Effect of alcoholic beverages on postprandial glycemia and insulinemia in lean, young, healthy adults.

BACKGROUND: Ethanol's ability to inhibit gluconeogenesis might reduce postprandial glycemia in realistic meal settings. OBJECTIVE: The objective was to explore the effect of 3 types of alcoholic beverages consumed alone, with a meal, or 1 h before a meal on postprandial glycemia in healthy subjects. DESIGN: In study 1, isoenergetic (1000 kJ) servings of beer, white wine, and gin were compared with a 1000-kJ portion of white bread. In study 2, the same servings were compared with water as an accompaniment to a bread meal. In study 3, 20-g alcohol portions were served as a premeal drink. Fingertip capillary blood samples were taken at regular intervals over 2-3 h. RESULTS: In study 1, the mean (+/-SE) glucose scores for beer (58 +/- 11), wine (7 +/- 3), and gin (10 +/- 5) were significantly lower (P < 0.001) than those for bread (= 100). In study 2, meals consumed with beer (84 +/- 11; P = 0.03), wine (63 +/- 6; P < 0.001), and gin (80 +/- 12; P = 0.007) produced less glycemia than did the meal consumed with water (= 100). In study 3, all 3 beverages reduced the postprandial glycemic response to the subsequent meal (67 +/- 5, 75 +/- 6, and 78 +/- 4 with the beer, wine, and gin trials, respectively; P < 0.003). CONCLUSION: In realistic settings, alcoholic beverage consumption lowers postprandial glycemia by 16-37%, which represents an unrecognized mechanism by which alcohol may reduce the risk of chronic disease.

Including walnuts in a low-fat/modified-fat diet improves HDL cholesterol-to-total cholesterol ratios in patients with type 2 diabetes.

OBJECTIVE: The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 +/- 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA1c, total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model. RESULTS: The walnut group achieved a significantly greater increase in HDL cholesterol-to-total cholesterol ratio (P=0.049) and HDL (P=0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P=0.032) and time (P=0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA1c levels. The higher dietary polyunsaturated fat-to-saturated fat ratio and intakes of omega-3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake. CONCLUSIONS: Structured "whole of diet" advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes.

Malabsorption may contribute to malnutrition in the elderly.

Malnutrition, either actually malnourished or at risk, is present in 80% of the elderly population presenting to hospital for admission. Although many factors contribute to this situation, one yet to be explored is malabsorption. We therefore aimed to assess nutritional status as well as the prevalence of altered mucosal permeability and celiac disease among a group of elderly patients presenting for rehabilitation. Forty-eight subjects were recruited (16 females) with a mean age of 83.7 (SD 6.1), body mass index 21.8 kg/m(2) (SD 3.9), mini-nutritional assessment (MNA) 19.5 (SD 3.4). They had no current gastrointestinal symptoms and undertook an assessment of mucosal permeability using the dual sugar absorption test of lactulose (7.5 g) and rhamnose (1 g). Ten of the 48 subjects had increased mucosal permeability with an L:R ration ranging from 0.0860 to 7.706 (N 0.01-0.08). These subjects were all at risk or malnourished according to the MNA score and they had a significantly lower mean MNA score of 17.2 (SD 3.5) compared to normal absorbers with a mean of 19.5 (SD 3.4). Two of the subjects had positive tissue trans-glutaminase antibodies. The higher risk of potential malabsorption in this elderly population has significant implications both for nutritional supplementation and for drug absorption as well as being a possible major contributor to malnutrition.