Outpatient Nutrition Care

Meta-Analysis: Long-Term Low-Carbohydrate Diets Improve Dyslipidemia but Not Glycemic Control in Type 2 Diabetes – J Diabetes Investig

17 Aug, 2024 | 19:14h | UTC

Study Design and Population: This systematic review and meta-analysis examined the impact of long-term low-carbohydrate diets (LCD) on glycemic control and other metabolic parameters in adults with type 2 diabetes. Six randomized controlled trials (RCTs) involving 524 participants were included, with intervention durations ranging from 12 to 24 months.

Main Findings: The meta-analysis found no significant difference in glycated hemoglobin (HbA1c) levels between participants on long-term LCD and those on control diets (SMD -0.11, 95% CI -0.33 to 0.11, P = 0.32). Similarly, there were no significant differences in weight loss, blood pressure, or low-density lipoprotein (LDL) cholesterol levels. However, LCDs were associated with a significant increase in high-density lipoprotein (HDL) cholesterol (SMD 0.22, 95% CI 0.04 to 0.41, P = 0.02) and a decrease in triglyceride levels (SMD -0.19; 95% CI -0.37 to -0.02; P = 0.03).

Implications for Practice: While long-term LCDs do not appear to improve glycemic control in individuals with type 2 diabetes, they may be beneficial for managing dyslipidemia, specifically by increasing HDL cholesterol and reducing triglycerides. These findings suggest that LCDs could be considered as part of a strategy for addressing cardiovascular risk factors in this population, but they should not be relied upon for glycemic management.

Reference: Ichikawa, T., Okada, H., Hironaka, J., Nakajima, H., Okamura, T., Majima, S., … & Fukui, M. (2024). Efficacy of long‐term low carbohydrate diets for patients with type 2 diabetes: A systematic review and meta‐analysis. Journal of Diabetes Investigation. https://doi.org/10.1111/jdi.14271.

RCT: Dietary Acid Reduction with Fruits and Vegetables Slows CKD Progression and Lowers CVD Risk in Hypertensive Patients – Am J Med

17 Aug, 2024 | 15:49h | UTC

Study Design and Population: This five-year randomized control trial included 153 hypertensive patients with macroalbuminuria and normal kidney function. Participants were randomly assigned to one of three groups: a diet rich in base-producing fruits and vegetables, oral sodium bicarbonate (NaHCO3), or Usual Care. The primary objective was to assess the effects of dietary acid reduction on chronic kidney disease (CKD) progression and cardiovascular disease (CVD) risk.

Main Findings: The study found that both fruits and vegetables and NaHCO3 slowed CKD progression compared to Usual Care, with significantly higher estimated glomerular filtration rates in the intervention groups. However, only the fruits and vegetables group showed significant reductions in systolic blood pressure, LDL cholesterol, and body mass index, leading to greater improvements in CVD risk indices.

Implications for Practice: The results support using fruits and vegetables as a foundational treatment for hypertension to reduce CKD progression and lower CVD risk, potentially with reduced reliance on pharmacological interventions.

Reference: Goraya, N., Madias, N. E., Simoni, J., Kahlon, M., Aksan, N., & Wesson, D. E. (2024). Kidney and Cardiovascular Protection Using Dietary Acid Reduction in Primary Hypertension: A Five-Year, Interventional, Randomized, Control Trial. The American Journal of Medicine, 000(000), 1-14. DOI: https://doi.org/10.1016/j.amjmed.2024.06.006.

RCT: Eliminating Fasting Before Contrast-Enhanced CT in Outpatients Reduces Nausea and Vomiting Without Increasing Acute Adverse Reactions – Insights Imaging

11 Aug, 2024 | 13:41h | UTC

Study Design and Population: This single-center, randomized clinical trial was conducted in Spain with 1,103 adult outpatients undergoing non-emergency contrast-enhanced CT scans. Patients were randomized into two groups: one group fasted for at least 6 hours (control), while the other group had no food restrictions (intervention). The primary aim was to assess whether eliminating fasting affects the incidence of acute adverse reactions (AARs), such as nausea and vomiting.

Main Findings: The study found no significant difference in the overall incidence of acute adverse reactions between the fasting and non-fasting groups (3.21% vs. 2.30%; p = 0.36). However, the non-fasting group had a significantly lower incidence of nausea and vomiting (0.92% vs. 2.86%; p = 0.02). Multivariate logistic regression identified fasting, age, allergies, neurological diseases, and contrast media concentration as independent risk factors for nausea and vomiting.

Implications for Practice: The findings suggest that the traditional practice of fasting before contrast-enhanced CT scans is unnecessary and may increase the risk of nausea and vomiting. Therefore, unrestricted food intake should be allowed for most contrast-enhanced CT exams, reserving fasting only for specific imaging procedures.

Reference: Zitan Saidi et al. (2024). Fasting before contrast-enhanced CT and the incidence of acute adverse reactions: a single-center randomized clinical trial. Insights into Imaging, 15(195). DOI: 10.1186/s13244-024-01767-9.

Systematic Review: Uncertain Impact of Vitamin D Supplementation During Pregnancy on Key Maternal and Neonatal Outcomes – Cochrane Database Syst Rev

11 Aug, 2024 | 12:42h | UTC

Study Design and Population: This Cochrane systematic review evaluates the effects of vitamin D supplementation alone or in combination with calcium and other vitamins/minerals during pregnancy. The analysis included 10 randomized controlled trials (RCTs) with a total of 2,313 pregnant women. The review excluded 20 studies from previous versions due to trustworthiness concerns and incorporated one new study.

Main Findings: The evidence regarding vitamin D supplementation alone was very uncertain for its impact on pre-eclampsia, gestational diabetes, preterm birth, and nephritic syndrome. There is low-certainty evidence suggesting that vitamin D may reduce the risk of severe postpartum hemorrhage and low birthweight, though the possibility of increased risk cannot be excluded. Supplementation with vitamin D plus calcium showed very uncertain effects on preterm birth and low birthweight, with no conclusive data on pre-eclampsia, gestational diabetes, or maternal adverse events. The combination of vitamin D, calcium, and other vitamins/minerals also yielded very uncertain evidence for all outcomes examined.

Implications for Practice: The current evidence does not provide strong support for routine vitamin D supplementation during pregnancy due to the low and very uncertain evidence on key outcomes. Further high-quality RCTs are needed to better understand the effects, particularly concerning maternal adverse events and neonatal health.

Reference: Palacios, C., Kostiuk, L. L., Cuthbert, A., & Weeks, J. (2024). Vitamin D supplementation for women during pregnancy. Cochrane Database of Systematic Reviews, 7(7), CD008873. DOI: 10.1002/14651858.CD008873.pub5.

Consensus Recommendations: Cardiovascular Risks in People With Narcolepsy – J Am Hear Assoc

10 Aug, 2024 | 21:48h | UTC

Introduction: The Journal of the American Heart Association recently published a consensus guideline by a panel of sleep and cardiology experts to address the heightened cardiovascular risks in individuals with narcolepsy. Given the increased prevalence of hypertension and cardiometabolic comorbidities in this population, the panel developed recommendations aimed at mitigating these risks.

Key Points:

1 – Increased Cardiovascular Risk in Narcolepsy:

– Individuals with narcolepsy, both Type 1 (NT1) and Type 2 (NT2), exhibit higher rates of cardiovascular and cardiometabolic diseases, such as hypertension, obesity, and diabetes, compared to the general population.

– The association of narcolepsy with conditions like obstructive sleep apnea (OSA) and restless legs syndrome further elevates cardiovascular risk.

2 – Monitoring and Early Detection:

– Clinicians should annually monitor blood pressure, weight, and waist circumference in patients with narcolepsy, even in the absence of existing cardiovascular disease.

– Screening for lipid levels and hemoglobin A1c is recommended, especially in patients with risk factors like hypertension, obesity, and diabetes.

3 – Lifestyle and Therapeutic Interventions:

– Patients should be educated about the link between narcolepsy and cardiovascular disease. Emphasis should be placed on maintaining optimal sleep duration, regular exercise, healthy eating, and reducing sodium intake.

– The American Heart Association’s “Life’s Essential 8” guidelines should be followed to enhance overall cardiovascular health.

4 – Medication Management:

– Narcolepsy medications, particularly stimulants and sodium oxybate, can increase cardiovascular risk. Clinicians should consider the patient’s cardiovascular profile when prescribing these treatments and explore alternatives with lower cardiovascular impact if necessary.

5 – Sodium Reduction:

– High sodium intake, from both diet and certain narcolepsy medications, is associated with increased blood pressure and cardiovascular disease. Patients should be advised to reduce sodium intake, and clinicians should consider prescribing lower-sodium alternatives when possible.

Conclusion: These expert consensus recommendations underscore the importance of proactive cardiovascular risk management in patients with narcolepsy. By implementing these guidelines, clinicians can help mitigate the long-term cardiovascular risks associated with this chronic sleep disorder.

Guideline Reference: Kwon Y, Gami AS, Javaheri S, et al. Cardiovascular Risks in People With Narcolepsy: Expert Panel Consensus Recommendations. Journal of the American Heart Association. 2024;13. DOI: 10.1161/JAHA.124.035168. Available at: https://doi.org/10.1161/JAHA.124.035168.

Erythritol Ingestion Increases Platelet Reactivity and Thrombosis Potential in Healthy Adults – Arterioscler Thromb Vasc Biol

10 Aug, 2024 | 21:11h | UTC

Study Design and Population: This interventional study evaluated the effects of erythritol versus glucose on platelet reactivity and thrombosis potential in 20 healthy volunteers, with 10 participants in each group. Researchers measured erythritol plasma levels and assessed platelet function through aggregometry and granule marker analysis both before and after ingestion of 30 g of erythritol or glucose.

Main Findings: Erythritol ingestion resulted in a more than 1000-fold increase in plasma erythritol concentration and significantly enhanced stimulus-dependent platelet aggregation and release of serotonin and CXCL4, markers of platelet activation. In contrast, glucose ingestion did not significantly alter platelet reactivity or granule marker release, highlighting erythritol’s unique pro-thrombotic effects.

Implications for Practice: These findings raise concerns regarding the safety of erythritol as a non-nutritive sweetener, particularly its potential to enhance thrombosis risk. The results suggest a need to reevaluate erythritol’s safety status and consider its impact on cardiovascular health in regulatory guidelines.

Reference: Witkowski, M., Wilcox, J., Province, V., Wang, Z., Nemet, I., Tang, W. H. W., & Hazen, S. L. (2024). Ingestion of the non-nutritive sweetener erythritol, but not glucose, enhances platelet reactivity and thrombosis potential in healthy volunteers. Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/ATVBAHA.124.321019

New Guidelines Recommend Against Routine Vitamin D Testing and Treatment for Healthy Adults – J Clin Endocrinol Metab

4 Aug, 2024 | 19:19h | UTC

Introduction: The Endocrine Society has developed new clinical practice guidelines focused on the use of vitamin D for the prevention of various diseases. These guidelines were created by a multidisciplinary panel, including experts in adult and pediatric endocrinology, internal medicine, obstetrics and gynecology, nutrition, and epidemiology.

Key Points:

1 – Empiric Vitamin D Supplementation in Children and Adolescents:

– Recommended to prevent nutritional rickets.

– May lower the risk of respiratory tract infections.

– Dosage in trials ranged from 300 to 2000 IU daily, with an average of about 1200 IU per day.

2 – Empiric Vitamin D Supplementation or Testing in Adults Under 75:

– Not recommended for generally healthy adults without specific indications.

3 – Empiric Vitamin D Supplementation in Adults Over 75:

– Suggested due to its potential to lower the risk of mortality.

– Treatment should be empirical, no testing recommended if there are no established indications for testing (e.g., hypocalcemia).

– Recommended daily rather than intermittent high doses. Dosage in clinical trials ranged from 400 to 3333 IU daily equivalent.

4 – Vitamin D Supplementation During Pregnancy:

– Suggested to lower the risk of preeclampsia, intrauterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality.

– Empiric supplementation recommended without routine 25(OH)D testing unless there are established indications for testing.

– Dosages in trials ranged from 600 to 5000 IU daily equivalent, with an average of about 2500 IU per day.

5 – Vitamin D and High-Risk Prediabetes:

– Suggested to reduce the progression to diabetes.

– In clinical trials, vitamin D dosages ranged from 842 to 7543 IU daily. The estimated weighted average was approximately 3500 IU per day.

6 – Routine 25(OH)D Testing:

– Not recommended for the general population, including those with obesity or dark complexion.

– No clear evidence defining optimal target levels for disease prevention.

Conclusion: These guidelines emphasize the importance of targeted vitamin D supplementation for specific age groups and conditions, while advising against routine testing for vitamin D levels in the general population. Empiric supplementation is considered beneficial, particularly in children, pregnant women, and older adults, and is feasible, cost-effective, and generally acceptable.

Guideline Reference: Demay, M. B., et al. (2024). Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 109, 1907-1947. Available at: https://doi.org/10.1210/clinem/dgae290

RCT: Effects of combined time-restricted eating and high-intensity functional training on body composition and cardiometabolic health in women with obesity – PLOS One

7 May, 2024 | 15:28h | UTC

This randomized clinical trial investigated the effects of time-restricted eating (TRE) and high-intensity functional training (HIFT), both separately and in combination, on body composition and cardiometabolic health in inactive women with obesity. Sixty-four participants were assigned to three groups: TRE alone, HIFT alone, and both TRE and HIFT (TRE-HIFT). Over 12 weeks, the TRE-HIFT group showed the most significant improvements in waist and hip circumference, fat mass, total cholesterol, triglyceride levels, insulin sensitivity, and blood glucose levels compared to the other groups. Weight and BMI reductions were also more substantial in the TRE-HIFT group than in the HIFT-only group. Furthermore, while all groups exhibited improvements, those combining both interventions experienced more pronounced changes in cardiometabolic parameters, suggesting the potential of integrated lifestyle interventions for enhancing health outcomes in this population.

Reference (link to free full-text):

Ranya Ameur et al. (2024). Unlocking the power of synergy: High-intensity functional training and early time-restricted eating for transformative changes in body composition and cardiometabolic health in inactive women with obesity. PLOS ONE. DOI: https://doi.org/10.1371/journal.pone.0301369

M-A: Effects of long-term salt substitution on cardiovascular mortality and events – Ann Intern Med

5 May, 2024 | 15:10h | UTC

This systematic review and meta-analysis assessed the impact of long-term salt substitution on cardiovascular outcomes by analyzing data from 16 randomized controlled trials (RCTs). The primary investigation focused on mortality, major cardiovascular events (MACE), and adverse events with a study period of six months or longer. Key findings include a potential reduction in all-cause mortality (rate ratio [RR] of 0.88) and cardiovascular mortality (RR of 0.83), based on low-certainty evidence from studies predominantly conducted in China or Taiwan among older adults or those at higher cardiovascular risk. Results also indicated a slight reduction in MACE (RR of 0.85) with very low certainty. Evidence suggests no significant increase in serious adverse events. Limitations include the dominance of a single large RCT and limited generalizability of results to Western populations. The study concludes that while salt substitution could reduce mortality, the effects on cardiovascular events remain uncertain, with more robust evidence needed for broader demographic applicability.

Reference (link to abstract – $ for full-text):

Hannah Greenwood et al. (2024). Long-Term Effect of Salt Substitution for Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Annals of Internal Medicine, Volume 178, Pages 23-31. DOI: 10.7326/M23-2626.

Cohort Study | Vegetarian diet linked to elevated hip fracture risk; BMI plays a partial role

9 Aug, 2023 | 15:16h | UTC

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants – BMC Medicine

RCT | Maternal egg intake in early neonatal period does not impact infant egg allergy risk

2 Aug, 2023 | 13:47h | UTC

Effect of Maternal Egg Intake During the Early Neonatal Period and Risk of Infant Egg Allergy at 12 Months Among Breastfeeding Mothers: A Randomized Clinical Trial – JAMA Network Open

See also: Visual Abstract

Review | Vegetarian and vegan diets: benefits and drawbacks

1 Aug, 2023 | 14:11h | UTC

Vegetarian and vegan diets: benefits and drawbacks – European Heart Journal (free for a limited period)

Commentary on Twitter

Vegetarian and vegan diets: benefits and drawbacks https://t.co/6XtpEH1RKV @escardio #EHJ #ESCYoung @rladeiraslopes @ehj_ed pic.twitter.com/zAQHJdKpCL

— European Society of Cardiology Journals (@ESC_Journals) July 31, 2023

An ESPGHAN position paper on the diagnosis, management and prevention of cow’s milk allergy

31 Jul, 2023 | 14:28h | UTC

An ESPGHAN position paper on the diagnosis, management and prevention of cow’s milk allergy – Journal of Pediatric Gastroenterology and Nutrition

Study | Childhood deaths in high-mortality settings mostly preventable; infection, malnutrition top causes

31 Jul, 2023 | 14:05h | UTC

Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network – JAMA Network Open

Invited Commentary: Need for a Structural Approach to Promote Child Survival – JAMA Network Open

News Release: Eight out of ten child deaths in low-income countries could be prevented – Barcelona Institute for Global Health

WHO updates guidelines on fats and carbohydrates

28 Jul, 2023 | 14:25h | UTC

News Release: WHO updates guidelines on fats and carbohydrates – World Health Organization

Guidelines:

Saturated fatty acid and trans-fatty acid intake for adults and children: WHO guideline – World Health Organization

Total fat intake for the prevention of unhealthy weight gain in adults and children: WHO guideline – World Health Organization

Carbohydrate intake for adults and children: WHO guideline – World Health Organization

Commentary on Twitter (thread – click for more)

Avoid #TransFats! Trans fats are found in

?️ baked & fried foods,
?️ pre-packaged snacks,
?️ meat & dairy foods from animals such as cows or sheep,
?️ processed foods.

Limit your trans fats intake to less than 1% of total energy intake ?https://t.co/vCZlOtUeLj #HealthyDiets pic.twitter.com/l0ErFXvO4Q

— World Health Organization (WHO) (@WHO) July 17, 2023

Commentary: M-A: Vegetarian diets may modestly improve cardiometabolic profile in high-risk individuals – HCP Live

RCT | Vitamin D supplementation shows no cognitive benefit in mild cognitive impairment intervention

25 Jul, 2023 | 14:00h | UTC

Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial – JAMA Network Open

Commentary: Exercise and Cognitive Training Slow Thinking Declines. Vitamin D? Not So Much – HealthDay

2ry analysis of a RCT | Vitamin D supplementation does not affect cognitive function in older adults

RCT: Oral Vitamin D supplementation (60.000 IU per month) did not reduce mortality in patients 60 years or older (unscreened individuals in Australia, many without insufficiency, average 30ng/mL). Exploratory analyses pointed towards an increased risk of death from cancer.

Randomized Trial: Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease

Meta-Analysis: Vitamin D Not Effective for Cardiovascular Disease Prevention

Association between vitamin D supplementation and mortality: systematic review and meta-analysis – The BMJ

USPSTF Draft Statement: Insufficient evidence to recommend multivitamin supplements for the prevention of CVD or cancer. The statement also recommends against the use of beta-carotene (increases risk of CVD mortality and lung cancer) or vitamin E (clear evidence of no benefit)

Vitamin D, calcium, other vitamins, and supplements do not prevent cardiovascular diseases

Cohort Study | BMI of 25.0–29.9 not linked with higher mortality in 21st century U.S. adults

25 Jul, 2023 | 13:58h | UTC

Body mass index and all-cause mortality in a 21st century U.S. population: A National Health Interview Survey analysis – PLOS One

News Release: No increase in mortality for most overweight people, study finds – PLOS

Commentary: Expert reaction to study looking at BMI and all-cause mortality – Science Media Centre

RCT | MIND diet, a hybrid of Mediterranean and DASH, shows no superiority in preventing cognitive decline

21 Jul, 2023 | 13:38h | UTC

Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

‘MIND diet,’ intended to prevent dementia, doesn’t offer significant brain benefit, trial suggests – Live Science

Revised Mediterranean Diet Shows No Significant Impact on Cognition, MRI Outcomes in Older Persons – Neurology Live

Commentary on Twitter

Original Article: Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons https://t.co/ED5Rd6oCTf #AAIC23

— NEJM (@NEJM) July 19, 2023

IARC, WHO agency, identifies aspartame as potentially carcinogenic but probably safe within established acceptable daily intake

18 Jul, 2023 | 13:58h | UTC

News Release: Aspartame hazard and risk assessment results released – World Health Organization

Commentaries:

Expert reaction to IARC and JEFCA summary on aspartame – Science Media Centre

Does artificial sweetener aspartame really cause cancer? What the WHO listing means for your diet soft drink habit – The Conversation

Aspartame Hazard and Risk Assessment Results Released by IARC and JECFA – The ASCO Post

Single Arm Trial | Low-carbohydrate diet improves glycemic control in type 1 diabetes

13 Jul, 2023 | 13:04h | UTC

Effects of a low-carbohydrate diet in adults with type 1 diabetes management: A single arm non-randomised clinical trial – PLOS One

Related:

Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet – Pediatrics (link to abstract – $ for full-text)

Meta-analysis of randomized trials: patients adhering to a low carbohydrate diet for six months may experience remission of diabetes without adverse consequences

RCT | A calorie-unrestricted low-carbohydrate, high-fat diet resulted in short-term weight loss and better glycemic control.

Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials – Nutrients

Consensus Statement: Effect of carbohydrate-restricted diets and intermittent fasting on obesity, type 2 diabetes mellitus, and hypertension management.

Effects of a 6-month, low-carbohydrate diet on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes: An open-label randomized controlled trial – Diabetes, Obesity and Metabolism

Lower carbohydrate diets for adults with type 2 diabetes – British Journal of Nutrition

Low carbohydrate diet: Insights from a general practice service in patients with type 2 diabetes

Diabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review – Canadian Journal of Diabetes

Low Carbohydrate Diets for Diabetes: A Review of the Clinical Effectiveness and Guidelines – Canadian Agency for Drugs and Technologies in Health

Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide – British Journal of General Practice