Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study.

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (padjusted = 0.0124 and padjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (padjusted = 0.027 and padjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Dietary carbohydrates: a review of international recommendations and the methods used to derive them.

BACKGROUND/OBJECTIVES: Renewed dietary recommendations for carbohydrates have recently been published by various international health authorities. The present work (1) reviews the methods and processes (systematic approach/review, inclusion of public consultation) used to identify, select and grade the evidence underpinning the recommendations, particularly for total carbohydrate (CHO), fibre and sugar consumption, and (2) examines the extent to which variation in the methods and processes applied relates to any differences in the final recommendations. SUBJECTS/METHODS: A search of WHO, US, Canada, Australia and European sources identified 19 documents from 13 authorities with the desired detailed information. Processes and methods applied to derive recommendations were compiled and compared. RESULTS: (1) A relatively high total CHO and fibre intake and limited intake of (added or free) sugars are generally recommended. (2) Even where recommendations are similar, the specific justifications for quantitative/qualitative recommendations differ across authorities. (3) Differences in recommendations mainly arise from differences in the underlying definitions of CHO exposure and classifications, the degree to which specific CHO-providing foods and food components were considered, and the choice and number of health outcomes selected. (4) Differences in the selection of source material, time frames or data aggregation and grading methods appeared to have minor influence. CONCLUSIONS: Despite general consistency, apparent differences among the recommendations of different authorities would likely be minimized by: (1) More explicit quantitative justifications for numerical recommendations and communication of uncertainty, and (2) greater international harmonization, particularly in the underlying definitions of exposures and range of relevant nutrition-related outcomes.

The Impact of Dietary Factors on Glycemic Control, Insulin Sensitivity and Secretion in the First Years after Diagnosis of Diabetes.

BACKGROUND: Dietary factors play an important role in the prevention of diabetes mellitus. We tested the hypothesis that dietary factors related to diabetes onset also associate with its progression, i. e., early time courses of insulin sensitivity and secretion in both type 1 and type 2 diabetes. METHODS: In a prospective observational study, well-controlled recent-onset diabetes patients (n=127) underwent detailed metabolic characterization within the first year after diagnosis. A follow-up was conducted 2 years after the first examination. Insulin secretion and sensitivity were assessed by intravenous glucose tolerance testing. Baseline food consumption was analyzed by a food propensity questionnaire. Multivariate linear regression analysis was used to assess associations between consumption frequencies at baseline with metabolic changes during the first 2 years. RESULTS: Within the first 2 years, metabolic control did not change in patients with type 1 and type 2 diabetes on average. In type 1 diabetes, an increased consumption frequency of refined grains by one time/day at baseline associated with higher HbA1c by 0.60% (95% CI: 0.04; 1.16), P=0.04 after 2 years compared to baseline. In type 2 diabetes, an increased consumption frequency of meat/meat products by one time/day at baseline associated with lower beta-cell adaptation index (-7.25% (95% CI: -13.16; -0.93), P=0.03) after adjustment for age, sex, BMI, and changes of BMI and glucose-lowering medication. CONCLUSION: Dietary factors associate with the initial course of diabetes. Reduced consumption of refined grains in type 1 diabetes and of meat products in type 2 diabetes may contribute to preservation of insulin secretion and sensitivity.

Glycaemic and insulin index of four common German breads.

BACKGROUND/OBJECTIVES: German-style breads are recommended as a lower glycaemic index (GI) alternative, yet little data is available. Our aim was to test the GI and insulin index (II) of four breads and rolls commonly consumed in Germany. SUBJECTS/METHODS: Four German bread products were tested for their GI and II in 12 healthy subjects according to the International Standard Organization guidelines. RESULTS: Only the wholemeal rye bread with visible intact grains and sunflower seeds was identified as low GI (GI=55). Both the wholemeal spelt wheat (GI=63) and the rye wheat sourdough bread (GI=62) were classified as medium GI, whereas soft pretzel was high GI (GI=80, P<0.05 compared with other products). The II of soft pretzels (II=102) was also highest and differed significantly from wholemeal rye (II=70) and rye sourdough bread (II=72) but not from wholemeal spelt wheat (II=77). CONCLUSIONS: Contrary to popular belief, these German-style breads are medium to high GI, with the exception of the rye bread with intact grains and seeds. The results highlight the need to test, rather than 'guestimate', the GI of local products, and develop a broader range of low-GI breads.

Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC).

BACKGROUND AND AIMS: The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS: International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS: The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS: Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.

Effects of human milk and formula on postprandial glycaemia and insulinaemia.

BACKGROUND/OBJECTIVES: Consumption of formula in place of human milk may produce differences in postprandial glycaemia and insulinaemia that contribute to metabolic programming in the first year of life. The objective of the current study was to determine glycaemic and insulinaemic responses to human milk compared with a typical commercial formula, and then compare 11 other formulas. SUBJECTS/METHODS: On separate mornings in random order, 10 healthy breastfeeding mothers consumed 25 g available carbohydrate portions of their own milk, a formula and reference food (25 g glucose on two occasions). In the second study, 10 different healthy subjects consumed 25 g available carbohydrate portions of 11 different commercial formulas and three reference foods (25 g glucose on three occasions). Fingerpick blood samples were taken at regular intervals over 2 h, and the glycaemic index (GI) and insulin index determined according to a standardised protocol. RESULTS: There were no significant differences in postprandial glycaemia or insulinaemia after human milk vs a typical formula (P = 0.3). Both produced a low GI (mean ± s.e.m.: 38 ± 7 vs 34 ± 7, respectively) and high insulin index (87 ± 14 vs 94 ± 16). The GI and insulin indices of the other formulas ranged from 18 ± 3 to 67 ± 6 and 53 ± 9 to 209 ± 33, respectively. CONCLUSIONS: Human milk and a typical formula elicit similar postprandial glycaemic and insulinaemic responses, but there is a wide range of responses to other formulas.

Velocities of weight, height and fat mass gain during potentially critical periods of growth are decisive for adult body composition.

OBJECTIVES: To examine whether maximal velocities of weight, height and fat mass during potentially critical periods of growth were associated with body composition in young adulthood. SUBJECTS/METHODS: Analyses were performed on 277 female and 271 male participants of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study with anthropometric measurements in young adulthood (18-25 years) as well as early life (0-2 years), mid-childhood (3-8 years) or puberty (9-15 years). Maximum growth velocities were calculated using the SuperImposition by Translation And Rotation (SITAR) routine or polynomial functions and related to adult fat mass index (FMI) and fat-free mass index (FFMI). RESULTS: In early life, faster weight gain was associated with a moderately higher FMI and FFMI in young adulthood in women only (Ptrend=0.01). In mid-childhood and puberty, weight and fat mass velocities were related to adult FMI and FFMI in both sexes (Ptrend⩽0.002): relative differences between the highest and lowest tertiles of these growth velocities ranged 33-69% for adult FMI and 6-12% for adult FFMI. A higher mid-childhood height velocity was related to a modestly higher adult FMI in women only (Ptrend=0.0005). CONCLUSIONS: Faster gain in weight and body fat during mid-childhood and puberty appear to be particularly relevant for adult fat mass.

Prospective association of protein intake during puberty with body composition in young adulthood.

OBJECTIVE: To examine the association of habitual animal and plant protein intake during the potentially critical period of puberty with body composition in young adulthood. DESIGN AND METHODS: Multivariable regression analyses were performed on data from 140 female and 122 male participants of the DONALD Study with ≥2 3-day weighed dietary records during puberty (girls 9-14 years; boys 10-15 years) and anthropometric measurements in young adulthood (18-25 years). Fat-free mass index (FFMI) and fat mass index (FMI) were estimated from four skinfolds. RESULTS: In women, a higher pubertal animal protein consumption was independently related to higher levels of FFMI (ptrend = 0.001), but not to FMI (ptrend = 0.5). Adjusted means of FFMI in energy-adjusted tertiles of animal protein intake were 15.3 (95% confidence interval: 15.0, 15.5), 15.4 (15.1, 15.7), 16.2 (15.9, 16.6) kg/m(2) . In men, a higher animal protein intake was related to a higher FFMI (ptrend = 0.04) and a lower FMI (ptrend = 0.001) only after adjusting FFMI for current FMI levels and vice versa. Plant protein was not associated with body composition among either sex. CONCLUSIONS: Our results show that a higher pubertal animal protein consumption may yield a higher fat-free mass in young adulthood.

Increase in prevalence of adiposity between the ages of 7 and 11 years reflects lower remission rates during this period.

UNLABELLED: What is already known about this subject? A considerable increase in the prevalence of overweight during the primary school years (7-11 years) has been reported. What this study adds? This reflects lower remission rates of excess body fat (i.e. the proportion of shifts from excess to normal body fat) between the ages of 7 and 11 years as compared with nearly balanced incidence and remission rates of excess body fat between the ages of 3 and 7 years. OBJECTIVE: This study aimed to compare the age-specific balance between incidence and remission of excess body fat between the ages of 3-7 and 7-11 years using the data from a longitudinal study. DESIGN: Longitudinal analysis based on the data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study, an ongoing, open cohort study in healthy children, conducted in Dortmund, Germany. Excess body fat was defined by the sum of triceps and subscapular skin-fold measurements above the 90th reference percentile of the new German standard; overweight was defined using different national and international standards. The main outcome parameters were incidence and remission rates of excess body fat (n = 496) and overweight (n = 518) between the ages of 3 and 7 years and between the ages of 7 and 11 years. RESULTS: The incidence rates of excess skin-fold thickness between the ages of 3 and 7 years (4.2 [2.4, 6.2]%) and between the ages of 7 and 11 years (4.3 [2.6, 6.2]%) were almost identical. By contrast, remission rates were significantly lower during the age period of 7-11 years (primary school age) than during the age period of 3-7 years (pre-school age): 37.5 (21.9, 53.1%) compared with 72.3 (59.6, 85.1%). CONCLUSIONS: These data point to the low remission of excess body fat as an important driving force for the increasing prevalence of excess body fat in children between the ages of 7 and 11 years. Public health initiatives in children should encompass both primary prevention and interventions targeted at children already overweight at school entry.

[The DONALD cohort. An updated overview on 25 years of research based on the Dortmund Nutritional and Anthropometric Longitudinally Designed study]. / Die DONALD Kohorte. Ein aktueller Überblick zu 25 Jahren Forschung im Rahmen der Dortmund Nutritional and Anthropometric Longitudinally Designed Study.

The DONALD study has been conducted in Dortmund, Germany since 1985 to examine the complex relations between nutritional intake, metabolism and growth from infancy to adulthood. Every year, approximately 40 infants are newly recruited into the open cohort study. Examinations conducted at ages 3, 6, 9, 12, 18, 24 months and then annually until young adulthood, comprise anthropometry, a 3 day weighed dietary record, a 24 h urine sample (from age 3-4 years onwards), medical examinations and parental interviews. Since 2005, participants are invited for follow-up visits during adulthood (including fasting blood samples). Approximately 1,400 children have been recruited into the study up to 2010. Recent findings revealed e.g. (i) the relevance of early life factors for subsequent development of body composition and puberty timing, (ii) the relation between pubertal hormonal status and puberty onset, (iii) age and time trends in iodine status and modern dietary habits and (iv) potential furan and benzol exposition by commercial weaning foods. Future analyses will provide insight into the extent to which health in young adulthood is receptive to diet, anthropometric pattern and hormonal status in distinct potentially critical periods during childhood.

Prospective associations of dietary insulin demand, glycemic index, and glycemic load during puberty with body composition in young adulthood.

BACKGROUND: Puberty is a so-called critical period for overweight development and is characterized by physiological insulin resistance during mid-puberty. This study addressed the hypothesis that habitual consumption of a diet inducing higher levels of postprandial glycemia or insulinemia during puberty may have an unfavorable effect on the body composition in young adulthood. METHODS: Multivariate regression analysis was performed on 262 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with at least two 3-day weighed dietary records during puberty (baseline: girls 9-14 years; boys 10-15 years) and anthropometric measurements in young adulthood (18-25 years). A published dietary glycemic index was assigned to each carbohydrate-containing food. Similarly, each food was assigned a food insulin index (insulinemic response to a 1 MJ portion of food relative to 1 MJ of glucose) using 121 values measured at Sydney University. RESULTS: Dietary glycemic index or glycemic load during puberty was not related to body composition in young adulthood. In contrast, a higher dietary insulin index and a higher dietary insulin load during puberty were associated with higher levels of percentage of body fat (%BF) in young adulthood, even after adjustment for early life, socioeconomic and nutritional factors; %BF in energy-adjusted tertiles of dietary insulin index were 22.9 (95% confidence intervals (CI): 21.6, 24.1), 24.5 (23.2, 25.7), 24.7 (23.5, 25.9) %, P (for trend)=0.01; %BF in energy-adjusted tertiles of dietary insulin load were 22.8 (95% CI: 21.5, 24.0), 24.5 (23.2, 25.7), 24.8 (23.6, 26.0) %, P (for trend)=0.01. Adjustment for baseline %BF attenuated these relationships (P (for trend)=0.1 and=0.08, respectively). Dietary insulin demand was not related to body mass index. CONCLUSION: This study suggests a prospective adverse influence of dietary insulin demand during puberty on %BF in young adulthood. Postprandial increases in insulinemia rather than increases in glycemia appear to be implicated in an unfavorable development of body composition.

Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective.

In recent years, several alternative dietary approaches, including high-protein and low-glycaemic-load diets, have produced faster rates of weight loss than traditional low-fat, high-carbohydrate diets. These diets share an under-recognised unifying mechanism: the reduction of postprandial glycaemia and insulinaemia. Similarly, some food patterns and specific foods (potatoes, white bread, soft drinks) characterised by hyperglycaemia are associated with higher risk of adiposity and type 2 diabetes. Profound compensatory hyperinsulinaemia, exacerbated by overweight, occurs during critical periods of physiological insulin resistance such as pregnancy and puberty. The dramatic rise in gestational diabetes and type 2 diabetes in the young may therefore be traced to food patterns that exaggerate postprandial glycaemia and insulinaemia. The dietary strategy with the strongest evidence of being able to prevent type 2 diabetes is not the accepted low-fat, high-carbohydrate diet, but alternative dietary approaches that reduce postprandial glycaemia and insulinaemia without adversely affecting other risk factors.

The influence of habitual protein intake in early childhood on BMI and age at adiposity rebound: results from the DONALD Study.

OBJECTIVE: To analyse the influence of habitual protein intake in early childhood on age and body mass index (BMI) at adiposity rebound (AR), a potential critical period for the development of obesity. SUBJECTS: A total of 313 children (161 boys, 152 girls) participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. METHODS: Weighted summary indices were created reflecting habitual, energy-adjusted protein intake (expressed as % of energy) and protein intake per kg reference body weight per day (g/kg RBW/day) between the age of 12 and 24 months. Body mass index standard deviation scores (BMI-SDS), age at AR and covariates (mother's BMI, gestational age, breastfeeding and siblings) were included in the final models. RESULTS: After adjusting for potential confounders, girls in the highest tertile (T3) of habitual energy-adjusted protein intake had a significantly higher BMI-SDS at AR than those in T1 (T1: -0.61 (95% CI: -0.90; -0.31), T2: -0.49 (-0.79; -0.20), T3: -0.08 (-0.36; 0.20), P for difference=0.01). A comparable association existed with habitual protein intake expressed as g/kg RBW/day (T1: -0.64 (-0.93; -0.36), T2: -0.22 (-0.52; 0.09), T3: -0.25 (-0.54; 0.04), P=0.04). In boys, there were no differences in BMI-SDS at AR between tertiles of habitual protein intake (% of energy or g/kg RBW/day) (P>0.05). Boys in the lowest tertile of habitual energy-adjusted protein intake tended to experience a later AR (T1: 6.0 (5.6; 6.4), T2: 5.5 (5.1; 5.9), T3: 5.4 (5.0; 5.9) years, P=0.07). But neither in girls nor in boys was age at AR significantly different between tertiles of habitual protein intake (% of energy or g/kg RBW/day) (P>0.05). CONCLUSION: A higher habitual protein intake between the age of 12 and 24 months was associated with a higher BMI-SDS at AR in girls, but not in boys. There was no consistent relation between habitual protein intake in early childhood and timing of AR.

A comparative evaluation of two different approaches to estimating age at adiposity rebound.

OBJECTIVE: To compare different approaches (visual estimation of individual BMI curves with polynomial models) to estimate age at adiposity rebound (AR), as different approaches might lead to different results. AR has been suggested as a critical period between intra-uterine life and early adulthood, and recent data showed that early age at AR is associated with higher body mass later in life. METHODS: Longitudinal anthropometric data from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used to obtain individual BMI growth curves. We then compared the visual estimation approach to polynomial models in three different scenarios reflected by different data sets: an idealistic, an realistic, and a realistic scenario with imputed values. RESULTS: In all three scenarios, the visual estimation yielded significantly higher estimates than the polynomial models of 2nd or 3rd order. Cross-tabulations of groups of age at AR (early, medium, and late) showed that truly concordant classification was low, ranging only from 51 to 63%. A closer examination of the data indicated that the differences in estimates were mainly due to differences in the underlying definitions: the polynomial models select the nadir in the growth curve as the age at AR, whereas the visual estimation deviates from this concept in those cases where there is plateau in the growth curve. In the latter instance, the turning point of the growth curve before its increase is selected as the age at rebound. CONCLUSIONS: Estimating AR with the visual approach appears to best reflect the physiological basis of the AR, and is also preferable, because it resulted in the lowest number of children with missing estimates for age at AR. Only when the underlying criteria for the estimation of AR with the visual approach were modified, could concordant results between the two approaches be obtained. Considering the underlying physiological basis, it became clear that approaches which determine AR by simply identifying the nadir in the BMI curve do not reflect AR appropriately. This refers to those cases in which the nadir in the growth curve and the turning point at the onset of the adiposity increase are not identical.

Differences between recumbent length and stature measurement in groups of 2- and 3-y-old children and its relevance for the use of European body mass index references.

OBJECTIVE: To compare length and stature measurements of young children and to examine the relevance of any difference for comparison with body mass index (BMI) references designed for use from birth to adulthood. SUBJECTS: A total of 426 2-y-old and 525 3-y-old children included in the Dortmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study. DATA ANALYSIS: Length and stature were measured to the nearest millimetre using a stadiometre. Agreement between both measurements at age 2 and 3 y, respectively, was determined by mean differences and by comparison with the German BMI reference. RESULTS: The average length of 2-y-old girls and boys was 88.3 (3.1) and 89.9 (3.2) cm, mean differences (stature minus length) were -0.47 (0.65) and -0.45 (0.64) cm. The corresponding BMI values were 16.18 (1.3) and 16.46 (1.2) kg/m2, with mean differences of +0.17 (0.24) and +0.16 (0.23). According to stature, 9.4% of the girls and 10.8% of the boys were overweight (>90th percentile), while length classified 7.1 and 9.4% as overweight. Similar mean differences between length and stature were observed at age 3 y: -0.53 (0.62) and -0.47 (0.65) cm in height and +0.17 (0.20) and +0.14 (0.20) kg/m2 in the BMI of girls and boys, respectively. According to stature, 7.6 and 7.3% were overweight as opposed to 5.4 and 4.8% using length. The observed differences increased with higher BMI levels. CONCLUSION: Changing measurements from length to stature results in an upward shift of BMI, not reflected in current European BMI references. This small but systematic error may result in misinterpretation of individual BMI levels or trend observations.

Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids.

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.

Nutrient intakes as predictors of body weight in European people with type 1 diabetes.

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.

Carbohydrate sources and glycaemic control in Type 1 diabetes mellitus. EURODIAB IDDM Complications Study Group.

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.

Associations of fat and cholesterol intake with serum lipid levels and cardiovascular disease: the EURODIAB IDDM Complications Study.

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.