RESUMO
BACKGROUND/OBJECTIVES: The study aimed to compare the effects of two eucaloric meal patterns (3 vs 6 meals/day) on glycaemic control and satiety in subjects with impaired glucose tolerance and plasma glucose (PG) levels 140-199mg/dL at 120min (IGT-A) or PG levels 140-199mg/dL at 120min and >200mg/dL at 30/60/90min post-oral glucose load on 75-g OGTT (IGT-B), or overt treatment-naïve type 2 diabetes (T2D). SUBJECTS/METHODS: In this randomized crossover study, subjects with IGT-A (n=15, BMI: 32.4±5.2kg/m2), IGT-B (n=20, BMI: 32.5±5kg/m2) or T2D (n=12, BMI: 32.2±5.2kg/m2) followed a weight-maintenance diet (45% carbohydrates, 20% proteins, 35% fats) in 3 or 6 meals/day (each intervention lasting 12 weeks). Anthropometrics, diet compliance and subjective appetite were assessed every 2 weeks. OGTT and measurements of HbA1c and plasma lipids were performed at the beginning and end of each intervention period. RESULTS: Body weight and physical activity levels remained stable throughout the study. In T2D, HbA1c and PG at 120min post-OGTT decreased with 6 vs 3 meals (P<0.001 vs P=0.02, respectively). The 6-meal intervention also improved post-OGTT hyperinsulinaemia in IGT-A subjects and hyperglycaemia in IGT-B subjects. In all three groups, subjective hunger and desire to eat were reduced with 6 vs 3 meals/day (P<0.05). There were no differences in HOMA-IR or plasma lipids between interventions. CONCLUSION: Although weight loss remains the key strategy in hyperglycaemia management, dietary measures such as more frequent and smaller meals may be helpful for those not sufficiently motivated to adhere to calorie-restricted diets. Our study shows that 6 vs 3 meals a day can increase glycaemic control in obese patients with early-stage T2D, and may perhaps improve and/or stabilize postprandial glucose regulation in prediabetes subjects.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Intolerância à Glucose/dietoterapia , Resistência à Insulina/fisiologia , Refeições , Resposta de Saciedade/fisiologia , Adulto , Índice de Massa Corporal , Estudos Cross-Over , Diabetes Mellitus Tipo 2/sangue , Feminino , Intolerância à Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial/fisiologia , Resultado do TratamentoRESUMO
BACKGROUND: Adherence to a gluten-free diet (GFD) demonsrates various difficulties, including the high cost of the diet. The present study aimed to (i) compare the cost of gluten-free products (GFP) from supermarkets and pharmacies with the cost of their conventional counterparts and (ii) estimate the weekly economic burden of a GFD. METHODS: The prices of all food products labelled as 'gluten-free' available at four supermarket chains in Athens, as well as the prices of all similar conventional food products, were recorded. The prices of the pharmacy GFP were recorded from the official list of the National Health Service Organisation. For every product, the price per 100 g was calculated. All products were classified into 24 categories, which consisted of three subcategories: conventional, supermarket GFP and pharmacy GFP. Three weekly menus were designed for children, adolescents and adults, selecting the upper levels of energy intake, to cover the majority of the patients. For all three weekly menus, the price difference between conventional and GFP, both from supermarkets and pharmacies, was calculated. RESULTS: Compared with conventional food products, all supermarket GFP, except for one, were more expensive by 22-334% (P < 0.05) and all pharmacy GFP were more expensive by 88-476% (P < 0.05). The weekly economic burden of a GFD ranged from 12 to 28 per week, depending on age and GFP place of purchase. CONCLUSIONS: The present study confirms the higher cost of GFP compared to their conventional equivalents in Greece, leading to a weekly economic burden for people on a gluten-free diet.
Assuntos
Dieta Livre de Glúten/economia , Adolescente , Adulto , Criança , Comércio/economia , Análise Custo-Benefício , Custos e Análise de Custo , Rotulagem de Alimentos/economia , Grécia , Humanos , Cooperação do Paciente , Adulto JovemRESUMO
BACKGROUND/OBJECTIVES: The aim of the study was to compare the effect of two-meal patterns (three vs six meals per day) on glucose and insulin levels in women with polycystic ovary syndrome (PCOS). SUBJECTS/METHODS: In a randomised, crossover, 24-week study, 40 women with PCOS, aged 27±6 years, body mass index 27±6 kg/m(2), followed a weight maintenance diet (% carbohydrates:protein:fat, 40:25:35), consumed either as a three- or a six-meal pattern, with each intervention lasting for 12 weeks. Anthropometric measurements, diet compliance and subjective hunger, satiety and desire to eat were assessed biweekly. All women underwent an oral glucose tolerance test (OGTT) with 75 g glucose for measurement of plasma glucose and insulin at the beginning and end of each intervention. HaemoglobinA1c (HbA1c), blood lipids and hepatic enzymes were measured at the beginning and end of each intervention. RESULTS: Body weight remained stable throughout the study. Six meals decreased significantly fasting insulin (P=0.014) and post-OGTT insulin sensitivity (Matsuda index, P=0.039) vs three meals. After incorporation of individual changes over time, with adjustment for potential confounders, the only variable that remained significant was the Matsuda index, which was then used in multivariate analysis and general linear models. Six meals improved post-OGTT insulin sensitivity independently of age and body weight vs three meals (P=0.012). No significant differences were found between six and three meals for glucose, HbA1c, blood lipids, hepatic enzymes, subjective desire to eat and satiety. CONCLUSIONS: Six meals had a more favourable effect on post-OGTT insulin sensitivity in women with PCOS compared with isocaloric three meals.
Assuntos
Glicemia/análise , Comportamento Alimentar , Insulina/sangue , Refeições/fisiologia , Síndrome do Ovário Policístico/dietoterapia , Adulto , Estudos Cross-Over , Jejum/sangue , Feminino , Teste de Tolerância a Glucose , Humanos , Resistência à Insulina , Síndrome do Ovário Policístico/sangue , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: The aim of the present study was to identify indicators of malnutrition, as obtained by anthropometric measurements, that might be potential predictors of transplant outcomes. METHODS: One hundred and three patients receiving a graft from a living or a deceased donor were included in this prospective study. Body mass index (BMI) based on pretransplant dry body weight, triceps skinfold, mid-arm muscle circumference and corrected mid-arm muscle area were measured. Post-transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were collected until patient discharge. RESULTS: Delayed graft function developed in 36.9% of the patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07-1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, P = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [ß = -0.014 (0.005), P = 0.004], being overweight [ß = -0.151 (0.041), P < 0.001] and obesity [ß = -0.188 (0.053), P = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves. CONCLUSIONS: The likelihood of DGF was higher among obese patients, whereas GFR at discharge was negatively associated with being overweight and obesity.
Assuntos
Índice de Massa Corporal , Peso Corporal , Função Retardada do Enxerto/fisiopatologia , Transplante de Rim , Adulto , Braço , Função Retardada do Enxerto/complicações , Função Retardada do Enxerto/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Obesidade/complicações , Obesidade/fisiopatologia , Sobrepeso/complicações , Sobrepeso/fisiopatologia , Estudos ProspectivosRESUMO
BACKGROUND: Although dietary habits have been associated with the likelihood of the metabolic syndrome (MetS) in the general population, similar associations in non-alcoholic fatty liver disease (NAFLD) patients have not been explored. The aim of this cross-sectional study was to assess the presence of the MetS and to explore its potential association with dietary habits in a sample of NAFLD patients. METHODS: Seventy-three adult patients with recent NAFLD diagnosis based on elevated liver enzyme levels and evidence of hepatic steatosis on ultrasound were enrolled. Participants' habitual food consumption was retrospectively assessed through a food frequency questionnaire and adherence to the Mediterranean diet (MD) was assessed via the Mediterranean Diet Score (MedDietScore). The presence of the MetS was defined as the concomitant presence of at least three of its individual components, according to the criteria proposed by a recent joint statement of several major organisations. RESULTS: The MetS was present in 46.5% of the sample, with increased waist circumference values and decreased high-density lipoprotein cholesterol levels being the most prevalent disorders (63% and 88.7%, respectively). Consumption of refined grains [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.00-1.05] and red meat and products (OR = 1.10, 95% CI = 1.01-1.21) were positively associated with the presence of the MetS, whereas the consumption of whole grains (OR = 0.92, 95% CI = 0.84-0.99) and MedDietScore (OR = 0.87, 95% CI = 0.76-0.99) were negatively associated, after adjusting for participants' age, sex, daily energy intake and time spent in sedentary activities. CONCLUSIONS: Low refined grain and red meat intake, high whole grain intake and high adherence to the MD were associated with lower odds of the MetS in NAFLD patients.
Assuntos
Dieta , Síndrome Metabólica/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Adulto , HDL-Colesterol/sangue , Estudos Transversais , Dieta Mediterrânea , Grão Comestível , Comportamento Alimentar , Feminino , Manipulação de Alimentos , Grécia/epidemiologia , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Carne Vermelha , Estudos Retrospectivos , Inquéritos e Questionários , Circunferência da CinturaRESUMO
OBJECTIVE: The present study aimed to explore potential associations between adherence to a Mediterranean diet and serum uric acid (UA) levels. METHODS: The sample consisted of 2380 men and women free of cardiovascular or renal disease who participated in the ATTICA study. Dietary intake was assessed using a food frequency questionnaire (FFQ) and adherence to the Mediterranean diet was evaluated with the MedDietScore. Serum UA was measured and hyperuricaemia was defined as UA concentration > 7.0 mg/dL in men or > 6.0 mg/dL in women. RESULTS: MedDietScore was inversely associated with UA levels (b-coefficient per quartile of the score = -0.07 ± 0.03, p = 0.02) independently of sex, presence of overweight, hypertension, or abnormal glucose metabolism, and alcohol or coffee intake. Those at the fourth quartile of MedDietScore had a 70% lower likelihood of having hyperuricaemia [odds ratio (OR) 0.30, 95% confidence interval (CI) 0.11-0.82] compared to those at the first quartile, after adjustment for several confounders. According to stratified analyses by sex, body mass index (BMI) status, hypertension, abnormal glucose, alcohol and coffee intake, the inverse association between serum UA and MedDietScore remained significant in women (b-coefficient = -0.194 ± 0.055, p < 0.001), overweight subjects (b-coefficient = -0.103 ± 0.047, p = 0.02), in those with normal glucose metabolism (b-coefficient = -0.074 ± 0.037, p = 0.04), and in those abstaining from alcohol (b-coefficient = -0.212 ± 0.073, p = 0.004) and coffee (b-coefficient = -0.221 ± 0.096, p = 0.02). CONCLUSION: Adherence to the Mediterranean diet is associated with lower serum UA levels and lower likelihood of hyperuricaemia. These findings support a potential role of this dietary pattern in the prevention and treatment of hyperuricaemia and gout.
Assuntos
Dieta Mediterrânea , Hiperuricemia/diagnóstico , Ácido Úrico/sangue , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hiperuricemia/sangue , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Adiponectin, a fat derived cytokine, is a potential independent contributor to bone mineral density (BMD); however, its action on bone metabolism in humans is still unclear. AIM: The aim of this study was to investigate the relationship of adiponectin with bone mass indices and bone metabolic markers in middle-aged post-menopausal women without diabetes. SUBJECTS AND METHODS: A random sample consisted of 81 post-menopausal women (age range 45-61 yr, osteopenic/osteoporotic no.=43) was studied. Lumbar-spine BMD (BMD(L2-L4)) and total-body bone mineral content (TBBMC) were measured with dual X-ray absorptiometry. Plasma levels of total and high-molecular weight (HMW) adiponectin, osteoprotegerin (OPG), soluble receptor activator of nuclear factor-κB ligand (sRANKL) and IGF-I were determined. RESULTS: No association was observed between total or HMW adiponectin and BMD(L2-L4) or TBBMC. On the contrary, adiponectin levels were positively associated with OPG levels (partial r=0.276, p=0.015) and negatively with IGF-I (partial r=-0.438, p<0.001), in multiple regression models after adjustment for potential confounders. HMW adiponectin showed a negative association with IGF-I (partial r=-0.266, p=0.049) in the multiple regression models but not with OPG, TBBMC or BMD(L2-L4). CONCLUSIONS: Although we failed to show statistically significant association between circulating adiponectin levels and indices of bone mass in women during the postmenopausal period, we showed significant associations with OPG and IGF-I levels, suggesting an anabolic role of adiponectin, which may contribute in the understanding of the interplay between adipose tissue-derived hormones and bone metabolism.
Assuntos
Adiponectina/sangue , Remodelação Óssea/fisiologia , Osso e Ossos/metabolismo , Osteoporose Pós-Menopausa/metabolismo , Pós-Menopausa/metabolismo , Absorciometria de Fóton , Adiponectina/química , Biomarcadores/metabolismo , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/metabolismo , Vértebras Lombares/patologia , Pessoa de Meia-Idade , Peso Molecular , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/patologia , Osteoprotegerina/metabolismo , Ligante RANK/metabolismoRESUMO
BACKGROUND AND AIMS: IL-18 expression is up-regulated in atherosclerotic plaques, and higher levels are seen in obese and Type 2 Diabetic individuals. More recently, a possible role for IL-18 in glucose and energy homeostasis has been suggested. METHODS AND RESULTS: We investigated variation within the IL18 gene and its association with measures of obesity and the metabolic syndrome. Five IL18 tagging single nucleotide polymorphisms (rs1946519, rs2043055, rs549908, rs360729, rs3882891) were selected and genotyped in the Gene-Diet Attica Investigation on childhood obesity (GENDAI) (age range 10-14 yrs); in young European men in the second European Atherosclerosis Research offspring Study (EARSII), an offspring study (age range 18-28 yrs) and in a group of healthy women from the Greek Obese Women study (GrOW) (age range 18-74 yrs). Six common haplotypes were observed. In GrOW, Hap6 (Frequency-2.6%) was associated with higher insulin levels (p<0.0001), estimates of HOMA(-Insulin Resistance) (p<0.0001) and HOMA(-ß-cell) (p<0.0001) compared to the common haplotype Hap1 (Frequency-33.2%). In EARSII, rs2043055 was associated with peak and area under the curve triglycerides (p=0.001 and p=0.002, respectively) after an oral fat tolerance test in 'cases' but not 'controls'. None of the haplotypes were associated with measures of body fatness in any of the studies. CONCLUSION: Association of IL18 variation with insulin levels and estimates of insulin resistance were only observed in our adult study, suggesting that the effects of IL-18 are only associated with increasing age. Taken together with the association of IL18 variants with post-prandial measures, this provides support for IL-18 as a metabolic factor.
Assuntos
Resistência à Insulina/genética , Insulina/sangue , Interleucina-18/genética , Síndrome Metabólica/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Adulto , Idoso , Criança , Europa (Continente) , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Grécia , Humanos , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Obesidade/sangue , Período Pós-Prandial , Triglicerídeos/sangue , Adulto JovemRESUMO
BACKGROUND: The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24-h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents. METHODS: A randomly selected subgroup (n = 623) of a representative sample of 3-18-year-old Greek children and adolescents was used in the present analysis. Information on participants' socio-demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24-h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season). RESULTS: Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders (P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters. CONCLUSIONS: The use of a second 24-h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake.
Assuntos
Inquéritos sobre Dietas/métodos , Dieta , Estações do Ano , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Ingestão de Energia , Feminino , Grécia , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: The aim of the present study was to evaluate the association between meat consumption and the prevalence of a first, non-fatal event of an acute coronary syndrome (ACS), in a Greek sample. DESIGN: Randomized, case-control study. SETTING: Tertiary care. SUBJECTS: A total of 848 out of 956 patients who had been randomly selected from hospitals with first event of an ACS and 1078 population-based controls, age and sex matched. INTERVENTIONS: Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semiquantitative food-frequency questionnaire. Multiple logistic regression analysis estimated the odds ratio of having ACS by level of meat intake, after taking into account several confounders. RESULTS: Patients consumed higher quantities of meat compared with controls (6.5+/-2.9 vs 4.9+/-2.1 portions per month, P<0.001). Food-specific analysis showed that red meat consumption was strongly associated with 52% increased odds of ACS (95% confidence interval (CI) 1.47-1.58). On the contrary, white meat consumption seems to be associated with only 18% likelihood of having cardiac events (95% CI 1.11-1.26). Participants who consumed >8 portions red meat and >12 portions white meat per month had 4.9 times and 3.7 higher odds of having ACS, respectively (P<0.001), compared with low meat intake (<4 portions and <8 portions per month, respectively). CONCLUSIONS: Increased red meat consumption showed a strong positive association with cardiac disease risk, whereas white meat consumption showed less prominent results, after controlling for several potential confounding factors.
Assuntos
Síndrome Coronariana Aguda/epidemiologia , Comportamento Alimentar , Carne , Síndrome Coronariana Aguda/etiologia , Estudos de Casos e Controles , Feminino , Grécia/epidemiologia , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Chronic inflammation has been suggested to play an important role in metabolic diseases, such as atherothrombosis and type 2 diabetes. A lot of research has focused on the immunomodulatory effects of several nutrients, such as fatty acids, antioxidants, carbohydrates, specific amino acids, micronutrients, and alcohol, which play a crucial role in the maintenance of an "optimal" immune response. In addition, specific dietary patterns, such as the Mediterranean diet, are evolving as protective against cardiovascular disease, because of their anti-inflammatory properties. In this article, the existing data concerning the nutrients' pro- and anti-inflammatory properties are presented, as well as dietary patterns that could protect from chronic inflammation and its metabolic and atherothrombotic complications.