Effects of Nutrition Intervention on Blood Glucose, Body Composition, and Phase Angle in Obese and Overweight Patients with Diabetic Foot Ulcers.

Nutrition can play an important role in the treatment of chronic wounds such as diabetic foot ulcers (DFUs); however, diet therapy is not currently part of the standard care for DFUs. There are numerous controversies about dietary recommendations, especially regarding calories and macronutrients, for overweight and obese patients with DFUs. This study examined the effects of nutrition education and supplementation on body composition in overweight and obese patients with DFUs. Twenty-nine patients with DFUs between the ages of 30 and 70 years were randomly assigned to either the treatment group (nutritional supplements, diet education, and standard care) or the control group (standard care). At baseline, the mean body mass index (BMI) was 33.5 kg/m2 for the treatment group and 34.1 kg/m2 for the control group. HbA1c decreased in both groups, with no significant difference between the groups. On average, patients in the treatment group lost less lean body mass and gained less fat than the control group ((3.8 kg vs. 4.9 kg) and (0.9 kg vs. 3.6 kg), respectively). While the interaction between group and time did not reach statistical significance for any of the study variables after adjustments for confounding variables, the observed changes are clinically relevant.

Nutritional Supplementation Concurrent with Nutrition Education Accelerates the Wound Healing Process in Patients with Diabetic Foot Ulcers.

Trials on nutritional supplements for the treatment of diabetic foot ulcer (DFU) have only evaluated the effects of supplementation with specific nutrients. Additionally, nutrition education has not been a systematic part of these studies. The aim of this study was to evaluate the effects of a nutrient-dense formula combined with nutrition education on wound healing in DFU patients. Twenty-nine patients were randomly assigned to the treatment group (n = 15) receiving two servings of supplements daily plus nutrition education or control group (n = 14) that received the standard of care but no additional nutritional or educational intervention. Both groups were followed for a maximum of 12 weeks. Wound healing, as measured by planimetry, was examined at baseline and every four weeks until complete wound closure or up to 12 weeks. There were no significant differences between groups for BMI, age, duration of diabetes, wound age estimation, or wound area at baseline. The treatment group experienced a faster wound healing rate (6.43 mm2/week more reduction in the wound area) than the control group. The mean reduction in the wound area during the first four weeks of the study was almost 13-fold greater in the treatment group compared to the control group (18.0 mm2/week vs. 1.4 mm2/week, respectively). Our findings showed that nutrition supplementation plus nutrition education significantly accelerated wound healing in DFU patients compared to those who just received a standard-of-care regimen.

The effect of six days of dietary nitrate supplementation on performance in trained CrossFit athletes.

BACKGROUND: While it is well established that dietary nitrate reduces the metabolic cost of exercise, recent evidence suggests this effect is maintained 24 h following the final nitrate dose when plasma nitrite levels have returned to baseline. In addition, acute dietary nitrate was recently reported to enhance peak power production. Our purpose was to examine whether chronic dietary nitrate supplementation enhanced peak power 24 h following the final dose and if this impacted performance in a heavily power-dependent sport. METHODS: In a double-blind, randomized, crossover design, maximal aerobic capacity, body composition, strength, maximal power (30 s Wingate), endurance (2 km rowing time trial), and CrossFit performance (Grace protocol) were assessed before and after six days of supplementation with nitrate (NO) (8 mmol·potassium nitrate·d-1) or a non-caloric placebo (PL). A 10-day washout period divided treatment conditions. Paired t-tests were utilized to assess changes over time and to compare changes between treatments. RESULTS: Peak Wingate power increased significantly over time with NO (889.17 ± 179.69 W to 948.08 ± 186.80 W; p = 0.01) but not PL (898.08 ± 183.24 W to 905.00 ± 157.23 W; p = 0.75). However, CrossFit performance was unchanged, and there were no changes in any other performance parameters. CONCLUSION: Consuming dietary nitrate in the potassium nitrate salt form improved peak power during a Wingate test, but did not improve elements of strength or endurance in male CrossFit athletes.

Nighttime feeding likely alters morning metabolism but not exercise performance in female athletes.

The timing of morning endurance competition may limit proper pre-race fueling and resulting performance. A nighttime, pre-sleep nutritional strategy could be an alternative method to target the metabolic and hydrating needs of the early morning athlete without compromising sleep or gastrointestinal comfort during exercise. Therefore, the purpose of this investigation was to examine the acute effects of pre-sleep chocolate milk (CM) ingestion on next-morning running performance, metabolism, and hydration status. Twelve competitive female runners and triathletes (age, 30 ± 7 years; peak oxygen consumption, 53 ± 4 mL·kg(-1)·min(-1)) randomly ingested either pre-sleep CM or non-nutritive placebo (PL) ∼30 min before sleep and 7-9 h before a morning exercise trial. Resting metabolic rate (RMR) was assessed prior to exercise. The exercise trial included a warm-up, three 5-min incremental workloads at 55%, 65%, and 75% peak oxygen consumption, and a 10-km treadmill time trial (TT). Physiological responses were assessed prior, during (incremental and TT), and postexercise. Paired t tests and magnitude-based inferences were used to determine treatment differences. TT performances were not different ("most likely trivial" improvement with CM) between conditions (PL: 52.8 ± 8.4 min vs CM: 52.8 ± 8.0 min). RMR was "likely" increased (4.8%) and total carbohydrate oxidation (g·min(-1)) during exercise was "possibly" or likely increased (18.8%, 10.1%, 9.1% for stage 1-3, respectively) with CM versus PL. There were no consistent changes to hydration indices. In conclusion, pre-sleep CM may alter next-morning resting and exercise metabolism to favor carbohydrate oxidation, but effects did not translate to 10-km running performance improvements.

Combined whole-body vibration training and l-citrulline supplementation improves pressure wave reflection in obese postmenopausal women.

Postmenopausal women have increased wave reflection (augmentation pressure (AP) and index (AIx)) and reduced muscle function that predispose them to cardiac diseases and disability. Our aim was to examine the combined and independent effects of whole-body vibration training (WBVT) and l-citrulline supplementation on aortic hemodynamics and plasma nitric oxide metabolites (NOx) in postmenopausal women. Forty-one obese postmenopausal women were randomized to 3 groups: l-citrulline, WBVT+l-citrulline and WBVT+Placebo for 8 weeks. Brachial and aortic systolic blood pressure, diastolic blood pressure, AP, AIx, AIx adjusted to 75 beats/min (AIx@75), and NOx were measured before and after 8 weeks. All groups similarly decreased (P < 0.05) brachial and aortic pressures as well as AP, and similarly increased (P < 0.05) NOx levels. AIx and AIx@75 decreased (P < 0.01) in the WBVT+l-citrulline and WBVT+Placebo groups, but not in the l-citrulline group. The improvement in AIx@75 (-10.5% ± 8.8%, P < 0.05) in the WBVT+l-citrulline group was significant compared with the l-citrulline group. l-Citrulline supplementation and WBVT alone and combined decreased blood pressures. The combined intervention reduced AIx@75. This study supports the effectiveness of WBVT+l-citrulline as a potential intervention for prevention of hypertension-related cardiac diseases in obese postmenopausal women.

The effects of a multi-ingredient dietary supplement on body composition, adipokines, blood lipids, and metabolic health in overweight and obese men and women: a randomized controlled trial.

BACKGROUND: The present study investigated the effects of a multi-ingredient dietary supplement (MIDS) containing caffeine, conjugated linoleic acid (CLA), green tea, and branched-chain amino acids (BCAA) taken for 8 weeks on body composition, blood lipid profile, glucose, insulin, adiponectin, leptin, and high-sensitivity C-reactive protein (hs-CRP) in overweight and obese men and women. METHODS: Twenty-two participants completed the study (PL, n = 11; 7 women, 4 men; age, 34 ± 3.5 years; height, 169.2 ± 3.3 cm; body mass, 96.9 ± 6.8 kg; BMI, 34.1 ± 1.8 kg/m(2); MIDS, n = 11; 9 women, 2 men; age, 36 ± 3.4 years; height, 173.2 ± 2.9 cm; body mass, 91.9 ± 5.6 kg; BMI, 30.0 ± 1.5 kg/m(2)). Participants were randomly assigned and stratified by body fat percentage to two groups: 1) a soybean oil placebo (PL) or 2) MIDS. Each group consumed two pills with breakfast and two pills with lunch. Body composition and android fat, waist and hip circumferences, blood pressure and heart rate were measured at baseline and after 8 weeks of supplementation. RESULTS: There were no significant changes for any of the variables of body composition. Feelings of hunger were significantly higher in MIDS versus PL with no changes observed in satiety or desire to eat. Heart rate and blood pressure were unaltered in MIDS after 8 weeks of supplementation. Furthermore, lipid profile, food intake, mood state variables, fasting blood glucose, and endocrine markers did not significantly change regardless of group. CONCLUSION: MIDS intake does not appear to alter body composition or markers of cardiovascular health versus PL. Moreover, MIDS may actually increase feelings of hunger versus PL.

Low-grade chronic inflammation perpetuated by modern diet as a promoter of obesity and osteoporosis.

Some of the universal characteristics of pre-agricultural hominin diets are strikingly different from the modern human diet. Hominin dietary choices were limited to wild plant and wild animal foods, while the modern diet includes more than 70 % of energy consumed from refined sugars, refined vegetable oils, and highly processed cereals and dairy products. The modern diet, with higher intake of fat has also resulted in a higher ratio of omega-6 (n-6) to omega-3 (n-3) polyunsaturated fatty acids (PUFA), contributing to low-grade chronic inflammation (LGCI) and thus promoting the development of many chronic diseases, including obesity and osteoporosis. In this review, we describe the changes in modern diet, focusing on the kind and amount of consumed fat; explain the shortcomings of the modern diet with regard to inflammatory processes; and delineate the reciprocity between adiposity and inflammatory processes, with inflammation being a common link between obesity and osteoporosis. We present the evidence that overconsumption of n-6 PUFA coupled with under-consumption of n-3 PUFA results in LGCI and, along with the increased presence of reactive oxygen species, leads to a shift in mesenchymal stem cells (precursors for both osteoblasts and adipocytes) lineage commitment toward increased adipogenesis and suppressed osteoblastogenesis. In turn, high n-6 to n-3 PUFA ratios in the modern diet, coupled with increased synthesis of pro-inflammatory cytokines due to adiposity, propagate obesity and osteoporosis by increasing or maintaining LGCI.

Nutrition supplementation for diabetic wound healing: a systematic review of current literature.

There are 25.8 million people with diabetes in the United States (Centers for Disease Control and Prevention 2011 National Diabetes Fact Sheet). This number is expected to increase by 1 million per year. Diabetic foot ulcers (DFUs) occur in patients with a history of poorly controlled blood glucose. Almost 30% of people with diabetes aged 40 years or older experience DFUs caused by an impaired nerve sensation. It is one of the more persistent types of chronic wounds, which poses an economic burden on individuals and society and reduces the quality of life of patients and their families. This paper reviews the efficacy of nutrition supplementation in diabetic wound healing, including both human and animal studies. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods, the search was conducted in PubMed and ISI's Web of Science databases. Studies in which diabetic wounds/foot ulcers were treated with specific nutritional or herbal suplements were selected. This review includes 4 human and 9 animal studies that met the criteria of the search. Positive outcomes in the human studies were not significant while the nutritional supplements used in the animal studies were effective and promoted wound healing. The most notable effect of supplementation with curcumin, L-Arginine, or vitamin E have been shown in animal sudies. More human studies need to be conducted to determine the efficacy of these nutritional supplements in promoting wound healing.

Solar drying of mangoes: preservation of an important source of vitamin A in French-speaking West Africa.

Vitamin A deficiency, which is especially widespread among children younger than age 5 years, is a major barrier to reducing child mortality rates in French-speaking West Africa. A large amount of an indigenous plant source of provitamin A carotenoids are lost to postharvest waste. For example, the postharvest loss of mangoes in the region exceeds an annual total of 100,000 metric tons. In our study, 3.75 metric tons of fresh mangoes were dried using a solar dryer to a final moisture content of 10% to 12%, yielding a total of 360 kg dried mango. The product analysis revealed 4,000+/-500 microg beta carotene/100 g and 3,680+/-150 microg beta carotene/100 g after 2 and 6 months of storage, respectively. Thus, one greenhouse solar dryer is capable of reducing postharvest mango waste by 3.75 tons providing up to 1.15 million retinol activity equivalents of dietary vitamin A. The use of this technology that requires solar energy and manpower has the potential of increasing dietary vitamin A supply by up to 27,000-fold, compared to the currently available vitamin A in the region. Moreover, mango is a fruit that is well-liked by the population in this geographic area increasing the likelihood of its ready acceptance. Reducing postharvest loss of mangoes by using greenhouse model solar dryers is a promising strategy to help combat vitamin A deficiency in French-speaking West Africa.

High-fat diets promote insulin resistance through cytokine gene expression in growing female rats.

To determine if tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). IL-6 gene expression is influenced by amount and source of dietary fat, 30 weanling female rats were randomly assigned to a moderate-fat soybean oil (MFS; 22% of total energy fed as fat), high-fat (HF) soybean oil (HFS; 39% of total energy fed as fat), or HF tallow (HFT; 39% of total energy fed as fat) diet treatments. Oral glucose tolerance tests (OGTT) were conducted serially over 10 weeks of treatment. HFT and HFS rats gained more weight and had greater body fat than the MFS rats fed similar amounts of energy. Both groups of HF-fed rats had greater (P<.05) insulin resistance (homeostasis model assessment) than MFS-fed rats. TNF-alpha mRNA abundance quantified by real-time reverse transcriptase-polymerase chain reaction was greater (P<.05) in liver and lower (P<.05) in adipose tissue in HFT compared to HFS and MFS rats. There were positive correlations (P<.05) between hepatic TNF-alpha mRNA and insulin resistance, and negative correlations between insulin sensitivity and hepatic TNF-alpha mRNA and hepatic IL-6 mRNA. During Week 3 and Week 6 OGTTs, hyperinsulinemic responses were observed in the HFT group, after which, on Week 9, insulin secretion was diminished in response to the OGTT, suggesting impaired pancreatic insulin secretion. HFS rats exhibited insulin resistance on Week 9 OGTT. In summary, an HFT diet fed to growing female rats caused insulin resistance associated with increased hepatic TNF-alpha mRNA leading to pancreatic insufficiency. Early-onset insulin resistance related to the inflammatory process in obesity is influenced by the amount and type of fat in the diet.

Intrafamilial correlates of overweight and obesity in African-American and Native-American grandparents, parents, and children in rural Oklahoma.

Study objectives were to describe overweight in Native-American and African-American three-generation families and to examine relationships among the individual variables of body mass index (BMI), television hours, and activity levels. Forty-four Native-American and 40 African-American families were recruited from 10 sites through community contacts at health, senior, community, and tribal centers. Ninety percent of parents and grandparents had BMIs above 25.0. Forty-two percent of African-American and 61% of Native-American children had a BMI above the 85th percentile. More than 35% of total energy was from fat. Significant correlations were observed between parent and child BMI and television hours, grandparent and child BMI, and grandparent and parent activity with child television hours. Sedentary caretakers facilitate more television viewing and less activity in children. Dietetics professionals should plan family-friendly daily physical activities, like walking, and diets lower in fat, sugar, and total energy, with higher intakes of fresh fruits and vegetables, whole grains, and low-fat dairy products for children and caretakers.