Role of low-carbohydrate diet in type 1 diabetes / 中华内分泌代谢杂志

Low-carbohydrate diet is becoming popular recently. It requires carbohydrate intake lower than 130 g/d(or <26% of total energy intake) while fat and protein intake are not defined. Low-carbohydrate diet contributes to better glycemic control in patients with type 1 diabetes: lowering HbA 1C and glycemic variability, and improving time in range(TIR). Low-carbohydrate diet reduces insulin dosage in type 1 diabetic patients and does not increase the risks of hypoglycemia and diabetic ketoacidosis. This review summarized the research evidence of low-carbohydrate diet to explore the role and safety in disease management.

Effects of low-carbohydrate diet versus low-fat diet on non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials / 中华临床营养杂志

Objective:To compare the effects of low-carbohydrate diet (LCD) and low-fat diet (LFD) in the lifestyle intervention of non-alcoholic fatty liver disease (NAFLD) through a meta-analysis of randomized controlled trials.Methods:PubMed, Embase, Web of Science, Cochrane, CNKI and Wanfang were searched for relevant studies and study references and conference proceedings were manually searched. Two authors independently screened the items retrieved, extracted the data and assessed the quality of included studies. Meta-analysis was performed using R4.4.1 and RevMan5.4.1. Data were pooled using random-effects models and potential sources of heterogeneity were investigated using stratified meta-analysis. Funnel plots and Peters' test were used to assess publication bias.Results:Nine studies with a total of 510 participants met our inclusion criteria. Meta-analysis results showed that LCD and LFD interventions had similar effects on the reduction of intrahepatic lipid content in NAFLD patients ( SMD: -0.31,95% CI: 0.97 to 0.35, P = 0.36). There were no significant differences in changes of alanine aminotransferase ( SMD: -0.25, 95%CI: 0.91 to 0.41, P = 0.45) and aspartate aminotransferase ( SMD: -0.45, 95%CI: 1.63 to 0.72, P = 0.45) levels, either. Subgroup analyses implied that the duration of different interventions might be the cause of heterogeneity across studies. No significant publication bias was showed in the meta-analysis. Conclusion:Current evidence from randomized controlled studies does not support the superiority of LCD over LFD in the treatment of NAFLD.

Association between dietary patterns during pregnancy and gestational diabetes mellitus / 预防医学

Objective@#To explore the association between dietary patterns during pregnancy and the development of gestational diabetes mellitus (GDM), so as to provide the guidance of diet balance and GDM prevention for pregnant women.@*Methods@#Pregnant women who underwent prenatal examination at the First Affiliated Hospital of Xinjiang Medical University from December 2021 to July 2022 were selected as the subjects. The oral glucose tolerance test (OGTT) was employed at 24 to 28 weeks of gestation to diagnose GDM. The questionnaire of "The Survey on Nutrition and Health of Pregnant Women in China" was used to collect general information, food intake frequency and amount during a month before OGTT. Dietary patterns were determined by factor analysis, and the association between dietary patterns and the development of GDM was identified using a multivariable logistic regression model. @*Results@#Totally 449 pregnant women were included, with a median (interquartile range) age of 31.00 (5.00) years and a median (interquartile range) gestational age of 35.00 (3.00) weeks. There were 7 dietary patterns named potato-cereal pattern, poultry-meat-dessert pattern, milk-egg-aquatic product pattern, mushroom-vegetable-offal pattern, fruit-bean pattern, pickle-wheaten food pattern, and beverage-nut pattern according to the food types with high factor loads. There were 89 cases diagnosed as GDM, with a prevalence rate of 19.82%. Multivariable logistic regression analysis showed that the development of GDM was associated with the poultry-meat-dessert pattern (OR=0.242, 95%CI: 0.086-0.678) and the fruit-bean pattern (OR=0.093, 95%CI: 0.025-0.342), compared with the potato-cereal pattern. @*Conclusion@#Compared to the potato-cereal pattern, the poultry-meat-dessert pattern and the fruit-bean pattern may reduce the risk of GDM. Key words： gestational diabetes mellitus dietary pattern pregnant woman low carbohydrate diet

A dietary intervention study on the effects of different dietary structures on postprandial drowsiness / 上海预防医学

ObjectiveTo find the type of dietary structure that can effectively prevent or improve postprandial sleepiness in the Chinese population， and provide scientific basis and solutions for improving or avoiding postprandial sleepiness. MethodsIn this study， a six-day dietary intervention trial was conducted for 20 volunteers on four different diets （normal diet， high-fat diet， high-carbohydrate diet and healthy diet）. ResultsThe results showed that sleepiness increased after all four types of meals， but decreased after 30 minutes in the healthy balanced diet group； meanwhile， it increased for 60 minutes before it declined in the high-carbohydrate， high-fat， and normal diet （control） group. At 60 minutes after meal， the drowsiness of the healthy balanced diet group was the weakest， and that of the high carbohydrate diet groups was the strongest， while that of the normal diet group and the high fat diet group was intermediate （P<0.000 1）. Postprandial sleepiness was positively correlated with intake of carbohydrate and manganese， and negatively correlated with intake of protein， some mineral elements and vitamins. ConclusionThese results suggest that controlling carbohydrate and fat intake and appropriately increasing the intake of mineral elements and vitamins in a healthy and balanced diet can significantly improve and prevent postprandial sleepiness.

Research progress on low carbohydrate diet in the control of overweight and obesity / 预防医学

@#Overweight and obesity are main risk factors for chronic metabolic diseases, and are strongly associated with the increased risk of premature death. Low carbohydrate diet (LCD) has been proven to effectively control body weight and fat mass in overweight and obese patients by short-term (≤6 months) dietary intervention studies. The mechanisms include regulation of energy metabolism, anti-inflammatory, antioxidant, alteration in expression of lipid metabolic-related genes and modulation of intestinal flora. However, the conclusions are inconsistent on whether LCD can cause durable weight loss and reduce the risk of overweight and obesity. This review summarizes the current research progress on the mechanisms, epidemiological studies, intervention studies and potential risks of LCD in controlling overweight and obesity, providing a reference for the future research and clinical application.

Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial / 医学前沿

Lifestyle interventions, including dietary adjustments and exercise, are important for obesity management. This study enrolled adults with overweight or obesity to explore whether either low-carbohydrate diet (LCD) or exercise is more effective in metabolism improvement. Forty-five eligible subjects were randomly divided into an LCD group (n = 22) and an exercise group (EX, n = 23). The subjects either adopted LCD (carbohydrate intake < 50 g/day) or performed moderate-to-vigorous exercise (⩾ 30 min/day) for 3 weeks. After the interventions, LCD led to a larger weight loss than EX ( - 3.56 ± 0.37 kg vs. - 1.24 ± 0.39 kg, P < 0.001), as well as a larger reduction in fat mass ( - 2.10 ± 0.18 kg vs. - 1.25 ± 0.24 kg, P = 0.007) and waist circumference ( - 5.25 ± 0.52 cm vs. - 3.45 ± 0.38 cm, P = 0.008). Both interventions reduced visceral and subcutaneous fat and improved liver steatosis and insulin resistance. Triglycerides decreased in both two groups, whereas low-density lipoprotein cholesterol increased in the LCD group but decreased in the EX group. Various glycemic parameters, including serum glycated albumin, mean sensor glucose, coefficient of variability (CV), and largest amplitude of glycemic excursions, substantially declined in the LCD group. Only CV slightly decreased after exercise. This pilot study suggested that the effects of LCD and exercise are similar in alleviating liver steatosis and insulin resistance. Compared with exercise, LCD might be more efficient for weight loss and glucose homeostasis in people with obesity.

Dietary Interventions for Weight Loss

@#Obesity is a complex and chronic condition that requires continuing care. A variety of diet plans are available for use in the clinical setting. Exactly what type of diet may be most beneficial remains controversial. Numerous clinical trials have been carried out over the years comparing an array of dietary interventions for weight loss, including calorie restriction diets, altered macronutrient composition diets or specific dietary patterns. This paper will provide an overview of the evidence-based dietary interventions for clinical practice.

Efeitos da restrição de carboidratos no manejo do diabetes mellitus: revisão de literatura científica / Effects of carbohydrate-restricted diets in the management of diabetes mellitus: review of scientific literature

O objetivo do presente estudo foi avaliar, por meio de uma revisão da literatura, evidências da utilização de dietas com restrição de carboidratos no manejo do diabetes mellitus (DM). As buscas eletrônicas e manuais foram até abril de 2019, e incluíram trabalhos publicados a partir de 2008. Foram excluídos estudos de pesquisas in vitro e em animais, revisões de literatura, livros, monografias, dissertações, teses, estudos de caso e relatos de caso. Os artigos remanescentes foram submetidos à análise de sua qualidade metodológica pela Escala JADAD cinco pontos. Um total de 19 estudos randomizados e com qualidade média de três pontos foram selecionados e analisados quanto aos tipos de dieta utilizadas, adesão, tipo de DM, tempo de intervenção, consumo reportado de carboidratos e resultados observados para os grupos controle e intervenção. Dentre os parâmetros escolhidos para mensurar os possíveis efeitos das dietas, destacaram-se alteração de peso e IMC, Hb1Ac, variabilidade ou controle glicêmico, perfil lipídico e alteração nas doses de insulina ou medicação utilizadas. Em quatro estudos não foram observadas vantagens significativas de uma dieta restrita em carboidratos, e 15 trabalhos relataram melhoras em um ou mais parâmetros. Tais resultados podem representar uma grande vantagem na adoção desta estratégia alimentar no manejo do DM e na prevenção de complicações da doença. Contudo, existem limitações nos estudos, que precisam ter suas hipóteses verificadas no longo prazo, e pesquisas adicionais devem ser realizadas para configurar uma estratégia oficial no controle do DM. (AU)

This study aimed to evaluate, through a literature review, evidence of the use of diets with carbohydrate restriction in the management of diabetes mellitus (DM). Electronic and manual searches were conducted until April 2019, including works published from 2008 onwards. Studies on in vitro and animal research, literature reviews, books, monographs, dissertations, theses, case studies and case reports were excluded. The remaining articles were submitted to analysis of their methodological quality by the five-point JADAD Scale. Nineteen randomized studies with an average quality of three points were selected and analyzed regarding the types of diet used, adherence, type of DM, time of intervention, reported consumption of carbohydrates and results observed for the control and intervention group. Among the parameters chosen to measure the possible effects of diets, weight and BMI changes, Hb1Ac, variability or glycemic control, lipid profile and changes in insulin doses or medication used stood out. In four studies, no significant advantages were observed from a carbohydraterestricted diet, and 15 studies reported improvements in one or more parameters. Such results can represent a great advantage in adopting this dietary strategy in the management of DM and in preventing complications of the disease. However, there are limitations in the studies, which need to have their hypotheses verified in the long term, and additional research must be carried out to configure an official strategy in the control of DM. (AU)

Effects of low-carbohydrate diet on body weight and glycolipid metabolism in normal rats and obese rats / 上海交通大学学报（医学版）

Objective:To explore the effects of low-carbohydrate diet (LCD) on body weight and glycolipid metabolism in obese rats and normal weight rats. Methods:Eighty male normal weight Sprague-Dawley rats were divided randomly into three groups, i.e., normal control diet group (CD group, n=10), LCD group (n=10) and traditional high-fat diet group (HFD group, n=60). After eight weeks, 30 obese rats were selected from HFD group. Then the obese rats were divided randomly into three groups. The feed of two groups was changed from HFD to LCD (HFD-LCD group) or CD (HFD-CD group), and the rest group was fed with HFD continuously. The experiment lasted for another eight weeks. The feed of CD group and LCD group remained unchanged. The measurement indicators included body weight, feed intake, visceral fat, and blood biochemical indexes (fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and serum β-hydroxybutyrate concentration). Results:In normal rats, from the 6th week, the body weight of LCD group was significantly lower than that of HFD group (P0.05). But at the end of the 16th week, total cholesterol of LCD group was significantly higher than that of CD group (P=0.001) and high-density lipoprotein cholesterol was lower (P=0.021). In the obese rats, at the end of the 16th week, the body weight of HFD-LCD group was significantly lower than that of HFD group and HFD-CD group (P0.05). In the obese rats, compared with HFD group, the intervention of HFD-LCD (β=-88.56, P=0.000) and HFD-CD (β=-39.08, P=0.007) resulted in the decrease of body weight. β-hydroxybutyrate level was helpful to weight loss in the range of 1-2 times of HFD-CD group (β=-34.92, P=0.006). Conclusion:LCD may have different effects on body weight and lipid metabolism between normal weight rats and obese rats, LCD has no weight loss effect on the normal weight rats, but can increase total cholesterol; however, in obese rats LCD can reduce weight and improve the metabolism of glycolipid.

Impact of low-carbohydrate diet intervention on weight rebound in obese type 2 diabetes mellitus patients who underwent metabolic surgery / 中华内分泌外科杂志

Objective To observe the improvement of weight rebound in obese type 2 diabetes mellitus patients who underwent metabolic surgery after low-carbohydrate diet intervention.Methods 38 patients with obese type 2 diabetes mellitus who had underwent metabolic surgery in Changhai Hospital from Jan.2010 to Nov.2015,were randomly divided into two groups and intervened by low carbohydrate (LC) diet or diabetes mellitus (DM) diet.The blood glucose and body weight of the two groups were compared and analyzed.Results There was no statistical difference in fasting blood glucose,HbA1c,fasting C-peptide,body weight,waistline and BMI value(t=0.34,S=1.00-32.5,P＞0.05)in diabetes mellitus diet intervention group;while there was significant statistical difference in fasting blood glucose,body weight,waistline and BMI (t=2.38,S=17-24.5,P＜0.05)in low-carbo hydrate diet intervention group.There was significant differences in body weight difference (Z=2.31,P＜0.05),BMI difference(Z=2.36,P＜0.05),and weight rebound rate(P＜0.05) between the two groups,with the low carbohydrate diet intervention group displaying advantages.Conclusions Low carbohydrate diet intervention can improve fasting blood glucose,obesity indexes in obese type 2 diabetes mellitus patients who underwent metabolic surgery.Compared with diabetes mellitus diet intervention,low carbohydrate diet intervention can more greatly improve weight,weight rebound rate,rebound scale and have more advantages for maintaining the operation effects.

Effects of low-carbohydrate diet and resistance exercise training on physical characteristics and concentrations of plasma metabolites and hormones / 体力科学

We clarify the effect of combination of low-carbohydrate diet and resistance exercise training on physical characteristics and plasma concentrations of metabolites and hormones in humans. Intervention of low-carbohydrate diet and resistance exercise training were performed on 7 healthy men and 3 women (age 39.6 ± 7.0 year; BMI 25.1 ± 3.6 kg/m2) for 8 - 12 weeks. Physical characteristics and 106 test items including and blood concentrations of metabolites and hormones were measured before and after the intervention. The effects of intervention were analyzed by a paired t-test, in which multiple testing was corrected by the method of Storey (significant variation q <0.1). In both men and women, carbohydrate and energy intake per day were low, and protein intake per day was almost the same as the recommended dietary allowance. Because carbohydrate intake were limited (174 kcal), resulting in reduction of total energy (1186 kcal). After the intervention, body weight, BMI (Body Mass Index), fat mass, body fat, muscle mass and body water content significantly decreased, while muscle mass per body mass significantly increased. Glycine, 3-methyl histidine, inorganic phosphorous, urea nitrogen, urea nitrogen per creatinine, were significantly increased, while HbA1c, white blood cell count, β-aminoisobutyric acid, adrenalin, free T4, blood ammonia, γGTP, cholinesterase, and leptin were decreased.

Efeito da ingestão de sucos de laranja, variedades Moro e Pera, sobre o estresse oxidativo de camundongos saudáveis e com resistência à insulina induzida por dieta hiperlipídica e hiperglicídica / Effect of orange juices intake, cv. Moro and Pera, in oxidative stress of healthy and insulin resistant mice induced by high-fat and high carbohydrate diet

As laranjas, das variedades Moro e Pera, são conhecidas por sua composição de flavonoides, em especial, a subclasse flavanona, além das antocianinas na laranja Moro. Ambas as subclasses apresentam capacidade antioxidante, anti-inflamatória e hipolipidêmica, podendo atenuar as alterações metabólicas decorrentes do consumo de uma dieta hiperlipídica e hiperglicídica. Assim, o objetivo deste trabalho foi avaliar o efeito da ingestão de sucos de laranja, das variedades Moro e Pera, sobre os parâmetros oxidativos de camundongos saudáveis e com resistência à insulina, esta última induzida por uma dieta hiperlipídica e hiperglicídica. Camundongos machos, da linhagem C57Bl/6, foram distribuídos em seis grupos, três grupos receberam uma dieta controle e três grupos uma dieta hiperlipídica e hiperglicídica, durante 12 semanas. Concomitante às dietas, dois grupos de cada tratamento receberam suco de laranja Pera e o outro suco de laranja Moro em substituição à água de beber. Na 10ª e 11ª semana, foram realizados o ipITT e o ipGTT. No final do tratamento, foram coletados o sangue, fígado e coração. As flavanonas majoritárias caracterizadas em ambos os sucos foram a narirutina e hesperitina. Além das flavanonas, a cianidina 3-glucosídeo foi a antocianina majoritária no suco de laranja Moro. O consumo de dieta hiperlipídica e hiperglicídica acarretou em ganho de peso e adiposidade corporal, além de alterações metabólicas, como intolerância à insulina e a glicose, com o desenvolvimento da resistência insulínica, de acordo com o índice de HOMA-IR. Contudo, o suco de laranja, da variedade Pera, foi capaz de atenuar os parâmetros metabólicos como a sensibilidade à insulina, além da adiposidade e peso corporal. No tecido hepático, foi observado redução da peroxidação lipídica e da expressão proteica da enzima catalase nos animais tratados com dieta hiperlipídica e hiperglicídica, quando comparado à dieta controle; e aumento na atividade de superóxido dismutase no tecido cardíaco. Não se observou diferenças significativas nas demais enzimas antioxidantes, bem como no dano oxidativo ao DNA avaliado pelo ensaio do cometa. No tecido cardíaco, foi observado aumento da peroxidação lipídica e de glutationa peroxidase nos animais tratados com dieta controle mais suco de laranja Pera e suco de laranja Moro, respectivamente. Assim, a dieta hiperlipídica e hiperglicídica não acarretou em estresse oxidativo e, de maneira geral, os sucos não alteraram este quadro. Como conclusão, o suco de laranja Pera, atenuou as alterações metabólicas relacionadas ao metabolismo de carboidratos, mas não alterou os parâmetros de estresse oxidativo

Oranges, Moro and Pera varieties, are known for their composition of flavonoids, especially the subclass flavanone, beyond the anthocyanins in the Moro variety. Both subclasses present antioxidant, anti-inflammatory and hypolipidemic capacities, and may attenuate the metabolic alterations due to the consumption of a hyperlipidemic and hyperglycemic diet. Thus, the objective of this study was to evaluate the effect of orange juice intake, Moro and Pera varieties, on the oxidative parameters of insulin resistant mice induced by a high-fat and high carbohydrate diet. Mice (C57Bl/6 strain) were distributed in six groups: three groups received a control diet and three groups received a high-fat and high carbohydrate diet during 12 weeks. Concomitantly to the diets, two groups of each treatment received Pera and Moro orange juice in replacement of water. The ipITT and ipGTT were done at 11 e 12 week. At the ending of the treatment, blood, liver and heart were collected. The flavanones narirutine and hesperitin were the major flavanones in both juices. In addition, cyanidin 3-glycoside was the major anthocyanin in Moro orange juice. The consumption of high-fat and high carbohydrate diet resulted in weight gain and body adiposity, and metabolic alterations, such as decrease in insulin tolerance and development of insulin resistance, according to the HOMA-IR index. However, orange juice of the Pera variety was able to attenuate metabolic parameters increasing insulin sensitivity and decreasing adiposity and body weight. In hepatic tissue, decrease on lipid peroxidation and protein expression of the catalase were observed in animals treated with high-fat and high carbohydrate diet when compared to the control diet; and an increase activity of the superoxide dismutase in cardiac tissue. No significant differences were observed in the other antioxidant enzymes, as well as in the oxidative DNA damage assessed by the comet assay. In cardiac tissue, lipid peroxidation and glutathione peroxidase were increased in animals treated with control diet plus Pera and Moro orange juice, respectively. Thus, the high-fat and high carbohydrate diet did not promote oxidative stress and, in general, the juices did not alter oxidative parameters. In conclusion, Pera orange juice attenuate the metabolic alterations related to the metabolism of carbohydrates, but not alter oxidative stress parameters

Effects of Low-carbohydrate and High-fat Diet Supplemented with Ketogenic Drink on Cognitive Function and Physical Performance in the Elderly at High Risk for Dementia / 대한지역사회영양학회지

OBJECTIVES: Reduced glucose utilization in the main parts of the brain involved in memory is a major cause of Alzheimer's disease, in which ketone bodies are used as the only and effective alternative energy source of glucose. This study examined the effects of a low-carbohydrate and high-fat (LCHF) diet supplemented with a ketogenic nutrition drink on cognitive function and physical activity in the elderly at high risk for dementia.METHODS: The participants of this study were 28 healthy elderly aged 60-91 years showing a high risk factor of dementia or whose Korean Mini-Mental State Examination (K-MMSE) score was less than 24 points. Over 3 weeks, the case group was given an LCHF diet with nutrition drinks consisting of a ketone/non-ketone ratio of 1.73:1, whereas the control group consumed well-balanced nutrition drinks while maintaining a normal diet. After 3 weeks, K-MMSE, body composition, urine ketone bodies, and physical ability were all evaluated.RESULTS: Urine ketone bodies of all case group subjects were positive, and K-MMSE score was significantly elevated in the case group only (p=0.021). Weight and BMI were elevated in the control group only (p<0.05). Grip strength was elevated in all subjects (p<0.01), and measurements of gait speed and one leg balance were improved only in the case group (p<0.05).CONCLUSIONS: We suggest that adherence to the LCHF diet supplemented with a ketogenic drink could possibly influence cognitive and physical function in the elderly with a high risk factor for dementia. Further, we confirmed the applicability of this dietary intervention in the elderly based on its lack of any side effects or changes in nutritional status.

Blood Sugar Control and Low-Carbohydrate High-Fat Diet / 임상당뇨병

Diabetes patients and pre-diabetic patients are increasing worldwide. Type 2 diabetes starts with insulin resistance, and the long-term habit of stimulating insulin secretions causes insulin resistance and accumulates body fat to develop obesity and non-alcoholic fatty liver into diabetes. It also causes a variety of chronic diseases such as high blood pressure, polycystic ovary diseases, cancer and dementia. Insulin resistance is caused by an unbalanced lifestyle, and among other factors, the balance of the macronutrient is a very important factor. Koreans are characterized by high carbohydrate intake. Given the increasing prevalence of diabetes and the characteristics of Korean physical and eating habits, a more effective balance of diet education is needed. Therefore, it is very important for clinical dietitian to understand the carbohydrate and fat metabolism caused by insulin, and the concept of balanced diet for blood sugar control needs to be shifted from low-fat high-carbohydrate diet to low-carbohydrate high-fat diet.

The role of specific carbohydrate diet in pediatric inflammatory bowel disease / 中华实用儿科临床杂志

Nutrition treatment plays an important role in the treatment and follow - up management of pediatric inflammatory bowel disease (IBD). The theory of specific carbohydrate diet(SCD),first presented in 1951,is a strict diet limitation focused on the sorts of carbohydrate:monosaccharide is the only kind of carbohydrate that is permitted, disaccharide and most complex carbohydrate like polysaccharide and starch are eliminated,intake of protein and fat is not limited,and processed meat and other processed food are cut down appropriately. Currently,mechanism of SCD diet′s treatment efficacy on IBD is not elucidated clearly. The hypothesis of this theory is:(1)Bowel inflammation of IBD patients leads to the decline of disaccharidase′s function,thus glucose,galactose and fructose are the only kinds of car-bohydrate that can be absorbed. (2)Occurrence of IBD is related to the disorder of bowel bacteria. The change of diet may regulate the bowel bacteria,which may be helpful to the symptoms of IBD. Retrospective case studies and case re-ports preliminarily indicated the efficacy of SCD in improving pediatric IBD symptoms and maintenance of clinical re-mission. However,high level evidence is still required to support the hypothesis. The limitation of carbohydrate by SCD would be the clue for the diet of pediatric IBD patients. However,the menu should be formulated according to the eating habits and the available food,as well as the requirement of the growth and development in children.

High-Carbohydrate Diets and Food Patterns and Their Associations with Metabolic Disease in the Korean Population

PURPOSE: Although an Asian diet is typically high in carbohydrate and low in fat, there has been a steady increase in the rate of cardiometabolic disease in Asian countries over the past decade. We evaluated food patterns of a high-carbohydrate diet and examined their associations with metabolic disease. MATERIALS AND METHODS: Using data from the 2013–2015 Korean National Health and Nutrition Examination Survey, we included a total of 13106 subjects aged 20 years or older in this study. Diet was divided into seven groups according to the percentage of energy from carbohydrates. Food patterns were evaluated as individual servings per food group. Multivariate logistic regression was conducted to estimate odds ratios (OR) for metabolic disease. RESULTS: The proportions of men and women exceeding the recommended range of carbohydrate intake were 58.0% and 60.0%, respectively. A higher carbohydrate diet was associated with intake of low energy and saturated fats, with more grains and fruit, but less meat, fish, egg, bean (MFEB), and dairy consumption. Carbohydrate intake decreased by 3.0–3.4% per serving of MFEB and milk. In men, the highest carbohydrate group showed an OR of 1.35 [95% confidence interval (CI), 0.91 to 1.99] for metabolic syndrome, although this failed to show statistical significance. In women, the highest carbohydrate group had an OR of 1.38 (95% CI, 1.06 to 1.80) for a reduced level of high-density lipoprotein cholesterol. CONCLUSION: This study suggests that a very-high-carbohydrate diet for the Korean population is attributable to lower consumption of MFEB and dairy products and is associated with several metabolic risk factors. The appropriate distribution of macronutrients for the prevention and management of metabolic disease should be explored.

Efectividad del conteo de hidratos de carbono para el control metabólico de niños con diabetes mellitus tipo 1: revisión sistemática / Effectiveness of carbohydrate counting for metabolic control of children with type 1 diabetes mellitus: Systematic review

El conteo de hidratos de carbono como intervención terapéutica en pacientes con diabetes mellitus tipo 1 (DM1) desempeña un importante papel para obtener el nivel óptimo de glucemia posprandial, que se demuestra con los correctos niveles de hemoglobina glucosilada (HbA1c). Sin embargo, las recomendaciones para niños con DM1 se basan en revisiones narrativas de la evidencia disponible. Nuestro objetivo fue evaluar mediante una revisión sistemática la eficacia del conteo de hidratos de carbono sobre el control metabólico de niños con DM1. Se realizó la búsqueda en Pubmed, Google Académico y el registro de ensayos controlados de la colaboración Cochrane, CENTRAL. Se desarrolló una búsqueda desde enero del 2000 hasta septiembre del 2015. Se identificaron 5 ensayos elegibles, de 261 estudios potencialmente relevantes; 2 ensayos clínicos fueron incluidos. La calidad de los estudios en general no fue adecuada. Los 2 estudios incluidos concuerdan en la reducción de los niveles de HbA1c con la técnica del recuento de hidratos de carbono, como medida de control metabólico. En general, los demás parámetros medidos mostraron resultados contradictorios sin diferencias significativas, a excepción de la lipoproteína de alta densidad en uno de los estudios, que fue más alta en el grupo intervención. Aunque el conteo de hidratos de carbono es una técnica prometedora en el control metabólico para niños con DM1, la evidencia encontrada en esta revisión no es suficiente para recomendarla.

Carbohydrate counting as a therapeutic intervention in patients with Diabetes Mellitus type 1 (DM1) plays an important role in obtaining an optimal postprandial glucose level, which is demonstrated with the correct levels of glycosylated haemoglobin (HbA1c). However, recommendations for children with DM1 are based on narrative reviews of the available evidence. Our objective was to evaluate the effectiveness of carbohydrate counting on metabolic control of children with DM1. This study was a systematic review. The search was conducted in PubMed, Google Scholar, and controlled trials of the Cochrane collaboration (CENTRAL), published from January 2000 to September 2015. Five eligible trials out of 261 potentially relevant studies were identified, which include two trials. The quality of the studies was generally poor. The two studies included agreed on the positive impact of carbohydrate counting in reducing HbA1c levels as a measure of metabolic control. In general, the other parameters measured showed conflicting results with no significant differences, except for the high density lipoprotein in one study, higher in the intervention group. Although carbohydrate counting is a promising technique for metabolic control in children with type 1 diabetes, the evidence found in this review is not enough to recommend it.

Efficacy of different duration of low-carbohydrate diet intervention on glycosylated hemoglobin in ;type 2 diabetes patients：a Meta analysis / 中国实用护理杂志

Objective To evaluate the efficacy of different duration of low-carbohydrate diet (LCD) intervention on glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients. Methods Randomized controlled trials (RCTs) of LCD intervention in T2DM patients were collected in the databases such as MEDLINE, PubMed, OVID, China National Knowledge Infrastructure, China Scientific Journal Database by VIP, Wanfang database, et al.Data were analyzed by RevMan 5.3 version. Results Eight RCTs were included. The results of Meta-analysis indicated that the effects of lowering HbA1c by LCD intervention for three (Z=2.28, P<0.05) and six months (Z=14.99, P<0.01) were better than other diabetes diets, but there was no significant statistical difference between one (Z=0.65, P=0.51) and two years (Z=1.62, P=0.10). Conclusions Hypoglycemic effect of short-term LCD was better than other diabetes diets, but long-term effect was similar between them. LCD was a therapeutic diet suitable for T2DM patients.

Effects of a Low-carbohydrate, High-fat Diet

It appears that a low-carbohydrate high-fat diet is more effective in weight loss than conventional low-fat diets for short-term periods of approximately 6 months. However, for long-term periods of about 1 year or more, the effects of a low-carbohydrate diet are reduced and the difference in weight loss between low-carbohydrate and low-fat diets disappears. A low-carbohydrate diet can lead to low triglycerides and high HDL cholesterol, and may even lead to an increase in LDL cholesterol. The effects of a low-carbohydrate diet on glycemic control are not clear, and there is no effect on blood pressure. A low-carbohydrate diet may lead to cardiovascular disease, and can increase cardiovascular and all-cause mortality.

Effects of very-low-carbohydrate diet on body and function index in overweight or obese subjects / 中华全科医师杂志

Objective To assess the effects of very-low-carbohydrate diet (VLCD) on body function and body composition in obese or overweight subjects.Methods Thirty five overweight or obese subjects were enrolled in the study,including 10 males and 25 females with a mean age of (43 ± 10) years.All subjects received VLCD intervention and 30 min moderate-intensity exercise daily for 3 months.The height,weight,blood pressure,heart rate,blood lipids and body composition were measured before and 1,3 months after intervention.ANOVA or nonparametric test was used for statistical analysis.Results After 3-month intervention,compared to baseline,the average body weight was decreased by 17.2 and 5.9 kg,waist circumference was decreased by 15.1 and 4.5 cm,BMI index decreased by 4.3 and 3.4 kg/cm2,waist to hip ratio was decreased by 0.1 and 0.1,for males and females,respectively (F =11.65 and 5.28,8.36 and 3.73,9.28 and 12.06,3.32 and 19.43,all P ＜ 0.05).Compared with the baseline,the systolic pressure was decreased by 12.2 and 9.2 mmHg(1 mmHg =0.133 kPa),triglycerides were decreased by 0.25 and 0.42 mmol/L,fasting blood glucose was decreased by 0.13 and 0.43 mmol/L after 1 month and 3 months of intervention,respectively.The proportion of patients with fatty liver was decreased from 69％ (24/35) at baseline to 49％ (17/35) at 1 month after intervention and further to 6％ (2/32) at 3 months after intervention (x2 =27.52,P ＜ 0.05).Conclusion The results indicate that VLCD can effectively control the body weight,and significantly improve the state of body function disorder.