Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy Modulation of gut microbiota dysbioses in type 2 diabetic patients by macrobiotic Ma-Pi 2 diet Diet, Inflammation, and Glycemic Control in Type 2 Diabetes: An Integrative Review of the Literature Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT). A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Biomarkers of insulin action during single soccer sessions before and after a 12-week training period in type 2 diabetes patients on a caloric-restricted diet Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries Combination of recreational soccer and caloric restricted diet reduces markers of protein catabolism and cardiovascular risk in patients with type 2 diabetes The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study-a 3-mo randomized controlled trial. The family Coriobacteriaceae is a potential contributor to the beneficial effects of Roux-en-Y gastric bypass on type 2 diabetes. Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: the ENTRED surveys (2001 and 2007). A low-carbohydrate as compared with a low-fat diet in severe obesity. Vegetarian diet-induced increase in linoleic acid in serum phospholipids is associated with improved insulin sensitivity in subjects with type 2 diabetes Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes. Intake of dietary saturated fatty acids and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort: associations by types, sources of fatty acids and substitution by macronutrients Egg consumption and risk of type 2 diabetes in older adults. Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes Egg consumption and risk of incident type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Dairy Products and Prevention of Type 2 Diabetes: Implications for Research and Practice Daily physical activity and macronutrient distribution of low-calorie diets jointly affect body fat reduction in obese women. Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. Prevention of type 2 diabetes - where is the evidence? Established dietary estimates of net acid production do not predict measured net acid excretion in patients with Type 2 diabetes on Paleolithic–Hunter–Gatherer-type diets Effects of protein vs. carbohydrate-rich diets on fuel utilisation in obese women during weight loss. Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Dietary restriction in obese children and its relation with eating behavior, fibroblast growth factor 21 and leptin: a prospective clinical intervention study Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Quarterly individual outpatients lifestyle counseling after initial inpatients education on type 2 diabetes: the REDIA Prev-2 randomized controlled trial in Reunion Island. Comparison of a carbohydrate-free diet vs. fasting on plasma glucose, insulin and glucagon in type 2 diabetes. Substitution analysis in nutritional epidemiology: proceed with caution Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial. Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial Dairy product intake in relation to glucose regulation indices and risk of type 2 diabetes. Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Exercise without weight loss is an effective strategy for obesity reduction in obese individuals with and without Type 2 diabetes. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK Comparison of Two Calorie-Reduced Diets of Different Carbohydrate and Fiber Contents and a Simple Dietary Advice Aimed to Modify Carbohydrate Intake on Glycemic Control and Inflammatory Markers in Type 2 Diabetes: A Randomized Trial A Randomized Controlled Trial of a Mini Low-Carbohydrate Diet and an Energy-Controlled Diet Among Japanese Patients With Type 2 Diabetes Effects of High-Protein Versus High-Carbohydrate Diets on Markers of β-Cell Function, Oxidative Stress, Lipid Peroxidation, Proinflammatory Cytokines, and Adipokines in Obese, Premenopausal Women Without Diabetes Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Effects of increased dietary protein-to-carbohydrate ratios in women with polycystic ovary syndrome. Adherence to a Healthy Nordic Food Index Is Associated with a Lower Risk of Type-2 Diabetes—The Danish Diet, Cancer and Health Cohort Study Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Dairy product consumption and risk of type 2 diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk Effect of Diet or Diet Plus Physical Activity Versus Usual Care on Inflammatory Markers in Patients with Newly Diagnosed Type 2 Diabetes: The Early ACTivity In Diabetes (ACTID) Randomized, Controlled Trial Diabetes-specific Quality of Life After a Low-carbohydrate and Low-fat Dietary Intervention Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Liver Fat Is Reduced by an Isoenergetic MUFA Diet in a Controlled Randomized Study in Type 2 Diabetic Patients A prospective comparison of ‘conventional’ and high carbohydrate / high fibre / low fat diets in adults with established Type 1 (insulin-dependent) diabetes Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Dietary composition and physiologic adaptations to energy restriction. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Sleep Duration and Risk of Type 2 Diabetes Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity
Background Type 2 diabetes ( T2D ) is associated with a prion diminished quality of life , especially due to the severe complications that it implicates . Changing dietary habits is an absolute priority , as well as implementing nutritional motivational programs . The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D . Methods A total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet , the classes of nutrients , the distribution of the meals during the day and the dietary choices . During regular meetings , the patients were requested to fill out a question naire about their dietary habits and behaviours . Clinical and metabolic parameters were also analysed . Results At the end of the intervention the number of people who declared that they ate five meals a day ( p = 0.006 ) and preferred to have fruit for snack ( p = 0.004 ) increased , while there was a reduction in the use of sweeteners and an elimination of the use of fructose ( p = 0.05 ) . The total daily consumption of kilocalories ( kcal ) had been reduced and the percentages of carbohydrates , proteins and lipids , after the intervention , follow the guidelines . In relation to this , a significant improvement ( p < 0.05 ) was registered in systolic and diastolic pressure , BMI and waist circumference , as well as in glycaemic values ( p = 0.018 ) . Conclusions A nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D . We hope that a similar intervention will be applied in Campania and in other Italian regions . Trial registration Registration number is IS RCT N11067689 ; date of registration : 10/09/2018 . Retrospectively registered The gut microbiota exerts a role in type 2 diabetes ( T2D ) , and deviations from a mutualistic ecosystem layout are considered a key environmental factor contributing to the disease . Thus , the possibility of improving metabolic control in T2D by correcting gut microbiome dysbioses through diet has been evaluated . Here , we explore the potential of two different energy-restricted dietary approaches – the fibre-rich macrobiotic Ma-Pi 2 diet or a control diet recommended by Italian professional societies for T2D treatment – to correct gut microbiota dysbioses in T2D patients . In a previous 21-d open-label MADIAB trial , fifty-six overweight T2D patients were r and omised to the Ma-Pi 2 or the control diet . For the present study , stools were collected before and after intervention from a subset of forty MADIAB participants , allowing us to characterise the gut microbiota by 16S rRNA sequencing and imputed metagenomics . To highlight microbiota dysbioses in T2D , the gut microbiota of thirteen normal-weight healthy controls were characterised . According to our findings , both diets were effective in modulating gut microbiome dysbioses in T2D , result ing in an increase of the ecosystem diversity and supporting the recovery of a balanced community of health-promoting SCFA producers , such as Faecalibacterium , Roseburia , Lachnospira , Bacteroides and Akkermansia .  The Ma-Pi 2 diet , but not the control diet , was also effective in counteracting the increase of possible pro-inflammatory groups , such as Collinsella and Streptococcus , in the gut ecosystem , showing the potential to reverse pro-inflammatory dysbioses in T2D , and possibly explaining the greater efficacy in improving the metabolic control Type 2 diabetes ( T2D ) is a growing national health problem affecting 35 % of adults ≥20 years of age in the United States . Recently , diabetes has been categorized as an inflammatory disease , sharing many of the adverse outcomes as those reported from cardiovascular disease . Medical nutrition therapy is recommended for the treatment of diabetes ; however , these recommendations have not been up date d to target the inflammatory component , which can be affected by diet and lifestyle . To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D , we conducted an integrative review of the literature . A comprehensive search of the PubMed , CINAHL , Scopus , and Web of Science data bases from January 2000 to May 2012 yielded 786 articles . The final 16 studies met the selection criteria including r and omized control trials , quasiexperimental , or cross-sectional studies that compared varying diets and measured inflammatory markers . The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers . The Mediterranean diet demonstrated the most clinical ly significant reduction in glycosylated hemoglobin ( HbA1c ) . Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking . Continued research is warranted Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes ( T2DM ) and the debate persists : which dietary strategy is most effective . In the Dietary Intervention R and omized Controlled Trial ( DIRECT ) 322 moderately obese participants were r and omized for 2 years to one of three diet groups : low-fat , Mediterranean and low-carbohydrate . Differential effects were observed in the sub-group of patients with T2DM at 24 months : participants r and omized to the Mediterranean diet , which had the highest intake of dietary fibers and unsaturated to saturated fat ratio , achieved greater significant improvements in fasting plasma glucose and insulin levels . Patients who were r and omized to the low-carbohydrate diet , which had the minimal intake of carbohydrates , achieved a significant reduction of hemoglobin A1C . Although improvements were observed in all groups , the low-fat diet was likely to be less beneficial in terms of glycemic control and lipid metabolism . Interpretation of results from different studies on dietary strategies may be complex since there is often no consistency in diet compositions , calorie restriction , intensity of intervention , dietary assessment or extent of adherence in the trial . Nevertheless , it seems that low fat restricted calorie diets are effective for weight loss and are associated with some metabolic benefits ; however , some recent trials have shown that low carbohydrate diets are as efficient in inducing weight loss and in some metabolic measures such as serum triglycerides and HDL-cholesterol may be even superior to low fat diets . When addressing the issue of diet quality rather than quantity applying the glycemic index may have some added benefits . Furthermore special features of the Mediterranean diet have apparent additional favorable effects for patients with T2DM OBJECTIVE Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance , many patients are unable to comply with such dietary therapy for long periods . The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association . However , r and omised trials of dietary interventions in Japanese patients with type 2 diabetes are scarce . Therefore , the aim of this study was to examine the effects of a non-calorie-restricted , low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet . METHODS The enrolled patients were r and omly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet . The patients received consultations every two months from a registered dietician for six months . We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles . RESULTS The HbA1c levels decreased significantly from baseline to six months in the low-carbohydrate diet group ( baseline 7.6±0.4 % , six months 7.0±0.7 % , p=0.03 ) but not in the calorie-restricted group ( baseline 7.7±0.6 % , six months 7.5±1.0 % , n.s . ) , ( between-group comparison , p=0.03 ) . The patients in the former group also experienced improvements in their triglyceride levels , without experiencing any major adverse effects or a decline in the quality of life . CONCLUSION Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet BACKGROUND We investigated the biomarkers of insulin action as well as changes in free fatty acids and lactate concentration after an acute soccer session pre and post training with caloric-restricted diet versus diet alone in type 2 diabetes ( T2D ) patients . METHODS Fifty-one middle-aged ( 61.1 ± 6.4 years ) T2D patients were r and omly allocated to the soccer+diet group ( SDG ) or the diet group ( DG ) . The control group comprised T2D patients observing a caloric-restricted diet who did not receive soccer training .  Over 12 weeks , SDG performed 3 × 40 min per week of soccer training . RESULTS The first soccer session for SDG induced acute increases in blood lactate ( 1.4 ± 0.1 - 6.0 ± 0.7 mmol/L , P < 0.05 ) and glucagon levels ( 112.1 ± 6.2 - 142.9 ± 8.0 pg/mL , P < 0.05 ) , whereas glucose and insulin levels remained unchanged . Moreover , this session showed suppressed insulin levels as well as higher free fatty acids , lactate levels and glucagon/insulin ratio compared to DG ( p < 0.05 ) . After 12 weeks , a baseline decrease was observed in glucagon , leptin and lactate levels in SDG and DG ( p < 0.05 ) , whereas HOMA-IR , Adipo-IR and glucose levels were lower only in SDG ( p < 0.05 ) . At the last soccer training session , the blood lactate response was significantly lower than for the first session ( 4.0 ± 0.4 vs 6.0 ± 0.7 mmol/L ) . At 48 h pre intervention , a decrease was observed in leptin levels ( p < 0.05 ) , which remained lower post intervention . The positive correlation between leptin and insulin , and the lower levels after training , could be attributed to the improved insulin sensitivity along with the weight loss observed in both groups ( ~3.4 kg for DG and 3.7 kg for SDG ) . CONCLUSION Acute soccer sessions markedly improved insulin action markers in T2D patients , while the cumulative effects enhanced insulin sensitivity and decreased risk factors associated with cardiovascular disease after 12 weeks of intervention better than caloric-restricted diet Background / Objectives : Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes ( T2D ) risk , but studies on foods high in fat per unit weight are sparse . We assessed whether the intake of vegetable oil , butter , margarine , nuts and seeds and cakes and cookies is related to incident T2D.Subjects/ Methods : A case-cohort study was conducted , nested within eight countries of the European Prospect i ve Investigation into Cancer ( EPIC ) , with 12 403 incident T2D cases and a subcohort of 16 835 people , identified from a cohort of 340 234 people . Diet was assessed at baseline ( 1991–1999 ) by country-specific question naires . Country-specific hazard ratios ( HRs ) across four categories of fatty foods ( nonconsumers and tertiles among consumers ) were combined with r and om-effects meta- analysis . Results : After adjustment not including body mass index ( BMI ) , nonconsumers of butter , nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption . Among consumers , cakes and cookies were inversely related to T2D ( HRs across increasing tertiles 1.14 , 1.00 and 0.92 , respectively ; P-trend < 0.0001 ) . All these associations attenuated upon adjustment for BMI , except the higher risk of nonconsumers of cakes and cookies ( HR 1.57 ) . Higher consumption of margarine  became positively associated after BMI adjustment ( HRs across increasing consumption tertiles : 0.93 , 1.00 and 1.12 ; P-trend 0.03 ) . Within consumers , vegetable oil , butter and nuts and seeds were unrelated to T2D . Conclusions : Fatty foods were generally not associated with T2D , apart from weak positive association for margarine . The higher risk among nonconsumers of cakes and cookies needs further explanation Background Moderate calorie-restricted diets and exercise training prevent loss of lean mass and cardiovascular risk . Because adherence to routine exercise recommendation is generally poor , we utilized recreational soccer training as a novel therapeutic exercise intervention in type 2 diabetes ( T2D ) patients . Objective We compared the effects of acute and chronic soccer training plus calorie-restricted diet on protein catabolism and cardiovascular risk markers in T2D . Design , setting and subjectsFifty-one T2D patients ( 61.1±6.4 years , 29 females : 22 males ) were r and omly allocated to the soccer+diet-group ( SDG ) or to the dietgroup ( DG ) . The 40-min soccer sessions were held 3 times per week for 12 weeks . Results Nineteen participants attended 100 % of scheduled soccer sessions , and none suffered any injuries . The SDG group showed higher levels of growth hormone ( GH ) , free fatty acids and ammonia compared with DG . After 12 weeks , insulin-like growth factor binding protein (IGFPB)-3 and glucose levels were lower in SDG , whereas insulin-like growth factor (IGF)-1/ IGFBP-3 ratio increased in both groups . After the last training session , an increase in IGF-1/IGFBP-3 and attenuation in ammonia levels were suggestive of lower muscle protein catabolism . Conclusions Recreational soccer training was popular and safe , and was associated with decreased plasma glucose and IGFBP-3 levels , decreased ammoniagenesis , and increased lipolytic activity and IGF-1/IGFBP-3 ratio , all indicative of attenuated catabolism BACKGROUND Previously published research that examined the effects of high egg consumption in people with type 2 diabetes ( T2D ) produced conflicting results leading to recommendations to limit egg intake . However , people with T2D may benefit from egg consumption because eggs are a nutritious and convenient way of improving protein and micronutrient contents of the diet , which have importance for satiety and weight management . OBJECTIVE In this r and omized controlled study , we aim ed to determine whether a high-egg diet ( 2 eggs/d for 6 d/wk ) compared with a low-egg diet ( < 2 eggs/wk ) affected circulating lipid profiles , in particular high-density lipoprotein ( HDL ) cholesterol , in overweight or obese people with prediabetes or T2D . DESIGN A total of 140 participants were r and omly assigned to one of the 2 diets as part of a 3-mo weight maintenance study . Participants attended the clinic monthly and were instructed on the specific types of foods and quantities to be consumed . RESULTS There was no significant difference in the change in HDL cholesterol from screening to 3 mo between groups ; the mean difference ( 95 % CI ) between high- and low-egg groups was + 0.02 mmol/L ( -0.03 , 0.08 mmol/L ; P = 0.38 ) . No between-group differences were shown for total cholesterol , low-density lipoprotein cholesterol , triglycerides , or glycemic control . Both groups were matched for protein intake , but the high-egg group reported less hunger and greater satiety postbreakfast . Polyunsaturated fatty acid ( PUFA ) and monounsaturated fatty acid ( MUFA ) intakes significantly increased from baseline in both groups . CONCLUSIONS High egg consumption did not have an adverse effect on the lipid profile of people with T2D in the context of increased MUFA and PUFA consumption . This study suggests that a high-egg diet can be included safely as part of the dietary management of T2D , and it may provide greater satiety . This trial was registered at the Australia New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au/ ) as ACTRN12612001266853 BACKGROUND Changes in gut microbiota induced by bariatric surgery have been associated with metabolic benefits . OBJECTIVES Our aim was to identify specific gut microbiota that may contribute to the improvement of  type 2 diabetes ( T2D ) after Roux-en-Y gastric bypass ( RYGB ) .  SETTING Laboratories of Shanghai Diabetes Institute and Shanghai Sixth People 's Hospital . METHODS Diabetic rats induced via a high-fat diet and low-dose streptozotocin administration  were r and omized to RYGB or sham surgery , and stool sample s were collected at baseline and at postoperative week 8 . The fecal microbiota was profiled using 16S ribosomal RNA gene sequencing . Additionally , we performed a case-control study of the gut microbial community profiles of T2D patients compared with those of healthy individuals via 16S ribosomal RNA gene sequencing of mucosal-luminal interface sample s collected from the ascending colon during colonoscopy . RESULTS RYGB significantly reduced the weight and improved glucose tolerance and insulin sensitivity in diabetic rats . Principal coordinate analysis showed that RYGB caused marked alterations in the gut microbiota . The RYGB group was postoperatively enriched for Bacteroidetes , Proteobacteria , Fusobacteria , and Actinobacteria , whereas the sham surgery group was enriched for Firmicutes and Verrucomicrobia . Based on the gut microbial patterns in the T2D patients , we found that the family Coriobacteriaceae within Actinobacteria might contribute to the beneficial effects of RYGB on T2D . CONCLUSIONS RYGB significantly improves glucose metabolism and alters the gut microbiota . Moreover , the family Coriobacteriaceae may partly mediate the beneficial effects of RYGB on T2D and thus possibly contribute to the development of novel bacteria-based therapeutic approaches AIMS The study aim ed to assess the prevalence , quality of screening and treatment of chronic kidney disease ( CKD ) , and their trends between 2001 and 2007 , in French adults with type 2 diabetes ( T2D ) . METHODS The 2007 ENTRED survey r and omly selected , from French medical insurance fund data bases , 8926 adults treated for diabetes who had been reimbursed at least three times over the previous 12 months for oral hypoglycaemic agents or insulin .  Medical reimbursement data were extracted and two sets of question naires were mailed , one to all patients ( 48 % response rate ) and the other to their doctors ( 62 % ) . Analyses were restricted to the 3894 responders with T2D ( 2232 with data from their doctors ) . Trends between the 2001 and 2007 ENTRED surveys were studied . RESULTS Participants ' mean age was 66 years . The prevalence of CKD was estimated to be at least 29 % , based on doctors ' data ( missing data included ) . Overall , only 17 % had no cl aims for serum creatinine measurements during the year , and 71 % had no cl aims for albuminuria tests ; nonetheless , both figures had decreased from 2001 . Older people , those who lived alone and those who felt poorly informed about diabetes were more likely to have made no cl aims for CKD screening . Assessment of quality of care ( prescribing antihypertensive treatment when indicated ) was possible for 66 % of responders , of whom 25 % did not receive such treatment . CONCLUSION CKD is frequently seen in patients with T2D and is likely to be underestimated because albuminuria screening remains inadequate , despite significant improvements since 2001 . Further efforts are needed to improve CKD screening , patient and doctor awareness , and adequate use of antihypertensive/nephroprotective medications BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed BACKGROUND AND AIMS : Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications . We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose ( MCR ) than conventional hypocaloric diet . The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes ( T2D ) . METHODS : Subjects with T2D ( n=74 ) were r and omly assigned into a vegetarian group ( VG , n=37 ) following vegetarian diet or a control group ( CG , n=37 ) following a conventional diet . Both diets were calorie restricted ( −500 kcal day–1 ) . Participants were examined at baseline , 12 weeks of diet intervention and 24 weeks ( subsequent 12 weeks of diet were combined with aerobic exercise ) . The fatty acid composition of serum phospholipids was measured by gas liquid chromatography . MCR was measured by hyperinsulinemic isoglycemic clamp . Visceral fat ( VF ) was measured by magnetic resonance imaging . RESULTS : Linoleic acid ( LA ; 18:2n6 ) increased in VG ( P=0.04 ) , whereas it decreased in CG ( P=0.04 ) in response to dietary interventions . It did not change significantly after the addition of exercise in either group ( group × time P<0.001 ) . In VG , changes in 18:2n6 correlated positively with changes in MCR ( r=+0.22 ; P=0.04 ) and negatively with changes in VF ( r=−0.43 ; P=0.01 ) . After adjustment for changes in body mass index , the association between 18:2n6 and MCR was no longer significant . The addition of exercise result ed in greater changes of phospholipid fatty acids composition in VG than in CG . CONCLUSION : We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids We evaluated the effects of recreational football training combined with calorie-restricted diet ( football + diet ) vs calorie-restricted diet alone ( diet ) on aerobic fitness , lipid profile , and insulin resistance indicators in type 2 diabetes ( T2D ) patients . Forty-four T2D patients aged 48 - 68 years ( 27 females , 17 males ) were r and omly allocated to the football + diet group ( FDG ; n = 22 ) or to the diet group ( DG ; n = 22 ) , of whom 19 FDG and 15 DG subjects completed the study . The football training was performed for 3 × 40 min/week for 12 weeks . Dual-energy X-ray absorptiometry scanning , treadmill testing , and fasting blood samplings were performed pre and post-intervention . After 12 weeks , maximal oxygen uptake ( VO₂max ) was elevated ( P < 0.05 ) by 10 ± 4 % in FDG but not in DG ( -3 ± 4 % , P < 0.05 ) . After 12 weeks , reductions in blood triglycerides ( 0.4 ± 0.1 mmol/L ) , total cholesterol ( 0.6 ± 0.2 mmol/L ) , low-density lipoprotein , and very low-density lipoprotein levels were observed only in FDG . Fat mass decreased ( P < 0.05 ) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG . The lower ( P < 0.05 ) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG . In conclusion , football combined with restricted diet was effective in enhancing VO₂max , reducing total cholesterol and triglycerides , and increasing insulin sensitivity , potentially providing better tools for the prevention of T2D complications than diet alone Purpose The association between dietary saturated fatty acids ( SFA ) intake and  type 2 diabetes ( T2D )  remains unclear . This study aim ed at investigating the association between SFA intake and T2D risk based on ( 1 ) individual SFA ( differing in carbon chain length ) , ( 2 ) food sources of SFA and ( 3 ) the substituting macronutrients . Methods 37,421 participants from the European Prospect i ve Investigation into Cancer and Nutrition-Netherl and s ( EPIC-NL ) cohort were included in this study . Baseline dietary intake was assessed by a vali date d food frequency question naire . T2D risks were estimated by Cox regression models adjusted for non-dietary and dietary covariates . Results 893 incident T2D cases were documented during 10.1-year follow-up . We observed no association between total SFA and T2D risk . Marginally inverse associations were found for lauric acid ( HR per 1 SD of energy% , 95 % CI 0.92 , 0.85–0.99 ) , myristic acid ( 0.89 , 0.79–0.99 ) , margaric acid ( 0.84 , 0.73–0.97 ) , odd-chain SFA ( pentadecylic plus margaric acids ; 0.88 , 0.79–0.99 ) , and cheese derived SFA ( 0.90 , 0.83–0.98 ) . Soft and liquid fats derived SFA was found related to higher T2D risk ( 1.08 , 1.01–1.17 ) . When substituting SFA by proteins , carbohydrates and polyunsaturated fatty acids , significantly higher risks of T2D were observed ( HRs per 1 energy% ranging from 1.05 to 1.15 ) . Conclusion In this Dutch population , total SFA does not relate to T2D risk . Rather , the association may depend on the types and food sources of SFA . Cheese-derived SFA and individual SFA that are commonly found in cheese , were significantly related to lower T2D risks . We can not exclude the higher T2D risks found for soft and liquid fats derived SFA and for substituting SFA with other macronutrients are influenced by residual confounding by trans fatty acids or limited intake variation in polyunsaturated fatty acids and vegetable protein BACKGROUND Type 2 diabetes ( T2D ) remains an important public health issue in the United States . There are limited and inconsistent data on the association between egg consumption and fasting glucose or incident diabetes . OBJECTIVES We assessed the association between  egg  intake and  incident diabetes in older adults . DESIGN In this prospect i ve study of 3898 men and women from the Cardiovascular Health Study ( 1989 - 2007 ) , we assessed egg consumption by using a picture-sorted food question naire and ascertained incident T2D annually by using information on hypoglycemic agents and plasma glucose . We used Cox proportional hazards models to estimate adjusted relative risks . RESULTS During a mean follow-up of 11.3 y , 313 new cases of T2D occurred . Crude incidence rates of T2D were 7.39 , 6.83 , 7.00 , 6.72 , and 12.20 per 1000 person-years in people who reported egg consumption of never , < 1 egg/mo , 1 - 3 eggs/mo , 1 - 4 eggs/wk , and almost daily , respectively . In multivariable-adjusted models , there was no association between egg consumption and increased risk of T2D in either sex and overall . In a secondary analysis , dietary cholesterol was not associated with incident diabetes ( P for trend = 0.47 ) . In addition , egg consumption was not associated with clinical ly meaningful differences in fasting glucose , fasting insulin , or measures of insulin resistance despite small absolute analytic differences that were significant . CONCLUSION In this cohort of older adults with limited egg intake , there was no association between egg consumption or dietary cholesterol and increased risk of incident T2D Approximately 80 % of patients with type 2 diabetes are overweight/obese ( 1 ) , and weight loss is the mainstay of treatment for these individuals . However , there is growing controversy as to whether reduced-fat or reduced-carbohydrate diets are best suited for this purpose , and results ( 2–8 ) in nondiabetic subjects suggest that lower carbohydrate diets are similarly or more efficacious in improving weight , triglycerides , and HDL cholesterol . There are no published r and omized studies evaluating the role of dietary macronutrients with respect to weight loss and cardiovascular risk improvement in patients with type 2 diabetes . Thus , we r and omized diet-treated patients with type 2 diabetes to hypocaloric diets , moderately restricted in either carbohydrate or fat , to determine whether weight loss or metabolic improvement differed as a function of macronutrient composition . A total of 29 patients with diet-treated type 2 diabetes were recruited from the San Francisco Bay area . All subjects gave written informed consent . Inclusion criteria included BMI 27–36 kg/m2 , fasting plasma glucose concentration 7.2–8.3 mmol/l , no use of antihyperglycemic medications , and stable weight for 3 months . Subjects on anti-hypertensive or cholesterol-lowering drugs or aspirin were allowed to continue their medications . Insulin-mediated glucose uptake was quantified by a modification ( 9 ) of the insulin suppression test as originally described ( 10 ) and vali date d ( 11 ) . In this test , a 180-min infusion of somatostatin ( 0.27 μg/m2 per min ) , insulin ( 25 mU/m2 per min ) , BACKGROUND The prevalence of type 2 diabetes ( T2D ) is increasing around the world . Eggs are a major source of cholesterol , which has been associated with elevated blood glucose and an increased risk of T2D . However , there are limited and conflicting data from prospect i ve population studies on the association between egg consumption and risk of T2D . OBJECTIVE We investigated the association between egg consumption and risk of incident T2D in middle-aged and older men from eastern Finl and . DESIGN The study included 2332 men aged 42 - 60 y in 1984 - 1989 at the baseline examinations of the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor Study .  Dietary intakes were assessed with 4-d food records at baseline . Incident T2D was assessed by self-administered question naires ; by fasting and 2-h oral-glucose-tolerance-test blood glucose measurement at re-examination rounds 4 , 11 , and 20 y after baseline ; and by record linkage to a hospital discharge registry and reimbursement register of diabetes medication expenses . Cox proportional hazards regression analyses were used to estimate associations with the risk of incident T2D . Associations with the metabolic risk markers at baseline and at the 4-y examinations were analyzed by ANCOVA . RESULTS During an average follow-up of 19.3 y , 432 men developed T2D . After adjustment for potential confounders , those in the highest compared with the lowest egg intake quartile had a 38 % ( 95 % CI : 18 % , 53 % ; P-trend across quartiles < 0.001 ) lower risk of incident T2D . Analyses with metabolic risk markers also suggested an inverse association with fasting plasma glucose and serum C-reactive protein but not with serum insulin . The associations between cholesterol intake and risk of T2D , plasma glucose , serum insulin , and C-reactive protein were mainly nonsignificant , especially after accounting for egg consumption . CONCLUSION Higher egg intake was associated with a lower risk of T2D in this cohort of middle-aged and older men A growing body of scientific evidence has linked dairy intake to a reduced  type 2 diabetes ( T2D ) risk . Using an evidence -based approach , we review ed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D . Evidence indicates that dairy intake is significantly associated with a reduced T2D risk , and likely in a dose-response manner . The association between low-fat dairy and T2D risk reduction appears consistent . A beneficial impact is suggested for regular-fat dairy . The role of specific dairy products needs to be clarified . Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome , as well as several dairy components , such as calcium , vitamin D , dairy fat , and specifically trans-palmitoleic acid . To conclude , there is strong , consistent , and accumulating evidence that dairy intake reduces the risk of T2D . More research is needed to better underst and the role of regular-fat and specific dairy products . Well- design ed r and omized controlled trials and mechanistic studies are needed to support these findings . Efforts to translate this evidence into clinical practice and public health guidance are needed Inadequate dietary patterns and sedentary lifestyles are believed to be important factors in predisposing people to obesity . This study analyzed the potential interaction between habitual physical activity and the carbohydrate (CHO)-fat distribution in 2 hypocaloric diets and the impact of such interplay on body composition changes . Forty healthy obese women , 20 - 50 years old , were r and omly assigned to a high- or low-CHO energy-restricted diet , which was low or high in fat , respectively , during 10 weeks . Baseline and final measurements were performed to assess dietary habits , resting metabolic rate , and body composition changes . Physical activity was measured with a triaxial accelerometer and with a question naire . There were no significant differences in anthropometric and metabolic variables between both dietary groups at baseline . However , there was a positive correlation between total free-living physical activity and arm muscle preservation after 10 weeks ( r = 0.371 ; p = 0.024 ) . Interestingly , an interaction between macronutrient ( CHO-fat distribution ) intake and physical activity was found , since less-active subjects with a high-CHO-low-fat diet showed a greater fat loss than those more active with a lower-CHO-high-fat diet , whereas more-active subjects with a high-CHO-low-fat diet showed a smaller fat loss than those receiving a low-CHO-high-fat diet . Physical activity and the macronutrient content of energy-restricted diets , when design ed to promote body fat mass reduction , should be considered together to better predict the outcome This summer , 25 overweight and obese adults participating in a tightly controlled feeding study will take up fulltime residence for 3 months at a wooded lakefront center in Ashl and , Massachusetts . However , before checking in at Framingham State University ’s Warren Conference Center and Inn , they will have to lose 15 % of their body weight on a calorie-restricted diet with home-delivered meals . Those who pass this hurdle will be invited to the inn , where they ’ll be r and omly assigned to 1 of 3 equal-calorie diets : a lowfat , high-carbohydrate diet that ’s either high or low in added sugar or a very lowcarbohydrate , high-fat ketogenic diet that causes the body to switch from burning carbohydrates to burning fat . The group will be the first of 5 that will participate in the trial over 3 years . Changes in body fat mass and energy expenditure will be assessed to determine if any of the diets have a unique effect on metabolism , while controlling calorie intake , in people who have already lost weight . “ It ’s hard to lose weight , but it ’s much harder to maintain that weight loss because of well-described physiological adaptations , ” said coprincipal investigator David S. Ludwig , MD , PhD , a professor of pediatrics and nutrition at Harvard Medical School and Harvard T.H. Chan School of Public Health . After most diet-induced weight loss , “ hunger goes up and metabolic rate goes down , and tendency to restore fat increases . ” But there are hints that the ketogenic diet may be different . A meta- analysis of 13 r and omized controlled trials suggested that people on ketogenic diets tend to lose more weight and keep more of it off than people on low-fat diets . People placed on these diets often report decreased hunger , according to Amy Miskimon Goss , PhD , RD , an assistant professor at the University of Alabama at Birmingham ( UAB ) Nutrition Obesity Research Center . The appetitesuppressing powers of the diet are n’t fully understood but could have to do with the satiating properties of fat and protein , changes in appetite-regulating hormones on a low-carb diet , a direct hunger-reducing role of ketone bodies— the body ’s main fuel source on the diet — or other factors . Additionally , the ketogenic diet may not affect metabolism the same way other diets do . In a previous study , Ludwig found that metabolism slowed by more than 400 kcal/d on a low-fat diet while there was no significant decline in metabolic rate on a  very low-carb diet . Medical News & Perspectives ........ Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that Background / objectives : Formulas developed to estimate diet-dependent net acid excretion ( NAE ) generally agree with measured values for typical Western diets . Whether they can also appropriately predict NAE for ‘ Paleolithic-type ’ ( Paleo ) diets — which contain very high amounts of fruits and vegetables ( F&V ) and concurrent high amounts of protein is unknown . Here , we compare measured NAEs with established NAE estimates in subjects with Type 2 diabetes (T2D).Subjects/ methods : Thirteen subjects with well-controlled T2D were r and omized to either a Paleo or American Diabetes Association ( ADA ) diet for 14 days . Twenty-four hour urine collection s were performed at baseline and end of the diet period , and analyzed for titratable acid , bicarbonate and ammonium to calculate measured NAE . Three formulas for estimating NAE from dietary intake were used ; two ( NAE_diet R or L ) that include dietary mineral intake and sulfate- and organic acid ( OA ) production , and one that is empirically derived ( NAE_diet F ) only considering potassium and protein intake . Results : Measured NAE on the Paleo diet was significantly lower than on the ADA-diet ( + 31±22 vs 112±52 mEq/day , P=0.002 ) . Although all formula estimates showed similar and reasonable correlations ( r=0.52–0.76 ) with measured NAE , each one underestimated measured values . The formula with the best correlation did not contain an estimate of dietary OA production . Conclusions : Paleo-diets are lower in NAE than typical Western diets . However , commonly used formulas clearly underestimate NAE , especially for diets with very high F&V ( as the Paleo diet ) , and in subjects with T2D . This may be due to an inappropriate estimation of proton loads stemming from OAs , underlining the necessity for improved measures of OA-related proton sources BACKGROUND Energy restriction is a common therapeutic approach for weight reduction , but the most effective macronutrient distribution of the hypoenergetic diet as well as the role of the metabolic processes involved require further investigations . OBJECTIVE To study the effect of a high protein ( HP ) hypoenergetic diet compared with a high carbohydrate ( HC ) hypoenergetic diet on fuel utilisation changes during the weight loss process in obese women . DESIGN Eleven obese ( BMI > 30 ) women were r and omly assigned to a 10w dietary intervention study comparing HP ( 30 % protein ) or HC ( 55 % carbohydrate ) energy restricted diets providing 30 % energy fat content . Substrate utilisation was evaluated by indirect calorimetry . Body weight and composition ( Bod Pod ) and blood measurements were performed before and after weight loss . RESULTS On average , the individuals on the HP dietary group lost 4.4 kg more than those in the HC program ( p<0.50 ) , which was mainly due to a fat mass loss ( 3.7 kg , p<0.05 ) with no statistical differences in lean body mass reduction . These losses were accompanied by a significant decrease in fasting leptin in the HP group ( -52 % ; P<0.05 ) . On the other h and post-absorptive lipid oxidation decreased in the HC group ( -48 % ) and remained unchanged in the HP groups . CONCLUSIONS The replacement of some dietary carbohydrate by protein in energy restricted diets , improves weight and fat losses and specifically promotes lipid oxidation in the fasting state , without major different in lean body mass depletion The roles of different dietary proteins in the aetiology of  type 2 diabetes ( T2D ) remain unclear . We investigated the associations of dietary proteins with the  risk of incident T2D in Finnish men from the prospect i ve Kuopio Ischaemic Heart Disease Risk Factor Study . The study included 2332 men aged 42 - 60 years at the baseline examinations in 1984 - 1989 .  Protein intakes were calculated from 4-d dietary records . Incident T2D was determined by self-administered question naires , fasting blood glucose measurements , 2-h oral glucose tolerance tests , and with national registers . The multivariable-adjusted risk of T2D on the basis of protein intakes was compared by the Cox proportional hazard ratios ( HR ) . During the mean follow-up of 19·3 years , 432 incident T2D cases were identified .  Total , animal , meat or dairy product protein  intakes were not associated with risk of T2D when the potential confounders were accounted for . Plant ( multivariable-adjusted extreme-quartile HR 0·65 ; 95 % CI 0·42 , 1·00 ; P trend 0·04 ) and egg ( HR 0·67 ; 95 % CI 0·44 , 1·00 ; P trend 0·03 ) protein intakes were associated with a decreased risk of T2D . Adjustments for BMI , plasma glucose and serum insulin slightly attenuated associations . Replacing 1 % energy from carbohydrates with energy from protein was associated with a 5 % ( 95 % CI 0 , 11 ) increased risk of T2D , but adjustment for fibre intake attenuated the association . Replacing 1 % of energy from animal protein with energy from plant protein was associated with 18 % ( 95 % CI 0 , 32 ) decreased risk of T2D . This association remained after adjusting for BMI . In conclusion , favouring plant and egg proteins appeared to be beneficial in preventing T2D Background Obesity is significant problem involving eating behavior and peripheral metabolic conditions . The effect of carbohydrate and fat restriction on appetite regulation , fibroblast growth factor 21 ( FGF21 ) and leptin in children has not been defined . Our objective was to compare the effect of both diets . Methods One hundred and twenty children with body mass index ( BMI ) higher than the equivalent of 30 kg/m2 for an adult , as corrected for gender and age were r and omly assigned to ( n = 60 ) a low-carbohydrate ( L-CHO ) diet or ( n = 60 ) a low-fat ( L-F ) diet for 2 months . Fifty-three ( 88.3 % ) subjects on the low-carbohydrate-diet and 45 ( 75 % ) on the low-fat diet completed the study .  Anthropometric measures , leptin and FGF21 levels were measured before and after the intervention . Comparison of the data for both of the diet groups was carried out using the t-test for independent variables . Intragroup comparisons before and after of each of the dietary treatments were performed using ANOVA for repeated measures . Factors associated with FGF21 , leptin levels and satiety , were analyzed by multiple regression . Results After both of the diets , weight , leptin , food responsiveness , and enjoyment of food significantly decreased and high density lipoprotein cholesterol ( HDL ) increased , but FGF21 decreased . Before and after both of the interventions FGF21 was associated with triglycerides . Before the diet , satiety was associated with lower screen time ( p < 0.04 ) and insulin levels ( p < 0.05 ) . Conclusions Both dietary restrictions improved the metabolic and hormonal parameters of obese children . FGF21 is an indicator of a beneficial metabolic response in younger children . After 2 months an adaptation of the eating behavior to food restriction was observed BACKGROUND Few well-controlled studies have comprehensively examined the effects of very-low-carbohydrate diets on  type 2 diabetes ( T2D ) . OBJECTIVE We compared the effects of a very-low-carbohydrate , high-unsaturated fat , low-saturated fat ( LC ) diet with a high-carbohydrate , low-fat ( HC ) diet on glycemic control and cardiovascular disease risk factors in T2D after 52 wk . DESIGN In this r and omized controlled trial that was conducted in an outpatient research clinic , 115 obese adults with T2D [ mean ± SD age : 58 ± 7 y ; body mass index ( in kg/m(2 ) ) : 34.6 ± 4.3 ; glycated hemoglobin ( HbA1c ) : 7.3 ± 1.1 % ; duration of diabetes : 8 ± 6 y ] were r and omly assigned to consume either a hypocaloric LC diet [ 14 % of energy as carbohydrate ( carbohydrate < 50 g/d ) , 28 % of energy as protein , and 58 % of energy as fat ( < 10 % saturated fat ) ] or an energy-matched HC diet [ 53 % of energy as carbohydrate , 17 % of energy as protein , and 30 % of energy as fat ( < 10 % saturated fat ) ] combined with supervised aerobic and resistance exercise ( 60 min ; 3 d/wk ) . Outcomes were glycemic control assessed with use of measurements of HbA1c , fasting blood glucose , glycemic variability assessed with use of 48-h continuous glucose monitoring , diabetes medication , weight , blood pressure , and lipids assessed at baseline , 24 , and 52 wk . RESULTS Both groups achieved similar completion rates ( LC diet : 71 % ; HC diet : 65 % ) and mean ( 95 % CI ) reductions in weight [ LC diet : -9.8 kg ( -11.7 , -7.9 kg ) ; HC diet : -10.1 kg ( -12.0 , -8.2 kg ) ] , blood pressure [ LC diet : -7.1 ( -10.6 , -3.7)/-6.2 ( -8.2 , -4.1 ) mm Hg ; HC diet : -5.8 ( -9.4 , -2.2)/-6.4 ( -8.4 , -4.3 ) mm Hg ] , HbA1c [ LC diet : -1.0 % ( -1.2 % , -0.7 % ) ; HC diet : -1.0 % ( -1.3 % , -0.8 % ) ] , fasting glucose [ LC diet : -0.7 mmol/L ( -1.3 , -0.1 mmol/L ) ; HC diet : -1.5 mmol/L ( -2.1 , -0.8 mmol/L ) ] , and LDL cholesterol [ LC diet : -0.1 mmol/L ( -0.3 , 0.1 mmol/L ) ; HC diet : -0.2 mmol/L ( -0.4 , 0.03 mmol/L ) ] ( P-diet effect ≥ 0.10 ) . Compared with the HC-diet group , the LC-diet group achieved greater mean ( 95 % CI ) reductions in the diabetes medication score [ LC diet : -0.5 arbitrary units ( -0.7 , -0.4 arbitrary units ) ; HC diet : -0.2 arbitrary units ( -0.4 , -0.06 arbitrary units ) ; P = 0.02 ] , glycemic variability assessed by measuring the continuous overall net glycemic action-1 [ LC diet : -0.5 mmol/L ( -0.6 , -0.3 mmol/L ) ; HC diet : -0.05 mmol/L ( -0.2 , -0.1 mmol/L ) ; P = 0.003 ] , and triglycerides [ LC diet : -0.4 mmol/L ( -0.5 , -0.2 mmol/L ) ; HC diet : -0.01 mmol/L ( -0.2 , 0.2 mmol/L ) ; P = 0.001 ] and greater mean ( 95 % CI ) increases in HDL cholesterol [ LC diet : 0.1 mmol/L ( 0.1 , 0.2 mmol/L ) ; HC diet : 0.06 mmol/L ( -0.01 , 0.1 mmol/L ) ; P = 0.002 ] . CONCLUSIONS Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose . The LC diet , which was high in unsaturated fat and low in saturated fat , achieved greater improvements in the lipid profile , blood glucose stability , and reductions in diabetes medication requirements , suggesting an effective strategy for the optimization of T2D management . This trial was registered at www.anzctr.org.au as ACTRN12612000369820 BACKGROUND Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates . METHODS In this 2-year trial , we r and omly assigned 322 moderately obese subjects ( mean age , 52 years ; mean body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 31 ; male sex , 86 % ) to one of three diets : low-fat , restricted-calorie ; Mediterranean , restricted-calorie ; or low-carbohydrate , non-restricted-calorie . RESULTS The rate of adherence to a study diet was 95.4 % at 1 year and 84.6 % at 2 years . The Mediterranean-diet group consumed the largest amounts of  dietary fiber  and had the highest ratio of monounsaturated to saturated fat ( P<0.05 for all comparisons among treatment groups ) . The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat , protein , and cholesterol and had the highest percentage of participants with detectable urinary ketones ( P<0.05 for all comparisons among treatment groups ) . The mean weight loss was 2.9 kg for the low-fat group , 4.4 kg for the Mediterranean-diet group , and 4.7 kg for the low-carbohydrate group ( P<0.001 for the interaction between diet group and time ) ; among the 272 participants who completed the intervention , the mean weight losses were 3.3 kg , 4.6 kg , and 5.5 kg , respectively . The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20 % in the low-carbohydrate group and 12 % in the low-fat group ( P=0.01 ) . Among the 36 subjects with diabetes , changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet ( P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels ) . CONCLUSIONS Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets . The more favorable effects on lipids ( with the low-carbohydrate diet ) and on glycemic control ( with the Mediterranean diet ) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions . ( Clinical Trials.gov number , NCT00160108 . OBJECTIVE We performed this study as a pilot experiment to investigate the short term effects of two diets of varying composition on weight loss as the primary outcome in obese women with polycystic ovary syndrome ( PCOS ) seeking fertility . DESIGN R and omized clinical trial . SETTING Academic medical center . PATIENT(S ) Thirty-five obese women with PCOS . INTERVENTION(S ) We examined the effects of a 1-month dietary intervention on the PCOS phenotype . Participants were r and omized to one of two energy-restricted diets ; high protein ( HP : 30 % protein , 40 % carbohydrate , and 30 % fat ) or high carbohydrate ( HC : 15 % protein , 55 % carbohydrate , and 30 % fat ) . The fat content was held constant in both diets . MAIN OUTCOME MEASURE(S ) Primary - change in body weight ; Secondary - biometric , hormonal , lipid and lipoprotein , and markers of glucose homeostasis and energy metabolism . RESULT ( S ) Twenty-six women completed the study . Both the HP ( -3.7 + /- 1.9 kg ) and HC ( -4.4 + /- 1.5 kg ) diets result ed in significant weight loss , but there was no significant difference in mean weight loss between the two groups . There were also no differences between diets on a variety of measures including circulating and rogens , measures of glucose metabolism , and leptin . However , the effects of a hypocaloric diet per se on improving metabolic and reproductive abnormalities in a group of PCOS women were marked by a decline in circulating and rogens ( P=.03 ) , fasting and area under the curve ( AUC ) insulins ( P<.05 ) on a 3-hour oral glucose tolerance test ( OGTT ) , and fasting and AUC leptin levels ( P<.0001 ) . There was a high prevalence of menstrual bleeding during the trial ( 14 out of 26 patients ) . CONCLUSION ( S ) Those who completed the short-term hypocaloric diet had a significant weight loss and a significant improvement in their reproductive and metabolic abnormalities . There was no increased benefit to a high-protein diet . Future diet studies evaluating the ideal composition of a hypocaloric diet in women with PCOS will require a large study population , and will most likely require a multicenter trial AIMS This study aim ed to describe the 1-year evolution of type 2 diabetes ( T2D ) patients who attended in patients education  , and to assess whether quarterly out patients counseling visits by nurses and dietitians can improve metabolic control and health-related behaviours . METHODS Following in-hospital educational sessions , 398 adult T2D patients were r and omized to either attend quarterly individual lifestyle counseling visits by a nurse and a dietitian ( intervention group ) , or receive the usual care ( control group ) . Primary ( HbA(1c ) ) and secondary endpoints ( fasting blood glucose , lipids , body mass index , waist circumference , fat mass , blood pressure , diet , physical activity ) were assessed at baseline and at 12 months . RESULTS HbA(1c ) changes from baseline to 12 months were -1.74±2.64 % ( P<0.0001 ) for the intervention group and -2.02±2.57 % ( P<0.0001 ) for the control group . There was no statistically significant difference between the intervention group ( n=153 ) and the controls ( n=166 ) for any of the clinical and biological outcomes . In both groups , total energy and fat intakes decreased significantly from baseline levels . Also , no difference was found between the groups for any dietary outcome . A slight enhancement in sports activity was observed in the intervention group , but the difference between the two groups did not reach statistical significance , and no difference was found concerning any other physical activity scores . CONCLUSION In this study of adults with T2D , patients significantly improved their metabolic control , and dietary and exercise habits , 1 year after receiving intensive in patients education , whereas subsequent quarterly out patients counseling visits with nurses and dietitians have not demonstrated any superiority compared with the usual care OBJECTIVE Hyperglycemia improves when patients with type 2 diabetes are placed on a weight-loss diet . Improvement typically occurs soon after diet implementation . This rapid response could result from low fuel supply ( calories ) , lower carbohydrate content of the weight-loss diet , and /or weight loss per se . To differentiate these effects , glucose , insulin , C-peptide and glucagon were determined during the last 24 h of a 3-day period without food ( severe calorie restriction ) and a calorie-sufficient , carbohydrate-free diet . RESEARCH DESIGN Seven subjects with untreated type 2 diabetes were studied . A r and omized-crossover design with a 4-week washout period between arms was used . METHODS Results from both the calorie-sufficient , carbohydrate-free diet and the 3-day fast were compared with the initial st and ard diet consisting of 55 % carbohydrate , 15 % protein and 30 % fat . RESULTS The overnight fasting glucose concentration decreased from 196 ( st and ard diet ) to 160 ( carbohydrate-free diet ) to 127 mg/dl ( fasting ) . The 24 h glucose and insulin area responses decreased by 35 % and 48 % on day 3 of the carbohydrate-free diet , and by 49 % and 69 % after fasting . Overnight basal insulin and glucagon remained unchanged . CONCLUSIONS Short-term fasting dramatically lowered overnight fasting and 24 h integrated glucose concentrations . Carbohydrate restriction per se could account for 71 % of the reduction . Insulin could not entirely explain the glucose responses . In the absence of carbohydrate , the net insulin response was 28 % of the st and ard diet . Glucagon did not contribute to the metabolic adaptations observed Substitution analysis has been increasingly used in nutritional epidemiologic research . It was originally used to compare the health effects of different macronutrients in an isocaloric setting [ 1 ] . This application is easy to underst and , since calories are considered relatively constrained for an individual . In essence , substitution analysis provides a statistical technique to mimic feeding studies that aim to identify the optimal diet by altering macronutrient composition while holding total caloric intake constant [ 2 ] . Using this approach , for instance , it has been established that replacing saturated fats and trans fats with monounsaturated and polyunsaturated fats ismore effective in preventing coronary heart disease than reducing overall fat intake by replacing it with the commonly consumed carbohydrate sources [ 3 ] . Beyond the health effects of macronutrient composition , an increasing number of studies have started using substitution analysis to compare the relative health associations of different food sources of certain macronutrients . For example , as a major source of carbohydrate in the US , potatoes and potato products have been compared with whole grains and refined grains for the influence on type 2 diabetes ( T2D ) [ 4 ] . Reciprocal substitution of major dietary protein sources , such as red meat , fish , poultry , dairy , and plants , have been studied in cardiovascular disease and mortality [ 5 , 6 ] . Exemplified as further expansion of the application , two studies in this issue of the Journal used substitution analysis to assess intake of different foods within a certain category in relation to disease risk . van den Br and t [ 7 ] compared the associations of two commonly consumed beverages , tea and coffee , with  mortality  in the Netherl and s Cohort Study and observed a sex-specific association pattern : while replacing coffee with tea was associated with lower mortality in men , a higher percentage of tea consumption of total coffee and tea was associated with increased mortality in women [ 7 ] . Laursen et al. [ 8 ] evaluated the associations for substitutions between subgroups of dairy products with the risk of stroke in the Danish Diet , Cancer and Health cohort , and found a beneficial association with ischemic stroke for substitution of whole-fat fermented milk for semi-skimmed fermented milk , cheese , buttermilk or milk of any fat content . Applying similar principles , Schwingshackl et al. [ 9 ] performed a network meta- analysis of 56 r and omized trials to assess the comparative efficacy of nine different dietary approaches on glycemic control in T2D patients . The findings suggest that , while all dietary approaches significantly reduce HbA1c and fasting glucose compared to a control diet , the Mediterranean diet seems most efficacious for improving glycemic control in T2D patients . These studies represent exp and ed applications of the substitution modeling approach from nutrient-based analysis to comparison of food groups or dietary patterns . These applications are particularly useful to inform dietary guidelines by either prioritizing foods within a certain group ( e.g. , beverage , dairy ) or identifying the optimal diet for better disease control and prevention . However , these applications pose new challenges , because compared to macronutrients , foods are far more complicated in several aspects . First , most food groups encompass more than three types of foods . For example , besides tea and coffee , there are other beverages such as water , juice and soda that may & Edward Giovannucci OBJECTIVE This study sought to examine the effects of a 3-month programme of dietary advice to restrict carbohydrate intake compared with reduced-portion , low-fat advice in obese subjects with poorly controlled Type 2 diabetes . RESEARCH DESIGN AND METHODS One hundred and two patients with Type 2 diabetes were recruited across three centres and r and omly allocated to receive group education and individual dietary advice .  Weight , glycaemic control , lipids and blood pressure were assessed at baseline and 3 months . Dietary quality was assessed at the end of study . RESULTS Weight loss was greater in the low-carbohydrate ( LC ) group ( -3.55 + /- 0.63 , mean + /- sem ) vs. -0.92 + /- 0.40 kg , P = 0.001 ) and cholesterol : high-density lipoprotein ( HDL ) ratio improved ( -0.48 + /- 0.11 vs. -0.10 + /- 0.10 , P = 0.01 ) . However , relative saturated fat intake was greater ( 13.9 + /- 0.71 vs. 11.0 + /- 0.47 % of dietary intake , P < 0.001 ) , although absolute intakes were moderate . CONCLUSIONS Carbohydrate restriction was an effective method of achieving short-term weight loss compared with st and ard advice , but this was at the expense of an increase in relative saturated fat intake Background Plant-based diets have been recommended to reduce the risk of type 2 diabetes ( T2D ) . However , not all plant foods are necessarily beneficial . We examined the association of an overall plant-based diet and hypothesized healthful and unhealthful versions of a plant-based diet with T2D incidence in three prospect i ve cohort studies in the US . Methods and Findings We included 69,949 women from the Nurses ’ Health Study ( 1984–2012 ) , 90,239 women from the Nurses ’ Health Study 2 ( 1991–2011 ) , and 40,539 men from the Health Professionals Follow-Up Study ( 1986–2010 ) , free of chronic diseases at baseline .  Dietary data were collected every 2–4 y using a semi-quantitative food frequency question naire . Using these data , we created an overall  plant-based diet index  ( PDI ) , where plant foods received positive scores , while animal foods ( animal fats , dairy , eggs , fish/seafood , poultry/red meat , miscellaneous animal-based foods ) received reverse scores . We also created a healthful plant-based diet index ( hPDI ) , where healthy plant foods ( whole grains , fruits , vegetables , nuts , legumes , vegetable oils , tea/coffee ) received positive scores , while less healthy plant foods ( fruit juices , sweetened beverages , refined grains , potatoes , sweets/desserts ) and animal foods received reverse scores . Lastly , we created an unhealthful plant-based diet index ( uPDI ) by assigning positive scores to less healthy plant foods and reverse scores to healthy plant foods and animal foods . We documented 16,162 incident T2D cases during 4,102,369 person-years of follow-up . In pooled multivariable-adjusted analysis , both PDI and hPDI were inversely associated with T2D ( PDI : hazard ratio [ HR ] for extreme deciles 0.51 , 95 % CI 0.47–0.55 , p trend < 0.001 ; hPDI : HR for extreme deciles 0.55 , 95 % CI 0.51–0.59 , p trend < 0.001 ) . The association of T2D with PDI was considerably attenuated when we additionally adjusted for body mass index ( BMI ) categories ( HR 0.80 , 95 % CI 0.74–0.87 , p trend < 0.001 ) , while that with hPDI remained largely unchanged ( HR 0.66 , 95 % CI 0.61–0.72 , p trend < 0.001 ) . uPDI was positively associated with T2D even after BMI adjustment ( HR for extreme deciles 1.16 , 95 % CI 1.08–1.25 , p trend < 0.001 ) . Limitations of the study include self-reported diet assessment , with the possibility of measurement error , and the potential for residual or unmeasured confounding given the observational nature of the study design . Conclusions Our study suggests that plant-based diets , especially when rich in high- quality plant foods , are associated with substantially lower risk of developing T2D . This supports current recommendations to shift to diets rich in healthy plant foods , with lower intake of less healthy plant and animal foods Aims /hypothesisThis study compared the long-term weight loss and health outcomes at 1-year follow-up , after a 12-week intensive intervention consisting of two low-fat , weight-loss diets , which differed in protein content . Methods We r and omly assigned 66 obese patients ( BMI : 27–40 kg/m2 ) with Type 2 diabetes to either a low-protein ( 15 % protein , 55 % carbohydrate ) or high-protein diet ( 30 % protein , 40 % carbohydrate ) for 8 weeks of energy restriction ( ~6.7 MJ/day ) and 4 weeks of energy balance . Subjects were asked to maintain the same dietary pattern for a further 12 months of follow-up . Results The study was completed by 38 of the subjects , with equal dropouts in each group . At Week 64 , weight reductions against baseline were −2.2±1.1 kg ( low protein ) and −3.7±1.0 kg ( high protein ) , p<0.01 , with no diet effect . Fat mass was not different from baseline in either group . At Week 12 , both diets reduced systolic and diastolic blood pressure by 6 and 3 mm Hg respectively , but blood pressure increased more with weight regain during follow-up in the low-protein group ( p≤0.04 ) . At Week 64 , both diets significantly increased HDL cholesterol and lowered C-reactive protein concentrations . There was no difference in the urinary urea : creatinine ratio at baseline between the two groups , but this ratio increased at Week 12 ( in the high-protein group only , p<0.001 , diet effect ) , remaining stable during follow-up in both diets . Conclusions /interpretationA high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with Type 2 diabetes BACKGROUND AND AIM A high intake of dairy has been linked to lower risk of type 2 diabetes ( T2D ) . The relationship between dairy intake and glucose metabolism is still not well understood . The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and T2D and measures of glucose metabolism . METHODS AND RESULTS A total of 5953 Danish men and women aged 30 - 60 years without baseline diabetes or cardiovascular diseases were included in this prospect i ve analysis . The dairy intake at baseline was categorised into low-fat dairy , full-fat dairy , milk and milk products , cheese and fermented dairy .  Fasting plasma glucose ( FPG ) , 2-h plasma glucose ( 2hPG ) , HbA1c , insulin resistance ( HOMA2-IR ) and beta-cell function ( HOMA2-B ) were considered at 5-year follow-up . In the maximally-adjusted model ( demographics , lifestyle factors , dietary factors and waist ) , cheese intake was inversely associated with 2hPG ( β = -0.048 , 95 % CI -0.095 ; -0.001 ) . Fermented dairy intake was inversely associated with FPG ( β = -0.028 , 95 % CI -0.048 ; -0.008 ) and HbA1c ( β = -0.016 , 95 % CI -0.030 ; -0.001 ) . Total dairy intake and the dairy subgroups were not related to HOMA-IR and HOMA-B in the maximally-adjusted model . Furthermore , there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D . CONCLUSION Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures ; however , this did not translate into a significant association with incident T2D BACKGROUND Diet plays a key role in the development of type 2 diabetes ( T2D ) , but little is known about the contributions of specific nutrients in population s in which dietary patterns differ from Western population s. OBJECTIVE We examined associations between  calcium and magnesium intakes and the risk of T2D in a Chinese population . DESIGN We used data from a population -based , prospect i ve study of 64,191 women who were free of T2D or other chronic diseases at study recruitment and were living in urban Shanghai , China .  Dietary intake , physical activity , and anthropometric measurements were assessed through in-person interviews . A Cox regression model was used to evaluate the association of the exposures under study with the risk of T2D . RESULTS An inverse association between calcium and magnesium intakes and T2D risk was observed . The relative risks for the lowest to the highest quintiles of calcium intake were 1.00 , 0.82 , 0.73 , 0.67 , and 0.74 ( P for trend < 0.001 ) , and for magnesium they were 1.00 , 0.84 , 0.84 , 0.79 , and 0.86 ( P for trend < 0.001 ) . Milk intake was also inversely associated with the risk of T2D . CONCLUSION Our data suggest that calcium and magnesium intakes may protect against the development of T2D in this population It is unclear whether chronic exercise without caloric restriction or weight loss is a useful strategy for obesity reduction in obese men with and without Type 2 diabetes ( T2D ) . We examined the effects of exercise without weight loss on total and regional adiposity and skeletal muscle mass and composition in lean men and in obese men with and without T2D . Twenty-four men participated in 13 wk of supervised aerobic exercise , five times per week for 60 min at a moderate intensity ( approximately 60 % peak oxygen uptake ) . Total and regional body composition was measured by magnetic resonance imaging .  Skeletal muscle composition was determined using computed tomography .  Cardiorespiratory fitness was assessed using a grade d maximal treadmill test .  Body weight did not change within any group in response to exercise ( P > 0.1 ) . Significant reductions in total , abdominal subcutaneous , and visceral fat were observed within each group ( P < 0.01 ) . The reduction in total and abdominal subcutaneous fat was not different ( P > 0.1 ) between groups ; however , the reduction in visceral fat was greater ( P < 0.01 ) in the obese and T2D groups by comparison to the lean group . A significant ( P < 0.01 ) increase in total skeletal muscle , high-density muscle area , and mean muscle attenuation was observed independent of group , and these changes were not different between groups ( P > 0.1 ) . Accordingly , whole body fat-to-muscle ratio was increased ( P < 0.01 ) independent of groups . In conclusion , regular exercise without weight loss is associated with a substantial reduction in total and visceral fat and in skeletal muscle lipid in both obesity and T2D BACKGROUND Limited evidence suggests that a higher ratio of protein to carbohydrate during weight loss has metabolic advantages . OBJECTIVE The objective was to evaluate the effects of a diet with a high ratio of protein to carbohydrate during weight loss on body composition , cardiovascular disease risk , nutritional status , and markers of bone turnover and renal function in overweight women . DESIGN The subjects were r and omly assigned to 1 of 2 isocaloric 5600-kJ dietary interventions for 12 wk according to a parallel design : a high-protein ( HP ) or a high-carbohydrate ( HC ) diet . RESULTS One hundred women with a mean ( + /-SD ) body mass index ( in kg/m(2 ) ) of 32 + /- 6 and age of 49 + /- 9 y completed the study .  Weight loss was 7.3 + /- 0.3 kg with both diets . Subjects with high serum triacylglycerol ( > 1.5 mmol/L ) lost more fat mass with the HP than with the HC diet ( x + /- SEM : 6.4 + /- 0.7 and 3.4 + /- 0.7 kg , respectively ; P = 0.035 ) and had a greater decrease in triacylglycerol concentrations with the HP ( -0.59 + /- 0.19 mmol/L ) than with the HC ( -0.03 + /- 0.04 mmol/L ) diet ( P = 0.023 for diet x triacylglycerol interaction ) . Triacylglycerol concentrations decreased more with the HP ( 0.30 + /- 0.10 mmol/L ) than with the HC ( 0.10 + /- 0.06 mmol/L ) diet ( P = 0.007 ) . Fasting LDL-cholesterol , HDL-cholesterol , glucose , insulin , free fatty acid , and C-reactive protein concentrations decreased with weight loss . Serum vitamin B-12 increased 9 % with the HP diet and decreased 13 % with the HC diet ( P < 0.0001 between diets ) . Folate and vitamin B-6 increased with both diets ; homocysteine did not change significantly . Bone turnover markers increased 8 - 12 % and calcium excretion decreased by 0.8 mmol/d ( P < 0.01 ) . Creatinine clearance decreased from 82 + /- 3.3 to 75 + /- 3.0 mL/min ( P = 0.002 ) . CONCLUSION An energy-restricted , high-protein , low-fat diet provides nutritional and metabolic benefits that are equal to and sometimes greater than those observed with a high-carbohydrate diet Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = Objectives The aim of this study was to compare the effect of a simple dietary advice with two energy-restricted diets with different carbohydrate and fiber contents on anthropometric , biochemical , and inflammatory markers over an 8-wk intervention period in individuals with diabetes . Methods Forty-seven patients with type 2 diabetes ( 31 women and 16 men ; age : 52.9 ± 8.0 years , body mass index : 29.5 ± 4.9 kg.m-2 ) completed an 8-wk r and omized intervention trial that compared a simple dietary advice aim ed to modulate carbohydrate intake ( n = 13 ) with the two calorie-restricted ( CR ) diets ( 25 % caloric restriction from total energy requirements ) differing with regard to carbohydrate and fiber content , one with higher fiber ( CRHF ) containing 55 % energy from carbohydrate plus a tablespoon of psyllium powder ( n = 18 ) and the other with lower carbohydrate ( CRLC ) containing 40 % energy from carbohydrate plus placebo powder ( n = 16 ) . Weight , plasma concentrations of glucose , insulin , lipids , interleukin-6 ( IL-6 ) , and tumor necrosis factor alpha ( TNF-α ) were determined at baseline and after 8 weeks . Results The mean change of body weight and plasma lipids were not different between the groups . Fasting plasma insulin and the homeostasis model assessment of insulin resistance ( HOMA-IR ) were significantly lower in the CRHF group ( changes from baseline values in simple advice , CRHF , and CRLC were 1.3 ± 1.9 , -1.0 ± 1.2 , and 0.3 ± 3.1 µIL/mL for insulin and 0.5 ± 0.7 , -0.3 ± 0.6 , and 0.2 ± 0.9 for HOMA-IR , respectively ) . The levels of IL-6 significantly decreased in the CRHF and CRLC groups ( changes from baseline values in simple advice , CRHF , and CRLC were 7.5 ± 6.8 , -1.2 ± 4.7 , and -4.2 ± 5.6 pg/mL , respectively ) . TNF-α levels were significantly lower only in the CRHF compared to the advice group ( P < 0.05 ) . Conclusions Our results suggest that in comparison with simple advice to modify carbohydrate intake , a calorie-restricted , moderate carbohydrate diet supplemented with psyllium has better effects on plasma insulin and pro-inflammatory cytokines in patients with type 2 diabetes Background Low-carbohydrate diets have been shown to effectively improve the metabolic status of patients with type 2 diabetes mellitus . However , patients may find it challenging to maintain a strict low-carbohydrate diet . The objective of this study was to determine if a one-meal , low-carbohydrate diet is as effective in improving metabolic status as a conventional , energy-restricted diet among patients with type 2 diabetes mellitus . Methods In this 12-week r and omized controlled study , the primary endpoint was differences in the changes of plasma glycosylated hemoglobin ( HbA1c ) levels between the two experimental groups . Since the two groups had differences in body weight , body mass index , and waist circumference , propensity score matching was used to assess HbA1c outcomes via cohort pairs according to age , sex , body weight , HbA1c level , and waist circumference . Results There were no differences in the changes in HbA1c between the two groups ( P = 0.95 ) . In addition , there were no differences in the changes in glycated albumin , 1,5-anhydroglucitol , lipid profile , body weight , waist circumference , and fat mass between the two groups . The mini low-carbohydrate diet group had an increased protein intake ( P = 0.0085 ) , as compared with the control group . However , neither group showed changes in their Diabetes Treatment Satisfaction Question naire score . Conclusion Either diet would be effective for improving the metabolic status of this study population OBJECTIVE To study the effects of high-protein versus high-carbohydrate diets on various metabolic end points ( glucoregulation , oxidative stress [ dichlorofluorescein ] , lipid peroxidation [ malondialdehyde ] , proinflammatory cytokines [ tumor necrosis factor-α and interleukin-6 ] , adipokines , and resting energy expenditure [ REE ] ) with high protein – low carbohydrate ( HP ) and high carbohydrate – low protein ( HC ) diets at baseline and after 6 months of dietary intervention . RESEARCH DESIGN AND METHODS We recruited obese , premenopausal women aged 20–50 years with no diabetes or prediabetes who were r and omized to HC ( 55 % carbohydrates , 30 % fat , and 15 % protein ) or HP ( 40 % carbohydrates , 30 % fat , and 30 % protein ) diets for 6 months . The diets were provided in prepackaged food , which provided 500 kcal restrictions per day . The above metabolic end points were measured with HP and HC diet at baseline and after 6 months of dietary intervention . RESULTS After 6 months of the HP versus HC diet ( 12 in each group ) , the following changes were significantly different by Wilcoxon rank sum test for the following parameters : dichlorofluorescein ( −0.8 vs. −0.3 µmol/L , P < 0.0001 ) , malondialdehyde ( −0.4 vs. −0.2 μmol/L , P = 0.0004 ) , C-reactive protein ( −2.1 vs. −0.8 mg/L , P = 0.0003 ) , E-selectin ( −8.6 vs. −3.7 ng/mL , P = 0.0007 ) , adiponectin ( 1,284 vs. 504 ng/mL , P = 0.0011 ) , tumor necrosis factor-α ( −1.8 vs. −0.9 pg/mL , P < 0.0001 ) , IL-6 ( −1.3 vs. −0.4 pg/mL , P < 0.0001 ) , free fatty acid ( −0.12 vs. 0.16 mmol/L , P = 0.0002 ) , REE ( 259 vs. 26 kcal , P < 0.0001 ) , insulin sensitivity ( 4 vs. 0.9 , P < 0.0001 ) , and β-cell function ( 7.4 vs. 2.1 , P < 0.0001 ) . CONCLUSIONS To our knowledge , this is the first report on the significant advantages of a 6-month hypocaloric HP diet versus hypocaloric HC diet on markers of β-cell function , oxidative stress , lipid peroxidation , proinflammatory cytokines , and adipokines in normal , obese females without diabetes There has been interest in the effect of various types and amounts of dietary carbohydrates and proteins on blood glucose . On the basis of our previous data , we design ed a high-protein/low-carbohydrate , weight-maintaining , nonketogenic diet . Its effect on glucose control in people with untreated type 2 diabetes was determined . We refer to this as a low-biologically-available-glucose ( LoBAG ) diet .  Eight men were studied using a r and omized 5-week crossover design with a 5-week washout period . The carbohydrate : protein : fat ratio of the control diet was 55:15:30 . The test diet ratio was 20:30:50 . Plasma and urinary beta-hydroxybutyrate were similar on both diets . The mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl , respectively . The percentage of glycohemoglobin was 9.8 + /- 0.5 and 7.6 + /- 0.3 , respectively . It was still decreasing at the end of the LoBAG diet . Thus , the final calculated glycohemoglobin was estimated to be approximately 6.3 - 5.4 % . Serum insulin was decreased , and plasma glucagon was increased . Serum cholesterol was unchanged . Thus , a LoBAG diet ingested for 5 weeks dramatically reduced the circulating glucose concentration in people with untreated type 2 diabetes . Potentially , this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention . The long-term effects of such a diet remain to be determined BACKGROUND Some evidence has suggested that a diet with a higher ratio of protein to carbohydrates has metabolic advantages in the treatment of polycystic ovary syndrome ( PCOS ) . OBJECTIVE The objective of this study was to compare the effect of a high-protein ( HP ) diet to a st and ard-protein ( SP ) diet in women with PCOS . DESIGN A controlled , 6-mo trial was conducted in 57 PCOS women . The women were assigned through rank minimization to one of the following 2 diets without caloric restriction : an HP diet ( > 40 % of energy from protein and 30 % of energy from fat ) or an SP diet ( < 15 % of energy from protein and 30 % of energy from fat ) . The women received monthly dietary counseling . At baseline and 3 and 6 mo , anthropometric measurements were performed , and blood sample s were collected . RESULTS Seven women dropped out because of pregnancy , 23 women dropped out because of other reasons , and 27 women completed the study . The HP diet produced a greater weight loss ( mean : 4.4 kg ; 95 % CI : 0.3 , 8.6 kg ) and body fat loss ( mean : 4.3 kg ; 95 % CI : 0.9 , 7.6 kg ) than the SP diet after 6 mo . Waist circumference was reduced more by the HP diet than by the SP diet . The HP diet produced greater decreases in glucose than did the SP diet , which persisted after adjustment for weight changes . There were no differences in testosterone , sex hormone-binding globulin , and blood lipids between the groups after 6 mo . However , adjustment for weight changes led to significantly lower testosterone concentrations in the SP-diet group than in the HP-diet group . CONCLUSION Replacement of carbohydrates with protein in ad libitum diets improves weight loss and improves glucose metabolism by an effect that seems to be independent of the weight loss and , thus , seems to offer an improved dietary treatment of PCOS women Background : Type-2 diabetes ( T2D ) prevalence is rapidly increasing worldwide . Lifestyle factors , in particular obesity , diet , and physical activity play a significant role in the etiology of the disease . Of dietary patterns , particularly the Mediterranean diet has been studied , and generally a protective association has been identified . However , other regional diets are less explored . Objective : The aim of the present study was to investigate the association between adherence to a healthy Nordic food index and the risk of T2D . The index consists of six food items : fish , cabbage , rye bread , oatmeal , apples and pears , and root vegetables . Methods : Data was obtained from a prospect i ve cohort study of 57,053 Danish men and women aged 50–64 years , at baseline , of whom 7366 developed T2D ( median follow-up : 15.3 years ) . The Cox proportional hazards model was used to assess the association between the healthy Nordic food index and risk of T2D , adjusted for potential confounders . Results : Greater adherence to the  healthy Nordic food index was significantly associated with lower risk of T2D after adjusting for potential confounders . An index score of 5−6 points ( high adherence ) was associated with a statistically significantly 25 % lower T2D risk in women ( HR : 0.75 , 95%CI : 0.61–0.92 ) and 38 % in men ( HR : 0.62 ; 95%CI : 0.53–0.71 ) compared to those with an index score of 0 points ( poor adherence ) . Conclusion : Adherence to a healthy Nordic food index was found to be inversely associated with risk of T2D , suggesting that regional diets other than the Mediterranean may also be recommended for prevention of T2D BACKGROUND It is not clear whether varying the protein-to-carbohydrate ratio of weight-loss diets benefits body composition or metabolism . OBJECTIVE The objective was to compare the effects of 2 weight-loss diets differing in protein-to-carbohydrate ratio on body composition , glucose and lipid metabolism , and markers of bone turnover . DESIGN A parallel design included either a high-protein diet of meat , poultry , and dairy foods ( HP diet : 27 % of energy as protein , 44 % as carbohydrate , and 29 % as fat ) or a st and ard-protein diet low in those foods ( SP diet : 16 % of energy as protein , 57 % as carbohydrate , and 27 % as fat ) during 12 wk of energy restriction ( 6 - 6.3 MJ/d ) and 4 wk of energy balance ( approximately 8.2 MJ/d ) . Fifty-seven overweight volunteers with fasting insulin concentrations > 12 mU/L completed the study . RESULTS Weight loss ( 7.9 + /- 0.5 kg ) and total fat loss ( 6.9 + /- 0.4 kg ) did not differ between diet groups . In women , total lean mass was significantly ( P = 0.02 ) better preserved with the HP diet ( -0.1 + /- 0.3 kg ) than with the SP diet ( -1.5 + /- 0.3 kg ) . Those fed the HP diet had significantly ( P < 0.03 ) less glycemic response at weeks 0 and 16 than did those fed the SP diet . After weight loss , the glycemic response decreased significantly ( P < 0.05 ) more in the HP diet group . The reduction in serum triacylglycerol concentrations was significantly ( P < 0.05 ) greater in the HP diet group ( 23 % ) than in the SP diet group ( 10 % ) . Markers of bone turnover , calcium excretion , and systolic blood pressure were unchanged . CONCLUSION Replacing carbohydrate with protein from meat , poultry , and dairy foods has beneficial metabolic effects and no adverse effects on markers of bone turnover or calcium excretion OBJECTIVE To determine the optimal diet for improving glucose and lipid profiles in obese patients with type 2 diabetes during moderate energy restriction . RESEARCH DESIGN AND METHODS A total of 35 free-living obese patients with type 2 diabetes were assigned to one of three 1,600 kcal/day diets for 12 weeks . The diets were high carbohydrate ( 10 % fat , 4 % saturated ) , high monounsaturated fat ( MUFA ) ( 32 % fat , 7 % saturated ) , or high saturated fat ( SFA ) ( 32 % fat , 17 % saturated ) . RESULTS Diet composition did not affect the magnitude of weight loss , with subjects losing an average of 6.6 + /- 0.9 kg . Energy restriction and weight loss result ed in reductions in fasting plasma glucose ( -14 % ) , insulin ( -27 % ) , GHb ( -14 % ) , and systolic ( -7 % ) and diastolic blood pressure ( -10 % ) levels and the glucose response area ( -17 % ) independent of diet composition . Diet composition did affect the lipoprotein profile . LDL was 10 % and 17 % lower with the high-carbohydrate and high-MUFA diets , respectively , whereas no change was observed with the high-SFA diet ( P < 0.001 for effect of diet ) . HDL was transiently reduced on the high-carbohydrate diet at weeks 1 , 4 , and 8 , whereas higher fat consumption maintained these levels . The total cholesterol : HDL ratio , although significantly reduced on the high-MUFA diet ( P < 0.01 ) , was not different from the other two diets after adjustment for baseline differences . CONCLUSIONS Energy restriction , independent of diet composition , improves glycemic control ; however , reducing SFA intake by replacing SFA with carbohydrate or MUFA reduces LDL maximally during weight loss and to a greater degree than has been shown in weight-stable studies Abstract Purpose The possible effects of dairy consumption on diabetes prevention remain controversial . The aim of this study was to investigate the association between the dairy consumption and  type 2 diabetes ( T2D ) risk  in an elderly Mediterranean population at high cardiovascular risk . Methods We prospect ively followed 3,454 non-diabetic individuals from the PREDIMED study .  Dairy consumption was assessed at baseline and yearly using food frequency question naires and categorized into total , low-fat , whole-fat , and subgroups : milk , yogurt , cheeses , fermented dairy , concentrated full fat , and processed dairy .  Hazard ratios ( HRs ) were calculated using Cox proportional hazards regression models . Results During a median follow-up of 4.1 years , we documented 270 incident T2D cases . After multivariate adjustment , total dairy product consumption was inversely associated with T2D risk [ 0.68 ( 95 % CI 0.47–0.98 ) ; P-trend = .040 ] . This association appeared to be mainly attributed to low-fat dairy ; the multivariate HRs ( 95 % CIs ) comparing the highest versus the lowest tertile consumption were 0.65 ( 0.45–0.94 ) for low-fat dairy products and 0.67 ( 0.46–0.95 ) for low-fat milk ( both P-trend < .05 ) . Total yogurt consumption was associated with a lower T2D risk [ HR 0.60 ( 0.42–0.86 ) ; P-trend = .002 ] . An increased consumption of total low-fat dairy and total yogurt during the follow-up was inversely associated with T2D ; HRs were 0.50 ( 0.29–0.85 ) , 0.44 ( 0.26–0.75 ) , and 0.55 ( 0.33–0.93 ) , respectively . Substituting one serving/day of a combination of biscuits and chocolate and whole grain biscuits and homemade pastries for one serving/day of yogurt was associated with a 40 and 45 % lower risk of T2D , respectively . No significant associations were found for the other dairy subgroups ( cheese , concentrated full fat , and processed dairy products ) . Conclusions A healthy dietary pattern incorporating a high consumption of dairy products and particularly yogurt may be protective against T2D in older adults at high cardiovascular risk Background Inflammation plays a major role in diabetes‐associated cardiovascular disease ( CVD ) . There is uncertainty whether diet and physical activity interventions can be successfully integrated into healthcare setting s and reduce markers of inflammation and risk of CVD in patients with type 2 diabetes ( T2D ) . Methods and Results Systemic markers of inflammation were determined in a 12‐month , real‐world , multicenter , r and omized , controlled trial that investigated the effect of diet , diet plus physical activity , and usual care in 593 individuals with newly diagnosed T2D . During the first 6 months , serum C‐reactive protein ( CRP ) improved by −21 ( −36 to −1.4)% and −22 ( −38 to −3.1)% in diet and diet plus physical activity arms versus usual care . There were also improvements in adiponectin and soluble intercellular adhesion molecule‐1 ( sICAM‐1 ) . Though medication‐adjusted CRP was improved between 6 and 12 months for usual care , both interventions were more successful in reducing the relative risk of a high‐risk CRP level of > 3 mg/L ( risk ratios of 0.72 [ 0.55 to 0.95 ] for diet versus usual care and 0.67 [ 0.50 to 0.90 ] for diet plus activity versus usual care  ) . Furthermore , sICAM‐1 ( a marker of vascular risk ) , remained substantially lower than usual care in both intervention arms at 12 months . Conclusions Motivational , unsupervised diet and /or diet plus physical activity interventions given soon after diagnosis in real‐world healthcare setting s improve markers of inflammation and cardiovascular risk in patients with T2D , even after accounting for the effect of adjustments to medication to try and control blood pressure , glycated hemoglobin , and lipids . Clinical Trial Registration URL : http://www.controlled-trials.com/. Unique identifier : IS RCT N92162869 Purpose The purpose of the study was to examine the impact of a 12-month weight loss intervention with either a low-carbohydrate or a low-fat diet on quality of life ( QOL ) among obese patients with type 2 diabetes . Methods Participants were enrolled in a r and omized trial comparing a low-carbohydrate to a low-fat diet in type 2 diabetes . QOL was assessed with the Diabetes-39 question naire , which measures QOL within 5 distinct scales : anxiety and worry , diabetes control , energy and mobility , social burden , and sexual functioning . Repeated measures ANOVA compared change in QOL scales at baseline and 6 and 12 months . Results Forty-six participants completed all measures . Following 12 months , there was a significant reduction in the scores related to sexual function and energy and mobility , suggesting improvement in QOL related to these domains . These changes were not significantly different between dietary arms . Changes in weight , A1C , and dietary composition were not significantly correlated with changes in QOL . Conclusions Participants with diabetes have various options for weight loss . Dietary interventions with either low-carbohydrate or low-fat diets may lead to some improvements in QOL in patients with type 2 diabetes BACKGROUND Obese , insulin-resistant persons are at risk of cardiovascular disease . How best to achieve both weight loss and clinical benefit in these persons is controversial , and recent reports question ed the superiority of low-fat diets . OBJECTIVE We aim ed to ascertain the effects of moderate variations in the carbohydrate and fat content of calorie-restricted diets on weight loss and cardiovascular disease risk in obese , insulin-resistant persons . DESIGN Fifty-seven r and omly assigned , insulin-resistant , obese persons completed a 16-wk calorie-restricted diet with 15 % of energy as protein and either 60 % and 25 % or 40 % and 45 % of energy as carbohydrate and fat , respectively . Baseline and postweight-loss insulin resistance ; daylong glucose , insulin , and triacylglycerol concentrations ; fasting lipid and lipoprotein concentrations ; and markers of endothelial function were quantified . RESULTS Weight loss with 60 % or 40 % of energy as carbohydrate ( 5.7 + /- 0.7 or 6.9 + /- 0.7 kg , respectively ) did not differ significantly , and improvement in insulin sensitivity correlated with the amount of weight lost ( r = 0.50 , P < 0.001 ) . Subjects following the diet with 40 % of energy as carbohydrate had greater reductions in daylong insulin and triacylglycerol ( P < 0.05 ) and fasting triacylglycerol ( 0.53 mmol/L ; P = 0.04 ) concentrations , greater increases in HDL-cholesterol concentrations ( 0.12 mmol/L ; P < 0.01 ) and LDL particle size ( 1.82 s ; P < 0.05 ) , and a greater decrease in plasma E-selectin ( 5.6 ng/L ; P = 0.02 ) than did subjects following the diet with 60 % of energy as carbohydrate . CONCLUSIONS In obese , insulin-resistant persons , a calorie-restricted diet , moderately lower in carbohydrate and higher in unsaturated fat , is as efficacious as the traditional low-fat diet in producing weight loss and may be more beneficial in reducing markers for cardiovascular disease risk A periodic fasting diet improves markers of metabolic dysfunction , particularly in people already at risk .  Fasting : More than a fad Mice that fast periodically are healthier , metabolically speaking . To explore whether fasting can help people as well , Wei et al. studied 71 people who either consumed a fasting-mimicking diet for 5 days each month for 3 months or maintained their normal diet for 3 months and then switched to the fasting schedule .  The fasting-like diet reduced body weight and body fat , lowered blood pressure , and decreased the hormone IGF-1 , which has been implicated in aging and disease . A post hoc analysis replicated these results and also showed that fasting decreased BMI , glucose , triglycerides , cholesterol , and C-reactive protein ( a marker for inflammation ) . These effects were generally larger in the subjects who were at greater risk of disease at the start of the study . A larger study is needed to replicate these results , but they raise the possibility that fasting may be a practical road to a healthy metabolic system . Calorie restriction or changes in dietary composition can enhance healthy aging , but the inability of most subjects to adhere to chronic and extreme diets , as well as potentially adverse effects , limits their application . We r and omized 100 generally healthy participants from the United States into two study arms and tested the effects of a fasting-mimicking diet (FMD)—low in calories , sugars , and protein but high in unsaturated fats — on markers/risk factors associated with aging and age-related diseases . We compared subjects who followed 3 months of an unrestricted diet to subjects who consumed the FMD for 5 consecutive days per month for 3 months . Three FMD cycles reduced body weight , trunk , and total body fat ; lowered blood pressure ; and decreased insulin-like growth factor 1 ( IGF-1 ) . No serious adverse effects were reported . After 3 months , control diet subjects were crossed over to the FMD program , result ing in a total of 71 subjects completing three FMD cycles . A post hoc analysis of subjects from both FMD arms showed that body mass index , blood pressure , fasting glucose , IGF-1 , triglycerides , total and low-density lipoprotein cholesterol , and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk . Thus , cycles of a 5-day FMD are safe , feasible , and effective in reducing markers/risk factors for aging and age-related diseases . Larger studies in patients with diagnosed diseases or selected on the basis of risk factors are warranted to confirm the effect of the FMD on disease prevention and treatment The role of dietary cholesterol in people with diabetes has been little studied . We investigated the effect of a hypoenergetic high-protein high-cholesterol ( HPHchol ) diet compared to a similar amount of animal protein ( high-protein low-cholesterol , HPLchol ) on  plasma lipids , glycaemic control and cardiovascular risk markers in individuals with type 2 diabetes . A total of sixty-five participants with type 2 diabetes or impaired glucose tolerance ( age 54·4 ( sd 8·2 ) years ; BMI 34·1 ( sd 4·8 ) kg/m2 ; LDL-cholesterol ( LDL-C ) 2·67 ( sd 0·10 ) mmol/l ) were r and omised  to either HPHchol or HPLchol . Both hypoenergetic dietary interventions ( 6 - 7 MJ ; 1·4 - 1·7 Mcal ) and total carbohydrate : protein : fat ratio of 40:30:30 % were similar but differed in cholesterol content ( HPHchol , 590 mg cholesterol ; HPLchol , 213 mg cholesterol ) . HPHchol participants consumed two eggs per d , whereas HPHchol participants replaced the eggs with 100 g of lean animal protein . After 12 weeks , weight loss was 6·0 ( sd 0·4 ) kg ( P < 0·001 ) . LDL-C and homocysteine remained unchanged . All the subjects reduced total cholesterol ( - 0·3 ( sd 0·1 ) mmol/l , P < 0·001 ) , TAG ( - 0·4 ( sd 0·1 ) mmol/l , P < 0·001 ) , non-HDL-cholesterol ( HDL-C , - 0·4 ( sd 0·1 ) mmol/l , P < 0·001 ) , apo-B ( - 0·04 ( sd 0·02 ) mmol/l , P < 0·01 ) , HbA1c ( - 0·6 ( sd 0·1 ) % , P < 0·001 ) , fasting blood glucose ( - 0·5 ( sd 0·2 ) mmol/l , P < 0·01 ) , fasting insulin ( - 1·7 ( sd 0·7 ) mIU/l , P < 0·01 ) , systolic blood pressure ( - 7·6 ( sd 1·7 ) mmHg , P < 0·001 ) and diastolic blood pressure ( - 4·6 ( sd 1·0 ) mmHg ; P < 0·001 ) . Significance was not altered by diet , sex , medication or amount of weight loss . HDL-C increased on HPHchol ( + 0·02 ( sd 0·02 ) mmol/l ) and decreased on HPLchol ( - 0·07 ( sd 0·03 ) mmol/l , P < 0·05 ) . Plasma folate and lutein increased more on HPHchol ( P < 0·05 ) . These results suggest that a high-protein energy-restricted diet high in cholesterol from eggs  improved glycaemic and lipid profiles , blood pressure and apo-B in individuals with type 2 diabetes OBJECTIVE To evaluate the effects of qualitative dietary changes and the interaction with aerobic exercise training on liver fat content independent of weight loss in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS With use of a factorial 2 × 2 r and omized parallel-group design , 37 men and 8 women , aged 35–70 years , with type 2 diabetes in satisfactory blood glucose control on diet or diet plus metformin treatment  were assigned to one of the following groups for an 8-week period : 1 ) high-carbohydrate/high-fiber/low – glycemic index diet ( CHO/fiber group ) , 2 ) high-MUFA diet ( MUFA group ) , 3 ) high-carbohydrate/high-fiber/low – glycemic index diet plus physical activity program ( CHO/fiber+Ex group ) , and 4 ) high-MUFA diet plus physical activity program ( MUFA+Ex group ) . Before and after intervention , hepatic fat content was measured by 1H NMR . RESULTS Dietary compliance was optimal and body weight remained stable in all groups . Liver fat content decreased more in MUFA ( −29 % ) and MUFA+Ex ( −25 % ) groups than in CHO/fiber ( −4 % ) and CHO/fiber+Ex groups ( −6 % ) . Two-way repeated- measures ANOVA , including baseline values as covariate , showed a significant effect on liver fat content for diet ( P = 0.006 ) , with no effects for exercise training ( P = 0.789 ) or diet-exercise interaction ( P = 0.712 ) . CONCLUSIONS An isocaloric diet enriched in MUFA compared with a diet higher in carbohydrate and fiber was associated with a clinical ly relevant reduction of hepatic fat content in type 2 diabetic patients independent of an aerobic training program and should be considered for the nutritional management of hepatic steatosis in people with type 2 diabetes Summary Diabetic associations throughout the world are recommending high carbohydrate / high fibre / low fat diets for diabetic patients as a means of improving general health and metabolic control . We have previously shown that the efficacy of a ‘ conventional ’ low carbohydrate diet can be greatly increased by improving the method of dietary education . To test whether further improvement in metabolic control could be achieved by changing to a high carbohydrate / high fibre / low fat diet we have followed a group of 40 Type 1 ( insulin dependent ) diabetic adults for up to 19 months . They had all been prescribed a conventional low carbohydrate diet taught by one of three methods ( dietician only , practical lunchtime demonstration or videotape ) . Those taught by dietician only were left as a control group for follow-up ( group A ) . The others were r and omized either to continue on their present diet ( group B ) or to change to a high carbohydrate / high fibre / low fat diet ( group C ) . At final assessment those in groups B and C were more knowledgeable , compliant and better controlled than group A. Those in group C achieved a change from 38 % carbohydrate / 43 % fat / 20 g fibre daily to 45 % carbohydpate / 34 % fat / 32 g fibre daily . However , metabolic control in group C deteriorated while taking the high carbohydrate / high fibre / low fat diet ( haemoglobin A1 went from 9.4±0.5 % to 11.2±0.5 % , p<0.01 , over 4 months ) . None of the patients in group C changed their eating habits or those of their families nearly as much as was recommended . This study suggests that imaginative and practical teaching methods are the most important factor influencing dietary compliance and metabolic control in Type 1 diabetic adults and that no additional improvement is achieved in this group by changing to a high carbohydrate / high fibre / low fat diet The adequate composition of carbohydrate and fat in low calorie diets for type 2 diabetes mellitus patients with obesity is not fully established . The aim of this study was to investigate the effects of low carbohydrate diet on glucose and lipid metabolism , especially on visceral fat accumulation , and comparing that of a high carbohydrate diet .  Obese subjects with type 2 diabetes mellitus were r and omly assigned to take a low calorie and low carbohydrate diet ( n = 11 , 1000 kcal per day , protein : carbohydrate : fat = 25:40:35 ) or a low calorie and high carbohydrate diet ( n = 11 , 1000 kcal per day , protein : carbohydrate : fat = 25:65:10 ) for 4 weeks . Similar decreases in body weight and serum glucose levels were observed in both groups . Fasting serum insulin levels were reduced in the low carbohydrate diet group compared to the high carbohydrate diet group ( -30 % versus -10 % , P < 0.05 ) . Total serum cholesterol and triglyceride levels decreased in both groups , but were not significantly different from each other . High-density lipoprotein-cholesterol ( HDL-C ) increased in the low carbohydrate diet group but not in the high carbohydrate diet group ( + 15 % versus 0 % , P < 0.01 ) . There was a larger decrease in visceral fat area measured by computed tomography in the low carbohydrate diet group compared to the high carbohydrate diet group ( -40 cm(2 ) versus -10 cm(2 ) , P < 0.05 ) . The ratio of visceral fat area to subcutaneous fat area did not change in the high carbohydrate diet group ( from 0.70 to 0.68 ) , but it decreased significantly in the low carbohydrate diet group ( from 0.69 to 0.47 , P < 0.005 ) . These results suggest that , when restrict diet was made isocaloric , a low calorie/low carbohydrate diet might be more effective treatment for a reduction of visceral fat , improved insulin sensitivity and increased in HDL-C levels than low calorie/high carbohydrate diet in obese subjects with type 2 diabetes mellitus BACKGROUND The concept of a body weight set point , determined predominantly by genetic mechanisms , has been proposed to explain the poor long-term results of conventional energy-restricted diets in the treatment of obesity . OBJECTIVE The objective of this study was to examine whether dietary composition affects hormonal and metabolic adaptations to energy restriction . DESIGN A r and omized , crossover design was used to compare the effects of a high-glycemic-index ( high-GI ) and a low-glycemic-index ( low-GI ) energy-restricted diet . The macronutrient composition of the high-GI diet was ( as percent of energy ) 67 % carbohydrate , 15 % protein , and 18 % fat and that of the low-GI diet was 43 % carbohydrate , 27 % protein , and 30 % fat ; the diets had similar total energy , energy density , and fiber contents . The subjects , 10 moderately overweight young men , were studied for 9 d on 2 separate occasions . On days -1 to 0 , they consumed self-selected foods ad libitum . On days 1 - 6 , they received an energy-restricted high- or low-GI diet . On days 7 - 8 , the high- or low-GI diets were consumed ad libitum . RESULTS Serum leptin decreased to a lesser extent from day 0 to day 6 with the high-GI diet than with the low-GI diet . Resting energy expenditure declined by 10.5 % during the high-GI diet but by only 4.6 % during the low-GI diet ( 7.38 + /- 0.39 and 7.78 + /- 0.36 MJ/d , respectively , on days 5 - 6 ; P = 0.04 ) . Nitrogen balance tended to be more negative , and energy intake from snacks on days 7 - 8 was greater , with the high-GI than the low-GI diet . CONCLUSION Diets with identical energy contents can have different effects on leptin concentrations , energy expenditure , voluntary food intake , and nitrogen balance , suggesting that the physiologic adaptations to energy restriction can be modified by dietary composition BACKGROUND Low-carbohydrate diets have been used to manage obesity and its metabolic consequences . OBJECTIVE The objective was to study the effects of moderate carbohydrate restriction on  atherogenic dyslipidemia before and after weight loss and in conjunction with a low or high dietary saturated fat intake . DESIGN After 1 wk of consuming a basal diet , 178 men with a mean body mass index ( in kg/m(2 ) ) of 29.2 + /- 2.0 were r and omly assigned to consume diets with carbohydrate contents of 54 % ( basal diet ) , 39 % , or 26 % of energy and with a low saturated fat content ( 7 - 9 % of energy ) ; a fourth group consumed a diet with 26 % of energy as carbohydrate and 15 % as saturated fat . After 3 wk , the mean weight loss ( 5.12 + /- 1.83 kg ) was induced in all diet groups by a reduction of approximately 1000 kcal/d for 5 wk followed by 4 wk of weight stabilization . RESULTS The 26%-carbohydrate , low-saturated-fat diet reduced triacylglycerol , apolipoprotein B , small LDL mass , and total : HDL cholesterol and increased LDL peak diameter . These changes were significantly different from those with the 54%-carbohydrate diet . After subsequent weight loss , the changes in all these variables were significantly greater and the reduction in LDL cholesterol was significantly greater with the 54%-carbohydrate diet than with the 26%-carbohydrate diet . With the 26%-carbohydrate diet , lipoprotein changes with the higher saturated fat intakes were not significantly different from those with the lower saturated fat intakes , except for LDL cholesterol , which decreased less with the higher saturated fat intake because of an increase in mass of large LDL . CONCLUSIONS Moderate carbohydrate restriction and weight loss provide equivalent but nonadditive approaches to improving atherogenic dyslipidemia . Moreover , beneficial lipid changes result ing from a reduced carbohydrate intake were not significant after weight loss In this study of 4525 children , a 1-hour-longer sleep duration was associated with lower levels of adiposity , insulin resistance , and fasting glucose . BACKGROUND : Associations between sleep duration and type 2 diabetes  ( T2D ) risk markers in childhood have been little studied . We examined associations between self-reported  sleep duration  and T2D risk markers in children . METHODS : Cross-sectional study of 4525 multiethnic UK children aged 9 to 10 years .  Sleep time  was calculated from self-reported usual time of going to bed and getting up on a school day , vali date d in a subset using accelerometers . Fasting blood sample s provided levels of serum lipids and insulin , plasma glucose , and HbA1c . Physical measures included height , weight , bioimpedance , and blood pressure . Multilevel linear regression models of anthropometric , T2D , and cardiovascular risk markers with sleep duration were adjusted for sex , age , month , ethnicity , socioeconomic position , observer ( physical measures only ) , and r and om effect of school . RESULTS : On average , children slept 10.5 hours per night ( 95 % range 8.0–12.0 hours ) . There were strong inverse grade d relationships between sleep duration , adiposity , and diabetes risk markers . In adjusted models , a 1-hour-longer sleep duration was associated with 0.19 lower BMI ( 95 % confidence interval [ CI ] 0.09 to 0.28 ) , 0.03 kg/m5 lower fat mass index ( 95 % CI 0.00 to 0.05 kg/m5 ) , 2.9 % lower homeostasis model assessment insulin resistance ( 95 % CI 1.2 % to 4.4 % ) , and 0.24 % lower fasting glucose ( 95 % CI 0.03 % to 0.44 % ) ; there was no association with HbA1c or cardiovascular risk . Associations with insulin and glucose remained after an additional adjustment for adiposity markers . CONCLUSIONS : The finding of an inverse association between sleep duration and T2D risk markers in childhood is novel . Intervention studies are needed to establish the causality of these associations , which could provide a simple strategy for early T2D prevention BACKGROUND Little is known about the association between eating patterns and  type 2 diabetes ( T2D ) risk .  OBJECTIVE The objective of this study was to prospect ively examine associations between breakfast omission , eating frequency , snacking , and  T2D risk in men . DESIGN Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D , cardiovascular disease , and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D . RESULTS We documented 1944 T2D cases during follow-up . After adjustment for known risk factors for T2D , including BMI , men who skipped breakfast had 21 % higher risk of T2D than did men who consumed breakfast ( RR : 1.21 ; 95 % CI : 1.07 , 1.35 ) . Compared with men who ate 3 times/d , men who ate 1 - 2 times/d had a higher risk of T2D ( RR : 1.25 ; 95 % CI : 1.08 , 1.45 ) . These findings persisted after stratification by BMI or diet quality . Additional snacks beyond the 3 main meals ( breakfast , lunch , and dinner ) were associated with increased T2D risk , but these associations were attenuated after adjustment for BMI . CONCLUSIONS Breakfast omission was associated with an increased risk of T2D  in men even after adjustment for BMI . A direct association between snacking between meals and T2D risk was mediated by BMI Abstract . Aims /hypothesis : British dietary recommendations are to decrease total fat intake to less than 30 % of daily energy intake and saturated fat to less than 10 % . In practice , it is difficult for people to make these changes . It may be easier to encourage people to switch from a diet rich in saturated fatty acids to one rich in polyunsaturated fatty acids . Methods : A total of 17 subjects – six people with Type II ( non-insulin-dependent ) diabetes mellitus , six non-obese and five obese people without diabetes – were r and omised to spend two 5-week periods on a diet rich in saturated or in polyunsaturated fatty acids , in a crossover design . At the start of the study and after each dietary period , we assessed abdominal fat distribution using magnetic resonance imaging , insulin sensitivity using hyperinsulinaemic-euglycaemic clamps and fasting lipid parameters . Results : Dietary compliance , assessed by weekly 3-day dietary records and measurement of biochemical markers , was good . Energy and fat intake appeared to be reduced on the diet rich in polyunsaturated fatty acids although body weights did not change . Insulin sensitivity and plasma low density lipoprotein cholesterol concentrations improved with the diet rich in polyunsaturated fatty acids compared with the diet rich in saturated fatty acids . There was also a decrease in abdominal subcutaneous fat area . Conclusion /interpretation : If this result is confirmed in longer-term studies , this dietary manipulation would be more readily achieved by the general population than the current recommendations and could result in considerable improvement in insulin sensitivity , reducing the risk of developing Type II diabetes . [ Diabetologia ( 2002 ) 45 : 369–377
There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .