RESUMEN
BACKGROUND/OBJECTIVES: Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes. SUBJECTS/METHODS: A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks. RESULTS: Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009). CONCLUSIONS: This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.
Asunto(s)
Diabetes Mellitus Tipo 1/sangre , Dieta/efectos adversos , Conducta Alimentaria , Hemoglobina Glucada/análisis , Adolescente , Adulto , Análisis de Varianza , Glucemia/metabolismo , Registros de Dieta , Fibras de la Dieta/efectos adversos , Proteínas en la Dieta/efectos adversos , Ejercicio Físico , Femenino , Estudios de Seguimiento , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Fumar , Encuestas y Cuestionarios , Verduras , Adulto JovenRESUMEN
AIMS/HYPOTHESIS: The aim of this study was to examine the association of physical activity (PA) with all-cause mortality and incident and prevalent cardiovascular disease (CVD) among patients with type 1 diabetes. METHODS: The EURODIAB Prospective Complications Study is a cohort including 3,250 male and female patients with type 1 diabetes (mean age 32.7 ± 10.2 years) from 16 European countries, of whom 1,880 participated in follow-up examinations. In analysis 1 (longitudinal), the association of baseline PA (based on the reported number of hours per week spent in mild, moderate and vigorous PA) with all-cause mortality and incident CVD was examined by performing survival analysis. In analysis 2 (cross-sectional), we focused on the association between PA at follow-up (data on sports, walking distance and regular bicycling) and prevalent CVD by performing logistic regression analysis. Adjustments were made for age, sex, BMI, smoking, consumption of alcohol, consumption of certain nutrients and diabetic complications. RESULTS: Analysis 1 (longitudinal): participation in moderate or vigorous PA once a week or more was borderline inversely associated with all-cause mortality (men and women combined) (HR 0.66, 95% CI 0.42, 1.03) and incident CVD (women only) (HR 0.66, 95% CI 0.40, 1.08). No association was found in men. Analysis 2 (cross-sectional): total PA (indexed by sports, walking, bicycling) and distance walked were inversely associated with prevalent CVD (OR(totalPA) 0.66, 95% CI 0.45, 0.97; and OR(walking) 0.61, 95% CI 0.42, 0.89). CONCLUSIONS/INTERPRETATION: PA showed a borderline inverse association with both all-cause mortality (both sexes) and incident CVD (women only) in patients with type 1 diabetes. Since this is an under-researched clinical population, future longitudinal studies with objective PA measurements are needed to expand on these results.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 1/mortalidad , Angiopatías Diabéticas/epidemiología , Cardiomiopatías Diabéticas/epidemiología , Mortalidad , Actividad Motora , Adulto , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/terapia , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/mortalidad , Angiopatías Diabéticas/prevención & control , Cardiomiopatías Diabéticas/complicaciones , Cardiomiopatías Diabéticas/mortalidad , Cardiomiopatías Diabéticas/prevención & control , Europa (Continente)/epidemiología , Ejercicio Físico , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND AND AIMS: A healthy diet has been inversely associated with endothelial dysfunction (ED) and low-grade inflammation (LGI). We investigated the association between nutrient consumption and biomarkers of ED and LGI in type 1 diabetes. METHODS AND RESULTS: We investigated 491 individuals. Nutrient consumption and lifestyle risk factors were measured in 1989 and 1997. Biomarkers of ED (von Willebrand factor, soluble vascular cell adhesion molecule-1 and soluble endothelial selectin) and LGI (C-reactive protein, interleukin 6 and tumour necrosis factor α) were measured in 1997 and averaged into Z-scores. The nutrient residual method was used to adjust individual nutrient intake for energy intake. Data were analysed with generalised estimation equations. We report increments/decrements in nutrient consumption, averaged over time, per +1 standard deviation (SD) of 1997 ED or LGI Z-scores, after adjustment for sex, age, duration of diabetes, investigation centre, body mass index, energy intake, smoking behaviour, alcohol consumption, and each of the other nutrients. One SD elevation in ED Z-score was associated with a diet lower in fibre [ß(95%CI);-0.09(-0.18;-0.004)], polyunsaturated fat [-0.18(-0.31;-0.05)] and vegetable protein [-0.10(-0.20;-0.001)]. For the LGI Z-score results showed associations with fibre [-0.09(-0.17;-0.01)], polyunsaturated fat [-0.14(-0.24;-0.03)] and cholesterol [0.10(0.01; 0.18)]. CONCLUSION: In type 1 diabetes, consumption of less fibre, polyunsaturated fat and vegetable protein, and more cholesterol over the study period was associated with more ED and LGI. Following dietary guidelines in type 1 diabetes may reduce cardiovascular disease risk by favourably affecting ED and LGI.
Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Diabetes Mellitus Tipo 1/fisiopatología , Conducta Alimentaria , Inflamación/fisiopatología , Adolescente , Adulto , Biomarcadores/sangre , Índice de Masa Corporal , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 1/complicaciones , Fibras de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Endotelio/fisiopatología , Ingestión de Energía , Ácidos Grasos Insaturados/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Inflamación/complicaciones , Interleucina-6/sangre , Estilo de Vida , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Factor de Necrosis Tumoral alfa/sangre , Verduras , Adulto JovenRESUMEN
AIMS/HYPOTHESIS: Low adherence to recommendations for dietary saturated fatty acid (SFA) and fibre intake in patients with type 1 diabetes mellitus may heighten their increased risk of cardiovascular disease (CVD) and mortality. We examined the relationship of SFA and total, soluble and insoluble fibre with incident CVD and all-cause mortality in type 1 diabetic patients. METHODS: A prospective cohort analysis was performed in 2,108 European type 1 diabetic patients aged 15-60 years who were free of CVD at baseline and enrolled in the EURODIAB Prospective Complications Study (51% male). Diet was assessed from a standardised 3 day dietary record. HR were calculated using Cox proportional hazards models. RESULTS: During a mean follow-up of 7.3 years, 148 incident cases of fatal and non-fatal CVD and 46 all-cause deaths were documented. No statistically significant association was found between SFA and CVD and all-cause mortality. Total dietary fibre, per 5 g/day, was associated with lower all-cause mortality risk (HR 0.72; 95% CI 0.55, 0.95). This association was stronger for soluble fibre (per 5 g/day, HR 0.34; 95% CI 0.14, 0.80) compared with insoluble fibre (per 5 g/day; HR 0.66; 95% CI 0.45, 0.97). Similar results were found for the association with CVD. CONCLUSIONS/INTERPRETATION: This study suggests that reported dietary SFA is not significantly associated with CVD and all-cause mortality in type 1 diabetic patients. On the contrary, higher dietary fibre consumption, especially soluble fibre, within the range commonly consumed by type 1 diabetic patients, may contribute to the prevention of CVD and all-cause mortality in type 1 diabetic patients.
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 1/mortalidad , Angiopatías Diabéticas/mortalidad , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Hipercolesterolemia/mortalidad , Hipertensión/mortalidad , Adolescente , Adulto , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/etiología , Registros de Dieta , Ingestión de Energía , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipercolesterolemia/sangre , Hipercolesterolemia/complicaciones , Hipertensión/sangre , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Educación del Paciente como Asunto , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
The Expert Group Diabetes and Nutrition of the European Diabetes Association has compiled evidence-based recommendations for the treatment and prevention of diabetes mellitus. These recommendations have been coordinated with all the major relevant societies in Germany. This has enabled a uniform approach to the dietary treatment of persons with diabetes that is supported by the German Diabetes Association, the German Obesity Association, the German Association of Nutritional Medicine and the German Association for Nutrition. The scientific background to the dietary recommendations have also been incorporated in a nutrition training programme and a patient information guide with the aim of promoting countrywide implementation.
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Diabetes Mellitus/dietoterapia , Dieta para Diabéticos , Medicina Basada en la Evidencia , Consumo de Bebidas Alcohólicas , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Femenino , Índice Glucémico , Humanos , Masculino , Pérdida de PesoAsunto(s)
Enfermedad Coronaria/mortalidad , Dieta Mediterránea/estadística & datos numéricos , Esperanza de Vida , Mortalidad , Neoplasias/mortalidad , Cooperación del Paciente/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/prevención & control , Registros de Dieta , Femenino , Grecia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/prevención & control , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Encuestas y CuestionariosAsunto(s)
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/prevención & control , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Medicina Basada en la Evidencia , Humanos , Hipoglucemiantes/uso terapéutico , EscociaRESUMEN
The EURODIAB Complications Study, a clinic based epidemiological project including 3250 individuals with type 1 diabetes from 31 European centres analysed the natural dietary fibre intake and possible benefits for patients with diabetes. The mean intake of natural dietary fibre in the cohort of patients with type 1 diabetes was 17.3 g/day for all centres with a centre range of 13.9-21.9 g/day. The fibre consumption was lowest in patients from Eastern European centres compared to patients from centres in Southern and North-Western Europe. The fibre density was highest in patients from Southern Europe. Total fibre intake was significantly inversely related to HbA1c levels; severe ketoacidosis risk fell significantly with higher fibre intakes. Higher intakes of total fibre were independently associated with significantly higher levels of high density lipoprotein-cholesterol in male and in female patients. Fibre intakes in men with diabetes were also inversely related to ratios of total cholesterol to high density lipoprotein-cholesterol and to levels of low density lipoprotein-cholesterol. Higher fibre intakes are also associated with decreases in plasma oestradiol and oestrone levels. A protective effect of total fibre intake against cardiovascular disease was observed in females but not in males with diabetes.
Asunto(s)
Diabetes Mellitus Tipo 1/dietoterapia , Fibras de la Dieta/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Carbohidratos de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Europa (Continente) , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
BACKGROUND: Little is known about the variation of the glycemic index (GI) in the diet of European outpatients with type 1 diabetes and how the GI of a commonly consumed diet is associated with metabolic control. OBJECTIVE: The present study examined the calculated dietary GI of European outpatients with type 1 diabetes for possible relations to glycated hemoglobin (Hb A(1c)) and serum lipid concentrations. DESIGN: The relation of the GI (calculated from a 3-d dietary record) to Hb A(1c), serum cholesterol (total, LDL, and HDL), and fasting triacylglycerol was analyzed in 2810 people with type 1 diabetes from the EURODIAB Complications Study. RESULTS: The GI was independently related to Hb A(1c) (P = 0.0001). Compared with the highest GI quartile (median GI: 89), adjusted Hb A(1c) in the lowest GI quartile (median GI: 75) was 11% lower in patients from southern European centers and 6% lower in patients from northern, western, and eastern European centers. Of the serum lipids, only the HDL cholesterol in patients from these European centers was independently related to the GI (P = 0.002). In southern European centers, the consumption of pasta, temperate-climate fruit, white bread, and potatoes largely determined the patients' dietary GI, whereas in the northern, western, and eastern European centers, consumption of bread, potatoes, and temperate-climate fruit was most relevant. CONCLUSIONS: This study in European patients with type 1 diabetes showed that a lower dietary GI is related to lower Hb A(1c) concentrations, independently of fiber intake. The consumption of bread and pasta had the biggest effect on the overall dietary GI of European outpatients.
Asunto(s)
Glucemia/metabolismo , Colesterol/sangre , Diabetes Mellitus Tipo 1/metabolismo , Hemoglobina Glucada/análisis , Triglicéridos/sangre , Adolescente , Adulto , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Registros de Dieta , Carbohidratos de la Dieta/metabolismo , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Overweight and obesity are also found among persons with type 1 diabetes. OBJECTIVE: The present study examined which nutrients predict the body mass index (BMI), the waist-to-hip ratio (WHR) and the waist circumference (WC) of European persons with type 1 diabetes. DESIGN: Cross-sectional, clinic-based study (EURODIAB Complications Study). SUBJECTS AND METHODS: Nutrient intakes (assessed by a 3-day dietary record) predicting measures of body weight (BMI, WHR and WC) were determined by stepwise forward regression analysis in 1458 males and 1410 females with type 1 diabetes (P< or =0.05 for inclusion). RESULTS: In men, a higher carbohydrate intake was a significant independent predictor for lower levels of BMI, WHR and WC, an increased saturated fat intake and a lower intake of cereal fibre predicted a higher WHR, a higher monounsaturated fat intake and a lower glycaemic index of the diet determined lower levels of WHR and WC, and a moderate consumption of alcohol determined an increased WC. In women, a higher carbohydrate intake predicted a lower BMI and a thinner WC, no alcohol consumption determined a lower BMI, and an increased intake of saturated fat and a lower consumption of cereal fibre were significant independent predictors for a higher WHR. CONCLUSIONS: A modified fat intake, an increase of carbohydrate and cereal fibre intake and a preferred consumption of low glycaemic index foods are independently related to lower measures of body weight in European persons with type 1 diabetes.
Asunto(s)
Peso Corporal/fisiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus/epidemiología , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Obesidad , Adulto , Glucemia/análisis , Composición Corporal , Constitución Corporal , Estudios Transversales , Registros de Dieta , Ingestión de Energía , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Análisis de RegresiónRESUMEN
AIMS: Little information is available on the relationship between glycated haemoglobin levels and the source or amount of dietary carbohydrate. The present study compares the association of carbohydrate intake with HbA1c between European individuals with Type 1 diabetes mellitus injecting insulin once or twice per day and those with > or = 3 daily injections. METHODS: The relation of carbohydrate intake (total, cereal, fruit, vegetable, milk, and potato carbohydrate assessed by a 3-day dietary record) to HbA1c was examined in 2084 patients (age 32.6 +/- 10.2 years, duration of diabetes 14.8 +/- 9.5 years) included in the EURODIAB Complications Study. RESULTS: In both insulin injection regimens, an increased intake of total carbohydrate (% of energy) and a higher consumption of potato carbohydrates (g) were associated with higher levels of HbA1c, whereas an increased intake of vegetable carbohydrate (g) was inversely related to HbA1c. These tendencies were all more pronounced in persons with one or two daily insulin injections. Consumption of cereal and fruit carbohydrates (g) was not related to HbA1c, irrespective of the insulin injection regimen. A trend of HbA1c to increase with higher intakes of milk carbohydrate was confined to those with one or two insulin injections per day (test for interaction: P = 0.01). CONCLUSIONS: In particular, subjects with only 1 or 2 daily insulin injections per day should receive specific advice to correctly consider milk and potato carbohydrates. On the other hand, people with Type 1 diabetes may profit from a higher consumption of vegetable carbohydrates for their levels of HbA1c.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 1/sangre , Carbohidratos de la Dieta/administración & dosificación , Hemoglobina Glucada/análisis , Adulto , Animales , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Grano Comestible , Ingestión de Energía , Femenino , Frutas , Humanos , Insulina/administración & dosificación , Masculino , Leche , Solanum tuberosum , VerdurasRESUMEN
The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study examined the fat and cholesterol intakes of European individuals with type 1 diabetes for possible relations to serum lipid levels (total cholesterol, HDL- and LDL-cholesterol, fasting triglycerides) and to the prevalence of cardiovascular disease (past history or electrocardiogram abnormalities). Fat intake (total fat, saturated fat, cholesterol) from 2,868 subjects with type 1 diabetes (mean age 32.9 +/- 10.2 years (range: 14-61 years), mean diabetes duration 14.7 +/- 9.4 years (range: 1-56 years)) was assessed by a standardized 3-day dietary record at the Nutrition Co-Ordinating Centre (Düsseldorf). Serum lipid levels were determined in the central laboratory (London) by standard enzymatic methods. Energy-adjusted total and LDL-cholesterol levels increased significantly with higher intakes of total fat, saturated fat and cholesterol. However, these relations were largely explained by concomitant decreases in dietary fibre intake. For levels of HDL-cholesterol and triglycerides no independent associations were observed with fat or cholesterol intake. Increased intakes of total fat, saturated fat and cholesterol were also related to higher prevalences of cardiovascular disease. These associations were, however, no longer significant after adjustment for dietary fibre intake for which we previously demonstrated independent associations with the serum cholesterol pattern and CVD. Since higher fat intakes are commonly accompanied by lower carbohydrate and fibre intakes we conclude that restricted intakes of cholesterol, saturated fat and total fat combined with higher fibre intakes beneficially affect both the levels of total and LDL-cholesterol and the risk for cardiovascular disease in European individuals with type 1 diabetes.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Colesterol en la Dieta/administración & dosificación , Diabetes Mellitus Tipo 1/complicaciones , Grasas de la Dieta/administración & dosificación , Lípidos/sangre , Adulto , Enfermedades Cardiovasculares/epidemiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 1/epidemiología , Fibras de la Dieta/administración & dosificación , Electrocardiografía , Ingestión de Energía , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Triglicéridos/sangreRESUMEN
OBJECTIVE: A cross-sectional analysis of dietary fiber intake was performed in European type 1 diabetic patients enrolled in the EURODIAB IDDM Complications Study to explore its potential relationship to serum cholesterol levels and the prevalence of cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: Dietary intake was assessed by a standardized 3-day dietary record. For analysis of fiber intake (total, soluble, and insoluble) and its associations with CVD (past history or electrocardiogram abnormalities), complete data were available from 1,050 male and 1,012 female individuals. Relationships of fiber intakes to serum cholesterol levels (total, HDL, and LDL cholesterol) were examined in 926 men and 881 women with type 1 diabetes. RESULTS: Higher intakes of total fiber (g/day) were independently associated with significantly higher levels of HDL cholesterol in male (P = 0.01) and female individuals (P = 0.03). Fiber intakes of men with type 1 diabetes were also inversely related to ratios of total cholesterol to HDL cholesterol (P = 0.0001) and levels of LDL cholesterol (P = 0.0002). A protective effect of total fiber intake against CVD was observed for female subjects, where a significant trend was maintained after adjustment for potential confounders, including energy and saturated fat (P = 0.03 vs. P = 0.2 in men). Results were similar in separate analyses of soluble and insoluble fiber. CONCLUSIONS: The present study demonstrates that higher fiber intakes are independently related to beneficial alterations of the serum cholesterol pattern in men and to a lower risk for CVD in European insulin-dependent women. Beneficial effects can already be observed for fiber amounts within the range commonly consumed by outpatients with type 1 diabetes.
Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Colesterol/sangre , Diabetes Mellitus Tipo 1/complicaciones , Fibras de la Dieta/administración & dosificación , Adulto , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Registros de Dieta , Ingestión de Energía , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , PrevalenciaRESUMEN
This study compares the prevalence of chronic complications, the quality of metabolic control and the nutritional intake in people with type 1 diabetes in different European regions. The EURODIAB Complications Study included a sample of 3250 European patients with type 1 diabetes stratified for gender, age and diabetes duration. All examinations were performed using standardised, validated methods. HBA1c, LDL-cholesterol and fasting triglycerides were higher in the eastern European centres than in the southern or north-western European centres. Acute (severe ketoacidosis, severe hypoglycaemia) and chronic diabetes complications (retinopathy, nephropathy, neuropathy, cardiovascular disease) were all considerably more frequent in the eastern European centres. HbA1c was lower in the German centres than in the total EURODIAB cohort or in the north-western European centres, but severe hypoglycaemia and proliferative retinopathy were more common. Persons from the eastern European and the German centres consumed undesirably high amounts of cholesterol, total and saturated fat. Overall, improvements in the prevention, detection and management of diabetes complications in persons with type 1 diabetes are essential throughout Europe, particularly in eastern European regions. Since elevated LDL-cholesterol levels and hypertension were strikingly common in this relatively young cohort of European people with type 1 diabetes, generally more attention should be directed towards an adequate management of these cardiovascular risk factors.
Asunto(s)
Diabetes Mellitus Tipo 1 , Evaluación Nutricional , Adulto , LDL-Colesterol/sangre , Estudios de Cohortes , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/metabolismo , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/metabolismo , Retinopatía Diabética/epidemiología , Retinopatía Diabética/metabolismo , Europa (Continente)/epidemiología , Femenino , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/epidemiología , Hiperglucemia/metabolismo , Hipertensión/epidemiología , Hipertensión/metabolismo , Estilo de Vida , Masculino , PrevalenciaRESUMEN
The effect of dietary fibre intake on glycaemic control is still controversial. This study analysed the intake of natural dietary fibre in patients with Type I diabetes mellitus enrolled in the EURODIAB IDDM Complications Study to determine any associations with HbA1c levels and with the prevalence of severe ketoacidosis or severe hypoglycaemia. Dietary intake was assessed by a 3-day dietary record. The relation between intake of fibre (total, soluble and insoluble) and HbA1c was examined in 2065 people with Type I diabetes. Associations with severe ketoacidosis (requiring admission to hospital) and severe hypoglycaemia (requiring the help of another person) were analysed in 2687 people with Type I diabetes. Total fibre intake (g/day) was inversely related to HbA1c (p = 0.02), independently of carbohydrate intake, total energy intake and other factors regarding lifestyle and diabetes management. Severe ketoacidosis risk fell significantly with higher fibre intake (p = 0.002), with an adjusted odds ratio of 0.48 (95 % confidence interval 0.27 to 0.84) in the highest quartile ( > or = 23.0 g fibre/day) compared with the lowest quartile ( < or = 13.7 g fibre/day). The occurrence of severe hypoglycaemia was not related to fibre intake. Beneficial effects of fibre on HbA1c and the risk of severe ketoacidosis were particularly pronounced in patients from southern European centres. This study shows that higher fibre intake is independently related to a reduction in HbA1c levels in European people with Type I diabetes. Furthermore, increased fibre intake may reduce the risk of severe ketoacidosis. These beneficial effects were already observed for fibre intake within the range commonly consumed by people with Type I diabetes.