OSM), and serum total protein (S _TP) were measured in blood.

Results

Significant relationships were present between TFI and urinary biomarkers in all women (P < 0.004); these relationships were not different between PREG and NP, and LACT and NL, except U _VOL in PREG (P = 0.0017). No significant relationships between TFI and hematological biomarkers existed (P > 0.05).

Conclusion

Urinary biomarkers of hydration, but not hematological biomarkers, have a strong relationship with TFI in PREG, LACT, NP, and NL women. These data suggest that urinary biomarkers of hydration reflect TFI during pregnancy and breast-feeding.

     

Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus

Purpose

We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).

Methods

A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group’s five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.

Results

The mean EQ-5D-5L index scores were 0.971?±?0.082 among individuals with unilateral DR and 0.970?±?0.145 among those with bilateral DR, which were lower compared with those without DR (0.986?±?0.045, P?=?0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR]?=?0.16, P?=?0.02, comparing participants with unilateral vs. no DR; OR?=?0.11; P?=?0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P?>?0.05).

Conclusion

Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities.

     

Can single disease payment system based on clinical pathway reduce hospitalization costs in rural area? A case study of uterine leiomyoma in Anhui,China

Background

Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example.

Methods

The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years.

Results

The total hospitalization expenditure (per-time) dropped from 919.08?±?274.92 USD to 834.91?±?225.29 USD and length of hospital stay reduced from 9.96?±?2.39?days to 8.83?±?1.95?days(P?<?0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P?<?0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (??0.360); while the CV of materials expense increased the most (0.186).

Conclusion

There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.

     

The longitudinal course of depression symptomatology following a palliative rehabilitation program

Purpose

Patients with advanced cancer have increased life expectancy but suffer from ongoing burden. Depressive symptomatology is their most common mental health concern. The Ottawa Palliative Rehabilitation Program (PRP) offers rehabilitation for this population. It offers 8 weeks of individualized interdisciplinary rehabilitation, post cancer treatment. Interventions include medical (physician and nurse), physiotherapy, occupational therapy, dietary, and social work using a general self-efficacy framework. Pilot data suggest benefits in a range of domains, including ratings of feeling “depressed.” We examined whether reduced symptomatology was maintained 3 months after PRP completion.

Methods

Participants with advanced heterogeneous cancers who completed the PRP were mailed the Hospital Anxiety and Depression Scale (among others) 3-month post-PRP (n?=?44). Demographic and medical information were obtained from patient files.

Results

There was a significant linear trend (mean T1: 6.79?±?2.29; T2: 5.23?±?3.06; T3: 4.59?±?3.34; p?=?0.007) with statistically and clinically significant decreases in reported depressive symptomatology between T1 and T2 (p?=?0.042) and T1 and T3 (p?=?0.007). There was a significant decreases in number of cases reporting symptomatology scores in the clinical range from T1 to T3 (p?=?0.038).

Conclusion

Patients who undergo a palliative rehabilitation program may experience relief of mild depressive symptomatology, maintainable 3-month post-PRP. The sample was exhibiting mild symptomatology and these results may not be generalizable to those with higher scores; a lack of specialized psychosocial clinician may have affected the acquired sample. Experimental designs are needed to more thoroughly compare these findings to independent rehabilitation interventions.

     

The acute effects of dietary carbohydrate reduction on postprandial responses of non-esterified fatty acids and triglycerides: a randomized trial

Background

Postprandial non-esterified fatty acid (NEFA) and triglyceride (TG) responses are increased in subjects with type 2 diabetes mellitus (T2DM) and may impair insulin action and increase risk of cardiovascular disease and death. Dietary carbohydrate reduction has been suggested as non-pharmacological therapy for T2DM, but the acute effects on NEFA and TG during subsequent meals remain to be investigated.

Methods

Postprandial NEFA and TG responses were assessed in subjects with T2DM by comparing a carbohydrate-reduced high-protein (CRHP) diet with a conventional diabetes (CD) diet in an open-label, randomized, cross-over study. Each diet was consumed on two consecutive days, separated by a wash-out period. The iso-caloric CRHP/CD diets contained 31/54 E% from carbohydrate, 29/16 E% energy from protein and 40/30 E% from fat, respectively. Sixteen subjects with well-controlled T2DM (median HbA_1c 47?mmol/mol, (37–67?mmol/mol) and BMI 30?±?4.4?kg/m²) participated in the study. NEFA and TG were evaluated following breakfast and lunch.

Results

NEFA net area under curve (AUC) was increased by 97?±?38?μmol/Lx270 min (p?=?0.024) after breakfast but reduced by 141?±?33?μmol/Lx180 min (p?<?0.001) after lunch on the CRHP compared with CD diet. Likewise, TG net AUC was increased by 80?±?28?μmol/Lx270 min (p?=?0.012) after breakfast but reduced by 320?±?60?μmol/Lx180 min (p?<?0.001) after lunch on the CRHP compared with CD diet.

Conclusions

In well-controlled T2DM a modest reduction of dietary carbohydrate with a corresponding increase in protein and fat acutely reduced postprandial serum NEFA suppression and increased serum TG responses after a breakfast meal but had the opposite effect after a lunch meal. The mechanism behind this second-meal phenomenon of CRHP diet on important risk factors for aggravating T2DM and cardiovascular disease awaits further investigation.

Trial registration

The study was registered at clinicaltrials.gov ID: NCT02472951. https://clinicaltrials.gov/ct2/show/NCT02472951. Registered June 16, 2015.