Diet quality and therapeutic targets in patients with type 2 diabetes : evaluation of concordance between dietary indexes

Background: This study aimed to evaluate the concordance between two dietary indexes, the Healthy Eating Index (HEI) and the Diabetes Healthy Eating Index (DHEI), in evaluating diet quality and its possible association with therapeutic targets in patients with type 2 diabetes. Methods: Cross-sectional study of outpatients with type 2 diabetes mellitus treated at a university hospital. Dietary information was obtained from a quantitative food frequency questionnaire (previously validated for use in patients with type 2 diabetes) and converted into daily intakes. Diet quality was assessed using two dietary indexes: HEI (12 components, nine food groups and three moderation components) and DHEI (10 components, six food groups, three nutrient groups, and one for variety of diet). In both indexes, the sum of the scores for each component yields an overall score converted on a scale from 0 to 100%; diet quality is subsequently ranked as low (80%). Patients underwent clinical and laboratory assessment. Those with fasting blood glucose values 70–130 mg/dL, A1c < 7%, total cholesterol <200 mg/dL, LDL-cholesterol <100 mg/dL, and triglycerides <150 mg/dL were considered to meet therapeutic targets. All analyses were conducted in PASW Statistics 18.0, and p < 0.05 deemed significant. Results: We analyzed 148 patients with type 2 diabetes (73% white, mean age 63.2 ± 9.4 years, median diabetes duration 10 [IQR 5–19] years, mean A1c% 8.4 ± 2.0%, and mean BMI 30.5 ± 4.2 kg/m2). Mean energy intake was 2114 ± 649 kcal/day. DHEI scores were 17.0 (95%CI -6.8 to 41.0) points lower than HEI scores (55.9 ± 14.2% vs. 72.9 ± 10.7%, respectively; P < 0.001), suggesting there is no agreement (Bland-Altman method), and the Pearson correlation coefficient was 0.55 (P < 0.001). More patients were classified as having a low-quality diet by the DHEI than by the HEI (38.5% vs. 1.4%; P < 0.001). A higher proportion of patients (35.7%) with out-of-target total cholesterol levels had a low-quality diet evaluated by the DHEI (P = 0.03). We did not find associations between overall score of HEI and therapeutic targets. Conclusions: In its intended population of patients with type 2 diabetes, the DHEI seems to be a more rigorous tool to evaluate association between diet quality and changes in metabolic parameters

Bariatric surgery in the treatment of obesity: impacts on bone metabolism

A obesidade é um problema de saúde pública de proporções epidêmicas que atinge parte significativa da população mundial. O aumento da morbidade associada à obesidade é particularmente importante por estar relacionado com o aumento no risco de doenças crônicas não transmissíveis. Dietoterapia e estímulo à prática de atividades físicas, associados à terapia comportamental, constituem a abordagem inicial do problema, que pode incluir o uso de medicamentos antiobesidade. Esgotadas as chances de sucesso do tratamento clínico, indica-se o tratamento cirúrgico. Além do benefício de significativa redução de peso, a cirurgia bariátrica se associa com redução na incidência de diabetes, melhora da dislipidemia e redução de mortalidade. Entretanto, paraefeitos da cirurgia bariátrica devem ser considerados, os quais podem ocorrer tanto em curto prazo quanto tardiamente. Alterações no metabolismo do cálcio e da vitamina D e perda de massa óssea no pós-operatório são efeitos adversos importantes que têm sido relatados nos últimos anos. A deficiência da vitamina D leva à diminuição da absorção intestinal de cálcio, redução da calcemia, seguida de elevação do paratormônio, que determina então aumento da mobilização do cálcio ósseo e diminuição da sua eliminação renal, juntamente com aumento na depuração do fosfato. Indivíduos obesos que se submetem a procedimentos que promovem restrição e/ou disabsorção de nutrientes são os que apresentam maior risco de alterações no metabolismo do cálcio, fósforo e deficiência de vitamina D. A perda de massa óssea se inicia já nos primeiros meses de pós-operatório As técnicas cirúrgicas que causam disabsorção constituem-se em risco elevado para desenvolvimento de doenças ósseas. Entretanto, há estudos demonstrando alterações no metabolismo ósseo em técnicas puramente restritivas. Em relação ao risco de fraturas, sabe-se que baixo peso corporal é fator de risco para fraturas, principalmente em idosos. Entretanto, poucos estudos têm demonstrado a ocorrência de fraturas após a cirurgia bariátrica, os quais apresentam resultados controversos. Com base nesta revisão, a cirurgia bariátrica está associada com redução na absorção de cálcio, deficiência de vitamina D, perda de massa óssea e, possivelmente, aumento no risco de fraturas.Obesity is a public health problem of epidemic proportions that affects a significant portion of the world population. The increase of morbidity associated with obesity is particularly important because it is related to increased risk of chronic diseases. Diets and stimulation to physical activity, in association to behavioral therapy, are the initial approach to the problem, which may include the use of pharmacological agents. Exhausted the chances of success of clinical treatment, surgical treatment is indicated. Besides the benefit of significantly weight reduction, bariatric surgery is associated with reduction in the incidence of diabetes, dyslipidemia and mortality. However, adverse effects of bariatric surgery should be considered, which can occur both in the short term, as in the long term. Changes in calcium and vitamin D metabolism and bone loss in post-operative care are significant adverse effects that have been reported in recent years. Deficiency of vitamin D leads to decreased intestinal calcium absorption, reduced calcium levels and parathyroid hormone rise, determining increased bone calcium mobilization and decreased renal elimination, along with increased phosphate clearance. Obese subjects who undergo procedures that promote restriction and/or malabsorption of nutrients are at greatest risk of changes in the metabolism of calcium, phosphorus and vitamin D deficiency Bone loss begins in the first months after surgery. Surgical techniques that cause malabsorption are at the higher risk levels for developing bone diseases. However, there are studies demonstrating changes in bone metabolism in purely restrictive techniques. Regarding fractures risk, it is known that low body weight is a risk factor for fractures, especially in the elderly. However, few studies have demonstrated the occurrence of fractures after bariatric surgery, which is controversial. Based on this review, bariatric surgery is associated with reduced calcium absorption, vitamin D deficiency, bone loss and possibly increased risk of fractures

Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico. Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados. Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05). Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters. Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared. Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet’s glycemic index (p = 0.05). Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups