Brita Karlström

Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus

Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus.

Reliability of anthropometric measurements in overweight and lean subjects: consequences for correlations between anthropometric and other variables.

OBJECTIVE: To estimate the reliability of anthropometric measurements in overweight and lean subjects, and to examine the influence of this reliability on correlations to other variables, since low reliability leads to underestimation of correlations.DESIGN: Replicate measurements by two observers in 26 overweight and 25 lean subjects measured at two occasions.MEASUREMENTS: Sagittal abdominal diameter (SAD), waist circumference (waist), waist-to-hip ratio (W/H) and skinfold measurements.RESULTS: Intra-class correlation coefficients (ICCs) for SAD and waist were higher than for W/H (0.98 vs 0.90, P<0.001, and 0.97 vs 0.90, P=0.001, respectively). For waist, the ICC was lower for overweight than for lean subjects (0.85 vs 0.95, P=0.030), but the ICC values were comparable for SAD and W/H (0.92 vs 0.95 and 0.78 vs 0.83, respectively). Intra-observer variations (IOV) for SAD and waist were lower than for W/H (coefficients of variation; 1.6%, 1.4% and 2.3%, respectively), as were intra-subject variations (ISV) (2.7%, 3.0% and 3.4%, respectively). ICC values ranged from 0.84 to 0.93 and were lower for overweight than for lean subjects for biceps, subscapular and umbilical skinfolds (P=0.031, P<0.001 and P=0.048, respectively). Coefficients of variations for skinfold measurements ranged between 7.3% and 16.0% for IOV and between 14.9% and 20.8% for ISV.CONCLUSIONS: The low ICC values imply that correlations can be underestimated in overweight groups. We propose that, because of their higher reliability, SAD and waist have a higher predictive capacity for cardiovascular risk than W/H. SAD is the only measurement with high reliability in both weight groups and its use is recommended.

Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden

BACKGROUND Comparative studies on dietary patterns and long-term mortality are sparse. OBJECTIVE The objective was to examine the relations between 10-y mortality and adherence to the World Health Organization dietary guidelines [Healthy Diet Indicator (HDI)], a Mediterranean-like diet, and a carbohydrate-restricted (CR) diet in elderly Swedish men. DESIGN Dietary habits were determined by 7-d dietary records in a population-based longitudinal study of 924 Swedish men (age: 71 ± 1 y). The HDI score (-1 to 8 points), the Mediterranean Diet Score (MDS; 0-8 points), and the CR score (2-20 points) were calculated for each participant. Nonadequate reporters of energy intake were identified (n = 413). Mortality was registered during a median follow-up of 10.2 y. Cox proportional hazards regression, with multivariable adjustments, was used to determine the effects of adherence to each dietary pattern. RESULTS Two hundred fifteen and 88 subjects died of all-cause and cardiovascular disease, respectively. In all individuals, risk relations to mortality for each SD increment in the scores were observed for only MDS, with an adjusted hazard ratio (HR) of 0.83 (95% CI: 0.70, 0.99). Among adequate dietary reporters (n = 511), adjusted HRs for each SD increment in scores were enhanced for MDS (ie, 0.71; 95% CI: 0.55, 0.92) for all-cause mortality and 0.63 (95% CI: 0.42, 0.96) for cardiovascular mortality. Corresponding HRs for CR diet score were 1.19 (95% CI: 0.97, 1.45) for all-cause mortality and 1.44 (95% CI: 1.03, 2.02) for cardiovascular mortality. CONCLUSION Adherence to a Mediterranean-like dietary pattern reduced mortality, whereas adherence to a CR dietary pattern appeared to increase mortality in elderly Swedish men, especially when only adequate dietary reporters were considered.

Changes in food habits in healthy Swedish adolescents during the transition from adolescence to adulthood

Objective: To investigate the change in food habits in Swedish adolescents between 15 and 21 y of age with reference to age, sex, region and socioeconomic background.Design: A longitudinal study from 1993 to 1999.Setting: Two different regions in Sweden, the university city of Uppsala and the industrial town of Trollhättan.Subjects: On three different occasions, 1993, 1995 and 1999, 208 adolescents, 96 males and 112 females, were studied.Methods: A food frequency questionnaire containing 29 different food groups was used. The questionnaire also contained questions about food habits and amounts of some food items and socioeconomic conditions of the participants and their families.Results: At 17 and 21 y of age, the adolescents consumed significantly more often pasta, vegetables, coffee and tea compared to age 15, while the frequency consumption of fat spread, milk, bread, potatoes, carrots and buns and biscuits decreased. The changes between 15 and 17 were smaller than between age 17 and 21. At age 21, the males decreased their intake of fruit, while the females decreased their intake of meat. No-meat consumers among females increased from 2 to 13%. Higher educational level of the mothers of the adolescents was associated with more frequent consumption of vegetables and pasta between ages 17 and 21. Milk consumption decreased significantly in both sexes. Breakfast habits did not change: 90% had breakfast five times/week or more.Conclusions: Food habits change significantly during adolescence along with lifestyle changes. Therefore, health promotion during adolescence ought to be more supported by the society.Sponsorship: County Councils of Uppsala and Älvsborg and the Dairies Association of Research and Development.

Reduction of high density lipoprotein cholesterol and apolipoprotein a-i concentrations by a lipid-lowering diet

Nine hyperlipoproteinaemic patients were treated with a serum lipid-lowering diet during 4 weeks in a metabolic ward. The diet contained 35% energy from fat and the ratio between polyunsaturated and saturated fats (the P/S ratio) was 2.0. This treatment caused a reduction of the serum concentrations of the low density lipoprotein cholesterol (Chol) by 17% (P less than 0.01), of the apolipoprotein (apo) B by 27% (P less than 0.01), of high density lipoprotein (HDL) Chol by 15% (P less than 0.05) and of the apo A-I by 9% (P less than 0.02). The apo B/apo A-I ratio decreased by 19% (P less than 0.01). It is suggested that the reduced HLD Chol and apo A-I concentrations may be due to both the qualitative change to more polyunsaturated fats in the diet and to the reduction of the total dietary fat intake.

LIPGENE food-exchange model for alteration of dietary fat quantity and quality in free-living participants from eight European countries

Controlled human intervention trials are required to confirm the hypothesis that dietary fat quality may influence insulin action. The aim was to develop a food-exchange model, suitable for use in free-living volunteers, to investigate the effects of four experimental diets distinct in fat quantity and quality: high SFA (HSFA); high MUFA (HMUFA) and two low-fat (LF) diets, one supplemented with 1.24 g EPA and DHA/d (LFn-3). A theoretical food-exchange model was developed. The average quantity of exchangeable fat was calculated as the sum of fat provided by added fats (spreads and oils), milk, cheese, biscuits, cakes, buns and pastries using data from the National Diet and Nutrition Survey of UK adults. Most of the exchangeable fat was replaced by specifically designed study foods. Also critical to the model was the use of carbohydrate exchanges to ensure the diets were isoenergetic. Volunteers from eight centres across Europe completed the dietary intervention. Results indicated that compositional targets were largely achieved with significant differences in fat quantity between the high-fat diets (39.9 (sem 0.6) and 38.9 (sem 0.51) percentage energy (%E) from fat for the HSFA and HMUFA diets respectively) and the low-fat diets (29.6 (sem 0.6) and 29.1 (sem 0.5) %E from fat for the LF and LFn-3 diets respectively) and fat quality (17.5 (sem 0.3) and 10.4 (sem 0.2) %E from SFA and 12.7 (sem 0.3) and 18.7 (sem 0.4) %E MUFA for the HSFA and HMUFA diets respectively). In conclusion, a robust, flexible food-exchange model was developed and implemented successfully in the LIPGENE dietary intervention trial.

Gene-nutrient interactions in the metabolic syndrome: single nucleotide polymorphisms in ADIPOQ and ADIPOR1 interact with plasma saturated fatty acids to modulate insulin resistance

BACKGROUND Progression of the metabolic syndrome (MetS) is determined by genetic and environmental factors. Gene-environment interactions may be important in modulating the susceptibility to the development of MetS traits. OBJECTIVE Gene-nutrient interactions were examined in MetS subjects to determine interactions between single nucleotide polymorphisms (SNPs) in the adiponectin gene (ADIPOQ) and its receptors (ADIPOR1 and ADIPOR2) and plasma fatty acid composition and their effects on MetS characteristics. DESIGN Plasma fatty acid composition, insulin sensitivity, plasma adiponectin and lipid concentrations, and ADIPOQ, ADIPOR1, and ADIPOR2 SNP genotypes were determined in a cross-sectional analysis of 451 subjects with the MetS who participated in the LIPGENE (Diet, Genomics, and the Metabolic Syndrome: an Integrated Nutrition, Agro-food, Social, and Economic Analysis) dietary intervention study and were repeated in 1754 subjects from the LIPGENE-SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) case-control study (http://www.ucd.ie/lipgene). RESULTS Single SNP effects were detected in the cohort. Triacylglycerols, nonesterified fatty acids, and waist circumference were significantly different between genotypes for 2 SNPs (rs266729 in ADIPOQ and rs10920533 in ADIPOR1). Minor allele homozygotes for both of these SNPs were identified as having degrees of insulin resistance, as measured by the homeostasis model assessment of insulin resistance, that were highly responsive to differences in plasma saturated fatty acids (SFAs). The SFA-dependent association between ADIPOR1 rs10920533 and insulin resistance was replicated in cases with MetS from a separate independent study, which was an association not present in controls. CONCLUSIONS A reduction in plasma SFAs could be expected to lower insulin resistance in MetS subjects who are minor allele carriers of rs266729 in ADIPOQ and rs10920533 in ADIPOR1. Personalized dietary advice to decrease SFA consumption in these individuals may be recommended as a possible therapeutic measure to improve insulin sensitivity. This trial was registered at clinicaltrials.gov as NCT00429195.

Obesity and body fat classification in the metabolic syndrome: Impact on cardiometabolic risk metabotype

Obesity is a key factor in the development of the metabolic syndrome (MetS), which is associated with increased cardiometabolic risk. We investigated whether obesity classification by BMI and body fat percentage (BF%) influences cardiometabolic profile and dietary responsiveness in 486 MetS subjects (LIPGENE dietary intervention study).

Glucose and insulin responses in healthy women after intake of composite meals containing cod-, milk-, and soy protein

Objective:To evaluate the metabolic effect of three different kinds of dietary proteins as part of composite meals with similar macronutrient composition in healthy subjects.Design:A randomised meal study.Setting:Metabolic ward.Subjects and methods:In total, 17 healthy women, 30–65 years old, consumed three meals in randomised order. The meals consisted of foodstuffs with similar nutrient composition but different types of protein (cod, cottage cheese, or soy protein isolate). The distribution of energy from protein, fat and carbohydrates was 33, 26, and 41 energy percent, respectively. Total amount of energy was 2300 kJ. Blood samples were drawn for assay of B-glucose, S-insulin, S-free fatty acids, S-triglycerides, and C-peptide in the fasting state and at seven times (20, 40, 60, 90, 120, 180, and 240 min) after starting to eat the test meal.Results:The blood glucose response after the cod protein meal differed from that of the soy protein meal, with a larger area under the curve (AUC) calculated up to 120 min. The serum insulin response after the milk protein meal differed from that of the cod protein meal with a larger AUC calculated up to 240 min. The insulin/C-peptide and the insulin/glucose ratios differed between the meals; the insulin/C-peptide ratio was higher after the milk protein meal compared to the cod, and soy protein meal at 120 min. The insulin/glucose ratio was lower after the cod protein meal compared to the milk, and soy protein meals at 120 min. The results showed that the metabolic responses differed after meals with similar macronutrient composition containing cod-, milk-, or soy protein.

A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomised 2-y clinical trial

OBJECTIVE: To compare two group treatment programmes for obese outpatients. Both programmes included behaviour modification, nutrition counselling, very-low-calorie diet (VLCD) and a continuous measuring of metabolic and anthropometrical status, but they differed regarding the treatment intensiveness. The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results.DESIGN: A 2-y randomised clinical trial.SUBJECTS: A total of 43 obese subjects aged 24–60 y, BMI 35 kg/m2 (29–48).INTERVENTION: Two programmes were used. Both were based on group therapy and were supervised by a dietitian and a psychologist. Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year. Group 2 had planned group meetings every third month. Anthropometrical and metabolic data were measured every third month in both groups. The VLCD periods were the same.RESULTS: There was no evidence that a more intensive treatment promotes a larger weight reduction. Weight reduction after 1 y: group 1, −7.6 (±0.97) kg, BMI −2.6 (±0.3) kg/m2; group 2, −6.4 (±1.16) kg, BMI −2.2 (±0.4) kg/m2. Weight reduction after 2 y: group 1, −6.8 (±1.4) kg, BMI −2.4 (±0.3) kg/m2; group 2, −8.6 (±1.6) kg, BMI −3.0 (±0.3) kg/m2. The dropout rate was 26%.CONCLUSION: There were no significant differences in weight reduction, compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction. This observation is of value when setting up treatment programmes. To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance. Both treatment programmes gave highly significant weight reductions in the range of 5–10%, which has been referred to as a realistic goal for the treatment of obese patients.