Attitudes and barriers to dietary advice aimed at reducing risk of type 2 diabetes in first-degree relatives of patients with type 2 diabetes.

OBJECTIVE: To evaluate the attitudes to and adoption of dietary advice in nondiabetic first-degree relatives of patients with type 2 diabetes and to examine barriers to adherence. DESIGN: One-year controlled intervention study, where treatment group (n=73) received lifestyle education. Attitudes towards dietary advice, change in dietary habits and importance of potential barriers to adherence were evaluated by questionnaires. Nondiabetic relatives (25-55 years; males and females) of individuals with type 2 diabetes were recruited. Education was based on current nutrition recommendations and aimed at improving dietary fat quality, increasing intake of fruit and vegetables, with additional advice to reduce dietary glycaemic index (GI). MAIN OUTCOME MEASURES: Attitudes and importance of barriers were classified by the intervened subjects into four categories ranging from 'No problem' to 'Yes, definitely a problem'. Dietary adherence was monitored by food frequency questionnaire at baseline and after 1 year. RESULTS: Participants were generally in favour of advice aimed at improving dietary fat quality. Attitudes towards advice to reduce GI varied widely. Food selection changed in accordance with predefined dietary goals. 'Forgetfulness', 'low availability in lunch restaurant' and 'lack of ideas for cooking' were barriers to adherence. CONCLUSIONS: Dietary advice aimed at reducing risk of type 2 diabetes was generally positively received and adopted in subjects with heredity for the disease. The most prevalent barriers reported are potentially modifiable.

Suppression of nocturnal fatty acid concentrations by bedtime carbohydrate supplement in type 2 diabetes: effects on insulin sensitivity, lipids, and glycemic control.

BACKGROUND: Bedtime ingestion of slow-release carbohydrates leads to sustained nocturnal fatty acid suppression and improved glucose tolerance in type 2 diabetic patients. OBJECTIVE: This study assessed the effects of 2 different doses of bedtime carbohydrate supplement (BCS) on morning glycemic control and glycated hemoglobin (Hb A(1c)) in type 2 diabetic patients. In addition, the effects of the high-dose BCS on insulin sensitivity and postprandial glucose and triacylglycerol concentrations were assessed. DESIGN: Two BCS doses were studied separately in 7-wk randomized, placebo-controlled, double-blind studies with either a parallel (low-dose BCS; n = 24 patients) or crossover (high-dose BCS; n = 14 patients) design. The effects of the low and high doses (0.30 and 0.55 g uncooked cornstarch/kg body wt, respectively) were compared with those of a starch-free placebo. RESULTS: Compared with the starch-free placebo, the high-dose BCS ( approximately 45 g) produced enhanced nocturnal glucose (P < 0.01) and insulin (P < 0.01) concentrations as well as a 32% suppression of fatty acid concentrations (P < 0.01). Moreover, glucose tolerance (P < 0.05) and C-peptide response (P < 0.05) improved after breakfast the next morning. The low-dose BCS ( approximately 25 g) improved fasting blood glucose concentrations (P < 0.05). However, there were no improvements in insulin sensitivity, postprandial triacylglycerol concentrations, or Hb A(1c) after 7 wk. CONCLUSION: Nocturnal fatty acid suppression by BCS improved fasting and postprandial blood glucose concentrations in type 2 diabetic patients the next morning. In contrast, no improvements in insulin sensitivity, postprandial triacylglycerol concentrations, or long-term glycemic control assessed by Hb A(1c) were seen after BCS supplementation.

[Oats can be included in gluten-free diet]. / Havre kan ingå i den glutenfria kosten.

In the management of coeliac disease, it has been widely accepted that oats must also be excluded from the diet, along with wheat, rye and barley. The article consists in a review of published reports, and an account of our experience of including oats in the gluten-free diets of adults. Oats were found to be safe and well tolerated by adults with coeliac disease and dermatitis herpetiformis, though the risk of wheat contamination of commercial oat products remains a cause of concern. Similar findings were reported from a study of adolescents, but no such studies have been made of small children. Thus, the inclusion of oats, known to be a fibre-rich, naturally gluten-free food, would broaden the range of foodstuffs tolerable to coeliac patients, though for safety reasons they should be used only by adults until more information is available.

Lipid intolerance in smokers.

OBJECTIVES: Smokers have recently been shown to be insulin resistant and to exhibit several characteristics of the insulin resistance syndrome (IRS). In this study, we assessed fasting and postprandial lipid levels in healthy, normolipidaemic, chronic smokers and a matched group of non-smoking individuals. DESIGN: A standardized mixed meal (containing 3.78 MJ and 51 g of fat) was given in the morning after an overnight fast. The smokers were either abstinent from tobacco for 48 h or were allowed to smoke freely, including being allowed to smoke six cigarettes during the study. SUBJECTS: Twenty-two middle-aged, healthy male subjects, nine habitual smokers and 13 non-smoking control subjects, were recruited to the study. The smokers had all been smoking at least 10 cigarettes per day for at least 10 years. RESULTS: The smokers exhibited a lipid intolerance in that their postprandial increase in triglyceride levels was more than 50% higher than in the non-smokers' group. This lipid intolerance could not be discerned in the postabsorptive state because the fasting triglyceride levels were the same in both groups, while the smokers had significantly lower high-density lipoprotein (HDL) cholesterol. The peak postprandial triglyceride level correlated closely and negatively with fasting HDL cholesterol, indicating an impaired lipolytic removal capacity in smokers. CONCLUSIONS: Healthy, normotriglyceridaemic smokers exhibit an abnormal postprandial lipid metabolism consistent with lipid intolerance. It is suggested that postprandial hyperlipidaemia is a characteristic trait of the insulin resistance syndrome and that the defect in lipid removal is related to the low HDL cholesterol in this syndrome. The insulin resistance syndrome is likely to be an important reason for the increased propensity for cardiovascular disease in smokers.

[Hospital food in a Scandinavian team project]. / Sjukhusmat i nordiskt samarbete.

Every meal for the hospitalized patient could be a nice break in the day and give the right amount of essential nutrients. However, studies of food consumption among patients in different Nordic hospitals indicate another reality. There are specific recommendations for food in hospital in all the nordic countries, but the practical aspects are paid less attention. The Nordic Council of Ministers has initiated a joint nordic project to reach the goal "Optimal food in optimal environments". The physician is a very central person, being responsible for the nutritional prescriptions. He also has the opportunity to stress the importance of the patient's nutritional situation.

Food and nutrient intakes in Swedish diabetic children.

Food and energy intakes in diabetic children, 7-9 and 12-14 years of age, were studied by the 7-d record method. The mean duration of diabetes in the younger group was 3.0 years and in the older group 4.2. The children had 3 main meals and 3.4 light meals daily. The median daily number of sandwiches was 7, often offered as snacks. All children used a low-fat margarine, low-fat cheese and low-fat milk. Sweets and diabetic food were seldom used. Of the energy intake protein contributed 18 per cent, fat 32 per cent and carbohydrates 50 per cent, including sucrose 2 per cent. Mean daily intake of fibre was 20 g. Compared to healthy children of the same age and from the same areas of Sweden the diabetics had a more regular meal pattern, their energy intakes did not differ, but the diet of diabetics was lower in fat and sucrose and higher in protein. The mean height, weight and BMI did not differ from healthy children.

Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden.

Dietary intake as initially estimated in a cross-sectional study has been related to the 12-y incidence of diabetes mellitus in a prospective study of 1462 women. In addition, all 50-y-old women (n = 352) were subjected to an intravenous glucose tolerance test. Because of the sampling procedure and a high participation rate the participants were representative of middle-aged women in the general population. No differences of statistical significance were observed concerning intake of energy and different nutrients. Neither did the number of meals nor the longest time between meals differ between women who developed diabetes and those who did not. Women with impaired glucose tolerance who developed diabetes did not differ from those who did not develop diabetes, concerning dietary intake. Body mass index was significantly higher in women who developed diabetes compared with other women. No specific dietary recommendations can be based on the results of this study.

Diet in relation to number of remaining teeth in a population of middle-aged women in Gothenburg, Sweden.

An examination of the number of remaining teeth was performed in a sample of women representative of middle-aged women in the city of Gothenburg, Sweden. A dietary history was recorded in a subsample comprising altogether 437 women. When carrying out multivariate analyses of the total series, taking age into consideration as a background factor, significant correlations were observed between prevalence of edentulousness on one hand and intake of energy, fat and calcium on the other. Edentulous women had lower intake of ascorbic acid than other women.

Diabetic nephropathy: is dietary protein harmful?

The suggested harmful effect of dietary protein on renal function in diabetic nephropathy was tested in three groups of insulin-dependent diabetic patients: 1) 10 patients without signs of nephropathy in spite of at least 30 years of diabetes; 2) 11 patients with nephropathy and reduced but stable glomerular filtration rate (GFR) (decline less than 4 ml/min per year [mean 1.8] during the last 2 years); 3) 10 patients with progressive nephropathy with GFR declining by an average of 11 ml/min per year. Dietary protein intake was estimated from a dietary history interview, as well as from urinary excretion of nitrogen (mean = 4.7 samples). Both methods showed a wide range of protein intake in all three groups of patients (0.6-2.3 g/kg body weight [BW]). The mean values did not differ between the groups, 1.30, 1.34, and 1.24 g/kg BW by interview, and 1.20, 1.10, and 1.13 g based on urinary nitrogen levels. There was no correlation between rate of decline of GFR and protein intake, even in those patients with no or minimal decline. These results do not support the hypothesis that dietary protein is a factor of importance in the development or progression of human diabetic nephropathy.

Platelets and coagulation in patients with familial hypercholesterolemia (type IIa).

Seventeen subjects with hypercholesterolemia (type IIa) were compared with 11 normocholesterolemic family members (controls) with similar dietary habits. The type IIa subjects had a shorter bleeding time. Beta-thromboglobulin in plasma and thromboxane B2 and malondialdehyde released from platelets before and after stimulation with collagen or thrombin were similar. No differences in platelet sensitivity to adenosine diphosphate, thrombin or collagen were observed. Gel-filtered platelets from type IIa subjects had a tendency to spontaneous aggregation and lower procoagulant activity. Platelet sensitivity to prostacyclin was slightly higher in type IIa subjects. No differences in a series of coagulation parameters were observed between the groups. This study has shown some deviations from normal in platelets from subjects with familial hypercholesterolemia. These changes may contribute to the increased tendency to occlusive vascular diseases in such subjects.

Evaluation of the heart rate method to determine the daily energy expenditure in disease. A study in juvenile diabetics.

Three different methods for the determination of the daily energy expenditure in disease were evaluated. The methods were based on a heart rate technique that caused the least possible interference with usual bahaviour of the patients. The study was performed on six juvenile diabetics in their homes and during a hospital stay of 3 weeks with sedentary as well as moderate physical activity. The daily energy supply derived from food analyses and urinary glucose losses, the body weight, and the total body potassium were followed. The three methods were: individual relationships between energy expenditure and heart rate with (method A) and without (method B) considering different body positions and the use of tabulated data on these relationships (method C). It was concluded that individual relationships had to be established and, furthermore, that these relationships must be determined within the whole activity area of the subjects. No consideration of the body position was found to be necessary. The blood glucose level had no influence on the energy expenditure or the heart rate. The activity of this group of diabetics was not significiantly different from what is normally expected for healthy subjects under similar conditions. The proposed heart rate method was found applicable in sedentary as well as physically active persons and would be possible to use in other patient groups.

The study of women in Gothenburg 1968-1969. Intake of energy and nutrients in five age groups.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.

Studies of glycemia and glucosuria in diabetics after breakfast meals of different composition.

In series I, The effect of four isocaloric, ordinary diabetic breakfast meals on the blood glucose level and on the urinary glucose loss was tested in 9 adult diabetes and three healthy subjects (ages 60 to 75) as well as in five insulin-treated diabetics (ages 18 to 40). All breakfasts derived 20% of the energy from protein, 35% from fat, and 45% from carbohydrates (CHO). The oligosaccharides amounted to 5, 30, 45, and 65% of CHO, respectively. In series II, four isocaloric breakfast meals with CHO amounting to 35 or 70% of the energy, oligosaccharides furnishing one-third or two-thirds of the CHO at each level, were tested in the same way in eight of adult diabetics and in the three healthy subjects. The two breakfasts with the highest percentage of oligosaccharides in series I caused the smallest increase in the blood glucose level in the adult subjects. In the adults as well as in the juveniles, these breakfasts gave rise to clear symptoms of hypoglycemia and/or a feeling of a deficient satiety in several subjects. In juveniles, the initial blood glucose level turned out to be of greater importance for the outcome of the test than the kind of carbohydrates consumed. In series II, The CHO-rich meals caused significantly greater blood glucose increases than did the low-CHO meals. Despite the unexpected findings that ordinary diabetics breakfast meals, high in oligosaccharides, gave a smaller increase in blood glucose than did meals in which wheat starch predominated, the use of diets rich in oligosaccharides should be avoided because of the risk of overconsumption owing to hypoglycemic symptoms or to the deficient feeling of satiety.

Specially designed sweeteners and food for diabetics--a real need?

In the first part of this study, the effect of four isocaloric mixed breakfast meals on the blood glucose and urinary glucose losses was tested in nine adult diabetics and in three healthy subjects, ages 60 to 75. Three of the test meals consisted of a base diet supplemented with applesauce sweetened with sucrose, fructose, or sorbitol. In the fourth test meal, the starch was increased together with saccharine. In the second part of the study, analyses for free glucose and sucrose in several timed food preparations, ordinary as well as food preparations specially designed for diabetics, were performed. The amount of sucrose equivalents (S(eg)) in one ordinary serving of the various products was estimated. No significant differences among sucrose, fructose, and sorbitol-containing meals with respect to the effect on the blood glucose level or on glucosuria were found. The saccharine-containing meal gave a significantly greater blood glucose increase at 60 min only. The amount of sucrose in ordinary marinated foods, such as herring, cucumber, and common beet was negligible. Water-packed fruits supplied one half of the amount of S(eq) or less, compared with fruits packed in sorbitol-sweetened syrup. The amount of S(eq) in the latter products as well as in fruits packed in unsweetened juice equalled that of the fleshy substance of ordinary sucrose-sweetened products. It was concluded that fructose or sorbitol has no advantages over sucrose, as regards the effect on blood glucose in well-regulated adult diabetics, and that it seems unnecessary to have specially sweetened foods designed for diabetics.