Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy Modulation of gut microbiota dysbioses in type 2 diabetic patients by macrobiotic Ma-Pi 2 diet Diet, Inflammation, and Glycemic Control in Type 2 Diabetes: An Integrative Review of the Literature Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT). A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Biomarkers of insulin action during single soccer sessions before and after a 12-week training period in type 2 diabetes patients on a caloric-restricted diet Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries Combination of recreational soccer and caloric restricted diet reduces markers of protein catabolism and cardiovascular risk in patients with type 2 diabetes The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study-a 3-mo randomized controlled trial. The family Coriobacteriaceae is a potential contributor to the beneficial effects of Roux-en-Y gastric bypass on type 2 diabetes. Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: the ENTRED surveys (2001 and 2007). A low-carbohydrate as compared with a low-fat diet in severe obesity. Vegetarian diet-induced increase in linoleic acid in serum phospholipids is associated with improved insulin sensitivity in subjects with type 2 diabetes Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes. Intake of dietary saturated fatty acids and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort: associations by types, sources of fatty acids and substitution by macronutrients Egg consumption and risk of type 2 diabetes in older adults. Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes Egg consumption and risk of incident type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Dairy Products and Prevention of Type 2 Diabetes: Implications for Research and Practice Daily physical activity and macronutrient distribution of low-calorie diets jointly affect body fat reduction in obese women. Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. Prevention of type 2 diabetes - where is the evidence? Established dietary estimates of net acid production do not predict measured net acid excretion in patients with Type 2 diabetes on Paleolithic–Hunter–Gatherer-type diets
Background Type 2 diabetes ( T2D ) is associated with a prion diminished quality of life , especially due to the severe complications that it implicates . Changing dietary habits is an absolute priority , as well as implementing nutritional motivational programs . The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D . Methods A total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet , the classes of nutrients , the distribution of the meals during the day and the dietary choices . During regular meetings , the patients were requested to fill out a question naire about their dietary habits and behaviours . Clinical and metabolic parameters were also analysed . Results At the end of the intervention the number of people who declared that they ate five meals a day ( p = 0.006 ) and preferred to have fruit for snack ( p = 0.004 ) increased , while there was a reduction in the use of sweeteners and an elimination of the use of fructose ( p = 0.05 ) . The total daily consumption of kilocalories ( kcal ) had been reduced and the percentages of carbohydrates , proteins and lipids , after the intervention , follow the guidelines . In relation to this , a significant improvement ( p < 0.05 ) was registered in systolic and diastolic pressure , BMI and waist circumference , as well as in glycaemic values ( p = 0.018 ) . Conclusions A nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D . We hope that a similar intervention will be applied in Campania and in other Italian regions . Trial registration Registration number is IS RCT N11067689 ; date of registration : 10/09/2018 . Retrospectively registered The gut microbiota exerts a role in type 2 diabetes ( T2D ) , and deviations from a mutualistic ecosystem layout are considered a key environmental factor contributing to the disease . Thus , the possibility of improving metabolic control in T2D by correcting gut microbiome dysbioses through diet has been evaluated . Here , we explore the potential of two different energy-restricted dietary approaches – the fibre-rich macrobiotic Ma-Pi 2 diet or a control diet recommended by Italian professional societies for T2D treatment – to correct gut microbiota dysbioses in T2D patients . In a previous 21-d open-label MADIAB trial , fifty-six overweight T2D patients were r and omised to the Ma-Pi 2 or the control diet . For the present study , stools were collected before and after intervention from a subset of forty MADIAB participants , allowing us to characterise the gut microbiota by 16S rRNA sequencing and imputed metagenomics . To highlight microbiota dysbioses in T2D , the gut microbiota of thirteen normal-weight healthy controls were characterised . According to our findings , both diets were effective in modulating gut microbiome dysbioses in T2D , result ing in an increase of the ecosystem diversity and supporting the recovery of a balanced community of health-promoting SCFA producers , such as Faecalibacterium , Roseburia , Lachnospira , Bacteroides and Akkermansia .  The Ma-Pi 2 diet , but not the control diet , was also effective in counteracting the increase of possible pro-inflammatory groups , such as Collinsella and Streptococcus , in the gut ecosystem , showing the potential to reverse pro-inflammatory dysbioses in T2D , and possibly explaining the greater efficacy in improving the metabolic control Type 2 diabetes ( T2D ) is a growing national health problem affecting 35 % of adults ≥20 years of age in the United States . Recently , diabetes has been categorized as an inflammatory disease , sharing many of the adverse outcomes as those reported from cardiovascular disease . Medical nutrition therapy is recommended for the treatment of diabetes ; however , these recommendations have not been up date d to target the inflammatory component , which can be affected by diet and lifestyle . To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D , we conducted an integrative review of the literature . A comprehensive search of the PubMed , CINAHL , Scopus , and Web of Science data bases from January 2000 to May 2012 yielded 786 articles . The final 16 studies met the selection criteria including r and omized control trials , quasiexperimental , or cross-sectional studies that compared varying diets and measured inflammatory markers . The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers . The Mediterranean diet demonstrated the most clinical ly significant reduction in glycosylated hemoglobin ( HbA1c ) . Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking . Continued research is warranted Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes ( T2DM ) and the debate persists : which dietary strategy is most effective . In the Dietary Intervention R and omized Controlled Trial ( DIRECT ) 322 moderately obese participants were r and omized for 2 years to one of three diet groups : low-fat , Mediterranean and low-carbohydrate . Differential effects were observed in the sub-group of patients with T2DM at 24 months : participants r and omized to the Mediterranean diet , which had the highest intake of dietary fibers and unsaturated to saturated fat ratio , achieved greater significant improvements in fasting plasma glucose and insulin levels . Patients who were r and omized to the low-carbohydrate diet , which had the minimal intake of carbohydrates , achieved a significant reduction of hemoglobin A1C . Although improvements were observed in all groups , the low-fat diet was likely to be less beneficial in terms of glycemic control and lipid metabolism . Interpretation of results from different studies on dietary strategies may be complex since there is often no consistency in diet compositions , calorie restriction , intensity of intervention , dietary assessment or extent of adherence in the trial . Nevertheless , it seems that low fat restricted calorie diets are effective for weight loss and are associated with some metabolic benefits ; however , some recent trials have shown that low carbohydrate diets are as efficient in inducing weight loss and in some metabolic measures such as serum triglycerides and HDL-cholesterol may be even superior to low fat diets . When addressing the issue of diet quality rather than quantity applying the glycemic index may have some added benefits . Furthermore special features of the Mediterranean diet have apparent additional favorable effects for patients with T2DM OBJECTIVE Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance , many patients are unable to comply with such dietary therapy for long periods . The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association . However , r and omised trials of dietary interventions in Japanese patients with type 2 diabetes are scarce . Therefore , the aim of this study was to examine the effects of a non-calorie-restricted , low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet . METHODS The enrolled patients were r and omly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet . The patients received consultations every two months from a registered dietician for six months . We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles . RESULTS The HbA1c levels decreased significantly from baseline to six months in the low-carbohydrate diet group ( baseline 7.6±0.4 % , six months 7.0±0.7 % , p=0.03 ) but not in the calorie-restricted group ( baseline 7.7±0.6 % , six months 7.5±1.0 % , n.s . ) , ( between-group comparison , p=0.03 ) . The patients in the former group also experienced improvements in their triglyceride levels , without experiencing any major adverse effects or a decline in the quality of life . CONCLUSION Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet BACKGROUND We investigated the biomarkers of insulin action as well as changes in free fatty acids and lactate concentration after an acute soccer session pre and post training with caloric-restricted diet versus diet alone in type 2 diabetes ( T2D ) patients . METHODS Fifty-one middle-aged ( 61.1 ± 6.4 years ) T2D patients were r and omly allocated to the soccer+diet group ( SDG ) or the diet group ( DG ) . The control group comprised T2D patients observing a caloric-restricted diet who did not receive soccer training .  Over 12 weeks , SDG performed 3 × 40 min per week of soccer training . RESULTS The first soccer session for SDG induced acute increases in blood lactate ( 1.4 ± 0.1 - 6.0 ± 0.7 mmol/L , P < 0.05 ) and glucagon levels ( 112.1 ± 6.2 - 142.9 ± 8.0 pg/mL , P < 0.05 ) , whereas glucose and insulin levels remained unchanged . Moreover , this session showed suppressed insulin levels as well as higher free fatty acids , lactate levels and glucagon/insulin ratio compared to DG ( p < 0.05 ) . After 12 weeks , a baseline decrease was observed in glucagon , leptin and lactate levels in SDG and DG ( p < 0.05 ) , whereas HOMA-IR , Adipo-IR and glucose levels were lower only in SDG ( p < 0.05 ) . At the last soccer training session , the blood lactate response was significantly lower than for the first session ( 4.0 ± 0.4 vs 6.0 ± 0.7 mmol/L ) . At 48 h pre intervention , a decrease was observed in leptin levels ( p < 0.05 ) , which remained lower post intervention . The positive correlation between leptin and insulin , and the lower levels after training , could be attributed to the improved insulin sensitivity along with the weight loss observed in both groups ( ~3.4 kg for DG and 3.7 kg for SDG ) . CONCLUSION Acute soccer sessions markedly improved insulin action markers in T2D patients , while the cumulative effects enhanced insulin sensitivity and decreased risk factors associated with cardiovascular disease after 12 weeks of intervention better than caloric-restricted diet Background / Objectives : Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes ( T2D ) risk , but studies on foods high in fat per unit weight are sparse . We assessed whether the intake of vegetable oil , butter , margarine , nuts and seeds and cakes and cookies is related to incident T2D.Subjects/ Methods : A case-cohort study was conducted , nested within eight countries of the European Prospect i ve Investigation into Cancer ( EPIC ) , with 12 403 incident T2D cases and a subcohort of 16 835 people , identified from a cohort of 340 234 people . Diet was assessed at baseline ( 1991–1999 ) by country-specific question naires . Country-specific hazard ratios ( HRs ) across four categories of fatty foods ( nonconsumers and tertiles among consumers ) were combined with r and om-effects meta- analysis . Results : After adjustment not including body mass index ( BMI ) , nonconsumers of butter , nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption . Among consumers , cakes and cookies were inversely related to T2D ( HRs across increasing tertiles 1.14 , 1.00 and 0.92 , respectively ; P-trend < 0.0001 ) . All these associations attenuated upon adjustment for BMI , except the higher risk of nonconsumers of cakes and cookies ( HR 1.57 ) . Higher consumption of margarine  became positively associated after BMI adjustment ( HRs across increasing consumption tertiles : 0.93 , 1.00 and 1.12 ; P-trend 0.03 ) . Within consumers , vegetable oil , butter and nuts and seeds were unrelated to T2D . Conclusions : Fatty foods were generally not associated with T2D , apart from weak positive association for margarine . The higher risk among nonconsumers of cakes and cookies needs further explanation Background Moderate calorie-restricted diets and exercise training prevent loss of lean mass and cardiovascular risk . Because adherence to routine exercise recommendation is generally poor , we utilized recreational soccer training as a novel therapeutic exercise intervention in type 2 diabetes ( T2D ) patients . Objective We compared the effects of acute and chronic soccer training plus calorie-restricted diet on protein catabolism and cardiovascular risk markers in T2D . Design , setting and subjectsFifty-one T2D patients ( 61.1±6.4 years , 29 females : 22 males ) were r and omly allocated to the soccer+diet-group ( SDG ) or to the dietgroup ( DG ) . The 40-min soccer sessions were held 3 times per week for 12 weeks . Results Nineteen participants attended 100 % of scheduled soccer sessions , and none suffered any injuries . The SDG group showed higher levels of growth hormone ( GH ) , free fatty acids and ammonia compared with DG . After 12 weeks , insulin-like growth factor binding protein (IGFPB)-3 and glucose levels were lower in SDG , whereas insulin-like growth factor (IGF)-1/ IGFBP-3 ratio increased in both groups . After the last training session , an increase in IGF-1/IGFBP-3 and attenuation in ammonia levels were suggestive of lower muscle protein catabolism . Conclusions Recreational soccer training was popular and safe , and was associated with decreased plasma glucose and IGFBP-3 levels , decreased ammoniagenesis , and increased lipolytic activity and IGF-1/IGFBP-3 ratio , all indicative of attenuated catabolism BACKGROUND Previously published research that examined the effects of high egg consumption in people with type 2 diabetes ( T2D ) produced conflicting results leading to recommendations to limit egg intake . However , people with T2D may benefit from egg consumption because eggs are a nutritious and convenient way of improving protein and micronutrient contents of the diet , which have importance for satiety and weight management . OBJECTIVE In this r and omized controlled study , we aim ed to determine whether a high-egg diet ( 2 eggs/d for 6 d/wk ) compared with a low-egg diet ( < 2 eggs/wk ) affected circulating lipid profiles , in particular high-density lipoprotein ( HDL ) cholesterol , in overweight or obese people with prediabetes or T2D . DESIGN A total of 140 participants were r and omly assigned to one of the 2 diets as part of a 3-mo weight maintenance study . Participants attended the clinic monthly and were instructed on the specific types of foods and quantities to be consumed . RESULTS There was no significant difference in the change in HDL cholesterol from screening to 3 mo between groups ; the mean difference ( 95 % CI ) between high- and low-egg groups was + 0.02 mmol/L ( -0.03 , 0.08 mmol/L ; P = 0.38 ) . No between-group differences were shown for total cholesterol , low-density lipoprotein cholesterol , triglycerides , or glycemic control . Both groups were matched for protein intake , but the high-egg group reported less hunger and greater satiety postbreakfast . Polyunsaturated fatty acid ( PUFA ) and monounsaturated fatty acid ( MUFA ) intakes significantly increased from baseline in both groups . CONCLUSIONS High egg consumption did not have an adverse effect on the lipid profile of people with T2D in the context of increased MUFA and PUFA consumption . This study suggests that a high-egg diet can be included safely as part of the dietary management of T2D , and it may provide greater satiety . This trial was registered at the Australia New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au/ ) as ACTRN12612001266853 BACKGROUND Changes in gut microbiota induced by bariatric surgery have been associated with metabolic benefits . OBJECTIVES Our aim was to identify specific gut microbiota that may contribute to the improvement of  type 2 diabetes ( T2D ) after Roux-en-Y gastric bypass ( RYGB ) .  SETTING Laboratories of Shanghai Diabetes Institute and Shanghai Sixth People 's Hospital . METHODS Diabetic rats induced via a high-fat diet and low-dose streptozotocin administration  were r and omized to RYGB or sham surgery , and stool sample s were collected at baseline and at postoperative week 8 . The fecal microbiota was profiled using 16S ribosomal RNA gene sequencing . Additionally , we performed a case-control study of the gut microbial community profiles of T2D patients compared with those of healthy individuals via 16S ribosomal RNA gene sequencing of mucosal-luminal interface sample s collected from the ascending colon during colonoscopy . RESULTS RYGB significantly reduced the weight and improved glucose tolerance and insulin sensitivity in diabetic rats . Principal coordinate analysis showed that RYGB caused marked alterations in the gut microbiota . The RYGB group was postoperatively enriched for Bacteroidetes , Proteobacteria , Fusobacteria , and Actinobacteria , whereas the sham surgery group was enriched for Firmicutes and Verrucomicrobia . Based on the gut microbial patterns in the T2D patients , we found that the family Coriobacteriaceae within Actinobacteria might contribute to the beneficial effects of RYGB on T2D . CONCLUSIONS RYGB significantly improves glucose metabolism and alters the gut microbiota . Moreover , the family Coriobacteriaceae may partly mediate the beneficial effects of RYGB on T2D and thus possibly contribute to the development of novel bacteria-based therapeutic approaches AIMS The study aim ed to assess the prevalence , quality of screening and treatment of chronic kidney disease ( CKD ) , and their trends between 2001 and 2007 , in French adults with type 2 diabetes ( T2D ) . METHODS The 2007 ENTRED survey r and omly selected , from French medical insurance fund data bases , 8926 adults treated for diabetes who had been reimbursed at least three times over the previous 12 months for oral hypoglycaemic agents or insulin .  Medical reimbursement data were extracted and two sets of question naires were mailed , one to all patients ( 48 % response rate ) and the other to their doctors ( 62 % ) . Analyses were restricted to the 3894 responders with T2D ( 2232 with data from their doctors ) . Trends between the 2001 and 2007 ENTRED surveys were studied . RESULTS Participants ' mean age was 66 years . The prevalence of CKD was estimated to be at least 29 % , based on doctors ' data ( missing data included ) . Overall , only 17 % had no cl aims for serum creatinine measurements during the year , and 71 % had no cl aims for albuminuria tests ; nonetheless , both figures had decreased from 2001 . Older people , those who lived alone and those who felt poorly informed about diabetes were more likely to have made no cl aims for CKD screening . Assessment of quality of care ( prescribing antihypertensive treatment when indicated ) was possible for 66 % of responders , of whom 25 % did not receive such treatment . CONCLUSION CKD is frequently seen in patients with T2D and is likely to be underestimated because albuminuria screening remains inadequate , despite significant improvements since 2001 . Further efforts are needed to improve CKD screening , patient and doctor awareness , and adequate use of antihypertensive/nephroprotective medications BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed BACKGROUND AND AIMS : Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications . We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose ( MCR ) than conventional hypocaloric diet . The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes ( T2D ) . METHODS : Subjects with T2D ( n=74 ) were r and omly assigned into a vegetarian group ( VG , n=37 ) following vegetarian diet or a control group ( CG , n=37 ) following a conventional diet . Both diets were calorie restricted ( −500 kcal day–1 ) . Participants were examined at baseline , 12 weeks of diet intervention and 24 weeks ( subsequent 12 weeks of diet were combined with aerobic exercise ) . The fatty acid composition of serum phospholipids was measured by gas liquid chromatography . MCR was measured by hyperinsulinemic isoglycemic clamp . Visceral fat ( VF ) was measured by magnetic resonance imaging . RESULTS : Linoleic acid ( LA ; 18:2n6 ) increased in VG ( P=0.04 ) , whereas it decreased in CG ( P=0.04 ) in response to dietary interventions . It did not change significantly after the addition of exercise in either group ( group × time P<0.001 ) . In VG , changes in 18:2n6 correlated positively with changes in MCR ( r=+0.22 ; P=0.04 ) and negatively with changes in VF ( r=−0.43 ; P=0.01 ) . After adjustment for changes in body mass index , the association between 18:2n6 and MCR was no longer significant . The addition of exercise result ed in greater changes of phospholipid fatty acids composition in VG than in CG . CONCLUSION : We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids We evaluated the effects of recreational football training combined with calorie-restricted diet ( football + diet ) vs calorie-restricted diet alone ( diet ) on aerobic fitness , lipid profile , and insulin resistance indicators in type 2 diabetes ( T2D ) patients . Forty-four T2D patients aged 48 - 68 years ( 27 females , 17 males ) were r and omly allocated to the football + diet group ( FDG ; n = 22 ) or to the diet group ( DG ; n = 22 ) , of whom 19 FDG and 15 DG subjects completed the study . The football training was performed for 3 × 40 min/week for 12 weeks . Dual-energy X-ray absorptiometry scanning , treadmill testing , and fasting blood samplings were performed pre and post-intervention . After 12 weeks , maximal oxygen uptake ( VO₂max ) was elevated ( P < 0.05 ) by 10 ± 4 % in FDG but not in DG ( -3 ± 4 % , P < 0.05 ) . After 12 weeks , reductions in blood triglycerides ( 0.4 ± 0.1 mmol/L ) , total cholesterol ( 0.6 ± 0.2 mmol/L ) , low-density lipoprotein , and very low-density lipoprotein levels were observed only in FDG . Fat mass decreased ( P < 0.05 ) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG . The lower ( P < 0.05 ) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG . In conclusion , football combined with restricted diet was effective in enhancing VO₂max , reducing total cholesterol and triglycerides , and increasing insulin sensitivity , potentially providing better tools for the prevention of T2D complications than diet alone Purpose The association between dietary saturated fatty acids ( SFA ) intake and  type 2 diabetes ( T2D )  remains unclear . This study aim ed at investigating the association between SFA intake and T2D risk based on ( 1 ) individual SFA ( differing in carbon chain length ) , ( 2 ) food sources of SFA and ( 3 ) the substituting macronutrients . Methods 37,421 participants from the European Prospect i ve Investigation into Cancer and Nutrition-Netherl and s ( EPIC-NL ) cohort were included in this study . Baseline dietary intake was assessed by a vali date d food frequency question naire . T2D risks were estimated by Cox regression models adjusted for non-dietary and dietary covariates . Results 893 incident T2D cases were documented during 10.1-year follow-up . We observed no association between total SFA and T2D risk . Marginally inverse associations were found for lauric acid ( HR per 1 SD of energy% , 95 % CI 0.92 , 0.85–0.99 ) , myristic acid ( 0.89 , 0.79–0.99 ) , margaric acid ( 0.84 , 0.73–0.97 ) , odd-chain SFA ( pentadecylic plus margaric acids ; 0.88 , 0.79–0.99 ) , and cheese derived SFA ( 0.90 , 0.83–0.98 ) . Soft and liquid fats derived SFA was found related to higher T2D risk ( 1.08 , 1.01–1.17 ) . When substituting SFA by proteins , carbohydrates and polyunsaturated fatty acids , significantly higher risks of T2D were observed ( HRs per 1 energy% ranging from 1.05 to 1.15 ) . Conclusion In this Dutch population , total SFA does not relate to T2D risk . Rather , the association may depend on the types and food sources of SFA . Cheese-derived SFA and individual SFA that are commonly found in cheese , were significantly related to lower T2D risks . We can not exclude the higher T2D risks found for soft and liquid fats derived SFA and for substituting SFA with other macronutrients are influenced by residual confounding by trans fatty acids or limited intake variation in polyunsaturated fatty acids and vegetable protein BACKGROUND Type 2 diabetes ( T2D ) remains an important public health issue in the United States . There are limited and inconsistent data on the association between egg consumption and fasting glucose or incident diabetes . OBJECTIVES We assessed the association between  egg  intake and  incident diabetes in older adults . DESIGN In this prospect i ve study of 3898 men and women from the Cardiovascular Health Study ( 1989 - 2007 ) , we assessed egg consumption by using a picture-sorted food question naire and ascertained incident T2D annually by using information on hypoglycemic agents and plasma glucose . We used Cox proportional hazards models to estimate adjusted relative risks . RESULTS During a mean follow-up of 11.3 y , 313 new cases of T2D occurred . Crude incidence rates of T2D were 7.39 , 6.83 , 7.00 , 6.72 , and 12.20 per 1000 person-years in people who reported egg consumption of never , < 1 egg/mo , 1 - 3 eggs/mo , 1 - 4 eggs/wk , and almost daily , respectively . In multivariable-adjusted models , there was no association between egg consumption and increased risk of T2D in either sex and overall . In a secondary analysis , dietary cholesterol was not associated with incident diabetes ( P for trend = 0.47 ) . In addition , egg consumption was not associated with clinical ly meaningful differences in fasting glucose , fasting insulin , or measures of insulin resistance despite small absolute analytic differences that were significant . CONCLUSION In this cohort of older adults with limited egg intake , there was no association between egg consumption or dietary cholesterol and increased risk of incident T2D Approximately 80 % of patients with type 2 diabetes are overweight/obese ( 1 ) , and weight loss is the mainstay of treatment for these individuals . However , there is growing controversy as to whether reduced-fat or reduced-carbohydrate diets are best suited for this purpose , and results ( 2–8 ) in nondiabetic subjects suggest that lower carbohydrate diets are similarly or more efficacious in improving weight , triglycerides , and HDL cholesterol . There are no published r and omized studies evaluating the role of dietary macronutrients with respect to weight loss and cardiovascular risk improvement in patients with type 2 diabetes . Thus , we r and omized diet-treated patients with type 2 diabetes to hypocaloric diets , moderately restricted in either carbohydrate or fat , to determine whether weight loss or metabolic improvement differed as a function of macronutrient composition . A total of 29 patients with diet-treated type 2 diabetes were recruited from the San Francisco Bay area . All subjects gave written informed consent . Inclusion criteria included BMI 27–36 kg/m2 , fasting plasma glucose concentration 7.2–8.3 mmol/l , no use of antihyperglycemic medications , and stable weight for 3 months . Subjects on anti-hypertensive or cholesterol-lowering drugs or aspirin were allowed to continue their medications . Insulin-mediated glucose uptake was quantified by a modification ( 9 ) of the insulin suppression test as originally described ( 10 ) and vali date d ( 11 ) . In this test , a 180-min infusion of somatostatin ( 0.27 μg/m2 per min ) , insulin ( 25 mU/m2 per min ) , BACKGROUND The prevalence of type 2 diabetes ( T2D ) is increasing around the world . Eggs are a major source of cholesterol , which has been associated with elevated blood glucose and an increased risk of T2D . However , there are limited and conflicting data from prospect i ve population studies on the association between egg consumption and risk of T2D . OBJECTIVE We investigated the association between egg consumption and risk of incident T2D in middle-aged and older men from eastern Finl and . DESIGN The study included 2332 men aged 42 - 60 y in 1984 - 1989 at the baseline examinations of the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor Study .  Dietary intakes were assessed with 4-d food records at baseline . Incident T2D was assessed by self-administered question naires ; by fasting and 2-h oral-glucose-tolerance-test blood glucose measurement at re-examination rounds 4 , 11 , and 20 y after baseline ; and by record linkage to a hospital discharge registry and reimbursement register of diabetes medication expenses . Cox proportional hazards regression analyses were used to estimate associations with the risk of incident T2D . Associations with the metabolic risk markers at baseline and at the 4-y examinations were analyzed by ANCOVA . RESULTS During an average follow-up of 19.3 y , 432 men developed T2D . After adjustment for potential confounders , those in the highest compared with the lowest egg intake quartile had a 38 % ( 95 % CI : 18 % , 53 % ; P-trend across quartiles < 0.001 ) lower risk of incident T2D . Analyses with metabolic risk markers also suggested an inverse association with fasting plasma glucose and serum C-reactive protein but not with serum insulin . The associations between cholesterol intake and risk of T2D , plasma glucose , serum insulin , and C-reactive protein were mainly nonsignificant , especially after accounting for egg consumption . CONCLUSION Higher egg intake was associated with a lower risk of T2D in this cohort of middle-aged and older men A growing body of scientific evidence has linked dairy intake to a reduced  type 2 diabetes ( T2D ) risk . Using an evidence -based approach , we review ed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D . Evidence indicates that dairy intake is significantly associated with a reduced T2D risk , and likely in a dose-response manner . The association between low-fat dairy and T2D risk reduction appears consistent . A beneficial impact is suggested for regular-fat dairy . The role of specific dairy products needs to be clarified . Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome , as well as several dairy components , such as calcium , vitamin D , dairy fat , and specifically trans-palmitoleic acid . To conclude , there is strong , consistent , and accumulating evidence that dairy intake reduces the risk of T2D . More research is needed to better underst and the role of regular-fat and specific dairy products . Well- design ed r and omized controlled trials and mechanistic studies are needed to support these findings . Efforts to translate this evidence into clinical practice and public health guidance are needed Inadequate dietary patterns and sedentary lifestyles are believed to be important factors in predisposing people to obesity . This study analyzed the potential interaction between habitual physical activity and the carbohydrate (CHO)-fat distribution in 2 hypocaloric diets and the impact of such interplay on body composition changes . Forty healthy obese women , 20 - 50 years old , were r and omly assigned to a high- or low-CHO energy-restricted diet , which was low or high in fat , respectively , during 10 weeks . Baseline and final measurements were performed to assess dietary habits , resting metabolic rate , and body composition changes . Physical activity was measured with a triaxial accelerometer and with a question naire . There were no significant differences in anthropometric and metabolic variables between both dietary groups at baseline . However , there was a positive correlation between total free-living physical activity and arm muscle preservation after 10 weeks ( r = 0.371 ; p = 0.024 ) . Interestingly , an interaction between macronutrient ( CHO-fat distribution ) intake and physical activity was found , since less-active subjects with a high-CHO-low-fat diet showed a greater fat loss than those more active with a lower-CHO-high-fat diet , whereas more-active subjects with a high-CHO-low-fat diet showed a smaller fat loss than those receiving a low-CHO-high-fat diet . Physical activity and the macronutrient content of energy-restricted diets , when design ed to promote body fat mass reduction , should be considered together to better predict the outcome This summer , 25 overweight and obese adults participating in a tightly controlled feeding study will take up fulltime residence for 3 months at a wooded lakefront center in Ashl and , Massachusetts . However , before checking in at Framingham State University ’s Warren Conference Center and Inn , they will have to lose 15 % of their body weight on a calorie-restricted diet with home-delivered meals . Those who pass this hurdle will be invited to the inn , where they ’ll be r and omly assigned to 1 of 3 equal-calorie diets : a lowfat , high-carbohydrate diet that ’s either high or low in added sugar or a very lowcarbohydrate , high-fat ketogenic diet that causes the body to switch from burning carbohydrates to burning fat . The group will be the first of 5 that will participate in the trial over 3 years . Changes in body fat mass and energy expenditure will be assessed to determine if any of the diets have a unique effect on metabolism , while controlling calorie intake , in people who have already lost weight . “ It ’s hard to lose weight , but it ’s much harder to maintain that weight loss because of well-described physiological adaptations , ” said coprincipal investigator David S. Ludwig , MD , PhD , a professor of pediatrics and nutrition at Harvard Medical School and Harvard T.H. Chan School of Public Health . After most diet-induced weight loss , “ hunger goes up and metabolic rate goes down , and tendency to restore fat increases . ” But there are hints that the ketogenic diet may be different . A meta- analysis of 13 r and omized controlled trials suggested that people on ketogenic diets tend to lose more weight and keep more of it off than people on low-fat diets . People placed on these diets often report decreased hunger , according to Amy Miskimon Goss , PhD , RD , an assistant professor at the University of Alabama at Birmingham ( UAB ) Nutrition Obesity Research Center . The appetitesuppressing powers of the diet are n’t fully understood but could have to do with the satiating properties of fat and protein , changes in appetite-regulating hormones on a low-carb diet , a direct hunger-reducing role of ketone bodies— the body ’s main fuel source on the diet — or other factors . Additionally , the ketogenic diet may not affect metabolism the same way other diets do . In a previous study , Ludwig found that metabolism slowed by more than 400 kcal/d on a low-fat diet while there was no significant decline in metabolic rate on a  very low-carb diet . Medical News & Perspectives ........ Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that Background / objectives : Formulas developed to estimate diet-dependent net acid excretion ( NAE ) generally agree with measured values for typical Western diets . Whether they can also appropriately predict NAE for ‘ Paleolithic-type ’ ( Paleo ) diets — which contain very high amounts of fruits and vegetables ( F&V ) and concurrent high amounts of protein is unknown . Here , we compare measured NAEs with established NAE estimates in subjects with Type 2 diabetes (T2D).Subjects/ methods : Thirteen subjects with well-controlled T2D were r and omized to either a Paleo or American Diabetes Association ( ADA ) diet for 14 days . Twenty-four hour urine collection s were performed at baseline and end of the diet period , and analyzed for titratable acid , bicarbonate and ammonium to calculate measured NAE . Three formulas for estimating NAE from dietary intake were used ; two ( NAE_diet R or L ) that include dietary mineral intake and sulfate- and organic acid ( OA ) production , and one that is empirically derived ( NAE_diet F ) only considering potassium and protein intake . Results : Measured NAE on the Paleo diet was significantly lower than on the ADA-diet ( + 31±22 vs 112±52 mEq/day , P=0.002 ) . Although all formula estimates showed similar and reasonable correlations ( r=0.52–0.76 ) with measured NAE , each one underestimated measured values . The formula with the best correlation did not contain an estimate of dietary OA production . Conclusions : Paleo-diets are lower in NAE than typical Western diets . However , commonly used formulas clearly underestimate NAE , especially for diets with very high F&V ( as the Paleo diet ) , and in subjects with T2D . This may be due to an inappropriate estimation of proton loads stemming from OAs , underlining the necessity for improved measures of OA-related proton sources
There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .