Ole Rasmussen

Effects on blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects.

OBJECTIVE To compare the influence on blood pressure, glucose, and lipid levels of a diet rich in monounsaturated fatty acids with an isocaloric, highcarbohydrate diet in 15 NIDDM subjects. RESEARCH DESIGN AND METHODS A crossover design with diet interventions and wash-out periods of 3 wk was applied. The patients were randomly assigned to a 3-wk treatment with a high-carbohydrate diet containing 50% of energy as carbohydrate and 30% of energy as fat (10% of energy as monounsaturated fatty acids) or an isocaloric diet with 30% of energy as carbohydrate and 50% of energy as fat (30% of energy as monounsaturated fatty acids). On the last day of the two diets, 24-h ambulatory blood pressure was measured and day profiles of glucose, hormones, and lipids were performed to a test menu rich in carbohydrates. RESULTS The diet rich in monounsaturated fat reduced daytime systolic (131 ± 3 vs. 137 ± 3 mmHg, P < 0.04) and 24-h systolic blood pressure (126 ± 8 vs. 130 ± 10 mmHg, P < 0.03) as well as daytime diastolic (78 ± 2 vs. 84 ± 2 mmHg, P < 0.02) and diurnal diastolic blood pressure (75 ± 6 vs. 78 ± 5 mmHg, P < 0.03) as compared with the high-carbohydrate diet. Evidence of lowered blood glucose levels on the high-monounsaturated diet compared with the highcarbohydrate diet were found with lower fasting blood glucose (6.1 ± 0.3 vs. 6.8 ± 0.5 mM, P < 0.05), lower average blood glucose levels (7.4 ± 0.5 vs. 8.2 ± 0.6 mM, P < 0.04), and peak blood glucose responses (9.9 ± 0.6 vs. 11.3 ± 0.7 mM, P < 0.02). The two diets had the same impact on lipid levels. CONCLUSIONS A diet rich in monounsaturated fat has beneficial effects on blood pressure and glucose metabolism, whereas no adverse effects on lipid composition in NIDDM subjects is detected.

Effect of Meal Frequency on Blood Glucose, Insulin, and Free Fatty Acids in NIDDM Subjects

Objective— We studied the effects of meal frequency on blood glucose, serum insulin, and FFAs in 12 NIDDM subjects. Research Design and Methods— Subjects were assigned in random order to two 8-hr observation periods after an overnight fast. They received isocaloric diets with similar composition either as six small or as two large meals. At the end of each study period, an IVGTT was given. Results— Two large meals induced an 84% greater maximum amplitude of glucose excursions than six small meals (6.1 ± 0.5 vs. 3.3 ± 0.5 mM, P < 0.005) and higher insulin responses (P < 0.03). The Kg response to an IVGTT did not differ in the two situations. The average FFA level was lowest in response to frequent meals (P < 0.02). Conclusions— A higher meal frequency acutely subdues glucose excursions and reduces insulin and FFA levels during the daytime in older NIDDM subjects.

Comparison of the Effects on the Diurnal Blood Pressure, Glucose, and Lipid Levels of a Diet Rich in Monounsaturated Fatty Acids With a Diet Rich in Polyunsaturated Fatty Acids in Type 2 Diabetic Subjects

The influence on blood pressure, glucose metabolism, and lipid levels of an exchange of polyunsaturated fatty acids with monounsaturated fatty acids in the diet was compared in 16 Type 2 diabetic outpatients. In a cross‐over study design the patients were randomly assigned to 3 weeks treatments with a diet containing 30% energy as monounsaturated fatty acids, or an isoenergetic diet with 30% energy as polyunsaturated fatty acids. The contents of total fat, satuarated fatty acids, cholesterol, and fibre were similar in the two diets. On the last days of the two diet periods, 24‐h ambulatory blood pressure was measured and the responses of glucose, hormones, and lipids to a carbohydrate rich test meal were measured. As compared with the polyunsaturated fatty acids diet, the monounsaturated fatty acids diet reduced 24‐h systolic (129 ± 11 vs 124 ± 8 mmHg (mean ± SD), p = 0.02) and diastolic blood pressure (76 ± 11 vs 73 ± 8 mmHg, p = 0.02). The two diets had similar, beneficial effects on glycaemic control, and cholesterol and lipoprotein concentrations. A diet rich in monounsaturated fatty acids has beneficial effects on the blood pressure, while similar effects on glucose and lipid levels are observed in normotensive Type 2 diabetic subjects.

Decrease in von Willebrand factor levels after a high-monounsaturated-fat diet in non-insulin-dependent diabetic subjects.

High levels of von Willebrand factor (vWF) have been reported in diabetics with vascular complications, suggesting a role for this protein in the development of cardiovascular complications in non-insulin-dependent diabetes mellitus (NIDDM). Recently, a diet rich in monounsaturated fatty acids (MUFA) has been found to improve glycemic control and decrease diurnal blood pressure as compared with a high-carbohydrate (H-CHO) diet in NIDDM subjects. To study the impact of MUFA on the hemostatic system, we compared the levels of vWF, fibrinogen, fibronectin, and alpha 2-macroglobulin before and after 3 weeks on a high-MUFA (H-MUFA) diet and on an isocaloric H-CHO diet in 15 NIDDM subjects. In a crossover study, the patients were randomly assigned to a H-CHO diet (50% carbohydrate, 30% fat [10% MUFA]) or a H-MUFA diet (30% carbohydrate, 50% fat [30% MUFA]). Before and on the last day of the two diets, vWF, fibrinogen, fibronectin, and alpha 2-macroglobulin levels were measured. The H-MUFA diet caused a decrease in vWF from 1.31 +/- 0.08 to 1.13 +/- 0.08 U/mL (P < .004), whereas an unchanged level was observed after a H-CHO diet (1.19 +/- 0.11 v 1.25 +/- 0.11 U/mL, NS). The relative changes in vWF during 3 weeks on a H-MUFA and on a H-CHO diet attained -12.5% +/- 3.2% versus 5.7% +/- 3.5%, respectively (P < .0001). Furthermore, unchanged levels of fibrinogen, fibronectin, and alpha 2-macroglobulin were seen after usage of the two diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of alcohol on glucose, insulin, free fatty acid and triacylglycerol responses to a light meal in non-insulin-dependent diabetic subjects

Alcohol accounts for 4-6% of the average energy intake in most Western countries. Alcohol-induced hypoglycaemia is a well-known and feared complication in insulin-dependent diabetic subjects, but little attention has been paid to the impact of alcohol on carbohydrate metabolism in non-insulin-dependent diabetes. The aim of the present study was to investigate in non-insulin-dependent diabetic subjects the acute metabolic effects of a moderate amount of alcohol taken with a light meal, conditions chosen to mimic an everyday situation. The patients received 500 ml non-alcoholic beer with an alcohol content (ml/l) of 0 (treatment A) and 54 (treatment B) together with a light meal, implying identity of the contents of ingredients except for alcohol. We found similar serum glucose, insulin, free fatty acid and triacylglycerol responses irrespective of addition of a modern amount of alcohol. In conclusion, a moderate amount of alcohol can be taken with a meal without eliciting hypoglycaemia in non-insulin-dependent diabetic subjects.

Comparison of a Carbohydrate-Rich Diet and Diets Rich in Stearic or Palmitic Acid in NIDDM Patients: Effects on lipids, glycemic control, and diurnal blood pressure

OBJECTIVE To compare the effects on lipid levels, glycemic control, and diurnal blood pressure of two diets rich in one of the two quantitatively most important saturated fatty acids, stearic and palmitic acid, with a carbohydrate-rich diet in NIDDM patients. RESEARCH DESIGN AND METHODS A total of 15 NIDDM patients participated in a randomized crossover study with three 3-week diet interventions separated by 2-week washout periods. Patients started with a diet rich in stearic acid (44 E% [percent of total energy] fat [13 E% stearic acid], 40 E% carbohydrate, 15 E% protein), palmitic acid (45 E% fat [16 E% palmitic acid], 40 E% carbohydrate, 15 E% protein), or carbohydrate (29 E% fat, 51 E% carbohydrate, and 18 E% protein), then were shifted to the other two diets in a randomized block design. At the start and end of each intervention period, fasting blood samples were drawn for analysis of lipids and blood glucose. In addition, diurnal blood pressure was measured. RESULTS At the end of the 3-week interventions, total cholesterol was significantly higher after the palmitic acid-rich diet than after the stearic acid-rich or carbohydrate-rich diets (5.3 ± 1.3 vs. 5.0 ± 1.2 and 4.9 ± 1.2 mmol/l, respectively; P = 0.03). No significant differences in triglyceride, LDL, or HDL cholesterol levels were seen after the three intervention diets. No difference in effects between the diet periods were seen for fructosamine, HbA1c, fasting blood glucose, or diurnal blood pressure. CONCLUSIONS For the first time, it has been demonstrated that a diet rich in palmitic acid was not as effective in lowering cholesterol levels as carbohydrate-rich and stearic acid-rich diets in NIDDM patients. No deleterious effects were seen on diurnal blood pressure, triglyceride levels, and glycemic control. Development of foods containing stearic acid rather than the more atherogenic saturated fatty acids may allow a wider choice of acceptable foods to NIDDM patients.

Influence of Ripeness of Banana on the Blood Glucose and Insulin Response in Type 2 Diabetic Subjects

Banana is a popular and tasty fruit which often is restricted in the diet prescribed for diabetic patients owing to the high content of free sugars. However, in under‐ripe bananas starch constitutes 80–90% of the carbohydrate content, which as the banana ripens changes into free sugars. To study the effect of ripening on the postprandial blood glucose and insulin responses to banana, 10 type 2 (non‐insulin‐dependent) diabetic subjects consumed three meals, consisting of 120 g under‐ripe banana, 120 g over‐ripe banana or 40 g white bread on separate days. The mean postprandial blood glucose response area to white bread (181 ± 45 mmol I−1 × 240 min) was significantly higher compared with under‐ripe banana (62 ± 17 mmol I−1 × 240 min: p< 0.01) and over‐ripe banana (106 ± 17 mmol I−1 × 240 min: p < 0.01). Glycaemic indices of the under‐ripe and over‐ripe bananas differed (43 ± 10 and 74 ± 9: p < 0.01). The mean insulin response areas to the three meals were similar: 6618 ± 1398 pmol I−1 × 240 min (white bread), 7464 ± 1800 pmol I−1 × 240 min (under‐ripe banana) and 8292 ± 2406 pmol I−1 × 240 min (over‐ripe banana). The low glycaemic response of under‐ripe compared with over‐ripe bananas may be ascribed to the high starch content, which has previously been found to be only hydrolysed slowly by alfa‐amylase in humans. In conclusion, bananas, particularly under‐ripe, contain low glycaemic carbohydrates which are a cheap source of carbohydrate and an acceptable alternative as between‐meal snacks for Type 2 diabetic subjects.

Glycemic Effects of Spaghetti and Potato Consumed as Part of Mixed Meal on IDDM Patients

Recently, we demonstrated that spaghetti caused a significantly lower glycemic response in isoinsulinemic insulin-dependent diabetic (IDDM) subjects than an exchangeable amount of potato. The question is, however, whether the difference of the glucose response in IDDM patients is preserved if these carbohydrate-rich foods are taken as part of a mixed meal. To answer this question, we evaluated blood glucose, free-insulin, and glucagon responses to exchangeable amounts of spaghetti and potato when ingested together with bolognese sauce in seven IDDM patients who had attained euglycemia with the artificial pancreas before meal intake. The potato (200 g raw wt) with bolognese sauce (167 g) and spaghetti (50 g raw wt) with bolognese sauce (167 g) had ∼ identical caloric content (435 and 447 kcal, respectively), fat (18 g each), protein (23 and 26 g, respectively), and carbohydrate (47 and 48 g, respectively). Blood glucose increment after white spaghetti and bolognese sauce was only ∼ 50% of that seen in response to potato and bolognese sauce. Similar constant insulin levels and increments in glucagon were seen. A major determinant of the postmeal glucose rise in IDDM patients seems to be dependent on the kind of carbohydrate in the meal. The approach by which the insulinemia was kept constant by the artificial pancreas seems to be a valuable tool for studying glycemic responses to different meals in IDDM patients who otherwise show great variations in circulating insulin and glucose levels when treated by subcutaneously administered insulin.

Ambulatory blood pressure as predictor of preeclampsia in diabetic pregnancies with respect to urinary albumin excretion rate and glycemic regulation

Background. Twenty‐four‐hour ambulatory blood pressure was evaluated as a predictor of preeclampsia in women with insulin‐dependent diabetes mellitus with respect to urinary albumin excretion rate and glycemic regulation.

The acute impact of ethanol on glucose, insulin, triacylglycerol, and free fatty acid responses and insulin sensitivity in type 2 diabetes

The aim of the present study was to evaluate the acute effect of ethanol on insulin sensitivity, and glucose, insulin, free fatty acid (FFA), and triacylglycerol responses in ten patients with non-insulin-dependent (type 2) diabetes. In the test study an oral dose of 0.66 g ethanol/kg followed by continuous intravenous infusion of 0.1 g ethanol/kg per h was given to maintain a constant ethanol level in the blood. In the control study identical volumes of oral water and intravenous saline (9 g NaCl/l) were given. After 90 min insulin sensitivity was determined by the hyperinsulinaemic, euglycaemic clamp technique. Ethanol caused no change in blood glucose or insulin concentrations. The FFA level was suppressed by ethanol while the triacylglycerol level was unaffected. The insulin sensitivity was not affected by ethanol. No major acute effect of ethanol on the glycaemic control in fasting type 2 diabetic patients was found in comparison with what is seen in healthy people. The present study, along with the sparse literature, indicates that the ability of ethanol to induce hypoglycaemia is attenuated or absent in diet-treated type 2 diabetes. Furthermore, we found no change in insulin sensitivity. Consequently, the risk of acute ethanol-induced aberrations in carbohydrate metabolism in diet-treated type 2 diabetes seems to be less than previously expected, when alcohol is not taken as a part of a meal.