Nutritional Status of Patients with Cutaneous Leishmaniasis from a Tropical Area of Bolivia, and Implications for Zinc Bioavailability

Macro and micronutrient deficiencies are a significant problem among people in rural areas in developing countries. Deficiencies may lead to an impaired immune system making the organism vulnerable to infections and diseases. In this paper, the dietary intake, anthropometric measurements, zinc and copper levels in serum, of patients with cutaneous leishmaniasis (CL) are compared with a group of healthy controls and reference values. Results showed no significant differences in most nutrient intake or anthropometrics between patients and controls. However, serum zinc level of pa- tients (80 μg/dl) was significantly lower (P < 0.001) than in controls (85 μg/dl), likely explained by the presence of leishmaniasis. The median serum zinc level in both groups was below the reference values, even though their median zinc intake met the zinc recommendations from WHO. Consequently, besides the presence of leishmaniasis, serum zinc levels may be compromised by inhibitory components in their diet, such as phytates, as it is shown by the molar ratio phytate:zinc (Phy:Zn) that was between 11 and 19, while 15 is the level said to compromise zinc status. There were significant (P < 0.05) negative correlations between serum zinc and Phy:Zn, for patients (r = −0.413) and controls (r = −0.410). In conclusion this study shows that patients with CL in Chapare, Bolivia had low serum zinc levels due to the leishmaniasis per se and the decreased zinc bioavailability in their diet. CL infection was not in direct association with the nutritional status indicated by the anthropometric or dietary assessments. However, dietary intake showed 5 essen- tial nutrients below the nutrient recommendation in both groups

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study

<p>Abstract</p> <p>Background</p> <p>Our aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin.</p> <p>Methods</p> <p>In a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records.</p> <p>Results</p> <p>Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, <it>p </it>= 0.01), triacylglycerol (-0.4 mmol/L, <it>p </it>= 0.003), diastolic blood pressure (-4 mmHg, <it>p </it>= 0.03), weight (-3 kg, <it>p </it>= 0.01), BMI (-1 kg/m², <it>p </it>= 0.04) and waist circumference (-4 cm, <it>p </it>= 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, <it>p </it>= 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55).</p> <p>Conclusion</p> <p>Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00435240.</p

A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease

BACKGROUND: We found marked improvement of glucose tolerance and lower dietary energy intake in ischemic heart disease (IHD) patients after advice to follow a Paleolithic diet, as compared to a Mediterranean-like diet. We now report findings on subjective ratings of satiety at meals and data on the satiety hormone leptin and the soluble leptin receptor from the same study. METHODS: Twenty-nine male IHD patients with impaired glucose tolerance or diabetes type 2, and waist circumference > 94 cm, were randomized to ad libitum consumption of a Paleolithic diet (n = 14) based on lean meat, fish, fruit, vegetables, root vegetables, eggs, and nuts, or a Mediterranean-like diet (n = 15) based on whole grains, low-fat dairy products, vegetables, fruit, fish, and oils and margarines during 12 weeks. In parallel with a four day weighed food record the participants recorded their subjective rating of satiety. Satiety Quotients were calculated, as the intra-meal quotient of change in satiety during meal and consumed energy or weight of food and drink for that specific meal. Leptin and leptin receptor was measured at baseline and after 6 and 12 weeks. Free leptin index was calculated as the ratio leptin/leptin receptor. RESULTS: The Paleolithic group were as satiated as the Mediterranean group but consumed less energy per day (5.8 MJ/day vs. 7.6 MJ/day, Paleolithic vs. Mediterranean, p = 0.04). Consequently, the quotients of mean change in satiety during meal and mean consumed energy from food and drink were higher in the Paleolithic group (p = 0.03). Also, there was a strong trend for greater Satiety Quotient for energy in the Paleolithic group (p = 0.057). Leptin decreased by 31% in the Paleolithic group and by 18% in the Mediterranean group with a trend for greater relative decrease of leptin in the Paleolithic group. Relative changes in leptin and changes in weight and waist circumference correlated significantly in the Paleolithic group (p < 0.001) but not in the Mediterranean group. Changes in leptin receptor and free leptin index were not significant. CONCLUSIONS: A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet. TRIAL REGISTRATION: ClinicalTrials.gov NCT0041949

Palaeolithic diet decreases fasting plasma leptin concentrations more than a diabetes diet in patients with type 2 diabetes:A randomised cross-over trial

BACKGROUND: We have previously shown that a Palaeolithic diet consisting of the typical food groups that our ancestors ate during the Palaeolithic era, improves cardiovascular disease risk factors and glucose control compared to the currently recommended diabetes diet in patients with type 2 diabetes. To elucidate the mechanisms behind these effects, we evaluated fasting plasma concentrations of glucagon, insulin, incretins, ghrelin, C-peptide and adipokines from the same study. METHODS: In a randomised, open-label, cross-over study, 13 patients with type 2 diabetes were randomly assigned to eat a Palaeolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts, or a diabetes diet designed in accordance with current diabetes dietary guidelines during two consecutive 3-month periods. The patients were recruited from primary health-care units and included three women and 10 men [age (mean ± SD) 64 ± 6 years; BMI 30 ± 7 kg/m(2); diabetes duration 8 ± 5 years; glycated haemoglobin 6.6 ± 0.6 % (57.3 ± 6 mmol/mol)] with unaltered diabetes treatment and stable body weight for 3 months prior to the start of the study. Outcome variables included fasting plasma concentrations of leptin, adiponectin, adipsin, visfatin, resistin, glucagon, insulin, C-peptide, glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 and ghrelin. Dietary intake was evaluated by use of 4-day weighed food records. RESULTS: Seven participants started with the Palaeolithic diet and six with the diabetes diet. The Palaeolithic diet resulted in a large effect size (Cohen’s d = −1.26) at lowering fasting plasma leptin levels compared to the diabetes diet [mean difference (95 % CI), −2.3 (−5.1 to 0.4) ng/ml, p = 0.023]. No statistically significant differences between the diets for the other variables, analysed in this study, were observed. CONCLUSIONS: Over a 3-month study period, a Palaeolithic diet resulted in reduced fasting plasma leptin levels, but did not change fasting levels of insulin, C-peptide, glucagon, incretins, ghrelin and adipokines compared to the currently recommended diabetes diet. Trial registration: ClinicalTrials.gov NCT00435240 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12933-016-0398-1) contains supplementary material, which is available to authorized users

A bilberry drink with fermented oatmeal decreases postprandial insulin demand in young healthy adults

Background: in traditional medicine, blueberries have been used to facilitate blood glucose regulation in type 2 diabetes. Recent studies in diabetic mice have indicated facilitated glycaemic regulation following dietary supplementation with extracts from European blueberries, also called bilberries, (Vaccinium myrtillus). The purpose of the present study was to investigate the impact of fermented oat meal drinks containing bilberries or rosehip (Rosa canina) on glycaemic and insulinaemic responses. Methods: glycaemic and insulinaemic responses in young healthy adults were measured in two series. In series 1, two drinks based on oat meal (5%), fermented using Lactobacillus plantarum 299v, and added with fruit (10%); bilberries (BFOMD) or rose hip (RFOMD) respectively, were studied. In series 2, BFOMD was repeated, additionally, a drink enriched with bilberries (47%) was tested (BBFOMD). As control a fermented oat meal drink (FOMD) was served. Results: in series 1 the bilberry-and rosehip drinks, gave high glucose responses similar to that after the reference bread. However, the insulin index (II) after the BFOMD was significantly lower (II = 65) (P < 0.05). In series 2 a favourably low insulin demand to BFOMD was confirmed. FOMD gave high glucose response (GI = 95) but, significantly lower insulin response (II = 76). BBFOMD gave remarkably low insulin response II = 49, and tended to lower glycaemia (GI = 79) (P = 0.0684). Conclusion: a fermented oat meal drink added with bilberries induced a lower insulin response than expected from the glycaemic response. The mechanism for the lowered acute insulin demand is still unclear, but may be related to some bio-active component present in the bilberries, or to the fermented oat meal base

Metabolic responses to starch in oat and wheat products. On the importance of food structure, incomplete gelatinization or presence of viscous dietary fibre

Objective: Evaluate the impotrtance of incomplete gelatinization, food structure and presence of viscous dietary fibre for the postprandial glycaemic and insulinaemic responses to oat and wheat products. Design: Three common breakfast meals were tested, "raw" rolled oats (muesli), boiled rolled oats (oat porridge) and white wheat bread. Boiled intact oat and wheat kernels (kernel porridges) were also included. For comparison, glycemic indices (GIs) were calculated both from analysis of capillary and venous blood samples. Subjects: Nine healthy male volunteers between 65 and 70 years of age participated in the study. Results: The rolled oats and oat porridge elicited high metabolic responses. No differences in glycaemic and insulinaemic indices (IIs) were seen between these products and white bread. In contrast, the kernel porridges produced low glucose and insulin responses. No differences were obtained in GI values whether based on capillary or venous blood. However, with some products capillary blood allowed smaller differences to be detected. Conclusions: Neither incompleate gelatinization in rolled oats nor naturally occuring viscous dietary fibre in oats affect postprandial glycaemia, whereas enclosure if intact kernels significantly blunt metabolic responses

Determination of glycaemic index; some methodological aspects related to the analysis of carbohydrate load and characteristics of the previous evening meal

Objectives: To determine the possible differences in glycaemic index (GI) depending on ( 1) the analytical method used to calculate the 'available carbohydrate' load, that is, using carbohydrates by difference ( total carbohydrate by difference, minus dietary fibre (DF)) as available carbohydrates vs available starch basis ( total starch minus resistant starch (RS)) of a food rich in intrinsic RS and ( 2) the effect of GI characteristics and/or the content of indigestible carbohydrates ( RS and DF) of the evening meal prior to GI testing the following morning. Design: Blood glucose and serum insulin responses were studied after subjects consuming ( 1) two levels of barley kernels rich in intrinsic RS (15.2%, total starch basis) and ( 2) after a standard breakfast following three different evening meals varying in GI and/or indigestible carbohydrates: pasta, barley kernels and white wheat bread, respectively. Subjects: Healthy adults with normal body mass index. Results: ( 1) Increasing the portion size of barley kernels from 79.6 g ( 50 g ` available carbohydrates') to 93.9 g ( 50 g available starch) to adjust for its RS content did not significantly affect the GI or insulin index (II). ( 2) The low GI barley evening meal, as opposed to white wheat bread and pasta evening meals, reduced the postprandial glycaemic and insulinaemic ( 23 and 29%, respectively, P<0.05) areas under the curve at a standardized white bread breakfast fed the following morning. Conclusion: ( 1) Increasing portion size to compensate for the considerable portion of RS in a low GI barley product had no significant impact on GI or II. However, for GI testing, it is recommended to base carbohydrate load on specific analyses of the available carbohydrate content. ( 2) A low GI barley evening meal containing high levels of indigestible carbohydrates ( RS and DF) substantially reduced the GI and II of white wheat bread determined at a subsequent breakfast meal

Muesli with 4g oat beta-glucans lowers glucose and insulin responses after a bread meal in healty subjects

Objective: To evaluate the impact of an extruded muesli product based on -glucan-rich oat bran on postprandial glycaemia and insulinaemia. Subject/Design: The study is divided in two series. Blood glucose and serum insulin responses were studied after subjects consuming test meals including a serving of muesli with 3 g (series 1) and 4 g (series 2) of -glucans, respectively. The muesli was a component in a single serving packet with muesli and yoghurt. This was served together with white wheat bread in the morning after an overnight fast. The compositions were standardized to contain 50 g available carbohydrates. As a reference meal a serving packet without -glucans was included. The study was performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. Nineteen and thirteen healthy volunteers with normal body mass index were recruited for series 1 and 2, respectively. Results: Muesli with 3 g of -glucans, included in a mixed bread meal, gave no significant differences in glycaemic response compared to a reference meal without muesli and -glucans. In contrast, muesli with 4 g of -glucans significantly (P<0.05) lowered the glucose and insulin responses compared to the reference meal. Conclusions: Muesli enriched with 4 g of -glucans reduces postprandial glucose and insulin levels to a breakfast based on high glycaemic index products. A total of 4 g of beta-glucans from oats seems to be a critical level for a significant decrease in glucose and insulin responses in healthy people

Diet inequality prevails among consumers interested andknowledgeable in nutrition

BACKGROUND: Previous studies have demonstrated a correlation between diet cost and adherence to nutritional recommendations among consumers in general. This has adverse effects on diet and health inequality. It could be hypothesized that consumers knowledgeable in nutrition escape this correlation. OBJECTIVE: Investigate whether the previously observed relationship between diet cost and nutritional quality prevails among consumers with an above-average interest in and knowledge of nutrition. DESIGN: Full open diet registrations of 330 students taking a basic university-level course in nutrition over a total of 780 days. RESULTS: The consumers with the highest daily average diet cost differ from the lowest cost quartile: The diets had higher micronutrient density, more fruits and vegetables, and lower energy density. The highest cost daily diet quartile had a significantly higher energy adjusted intake of the micronutrients that were on average consumed below the recommendation (vitamin D, folate, and iron for women). On the other hand, alcohol intake was significantly higher among the high diet cost group. The highest diet cost respondents consumed more fish, meat, coffee, and spreads, whereas the lowest diet cost respondents had a higher consumption of cereals, bread, jam, sausage, and milk. CONCLUSIONS: Dietary differences prevail even in the above-average interested and knowledgeable group. The respondents did not use their higher level of knowledge to break this commonly observed relationship. This suggests that an increased minimum level of knowledge in nutrition may not by itself eliminate dietary inequality