Macronutrient Balance Research Articles

A nutritional approach to microbiota in Parkinson's disease.

Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor impairment and the accumulation of alpha-synucleinopathy (α-syn), which can affect different levels of the brain-gut axis. There is a two-way communication between the gastrointestinal tract, and brain that includes the gut microbiota. This bidirectional communication between the gut microbiota and the brain includes many pathways, such as immune mechanisms, the vagus nerve, and microbial neurometabolite production. The common cause of constipation in PD is thought to be the accumulation of α-syn proteins in the enteric nervous system. Recent studies have focused on changes in microbial metabolites and gut microbiota dysbiosis. Microbiota dysbiosis is associated with increased intestinal permeability, intestinal inflammation, and neuroinflammation. Many factors, such as unbalanced nutrition, antibiotic use, age, and infection, result in alteration of microbial metabolites, triggering α-syn accumulation in the intestinal mucosa cells. Increased evidence indicates that the amount, type, and balance of dietary macronutrients (carbohydrates, proteins, and fats); high consumption of vegetables, fruits, and omega-3 fatty acids; and healthy diet patterns such as the Mediterranean diet may have a great protective impact on PD. This review focuses on the potential benefits of prebiotics, probiotics, and synbiotics to regulate microbiota dysbiosis along with the effect of diet on the gut microbiota in PD.

Jean-Pierre Flatt, PhD (1933-2018)

Jean-Pierre Flatt, PhD (1933-2018)

Neuronal SIRT1 regulates macronutrient-based diet selection through FGF21 and oxytocin signalling in mice

Diet affects health through ingested calories and macronutrients, and macronutrient balance affects health span. The mechanisms regulating macronutrient-based diet choices are poorly understood. Previous studies had shown that NAD-dependent deacetylase sirtuin-1 (SIRT1) in part influences the health-promoting effects of caloric restriction by boosting fat use in peripheral tissues. Here, we show that neuronal SIRT1 shifts diet choice from sucrose to fat in mice, matching the peripheral metabolic shift. SIRT1-mediated suppression of simple sugar preference requires oxytocin signalling, and SIRT1 in oxytocin neurons drives this effect. The hepatokine FGF21 acts as an endocrine signal to oxytocin neurons, promoting neuronal activation and Oxt transcription and suppressing the simple sugar preference. SIRT1 promotes FGF21 signalling in oxytocin neurons and stimulates Oxt transcription through NRF2. Thus, neuronal SIRT1 contributes to the homeostatic regulation of macronutrient-based diet selection in mice.

Association between enteral macronutrient delivery and inflammatory response in critically ill children

Background and aimsAn important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children. MethodWe prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h. ResultsA total of 87 children (0–16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50–103), 85% (43–120), 63% (42–102) and 45% (23–65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). ConclusionThe inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.

38. Relationship between early pregnancy nutrition and abdominal subcutaneous fat

Introduction Objective clinical measures of metabolic health during pregnancy would be desirable. As recent work suggests dietary macronutrient balance is important in regulating energy intake and metabolic health the aim of this study was to assess the associations between dietary macronutrient composition and US measures of SAT layers. Method 200 women recruited at 11–14 weeks gestation completed a food frequency questionnaire and measurements were performed on abdominal SAT, dividing it into the two anatomical layers superficial SAT (SSAT) and deep SAT (DSAT), assessing SAT density with US strain elastography. Plausible diets of 185 women were used. Generalised additive models using thin plate regression splines were used to associate intake of dietary protein, carbohydrate and fat (kJ/day) with these measures of SAT. Result Dietary intake did not differ between the body mass index (BMI) categories, except when macronutrients intakes were adjusted for weight. In early pregnancy, there was an association between a high protein, low fat intake diet with increased SSAT thickness. There was no significant association of macronutrient intake with DSAT. When assessing the relationship of SAT density with macronutrient intake there was an association between decreased density of SSAT with low fat intake. There was no association of macronutrients and SAT density in the DSAT. Conclusion Although it is difficult to make assumptions from human studies using dietary recollection and considering a life-time of dietary pattern has contributed to the current body AT, macronutrient balance may have a prominent place in metabolic health, deposition and density of AT and long-term AT distribution. Prospective studies are warranted to investigate whether SAT measures meaningfully reflect macronutrient composition and metabolic health in pregnancy.

How to improve strawberry productivity, nutrients composition, and beneficial rhizosphere microflora by biofertilization and mineral fertilization?

The main objective of this study was to investigate and compare the effects of fertilizer types on the counts of soil microorganisms, the mineral leaf composition, and productivity of three strawberry cultivars in the period 2012–2013. Two types of fertilizers were applied—mineral and microbiological. Significantly higher number of Azotobacter, ammonifiers, oligonitrophils, and total microbial count were observed under biofertilizers treatment. Significantly higher counts of fungi and actinomycetes were obtained under mineral fertilizer treatment, compared to other fertilizer treatments. The use of mineral fertilizer led to the most favorable balance of macronutrients and micronutrients in the leaf. In 2012, the generative potential and yield increased after mineral fertilization, whereas in 2013 these parameters were positively affected by mineral fertilizer and Biofertilizer 1. Given the obtained results, in order to improve technology of strawberry production, a partial substitution of mineral fertilizers by microbiological ones can be recommended.

Relationships Between Early Nutrition and Blood Glucose Concentrations in Very Preterm Infants.

The aim of the study was to determine whether changes to early nutrition are associated with levels of glycemia in very preterm infants. A retrospective, observational study of infants <1500 g or <30 weeks' gestation admitted to Neonatal Intensive Care, National Women's Hospital, New Zealand, before (Old Protocol) and after (New Protocol) a change in nutritional protocol. Nutritional intakes were calculated and averaged by day for postnatal days 1 to 7 (week 1) and 1 to 28 (month 1). Relationships between glycemia measures, macronutrient intakes, and achievement of 10% enteral feeds (≥10% total intake) were explored using logistic regression. Old Protocol (n = 190) and New Protocol (n = 267) groups had similar baseline characteristics. In week 1, New Protocol infants received more protein, less fat, and carbohydrate, had lower mean blood glucose concentrations (BGCs) (mean ± SD 4.9 ± 1.2 vs 5.6 ± 1.4 mmoll/L, P < 0.0001), less hyperglycemia (BGC > 8.5 mmol/L, 71 [27%] vs 80 [42%], P = 0.0005), but similar hypoglycemia (BGC < 2.6). In month 1, New Protocol infants also had less hyperglycemia (105 [39%] vs 96 [51%], P = 0.02) and lower mean BGC (5.0 ± 1.1 vs 5.5 ± 1.1 mmol/L, P < 0.0001), but insulin usage was similar. After adjustment for birth weight z score and gestational age, hyperglycemia was significantly associated with week 1 intakes (g · kg · day) of protein (odds ratio [95% confidence intervals] 0.47 [0.23-0.79], P = 0.004), fat (0.54 [0.40-0.74], P < 0.0001), and carbohydrate (1.25 [1.09-1.44], P < 0.0001). These relationships were similar for month 1. Each additional day to achieve 10% enteral feeds was associated with increased odds of hypoglycemia (1.09 [1.00-1.18], P = 0.04) and hyperglycemia (1.16 [1.06-1.28], P = 0.002). In very preterm infants, macronutrient balance and small, early enteral feeds may assist glycemic control.

Fibroblast growth factor 21, adiposity, and macronutrient balance in a healthy, pregnant population with overweight and obesity

ABSTRACTAim of the study: The regulation and actions of fibroblast growth factor 21 (FGF21) are responsive to energy status and macronutrient balance, and investigations of FGF21 in normal pregnancy, which could be informative for FGF21 biology, are seldom. The goal of our study was to examine FGF21 levels in a contemporary healthy, pregnant population.Methods: We phenotyped 43 women with overweight and obesity during pregnancy for weight, body composition, and fasting blood. Serum FGF21 was measured during the first and third trimesters. Placentas were collected at delivery.Results: Maternal FGF21 concentrations were positively correlated with body mass index and adiposity, but not lean mass or glucose homeostasis. FGF21 concentrations significantly increased from the first to third trimester of pregnancy (0.105 vs. 0.256 ng/mL, p < 0.0001). Changes in FGF21 concentrations across pregnancy were not associated with changes in body weight or composition but inversely with the change in fasting glucose. FGF21 mRNA levels in placenta were very low and do not likely contribute to FGF21 in the maternal circulation.Conclusions: FGF21 increases throughout pregnancy in our healthy cohort with overweight and obesity, independent of the placenta, and does not appear to be sensing the changes in energy balance (reflected in the change in maternal energy stores), but changes in macronutrient status. Thus, we propose FGF21 may be a potential signal of maternal nutrient status in pregnancy.

Consistent pollen nutritional intake drives bumble bee (Bombus impatiens) colony growth and reproduction across different habitats.

Foraging behavior is a critical adaptation by insects to obtain appropriate nutrients from the environment for development and fitness. Bumble bees (Bombus spp.) form annual colonies which must rapidly increase their worker populations to support rearing reproductive individuals before the end of the season. Therefore, colony growth and reproduction should be dependent on the quality and quantity of pollen resources in the surrounding landscape. Our previous research found that B. impatiens foraging preferences to different plant species were shaped by pollen protein:lipid nutritional ratios (P:L), with foragers preferring pollen species with a ~5:1 P:L ratio. In this study, we placed B. impatiens colonies in three different habitats (forest, forest edge, and valley) to determine whether pollen nutritional quality collected by the colonies differed between areas that may differ in resource abundance and diversity. We found that habitat did not influence the collected pollen nutritional quality, with colonies in all three habitats collecting pollen averaging a 4:1 P:L ratio. Furthermore, there was no difference in the nutritional quality of the pollen collected by colonies that successfully reared reproductives and those that did not. We found however, that “nutritional intake,” calculated as the colony‐level intake rate of nutrient quantities (protein, lipid, and sugar), was strongly related to colony growth and reproductive output. Therefore, we conclude that B. impatiens colony performance is a function of the abundance of nutritionally appropriate floral resources in the surrounding landscape. Because we did not comprehensively evaluate the nutrition provided by the plant communities in each habitat, it remains to be determined how B. impatiens polylectic foraging strategies helps them select among the available pollen nutritional landscape in a variety of plant communities to obtain a balance of key macronutrients.

A Common Allele in FGF21 Associated with Sugar Intake Is Associated with Body Shape, Lower Total Body-Fat Percentage, and Higher Blood Pressure

SummaryFibroblast growth factor 21 (FGF21) is a hormone that has insulin-sensitizing properties. Some trials of FGF21 analogs show weight loss and lipid-lowering effects. Recent studies have shown that a common allele in the FGF21 gene alters the balance of macronutrients consumed, but there was little evidence of an effect on metabolic traits. We studied a common FGF21 allele (A:rs838133) in 451,099 people from the UK Biobank study, aiming to use the human allele to inform potential adverse and beneficial effects of targeting FGF21. We replicated the association between the A allele and higher percentage carbohydrate intake. We then showed that this allele is more strongly associated with higher blood pressure and waist-hip ratio, despite an association with lower total body-fat percentage, than it is with BMI or type 2 diabetes. These human phenotypes of variation in the FGF21 gene will inform research into FGF21’s mechanisms and therapeutic potential.

Dietary Protein and Carbohydrate Levels Affect Performance and Digestive Physiology of Plodia interpunctella (Lepidoptera: Pyralidae).

In this study, life history and nutritional indices of Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae) was evaluated on six food commodities: dried fig, dried wheat germ, dried white mulberry, groundnut, pistachio, and raisin, compared with artificial diet. The influence of dietary macronutrient content on digestive α-amylase was also assessed. A delay in the developmental time of P. interpunctella immature stages was detected when larvae were fed on raisin. The highest survival rate of immature stages was on the artificial diet, and the lowest was on raisin. The highest realized fecundity and fertility were recorded for the females reared on artificial diet. Overall, fourth instar P. interpunctella reared on artificial diet had the highest relative consumed and growth rate, and lowest rates were observed in larvae fed raisin. Amylolytic activity and isoform patterns varied depending on larval instar and diets, but were higher for larvae fed artificial diet with moderate carbohydrate and protein. Zymograms showed the presence of three isoforms of α-amylase in midgut extracts of P. interpunctella fed different diets. Larvae fed dried white mulberry, fig, and raisin had one (A2) α-amylase isoform. The data suggest that dietary carbohydrate and protein content induce changes in nutritional efficiency, development, and α-amylase activity. A survey of the differences in digestive enzyme activity in response to macronutrient balance and imbalance highlight their importance in the nutrition of insects.

Within‐diet variation in rates of macronutrient consumption and reproduction does not accompany changes in lifespan in Drosophila melanogaster

AbstractInterventions such as caloric or dietary restriction extend lifespan in organisms spanning from yeast to primates. Despite its positive influence on longevity, dietary restriction has been found to negatively affect reproduction. Many studies have reported negative correlations between lifespan and reproductive characteristics (such as mating rate, fecundity, reproductive period, and others). Such correlation gives the appearance of a resource‐based trade‐off between these two life‐history traits. Here, we have used nutritional geometry to confirm previous findings in flies that dietary macronutrient balance (protein‐to‐carbohydrate ratio, P:C) impacts both lifespan and reproduction, such that across a series of diets differing in P:C, maximum lifespan was observed at a lower P:C (1:8) than that which supported highest fecundity (1:1.5). We have then addressed the question whether variation among Drosophila melanogasterMeigen (Diptera: Drosophilidae) fruit flies in food intake and egg production within a single dietary treatment is negatively associated with within‐diet variation in lifespan, as might be expected under a resource‐based trade‐off. There was no such association between intake rate, egg production, and longevity. We noted that the smaller sample sizes and smaller inter‐individual variance apparent within — as compared to across — diet treatments may have weakened any signature of a trade‐off between lifespan and reproduction. Thus, we conclude that, whereas dietary macronutrient ratio is a primary determinant of both reproduction and longevity, neither eating less nor laying fewer eggs per se predicted lifespan. This supports the view that there is not a simple quantitative resource‐based trade‐off between lifespan and reproduction, but rather these represent life‐history traits with qualitatively different nutritional optima.

Nutritional geometry of paternal effects on embryo mortality.

Well-established causal links exist between maternal nutritional deficits and embryo health and viability. By contrast, environmental effects operating through the father that could influence embryo mortality have seldom been examined. Yet, ejaculates can require non-trivial resource allocation, and seminal plasma components are increasingly recognized to exert wide-ranging effects on females and offspring, so paternal dietary effects on the embryo should be expected. We test for effects of varying levels of protein (P), carbohydrate (C) and caloric load in adult male diet on embryo mortality in Drosophila melanogaster We demonstrate that macronutrient balance and caloric restriction exert significant effects, and that nutritional effects are more impactful when a prior mating has occurred. Once-mated males produced embryos with marginally elevated mortality under high-caloric densities and a 1 : 8 P : C ratio. In contrast, embryos produced by twice-mated males were significantly more likely to die under male caloric restriction, an outcome that may have resulted from shifts in ejaculate quality and/or epigenetic paternal effects. Body nutrient reserves were strongly and predictably altered by diet, and body condition, in turn, was negatively related to embryo mortality. Thus, sire nutritional history and resultant shifts in metabolic state predict embryo viability and post-fertilization fitness outcomes.

Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa.

The World Health Organization recommends that human immunodeficiency virus (HIV)-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings. We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5 to 9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population were used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the World Health Organization and Acceptable Macronutrient Distribution Ranges established by the IOM. The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs 1196 kcal/day, P = 0.002), but proportions below the recommended energy requirement were similar in the 2 groups (82.5% vs 85.2%, P = 0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared with the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups. Our findings suggest that the typical diet of HIV-infected children and uninfected children in Johannesburg, South Africa, does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.

Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk ,

Background: Meal skipping has become an increasing trend of the modern lifestyle that may lead to obesity and type 2 diabetes.Objective: We investigated whether the timing of meal skipping impacts these risks by affecting circadian regulation of energy balance, glucose metabolism, and postprandial inflammatory responses.Design: In a randomized controlled crossover trial, 17 participants [body mass index (in kg/m2): 23.7 ± 4.6] underwent 3 isocaloric 24-h interventions (55%, 30%, and 15% carbohydrate, fat, and protein, respectively): a breakfast skipping day (BSD) and a dinner skipping day (DSD) separated by a conventional 3-meal-structure day (control). Energy and macronutrient balance was measured in a respiration chamber. Postprandial glucose, insulin, and inflammatory responses in leukocytes as well as 24-h glycemia and insulin secretion were analyzed.Results: When compared with the 3-meal control, 24-h energy expenditure was higher on both skipping days (BSD: +41 kcal/d; DSD: +91 kcal/d; both P < 0.01), whereas fat oxidation increased on the BSD only (+16 g/d; P < 0.001). Spontaneous physical activity, 24-h glycemia, and 24-h insulin secretion did not differ between intervention days. The postprandial homeostasis model assessment index (+54%) and glucose concentrations after lunch (+46%) were, however, higher on the BSD than on the DSD (both P < 0.05). Concomitantly, a longer fasting period with breakfast skipping also increased the inflammatory potential of peripheral blood cells after lunch.Conclusions: Compared with 3 meals/d, meal skipping increased energy expenditure. In contrast, higher postprandial insulin concentrations and increased fat oxidation with breakfast skipping suggest the development of metabolic inflexibility in response to prolonged fasting that may in the long term lead to low-grade inflammation and impaired glucose homeostasis. This trial was registered at clinicaltrials.gov as NCT02635139.

CHEWING RATE IS LINKED TO APPETITE AND HUNGER

ObjectiveEnergy balance is vital for the prevention and treatment of the obesity. In this context, the controlling of appetite has a critical role for both energy balance and obesity. Therefore, the aim of the study was to examine the effect of chewing rate on appetite and hunger.MethodsThis study was conducted to the healthy adults (n=36) aged 18–28 years. The dietary manipulation started after a standard breakfast. Then, lunch was served ad libitum consisting of standard mini pizza with balanced macronutrient and micronutrient content. During the study, while the number and the duration of chewing (second) were recorded, visual analog scale (VAS) was filled by subjects at 0., 5., 10., 15., 20., 25., 30., 45., 60. minutes and at the end of the study. Chewing rate was calculated by dividing the number of chewing by duration of the chewing (chew/second). One day 24 h dietary recall was recorded. The manipulation period was repeated three times in two weeks intervals.ResultsThis study showed that, the higher chewing rate was associated with the feeling of hunger at 0th, 5th, 10th and 15th minutes significantly (p&lt;0.05). In parallel, increased chewing rate was significantly related to the formation of the desire to eat more at the 5th and 10th minutes (p&lt;0.05). Between chewing rate and energy intake was a positive correlation, but this was not significant. However, chewing rate did not affect the feeling of fullness and the opinion about the taste of meal.ConclusionThe results reveal that the higher chewing rate caused delay in suppression of appetite and hunger, especially at the first 15 minutes after the meal started. Therefore, decreasing chewing rate may be a strategy to develop the feeling of satiety, daily energy intake and thus controlling the obesity.

Macronutrient Balance of Nickel-Stressed Lettuce Plants Grown under Different Sulfur Levels

ABSTRACTThis study investigated whether intensive nutrition with sulfur–sulfate (S-SO4) (2, 6, or 9 mM S) of nickel-stressed (0, 0.0004, 0.04, or 0.08 mM Ni) butterhead lettuce cv. Justyna may improve macronutrient balance and reduce Ni bioaccumulation. Nickel exposure resulted in various unfavorable changes in the macronutrient content together with increase of Ni accumulation in the biomass. Intensive S nutrition of Ni-treated lettuce seems to have no beneficial effect on macronutrient balance. In general, it significantly reduced the root and foliar phosphorus (P), potassium (K), calcium (Ca), and S content and simultaneously did not affect the magnesium (Mg) content in the biomass. At the same time, the nitrogen (N) content was reduced in roots and elevated in shoots. Supplementation of Ni-exposed lettuce with high S doses raised in roots and reduced foliar Ni accumulation; however, Ni content in useable parts exceeded the acceptable limits established for consumption.

The Calculator of Anti-Alzheimer's Diet. Macronutrients.

The opinions about optimal proportions of macronutrients in a healthy diet have changed significantly over the last century. At the same time nutritional sciences failed to provide strong evidence backing up any of the variety of views on macronutrient proportions. Herein we present an idea how these proportions can be calculated to find an optimal balance of macronutrients with respect to prevention of Alzheimer’s Disease (AD) and dementia. These calculations are based on our published observation that per capita personal income (PCPI) in the USA correlates with age-adjusted death rates for AD (AADR). We have previously reported that PCPI through the period 1925–2005 correlated with AADR in 2005 in a remarkable, statistically significant oscillatory manner, as shown by changes in the correlation coefficient R (Roriginal). A question thus arises what caused the oscillatory behavior of Roriginal? What historical events in the life of 2005 AD victims had shaped their future with AD? Looking for the answers we found that, considering changes in the per capita availability of macronutrients in the USA in the period 1929–2005, we can mathematically explain the variability of Roriginal for each quarter of a human life. On the basis of multiple regression of Roriginal with regard to the availability of three macronutrients: carbohydrates, total fat, and protein, with or without alcohol, we propose seven equations (referred to as “the calculator” throughout the text) which allow calculating optimal changes in the proportions of macronutrients to reduce the risk of AD for each age group: youth, early middle age, late middle age and late age. The results obtained with the use of “the calculator” are grouped in a table (Table 4) of macronutrient proportions optimal for reducing the risk of AD in each age group through minimizing Rpredicted−i.e., minimizing the strength of correlation between PCPI and future AADR.

The Effects of Dietary Macronutrient Balance on Skin Structure in Aging Male and Female Mice.

Nutrition influences skin structure; however, a systematic investigation into how energy and macronutrients (protein, carbohydrate and fat) affects the skin has yet to be conducted. We evaluated the associations between macronutrients, energy intake and skin structure in mice fed 25 experimental diets and a control diet for 15 months using the Geometric Framework, a novel method of nutritional analysis. Skin structure was associated with the ratio of dietary macronutrients eaten, not energy intake, and the nature of the effect differed between the sexes. In males, skin structure was primarily associated with protein intake, whereas in females carbohydrate intake was the primary correlate. In both sexes, the dermis and subcutaneous fat thicknesses were inversely proportional. Subcutaneous fat thickness varied positively with fat intake, due to enlarged adipocytes rather than increased adipocyte number. We therefore demonstrated clear interactions between skin structure and macronutrient intakes, with the associations being sex-specific and dependent on dietary macronutrient balance.

A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control

The usefulness of low-carbohydrate diet (LCD) for Japanese patients with type 2 diabetes mellitus (T2DM) has not been fully investigated. Therefore, we compared the effectiveness and safety of LCD with calorie restricted diet (CRD). This prospective, randomized, open-label, comparative study included 66 T2DM patients with HbA1c >7.5% even after receiving repeated education programs on CRD. They were randomly allocated to either the 130g/day LCD group (n=33) or CRD group (n=33). Patients received personal nutrition education of CRD or LCD for 30min at baseline, 1, 2, 4, and 6 months. Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients (28× ideal body weight calories per day). Patients of the LCD group were advised to maintain the intake of 130g/day carbohydrate without other specific restrictions. Several parameters were assessed at baseline and 6 months after each intervention. The primary endpoint was a change in HbA1c level from baseline to the end of the study. At baseline, BMI and HbA1c were 26.5 (24.6-30.1) and 8.3 (8.0-9.3), and 26.7 (25.0-30.0) kg/m2 and 8.0 (7.6-8.9) %, in the CRD and LCD, respectively. At the end of the study, HbA1c decreased by-0.65 (-1.53 to-0.10) % in the LCD group, compared with 0.00 (-0.68 to 0.40) % in the CRD group (p<0.01). Also, the decrease in BMI in the LCD group [-0.58 (-1.51 to-0.16) kg/m2] exceeded that observed in the CRD group (p=0.03). Our study demonstrated that 6-month 130g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with T2DM. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD. This trial was registered at http://www.umin.ac.jp/english/ (University Hospital Medical Information Network: study ID number 000010663).