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SunGold Kiwifruit Supplementation of Individuals with Prediabetes Alters Gut Microbiota and Improves Vitamin C Status, Anthropometric and Clinical Markers.
Wilson, R, Willis, J, Gearry, RB, Hughes, A, Lawley, B, Skidmore, P, Frampton, C, Fleming, E, Anderson, A, Jones, L, et al
Nutrients. 2018;10(7)
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Increased plasma glucose levels are linked with increased oxidative stress. An increase in the uptake of antioxidants such as vitamin C through diet has been demonstrated by several studies as contributing to the maintenance of normal glucose levels and reducing the risk factors for Type 2 diabetes. The aim of this study was to investigate the vitamin C status, anthropometric measurements and faecal microbiota of an individual on consumption of high vitamin C kiwi fruit for a period of 12 weeks. Baseline measures were compared at the end of 12 weeks resulting in significant increase in plasma vitamin C status (14 µmol/L, p < 0.001). Significant reduction in blood pressure measurement (4 mmHg, p = 0.029), reduction in waist- to- hip ratio and waist- circumference, decrease in blood glucose marker HbA1c (1 mmol/mol, p = 0.005) and increase in fasting glucose (0.1 mmol/L, p = 0.046) were also observed at the end of twelve weeks. Faecal microbiota composition showed an increase in the abundance of uncharacterised bacterial family. The authors concluded that these result were not sufficiently significant to draw conclusions and further studies with larger sample sizes are required to confirm the outcomes of this study.
Abstract
Kiwifruit are a nutrient dense food and an excellent source of vitamin C. Supplementation of the diet with kiwifruit enhances plasma vitamin C status and epidemiological studies have shown an association between vitamin C status and reduced insulin resistance and improved blood glucose control. In vitro experiments suggest that eating kiwifruit might induce changes to microbiota composition and function; however, human studies to confirm these findings are lacking. The aim of this study was to investigate the effect of consuming two SunGold kiwifruit per day over 12 weeks on vitamin C status, clinical and anthropometric measures and faecal microbiota composition in people with prediabetes. This pilot intervention trial compared baseline measurements with those following the intervention. Participants completed a physical activity questionnaire and a three-day estimated food diary at baseline and on completion of the trial. Venous blood samples were collected at each study visit (baseline, 6, 12 weeks) for determination of glycaemic indices, plasma vitamin C concentrations, hormones, lipid profiles and high-sensitivity C-reactive protein. Participants provided a faecal sample at each study visit. DNA was extracted from the faecal samples and a region of the 16S ribosomal RNA gene was amplified and sequenced to determine faecal microbiota composition. When week 12 measures were compared to baseline, results showed a significant increase in plasma vitamin C (14 µmol/L, p < 0.001). There was a significant reduction in both diastolic (4 mmHg, p = 0.029) and systolic (6 mmHg, p = 0.003) blood pressure and a significant reduction in waist circumference (3.1 cm, p = 0.001) and waist-to-hip ratio (0.01, p = 0.032). Results also showed a decrease in HbA1c (1 mmol/mol, p = 0.005) and an increase in fasting glucose (0.1 mmol/L, p = 0.046), however, these changes were small and were not clinically significant. Analysis of faecal microbiota composition showed an increase in the relative abundance of as yet uncultivated and therefore uncharacterised members of the bacterial family Coriobacteriaceae. Novel bacteriological investigations of Coriobacteriaceae are required to explain their functional relationship to kiwifruit polysaccharides and polyphenols.
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2.
Inadequate Vitamin C Status in Prediabetes and Type 2 Diabetes Mellitus: Associations with Glycaemic Control, Obesity, and Smoking.
Wilson, R, Willis, J, Gearry, R, Skidmore, P, Fleming, E, Frampton, C, Carr, A
Nutrients. 2017;(9)
Abstract
Vitamin C (ascorbate) is an essential micronutrient in humans, being required for a number of important biological functions via acting as an enzymatic cofactor and reducing agent. There is some evidence to suggest that people with type 2 diabetes mellitus (T2DM) have lower plasma vitamin C concentrations compared to those with normal glucose tolerance (NGT). The aim of this study was to investigate plasma vitamin C concentrations across the glycaemic spectrum and to explore correlations with indices of metabolic health. This is a cross-sectional observational pilot study in adults across the glycaemic spectrum from NGT to T2DM. Demographic and anthropometric data along with information on physical activity were collected and participants were asked to complete a four-day weighed food diary. Venous blood samples were collected and glycaemic indices, plasma vitamin C concentrations, hormone tests, lipid profiles, and high-sensitivity C-reactive protein (hs-CRP) were analysed. A total of 89 participants completed the study, including individuals with NGT (n = 35), prediabetes (n = 25), and T2DM managed by diet alone or on a regimen of Metformin only (n = 29). Plasma vitamin C concentrations were significantly lower in individuals with T2DM compared to those with NGT (41.2 µmol/L versus 57.4 µmol/L, p < 0.05) and a higher proportion of vitamin C deficiency (i.e. <11.0 µmol/L) was observed in both the prediabetes and T2DM groups. The results showed fasting glucose (p = 0.001), BMI (p = 0.001), smoking history (p = 0.003), and dietary vitamin C intake (p = 0.032) to be significant independent predictors of plasma vitamin C concentrations. In conclusion, these results suggest that adults with a history of smoking, prediabetes or T2DM, and/or obesity, have greater vitamin C requirements. Future research is required to investigate whether eating more vitamin C rich foods and/or taking vitamin C supplements may reduce the risk of progression to, and/or complications associated with, T2DM.
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Impact of Egg Consumption on Cardiovascular Risk Factors in Individuals with Type 2 Diabetes and at Risk for Developing Diabetes: A Systematic Review of Randomized Nutritional Intervention Studies.
Richard, C, Cristall, L, Fleming, E, Lewis, ED, Ricupero, M, Jacobs, RL, Field, CJ
Canadian journal of diabetes. 2017;(4):453-463
Abstract
Observational studies have reported inconclusive results regarding the relationship between egg consumption (and dietary cholesterol) and the risk for cardiovascular diseases (CVDs) in individuals with type 2 diabetes, which has led to inconsistent recommendations to patients. We reviewed the evidence of egg consumption on major CVD risk factors in individuals with or at risk for type 2 diabetes (prediabetes, insulin resistance or metabolic syndrome). We performed a systematic search in the databases PubMed, MEDLINE, EMBASE and Web of Science in January 2016. Inclusion criteria included randomized controlled trials in which the amount of egg consumed was manipulated and compared to a control group that received no-egg or low-egg diets (<2 eggs/week). We found 10 articles (6 original trials) that met our inclusion criteria. The majority of studies found that egg consumption did not affect major CVD risk factors. Consumption of 6 to 12 eggs per week had no impact on plasma concentrations of total cholesterol, low-density lipoprotein-cholesterol, triglycerides, fasting glucose, insulin or C-reactive protein in all studies that reported these outcomes in comparison with control groups. An increase in high-density lipoprotein-cholesterol with egg consumption was observed in 4 of 6 studies. Results from randomized controlled trials suggest that consumption of 6 to 12 eggs per week, in the context of a diet that is consistent with guidelines on cardiovascular health promotion, has no adverse effect on major CVD risk factors in individuals at risk for developing diabetes or with type 2 diabetes. However, heterogeneities in study design, population included and interventions prevent firm conclusions from being drawn.
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An exploration of culture, diabetes, and nursing in the South Asian community: a metasynthesis of qualitative studies.
Fleming, E, Gillibrand, W
Journal of transcultural nursing : official journal of the Transcultural Nursing Society. 2009;(2):146-155
Abstract
South Asian people are often perceived as a homogenous group whose culture is prescriptive and constraining. A metasynthesis of how culture influences diabetes self-management in the context of a South Asian population was undertaken. Theory explication was used to deconstruct and reconceptualize the findings of the studies. Eleven publications reported themes of health beliefs, individuality, context, and shared experiences. The results indicate that culture does not influence diabetes self-management in a rigid and prescriptive way; instead, individuals negotiate and interpret culture in a shifting and diverse context. An individualized approach to delivering culturally appropriate nursing care should be taken.
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5.
Protease inhibition in African subtypes of HIV-1.
Velázquez-Campoy, A, Vega, S, Fleming, E, Bacha, U, Sayed, Y, Dirr, HW, Freire, E
AIDS reviews. 2003;(3):165-71
Abstract
Of the 42 million people infected with HIV-1 worldwide, 30 million are in Africa. However, the HIV-1 subtypes prevalent in Africa are not the same that are prevalent in North America and Western Europe. In these developed regions, subtype B is responsible for the vast majority of HIV infections, whereas in sub-Saharan Africa subtypes A and C, and to a lesser extent subtype G, account for most of the infections. These subtypes exhibit genomic differences as large as 30% with respect to subtype B. These differences involve current drug targets, including the HIV-1 protease. Since protease inhibitors have been developed and tested against the HIV-1 B subtype, and proteases from other subtypes carry up to ten amino acid polymorphisms, it is important to assess the influence of these naturally occurring polymorphisms on the potency of existing inhibitors, as well as their synergistic interactions with mutations known to cause drug resistance. This review will examine the effects of naturally occurring polymorphisms on the efficacy of current protease inhibitors and the effects of well characterized drug-resistant mutations within the framework of non-B subtypes. At the biochemical level, non-B-subtype polymorphisms lower the binding affinities of existing clinical inhibitors, but not to the point of causing drug resistance. However, these polymorphisms amplify the effects of mutations causing drug resistance and may play a role in the long-term viability of these inhibitors.
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6.
The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature.
Fleming, E, Carter, B, Gillibrand, W
Journal of clinical nursing. 2002;(5):560-7
Abstract
Adolescents with diabetes have unique health needs, which impact upon their transition from children's health care services into adult health care services. These health needs result from the precarious period in their lives, when they have to cope with the stresses of being a maturing person. This coincides with their move from the children's into the adult health care service. Whilst coping with these pressures they must also keep their diabetes under control. The impact of emotional and physical demands upon the adolescent means that they are more susceptible to non-adherence, which may result in reduced diabetic control. This literature review identifies some of the many barriers erected to the transition into the adult health care system; these barriers may be constructed by any one of the parties involved: the children's health care team, adult health care team, the adolescent or their family. Principles of a successful transition are explored, along with the prerequisite qualities required of health care providers and the health care service.