Realistic changes in monounsaturated fatty acids and soluble fibers are able to improve glucose metabolism

Abstract\ud \ud Background/objectives\ud Cardioprotective effects of Mediterranean-style diet have been shown. Instead of excluding foods, replacement or addition may facilitate compliance with impact on glucose metabolism of individuals at cardiometabolic risk. This study investigated the effect of changing selected nutrients intake on glucose metabolism during a lifestyle intervention tailored to living conditions of prediabetic Brazilians.\ud \ud \ud Subjects/methods\ud 183 prediabetic adults treated under the Brazilian public health system underwent an 18-month intervention on diet and physical activity. Dietary counseling focused on reducing saturated fat replaced by unsaturated fatty acids. Data were collected at baseline and after follow-up. ANOVA and multiple linear regression were used to test association of changes in nutrients intake with changes in plasma glucose.\ud \ud \ud Results\ud Changes in fasting and 2-h plasma glucose but not in weight, HOMA-IR or C-reactive protein decreased after intervention across tertiles of MUFA changes (p-trend 0.017 and 0.024, respectively). Regression models showed that increase in MUFA intake was independently associated with reduction in fasting (β -1.475, p = 0.008) and 2-h plasma glucose (β -3.321, p = 0.007). Moreover, increase in soluble fibers intake was associated with decrease in fasting plasma glucose (β -1.579, p = 0.038). Adjustment for anthropometric measurements did not change the results but did after including change in insulin in the models.\ud \ud \ud Conclusions\ud Increases of MUFA and soluble fibers intakes promote benefits on glucose metabolism, independently of adiposity, during a realistic lifestyle intervention in at-risk individuals. Mechanisms mediating these processes may include mainly insulin sensitivity improvement.Research supported by FAPESP (# 07/55120-0)

Analysis of the association of fruits and vegetables and micronutrients intakes with markers of oxidative and inflammatory status and insulin resistance in individuals at cardiometabolic risk

Introdução: O atual estilo de vida traz consequências negativas no que se refere aos padrões dietéticos, nível de atividade física (AF), uso de tabaco e estresse psicossocial, os quais predispõem ao aumento de doenças crônicas não-transmissíveis. Dieta rica em frutas, legumes e verduras (FLV) pode atenuar os efeitos sobre o risco cardiometabólico, havendo evidências consistentes de benefícios na prevenção da obesidade, dislipidemia e diabetes tipo 2. O consumo de FLV, fontes de vitaminas e minerais essenciais para a homeostase corporal está aquém do desejado. Estes alimentos contribuem para um perfil cardiometabólico favorável, atenuando o estresse oxidativo, inflamação e resistência à insulina. Objetivo: Este estudo analisou a associação entre o consumo FLV e de certos micronutrientes com marcadores do estado oxidativo, inflamatório e de resistência à insulina em indivíduos de risco cardiometabólico. Métodos:Nesta análise transversal foram incluídos 205 participantes (65 por cento mulheres; média de idade de 54,1 anos) do Estudo de Prevenção de Diabetes do CS-Escola da FSP-USP, com pré-diabetes ou de síndrome metabólica sem diabetes. Foram submetidos a questionários e coletas de sangue. Entre as dosagens, a superóxido dismutase (SOD) e a LDL oxidada (LDLox) serviram para indicar o estado anti/pró-oxidativo. O nível de AF foi medido pela versão longa do IPAQ. Três recordatórios alimentares de 24h foram empregados para cálculo da ingestão de micronutrientes e de FLV. Três categorias de consumo de FLV consumidas foram criadas considerando-se a recomendação internacional e a ingestão de micronutrientes estratificada segundo tercis de consumo, analisados por ANOVA. Coeficiente de Pearson e regressão linear múltipla foram também empregados. Resultados: Os participantes consumiram uma média de 1800 kcal/dia e 3,7 porções/1000 kcal de FLV. Ao longo das categorias de ingestão de FLV, os valores médios de circunferência da cintura (p=0,06) e pressão arterial diastólica (p=0,05) tenderam a diminuir e adiponectina (p=0,05) a aumentar. Indivíduos no tercil mais alto de ingestão de zinco apresentaram valores mais baixos de massa gorda e HOMA-IR, enquanto as concentrações de PCR foram marginalmente significantes (p=0,06). O HOMA-IR associou-se inversamente com ingestão de zinco e magnésio em todos os modelos. Associações diretas foram encontradas entre as concentrações de SOD com ingestão de FLV, bem como de magnésio em modelos ajustados. A concentração de LDLox se associou inversamente a ingestões de magnésio, vitaminas C e E em modelos ajustados. Resultados similares foram encontrados entre a concentração de LDLox e FLV, mas perdeu a significância após ajustes. Associação direta entre LDLox e ingestão de selênio manteve-se nos modelos ajustados. Conclusão: Nosso estudo sugere que a análise do consumo de FLV e/ou de certas vitaminas e minerais, ainda que estejam abaixo dos níveis recomendados, pode ser útil para identificar estresse oxidativo e resistência à insulina.Introduction: Current lifestyle has deleterious consequences in dietary habits, physical activity, smoking and psychosocial stress, which have predisposed to non-communicable chronic diseases. A diet rich in fruits and vegetables can attenuate the effects on cardiometabolic risk, and there is consistent evidence of its benefit on the prevention of obesity, dyslipidemia and type 2 diabetes. Worldwide the consumption of fruits and vegetables, sources of vitamins and minerals, which are essential for body homeostasis, is low. These foods contribute to a favorable cardiometabolic profile, attenuating oxidative stress, inflammation and insulin resistance. Objective: Associations between the consumption of certain micronutrients and fruits and vegetables with markers of oxidative status, inflammation and insulin resistance were examined in individuals at cardiometabolic risk. Methods: This cross-sectional analysis included 205 participants (65 per cent women, mean age 54.1 years) with pre-diabetes or with metabolic syndrome without diabetes of the Diabetes Prevention Study of the FSP-USP Health Care Unit. They were submitted to questionaires blood collection. Superoxide dismutase (SOD) and oxidized LDL (oxLDL) were used to indicate the oxidative status. The physical activity level was measured by the long version of IPAQ. Three 24-hour dietary recalls were used to calculate intake of micronutrients and of fruits and vegetables. Three categories of fruits and vegetables consumption were created taking into consideration international recommendations, and micronutrient intake were grouped according tertiles of consumption, these categories analyzed by ANOVA. Pearsons correlation coefficient and multiple linear regression were used. Results: Participants consumed a mean of 1,800 kcal per day and 3.7/1000 kcal servings of fruit and vegetables. Mean values of waist circumference (p=0.06) and diastolic blood pressure (p=0.05) tended to decrease, and adiponectin (p=0.05) to increase across the categories of fruits and vegetables intake. Individuals in the highest tertile of zinc intake showed lower values of fat mass and HOMA-IR, while CRP concentrations were marginally significant (p=0.06). HOMA-IR was inversely associated with zinc and magnesium intakes in all the models. Direct associations were found between SOD concentrations and fruits and vegetables as well as magnesium intakes in adjusted models, while oxLDL concentration was inversely associated with magnesium, vitamin C and E intakes. Similar results were found between oxLDL concentration and fruits and vegetables intake but significance disappeared after adjustments. A direct association between oxLDL and selenium intake was detected after multiple adjustments. Conclusion: Our study suggest that fruits and vegetables and/or selected vitamins and minerals intakes albeit below recommended levels may be useful to identifying oxidative stress and insulin resistance

[Software development for health monitoring in the Nutritionist \'Health Study: application in the analysis of the relationship between literacy in nutrition and diet

Introdução: Nicho interessante de pesquisa sobre o papel de hábitos de vida na saúde são os nutricionistas e estudantes de nutrição. Nesse sentido, surge o Nutritionists Health Study (NutriHS) na FSP-USP. Estudos desta natureza geram quantidade apreciável de informação, sendo desejável o uso de tecnologia para facilitar a obtenção e processamento de dados. Objetivos: O conjunto dos objetivos desta tese, que vão desde a criação de sistema web até sua aplicação no NutriHS, foram: 1) analisar softwares internacionalmente disponíveis, voltados à coleta e análise de dados sobre nutrição e alimentação; 2) desenvolver e implementar o sistema web, o e-NutriHS; 3) elaborar a documentação do sistema web; 4) proceder a validação os dados coletados pelo e-NutriHS; 5) comparar hábitos de vida (dieta e atividade física), medidas antropométricas e perfil bioquímico de estudantes de Nutrição e nutricionistas. Métodos: Realizou-se busca sistemática de estudos que utilizavam sistemas informatizados baseados na web. No desenvolvimento do e-NutriHS empregaram-se linguagens de programação livres: para o banco de dados utilizou-se MySQL 5.0 server via phpMyAdmin, localhost via UNIX socket e para a camada de apresentação Jquery 1.8, PHP 5.6, CSS e HTML 5. A documentação incluiu fluxogramas, arquitetura, código fonte e abordagem IBM Rational Unified Process, permitindo o desenvolvimento guiado por casos de uso, atendendo às recomendações do Instituto Nacional de Propriedade Industrial. Implementou-se a coleta de dados do NutriHS sobre hábitos de vida, eventos precoces da vida, saúde e clínico-laboratoriais, de estudantes de Nutrição em diferentes períodos do curso (1ª metade e 2ª metade) e graduados, por meio eletrônico e presencial. Bland-Altman e Kappa foram usadas para análises de concordância entre dados referidos e aferidos. Subgrupos de participantes foram comparados quanto a diversas variáveis (incluindo índice de dieta saudável) por ANOVA. Resultados: A busca das ferramentas de coleta eletrônica de dados de nutrição resultou em 10 estudos. A documentação do e-NutriHS incluiu detalhamento de fluxogramas, arquitetura, código fonte e casos de uso, atendendo às recomendações para registro de software. 723 indivíduos completaram dados autorreferidos no sistema e 228 realizaram antropometria, medidas de pressão arterial, composição corporal e coleta de materiais biológicos. Detectaram-se fortes correlações entre os valores antropométricos relatados e aferidos. A comparação de subgrupos mostrou tendência a menor consumo de energia, colesterol e carne vermelha e maior consumo de frutas & verduras nos grupos com maior duração da exposição a conhecimentos em nutrição. Os graduados apresentaram melhor escore de componentes do índice de dieta saudável e melhores índices lipídicos. Tais índices associaram-se ao consumo de frutas & verduras e inversamente ao de grãos refinados. Discussão: Instrumentos disponíveis na literatura apontam o meio eletrônico como de utilidade para condução de pesquisa em epidemiologia nutricional. O e-NutriHS atendeu adequadamente aos propósitos, motivando encaminhar seu registro de software. Com ferramenta eletrônica amigável, o NutriHS destacou-se como importante iniciativa de pesquisa em nutrição. Sugeriu que aquisição de conhecimento e habilidades traz benefícios clínicos que poderão, no longo prazo, reduzir o risco cardiometabólico. Conclui-se que o desenvolvimento do e-NutriHS proporcionou rápida implementação do NutriHS, gerando dados de alta qualidade e baixo custo. Abrem-se perspectivas de testar hipóteses sobre mecanismos de doenças e intervenções na sua fase longitudinal que poderão ser úteis para a saúde pública.Introduction: An interesting field of research on the role of lifestyle on health involves undergraduates and graduates of Nutrition Colleges. In this sense, emerges the Nutritionists\' Health Study (NutriHS) in the FSP-USP. This kind of study generates appreciable amount of information requiring technology to facilitate the data collection and processing. Objectives: The objectives for the development of this thesis began by programing a computerized system to its application in NutriHS. They were: 1) to analyze internationally available softwares addressed to the collection and analysis of data on nutrition; 2) to develop and implement the web system, e-NutriHS; 3) to develop the web system documentation; 4) to validate the data collected by NutriHS system; 5) to compare lifestyle habits (diet and physical activity), anthropometric measurements and biochemical profile of Nutrition undergraduates and nutritionists. Methods: A systematic search of epidemiological studies using web-based systems was performed. For the development of the e-NutriHS system free programming languages were employed: MySQL 5.0 for database server via phpMyAdmin, localhost via UNIX socket; and jQuery 1.8, PHP 5.6, CSS and HTML 5 for the users layer. Its documentation included detailed flowcharts, architecture, source code and the IBM Rational Unified Process approach, according to the National Institute of Industrial Property recommendations. Electronic data collection of the NutriHS participants on lifestyle, early life events, health and clinical laboratory from the undergraduates at different stages of course (1st half and 2nd half) and graduated, as well as face-to-face data collection, were implemented. Bland-Altman and Kappa were used for correlation analysis between reported and measured data. Subgroups of participants were compared according to a number of variables (including healthy eating index) by ANOVA. Results: Ten studies were selected in the search of webbased instruments. The e-NutriHS documentation included flowcharts, architecture, source code and use cases, taking into account the recommendations for software registration. 723 subjects completed self-reported data and 228 had measurements of anthropometry, blood pressure, body composition and collection of biological materials taken. Strong correlations were detected between reported and measured anthropometric values. In subgroups comparisons, a trend to lower energy and cholesterol red meat and higher fruits and vegetables intakes were found in groups with longer exposure to nutrition knowledge. The graduated group had better scores of some components the health eating index and better lipid indices. Lipid indices were associated with the intake fruits & vegetables and inversely with refined grains. Discussion: The systematic review indicates that web-based instruments are useful for conducting research in nutritional epidemiology. The e-NutriHS met its purposes appropriately, which led to referral to the software registration. The NutriHS has represented a major initiative research in nutrition. This suggested that acquisition of knowledge and skills reflects in clinical benefits that could reduce long term cardiometabolic risk. We conclude that the e-NutriHS development accelerate the NutriHS implementation, generating high-quality low-cost data. Perspectives of testing hypotheses about the mechanisms of nutrition-related diseases and interventions in the longitudinal phase are opened with potential use in public health

Lifestyle intervention using the psychoeducational approach is associated with greater cardiometabolic benefits and retention of individuals with worse health status

ABSTRACT Objective This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention – traditional or interdisciplinary psychoeducation-based intervention – in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. Subjects and methods Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. Results Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. Conclusion The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle

Lifestyle intervention using the psychoeducational approach is associated with greater cardiometabolic benefits and retention of individuals with worse health status

ABSTRACT Objective: This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention -traditional or interdisciplinary psychoeducationbased intervention -in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. Subjects and methods: Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. Results: Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. Conclusion: The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle. Arch Endocrinol Metab. 2017;61(1):36-4