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Effects of intermittent very-low calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus: A randomized controlled trial.
Umphonsathien, M, Rattanasian, P, Lokattachariya, S, Suansawang, W, Boonyasuppayakorn, K, Khovidhunkit, W
Journal of diabetes investigation. 2022;13(1):156-166
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Various studies have shown that intermittent low-calorie diets are effective in reducing weight and improving glycaemic control. In this randomized controlled trial, two intermittent very-low calorie diets (2 days per week and 4 days per week) were evaluated against a control group with respect to achieving diabetes remission, improving glycemic control, metabolic parameters, and quality of life in Type 2 diabetic patients. There was a significant reduction in HbA1c and insulin resistance in the 2 days/week and 4 days/week intermittent very-low calorie groups at week 20. Both the intervention groups achieved diabetes remission with 29% of participants not requiring glucose-lowering medications at week 20. Both intervention groups also showed a significant reduction in serum triglycerides, body weight, body mass index, and fat mass. Aspartate transaminase and alanine aminotransferase levels, as well as blood pressure, decreased significantly with a 4 day/week intermittent low-calorie diet. Both intervention groups experienced improved quality of life at week 10 and the interventions were generally well tolerated. To generalise the results, longer-term, robust studies are required. These results can help healthcare providers understand the clinical relevance of intermittent very-low calorie diets in managing Type 2 diabetes and obesity.
Abstract
AIMS/INTRODUCTION Very few studies assess the effectiveness of different protocols of intermittent very-low calorie diet (VLCD) in patients with diabetes. This study was designed to compare the effects of 2 days/week and 4 days/week of intermittent VLCD on glycemic control, diabetes remission, metabolic parameters and quality of life in patients with type 2 diabetes and obesity. MATERIALS AND METHODS Participants with obesity and type 2 diabetes were recruited and randomly assigned to three groups, consisting of control, 2 days/week and 4 days/week of intermittent VLCD. In the intermittent VLCD groups, participants received a 600-kcal diet per day on restricted days and ad libitum food consumption on non-restricted days. Glycemic control, rate of diabetes remission, metabolic parameters and quality of life were evaluated at baseline, weeks 2, 10 and 20. RESULTS A total of 40 participants were enrolled. The mean body mass index was 30.1 ± 5.9 kg/m2 , and the mean glycated hemoglobin was 7.4 ± 1.2%. At week 20, there was an improvement in glycemic control in both intermittent VLCD groups with significant decreases in glycated hemoglobin levels and insulin resistance index throughout the study periods. Diabetes remission without the need for medications was equally found in 29% of participants in both intermittent VLCD groups. Serum triglyceride, bodyweight, body mass index and fat mass were also significantly decreased in both VLCD groups. No serious adverse events were encountered. CONCLUSION Intermittent VLCD was highly effective in achieving optimal glycemic control. The effects of 2 days/week and 4 days/week of intermittent VLCD on diabetes remission were relatively similar.
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A Low-FODMAP Diet Provides Benefits for Functional Gastrointestinal Symptoms but Not for Improving Stool Consistency and Mucosal Inflammation in IBD: A Systematic Review and Meta-Analysis.
Peng, Z, Yi, J, Liu, X
Nutrients. 2022;14(10)
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The low-FODMAP diet eliminates carbohydrates that cannot be easily digested in order to reduce functional gastrointestinal symptoms associated with irritable bowel disease (IBD). The symptoms of irritable bowel disease include abdominal pain and bloating. This systematic review and meta-analysis aimed to evaluate whether a low-FODMAP diet can alleviate functional gastrointestinal symptoms in individuals with inflammatory bowel disease. In comparison with a regular diet, a low-FODMAP diet significantly reduced symptoms of bloating, wind, flatulence, abdominal pain, fatigue, and lethargy in patients with IBD. In addition, patients with Crohn's disease have achieved remission or reduced symptoms after following a low-FODMAP diet. Healthcare professionals can use this study to understand better the effects of a low-FODMAP diet on patients with IBD who have functional gastrointestinal symptoms. Further robust studies are, however, required to evaluate the evidence's robustness and identify the mechanism behind the improvement of symptoms.
Expert Review
Conflicts of interest:
None
Take Home Message:
- LFD use in IBD improved symptoms of bloating, wind or flatulence, borborygmi, abdominal pain, and fatigue or lethargy, but not nausea and vomiting.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
This meta-analysis assesses the efficacy of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (LFD) in inflammatory bowel disease [IBD: ulcerative colitis (UC) and Crohn’s disease (UC)] participants with functional gastrointestinal symptoms (FGSs).
Methods
A search was performed on PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), WanFang (Chinese) Database up to March 2022. Quality assessment of all included studies was performed.
Results
9 studies (4 randomised controlled trials, 5 non-randomised studies) with a total of 351 participants diagnosed with IBD were included, and compared LFD with a placebo diet or normal diet (ND), overall and individual
LFD Effects of FGS:
- Overall 9 studies: an improvement (0.47, 0.33–0.66, p = 0.0000)
- No difference in the subgroup classified by disease type
- CD and UC: no improvement
Individual improvement:
- Bloating (0.37, 0,24-0,57, p=0.0000); wind or flatulence (0.38, 0,28-0,51, p=0.0000); borborygmi (0.48, 0,26-0,89, p=0.0000), abdominal pain (0.5, 0,37-0,68, p=0.0000), fatigue/lethargy (0.71, 0,61-0,82, p=0.0000)
- No difference in nausea and vomiting (0.54, 0,22-1,32, p=018)
IBS Quality of Life Score:
- 2 studies: reduced Short IBD Questionnaire (SIBDQ) score (11.24, 6.61-15.87, p=0.0000)
Bristol Stool Form Chart:
- 2 studies: normal stool consistency (type 3-4); no difference (5.99, 0.17-216.51, p=0.33)
- 2 other studies: no difference (-0.17, 0.48 - 0.15, p=0.30)
Diseases activity (Harvey-Bradshaw index):
- 2 studies using the Mayo score: no difference (-32, -1,09-0.45, p=0.41)
- 3 studies using BHi score: reduction (-1.09, -1,77-0.42, p=0.002)
Faecal calprotectin:
- 2 studies: no change (-16.03, -36,78-4.73, p=0.13)
Limitations
- Comparison diets were not standardised, suggesting the potential of different dietary habits to bias results..
- Heterogeneity of included studies, and the relatively small sample size of the studies can reduce the reliability of the results.
Conclusion
While the study found inconsistent definition standards for FGS, all the nine studies showed that LFD was associated with an improvement in some symptoms.
Clinical practice applications:
- This study suggests that IBD patients with FGSs may benefit from LFD treatment with the assistance of a healthcare professional.
Considerations for future research:
- This study has shown that LFD can improve FGSs in IBD, but further research with a larger sample size and more comprehensive analysis is warranted to replicate the results.
- The description of the findings and Quality of Life data are a little unclear. The impact on Quality of Life warrants further investigation, as clinicians need to consider the impact of following a restrictive diet on Quality of Life.
Abstract
BACKGROUND A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (LFD) is claimed to improve functional gastrointestinal symptoms (FGSs). However, the role of LFD in inflammatory bowel disease (IBD) patients with FGSs remains unclear. OBJECTIVE To systematically assess the efficacy of LFD in IBD patients with FGSs. METHODS Six databases were searched from inception to 1 January 2022. Data were synthesized as the relative risk of symptoms improvement and normal stool consistency, mean difference of Bristol Stool Form Scale (BSFS), Short IBD Questionnaire (SIBDQ), IBS Quality of Life (IBS-QoL), Harvey-Bradshaw index (HBi), Mayo score, and fecal calprotectin (FC). Risk of bias was assessed based on study types. A funnel plot and Egger's test were used to analyze publication bias. RESULTS This review screened and included nine eligible studies, including four randomized controlled trials (RCTs) and five before-after studies, involving a total of 446 participants (351 patients with LFD vs. 95 controls). LFD alleviated overall FGSs (RR: 0.47, 95% CI: 0.33-0.66, p = 0.0000) and obtained higher SIBDQ scores (MD = 11.24, 95% CI 6.61 to 15.87, p = 0.0000) and lower HBi score of Crohn's disease (MD = -1.09, 95% CI -1.77 to -0.42, p = 0.002). However, there were no statistically significant differences in normal stool consistency, BSFS, IBS-QoL, Mayo score of ulcerative colitis, and FC. No publication bias was found. CONCLUSIONS LFD provides a benefit in FGSs and QoL but not for improving stool consistency and mucosal inflammation in IBD patients. Further well-designed RCTs are needed to develop the optimal LFD strategy for IBD.
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Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study).
Represas-Carrera, F, Couso-Viana, S, Méndez-López, F, Masluk, B, Magallón-Botaya, R, Recio-Rodríguez, JI, Pombo, H, Leiva-Rus, A, Gil-Girbau, M, Motrico, E, et al
International journal of environmental research and public health. 2021;18(11)
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Life habits such as smoking, physical activity, and diet affect glycaemic control. The objective of this multicentre randomised cluster trial (EIRA study) was to evaluate the effectiveness of multicomponent educational interventions on glycaemic control in Type 2 diabetic patients. Interventions in multicomponent individual, group and community settings included smoking cessation, the Mediterranean diet and physical activity, as well as an assessment of the quality of life. Participants had unhealthy lifestyles prior to the intervention. The study was conducted in 26 primary healthcare centres in seven health departments in Spain over a period of 12 months. A brief intervention aimed to change the habits of the participants, including increasing physical activity, quitting smoking and adhering to the Mediterranean diet. After 12 months of intervention, there were no statistically significant improvements in glycaemic control, physical activity, sedentary lifestyle, smoking, or quality of life. However, adherence to the Mediterranean diet was statistically significant. Further research is needed to determine the effectiveness of multicomponent interventions in improving glycaemic control. The clinical applicability of multicomponent interventions to tackle type 2 diabetes, obesity, and unhealthy lifestyles should be considered by healthcare providers.
Abstract
Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
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The impact of nutrition and lifestyle on male fertility.
Benatta, M, Kettache, R, Buchholz, N, Trinchieri, A
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2020;92(2)
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The impact of environmental, lifestyle and nutritional factors on unexplained male fertility has long been acknowledged. Yet, little research had been dedicated to the topic, despite declining semen quality having become a worldwide phenomena. Available studies have yielded limited, and at times conflicting, evidence. Hence this literature review sought to capture the current knowledge around unexplained male infertility and environmental, lifestyle, diet and nutrients factors. Summarized is the evidence from 69 studies, including population observations and clinical trials. The collected outcomes showed that a Western-type diet, rich in red and processed meats, refined grains, high-energy drinks and sweets, trans and saturated fats was associated with poor semen quality. Whereby higher intakes of fruits and vegetables, whole grains, omega-3 and poultry showed beneficial effects. However, as only selected groups were examined, more research is needed to project such findings onto the wider population. The reviewed evidence also included alcohol consumption, which showed high alcohol intake closely correlated to declining sperm concentrations. Whilst the verdict on caffeine consumption and the impact on sperm quality was inconclusive. In addition, several interventional studies evaluated the effect of dietary supplementation on various parameters of semen, where coenzyme Q10, L-carnitine, vitamin E, antioxidants, combined nutrient formulations and herbal blends all had positive outcomes. The review on zinc and folic acid supplementation yielded mixed results. This brief recap of the current evidence on environmental, lifestyle and nutritional influences on male infertility summarises the dietary foundations for the support of unexplained male infertility.
Abstract
BACKGROUND AND AIMS Male unexplained infertility has long been suspected to result from environmental, lifestyle and nutritional factors. However, the literature on the subject is still scarce, and clinical studies providing robust evidence are even scarcer. In addition, some similar studies come to different conclusions. Dietary pattern can influence spermatogenesis by its content of fatty acids and antioxidants. Yet, in an age of industrialized mass food production, human bodies become more exposed to the ingestion of xenobiotics, as well as chemicals used for production, preservation, transportation and taste enhancement of foods. We attempted in this paper to collect the available evidence to date on the effect of nutritional components on male fertility. MATERIAL AND METHODS A systematic search of the relevant literature published in PubMed, ScienceDirect and Cochrane Central Register of Controlled Trials Database was conducted. Literature was evaluated according to the Newcastle-Ottawa- Scale. RESULTS Epidemiological observations are concordant in demonstrating an association of low-quality sperm parameters with higher intake of red meat, processed and organ meat and fullfat dairy. On the contrary, better semen parameters were observed in subjects consuming a healthy diet, rich in fruit, vegetables, whole grains and fish. Evidences of the negative impact on male fertility of by-products of water disinfection, accumulation in food chain of persistent organochlorine pollutants, pesticides, phthalates from food and water containers and hormones used in breeding cattle have been reported. Clinical trials of the effects of micronutrients on semen parameters and outcomes of assisted fertilization are encouraging, although optimal modality of treatment should be established. CONCLUSIONS Although quality of evidence should be ameliorated, it emerges that environmental factors can influence male fertility. Some nutrients may enhance fertility whereas others will worsen it. With diagnostic analysis on a molecular or even sub-molecular level, new interactions with micronutrients or molecular components of our daily ingested foods and leisure drugs may lead to a better understanding of so far suspected but as yet unexplained effects on male spermatogenesis and fertility.
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Maternal anxiety and diet quality among mothers and toddlers from low-income households.
Trude, ACB, Black, MM, Surkan, PJ, Hurley, KM, Wang, Y
Maternal & child nutrition. 2020;16(4):e12992
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Childhood obesity is increasing and is an indicator that obesity may develop in adulthood. Mothers have a large influence on children’s weight-related behaviours and diet quality, but mental well-being of the mother in relation to this is understudied. Mothers from low-income households may be susceptible to lower mental well-being and low diet quality potentially influencing their children. This observational study of 277 low-income mother-toddler relationships aimed to examine the association of maternal anxiety and toddler diet quality over six months. The results showed that higher maternal anxiety was associated with lower maternal diet quality and lower toddler diet quality. It was concluded that high anxiety in mothers with toddlers from low-income households is associated with poorer diet quality in both the mother and toddler. However, it should be noted that whether anxiety is causing poor diet or poor diet is causing anxiety cannot be determined. This study could be used by healthcare professionals to include nutritional recommendations with anxiety management to improve parental and toddler diet.
Abstract
We evaluated the association between maternal anxiety score and diet quality over time among mothers and toddlers in low-income families. Longitudinal data were collected from 267 mother-toddler dyads in an obesity prevention trial. Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children and paediatric clinics between 2007 and 2010. Dyads were assessed at study enrolment (Time 1), 6-month (Time 2), and 12-month follow-up (Time 3). On the basis of a 1-day 24-hr dietary recall, we estimated maternal and toddler diet quality using the Healthy Eating Index 2015. Anxiety, a time-varying variable, was assessed via the State-Trait Anxiety Inventory. Associations between maternal anxiety score and maternal and toddler diet quality over time were assessed in adjusted mixed models. Maternal and toddler diet quality were positively correlated (r = .48, p < .001). Higher maternal anxiety scores were related to lower toddler Healthy Eating Index scores (b = -0.51, 95% confidence interval, CI [-0.87, -0.15]) with no significant variation over time. The relation between maternal diet quality and anxiety score varied over time (b = 0.28, p = .03, for time-anxiety interaction). Higher maternal anxiety scores were associated with lower maternal diet quality at Time 1 (b = -0.71, 95% CI [-1.09, 0.34]) and at Time 2 (b = -0.51, 95% CI [-0.97, -0.05]), but not at Time 3 (b = -0.14, 95% CI [-0.54, 0.26]). Findings suggest that mothers and toddlers exhibited similar low-quality dietary patterns and that lower diet quality was associated with higher maternal anxiety scores. Approaches to enhance diet quality may consider incorporating anxiety-reducing strategies into maternal and toddler care and feeding behaviour guidelines.
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Psychological and Sleep Effects of Tryptophan and Magnesium-Enriched Mediterranean Diet in Women with Fibromyalgia.
Martínez-Rodríguez, A, Rubio-Arias, JÁ, Ramos-Campo, DJ, Reche-García, C, Leyva-Vela, B, Nadal-Nicolás, Y
International journal of environmental research and public health. 2020;17(7)
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Fibromyalgia is a syndrome with unknown cause, characterised by muscle pain and physical exhaustion and is especially common in women aged 20-55 years. Anxiety, mood disturbance and psychological disorders are also often reported. Two micronutrients found in food, which may be of benefit to fibromyalgia patients are tryptophan (TRY) and magnesium (MG). This randomised control trial aimed to determine the effects of a Mediterranean diet supplemented with TRY and MG in 22 women with fibromyalgia for 16 weeks. The results showed that supplementation improved anxiety, mood, eating disorders and body image, but did not affect sleep quality. It was concluded that Mediterranean diet supplemented with TRY and MG was of benefit to anxiety, depression and reduced eating disorders but did not affect sleep quality. This study could be used by healthcare professionals to recommend a Mediterranean diet enriched with TRY and MG to improve symptoms of depression and anxiety in women with fibromyalgia.
Abstract
Anxiety, mood disturbance, eating and sleep disorders, and dissatisfaction with body image are prevalent disorders in women with fibromyalgia. The authors of this study aimed to determine the effects of tryptophan (TRY) and magnesium-enriched (MG) Mediterranean diet on psychological variables (trait anxiety, mood state, eating disorders, self-image perception) and sleep quality in women with fibromyalgia (n = 22; 49 ± 5 years old). In this randomized, controlled trial, the participants were randomly assigned to the experimental group and the placebo group. The intervention group received a Mediterranean diet enriched with high doses of TRY and MG (60 mg of TRY and 60 mg of MG), whereas the control group received the standard Mediterranean diet. Pittsburgh Sleep Quality Questionnaire, Body Shape Questionnaire, State-Trait Anxiety Inventory (STAI), Profile of Mood States (POMS-29) Questionnaire, Eating Attitudes Test-26, and Trait Anxiety Inventory were completed before and 16 weeks after the intervention. Significant differences were observed between groups after the intervention for the mean scores of trait anxiety (p = 0.001), self-image perception (p = 0.029), mood disturbance (p = 0.001), and eating disorders (p = 0.006). This study concludes that tryptophan and magnesium-enriched Mediterranean diet reduced anxiety symptoms, mood disturbance, eating disorders, and dissatisfaction with body image but did not improve sleep quality in women with fibromyalgia.
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An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients.
Gallé, F, Marte, G, Cirella, A, Di Dio, M, Miele, A, Ricchiuti, R, Liguori, F, Maida, P, Liguori, G
PloS one. 2020;15(10):e0241336
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Bariatric surgery is currently the most effective method of weight loss for individuals with obesity. However sustained weight loss after surgery can be hindered by unhealthy behaviours that have sustained since before the procedure. Motivational, educational, diet and exercise programmes have been shown to help sustain weight loss following surgery. This non-randomised control trial over 12 months, aimed to assess the effects of a motivational, educational diet and exercise programme on fitness and quality of life in 82 individuals following bariatric surgery. The results showed that a diet and exercise programme improved quality of life and fitness. There was an increased daily intake of fruits and vegetables, eating behaviours were improved and there was a greater weight loss in those following the programme. It was concluded that the diet and exercise programme was responsible for behavioural changes that ensured better quality of life and sustained weight loss following surgery. Health care professionals could use this study to understand the need to recommend motivational and educationally based diet and exercise programme to patients following bariatric surgery.
Abstract
INTRODUCTION Unhealthy lifestyles may hinder bariatric surgery outcomes. This non-randomized controlled study aimed to evaluate the effects of an integrated post-operative exercise-based educational and motivational program in improving behaviors, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention. METHODS A group of adult sedentary bariatric patients chose to attend a 12-month exercise program integrated with diet education and motivational support, or to receive usual care. Dietary habits, binge eating disorder, physical activity, obesity-related quality of life, Body Mass Index, waist and hip circumference, VO2max, strength and flexibility were assessed at the start and at the end of the study in both groups. RESULTS On a total of 82 patients enrolled, follow-up measures were obtained from 28 (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) patients included in the intervention and control group, respectively. All the behavioral and physical outcomes improved significantly in the participants to the intervention, while the control group showed lesser changes, especially regarding quality of life and physical fitness. CONCLUSIONS Notwithstanding the self-selection, these results suggest that a timely postoperative behavioral multidisciplinary program for bariatric patients may be effective in establishing healthy behaviors which can lead to better surgery outcomes.
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PROFAST: A Randomized Trial Assessing the Effects of Intermittent Fasting and Lacticaseibacillus rhamnosus Probiotic among People with Prediabetes.
Tay, A, Pringle, H, Penning, E, Plank, LD, Murphy, R
Nutrients. 2020;12(11)
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The prevalence of diabetes is increasing worldwide, and with it, the risk of cardiovascular disease is also increasing. Intermittent fasting has been shown to reduce weight and improve glycaemic control. Weight control and glycaemic control were also improved with probiotic Lacticaseibacillus rhamnosus HN001 supplementation. This pilot, 12-week, double-blinded, two-armed, randomized 1:1 study aimed to investigate the combined effects of intermittent fasting with daily probiotic Lacticaseibacillus rhamnosus HN001 supplementation on glycaemic management in participants with prediabetes. For two days, participants restricted their calorie intake to 600-650 kcal, followed by five days of ad libitum consumption (5:2). Intermittent fasting for 12 weeks improved glycaemic control (reduced HbA1c) and reduced body weight by 5%. The supplementation with Lacticaseibacillus rhamnosus HN001 did not significantly improve these outcomes. Probiotic supplementation significantly improved mental health and social functioning in participants. There is a need for further large, robust studies to assess the effects of intermittent fasting alone and when it is combined with different exercise forms and different prebiotic and probiotic supplements on cardiometabolic markers and mental health. The findings of this study may be useful to healthcare professionals in understanding the effects of fasting on metabolism as well as the psychological benefits of Lacticaseibacillus rhamnosus HN001 supplementation.
Abstract
Both intermittent fasting and specific probiotics have shown promise in improving glucose tolerance with a potential for synergistic effects through alterations to gut microbiota. In this randomized, double-blinded, two-arm feasibility study, we investigated whether intermittent fasting, supplemented with Lacticaseibacillus rhamnosus HN001 probiotic, reduces HbA1c in individuals with prediabetes. All participants with HbA1c 40-50 mmol/mol commenced intermittent fasting (2 days per week of calorie restriction to 600-650 kcal/day) and were randomized 1:1 to either daily probiotic (Lacticaseibacillus rhamnosus HN001) or placebo for 12 weeks. The primary outcome was a change in HbA1c. Secondary outcomes included changes in anthropometry, body composition, glucoregulatory markers, lipids, hunger hormones, liver enzymes, inflammatory markers, gut hormones, calorie and macronutrient intake, quality of life, hunger, mood and eating behavior. Of 33 participants who commenced the trial, 26 participants (mean age 52 years, body mass index (BMI) 34.7 kg/m2) completed the intervention (n = 11 placebo, n = 15 probiotic). HbA1c decreased from 43 ± 2.7 mmol/mol to 41 ± 2.3 mmol/mol, p < 0.001, with average of 5% weight loss. No significant between-group differences were seen in primary or secondary outcomes except for social functioning (p = 0.050) and mental health (p = 0.007) scores as improvements were seen in the probiotic group, but not in the placebo group. This study shows additional psychological benefits of probiotic supplementation during intermittent fasting to achieve weight loss and glycemic improvement in prediabetes.
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Egg Consumption in U.S. Children is Associated with Greater Daily Nutrient Intakes, including Protein, Lutein + Zeaxanthin, Choline, α-Linolenic Acid, and Docosahexanoic Acid.
Papanikolaou, Y, Fulgoni, VL
Nutrients. 2019;11(5)
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Dietary guidelines recommend children and adolescents consume nutrient-dense foods to promote growth and development, and recently eggs have been included in these recommendations. At present, there are no studies in children and adolescents that have examined nutrient-related associations of egg consumption. Therefore, the aim of this study was to investigate egg consumption and nutrient intakes, diet quality and growth outcomes relative to non-egg consumers. Using cross-sectional data from the US National Health and Nutrition Examination Survey (NHANES), data from 3,299 egg consumers and 17,030 non-egg consumers aged 2-18 was examined. Compared with non-egg consumption, egg consumption was associated with elevated intake of protein, healthy fats, antioxidants and various vitamins and minerals, and lower intake of sugar. There were several shortfall nutrients associated with egg consumption including fibre, iron, and folate. No associations were found when examining diet quality and growth-relate measures. This analysis demonstrated several nutrient-related benefits to support the continued inclusion of eggs in the dietary patterns of children and adolescents. Based on these results, the authors conclude this study illustrates an opportunity to communicate the benefits linked with egg consumption to individuals that influence children and adolescents.
Abstract
Dietary pattern recommendations include consuming a variety of nutrient-dense foods in children and adolescents to promote optimal growth and development. The current study investigated associations with egg consumption and nutrient intakes, diet quality, and growth outcomes relative to non-egg consumers. The analysis used data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2001-2012 in children and adolescents aged 2-18 years (N = 3,299, egg consumers; N = 17,030, egg non-consumers). Daily energy and nutrient intakes were adjusted for the complex sample design of NHANES using appropriate weights. Consuming eggs was associated with increased daily energy intake relative to non-egg consumption. Children and adolescents consuming eggs had elevated daily intake of protein, polyunsaturated, monounsaturated and total fat, α-linolenic acid, docosahexaenoic acid (DHA), choline, lutein + zeaxanthin, vitamin D, potassium, phosphorus, and selenium. Egg consumers had greater consumption, sodium, saturated fat, with reduced total and added sugar versus egg non-consumers. The analysis also showed that egg consumption was linked with lower intake of dietary folate, iron, and niacin. No associations were determined when examining diet quality and growth-related measures. A sub-analysis considering socioeconomic status showed that egg consumption was positively related with daily lutein + zeaxanthin and DHA intake. The current analysis demonstrated several nutrient-related benefits to support the continued inclusion of eggs in the dietary patterns of children and adolescents.
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Food Exclusion Based on IgG Antibodies Alleviates Symptoms in Ulcerative Colitis: A Prospective Study.
Jian, L, Anqi, H, Gang, L, Litian, W, Yanyan, X, Mengdi, W, Tong, L
Inflammatory bowel diseases. 2018;24(9):1918-1925
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Ulcerative Colitis (UC) is a chronic debilitating inflammatory bowel disease that may need lifetime management. Dietary management of UC by eliminating food antigens that may be causing a delayed immune response is one of the approaches used widely to manage the disease. Food intolerance, mediated by immunoglobulin G antibodies in response to food antigens that are otherwise harmless, could be one cause of UC. Low levels of digestive enzymes may result in poor digestion of glucose, amino acids, and glycerol, followed by an immune reaction that leads to food sensitivities. Ninety-seven UC patients were enrolled in this open-label, stratified, prospective, randomised controlled trial to evaluate the effect of an elimination diet versus a sham diet (a normal healthy diet). Following an IgG-specific exclusion diet for six months resulted in the alleviation of UC symptoms and an improvement in health-related quality of life. Further studies are needed to confirm the effectiveness of the exclusion diet since the intervention group did not show a significant reduction in IgG antibody levels. These results can be used by healthcare professionals to understand the potential role of exclusion diets in the management of UC.
Abstract
BACKGROUND Most patients with ulcerative colitis (UC) rely predominantly on medication for disease control. Diet interventions can reduce pharmaceutical expenditures and prolong remission. We designed a prospective study to evaluate whether an immunoglobulin G (IgG)-guided exclusion diet would improve symptoms and quality of life (QoL) in patients with UC. METHODS The 6-month diet intervention included 97 patients with UC, who were randomly divided into an intervention group (n = 49) and a control (n = 48) group. Individual diet plans were created for the intervention group according to IgG titers; the control group ate a healthy diet as normal. Observational indices included disease activity, extraintestinal manifestations, nutritional status, and QoL. Relationships between food-specific IgG antibodies and these indices were also analyzed. RESULTS At baseline, there were no significant differences between the groups. Food-specific IgG antibodies were detected in 70.10% of participants. After intervention, the Mayo score was significantly lower in the intervention group than in the control group (2.41 ± 0.89 vs 3.52 ± 1.15, P < 0.05). The number of patients with extraintestinal manifestations decreased from 7 to 2 in the intervention group and from 6 to 5 in the control group. As for nutritive indices, the intervention group had higher mean body mass index and albumin than the control group (23.88 ± 3.31 vs 21.50 ± 6.24 kg/m2, respectively, P < 0.05; 48.05 ± 6.39 vs 45.72 ± 5.48 g/L, respectively, P < 0.05), whereas prealbumin and transferrin were not significantly different between the groups. QoL improved after food exclusion (P < 0.05). CONCLUSIONS An IgG-guided exclusion diet ameliorated UC symptoms and improved QoL. Interactions between IgG-based food intolerance and UC warrant further study.