Increased Carbohydrate Intake Research Articles

Beyond Expected Patterns in Insulin Needs of People With Type 1 Diabetes: Temporal Analysis of Automated Insulin Delivery Data

Abstract Background Type 1 diabetes (T1D) is a chronic condition in which the body produces too little insulin, a hormone needed to regulate blood glucose. Various factors such as carbohydrates, exercise, and hormones impact insulin needs. Beyond carbohydrates, most factors remain underexplored. Regulating insulin is a complex control task that can go wrong and cause blood glucose levels to fall outside a range that protects people from adverse health effects. Automated insulin delivery (AID) has been shown to maintain blood glucose levels within a narrow range. Beyond clinical outcomes, data from AID systems are little researched; such systems can provide data-driven insights to improve the understanding and treatment of T1D. Objective The aim is to discover unexpected temporal patterns in insulin needs and to analyze how frequently these occur. Unexpected patterns are situations where increased insulin does not result in lower glucose or where increased carbohydrate intake does not raise glucose levels. Such situations suggest that factors beyond carbohydrates influence insulin needs. Methods We analyzed time series data on insulin on board (IOB), carbohydrates on board (COB), and interstitial glucose (IG) from 29 participants using the OpenAPS AID system. Pattern frequency in hours, days (grouped via k-means clustering), weekdays, and months were determined by comparing the 95% CI of the mean differences between temporal units. Associations between pattern frequency and demographic variables were examined. Significant differences in IOB, COB, and IG across temporal dichotomies were assessed using Mann-Whitney U tests. Effect sizes and Euclidean distances between variables were calculated. Finally, the forecastability of IOB, COB, and IG for the clustered days was analyzed using Granger causality. Results On average, 13.5 participants had unexpected patterns and 9.9 had expected patterns. The patterns were more pronounced (d>0.94) when comparing hours of the day and similar days than when comparing days of the week or months (0.3<d<0.52). Notably, 11 participants exhibited a higher IG overnight despite concurrently higher IOB (10/11). Additionally, 17 participants experienced an increase in IG after COB decreased after meals. The significant associations between pattern frequency and demographics were moderate (0.31≤τ≤0.48). Between clusters, mean IOB (P=.03, d=0.7) and IG (P=.02, d=0.67) differed significantly, but COB did not (P=.08, d=0.55). IOB and IG were most similar (mean distance 5.08, SD 2.25), while COB and IG were most different (mean distance 11.43, SD 2.6), suggesting that AID attempts to counteract both observed and unobserved factors that impact IG. Conclusions Our study shows that unexpected patterns in the insulin needs of people with T1D are as common as expected patterns. Unexpected patterns cannot be explained by carbohydrates alone. Our results highlight the complexity of glucose regulation and emphasize the need for personalized treatment approaches. Further research is needed to identify and quantify the factors that cause these patterns.

Energy Availability in Female Collegiate Beach Volleyball Athletes.

Willingham, BD, Daou, M, VanArsdale, J, Thomas, M, and Saracino, PG. Energy availability in female collegiate beach volleyball athletes. J Strength Cond Res 38(11): 1941-1950, 2024-Low energy availability (LEA) is a present risk for many female athletes. Yet, the literature on LEA is often reliant on single, short-term, snapshots, which may not be reflective of the chronic energy balance surrounding female athletes in sport. Therefore, the purpose of this study was to establish the current prevalence of LEA in female collegiate beach volleyball athletes during the preseason and across the competitive season. One-way repeated measures analysis of variance was used to compare measures of EA (i.e., dietary intake, activity energy expenditure [EE], body composition) and EE (i.e., resting metabolic rate and thermic effect of feeding) at 4 timepoints-once in the preseason (i.e., Fall), and 3 times across the 10-week competitive season in Spring (i.e., week 1, week 5, and week 9). Significance was set at p ≤ 0.05. Although mean EA was in the subclinical zone (i.e., 30-45 kcal·kg FFM-1·d-1) at each timepoint, the prevalence of LEA for individuals was 30.8% in the preseason, 37.5% at week 1, 25.0% at week 5, and 62.5% at week 9. Further, carbohydrate intake was below the recommended range for power athletes at each timepoint, suggesting that female beach volleyball athletes with LEA may benefit from increasing carbohydrate intake. Despite no statistical differences in body mass across the season (p = 0.577), there was a trend for increasing fat-free mass (p = 0.062) as the season progressed. Importantly, LEA is not a team-wide condition but an individual one. Therefore, approaches to mitigate LEA should be individualized.

Increased carbohydrate intake does not alter insulin resistance in type 2 diabetic patients

Increased carbohydrate intake does not alter insulin resistance in type 2 diabetic patients

Nutritional Management of Patients with Fatty Acid Oxidation Disorders.

Treatment of fatty acid oxidation disorders is based on dietary, pharmacological and metabolic decompensation measures. It is essential to provide the patient with sufficient glucose to prevent lipolysis and to avoid the use of fatty acids as fuel as far as possible. Dietary management consists of preventing periods of fasting and restricting fat intake by increasing carbohydrate intake, while maintaining an adequate and uninterrupted caloric intake. In long-chain deficits, long-chain triglyceride restriction should be 10% of total energy, with linoleic acid and linolenic acid intake of 3-4% and 0.5-1% (5/1-10/1 ratio), with medium-chain triglyceride supplementation at 10-25% of total energy (total MCT+LCT ratio = 20-35%). Trihepatnoin is a new therapeutic option with a good safety and efficacy profile. Patients at risk of rhabdomyolysis should ingest MCT or carbohydrates or a combination of both 20 min before exercise. In medium- and short-chain deficits, dietary modifications are not advised (except during exacerbations), with MCT contraindicated and slow sugars recommended 20 min before any significant physical exertion. Parents should be alerted to the need to increase the amount and frequency of carbohydrate intake in stressful situations. The main measure in emergency hospital treatment is the administration of IV glucose. The use of carnitine remains controversial and new therapeutic options are under investigation.

Beneficial Recognition of Glucose Variability for Adequate Lifestyle by Continuous Glucose Monitoring (CGM)

Recently, actual changes in blood glucose can be measured by continuous glucose monitoring (CGM) using FreeStyle Libre. The case involves a 67-year-old male patient with type 2 diabetes (T2D) treated with Multiple Daily Insulin (MDI) therapy, who underwent CGM. Analysis of the CGM data revealed that hyperglycemia resulted from increased carbohydrate intake and irregular meal timings and quantities. The estimated HbA1c from CGM was 6.6%, whereas the HbA1c value recorded at the outpatient clinic during the same period was 7.3%. The use of CGM applications encourages diabetic patients to be mindful of their carbohydrate intake in daily life, leading to an increased ratio of time spent in the target range (TIR).

Impact of nutrition education programme and controlled dietary modification on nutritional status in young male athletes

PurposeThe current study sought to assess the synergistic effects of an eight-week nutrition education program (NEP) and controlled dietary modification (CDM) on the nutrition knowledge (NK), nutrition practice (NP), and daily dietary intake of nutrition counselling group (NCG) versus ad-libitum group (ALG), as well as to identify the dietary factors predicting athletes' NP. MethodsA total of 105 male players (14–18 years) from the sports disciplines-football, hockey, swimming, and athletics-were block randomized into the NCG and the ALG. The NCG underwent an 8-week nutritional intervention (NI) that included NEP and CDM, while ALG did not participate in the NI and followed ad-libitum dietary intake. Primary data on each subject's NK, NP, daily food intake, and anthropometric measurements were collected before and after the intervention period for paired and case-control analysis. ResultsA strong association has been depicted between players’ NK and NP. Daily intake of carbohydrate, protein, calcium, and dietary fibre could be referred to as the significant positive predictors of NP, while fat intake is the negative predictor. The synergistic implementation of NEP and CDM reduced the energy deficits among the NCGby significantly increasing their daily calorie intake to an average of 97%. Protein intake was significantly increased, thus meeting 88% of the recommendation, while the increase in carbohydrate intake was insignificant, meeting 89% of the standards post-NI. Further, the NCG showed significant increases in intake of minerals like calcium, phosphorus, iron, zinc, and selenium, while the ALG had substantial reductions. The former also exhibited significant rises in vitamin A, B9, B12, C, and E intakes. The most significant spikes in macro and micronutrient intake were observed in the footballers and hockey players, who were also the groups with the largest increases in NK and NP scores. ConclusionThe equilibrium in macronutrient bifurcations and relative macronutrient and micronutrient intake post-intervention indicates the effectiveness of nutritional enactment through an 8-week controlled dietary modification and systematic nutrition education programme on the nutritional status of young athletes. Therefore, good nutrition knowledge may improve the dietary patterns and nutrition intake of athletes. Intervention studies should emphasize nutrition education, aiming for improved athletic performance.

FRI080 Post Bariatric Hypoglycemia And Pregnancy: Successful Utilization Of Remnant Stomach Gastrostomy Tube Placement In Severe Refractory Hypoglycemia After Roux-en-Y Gastric Bypass Surgery

Abstract Disclosure: S.S. Habbsa: None. A. Port: None. Introduction: Post bariatric hypoglycemia (PBH) can occur following Roux-En-Y Gastric Bypass (RYGB). Due to an exaggerated glucagon-like-peptide-1 (GLP-1) response from rapid nutrient transit to the distal bowel, patients with PBH exhibit endogenous hyperinsulinemic hypoglycemia following a carbohydrate load. Severe cases can result in significantly impaired quality of life (QoL), including syncope, seizures, and nutritional deficits from restricted intake. Recently, remnant stomach percutaneous endoscopy gastrostomy (PEG) tube placement has been reported in a handful of cases as a successful long-term strategy for RYGB-PBH refractory to nutritional and medical therapy. However, there are no known outcomes in pregnancy. Case: A 25-year-old female with a history of RYGB presented with increasingly severe and frequent PBH beginning 12 months after surgery. Mixed meal testing was consistent with prandial hypoglycemia (down to 20 mg/dL) with hyperinsulinemia (C-peptide 11 [0.80 - 3.10 ng/mL], Insulin 50 [<23 uIU/mL]). Ultrasound was negative for pancreatic anomalies. Dietary modification and medical therapy with acarbose, diazoxide, and liraglutide were unsuccessful. 3 years after RYGB, she required hospitalization for hypoglycemic seizures, and she underwent remnant stomach PEG tube placement. Oral intake was discontinued (except for protein for comfort) and substituted with 12-hour nocturnal feeds. Her PBH diminished, and she reported significant improvement in QoL. 6 years after PEG placement, the patient became pregnant. Working closely with a dietician, she increased caloric intake by 200-250 kcal/day in the second and third trimesters. Screening for gestational diabetes with oral glucose tolerance testing was deferred given risk of PBH exacerbation, and CGM was used instead for glycemic monitoring. Intolerance to overnight feeds was remedied using concentrated enteral formulas and incorporation of short daytime tube feed boluses. She delivered a healthy baby via elective C-section. During lactation, due to concern for food protein allergy, she was transitioned to a non-dairy non-soy-based feeding regimen. She returned to her pre-pregnancy weight and her sugars remained stable. Conclusion: This is the first case report documenting safe and effective use of remnant stomach enteral feeds for management of severe refractory PBH post RYGB during pregnancy and lactation. Pregnancy presents a unique situation in which increased carbohydrate intake is necessary to support fetal development; however, this can be life-threatening for patients with severe PBH. Remnant stomach PEG feeds utilize the original gut without need for surgical RYGB reversal, preventing rapid nutrient transit. Long-term reversal of PBH, sustained weight loss and customizable feeding regimens support the use of remnant PEG placement for severe RYGB-PBH in the appropriate patient. Presentation: Friday, June 16, 2023

Association between changes in carbohydrate intake and long term weight changes: prospective cohort study.

To comprehensively examine the associations between changes in carbohydrate intake and weight change at four year intervals. Prospective cohort study. Nurses' Health Study (1986-2010), Nurses' Health Study II (1991-2015), and Health Professionals Follow-Up Study (1986-2014). 136 432 men and women aged 65 years or younger and free of diabetes, cancer, cardiovascular disease, respiratory disease, neurodegenerative disorders, gastric conditions, chronic kidney disease, and systemic lupus erythematosus before baseline. Weight change within a four year period. The final analyses included 46 722 women in the Nurses' Health Study, 67 186 women in the Nurses' Health Study II, and 22 524 men in the Health Professionals Follow-up Study. On average, participants gained 1.5 kg (5th to 95th centile -6.8 to 10.0) every four years, amounting to 8.8 kg on average over 24 years. Among men and women, increases in glycemic index and glycemic load were positively associated with weight gain. For example, a 100 g/day increase in starch or added sugar was associated with 1.5 kg and 0.9 kg greater weight gain over four years, respectively, whereas a 10 g/day increase in fiber was associated with 0.8 kg less weight gain. Increased carbohydrate intake from whole grains (0.4 kg less weight gain per 100 g/day increase), fruit (1.6 kg less weight gain per 100 g/day increase), and non-starchy vegetables (3.0 kg less weight gain per 100 g/day increase) was inversely associated with weight gain, whereas increased intake from refined grains (0.8 kg more weight gain per 100 g/day increase) and starchy vegetables (peas, corn, and potatoes) (2.6 kg more weight gain per 100 g/day increase) was positively associated with weight gain. In substitution analyses, replacing refined grains, starchy vegetables, and sugar sweetened beverages with equal servings of whole grains, fruit, and non-starchy vegetables was associated with less weight gain. The magnitude of these associations was stronger among participants with overweight or obesity compared with those with normal weight (P<0.001 for interaction). Most of these associations were also stronger among women. The findings of this study highlight the potential importance of carbohydrate quality and source for long term weight management, especially for people with excessive body weight. Limiting added sugar, sugar sweetened beverages, refined grains, and starchy vegetables in favor of whole grains, fruit, and non-starchy vegetables may support efforts to control weight.

Substitutability of nicotine and sucrose in rats: A behavioral economic analysis

Despite considerable evidence suggesting that sweet foods are a substitute for nicotine in humans, no formal behavioral economic analysis of this interrelationship has been conducted in nonhumans. The purpose of the present study was to examine this phenomenon in rats using concurrent schedules of sucrose pellet, chow pellet, and nicotine reinforcer delivery. Rats responded on separate levers that delivered sucrose pellets, chow pellets, or nicotine infusions under concurrent fixed-ratio (FR) 1 schedules for each commodity within a closed economy. Following stable food and nicotine intake, the unit price of either sucrose or nicotine (the primary commodity) was increased while the two alternative commodities remained unchanged. Substitution was quantified using a behavioral economic cross-price model, as well as a novel commodity relation index that normalizes consumption of dissimilar commodities. Asymmetrical partial substitution was observed, wherein sucrose served as a partial substitute for nicotine, but nicotine failed to substitute for sucrose. Moreover, sucrose was a stronger partial substitute for nicotine than chow in most rats. These findings indicate that substitution of food for nicotine depends on the type of food. These findings mirror the selective increase in carbohydrate intake that can occur during smoking cessation and demonstrate a behavioral economic mechanism that may mediate it.

Assessments of energy, macro and micronutrient intakes in children and adolescents with type 1 diabetes mellitus

Objective: This study aims at examining dietary intake in children and adolescents with type 1 diabetes mellitus (DM) and comparing&#x0D; the results with national dietary intake recommendations.&#x0D; Patients and Methods: One hundred fifty children and adolescents (52.7% female) with an average age of 12.2±3.1 years and with&#x0D; type 1 DM who were followed by the Pediatric Endocrinology Polyclinic participated in the study. Three-day food intake records and&#x0D; clinical information regarding the type 1 DM condition of the participants were obtained.&#x0D; Results: No gender-related significant difference was found among the participants regarding food intake. The percentage of energy&#x0D; derived from fat (average 39.6%) and saturated fat (16.1%) were higher than the recommended levels in both gender groups. The&#x0D; percentage of energy derived from carbohydrates (female 44.1±5.7%, male 43.0±6.8%) was below the recommended levels. The dietary&#x0D; fiber intake in children aged 6-10 years with type 1 DM met recommendations, whereas, it was below the recommended levels in other&#x0D; age groups. Micronutrient inadequacy was common in children and adolescents with type 1 DM.&#x0D; Conclusions: The authors believe that guidelines and programs are needed for children and adolescents with type 1 DM to reduce&#x0D; total fat and saturated fat intake, increase carbohydrate and dietary fiber intake up to the recommended levels, and prevent multiple&#x0D; micronutrient inadequacies.

Impact of Diet and Lifestyle Modification and Weight Reduction on Essential Hypertension

Objectives: This study was to assess the impact of diet and lifestyle modification with weight reduction on blood pressure in patients with essential hypertension and to impart awareness regarding the importance of dietary modifications, physical exercise, and weight reduction in controlling or reversing high blood pressure and prevention of end-organ damage. Methods: This was a prospective observational study among overweight or obese hypertensives. We included 60 consecutive patients, who after sticking to the diet and lifestyle advice achieved weight reduction. They all were overweight, or had a history of weight gain, and had hypertension, or were newly diagnosed to have persistent hypertension. They were motivated to achieve weight reduction and educated about healthy eating habits using diet charts and tips for lifestyle modifications. Sixty such consecutive subjects, without any secondary causes for hypertension, and who complied with the diet and lifestyle advised, and thus achieved weight reduction only were subjected to statistical analysis. Those who did not achieve weight reduction were not taken for analysis Results: 90 % of the subjects had their BMI above normal and the remaining 10% of subjects had an upper range of normal BMI, but all of them gave a history of weight gain. The majority of the subjects were having faulty dietary habits with increased carbohydrate intake as the primary reason for weight gain, besides having inadequate vegetables, fruits and protein intake, along with 15% consuming junk food on a daily basis. After lifestyle intervention, weight reduction was achieved in all the subjects studied, and there was a significant reduction in both systolic and diastolic blood pressures with the weight loss achieved, and it was statistically significant. The association of decrease in SBP with a decrease in weight was significant with a p-value of &lt;0.001. The mean initial systolic blood pressure was 154.13 mmHg (SD 13.31), and the follow up mean was 137.33 mmHg (SD 12.87). The mean decrease in SBP was 16.8mmHg, and the mean change in weight was 9.4 Kg. Most of the hypertensives had their drug number or dose decreased and some of them had their drugs stopped completely. Conclusions: Educating the subjects on balanced diet with restriction of carbohydrates with increased intake of vegetables, adequate fruits, ensuring adequate protein and adequate water intake was the key intervention. The results of the study strongly pointed towards the inevitable role diet, lifestyle and weight reduction had on the achievement of blood pressure control and even reversal of hypertension. Faulty dietary habits with excessive calorie intake, decreased vegetables and fruits, low physical activity and sedentary nature of work contributed to weight gain. Both systolic and diastolic BP decreased on weight reduction implying thereby weight gain as the primary cause for both. Awareness regarding the disease and its complications was very low. In addition, dietary malpractices were detected and halted, and this reinforced the positive results. It also had a favorable impact on the comorbidities they suffered from.

Increased carbohydrate intake does not impair continual gyceamia in older type 2 diabetic patients.

Increased carbohydrate intake does not impair continual gyceamia in older type 2 diabetic patients.

The impact of alcoholic drinks and dietary factors on epigenetic markers associated with triglyceride levels.

Background: Many epigenetic loci have been associated with plasma triglyceride (TG) levels, but epigenetic connections between those loci and dietary exposures are largely unknown. This study aimed to characterize the epigenetic links between diet, lifestyle, and TG. Methods: We first conducted an epigenome-wide association study (EWAS) for TG in the Framingham Heart Study Offspring population (FHS, n = 2,264). We then examined relationships between dietary and lifestyle-related variables, collected four times in 13years, and differential DNA methylation sites (DMSs) associated with the last TG measures. Third, we conducted a mediation analysis to evaluate the causal relationships between diet-related variables and TG. Finally, we replicated three steps to validate identified DMSs associated with alcohol and carbohydrate intake in the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) study (n = 993). Results: In the FHS, the EWAS revealed 28TG-associated DMSs at 19 gene regions. We identified 102 unique associations between these DMSs and one or more dietary and lifestyle-related variables. Alcohol and carbohydrate intake showed the most significant and consistent associations with 11TG-associated DMSs. Mediation analyses demonstrated that alcohol and carbohydrate intake independently affect TG via DMSs as mediators. Higher alcohol intake was associated with lower methylation at seven DMSs and higher TG. In contrast, increased carbohydrate intake was associated with higher DNA methylation at two DMSs (CPT1A and SLC7A11) and lower TG. Validation in the GOLDN further supports the findings. Conclusion: Our findings imply that TG-associated DMSs reflect dietary intakes, particularly alcoholic drinks, which could affect the current cardiometabolic risk via epigenetic changes. This study illustrates a new method to map epigenetic signatures of environmental factors for disease risk. Identification of epigenetic markers of dietary intake can provide insight into an individual's risk of cardiovascular disease and support the application of precision nutrition. Clinical Trial Registration: www.ClinicalTrials.gov, the Framingham Heart Study (FHS), NCT00005121; the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN), NCT01023750.

The return from underperformance to sustainable world-class level: A case study of a male cross-country skier.

Purpose: To determine the main factors associated with unexpected underperformance and prospectively describe the holistic process of returning to sustainable world-class level in a male cross-country skier. Methods: Longitudinal training data was retrospectively analyzed across nine seasons (2012-2013 to 2020-2021), and categorized into training forms (endurance, strength, and speed), intensities [low- (LIT), moderate- (MIT), and high-intensity training (HIT)], and modes (specific and non-specific). Performance data was obtained from the International Ski and Snowboard Federation. Following two seasons of unexpected underperformance (2019-2020 and 2020-2021), the participant was prospectively followed in the process of returning to sustainable world-class level (2021-2022). Day-to-day training data and physiological tests were analyzed, and interviews with the participant and the head coach conducted. Results: Longitudinal training data from 2012-2013 to 2018-2019 demonstrated a non-linear 30% increase in total training volume (from 772 to 1,002h), mainly caused by increased volume of ski-specific endurance training without changes in intensity distribution. Coincidingly, the participant gradually reached a world-class performance level. After two seasons of unexpected underperformance with relatively similar training volumes and intensity distributions as in the preceding seasons, the possible contributing factors were identified: lack of training periodization, limited monitoring and intensity control, particularly in connection with a "extreme" regime of training with low carbohydrate availability and days including two MIT sessions, as well as lack of systematic technique training and follow-up by coaches on a daily basis. Consequently, the return to world-class level included the introduction of a clear micro-cycle periodization, more systematic physiological monitoring and testing, more accurate intensity control, increased carbohydrate intake during and between sessions, as well as increased emphasize on technique training and an assistant coach present during day-to-day training. Conclusion: These longitudinal data describe the main factors leading to unexpected underperformance, in addition to providing unique insights into the corresponding process of returning to sustainable world-class level in a male cross-country skier. The holistic approach described in this case study may serve as a theoretical framework for future studies and practical work with underperforming endurance athletes.

Associations of Dietary Intake with the Intestinal Microbiota and Short-Chain Fatty Acids Among Young Adults with Type 1 Diabetes and Overweight or Obesity

BackgroundDiet, a key component of type 1 diabetes (T1D) management, modulates the intestinal microbiota and its metabolically active byproducts—including SCFA—through fermentation of dietary carbohydrates such as fiber. However, the diet–microbiome relationship remains largely unexplored in longstanding T1D. ObjectivesWe evaluated whether increased carbohydrate intake, including fiber, is associated with increased SCFA-producing gut microbes, SCFA, and intestinal microbial diversity among young adults with longstanding T1D and overweight or obesity. MethodsYoung adult men and women with T1D for ≥1 y, aged 19–30 y, and BMI of 27.0–39.9 kg/m2 at baseline provided stool samples at baseline and 3, 6, and 9 mo of a randomized dietary weight loss trial. Diet was assessed by 1–2 24-h recalls. The abundance of SCFA-producing microbes was measured using 16S rRNA gene sequencing. GC-MS measured fecal SCFA (acetate, butyrate, propionate, and total) concentrations. Adjusted and Bonferroni-corrected generalized estimating equations modeled associations of dietary fiber (total, soluble, and pectins) and carbohydrate (available carbohydrate, and fructose) with microbiome-related outcomes. Primary analyses were restricted to data collected before COVID-19 interruptions. ResultsFiber (total and soluble) and carbohydrates (available and fructose) were positively associated with total SCFA and acetate concentrations (n = 40 participants, 52 visits). Each 10 g/d of total and soluble fiber intake was associated with an additional 8.8 μmol/g (95% CI: 4.5, 12.8 μmol/g; P = 0.006) and 24.0 μmol/g (95% CI: 12.9, 35.1 μmol/g; P = 0.003) of fecal acetate, respectively. Available carbohydrate intake was positively associated with SCFA producers Roseburia and Ruminococcus gnavus. All diet variables except pectin were inversely associated with normalized abundance of Bacteroides and Alistipes. Fructose was inversely associated with Akkermansia abundance. ConclusionsIn young adults with longstanding T1D, fiber and carbohydrate intake were associated positively with fecal SCFA but had variable associations with SCFA-producing gut microbes. Controlled feeding studies should determine whether gut microbes and SCFA can be directly manipulated in T1D.

Dietary fat intake is associated with insulin resistance and an adverse vascular profile in patients with T1D: a pooled analysis

BackgroundInsulin resistance (IR) increases vascular risk in individuals with Type 1 Diabetes (T1D). We aimed to investigate the relationship between dietary intake and IR, as well as vascular biomarkers in T1D.MethodsBaseline data from three randomised controlled trials were pooled. Estimated glucose disposal rate (eGDR) was used as an IR marker. Employing multivariate nutrient density substitution models, we examined the association between macronutrient composition and IR/vascular biomarkers (tumour necrosis factor-α, fibrinogen, tissue factor activity, and plasminogen activator inhibitor-1).ResultsOf the 107 patients, 50.5% were male with mean age of 29 ± 6 years. Those with lower eGDR were older with a longer diabetes duration, higher insulin requirements, and an adverse vascular profile (p < 0.05). Patients with higher degrees of IR had higher total energy intake (3192 ± 566 vs. 2772 ± 268 vs. 2626 ± 395 kcal/d for eGDR < 5.1 vs. 5.1–8.6 vs. ≥ 8.7 mg/kg/min, p < 0.001) and consumed a higher absolute and proportional amount of fat (47.6 ± 18.6 vs. 30.4 ± 8.1 vs. 25.8 ± 10.4%, p < 0.001). After adjusting for total energy intake, age, sex, and diabetes duration, increased carbohydrate intake offset by an isoenergetic decrease in fat was associated with higher eGDR (β = 0.103, 95% CI 0.044–0.163). In contrast, increased dietary fat at the expense of dietary protein intake was associated with lower eGDR (β = − 0.119, 95% CI − 0.199 to − 0.040). Replacing fat with 5% isoenergetic amount of carbohydrate resulted in decreased vascular biomarkers (p < 0.05).ConclusionHigher fat, but not carbohydrate, intake is associated with increased IR and an adverse vascular profile in patients with T1D.

Macronutrients and the state of happiness and mood in undergraduate youth of a military training course

Previous studies have reported a high prevalence of mental disorders among military organizations. Depression and anxiety are among the most important mental disorders, and depression, suicidal ideation, and violence have been found to be negatively associated with happiness and social support. Therefore, improving mood and increasing happiness can reduce the prevalence of mental disorders in military centers. Diet can improve happiness through specific molecular mechanisms and change our mood by affecting the chemical composition of the brain. Therefore, the present study examined the relationship between the quality and quantity of macronutrients in soldiers' diets with their mood and happiness. In the current cross-sectional study, 300 healthy soldiers were selected. Food intake data was collected using 168-item semi-quantitative food frequency questionnaire during the last year of their military training 2-year period. Then, we calculated the quality and quantity of macronutrients. Mood was assessed using the Profile of Mood States (POMS) questionnaire and happiness with the Oxford Happiness Questionnaire (OHQ). The mean±standard deviation of participants' age was 23.70±1.76 years. A significant relationship was observed between mood score and carbohydrate quantity (OR: 0.32, 95% CI: 0.12-0.88, P-value for trend=0.03). This suggests that increasing carbohydrate intake improved the participants' mood. No association was found between mood score with protein quantity (OR: 2.15, 95% CI: 0.80-5.75; P-value for trend=0.12), and gram of fat intake (OR: 1.95, 95% CI: 0.74-5.13; P-value for trend=0.15). None of the indicators related to macronutrient quality were significantly associated with happiness and mood scores in young soldiers (P≥0.05). Findings presented in this study showed that increased carbohydrate intake was significantly associated with better mood. However, mood is not related to the amount of proteins and fats and none of the parameters of macronutrient quality. Also, there was no significant relationship between the quantity and quality of macronutrients with happiness score.

Exiting the Cave

This is a follow-up of a recent case study of the Paleolithic diet that investigates dietary changes, including energy intake, food sources, and macronutrient and micronutrient distribution, associated with a transition from a Paleolithic diet toward a more omnivorous pattern. We observed a more than 40% increase in carbohydrate intake and a 10% decrease in fat intake, including 20% less energy from saturated fat, less intake of nearly all micronutrients, and a substantially greater energy contribution from nonpaleo sources, including ultraprocessed foods. This analysis of 2 full years of nutrition data provides a unique description of changing dietary patterns in a free-living individual.

Heat Adaptation and Nutrition Practices: Athlete and Practitioner Knowledge and Use.

To survey elite athletes and practitioners to identify (1)knowledge and application of heat acclimation/acclimatization (HA) interventions, (2)barriers to HA application, and (3)nutritional practices supporting HA. Elite athletes (n = 55) and practitioners (n = 99) completed an online survey. Mann-Whitney U tests (effect size [ES; r]) assessed differences between ROLE (athletes vs practitioners) and CLIMATE (hot vs temperate). Logistic regression and Pearson chi-square (ES Phi [ϕ]) assessed relationships. Practitioners were more likely to report measuring athletes' core temperature (training: practitioners 40% [athletes 15%]; P = .001, odds ratio = 4.0, 95% CI, 2%-9%; competition: practitioners 25% [athletes 9%]; P = .020, odds ratio = 3.4, 95% CI, 1%-10%). Practitioners (55% [15% athletes]) were more likely to perceive rectal as the gold standard core temperature measurement site (P = .013, ϕ = .49, medium ES). Temperate (57% [22% hot]) CLIMATE dwellers ranked active HA effectiveness higher (P < .001, r = .30, medium ES). Practitioners commonly identified athletes' preference (48%), accessibility, and cost (both 47%) as barriers to HA. Increasing carbohydrate intake when training in the heat was more likely recommended by practitioners (49%) than adopted by athletes (26%; P = .006, 95% CI, 0.1%-1%). Practitioners (56% [28% athletes]) were more likely to plan athletes' daily fluid strategies, adopting a preplanned approach (P = .001; 95% CI, 0.1%-1%). Practitioners, and to a greater extent athletes, lacked self-reported key HA knowledge (eg,core temperature assessment/monitoring methods) yet demonstrated comparatively more appropriate nutritional practices (eg,hydration).

Associations of Diet With the Intestinal Microbiota and Short-Chain Fatty Acids Among Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study

ObjectivesDiet, a key component of type 1 diabetes (T1D) management, modulates the intestinal microbiota and its metabolically active byproducts, short-chain fatty acids (SCFA), via fermentation of dietary carbohydrates such as fiber. The relationships among diet, the intestinal microbiota, and SCFA have been studied proximal to T1D onset, but remain largely unexplored in longstanding T1D. We hypothesized that increased carbohydrate intake, including fiber, was associated with increased SCFA-producing microbes, fecal SCFA, and gut microbial diversity among adults with longstanding T1D and overweight or obesity.MethodsParticipants provided stool samples at up to four time points. Trained interviewers collected 24-hour dietary recalls. 16S rRNA gene sequencing determined the abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry computed total and specific fecal SCFA (acetate, butyrate, and propionate) levels. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of dietary fiber and carbohydrate with the abundance of SCFA-producing microbes, fecal SCFA, and gut microbial diversity. Data collection was interrupted by COVID-19; therefore, analyses were repeated with restriction to pre-COVID visits.ResultsData were available for 44 participants at 99 visits, including 42 participants with 57 visits pre-COVID. Intake of soluble fiber (all data) and available carbohydrates (pre-COVID) were inversely associated with the genus Bacteroides and Eubacterium alistipes. Pre-COVID, total and soluble fiber and available carbohydrates were positively associated with total SCFA and acetate levels, and available carbohydrates were positively associated with the genus Roseburia and Eubacterium ventriosum.ConclusionsIn our sample of young adults with longstanding T1D, increased carbohydrate intake, including fiber, was associated with both reduced and increased SCFA-producing microbes but increased total fecal SCFA and acetate, which might influence lipid metabolism and weight. Mechanistic studies may examine how a diet designed to modulate the SCFA-producing capacity of the intestinal microbiota influences metabolism and energy balance in the metabolically unique setting of T1D.Funding SourcesNational Institute of Diabetes and Digestive and Kidney Diseases.