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Effect of a family and interdisciplinary intervention to prevent T2D: randomized clinical trial.
Vargas-Ortiz, K, Lira-Mendiola, G, Gómez-Navarro, CM, Padilla-Estrada, K, Angulo-Romero, F, Hernández-Márquez, JM, Villa-Martínez, AK, González-Mena, JN, Macías-Cervantes, MH, Reyes-Escogido, ML, et al
BMC public health. 2020;20(1):97
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In individuals at high risk of type 2 diabetes, lifestyle interventions rather than medication have been more successful in preventing development of the disease, however the benefits of lifestyle strategies diminishes over time due to possible adherence issues. Prolonged lifestyle changes may be affected by lack of family support, but research on family support during lifestyle changes in individuals prior to diabetes is lacking. This parallel randomised control trial of 122 patients with prediabetes and 101 of their family members aimed to assess the impact of family supported diet and exercise changes compared to self-motivation on individuals with prediabetes. At 6 months, body measurements and markers of prediabetes improved in both groups. Lipids were significantly improved in the group with family support compared to having no support. At 12 months there were a high number of dropouts due to lack of patient interest. Benefits shown at 6 months in both groups were only maintained or improved upon with family support and the lipid profile of the individual intervention group actually worsened in comparison to when participants entered the trial. After 12 months the incidence rate of type 2 diabetes was similar in both groups. Individuals with prediabetes who had family support whilst undergoing a diet and exercise regime were more successful at maintaining improvements of factors contributing to diabetes, compared to individuals without support. However this did not affect the occurrence of type 2 diabetes. Clinicians could use this paper to communicate the importance of family support during lifestyle changes in patients at high risk of developing type 2 diabetes, although close monitoring may be required to ensure compliance.
Abstract
BACKGROUND Lifestyle changes can reduce the risk of T2D; however, no study has evaluated the effect of a lifestyle intervention involving patients´ family. The aim of this study was to compare the impact of an interdisciplinary family (FI) Vs individual intervention (II) on glucose metabolism, insulin resistance (IR), pancreatic β-cell function and cardiovascular risk markers in patients with prediabetes, as well as to measure the impact on their families' metabolic risk. METHODS Randomized Clinical Trial (RCT) to compare the impact of FI and II on IR and pancreatic β-cell function in subjects with prediabetes. There were 122 subjects with prediabetes (and 101 family members) randomized to FI or II. Data were collected in 2015-2016 and analyzed in 2017-2018. FI group had the support of their family members, who also received personalized diet and exercise recommendations; patients and their family members attended monthly a lifestyle enhancement program. II group received personalized diet and exercise recommendations. The follow-up was for 12 months. Glucose, IR, pancreatic β-cell function and secondary outcomes (body composition and lipid profile) were assessed at baseline, 6 and 12 months. RESULTS FI group improved area under the glucose curve (AUC) (from 18,597 ± 2611 to 17,237 ± 2792, p = 0.004) and the Matsuda index (from 3.5 ± 2.3 to 4.7 ± 3.5, p = 0.05) at 12 months. II group improved Disposition Index (from 1.5 ± 0.4 to 1.9 ± 0.73, p < .0001) at 12 months. The improvements achieved in weight and lipids at 6 months, were lost in II group at 12 moths, whereas in FI persisted. Adherence up to 12 months was not different between the study groups (FI 56% Vs II 60%). CONCLUSIONS FI intervention was more effective by improving glucose AUC, insulin sensitivity and lipid profile, besides that, metabolic risk in family members of the FI group was maintained, while the risk of II group was increased. TRIAL REGISTRATION This study was retrospectively registered at clinicaltrials.gov on December 15, 2015 (NTC026365646).
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Long-term effects of a three-component lifestyle intervention on emotional well-being in women with Polycystic Ovary Syndrome (PCOS): A secondary analysis of a randomized controlled trial.
Jiskoot, G, Dietz de Loos, A, Beerthuizen, A, Timman, R, Busschbach, J, Laven, J
PloS one. 2020;15(6):e0233876
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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women in their reproductive years. The condition is often associated with higher rates of depression and anxiety, particularly with a Body Mass Index (BMI) of >30. As weight-loss has shown to improve a host of symptoms experienced in PCOS, the authors sought to investigate whether weight-loss would also lead to a reduction in depressive symptoms. This secondary analysis of a longitudinal, randomised trial of 155 women, compared a combined lifestyle intervention of diet advice, eating behaviour, exercise and standardised Cognitive Behaviour Therapy (CBT) to standard advice for weight reduction. Over a 12-months the chosen lifestyle interventions demonstrated a sustained improvement in self-assessed depression scores, though independent of weight-loss. However, weight-loss itself was closely linked with improved body image and self-esteem. Additional monitoring of hormones (androgens, insulin, cortisol) and calculations for insulin sensitivity (HOMA-IR ) did not show any direct link with depressive scores. This study affirms the benefit of integrative lifestyle approaches on emotional well-being in women with PCOS. Practitioners might find it of interest that improvements in emotional well-being can occur independent of weight loss in individuals experiencing depressive symptoms with PCOS.
Abstract
Many women with Polycystic Ovary Syndrome (PCOS) report high depression rates. The relationship between PCOS and these high depression rates is unclear. Two-component lifestyle interventions have revealed short-term effects on depression scores in this group of women. In general, 3-component interventions including diet, exercise, and cognitive behavioral therapy (CBT) are more effective in the long-term to improve emotional well-being. This has not yet been studied in women with PCOS. This study examined the effect of 20 CBT lifestyle (LS) sessions combined with a healthy diet and physical therapy with or without 9 months additional feedback through Short Message Service (SMS) via mobile phone, compared to care as usual (CAU, involving advice to lose weight). In this secondary analysis, 155 women with PCOS and a BMI above 25 kg/m2 were eligible. Depression scores decreased significantly in the LS programme compared to CAU (P = 0.045). In both the LS programme without SMS (P = 0.036) and the LS programme with SMS (P = 0.011) depression scores decreased while no change was observed in CAU (P = 0.875). Self-esteem scores improved significantly in the LS programme compared to CAU (P = 0.027). No differences in body image scores were observed in LS participants compared to CAU (P = 0.087), although body image improved significantly in both the LS without SMS (P = 0.001) and with SMS (P = 0.008) study arms. We found no significant mediating role by androgens in the relationship between LS participants and emotional well-being. Only weight-loss mediated the relationship between LS and self-esteem. To conclude, a three-component lifestyle intervention programme with or without additional SMS resulted in significant improvements in depression and self-esteem compared to CAU, in women with PCOS, obesity, and a wish to achieve a pregnancy. Testosterone, androstenedione, DHEA, insulin, HOMA-IR, and cortisol did not mediate this effect. Weight loss mediated the effects on self-esteem but not on depression and body-image. This suggests that lifestyle treatment independent of weight loss can reduce depression and body-image, but both lifestyle treatment and weight loss can improve self-esteem. Thus, a three-component lifestyle intervention based on CBT could prove successful in improving mood in women with PCOS who are overweight or obese and attempting to become pregnant.
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Combining Short-Term Interval Training with Caloric Restriction Improves ß-Cell Function in Obese Adults.
Francois, ME, Gilbertson, NM, Eichner, NZM, Heiston, EM, Fabris, C, Breton, M, Mehaffey, JH, Hassinger, T, Hallowell, PT, Malin, SK
Nutrients. 2018;10(6)
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The development of type 2 diabetes is characterised by insulin resistance and dysfunction of the pancreas. Over time, loss of function of the ß-cells of the pancreas leads to impaired tolerance of blood sugar and type 2 diabetes. Low-calorie diets have been shown to improve blood sugar regulation, but it is unclear what impact interval exercise has in addition to a low-calorie diet. This study tested the hypothesis that combining interval exercise with a low-calorie diet would enhance pancreatic function compared to a low calorie diet alone in adults with obesity. Twenty-six obese adults were assigned to 2 weeks of a LCD (1200 kcal/day), using meal replacement shakes for breakfast and lunch. Half the group also underwent 60 minutes of interval training a day; after each session they received a 350 kcal shake to compensate for the calories burned during training. A series of blood tests was carried out to measure glucose tolerance and insulin secretion rates. Combining a low calorie diet with interval training reduced glucose and insulin secretion rates, whereas the low calorie diet alone did not. Both interventions improved insulin sensitivity. The authors concluded that the data supports combining low calorie diets with interval training to preserve pancreatic function and prevent type 2 diabetes.
Abstract
Although low-calorie diets (LCD) improve glucose regulation, it is unclear if interval exercise (INT) is additive. We examined the impact of an LCD versus LCD + INT training on ß-cell function in relation to glucose tolerance in obese adults. Twenty-six adults (Age: 46 ± 12 year; BMI 38 ± 6 kg/m²) were randomized to 2-week of LCD (~1200 kcal/day) or energy-matched LCD + INT (60 min/day alternating 3 min at 90 and 50% HRpeak). A 2 h 75 g oral glucose tolerance test (OGTT) was performed. Insulin secretion rates (ISR) were determined by deconvolution modeling to assess glucose-stimulated insulin secretion ([GSIS: ISR/glucose total area under the curve (tAUC)]) and ß-cell function (Disposition Index [DI: GSIS/IR]) relative to skeletal muscle (Matsuda Index), hepatic (HOMA-IR) and adipose (Adipose-IRfasting) insulin resistance (IR). LCD + INT, but not LCD alone, reduced glucose and total-phase ISR tAUC (Interactions: p = 0.04 and p = 0.05, respectively). Both interventions improved skeletal muscle IR by 16% (p = 0.04) and skeletal muscle and hepatic DI (Time: p < 0.05). Improved skeletal muscle DI was associated with lower glucose tAUC (r = -0.57, p < 0.01). Thus, LCD + INT improved glucose tolerance more than LCD in obese adults, and these findings relate to ß-cell function. These data support LCD + INT for preserving pancreatic function for type 2 diabetes prevention.
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Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial.
Gardner, CD, Trepanowski, JF, Del Gobbo, LC, Hauser, ME, Rigdon, J, Ioannidis, JPA, Desai, M, King, AC
JAMA. 2018;319(7):667-679
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Obesity is a major public health challenge and different dietary strategies are employed to lose weight. This randomised clinical trial of 609 obese adults between the age of 18 and 50 aimed to determine the effects of a healthy low-fat diet in comparison to a healthy low-carbohydrate diet on weight change over a 12 month period. The study also assessed whether 3 genetic markers and blood sugar management affected weight loss in the 2 groups. Participants in the study were offered 22 group sessions of health coaching to support adherence to the programme. 481 participants completed the study. The low-carbohydrate group lost on average 6kg and the low-fat group lost on average 5.4kg. The difference between the 2 groups did not achieve significance for weight loss. There was also no significant genetic or blood sugar management effect in relation to dietary pattern and weight loss. The authors of this study conclude that the results of this study do not help in identifying which dietary type is better for whom in relation to 3 genetic markers and blood sugar management.
Abstract
Importance: Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets. Objective: To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss. Design, Setting, and Participants: The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss. Interventions: Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality. Main Outcomes and Measures: Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss. Results: Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 μIU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs -6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups. Conclusions and Relevance: In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom. Trial Registration: clinicaltrials.gov Identifier: NCT01826591.
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Type-4 Resistant Starch in Substitution for Available Carbohydrate Reduces Postprandial Glycemic Response and Hunger in Acute, Randomized, Double-Blind, Controlled Study.
Stewart, ML, Wilcox, ML, Bell, M, Buggia, MA, Maki, KC
Nutrients. 2018;10(2)
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Resistant starch is a combination of dietary fibre and carbohydrate that ‘resists’ digestion in the small intestine and is fermented in the large intestine by gut bacteria. It is associated with a number of health benefits, particularly the management of blood glucose levels. This small double-blind, randomised controlled trail allocated 36 healthy individuals (mostly female, average age 46 and BMI 26) to eat either a low-fibre scone or a scone with added resistant starch in the form of acid-hydrolyzed and heat treated maize starch. The response of blood glucose and blood insulin levels were measured, as well as participants feeling of fullness and intestinal comfort after eating the scones. The scone with the added resistant starch had significantly lower blood glucose (43-45% lower) and blood insulin (35-40% lower) levels after eating the scone, when compared to those eating the low-fibre scone. They also reported feeling fuller for longer and had no particular digestive symptoms. Whilst this is a small study, Nutrition Practitioners may want to investigate dietary sources of resistant starch when working with clients to balance blood glucose and insulin levels.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Based on the findings of the Predict Study, it is highly probable that the same meal will elicit a different glycaemic response in individuals with different gut microbial compositions.
- The gut microbiota, therefore, needs to be taken into consideration when assessing glycaemic responses to a meal.
- Healthcare practitioners may like to consider the use of resistant starches as an additional tool to balance blood sugar responses to a meal.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Dietary modulation of the gut microbiota impacts human health. This paper discusses the effects of a man-made type of resistant starch on the glycaemic response to a meal. Based on the initial findings of the Predict Study, it is highly probably that the same meal will elicit a different glycaemic (and wider metabolic) response in individuals with different gut microbial compositions. So this paper confirms the need to take the gut microbiota into consideration when assessing glycaemic responses to a meal, both in research and in clinical practice.
Clinical practice applications:
Not all fibres are equal, and not all starches are equal. Type 4 resistant starch is a novel addition to the already known types 1, 2, and 3 and provides with clinicians with an additional tool to balance their patient's blood sugar response to a meal based on the effect of resistant starch on the gut microbiota.
Considerations for future research:
Resistant starches are known for their ability to affect gut microbiota composition and short-chain fatty acid concentrations which, in turn, have the ability to modulate immune and metabolic functions in the host, including cholesterol, fasting glucose, glycosylated haemoglobin, and pro-inflammatory markers. Further studies on glycaemic and wider metabolic responses to a meal must take into consideration the effect of resistant starches on gut microbial composition. Not doing so may be skewing scientific findings.
Abstract
Resistant starch (RS) is a type of dietary fiber that has been acknowledged for multiple physiological benefits. Resistant starch type 4 (RS4) is a subcategory of RS that has been more intensively studied as new types of RS4 emerge in the food supply. The primary aim of this randomized, double-blind, controlled study was to characterize the postprandial glucose response in healthy adults after consuming a high fiber scone containing a novel RS4 or a low fiber control scone without RS4. Secondary aims included assessment of postprandial insulin response, postprandial satiety, and gastrointestinal tolerance. The fiber scone significantly reduced postprandial glucose and insulin incremental areas under the curves (43-45% reduction, 35-40% reduction, respectively) and postprandial glucose and insulin maximum concentrations (8-10% and 22% reduction, respectively). The fiber scone significantly reduced hunger and desire to eat during the 180 min following consumption and yielded no gastrointestinal side effects compared with the control scone. The results from this study demonstrate that a ready-to-eat baked-good, such as a scone, can be formulated with RS4 replacing refined wheat flour to yield statistically significant and clinically meaningful reductions in blood glucose and insulin excursions. This is the first study to report increased satiety after short-term RS4 intake, which warrants further investigation in long-term feeding studies.
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Use of Novel High-Protein Functional Food Products as Part of a Calorie-Restricted Diet to Reduce Insulin Resistance and Increase Lean Body Mass in Adults: A Randomized Controlled Trial.
Johnston, CS, Sears, B, Perry, M, Knurick, JR
Nutrients. 2017;9(11)
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Reducing insulin resistance (IR) is achieved by either calorie restriction or increase of lean muscle mass, however calorie restriction tends to lead to a decrease of lean mass. The aim of this trial was to determine whether the protein content of a low-calorie diet impacted insulin resistance levels. Twenty-one healthy adults at risk of IR were randomly assigned to receive either high-protein diet or conventional diet food packages, both of which had the same calorie restriction. Weight and blood samples were collected at baseline and six weeks. This study found that an increased protein consumption with moderate calorie restriction was 140% more effective for reducing IR compared to a conventional, isocaloric diet. While significant weight loss occurred in both groups, the reduction in IR was significantly associated only with the increase of lean mass. These results justify future long-term studies focusing on the combination of various dietary strategies to reduce IR and increase lean mass.
Abstract
Significant reductions in insulin resistance (IR) can be achieved by either calorie restriction or by the increase of lean mass. However, calorie restriction usually results in significant loss of lean mass. A 6-week randomized controlled feeding trial was conducted to determine if a calorie-restricted, high-protein diet (~125 g protein/day consumed evenly throughout the day) using novel functional foods would be more successful for reducing IR in comparison to a conventional diet (~80 g protein/day) with a similar level of calorie restriction. Healthy adults (age 20-75 years; body mass index, 20-42 kg/m²) with raised triglyceride/high-density lipoprotein ratios were randomly assigned to the control group (CON: test foods prepared using gluten-free commercial pasta and cereal) or to the high-protein group (HPR: test foods prepared using novel high-protein pasta and cereal both rich in wheat gluten). Mean weight loss did not differ between groups (-2.7 ± 2.6 and -3.2 ± 3.0 kg for CON (n = 11) and HPR (n = 10) respectively, p = 0.801); however, the 6-week change in fat-free mass (FFM) differed significantly between groups (-0.5 ± 1.5 and +1.5 ± 3.8 kg for CON and HPR respectively, p = 0.008). IR improved in HPR vs. CON participants (homeostasis model assessment-estimated insulin resistance [HOMAIR] change: -1.7 ± 1.4 and -0.7 ± 0.7 respectively; p = 0.020). The change in HOMA-IR was related to the change in FFM among participants (r = -0.511, p = 0.021). Thus, a high-protein diet using novel functional foods combined with modest calorie restriction was 140% more effective for reducing HOMA-IR in healthy adults compared to a lower protein, standard diet with an equal level of calorie restriction.
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Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial.
Johansen, MY, MacDonald, CS, Hansen, KB, Karstoft, K, Christensen, R, Pedersen, M, Hansen, LS, Zacho, M, Wedell-Neergaard, AS, Nielsen, ST, et al
JAMA. 2017;318(7):637-646
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First-line treatment of Type 2 diabetes includes diet, physical activity, and weight loss prior to or in parallel with initiation of medication. The aim of this study was to examine whether an intensive lifestyle intervention results in equivalent blood sugar control compared with standard care. A secondary aim was to test whether an intensive lifestyle intervention leads to a reduction in glucose-lowering medication in participants with Type 2 diabetes. The study was a randomized, assessor-blind clinical study of 98 adults with Type 2 diabetes diagnosed for less than 10 years. The participants were randomly assigned (2:1; stratified by sex) to the lifestyle group (n = 64) or the standard care group (n = 34). Results show that an intensive lifestyle intervention did not achieve comparable blood sugar control in comparison with standard care, however, the former led to a substantial and parallel reduction in glucose-lowering medication. The authors conclude that even though a lifestyle intervention compared to standard care did not result in the expected glycaemic control, it was still in a direction consistent with benefit.
Abstract
Importance: It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes. Objective: To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes. Design, Setting, and Participants: Randomized, assessor-blinded, single-center study within Region Zealand and the Capital Region of Denmark (April 2015-August 2016). Ninety-eight adult participants with non-insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included. Participants were randomly assigned (2:1; stratified by sex) to the lifestyle group (n = 64) or the standard care group (n = 34). Interventions: All participants received standard care with individual counseling and standardized, blinded, target-driven medical therapy. Additionally, the lifestyle intervention included 5 to 6 weekly aerobic training sessions (duration 30-60 minutes), of which 2 to 3 sessions were combined with resistance training. The lifestyle participants received dietary plans aiming for a body mass index of 25 or less. Participants were followed up for 12 months. Main Outcomes and Measures: Primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 12-month follow-up, and equivalence was prespecified by a CI margin of ±0.4% based on the intention-to-treat population. Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication. Results: Among 98 randomized participants (mean age, 54.6 years [SD, 8.9]; women, 47 [48%]; mean baseline HbA1c, 6.7%), 93 participants completed the trial. From baseline to 12-month follow-up, the mean HbA1c level changed from 6.65% to 6.34% in the lifestyle group and from 6.74% to 6.66% in the standard care group (mean between-group difference in change of -0.26% [95% CI, -0.52% to -0.01%]), not meeting the criteria for equivalence (P = .15). Reduction in glucose-lowering medications occurred in 47 participants (73.5%) in the lifestyle group and 9 participants (26.4%) in the standard care group (difference, 47.1 percentage points [95% CI, 28.6-65.3]). There were 32 adverse events (most commonly musculoskeletal pain or discomfort and mild hypoglycemia) in the lifestyle group and 5 in the standard care group. Conclusions and Relevance: Among adults with type 2 diabetes diagnosed for less than 10 years, a lifestyle intervention compared with standard care resulted in a change in glycemic control that did not reach the criterion for equivalence, but was in a direction consistent with benefit. Further research is needed to assess superiority, as well as generalizability and durability of findings. Trial Registration: clinicaltrials.gov Identifier: NCT02417012.
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Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial.
Trepanowski, JF, Kroeger, CM, Barnosky, A, Klempel, MC, Bhutani, S, Hoddy, KK, Gabel, K, Freels, S, Rigdon, J, Rood, J, et al
JAMA internal medicine. 2017;177(7):930-938
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Restricting calories every second day to as low as 500 calories (alternate day fasting) has become popular in recent years as a weight loss strategy. This randomised clinical trial of 69 obese, but otherwise healthy, individuals aimed to assess the impact of alternate day fasting for 6 months on weight loss and risk factors for heart disease, in comparison to more traditional daily calorie restriction. The study results showed that average weight loss was similar for the alternate day fasting group and daily calorie restriction group, compared to control. Average HDL cholesterol levels were higher at month 6 and average LDL cholesterol levels were higher at month 12 in the alternate day fasting group, compared to the daily calorie restriction group. There were no other statistically significant differences between the 2 groups for other markers of heart disease. Drop out rates were highest in the alternate day fasting group, suggesting that it is a harder diet to stick to in the longer term. Nutrition practitioners practising individualised nutrition can use the results of this trial to work with overweight clients in choosing the best dietary strategy for weight loss in relation to their clients’ goals and lifestyle.
Abstract
Importance: Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. Objective: To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. Design, Setting, and Participants: A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. Interventions: Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. Main Outcomes and Measures: The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Results: Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. Conclusions and Relevance: Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. Trial Registration: clinicaltrials.gov Identifier: NCT00960505.
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A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel.
Zinn, C, McPhee, J, Harris, N, Williden, M, Prendergast, K, Schofield, G
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2017;42(11):1158-1164
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A global rise in overweight and obesity has created uncertainty around the efficacy of current nutritional guidelines that favour a high-carbohydrate, low-fat (HCLF) diet. Evidence has shown a low-carbohydrate, high-fat (LCHF) diet, compared with a HCLF diet, is at least as effective in reducing body weight and waist circumference and is more effective for improving metabolic health. The aim of this study was evaluate changes in weight and metabolic health between these two dietary approaches among 26 overweight and obese defence force personnel. Participants were randomly allocated to a HCLF or LCHF diet for 12 weeks. Weight, waist circumference, fasting lipids and glycaemic markers were assessed at baseline and 12 weeks. Both study groups demonstrated a significant reduction in weight and waist circumference, and the LCHF group showed further improvements in metabolic markers. Based on these results, the authors conclude a high-fat dietary approach shows promise for short-term weight loss and improved metabolic health compared with current dietary guidelines among the defence force population.
Abstract
Overweight, obesity, and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel. In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids, and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t statistic and interpreted using a p < 0.05 level of statistical significance. Between-group mean differences and confidence intervals were analysed using effect sizes and magnitude-based inferences. Twenty-six participants completed the trial (14 intervention, 12 control). Both groups showed statistically significant weight and waist circumference reductions; the intervention group significantly reduced triglycerides and serum glucose and significantly increased high-density lipoprotein cholesterol (HDLc). Relative to control, the intervention group showed small, possibly to likely beneficial effects for weight, triglycerides, glucose, insulin, and homeostasis model assessment of insulin resistance; moderate, likely beneficial effects for HDL cholesterol, triglyceride:HDLc ratio and HbA1c; and a small, likely harmful effect for low-density lipoprotein cholesterol. This dietary approach shows promise for short-term weight loss and improved metabolic health outcomes conditions compared with mainstream recommendations. It should be offered to defence force personnel at least as a viable alternative means to manage their weight and health.
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A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account.
Krebs, JD, Parry Strong, A, Cresswell, P, Reynolds, AN, Hanna, A, Haeusler, S
Asia Pacific journal of clinical nutrition. 2016;25(1):78-84
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With the advent of self-managed insulin by injection, Type 1 diabetics were able to eat a normal diet and not worry about their carbohydrate intake. However this regime requires careful carbohydrate counting and insulin dosing, which is not always easy to do. With interest in low carbohydrate diets in the management of Type 2 diabetes increasing, some Type 1 diabetics are restricting their carbohydrates in order to better control their blood glucose levels. This pilot study was a small, single-blinded randomised control trial of 10 individuals. It aimed to determine the effects of low carbohydrate diets on glycaemic control, daily insulin requirements and quality of life in Type 1 Diabetes, when compared to those on a normal diet. The results showed that HbA1C reduced significantly in the carbohydrate restricted group compared to the group eating a normal diet. The amount of injected insulin also showed a significant reduction in the low-carbohydrate group. There were no changes in blood pressure, creatinine or lipid profile in either of the groups. A low-carbohydrate diet is a feasible option for clients with Type 1 Diabetes who are looking for improved glycaemic control and reduced doses of insulin, particularly if they would like to lose weight.
Abstract
BACKGROUND AND OBJECTIVES To determine the effect of a low carbohydrate diet and standard carbohydrate counting on glycaemic control, glucose excursions and daily insulin use compared with standard carbohydrate counting in participants with type 1 diabetes. METHODS AND STUDY DESIGN Participants (n=10) with type 1 diabetes using a basal; bolus insulin regimen, who attended a secondary care clinic, were randomly allocated (1:1) to either a standard carbohydrate counting course or the same course with added information on following a carbohydrate restricted diet (75 g per day). Participants attended visits at baseline and 12 weeks for measurements of weight, height, blood pressure, HbA1c, lipid profile and creatinine. They also completed a 3-day food diary and had 3 days of continuous subcutaneous glucose monitoring. RESULTS The carbohydrate restricted group had significant reductions in HbA1c (63 to 55 mmol/mol (8.9-8.2%), p<0.05) and daily insulin use (64.4 to 44.2 units/day, p<0.05) and non-significant reductions in body weight (83.2 to 78.0 kg). There were no changes in blood pressure, creatinine or lipid profile and all outcomes in the carbohydrate counting group were unchanged. There was no change in glycaemic variability as measured by the mean amplitude of glycaemic excursion in either group. CONCLUSIONS A low carbohydrate diet is a feasible option for people with type 1 diabetes, and may be of benefit in reducing insulin doses and improving glycaemic control, particularly for those wishing to lose weight. 背景与目的:在1 型糖尿病患者中,与标准碳水化合物计数比较,确定低碳水 化合物饮食对血糖控制、血糖波动以及每日胰岛素使用的影响。方法与研究 设计:参加二级保健门诊使用普通膳食以注射胰岛素为治疗方案的10 例1 型 糖尿病患者,按照1:1 的比例随机分配到一个标准的碳水化合物计数组,或限 制碳水化合物饮食组(每天75 g)。测量了所有志愿者基线和12 周的体重、 身高、血压、糖化血红蛋白、血脂和肌酐,志愿者完成了为期3 天的食物日记 和3 天持续皮下血糖监测。结果:碳水化合物限制组HbA1c(63-55 mmol/mol (8.9-8.2 %),p<0.05)和每日胰岛素用量(64.4-44.2 U/d,p<0.05)显著减 少,体重(83.2-78 kg)的变化无显著差异。碳水化合物计数组血压、肌酐或 血脂所有指标均无显著改变。通过平均血糖波动幅度计算的血糖变异性在任何 一组中均无改变。结论:低碳水化合物饮食是1 型糖尿病患者一个可行的选 择,可以减少胰岛素剂量和改善血糖控制,特别是对那些希望减肥的患者。.