Effects of stevia on glycemic and lipid profile of type 2 diabetic patients: A randomized controlled trial.

OBJECTIVE: Stevia (Stevia rebaudiana Bertoni) is a natural and healthy alternative sweetener to sugar and artificial sweeteners, which has become important for human diets and food manufactures. In this study, the effects of stevia or sucralose as tea sweeteners on glycemic and lipid profile of type 2 diabetic patients were investigated. MATERIALS AND METHODS: A double-blind clinical trial was carried out in 34 type 2 diabetic patients. These patients were assigned into two groups of stevia (n=15) (received 1 cup of 2% stevia extract-sweet tea in three meals) and non-stevia (n=19) (received one tablet of sucralose sweetener) daily for eight weeks. Glycemic response and lipid profile of the participants were assessed. Furthermore, height, weight and body mass index (BMI) of the participants were measured as well as their dietary intakes at the baseline and at the end of the study. RESULTS: Findings showed no significant differences in fasting blood sugar (FBS) levels between the base line and after two hours, in participants. Also, no significant differences in insulin, glycosylated hemoglobin (HbA1C) and lipid levels were found between the two groups. CONCLUSION: Results of the current study showed that the highlighted doses of stevia in sweetened tea could be an alternative to sucralose in diabetic patients with no effects on blood glucose, HbA1C, insulin and lipid levels.

Content Analysis of Food Advertising in Iranian Children's Television Programs.

BACKGROUND: Advertisements can influence children's health related behaviors. Television advertisements are the main avenues directing commercials at children in Iran. This study aimed to explore the content of food advertisement during children's television programs in 2007-8 and to compare it with those reported in 2000. METHODS: All advertisements broadcasted before, during, and after children's programs aired on two major Iran national television networks were videotaped for a period of 4 weeks during 2007-8. For each advertisement, type of product(s) and mode of presentation (s) were coded. RESULTS: A total of 229 television advertisements were broadcasted. Food commercials were the most frequent group (31%) across the two channels. Among the food products advertised, calorie dense foods, including chocolate, soft drinks, extruded cereals, ice cream, cookies and candies were the most frequent. The appeal mainly used in television food advertisements was "stimulation of hunger/thirst" (38.5%). The advertisements were mostly presented as animations (54%) and the messages used were mainly directed to good taste. CONCLUSION: Although the total number of food advertisements during children's television programs has decreased but the consumption of high fat, high sugar, low nutrient dense foods continues to be promoted. Policies to address the issue should be scrutinized.

Regular consumption of both vitamin D- and calcium- and vitamin D-fortified yogurt drink is equally accompanied by lowered blood lipoprotein (a) and elevated apoprotein A1 in subjects with type 2 diabetes: a randomized clinical trial.

OBJECTIVE: Cardiovascular disease (CVD) is the major morbidity and cause of death in diabetic subjects. Observational studies have shown the association of low vitamin D status with poor glycemic control, atherogenic lipid profile, and CVD. However, the possible link between circulating 25-hydroxycholecalciferol and apoproteins (Apo A1 and B) and the atherogenic lipoprotein (a) [Lp(a)] has not been documented to date. METHODS: Ninety subjects with type 2 diabetes (T2D) aged 30-60 years from both sexes were randomly allocated to one of the 3 groups to receive 2 bottles a day of either (1) plain doogh (PD; containing 150 mg calcium and no detectable vitamin D/250 mL); (2) vitamin D-fortified doogh (DD; containing 150 mg calcium and 500 IU vitamin D/250 mL); or (3) calcium- and vitamin D-fortified doogh (CDD; containing 250 mg calcium and 500 IU vitamin D/250 mL) for 12 weeks. Anthropometric, dietary, and laboratory assessments, including Apo A1, Apo B, and Lp(a), were done. RESULTS: Improvement of vitamin D status in DD and CDD groups, compared to PD, resulted in a significant increase in Apo A1 (mean changes 0.22 ± 0.38, 0.20 ± 0.27 and 0.01 ± 0.35 g/L, respectively, p = 0.047) and a significant decrease in serum Lp(a) (mean changes -0.08 ± 0.30, -0.08 ± 0.31, and 0.14 ± 0.25 µmol/L, respectively, p = 0.011). There was no significant difference between DD and CDD groups. Serum Apo B did not change significantly in any of the groups. CONCLUSIONS: Significant amelioration of serum Apo A1 and Lp(a) following improvement of vitamin D status in T2D subjects may have preventive implications against long-term diabetic complications, notably CVD. This trial was registered at ClinicalTrials.gov as NTC01229891.

Vitamin D Receptor Fok-I polymorphism modulates diabetic host response to vitamin D intake: need for a nutrigenetic approach.

OBJECTIVE: Interpopulation as well as interindividual variations in response to vitamin D intake commonly observed in subjects with type 2 diabetes may be related to genetic makeup. One of the candidate genes potentially responsible for this diversity is vitamin D receptor (VDR). This study aimed to investigate the interactive effect of VDR Fok-I polymorphism and vitamin D intake on diverse aspects of diabetic host response. RESEARCH DESIGN AND METHODS: Glycemic status, lipid profiles, inflammatory biomarkers, and VDR Fok-I genotypes were determined in diabetic subjects (n = 140) who participated in a randomized controlled trial. Participants consumed two 250-mL bottles per day of yogurt drink (doogh) fortified with 500 IU vitamin D/250 mL for 12 weeks. RESULTS: Mean serum 25(OH)D increased by ~30 nmol/L (P < 0.001). The time × intervention effect was significant for 25(OH)D (P = 0.030), HDL (P = 0.011), high-sensitivity C-reactive protein (hsCRP) (P < 0.001), interleukin (IL)-4 (P = 0.008), and IL-6 (P = 0.017) among the genotypic groups. The alleles were defined as ''F'' or ''f'' depending on the absence or presence of the restriction site, respectively. The least increment in 25(OH)D was in ff (23.0 ± 3.8 nmol/L) compared with Ff (31.2 ± 3.4 nmol/L) and FF (35.6 ± 2.7 nmol/L) (P for trend = 0.009), but only the difference between ff and FF was significant (P = 0.023). FF group had the largest decrement of both hsCRP and IL-6 compared with Ff (P < 0.001 and P = 0.038) and ff (P = 0.010 and P = 0.048), respectively. CONCLUSIONS: We concluded that those of VDR ff genotype may be regarded as "low responders" to vitamin D intake in terms of response of circulating 25(OH)D and certain inflammatory biomarkers. A nutrigenetic approach may, therefore, be needed to protect diabetic patients from vitamin D deficiency.

Improvement of vitamin D status via daily intake of fortified yogurt drink either with or without extra calcium ameliorates systemic inflammatory biomarkers, including adipokines, in the subjects with type 2 diabetes.

CONTEXT: Systemic inflammation is thought to have a central role in diabetic long-term complications. OBJECTIVE: The aim of this study was to investigate the effects of vitamin D either with or without extra calcium on certain inflammatory biomarkers in the subjects with type 2 diabetes (T2D). DESIGN, SETTING, AND PARTICIPANTS: This was a double-blind, randomized, controlled trial conducted over 12 wk in 90 T2D subjects aged 30-60 yr from both sexes. INTERVENTION: Subjects were randomly allocated to one of three groups to receive two 250-ml bottles a day of plain Persian yogurt drink or doogh (PD, containing 150 mg calcium and no detectable vitamin D(3)/250 ml), vitamin D-fortified doogh (DD, containing 500 IU vitamin D(3) and 150 mg calcium/250 ml), or calcium + vitamin D(3)-fortified doogh (CDD, containing 500 IU vitamin D(3) and 250 mg calcium/250 ml). OUTCOME MEASURES: The changes in inflammatory markers were evaluated. RESULTS: Compared to the baseline values, highly sensitive C-reactive protein, IL-1ß, IL-6, fibrinogen, and retinol binding protein-4 concentrations significantly decreased in both the DD and CDD groups. Although the decrement in highly sensitive C-reactive protein and fibrinogen was more in CDD compared to DD (-4.0 ± 8.5 vs. -1.3 ± 2.8 mg/liter, and -0.40 ± 0.74 and -0.20 ± 0.52 mg/liter, respectively), the differences were not significant. There was a significant increase in serum adiponectin in both the DD and CDD groups (51.3 ± 65.3 vs. 57.1 ± 33.8 µg/liter; P < 0.05). Mean adiponectin changes in CDD were significantly higher than in PD (P = 0.021). CONCLUSIONS: Daily intake of vitamin D-fortified doogh improved inflammatory markers in T2D subjects, and extra calcium conferred additional benefit only for the antiinflammatory adipokine, i.e. adiponectin.

Regular consumption of vitamin D-fortified yogurt drink (Doogh) improved endothelial biomarkers in subjects with type 2 diabetes: a randomized double-blind clinical trial.

BACKGROUND: Endothelial dysfunction has been proposed as the underlying cause of diabetic angiopathy that eventually leads to cardiovascular disease, the major cause of death in diabetes. We recently demonstrated the ameliorating effect of regular vitamin D intake on the glycemic status of patients with type 2 diabetes (T2D). In this study, the effects of improvement of vitamin D status on glycemic status, lipid profile and endothelial biomarkers in T2D subjects were investigated. METHODS: Subjects with T2D were randomly allocated to one of the two groups to receive either plain yogurt drink (PYD; containing 170 mg calcium and no vitamin D/250 mL, n1 = 50) or vitamin D3-fortified yogurt drink (FYD; containing 170 mg calcium and 500 IU/250 mL, n2 = 50) twice a day for 12 weeks. Anthropometric measures, glycemic status, lipid profile, body fat mass (FM) and endothelial biomarkers including serum endothelin-1, E-selectin and matrix metalloproteinase (MMP)-9 were evaluated at the beginning and after the 12-week intervention period. RESULTS: The intervention resulted in a significant improvement in fasting glucose, the Quantitative Insulin Check Index (QUICKI), glycated hemoglobin (HbA1c), triacylglycerols, high-density lipoprotein cholesterol (HDL-C), endothelin-1, E-selectin and MMP-9 in FYD compared to PYD (P < 0.05, for all). Interestingly, difference in changes of endothelin-1, E-selectin and MMP-9 concentrations in FYD compared to PYD (-0.35 ± 0.63 versus -0.03 ± 0.55, P = 0.028; -3.8 ± 7.3 versus 0.95 ± 8.3, P = 0.003 and -2.3 ± 3.7 versus 0.44 ± 7.1 ng/mL, respectively, P < 0.05 for all), even after controlling for changes of QUICKI, FM and waist circumference, remained significant for endothelin-1 and MMP-9 (P = 0.009 and P = 0.005, respectively) but disappeared for E-selectin (P = 0.092). On the contrary, after controlling for serum 25(OH)D, the differences disappeared for endothelin-1(P = 0.066) and MMP-9 (P = 0.277) but still remained significant for E-selectin (P = 0.011). CONCLUSIONS: Ameliorated vitamin D status was accompanied by improved glycemic status, lipid profile and endothelial biomarkers in T2D subjects. Our findings suggest both direct and indirect ameliorating effects of vitamin D on the endothelial biomarkers. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01236846.

Daily consumption of vitamin D- or vitamin D + calcium-fortified yogurt drink improved glycemic control in patients with type 2 diabetes: a randomized clinical trial.

BACKGROUND: Low serum concentrations of 25-hydroxyvitamin D [25(OH)D] have been associated with impaired glucose tolerance and diabetes. OBJECTIVE: This study aimed to compare the effects of daily intake of vitamin D- or vitamin D(3) + calcium-fortified yogurt drink on glycemic status in subjects with type 2 diabetes (T2D). DESIGN: Ninety diabetic subjects were randomly allocated to 3 groups to consume plain yogurt drink (PY; containing no vitamin D and 150 mg Ca/250 mL), vitamin D-fortified yogurt drink (DY; containing 500 IU vitamin D(3) and 150 mg Ca/250 mL), or vitamin D + calcium-fortified yogurt drink (DCY; containing 500 IU vitamin D(3) and 250 mg Ca/250 mL) twice per day for 12 wk. Fasting serum glucose (FSG), glycated hemoglobin (Hb A(1c)), homeostasis model assessment of insulin resistance (HOMA-IR), serum lipid profile, and percentage fat mass (FM) were assessed before (baseline) and after the intervention. RESULTS: In both the DY and DCY groups, mean serum 25(OH)D(3) improved (+32.8 ± 28.4 and +28.8 ± 16.1 nmol/L, respectively; P < 0.001 for both), but FSG [-12.9 ± 33.7 mg/dL (P = 0.015) and -9.6 ± 46.9 mg/dL (P = 0.035)], Hb A(1c) [-0.4 ± 1.2% (P < 0.001) and -0.4 ± 1.9% (P < 0.001)], HOMA-IR [-0.6 ± 1.4 (P = 0.001) and -0.6 ± 3.2 (P < 0.001)], waist circumference (-3.6 ± 2.7 and -2.9 ± 3.3; P < 0.001 for both), and body mass index [in kg/m(2); -0.9 ± 0.6 (P < 0.001) and -0.4 ± 0.7 (P = 0.005)] decreased significantly more than in the PY group. An inverse correlation was observed between changes in serum 25(OH)D(3) and FSG (r = -0.208, P = 0.049), FM (r = -0.219, P = 0.038), and HOMA-IR (r = -0.219, P = 0.005). CONCLUSION: Daily intake of a vitamin D-fortified yogurt drink, either with or without added calcium, improved glycemic status in T2D patients. This trial was registered at clinicaltrials.gov as NCT01229891.