The beneficial short-term effects of a high-protein/low-carbohydrate diet on glycaemic control assessed by continuous glucose monitoring in patients with type 1 diabetes.

AIM: To compare the effects of three different but isocaloric dietary patterns, high-protein/low-carbohydrate (HPD) with 20% of calories as carbohydrates, Mediterranean/low glycaemic index (MED) with 40% carbohydrates, and a reference diet (REF) with 50% carbohydrates, in patients with type 1 diabetes (T1D). MATERIALS AND METHODS: In a randomized crossover study, 15 patients with T1D were assigned to the three dietary patterns for three separate weeks, with 7-day washout periods in between. Continuous glucose monitoring was applied during the intervention periods. The primary outcome was glycaemic control, as measured by the percentage of time patients spent within the euglycaemic range (TIR70-140 mg/dl ). Other key glycaemic metrics were also investigated as secondary outcomes. RESULTS: TIR70-140 was not statistically different between HPD, MED and REF (p = .105). Pairwise analysis revealed a statistically significant difference between HPD and REF at the .05 level, which was not retained after applying Bonferroni correction (54.87% ± 14.11% vs. 48.33% ± 13.72%; p = .018). During the HPD period, 11 out of 15 participants spent more time within TIR70-140 compared with either the REF or MED. The HPD performed significantly better than the REF in terms of TIR70-180 (74.33% ± 12.85% vs. 67.53% ± 12.73%; p = .012), glycaemic variability (coefficient of variation: 36.18% ± 9.30% vs. 41.48% ± 8.69%; p = .016) and time spent in the hypoglycaemic range (TBR70 mg/dl ; median: 12, IQR: 16 vs. median: 14, IQR: 20; p = .007), whereas no statistically significant differences were observed between MED and HPD or REF. CONCLUSIONS: Compared with REF and MED, an HPD plan may have a positive impact on glycaemic control in patients with T1D. During the HPD, patients spent a shorter time in hypoglycaemia and exhibited lower glycaemic variability.

Pythagorean self-awareness intervention: A novel cognitive stress management technique for body weight control.

BACKGROUND: Over the past decades, the prevalence of obesity has markedly increased worldwide. Stress is recognized as a substantial contributor to increased body weight; therefore, stress management interventions, especially cognitive behavioural, are becoming increasingly popular. The impact of stress management on stress- and obesity-related biomarkers (eg blood lipid profile, HBA1c, inflammatory biomarkers, such as CRP) has been scarcely studied. The aim of this study was to assess the effect of a novel cognitive behavioural stress management intervention, called 'Pythagorean Self-Awareness Intervention' (PSAI), in overweight/obese adults. MATERIALS AND METHODS: This was a two-armed 1:1 randomized, nonblind controlled study including overweight/obese individuals. The control group followed a personalized Mediterranean low-calorie diet, and the intervention group followed the same diet in addition to the PSAI intervention for 8 weeks. Measurements included demographic, anthropometric (ie BMI, waist-to-hip ratio), stress (ie perceived stress, salivary cortisol), dietary behaviour (ie emotional eating) and metabolic parameters (ie blood lipid profile, HBA1c, CRP, body composition in fat and water). Outcome per-protocol analysis was performed using mixed linear models adjusted for age and gender. RESULTS: A total of 49 of 62 eligible adults were analysed in the study (there were three dropouts in the intervention group and 10 dropouts in the control group); 28 were assigned to the intervention group (mean age 54.7 ± 11.9 years) and 21 to the control group (mean age 51.8 ± 11.9 years). The intervention group showed a statistically significant decrease in perceived stress, cortisol concentrations 30 minutes after awakening, cortisol's area under the curve, BMI, waist-to-hip ratio, restrained, emotional and external eating behaviour, fasting glucose, LDL, triglycerides, HbA1c and body and trunk fat, compared with the control group. Based on the observed effect sizes, clinically meaningful changes may be more evident in stress perception, restrained and external eating behaviour, Hb1ac and trunk fat. The compliance to the PSAI intervention reached 100%, and there were no adverse effects. CONCLUSIONS: The PSAI technique may be an effective stress management method for overweight/obese adults. Future and larger randomized controlled studies are needed to allow generalization of these findings.

Diet, life-style and cardiovascular morbidity in the rural, free living population of Elafonisos island.

BACKGROUND: There are about 70 small islands in the Aegean and Ionian Sea, of less than 300 Km2 and 5000 inhabitants each, comprising a total population of more than 75,000 individuals with geographical and socioeconomic characteristics of special interest. The objective of the present study was to assess lifestyle characteristics and the state of cardiovascular risk of the population of a small Eastern Mediterranean island, Elafonisos. METHODS: PERSEAS (Prospective Evaluation of cardiovascular Risk Surrogates in Elafonisos Area Study) is an ongoing, population-based, longitudinal survey of cardiovascular risk factors, life-style characteristics and related morbidity/mortality performed in a small and relatively isolated island of the Aegean Sea, named Elafonisos. Validated, closed-ended questionnaires for demographic, socio-economic, clinical and lifestyle characteristics were distributed and analyzed. The MedDietScore, a validated Mediterranean diet score was also calculated. In addition, all participants underwent measurement of anthropometric parameters, blood pressure and a full blood panel for glucose and lipids. RESULTS: The analysis included 596 individuals who represented 74.5% of the target population. The mean age of the population was 49.5 ± 19.6 years and 48.2% were males. Fifty participants (8.4%) had a history of cardiovascular disease (CVD). The rates of reported diabetes, hypertension, and hypercholesterolemia were 7.7%, 30.9% and 30.9% respectively, with screen-detection of each condition accounting for an additional 4.0%, 12.9%, and 23.3% of cases, respectively. Four hundred and seven individuals (68.3%) were overweight or obese, 25% reported being physically inactive and 36.6% were active smokers. The median MedDietScore was 25 [interquartile range: 6, range 12-47] with higher values significantly associated with older age, better education, increased physical activity, absence of history of diabetes and known history of hypercholesterolemia. CONCLUSIONS: Obesity and traditional risk factors for CVD are highly prevalent among the inhabitants of a small Mediterranean island. Adherence to the traditional Mediterranean diet in this population is moderate, while physical activity is low. There seems to be a need for lifestyle modification programs in order to reverse the increasing cardiovascular risk trends in rural isolated areas of the Mediterranean basin.

The Role of Nutrients and Diet Characteristics in the Management of Diabetic Foot Ulcers: A Systematic Review.

Diabetic foot ulcers (DFUs) are common complications of diabetes mellitus that affect patients' quality of life and pose a burden on the healthcare system. Although malnutrition and specific nutritional deficiencies can seriously impact wound healing in patients with chronic nonhealing wounds, the role of nutrition in the prevention and management of DFUs is still not clear. This review discusses the significance of frequent diet assessment and nutritional education of patients with DFUs with individualized correction of deficiencies and emphasis on adequate protein intake along with correction of vitamins D, C, E, and selenium status. Future research should clarify the impact of nutritional interventions, potentially involving the use of probiotics, zinc, and omega-3 fatty acids, and successfully translating the findings into practical guidelines for use in everyday clinical practice.

Evaluation of Vitamin D Levels in Patients With Diabetic Foot Ulcers.

Low vitamin D levels have been associated with several diseases as its receptors are expressed in almost all tissues of the human body. Literature data have shown delayed diabetic foot ulcer (DFU) healing in patients with low vitamin D; however, data on the association between vitamin D levels and DFU in Mediterranean countries are scarce. In this cross-sectional study we examined for differences in serum vitamin D levels between patients with DFU, people with diabetes mellitus (DM) without DFU and healthy individuals in a Southern European country. A total of 96 subjects (33 patients with DFU, 35 patients without DFU and 28 healthy controls) were recruited. Medical and dietary history was obtained and total serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Serum vitamin D levels differed significantly among the three groups of participants; sub-analysis showed that healthy individuals had higher vitamin D levels when compared with patients with and without DFU, while vitamin D levels did not differ between patients with and without DFU (17.9 ± 6.7 vs. 19.8 ± 8.7 ng/mL, P = 0.329, respectively). More than half of patients with DM with or without DFU had vitamin D levels <20 ng/ml. A positive correlation was found between vitamin D and sun exposure duration in participants without DFU. In conclusion, although serum vitamin D levels did not differ between people with and without DFU, the prevalence of deficiency and insufficiency was high in both groups in a Mediterranean country. This finding highlights the need for screening and supplementation with vitamin D in individuals with DM.

The Effect of Probiotic Supplements on Metabolic Parameters of People with Type 2 Diabetes in Greece-A Randomized, Double-Blind, Placebo-Controlled Study.

The role of probiotic supplementation in type 2 diabetes (T2D) treatment is controversial. The present study aimed to assess the effects of a multi-strain probiotic supplement (LactoLevureR (containing Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium lactis, and Saccharomyces boulardii)) over 6 months, primarily on glycemic control as well as on lipid levels and alterations in the gut microbiome, among individuals with T2D residing in Greece. A total of 91 adults with T2D (mean age [±SD] 65.12 ± 10.92 years, 62.6% males) were randomized to receive the probiotic supplement or a matching placebo capsule, once daily, for 6 months. Blood chemistries and anthropometric parameters were conducted every 3 months, and stool samples were collected at baseline and at 6 months. Significant reductions in HbA1c, fasting blood glucose, and total cholesterol were observed in participants treated with the probiotic supplement (n = 46) compared to the controls (n = 45), even after adjustment for a greater decrease in adiposity (waist circumference). Although there were no statistically significant differences in the diversity of the gut microbiome (α and ß diversity), the administration of probiotics did influence several genera, metabolites, and key enzymes associated with diabetes. Overall, the administration of the multi-strain probiotic LactoLevureR over a 6-month period in individuals with T2D was well-tolerated and had a positive impact on metabolic parameters, alongside improvements in indices of adiposity.

Effect of Long-Term Hydroxytyrosol Administration on Body Weight, Fat Mass and Urine Metabolomics: A Randomized Double-Blind Prospective Human Study.

Hydroxytyrosol (HT) is a natural antioxidant found in olive products and characterized by well-documented beneficial effects on human health. Several research studies are ongoing that aim to investigate its potency and molecular mechanism of action. The present study aimed to investigate the potential effect of HT on human obesity through a randomized double-blind prospective design. HT in two different doses (15 and 5 mg/day) and a placebo capsule was administered to 29 women with overweight/obesity for six months and their weight and fat mass were monitored at three time points (baseline, 4, 12 and 24 weeks). Statistically significant weight and visceral fat mass loss (%weight loss: p = 0.012, %visceral fat loss: p = 0.006) were observed in the group receiving the maximum HT dosage versus placebo after 4 weeks of the intervention, with attenuation of these findings at 12 and 24 weeks of the study. Urine samples were collected during the intervention and analyzed via liquid chromatography-high-resolution mass spectrometry for untargeted metabolomic purposes and comparisons between study groups were performed. HT administration was safe and well-tolerated. To the best of our knowledge, this is the first human cohort investigating the effects of HT on obesity for a prolonged study period.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review.

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Carbohydrate restriction in the morning increases weight loss effect of a hypocaloric Mediterranean type diet: a randomized, parallel group dietary intervention in overweight and obese subjects.

OBJECTIVE: The aim of this study was to examine the effect of carbohydrate restriction in the morning in the framework of a hypocaloric Mediterranean diet on weight loss and metabolic parameters. METHODS: Seventy overweight/obese individuals were randomized to two hypocaloric dietary regimens: one Mediterranean diet (Med-D) and one morning carbohydrate-restriction diet (MCR-D). Participants assigned to the MCR-D were permitted to consume a breakfast low in carbohydrate content, whereas typical Mediterranean morning meals were allowed in the Med-D group. Both diets were identical from midday on. Participants were followed over a period of 2 mo. RESULTS: Individuals in both groups achieved significant reductions in body weight, body mass index, waist circumference, and body fat mass. These reductions were more pronounced in the MCR-D than in the Med-D group (all P < 0.001). More participants in the MCR-D group achieved loss of 5% to 10% of body weight by the end of the first month, as well as 5% to 10% and >10% of body weight by the end of the second month (all P < 0.001). All participants achieved loss of ≥5% baseline body weight by the end of the intervention. Both groups achieved similar reductions in fasting serum glucose, glycated hemoglobin, and serum triacylglycerols as well as improvement in insulin sensitivity. Individuals in the Med-D group showed reductions in total and low-density lipoprotein cholesterol, whereas no such effect was observed in the MCR-D group. CONCLUSIONS: Integration of morning carbohydrate restriction into a Mediterranean-type hypocaloric diet resulted in greater weight loss while retaining metabolic benefits in glycemia-related parameters.

The effect of a non-intensive community-based lifestyle intervention on the prevalence of metabolic syndrome. The DEPLAN study in Greece.

OBJECTIVE: The aim of the present study was to evaluate the effectiveness of a non-intensive, community-based, lifestyle intervention program on the prevalence of metabolic syndrome (MS), in individuals at high risk for development of type 2 diabetes (T2D). DESIGN: In accordance with the FINDRISC score, 191 high-risk persons for T2D, 56.3±10.8 years old, participated in a one-year lifestyle intervention program consisting of six bi-monthly sessions with a dietician. MS prevalence was assessed at baseline and one year later. RESULTS: The intervention was completed by 125 participants. They lost on average 1.0±4.8 kg (p=0.025) (mean±SD) and registered favourable dietary changes. The baseline prevalence of MS was similar among age groups and genders and decreased after one year (from 63.4±48.4% to 54.8±50.0%, p<0.001). In a multiple logistic regression model, younger age (p=0.009), male gender (p=0.004), improvement of the dietary score after one year (p=0.022), a lower FINDRISC score (p=0.033), a lower triglyceride level (p=0.010) and a higher baseline HDL-C level (p=0.003) were significantly and independently associated with improvement in MS status. CONCLUSIONS: A non-intensive lifestyle intervention program to prevent T2D is effective in decreasing the prevalence of MS in individuals at high risk for T2D development, possibly conferring multiple cardiovascular health benefits.

The association between physical activity and the development of acute coronary syndromes in diabetic subjects (the CARDIO2000 II study).

BACKGROUND: The prevalence of type-2 diabetes is increasing dramatically, primarily being driven by environmental factors, like dietary and exercise habits. In this study we investigated the association of physical activity and acute coronary events in diabetic patients, an issue that has not been adequately studied so far. DESIGN: Cross-sectional, case-control study. METHODS: We studied demographic, lifestyle, dietary and clinical information in 216 hospitalized diabetic patients (171 men, 45 women) with a first event of an acute coronary syndrome and 196 frequency matched (by age and sex) diabetic controls (154 men, 42 women) without any evidence of coronary heart disease. Physical activity was evaluated according to the kcal/min expended and the weekly frequency of exercise. Physically active were considered those who reported non-occupational physical activity >once/week (at least 30 min/time). RESULTS: Seventy-eight (36%) of 216 patients and 110 (56%) of 196 controls were classified as physically active (P<0.001). Multivariate conditional logistic regression analysis revealed that the odds ratio for developing an acute coronary event in diabetic subjects who reported moderate levels of physical activity was 0.22 [95% confidence interval (CI): 0.12-0.47], while in those who reported vigorous physical activity it was 0.33 (95% CI: 0.21-0.59), after adjusting for age, sex, and the conventional cardiovascular risk factors. CONCLUSIONS: Physical activity (moderate and vigorous) seems to be associated with a lower prevalence of acute coronary events in the investigated group of diabetic subjects. Light physical activity does not seem to have any significant association with the development of acute coronary events.