Habitual Dietary Fiber Intake,Fecal Microbiota,and Hemoglobin A1c Level in Chinese Patients with Type 2 Diabetes

High-fiber diet interventions have been proven to be beneficial for gut microbiota and glycemic control in diabetes patients. However, the effect of a low level of fiber in habitual diets remains unclear. This study aims to examine the associations of habitual dietary fiber intake with gut microbiome profiles among Chinese diabetes patients and identify differential taxa that mediated associations of dietary fiber with HbA1c level. Two cross-sectional studies and one longitudinal study were designed based on two follow-up surveys in a randomized trial conducted during 2015–2017. The study included 356 and 310 participants in the first and second follow-ups, respectively, with 293 participants in common in both surveys. Dietary fiber intake was calculated based on a 3-day 24-h diet recall at each survey and was classified into a lower or a higher group according to the levels taken based on the two surveys using 7.2 g/day as a cut-off value. HbA1c was assayed to assess glycemic status using a cut-off point of 7.0% and 8.0%. Microbiome was profiled by 16S rRNA sequencing. A high habitual dietary fiber intake was associated with a decrease in α-diversity in both the cross-sectional and longitudinal analyses. At the first follow–up, phylum Firmicutes and Fusobacteria were negatively associated with a higher dietary fiber intake (p < 0.05, Q < 0.15); at the second follow-up, genus Adlercreutzia, Prevotella, Ruminococcus, and Desulfovibrio were less abundant in patients taking higher dietary fiber (p < 0.05, Q < 0.15); genus Desulfovibrio and Ruminococcaceae (Unknown), two identified differential taxa by HbA1c level, were negatively associated with dietary fiber intake in both the cross-sectional and longitudinal analyses, and mediated the dietary fiber-HbA1c associations among patients taking dietary fiber ≥ 7.2 g/day (mediation effect β [95%CI]: −0.019 [−0.043, −0.003], p = 0.018 and −0.019 [−0.046, −0.003], p = 0.016). Our results suggest that habitual dietary fiber intake has a beneficial effect on gut microbiota in Chinese diabetes patients. Further studies are needed to confirm our results.     

糖化血红蛋白对妊娠糖尿病的筛查和诊断价值研究

目的探讨糖化血红蛋白(HbAlc)对妊娠糖尿病(GDM)的筛查、诊断的价值。方法 932名足月单胎妊娠初产妇女在孕24～28周常规行75 g口服糖耐量试验(OGTT)和HbAlc检测,分别对照HbAlc各个切点的OGTT结果,观察不同HbAlc切点的诊断敏感性和特异性。结果 HbAlc在5.5%的敏感性为92.73%,特异性为51.43%;在6.0%的敏感性为72.73%,特异性为88.14%;在6.5%的敏感性为49.09%,特异性为99.77%。HbAlc超过5.5%后GDM的检出率即明显增加。如果考虑单个切点的诊断价值,HbAlc在6.0%为较适宜的切点。但在强调早期发现、干预孕期轻度高血糖的治疗新理念下,其作为筛查标准的敏感性不够。HbAlc≤5.5%的孕妇GDM风险低,HbAlc≥6.5%的孕妇极可能为GDM。HbAlc在5.5%～6.5%的孕妇为HbAlc受损,其GDM发病风险明显增加,须加强孕期监测和管理。结论选择HbAlc在5.5%和6.5%两个切点,保证筛查的高敏感性和诊断的高特异性,可以更好地识别孕期高血糖。     

糖化血红蛋白与2型糖尿病患者慢性并发症的相关性研究

目的探讨糖化血红蛋白(HbA1c)水平与2型糖尿病患者慢性并发症的相关性。方法 92例2型糖尿病患者按有无慢性并发症分为慢性并发症组52例和无慢性并发症组40例,另选70例健康成年人为对照组,对三组对象进行HbA1c、空腹血糖(FBG)测定,并进行分析比较。结果 2型糖尿病患者的HbA1c和FBG明显高于对照组,差异有统计学意义(P<0.01);有慢性并发症患者的HbA1c明显高于无并发症者,差异有统计学意义(P<0.01)。结论糖尿病患者慢性并发症的发生与HbA1c有密切关系,HbA1c的控制有助于预防糖尿病及其慢性并发症的发生。     

The Prospective Associations of Lipid Metabolism-Related Dietary Patterns with the Risk of Diabetes in Chinese Adults

Background: This study aimed to identify lipid metabolism-related dietary patterns with reduced rank regression (RRR) among Chinese adults and examine their associations with incident diabetes. Methods: We derived lipid metabolism-related dietary patterns using an RRR with 21 food groups as predictors as well as total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, body mass index (BMI), and waist circumference from the responses of 17,318 participants from the second resurvey of the China Kadoorie Biobank (CKB). The dietary scores were calculated for the entire cohort. We followed up 479,207 participants for diabetes incidence from the baseline and used multivariable Cox regression models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Two lipid metabolism-related dietary patterns were extracted. The dietary pattern—characterized by high intakes of fish, poultry, and other staples as well as fresh fruit and vegetables—was correlated with a higher BMI, waist circumference, and LDL cholesterol. Participants in the highest quintile (Q5) had a 44% increased risk of diabetes incidence when compared with those in the lowest quintile (Q1) (HR = 1.44; 95% CI: 1.31–1.59). Conclusions: A dietary pattern characterized by high intakes of both animal and plant foods was related to obesity and dyslipidemia and could increase the risk of diabetes incidence.     

2型糖尿病患者糖化血红蛋白与慢性并发症的关系

目的探讨2型糖尿病患者糖化血红蛋白（HbAlc）的控制情况及其与糖尿病慢性并发症的关系。方法对80例2型糖尿病及糖尿病伴有慢性并发症患者与60例正常人的糖化血红蛋白（HbAlc）、空腹血糖（FBG）进行比较。结果2型糖尿病患者的HbAlc与FBG呈显著正相关,差异有统计学意义（P〈O．01）。2型糖尿病伴有慢性并发症患者的HbAlc明显高于无并发症者,差异有统计学意义（P％0．01）。结论糖尿病患者慢性并发症的发生与HbAlc有关,HbAlc的控制,对预防糖尿病及其慢性并发症的发生、发展,提高社区糖尿病患者的生活质量都非常重要。     

Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus

Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297–700) vs. 328 (167–447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13–48) vs. 34 (14–77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D.     

Dietary Changes and Gut Dysbiosis in Children With Type 1 Diabetes

Objective: Gut dysbiosis in type 1 diabetes (T1D), characterized by high Bacteroides proportion, tends to reverse as T1D progresses, without reaching full recovery. Since diet influences microbiota structure, the aim was to evaluate the impact of dietary changes on Bacteroides proportion the first year of T1D evolution.

Methods: Dietary intake was assessed by 24-hour recalls and Bacteroides proportion by quantitative polymerase chain reaction, in 10 Mexican children (11.6 ± 1.92 years) with T1D at baseline and 3, 6 and 9 months' follow-up. Repeated measures analysis of variance and multiple linear regression were performed to compare ingested nutrients in relation with Bacteroides proportion. Effects over time were evaluated by mixed regression models.

Results: Patients with T1D decreased their energy (2621.89 to 1867.85 kcal, p = 0.028), protein (83.06 to 75.17 g, p = 0.012), and saturated fat consumption (40.83 to 25.23 g, p = 0.031) from baseline to 3 months, without posterior changes. Bacteroides proportion increased in the first months and tended to decrease at around 9 months (p > 0.05) and was positively correlated with saturated fat (β = 3.70, p = 0.009) and total carbohydrates (β = 0.73, p = 0.005) at 3 months. Carbohydrate consumption was related to decreased Bacteroides abundance over time (β = ?14.9, p = 0.004), after adjusting for glycosylated hemoglobin.

Conclusions: Besides autoimmunity, diet appears to have a central role determining the T1D-associated dysbiosis evolution.     

Association Between Different Hemoglobin A1c Levels and Clinical Outcomes Among Elderly Nursing Home Residents With Type 2 Diabetes Mellitus

Objective

New guidelines recommend a target glycated hemoglobin (HbA1c) of 7.5% to 8.0% in elderly persons with type 2 diabetes mellitus (T2DM), but real-world data regarding outcomes associated with different HbA1c levels in the elderly are limited. This study assessed outcomes and their association with defined HbA1c thresholds and age ranges in insulin-treated, elderly, patients with T2DM in long-term care (LTC).

Design

Retrospective analysis of medical charts and the Minimum Data Set (MDS) for the period September 2010 through September 2011.

Setting

A total of 117 nursing homes in the United States.

Participants

Eligible patients had resided in LTC for 3 months or more, had at least 1 full MDS assessment, 2 or more records of insulin dispensing with no pump use, and 1 or more HbA1c measurements.

Measurements

Outcomes that were measured included hypoglycemia, ketoacidosis, infections, falls, hospitalization, and emergency room (ER) visits.

Results

A total of 583 patients were included (mean age 78.9 years, mean chart observation length 55 days). In all groups, hypoglycemia was lowest in patients with an HbA1c level higher than 9.0%. In patients 75 years or older, infection rates were highest when HbA1c levels were higher than 9.0%. Falls increased by HbA1c level in patients aged 65 to 74 years, but decreased by HbA1c levels in patients 85 years or older. Ketoacidosis, hospitalization, and ER visits were low in all groups.

Conclusion

These data suggest that better glycemic levels may not necessarily be associated with better clinical outcomes, and different age groups may exhibit different patterns, thereby supporting the call for individualized glycemic control among elderly patients.     

MQ-6000糖化血红蛋白分析仪检测末梢血及静脉全血HbA1c对比研究

目的:采用MQ-6000糖化血红蛋白分析仪分别对末梢血HbA1c和静脉全血HbA1c进行检测并比较其相关性,探究末梢血HbA1c的临床价值。方法:随机选取自2017年8月~2019年1月来本院收治的78例糖尿病患者作为观察组,再选取38例健康体检者作为正常对照组。采用MQ-6000糖化血红蛋白分析仪分别检测对照组、观察组的末梢血和静脉全血HbA1c,并采用VARIANTⅡ对静脉全血HbA1c进行检测,同MQ-6000的检测结果进行比较。结果:观察组与对照组的末梢血和静脉全血HbA1c结果、MQ-6000与VARIANTⅡ的检测结果均无明显差异,P>0.05,无统计学意义,相关性均良好。结论:采用MQ-6000糖化血红蛋白分析仪检测末梢血和静脉全血HbA1c相关性良好,可以采用末梢血代替静脉全血对糖尿病进行检查监控,操作简单,减少患者痛苦。     

Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus

Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.     

2型糖尿病患者幽门螺杆菌感染与糖化血红蛋白的相关性研究

目的探讨2型糖尿病患者幽门螺杆菌感染与糖化血红蛋白的相关性。方法对250例转归明确、资料完整的2型糖尿病患者的幽门螺杆菌感染情况及糖化血红蛋白水平进行回顾性分析,探讨两者的相关性。结果幽门螺杆菌感染阳性率为74．0％,幽门螺杆菌感染阳性患者的糖化血红蛋白水平显著高于幽门螺杆菌阴性患者,幽门螺杆菌感染值与糖化血红蛋白水平呈显著负相关。结论2型糖尿病患者的幽门螺杆菌感染情况与糖化血红蛋白水平呈显著负相关,为临床预防和治疗2型糖尿病提供了新的理论依据。     

The Reliability and Validity of the Perceived Dietary Adherence Questionnaire for People with Type 2 Diabetes

Nutrition therapy is essential for diabetes treatment, and assessment of dietary intake can be time consuming. The purpose of this study was to develop a reliable and valid instrument to measure diabetic patients’ adherence to Canadian diabetes nutrition recommendations. Specific information derived from three, repeated 24-h dietary recalls of 64 type 2 diabetic patients, aged 59.2 ± 9.7 years, was correlated with a total score and individual items of the Perceived Dietary Adherence Questionnaire (PDAQ). Test-retest reliability was completed by 27 type 2 diabetic patients, aged 62.8 ± 8.4 years. The correlation coefficients for PDAQ items versus 24-h recalls ranged from 0.46 to 0.11. The intra-class correlation (0.78) was acceptable, indicating good reliability. The results suggest that PDAQ is a valid and reliable measure of diabetes nutrition recommendations. Because it is quick to administer and score, it may be useful as a screening tool in research and as a clinical tool to monitor dietary adherence.     

Reduced Rank Regression-Derived Dietary Patterns Related to the Fatty Liver Index and Associations with Type 2 Diabetes Mellitus among Ghanaian Populations under Transition: The RODAM Study

The Fatty Liver Index (FLI) is a proxy for the steatotic component of non-alcoholic fatty liver disease (NAFLD). For sub-Saharan African populations, the contribution of dietary factors to the development of NAFLD in the etiology of type 2 diabetes mellitus (T2DM) remains to be clarified. We identified sex-specific dietary patterns (DPs) related to the FLI using reduced ranked regression (RRR) and evaluated the associations of these DPs with T2DM. This analysis used data from the RODAM, a multi-center cross-sectional study of Ghanaian populations living in Ghana and Europe. The daily intake frequencies of 30 food groups served as the predictor variables, while the FLI was the response variable. The odds ratios and 95% confidence intervals for T2DM were calculated per one standard deviation increase in the DP score using logistic regression. In males, the DP score explained 9.9% of the variation in their food intake and 16.0% of the variation in the FLI. This DP was characterized by high intakes of poultry, whole-grain cereals, coffee and tea, condiments, and potatoes, and the chance of T2DM was 45% higher per 1 DP score-SD (Model 2). Our results indicate that the intake of modernized foods was associated with proxies of NAFLD, possibly underlying the metabolic pathways to developing T2DM.     

Anthropometric Characteristics,Dietary Patterns and Risk of Type 2 Diabetes Mellitus in Vietnam

Objective: To determine the impact of anthropometric characteristics and dietary patterns on Type 2 diabetes mellitus in Vietnam.

Methods: Data from 144 subjects (9m/39f newly diagnosed diabetics; 18m/78f control subjects) were analyzed in this case-control study. Height, weight, waist and hip circumferences and percent body fat were measured. Dietary intakes were assessed by 24-hour recall on three non-consecutive weekdays. Fasting blood samples were collected for the analysis of plasma glucose, fructosamine, protein and lipid concentrations.

Results: Although the body mass index (BMI, kg/m²) was similar between diabetic and control subjects, diabetic subjects had significantly greater percent body fat (31.1 ± 5.8% vs. 27.7 ± 6.2%) and waist-hip ratios (WHR, 0.91 ± 0.07 vs. 0.86 ± 0.08). Diabetic subjects had higher intakes of protein (p < 0.01), especially animal protein (p < 0.001), and consumed more meat (p < 0.01) than control subjects. Percent body fat and WHR were positively associated with diabetes (odds ratios [OR] 1.53 [95%CI 1.29–1.79] and 1.09 [95% CI 0.89–1.58], respectively) as were protein intake (OR 1.21 [95% CI 1.12–1.31]) and animal protein intake (OR 1.18 [95% CI 1.10–1.26]).

Conclusions: This study indicates that percent body fat and WHR are risk factors associated with diabetes even when the BMI is normal. Evolving dietary patterns with increasingly more protein and meat consumption may also contribute to the deterioration of glucose metabolism among Vietnamese people.     

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.     

Polyphenols Rich Diets and Risk of Type 2 Diabetes

Type 2 diabetes is an increasing health concern worldwide. Both genetic and environmental risk factors as improper dietary habits or physical inactivity are known to be crucial in the pathogenesis of type 2 diabetes. Polyphenols are a group of plant-derived compounds with anti-inflammatory and antioxidant properties that are associated with a low prevalence of metabolic conditions characterized by insulin resistance, including obesity, diabetes, and hypertension. Moreover, there is now full awareness that foods that are rich in phytochemicals and polyphenols could play an important role in preserving human cardiovascular health and substantial clinical evidence indicates that regular dietary consumption of such foods affects favorably carbohydrate metabolism. This review briefly summarizes the evidence relating dietary patterns rich in polyphenols with glucose metabolism and highlights the potential benefits of these compounds in the prevention of type 2 diabetes.     

Dietary Patterns and the Risk of Prediabetes in Taiwan: A Cross-Sectional Study

Background: prediabetes prevention and management are the main methods used to combat the prevalence of diabetes. Exploratory factor analysis is an upcoming method that is successful in identifying dietary patterns that correlate with healthy or unhealthy outcomes. Aim: this study aims to identify dietary patterns in Taiwan that are associated with the risk of prediabetes. Methods: anthropometric, blood glucose, 3 d/24 h dietary records, and food frequency questionnaire data were collected from subjects recruited at Taipei Tzu-Chi Hospital. The following five dietary patterns were identified using factor analysis: Western, prudent, convenience, Asian traditional, and continental. This cross-sectional study compares tertiles of dietary patterns and analyzes the significance of the characteristics. Results: the Western and the prudent patterns are the major dietary patterns found in other studies. A higher factor loading in the Western pattern is significantly related to a higher risk of prediabetes. A higher factor loading in the continental pattern is significantly related to a lower risk of prediabetes. Conclusion: decreasing meat and seafood consumption while increasing egg, coffee, and milk consumption may be associated with a decreased risk for prediabetes.     

Assessment of Daily Food and Nutrient Intake in Japanese Type 2 Diabetes Mellitus Patients Using Dietary Reference Intakes

Medical nutrition therapy for the management of diabetes plays an important role in preventing diabetes complications and managing metabolic control. However, little is known about actual eating habits of individuals with type 2 diabetic mellitus (T2DM), especially in Japan. Therefore, we sought to (1) assess the dietary intake of individuals with T2DM, and (2) characterize their intake relative to national recommendations. This cross-sectional study involved 149 patients (77 males and 72 females) aged 40–79 years with T2DM recruited at a Kyoto hospital. Dietary intake was assessed using a validated self-administered diet history questionnaire. Under-consumption, adequacy, and over-consumption, of nutrients were compared to the age- and sex-based standards of the Japanese Dietary Reference Intakes. Among the results, most notable are (1) the inadequacy of diets in men with respect to intake of vitamins and minerals, likely owing to low intake of vegetables and fruits; (2) excess contributions of fat intake to total energy in both sexes; and (3) excess consumption of sweets and beverages relative to the national average. The prevalence of diabetes complications may be increasing because of a major gap between the typical dietary intake of individuals with T2DM and dietary recommendation.     

Dietary Patterns,Their Nutrients,and Associations with Socio-Demographic and Lifestyle Factors in Older New Zealand Adults

Dietary patterns analyse combinations of foods eaten. This cross-sectional study identified dietary patterns and their nutrients. Associations between dietary patterns and socio-demographic and lifestyle factors were examined in older New Zealand adults. Dietary data (109-item food frequency questionnaire) from the Researching Eating, Activity and Cognitive Health (REACH) study (n = 367, 36% male, mean age = 70 years) were collapsed into 57 food groups. Using principal component analysis, three dietary patterns explained 18% of the variation in diet. Dietary pattern associations with sex, age, employment, living situation, education, deprivation score, physical activity, alcohol, and smoking, along with energy-adjusted nutrient intakes, were investigated using regression analysis. Higher ‘Mediterranean’ dietary pattern scores were associated with being female, higher physical activity, and higher education (p < 0.001, R² = 0.07). Higher ‘Western’ pattern scores were associated with being male, higher alcohol intake, living with others, and secondary education (p < 0.001, R² = 0.16). Higher ‘prudent’ pattern scores were associated with higher physical activity and lower alcohol intake (p < 0.001, R² = 0.15). There were positive associations between beta-carotene equivalents, vitamin E, and folate and ‘Mediterranean’ dietary pattern scores (p < 0.0001, R² ≥ 0.26); energy intake and ‘Western’ scores (p < 0.0001, R² = 0.43); and fibre and carbohydrate and ‘prudent’ scores (p < 0.0001, R² ≥ 0.25). Socio-demographic and lifestyle factors were associated with dietary patterns. Understanding relationships between these characteristics and dietary patterns can assist in health promotion.