The Diet of Diabetic Patients in Spain in 2008–2010: Accordance with the Main Dietary Recommendations—A Cross-Sectional Study

Background: No previous study has assessed the diet of the diabetic patients in the general population of an entire country in Europe. This study evaluates accordance of the diet of diabetic adults in Spain with nutritional recommendations of the European Association for the Study of Diabetes (EASD), American Diabetes Association (ADA), and the Mediterranean diet (MD). Methods and Findings: Cross-sectional study conducted in 2008-2010 among 12,948 persons representative of the population aged ≥18 years in Spain. Usual food consumption was assessed with a dietary history. EASD accordance was defined as ≥6 points on a score of 12 nutritional goals, ADA accordance as ≥3 points on a score of 6 goals, and MD accordance as ≥7 points on the Mediterranean Diet Adherence Screener. In the 609 diagnosed diabetic individuals, the diet was rich in saturated fat (11.2% of total energy), but trans fat intake was relatively low (1.1% energy) and monounsaturated fat intake was high (16.1% energy). Carbohydrate intake was relatively low (41.1% energy), but sugar intake was high (16.9% energy). Intake of cholesterol (322 mg/day) and sodium (3.1 g/day) was also high, while fiber intake was insufficient (23.8 g/day). EASD accordance was observed in 48.7% diabetic patients, ADA accordance in 46.3%, and MD accordance in 57.4%. The frequency of EASD, ADA and MD accordance was not statistically different between diagnosed and undiagnosed diabetic individuals. Conclusions: Only about half of diabetic patients in Spain have a diet that is consistent with the major dietary recommendations. The lack of dietary differences between diagnosed and undiagnosed diabetic individuals reflects deficiencies in diabetes managementThe ENRICA study is funded by Sanofi-Aventis. Additional funding is obtained from FIS grant PI09/1626 and from the ‘Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular

Whole Grain Products, Fish and Bilberries Alter Glucose and Lipid Metabolism in a Randomized, Controlled Trial: The Sysdimet Study

Due to the growing prevalence of type 2 diabetes, new dietary solutions are needed to help improve glucose and lipid metabolism in persons at high risk of developing the disease. Herein we investigated the effects of low-insulin-response grain products, fatty fish, and berries on glucose metabolism and plasma lipidomic profiles in persons with impaired glucose metabolism.Altogether 106 men and women with impaired glucose metabolism and with at least two other features of the metabolic syndrome were included in a 12-week parallel dietary intervention. The participants were randomized into three diet intervention groups: (1) whole grain and low postprandial insulin response grain products, fatty fish three times a week, and bilberries three portions per day (HealthyDiet group), (2) Whole grain enriched diet (WGED) group, which includes principally the same grain products as group (1), but with no change in fish or berry consumption, and (3) refined wheat breads (Control). Oral glucose tolerance, plasma fatty acids and lipidomic profiles were measured before and after the intervention. Self-reported compliance with the diets was good and the body weight remained constant. Within the HealthyDiet group two hour glucose concentration and area-under-the-curve for glucose decreased and plasma proportion of (n-3) long-chain PUFAs increased (False Discovery Rate p-values <0.05). Increases in eicosapentaenoic acid and docosahexaenoic acid associated curvilinearly with the improved insulin secretion and glucose disposal. Among the 364 characterized lipids, 25 changed significantly in the HealthyDiet group, including multiple triglycerides incorporating the long chain (n-3) PUFA.The results suggest that the diet rich in whole grain and low insulin response grain products, bilberries, and fatty fish improve glucose metabolism and alter the lipidomic profile. Therefore, such a diet may have a beneficial effect in the efforts to prevent type 2 diabetes in high risk persons.ClinicalTrials.gov NCT00573781

African American patients with gout: efficacy and safety of febuxostat vs allopurinol

<p>Abstract</p> <p>Background</p> <p>African Americans are twice as likely as Caucasians to develop gout, but they are less likely to be treated with urate-lowering therapy (ULT). Furthermore, African Americans typically present with more comorbidities associated with gout, such as hypertension, obesity, and renal impairment. We determined the efficacy and safety of ULT with febuxostat or allopurinol in African American subjects with gout and associated comorbidities and in comparison to Caucasian gout subjects.</p> <p>Methods</p> <p>This is a secondary analysis of the 6-month Phase 3 CONFIRMS trial. Eligible gouty subjects with baseline serum urate (sUA) ≥ 8.0 mg/dL were randomized 1:1:1 to receive febuxostat 40 mg, febuxostat 80 mg, or allopurinol (300 mg or 200 mg depending on renal function) daily. All subjects received gout flare prophylaxis. Primary efficacy endpoint was the proportion of subjects in each treatment group with sUA < 6.0 mg/dL at the final visit. Additional endpoints included the proportion of subjects with mild or with moderate renal impairment who achieved a target sUA < 6.0 mg/dL at final visit. Adverse events (AEs) were recorded throughout the study.</p> <p>Results</p> <p>Of the 2,269 subjects enrolled, 10.0% were African American and 82.1% were Caucasian. African American subjects were mostly male (89.5%), obese (BMI ≥ 30 kg/m²; 67.1%), with mean baseline sUA of 9.8 mg/dL and mean duration of gout of 10.4 years. The proportions of African American subjects with a baseline history of diabetes, renal impairment, or cardiovascular disease were significantly higher compared to Caucasians (<it>p </it>< 0.001). ULT with febuxostat 80 mg was superior to both febuxostat 40 mg (<it>p </it>< 0.001) and allopurinol (<it>p </it>= 0.004). Febuxostat 40 mg was comparable in efficacy to allopurinol. Significantly more African American subjects with mild or moderate renal impairment achieved sUA < 6.0 mg/dL in the febuxostat 80 group than in either the febuxostat 40 mg or allopurinol group (<it>p </it>< 0.05). Efficacy rates in all treatment groups regardless of renal function were comparable between African American and Caucasian subjects, as were AE rates.</p> <p>Conclusions</p> <p>In African American subjects with significant comorbidities, febuxostat 80 mg is significantly more efficacious than either febuxostat 40 mg or allopurinol 200/300 mg. Febuxostat was well tolerated in this African American population.</p> <p>Please see related article: <url>http://www.biomedcentral.com/1741-7015/10/15</url></p

Healthy dietary indices and risk of depressive outcomes : a systematic review and meta-analysis of observational studies

With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression.Peer reviewe

Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation

Exploring nutrition knowledge and dietary intake of adults with spinal cord injury in specialist rehabilitation

Study design Cross-sectional study. Objectives To explore nutrition knowledge and dietary intake in adults with spinal cord injury (SCI). Setting SCI centre, Australia. Methods A validated General Nutrition Knowledge Questionnaire-R (GNKQ-R) evaluated nutrition knowledge to explore correlations with dietary intake. Dietary intake (current and pre-hospitalisation) was compared with national dietary modelling tools and Nutrient Reference Values (NRV) for assessing nutritional adequacy. Results Fifty participants, predominantly male (70%), with a median age of 50 years took part in the study. The mean GNKQ-R score was 59 (13.1)/85 (69%). Participants with a higher level of education scored higher (82%; p \u3c 0.01). The GNKQ-R score was also positively associated with the level of education (r = 0.45; p = \u3c 0.01) with a large effect size (\u3e0.80 Cohen’s d). Non-conformance with Australian Dietary Guidelines (ADG) and failure to meet NRV were also noted. Low calcium intakes were found in 69% (n = 34) and saturated fatty acid (SFA) consumption exceeded both the acceptable macronutrient distribution range (AMDR) of 10% for adults (n = 32, 65%) and the lower target of 7% recommended for at-risk groups (n = 49, 100%). Lower nutrition knowledge scores were negatively correlated with SFA intake (r = −0.28; p = 0.05, two-tailed) with a large Cohen’s d effect size (\u3e0.80). Conclusions Discordance with the ADG for most food groups was exemplified by high intake of SFA. Individuals with SCI have elevated cardiovascular disease (CVD) risk. Poor nutrition knowledge correlated with high SFA intake, indicates a need for timely, targeted interventions for CVD prevention in this patient group