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Advances in Nutrition (Bethesda, Md.) Feb 2022Consuming fat results in postprandial lipemia, which is defined as an increase in blood triglyceride (TG) concentration. According to current knowledge, an excessively...
Impact of Meal Fatty Acid Composition on Postprandial Lipemia in Metabolically Healthy Adults and Individuals with Cardiovascular Disease Risk Factors: A Systematic Review.
Consuming fat results in postprandial lipemia, which is defined as an increase in blood triglyceride (TG) concentration. According to current knowledge, an excessively elevated postprandial TG concentration increases the risk of cardiovascular disease (CVD). It is well known that meal-dependent (e.g., nutrient composition) as well as meal-independent factors (e.g., age) determine the magnitude of the lipemic response. However, there is conflicting evidence concerning the influence of fatty acid (FA) composition on postprandial TG concentration. The FA composition of a meal depends on the fat source used; for example, butter and coconut oil are rich in SFAs, while olive oil and canola oil have a high content of unsaturated FAs. To investigate the influence of meals prepared with fat sources rich in either SFAs or unsaturated FAs on postprandial lipemia, we carried out a systematic literature search in PubMed, Scopus, and the Cochrane Library. Randomized crossover studies were analyzed and the AUC of postprandial TG concentration served as the primary outcome measure. To examine the influence of health status, we differentiated between metabolically healthy individuals and those with CVD risk factors. In total, 23 studies were included. The results show that, in metabolically healthy adults, the FA composition of a meal is not a relevant determinant of postprandial lipemia. However, in individuals with CVD risk factors, SFA-rich meals (>32 g SFA/meal) often elicited a stronger lipemic response than meals rich in unsaturated FAs. The results suggest that adults with hypertriglyceridemia, an elevated BMI (≥30 kg/m2), and/or who are older (>40 y) may benefit from replacing SFA sources with unsaturated FAs. These hypotheses need to be verified by further studies in people with CVD risk factors using standardized postprandial protocols. This review was registered in PROSPERO as CRD42021214508 (https://www.crd.york.ac.uk/prospero/).
Topics: Adult; Cardiovascular Diseases; Dietary Fats; Fatty Acids; Humans; Hyperlipidemias; Meals; Postprandial Period; Triglycerides
PubMed: 34427586
DOI: 10.1093/advances/nmab096 -
Frontiers in Nutrition 2021Millets (including sorghum) are known to be highly nutritious besides having a low carbon footprint and the ability to survive in high temperatures with minimal water....
Millets (including sorghum) are known to be highly nutritious besides having a low carbon footprint and the ability to survive in high temperatures with minimal water. Millets are widely recognised as having a low Glycaemic Index (GI) helping to manage diabetes. This systematic review and meta-analyzes across the different types of millets and different forms of processing/cooking collated all evidences. Of the 65 studies that were collected globally, 39 studies with 111 observations were used to analyze GI outcomes and 56 studies were used to analyze fasting, post-prandial glucose level, insulin index and HbA1c outcomes in a meta-analysis. It is evident from the descriptive statistics that the mean GI of millets is 52.7 ± 10.3, which is about 36% lower than in typical staples of milled rice (71.7 ± 14.4) and refined wheat (74.2 ± 14.9). The descriptive, meta and regression analyses revealed that Job's tears, fonio, foxtail, barnyard, and teff were the millets with low mean GI (<55) that are more effective (35-79%) in reducing dietary GI than the control samples. Millets with intermediate GI (55-69) are pearl millet, finger millet, kodo millet, little millet, and sorghum which have a 13-35% lower GI than the control with high GI (>69). A meta-analysis also showed that all millets had significantly ( < 0.01) lower GI than white rice, refined wheat, standard glucose or white wheat bread except little millet which had inconsistent data. Long term millet consumption lowered fasting and post-prandial blood glucose levels significantly ( < 0.01) by 12 and 15%, respectively, in diabetic subjects. There was a significant reduction in HbA1c level (from 6.65 ± 0.4 to 5.67 ± 0.4%) among pre-diabetic individuals ( < 0.01) who consumed millets for a long period. Minimally processed millets were 30% more effective in lowering GI of a meal compared to milled rice and refined wheat. In conclusion, millets can be beneficial in managing and reducing the risk of developing diabetes and could therefore be used to design appropriate meals for diabetic and pre-diabetic subjects as well as for non-diabetic people for a preventive approach.
PubMed: 34395493
DOI: 10.3389/fnut.2021.687428 -
Korean Journal of Women Health Nursing Jun 2021This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM). (Review)
Review
PURPOSE
This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM).
METHODS
The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality.
RESULTS
Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels.
CONCLUSION
Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions.
PubMed: 36313133
DOI: 10.4069/kjwhn.2021.05.13 -
The American Journal of Clinical... Aug 2021Starchy foods can have a profound effect on metabolism. The structural properties of starchy foods can affect their digestibility and postprandial metabolic responses,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Starchy foods can have a profound effect on metabolism. The structural properties of starchy foods can affect their digestibility and postprandial metabolic responses, which in the long term may be associated with the risk of type 2 diabetes and obesity.
OBJECTIVES
This systematic review sought to evaluate the clinical evidence regarding the impact of the microstructures within starchy foods on postprandial glucose and insulin responses alongside appetite regulation.
METHODS
A systematic search was performed in the PUBMED, Ovid Medicine, EMBASE, and Google Scholar databases for data published up to 18 January 2021. Data were extracted by 3 independent reviewers from randomized crossover trials (RCTs) that investigated the effect of microstructural factors on postprandial glucose, insulin, appetite-regulating hormone responses, and subjective satiety scores in healthy participants.
RESULTS
We identified 745 potential articles, and 25 RCTs (n = 369 participants) met our inclusion criteria: 6 evaluated the amylose-to-amylopectin ratio, 6 evaluated the degree of starch gelatinization, 2 evaluated the degree of starch retrogradation, 1 studied starch-protein interactions, and 12 investigated cell and tissue structures. Meta-analyses showed that significant reductions in postprandial glucose and insulin levels was caused by starch with a high amylose content [standardized mean difference (SMD) = -0.64 mmol/L*min (95% CI: -0.83 to -0.46) and SMD = -0.81 pmol/L*min (95% CI: -1.07 to -0.55), respectively], less-gelatinized starch [SMD = -0.54 mmol/L*min (95% CI: -0.75 to -0.34) and SMD = -0.48 pmol/L*min (95% CI: -0.75 to -0.21), respectively], retrograded starch (for glucose incremental AUC; SMD = -0.46 pmol/L*min; 95% CI: -0.80 to -0.12), and intact and large particles [SMD = -0.43 mmol/L*min (95% CI: -0.58 to -0.28) and SMD = -0.63 pmol/L*min (95% CI: -0.86 to -0.40), respectively]. All analyses showed minor or moderate heterogeneity (I2 < 50%). Sufficient evidence was not found to suggest how these structural factors influence appetite.
CONCLUSIONS
The manipulation of microstructures in starchy food may be an effective way to improve postprandial glycemia and insulinemia in the healthy population. The protocol for this systematic review and meta-analysis was registered in the international prospective register of systematic reviews (PROSPERO) as CRD42020190873.
Topics: Blood Glucose; Dietary Carbohydrates; Food Analysis; Humans; Postprandial Period; Starch
PubMed: 34049391
DOI: 10.1093/ajcn/nqab098 -
Frontiers in Nutrition 2021Most milk consumed by humans undergoes heat treatment to ensure microbiological safety and extend shelf life. Although heat treatment impacts the structure and...
Most milk consumed by humans undergoes heat treatment to ensure microbiological safety and extend shelf life. Although heat treatment impacts the structure and physiochemical properties of milk, effects on nutrient absorption in humans are unclear. Therefore, a rapid review was performed to identify studies conducted on healthy human adult subjects that have assessed the impacts of heat treatment of milk on protein and fat digestion and metabolism in the postprandial period (up to 24 h). Relevant databases (Medline, EMBASE, Cochrane, Scopus) were systematically screened for intervention studies on healthy adult men and women that assessed the impact of consuming heat-treated milk on the postprandial kinetics or appearance in peripheral circulation or urine of ingested proteins and/or lipids. The risk-of-bias assessment tool 2 was used for quality assessment. Of 511 unique database records, 4 studies were included encompassing 6 study treatments ( = 57 participants, 20-68 years). Three studies evaluated pasteurization, two evaluated ultra-high temperature (UHT) treatment, and one evaluated oven-heated milk. Protein and lipid appearances in peripheral blood were reported in two sets of two studies. None of the studies used the same heat treatments and outcome measures, limiting generalization of effects. Protein appearance (ng/mL or area under the curve) (as plasma amino acids - lysine) was reduced when milk was oven-heated for 5 h in one study ( = 7 participants), while the other study reported a reduced retention of dietary N with UHT milk ( = 25 participants). Overall plasma triacylglycerol responses were unaffected by milk heat treatments reported, but plasma fatty acid composition differed. The studies observed higher plasma myristic and palmitic acid abundance with successive heat treatment at 2 h ( = 11 participants; pasteurized) and 4 h ( = 14 participants; UHT) after ingestion; other differences were inconsistent. All studies had moderate-high risk of bias, which should be taken into consideration when interpreting findings. This review identified few studies reporting the effects of milk heat treatment on postprandial nutrient responses in adults. Although the findings suggest that milk heat treatment likely affects postprandial protein and lipid dynamics, generalization of the findings is limited as treatments, outcomes, and methods differed across studies. Because of the study variability, and the acute post-prandial nature of the studies, it is also difficult to draw conclusions regarding potential long-term health outcomes. However, the possibility that altered digestive kinetics may influence postprandial protein retention and anabolic use of dietary N suggests heat treatment of milk may impact outcomes such as long-term maintenance of muscle mass.
PubMed: 33996872
DOI: 10.3389/fnut.2021.643350 -
Nutrition & Diabetes Mar 2021Despite considerable literature supporting the potential health benefits of reducing postprandial glucose (PPG), and insulin (PPI) exposures, the size of a clinically... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Despite considerable literature supporting the potential health benefits of reducing postprandial glucose (PPG), and insulin (PPI) exposures, the size of a clinically relevant reduction is currently unknown. We performed a systematic review and meta-analysis to quantify effects of alpha-glucosidase-inhibiting (AGI) drugs on acute PPG and PPI responses.
METHODS
We searched EMBASE and MEDLINE until March 13, 2018 for controlled studies using AGI drugs together with a standardized carbohydrate load or mixed meal. The mean incremental PPG and PPI levels were calculated as outcomes. Meta-analyses, stratified by diabetes state, were performed by using random effects models.
RESULTS
The 66 included publications comprised 127 drug-control comparisons for PPG, and 106 for PPI, mostly testing acarbose or miglitol. The absolute effects on PPG were larger among individuals with diabetes (-1.5 mmol/l mean PPG [95% CI -1.9, -1.1] by acarbose, and -1.6 [-1.9, -1.4] by miglitol) as compared to individuals without diabetes (-0.4 [95% CI -0.5, -0.3] by acarbose, and -0.6 [-0.8, -0.4] by miglitol). Relative reductions in PPG by both drugs were similar for diabetic and non-diabetic individuals (43-54%). Acarbose and miglitol also significantly reduced mean PPI, with absolute and relative reductions being largest among individuals without diabetes.
CONCLUSIONS
The present meta-analyses provide quantitative estimates of reductions of PPG and PPI responses by AGI drugs in diabetes and non-diabetic individuals. These data can serve as benchmarks for clinically relevant reductions in PPG and PPI via drug or diet and lifestyle interventions.
Topics: 1-Deoxynojirimycin; Acarbose; Diabetes Mellitus; Glucose; Glycoside Hydrolase Inhibitors; Humans; Inositol; Insulin; Postprandial Period
PubMed: 33658478
DOI: 10.1038/s41387-021-00152-5 -
European Journal of Clinical Nutrition Nov 2021To determine the effect of oat β‑glucan (OBG) on acute glucose and insulin responses and identify significant effect modifiers we searched the MEDLINE, EMBASE, and... (Meta-Analysis)
Meta-Analysis Review
To determine the effect of oat β‑glucan (OBG) on acute glucose and insulin responses and identify significant effect modifiers we searched the MEDLINE, EMBASE, and Cochrane databases through October 27, 2020 for acute, crossover, controlled feeding trials investigating the effect of adding OBG (concentrate or oat-bran) to carbohydrate-containing test-meals compared to comparable or different carbohydrate-matched control-meals in humans regardless of health status. The primary outcome was glucose incremental area-under-the-curve (iAUC). Secondary outcomes were insulin iAUC, and glucose and insulin incremental peak-rise (iPeak). Two reviewers extracted the data and assessed risk-of-bias and certainty-of-evidence (GRADE). Data were pooled using generic inverse-variance with random-effects model and expressed as ratio-of-means with [95% CIs]. We included 103 trial comparisons (N = 538). OBG reduced glucose iAUC and iPeak by 23% (0.77 [0.74, 0.81]) and 28% (0.72 [0.64, 0.76]) and insulin by 22% (0.78 [0.72, 0.85]) and 24% (0.76 [0.65, 0.88]), respectively. Dose, molecular-weight, and comparator were significant effect modifiers of glucose iAUC and iPeak. Significant linear dose-response relationships were observed for all outcomes. OBG molecular-weight >300 kg/mol significantly reduced glucose iAUC and iPeak, whereas molecular-weight <300 kg/mol did not. Reductions in glucose iAUC (27 vs 20%, p = 0.03) and iPeak (39 vs 25%, p < 0.01) were significantly larger with different vs comparable control-meals. Outcomes were similar in participants with and without diabetes. All outcomes had high certainty-of-evidence. In conclusion, current evidence indicates that adding OBG to carbohydrate-containing meals reduces glycaemic and insulinaemic responses. However, the magnitude of glucose reduction depends on OBG dose, molecular-weight, and the comparator.
Topics: Blood Glucose; Cross-Over Studies; Humans; Insulin; Postprandial Period; beta-Glucans
PubMed: 33608654
DOI: 10.1038/s41430-021-00875-9 -
Nutricion Hospitalaria Feb 2021Introduction: research shows the potential effect of vitamin D supplementation with an improvement in the glycemic profile of pre-diabetic patients. Objective: this...
Introduction: research shows the potential effect of vitamin D supplementation with an improvement in the glycemic profile of pre-diabetic patients. Objective: this study evaluates the effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals. Methods: we analyzed studies published over the last ten years, and indexed in the Science Direct, PubMed, and LILACS databases. We searched studies using health descriptors related to vitamin D, pre-diabetes, and glycemic control markers. We considered randomized controlled trials eligible for inclusion. All phases of selection, data extraction, and risk of bias assessment were carried out by two independent evaluators. Results: we identified 309 articles, of which 4 met the inclusion criteria. Of these, 3 studies have shown that vitamin D supplementation does not alter glycemic control markers in pre-diabetic individuals. Only one study showed a positive effect after supplementation with 60,000 IU/month of vitamin D3 for 12 months, with a significant reduction in the concentrations of glycated hemoglobin, fasting glucose, and two-hour postprandial glucose. Conclusion: there is insufficient scientific evidence to confirm the beneficial effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals.
Topics: Bias; Biomarkers; Blood Glucose; Dietary Supplements; Fasting; Glycated Hemoglobin; Glycemic Control; Humans; Postprandial Period; Prediabetic State; Randomized Controlled Trials as Topic; Vitamin D; Vitamins
PubMed: 33319569
DOI: 10.20960/nh.03309 -
The Journal of Nutrition Feb 2021Oats are a whole grain cereal with potentially favorable effects on the postprandial glycemic response; however, the effects of oat processing on these glycemic benefits... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oats are a whole grain cereal with potentially favorable effects on the postprandial glycemic response; however, the effects of oat processing on these glycemic benefits are not well understood.
OBJECTIVES
The study objective was to determine the effects of differently processed oats on the postprandial blood glucose and insulin responses relative to refined grains.
METHODS
Eleven electronic databases were systematically searched to identify studies published up to and including May 2019. Randomized controlled trials comparing the postprandial blood glucose and insulin responses to oats compared with any refined grain were included, so long as the available carbohydrate content of the test meals was similar. Pooled effect sizes were computed using the difference in incremental area under the curves for blood glucose and insulin following the consumption of oats compared with the refined grain control.
RESULTS
Ten publications were included, with intact oat kernels studied in 3 comparisons, thick oat flakes (>0.6 mm) in 7 comparisons, and thin/quick/instant oat flakes (≤0.6 mm) in 6 comparisons. Compared with the consumption of the refined grain control, the consumption of intact oat kernels was associated with significant reductions in postprandial blood glucose (-45.5 mmol x min/L; 95% CI: -80.1, -10.9 mmol x min/L; P = 0.010) and insulin (-4.5 nmol x min/L; 95% CI: -7.1, -1.8 nmol x min/L; P = 0.001) responses; the consumption of thick oat flakes was associated with significant reductions in postprandial blood glucose (-30.6 mmol x min/L; 95% CI: -40.4, -20.9 mmol x min/L; P < 0.001) and insulin (-3.9 nmol x min/L; 95% CI: -5.3, -2.5 nmol x min/L; P < 0.001) responses; but, the consumption of thin/quick/instant oat flakes was not associated with any effects on the postprandial blood glucose and insulin responses.
CONCLUSIONS
A disruption in the structural integrity of the oat kernel is likely associated with a loss in the glycemic benefits of oats.
Topics: Avena; Blood Glucose; Diet; Food Handling; Humans; Insulin; Postprandial Period
PubMed: 33296453
DOI: 10.1093/jn/nxaa349 -
Nutrients Nov 2020Liver lipid accumulation is a hallmark of non-alcoholic fatty liver disease (NAFLD), broadly associated with insulin resistance. Inositols (INS) are ubiquitous polyols...
Liver lipid accumulation is a hallmark of non-alcoholic fatty liver disease (NAFLD), broadly associated with insulin resistance. Inositols (INS) are ubiquitous polyols implied in many physiological functions. They are produced endogenously, are present in many foods and in dietary supplements. Alterations in INS metabolism seems to play a role in diseases involving insulin resistance such as diabetes and polycystic ovary syndrome. Given its role in other metabolic syndromes, the hypothesis of an INS role as a supplement in NAFLD is intriguing. We performed a systematic review of the literature to find preclinical and clinical evidence of INS supplementation efficacy in NAFLD patients. We retrieved 10 studies on animal models assessing Myoinosiol or Pinitol deficiency or supplementation and one human randomized controlled trial (RCT). Overall, INS deficiency was associated with increased fatty liver in animals. Conversely, INS supplementation in animal models of fatty liver reduced hepatic triglycerides and cholesterol accumulation and maintained a normal ultrastructural liver histopathology. In the one included RCT, Pinitol supplementation obtained similar results. Pinitol significantly reduced liver fat, post-prandial triglycerides, AST levels, lipid peroxidation increasing glutathione peroxidase activity. These results, despite being limited, indicate the need for further evaluation of INS in NAFLD in larger clinical trials.
Topics: Animals; Cholesterol; Dietary Supplements; Female; Glutathione Peroxidase; Humans; Inositol; Insulin Resistance; Lipid Peroxidation; Liver; Male; Non-alcoholic Fatty Liver Disease; Postprandial Period; Randomized Controlled Trials as Topic; Treatment Outcome; Triglycerides
PubMed: 33153126
DOI: 10.3390/nu12113379