Nearly one in five older adults in Danish nursing homes live with type 2 diabetes.

AIM: This study aimed to investigate the prevalence of type 2 diabetes (T2D) among Danish nursing home residents (aged ⩾65 years). METHODS: Individuals with T2D in the Danish population of older adults in 2018 were identified using a Danish diabetes register based on administrative and clinical register data. Data on age, sex, type of housing, educational level and place of origin were obtained from various high-quality administrative registers. We calculated frequencies of T2D among older adults living in nursing homes and in other types of housing. We performed a multiple logistic regression analysis to estimate the odds ratio (OR) of T2D among people living in nursing homes and adjusted for sex, age, educational level and place of origin. RESULTS: All Danish older adults aged ⩾65 years, alive and living in Denmark on 31 December 2018 were included (N=1,170,517). Nursing home residents accounted for 37,891 older adults, and of these, 19% had T2D, whereas 14% of older adults living in other types of housing had T2D. According to the multiple logistic regression analysis, nursing home residents had a higher OR of having T2D compared to older adults living in other types of housing (OR=1.47; confidence interval 1.43-1.51) when adjusting for socio-demographic factors. CONCLUSIONS: The prevalence of T2D in nursing home residents exceeds the prevalence in the background population at ⩾65 years of age. This indicates a need for increased focus on individualised interdisciplinary care plans aimed at maintaining physical function and maximising quality of life for this group of vulnerable older adults.

Prevotella-to-Bacteroides ratio predicts body weight and fat loss success on 24-week diets varying in macronutrient composition and dietary fiber: results from a post-hoc analysis.

BACKGROUND/OBJECTIVES: Individuals with high pre-treatment bacterial Prevotella-to-Bacteroides (P/B) ratio have been reported to lose more body weight on diets high in fiber than subjects with a low P/B ratio. Therefore, the aim of the present study was to examine potential differences in dietary weight loss responses between participants with low and high P/B. SUBJECTS/METHODS: Eighty overweight participants were randomized (52 completed) to a 500 kcal/d energy deficit diet with a macronutrient composition of 30 energy percentage (E%) fat, 52 E% carbohydrate and 18 E% protein either high (≈1500 mg calcium/day) or low ( ≤ 600 mg calcium/day) in dairy products for 24 weeks. Body weight, body fat, and dietary intake (by 7-day dietary records) were determined. Individuals were dichotomized according to their pre-treatment P/B ratio derived from 16S rRNA gene sequencing of collected fecal samples to test the potential modification of dietary effects using linear mixed models. RESULTS: Independent of the randomized diets, individuals with high P/B lost 3.8 kg (95%CI, 1.8,5.8; P < 0.001) more body weight and 3.8 kg (95% CI, 1.1, 6.5; P = 0.005) more body fat compared to individuals with low P/B. After adjustment for multiple covariates, individuals with high P/B ratio lost 8.3 kg (95% CI, 5.8;10.9, P < 0.001) more body weight when consuming above compared to below 30 g fiber/10MJ whereas this weight loss was 3.2 kg (95% CI, 0.8;5.5, P = 0.008) among individuals with low P/B ratio [Mean difference: 5.1 kg (95% CI, 1.7;8.6, P = 0.003)]. Partial correlation coefficients between fiber intake and weight change was 0.90 (P < 0.001) among individuals with high P/B ratio and 0.25 (P = 0.29) among individuals with low P/B ratio. CONCLUSIONS: Individuals with high P/B lost more body weight and body fat compared to individuals with low P/B, confirming that individuals with a high P/B are more susceptible to weight loss on a diet rich in fiber.

Calcium intake and the associations with faecal fat and energy excretion, and lipid profile in a free-living population.

The aim of the present study was to investigate the associations between the habitual Ca intake and faecal fat and energy excretion as well as blood lipid profile in free-living normal-weight and overweight individuals. The participants were enrolled for an 8-d period where data from a 7-d diet registration (days 1-7), a 5-d faeces collection (days 3-7), a 2-d urine collection (days 5-7), and anthropometric measurements and a fasting blood sample (day 8) were collected. Analyses showed that dietary Ca intake (g/10 MJ per d) was positively associated with excretion of faecal fat (P = 0·004) and energy (P = 0·031) when adjusted for BMI, age, sex and intake of Ca-containing supplements. However, after adjustment for intake of fibre, the effect of Ca intake disappeared. Nevertheless, total cholesterol (CHOL) and LDL-CHOL concentrations were associated negatively with Ca intake (ß -0·62 (95 % CI -0·96, -0·28) mmol/l, P < 0·001, and ß -0·49 (95 % CI -0·78, -0·20) mmol/l, P = 0·001, respectively, per 1000 mg/10 MJ per d increase in Ca intake). In conclusion, incorporation of Ca-rich food products in a habitual diet was associated with reduced total CHOL and LDL-CHOL concentrations, which may lower the risk of CVD in the long term.

Metabolic Effects of a 24-Week Energy-Restricted Intervention Combined with Low or High Dairy Intake in Overweight Women: An NMR-Based Metabolomics Investigation.

We investigated the effect of a 24-week energy-restricted intervention with low or high dairy intake (LD or HD) on the metabolic profiles of urine, blood and feces in overweight/obese women by NMR spectroscopy combined with ANOVA-simultaneous component analysis (ASCA). A significant effect of dairy intake was found on the urine metabolome. HD intake increased urinary citrate, creatinine and urea excretion, and decreased urinary excretion of trimethylamine-N-oxide (TMAO) and hippurate relative to the LD intake, suggesting that HD intake was associated with alterations in protein catabolism, energy metabolism and gut microbial activity. In addition, a significant time effect on the blood metabolome was attributed to a decrease in blood lipid and lipoprotein levels due to the energy restriction. For the fecal metabolome, a trend for a diet effect was found and a series of metabolites, such as acetate, butyrate, propionate, malonate, cholesterol and glycerol tended to be affected. Overall, even though these effects were not accompanied by a higher weight loss, the present metabolomics data reveal that a high dairy intake is associated with endogenous metabolic effects and effects on gut microbial activity that potentially impact body weight regulation and health. Moreover, ASCA has a great potential for exploring the effect of intervention factors and identifying altered metabolites in a multi-factorial metabolomic study.

A randomised, controlled, crossover study of the effect of diet on angiopoietin-like protein 4 (ANGPTL4) through modification of the gut microbiome.

Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor that is involved in lipid metabolism and angiogenesis. Animal studies have suggested that the ANGPTL4 protein is modulated by the gut microbiota, possibly through increased concentrations of SCFA, such as C4, found in whole-fat milk or as a result of fermentation of inulin. This study investigated whether a standardised diet either high in fat content or supplemented with inulin powder would increase plasma ANGPTL4 in overweight men and whether this increase was mediated through a compositional change of the gut microbiota. The study had a crossover design with three arms, where participants were given a standardised isoenergetic diet supplemented with inulin powder, whole-fat milk or water (control). Plasma and urine samples were collected before and after each intervention period. Faecal samples and adipose tissue biopsies were collected after each intervention period. The study included twenty-one participants of whom eighteen completed the study. The dietary interventions did not change ANGPTL4 plasma concentration, nor was plasma ANGPTL4 associated with plasma lipids, TAG or NEFA concentration. The relative abundance of bifidobacteria following the inulin diet was higher, compared with the control diet. However, the changes in microbiota were not associated with plasma ANGPTL4 and the overall composition of the microbiota did not change between the dietary periods. Although weight was maintained throughout the dietary periods, weight was negatively associated with plasma ANGPTL4 concentration. In the adipose tissue, ANGPTL4 expression was correlated with leptin expression, but not with hypoxia-inducible factor 1α (HIF-1α) expression.

Relative validity and reproducibility of a food frequency questionnaire to assess dietary fiber intake in Danish adults.

BACKGROUND: Differences in habitual dietary fiber intake may modify effects of dietary fiber interventions, thus measurement of habitual dietary fiber intake is relevant to apply in intervention studies on fiber-rich foods, and food frequency questionnaire (FFQ) is a commonly used method. Rye bread is the major contributor of dietary fiber in the Danish population, and a nation-specific FFQ is therefore needed. OBJECTIVE: The aim of this study was to assess the relative validity and reproducibility of a self-administered quantitative FFQ designed to assess total dietary fiber intake among Danish adults. DESIGN: In order to assess the relative validity of the FFQ, a total of 125 participants completed both a 7-day weighed dietary recording (DR) and an FFQ consisting of 60 questions. To evaluate the reproducibility of the FFQ, a sub-group of 12 participants subsequently completed an FFQ approximately 6 months later. RESULTS: Estimates of mean dietary fiber intake were 24.9±9.8 and 28.1±9.4 g/day when applying the FFQ and DR, respectively, where FFQ estimates were ~12% lower (p<0.001). Pearson's correlation coefficient between the estimated dietary fiber intake of the two methods was r=0.63 (p<0.001), and 62% of the participants were grouped into the same tertile of intake according to the two methods. The estimates of mean dietary intake of first and second FFQ were very similar (22.2±4.0 and 23.3±4.1 g/day, respectively, p=0.42) and showed a correlation of r=0.95 (95% CI 0.83-0.99). CONCLUSION: The developed FFQ showed moderate underestimation of dietary fiber intake (g/day), adequate ranking of subjects according to their dietary fiber intake, and good reproducibility. The FFQ is therefore believed to be a valuable tool for epidemiology and screening in human interventions, where intake of dietary fibers is of specific interest.

Effects of hydrolysed casein, intact casein and intact whey protein on energy expenditure and appetite regulation: a randomised, controlled, cross-over study.

Casein and whey differ in amino acid composition and in the rate of absorption; however, the absorption rate of casein can be increased to mimic that of whey by exogenous hydrolysis. The objective of the present study was to compare the effects of hydrolysed casein (HC), intact casein (IC) and intact whey (IW) on energy expenditure (EE) and appetite regulation, and thereby to investigate the influence of amino acid composition and the rate of absorption. In the present randomised cross-over study, twenty-four overweight and moderately obese young men and women consumed three isoenergetic dietary treatments that varied in protein source. The study was conducted in a respiration chamber, where EE, substrate oxidation and subjective appetite were measured over 24 h at three independent visits. Moreover, blood and urine samples were collected from the participants. The results showed no differences in 24 h and postprandial EE or appetite regulation. However, lipid oxidation, estimated from the respiratory quotient (RQ), was found to be higher after consumption of IW than after consumption of HC during daytime (P= 0·014) as well as during the time after the breakfast meal (P= 0·008) when the food was provided. Likewise, NEFA concentrations were found to be higher after consumption of IW than after consumption of HC and IC (P< 0·01). However, there was no overall difference in the concentration of insulin or glucagon-like peptide 1. In conclusion, dietary treatments when served as high-protein mixed meals induced similar effects on EE and appetite regulation, except for lipid oxidation, where RQ values suggest that it is higher after consumption of IW than after consumption of HC.

Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men.

BACKGROUND: Calcium from different dairy sources might affect blood lipids and fecal fat excretion differently because of differences in the food matrix and nutritional composition. OBJECTIVE: We investigated whether milk- and cheese-based diets with similar calcium contents affect a saturated fatty acid-induced increase in blood lipids differently. DESIGN: Fifteen healthy, young men participated in a randomized 3 × 2-wk crossover study in which the following 3 isocaloric diets that were similar in fat contents and compositions were compared: control diet [nondairy diet (~500 mg Ca/d)], milk diet [semiskimmed milk-based diet (1700 mg Ca/d)], and cheese diet [semihard cow-cheese-based diet (1700 mg Ca/d)]. Blood was drawn before and after each period, and feces were collected for 5 d during each period. RESULTS: Saturated fatty acid-induced increases in total and low-density lipoprotein (LDL) cholesterol were lower with the milk diet (mean ± SD: 0.57 ± 0.13 and 0.53 ± 0.11 mmol/L, respectively) (P < 0.01) and cheese diet (0.41 ± 0.15 and 0.47 ± 0.12 mmol/L, respectively) (P < 0.05) than with the control diet (0.89 ± 0.12 and 0.84 ± 0.11 mmol/L, respectively). Fecal fat excretion increased more with the consumption of both the milk (5.2 ± 0.4 g/d) and cheese (5.7 ± 0.4 g/d) diets than with the control diet (3.9 ± 0.3 g/d) (P < 0.001). Changes in blood pressure, high-density lipoprotein cholesterol, triglycerides, and lipid ratios did not differ. CONCLUSIONS: Compared with the control diet, milk- and cheese-based diets attenuated saturated fatty acid-induced increases in total and LDL cholesterol and resulted in increased fecal fat excretion; however, effects of milk and cheese did not differ. Because the diets contained similar amounts of saturated fat, similar increases in total and LDL cholesterol could be expected; however, both milk and cheese attenuated these responses, which seem to be explained by their calcium contents. This trial was registered at clinicaltrials.gov as NCT01317251.

Milk minerals modify the effect of fat intake on serum lipid profile: results from an animal and a human short-term study.

Despite a high content of saturated fat, evidence from observational studies indicates that the consumption of dairy products may have a neutral effect or may be inversely associated with the risk of CVD. We aimed to examine whether milk minerals modify the effect of saturated fat on serum lipid profile. We present data from two studies. Study I had a randomised, blinded, parallel design (n 24 pigs) with a 10 d adaptation period during which a high-fat diet was fed to the pigs and a 14 d intervention period during which the same diet either enriched with milk minerals (MM group) or placebo (control group) was fed to the pigs. Study II had a randomised cross-over design (n 9 men) where the subjects were fed either a high-fat diet enriched with milk minerals (MM period) or a regular diet (control period). In both the studies, blood variables were measured before and after the intervention and faecal and urine samples were collected at the end of the dietary periods. The increase in plasma total cholesterol and LDL-cholesterol concentrations but not in HDL-cholesterol concentration was markedly lowered by milk minerals in both the studies. In the animal study, baseline adjusted total cholesterol and LDL-cholesterol concentrations in the MM group were 11% (P = 0.004) and 13% (P = 0.03) lower compared with those in the control group after the intervention. Similarly in the human study, baseline adjusted total cholesterol and LDL-cholesterol concentrations were 6% (P = 0.002) and 9% (P = 0.03) lower after the MM period compared with those in the control period. HDL-cholesterol concentration was not lowered by milk minerals. These short-term studies indicate that the addition of milk minerals to a high-fat diet to some extent attenuates the increase in total cholesterol and LDL-cholesterol concentrations, without affecting HDL-cholesterol concentration.

Associations between dairy protein intake and body weight and risk markers of diabetes and CVD during weight maintenance.

Dairy products have previously been reported to be associated with beneficial effects on body weight and metabolic risk markers. Moreover, primary data from the Diet, Obesity and Genes (DiOGenes) study indicate a weight-maintaining effect of a high-protein-low-glycaemic index diet. The objective of the present study was to examine putative associations between consumption of dairy proteins and changes in body weight and metabolic risk markers after weight loss in obese and overweight adults. Results were based on secondary analyses of data obtained from overweight and obese adults who completed the DiOGenes study. The study consisted of an 8-week weight-loss phase and a 6-month weight-maintenance (WM) phase, where the subjects were given five different diets varying in protein content and glycaemic index. In the present study, data obtained from all the subjects were pooled. Dairy protein intake was estimated from 3 d dietary records at two time points (week 4 and week 26) during the WM phase. Body weight and metabolic risk markers were determined at baseline (week -9 to -11) and before and at the end of the WM phase (week 0 and week 26). Overall, no significant associations were found between consumption of dairy proteins and changes in body weight and metabolic risk markers. However, dairy protein intake tended to be negatively associated with body weight gain (P=0·08; ß=-0·17), but this was not persistent when controlled for total protein intake, which indicates that dairy protein adds no additional effect to the effect of total protein. Therefore, the present study does not report that dairy proteins are more favourable than other proteins for body weight regulation.

Effect of dairy proteins on appetite, energy expenditure, body weight, and composition: a review of the evidence from controlled clinical trials.

Evidence supports that a high proportion of calories from protein increases weight loss and prevents weight (re)gain. Proteins are known to induce satiety, increase secretion of gastrointestinal hormones, and increase diet-induced thermogenesis, but less is known about whether various types of proteins exert different metabolic effects. In the Western world, dairy protein, which consists of 80% casein and 20% whey, is a large contributor to our daily protein intake. Casein and whey differ in absorption and digestion rates, with casein being a "slow" protein and whey being a "fast" protein. In addition, they differ in amino acid composition. This review examines whether casein, whey, and other protein sources exert different metabolic effects and targets to clarify the underlying mechanisms. Data indicate that whey is more satiating in the short term, whereas casein is more satiating in the long term. In addition, some studies indicate that whey stimulates the secretion of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide more than other proteins. However, for the satiety (cholecystokinin and peptide YY) and hunger-stimulating (ghrelin) hormones, no clear evidence exists that 1 protein source has a greater stimulating effect compared with others. Likewise, no clear evidence exists that 1 protein source results in higher diet-induced thermogenesis and promotes more beneficial changes in body weight and composition compared with other protein sources. However, data indicate that amino acid composition, rate of absorption, and protein/food texture may be important factors for protein-stimulated metabolic effects.

Dairy calcium intake modifies responsiveness of fat metabolism and blood lipids to a high-fat diet.

Intervention studies have demonstrated that saturated fat increases total and LDL-cholesterol concentrations, and it is therefore recommended that the intake of high-fat dairy products be limited. However, observational studies have found an inverse relationship between the intake of dairy products and incidence of CVD. We aimed to study whether the Ca content of dairy products influences the effect of dairy fat on the lipid profile. The study had a randomised cross-over design. Subjects (n 9) were randomised to one of the sequence of four isoenergetic 10 d diets: low Ca and low fat (LC/LF: approximately 700 mg Ca/d, 25 % of energy (fat); high Ca and LF (HC/LF: approximately 2800 mg Ca/d, 25 % of energy fat); LC and high fat (LC/HF: approximately 700 mg Ca/d, 49 E% fat); or HC and HF (approximately 2800 mg Ca/d, 49 E% fat). Blood variables were measured before and after each diet period, and faeces and urine were collected at the end of each diet period. A two-way ANOVA was used to examine the effect of Ca and fat intake. Independent of Ca intake, the HF diet increased the concentrations of total (9 %; P < 0·0001), LDL (14 %; P < 0·0001)- and HDL (13 %; P = 0·0002)-cholesterol compared with the LF diet. However, independent of fat intake, the HC diet decreased the concentrations of total (4 %; P = 0·0051) and LDL-cholesterol (10 %; P < 0·0001) but not HDL-cholesterol compared with the LC diet. In addition, total:HDL-cholesterol was decreased (5 %; P = 0·0299), and HDL:LDL was increased (12 %; P = 0·0097) by the HC diet compared with the LC diet. Faecal fat excretion was increased by both the HC (P < 0·0001) and HF (P = 0·0052) diets. In conclusion, we observed that dairy Ca seems to partly counteract the raising effect of dairy fat on total and LDL-cholesterol, without reducing HDL-cholesterol.

Dairy beverages and energy balance.

High dairy intakes have been associated with lower rates of obesity in observational studies, but mechanisms to explain the association are lacking. A high intake of dairy protein reduces spontaneous food intake and may be one important mechanism, but more specific effects of dairy calcium seem to exist. We have found that high versus low calcium intakes from dairy products had no effect on 24-h energy expenditure or substrate oxidation rates, but fecal fat excretion increased approximately 2.5-fold on the high-calcium diets. In a meta-analysis of intervention studies we found that increasing dairy calcium intake by 1200mg/day resulted in increased fecal fat excretion by 5.2 (1.6-8.8) g/day. Newer research shows that humans possess taste receptors for calcium in the gastrointestinal tract and that signaling may be linked to appetite regulation. A new line of evidence suggests that an inadequate calcium intake during an energy restricted weight loss program may trigger hunger and impair compliance to the diet. These mechanisms may be part of the explanation for the protective effects of dairy products with regard to obesity and metabolic syndrome.

Calcium supplementation for 1 y does not reduce body weight or fat mass in young girls.

BACKGROUND: Accumulating evidence from observational studies indicates that a high calcium intake may reduce body weight and body fat. However, few randomized trials have been conducted. OBJECTIVE: We examined whether calcium supplementation affects body weight and body fat in young girls and whether a relation exists between habitual calcium intake and body weight and body fat. DESIGN: A randomized, double-blind, placebo-controlled intervention study was conducted in 110 young girls. The subjects were randomly assigned to receive 500 mg Ca/d as calcium carbonate or placebo for 1 y. Two groups of girls were selected according to habitual calcium intake from a large group; one group consumed 1000-1304 mg/d (40th-60th percentile; n = 60) and the other group consumed <713 mg/d (<20th percentile; n = 50). Height, body weight, body fat, and calcium intake were measured at baseline and after 1 y. RESULTS: At baseline a significant negative correlation was observed between habitual dietary calcium intake and percentage of body fat (r = -0.242, P = 0.011). However, calcium supplementation had no effect on height, body weight, or percentage body fat. CONCLUSIONS: Habitual dietary calcium intake was inversely associated with body fat, but a low-dose calcium supplement had no effect on body weight, height, or body fat over 1 y in young girls. It is possible that the effect of calcium on body weight is only exerted if it is ingested as part of a meal, or the effect may be due to other ingredients in dairy products, and calcium may simply be a marker for a high dairy intake.