[Favourable effect of olive oil in patients with non-insulin-dependent diabetes. The effect on blood pressure, blood glucose and lipid levels of a high-fat diet rich in monounsaturated fat compared with a carbohydrate-rich diet]. / Gunstig virkning af olivenolie hos ikkeinsulinkraevende diabetikere. Virkningen på blodtryk, blodglukose og lipidniveauer af en dioet med et højt indhold af monoumoettet fedt sammenlignet med en kulhydratrig dioet.

To compare blood pressure, glucose and fat metabolism after a high-fat diet rich in monounsaturated fat reduced day time systolic (131 +/- 3 vs. 137 +/- 3 mmHg, p < 0.04) and 24-hour systolic blood pressure (126 +/- 8 vs. 130 +/- 10 mmHg, p < 0.03) as well as day time diastolic (78 +/- 2 vs. 84 +/- 52 mmHg, p < 0.02) and diurnal diastolic blood pressure (75 +/- 6 vs. 78 +/- 5 mmHg, p < 0.03) as compared with the high-carbohydrate diet. Evidence of improved glucose tolerance on the high-monounsaturated diet compared with the high-carbohydrate diet were found with lower fasting blood glucose (6.1 +/- 0.3 vs. 6.8 +/- 0.5 mM, p < 0.05), lower average blood glucose levels (7.4 +/- 0.5 vs. 8.2 +/- 0.6 mmol/l, p < 0.01) and peak blood glucose responses (9.9 +/- 0.6 vs. 11.3 +/- 0.7 mmol/l, p < 0.02). Similar levels of fasting triglyceride, total cholesterol, LDL- and HDL cholesterol were found after the two diets.

Effects on blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects.

OBJECTIVE: To compare the influence on blood pressure, glucose, and lipid levels of a diet rich in monounsaturated fatty acids with an isocaloric, high-carbohydrate diet in 15 NIDDM subjects. RESEARCH DESIGN AND METHODS: A crossover design with diet interventions and wash-out periods of 3 wk was applied. The patients were randomly assigned to a 3-wk treatment with a high-carbohydrate diet containing 50% of energy as carbohydrate and 30% of energy as fat (10% of energy as monounsaturated fatty acids) or an isocaloric diet with 30% of energy as carbohydrate and 50% of energy as fat (30% of energy as monounsaturated fatty acids). On the last day of the two diets, 24-h ambulatory blood pressure was measured and day profiles of glucose, hormones, and lipids were performed to a test menu rich in carbohydrates. RESULTS: The diet rich in monounsaturated fat reduced daytime systolic (131 +/- 3 vs. 137 +/- 3 mmHg, P < 0.04) and 24-h systolic blood pressure (126 +/- 8 vs. 130 +/- 10 mmHg, P < 0.03) as well as daytime diastolic (78 +/- 2 vs. 84 +/- 2 mmHg, P < 0.02) and diurnal diastolic blood pressure (75 +/- 6 vs. 78 +/- 5 mmHg, P < 0.03) as compared with the high-carbohydrate diet. Evidence of lowered blood glucose levels on the high-monounsaturated diet compared with the high-carbohydrate diet were found with lower fasting blood glucose (6.1 +/- 0.3 vs. 6.8 +/- 0.5 mM, P < 0.05), lower average blood glucose levels (7.4 +/- 0.5 vs. 8.2 +/- 0.6 mM, P < 0.04), and peak blood glucose responses (9.9 +/- 0.6 vs. 11.3 +/- 0.7 mM, P < 0.02). The two diets had the same impact on lipid levels. CONCLUSIONS: A diet rich in monounsaturated fat has beneficial effects on blood pressure and glucose metabolism, whereas no adverse effects on lipid composition in NIDDM subjects is detected.

Glycaemic responses to different types of bread in insulin-dependent diabetic subjects (IDDM): studies at constant insulinaemia.

To study the glycaemic effect of various Danish bread types in insulin-dependent diabetic subjects (IDDM) we looked at the incremental blood glucose areas after isocaloric meals of grained wholemeal rye bread, wholemeal bread (graham bread) and white bread in seven C-peptide negative diabetic subjects. Furthermore, we evaluated the glycaemic potency of dried fruits by exchanging 40 per cent of the starch of grained wholemeal rye bread as dried figs. Prior to the meal intake the patients had attained normoglycaemia and isoinsulinaemia by means of the artificial pancreas. The four test meals containing 50 g of available carbohydrate were taken in random order. The postprandial blood glucose response areas after whole-meal bread (1037 +/- 113 mM X 180 min) and white bread (1021 +/- 100 mM X 180 min) were significantly higher than that to grained wholemeal rye bread (786 +/- 66 mM X 180 min, P less than 0.05). Exchange of 40 per cent of the complex carbohydrate as grained wholemeal rye bread with simple sugars, such as figs, had no influence on the blood glucose response (786 +/- 66 mM X 180 min vs. 766 +/- 56 mM X 180 min). Constant and identical serum-free insulin levels at 30 mU/l and similar amounts of glucose lost in the urine were found after the four test meals. In conclusion, the difference in extraction rate of wheat in the form of white flour (0, 7) and wholemeal flour (1, 0) was not reflected in the glycaemic responses in IDDM subjects. Grained wholemeal rye bread is a fibre-rich, cheap nutrient which elicits a significantly lower glycaemic response compared to wholemeal and white bread and can be recommended to diabetic subjects.

Water volume and consumption time: influence on the glycemic and insulinemic responses in non-insulin-dependent diabetic subjects.

The present study was carried out to see if either the volume of water or the duration of ingestion time influence the postprandial blood glucose and insulin responses in non-insulin-dependent diabetic (NIDDM) subjects. Small test meals containing 40 g carbohydrate as rye bread (100 g) with butter (10 g) and tomatoes (75 g) were given to 10 NIDDM subjects. The meals were taken in random order with either 90 or 600 mL tap water. The meal with 90 mL tap water was ingested over 10 and 30 min. The glycemic responses to isocaloric meals of large and small volumes were similar (338 +/- 56 vs 384 +/- 67 mmol/L.240 min) as were the insulinemic responses (29,424 +/- 6512 min vs 27,140 +/- 6548 mumol/L.240 min). An extension of eating time from 10 to 30 min did not alter the glycemic (384 +/- 67 vs 370 +/- 54 mmol/L.240 min) or the insulinemic response (27,140 +/- 6548 vs 35,670 +/- 10,245 mumol/L.240 min) in the NIDDM patients.

Reducing protein in the diabetic diet.

Long-term protein intake may have pathogenic influence on development of late diabetic complications. A review of the latest results in insulin-dependent diabetic patients shows that short-term lowering of protein intake reduces the characteristic early glomerular hyperfiltration as well as microalbuminuria and proteinuria in diabetic nephropathy. A sustained beneficial effect on the progression rate of nephropathy may be achieved. Based on this evidence it is advisable to avoid the traditionally high protein intake in diabetes. We suggest a protein-controlled diet--with protein comprising 14 energy %--as a goal in uncomplicated diabetes. In patients with progressive albuminuria or proteinuria prescription of a low-protein diet with 10% protein should be considered as supplementation to antihypertensive treatment. At present we do not find sufficient evidence for suggesting an intake of 10% protein (corresponding approximately to recent recommendations on 0.8 g prot/kg body weight) also in uncomplicated diabetes. Both a 10 and 14% protein diet will differ somewhat from the diet of the background population and the present diet of many diabetic patients. Therefore the introduction of such diets requires a careful individualized diet therapy in which repetitive evaluation and estimation of compliance are performed. A reduction of protein intake to 10 energy % represents a profound diet intervention.

Postprandial glucose and insulin responses to rolled oats ingested raw, cooked or as a mixture with raisins in normal subjects and type 2 diabetic patients.

Cooking and processing of food may account for differences in blood glucose and insulin responses to food with similar contents of carbohydrate, fat, and protein. The present study was carried out to see if short-term cooking of rolled oats caused an increase in blood glucose. Furthermore, we wanted to see if dried fruit could substitute for some of the starch without deterioration of the postprandial blood glucose response. We therefore compared the blood glucose and insulin responses to three isocaloric, carbohydrate equivalent meals in 11 normal subjects and 9 Type 2 diabetic patients. Meals composed either of raw rolled oats, oatmeal porridge or a mixture of raw rolled oats with raisins were served. In normal subjects, the three meals produced similar glucose (75 +/- 22, 51 +/- 16 and 71 +/- 23 (+/- SE) mmol l-1 180 min, respectively) and insulin response curves (3160 +/- 507, 2985 +/- 632 and 2775 +/- 398 mU l-1 180 min, respectively). Type 2 diabetic patients also showed similar postprandial blood glucose (515 +/- 95, 531 +/- 83 and 409 +/- 46 mmol l-1 180 min, respectively) and insulin (5121 +/- 850, 6434 +/- 927 and 6021 +/- 974 mU l-1 180 min, respectively) responses to the three meals. Thus short-term cooking of rolled oats has no deleterious effect on blood glucose and insulin responses, and substitution of 25% of the starch meal with simple sugars (raisins) did not affect the blood glucose or insulin responses.

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.

Comparison of blood glucose and insulin responses in non-insulin dependent diabetic patients. Studies with spaghetti and potato taken alone and as part of a mixed meal.

Recently, we demonstrated that spaghetti caused significantly lower glycaemic response than rice and potato in insulin-dependent diabetic (IDDM) subjects and that this difference was also present when spaghetti and potato were taken as part of a mixed meal. We have now compared the blood glucose and insulin responses to 50 g of carbohydrate in the form of white bread, potato and white spaghetti in 6 non-insulin-dependent diabetic (NIDDM) patients. The blood glucose response after white spaghetti observed over a 3-h period was only 60 +/- 10 per cent (P less than 0.02) of that seen in response to potato (395 +/- 116 mmol/l x 180 min vs 641 +/- 108 mmol/l x 180 min) and 47 +/- 9 per cent (P less than 0.01) of that seen in response to white bread (395 +/- 116 mmol/l x 180 min vs 805 +/- 93 mmol/l x 180 min). Insulin responses showed an identical pattern reflecting the glycaemic responses. To see if the difference in the glucose responses in NIDDM patients is preserved if these carbohydrate-rich foods are taken as part of a mixed meal we looked at the blood glucose and insulin responses to 50 g of carbohydrate in the form of potato and white spaghetti when ingested together with bolognese sauce (167 g) in 7 NIDDM patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycemic effects of spaghetti and potato consumed as part of mixed meal on IDDM patients.

Recently, we demonstrated that spaghetti caused a significantly lower glycemic response in isoinsulinemic insulin-dependent diabetic (IDDM) subjects than an exchangeable amount of potato. The question is, however, whether the difference of the glucose response in IDDM patients is preserved if these carbohydrate-rich foods are taken as part of a mixed meal. To answer this question, we evaluated blood glucose, free-insulin, and glucagon responses to exchangeable amounts of spaghetti and potato when ingested together with bolognese sauce in seven IDDM patients who had attained euglycemia with the artificial pancreas before meal intake. The potato (200 g raw wt) with bolognese sauce (167 g) and spaghetti (50 g raw wt) with bolognese sauce (167 g) had approximately identical caloric content (435 and 447 kcal, respectively), fat (18 g each), protein (23 and 26 g, respectively), and carbohydrate (47 and 48 g, respectively). Blood glucose increment after white spaghetti and bolognese sauce was only approximately 50% of that seen in response to potato and bolognese sauce. Similar constant insulin levels and increments in glucagon were seen. A major determinant of the postmeal glucose rise in IDDM patients seems to be dependent on the kind of carbohydrate in the meal. The approach by which the insulinemia was kept constant by the artificial pancreas seems to be a valuable tool for studying glycemic responses to different meals in IDDM patients who otherwise show great variations in circulating insulin and glucose levels when treated by subcutaneously administered insulin.

Differential glycaemic effects of potato, rice and spaghetti in type 1 (insulin-dependent) diabetic patients at constant insulinaemia.

The blood glucose responses to cooked potato, rice and spaghetti were studied in six Type 1 (insulin-dependent) diabetic patients who had attained euglycaemia by the artificial pancreas prior to the meal intake. The amount of potato (raw weight 200 g), parboiled rice (raw weight 50 g), and spaghetti (raw weight 50 g) had approximately identical caloric content (range 203-225 kcal) and amount of available carbohydrate (range 39.4-43.4 g). The postprandial blood glucose response areas after cooked potato and cooked parboiled rice were similar (180 min values: cooked potato: 1190 +/- 110 mmol/l X min, cooked rice: 1160 +/- 140 mmol/l X min and 240 min values: cooked potato: 1690 +/- 140 mmol/l X min, cooked rice: 1740 +/- 210 mmol/l X min). In contrast, the response after cooked spaghetti was slower and less pronounced (180 min value: 830 +/- 80 mmol/l X min and 240 min value: 1320 +/- 120 mmol/l X min), and was significantly smaller than those of cooked potato (180 min: 2p less than 0.01 and 240 min: 2p less than 0.01) as well as cooked rice (180 min: 2p less than 0.01 and 240 min: 2p less than 0.02). Our study emphasizes the importance of determining the glycaemic response of foodstuffs under conditions of isoinsulinaemia.

Nutritional status of patients with cancer of the bladder before and during radiation therapy. Influence on survival?

The food intake and the nutritional status was assessed before and during radiotherapy in 30 patients with local bladder tumours. Eighteen patients received preoperative treatment (42 Gy/4 weeks, followed by cystectomy), and 12 patients received potential curative treatment (63 Gy/6 weeks). Fourteen patients had small tumours (category I-II) and 16 patients large tumours (category III-IV). Four weeks radiotherapy did not affect energy or protein intake, but category I-II patients had a higher intake (163% of basal metabolic rate (BMR)) than category III-IV patients (138% of BMR) after 4 weeks radiotherapy (p less than 0.06). The energy intake in patients treated for 6 weeks was decreased from 147% of BMR to 122% (p less than 0.01). The mean energy intake in category III-IV patients was correlated to weight loss (Rs = -0.51, p less than 0.05). After 4 weeks radiotherapy the change in weight was for category III-IV patients greater than for category I-II patients. The other changes in antropometric and biochemical parameters (fat-free body mass (FFM), body fat, arm muscle circumference, serum albumin, serum transferrin) were small and insignificant. If the patients were grouped according to age, tumour category, histologic grade, treatment, weight/height (W/H) index and changes in weight and antropometric parameters, it was found that only W/H index and changes in weight during 4 weeks radiotherapy had significant influence on survival. The significance of W/H index was closely related to tumour classification.

Energy and protein intake and nutritional status in non-surgically treated patients with small cell anaplastic carcinoma of the lung.

The spontaneous food intake and nutritional status was assessed in 23 patients with small cell anaplastic carcinoma of the lung before and two times during a treatment period of 6 weeks. Radiation therapy was given for 2 weeks followed by a course of chemotherapy and another 2 weeks of radiation therapy. The energy intake decreased during the treatment from 146 to 130 per cent of basal metabolic rate (p greater than 0.10). The protein intake remained unchanged (mean 0.9 g/kg body weight). There were insignificant and small losses of weight, body fat, free body mass and arm muscle circumference, and no changes were seen in serum albumin and serum transferrin. However, 6 patients suffered a weight loss of 5 per cent or more. No correlation existed between the nutritional parameters measured before treatment and the changes during treatment. Patients who suffered a loss of body weight could therefore not be singled out before the treatment.

Changes in food intake and nutritional status in patients treated with radiation therapy for cancer of the larynx and pharynx.

Nutritional status and food intake were recorded for 28 patients with cancer of the larynx and 13 patients with cancer of the pharynx. All patients were without distant metastases and received radiotherapy with a curative intent. No patients were nutritionally depleted when treatment began. Treatment did not induce changes in nutritional status or food intake in patients with cancer of the larynx. The mean energy intake was 135% of the basal metabolic rate (BMR), and the protein intake was 1 g/kg/day. Inversely, patients with cancer of the pharynx suffered a mean loss of body weight of 5 kg (p less than .01), which was almost equally divided between fat tissue (-2.2 kg) and fat-free cell mass (-2.6 kg). There were only minor or no changes in serum albumin and serum transferrin. Mean energy intake was 121% of BMR, and the mean protein intake was 0.9 g/kg/day. Neither nutritional support during admission nor dietetic instructions managed to preserve the nutritional status in patients with cancer of the pharynx. Therefore, these patients need a more intensified nutritional therapy, such as tube feeding.