bluuebunny/crossref_metadata_2025_split huggingface dataset:
600-P: Higher Hydration Status Is Indicative of Better Glucose Tolerance
Authors: APAFLO JEHU , LABADAH JOSHUA , NARVAEZ GABRIEL , ROCHA VICTORIA M. , MOSSAYEBI ALI , BAJPEYI SUDIP 
Published: June 2023

Introduction: Water intake is an important dietary behavior to replace high-caloric beverages and to enhance metabolic health. Type 2 diabetes is a metabolic disorder that has been shown to be more prevalent in Hispanics, a population shown to consume relatively less water compared to non-Hispanic Whites. The underlying cause of type 2 diabetes is insulin resistance, characterized by hyperglycemia and impaired glycemic control. However, whether a relationship exists between dehydration and the development of diabetes remains to be elucidated.
Purpose: To evaluate if hydration status indicates glucose tolerance among a dominant Mexican American population.
Methods: Sixty-one participants without diabetes (Age: 26.5 ± 9.1 years; BMI: 27.5 ± 6.0 kg/m2) participated in the study. Fasting blood glucose level was determined, and a 2-hour glucose tolerance test was performed following the ingestion of a 75g glucose drink. Blood glucose concentration levels were determined at 15−, 30−, 60−, 90−, and 120-minute time intervals post ingestion and glucose area under the curve was analyzed as well. Blood works were performed to determine blood urea nitrogen (BUN) and creatinine concentrations. Hydration status was estimated using the ratio of BUN to creatinine values.
Results: Hydration status measured by BUN/Creatinine was positively associated with glucose intolerance measured at 15−, 30−, 60−, and 90-minute post glucose load and by glucose area under the curve (r=0.33; r=0.43; r=0.37; r=0.27; and r=0.41 respectively; p&lt;0.05).
Conclusion: Adequate fluid consumption should be encouraged for glycemic control, especially among people with high diabetes risks.

Disclosure
J.Apaflo: None. J.Labadah: None. G.Narvaez: None. V.M.Rocha: None. A.Mossayebi: None. S.Bajpeyi: None.
601-P: Heterogeneity in Postprandial Glucose Response to Specific Carbohydrates and Mitigation with Premeal Fat, Fiber, or Protein
Authors: METWALLY AHMED A. , PERELMAN DALIA , EHLERT BENJAMIN W. , WU YUE , CELLI ALESSANDRA , BEJIKIAN CAROLINE , PARK HEYJUN , MCLAUGHLIN TRACEY , SNYDER MICHAEL 
Published: June 2023

Glycemic responses to foods are determined by total carbohydrates, glycemic index, and addition of fat, fiber, and protein. Interindividual variability in these responses are not well characterized. We propose that postprandial glucose response (PPGR) exhibits variability between individuals with regard to 1) “worst” or most glucose elevating food; 2) degree of mitigation by fat, fiber, or protein. Forty participants, healthy or with prediabetes, were given a repeated series of 7 standardized food challenges with the same amount of carbohydrates but varying in source (rice, bread, potatoes, pasta, berries, grapes, and beans) while wearing a CGM. We summarized PPGR and constructed a typical response to each food challenge. Rice exhibited the highest peak value and potatoes had the longest return to baseline time. However, cluster analysis revealed heterogeneity in PPGR indicating that the “worst” food differed between individuals. Participants were then pretreated with potential mitigators (fat, protein, or fiber) before a standardized food challenge. Cluster analysis revealed heterogeneity of mitigator effect between individuals and foods, and within individuals. Results indicate that diets can be individualized with regard to both carbohydrate choice and addition of fat, protein, or fiber to optimize metabolic health.

Disclosure
A.A.Metwally: Employee; Google LLC, Stock/Shareholder; Google LLC. D.Perelman: Advisory Panel; January, Inc. B.W.Ehlert: None. Y.Wu: None. A.Celli: None. C.Bejikian: None. H.Park: None. T.Mclaughlin: Board Member; January, Inc., Research Support; Merck & Co., Inc., Stock/Shareholder; Eiger Bio. M.Snyder: Advisory Panel; Genapsys, Jupiter, Neuvivo, Swaza, Mitrix, Other Relationship; Personalis, QBio, January, Inc., Fodsel, Filtricine, Protos, RTHM, Iollo, Marble Therapeutics, Mirvie, SensOmics.

Funding
Stanford Precision Health and Integrated Diagnostics Center (5R01DK110186)
602-P: A Higher Complex-Carbohydrate Diet Lowers Metabolically Unfavorable Markers Associated with Gestational Diabetes Mellitus
Authors: SUGINO KAMERON , HERNANDEZ TERI L. , BARBOUR LINDA A. , FRIEDMAN JACOB E. , FRANK DANIEL 
Published: June 2023

First-line, conventional dietary treatment for gestational diabetes (GDM) recommends a carbohydrate-restricted, higher fat diet to reduce postprandial glucose and mitigate glucose-mediated fetal macrosomia. However, a higher fat maternal diet may worsen insulin resistance (IR), impairing glucose uptake. Emerging studies have identified potentially impactful diet-sensitive metabolites associated with GDM, such as elevated aspartate and decreased deoxycholic acid have been associated with GDM risk and may confer worse IR. We performed a targeted metabolomic analysis in a subset from the “Choosing Healthy Options in Carbohydrate Energy” (CHOICE) study which randomized GDM women to a CHOICE (60% complex carb/25% fat/15% protein) or a conventional diet (CONV, 40% carb/45% fat/15%) from diagnosis to delivery. All meals were provided, diets were eucaloric, and fiber content was similar. Plasma was collected at baseline (31 wks) and 36 wks (n=20 CHOICE; n=17 CONV) and subjected to targeted metabolomic analysis (n=527 metabolites; n=12 short chain fatty acids). Thirty-one metabolites were significantly different between diets (p&lt; 0.05): species of ceramides (n=4), cholesterol esters (n=2), lysophosphatidyl choline (n=5), phosphatidyl choline (n=10), and triglycerides (n=6) as well as sphingomyelin C26:1, hexosylceramide d18:1/16:0, deoxycholic acid, and aspartate. Aspartate and one triglyceride species significantly decreased on CHOICE, but increased on CONV (p&lt;0.05). The remaining 29 metabolites were increased in women on CHOICE. In contrast, CONV resulted in a slight decrease in concentration of these metabolites, and a smaller increase of the ceramide species than CHOICE. These results suggest the CHOICE diet improves metabolic markers associated with GDM and IR compared to conventional GDM diet treatments.

Disclosure
K.Sugino: None. T.L.Hernandez: None. L.A.Barbour: None. J.E.Friedman: None. D.Frank: None.
608-P: Association of Neck Circumference and Sarcopenic Obesity in a Cohort of Chinese Community-Based Individuals
Authors: XU YITING , HU TINGTING , SHEN YUN , WANG YUFEI , MA XIAOJING , BAO YUQIAN 
Published: June 2023

Aims: Neck circumference (NC) is a simple and reliable anthropometric measurement for estimating obesity. Sarcopenic obesity is a distinct condition of sarcopenia in the context of obesity, with the cumulative health risks of both phenotypes. This study was aimed to explore the association between NC and sarcopenic obesity in a Shanghai community population.
Methods: The study included 1542 participants (622 men and 920 women) with mean age of 58.1 ± 7.06 years who underwent complete examinations at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index was calculated using the BIA equation from Janssen et al. The abdominal fat distribution, including visceral fat area (VFA), was assessed by magnetic resonance imaging. Elevated NC was defined as NC ≥ 38.5 cm in men and NC ≥ 34.5 cm in women. The definition of sarcopenic obesity combined low muscle mass (skeletal muscle mass index of 1 SD below the sex-specific mean value) with obesity which defined according to overall adiposity or fat distribution as body mass index (BMI) ≥ 25 kg/m2, fat% ≥ 25% in men and 30% in women, or VFA ≥ 80cm2, respectively.
Results: Subjects with elevated NC had a higher incidence of sarcopenic obesity in both men and women regardless of adiposity status assessed by BMI, fat%, or VFA (all P &lt; 0.001). During the follow up, higher cumulative incidence of sarcopenic obesity was found in those with elevated NC (all P &lt; 0.001). For each 1 cm increase in NC, multivariable-adjusted hazard ratios of sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; besides, the association assessed by high fat% or high VFA remained in both men and women.
Conclusion: NC was closely associated with the incidence of sarcopenic obesity, which suggested that it could be helpful to screening sarcopenic obesity in a community-based population.

Disclosure
Y.Xu: None. T.Hu: None. Y.Shen: None. Y.Wang: None. X.Ma: None. Y.Bao: None.
613-P: Low Muscle Mass and/or Function Is Common in Type 2 Diabetes
Authors: CONTE CATERINA , BOUSSETTA SARA , LEVA FRANCESCO , MORO PAOLO , BERRA CESARE C. , LUZI LIVIO 
Published: June 2023

Sarcopenia (low muscle mass/muscle function [MM/MF]) and sarcopenic obesity (sarcopenia+obesity, SO) have relevant clinical implications, but few data are available on pts with type 2 diabetes (T2D), especially in Western populations. We assessed the proportion of Caucasian pts with T2D and sarcopenia/SO and clinical correlates of sarcopenia. During routine follow-up outpatient visits (Jun-Dec 2022), we measured skeletal MM by bioelectrical impedance analysis (BIA) and MF by hand-grip strength in all pts except those with contraindications to BIA. Low MM and low MF were diagnosed using validated sex- and sex-/age-specific cut-offs, respectively, as recommended by ESPEN & EASO. Anthropometrics, glycemic control (HbA1c) and type/number of complications were recorded for all pts. A total of 116 pts with T2D were included (64.7% F, median [25°; 75° percentile] age 70.0 [62.3; 78.0] years, 35.3% with obesity). Sarcopenia was diagnosed in 12.9% of pts. Of these, 40% (5.2% of the total) had SO. Low MM with normal MF (LMM) and low MF with normal MM (LMF) were found in 16.4% and 21.6% of pts. There were no significant differences in sex, age, HbA1c, or number of complications between patients with or without sarcopenia nor among subgroups, but the proportion of elderly pts (age ≥65y) was lower among those with vs those without sarcopenia (26.7% vs 57.4%, p=0.026). Median BMI was greater (p&lt;0.05) in pts with LMM or sarcopenia vs those with normal MM/MF or LMF (31.6 [30.5; 34.6], 29.2 [26.1; 34.8], 26.7 [23.4; 30.4] and 24.5 [21.3; 29.8] kg/m2, respectively). At logistic regression adjusted by sex and age, the likelihood of sarcopenia increased by 11.4% for each unit increase in BMI (odds ratio 1.114, [95%CI 1.01; 1.23] p=0.037). In conclusion, the majority of Caucasian pts with T2D has low MM, MF or both (sarcopenia), the risk of sarcopenia increasing with greater BMI. The lower proportion of elderly suggests reduced life expectancy in T2D pts with sarcopenia. The assessment of sarcopenia in T2D should be implemented in routine clinical practice.

Disclosure
C.Conte: None. S.Boussetta: None. F.Leva: None. P.Moro: None. C.C.Berra: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis.
62-LB: Sleep Improves over Five Years of Very Low Carbohydrate Nutrition Therapy for Prediabetes Delivered by Continuous Remote Care
Authors: ADAMS REBECCA N. , ATHINARAYANAN SHAMINIE J. , VOLK BRITTANIE M. , PHINNEY STEPHEN D. , VOLEK JEFF , MCKENZIE AMY L. 
Published: June 2023

Background: People with prediabetes are more likely to suffer from poor sleep, and sleep characteristics are correlated with metabolic markers such as glycemia and weight. We previously reported 1-yr improvements in sleep and metabolic health among people with prediabetes participating in a very low carb intervention including nutritional ketosis delivered via continuous remote care. Improvements in metabolic health were also observed out to 5 yrs. Given the relationships between sleep and metabolic health, in this analysis we explored whether sleep characteristics that improved at 1 yr were also improved at 5 yrs.
Methods: Adults with prediabetes initially enrolled in a 2-yr single-arm trial were offered to continue for 3 more yrs of prospective follow-up. Of the 72 participants completing 2 yrs, 58 (81%) of participants consented to the extension and 45 (78%) were retained at 5 yrs. Baseline characteristics of those who extended include: 83% female, mean age= 53 yrs, mean HbA1c = 5.9%, and mean BMI= 39. Sleep was assessed with the Pittsburgh Sleep Quality Index at baseline, 3 mos, 1 yr, 2 yrs, 3.5 yrs, and 5 yrs. Among all extending participants, we explored changes over time in Global Sleep, Sleep Quality, Sleep Disturbances, and Daytime Dysfunction using 4 linear mixed effects models (intent-to-treat analyses) controlling for age, gender, and race.
Results: The overall effect of time was significant for all sleep measures, such that sleep improved over time (ps &lt;0.02). From baseline to 5 yrs, sleep score improvements ranged from 21-28% (ps &lt;0.02).
Conclusions: Participants in a virtual nutrition therapy intervention focused on nutritional ketosis reported long-term improvements in sleep out to 5 yrs concurrent with sustained metabolic health improvements. This provides additional evidence that this intervention benefits overall health. Additional research is needed to better understand what drove perceptions of sleep improvement.

Disclosure
R. N. Adams: Employee; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S. D. Phinney: Stock/Shareholder; Virta Health Corp. Board Member; Virta Health Corp. Employee; Virta Health Corp. J. Volek: Stock/Shareholder; Virta Health Corp. A. L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp.
620-P: Key Sociodemographic Factors and Food Packaging Attributes Associated with Poor Diet Quality among Rural Americans
Authors: QUINTERO ARIAS CAROLINA , RONY MELISSA , JENSEN ERICA , PRABU ANIRUDH , WISE NATHAN N. , DORAN KELLY , ANTHOPOLOS REBECCCA , ELBEL BRIAN , THORPE LORNA , LEE DAVID C. 
Published: June 2023

Introduction: In addition to socioeconomic factors, residents in rural areas face unique challenges that contribute to poor diet quality. We assessed Alternative Healthy Eating Index (aHEI) scores among residents of a rural county in New York with documented poor health outcomes.
Methods: In 2021, we performed a cross-sectional survey of residents in Sullivan County, NY. This survey included questions on sociodemographics and a validated food frequency questionnaire (FFQ). We used multivariable linear regression to identify factors associated with lower aHEI scores, including: age, sex, race/ethnicity, household type, income, education, unemployment, disability, distance to grocery store, frequency of eating from canned foods and plastic-wrapped foods consumption (two attributes not captured in the FFQ), use of food support programs, food insecurity, housing insecurity, and difficulty meeting essential household and medical expenses.
Results. Of 1,356 respondents analyzed, aHEI scores followed a normal distribution (mean: 56.5, standard deviation: 12.0). Adjusting for other factors, respondents that did not enter high school had an average aHEI that was 9.7 points lower compared to those that had completed college. Respondents reporting disability or food insecurity had lower aHEI compared to those that did not (respectively 3.6 and 3.2 points lower). Respondents consuming canned foods most of the time had a 6.0 lower aHEI than those that never ate canned foods.
Discussion. We identified potentially modifiable risk factors for poor diet quality among rural residents. Efforts to reduce food insecurity along with better access to healthy foods in order to reduce canned food intake may be needed to address these rural health disparities.

Disclosure
C.Quintero arias: None. D.C.Lee: None. M.Rony: None. E.Jensen: None. A.Prabu: None. N.N.Wise: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)
622-P: Characteristics of Diabetes Remission in Patients with Type 2 Diabetes
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , VYAWAHARE ANAGHA R. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D. 
Published: June 2023

Background: Lifestyle intervention in achieving Type 2 diabetes (T2D) remission is gaining increasing significance. We aimed to identify predictors of diabetes remission after a one-year lifestyle intervention program in the Indian population.
Materials and methods: The current study enrolled 4948 patients with diagnosed T2D (&gt;18 years) who underwent a lifestyle modification program at Freedom from Diabetes clinic between April & December 2021. The intervention included a customized vegan diet, exercise, stress management support, along with conventional medical management. Anthropometric and biochemical parameters were monitored with scheduled consultations every 3 months. Post-intervention remission was defined as HbA1c&lt;48mmol/mol for a minimum of 3 months in the absence of pharmacotherapy. The primary outcome measure was predictors of diabetes remission based on regression analysis.
Results: Post-intervention, data on 2764 patients were available for analysis where 837 (30.2%) achieved remission. Remission was significantly associated with intermittent fasting (during intervention), initial medication status (OHA, external insulin, both or never started medicines), age at onset, absolute change in HbA1c & body weight, HOMA-IR (post-intervention), and duration of diabetes.
Conclusion: T2D remission can be achieved in nearly one-third of the patients through lifestyle intervention. Few baseline (age at onset, duration of diabetes, medication status) and few post-intervention parameters (decrease in weight and HbA1c, HOMA-IR) are independently associated with predicting T2D remission in this Indian population.

Disclosure
P.Tripathi: Board Member; Freedom from Diabetes Clinic. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.
623-P: Impact of a Low-Carbohydrate vs. Low-Fat Breakfast on Blood Glucose Control in Type 2 Diabetes
Authors: OLIVEIRA BARBARA , CHANG COURTNEY , FALKENHAIN KAJA , OETSCH KATIE , FRANCOIS MONIQUE E. , LITTLE JONATHAN P. 
Published: June 2023

Postprandial hyperglycemia and glycemic variability are independent risk factors for cardiovascular disease and mortality in people living with type 2 diabetes (T2D). The highest glucose spike often occurs after the first morning meal, highlighting the major influence that breakfast has on overall glycemic control. We examined how advice and guidance to consume a low-carbohydrate (LC) versus standard dietary guidelines low-fat control (CTL) breakfast influenced glycemic control assessed by continuous glucose monitoring (CGM). Participants with T2D (N=121, 53% female, mean age 64 years) completed a remote 3-month parallel-group RCT comparing LC to CTL with 14-day CGM at the start and end of the intervention. Daily mean glucose, maximum glucose, area under the curve (AUC), mean amplitude of glycemic excursions, standard deviation (SD), and time above range (&gt;10mmol/L) were all significantly lower, and time in range (3.9-10mmol/L) significantly higher, in the LC group versus CTL (all P&lt;0.05). Post-breakfast mean and maximum glucose, SD and iAUC were also significantly lower in the LC group (all P&lt;0.001). A low-carbohydrate breakfast appears to be a simple dietary strategy to improve several CGM metrics when compared to a typical dietary guidelines breakfast in persons living with T2D.

Disclosure
B.Oliveira: None. C.Chang: None. K.Falkenhain: None. K.Oetsch: None. M.E.Francois: None. J.P.Little: None.

Funding
Egg Nutrition Center; Egg Farmers of Canada
625-P: Psychosocial Factors Predict Health Care Usage in Young Adults with Youth-Onset Type 2 Diabetes—TODAY2 iCount Study
Authors: TRIEF PAULA M. , USCHNER DIANE , ANDERSON BARBARA , WEN HUI , BULGER JANE D. , WEINSTOCK RUTH S. 
Published: June 2023

Background: Established diabetes care (“diabetes home”) and regular healthcare visits are important to achieve good outcomes. Nothing is known about psychosocial factors that predict healthcare usage (HCU) in young adults with youth-onset type 2 diabetes.
Objective: To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.
Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates, were used to identify predictors of sub-optimal HCU (defined as no diabetes home, 0 routine care visits, ≥1 urgent care visit in prior 6 months).
Participants: N= 366 TODAY2 participants. Mean age=26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, mean HbA1c=9.4%.
Main measures: HCU survey; reliable, valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities and self-management support.
Key Results: 25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥1 urgent care visit in prior 6 months. Beliefs in the necessity of (p&lt;0.001), and concerns about (p=0.004), diabetes medicines, and diabetes having negative psychosocial impacts (p=0.034), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of having a diabetes home (p=0.006). Necessity beliefs (p=0.002), concerns (p=0.025), and self-management support (p=0.014) predicted higher odds of having ≥ 1 diabetes care visit in prior 6 months, harm beliefs predicted lower odds (p=0.005).
Conclusions: Sub-optimal healthcare usage is common in young adults with youth-onset type 2 diabetes and is predicted by beliefs about medicines and self-management support. We must address these factors to help this vulnerable group establish a stable foundation for diabetes care.

Disclosure
P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)