Lowering dietary glycaemic index through nutrition education among Malaysian women with a history of gestational diabetes mellitus

Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM

Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes : a six months randomized trial

Background: Gestational Diabetes Mellitus (GDM) increases risks for type 2 diabetes and weight management is recommended to reduce the risk. Conventional dietary recommendations (energy-restricted, low fat) have limited success in women with previous GDM. The effect of lowering Glycaemic Index (GI) in managing glycaemic variables and body weight in women post-GDM is unknown. Objective: To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education, in the management of glucose tolerance and body weight in Asian women with previous GDM. Method. Seventy seven Asian, non-diabetic women with previous GDM, between 20- 40y were randomised into Conventional healthy dietary recommendation (CHDR) and low GI (LGI) groups. CHDR received conventional dietary recommendations only (energy restricted, low in fat and refined sugars, high-fibre). LGI group received advice on lowering GI in addition. Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test (2HPP) were measured at baseline and 6 months after intervention. Anthropometry and dietary intake were assessed at baseline, three and six months after intervention. The study is registered at the Malaysian National Medical Research Register (NMRR) with Research ID: 5183. Results: After 6 months, significant reductions in body weight, BMI and waist-to-hip ratio were observed only in LGI group (P<0.05). Mean BMI changes were significantly different between groups (LGI vs. CHDR: -0.6 vs. 0 kg/ m§ssup§2§esup§, P= 0.03). More subjects achieved weight loss ≥5% in LGI compared to CHDR group (33% vs. 8%, P=0.01). Changes in 2HPP were significantly different between groups (LGI vs. CHDR: median (IQR): -0.2(2.8) vs. +0.8 (2.0) mmol/L, P=0.025). Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group (-1.9±0.42 vs. +1.31±1.4 mmol/L, P<0.001). After 6 months, LGI group diets showed significantly lower GI (57±5 vs. 64±6, P<0.001), GL (122±33 vs. 142±35, P=0.04) and higher fibre content (17±4 vs.13±4 g, P<0.001). Caloric intakes were comparable between groups. Conclusion: In women post-GDM, lowering GI of healthy diets resulted in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription

Metabolic syndrome, abnormal glucose tolerance and high sensitivity-C-reactive protein among women with a history of Gestational Diabetes Mellitus

Background: Gestational Diabetes Mellitus (GDM) is a risk factor for diabetes and cardiovascular diseases. Early detection of cardio-metabolic risks is recommended for management. This study evaluated the associations between Metabolic Syndrome (MetS), abnormal glucose tolerance and cardiovascular risk factors in Malaysian women with prior GDM. Method: Seventy-seven, non-diabetic women post-GDM, aged 20-40 years (mean BMI: 26.4 ± 4.6kg/m2) with high type 2 diabetes risks, were evaluated at a median of four months postpartum. Their anthropometric and biochemical measurements were obtained. Results: The overall prevalence of MetS and dysglycaemia were 22% and 29% respectively. Dysglycaemic was predominantly impaired glucose tolerance (IGT: 77%).MetS was higher among dysglycaemic subjects although also detected in 13% of normo glycaemic subjects. Eighty percent of IGT subjects did not have MetS. Sixty-eight percent of subjects had intermediate or high CVD risks (hsCRP>1mg/L). hscRP increased with obesity and was not associated with glycaemic status. Infant birth weight, maternal age and triglycerides were independent predictors of dysglycaemia (p<0.05). Conclusion: Despite the low prevalence of MetS, elevated levels of hsCRP among these women with prior- GDM was highly prevalent. Normoglycaemic subjects with MetS demonstrated intermediate to high risk hsCRP levels. The findings also emphasize the importance of performing OGTT mainly in older post-GDM women, with higher triglycerides and infants who are large for gestational age

Data collection and analysis tools for food security and nutrition. Towards enhancing effective, inclusive, evidence-informed, decision making

Throughout the world, high-quality, timely and relevant data are key to inform actions that promote better access to food and improved nutrition. • Despite the abundant and growing availability of data and information relevant to food security and nutrition, often policymakers are not aware of the existence and relevance of such data or do not use them appropriately, due to challenges at each step of the data cycle, which includes: defining priorities and data needs; reviewing, consolidating, collecting and curating data; analyzing the data using appropriate tools; translating data into relevant insights to be disseminated and discussed; and, finally, using data for decision-making. • Fundamental data gaps still exist to correctly guide action and inform policymaking, especially in terms of timely and sufficiently granular data on people’s ability to locally produce and access food, on their actual food and nutrient consumption, and on their nutritional status. Increased and sustained financial investment is needed to overcome these gaps. • Several other constraints limit the effectiveness of data-informed policy action, especially in low-resource countries. Key among them is the low level of data literacy and analysis skills (for both qualitative and quantitative data) on the part of data and information users at all levels – from data collectors and analysts, to decision-makers, and to the people, as the ultimate beneficiaries of food security and nutrition policies. • The complexity of the system of public and private actors and institutions involved in food security and nutrition data, coupled with the rapidly changing characteristics of today’s data ecosystems due to the digital revolution and the pervasiveness of the internet, brings to centre stage the need for global coordination to improve data governance. Particularly urgent is the need to reach agreement on the nature of FSN data and information as a public good, and, on that basis, to establish a global legal framework that allows for the broadest possible circulation of relevant information, while preserving the rights of the people to whom the data ultimately belongs

Impact of mediterranean diet promotion on environmental sustainability: a longitudinal analysis

[EN]This article aims to estimate the differences in environmental impact (greenhouse gas [GHG] emissions, land use, energy used, acidification and potential eutrophication) after one year of promoting a Mediterranean diet (MD). Methods Baseline and 1-year follow-up data from 5800 participants in the PREDIMED-Plus study were used. Each participant's food intake was estimated using validated semi-quantitative food frequency questionnaires, and the adherence to MD using the Dietary Score. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The association between MD adherence and its environmental impact was calculated using adjusted multivariate linear regression models.SIPublicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Anomalous association of salivary amylase secretion with the postprandial glycaemic response to starch

BACKGROUND: This study is an investigation as to whether salivary amylase secretory rates are correlated with the magnitude of postprandial glycaemic responses to starch ingestion in healthy young Malaysian adults. METHODS: Fasting unstimulated and stimulated salivary amylase secretory rates were measured and ranked for 54 participants. Subjects (n = 5) with amylase activities below the median and subjects (n = 5) with amylase activities above the median were selected for subsequent carbohydrate challenge tests. Following an overnight fast, the postprandial glycaemic responses of these subjects were assessed to 50 g carbohydrate bolus challenges; glucose (n = 2), maltose (n = 1) and starch (n = 1), tested in random order. Blood glucose concentrations were estimated before each carbohydrate challenge and at half-hour intervals thereafter for 2 h. The magnitude of each glycaemic response was estimated from the area under the curve (AUC). RESULTS: High amylase secretors responded to the consumption of a starch bolus with significantly lower AUCs than low amylase secretors (267 +/− 64 vs. 159 +/− 72 mmol/L*120 min, p = 0.037; mean +/− SD). However, the glycaemic responses to maltose and glucose did not differ significantly between the two groups. These findings confirm that subjects with higher salivary amylase secretory rates have better glycaemic tolerance to a starch challenge than subjects with lower salivary amylase secretory rates. CONCLUSION: Low amylase secretion should be considered as a potential prognosticator for impaired glucose tolerance to dietary starch in young Malaysian adults

Diet quality of Malaysians across lifespan:A scoping review of evidence in a multi-ethnic population

Malaysia is a rapidly developing economy experiencing a nutrition transition. It suffers from a double burden of over- and undernutrition, making it essential to understand diet quality in the population. In this scoping review, we have collated the existing literature on Malaysian diet quality, including factors that influence it, and the association between diet quality and health outcomes across the lifespan of Malaysians. Overall, diet quality was poor in all age groups studied. The Healthy Eating Index (HEI) and its iterations were predominantly used in urban and clinical settings to evaluate diet-chronic disease relationships. These indices were significantly associated with cardio-metabolic and disease risks in adults. The Diet Diversity Score (DDS) and Food Variety Score (FVS) were used to gauge diet quality in maternal and child nutrition studies and were associated with appropriate growth and caloric intake. Deficiencies were found in fruit, vegetable, legumes, and dairy intake. Meat, salt, and sugar intake were found to be excessive in many studies. The findings can inform policies to improve diet quality in this population. The review also identified knowledge gaps that require further investigation

Association of adiposity and its changes over time with COVID-19 risk in older adults with overweight/obesity and metabolic syndrome: a longitudinal evaluation in the PREDIMED-Plus cohort

Background: Cross-sectionally, older age and obesity are associated with increased coronavirus disease-2019 (COVID-19) risk. We assessed the longitudinal associations of baseline and changes in adiposity parameters with COVID-19 incidence in older adults at high cardiovascular risk. Methods: This analysis included 6874 men and women (aged 55-75 years) with overweight/obesity and metabolic syndrome in the PREDIMED-Plus lifestyle intervention trial for cardiovascular risk reduction. Body weight, body-mass-index (BMI), waist circumference, waist-to-height ratio (WHtR), and a body shape index (ABSI) were measured at baseline and annual follow-up visits. COVID-19 was ascertained by an independent Event Committee until 31 December 2021. Cox regression models were fitted to evaluate the risk of COVID-19 incidence based on baseline adiposity parameters measured 5-6 years before the pandemic and their changes at the visit prior to censoring. Results: At the time of censoring, 653 incident COVID-19 cases occurred. Higher baseline body weight, BMI, waist circumference, and WHtR were associated with increased COVID-19 risk. During the follow-up, every unit increase in body weight (HRadj (95%CI): 1.01 (1.00, 1.03)) and BMI (HRadj: 1.04 (1.003, 1.08)) was associated with increased COVID-19 risk. Conclusions: In older adults with overweight/obesity, clinically significant weight loss may protect against COVID-19. Trial registration: This study is registered at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870).This work was supported by a project grant from the Fundación Francisco Soria Melguizo. The project also received support from the Community of Madrid and the European Union, through the European Regional Development Fund (ERDF)-REACT-EU resources of the Madrid Operational Program 2014–2020, in the action line of R + D + i projects in response to COVID-19, FACINGLCOVID-CM. The PREDIMED-Plus trial was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund. This study has been funded by Instituto de Salud Carlos III (ISCIII) through six coordinated FIS projects leaded by JS-S and JVi, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332, PI20/01802, PI20/00138, PI20/01532, PI20/00456, PI20/00339, PI20/00557, PI20/00886, PI20/01158; the Especial Action Project entitled: “Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to JS-S” and co-funded by the European Union. It is also supported by the European Research Council (Advanced Research Grant 2014–2019; agreement #340918) granted to MÁM-G; the Recercaixa (number 2013ACUP00194) grant to JS-S; grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, PI0137/2018); the PROMETEO/2017/017, PROMETEO 21/2021 grants from the Generalitat Valenciana; and the SEMERGEN grant. S.G.S is a recipient of the Maria Zambrano Fellowship with funding support from the Ministry of Universities and the Recovery, Transformation and Resilience Plan, Spain. The Fellowship is “Funded by the European Union – NextGenerationEU”. S.K.N. is supported by a postdoctoral fellowship from the Canadian Institutes of Health Research (CIHR, MFE-171207). JS-S was partially supported by ICREA under the ICREA Academia program. We thank CERCA Programme/Generalitat de Catalunya for institutional support. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript