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1.
Effects of Cynara scolymus L. on glycemic indices:A systematic review and meta-analysis of randomized clinical trials.
Jalili, C, Moradi, S, Babaei, A, Boozari, B, Asbaghi, O, Lazaridi, AV, Hojjati Kermani, MA, Miraghajani, M
Complementary therapies in medicine. 2020;:102496
Abstract
OBJECTIVES Cynara scolymus L. (common artichoke) and its products have been considered as potential phytotherapeutic agents for various conditions, such as cardiovascular, hepatic and gastric diseases, among others. Until now, the effects of artichoke and artichoke products administration on glycemic indices have not been sufficiently appraised. The present study evaluated the effects of artichoke and artichoke products administration on the glycemic indices. METHODS Clinical trials were identified in the Cochrane Library, PubMed, Embase and Scopus databases; to infinity until 15 March 2020. Weighted mean differences (WMD) were pooled using a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods. RESULTS Pooled analysis of nine Randomized controlled trials (RCTs), demonstrated that the administration of artichoke and artichoke products led to a significant reduced fasting blood sugar (FBS) (WMD: -5.28 mg/dl, 95 % CI: -8.95, -1.61; p = 0.005). However, other glycemic indeces including fasting insulin (WMD: -0.45 μIU/dL, 95 % CI: -1.14, 0.25; p = 0.20), HOMA-IR (MD: -0.25, 95 % CI: -0.57, 0.07; p = 0.12) or Hemoglobin A1c (HbA1c) (WMD: -0.09, 95 % CI: -0.20, 0.02; p = 0.09) did not alter after the administration of artichoke and artichoke products. A subgroup analysis comparing the kind of intervention, revealed that just the supplementation of artichoke and artichoke products, in a noco-supplementation form, was efficacy for the reduction of Homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: -0.52, 95 % CI: -0.85, -0.19; p = 0.002). CONCLUSIONS The supplementation of artichoke and artichoke products can significantly reduce the FBS concentrations in humans. Moreover, these outcomes suggested that just the supplementation of artichoke and artichoke products is more effective in the reduction of HOMA-IR levels than the co-supplementation form. However, additional clinical trials with longer study periods are necessitated to obtain a robust conclusion for producing new guidelines as part of a healthy diet.
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2.
The Impact of Dietary Glycemic Index and Glycemic Load on Postprandial Lipid Kinetics, Dyslipidemia and Cardiovascular Risk.
Lambadiari, V, Korakas, E, Tsimihodimos, V
Nutrients. 2020;(8)
Abstract
Many recent studies have acknowledged postprandial hypetriglyceridemia as a distinct risk factor for cardiovascular disease. This dysmetabolic state is the result of the hepatic overproduction of very low-density lipoproteins (VLDLs) and intestinal secretion of chylomicrons (CMs), which leads to highly atherogenic particles and endothelial inflammation. Postprandial lipid metabolism does not only depend on consumed fat but also on the other classes of nutrients that a meal contains. Various mechanisms through which carbohydrates exacerbate lipidemia have been identified, especially for fructose, which stimulates de novo lipogenesis. Glycemic index and glycemic load, despite their intrinsic limitations, have been used as markers of the postprandial glucose and insulin response, and their association with metabolic health and cardiovascular events has been extensively studied with contradictory results. This review aims to discuss the importance and pathogenesis of postprandial hypertriglyceridemia and its association with cardiovascular disease. Then, we describe the mechanisms through which carbohydrates influence lipidemia and, through a brief presentation of the available clinical studies on glycemic index/glycemic load, we discuss the association of these indices with atherogenic dyslipidemia and address possible concerns and implications for everyday practice.
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3.
Epigenetic Patterns in Five-Year-Old Children Exposed to a Low Glycemic Index Dietary Intervention during Pregnancy: Results from the ROLO Kids Study.
Geraghty, AA, Sexton-Oates, A, O'Brien, EC, Saffery, R, McAuliffe, FM
Nutrients. 2020;(12)
Abstract
A range of in utero and early-life factors can influence offspring epigenetics, particularly DNA methylation patterns. This study aimed to investigate the influence of a dietary intervention and factors in pregnancy on offspring epigenetic profile at five years of age. We also explored associations between body composition and methylation profile in a cross-sectional analysis. Sixty-three five-year-olds were selected from the ROLO Kids Study, a Randomized controlled trial Of a LOw glycemic index dietary intervention from the second trimester of pregnancy. DNA methylation was investigated in 780,501 CpG sites in DNA isolated from saliva. Principal component analysis identified no association between maternal age, weight, or body mass index (BMI) during pregnancy and offspring DNA methylation (p > 0.01). There was no association with the dietary intervention during pregnancy, however, gene pathway analysis identified functional clusters involved in insulin secretion and resistance that differed between the intervention and control. There were no associations with child weight or adiposity at five years of age; however, change in weight from six months was associated with variation in methylation. We identified no evidence of long-lasting influences of maternal diet or factors on DNA methylation at age five years. However, changes in child weight were associated with the methylome in childhood.
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4.
Effects of the Daily Consumption of Stevia on Glucose Homeostasis, Body Weight, and Energy Intake: A Randomised Open-Label 12-Week Trial in Healthy Adults.
Stamataki, NS, Crooks, B, Ahmed, A, McLaughlin, JT
Nutrients. 2020;(10)
Abstract
Stevia is a non-nutritive sweetener, providing sweet taste with no calories. This randomised, controlled, open-label 2-parallel arm trial examined the effects of daily stevia consumption on glycaemia in healthy adults. Secondary endpoints included body weight (BW) and energy intake (EI). Healthy participants (n = 28; aged 25 ± 5y, body mass index 21.2 ± 1.7 kg/m2) were randomised into either the stevia group (n = 14)-required to consume a stevia extract daily-or to the control group (n = 14). At weeks 0 and 12, the glucose and insulin responses to an oral glucose tolerance test were measured; BW and EI were assessed at weeks 0, 6, and 12. There was no significant difference in the glucose or insulin responses. There was a significant main effect of group on BW change (F(1,26) = 5.56, p = 0.026), as the stevia group maintained their weight as opposed to the control group (mean weight change at week 12: -0.22 kg, 95%CI [-0.96, 0.51] stevia group, +0.89 kg, 95%CI [0.16, 1.63] control group). The energy intake was significantly decreased between week 0 and 12 in the stevia group (p = 0.003), however no change was found in the control group (p = 0.973). Although not placebo-controlled, these results suggest that daily stevia consumption does not affect glycaemia in healthy individuals, but could aid in weight maintenance and the moderation of EI.
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5.
A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus.
Cheng, LJ, Jiang, Y, Wu, VX, Wang, W
Journal of advanced nursing. 2020;(2):459-474
Abstract
AIM: To systematically review the effectiveness of vinegar consumption in improving glycaemic control in adults with type 2 diabetes mellitus. DESIGN A systematic review and meta-analysis. REVIEW SOURCES The CINAHL, Excerpta Medica database (EMBASE), Medline, PubMed, Scopus and Cochrane databases were searched in April 2019. Interventional studies published in the English language, from inception to 15 April 2019, were included. REVIEW METHODS Two investigators independently assessed the quality of the studies, discussed their findings to reach consensus and complied with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Random-effects meta-analysis was conducted in Review Manager 5.3.5 to assess the effect size. A series of subgroup and sensitivity analyses were conducted to explore the causes of heterogeneity. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of six relevant studies, including 317 patients with type 2 diabetes mellitus, were selected from 356 studies identified through electronic searches and reference lists. The meta-analysis showed significantly better fasting blood glucose and haemoglobin A1c (HbA1c) level. In secondary analyses, there was a remarkable reduction in total cholesterol and low-density lipoprotein postintervention. CONCLUSION Vinegar content varied across the studies, and the sample sizes in the included studies were relatively small. Therefore, caution should be exercised when trying to extrapolate the results to a larger population. IMPACT Existing reviews are limited to narrative synthesis, lacking critical appraisal, heterogenous outcomes, nor any report of fasting blood glucose and HbA1c. This meta-analysis review extends the evidence on the beneficial effects of vinegar on glycaemic control as measured by HbA1c and fasting blood glucose. Clinicians could incorporate vinegar consumption as part of their dietary advice for patients with diabetes.
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6.
Effect of High Versus Low Carbohydrate Intake in the Morning on Glycemic Variability and Glycemic Control Measured by Continuous Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus-A Randomized Crossover Study.
Rasmussen, L, Christensen, ML, Poulsen, CW, Rud, C, Christensen, AS, Andersen, JR, Kampmann, U, Ovesen, PG
Nutrients. 2020;(2)
Abstract
Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (-0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (-0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.
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7.
Lowering breakfast glycemic index and glycemic load attenuates postprandial glycemic response: A systematically searched meta-analysis of randomized controlled trials.
Toh, DWK, Koh, ES, Kim, JE
Nutrition (Burbank, Los Angeles County, Calif.). 2020;:110634
Abstract
Low glycemic index (GI) diets are recommended to reduce the risk for chronic diseases by managing postprandial elevations in blood glucose and insulin. However, to our knowledge, a systematic review of randomized controlled trials (RCTs) to investigate this relationship and interpret its clinical relevance has yet to be performed. This review aims to assess the effect of low versus high GI breakfast meals on postprandial glycemic and insulinemic responses in adults. Two researchers independently screened 1100 articles from PubMed, CINAHL, Medline, and Cochrane databases and extracted data from 11 qualified RCTs. Meta-analyses were performed to calculate overall effect sizes of postintervention blood glucose concentration change values at different time points (60, 90, and 120 min) using a random-effects model, reporting their weighted mean differences (WMDs) and 95% confidence intervals (CIs). Low GI breakfasts significantly reduced postprandial blood glucose concentrations at all time points: 60 min (WMD: -1.32 mmol/L; 95% CIs, -1.64 to -0.99), 90 min (WMD: -0.74 mmol/L; 95% CI, -0.92 to -0.56), and 120 min (WMD: -0.44 mmol/L; 95% CI, -0.63 to -0.26). Further analyses not only indicated similar trends following the stratification of studies according to the glycemic load, but also showed a more pronounced decline in glycemic response among individuals with metabolic impairments. These results highlight the benefits of lowering breakfast meal GI to provide clinically relevant reductions in acute glucose response.
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8.
Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans.
Wolever, TMS, Mattila, O, Rosa-Sibakov, N, Tosh, SM, Jenkins, AL, Ezatagha, A, Duss, R, Steinert, RE
Nutrients. 2020;(8)
Abstract
To see if the molecular weight (MW) and viscosity of oat β-glucan (OBG) when taken before eating determine its effect on postprandial glycemic responses (PPRG), healthy overnight-fasted subjects (n = 16) were studied on eight separate occasions. Subjects consumed 200 mL water alone (Control) or with 4 g OBG varying in MW and viscosity followed, 2-3 min later, by 113 g white-bread. Blood was taken fasting and at 15, 30, 45, 60, 90, and 120 min after starting to eat. None of the OBG treatments differed significantly from the Control for the a-priori primary endpoint of glucose peak-rise or secondary endpoint of incremental area-under-the-curve (iAUC) over 0-120 min. However, significant differences from the Control were seen for glucose iAUC over 0-45 min and time to peak (TTP) glucose. Lower log(MW) and log(viscosity) were associated with higher iAUC 0-45 (p < 0.001) and shorter TTP (p < 0.001). We conclude that when 4 g OBG is taken as a preload, reducing MW does not affect glucose peak rise or iAUC0-120, but rather accelerates the rise in blood glucose and reduces the time it takes glucose to reach the peak. However, this is based on post-hoc calculation of iAUC0-45 and TTP and needs to be confirmed in a subsequent study.
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9.
Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial.
Taheri, S, Zaghloul, H, Chagoury, O, Elhadad, S, Ahmed, SH, El Khatib, N, Amona, RA, El Nahas, K, Suleiman, N, Alnaama, A, et al
The lancet. Diabetes & endocrinology. 2020;(6):477-489
Abstract
BACKGROUND Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in north Africa. We aimed to assess whether an intensive lifestyle intervention would lead to significant weight loss and improved glycaemia in young individuals with early diabetes. METHODS This open-label, parallel-group, randomised controlled trial (DIADEM-I), done in primary care and community settings in Qatar, compared the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, aged 18-50 years, with a short diabetes duration (≤3 years), had a BMI of 27·0 kg/m2 or more, and who were from the Middle East and north Africa region. Participants were randomly allocated (1:1) either to the intensive lifestyle intervention group or the usual medical care control group by a computer-generated sequence and an online randomisation service. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. Participants in the control group received usual diabetes care, which was based on clinical guidelines. The primary outcome was weight loss at 12 months after receiving the assigned intervention. Our analysis was based on the intention-to-treat principle. Key secondary outcomes included diabetes control and remission. The trial was registered with the ISRCTN registry, ISRCTN20754766, and ClinicalTrials.gov, NCT03225339. FINDINGS Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg (95% CI 9·72 to 14·23) compared with 3·98 kg (2·78 to 5·18) in the control group (adjusted mean difference -6·08 kg [95% CI -8·37 to -3·79], p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (odds ratio [OR] 12·03 [95% CI 5·17 to 28·03], p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001). Five serious adverse events were reported in four participants in the control group; four admissions to hospital because of unanticipated events (supraventricular tachycardia, abdominal pain, pneumonia, and epididymo-orchitis), and one admission to hospital for an anticipanted event (hyperglycaemia). INTERPRETATION Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing. FUNDING Qatar National Research Fund.
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10.
The effect of okra (Abelmoschus esculentus) on lipid profiles and glycemic indices in Type 2 diabetic adults: Randomized double blinded trials.
Moradi, A, Tarrahi, MJ, Ghasempour, S, Shafiepour, M, Clark, CCT, Safavi, SM
Phytotherapy research : PTR. 2020;(12):3325-3332
Abstract
The aim of the present study was to investigate the effect of okra consumption on serum levels of lipid profiles and glycemic indices in Type 2 diabetic (T2D) patients. The present study was a randomized, double-blinded clinical trial, carried out in Kerman, Iran. Sixty T2D patients were randomized into intervention and control groups and received 10 g okra powder blended in 150 g conventional yogurt or conventional yogurt alone, along with dinner and lunch, for 8 weeks. Glycemic markers and lipid profile were assessed, as well as anthropometric measures, at the beginning and end of study. The findings showed that 8 weeks okra consumption resulted in a significant decrease in fasting plasma glucose (-15.61 ± 19.44 vs. -3.40 ± 24.78; p = .02), homeostatic model of assessment for insulin resistance (-1.17 ± 1.61 vs. -0.14 ± 1.64; p = .01), quantitative insulin sensitivity check index (0.01 ± 0.007 vs. 0.00 ± 0.01; p = .004), triacylglycerol (-22.30 ± 32.46 vs. -3.86 ± 30.57; p = .001), total cholesterol (-10.23 ± 10.36 vs. -2.03 ± 13.94; p = .004), low-density lipoprotein cholesterol (LDL-C; -8.15 ± 10.01 vs. -2.31 ± 9.37; p = .02), and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (-0.28 ± 0.37 vs. -0.08 ± 0.24; p = .01). No significant difference was observed between groups in HDL-C, glycated hemoglobin, fasting insulin levels, and anthropometric measures. The present study suggests that okra consumption can elicit improvements in lipid profile, as well as glycemic markers, among T2D patients.