Associations of perceived neighborhood safety and crime with cardiometabolic risk factors among a population with type 2 diabetes

Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a sample (n=721) of adults (mean age:63) with diabetes. Self-reported neighborhood safety, violent crime, physical activity, and stress were collected and linked to clinical measures of BMI and HbA1c. Approximately 54% and 15% of patients reported neighborhood safety concerns and violent crimes, respectively. Any neighborhood safety concerns (β=1.14, 95% C.I. 0.04–2.24) and violent crime (β=2.04, 95% C.I. 0.34–3.73) were associated with BMI in adjusted analysis. Any violent crime was associated with class II–III obesity (BMI≥35) (OR=1.34, 95% C.I.: 1.02, 1.75). There were no significant associations between neighborhood safety concerns or violent crime with stress, physical activity, or HbA1c. Neighborhood safety is associated with BMI and obesity. Further studies, including longitudinal designs, are needed to study how people with diabetes may be influenced by a sense of poor personal safety in their neighborhoods.     

Associations of Dietary Patterns and Nutrients with Glycated Hemoglobin in Participants with and without Type 1 Diabetes

Background: Diet has been associated with poor glycemic control in diabetes. Few studies have examined this association in people with type 1 diabetes (T1D), who are at a higher risk for cardiovascular disease than people without diabetes. Methods: We report data from cross-sectional and longitudinal analyses from a coronary artery calcification in type 1 diabetes (CACTI) study (n = 1257; T1D: n = 568; non-diabetic controls: n = 689) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Dietary patterns based on variations in food group intake were created with principal components analysis. Linear regression was used to examine the associations of dietary patterns, macronutrients, and food groups with HbA1c in a model adjusted for relevant covariates and stratified by diabetes status. Results: Three dietary patterns were identified: “fruits, veggies, meats, cereal”, “baked desserts” and “convenience foods and alcohol” patterns. At baseline, a higher intake of the “baked dessert” pattern was significantly associated with higher HbA1c in T1D at baseline as well at year 6 of the study when adjusted for age, sex, BMI, total calories, and diabetes duration. No such associations were observed in the case of non-diabetic controls. Dietary saturated fats and animal fats were also positively associated with HbA1c in adults with T1D at baseline and/or at year 6. Conclusions: The habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and saturated fats, such as in baked desserts, may increase risks of poor glycemic control in T1D.     

Effect of pramlintide on weight in overweight and obese insulin-treated type 2 diabetes patients

OBJECTIVE: Several randomized, placebo-controlled, double-blind trials in insulin-treated patients with type 2 diabetes have shown that adjunctive therapy with pramlintide reduces hemoglobin (Hb)A1c with concomitant weight loss. This analysis further characterizes the weight-lowering effect of pramlintide in this patient population. RESEARCH METHODS AND PROCEDURES: This pooled post hoc analysis of two long-term trials included all patients who were overweight/obese at baseline (BMI > 25 kg/m2), and who were treated with either 120 microg pramlintide BID (n = 254; HbA1c 9.2%; weight, 96.1 kg) or placebo (n = 244; HbA1c 9.4%; weight, 95.0 kg). Statistical endpoints included changes from baseline to week 26 in HbA1c, body weight, and insulin use. RESULTS: Pramlintide treatment resulted in significant reductions from baseline to week 26, compared with placebo, in HbA1c and body weight (both, p < 0.0001), for placebo-corrected reductions of -0.41% and -1.8 kg, respectively. Approximately three times the number of patients using pramlintide experienced a > or = 5% reduction of body weight than with placebo (9% vs. 3%, p = 0.0005). Patients using pramlintide also experienced a proportionate decrease in total daily insulin use (r = 0.39, p < 0.0001). The greatest placebo-corrected reductions in weight at week 26 were observed in pramlintide-treated patients with a BMI >40 kg/m2 and in those concomitantly treated with metformin (both, p < 0.001), for placebo-corrected reductions of -3.2 kg and -2.5 kg, respectively. DISCUSSION: These findings support further evaluation of the weight-lowering potential of pramlintide in obese patients with type 2 diabetes.     

BMI与腰围对阻塞性睡眠呼吸暂停与2型糖尿病的中介效应

  目的  探究BMI和腰围(waist circumference, WC)对阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与2型糖尿病、糖代谢连续测量指标之间的中介效应。  方法  纳入分析的1 615名研究对象来自动脉粥样硬化多民族研究(Multi-Ethnic Study of Atherosclerosis, MESA)。OSA评价指标为呼吸暂停低通气指数(apnea-hypopnea index,AHI),由多导睡眠图测定。糖代谢连续测量指标包括FPG和糖化血红蛋白(glycated hemoglobin,HbA1c)。肥胖指标包括全身肥胖指标BMI和腹型肥胖指标WC。  结果  OSA与2型糖尿病显著相关,后者的患病风险随OSA严重程度增加而升高(P < 0.001)。BMI和WC均介导重度OSA与2型糖尿病之间的关联,其中腹型肥胖指标WC的中介效应为1.296(95% CI: 1.182~1.466),中介效应比例为56.397%;BMI的中介效应为1.291(95% CI: 1.173~1.479),中介效应比例为55.400%。BMI和WC同样介导重度OSA与FPG、HbA1c之间的关联。  结论  OSA与2型糖尿病、FPG和HbA1c的关系,与肥胖程度增加有关。提示OSA患者通过早期的体重干预,特别是控制腹型肥胖对降低糖尿病和心血管并发症的患病率具有重要意义。     

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.     

老年男性2型糖尿病患者骨质疏松相关因素分析

目的 探讨与老年男性2型糖尿病（type 2 diabetes mellitus,T2DM）骨质疏松（osteoporosis,OP）发生相关的因素。方法 选取老年男性T2DM患者288例,根据OP诊断标准分为骨量正常组（72例）、骨量减少组（118例）和骨质疏松组（98例）。测量身高、体重,计算体质指数（body mass index,BMI）;测定空腹血糖（fasting blood glucose,FBG）、糖化血红蛋白（glycosylated hemoglobinA1c,HbA1c）、甲状旁腺素（parathyroid hormone,PTH）、血清钙（serum calcium,Ca）、血清磷（serum phosphonium,P）、25羟维生素D （serum 25-hydroxyvitamin D,25-OH-VD）及尿白蛋白/肌酐（urinary albumin/creatinine ratio,ACR）,记录患者病程、降糖药物使用和糖尿病慢性并发症情况。结果 与骨量正常组比较,骨质疏松组和骨量减少组病程较长和HbA1c较高,BMI减低,差异均有统计学意义（均有P<0.05）。相关分析显示股骨颈、三角区、大转子、腰椎（lumbar vertebrae,L）2-4节骨密度（bone mineral density,BMD）与BMI均呈正相关（均有P<0.05）,但与HbA1C均呈负相关（均有P<0.05）。骨质疏松组糖尿病肾病、糖尿病视网膜病变发生率均高于骨量正常组、骨量减少组（均有P<0.05）;骨质疏松组糖尿病神经病变发生率高于骨量正常组（χ2=6.168,P=0.013）。Logistic回归分析显示BMI、HbA1c及糖尿病肾病与糖尿病骨质疏松发生相关（均有P<0.05）。结论 低BMI,血糖控制不佳和糖尿病肾病是老年男性T2DM患者OP发生的危险因素。     

低血糖负荷食物交换份法结合移动饮食管理对2型糖尿病患者血糖改善的效果探索

目的 探索低血糖负荷（glycemic load,GL）食物交换份法结合移动饮食管理对2型糖尿病患者血糖的影响。方法 在医院招募2型糖尿病患者58例,随机分为参考主食（reference staple food,RF）组和自选食物（self-choice,SC）组,RF组26例,SC组32例。对两组研究对象进行统一的糖尿病医学营养教育,之后分别对两组对象进行连续42天的低GL食物交换份法干预, RF组由研究者提供低GL主食,SC组自选每日全部食物。全体研究对象每日在移动饮食管理平台记录食物摄入情况,研究者每日对其饮食GL和能量摄入进行计算、监测和核查分析比较两组对象平均每日饮食GL及能量摄入情况,在干预前和干预后的第14、28、42天检测并比较两组的体重、体脂率、身体质量指数（body mass index ,BMI）、腰围、空腹血糖（fasting blood glucose ,FBG）、2小时餐后血糖（postprandial 2h blood glucose ,2hPBG）、空腹胰岛素（fasting insulin ,Ins）、空腹C肽（fasting C-peptide ,C-P）和糖化血红蛋白（glycosylated hemoglobin ,HbA1c）。结果 干预期间,两组研究对象的平均每日饮食GL和能量摄入均低于干预前（P＜0.05）,且基本达到预期目标。与干预前相比,干预后两组FBG、HbA1c、体重、BMI和腰围均出现明显降低（P＜0.05）,其中RF组干预前FBG、HbA1c平均值分别为7.33 μmmol/L、7.02%,干预后分别为6.31 μmmol/L、6.33%（t=4.28,P＜0.001;t=5.43,P＜0.001）,SC组干预前FBG、HbA1c平均值分别为7.83 μmmol/L、7.27%,干预后分别为7.27 μmmol/L、6.81%（t=2.89,P=0.007;t=5.11,P＜0.001）。结论 低GL食物交换份法结合移动饮食管理对2型糖尿病患者的血糖、体重具有较好的改善效果,两种方法的结合可成为2型糖尿病防治更科学、可行、合理、精准的饮食管理方案。     

妊娠期糖尿病患者糖化血红蛋白测定的临床意义

目的:检测妊娠期糖尿病(gestational diabetes mellitus,GDM)患者的糖化血红蛋白(glycosylated hemoglobin A,HbA1C)水平,分析HbA1C在GDM血糖监测及预测新生儿不良结局中的意义。方法:根据HbA1C水平将149例GDM患者分为低HbA1C(LH)组(HbA1C≤5.6%)和高HbA1C(HH)组(HbA1C>5.6%)。分别检测两组的血压、血糖、血脂,记录分娩后新生儿的情况,比较两组各指标的差异并进行HbA1C与各指标的相关性分析。结果:HH组的体重(W)、体重指数(BMI)、空腹血糖(FBG)、HbA1C明显高于低LH组(P<0.05);HbA1C与BMI、W、新生儿体重、FBG呈正相关(r分别为0.840、0.804、0.357、0.241,P<0.05);HH组新生儿发生低血糖、巨大儿的情况较LH组明显增加,比值比分别为3.63、4.84。结论:HbA1C在GDM患者血糖监测及预测新生儿低血糖和巨大儿的发生中有重要作用。     

Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes

OBJECTIVE: Our objective was to assess effects of dietary supplementation with coenzyme Q10 (CoQ) on blood pressure and glycaemic control in subjects with type 2 diabetes, and to consider oxidative stress as a potential mechanism for any effects. SUBJECTS AND DESIGN: Seventy-four subjects with uncomplicated type 2 diabetes and dyslipidaemia were involved in a randomised double blind placebo-controlled 2x2 factorial intervention. SETTING: The study was performed at the University of Western Australia, Department of Medicine at Royal Perth Hospital, Australia. INTERVENTIONS: Subjects were randomly assigned to receive an oral dose of 100 mg CoQ twice daily (200 mg/day), 200 mg fenofibrate each morning, both or neither for 12 weeks. MAIN OUTCOME MEASURES: We report an analysis and discussion of the effects of CoQ on blood pressure, on long-term glycaemic control measured by glycated haemoglobin (HbA(1c)), and on oxidative stress assessed by measurement of plasma F2-isoprostanes. RESULTS: Fenofibrate did not alter blood pressure, HbA(1c), or plasma F2-isoprostanes. There was a 3-fold increase in plasma CoQ concentration (3.4+/-0.3 micro mol/l, P<0.001) as a result of CoQ supplementation. The main effect of CoQ was to significantly decrease systolic (-6.1+/-2.6 mmHg, P=0.021) and diastolic (-2.9+/-1.4 mmHg, P=0.048) blood pressure and HbA(1c) (-0.37+/-0.17%, P=0.032). Plasma F2-isoprostane concentrations were not altered by CoQ (0.14+/-0.15 nmol/l, P=0.345). CONCLUSIONS: These results show that CoQ supplementation may improve blood pressure and long-term glycaemic control in subjects with type 2 diabetes, but these improvements were not associated with reduced oxidative stress, as assessed by F2-isoprostanes. SPONSORSHIP: This study was supported by a grant from the NH&MRC, Australia.     

家族史、肥胖及自我管理行为在2型糖尿病患者糖化血红蛋白达标中的作用

目的 探讨家族史、肥胖及自我管理行为对中国基层2型糖尿病(type 2 diabetes mellitus, T2D)患者糖化血红蛋白(hemoglobin A1c, HbA1c)控制达标的作用。 方法 对2016年1月—2019年12月五家糖尿病专科连锁医院连续就诊且资料存储于院内糖尿病共同照护信息系统的门诊或住院T2D患者基线数据进行横断面分析,比较HbA1c是否达标(HbA1c<7.0%)两组的一般状况,采用多因素logistic 回归分析对HbA1c未达标相关因素进行分析。 结果 共纳入8 506例患者, HbA1c达标率27.75 %,有家族史者2 860例(33.62 %),肥胖者1 541例(18.12 %)。HbA1c是否达标,两组在年龄、病程、体质量指数、吸烟、学历、饮食依从性、运动、遵嘱监测血糖、遵嘱用药及治疗方案方面的比较,差异有统计学意义(均P＜0.05)。多因素logistic回归分析显示,肥胖(OR=1.226,95%CI:1.042～1.441)和病程长(OR=1.019,95%CI:1.009～1.028)增加了HbA1c不达标的风险,单纯口服药治疗(OR=0.388,95%CI:0.345～0.436)、遵嘱用药(OR=0.805,95%CI:0.699～0.928)、规律运动(OR=0.886,95%CI:0.786～1.000)降低了HbA1c不达标的风险。 结论 本研究提示中国基层T2D患者HbA1c达标率低,治疗方案、遵嘱用药、规律运动及肥胖是HbA1c达标的相关因素。在临床糖尿病管理中需特别关注胰岛素治疗患者及肥胖患者,并关注患者在遵嘱用药及规律运动方面的依从性。     

糖化白蛋白、糖化白蛋白与糖化血红蛋白比值临床应用初探

目的：探讨在孕晚期妊娠期糖尿病（GDM）产妇中,糖化白蛋白（GA）、糖化白蛋白与糖化血红蛋白的比值（GA ／A1c）作为血糖监测指标的临床应用价值。方法选取2014年6月至12月于中国医科大学附属盛京医院例行常规产科检查并在本院足月分娩、单胎、无其他合并症及并发症的妊娠期糖尿病产妇共323例,测定分娩前一周 GA 水平,计算 GA ／A1c,分析 GA、GA ／A1c 与产妇体重指数（BMI）、血糖水平及新生儿出生体重间的关系。结果（1）GA 与糖化血红蛋白（HbA1c）呈线性正相关（r ＝0.4,P ＜0.001）,直线回归方程为 GA ＝5.9＋0.9HbA1c。（2）GA ／A1c 与 BMI 呈线性负相关（r ＝－0.1,P ＝0.03）,直线回归方程为 GA ／A1c ＝2.2－0.008BMI。（3）HbA1c 与出生体重呈线性正相关（r ＝0.2,P ＝0.01）。结论在孕晚期 GDM产妇中,GA、GA ／A1c 可作为临床血糖监测及评估的新指标。     

Continuity of care and intermediate outcomes of type 2 diabetes mellitus

BACKGROUND: The relevance of continuity of care in chronic illness is uncertain. OBJECTIVE: We evaluated whether experienced continuity of care for type 2 diabetes is associated with HbA1c, blood pressure or body weight. METHODS: Cohort study in 19 family practices in London, UK. Participants were 209 type 2 diabetic patients with 156 (75%) followed-up at 10 months. Main measures were experienced continuity of care (ECC) by patient questionnaire (mean score 62.1, SD 16.0), satisfaction with care, health-related quality of life [short-form 12 (SF-12)], HbA1c, blood pressure and body weight. Analyses were adjusted for baseline values, age, sex, ethnicity, duration of diabetes, diabetes treatment, education, housing tenure and whether living alone. RESULTS: Experienced continuity scores were obtained for 193 (92%) of participants at baseline and 156 (75%) at follow-up with no difference in outcome measures between those followed-up and those not. Subjects with the highest satisfaction ratings, compared with the lowest, had higher experienced continuity (difference in experienced continuity 7.87, 95% confidence interval 3.22-12.5, P = 0.001). ECC was not associated with HbA1c (adjusted difference per 10-unit increase in ECC score, -0.09%, -0.29 to 0.12%, P = 0.402), systolic blood pressure (-0.41, -2.88 to 2.06 mm Hg, P = 0.746), body mass index (-0.08, -0.34 to 0.18 kg/m(2), P = 0.562) or SF-12 physical component score (0.73, -0.88 to 2.35, P = 0.375). CONCLUSION: Experienced continuity of diabetes care is associated with greater patient satisfaction but not with improved intermediate outcomes during 10 months follow-up in this setting. Studies with more subjects will be required to determine whether continuity of care is associated with the frequency of adverse events.     

Day-to-day consistency in amount and source of carbohydrate intake associated with improved blood glucose control in type 1 diabetes.

OBJECTIVE: To determine if a relationship exists between blood glucose control and variability in nutrient intake from day-to-day in subjects with type 1 diabetes. METHODS: Two three-day diet records and one measurement of glycated hemoglobin (HbA1c) were obtained from 272 subjects with type 1 diabetes treated with a mixture of regular and NPH insulins before breakfast and supper and using a standardized algorithm to adjust insulin dose according to the results of self-monitoring of blood glucose two to four times daily. Day-to-day variation in nutrient intake was expressed as the coefficient of variation (CV = SDx100/mean). RESULTS: Nutrient intakes in the study population (mean +/- SD) were energy 8.35+/-2.43 MJ, fat 81+/-30 g, protein 94+/-28 g, carbohydrate 227+/-68 g, starch 126+/-38 g and dietary fiber 20+/-6 g with diet glycemic index being 84.2+/-7.4. Neither energy, nutrient intakes nor insulin dose was significantly related to HbA1c. Day-to-day variation of carbohydrate (p = 0.0097) and starch (p = 0.0016) intakes and diet glycemic index (p = 0.033) was positively related to HbA1c, and the associations remained significant when adjusted for age, sex, duration of diabetes and BMI. Day-to-day variation in energy, protein or fat intakes was not related to HbA1c. CONCLUSIONS: Consistency in the amount and source of carbohydrate intake from day-to-day is associated with improved blood glucose control in people with type 1 diabetes, a result which supports continued educational efforts to achieve adherence to a diabetes diet plan. This conclusion may not apply to people on intensified insulin therapy who adjust their insulin dose based on their actual carbohydrate intake at each meal.     

D2 dopamine receptor Taq1A polymorphism, body weight, and dietary intake in type 2 diabetes

OBJECTIVE: Certain D2 dopamine receptor Taq 1A genotypes (A1A1, A1A2) have been associated with obesity and substance abuse. We hypothesized that their presence would be associated with reduced efficacy of dietary interventions in individuals with type 2 diabetes. METHODS: In the course of a randomized clinical trial in an outpatient research center in which 93 adults with type 2 diabetes were assigned to a low-fat vegan diet or a diet following 2003 American Diabetes Association guidelines for 74 wk, Taq 1A genotype was determined. Nutrient intake, body weight, and hemoglobin A1c (A1c) were measured over 74 wk. RESULTS: The A1 allele was highly prevalent, occurring in 47% of white participants (n = 49), which was significantly higher than the 29% prevalence previously reported in non-diabetic whites (P = 0.01). The A1 allele was found in 55% of black participants (n = 44). Black participants with A1(+) genotypes had significantly greater mean body weight (11.2 kg heavier, P = 0.05) and greater intake of fat (P = 0.002), saturated fat (P = 0.01), and cholesterol (P = 0.02) compared with A2A2 (A1(-)) individuals; dietary changes during the study did not favor one genotype group. Among whites, baseline anthropometric and nutrient differences between gene groups were small. However, among whites in the vegan group, A1(+) individuals reduced fat intake (P = 0.04) and A1c (P = 0.01) significantly less than did A1(-) individuals. CONCLUSION: The A1 allele appears to be highly prevalent among individuals with type 2 diabetes. Potential influences on diet, weight, and glycemic control merit further exploration.     

妊娠期糖尿病孕妇胎盘组织Akt和GLUT-1的表达与新生儿体重的相关性

目的探讨妊娠期糖尿病(GDM)孕妇胎盘组织Akt和GLUT-1的表达与新生儿体重的相关性。方法选取我院收治的40例GDM患者作为研究组,另选取40例健康孕妇作为对照组,检测两组孕妇的孕期BMI、孕期增重、 FPG、 FINS、HbA1c水平,分析胎盘组织Akt和GLUT-1表达情况及其与新生儿体重的相关性。结果研究组胎盘组织Akt和GLUT-1表达明显低于对照组(P <0.05)。Pearson相关性分析显示,Akt表达(r=-0.697, P=0.035)、 GLUT-1表达(r=-0.768, P=0.029)均与新生儿体重呈负相关。结论 GDM孕妇胎盘组织中Akt和GLUT-1表达水平下降可能是造成新生儿体重上升的原因。     

Use of diabetes preventive care and complications risk in two African-American communities

BACKGROUND: We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. METHODS: Cross-sectional, population-based study of 625 African-American adults with diagnosed diabetes. Participants had a household interview to determine receipt of preventive care services including glycosylated hemoglobin (HbA(1c)), blood pressure, lipid, foot, dilated eye, and dental examinations; diabetes education; and health promotion counseling. A total of 383 gave blood samples to determine HbA(1c) and lipid values. RESULTS: Annual dilated eye, foot, and lipid examinations were reported by 70% to 80% of the population, but only 46% reported HbA(1c) tests. Rates of regular physical activity (31%) and daily self-monitoring of blood glucose (40%) were low. Sixty percent of the population had an HbA(1c) level >8% and one fourth had an HbA(1c) level >10%. Half of the population had a low-density lipoprotein value >130 mg/dL. Lack of insurance was the most consistent correlate of inadequate care (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.3-3.9), having HbA(1c) >9.5% (OR=2.1, 95% CI=1.1-4.2), and LDL levels >130 mg/dL (OR=2.1; 95% CI=1.0-4.5). CONCLUSIONS: Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.     

Interactions between Vitamin D Genetic Risk and Dietary Factors on Metabolic Disease-Related Outcomes in Ghanaian Adults

The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25–60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI (p_interaction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency (p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, p_interaction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c (p = 0.049). In summary, our study has identified novel gene–diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.     

Reported dietary intakes of patients with insulin-dependent diabetes mellitus: limitations of dietary recall.

Reported dietary intakes were assessed in young patients with insulin-dependent diabetes mellitus (IDDM). We studied 44 IDDM patients (24 males, 20 females, mean +/- SD age 13.2 +/- 4.5 yr) and compared them with 44 healthy age- and sex-matched control subjects. Estimated intakes from 24-h dietary recall were analyzed in relation to body weight and degree of diabetes control. The reported energy intake of the IDDM patients with greater than 120% ideal body weight (IBW) for height was 66, 59/88% (where X = geometric mean, L1 = lower confidence limit/L2 = upper confidence limit) of recommended daily allowance (RDA), whereas those with IBW less than 120% reported 90, 67/120% (p less than 0.01). Patients with increased weights in comparison with IBW had higher hemoglobin A1c (HbA1c) levels (11.9 +/- 2.7%) than those with weights more appropriate for IBW (9.7 +/- 2.4%, p less than 0.025). IDDM patients reported overconsumption of protein and fat, but their carbohydrate intake was low. Analysis of dietary recalls revealed high protein intake (X +/- SD, 20.0 +/- 5.0% of total calorie intake), especially in older (27 +/- 4%) compared with younger (19 +/- 2%-19 +/- 4%, p less than 0.01) patients. Proportions of carbohydrate, protein, and fat did not correlate with variations in body weight and/or HbA1c. The reported intake of protein per kilogram body weight was not significantly different between appropriate-weight and overweight IDDM patients. There was no significant difference in reported total energy intakes of IDDM patients compared with their healthy control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dietary energy density is associated with body mass index and waist circumference, but not with other metabolic risk factors, in free-living young Japanese women

OBJECTIVE: Little is known about the relation of dietary energy density (kilocalories per gram) to metabolic risk factors, particularly in young adults and non-Western populations. We examined the cross-sectional associations between dietary energy density and several metabolic risk factors in free-living young Japanese women. METHODS: The subjects were 1136 female Japanese dietetic students 18-22 y of age. Dietary energy density was estimated based on foods only, using a self-administered diet history questionnaire; before the present analysis, this measurement was validated against 16-d weighed dietary records in 92 Japanese women 31-69 y of age (Pearson's correlation coefficient 0.52). Body height and weight, from which body mass index (BMI) was derived, waist circumference, and blood pressure were measured, and fasting blood samples were collected for biochemical measurements. RESULTS: Mean BMI was 21.3 kg/m(2) (standard deviation 2.7), mean waist circumference was 72.9 cm (standard deviation 7.1), and mean dietary energy density was 1.41 kcal/g (standard deviation 0.23). After adjustment for potential confounding factors, dietary energy density was positively associated with BMI (P for trend = 0.004). Dietary energy density also showed an independent and positive association with waist circumference (P for trend <0.0001). No significant associations were observed between dietary energy density and any of the other metabolic risk factors examined. CONCLUSION: Dietary energy density was independently and positively associated with BMI and waist circumference, but not with other metabolic risk factors, in free-living young Japanese women who are not only lean but whose dietary energy density is also low compared with Western populations.     

Decreases in dietary glycemic index are related to weight loss among individuals following therapeutic diets for type 2 diabetes

This study assessed the effect of changes in glycemic index (GI) and load (GL) on weight loss and glycated hemoglobin (HbA1c) among individuals with type 2 diabetes beginning a vegan diet or diet following the 2003 American Diabetes Association (ADA) recommendations. The study was a 22-wk, randomized trial of 99 participants with type 2 diabetes who were counseled to follow 1 of 2 diet treatments. GI and GL changes were assessed based on 3-d dietary records. The relationships between GI/GL and changes in weight and HbA1C were calculated. In an intention-to-treat analysis (n = 99), the vegan group reduced GI to a greater extent than the ADA group (P < 0.05), but GL was reduced further in the ADA than the vegan group (P < 0.001). GI predicted changes in weight (P = 0.001), adjusting for changes in fiber, carbohydrate, fat, alcohol, energy intake, steps per day, group, and demographics, such that for every point decrease in GI, participants lost ~0.2 kg (0.44 lb). GI was not a predictor for changes in HbA1C after controlling for weight loss (P = 0.33). Weight loss was a predictor of changes in HbA1C (P = 0.047). GL was not related to weight loss or changes in HbA1C. A low-GI diet appears to be one of the determinants of success of a vegan or ADA diet in reducing body weight among people with type 2 diabetes. The reduction of body weight, in turn, was predictive of decreasing HbA1C.