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To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact.
Via Danish registers, we identified all 56,640 individuals from the Central- and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000-2016 as well as 315,694 age and sex matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the five years prior to the onset of T2D were not included. For this cohort, we first assessed the two-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score matched controls – taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact.
A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age and sex matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score matched controls (HR=1.51, 95% CI=1.43-1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR=1.14, 95% CI=0.98-1.32). Older age, somatic comorbidity, and being divorced/widowed was associated with both psychopharmacological treatment and psychiatric hospital contact following T2D.
Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.
Prenatal diethylstilbestrol (DES) exposure is associated with increased risk of hormonally mediated cancers and other medical conditions. We evaluated the association between DES and risk of pancreatic cancer and pancreatic disorders, type 2 diabetes, and gallbladder disease, which may be involved with this malignancy. Our analyses used follow-up data from the US National Cancer Institute DES Combined Cohort Study. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age, sex, cohort, body mass index, smoking, and alcohol for the association between prenatal DES exposure and type 2 diabetes, gallbladder disease (mainly cholelithiasis), pancreatic disorders (mainly pancreatitis), and pancreatic cancer among 5667 exposed and 3315 unexposed individuals followed from 1990 to 2017. Standardized incidence rate (SIR) ratios for pancreatic cancer were based on age-, race-, and calendar year-specific general population cancer incidence rates. In women and men combined, the hazards for total pancreatic disorders and pancreatitis were greater in the prenatally DES exposed than the unexposed (HR = 11, 95% CI 2.6–51 and HR = 7.0, 95% CI 1.5–33, respectively). DES was not associated overall with gallbladder disease (HR = 1.2, 95% CI 0.88–1.5) or diabetes (HR = 1.1, 95% CI 0.9–1.2). In women, but not in men, DES exposure was associated with increased risk of pancreatic cancer compared with the unexposed (HR: 4.1, 95% CI 0.84–20) or general population (SIR: 1.9, 95% CI 1.0–3.2). Prenatal DES exposure may increase the risk of pancreatic disorders, including pancreatitis in women and men. The data suggested elevated pancreatic cancer risk in DES-exposed women, but not in exposed men.
This study aimed to describe the process of care, assess the quality of care based on defined indicators, and identify challenges associated with providing diabetes care via sub-district health promotion hospital (SHPH) facilities in Thailand. Primary care policy has directed that diabetes care be delivered via SHPH in order to reduce hospital congestion and minimize travel costs for patients. Limited data is available regarding the structure for providing care. Likewise, barriers to delivery of optimal care have not been well defined, especially from the perspective of health care providers. This study employed mixed-methods research, which included semi-structured interviews to gain insights into the current diabetes care process, a descriptive study to evaluate quality of care, and use of a focus group to identify challenges associated with delivery of diabetic care via SHPH. Diabetes care processes in primary care included multiple steps and involved collaboration between various health care providers at both the hospital and SHPH. Four process indicators and one outcome had been achieved but performance of other indicators was apparently low. Three factors were found to pose challenges to providing this service: the resources of the health service, the delivery of services, and patient factors. SHPH require additional support, particularly in the areas of primary care workforce, finance, medical device procurement, and patient information systems. While delivery of diabetes care via primary care centers has been well established in Thailand, regional differences in the quality of care persist. Additional support is required to strengthen the primary care system nationwide.
To determine the optimal anthropometric cut-off points for predicting the likelihood ratios of hypertension and diabetes in the Peruvian population.
A cross-sectional study was performed to establish cut-off values for body mass index (BMI) and waist circumference [WC], waist-height ratio [WHtR], and Conicity index [C-index]) associated with increased risk of hypertension and diabetes. Youden’s index (YIndex), area under the curve (AUC), sensitivity and specificity were considered.
Peruvian population over the age of 18 years.
31,553 subjects were included; 57% being women. Among the women, 53.06% belonged to the 25 to 44-year-old age group [mean age: 41.66 in men and 40.02 in women]. The mean BMI, WHtR and C-index values were higher in women 27.49, 0.61, 1.30 respectively; while the mean WC value was higher in men 92.12 cm (SD±11.28). The best predictors of hypertension in men were the WHtR (AUC=0.64) and the C-index (AUC=0.64) with an optimal cut-off point of 0.57 (YIndex=0.284) and 1.301 (YIndex=0.284), respectively. Women showed an AUC of 0.63 and 0.61 in the WHtR and C-index, respectively, with an optimal cut-off of 0.61 (YIndex=0.236) and 1.323 (YIndex=0.225). The best predictor for diabetes was the C-index: with an AUC=0.67 and an optimal cut-off of 1.337 (YIndex=0.346) for men, and an AUC=0.66 and optimal cut-off of 1.313 (YIndex=0.319) for women.
Our findings show that in Peruvian adults, the WHtR and the C-index have the strongest association with hypertension in both sexes. Likewise, the C-index had the strongest association with diabetes.
Few studies have suggested that long-term adherence to low-carbohydrate diets (LCD) may affect maternal glucose metabolism in western countries. We aimed to investigate the association between LCD during pregnancy and glucose metabolism in Chinese population. A total of 1,018 women in mid-pregnancy were recruited in 2017-2018. Participants underwent a 75g oral glucose tolerance test (OGTT). Daily dietary intakes over the past month were accessed using a validated food frequency questionnaire. The overall, animal, and vegetable LCD scores which represent adherence to different low-carbohydrate dietary patterns were calculated. Mixed linear regression and generalized linear mixed regression were conducted to evaluate the associations between LCD scores and maternal glucose metabolism. Of the 1,018 subjects, 194 (19.1%) was diagnosed with gestational diabetes mellitus (GDM). The overall LCD score (β: 0.024, standard error (SE): 0.008, PFDR=0.02) and animal LCD score (β: 0.023, SE: 0.008, PFDR=0.02) was positively associated with OGTT 1-h glucose. No significant associations were found between the three different LCD scores with fasting plasma glucose (FPG), OGTT 2-h glucose, or insulin resistance, respectively. Compared with the lowest quartile, the crude odds ratios of GDM for the highest quartile were 1.84 (95% CI: 1.14, 2.95) for overall LCD score (P for trend = 0.02) and 1.56 (1.00, 2.45) for animal LCD score (P for trend = 0.02). However, these associations became nonsignificant after adjustment for covariates. In conclusion, a low-carbohydrate dietary pattern with high animal protein and fat is associated with higher postprandial 1-h glucose levels in Chinese pregnant women.
The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice.
Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway.
Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February–May 2017.
Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients’ questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients’ in clinical decisions or goal setting during consultations.
The association between egg consumption and diabetes is inconclusive. We aimed to examine the association between long-term egg consumption and its trajectory with diabetes in Chinese adults. A total of 8 545 adults aged ≥ 18 years old who attended the China Health and Nutrition Survey from 1991 to 2009 were included in this analysis. Egg consumption at each survey was assessed by a three-day 24-hour recall and weighed food record methods. The consumption trajectories of egg were modelled with the latent class group approach. Diabetes was diagnosed based on fasting blood glucose in 2009. Logistic regression was used to examine the association. The mean age of the study population was 50.9 (SD 15.1) years. 11.1% had diabetes in 2009. Egg consumption nearly doubled in 2009 from 16 g/day in 1991. Compared with the first quartile of egg consumption (0-9.0 g/day), the adjusted OR (95% CI) of diabetes for the second (9.1-20.6 g/day), third (20.7-37.5 g/day), and fourth (≥ 37.6 g/day) quartiles were 1.29 (95% CI 1.03, 1.62), 1.37 (95% CI 1.09, 1.72), and 1.25 (95% CI 1.04, 1.64), respectively (P for trend = 0.029). Three trajectory groups of egg consumption were identified. Compared with Group 1 (30.7%, low baseline intake and slight increase), both Group 2 (62.2%, medium baseline intake and increase) and Group 3 (7.1%, high baseline intake and decrease) were associated with an increased odds ratio (OR) for diabetes. The results suggested that higher egg consumption was positively associated with the risk of diabetes in Chinese adults.
Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30%.
We conducted a randomised, inactive-placebo controlled, double-blind trial of 500mg of slow-release vitamin C in 16 people with foot ulcers conducted in the foot-wound clinic at Westmead Hospital. Nine were randomised to control and 7 to vitamin C. When serum vitamin C results become available at 4 weeks, all people with deficiency were offered both vitamin C and glucosamine tablets for the next 4 weeks. Patients without baseline deficiency continued their original assigned treatment.
The primary outcome was percent ulcer healing (reduction in ulcer size) at 8 weeks.
Fifty percent of subjects had baseline vitamin C deficiency, half having undetectable levels. Healing at 8 weeks was significantly better in the vitamin C group (median 100% versus –14%, p=0.041). Healing without amputation occurred in all patients in the vitamin C group. In contrast, 44% of controls had not healed their ulcer at the end of the study period.
Vitamin C improved healing of foot ulcers. Further studies are needed to determine whether there is a threshold effect for serum vitamin C above which therapy is ineffective and whether there are better or lesser responding subgroups. Because of its low cost and ease of access and administration we recommend offering vitamin C therapy to all people who have chronic foot ulcers and potentially suboptimal vitamin C intake.
To analyse differences in the prevalence of prediabetes (PD), undiagnosed diabetes (UDD) and diagnosed diabetes (DD) and associated factors between Brazilian and English older adults.
England and Brazil.
5301 participants of the English Longitudinal Study of Ageing study and 1947 participants of the Brazilian Longitudinal Study of Aging study classified as non-diabetics, PD, UDD and DD.
The prevalence of PD, UDD and DD was 48·6, 3 and 9·6 % in England and 33, 6 and 20 % in Brazil. In England, the increase in age, non-white skin colour, smoking, general obesity and abdominal obesity were associated with PD, UDD and DD, whereas hypertriglyceridaemia, low HDL levels, hypertension and stroke were associated with UDD and DD. In Brazil, the increase in age was associated with DD and UDD, non-white skin colour and smoking were associated with UDD and abdominal obesity and hypertriglyceridaemia were associated with all three conditions. CVD in England and schooling in Brazil were associated with PD and DD. A sedentary lifestyle was associated with DD in both samples.
The prevalence of diabetes was higher in the Brazilian sample. Different associated factors were found in the two samples, which may be related to differences in nutritional transition, access to healthcare services and the use of such services.
Shifts in the maternal gut microbiota have been implicated in the development of gestational diabetes mellitus (GDM). Understanding the interaction between gut microbiota and host glucose metabolism will provide a new target of prediction and treatment. In this nested case-control study, we aimed to investigate the causal effects of gut microbiota from GDM patients on the glucose metabolism of germ-free (GF) mice. Stool and peripheral blood samples, as well as clinical information, were collected from 45 GDM patients and 45 healthy controls (matched by age and prepregnancy body mass index (BMI)) in the first and second trimester. Gut microbiota profiles were explored by next-generation sequencing of the 16S rRNA gene, and inflammatory factors in peripheral blood were analyzed by enzyme-linked immunosorbent assay. Fecal samples from GDM and non-GDM donors were transferred to GF mice. The gut microbiota of women with GDM showed reduced richness, specifically decreased Bacteroides and Akkermansia, as well as increased Faecalibacterium. The relative abundance of Akkermansia was negatively associated with blood glucose levels, and the relative abundance of Faecalibacterium was positively related to inflammatory factor concentrations. The transfer of fecal microbiota from GDM and non-GDM donors to GF mice resulted in different gut microbiota colonization patterns, and hyperglycemia was induced in mice that received GDM donor microbiota. These results suggested that the shifting pattern of gut microbiota in GDM patients contributed to disease pathogenesis.
Replacing intake of SFA with PUFA reduces serum cholesterol levels and CVD risk. The effect on glycaemic regulation is, however, less clear. The main objective of the present study was to investigate the short-term effect of replacing dietary SFA with PUFA on glycaemic regulation. Seventeen healthy, normal-weight participants completed a 25-d double-blind, randomised and controlled two-period crossover study. Participants were allocated to either interventions with PUFA products or SFA products (control) in a random order for three consecutive days, separated by a 1·5-week washout period between the intervention periods. Glucose, insulin and TAG were measured before and after an oral glucose tolerance test. In addition, fasting total cholesterol, NEFA and plasma total fatty acid profile were measured before and after the 3-d interventions. Fasting and postprandial glucose, insulin, and TAG levels and fasting levels of NEFA and plasma fatty acid profile did not differ between the groups. However, replacing dietary SFA with PUFA significantly reduced total cholesterol levels by 8 % after 3 d (P = 0·002). Replacing dietary SFA with PUFA for only 3 d has beneficial cardio-metabolic effects by reducing cholesterol levels in healthy individuals.
The present study aimed to investigate the association of early-life exposure to famine with abdominal fat accumulation and function and further evaluate the influence of first-degree family history of diabetes and physical activity on this association. The present work analysed parts of the REACTION study. A total of 3033 women were enrolled. Central obesity was defined as waist circumferences (W) ≥ 85 cm. Chinese visceral adiposity index (CVAI) was used to evaluate visceral adipose distribution and function. Partial correlation analysis showed BMI, W, glycated Hb and CVAI were associated with early-life exposure to famine (both P < 0·05). Logistic regression showed that the risks of overall overweight/obesity and central obesity in fetal, early-childhood, mid-childhood and late-childhood exposed subgroups were increased significantly (all P < 0·05). Compared with the non-exposed group, the BMI, W and CVAI of fetal, early- to late-childhood exposed subgroups were significantly increased both in those with or without first-degree family history of diabetes and in those classified as physically active or inactive, respectively (all P < 0·05). The associations of BMI, W and CVAI with early-life exposure to famine were independent of their associations with first-degree family history of diabetes (all P < 0·01) or physical activity status (all P < 0·001). Early-life exposure to famine contributed to abdominal fat accumulation and dysfunction, which was independent of the influence of genetic background and exercise habits. Physical activity could serve as a supplementary intervention for women with high risk of central obesity.
Diabetic pregnancies are cleary associated with maternal type 2 diabetes and metabolic syndrome as well as atherosclerotic diseases in the offspring. The global prevalence of hyperglycemia in pregnancy was estimated as 15.8% of live births to women in 2019, with an upward trend. Numerous parental risk factors as well as trans-generational mechanisms targeting the utero-placental system, leading to diabetes, dysmetabolic and atherosclerotic conditions in the next generation, seem to be involved within this pathophysiological context. To focus on the predictable impact of trans-generational diabetic programming, we studied age- and gender-matched offspring of diabetic and nondiabetic mothers. The offspring generation consists of three groups: C57BL/6-J-Ins2Akita (positive control group), wild-type C57BL/6-J-Ins2Akita (experimental group), and C57BL/6-J mice (negative control group). We undertook intraperitoneal glucose tolerance tests at 3 and 11 weeks of age. Moreover, this in vivo model was complemented by a corresponding in silico model. Although at 3 weeks of age, no significant effects could be observed, we could demonstrate at 11 weeks of age characteristic and significant differences in relation to maternal diabetic imprinting based on the in silico model-based predictors. These predictors allow the generation of a concise classification tree assigning maternal diabetic imprinting correctly in 91% of study cases. Our data show that hyperglycemic in utero milieu contributes to trans-generational diabetic programming leading to impaired glucose tolerance in the offspring of diabetic mothers early on. These observations can be clearly and early distinguished from genetically determined diabetes, for example, type 1 diabetes, in which basal glucose values are significantly raised.
This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called ‘Enhanced Primary Healthcare’ (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients’ experience and healthcare providers’ job satisfaction.
In 2014, almost two-thirds of Malaysia’s adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients.
This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to ‘intervention’ and ‘control’ arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.
Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.
The effects of dietary fibre (DF) and protein on insulin response, lipidaemia and inflammatory biomarkers were studied in a model experiment with juvenile obese Göttingen minipigs. After 20 weeks feeding on a high-fat fructose-rich low-DF diet, forty-three 30-week-old minipigs (31·3 (sem 4·0) kg body weight) were allocated to low- or high-DF and -protein diets for 8 weeks in a 2 × 2 factorial design. High DF contents decreased (P = 0·006) while high protein increased (P < 0·001) the daily gain. High protein contents increased fasting plasma concentrations of glucose (P = 0·008), NEFA (P = 0·015), ghrelin (P = 0·008) and non-fasting LDL:HDL ratios (P = 0·015). High DF increased ghrelin (P = 0·036) and C-peptide levels (P = 0·011) in the non-fasting state. High protein increased the gene expression of fructose-bisphosphatase 1 in liver tissue (P = 0·043), whereas DF decreased fatty acid synthase expression in adipose tissue (P = 0·035). Interactions between DF and protein level were observed in the expression of leptin receptor in adipose tissue (P = 0·031) and of PPARγ in muscle (P = 0·018) and adipose tissue (P = 0·004). In conclusion, high DF intake reduced weight gain and had potential benefit on β-cell secretory function, but without effect on the lipid profile in this young obese model. High dietary protein by supplementing with whey protein did not improve insulin sensitivity or lipidaemia, and combining high DF with high protein did not alleviate the risk of metabolic abnormalities.
The diabetes epidemic is expanding rapidly in India, with 69.2 million people living with diabetes in 2015. This study assessed the spatial pattern and determinants of diagnosed diabetes prevalence in the districts of six states and one union territory (UT) in southern India – a region that has a high prevalence of diabetes. Using cross-sectional population-based survey data from the 2012–13 District Level Household and Facility Survey-4, the prevalence and magnitude of diagnosed diabetes at district level for the population aged 18 years and above were computed. Moran’s I was calculated to explore the spatial clustering of diagnosed diabetes prevalence. Ordinary Least Square (OLS) and Spatial Lag (SL) regression models were carried out to investigate the spatial determinants of diagnosed diabetes prevalence. The prevalence of diagnosed diabetes was found to be substantially higher than that of self-reported diabetes in southern India (7.64% vs 2.38%). Diagnosed diabetes prevalence in the study area varied from 10.52% in Goa to 4.89% in Telangana. The Moran’s I values signified positive moderate autocorrelation. Southern India had 14.15 million individuals with diagnosed diabetes in 2012–13. Bangalore had the highest number of persons with diagnosed diabetes, and Palakkad had the smallest number. In the OLS and SL models, the proportion of people with secondary education and above, wealthy and Christian populations were found to be significant determinants of diagnosed diabetes prevalence. In addition, in the OLS model, the proportion of Scheduled Tribe population showed a negative relationship with diagnosed diabetes prevalence. In order to prevent or postpone the onset age for diabetes, there is a need to raise awareness about diabetes in India.
Our objective was to investigate associations of body size (birth weight and body mass index (BMI)) and growth in height, body fat (adiposity) and lean mass during childhood and adolescence, with risk markers for diabetes in young South Asian adults. We studied 357 men and women aged 21 years from the Pune Children’s Study birth cohort. Exposures were 1) birth weight, 21-year BMI, both of these mutually adjusted, and their interaction, and 2) uncorrelated conditional measures of growth in height and proxies for gain in adiposity and lean mass from birth to 8 years (childhood) and 8 to 21 years (adolescence) constructed from birth weight, and weight, height, and skinfolds at 8 and 21 years. Outcomes were plasma glucose and insulin concentrations during an oral glucose tolerance test and derived indices of insulin resistance and secretion. Higher 21-year BMI was associated with higher glucose and insulin concentrations and insulin resistance, and lower disposition index. After adjusting for 21-year BMI, higher birth weight was associated with lower 120-min glucose and insulin resistance, and higher disposition index. In the growth analysis, greater adiposity gain during childhood and adolescence was associated with higher glucose, insulin and insulin resistance, and lower disposition index, with stronger effects from adolescent gain. Greater childhood lean gain and adolescent height gain were associated with lower 120-min glucose and insulin. Consistent with other studies, lower birth weight and higher childhood weight gain increases diabetes risk. Disaggregation of weight gain showed that greater child/adolescent adiposity gain and lower lean and height gain may increase risk.
To explore stakeholder perspectives regarding online diabetes nutrition education for American Indians and Alaska Natives (AI/AN) with type 2 diabetes (T2D).
Qualitative data were collected through focus groups and interviews. Focus group participants completed a brief demographic and internet use survey.
Focus groups and community participant interviews were conducted in diverse AI/AN communities. Interviews with nationally recognised content experts were held via teleconference.
Eight focus groups were conducted with AI/AN adults with T2D (n 29) and their family members (n 22). Community participant interviews were conducted with eleven clinicians and healthcare administrators working in Native communities. Interviews with nine content experts included clinicians and researchers serving AI/AN.
Qualitative content analysis used constant comparative method for coding and generating themes across transcripts. Descriptive statistics were computed from surveys. AI/AN adults access the internet primarily through smartphones, use the internet for many purposes and identify opportunities for online diabetes nutrition education.
Online diabetes nutrition education may be feasible in Indian Country. These findings will inform the development of an eLearning diabetes nutrition education programme for AI/AN adults with T2D.
Sarcopenic obesity is characterised by the double burden of diminished skeletal muscle mass and the presence of excess adiposity. From a mechanistic perspective, both obesity and sarcopenia are associated with sub-acute, chronic pro-inflammatory states that impede metabolic processes, disrupting adipose and skeletal functionality, which may potentiate disease. Recent evidence suggests that there is an important cross-talk between metabolism and inflammation, which has shifted focus upon metabolic-inflammation as a key emerging biological interaction. Dietary intake, physical activity and nutritional status are important environmental factors that may modulate metabolic-inflammation. This paradigm will be discussed within the context of sarcopenic obesity risk. There is a paucity of data in relation to the nature and the extent to which nutritional status affects metabolic-inflammation in sarcopenic obesity. Research suggests that there may be scope for the modulation of sarcopenic obesity with alterations in diet. The potential impact of increasing protein consumption and reconfiguration of dietary fat composition in human dietary interventions are evaluated. This review will explore emerging data with respect to if and how different dietary components may modulate metabolic-inflammation, particularly with respect to adiposity, within the context of sarcopenic obesity.
We aimed to fully review the association of empirical dietary patterns with the risk of non-communicable chronic diseases and to rate the quality of the evidence. Published meta-analyses of observational studies investigating the association of empirically derived dietary patterns with the risk of chronic diseases were identified by searching PubMed and Scopus till September 2019. Two independent reviewers extracted the information and rated the quality of the evidence by NutriGrade score. For each meta-analysis, cross-sectional and case–control studies were excluded and then summary relative risk was recalculated by using a random-effects model. Sixteen meta-analyses of prospective cohort studies, reporting eighteen SRR for healthy dietary patterns and sixteen SRR for unhealthy patterns obtained from 116 primary prospective cohort studies with 4·8 million participants, were included. There was moderate quality of evidence for the inverse association of healthy dietary patterns with the risk of type 2 diabetes (T2D), fracture and colorectal and breast cancers. There was also low-quality evidence for the inverse relation between healthy dietary patterns and the risk of all-cause and cardiovascular mortality, depression, CHD and respiratory diseases. There was moderate quality of evidence for a positive association between unhealthy dietary patterns and the risk of T2D, fracture and the metabolic syndrome. Adopting a healthy dietary pattern may reduce the risk of T2D, CHD and premature death. More research is needed for outcomes for which the quality of the evidence was rated low, such as respiratory disease, mental illness and site-specific cancers.