Dietary Carbohydrate Intake Research Articles

Macronutrient intake and risk of urothelial cell carcinoma in the European prospective investigation into cancer and nutrition

Previous studies have suggested that dietary factors may be important in the development of bladder cancer. We examined macronutrient intake in relation to risk of urothelial cell carcinoma among 469,339 men and women in the European Prospective Investigation into Cancer and Nutrition. Associations were examined using Cox regression, stratified by sex, age at recruitment and centre and further adjusted for smoking status and duration, body mass index and total energy intake. After an average of 11.3 years of follow-up, 1,416 new cases of urothelial cell carcinoma were identified. After allowing for measurement error, a 3% increase in the consumption of energy intake from animal protein was associated with a 15% higher risk (95% confidence interval [CI]: 3-30%; p(trend) = 0.01) and a 2% increase in energy from plant protein intake was associated with a 23% lower risk (95% CI: 36-7%, p(trend) = 0.006). Dietary intake of fat, carbohydrate, fibre or calcium was not associated with risk. These findings suggest that animal and/or plant protein may affect the risk of urothelial cell carcinoma, and examination of these associations in other studies is needed.

Effect of Dietary Macronutrient Composition on AMPK and SIRT1 Expression and Activity in Human Skeletal Muscle

Adenosine monophosphate-activated protein kinase (AMPK), silent mating type information regulation 2 homologue 1 (SIRT 1), and peroxisome proliferator-activated receptor γ co-activator α (PGC1α) constitute an energy sensing cellular network that controls mitochondrial biogenesis. Caloric restriction activates both AMPK and SIRT-1 to increase ATP production from fat oxidation. We characterized AMPK and SIRT 1 expression and activity in human skeletal muscle in response to dietary fat or carbohydrate intake on the background of either overfeeding or caloric restriction. AMPK phosphorylation and acetylation of PGC1α (as a measure of SIRT activity) were determined. Euglycemic-hyperinsulinemic clamp and muscle biopsies were performed in human subjects participating in 2 separate studies. In study 1, 21 lean healthy individuals were overfed for 5 days, while in study 2, 18 obese otherwise healthy individuals consumed a calorie-restricted diet for 5 days. Under both conditions - overfeeding and caloric restriction - high fat/low carbohydrate (HF/LC) diet significantly increased phosphorylation of AMPK and deacetylation of PGC1α in skeletal muscle without affecting total amounts of AMPK, PGC1α, or SIRT 1. In contrast, low fat/high carbohydrate (LF/HC) hypocaloric diet reduced phosphorylation of AMPK and deacetylation of PGC1α. Our data indicate that a relative deficiency in carbohydrate intake or, albeit less likely, a relative excess of fat intake even in the absence of caloric deprivation is sufficient to activate the AMPK-SIRT 1-PGC1α energy-sensing cellular network in human skeletal muscle.

Influence of High Glycemic Index and Glycemic Load Diets on Blood Pressure During Adolescence

We aimed to prospectively examine the association between the glycemic index and glycemic load of foods consumed and the dietary intakes of carbohydrates, sugars, fiber, and principal carbohydrate-containing food groups (eg, breads, cereals, and sugary drinks) with changes in blood pressure during adolescence. A total of 858 students aged 12 years at baseline (422 girls and 436 boys) were examined from 2004-2005 to 2009-2011. Dietary data were assessed from validated semiquantitative food frequency questionnaires. Blood pressure was measured using a standard protocol. In girls, after adjusting for age, ethnicity, parental education, parental history of hypertension, baseline height, baseline blood pressure, change in body mass index, and time spent in physical and sedentary activities, each 1-SD (1-SD = 7.10 g/d) increase in baseline dietary intake of total fiber was associated with a 0.96-, 0.62-, and 0.75-mmHg decrease in mean systolic (P = 0.02), diastolic (P = 0.01), and arterial blood pressures (P = 0.002), respectively, 5 years later. In girls, each 1-SD increase in dietary glycemic index, glycemic load, carbohydrate, and fructose was concurrently related to increases of 1.81 (P = 0.001), 4.02 (P = 0.01), 4.74 (P = 0.01), and 1.80 mm Hg (P = 0.03) in systolic blood pressure, respectively, >5 years. Significant associations between carbohydrate nutrition variables and blood pressure were not observed among boys. Excessive dietary intake of carbohydrates, specifically from high glycemic index/glycemic load foods, could adversely influence blood pressure, particularly in girls, whereas fiber-rich diets may be protective against elevated blood pressure during adolescence.

Association of total energy intake and macronutrient consumption with colorectal cancer risk: results from a large population-based case-control study in Newfoundland and Labrador and Ontario, Canada

BackgroundDiet is regarded as one of the most important environmental factors associated with colorectal cancer (CRC) risk. A recent report comprehensively concluded that total energy intake does not have a simple relationship with CRC risk, and that the data were inconsistent for carbohydrate, cholesterol and protein. The objective of this study was to identify the associations of CRC risk with dietary intakes of total energy, protein, fat, carbohydrate, fiber, and alcohol using data from a large case-control study conducted in Newfoundland and Labrador (NL) and Ontario (ON), Canada.MethodsIncident colorectal cancer cases (n = 1760) were identified from population-based cancer registries in the provinces of ON (1997-2000) and NL (1999-2003). Controls (n = 2481) were a random sample of residents in each province, aged 20-74 years. Family history questionnaire (FHQ), personal history questionnaire (PHQ), and food frequency questionnaire (FFQ) were used to collect study data. Logistic regression was used to evaluate the association of intakes of total energy, macronutrients and alcohol with CRC risk.ResultsTotal energy intake was associated with higher risk of CRC (OR: 1.56; 95% CI: 1.21-2.01, p-trend = 0.02, 5th versus 1st quintile), whereas inverse associations emerged for intakes of protein (OR: 0.85, 95%CI: 0.69-1.00, p-trend = 0.06, 5th versus 1st quintile), carbohydrate (OR: 0.81, 95%CI: 0.63-1.00, p-trend = 0.05, 5th versus 1st quintile) and total dietary fiber (OR: 0.84, 95% CI:0.67-0.99, p-trend = 0.04, 5th versus 1st quintile). Total fat, alcohol, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol were not associated with CRC risk.ConclusionThis study provides further evidence that high energy intake may increase risk of incident CRC, whereas diets high in protein, fiber, and carbohydrate may reduce the risk of the disease.

Genetic Variation in the Glucose-Dependent Insulinotropic Polypeptide Receptor Modifies the Association between Carbohydrate and Fat Intake and Risk of Type 2 Diabetes in the Malmö Diet and Cancer Cohort

A common genetic variant (rs10423928, A-allele) in the glucose-dependent insulinotropic polypeptide receptor gene (GIPR) is associated with decreased insulin secretion. Glucose-dependent insulinotropic polypeptide is secreted after food consumption and gipr knockout mice fed a high-fat diet are protected against obesity and disturbances in glucose homeostasis. Our objective was to examine the interactions between rs10423928 and macronutrients and fiber intakes on body mass index and type 2 diabetes risk. Among nondiabetic subjects in the Swedish population-based Malmö Diet and Cancer cohort (n = 24,840; 45-74 yr), 1541 diabetes cases were identified during 12 yr of follow-up. Dietary intakes were assessed using a diet history method. Incident type 2 diabetes was identified through registers. There was no indication that dietary intakes significantly modify the association between GIPR genotype and body mass index (P interaction >0.08). We observed significant interactions between GIPR genotype and quintiles of carbohydrate (P = 0.0005) and fat intake (P = 0.0006) on incident type 2 diabetes. The TT-genotype carriers within the highest compared with the lowest carbohydrate quintile were at 23% (95% confidence interval = 5-39%) decreased type 2 diabetes risk. In contrast, AA-genotype carriers in the highest compared with the lowest fat quintile were at 69% (95% confidence interval = 29-86%) decreased risk. Our prospective, observational study indicates that the type 2 diabetes risk by dietary intake of carbohydrate and fat may be dependent on GIPR genotype. In line with results in gipr knockout mice, AA-genotype carriers consuming high-fat low-carbohydrate diets had reduced type 2 diabetes risk, whereas high-carbohydrate low-fat diets benefitted the two thirds of population homozygous for the T-allele.

Association between dietary carbohydrate, glycemic index, glycemic load, and the prevalence of obesity in Korean men and women

Intake of high-glycemic index (GI) food has been postulated to reduce satiety, resulting in an increased total energy intake and reduced access to body fat as fuel. Thus, we hypothesize that high dietary GI and glycemic load (GL) are associated with an increased prevalence of obesity in the Korean population. Dietary GI and GL were calculated for 933 Korean men and women based on dietary intake assessed by food frequency questionnaires and using a GI table developed from published GI databases in a cross-sectional design. Mean differences in dietary GL and carbohydrate intake between obese and nonobese men were statistically significant after adjusting for covariates (P = .027 and .021, respectively). High dietary GL and carbohydrate intake were negatively associated with the prevalence of obesity among men in a multivariate-adjusted logistic regression model (P for trend = .026 and .036, respectively). Statistically significant effects of dietary GI and GL on the prevalence of obesity among women were observed in a generalized linear model (P = .002 and .042, respectively) and a logistic regression model (P for trend < .001 and = .007, respectively), after adjusting for covariates. Women with higher dietary GI and GL were more likely to be obese, a result consistent with our hypothesis. However, an inverse association for dietary GL and carbohydrate and prevalence of obesity was found in men, suggesting that mechanisms contributing to the prevalence of obesity between sexes may be different.

High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults

The traditional Asian diet, which is characterized as being high in carbohydrate with an abundance of vegetables, may be beneficial for preventing metabolic syndrome abnormalities within the Asian population. However, the prevalence of metabolic syndrome is increasing in Asian countries. This study explored the association between dietary carbohydrates and low high-density lipoprotein cholesterol (HDL-C) prevalence, one of the abnormalities of metabolic syndrome in Korean adults. We used the data from the Fourth Korea National Health and Nutrition Examination Survey and evaluated a total of 9947 Korean adults older 20 years. To measure carbohydrate quality and quantity, total carbohydrate intake (g/d), percentage of energy from carbohydrate, glycemic index, and glycemic load were divided into quintiles. Mean levels of HDL-C significantly decreased across the quintiles for all types of dietary carbohydrate intake except glycemic index after adjusting for potential variables in both men and women. Odds ratios for having low HDL-C in the highest quintile were 1.66 (95% confidence interval, 1.24-2.22) for total carbohydrate, 1.34 (1.02-1.75) for percentage of energy from carbohydrate, and 1.54 (1.17-2.03) for glycemic load in men as compared with the second quintile as a reference. Odds ratio for low HDL-C was 1.38 (1.12-1.71) for percentage of energy from carbohydrate in women. In conclusion, our study indicates that low HDL-C is associated with high carbohydrate intake without regard to energy or fat intake. Further studies would be necessary to optimize carbohydrate intake quantitatively on dyslipidemia for Asian population.

Trends in dietary energy, fat, carbohydrate and protein intake in Chinese children and adolescents from 1991 to 2009

Few studies have examined nutrition transition in children in China. Our aim, in the present study, was to examine temporal trends in dietary energy, fat, carbohydrate and protein intake in Chinese children aged 7–17 years. The analysis used individual level, consecutive 3 d dietary recall data from seven rounds of the China Health and Nutrition Surveys in 1991 (n 2714), 1993 (n 2542), 1997 (n 2516), 2000 (n 2142), 2004 (n 1341), 2006 (n 1072) and 2009 (n 996). Mixed-effect models were constructed to obtain adjusted means and to examine trends after adjusting for intra-class correlation within clusters and for covariates including age, sex, urban/rural residence and income. From 1991 to 2009, daily energy intake steadily declined from 9511·0 to 7658·2 kJ (P < 0·0001). There was a steady decline in daily carbohydrate intake from 382·5 to 254·1 g (P < 0·0001), and in the proportion of energy from carbohydrate from 66·7 to 56·8 % (P < 0·0001). In contrast, daily fat intake steadily increased from 54·8 to 66·0 g (P < 0·0001), as did the proportion of energy from fat from 21·5 to 30·0 % (P < 0·0001). The proportion of children who consumed a diet with more than 30 % of energy from fat increased from 20·1 to 49·4 % (P < 0·0001). The proportion of energy from protein increased from 11·8 to 13·1 % (P < 0·0001), although daily protein intake dropped from 66·2 to 58·0 g (P < 0·0001). Our data suggest that Chinese children have been undergoing a rapid nutrition transition to a high-fat diet.

Higher levels of serum triglyceride and dietary carbohydrate intake are associated with smaller LDL particle size in healthy Korean women

The aim of this study was to investigate the influencing factors that characterize low density lipoprotein (LDL) phenotype and the levels of LDL particle size in healthy Korean women. In 57 healthy Korean women (mean age, 57.4 ± 13.1 yrs), anthropometric and biochemical parameters such as lipid profiles and LDL particle size were measured. Dietary intake was estimated by a developed semi-quantitative food frequency questionnaire. The study subjects were divided into two groups: LDL phenotype A (mean size: 269.7Å, n = 44) and LDL phenotype B (mean size: 248.2Å, n = 13). Basic characteristics were not significantly different between the two groups. The phenotype B group had a higher body mass index, higher serum levels of triglyceride, total-cholesterol, LDL-cholesterol, apolipoprotein (apo)B, and apoCIII but lower levels of high density lipoprotein (HDL)-cholesterol and LDL particle size than those of the phenotype A group. LDL particle size was negatively correlated with serum levels of triglyceride (r = -0.732, P < 0.001), total-cholesterol, apoB, and apoCIII, as well as carbohydrate intake (%En) and positively correlated with serum levels of HDL-cholesterol and ApoA1 and fat intake (%En). A stepwise multiple linear regression analysis revealed that carbohydrate intake (%En) and serum triglyceride levels were the primary factors influencing LDL particle size (P < 0.001, R2 = 0.577). This result confirmed that LDL particle size was closely correlated with circulating triglycerides and demonstrated that particle size is significantly associated with dietary carbohydrate in Korean women.

Association between oral-health related factors and early childhood caries in children between age 36 and 72 months from Rural North Karnataka

Aims and Objectives: This study was conducted to investigate the association between oralhealth related factors and early childhood caries (ECC) and severe early childhood caries (SECC) in 3-6 year-old children. Materials and Methods: Data were collected from randomly selected 194 children, between 3 and 6 years of age, and their mothers, regarding oral hygiene habits, infant-feeding habits and salivary contact between the mother and the child. Children's deft, defs, and severity of early childhood caries were recorded. Results: Out of the 194 children examined, 79 had early childhood caries and 59 had severe early childhood caries. Statistical analyses revealed significant association between early childhood caries and Age of the child, breast feeding habits, bottle feeding, presence of Caries in the mother, brushing habit of the mother and increased dietary carbohydrate intake. Age of the child, Presence of caries of mother, DMFT /DMFS scores and Dietary habits of the mother were found to be significant risk factors for the severity of early childhood caries. Conclusion: It was apparent from this study that no single risk factor played important role in development of early childhood caries in preschool children. This study most certainly corroborates multifactorial etiology of early childhood caries. There is a need for education about the various risk factors for ECC, especially to the new mothers.

Nutrient timing with low carbohydrate diets

Low carbohydrate diets Various low carbohydrate diets have been shown to provide beneficial changes in body mass, lipid profiles and other health risk factors. Recent evidence indicates that diets with lower glycemic index carbohydrates and increased protein provide greater weight loss and maintenance of the reduced weight as compared with high glycemic and low protein diets. Insulin release is lower with lower blood glucose levels, thereby reducing fatty acid metabolism and storage. High intake of high glycemic response carbohydrates is associated with increased levels of insulin resistance which appears to be the common link between obesity and metabolic syndrome. Nutrient timing Nutrient timing is generally regarded as a nutritional strategy in which precise amounts of particular nutrients are delivered at precise time points, relative to exercise, in order to enhance performance or training effects. This somewhat general definition has been operationally limited by many to diets that utilize high glycemic carbohydrates prior to, during, and/or following exercise. These carbohydrates are considered vital as they provide an energy source as well as inducing increased insulin levels. As insulin directly influences the production of nitric oxide, vascular musculature is relaxed and circulation into the capillary beds of exercising muscles is increased. Carbohydrates, in particular higher glycemic carbohydrates, supply these critical benefits. Low carbohydrate nutrient timing The basic model of low carbohydrate nutrient timing applies specific proven micronutrients for enhanced exercise performance rather than relying on the ingestion of sugar and the subsequent insulin responses. First, reduced carbohydrate intake produces reduced insulin responses which shifts the metabolism to fatty acid utilization. Secondly, various nutritional components can provide additional energy sources and/or produce increased nitric oxide production with subsequent vasodilation. Items such as creatine and beta alanine can influence energy levels by affecting energy replenishment and acting as an anaerobic buffer. Branched chain amino acids provide a third energy source without which muscle tissue may be consumed with intense exercise. Various micronutrients can increase muscle blood flow to some degree. In particular, glycine proprionyl l-carnitine (GPLC) has been shown to dramatically increase nitric oxide synthesis in response to exercise stresses and to significantly increase exercise performance with reduced production of lactate. Conclusions The limited research in the area suggests that some athletes can train and compete in certain settings successfully with relatively low intake of dietary carbohydrates. It has been shown that pre-workout supplements containing common ingredients such as creatine, beta alanine, branched chain amino acids can substantially enhance exercise performance without ingestion of additional carbohydrates. Controlled clinical trials are needed to examine the effectiveness of nutrient timing with a low carbohydrate diet in various sports settings.

Diet and Colorectal Cancer: Analysis of a Candidate Pathway Using SNPS, Haplotypes, and Multi-Gene Assessment

There is considerable biologic plausibility to the hypothesis that genetic variability in pathways involved in insulin signaling and energy homeostasis may modulate dietary risk associated with colorectal cancer. We utilized data from 2 population-based case-control studies of colon (n = 1,574 cases, 1,970 controls) and rectal (n = 791 cases, 999 controls) cancer to evaluate genetic variation in candidate SNPs identified from 9 genes in a candidate pathway: PDK1, RP6KA1, RPS6KA2, RPS6KB1, RPS6KB2, PTEN, FRAP1 (mTOR), TSC1, TSC2, Akt1, PIK3CA, and PRKAG2 with dietary intake of total energy, carbohydrates, fat, and fiber. We employed SNP, haplotype, and multiple-gene analysis to evaluate associations. PDK1 interacted with dietary fat for both colon and rectal cancer and with dietary carbohydrates for colon cancer. Statistically significant interaction with dietary carbohydrates and rectal cancer was detected by haplotype analysis of PDK1. Evaluation of dietary interactions with multiple genes in this candidate pathway showed several interactions with pairs of genes: Akt1 and PDK1, PDK1 and PTEN, PDK1 and TSC1, and PRKAG2 and PTEN. Analyses show that genetic variation influences risk of colorectal cancer associated with diet and illustrate the importance of evaluating dietary interactions beyond the level of single SNPs or haplotypes when a biologically relevant candidate pathway is examined.

Carbohydrate catabolic flexibility in the mammalian intestinal commensal Lactobacillus ruminis revealed by fermentation studies aligned to genome annotations

BackgroundLactobacillus ruminis is a poorly characterized member of the Lactobacillus salivarius clade that is part of the intestinal microbiota of pigs, humans and other mammals. Its variable abundance in human and animals may be linked to historical changes over time and geographical differences in dietary intake of complex carbohydrates.ResultsIn this study, we investigated the ability of nine L. ruminis strains of human and bovine origin to utilize fifty carbohydrates including simple sugars, oligosaccharides, and prebiotic polysaccharides. The growth patterns were compared with metabolic pathways predicted by annotation of a high quality draft genome sequence of ATCC 25644 (human isolate) and the complete genome of ATCC 27782 (bovine isolate). All of the strains tested utilized prebiotics including fructooligosaccharides (FOS), soybean-oligosaccharides (SOS) and 1,3:1,4-β-D-gluco-oligosaccharides to varying degrees. Six strains isolated from humans utilized FOS-enriched inulin, as well as FOS. In contrast, three strains isolated from cows grew poorly in FOS-supplemented medium. In general, carbohydrate utilisation patterns were strain-dependent and also varied depending on the degree of polymerisation or complexity of structure. Six putative operons were identified in the genome of the human isolate ATCC 25644 for the transport and utilisation of the prebiotics FOS, galacto-oligosaccharides (GOS), SOS, and 1,3:1,4-β-D-Gluco-oligosaccharides. One of these comprised a novel FOS utilisation operon with predicted capacity to degrade chicory-derived FOS. However, only three of these operons were identified in the ATCC 27782 genome that might account for the utilisation of only SOS and 1,3:1,4-β-D-Gluco-oligosaccharides.ConclusionsThis study has provided definitive genome-based evidence to support the fermentation patterns of nine strains of Lactobacillus ruminis, and has linked it to gene distribution patterns in strains from different sources. Furthermore, the study has identified prebiotic carbohydrates with the potential to promote L. ruminis growth in vivo.

P2-4 Dietary intake of carbohydrates and risk of type 2 diabetes: a systematic review and meta-analysis

IntroductionEpidemiologic evidence on the role of dietary intake of carbohydrates in development of type-2-diabetes is inconclusive.MethodsWe conducted a systematic review of studies reporting the association between dietary intake of carbohydrate...

Dietary Carbohydrate Utilization by European Sea Bass (Dicentrarchus labrax L.) and Gilthead Sea Bream (Sparus aurata L.) Juveniles

European sea bass and gilthead sea bream are two major marine finfish species reared in the Mediterranean region. Feeds for these species have high protein levels, usually supplied by fish meal. Research on alternatives to fish meal is mainly focused on plant protein feedstuffs, which are generally high in carbohydrates. Therefore, understanding the potential use of dietary carbohydrate is crucial for better utilization of such feedstuffs in the diets for these species. Factors that affect carbohydrate digestibility, metabolic utilization, as well as regulation of glucose metabolism are discussed. Data show that to ensure high digestibility, growth, and feed utilization, diets for these species should include around 20% digestible carbohydrate. Digestibility of native starch is high (above 70%) in both species, and it is further improved by processing starches (above 90%). Regarding carbohydrate complexity, it appears that European sea bass perform better with starch than glucose, while the opposite is true for gilthead sea bream. An enhancement in the activity of key enzymes of the glycolytic pathway and an increase of liver glycogen content is generally observed in the two species after feeding carbohydrates. An inverse regulation of the gluconeogenic enzyme activities with dietary carbohydrate intake is not observed in either species.

Carbohydrate intake, glycemic load, glycemic index, and risk of ovarian cancer

BackgroundOur objective was to determine the relationship between dietary glycemic load (GL), glycemic index (GI), carbohydrate intake, and ovarian cancer risk in a population-based case–control study. Patients and methodsA self-administered questionnaire was used to collect data on demographic and lifestyle factors, and a food frequency questionnaire was used to collect dietary information from 1366 women with ovarian cancer and 1414 population controls. ResultsGL was positively associated with ovarian cancer. The adjusted odds ratio (OR) for the highest versus the lowest quartile of intake was 1.24 [95% confidence interval (CI) 1.00–1.55, P for trend = 0.03]. Fiber intake was inversely associated with risk. The OR comparing women in the highest fiber-intake group with those in the lowest was 0.78 (95% CI 0.62–0.98, P for trend = 0.11). We found no association between GI, carbohydrate intake, and ovarian cancer. In analyses stratified by body mass index, the risk estimates for GL, carbohydrate, and sugar were higher among overweight/obese women; however, the interaction term was only significant for sugar (P for interaction = 0.004). ConclusionsOur results suggest that diets with a high GL may increase the risk of ovarian cancer, particularly among overweight/obese women, and a high intake of fiber may provide modest protection.

Lipid profile and nutritional intake in children and adolescents with Type 1 diabetes improve after a structured dietician training to a Mediterranean-style diet.

To evaluate if nutritional intakes and lipid profile fulfill international guidelines and recommendations before and after a structured dietician training to a Mediterranean- style diet in an Italian pediatric population with Type 1 diabetes. A 6-month prospective cohort study. Baseline and after-intervention nutritional intakes, lipid profile, glycated hemoglobin (HbA(1c)), and clinical parameters of 96 children and adolescents with Type 1 diabetes were assessed. A comparative computerized system which was approved and validated by the Italian Diabetologist Association was used to define the amounts of nutrients. At baseline mean daily dietary intakes of carbohydrates, proteins, and lipids were respectively (mean ± SEM) 51.8 ± 0.5, 15.9 ± 0.2, 33.8 ± 0.6%, with a contribution of cholesterol of 248.7 ± 12.5 mg/day. Fiber assumption was 18.0 ± 0.4 g/day. The 64.5% and 29.1% (p<0.0001) of subjects had at least one lipid parameter higher than 75(th) and 95(th) percentiles, respectively, of selected cut points (American Diabetes Association guidelines for total and LDL-cholesterol and American Academy of Pediatrics standards for HDL-cholesterol and triglycerides). Six months after the dietician intervention, dietary lipids and cholesterol decreased (p<0.0001) while fibers (p<0.0001) increased. LDL-cholesterol, non-HDL-cholesterol, and total cholesterol:HDL-cholesterol ratios significantly decreased (p<0.001) with a reduction of rate of subjects with at least one pathological lipid parameter (p<0.01) independently by weight and glucose control. Italian pediatric subjects with Type 1 diabetes present a balanced diet with exception of lipids intake and a suboptimal lipid profile. A structured dietician training to a Mediterranean-style diet improves the quality of nutrient intakes being followed by a reduction of LDL-cholesterol, non- HDL-cholesterol, and total cholesterol:HDL-cholesterol ratios.

Role of Higher Dietary Carbohydrate Intake in Cataract Development

subjects. 3 The same is true of high carbohydrate intake. Normal persons exposed to the highest carbohydrate intake do not develop diabetes or diabetes complication, such as cataract, since the blood glucose test results (A1C test, fasting plasma glucose test, and/or oral glucose tolerance test [OGTT]) remain within the normal range. The situation is different in diabetic patients and in patients with reduced tolerance to glucose. Before developing type 2 diabetes, individuals are in a disease stage called prediabetes, in which blood glucose levels are higher than normal, but are not yet high enough to be diagnosed as diabetic. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during the prediabetes period, which is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both IFG and IGT exhibit elevated glucose levels that are not sufficient to be classified as diabetes, but that represent the development of insulin resistance. Achieving glycemic control in patients with prediabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications

Author Response: Role of Higher Dietary Carbohydrate Intake in Cataract Development

Author Response: Role of Higher Dietary Carbohydrate Intake in Cataract Development

Pre-Race Dietary Carbohydrate Intake Can Independently Influence Sub-Elite Marathon Running Performance

We examined whether selected anthropometric and nutritional factors influenced field-based marathon running performance. An internet-based data collection tool allowed competitors in the 2009 London Marathon (n=257, mean ± SD age: 39 ± 8 years, finish time: 273.8 ± 59.5 min) to record a range of anthropometric, training and nutritional predictors. Multivariate statistical methods were used to quantify the change in running speed mediated by a unit change in each predictor via the 95% confidence interval for each covariate-controlled regression slope ( B). Gender ( B=1.22 to 1.95 km/h), body mass index ( B=-0.14 to -0.27 km/h), training distance ( B=0.01 to 0.04 km/h) and the amount of carbohydrate consumed the day before the race ( B=0.08 to 0.26 km/h) were significant predictors, collectively accounting for 56% of the inter-individual variability in running speed (P<0.0005). Further covariate-adjusted analysis revealed that those competitors who consumed carbohydrate the day before the race at a quantity of >7 g/kg body mass had significantly faster overall race speeds (P=0.01) and maintained their running speed during the race to a greater extent than with those who consumed <7 g/kg body mass (P=0.02). We conclude that, in addition to gender, body size and training, pre-race day carbohydrate intake can significantly and independently influence marathon running performance.