Simple messages to improve dietary quality: A pilot investigation

Public health recommendations for a healthy diet often involve complex messages, requiring in-depth knowledge for understanding and compliance. The present study compared the feasibility and initial efficacy of two simple messages (a high fiber diet or a low saturated fat diet) to a combination message (high fiber and low saturated fat) on the potential to impact dietary quality and metabolic health. Conclusions: A simple dietary message appears to improve overall dietary quality and aid in weight management. Simple messages are a novel approach which could make a significant impact on the prevention and treatment of chronic disease as well as weight management. Results support the need for a larger randomized controlled trial that is powered to examine the efficacy of a simplified dietary recommendation for dietary quality and metabolic health. It would be worth exploring the impact of simple messages in a larger trial to determine their usefulness as simple public health messages as an alternative the current complex recommendations

Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial

BACKGROUND: Dietary guidelines suggest limiting daily sodium intake to METHODS: Two hundred forty participants with metabolic syndrome enrolled in a dietary intervention trial to lose weight and improve dietary quality. Three 24-hour dietary recalls were collected at each visit which provided meal patterns and nutrient data, including sodium intake. A secondary data analysis was conducted to examine sodium consumption patterns at baseline and at one-year study visits. Sodium consumption patterns over time were examined using linear mixed models. RESULTS: The percentage of meals reported eaten in the home at both baseline and one-year follow-up was approximately 69%. Follow-up for the one-year dietary intervention revealed that the participants who consumed sodium greater than 2,300 mg/d declined from 75% (at baseline) to 59%, and those that consumed higher than 1,500 mg/d declined from 96% (at baseline) to 85%. Average sodium intake decreased from 2,994 mg at baseline to 2,558 mg at one-year (P \u3c 0.001), and the sodium potassium ratio also decreased from 1.211 to 1.047 (P \u3c 0.001). Sodium intake per meal varied significantly by meal type, location, and weekday, with higher intake at dinner, in restaurants, and on weekends. At-home lunch and dinner sodium intake decreased (P \u3c 0.05), while dinner sodium intake at restaurant/fast food chains increased from baseline to one-year (P \u3c 0.05). CONCLUSION: Sodium intake for the majority of participants exceeded the recommended dietary guidelines. Findings support actions that encourage low-sodium food preparation at home and encourage public health policies that decrease sodium in restaurants and prepared foods

Fine-Scale Mapping of the 4q24 Locus Identifies Two Independent Loci Associated with Breast Cancer Risk

Background: A recent association study identified a common variant (rs9790517) at 4q24 to be associated with breast cancer risk. Independent association signals and potential functional variants in this locus have not been explored. Methods: We conducted a fine-mapping analysis in 55,540 breast cancer cases and 51,168 controls from the Breast Cancer Association Consortium. Results: Conditional analyses identified two independent association signals among women of European ancestry, represented by rs9790517 [conditional P = 2.51 × 10−4; OR, 1.04; 95% confidence interval (CI), 1.02–1.07] and rs77928427 (P = 1.86 × 10−4; OR, 1.04; 95% CI, 1.02–1.07). Functional annotation using data from the Encyclopedia of DNA Elements (ENCODE) project revealed two putative functional variants, rs62331150 and rs73838678 in linkage disequilibrium (LD) with rs9790517 (r2 ≥ 0.90) residing in the active promoter or enhancer, respectively, of the nearest gene, TET2. Both variants are located in DNase I hypersensitivity and transcription factor–binding sites. Using data from both The Cancer Genome Atlas (TCGA) and Molecular Taxonomy of Breast Cancer International Consortium (METABRIC), we showed that rs62331150 was associated with level of expression of TET2 in breast normal and tumor tissue. Conclusion: Our study identified two independent association signals at 4q24 in relation to breast cancer risk and suggested that observed association in this locus may be mediated through the regulation of TET2. Impact: Fine-mapping study with large sample size warranted for identification of independent loci for breast cancer risk

A simple dietary message to improve dietary quality: Results from a pilot investigation

OBJECTIVE: The present study compared the feasibility of two simple messages (a high-fiber diet or a low saturated fat diet) to a combination message (high fiber/low saturated fat) on their potential to affect dietary quality and metabolic health. METHODS: Thirty-six subjects were randomized to one of three intervention conditions and received individual dietary counseling sessions. Study assessments occurred at baseline, 3 mo, and 6 mo. RESULTS: The sample was 84% female and 94% Caucasian. Mean body mass index was 31kg/m(2). At the 6-mo assessment phase, we retained all 12 patients in the high-fiber diet condition, 10 of 12 in the low saturated fat condition, and 9 of 12 in the combination condition. Participants reported that the dietary fiber intervention was easier to maintain compared with the other two intervention conditions (83% for high dietary fiber versus 60% for low saturated fat versus 33% for the combination, P=0.008). Overall dietary quality improved in all three conditions during the study (P=0.01). In addition to increasing fiber, the high-fiber condition decreased their saturated fat intake, even though a reduction in saturated fat was not a part of that intervention condition. Participants in all three conditions lost an average of 9 lb from baseline weight (P\u3c0.001). CONCLUSION: A simple dietary message is feasible and can improve overall dietary quality. Results support the need for a larger randomized controlled trial that is powered to detect the efficacy of a simplified dietary recommendation for dietary quality and metabolic health

Statin therapy and the risk for diabetes among adult women: do the benefits outweigh the risk

Purpose of review: The purpose of this review was to examine statin therapy and the risk for diabetes among adult women using a selective review. Recent findings: The literature contains reports of new-onset diabetes associated with statin use. While many studies do not report sex-specific results, there is evidence indicating the risk to benefit ratio may vary by gender. However, the absolute effects are not clear because women have historically been under-represented in clinical trials. Summary: A review of the literature indicates that the cardiovascular benefits of statins appear to outweigh the risk for statin-related diabetes. However, the effect may depend upon baseline diabetes risk, dose, and statin potency. Rigorous, long-term studies focused on the risks and benefits of statins in women are unavailable to sort for gender-specific differences. Until this changes, individualized attention to risk assessment, and strong prevention with lifestyle changes must prevail

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus

OBJECTIVE: This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM). METHODS: Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin \u3e7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA. RESULTS: The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m(2) (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20-35% from fat (\u3c7% saturated), and 20% from protein. CONCLUSION: These patients reported a low-carbohydrate, low-fiber, high-fat (especially saturated) diet, although they stated they are not following any of the popular low-carbohydrate diets. Patients with T2DM may find the current trend toward reducing weight through low-carbohydrate diets attractive for control of blood glucose, despite ADA recommendations. This dietary pattern may represent a popular trend that extends beyond our particular study and, if so, has serious cardiovascular implications in this vulnerable population of T2DM patients

A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes

OBJECTIVE: We compared the effects of a low glycemic index (GI) diet with the American Diabetes Association (ADA) diet on glycosylated hemoglobin (HbA1c) among individuals with type 2 diabetes. METHODS: Forty individuals with poorly controlled type 2 diabetes were randomized to a low-GI or an ADA diet. The intervention, consisting of eight educational sessions (monthly for the first 6 mo and then at months 8 and 10), focused on a low-GI or an ADA diet. Data on demographics, diet, physical activity, psychosocial factors, and diabetes medication use were assessed at baseline and 6 and 12 mo. Generalized linear mixed models were used to compare the two groups on HbA1c, diabetic medication use, blood lipids, weight, diet, and physical activity. RESULTS: Participants (53% female, mean age 53.5 y) were predominantly white with a mean body mass index of 35.8 kg/m(2). Although both interventions achieved similar reductions in mean HbA1c at 6 mo and 12 mo, the low-GI diet group was less likely to add or increase dosage of diabetic medications (odds ratio 0.26, P = 0.01). Improvements in high-density lipoprotein cholesterol, triacylglycerols, and weight loss were similar between groups. CONCLUSION: Compared with the ADA diet, the low-GI diet achieved equivalent control of HbA1c using less diabetic medication. Despite its limited size, this trial suggests that a low-GI diet is a viable alternative to the ADA diet. Findings should be evaluated in a larger randomized controlled trial

Depressive symptoms, Antidepressant Use and Diabetes in a Large Multiethnic National Sample of Postmenopausal Women

OBJECTIVE:To examine elevated depressive symptoms and antidepressant use in relation to diabetes incidence in the Women\u27s Health Initiative. RESEARCH DESIGN AND METHODS: A total of 161,808 postmenopausal women were followed for over an average of 7.6 years. Hazard ratios (HRs) estimating the effects of elevated depressive symptoms and antidepressant use on newly diagnosed incident diabetes were obtained using Cox proportional hazards models adjusted for known diabetes risk factors. RESULTS: Multivariable-adjusted HRs indicated an increased risk of incident diabetes with elevated baseline depressive symptoms (HR 1.13 [95% CI 1.07-1.20]) and antidepressant use (1.18 [1.10-1.28]). These associations persisted through year 3 data, in which respective adjusted HRs were 1.23 (1.09-1.39) and 1.31 (1.14-1.50). CONCLUSIONS: Postmenopausal women with elevated depressive symptoms who also use antidepressants have a greater risk of developing incident diabetes. In addition, longstanding elevated depressive symptoms and recent antidepressant medication use increase the risk of incident diabetes