Validating the use of photos to measure dietary intake: the method used by DialBetics, a smartphone-based self-management system for diabetes patients.

BACKGROUND: The accuracy of estimating nutritional intake and balance from photos of meals has not been well documented. However, DialBetics (DB)-our diabetes self-management support system, which is based on information and communication technologies-relies on the photos that type 2 diabetes patients take of their meals with smartphones. Therefore, we designed a study to evaluate this accuracy. METHODS: We prepared 61 dishes whose actual amount/value of total energy and each nutrient were known: protein, fat, carbohydrates, dietary fiber and salt. Their balance-the protein-fat-carbohydrate ratio-was also known, constituting the weighed food record (WFR). Smartphone photos of those dishes were taken, and three registered dietitians evaluated each dish from those photos, naming the dish and estimating the amount of each nutrient in it, plus the dish's balance. These estimated DB and WFR values were compared using the Wilcoxon matched-pairs rank-sum test; intraclass correlation coefficients (ICCs) were calculated. Agreement between the two values for each dish was assessed by Bland-Altman analysis. RESULTS: There were significant ICCs-0.84 for fat (95 % confidence interval 0.75-0.90) and 0.93 for carbohydrates (0.88, 0.96)-but no statistically significant differences between DB and WRF for other nutrients or balance. Bland-Altman analysis showed that differences between the two values were random and not biased against nutrient intake; 95 % limits of agreement were acceptable although wide (energy -198 to 210 kcal/dish; carbohydrates -22.7 to 25.8 g/dish). CONCLUSION: DB's diet evaluation by photos is reliable with apparent potential for assessing diets.

DialBetics With a Multimedia Food Recording Tool, FoodLog: Smartphone-Based Self-Management for Type 2 Diabetes.

BACKGROUND: Diabetes self-management education is an essential element of diabetes care. Systems based on information and communication technology (ICT) for supporting lifestyle modification and self-management of diabetes are promising tools for helping patients better cope with diabetes. An earlier study had determined that diet improved and HbA1c declined for the patients who had used DialBetics during a 3-month randomized clinical trial. The objective of the current study was to test a more patient-friendly version of DialBetics, whose development was based on the original participants' feedback about the previous version of DialBetics. METHOD: DialBetics comprises 4 modules: data transmission, evaluation, exercise input, and food recording and dietary evaluation. Food recording uses a multimedia food record, FoodLog. A 1-week pilot study was designed to determine if usability and compliance improved over the previous version, especially with the new meal-input function. RESULTS: In the earlier 3-month, diet-evaluation study, HbA1c had declined a significant 0.4% among those who used DialBetics compared with the control group. In the current 1-week study, input of meal photos was higher than with the previous version (84.8 ± 13.2% vs 77.1% ± 35.1% in the first 2 weeks of the 3-month trial). Interviews after the 1-week study showed that 4 of the 5 participants thought the meal-input function improved; the fifth found input easier, but did not consider the result an improvement. CONCLUSIONS: DialBetics with FoodLog was shown to be an effective and convenient tool, its new meal-photo input function helping provide patients with real-time support for diet modification.

High-fat and high-cholesterol diet rapidly induces non-alcoholic steatohepatitis with advanced fibrosis in Sprague-Dawley rats.

AIM: The development of fibrosis is considered an important phase in the progress of non-alcoholic steatohepatitis (NASH) towards the end stage of liver disease, including cirrhosis. However, few small animal models can display NASH-associated fibrosis. We aimed to establish a dietary model of NASH with rapid progression to fibrosis using genetically normal rats. METHODS: Nine-week-old male Sprague-Dawley rats were fed with normal, high-fat (HF), or two types of high-fat and high-cholesterol (HFC) diets for 9 weeks (n = 5 each). All HFC diets contained 1.25% or 2.5% cholesterol. RESULTS: The rats fed with the HF diet developed mild steatosis and inflammation without fibrosis at 18 weeks of age, whereas all rats given the HFC diet developed obvious steatosis and inflammation with hepatocyte ballooning and fibrosis. Two of five (40%) rats given the HFC diet containing 2.5% cholesterol progressed to liver cirrhosis. Hepatic total cholesterol levels were significantly higher in rats given the HFC, than the normal or HF diets. The HFC diet significantly and dose-dependently decreased microsomal triglyceride transfer protein expression. Cholesterol tended to suppress carnitine palmitoyltransferase activity and adenosine triphosphate-binding cassette transporter G5 expression. Adding cholesterol to the HF diet modified hepatic lipid metabolism at the molecular level. CONCLUSION: The HFC diet induced hepatic features of NASH and eventually progressed cirrhosis in Sprague-Dawley rats within 9 weeks.

DialBetics: A Novel Smartphone-based Self-management Support System for Type 2 Diabetes Patients.

Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed, using IT technology. But all of them allow only limited-or no-real-time interaction between patients and the system in terms of system response to patient input; few studies have effectively assessed the systems' usability and feasibility to determine how well patients understand and can adopt the technology involved. DialBetics is composed of 4 modules: (1) data transmission module, (2) evaluation module, (3) communication module, and (4) dietary evaluation module. A 3-month randomized study was designed to assess the safety and usability of a remote health-data monitoring system, and especially its impact on modifying patient lifestyles to improve diabetes self-management and, thus, clinical outcomes. Fifty-four type 2 diabetes patients were randomly divided into 2 groups, 27 in the DialBetics group and 27 in the non-DialBetics control group. HbA1c and fasting blood sugar (FBS) values declined significantly in the DialBetics group: HbA1c decreased an average of 0.4% (from 7.1 ± 1.0% to 6.7 ± 0.7%) compared with an average increase of 0.1% in the non-DialBetics group (from 7.0 ± 0.9% to 7.1 ± 1.1%) (P = .015); The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl (P = .019). BMI improvement-although not statistically significant because of the small sample size-was greater in the DialBetics group. DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs.

Mental, physical, dietary, and nutritional effects on irritable bowel syndrome in young Japanese women.

OBJECTIVE: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. The pathogenesis of IBS is multifactorial. The aim of this study was to investigate the prevalence of IBS using the Rome III criteria in young Japanese women and to assess the effects of mental, physical, dietary and nutritional factors on IBS. METHODS: In this cross-sectional study, data obtained from self-administered questionnaires, including age, height, weight, lifestyle, food habits, anxiety and depressive states and IBS-related symptoms, were analyzed in 245 participants. An established semiquantitative questionnaire available for clinical investigation (FFQg) was used to obtain a detailed assessment of food intake and the physical activity levels. RESULTS: The prevalence of IBS was 12.0%. Of the IBS participants, constipation-predominant IBS (25.0%) was more prevalent than the diarrhea-predominant subtype (17.9%). The IBS participants had lower body mass indices, consumed less eggs and milk and were more physically active than the non-IBS participants. In addition, an anxiety state was more common in the IBS participants. Those who hesitated with evacuation of stool and who thought that there is an association between abdominal symptoms, such as constipation and diarrhea, and menstruation were more predominant among the IBS participants. The percentage of individuals who reported often rushing to the toilet within the past year and experiencing borborygmus (rumbling stomach) was greater among the IBS participants. A logistic regression analysis revealed that milk intake was an independent predictor of IBS. CONCLUSION: The prevalence of IBS observed in this study was similar to that reported in previous studies conducted in Japan and other countries. Mental, physical, dietary and nutritional factors have an impact on IBS.

Phycocyanin prevents hypertension and low serum adiponectin level in a rat model of metabolic syndrome.

Endothelial dysfunction is associated with hypertension, atherosclerosis, and metabolic syndrome. Phycocyanin is a pigment found in the blue-green algae, Spirulina, which possesses antihypertensive effect. In this study, we hypothesized that phycocyanin derived from Spirulina exerts antihypertensive actions by improving endothelial dysfunction in metabolic syndrome. Spontaneously hypertensive/NIH-corpulent (SHR/NDmcr-cp) rats were divided into 4 groups then fed a normal diet with or without phycocyanin (2500-, 5000-, or 10,000-mg/kg diet) for 25 weeks. At 34 weeks of age, although systolic blood pressure was not significantly different among groups, phycocyanin-fed groups exhibited a dose-dependent decrease in blood pressure. Serum levels of adiponectin and messenger RNA levels of adiponectin and CCAAT/enhancer-binding protein α in the adipose tissue of rats fed diets containing phycocyanin tended to be higher than those of rats fed a normal diet, but the differences were not statistically significant. Immunohistochemistry analysis showed a significant and positive correlation between aortic endothelial nitric oxide synthase (eNOS) expression levels, a downstream target of the adiponectin receptor, and serum adiponectin levels, although there were no significant differences in eNOS expression among groups. There was also no significant correlation between eNOS expression levels and systolic blood pressure. These results suggest that long-term administration of phycocyanin may ameliorate systemic blood pressure by enhancing eNOS expression in aorta that is stimulated by adiponectin. Phycocyanin may be beneficial for preventing endothelial dysfunction-related diseases in metabolic syndrome.

Serum alanine aminotransferase concentration as a predictive factor for the development or regression of fatty liver.

Serum alanine aminotransferase (ALT) concentration is the most commonly used marker for hepatocellular injury. We investigated the suitable cutoff value of serum ALT for the diagnosis or prediction of fatty liver. In 1578 Japanese adults (1208 men, 370 women; 35-69 years of age) who visited our center both in 2000 and between April 2007 and March 2008 (2007-2008), serum ALT concentration was an independent predictor of fatty liver in men in 2000 and in both sexes in 2007-2008. A significant increase in the frequency of fatty liver was detected in participants with elevated serum ALT concentrations, and serum levels of ALT in 2000 were associated with fatty liver in 2007-2008 when the cutoff value was set at 30 IU/L in men and 19 IU/L in women. The frequency of fatty liver in 2007-2008 was significantly lower in participants without fatty liver in 2000 whose serum ALT decreased between 2000 and 2007-2008. Our results suggest that serum ALT might be not only an indicator of fatty liver but also a predictor of the regression of fatty liver, and cutoff values of serum ALT of 30 IU/L in men and 19 IU/L in women are suitable for the screening of fatty liver.

Genetic induction of phosphate toxicity significantly reduces the survival of hypercholesterolemic obese mice.

OBJECTIVE: The adverse effects of metabolic disorders in obesity have been extensively studied; however, the pathologic effects of hyperphosphatemia or phosphate toxicity in obesity have not been studied in similar depth and detail, chiefly because such an association is thought to be uncommon. Studies have established that the incidence of obesity-associated nephropathy is increasing. Because hyperphosphatemia is a major consequence of renal impairment, this study determines the in vivo effects of hyperphosphatemia in obesity. METHODS AND RESULTS: We genetically induced hyperphosphatemia in leptin-deficient obese (ob/ob) mice by generating ob/ob and klotho double knockout [ob/ob-klotho(-/-)] mice. As a control, we made ob/ob mice with hypophosphatemia by generating ob/ob and 1-alpha hydroxylase double knockout [ob/ob-1α(OH)ase(-/-)] mice. Compared to the wild-type mice, all three obese background mice, namely ob/ob, ob/ob-klotho(-/-), and ob/ob-1α(OH)ase(-/-) mice developed hypercholesterolemia. In addition, the hyperphosphatemic, ob/ob-klotho(-/-) genetic background induced generalized tissue atrophy and widespread soft-tissue and vascular calcifications, which led to a shorter lifespan; no such changes were observed in the hypophosphatemic, ob/ob-1α(OH)ase(-/-) mice. Significantly, in contrast to the reduced survival of the ob/ob-klotho(-/-) mice, lowering serum phosphate levels in ob/ob-1α(OH)ase(-/-) mice showed no such compromised survival, despite both mice being hypercholesterolemic. CONCLUSION: These genetic manipulation studies suggest phosphate toxicity is an important risk factor in obesity that can adversely affect survival.

Dietary and genetic evidence for enhancing glucose metabolism and reducing obesity by inhibiting klotho functions.

Klotho is a multifunctional protein involved in numerous biological functions, ranging from mineral ion metabolism to signaling activities. Recent studies have identified klotho as a target gene for peroxisome proliferator-activated receptor-γ (PPAR-γ), a master regulator of adipocyte differentiation, and an adipogenesis-promoting factor. In a similar line of observation, eliminating klotho function from mice resulted in the generation of lean mice with almost no detectable fat tissue. In contrast to the klotho-knockout mice (11.7±0.3 g at 9 wk), leptin-deficient (ob/ob) mice are severely obese (49.3±0.6 g at 9 wk), due to excessive fat accumulation. To study the in vivo role of klotho in obesity, we have generated and characterized ob/ob mice lacking klotho activity [ob/ob-klotho double-knockout (DKO) mice]. The ob/ob mice started to get bigger from 3 wk onward and gained almost 2 times more weight than their wild-type (WT) counterparts (WT vs. ob/ob: 34.8±1.3 vs. 65.5±1.2 g at 21 wk). The generated ob/ob-klotho DKO mice were not only viable throughout their adulthood but also showed markedly reduced fat tissue accumulation compared to their ob/ob littermates. The ob/ob-klotho DKO mice had significantly (P<0.01) less retroperitoneal, mesenteric, and epididymal fat accumulation, compared to their ob/ob counterparts. Similarly, the fatty liver that was consistently observed in the ob/ob mice was eliminated in the ob/ob-klotho DKO mice. Such structural improvement in the liver was also evident from markedly reduced fasting blood glucose levels in ob/ob-klotho DKO mice, compared to their ob/ob counterparts (ob/ob vs. ob/ob-klotho DKO: 266 ± 36 vs. 65±2 mg/dl). Finally, to study whether the absence of klotho can induce resistance to high-fat-diet-induced obesity, we provided a high-fat (60%) diet to klotho-knockout mice and compared them with normal-fat (20%) diet-fed klotho-knockout mice. No significant difference in body weight was detected in klotho-knockout mice fed either the normal-fat diet or high-fat diet, while WT mice fed the high-fat diet gradually gained body weight, compared to the normal-fat-diet-fed counterparts. The results of our dietary and genetic manipulation studies provide in vivo evidence for a role of klotho in obesity and offer a novel target to manipulate obesity and associated complications.

Olive leaf extract prevents spontaneous occurrence of non-alcoholic steatohepatitis in SHR/NDmcr-cp rats.

AIMS: Oxidative stress may play an important role in the pathogenesis of non-alcoholic steatohepatitis (NASH). Oleuropein, the active constituent of olive leaf, possesses anti-oxidant, hypoglycaemic, and hypolipidaemic activities. We aimed to investigate the preventive effects of olive leaf extract on hepatic fat accumulation in a rat model of NASH. METHODS: Spontaneously hypertensive/NIH-corpulent rats were fed a diet of AIN-93G with or without olive leaf extract (500, 1000, 2000 mg/kg diet, and control; 5 rats each) for 23 weeks. Serological and histopathological findings, anti-oxidative activity, and the alteration of fatty acid synthesis in the liver were evaluated. RESULTS: Histopathologically, a diet of AIN-93G containing more than 1000 mg/kg olive leaf extract had a preventive effect for the occurrence of NASH. Thioredoxin-1 expression in the liver was more evident in rats fed this diet, and 4-hydroxynonenal expression in the liver was less evident in these rats. There were no significant differences in the activities of hepatic carnitine palmitoyltransferase, fatty acid synthase, malic enzyme, and phosphatidic acid phosphohydrolase among the groups. CONCLUSIONS: Our data suggest that olive leaf extract may help prevent NASH, presumably through its anti-oxidative activity.

Predictive factors for the development or regression of Fatty liver in Japanese adults.

Fatty liver is commonly associated with alcohol or metabolic syndrome. We aimed to examine the longitudinal aspects of fatty liver, and clarify the independent predictors for the development or regression of fatty liver. In the present study, the clinical features of 1578 Japanese adults (1208 men and 370 women; 35 to 69 years of age) who visited our center both in 2000 and 2007-2008 were recorded and compared, including liver status diagnosed by ultrasonography. Of the 1578 participants, 217 (13.8%) showed fatty liver development, and 74 (4.7%) showed fatty liver regression. Logistic regression analysis revealed that body mass index and percentage body fat were strongly associated with the development or regression of fatty liver. Metabolic syndrome-related disorders such as serum levels of total cholesterol, triglyceride, uric acid, and fasting blood glucose were also associated with clinical course to some degree. However, the history of alcohol intake, the presence of metabolic syndrome, blood pressure, and habitual physical exercise were not independent predictors for the development or regression of fatty liver. Our present data suggest that control of body weight in men and the percentage body fat in women are particularly important for the prevention or treatment of fatty liver.

Pathological influence of obesity on renal structural changes in chronic kidney disease.

BACKGROUND: Role of obesity in renal pathological and structural changes remains poorly investigated, and this study was designed to examine the pathological effects of obesity on renal structural components in patients with chronic kidney diseases (CKD). METHODS: The study subjects were obese (body mass index, BMI > or = 25 kg/m2) patients with nonglomerulonephritis (non-GN, n = 26), IgA nephropathy (IgAN, n = 19), benign nephrosclerosis (BNS, n = 15), and thin basement membrane disease (TMD, n = 6), and 65 nonobese controls (n = 20, 20, 10, and 15, respectively). Patients were evaluated for glomerular lesions (mesangial proliferation and focal segmental/global glomerulosclerosis), glomerular size, and thickness of glomerular basement membrane (GBM). RESULTS: Urinary protein was higher in obese non-GN, IgAN, and BNS groups than in the respective controls. Focal segmental glomerulosclerosis (FSGS) lesions were noted in all obesity groups. The glomeruli were larger in size in obese than in nonobese patients of the non-GN and IgAN groups. The glomeruli of nonobese TMD and BNS patients were significantly larger in size than those of nonobese non-GN patients. GBM were thicker in obese than in nonobese patients irrespective of types of glomerular diseases, but only significantly so in non-GN and BNS groups. CONCLUSION: In non-GN, IgAN, and BNS, obesity worsens proteinuria and is associated with structural changes such as glomerulomegaly and GBM thickening, similar to changes observed in obesity-related nephropathy. Obesity seems to worsen the renopathological state in CKD.

Effects of a long-term high-fat diet and switching from a high-fat to low-fat, standard diet on hepatic fat accumulation in Sprague-Dawley rats.

To investigate the effects of a long-term high-fat diet and switching from high-fat to a low-fat diet on hepatic fat accumulation in Sprague-Dawley (SD) rats, 3-week-old male SD rats were fed a high-fat diet (HFD) containing 45% fat (kilocalories) for 43 weeks (HDHD group), an HFD for 23 weeks followed by a low-fat, standard diet (LFD) containing 10% fat for 20 weeks (HDLD group), and an LFD for 43 weeks (LDLD group). Histopathologically, steatosis and lobular inflammation was obvious in the HDLD and HDHD groups at 46 weeks of age, and ballooning hepatocytes and Mallory hyalines were seen in the HDHD group. Mild fibrosis was observed in 5 of 13 (38%) rats in the HDHD or HDLD groups. Our results demonstrate that a long-term high-fat diet can induce nonalcoholic steatohepatitis (NASH) in SD rats. Switching to a low-fat, standard diet prevented the progression of NASH, although steatosis was not improved.