Socio-demographic characteristics and body weight perceptions of study participants benefitting most from the Feel4Diabetes program based on their anthropometric and glycaemic profile changes

The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39–3.67, p < 0.001) and Eastern Europe (OR 1.55–2.47, p < 0.05), received more intensive intervention (OR 1.53–1.90, p = 0.002) and were younger (<40 years old) adults (OR 1.48–1.51, p < 0.05). Furthermore, individuals with tertiary education (OR 2.06, p < 0.001), who were unemployed (OR 1.62–1.68, p < 0.05) and perceived their body weight to be higher than normal (OR 1.58–3.00, p < 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024).These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations

Dietary models for the prevention of diabetes mellitus and association with markers of insulin resistance in high-risk families during the cross-sectional study period and after a lifestyle change intervention

Introduction:The combined effect of eating habits and lifestyle behaviors on indices of glycemic control related to the risk of developing type 2 diabetes mellitus (T2D) in healthy adults at high increased risk is not still clear.Aim:Investigation of diet habits and lifestyle behaviors in association to glycemic control markers (fasting glucose, fasting insulin) and insulin sensitivity (HOMA- IR) in a sample of adults at high risk for developing T2D with the use of multivariable models, controlling for socioeconomic characteristics and anthropometric indices, both at the cross-sectional phase, as well as after lifestyle intervention, with the aim to highlight the habits and behaviors that are related to improved levels of glycemic markers. An additional goal was to investigate the characteristics of the participants who benefited most from the lifestyle intervention based on the improvement in anthropometric characteristics and indices of glycemic control.Methodology:This study was part of the “Feel4Diabetes”- study, a two-year intervention which aimed to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease, as they have been identified based on the Finnish Diabetes Risk Score. The sample during the cross-sectional phase consisted of N = 2816 adults from high-risk families across 6 European countries. Anthropometric, hormonal and biochemical indicators, demographic characteristics and data about diet intake and eating habits, as well as other lifestyle behaviors were collected annually. Glycemic control indices were correlated both cross- sectionally and longitudinally with eating habits in multivariable models accounting for lifestyle behaviors, anthropometric and socioeconomic characteristics. Multivariable regression models were applied to the cross-sectional analyses, generalized estimation equations (GEE) models were applied to the longitudinal analyses, and principal component analysis (PCA) was used for the extraction of diet factors. To determine the characteristics of the participants who benefited the most, the variable of "participants who benefited" was created based on >5% improvement in the examined indicators and multivariable logistic regression was used. Results:Regular breakfast intake (> 3 times / week) was associated with improved levels of glycemic indices, both in the cross-sectional analysis and longitudinally. Longitudinal analysis showed that the beneficial effect of breakfast consumption frequency on fasting glucose was independent of age, BMI or waist circumference, socioeconomic status (SES), sedentary time or physical activity. In contrast, the effect of breakfast frequency consumption on fasting insulin and HOMAIR in men was depended on diet quality and physical activity. In the combined models, the breakfast frequency consumption acted as a modifier of the effect of eating frequency on glycemic indices, being an independent prognostic factor. A diet model with 3-4 eating occasions/ day including daily breakfast had the best effect on fasting glucose, while a model with more than 4 meal eating occasions/ day along with breakfast had the best effect on fasting insulin. HOMAIR index depended only on breakfast consumption. In the present study, were extracted 7 diet factors that explained 50.6% of the total variation in diet intake during the cross-sectional phase, 8 factors (56.50%) during the 1st follow up and 7 factors (56.67%) during the 2nd follow up. Common diet factors included: "healthy", "snacks", "animal proteins", "wholemeal bread", "simple sugars", "diet" and "alcohol" factor. Regardless of sex, age, BMI or waist circumference, SES, physical activity or sedentary lifestyle, breakfast intake and meal frequency, higher scores in the "animal protein" factor, “wholemeal bread” factor and "diet" factor were associated with improved levels of glycemic indices. In the present intervention, it appears that men, younger adults (5% στους εξεταζόμενους δείκτες και έγινε χρήση πολυπαραγοντικής λογιστικής παλινδρόμισης.Αποτελέσματα:Η συστηματική κατανάλωση πρωινού (>3 φορές/εβδομάδα) φαίνεται να συσχετίζεται με βελτιωμένα επίπεδα γλυκαιμικών δεικτών, τόσο κατά τη συγχρονική φάση, όσο και διαχρονικά. Η διαχρονική ανάλυση έδειξε ότι η ευεργετική επίδραση της αυξημένης κατανάλωσης πρωινού στη γλυκόζη νηστείας ήταν ανεξάρτητη από την ηλικία, το ΔΜΣ ή την περιφέρεια μέσης, το κοινωνικοοικονομικό επίπεδο (SES), τον καθιστικό χρόνο ή τη φυσική δραστηριότητα. Αντίθετα, η επίδραση της συχνότητας κατανάλωσης πρωινού στην ινσουλίνη νηστείας και τον δείκτη ΗΟΜΑ-IR στους άνδρες φαίνεται ότι εξαρτιόνταν από την ποιότητα της διατροφής και την φυσική δραστηριότητα. Στα συνδυαστικά μοντέλα, η συχνότητα κατανάλωσης πρωινού δρούσε ως τροποποιητής της επίδρασης της συχνότητας γευμάτων στην σχέση της με τους γλυκαιμικούς δείκτες, αποτελώντας ανεξάρτητο προγνωστικό παράγοντα. Επίσης, το διατροφικό μοντέλο με 3-4 γευματικά επεισόδια ημερησίως, συμπεριλαμβανομένης της καθημερινής κατανάλωσης πρωινού, είχε την μεγαλύτερη μείωση στη γλυκόζη νηστείας, ενώ πάνω από 4 γευματικά επεισόδια ημερησίως και καθημερινή κατανάλωση πρωινού εμφάνιζε την μεγαλύτερη μείωση στην ινσουλίνη νηστείας. Ο δείκτης HOMAIR εξαρτιόνταν μόνο από την κατανάλωση πρωινού. Στην παρούσα μελέτη, προέκυψαν 7 διατροφικοί παράγοντες, που εξηγούσαν το 50.6% της συνολικής διακύμανσης της διατροφικής πρόσληψης κατά τη συγχρονική φάση, 8 παράγοντες (56.50%) στο 1ο follow up και 7 παράγοντες (56.67%) στο 2ο follow up. Τα κοινά διατροφικά πρότυπα περιλάμβαναν: το «υγιεινό», των «σνακ», των «ζωικών πρωτεϊνών», του «ψωμιού ολικής», των «απλών σακχάρων», της «δίαιτας» και του «αλκοόλ». Ανεξάρτητα από το φύλο, την ηλικία, τον ΔΜΣ ή την περιφέρεια μέσης, το SES, τη φυσική δραστηριότητα ή την καθιστική ζωή, την κατανάλωση πρωινού και την συχνότητα γευμάτων, υψηλότερα σκορ στο διατροφικό πρότυπο των «ζωικών πρωτεϊνών», του «ψωμιού ολικής» και της «δίαιτας» φαίνεται ότι σχετίζονταν με βελτιωμένους γλυκαιμικούς δείκτες. Στην παρούσα παρέμβαση φαίνεται ότι οι άνδρες, οι νεότεροι ενήλικες (<40 ετών) και συμμετέχοντες από χώρες χαμηλού εισοδήματος και χώρες υψηλού εισοδήματος υπό μέτρα λιτότητας ήταν πιο πιθανόν να εμφανίσουν βελτίωση σε ανθρωπομετρικά χαρακτηριστικά και δείκτες γλυκαιμικού ελέγχου.Συμπεράσματα:Σε αυτή τη μελέτη παρέμβασης, η καθημερινή κατανάλωση πρωινού και μια μέτρια συχνότητα γευμάτων συσχετίστηκε με βελτιωμένα επίπεδα γλυκαιμικών δεικτών, ενώ η υψηλή προσκόλληση σε ένα διατροφικό πρότυπο το οποίο χαρακτηριζόταν από αυξημένη κατανάλωση ζωικών πρωτεϊνών, ανεπεξέργαστων δημητριακών και γαλακτοκομικών χαμηλών λιπαρών και χαμηλή πρόσληψη επεξεργασμένων υδατανθράκων, απλών σακχάρων, γαλακτοκομικών με πλήρη λιπαρά και αλκοόλ είχε ευεργετική επίδραση στους γλυκαιμικούς δείκτες, ανεξάρτητα από την κατανάλωση πρωινού ή τη συχνότητα γευμάτων.Τα αποτελέσματα των παραπάνω μοντέλων συσχέτισης διατροφικών συνηθειών με δείκτες γλυκαιμικού ελέγχου, λαμβάνοντας υπόψιν το κοινωνικοδημογραφικό προφίλ των ατόμων, τα οποία είναι πιο πιθανό να εμφανίσουν οφέλη για την υγεία από την εφαρμογή παρεμβάσεων στον τρόπο ζωής, που παρατηρήθηκαν στην παρούσα εργασία, αναδεικνύουν ποιοι είναι οι τροποποιήσιμοι διατροφικοί παράγοντες και οι συνήθειες του τρόπου ζωής, οι οποίοι σχετίζονται με τον κίνδυνο εμφάνισης ΣΔ2, τονίζοντας την ανάγκη προσαρμογής των μελλοντικών παρεμβάσεων και της δημόσιας πολιτικής για την υγεία στα χαρακτηριστικά και τις συμπεριφορές των πληθυσμών-στόχων, προκειμένου να αυξηθεί η αποτελεσματικότητά τους

Adherence to the Mediterranean Diet and Healthy Aging: A Narrative Review over the Last Decade.

Objective: Even though modern medicine has significantly contributed to the extension of human lifespan, it has failed to delay the upsurge of chronic diseases. Health benefits of the Mediterranean diet are well established. Thus, adherence to this diet pattern may be the key to healthy aging. Ôhe aim of this review is to investigate the potential benefits of the Mediterranean diet on healthy aging. Methods: A literature search of three databases (ScienceDirect, MEDLINE and The Cochrane Library) was conducted in order to trace all relevant studies published between January 1st 2010 and June 6th 2020 that focused on the impact of adherence to the Mediterranean diet on the physical and mental well-being of individuals aged 60 or older. Results:Twenty-two studies fulfilled the selection criteria and were classified into six groups, according to the main outcome of each study: mental health (eight studies), frailty (6), cardiovascular risk factors (3), plasma levels of uric acid (1), length of hospital stay (1), and aging mechanisms (3). Based on these studies, the protective role of Mediterranean diet on depression, cardiovascular and frailty risk was established. Moreover, adherence to the Mediterranean diet resulted in reduced plasma uric acid levels as well as decreased length of hospital stay and mortality risk among patients who were urgently admitted for any cause in a tertiary hospital. In contrast, results on the effect of Mediterranean diet on cognition were controversial, as studies presented positive or neutral correlations. Conclusions: This review provides evidence on the association between adherence to the Mediterranean diet and healthy aging and highlights the importance of conducting more studies among seniors in order to provide further insight into this matter

Safety evaluation of the food enzyme α‐amylase from the non‐genetically modified Bacillus amyloliquefaciens strain LMG‐S 32676

Abstract The food enzyme α‐amylase (4‐α‐d‐glucan glucanohydrolase; EC 3.2.1.1) is produced with the non‐genetically modified microorganism Bacillus amyloliquefaciens strain LMG‐S 32676 by Enmex SA de CV, a Kerry Company. The food enzyme under assessment is intended to be used in six food manufacturing processes: baking processes, brewing processes, distilled alcohol production, starch processing for the production of glucose syrups and other starch hydrolysates, refined and unrefined sugar production and yeast processing. Since residual amounts of total organic solids (TOS) are removed in distilled alcohol production and starch processing for glucose syrups production and other starch hydrolysates, the dietary exposure estimation was made only for the remaining four food processes. It was estimated to be up to 2.998 mg TOS/kg body weight per day in European populations. The production strain meets the requirements for the QPS approach. As no concerns arising from the manufacturing process were identified, the Panel considered that toxicological tests were not needed for the assessment of this food enzyme. A search for the similarity of the amino acid sequence of the food enzyme to known allergens was made and two matches with respiratory allergens were found. The Panel considered that a risk of allergic reactions upon dietary exposure to this food enzyme cannot be excluded (except for distilled alcohol production), but the likelihood is low. Based on the data provided, the Panel concluded that this food enzyme does not give rise to safety concerns, under the intended conditions of use

Safety evaluation of the food enzyme subtilisin from the non‐genetically modified Bacillus paralicheniformis strain DP‐Dzx96

Abstract The food enzyme subtilisin (serine endopeptidase, EC 3.4.21.62) is produced with the non‐genetically modified Bacillus paralicheniformis strain DP‐Dzx96 by Genencor International B.V. The food enzyme was considered free from viable cells of the production organism. The food enzyme is intended to be used in five food manufacturing processes: production of protein hydrolysates from plants and fungi, production of protein hydrolysates from meat and fish proteins, production of cooked rice, production of modified meat and fish products, and yeast processing. The production strain of the food enzyme contains known antimicrobial resistance genes. Bacitracin, a medically important antimicrobial, was detected in the food enzyme. The presence of bacitracin represents a risk for the development of antimicrobial resistant bacteria. A search for the similarity of the amino acid sequence of the food enzyme to known allergens was made and three matches with respiratory and two matches with food allergens were found. The Panel considered that, under the intended conditions of use, the risk of allergic reactions upon dietary exposure to this food enzyme, particularly in individuals sensitised to muskmelon or pomegranate, cannot be excluded, but would not exceed the risk of consuming these foods. Due to the presence of bacitracin, the Panel concluded that the food enzyme subtilisin produced with the non‐genetically modified Bacillus paralicheniformis strain DP‐Dzx96 cannot be considered safe

Food manufacturing processes and technical data used in the exposure assessment of food enzymes

Abstract Food enzymes are used for technical purposes in the production of food ingredients or foods‐as‐consumed. In the European Union, the safety of a food enzyme is evaluated by EFSA on the basis of a technical dossier provided by an applicant. Dietary exposure is an integral part of the risk assessment of food enzymes. To develop exposure models specific to each food manufacturing process in which food enzymes are used, different input data are required which are then used in tandem with technical conversion factors. This allows the use levels of food enzyme to be related to food consumption data collected in dietary surveys. For each food manufacturing process, EFSA identified a list of food groups (FoodEx1 classification system) and collated technical conversion factors. To ensure a correct and uniform application of these input data in the assessment of food enzyme dossiers, stakeholders were consulted via open calls‐for‐data. In addition to publishing and updating the identified input parameters on an annual basis, single‐process‐specific calculators of the Food Enzyme Intake Models (FEIMs) have been developed. These calculators have been deposited at https://zenodo.org/ since 2018 for open access. By 2023, EFSA had compiled the input data for a total of 40 food manufacturing processes in which food enzymes are employed. In this document, the food manufacturing processes are structured, food groups classified initially in the FoodEx1 system are translated into the FoodEx2 system, and technical factors are adjusted to reflect the more detailed and standardised FoodEx2 nomenclature. The development of an integrated FEIM‐web tool using this collection of input data is carried out for a possible release in 2024. This tool will be able to estimate the exposure to the food enzyme–total organic solids (TOS) when employed in multiple food manufacturing processes

Safety evaluation of the food enzyme α‐amylase from the non‐genetically modified Bacillus amyloliquefaciens strain BA

Abstract The food enzyme α‐amylase (4‐α‐d‐glucan glucanohydrolase; EC 3.2.1.1) is produced with the non‐genetically modified microorganism Bacillus amyloliquefaciens strain BA by HBI Enzymes Inc. The enzyme under assessment is intended to be used in six food processes: baking processes, brewing processes, distilled alcohol production, starch processing for the production of glucose syrups and other starch hydrolysates, production of dairy analogues and production of rice‐based meals. Since residual amounts of total organic solids (TOS) are removed during distillation and during the production of glucose syrups and other starch hydrolysates, dietary exposure was calculated only for the remaining four food manufacturing processes. It was estimated to be up to 4.805 mg TOS/kg body weight (bw) per day in European populations. The applicant did not provide sufficient data to demonstrate that the production strain meets the qualified presumption of safety (QPS) criteria, or proof of absence of viable cells and DNA from the production organism in the food enzyme. Therefore, the Panel was not able to conclude on the safety of the microbial source. A margin of exposure could not be calculated in the absence of toxicological studies. A search for the similarity of the amino acid sequence of the food enzyme to known allergens was made and two matches with respiratory allergens were found. The Panel considered that, under the intended conditions of use (other than distilled alcohol production), the risk of allergic reactions by dietary exposure cannot be excluded, but the likelihood is low. Based on the data provided, the Panel could not conclude on the safety of this food enzyme, under the intended conditions of use