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Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet
Abstract
Objective: The purpose of this study was to provide an initial assessment of the effective-ness of the high nutrient density (HND) diet on glycemic control and cardiovascular risk factors in participants with type 2 diabetes. Design: This was a retrospective case series study. Partici-pants were 13 adult type 2 diabetic U.S. women and men between the ages of 30 -80 years old. Glycosylated hemoglobin (HbA1C), lipid profile, blood pressure, BMI, and medication require-ments before and after commencement of the HND diet were compared. Results: After a me-dian length on the HND diet of 7 months, the mean HbA1C dropped from 8.2% to 5.8% (p = 0.002), with sixty-two percent of participants reaching normoglycemic levels (HbA1C < 6.0%). There was a substantial reduction in mean blood pressure for hypertensive participants (n=10) from a pre-intervention level of 148/87 mmHg to 121/74 mmHg (p = 0.0004 for systolic blood pressure, p = 0.01 for diastolic blood pressure). Triglycerides significantly decreased from a mean of 171 mg/dl to a mean of 103 mg/dl (p = 0.02). The mean HDL increased significantly from 48.3 mg/dl to 54.6 mg/dl (p = 0.03). The mean number of medications dropped from 4 to 1 (p = 0.0006). Conclusions: The HND diet was very effective in controlling glycemic levels and cardiovascular risk factors in 13 participants with type 2 diabe-tes. Therefore, there is a well-justified need for further study with the HND diet.
... In a recent review of the literature, researchers support the feasibility of diabetes type 2 remission in diabetic patients using lifestyle as the primary means of treatment, whereas PA appears to have a minor role compared to the dietary regimen; however, it may significantly improve insulin resistance and beta-cell activity [113]. In addition, it has been demonstrated that with regard to diabetes type 2 outcomes, a well-designed vegan diet in short-and long-term settings has the greatest success compared to a controlled diet and other dietary interventions [67,[114][115][116][117][118]. A vegan diet (n = 49) and a conventional "diabetes-type-diet" (n = 50) in the treatment of type 2 diabetes were tested in a long-term (74-week) randomized controlled trial, which showed that the vegan diet significantly improved diabetes type 2 status (i.e., glycaemia and plasma lipid concentration, body mass reduction) [114]. ...
... register [317] included 50 studies available with the "vegan diet" search filter; however, only three studies (6%) were industry funded. For comparison, for CVD (e.g., "cardiovascular drug" search filter only) or type 2 diabetes (e.g., "diabetes type 2 drug" search filter only), both of which a well-designed vegan diet may prevent or reverse [67,[99][100][101][102][114][115][116][117][118], we found 8506 (4382 (51%) industry funded) studies, respectively. ...
Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations , athletes or individuals with fast-paced lifestyles, there is room for further appropriate sup-plementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.
... 21 The results of this approach has also been reported in a pilot study of diabetes patients with dramatically favorable results, and a larger controlled trial is beginning shortly. 22 The effectiveness of this approach corroborates the many studies indicating a reduction in CAD mortality from the inclusion of these fat-rich whole foods. [23][24][25] In addition to providing fiber, protein, phytosterols, antioxidants, vitamins, and minerals, nuts and seeds are also a source of beneficial fatty acids, which enhance phytochemical and antioxidant absorption from other foods. ...
... Over 25 years of experience as a primary care physician teaching and motivating the public utilizing these methods has demonstrated the consistent effectiveness of this approach for weight reduction to dramatically lower blood pressure, treat/reverse type 2 diabetes, 22 and even help resolve food addictions. 20 The relatively large number of participants makes these results important for demonstrating the beneficial response following an NDPR diet to ameliorate CVD. ...
Background. The results presented from a practice survey include cases of interest, demonstrating improvements in cardiometabolic risk factors utilizing a Nutrient-Dense, Plant-Rich (NDPR) diet. It includes changes in weight, blood pressure, and lipids parameters derived from the survey and retrospective chart review. Methods. Practice records and interviews were used for case history descriptions. Participants’ data were collected via an online survey. Results. Adherence to a NDPR dietary protocol resulted in reduced low-density lipoprotein cholesterol and serum triglycerides. Compliance of greater than 80% with the target diet resulted in an average sustained weight loss of over 50 pounds in 75 obese subjects. There was a corresponding average reduction of 27.8 mm Hg in systolic blood pressure for the 127 survey responders with untreated hypertension at baseline, and a 42.2 mg/dL average decrease in low-density lipoprotein cholesterol for the 328 survey responders, not on cholesterol reducing medications. Conclusion. The outcomes from both the survey responders and cases demonstrate the potential for the NDPR dietary intervention to improve weight, blood pressure, lipids, and even reverse severe cardiovascular disease. Though this is a report of cases and self-reported benefits, it adds evidence to support the need for further studies investigating the potential of this dietary intervention.
... Another interesting work is to search for foods low in calories but still with high NFs. These foods might be comparable to, yet distinct from, foods with high micronutrient levels per calorie, which have been suggested to benefit weight and glycaemic control and cardiovascular risk management 33,34 . ...
Diet design for vegetarian health is challenging due to the limited food repertoire of vegetarians. This challenge can be partially overcome by quantitative, data-driven approaches that utilise massive nutritional information collected for many different foods. Based on large-scale data of foods' nutrient compositions, the recent concept of nutritional fitness helps quantify a nutrient balance within each food with regard to satisfying daily nutritional requirements. Nutritional fitness offers prioritisation of recommended foods using the foods' occurrence in nutritionally adequate food combinations. Here, we systematically identify nutritionally recommendable foods for semi- to strict vegetarian diets through the computation of nutritional fitness. Along with commonly recommendable foods across different diets, our analysis reveals favourable foods specific to each diet, such as immature lima beans for a vegan diet as an amino acid and choline source, and mushrooms for ovo-lacto vegetarian and vegan diets as a vitamin D source. Furthermore, we find that selenium and other essential micronutrients can be subject to deficiency in plant-based diets, and suggest nutritionally-desirable dietary patterns. We extend our analysis to two hypothetical scenarios of highly personalised, plant-based methionine-restricted diets. Our nutrient-profiling approach may provide a useful guide for designing different types of personalised vegetarian diets.
... [9,42] Similarly, Dunaief et al. in 2012 retrospectively studied 13 patients who had an average HbA1c of 8.2% dropped their HbA1c average to 5.8% after 7 months of eating high diet high in greens, fruits, nuts/seeds and beans/legumes which is similar to what is available in Nigeria that the study participants ate daily. [43] Predominantly plant-based foods were shown to be superior to the American Diabetes Association (ADA) diet in controlling serum glucose in T2DM in a 22 weeks randomized control trial of 99 subjects with T2DM. Among 49 participants in the intervention group, 48% had HbA1c levels improved 0.38%. ...
Background: The diagnosis of Type 2 diabetes mellitus is commonly associated with denial followed by a search for instant cure by spiritual intervention or herbal remedies. In the absence of effective health insurance policies in Nigeria, most treatments are paid for as out of pocket expenses, causing many with non-communicable diseases to go into poverty. The aim of this study is to evaluate the efficacy of a wholly Nigerian diet in achieving remission of type 2 diabetes mellitus. Method: Sixty study participants were randomized into matched control (standard of care) and treatment (dietary caloric restriction intervention) groups. Participants were followed for 24 weeks and samples taken at baseline, midline and at the end of the study for analysis. Results: While there was no change in mean HbA1c levels between baseline and at 6 months (8.390 ± 2.0242 compared to 8.140±2.1229), there was a statistically significant decrease in HbA1c value between baseline and at 6 months (7.617±2.0773 compared to 6.017±1.2301). Also, there was significant weight loss in the intervention group (mean waist circumference decreased from 88.82cm to 80.0cm [p=0.001] while BMI decreased from 22.67 to 22.86kg/m2 [p=0.025]).
... To further evidence the problem in Canada, the recent Healthy Eating Guidelines published by Health Canada perpetuate the notion that unhealthy eating patterns are an individuals responsibility, it makes little mention of the fact that most Canadians and their children's diets are greater than 40% UPF, it does not address this issue of particular concern directly, which other researchers and national guidelines have (Alam et al., 2019;American Heart Association, 2016;Health Canada, 2019;Campbell et al., 2016;Dunaief, Fuhrman, Dunaief, & Ying, 2012;Flint & Oliver, 2019;Monteiro, Levy, Claro, Castro, & Cannon, 2010;Monteiro et al., 2015;Moodie et al., 2013;Moreira et al., 2015;Moubarac et al., 2014;Moubarac, Batal, Louzada, Steele, & Monteiro, 2017; Public Health Agency of Canada, 2016;Shah et al., 2015;Vincent, McKay, Arden, 2015;Wright et al., 2017). ...
A Program plan proposal to Minimize Type 2 Diabetes Risk: Ad Valorem Taxation of Ultra-Processed Foods in Canada
... Besides a lower risk of cardiovascular diseases and certain types of cancer, type 2 diabetes, and some other chronic diseases (Hever & Cronise, 2017;Melina, Craig & Levin, 2016), science also associates vegan diet with a successful control of body weight (Barnard, Levin & Yokoyama, 2015;Huang, Huang, Hu & Chavarro, 2016; 14 Two systematic reviews and meta-analyses of researches (Dinu et al., 2015;Yokoyama, Levin & Barnard, 2017) showed that vegan diets are associated with a lowest risk of incidence of all types of cancer and lower values of lipids in comparison with a mixed diet. Turner-McGrievy, Mandes & Crimarco, 2017), with a reverse of progressive cardiovascular diseases (Esselstyn Jr., Gendy, Doyle, Golubic & Roizen, 2014;Ornish et al., 1998), with a reverse of type 2 diabetes (Anderson & Ward, 1979;Barnard et al., 2009;Dunaief, Fuhrman, Dunaief & Ying, 2012), with a reverse of the early stage of prostate cancer (Ornish et al., 2005), etc., which significantly lowers the need for medication (Hever & Cronise, 2017) and most likely increases longevity (Orlich et al., 2013;Ornish et al., 2013). Numerous reputable researches, such as the EPIC Oxford, Adventist Health Study 1 and 2 15 , and GEICO Study (Wirnitzer et al., 2016) and an overview of researches (Dinu, Abbate, Gensini, Casini & Sofi, 2016) have shown that vegans have the lowest incidence of cardiovascular diseases and cancer. ...
The majority of scientific evidence strongly associates a well-planned vegan diet with health, a successful control of body weight, a preventive measure, and, in some cases, with the termination and the reverse of the most common chronic non-communicable diseases, such as cardiovascular diseases, type 2 diabetes, certain cancers, and some other diseases. Numerous athletes have accepted these findings and adopted this lifestyle choice. Furthermore, the athletes choose well-planned vegan diet with the intention of optimizing their athletic abilities. The position of The British Dietetic Association (BDA) and The Academy of Nutrition and Dietetics (AND) on the vegetarian diet states that well-planned vegetarian diets, including the vegan diet, are healthy and nutritionally adequate and appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence and older adulthood. What is more, AND repeats its view from nearly ten years ago on the appropriateness of the vegan diet for the needs of athletes. The aim of this article is to justify the appropriateness of a well-planned vegan diet for the needs for competitive artistic gymnasts and to do so with a relative scientific transparency.
... Another interesting work is to search for foods low in calories but still with high NFs. These foods might be comparable to, yet distinct from, foods with high micronutrient levels per calorie, which have been suggested to benefit weight and glycaemic control and cardiovascular risk management 33,34 . We first observed that the calorie level of each food clearly follows a bimodal distribution ( Supplementary Fig. S1). ...
Diet design for vegetarian health is challenging due to the limited food repertoire of vegetarians. This challenge can be partially overcome by quantitative, data-driven approaches that utilise massive nutritional information collected for many different foods. Based on large-scale data of foods' nutrient compositions, the recent concept of nutritional fitness helps quantify a nutrient balance within each food with regard to satisfying daily nutritional requirements. Nutritional fitness offers prioritisation of recommended foods using the foods' occurrence in nutritionally adequate food combinations. Here, we systematically identify nutritionally recommendable foods for semi- to strict vegetarian diets through the computation of nutritional fitness. Along with commonly recommendable foods across different diets, our analysis reveals favourable foods specific to each diet, such as immature lima beans for a vegan diet as an amino acid and choline source, and mushrooms for ovo-lacto vegetarian and vegan diets as a vitamin D source. Furthermore, we find that selenium and other essential micronutrients can be subject to deficiency in plant-based diets, and suggest nutritionally-desirable dietary patterns. We extend our analysis to two hypothetical scenarios of highly personalised, plant-based methionine-restricted diets. Our nutrient-profiling approach may provide a useful guide for designing different types of personalised vegetarian diets.
... Many studies continuously report that unhealthy diet, physical inactivity or tobacco consumption are modifiable, and a healthy lifestyle can effectively prevent critical health conditions [12], [13]. For example, recent medical experiments and studies report that the reversal of type-2 diabetes was examined after the appropriate medical interventions with healthy lifestyle adoption [14], [15]. ...
Prevalence of chronic diseases has become a serious problem in our society. These illnesses are commonly caused by dietary and lifestyle risk factors and are hard to cure completely. However, behavioral changes such as adopting a healthy diet and lifestyle are effective in reducing chronic conditions. In this research, we propose to build games that could support the Sustainable transformation of chronic patients in a Holistic and Adaptable manner using Real-time, Precise, and Persuasive (SHARPP) principles, processes, systems, and technologies. This research leverages wearable information technologies and chronic disease studies to design games that interweave virtual worlds with the real world. It not only supports patients to form healthy habits that prevent and revert chronic diseases but also helps individuals to balance various life dimensions.
... In one particularly successful study, which emphasized employing a plant-based diet and eliminating highly refined foods, good results were obtained in diabetic patients. After a median length on the diet of 7 months, the mean HbA1C dropped from 8.2% to 5.8% (p = 0.002), with sixty-two percent of participants reaching normoglycemic levels (HbA1C < 6.0%) [118]. A 3-month study of diabetic Koreans showed that a plant-based diet lowered their HbA1c levels by 0.9%, nearly triple the amount achieved with the Korean Diabetes Association diet [119]. ...
... Numerous studies have shown that nutrient-dense, plantrich (NDPR) diets are effective in reducing risk factors for CVD and other chronic diseases. The NDPR dietary patterns have been proven to be safe and effective in community and clinical applications and have been associated with (1) weight reduction, 7,8 (2) lipid normalization and management, [8][9][10][11] (3) glycemic control in diabetes, 12 (4) inflammation reduction, 13 (5) a reduction in the perceptions of hunger, 14 (6) precautionary approaches for cancer, 15 and (7) overall health and longevity. 16 In addition, NDPR dietary interventions have also been shown to be an efficient and cost-effective approach to reducing health care costs. ...
Setting:
The intervention was conducted at the Northern Arizona University (Flagstaff, AZ, USA) and sponsored by its Employee Assistance and Wellness Department. Participants • Participants were 35 employees with body mass indexes (BMIs) >25 kg/m2 who were ready and willing to make a lifestyle change, who were not currently participating in a weight loss program, and who were not taking any medications that could increase medical risk or had weight loss as a primary side effect. The average age of participants was 42.57 y; 91.4% were female, and 80% were Caucasian. Intervention • The intervention used a dietary protocol consisting of the daily consumption of greens, beans, legumes, and a variety of other vegetables, as well as fresh or frozen whole fruits, nuts, seeds, and whole grains. Participants were encouraged to minimize the consumption of refined grains, vegetable oils, processed foods, and animal products. Outcome Measures • The study measured serum lipids, height, weight, waist and hip circumference, waist-to-hip ratio, and blood pressure. Results • Based on paired-sample t tests and Wilcoxon signed-ranks test with a maximum level of P = .05, the intervention resulted in significant changes in weight, BMI, waist and hip measurements, high-density lipoproteins, low-density lipoproteins, and estimated average glucose. Conclusions • The findings favorably revealed that an NDPR dietary intervention that was developed for worksites was an effective approach for reducing CVD risk factors.
Background
Plant-based diets are associated with lower inflammatory biomarkers and reduced risk of age-related chronic diseases. Epigenetic biomarkers of aging are DNA methylation-based tools that estimate biological age and rate of aging, providing insights into age-related health risks. Healthy diet and lifestyle indicators correlate with slower epigenetic aging.
Objectives
Neither inflammatory biomarkers nor epigenetic aging has yet been studied in the nutrient-dense, plant-rich (Nutritarian) diet, a plant-based diet that emphasizes specific plant foods, such as cruciferous vegetables, beans and other legumes, onions and garlic, mushrooms, berries, nuts, and seeds. We aimed to compare inflammatory status and epigenetic age acceleration in females following a Nutritarian diet with those of females following a standard American diet (SAD).
Methods
We investigated dietary inflammatory potential, epigenetic age acceleration using first, second, and third-generation clocks, and additional health-related epigenetic biomarkers in this retrospective cohort study of 48 females who habitually (≥5 y) follow a Nutritarian diet and 49 females without obesity who habitually (≥5 y) follow a SAD. Participants completed a series of online questionnaires and provided a blood sample.
Results
Epigenetic age acceleration, indicated by the third-generation clock DunedinPACE, was significantly slower in the Nutritarian group than that in the SAD group (P = 4.26 × 10⁻⁶). The Nutritarian diet group showed lower dietary inflammatory potential, as indicated by Empirical Dietary Inflammatory Pattern and Dietary Inflammatory Index. We observed differences in methylation-predicted immune cell subsets (lower neutrophils and higher T regulatory cells) and a lower epigenetic biomarker proxy for C-reactive protein, both of which suggested a lower inflammatory status in the Nutritarian group. Epigenetic biomarker proxies for LDL cholesterol, body mass index (BMI), insulin-like growth factor binding protein 5, and blood glucose were also lower in the Nutritarian group.
Conclusions
Our findings suggest the Nutritarian diet could help reduce chronic inflammation and slow epigenetic aging.
Concerns regarding protein and amino acid deficiencies with plant-based proteins have precluded their use in chronic kidney disease (CKD) patients. Many of these concerns were debunked years ago, but recommendations persist regarding the use of "high-biological value" (animal-based) proteins in CKD patients, which may contribute to worsening of other parameters such as blood pressure, metabolic acidosis, and hyperphosphatemia. Plant-based proteins are sufficient in meeting both quantity and quality requirements. Those eating primarily plant-based diets have been observed to consume approximately 1.0 g/kg/day of protein, or more. CKD patients have been seen to consume 0.7-0.9 g/kg/day of mostly plant-based protein without any negative effects. Furthermore, those substituting animal-based proteins for plant-based proteins have shown reductions in severity of hypertension, hyperphosphatemia, and metabolic acidosis. Plant-based proteins, when consumed in a varied diet, are not only nutritionally adequate but have pleiotropic effects which may favor their use in CKD patients.
The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.
Higher nut consumption has been associated with lower risk of coronary heart disease (CHD) events in several epidemiologic studies. The study examined the association between intake of nuts and incident cardiovascular disease (CVD) in a cohort of women with type 2 diabetes. For the primary analysis, there were 6309 women with type 2 diabetes who completed a validated FFQ every 2-4 y between 1980 and 2002 and were without CVD or cancer at study entry. Major CVD events included incident myocardial infarction (MI), revascularization, and stroke. During 54,656 person-years of follow-up, there were 452 CHD events (including MI and revascularization) and 182 incident stroke cases. Frequent nut and peanut butter consumption was inversely associated with total CVD risk in age-adjusted analyses. After adjustment for conventional CVD risk factors, consumption of at least 5 servings/wk of nuts or peanut butter [serving size, 28 g (1 ounce) for nuts and 16 g (1 tablespoon) for peanut butter] was significantly associated with a lower risk of CVD (relative risk = 0.56; 95% CI: 0.36-0.89). Furthermore, when we evaluated plasma lipid and inflammatory biomarkers, we observed that increasing nut consumption was significantly associated with a more favorable plasma lipid profile, including lower LDL cholesterol, non-HDL cholesterol, total cholesterol, and apolipoprotein-B-100 concentrations. However, we did not observe significant associations for HDL cholesterol or inflammatory markers. These data suggest that frequent nut and peanut butter consumption is associated with a significantly lower CVD risk in women with type 2 diabetes.
Low-fat vegetarian and vegan diets are associated with weight loss, increased insulin sensitivity, and improved cardiovascular health.
We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia, weight, and plasma lipids.
Free-living individuals with type 2 diabetes were randomly assigned to a low-fat vegan diet (n = 49) or a diet following 2003 American Diabetes Association guidelines (conventional, n = 50) for 74 wk. Glycated hemoglobin (Hb A(1c)) and plasma lipids were assessed at weeks 0, 11, 22, 35, 48, 61, and 74. Weight was measured at weeks 0, 22, and 74.
Weight loss was significant within each diet group but not significantly different between groups (-4.4 kg in the vegan group and -3.0 kg in the conventional diet group, P = 0.25) and related significantly to Hb A(1c) changes (r = 0.50, P = 0.001). Hb A(1c) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets, respectively (P = 0.43). Hb A(1c) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets, respectively (P = 0.03). In analyses before alterations in lipid-lowering medications, total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups, respectively (P = 0.01); LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups, respectively (P = 0.03).
Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations. Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established. This trial was registered at clinicaltrials.gov as NCT00276939.
This article reviews recent epidemiologic evidence on nut intake and health outcomes. It focuses on studies in which nut consumption is directly assessed or when nuts are included in a dietary score or pattern. Epidemiologic studies have been remarkably consistent in showing an association between nut consumption and a reduced risk of coronary heart disease (CHD). Some evidence has emerged recently to suggest health-protective benefits of nuts other than CHD. Frequent nut intake probably reduces risk of diabetes mellitus among women, but its effects on men are unknown. Evidence on the anticarcinogenic effects of nuts is somewhat limited because studies in the past 2 decades have examined only 3 tumor sites, and the benefits appear to be manifested only in women. However, the protective benefits of frequent nut consumption on gallstone diseases are observed in both sexes. Long-term nut consumption is linked with lower body weight and lower risk of obesity and weight gain. A dietary pattern or score that includes nuts is consistently related with beneficial health outcomes, and this provides an indirect evidence of the salutary benefits of nut consumption. More longitudinal studies are needed to clarify the possible effects of nuts on diseases other than CHD.
Although cow milk has been widely recommended in Western countries as necessary for growth and bone health, evidence collected during the past 20 y shows the need to rethink strategies for building and maintaining strong bones. Osteoporotic bone fracture rates are highest in countries that consume the most dairy, calcium, and animal protein. Most studies of fracture risk provide little or no evidence that milk or other dairy products benefit bone. Accumulating evidence shows that consuming milk or dairy products may contribute to the risk of prostate and ovarian cancers, autoimmune diseases, and some childhood ailments. Because milk is not necessary for humans after weaning and the nutrients it contains are readily available in foods without animal protein, saturated fat, and cholesterol, vegetarians may have healthier outcomes for chronic disease if they limit or avoid milk and other dairy products. Bones are better served by attending to calcium balance and focusing efforts on increasing fruit and vegetable intakes, limiting animal protein, exercising regularly, getting adequate sunshine or supplemental vitamin D, and getting approximately 500 mg Ca/d from plant sources. Therefore, dairy products should not be recommended in a healthy vegetarian diet.
Epidemiologic and clinical trial evidence has demonstrated consistent benefits of nut and peanut consumption on coronary heart disease (CHD) risk and associated risk factors. The epidemiologic studies have reported various endpoints, including fatal CHD, total CHD death, total CHD, and nonfatal myocardial infarct. A pooled analysis of 4 U.S. epidemiologic studies showed that subjects in the highest intake group for nut consumption had an approximately 35% reduced risk of CHD incidence. The reduction in total CHD death was due primarily to a decrease in sudden cardiac death. Clinical studies have evaluated the effects of many different nuts and peanuts on lipids, lipoproteins, and various CHD risk factors, including oxidation, inflammation, and vascular reactivity. Evidence from these studies consistently shows a beneficial effect on these CHD risk factors. The LDL cholesterol-lowering response of nut and peanut studies is greater than expected on the basis of blood cholesterol-lowering equations that are derived from changes in the fatty acid profile of the diet. Thus, in addition to a favorable fatty acid profile, nuts and peanuts contain other bioactive compounds that explain their multiple cardiovascular benefits. Other macronutrients include plant protein and fiber; micronutrients including potassium, calcium, magnesium, and tocopherols; and phytochemicals such as phytosterols, phenolic compounds, resveratrol, and arginine. Nuts and peanuts are food sources that are a composite of numerous cardioprotective nutrients and if routinely incorporated in a healthy diet, population risk of CHD would therefore be expected to decrease markedly.
To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses' Health Study.
Prospective cohort study.
Nurses' Health Study.
86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease, stroke, or cancer at baseline in 1980.
Major coronary heart disease including non-fatal myocardial infarction and fatal coronary heart disease.
1255 major coronary disease events (861 cases of non-fatal myocardial infarction and 394 cases of fatal coronary heart disease) occurred during 14 years of follow up. After adjusting for age, smoking, and other known risk factors for coronary heart disease, women who ate more than five units of nuts (one unit equivalent to 1 oz of nuts) a week (frequent consumption) had a significantly lower risk of total coronary heart disease (relative risk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009) than women who never ate nuts or who ate less than one unit a month (rare consumption). The magnitude of risk reduction was similar for both fatal coronary heart disease (0.61, 0.35 to 1.05, P for trend=0.007) and non-fatal myocardial infarction (0.68, 0.47 to 1.00, P for trend=0.04). Further adjustment for intakes of dietary fats, fibre, vegetables, and fruits did not alter these results. The inverse association persisted in subgroups stratified by levels of smoking,use of alcohol, use of multivitamin and vitamin E supplements, body mass index, exercise, and intake of vegetables or fruits.
Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infarction. These data, and those from other epidemiological and clinical studies, support a role for nuts in reducing the risk of coronary heart disease.
Perhaps one of the most unexpected and novel findings in nutritional epidemiology in the past 5 y has been that nut consumption seems to protect against ischemic heart disease (IHD). Frequency and quantity of nut consumption have been documented to be higher in vegetarian than in nonvegetarian populations. Nuts also constitute an important part of other plant-based diets, such as Mediterranean and Asian diets. In a large, prospective epidemiologic study of Seventh-day Adventists in California, we found that frequency of nut consumption had a substantial and highly significant inverse association with risk of myocardial infarction and death from IHD. The Iowa Women's Health Study also documented an association between nut consumption and decreased risk of IHD. The protective effect of nuts on IHD has been found in men and women and in the elderly. Importantly, nuts have similar associations in both vegetarians and nonvegetarians. The protective effect of nut consumption on IHD is not offset by increased mortality from other causes. Moreover, frequency of nut consumption has been found to be inversely related to all-cause mortality in several population groups such as whites, blacks, and the elderly. Thus, nut consumption may not only offer protection against IHD, but also increase longevity.
"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.
Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.
The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
Major dietary patterns were studied for the ability to predict type 2 diabetes mellitus in a cohort of 4,304 Finnish men and women aged 40-69 years and free of diabetes at baseline in 1967-1972. Factor analysis was used to identify dietary patterns from dietary data that were collected using a 1-year dietary history interview. A total of 383 incident cases of type 2 diabetes occurred during a 23-year follow-up. Two major dietary patterns were identified. The pattern labeled "prudent" was characterized by higher consumption of fruits and vegetables, and the pattern labeled "conservative" was characterized by consumption of butter, potatoes, and whole milk. The relative risks (adjusted for nondietary confounders) between the extreme quartiles of the pattern scores were 0.72 (95% confidence interval: 0.53, 0.97; p(trend) = 0.03) for the prudent pattern and 1.49 (95% confidence interval: 1.11, 2.00; p(trend) = 0.01) for the conservative pattern. Thus, the prudent dietary pattern score was associated with a reduced risk and the conservative pattern score was associated with an increased risk of type 2 diabetes. In light of these results, it appears conceivable that the risk of developing type 2 diabetes can be reduced by changing dietary patterns.
Several lines of evidence suggest that rutin, flavonoid in fruits and vegetables, or one of its metabolites may effectively modulate advanced glycation end product (AGE) formation. Following ingestion, rutin forms metabolites that include 3,4-dihydroxyphenylacetic acid (3,4-DHPAA), 3,4-dihydroxytoluene (3,4-DHT), m-hydroxyphenylacetic acid (m-HPAA), 3-methoxy-4-hydroxyphenylacetic acid (homovanillic acid, HVA) and 3,5,7,3',5'-pentahydroxyflavonol (quercetin). We studied the effects of rutin and its metabolites on the formation of AGE biomarkers such as pentosidine, collagen-linked fluorescence, N(epsilon)-carboxymethyllysine (CML) adducts, glucose autoxidation and collagen glycation, using an in vitro model where collagen I was incubated with glucose. Rutin metabolites containing vicinyl dihydroxyl groups, i.e., 3,4-DHT, 3,4-DHPAA and quercetin, inhibited the formation of pentosidine and fluorescent adducts, glucose autoxidation and glycation of collagen I in a dose-dependent manner, whereas non-vicinyl dihydroxyl group-containing metabolites, i.e., HVA and m-HPAA, were much less effective. All five metabolites of rutin effectively inhibited CML formation. In contrast, during the initial stages of glycation and fluorescent AGE product accumulation, only vicinyl hydroxyl group-containing rutin metabolites were effective. These studies demonstrate that rutin and circulating metabolites of rutin can inhibit early glycation product formation, including both fluorescent and nonfluorescent AGEs induced by glucose glycation of collagen I in vitro. These effects likely contribute to the beneficial health effects associated with rutin consumption.
We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes.
Individuals with type 2 diabetes (n = 99) were randomly assigned to a low-fat vegan diet (n = 49) or a diet following the American Diabetes Association (ADA) guidelines (n = 50). Participants were evaluated at baseline and 22 weeks.
Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P < 0.001). Body weight change correlated with A1C change (r = 0.51, n = 57, P < 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h) (P = 0.013).
Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.
The vascular diseases, hypertension and atherosclerosis, affect millions of individuals worldwide, and account for a large number of deaths globally. A better understanding of the mechanism of these conditions will lead to more specific and effective therapies. Hypertension and atherosclerosis are both characterized by insulin resistance, and we suggest that this plays a major role in their etiology. The cause of insulin resistance is not known, but may be a result of a combination of genetic and lifestyle factors. In insulin resistance, alterations in glucose and lipid metabolism lead to the production of excess aldehydes including glyoxal and methylglyoxal. These aldehydes react non-enzymatically with free amino and sulfhydryl groups of amino acids of proteins to form stable conjugates called advanced glycation end products (AGEs). AGEs act directly, as well as via receptors to alter the function of many intra- and extracellular proteins including antioxidant and metabolic enzymes, calcium channels, lipoproteins, and transcriptional and structural proteins. This results in endothelial dysfunction, inflammation and oxidative stress. All these changes are characteristic of hypertension and atherosclerosis. Human and animal studies have demonstrated that increased AGEs are also associated with these conditions. A pathological role for AGEs is substantiated by studies showing that therapies that attenuate insulin resistance and/or lower AGEs, are effective in decreasing oxidative stress, lowering blood pressure, and attenuating atherosclerotic vascular changes. These interventions include lipoic acid and other antioxidants, AGE breakers or soluble receptors of AGEs, and aldehyde-binding agents like cysteine. Such therapies may offer alternative specific means to treat hypertension and atherosclerosis. An adjunct therapy may be to implement lifestyle changes such as weight reduction, regular exercise, smoking cessation, and increasing dietary intake of fruits and vegetables that also decrease insulin resistance as well as oxidative stress.
To assess the relation between adherence to a Mediterranean diet and the incidence of diabetes among initially healthy participants.
Prospective cohort study with estimates of relative risk adjusted for sex, age, years of university education, total energy intake, body mass index, physical activity, sedentary habits, smoking, family history of diabetes, and personal history of hypertension.
Spanish university department.
13 380 Spanish university graduates without diabetes at baseline followed up for a median of 4.4 years.
Dietary habits assessed at baseline with a validated 136 item food frequency questionnaire and scored on a nine point index. New cases of diabetes confirmed through medical reports and an additional detailed questionnaire posted to those who self reported a new diagnosis of diabetes by a doctor during follow-up. Confirmed cases of type 2 diabetes.
Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes. The incidence rate ratios adjusted for sex and age were 0.41 (95% confidence interval 0.19 to 0.87) for those with moderate adherence (score 3-6) and 0.17 (0.04 to 0.75) for those with the highest adherence (score 7-9) compared with those with low adherence (score <3). In the fully adjusted analyses the results were similar. A two point increase in the score was associated with a 35% relative reduction in the risk of diabetes (incidence rate ratio 0.65, 0.44 to 0.95), with a significant inverse linear trend (P=0.04) in the multivariate analysis.
Adherence to a Mediterranean diet is associated with a reduced risk of diabetes.
Adherence to traditional Mediterranean diet (MD) has been reported to be inversely associated with total, as well as cardiovascular, mortality. We have examined the relation between degree of such adherence and incidence of cancer overall in a general population sample of 25 623 participants (10 582 men, 15 041 women) of the Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). All subjects completed a validated, interviewer-administered, semi-quantitative food-frequency questionnaire at enrolment. Degree of adherence to the traditional MD was assessed through a 10-point scale (0 minimal; 9 maximal) that incorporated key dietary characteristics. During a median follow-up of 7.9 years and 188 042 total person-years, 851 medically confirmed incident cancer cases (421 men, 430 women) were recorded. Using proportional hazards regression with adjustment for potential confounders, we found that a higher degree of MD adherence was associated with lower overall cancer incidence. A two-point increase in the score corresponded to a 12% reduction in cancer incidence (adjusted hazard ratio, 0.88 (95% confidence interval 0.80, 0.95)). The association was exposure-dependent and stronger among women. This inverse association with MD adherence was considerably stronger than that predicted on the basis of the associations of the individual components of this diet and points to the value of analysing dietary patterns in cancer studies.
Context Nuts are high in unsaturated (polyunsaturated and monounsaturated) fat
and other nutrients that may improve glucose and insulin homeostasis.Objective To examine prospectively the relationship between nut consumption and
risk of type 2 diabetes.Design, Setting, and Participants Prospective cohort study of 83 818 women from 11 states in the
Nurses' Health Study. The women were aged 34 to 59 years, had no history of
diabetes, cardiovascular disease, or cancer, completed a validated dietary
questionnaire at baseline in 1980, and were followed up for 16 years.Main Outcome Measure Incident cases of type 2 diabetes.Results We documented 3206 new cases of type 2 diabetes. Nut consumption was
inversely associated with risk of type 2 diabetes after adjustment for age,
body mass index (BMI), family history of diabetes, physical activity, smoking,
alcohol use, and total energy intake. The multivariate relative risks (RRs)
across categories of nut consumption (never/almost never, <once/week, 1-4
times/week, and ≥5 times/week) for a 28-g (1 oz) serving size were 1.0,
0.92 (95% confidence interval [CI], 0.85-1.00), 0.84 (0.95% CI, 0.76-0.93),
and 0.73 (95% CI, 0.60-0.89) (P for trend <.001).
Further adjustment for intakes of dietary fats, cereal fiber, and other dietary
factors did not appreciably change the results. The inverse association persisted
within strata defined by levels of BMI, smoking, alcohol use, and other diabetes
risk factors. Consumption of peanut butter was also inversely associated with
type 2 diabetes. The multivariate RR was 0.79 (95% CI, 0.68-0.91; P for trend <.001) in women consuming peanut butter 5 times or more
a week (equivalent to ≥140 g [5 oz] of peanuts/week) compared with those
who never/almost never ate peanut butter.Conclusions Our findings suggest potential benefits of higher nut and peanut butter
consumption in lowering risk of type 2 diabetes in women. To avoid increasing
caloric intake, regular nut consumption can be recommended as a replacement
for consumption of refined grain products or red or processed meats.
LR: 20061115; JID: 7501160; 0 (Antilipemic Agents); 0 (Cholesterol, HDL); 0 (Cholesterol, LDL); 57-88-5 (Cholesterol); CIN: JAMA. 2001 Nov 21;286(19):2401; author reply 2401-2. PMID: 11712930; CIN: JAMA. 2001 Nov 21;286(19):2400-1; author reply 2401-2. PMID: 11712929; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712928; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712927; CIN: JAMA. 2001 May 16;285(19):2508-9. PMID: 11368705; CIN: JAMA. 2003 Apr 16;289(15):1928; author reply 1929. PMID: 12697793; CIN: JAMA. 2001 Aug 1;286(5):533-5. PMID: 11476650; CIN: JAMA. 2001 Nov 21;286(19):2401-2. PMID: 11712931; ppublish
The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.
Nuts, including peanuts, are now recognized as having the potential to improve the blood lipid profile and, in cohort studies, nut consumption has been associated with a reduced risk of coronary heart disease (CHD). More recently, interest has grown in the potential value of including nuts in the diets of individuals with diabetes. Data from the Nurses Health Study indicates that frequent nut consumption is associated with a reduced risk of developing diabetes and cardiovascular disease. Randomized controlled trials of patients with type 2 diabetes have confirmed the beneficial effects of nuts on blood lipids also seen in nondiabetic subjects, but the trials have not reported improvement in A1c or other glycated proteins. Acute feeding studies, however, have demonstrated the ability of nuts, when eaten with carbohydrate (bread), to depress postprandial glycemia. Furthermore, there was evidence of reduced postprandial oxidative stress associated with nut consumption. In terms of dietary composition, nuts have a good nutritional profile, are high in monounsaturated fatty acids (MUFA) and PUFA, and are good sources of vegetable protein. Incorporation of nuts in the diet may therefore improve the overall nutritional quality of the diet. We conclude that there is justification to consider the inclusion of nuts in the diets of individuals with diabetes in view of their potential to reduce CHD risk, even though their ability to influence overall glycemic control remains to be established.
To determine whether a 2-year lifestyle intervention program improves glucose tolerance and lipid levels in people with persistent impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM).
Screening for IGT and NIDDM was carried out in 1,752 people. Subjects with persistent IGT or NIDDM completed three 2-h oral glucose tolerance tests (OGTTs) before the start of the study and after 2 years. A single OGTT was carried out every 3 months. A 4-day food diary and a 7-day exercise diary were completed, and weight, blood pressure, glycated hemoglobin (HbA1), plasma lipids, and fasting and 2-h serum insulin were measured at baseline and every 3 months. Subjects were encouraged to make dietary changes and increase exercise.
Thirty-two subjects with persistent IGT and 20 subjects with NIDDM were recruited. Women reported significant decreases in total and saturated fat and an increase in carbohydrate, but few subjects reached the recommended intakes. Men achieved smaller dietary changes. There were significant decreases in body mass index, fasting and 2-h plasma glucose, HbA1, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels in both the IGT and NIDDM groups during the study.
Results suggest that a diet and exercise program can result in significant improvements in a range of clinical and metabolic variables in some people with IGT or NIDDM, although the absence of a control group precludes firm conclusions. Screening for IGT in those at high risk for developing NIDDM and offering those with persistent IGT a lifestyle intervention program could help reduce the progression of IGT to NIDDM.
The term Mediterranean diet refers to dietary patterns found in olive-growing areas of the Mediterranean region and described in the 1960s and beyond. There are several variants of the Mediterranean diet, but some common components can be identified: high monounsaturated/saturated fat ratio; ethanol consumption at moderate levels and mainly in the form of wine; high consumption of vegetables, fruits, legumes, and grains; moderate consumption of milk and dairy products, mostly in the form of cheese; and low consumption of meat and meat products. Growing evidence demonstrates that the Mediterranean diet is beneficial to health; the evidence is stronger for coronary heart disease, but it also applies to some forms of cancer. Results from recent investigations provide a strong biomedical foundation for the beneficial effects of the Mediterranean diet.
Adequate fruit and vegetable intake may lower the risk of several chronic diseases, but little is known about how it affects the risk of diabetes mellitus.
We examined whether fruit and vegetable consumption was associated with diabetes incidence in a cohort of U. S. adults aged 25-74 years who were followed for about 20 years.
In the analytic sample of 9,665 participants, 1,018 developed diabetes mellitus. The mean daily intake of fruits and vegetables as well as the percentage of participants consuming five or more fruits and vegetables per day was lower among persons who developed diabetes than among persons who remained free of this disease (P < 0.001). After adjustments for age, race or ethnicity, cigarette smoking, systolic blood pressure, use of antihypertensive medication, serum cholesterol concentration, body mass index, recreational exercise, nonrecreational exercise, and alcohol consumption, the hazard ratio for participants consuming five or more servings of fruits and vegetables per day compared with those consuming none was 0.73 (95% confidence interval (CI), 0.54-0.98) for all participants, 0.54 (95% CI, 0.36-0.81) for women, and 1.09 (95% CI, 0.63-1.87) for men. Adding education to the model changed the hazard ratios to 0.79 (95% CI, 0.59-1.06) for all participants, 0.61 (95% CI, 0.42-0.88) for women, and 1.14 (95% CI, 0.67-1.93) for men.
Fruit and vegetable intake may be inversely associated with diabetes incidence particularly among women. Education may explain partly this association.
Dietary nut intake has been associated with a reduced risk of coronary heart disease mortality; however, the mechanism is unclear. Since components of nuts may have antiarrhythmic properties, part of the benefit may be due to a reduction in sudden cardiac death.
We prospectively assessed whether increasing frequency of nut consumption, as ascertained by an abbreviated food frequency questionnaire at 12 months of follow-up, was associated with a lower risk of sudden cardiac death and other coronary heart disease end points among 21 454 male participants enrolled in the US Physicians' Health Study. Participants were followed up for an average of 17 years.
Dietary nut intake was associated with a significantly reduced risk of sudden cardiac death after controlling for known cardiac risk factors and other dietary habits (P for trend,.01). Compared with men who rarely or never consumed nuts, those who consumed nuts 2 or more times per week had reduced risks of sudden cardiac death (relative risk, 0.53; 95% confidence interval, 0.30-0.92) and total coronary heart disease death (relative risk, 0.70; 95% confidence interval, 0.50-0.98). In contrast, nut intake was not associated with significantly reduced risks of nonsudden coronary heart disease death or nonfatal myocardial infarction.
These prospective data in US male physicians suggest that the inverse association between nut consumption and total coronary heart disease death is primarily due to a reduction in the risk of sudden cardiac death.
The role of antioxidants in the pathogenesis of type 2 diabetes is uncertain.
We evaluated cross-sectional relations of dietary intakes and plasma concentrations of antioxidants with glucose metabolism in a high-risk population.
The subjects were 81 male and 101 female first- and second-degree, nondiabetic relatives of patients with type 2 diabetes. Antioxidant intake data were based on 3-d food records. Subjects taking supplements containing beta-carotene or alpha-tocopherol were excluded. Plasma antioxidant concentrations were measured by HPLC. By using multiple linear regression analysis and adjusting for demographic, anthropometric, and lifestyle covariates, we studied whether dietary and plasma alpha- and beta-carotene, lycopene, and alpha- and gamma-tocopherol were related to fasting and 2-h concentrations of glucose and nonesterified fatty acids during an oral-glucose-tolerance test, to the homeostasis model assessment index of insulin resistance, and to measures of beta cell function (incremental 30-min serum insulin concentration during an oral-glucose-tolerance test and first-phase insulin secretion during an intravenous-glucose-tolerance test).
In men, dietary carotenoids were inversely associated with fasting plasma glucose concentrations (P < 0.05), plasma beta-carotene concentrations were inversely associated with insulin resistance (P = 0.003), and dietary lycopene was directly related to baseline serum concentrations of nonesterified fatty acids (P = 0.034). In women, dietary alpha-tocopherol and plasma beta-carotene concentrations were inversely and directly associated, respectively, with fasting plasma glucose concentrations (P < 0.05). In both sexes, cholesterol-adjusted alpha-tocopherol concentrations were directly associated with 2-h plasma glucose concentrations (P < 0.05).
The data suggest an advantageous association of carotenoids, which are markers of fruit and vegetable intake, with glucose metabolism in men at high risk of type 2 diabetes.
Control of blood glucose levels, blood pressure, and cholesterol levels is proven to reduce the risk of vascular disease among individuals with diabetes mellitus; however, the current state of control of these risk factors among individuals in the United States is uncertain.
To examine 1999-2000 national data on control of risk factors for vascular disease among adults with previously diagnosed diabetes and to assess trends during the past decade.
Review of data from the Third National Health and Nutrition Examination Survey (NHANES III, conducted 1988-1994) and NHANES 1999-2000, cross-sectional surveys of a nationally representative sample of the noninstitutionalized civilian US population. Participants were adults aged 20 years and older with previously diagnosed diabetes who participated in both the interview and examination in either NHANES III (n = 1265) or NHANES 1999-2000 (n = 441).
Levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals.
Compared with NHANES III, participants with previously diagnosed diabetes in NHANES 1999-2000 were similar by age and sex, were less likely to be non-Hispanic white, were diagnosed at an earlier age, had a higher body mass index, and were more likely to use insulin in combination with oral agents. In NHANES 1999-2000, only 37.0% of participants achieved the target goal of HbA1c level less than 7.0% and 37.2% of participants were above the recommended "take action" HbA1c level of greater than 8.0%; these percentages did not change significantly from NHANES III (P =.11 and P =.87, respectively). Only 35.8% of participants achieved the target of systolic blood pressure (SBP) less than 130 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg, and 40.4% had hypertensive blood pressure levels (SBP > or =140 or DBP > or =90 mm Hg). These percentages did not change significantly from NHANES III (P =.10 and P =.56, respectively). Over half (51.8%) of the participants in NHANES 1999-2000 had total cholesterol levels of 200 mg/dL or greater (vs 66.1% in NHANES III; P<.001). In total, only 7.3% (95% confidence interval, 2.8%-11.9%) of adults with diabetes in NHANES 1999-2000 attained recommended goals of HbA1c level less than 7%, blood pressure less than 130/80 mm Hg, and total cholesterol level less than 200 mg/dL (5.18 mmol/L).
Further public health efforts are needed to control risk factors for vascular disease among individuals with diagnosed diabetes.
Evidence has accumulated indicating that oxidative stress may play a key role in the etiology of diabetic complications and the protective effects of antioxidant nutrients are a topic of intense research. The purpose of this study was both to obtain preliminary data on the effect of a diet high in fruit and vegetables on metabolic control and the oxidative status of patients with type 2 onset diabetes, and to identify the most useful biochemical parameters for future research. At the beginning of the study all subjects were asked to follow their usual diet and keep a seven-day food diary. Diabetic patients then received a dietary treatment designed to ensure a daily intake of 700-1000 g of fruit and vegetables; no dietary advice was given to controls. Dietary antioxidants, redox status markers, and parameters of metabolic control were measured in plasma and erythrocytes before and after the diet. Before following the diet, diabetic patients had lower levels of ascorbic acid, beta-carotene, and alpha-tocopherol/cholesterol ratio than controls. After the diet these parameters increased and there was also a reduction in total antioxidant capacity, uric acid, and malondialdehyde and a rise in reduced glutathione accompanied by a reduction in body mass index and cholesterol. In conclusion, a high consumption of fruit and vegetables by diabetic patients not receiving pharmacological treatment, seems to produce an improvement in some redox status parameters.
The identification of factors contributing to residual cardiovascular risk is important to improve the management of patients with established coronary artery disease (CAD). This study was conducted to assess the predictive value of atherogenic dyslipidemia (defined as high triglycerides and low high-density lipoprotein [HDL] cholesterol) for long-term outcomes in patients with CAD. In 284 patients (238 men, 46 women; mean age at baseline 59.2 +/- 8.9 years) with coronary stenosis (>50% in > or =1 vessel), the presence of atherogenic dyslipidemia was prospectively associated with the incidence of major adverse cardiovascular events (MACEs) during a median follow-up of 7.8 years. MACEs were defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, the recurrence of angina, and revascularization procedures. MACEs were observed in 111 (39.1%) patients with CAD. MACEs occurred more frequently in patients with atherogenic dyslipidemia (50.9%) than in those with isolated low HDL cholesterol or high triglycerides (33.0%) or with normal HDL cholesterol and triglyceride concentrations (29.2%) (p <0.01 for trend). Kaplan-Meier survival analysis showed a decrease in event-free survival in patients with compared with those without atherogenic dyslipidemia (log-rank p = 0.006). Patients with atherogenic dyslipidemia presented with increased plasma concentrations of remnants, denser low-density lipoprotein, more atherogenic HDL particles, and insulin-resistant status. After adjustment for potential confounding variables, the magnitude of increased risk associated with atherogenic dyslipidemia was 1.58 (95% confidence interval 1.12 to 2.21, p = 0.008). In conclusion, these data provide evidence that atherogenic dyslipidemia is an independent predictor of cardiovascular risk in patients with CAD, even stronger than isolated high triglycerides or low HDL cholesterol.
Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with Type 2 Diabetes
- T Y Li
- A M Brennan
- N M Weddick
- C Mantzoros
- N Rifai
- F B Hu
Li, T.Y., Brennan, A.M., Weddick, N.M., Mantzoros, C.,
Rifai, N. and Hu, F.B. (2009) Regular consumption of
nuts is associated with a lower risk of cardiovascular disease in women with Type 2 Diabetes. Journal of Nutrition, 139, 1333-1338. doi:10.3945/jn.108.103622