Ethnic Variability in Glucose and Insulin Response to Rice Among Healthy Overweight Adults: A Randomized Cross-Over Study.

Background: The influence of ethnicity on postprandial glucose and insulin responses has been reported earlier and rice is a major contributor to the overall glycaemic load of Asian and Arab diets. This study aims to compare postprandial glycaemic and insulinaemic responses to rice among healthy overweight Asian, Arab and European participants. Methods: In a randomized crossover design, 47 healthy overweight participants (23 Asian, 16 Arab, and 8 European) consumed 75 grams of glucose beverage or ate 270 grams of cooked basmati rice (75 g of available carbohydrate) on two separate occasions, separated by a one 1-week washout period. Blood glucose and insulin levels were determined at fasting 0 (fasting), 30, 60, and 120 minutes and used to determine the incremental area under the curve (iAUC). Results: The three groups were matched on body mass index and gender. Although no differences were noted statistically in most clinical features, a wide range of variation was noted in age, systolic, diastolic blood pressure. The fasting blood glucose and insulin levels were highest among Asians, followed by Arabs and Europeans (p < 0.01). According to the HOMA-IR test and the Matsuda index, Asians have a higher insulin resistance than Arabs or Europeans when consuming a glucose beverage (p < 0.001) and rice (p < 0.01). Postprandial glucose and insulin responses to glucose beverage did not differ between ethnic groups (p = 0.28; p = 0.10). Based on an unadjusted regression model, European participants had significantly lower iAUC-glucose (p = 0.02) and iAUC-insulin (p = 0.01) after rice consumption than Asian participants. In the adjusted model, the difference between the two groups remained for iAUC-insulin (p = 0.04) but not for iAUC-glucose (p = 0.07). Conclusion: Our study found that ethnic differences exist among healthy overweight adults in terms of insulin resistance, glycaemic response and insulinaemic response to rice. As a result of their high insulin resistance, Asian participants had a higher postprandial insulin spike than Europeans after eating rice. These findings could have substantial implications for nutrition recommendations based on ethnicity, particularly for Asians.

Lifestyle intervention in early pregnancy can prevent gestational diabetes in high-risk pregnant women in the UAE: a randomized controlled trial.

PURPOSE: A prevalence of gestational diabetes mellitus (GDM) is approximately three times higher than the global rate in the UAE. However, it has not yet been studied whether a 12-week moderate-intensity lifestyle intervention can prevent gestational diabetes among pregnant women at high risk in this region. PATIENTS AND METHODS: A pragmatic, open-label, randomized clinical trial was conducted. Sixty-three women aged 18 to 45 years, with ≤12 weeks of gestation, singleton pregnancy, and having ≥ two risk factors for GDM were randomly assigned to the Lifestyle Intervention (LI) group (n = 30) or Usual Care (UC) group (n = 33). The women in the LI group received a 12-week, moderate-intensity lifestyle intervention with individualized counseling on a diet, physical activity, and behavior change by a licensed dietitian. The women in the UC group received usual antenatal care. The primary outcome was the incidence of GDM based on the IADPSG criteria at 24-28 weeks of gestation. RESULTS: The incidence of GDM was 33.3% in LI group and 57.5% in UC group. The crude relative risk (RR) for GDM was 0.59 (95% CI, 0.32-1.04, p = 0.05). The multivariable logistic regression model without adjustment showed OR = 0.37 (95% CI, 0.13-1.02, p = 0.05) and after adjusting with Age, BMI and family history of diabetes reported OR = 0.26, 95%CI 0.07, 0.92, p = 0.04. in LI vs UC. The daily dietary intake of calories (- 120 kcal, p = < 0.01), carbohydrates (- 19 g, p < 0.01), and fat (- 5 g, p = 0.03) was reduced, and physical activity time (+ 52 min, p = 0.05) increased in the LI group after the intervention. However, the LI had no significant effect on maternal and neonatal outcomes. CONCLUSION: A 12-week moderate intensity lifestyle intervention in early pregnancy could reduce the relative risk of GDM by 41% among high-risk pregnant women in the UAE. These findings could impact public health outcomes in the region. TRIAL REGISTRATION: Trial registration Retrospectively registered NCT04273412,18/02/2020.

Impact of food pattern on glycemic control among type 2 diabetic patients: a cross-sectional study in the United Arab Emirates.

BACKGROUND: Optimum nutrition has an integral role in glycemic control of diabetic patients. In this study, we intend to explore the frequency of food group/item consumption and its association with the risk of poor glycemic control (HbA1c >7%) among type 2 diabetes (T2D) patients in the United Arab Emirates (UAE), since there are no data available in this region. METHODS: In this retrospective cross-sectional study, data on frequency of food group/item consumption of 843 T2D patients aged ≥18 years were collected from records documented by dietitians in a tertiary care center in the UAE. RESULTS: The trends of food consumption demonstrate that one-third of the participants consumed all five major food groups, and 10% adhered to the recommended "MyPlate" meal pattern with the optimum mix of food groups. Univariate analysis indicated that participants who adhered to the MyPlate meal pattern presented lower HbA1c (ß=-0.78, 95% CI -1.22, -0.25; P<0.01). Daily intake of fresh fruit was shown to be protective (ß=-0.64, 95% CI -1.26, -0.04; P=0.04) while fruit juice intake >1 time/day increased the risk of poor glycemic control (ß=1.53, 95% CI 0.72, 2.35; P<0.001). Multiple logistic regression models (area under the receiver operating characteristics curve =0.67) showed consumption of fizzy drinks and fast food ≥1 time/week increased the odds of poor glycemic control by 2.05 (95% CI 1.16, 3.68; P=0.01) and 1.83 (95% CI 1.02, 3.3 P=0.04), respectively, while fresh fruit consumption indicated a clinically relevant protective effect  (OR=0.65, 95% CI 0.23, 1.79; P=0.4). CONCLUSION: Consuming food such as fizzy drinks and fast food ≥1 time/week could possibly serve as an independent predictor for poor glycemic control, while fresh fruit could have a protective effect on glycemic control among T2D patients.Clinical Trial Registry: ClinicalTrials.gov Identifier: NCT03388229.

Clinical Practice Recommendations for the Management of Obesity in the United Arab Emirates.

With rapid urbanisation and improved living conditions as a result of rising incomes in Gulf Cooperation Council (GCC) countries, obesity has become a major and growing health problem for the region. The United Arab Emirates (UAE) has a resident population of 9.3 million (in 2016), many of whom (85.5%) lived in urban areas and led sedentary lifestyles. Based on the World Health Organisation (WHO) estimates for 2010, 25% of Emirati men and 40% of the women were obese. Obesity rates in this country has doubled from 16 to 34% compared to the year 2000, and severe obesity (BMI > 40 kg/m2) has risen dramatically from 2 to 11%. While a number of international guidelines for the management of obesity are already available in public domain, local guidelines for the UAE and the region, which are structured and individualized for the management of obesity, are sorely needed to help the family physician to provide affordable treatment for the patient at the point-of-care and to reduce the burden on the local healthcare system. A multi-disciplinary panel of international and regional experts who treat patients with overweight and obesity was convened with the aim of developing consensus recommendations for the UAE. The objective is to have a simple and easy-to-refer set of recommendations for busy clinicians as there were already many comprehensive international guidelines available. The panel reviewed and streamlined these recommendations in its entirety for relevance, coherence and usability in the local context. These recommendations for overweight and obesity management were circulated and endorsed by the local practising family medicine community, namely, the Emirates Medical Association and Family Medicine Society. We believe these recommendations would also be of interest to clinicians in other GCC countries. A summary and algorithm of these recommendations are provided.

Lifestyle Intervention for Weight Loss: a group-based program for Emiratis in Ajman, United Arab Emirates.

BACKGROUND: Lifestyle Intervention for Weight Loss (LIFE-8) is developed as a structured, group-based weight management program for Emiratis with obesity and type 2 diabetes. It is a 3-month program followed by a 1-year follow-up. The results from the first 2 years are presented here to indicate the possibility of its further adaptation and implementation in this region. METHODOLOGY: We recruited 45 participants with obesity and/or type 2 diabetes based on inclusion/exclusion criteria. The LIFE-8 program was executed by incorporating dietary modification, physical activity, and behavioral therapy, aiming to achieve up to 5% weight loss. The outcomes included body weight, fat mass, waist circumference, blood pressure, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and nutritional knowledge at 3 months and 12 months. RESULTS: We observed a reduction of 5.0% in body weight (4.8±2.8 kg; 95% CI 3.7-5.8), fat mass (-7.8%, P<0.01), and waist circumference (Δ=4±4 cm, P<0.01) in the completed participants (n=28). An improvement (P<0.05) in HbA1c (7.1%±1.0% vs 6.6%±0.7%) and FBG (8.2±2.0 mmol/L vs 6.8±0.8 mmol/L) was observed in participants with obesity and type 2 diabetes after the program. Increase in nutritional knowledge (<0.01) and overall evaluation of the program (9/10) was favorable. On 1-year follow-up, we found that the participants could sustain weight loss (-4.0%), while obese, type 2 diabetic participants sustained HbA1c (6.6%±0.7% vs 6.4%±0.7%) and further improved (P<0.05) the level of FBG (6.8±0.8 mmol/L vs 6.7±0.4 mmol/L). CONCLUSION: LIFE-8 could be an effective, affordable, acceptable, and adaptable lifestyle intervention program for the prevention and management of diabetes in Emiratis. It was successful not only in delivering a modest weight loss but also in improving glycemic control in diabetic participants.

Vitamin D3 supplementation and body composition in persons with obesity and type 2 diabetes in the UAE: A randomized controlled double-blinded clinical trial.

BACKGROUND & AIM: The co-existence of vitamin D deficiency with obesity and type 2 diabetes is highly prevalent in the United Arab Emirates. We do not have studies evaluating the vitamin D dose response and sufficiency, and if sufficient substitution dose during a longer period could decrease obesity or change fat distribution in obese type 2 diabetic vitamin D deficient Emiratis. METHODS: A randomized double-blind clinical trial was conducted for 6 months followed by another 6 months of un-blinded follow up with 87 obese, type 2 diabetic participants. Serum 25-hydroxy vitamin D (S-25(OH)D), anthropometric data, and life-style factors such as diet and sunlight exposure were measured. The study was executed in 3 phases in two arms vitamin D arm (n = 45) and placebo arm (n = 42); in Phase 1 the vitamin D arm received 6000 IU vitamin D3/day (3 months) followed by Phase 2 with 3000 IU vitamin D3/day. During follow up (phase 3) both the arms were un-blinded and supplemented with 2200 IU vitamin D3/day for another 6 months. RESULTS: At the baseline a significant (p < 0.01) positive association between body fat mass and body weight (r = 0.97) muscle mass (r = 0.47), water mass (r = 0.54), waist circumference (r = 0.82) and serum PTH (r = 0.28) was observed. On supplementation no significant changes in anthropometric dimensions was observed. S-25(OH) D peaked in phase 1 (77.2 ± 30.1 vs 28.5 ± 9.2, p = 0.003) followed by a decrease in phase 2 (62.3 ± 20.8, p = 0.006) paralleled by a decrease in parathyroid hormone in phase 2 (5.9 ± 2.4 vs 4.5 ± 1.8, p < 0.01) compared to baseline in vitamin D group. CONCLUSION: This study shows no significant influence of vitamin D supplementation on weight, fat mass or waist circumference in type 2 diabetic obese vitamin D deficient participants of Arab ethnicity after one year. Despite a relatively high daily dose of vitamin D3 we did not achieve target levels of S-25(OH)D above 75 nmol/L in this population. However, supplementation was safe, improved s- 25 (OH)D also reducing the incidence of eucalcemic parathyroid hormone elevation. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT02101151.

Vitamin D status and its relationship with metabolic markers in persons with obesity and type 2 diabetes in the UAE: a cross-sectional study.

AIM: To report vitamin D status and its impact on metabolic parameters in people in the United Arab Emirates with obesity and type 2 diabetes (T2D). METHODOLOGY: This cross-sectional study included 309 individuals with obesity and T2D who were randomly selected based on study criteria. Serum concentrations of 25-hydroxy vitamin D (s-25(OH)D), calcium, phosphorus, parathyroid hormone, alkaline phosphatase, glycemic profile, and cardiometabolic parameters were assessed in fasting blood samples, and anthropometric measurements were recorded. RESULTS: Vitamin D deficiency (s-25(OH)D < 50 nmol/L) was observed in 83.2% of the participants, with a mean s-25(OH)D of 33.8 ± 20.3 nmol/L. Serum 25(OH)D correlated negatively (P < 0.01) with body mass index, fat mass, waist circumference, parathyroid hormone, alkaline phosphatase, triglycerides, LDL-cholesterol, and apolipoprotein B and positively (P < 0.01) with age and calcium concentration. Waist circumference was the main predictor of s-25(OH)D status. There was no significant association between serum 25(OH)D and glycemic profile. CONCLUSION: There is an overwhelming prevalence of vitamin D deficiency in our sample of the Emirati population with obesity and T2D. Association of s-25(OH)D with body mass index, waist circumference, fat mass, markers of calcium homeostasis and cardiometabolic parameters suggests a role of vitamin D in the development of cardiometabolic disease-related process.

Nutritional therapy for the management of diabetic gastroparesis: clinical review.

Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.

Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome.

BACKGROUND/AIM: The aim of the study was to evaluate the effect of Ramadan fasting on metabolic markers, body composition and dietary intake in native Emiratis of Ajman, UAE with the metabolic syndrome (MS). DESIGN: 19 patients (14 Female, 5 Male) aged 37.1 ± 12.5 years, were encouraged healthy lifestyle changes during fasting and data was collected 1 week before and in the fourth week of Ramadan. RESULTS: No patients experienced complications or increased symptoms of hypoglycemia during Ramadan. Total energy consumption remained similar. Meal frequency decreased (3.2 ± 0.5 vs 2.1 ± 0.4 meals/day). Protein intake decreased 12% (P = 0.04) but fat intake increased 23% (P = 0.03). Body weight (103.9 ± 29.8 vs 102.1 ± 29.0 kg, P = 0.001) and waist circumference (123 ± 14 vs 119 ± 17 cm, P = 0.001) decreased. Forty percent of patients increased their physical activity due to increased praying hours. Fasting P-glucose (6.3 ± 1.7 vs 6.8 ± 2.0 mmol/L, P = 0.024) and B-HbA(1c) concentrations 6.3 ± 0.9 vs 6.5% ± 0.9%, P = 0.003) increased but P-insulin concentration, HOMA-IR index and lipid concentrations remained unchanged. CONCLUSION: The present study investigated the effect of Ramadan fasting on dietary intake, metabolic parameters and body composition showing that the energy consumption per day did not decrease, although the fat intake increased. However, the patients lost weight and reduced their waist circumference. Ramadan fasting has also elicited small but significant increases in Glucose and HbA(1c) after 4 weeks.