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Science, Technology and Medicine open access publisher.Publish, read and share novel research. 1) found a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe.
1) reported a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe.
3) a significant increase in energy adjusted total and LDL-cholesterol levels was associated with higher intakes of total fat, saturated fat and cholesterol. Table 4 summarizes the nutritional recommendations as well as the lifestyle recommendations for type 1 and type 2 diabetic patients. Diabetes occurs at the micro level as the body is unable to produce insulin that is required to sustain homeostasis (i.e.
As you are eating more and more, the cells and their receptors start sending signals to the rest of the body.
As the stress on the individual cells start to accumulate more and more, it will lead to severe diabetes in the individual.
As weight is shed, the body is able to get rid of the resistin that has developed and make sure everything returns back to normal. Diabetes requires the sugar inside to be circulated in a manner that is healthy for the body in the short and long-term. When the body starts to shut off at the cellular level, the sugar will begin to remain inside the bloodstream. To refresh the body and make sure the insulin is going where it is supposed to, the patient has to lose weight as soon as possible and start heading in the right direction. This is a protein that is released into the body that can become the catalyst for the individual becoming a diabetic. The more the insulin is resisted, the pancreas will try to overcompensate and produce more. To get help with your weight loss and get your Diabetes or obesity under control, contact the #1 weight loss doctor in Boca Raton, Dr, Sasson Moulavi today at 877-701-7277.
The body is simply not able to cope with all of the weight that is being accumulated on your frame.
The joints are not able to hold up the weight for long periods and this can weaken them to a point where you are not able to walk. The immune system is also taxed because it is not able to get to all parts of the body and rectify the problems that are occurring.
The human body requires a certain level of activity on a regular basis in order to remain healthy and fit. The body will start to feel more and more fatigued in a shorter span of time despite doing nothing. Make sure you are focused on losing weight to ensure you are able to sleep as required on a daily basis. For those who are overweight, this problem becomes a graver reality as their body needs extra rest to recuperate from handling the excess weight.
The importance of eating small meals for weight loss is still a subject that isn’t well understood by the majority of people. The rate at which your body burns calories depends on your body’s metabolism and this is the reason why metabolism is important in weight loss. Small meals that are taken at frequent intervals are good because people tend not to repeat the same kind of meal. The importance of eating small meals in weight loss is well rounded and is the perfect weight loss and dietary solution that you have been looking for for a long time. You might think that tangerines are just a great treat but new research shows that they also have potent health effects for your heart. According to the researchers, nobiletin was shown to prevent the buildup of fat in the liver by stimulating the expression of genes involved in burning excess fat, and inhibiting the genes responsible for manufacturing fat.
Tangerines, also known as mandarin oranges, have unique health properties which distinguish them from other oranges or citrus fruit.
Nooyi is clearly a leader who understands the huge potential for corporate good, both for the bottom line and for society. PepsiCo’s removal of artificial coloring and their reduction of sodium seems encouraging, considering the company’s vast market share. Reading through the article, it seemed to me that many of the changes are token gestures, not meaningful improvements in the nutritional quality of PepsiCo’s products. Perhaps my conclusion is too easy, a knee-jerk reaction from someone who spends her days thinking and writing about healthy food.
Seabrook reports that one of the new substances that PepsiCo will soon be using in its U.S.
Forbes also suggested a number of ways that snack foods could be made with ingredients that would better serve the body. Everyone I spoke with agreed that consumers need to read the ingredients list on packaged foods before purchasing them, despite any claims made on the front of the package. Consumption of at least 1 sugary drinks per day is significantly associated with the development of diabetes, according to a report by Vasanti S. Sugar-sweetened beverages were defined as soft drinks, fruit drinks, sports drinks, energy and vitamin water, sweetened iced tea, punch, cordials, squashes and lemonade.  Not included were 100% fruit juices without added sweeteners. One single extra sugary drink has about 200 calories.  That is equivalent to a 20 pound weight gain per year. This study further supports my reasons to stay away from sugar-sweetened beverages and switch to healthy alternatives, such as water. Look for products low in sugar, high fructose corn syrup, refined grains and partially hydrogenated oils.  Choose a 100 percent whole-wheat cracker made with canola oil, for example or snack on a cheeses and fruit plate instead of a bowl of cheese puffs. Limit TV viewing when the grandkids visit.  Certain shows seem to attract more junk food commercials than others, so you might want to discourage your grandkids from watching these shows.  Get them involved in outdoor activities! How do I remove a giant comedonal cyst (2x2 cm) from the interscapular area and leave minimal scarring in a keloid-forming patient?
The Canadian Diabetes Association (CDA) guidelines recommend universal screening of all women between 24-28 weeks of gestational age. The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study has shown that even mild hyperglycemia in pregnancy is associated with outcomes such as birth weight greater than the 90th percentile, increased rate of caesarean section and high cord plasma C-peptide levels which reflect fetal hyperinsulinemia.3 Adverse maternal and fetal outcomes associated with GDM are outlined in Table 2. Women with GDM should perform self-monitoring of blood glucose, but the glycemic targets to aim for in pregnancy differ from those sought in the non-pregnant female (Table 4).1 Lifestyle modification and dietary changes with the assistance of a registered dietician are the first steps of treatment. Pharmacologic therapies are initiated if a two-week trial of lifestyle modification fails to hit glycemic targets, or if there’s significant fasting hyperglycemia or a very high HbA1c. In another randomized trial, women between 24 and 31 weeks gestational age who had mild GDM were assigned to an intervention group that included glucose monitoring, dietary advice and insulin therapy and compared to a control group with routine care. Oral hypoglycemic agents such as glyburide and metformin are considered second-line agents of treatment for women with GDM who are non-adherent to insulin therapy or refuse insulin. In a landmark trial, 404 women with GDM at 11 to 33 weeks gestation were randomized to treatment with glyburide or insulin. In an open-label trial, women with GDM at 20 to 33 weeks gestation were assigned to treatment with metformin or insulin. There are no specific guidelines on the frequency of ante-natal visits, but women with GDM are generally seen at least every 1 to 2 weeks. Women with GDM have a 17-63% risk of developing Type 2 DM within 5 to 16 years after the pregnancy.11 Post-partum follow-up with a 75 g OGTT between 6 weeks and 6 months is recommended. Hypothyroidism is a common and potentially serious endocrine disorder in the general population.
The physiological effects of hypothyroidism are widespread and include cardiovascular, renal, gastrointestinal, neurological, and endocrine abnormalities. Mean fiber intake in 1102 individuals with type 1 diabetes across Europa (Toeller M, Soedamah-Muthu 2011). One study (Riley MD& Dwyer T 1998) found no significant association between energy adjusted monounsaturated fat intake or energy adjusted polyunsaturated fat intake and microalbuminuria, but reported a positive association between usual dietary saturated fat intake and microalbuminuria.
They also found more frequent acute and chronic complications (including nephropathy) in Eastern Europe people. They also found more frequent acute and chronic complications (including retinopathy) in Eastern European people.
Higher fiber intake had a protective significant effect against CVD in type 1 diabetic women but not in men.
This was associated with a higher prevalence of CVD, although after adjusting for dietary fiber intake, these associations were attenuated. They also found more frequent acute and chronic complications (including CVD) in Eastern European people. These recommendations are for all diabetic patients in general, based in the majority of cases on evidence from type 2 diabetic patients.
There are some people who believe diabetes and obesity are not interlinked, but research studies have shown these two to have a deeper connection.
The chances of recovering for diabetes tends to falter because the individual cells are being routinely stressed. There are limits in place that make sure the body does not overdo things which causes imbalance internally. This is to help the body save energy and focus on handling the excess weight that is present.
Not only will this lead to diabetes, it will lead to a sustained growth in weight which worsens the issue.
Being overweight can lead to a number of issues as the body is taxed to hold the excess weight in place.
You start to crave more and more food because of this added weight and that leads to worsened eating habits.
If you are continually eating poorly, this can become one of the major reasons for your excess weight becoming problematic in terms of health related issues. Energy related issues transpire because of the excess weight and this directly leads to diseases forming. If you are overweight, you will often have trouble sleeping and this does not always have to do with insomnia. The average human requires eight hours of sleep every day and those who are not hitting these requirements will get ill over time. Dieters have, for a long time, come up with different ways of using diets in a way that can help reduce weight loss.
The variety will ensure that you obtain the necessary nutrients for a good body functioning.
Researchers from The University of Western Ontario have discovered that a substance in tangerines not only helps to prevent obesity, but also protects against type 2 diabetes, and even atherosclerosis, the underlying cause of most heart attacks and strokes. One group of the mice became obese and showed all the signs associated with metabolic syndrome: elevated cholesterol and triglycerides, high blood levels of insulin and glucose, and a fatty liver.
She also sees that the health crisis created by obesity does not bode well for the future of PepsiCo’s profits, no doubt a factor in the company’s efforts to make healthier products.
But Seabrook’s article shows that PepsiCo’s plans to make “better for you” snacks and beverages revolve around new technology, huge research facilities and the development of new additives.
There are certainly plenty of nutrition experts who argue that we shouldn’t eat pre-packaged, processed foods at all, from those espousing the Paleo diet to those who favor the raw diet. Moulavi is a particularly interesting person to talk about the nutrition of processed foods with, because his company has created a weight-loss program that’s centered around prepackaged, portion-controlled cookies, bars and shakes.
Malik, ScD and his colleagues with the Harvard School of Public Heath, as reported in Diabetes Care.
Malik notes that although consumption of sugar-sweetened drinks has been associated with weight gain, their role in the development of diabetes has not been reviewed.  According to Dr. In pregnancy, insulin resistance occurs due to placental secretion of growth hormone, cortisol, human placental lactogen, and progesterone. Hypocaloric diets aren’t recommended as they can cause ketosis and lack adequate nutrients. Insulin lacks significant transplacental passage and is the standard of care for treatment of GDM. In a randomized trial, women between 24 and 34 weeks’ gestation who had GDM were assigned to receive dietary advice, blood glucose monitoring, and insulin therapy (intervention group) or routine care, which resembled clinical care without the knowledge of GDM diagnosis.
Physicians should discuss with their patients that the use of oral agents in pregnancy is off-label and long-term safety data are limited. Metformin alone or with supplemental insulin wasn’t associated with adverse outcomes such as respiratory distress, need for phototherapy or birth trauma.
Some studies have shown that offspring of mothers with GDM are at an increased risk of obesity and abnormal glucose tolerance but the importance of tight glycemic control to prevent these long-term outcomes isn’t established.1 Women with previous GDM should plan future pregnancies in consultation with their family physician or an endocrinologist to attain good glycemic control at conception and throughout pregnancy. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
Prebtani, MD, FRCPC, is Associate Professor of Medicine and Program Director of the Endocrinology & Metabolism Residency Training Program at McMaster University in Hamilton, ON.
In type 1 diabetic men it leads to positive changes of the serum cholesterol pattern (higher HDL, lower LDL, lower ratio total cholesterol:HDL cholesterol).
The recommended intake is <10% of the total energy intake which was only achieved by a small minority (14%) (Toeller M et al. Hypercholesterolemia is one form of hyperlipidemia. Familial hypercholesterolemia is the most common inherited type of hyperlipidemia (high fat or lipid levels in blood). A familial disorder that is characterized by an extremely high concentration of cholesterol in the blood and cells.Hypercholesterolemia - Genetics Home ReferenceHypercholesterolemia is a condition characterized by very high levels of cholesterol in the blood.
When the insulin is not being made on a consistent basis, the body will start to become frail and weaken. They will simply not read the emergence of new insulin that is coming in and that causes issues and results in diabetes. There are many people who believe losing weight is not important unless you want to look like a movie star. The joints tend to face the brunt of the woes that are presented because of weight related problems.
You will simply have physical issues such as breathing problems that keep you from sleeping properly. There are many people who do not focus on their weight and end up complaining when they are hit with a series of diseases and related health problems.


The frequency of eating, the type of food to be eaten, and the amounts of food to be taken in at a particular time, if all well-balanced can complete a successful weight loss program.
This is actually true if you take large meals at a time, but not when you take small healthy meals.
Some categories of food tend to have more calories than other categories and when taken in large chunks as in the case of taking two or three meals a day, they result in extra calories that would have otherwise not been there.
According to the research published in the journal Diabetes, the secret ingredient is a flavonoid known as nobiletin.
These metabolic abnormalities greatly increase the risk of cardiovascular disease and type 2 diabetes. Earlier this year, the company began making a number of Frito-Lay products with natural ingredients.
Although the company is moving towards using “all natural” products, these products will still be highly processed. Malik and the researchers, the high content of rapidly absorbable carbohydrates in sugar-sweetened drinks may increase risk of diabetes not only through obesity, but also by increasing glycemic load, leading to insulin resistance and inflammation. The patient is given a 50g oral glucose load at any of time of day and plasma glucose (PG) is measured 1 hour later. Gentle exercise such as walking is beneficial, although obstetrical concerns may limit physical activity.
In the intervention group, the composite end point of serious perinatal complications (death, shoulder dystocia, bone fracture or nerve injury) was significantly lower. There was no difference in the primary outcome, which was a composite of stillbirth or perinatal death and neonatal complications such as hyperbilirubinemia, hypoglycemia, hyperinsulinemia and birth trauma.
The group receiving metformin had less neonatal hypoglycemia but more spontaneous pre-term delivery. 1988) found a significant positive association between total fat intake and microalbuminuria. No association between energy adjusted MUFA and energy adjusted PUFA and microalbuminuria was found. The results of the post hoc analyses should be interpreted carefully, since it is a retrospective analysis which can generate hypotheses but not prove them.
CarbohydratesThe ‘Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes’ (DNSG EASD) guidelines for persons with type 1 and type 2 diabetes (Table 4) recommend that the most appropriate intake of carbohydrates consists of vegetables, legumes, fruits, wholegrain foods and naturally occurring foods rich in fiber. Recommendation was only achieved in 0.4% of the type 1 diabetic population (Toeller M et al.
Alcohol has favourable effects on HDL-cholesterol, inflammation and inhibition of platelet aggregation (Beulens et al. It predisposes to premature arteriosclerosis including coronary artery disease with heart attacks at an unusually young age. The chances of acquiring diseases that can be fatal increase the longer your body is not able to handle the excess weight. Small meals taken to frequently ensure that you do not go hungry as well as prevent you from overeating. Insulin hormone helps in increasing the levels of metabolism, which makes the body active as well. When you take small meals, the probability is that you will take more vitamins and minerals that do not contribute to weight gain.
They also have plans to reduce the amount of sodium and sugar in their products by 25 percent by the year 2015, under guidelines created by Derek Yach, the former World Health Organization cabinet director.
It’s also worth noting that because the term “all natural” is in no way regulated, it is one of the most common and abused packaging gimmicks. He cites ingredients such as flax seed, fish oil, blue green algae and pomegranate extract, which can all help the body perform essential functions. Fast-acting prandial insulin analogues such as Lispro and Aspart, regular insulin, and longer-acting insulins such as Neutral Protamine Hagedorn (NPH) are safe in pregnancy. Toeller2[1] Division of Human Nutrition, Wageningen University, Wageningen, Netherlands[2] Department of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University Duesseldorf, Germany1.
2009) found an increased risk of CVD in type 1 diabetic patients eating high amounts of fat and saturated fat. Data from the EURODIAB Prospective Complication Study on saturated fatty acid intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 2. Excess weight has the ability to cause numerous short and long-term health problems that could be avoided by losing weight. Contact us at the premier weight management center in Boca Raton, or one of our many other locations around North America and we look forward to helping you reach your goal weight. Apart from aiding weight loss, eating small meals has been shown to control blood sugar levels as well as ensuring proper nutrition. It is recommended to take five to six small meals in a day and not to exceed four hours without taking something. Those mice experienced no elevation in their levels of cholesterol, triglycerides, insulin or glucose, and gained weight normally. IntroductionDiabetes mellitus is with 220.000 deaths per year the eighth leading cause of death in high income countries (World Health Organization (WHO) 2008). They found that excess fat intake may contribute to hyperfiltration in type 1 diabetic patients. AlcoholIn cross-sectional analyses of the EURODIAB Prospective Complications Study (Beulens et al. Carbohydrates were negatively correlated with CHD risk factors (higher total cholesterol, LDL cholesterol, obesity, poorer glycaemic control).
Cross-sectional data of the EURODIAB Complications Study showed an inverse association between fiber and LDL cholesterol and a positive association between fiber and HDL cholesterol.
Data from the EURODIAB Prospective Complication Study on fiber intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 1. The even lower saturated fatty acid recommendation of <7% total energy of the ADA was not achieved by any of the centers (Figure 2). Because of this favourable effects we expect a beneficial effect on CVD, however to date no association was found between alcohol and CVD in type 1 diabetes patients (Bishop et al. Hypercholesterolemia refers to levels of cholesterol in the blood that are higher than normal. This is a big enough reason to start working on losing weight in order to prolong your quality of life for as long as you can. What happens is that, the body interprets this as starvation and an irregular food supply and slows down metabolism rates in order to conserve energy. Furthermore higher intakes of fat and protein were associated with greater odds of coronary artery calcium (CAC), which is a strong predictor for coronary events approximating CVD risk.
All centers indicated in Figure 2 exceed the recommendation of <7% saturated fat of the total energy intake. This is a perfect reaction, but given that, the starvation is not really the case, by the time you take the next meal, the other calories still exist. She has similar concerns about Splenda, which is used in a large number of PepsiCo products, including Pepsi One, all Propel beverages, Diet Mountain Dew and Amp Energy.
Worldwide approximately 285 million people had the disease in 2010 and this number will increase till 438 million in 2030 (World Diabetes Foundation (WDF) 2010). 2004) a progression of nephropathy with greater saturated fatty acid (SFA) consumption and lesser polyunsaturated fatty acid consumption (PUFA) was demonstrated.
The opposite was true for carbohydrate intake, higher intake was associated with a reduced odds of CAC.In conclusion a higher intake of total fat as well as saturated fat is positively correlated with CVD or CVD risk factors (atherosclerosis and CAC in these studies) and a higher intake of carbohydrate is negatively correlated with CVD or CVD risk factors. Type 1 diabetic patients from Italy had the lowest intake of saturated fatty acids, but this intake was still too high (Figure 2).
Children and other relatives at risk for familial hypercholesterolemia can be screened (checked) for the condition.
This simply translates to weight gain given that you will tend to take large chunks of food to satisfy your hunger.
One study reported an association between lifestyle risk factors (including alcohol) and atherosclerosis, which is often the underlying cause of CVD (Bishop et al. Furthermore dietary fiber is independently related to a lower risk for CVD in type 1 diabetic women. Keeping in mind that these samples are clinic based and not population based and that these figures may not exactly reflect the current nutritional intake, however it gives an indication of the status on fiber intake.
Also the association between alcohol and diabetic nephropathy and diabetic retinopathy was only observed in cross-sectional studies. 1992) examined whether alcohol consumption was associated with type 1 diabetic retinopathy. Since all these studies were cross-sectional, they could only look at the intake of certain nutrients and the prevalence of CVD or CVD risk factors at a certain time point. There were only a few studies examining the effect of MUFA or PUFA on chronic complications in type 1 diabetic patients.
Diabetes also has a great economic impact on the individual, nation healthcare system and economy (International Diabetes Federation (IDF) 2010). Eight studies reported an association between physical activity and CVD risk factors (Kriska AM et al. They could not conclude if these are related to each other and if the nutrients are responsible for the lower or higher prevalence of CVD. Unfortunately, this positive effect of fiber on CVD and CVD risk factors was only found in cross-sectional studies.
Physical activityThere are no specific guidelines concerning physical activity for type 1 diabetic patients. They found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes (Lee CC et al.
These conclusions are based on post-hoc analyses and a cross-sectional study respectively and should therefore be interpreted carefully. 2010).In conclusion these prospective studies are consistent with the cross-sectional studies about the detrimental effect of saturated fat on type 1 diabetic nephropathy. 1991) examined the relationship between physical activity and the occurrence of retinopathy in type 1 diabetic patients.
Randomized controlled trialsTwo randomized controlled trials reported an association between macronutrients and CVD (Table 2), but demonstrated conflicting conclusions.
Further research in prospective studies or randomized controlled trials is needed to ascertain the role of fiber in CVD. However, it was shown that the guidelines for type 2 diabetic patients are also applicable for type 1 diabetic patients. In type 1 diabetes the body does not produce insulin (American Diabetes Association (ADA) 2010).The disease has a strong genetic component, inherited mainly through the HLA complex but the exact cause is unknown. They found no association between physical activity (sports and leisure physical activity) and occurrence of retinopathy.4.
DNSG EASD do not recommend a low carbohydrate diet for type 1 and type 2 diabetic patients (Table 4).
Several randomized controlled trials (Table 3) showed that physical activity (endurance sports; on average 2 times a week 60 minutes) improves physical fitness as well as endothelial function in type 1 diabetic patients (Lehmann R et al. Most likely there is an environmental trigger in genetically susceptible people that causes an immune reaction. Diet, lifestyle and cardiovascular diseaseEight studies reported an association between macronutrients and CVD in type 1 diabetic patients.
2009), the authors concluded that a diet lower in carbohydrate and higher in MUFA might be preferable to a diet higher in carbohydrate and lower in MUFA for type 1 diabetic patients.
2009) to recommend a diet higher in MUFA and lower in carbohydrate for nonobese type 1 diabetic individuals to reduce CVD risk factors is doubtful.
The body's white blood cells mistakenly attack the insulin-producing pancreatic ?-cells (U.S.
This was solely based on the positive effect on triglyceride (TG) levels and plasminogen activator inhibitor 1 levels (PAI-1) in the first diet. It is more acceptable to avoid too much foods high in fast available carbohydrates, foods high in fat and cholesterol. Their conclusion is based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are.
A significant decrease in PAI-1 was found after 6 months in the lower carbohydrate and higher MUFA diet.
An earlier quote (Helgeson 2006) expressed this precisely: ‘families of adolescents with diabetes may be more concerned that the sugar in candy is going to translate into high blood glucose levels today than that the fat in potato chips will translate into cardiovascular disease in 10 years’. Furthermore, the small study population of 30 subjects limits the power of their conclusions.
Especially the improvement in endothelial function is important since endothelial dysfunction is an early sign of atherosclerosis, which is often the underlying cause of CVD. In order to make accurate recommendations concerning MUFA and PUFA intake for type 1 diabetic patients more research with more participants (preferably in a prospective study) is needed.
Also a positive effect on lipid related cardiovascular risk factors was found in one study (Lehmann R et al. A lower level of PAI-1 means less inhibition and more degradation of blood clots, which means a lower chance of developing atherosclerosis. This ‘food’ trigger explains why type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages (Sadauskaite-Kuehne V et al.
In the other diet group there was an increase in TG levels, also this increase was not significant.
Although the evidence is gained from randomized controlled trials, the conditions of these trials are really disappointing. MacronutrientsData on the relationship between macronutrients and incident CVD is lacking in patients with type 1 diabetes. 2010) found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes.
This involves acute complications, like hyperglycaemia and hypoglycaemia which can lead to a coma, but also chronic complications (National Institute for Public Health and the Environment (RIVM) 2007). Chronic complications can be subdivided into macrovascular and microvascular complications. Physical activityThere were no prospective studies on physical activity and type 1 diabetic nephropathy.


It decreases lipopolysaccharide-induced nuclear factor-kB (NF-kB ) activation and monocyte chemoattractant protein (MCP)-1 expression in human renal tubular cells (Lee CC et al. Cardiovascular disease is the major macrovascular complication and includes mainly myocardial infarction and stroke (American Diabetes Association (ADA) 2010).
Cross-sectional studies on fat and fiber in relation to CVDIn more detail, one cross-sectional study (Overby NC et al. The risk for cardiovascular disease, is 4-8 times higher for people with type 1 diabetes (Soedamah-Muthu SS et al.
1991) found the lowest occurrence of diabetic nephropathy in people being 7+ hours a week physically active (sports and leisure physical activity).3. 2006) found a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients compared with healthy same-age control subjects and a lower than recommended intake of fiber. Mainly because of the higher atherosclerotic risk due to more and bigger very low-density lipoprotein (VLDL) particles in the last diet.
Diet, lifestyle and retinopathyOnly two studies reported results for the association between macronutrients and type 1 diabetic retinopathy. They conclude that this higher intake of energy from saturated fat and this lower intake of energy from dietary fiber, vegetables and fruits could increase the risk of atherosclerosis, which is often the underlying cause of CVD. Furthermore the TG levels did not significantly differ between the two diets in this study.In conclusion, these trials show that the effect of carbohydrate or MUFA on cardiovascular disease risk factors in type 1 diabetic patients is still not elucidated. The major microvascular complications are diabetic nephropathy, diabetic neuropathy and diabetic retinopathy (American Diabetes Association (ADA) 2010). Furthermore two studies reported an association between alcohol consumption and diabetic retinopathy and one study reported an association between physical activity and diabetic retinopathy. Another study (Helgeson 2006) reported a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients, but they did not study associations with CVD or CVD risk factors.
There are no firm recommendations regarding protein intake for type 1 diabetic patients with incipient nephropathy.
An intake of 10-20% of total energy is recommended for patients with no evidence of nephropathy (Table 4). Their conclusions are based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are.
The recommendation for protein intake is most important for patients with diabetic nephropathy.
So the studies are in agreement with the guidelines but more research in better performed randomized controlled trials is needed to confirm this positive effect of physical activity on CVD in type 1 diabetic patients.
Furthermore, a negative association between carbohydrates and dietary fiber with retinopathy progression and risk factors was found. Furthermore none of these randomized controlled trials examined the potential positive effect of dietary fiber on CVD or the potential negative effect of saturated fat found in cross-sectional studies. Microalbuminuria can be seen as an early marker of diabetic kidney disease (Hovind P 2004).
The 25-year cumulative incidences of any visual impairment and severe visual impairment are 13% and 3%, respectively. Finally the high incidence of lower extremity amputations also stresses how serious the complications of type 1 diabetes are. The overall 25-year incidence of lower extremity amputations is 10.1% in 943 American type 1 diabetic patients (Sahakyan K et al. These complications account for the major morbidity and mortality associated with type 1 diabetes, so it is very important to treat them (Daneman D 2006).In type 1 diabetes, special attention is paid to balancing the insulin dose with episodes of activity and the quantity and timing of food intake to prevent acute episodes of hypoglycaemia and hyperglycaemia (Franz MJ et al. A hypothesis is that excessive protein intake causes renal vasodilatation and glomerular excessive perfusion leading to a raised glomerular transcapillary hydraulic pressure gradient ending in proteinuria and glomerular damage, conversely, will prevent kidney damage (Percheron C et al. However, this could also be due to the kind of study (cross-sectional) and the fact that markers for CVD were used instead of CVD as endpoint.
This is important because these acute complications can lead to a coma, but also because a high blood glucose concentration (glycosylated hemoglobin (HbA1c) ? 7%) in people with diabetes increases the risk for macrovascular as well as microvascular complications. So, indeed protein restriction is beneficial for type 1 diabetic patients with established nephropathy.
Other risk factors for these chronic complications are smoking, obesity, physical inactivity, high blood pressure and high cholesterol levels. Physical activityOf the eight studies that reported an association between physical activity and CVD there were five cross-sectional studies (Kriska AM et al. However, we have to mention that although this beneficial effect of a restricted protein intake was found in randomized controlled trials, the sample size of these trials were really small (maximum of 82 people).
Also people with a longer history of diabetes have a higher risk (National Institute for Public Health and the Environment (RIVM) 2007). Furthermore it is important to realise that the microvascular complications lie on the pathway between diabetes and cardiovascular disease.
Nephropathy for example is an important risk factor for cardiovascular disease in people with type 1 diabetes (Jensen T et al. 1987).Recent studies have shown that people with type 1 diabetes eat a more atherosclerosis-prone diet. This includes a high intake of energy from saturated fat and a low intake of fiber, fruits and vegetables, which could increase the risk of the development of atherosclerosis. Further studies with a larger sample size are needed to find a cutoff point for protein intake which would still have a positive effect on diabetic nephropathy and its feasibility.
It has been demonstrated that 80%-90% of type 2 diabetes and coronary heart disease cases can be prevented by healthy lifestyle behavior with a focus on healthy diet and exercise.(Stampfer et al.
The studies will be discussed in the following paragraphs by study design.One study (Kriska AM et al. 1991) examined the relationship between physical activity and the occurrence of CVD in type 1 diabetic patients. 2004) These studies suggest that there could be a potential role for diet in type 1 diabetes to reduce the risk of cardiovascular disease.
They found the lowest occurrence of CVD in people being 4-7 hours a week physical active (sports and leisure physical activity). There are more studies suggesting that diet (including alcohol) can play an important role in treating the complications of diabetes (Franz MJ et al. The other four cross-sectional studies examined an association between physical activity and CVD risk factors. Several studies have reviewed nutritional recommendations for people with diabetes (Franz MJ et al.
2007) found that increased frequency of regular physical activity was associated with lower TG levels.
Furthermore they are general and not always specific for the different type of complications.
2007) found besides the positive association with TG levels also a positive significant association between regular physical activity and HDL cholesterol levels.
An overview of the relationship between diet (including alcohol) and complications in type 1 diabetic patients is lacking. Also the effect of lifestyle (including physical activity and dietary patterns) on complications is still not elucidated for type 1 diabetic patients. Lack of physical activity together with an atherogenic diet could enhance development of complications especially in high risk type 1 diabetic patients.In the following paragraphs of this bookchapter the literature on associations between diet (including alcohol) and lifestyle and chronic complications in type 1 diabetic patients will be summarized. Impaired endothelial function is considered as an early sign of atherosclerosis, which is often the underlying cause of CVD. Since ‘diet’ and ‘lifestyle’ are broad terms the focus will be on macronutrients (carbohydrates (including fiber), proteins and fats (including cholesterol), alcohol, physical activity and dietary patterns. 2009) a significant inverse association between physical activity and CAC, a marker of coronary artery atherosclerosis, was demonstrated. In the final paragraphs all recommendations on diet and lifestyle in patients with type 1 diabetes will be put in perspective with the current literature.2. In conclusion all these studies found a beneficial effect of physical activity on cardiovascular risk factors. Diet, lifestyle and nephropathyEighteen studies reported an association between macronutrients and type 1 diabetic nephropathy. However, since all these studies were cross-sectional, they could only look at physical activity and the prevalence of CVD or CVD risk factors at a certain time point.
They could not conclude if these are related to each other and if physical activity was responsible for the lower prevalence of CVD.The three trials reporting an association between physical activity and cardiovascular disease risk factors (Table 3) were consistent in their conclusions.
The other five focussed on other dietary macronutrients such as fat, cholesterol or carbohydrate in relation with nephropathy. There were also three studies that reported results for protein as well as carbohydrate or fats and nephropathy.
Furthermore one study reported an association between alcohol consumption and nephropathy in type 1 diabetic patients and one study reported an association between physical activity and nephropathy in type 1 diabetic patients. 2011) examined the association between physical activity and brachial artery flow-mediated dilation (FMD). Endothelial dysfunction is reflected by an impaired FMD response and is an early sign of atherosclerosis.
ProteinOf the thirteen studies that reported an association between protein and nephropathy there were three cross-sectional studies (Toeller M et al. An increase in FMD was found in type 1 diabetic patients following an exercise training program (endurance sports; on average 2 times a week 60 minutes, Table 3).
2002) examined the impact of physical activity on lipid related cardiovascular risk factors (LDL cholesterol, HDL cholesterol and TG).
They both found a decrease in LDL cholesterol levels in the training group, but only in one of these (Lehmann R et al.
These will be discussed in the following paragraphs by study design.The three cross-sectional studies were not consistent in their conclusions on the effect of protein on diabetic nephropathy. 2000) failed to show a significant relationship between dietary protein intake and markers of early nephropathy, other than creatinine clearance. 1997) found a significant relationship between dietary protein intake and urinary albumin excretion rate (AER). The relation between physical fitness and CVD was not examined.In conclusion the three trials show that physical activity improves physical fitness as well as endothelial function in type 1 diabetic patients.
A higher AER was particularly found in people consuming more than 20% of their dietary food energy as protein.
A positive effect on lipid related cardiovascular risk factors was only found in one study (Lehmann R et al. Dietary patternsTwo cross-sectional studies reported an association between dietary patterns, in this case the ‘Dietary Approaches to Stop Hypertension’ (DASH) diet, and CVD risk factors (Gunther ALB et al. 2001) total protein intake was not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to decrease the risk.
Furthermore they could not confirm an association between a high total animal protein intake and having microalbuminuria. No cross-sectional or prospective studies were found examining the effect of a Mediterranean diet or a Western diet on CVD in type 1 diabetic patients. 1991) found in their cohort study that a predominantly vegetarian diet (low in animal protein) may have an important beneficial effect on diabetic nephropathy without the need for a heavily restricted total protein intake. 2008) reported an association between adherence to the DASH diet and hypertension in type 1 diabetic patients.
But they were not able to determine if the reduction in total protein intake rather than the reduction in the fraction of animal origin was primarily responsible for the fall in the fractional albumin clearance. They did not investigate a possible association between the DASH diet and CVD, but used hypertension as the main risk factor for CVD. 1998) cohort study showed that a low protein diet has a protective effect on the residual renal function in type 1 diabetic patients.In conclusion, these studies were not consistent in their conclusions on the effect of protein restriction on type 1 diabetic nephropathy.
2011) reported a possible association between the DASH diet and other CVD risk factors (total cholesterol, LDL cholesterol, HDL cholesterol, TG, LDL particle density, apolipoprotein B, body mass index (BMI), waist circumference, and adipocytokines) than blood pressure. In one of these four this decline was greater in the low protein diet group than in the usual protein diet group, but this difference was not significant (Hansen HP et al. Unfortunately there were no studies found examining the effect of dietary patterns on CVD events.5. Current recommendations on diet and lifestyle in patients with type 1 diabetes put in perspective Overall, fiber and saturated fat intake play an important role in type 1 diabetic patients, with a beneficial and detrimental effect on the chronic complications respectively. Many researchers have shown the inappropriate intake of these nutrients in patients with type 1 diabetes. Among these 2 studies, one (Brouhard BH & LaGrone L 1990) found a decline that was significantly greater in the usual protein group. Also moderate alcohol intake and physical activity may have beneficial effects in type 1 diabetic patients. Another study showed a decline in GFR in the low protein diet group, but did not directly compare this with the usual protein group (Dullaart RP et al.
Most of the findings are consistent with the guidelines for type 1 diabetic patients (Table 4).The main limitations are the lack of prospective studies on diet and lifestyle in type 1 diabetics, lack of randomized controlled trials and the limited number of studies on dietary cholesterol, protein, carbohydrates, fat, fiber and no cardiovascular morbidity data. The available studies, with their limitations, all indicate that diet and lifestyle play an important role in preventing chronic complications of type 1 diabetes.
1994) reported an increase in GFR during the low protein diet, but this increase was not significant. The rates of decline in both iothalamate and creatinine clearence were significantly slower in the patients in the study-diet group than in those in the control-diet group. In three of these five trials there was a decline in albuminuria in the low protein diet group as well as in the usual protein diet group (Dullaart RP et al.
Two of these three showed a significant greater decline in albuminuria in the low protein diet group than in the usual protein diet group (Dullaart RP et al. One of these (Brouhard BH& LaGrone L 1990) found a significant difference between the diet groups. 1988) type 1 diabetic patients with microalbuminuria consumed a significantly smaller percentage of total energy as carbohydrate compared with patients with normal albumin excretion.



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