Postprandial glucose and insulin responses to onion ingestion with breakfast in patients with type 2 diabetes

زمینه و هدف: مطالعات حیوانی گوناگون نشان می دهند که گیاهانی همچون پیاز می تواند بر سطح گلوکز و انسولین سرم تاثیر داشته باشند. این مطالعه با هدف بررسی تاثیر مصرف پیاز در وعده صبحانه بر پاسخ گلیسمی و انسولینمی مبتلایان به دیابت نوع دو انجام گرفت. روش بررسی: این مطالعه نیمه تجربی در دو روز به فاصله یک هفته بر روی 24 بیمار دیابتی نوع 2 مراجعه کننده به انجمن دیابت ایران انجام شد. در هر روز بررسی، پس از مراجعه بیماران مقدار 2 سی سی خون در حالت ناشتا جمع آوری شد. سپس صبحانه های مورد بررسی در اختیار آنان قرار گرفت که صبحانه روز دوم، همان صبحانه روز اول به انضمام 60 گرم پیاز بود. سپس در زمان های 60، 120، 180 دقیقه پس از اتمام صرف صبحانه ها، مجدداً میزان 2 سی سی خون از بیماران گرفته شد. در پایان، مقدار انسولین و گلوکز سرم بیماران در نمونه های خونی تهیه شده، اندازه گیری شد. داده ها با استفاده از آزمون های آماری آنالیز واریانس با اندازه گیری های مکرر و t زوجی مورد ارزیابی قرار گرفتند. یافته ها: در بیماران مورد مطالعه میانگین سنی 4/7±4/49 و طول مدت ابتلا به بیماری 05/5±9/6 سال بود. اثر صبحانه حاوی پیاز بر سطح قندخون به لحاظ آماری معنی دار نبود، در حالی که میزان انسولین سرم به طور معنی داری افزایش یافت (001/0>P). تفاوت معنی داری در سطح زیر منحنی گلوکز بین صبحانه روز اول و صبحانه روز دوم دیده شد (05/0

Effect of Dietary Supplementation with Conjugated Linoleic Acid on Bone Mineral Density, Bone Metabolism Markers and Inflammatory Markers in Healthy Post-menopausal Women: a Randomized Double Blind Placebo Controlled Trial

AbstractIntroduction: Conjugated linoleic acid (CLA) has been shown to positively influence on calcium and bone metabolism in experimental animals and cell culture, but there are limited human data available.Material and Methods: This double-blind, placebo-controlled trial study was done on 76 healthy post-menopausal women (aged 55.1) which randomly assigned to receive daily four CLA capsules G80 containing 3.2 g isomer blend (50:50% cis-9, trans-11: trans-10, cis-12 isomers) or four capsules containing high oleic sunflower oil as placebo for 12 weeks. Urine and blood samples were collected at weeks 0 and 12 and were analyzed for biomarkers of calcium and bone metabolism and inflammatory markers (TNF-α and IL-6). Subjects completed 3-day dietary records during the trial, in weeks 0 (baseline), 6 and 12.Results: supplementation with 3.2 g CLA isomer blend (50:50% cis-9,trans-11:trans-10,cis-12 isomers) for 12 weeks had no significant effects on bone formation markers (serum osteocalcin, bone-specific alkaline phosphatase) or bone resorption (urine C-telopeptide-related fraction of type 1 collagen degradation products), parathyroid hormone (PTH), urinary calcium, urinary creatinine and CTP to creatinine ratio. But serum interlukine-6 did not change significantly over 12 weeks in postmenopausal women.Conclusion: Under the conditions tested in postmenopausal women, 3.2 g CLA isomer blend (50:50% cis-9, trans-11: trans-10, cis-12 isomers) did not affect markers of bone metabolism and calcium

The effect of nutrition education on knowledge, attitude and practice of type 1 diabetic patients from Aligoodarz

چکیده: زمینه و هدف: مراقبت های پزشکی- تغذیه ای در بیماران مبتلا به دیابت از بروز و پیشرفت عوارض جلوگیری می کند. یافته های متناقضی در زمینه تأثیر آگاهی بر بهبود کنترل متابولیک بیماران مبتلا به دیابت نوع 1 وجود دارد. این بررسی با هدف تعیین تأثیر آموزش تغذیه بر آگاهی، نگرش و عملکرد مبتلایان به دیابت نوع 1 انجام شد. روش بررسی: در یک مطالعه مداخله ای قبل و بعد کلیه بیماران مبتلا به دیابت نوع 1 شهرستان الیگودرز (30 نفر) مورد بررسی قرار گرفتند. در شروع مطالعه فراسنج های بیوشیمیایی با روش های استاندارد اندازه گیری و پرسشنامه KAP (Knowledge Attitude Practices) سپس یاد آمد خوراک سه روزه، تکمیل گردید. بیماران به مدت 12 ساعت در زمینه کلیات بیماری دیابت، عوارض آن، نحوه پیشگیری و مراقبت های لازم جهت به تأخیر انداختن عوارض و تغذیه در بیماری دیابت و جانشین های مواد غذایی آموزش دیدند و سه ماه بعد از آموزش مجدداً فراسنج های بیوشیمیایی اندازه گیری و پرسشنامه KAP و یادآمد خوراک تکمیل شد و داده های قبل و بعد از آموزش مقایسه شدند. داده ها با استفاده از نرم افزارهای SPSS و Nuatritionist3 و آزمون های آماری t مزدوج و مک نمار تجزیه و تحلیل شدند. یافته ها: نتایج این مطالعه نشان داد که آموزش، تغییر معنی داری در میانگین وزن، نمایه توده بدنی (BMI)، فشــارخون سیستولیک و دیاستولیک، میزان مصرف انرژی و درشت مغذی ها ایجاد نکرد (05/0p>)، ولی باعث کاهش معنی داری در میزان قند خون ناشتا، کلسترول تام، درصد هموگلوبین گلیکوزیله (HbAlc)، LDL (Low Density Lipoprotein) سرم و تعداد دفعات هیپوگلیسمی در هفته گردید (001/0

Assessment of soy phytoestrogens' effects on bone turnover indicators in menopausal women with osteopenia in Iran: a before and after clinical trial

BACKGROUND: Osteoporosis is the gradual declining in bone mass with age, leading to increased bone fragility and fractures. Fractures in hip and spine are known to be the most important complication of the disease which leads in the annual mortality rate of 20% and serious morbidity rate of 50%. Menopause is one of the most common risk factors of osteoporosis. After menopause, sex hormone deficiency is associated with increased remodeling rate and negative bone balance, leading to accelerated bone loss and micro-architectural defects, resulting into increased bone fragility. Compounds with estrogen-like biological activity similar to "Isoflavones" present in plants especially soy, may reduce bone loss in postmenopausal women as they are similar in structure to estrogens. This research, therefore, was carried out to study the effects of Iranian soy protein on biochemical indicators of bone metabolism in osteopenic menopausal women. MATERIALS AND METHODS: This clinical trial of before-after type was carried out on 15 women 45–64 years of age. Subjects were given 35 g soy protein per day for 12 weeks. Blood and urine sampling, anthropometric measurement and 48-h-dietary recalls were carried out at zero, 6 and 12 weeks. Food consumption data were analyzed using Food Proccessor Software. For the study of bone metabolism indicators and changes in anthropometric data as well as dietary intake, and repeated analyses were employed. RESULTS: Comparison of weight, BMI, physical activity, energy intake and other intervening nutrients did not reveal any significant changes during different stages of the study. Soy protein consumption resulted in a significant reduction in the urinary deoxypyridinoline and increasing of total alkaline phosphatase (p < 0.05), although the alterations in osteocalcin, c-telopeptide, IGFBP3 and type I collagen telopeptide were not significant. CONCLUSION: In view of beneficial effect of soy protein on bone metabolism indicators, inclusion of this relatively inexpensive food in the daily diet of menopausal women, will probably delay bone resorption, thereby preventing osteoporosis

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Nutritional assessment of patients with type 1 Diabetes Mellitus

Type 1 diabetes mellitus is a chronic metabolic disorder affecting both young and old. Treatment goals are becoming standardised, but the degree towhich patients with type 1 diabetes meet their goals in practice is uncertain. The aim of this study was to evaluate the nutrition-related outcomes ofpatients with type 1 diabetes diagnosed since 1984 in the Illawana and at least oneyear post-diagnosis. Subjects were recruited from the list of patients registered atthe Diabetes Education Unit (DEU) of the Illawarra Area Health Service. All patients were aged between 18-40 years. For the purpose ofcomparison a similar nondiabetic group who were either relatives/friends of patients or volunteers was recruited. In these two groups, anthropometric measurements,blood pressure, glycosylated hemoglobin (HbAlc%), lipids, urine albumin:creatinine ratio, dietary intake as well as quality of life were assessed. Dietary intake of subjects was assessed by a meal-based diet history (Burkemethod), and food pattern and food preparation questionnaires (based on validated DCCT questionnaires). The results were analysed using Diet 1 (V4), which uses the Australian NUTTAB 1995 food composition database. The findings were compared to the Australian and American dietary goals and recommendations. In total 55 patients (18 female and 37 male) and 47 controls (17 female and 30 males) were seen. The means of body measurements including body massindex (BMI), waist to hip ratio ( WHR ) and body fat%, blood pressure and blood lipids and lipoproteins were within normal range and not significantly different between the two groups. However blood pressure was higher in overweight subjects in both groups. Also obesity or overweight was associated with an adverse lipid and lipoprotein pattern. Plasma fibrinogen concentration in peoplewith type 1 diabetes was significantly higher than in control subjects. Higher plasma fibrinogen levels were associated with higher B M I and elevated plasmatriglyceride and decreased HDL cholesterol concentrations. The albumin: creatinine ratios in spot and early morning urine samples of patients with type 1 diabetes were significantly higher than these ratios in the control group. The negative relationship of early morning urine sample with HDL cholesterol was noted. In this study the degree of glycemic control was evaluated by HbAlc%. Mean values were 8.52% (SD 2.21) and 8.56% (SD 1.91) for females and males respectively, higher than in the DCCT intensively treated patients and lower than in the DCCT conventionally treated patients. A number of variables including anthropometric measurements, blood pressure, diabetes history, blood and urine results were evaluated as independent variables in several models with HbAlc% in the diabetic group. No statistically significant associations were found. It was shown however that those with the least education had the poorest diabetic control but this also was not found to be significant. The dietary intake results indicated that only starch intake (in males andfemales) and dietary fibre intake (in males) were higher among patients than in controls when the macronutrient and alcohol intakes were compared in two groups. None of the same sex comparisons in diabetic and control subjects showed asignificant difference in regard to the energy intake and the contribution of macronutrients. No associations were found between dietary intakes and glycemiccontrol in diabetic subjects. The findings were compared to the recommended dietary intakes (RDI). Significantly more subjects with diabetes than controls reached the guidelines for fat consumption, however the majority of those with diabetes consumed saturated fatty acids at a level greater than the recommendations. Protein intake of patients with type 1 diabetes in terms of grams per body weight and its contribution to total energy intake was higher than recommended. The average carbohydrate (energy%) was similar in both groups and it was lower than the recommendations. Their micronutrient intake for both diabetic and control subjects were higher than the recommendations. Sodium intake in diabetic subjects was higher than in controls. The overall diet quality of the subjects was scored on the basis of several dietary recommendations. It was found that the higher the diet score (ie the moreclosely the diet adhered to the recommendations) the better the glycemic control but this association was not significant. Educated people in both groups had higher diet scores. Also in regard to consumption of basic food groups, it was found that diabetic subjects had more fruit than controls did. Both groups did not have legumes and nuts (low glycemic index foods) in their diets regularly. Not all the patients complied with their dietary prescriptions. Those with better dietary adherence had better glycemic control, although the correlation did not reach significance level. Quality of life of patients and controls was evaluated with the DiabetesQuality of Life Measure (applied in the DCCT ) and SF-36 (a tool which measures non-disease-specific aspects of quality of life). Our results were comparable with those from the DCCT , showing neither group of patients had severe complications. Diabetes worry subscale on the Diabetes Quality of Life Measure was associated negatively with the duration of diabetes and HbAlc%. The result of SF-36subscales were similar to controls, in both groups these subscales were inverselyrelated to either BMI and/or WHR. The results of this study highlights the possibility of improving diabetic control and as a result preventing the related complications in this group of patients by nutritional management. However caution should be taken in generalizing from these results, given the relatively small sample size. An up to date frequency counting of this disease is recommended. Then larger scale studies that involve the majority of the patients in this area and/or nutrition intervention programs (like nutrition education) are needed to confirm the generalisability of this study

EFFECTS OF COOKED LENTILS ON GLYCEMIC CONTROL AND BLOOD LIPIDS OF PATIENTS WITH TYPE 2 DIABETES

Abstract &nbsp;&nbsp; INTRODUCTION: Diabetes mellitus is the most important endocrine disease worldwide. Scientists recommend consumption of low glycemic index (LGI) foods for prevention and control of diabetess. This study was designed to test the effects of cooked lentil as a LGI food on blood glucose and lipid profile among type 2 diabetic patients. &nbsp;&nbsp; METHODS: In a randomized cross-over clinical trial, 30 individuals with type 2 diabetes were randomly divided into 2 groups (A and B). At the 1st step, group A followed the normal diet and group B followed normal diet plus 50 g cooked lentil and 6 g canula oil substitute of 30g bread and 20 g cheese. After 6 weeks these two groups stopped their diets and put on wash out period for 3 weeks and later the diets were switched between them and continued for another 6-week-period. Anthropometric measurements, dietary intakes, serum lipids and glucose levels were determined at the beginning and the end of each period. Data was analyzed by Food Processor II and SPSS-13 softwares. &nbsp;&nbsp; RESULTS: Body mass index, LDL-C, HDL-C ,triglycerides and serum Fructozamine were not significantly influenced by treatment whereas total cholesterol and fasting blood glucose decreased significantly (P &lt; 0.05). &nbsp;&nbsp; CONCLUSION: Cooked lentil consumption as a LGI food in breakfast can control FBS and serum total cholesterol. It might be a good regimen for improving glycemic control in type 2 diabetic patients. &nbsp; &nbsp;&nbsp; Keywords: Diabetes mellitus, Lentil, Lipid profiles, Blood glucose, Glycemic index.</p

Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study

OBJECTIVE: The recommended composition of a hypocaloric diet for obese women with polycystic ovary syndrome (PCOS) is unclear. The aim of this study was to investigate the effects of a high-protein, low-glycemic-load diet compared with a conventional hypocaloric diet on reproductive hormones, inflammatory markers, lipids, glucose, and insulin levels in obese women with PCOS. METHODS: A total of 60 overweight and obese women with PCOS who did not use insulin-sensitizing agents were recruited and randomly assigned to 1 of the 2 hypocaloric diet groups for a single-blind clinical trial. The groups included a conventional hypocaloric diet (CHCD) (15% of daily energy from protein) and a modified hypocaloric diet (MHCD) with a high-protein, low-glycemic load (30% of daily energy from protein plus low-glycemic-load foods selected from a list) that was prescribed via counseling visits weekly during 12 weeks of study. Anthropometric assessments and biochemical measurements including reproductive hormones, inflammatory factors, lipids, glucose, and insulin were performed on fasting blood samples at baseline and after 12 weeks of dietary intervention. RESULTS: Weight loss was significant and similar in the 2 groups. Mean of testosterone in the MHCD and CHCD groups decreased from 1.78 ± 0.32 to 1.31 ± 0.26 ng/ml and from 1.51 ± 0.12 to 1.15 ± 0.11 ng/ml, respectively (p \u3c 0.001). Follicle sensitizing hormone (FSH), luteinizing hormone (LH), and blood lipids concentrations were not changed except low-density lipoprotein cholesterol (LDL-C) was reduced by 24.5% ± 12.3% (p \u3c 0.001 for both) after 12 weeks of intervention. MHCD resulted in a significant reduction in insulin level, homeostatic model assessment for insulin resistance (HOMA), and high-sensitivity C- reactive protein (hsCRP) concentration (p \u3c 0.001). CONCLUSIONS: In this study both hypocaloric diets significantly led to reduced body weight and androgen levels in these two groups of women with PCOS. The combination of high-protein and low-glycemic-load foods in a modified diet caused a significant increase in insulin sensitivity and a decrease in hsCRP level when compared with a conventional die

Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Injury poses a major threat to health and longevity in adults aged 50 years or older. The increased life expectancy in the Eastern Mediterranean region warrants a further understanding of the ageing population's inevitable changing health demands and challenges. We aimed to examine injury-related morbidity and mortality among adults aged 50 years or older in 22 Eastern Mediterranean countries. Methods: Drawing on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we categorised the population into adults aged 50–69 years and adults aged 70 years and older. We examined estimates for transport injuries, self-harm injuries, and unintentional injuries for both age groups, with sex differences reported, and analysed the percentage changes from 1990 to 2019. We reported injury-related mortality rates and disability-adjusted life-years (DALYs). The Socio-demographic Index (SDI) and the Healthcare Access and Quality (HAQ) Index were used to better understand the association of socioeconomic factors and health-care system performance, respectively, with injuries and health status in older people. Healthy life expectancy (HALE) was compared with injury-related deaths and DALYs and to the SDI and HAQ Index to understand the effect of injuries on healthy ageing. Finally, risk factors for injury deaths between 1990 and 2019 were assessed. 95% uncertainty intervals (UIs) are given for all estimates. Findings: Estimated injury mortality rates in the Eastern Mediterranean region exceeded the global rates in 2019, with higher injury mortality rates in males than in females for both age groups. Transport injuries were the leading cause of deaths in adults aged 50–69 years (43·0 [95% UI 31·0–51·8] per 100 000 population) and in adults aged 70 years or older (66·2 [52·5–75·5] per 100 000 population), closely followed by conflict and terrorism for both age groups (10·2 [9·3–11·3] deaths per 100 000 population for 50–69 years and 45·7 [41·5–50·3] deaths per 100 000 population for ≥70 years). The highest annual percentage change in mortality rates due to injury was observed in Afghanistan among people aged 70 years or older (400·4% increase; mortality rate 1109·7 [1017·7–1214·7] per 100 000 population). The leading cause of DALYs was transport injuries for people aged 50–69 years (1798·8 [1394·1–2116·0] per 100 000 population) and unintentional injuries for those aged 70 years or older (2013·2 [1682·2–2408·7] per 100 000 population). The estimates for HALE at 50 years and at 70 years in the Eastern Mediterranean region were lower than global estimates. Eastern Mediterranean countries with the lowest SDIs and HAQ Index values had high prevalence of injury DALYs and ranked the lowest for HALE at 50 years of age and HALE at 70 years. The leading injury mortality risk factors were occupational exposure in people aged 50–69 years and low bone mineral density in those aged 70 years or older. Interpretation: Injuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. Funding: Bill & Melinda Gates Foundation

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019Research in context

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences &amp; Sichuan Provincial People's Hospital (2022QN38)