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OP66 LONG-TERM EFFECTS OF A LOW CARBOHYDRATE, LOW SATURATED FAT DIET VERSUS A CONVENTIONAL HIGH CARBOHYDRATE, LOW FAT DIET IN TYPE 2 DIABETES: A RANDOMISED TRIAL
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Oral presentation abstracts / Diabetes Research and Clinical Practice 106S1 (2014) S1–S41
(non-MetS) MetS; and further examine their association with clinical or metabolic parameters using a subpopulation of South Asian country. Method: The present study is a community-based crosssectional study performed on women from rural Bangladesh. A total of 1802 participants aged 15 years were selected using the stratified multistage random sampling. This sample size (1802) was sufficient to test all our formulated research hypotheses at the 5% level of significance, with a power of 80% (b = 0.20). We used the World Health Organization’s (WHO) STEPS approach (modified), which entails a stepwise collection of the risk factor data. Result: Plasma levels of VEGF were found to be significantly increased (MetS vs. non-MetS: 483.9 vs. 386.9, p < 0.001), whereas, the soluble forms of VEGF receptors, sVEGF-R1 and sVEGF-R2, were significantly decreased in subjects with Mets (sVEGF-R1, MetS vs. non-MetS: 512.5 vs. 631.3, p < 0.001; sVEGF-R2, MetS vs. non-MetS: 9,302.8 vs. 9,787.4, p = 0.004). After adjustment for age and all potential variables, multiple regression analysis revealed that plasma levels of VEGF had significant positive association with blood glucose (p = 0.019) and body mass index (p = 0.007). We also found that mean plasma levels of VEGF increased in direct proportion to levels of MetS components. Conclusion: The present study is the first ever to demonstrate a positive association between trends in levels of plasma VEGF and MetS using a large sample size from South Asia. The association between plasma VEGF and MetS needs further investigations in order to clearly decipher the clinical predictive value and accuracy of plasma VEGF in MetS. Reference(s) [1] Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh. [2] Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Nutrition & diabetes OP66 LONG-TERM EFFECTS OF A LOW CARBOHYDRATE, LOW SATURATED FAT DIET VERSUS A CONVENTIONAL HIGH CARBOHYDRATE, LOW FAT DIET IN TYPE 2 DIABETES: A RANDOMISED TRIAL J. Tay1,2,3 , N. Luscombe-Marsh3 , C. Thompson2 , M. Noakes3 , J. Buckley4 , G. Wittert2 , W. Yancy Jr5 , G. Brinkworth3 . 1 A*STAR, Singapore, Singapore ; 2 Medicine, University of Adelaide, 3 Food and Nutrition, CSIRO, 4 Nutrition Physiology Research Centre, University of South Australia, Adelaide, Australia ; 5 Medicine, Duke University Medical Center, Durham, United States Background: Few well-controlled studies have comprehensively examined the long-term effects of very low carbohydrate diets as part of a lifestyle modification program on glycemic control, cardiovascular risk factors and renal function in type 2 diabetes (T2D). Method: 115 adults with T2D (66 males, BMI 34.6±0.4 kg/m2 (mean ± SEM), age 58±1 yrs; HbA1c 7.3±0.1%) were randomised to consume a hypocaloric, very low carbohydrate, low saturated fat diet (LC 14% of energy as carbohydrate [CHO < 50 g/day], 28% protein, 58% fat [< 10% saturated fat]) or an energy matched high carbohydrate, low fat diet (HC 53% CHO, 17% protein, 30% fat [< 10% saturated fat]) combined with a structured exercise program (3d/wk) for 52 wks. Result: Both groups had similar completion rates (LC 41 [71%], HC 37 [65%]) and reductions in body weight (LC −9.8±1.0, HC −10.1±1.0 kg), fat mass (LC −7.9±0.9, HC −8.6±0.9 kg), blood pressure (LC −7.1/−6.2±1.7/1.0, HC −5.8/−6.4±1.8/1.0 mmHg), HbA1c (LC −1.0±0.1, HC −1.0±0.1%) and fasting glucose (LC −0.7±0.3, HC −1.5±0.3 %mmol/L); with no diet effect (P 0.09). Compared to HC, LC achieved a 3 fold greater
reduction in diabetes medication use (antiglycemic medication effect score; LC −0.6±0.1, HC −0.2±0.1; P < 0.01) and at least 2 fold greater decreases in glycemic variability indices indicating greater diurnal blood glucose stability: Mean Amplitude of Glucose Excursion (LC −1.7±0.3, HC −0.8±0.3 mmol/L), Continuous Overall Net Glycemic Action 1 (LC −0.5±0.1, HC −0.05±0.1 mmol/L), and SDGlucose (LC −0.7±0.1, HC −0.4±0.1 mmol/L); P = 0.003–0.09, time × diet effect. Triglycerides decreased (LC −0.4±0.1, HC −0.01±0.1 mmol/L; P = 0.001) and HDL-C increased (LC 0.1±0.03, HC 0.06±0.04 mmol/L; P = 0.002) more on LC, with no difference between groups for LDL-C reductions (LC −0.1±0.1, HC −0.2±0.1 mmol/L, P = 0.76 time × diet). Changes in eGFR did not differ between groups (LC −4±1, HC −2±1 ml/min/1.73 m2 , P = 0.25 time × diet) and levels were maintained within the normal range (90 ml/min/1.73 m2 ; LC 92±2, HC 90±2ml/min/1.73 m2 ). 6 participants (LC 3, HC 3) had moderately increased albuminuria at baseline (30– 300 mg/24h), which regressed to normal levels (< 30 mg/24hr) in 4 participants (LC 2, HC 2) after 52 weeks. Conclusion: Both LC and HC diets achieved comparable weight loss, improvements in HbA1c and fasting glucose, and maintained renal function. However, the LC yielded greater reductions in glucose lowering medication requirements, greater diurnal blood glucose stability and improved lipid profile suggesting LC are advantageous for T2D management. OP67 USE OF PHOTOGRAPHIC FOOD RECORDS IN DIABETIC PATIENTS: FINDINGS AND THE PATIENT’S PERSPECTIVE T.C. Won1 , S. Wong2 . 1 Collaborative Care, National Healthcare Group Polyclinic, 2 Collaborative Care, National Healthcare Group, Singapore, Singapore Background: Smart phone usage among patients is widespread. This trend can be harnessed to improve dietary counselling by Dietitians. Photographic-food-records (PFR) are shown to be an accurate method of measuring food-intake in adults. We aimed to study the use of PFR in assessing Diabetic patients as a complement to the Diet-Recall-History, and patient perspectives on its use. Method: 52 Type-2-Diabetic patients seen by the Dietician were recruited in Toa Payoh Polyclinic from 2012 to 2013. Participants were educated by the Dietitian on optimal food, carbohydrate, vegetable, fruit portions and cooking methods and they were taught to record three days PFR using their smartphones. The first Dietitian appointment entailed only traditional Diet-Recall history. At the second Dietitian visit, Diet recall history was taken followed by viewing the PFR. Dietitian highlighted discrepancies and re-affirmed accuracy, using the visual aid as reference and educational tool, ending with a Questionnaire survey. Analysis was carried using STATA SE version 12. Result: 49 patients completed the study, with 32.7% females (n = 16) and 67.4% males (n = 33), with only 5.8% (n = 3) drop-out rate. We found that only 71.4% and 48.9% of the participants accurately reported their vegetable and fruit portion respectively when verified with PFR, with 28.6% over-reporting their vegetable intake and 44.9% over-reporting their fruit intake. Only 36.7% accurately described their cooking method with 63.2% unaware that their meals were too oily. Results of the questionnaire showed that 63.3% of the participants became more aware of their food choices. When compared with diet recall, 61.2% preferred PFR and 75.5% clearly identified dietary improvements and learned better food portion estimation. 51.3% would continue to take photos of the food when requested. Results of the questionnaire showed that 63.3% of the participants became more aware of their food choices. When compared with diet recall, 61.2% preferred PFR and 75.5%
Oral presentation abstracts / Diabetes Research and Clinical Practice 106S1 (2014) S1–S41
(non-MetS) MetS; and further examine their association with clinical or metabolic parameters using a subpopulation of South Asian country. Method: The present study is a community-based crosssectional study performed on women from rural Bangladesh. A total of 1802 participants aged 15 years were selected using the stratified multistage random sampling. This sample size (1802) was sufficient to test all our formulated research hypotheses at the 5% level of significance, with a power of 80% (b = 0.20). We used the World Health Organization’s (WHO) STEPS approach (modified), which entails a stepwise collection of the risk factor data. Result: Plasma levels of VEGF were found to be significantly increased (MetS vs. non-MetS: 483.9 vs. 386.9, p < 0.001), whereas, the soluble forms of VEGF receptors, sVEGF-R1 and sVEGF-R2, were significantly decreased in subjects with Mets (sVEGF-R1, MetS vs. non-MetS: 512.5 vs. 631.3, p < 0.001; sVEGF-R2, MetS vs. non-MetS: 9,302.8 vs. 9,787.4, p = 0.004). After adjustment for age and all potential variables, multiple regression analysis revealed that plasma levels of VEGF had significant positive association with blood glucose (p = 0.019) and body mass index (p = 0.007). We also found that mean plasma levels of VEGF increased in direct proportion to levels of MetS components. Conclusion: The present study is the first ever to demonstrate a positive association between trends in levels of plasma VEGF and MetS using a large sample size from South Asia. The association between plasma VEGF and MetS needs further investigations in order to clearly decipher the clinical predictive value and accuracy of plasma VEGF in MetS. Reference(s) [1] Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh. [2] Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Nutrition & diabetes OP66 LONG-TERM EFFECTS OF A LOW CARBOHYDRATE, LOW SATURATED FAT DIET VERSUS A CONVENTIONAL HIGH CARBOHYDRATE, LOW FAT DIET IN TYPE 2 DIABETES: A RANDOMISED TRIAL J. Tay1,2,3 , N. Luscombe-Marsh3 , C. Thompson2 , M. Noakes3 , J. Buckley4 , G. Wittert2 , W. Yancy Jr5 , G. Brinkworth3 . 1 A*STAR, Singapore, Singapore ; 2 Medicine, University of Adelaide, 3 Food and Nutrition, CSIRO, 4 Nutrition Physiology Research Centre, University of South Australia, Adelaide, Australia ; 5 Medicine, Duke University Medical Center, Durham, United States Background: Few well-controlled studies have comprehensively examined the long-term effects of very low carbohydrate diets as part of a lifestyle modification program on glycemic control, cardiovascular risk factors and renal function in type 2 diabetes (T2D). Method: 115 adults with T2D (66 males, BMI 34.6±0.4 kg/m2 (mean ± SEM), age 58±1 yrs; HbA1c 7.3±0.1%) were randomised to consume a hypocaloric, very low carbohydrate, low saturated fat diet (LC 14% of energy as carbohydrate [CHO < 50 g/day], 28% protein, 58% fat [< 10% saturated fat]) or an energy matched high carbohydrate, low fat diet (HC 53% CHO, 17% protein, 30% fat [< 10% saturated fat]) combined with a structured exercise program (3d/wk) for 52 wks. Result: Both groups had similar completion rates (LC 41 [71%], HC 37 [65%]) and reductions in body weight (LC −9.8±1.0, HC −10.1±1.0 kg), fat mass (LC −7.9±0.9, HC −8.6±0.9 kg), blood pressure (LC −7.1/−6.2±1.7/1.0, HC −5.8/−6.4±1.8/1.0 mmHg), HbA1c (LC −1.0±0.1, HC −1.0±0.1%) and fasting glucose (LC −0.7±0.3, HC −1.5±0.3 %mmol/L); with no diet effect (P 0.09). Compared to HC, LC achieved a 3 fold greater
reduction in diabetes medication use (antiglycemic medication effect score; LC −0.6±0.1, HC −0.2±0.1; P < 0.01) and at least 2 fold greater decreases in glycemic variability indices indicating greater diurnal blood glucose stability: Mean Amplitude of Glucose Excursion (LC −1.7±0.3, HC −0.8±0.3 mmol/L), Continuous Overall Net Glycemic Action 1 (LC −0.5±0.1, HC −0.05±0.1 mmol/L), and SDGlucose (LC −0.7±0.1, HC −0.4±0.1 mmol/L); P = 0.003–0.09, time × diet effect. Triglycerides decreased (LC −0.4±0.1, HC −0.01±0.1 mmol/L; P = 0.001) and HDL-C increased (LC 0.1±0.03, HC 0.06±0.04 mmol/L; P = 0.002) more on LC, with no difference between groups for LDL-C reductions (LC −0.1±0.1, HC −0.2±0.1 mmol/L, P = 0.76 time × diet). Changes in eGFR did not differ between groups (LC −4±1, HC −2±1 ml/min/1.73 m2 , P = 0.25 time × diet) and levels were maintained within the normal range (90 ml/min/1.73 m2 ; LC 92±2, HC 90±2ml/min/1.73 m2 ). 6 participants (LC 3, HC 3) had moderately increased albuminuria at baseline (30– 300 mg/24h), which regressed to normal levels (< 30 mg/24hr) in 4 participants (LC 2, HC 2) after 52 weeks. Conclusion: Both LC and HC diets achieved comparable weight loss, improvements in HbA1c and fasting glucose, and maintained renal function. However, the LC yielded greater reductions in glucose lowering medication requirements, greater diurnal blood glucose stability and improved lipid profile suggesting LC are advantageous for T2D management. OP67 USE OF PHOTOGRAPHIC FOOD RECORDS IN DIABETIC PATIENTS: FINDINGS AND THE PATIENT’S PERSPECTIVE T.C. Won1 , S. Wong2 . 1 Collaborative Care, National Healthcare Group Polyclinic, 2 Collaborative Care, National Healthcare Group, Singapore, Singapore Background: Smart phone usage among patients is widespread. This trend can be harnessed to improve dietary counselling by Dietitians. Photographic-food-records (PFR) are shown to be an accurate method of measuring food-intake in adults. We aimed to study the use of PFR in assessing Diabetic patients as a complement to the Diet-Recall-History, and patient perspectives on its use. Method: 52 Type-2-Diabetic patients seen by the Dietician were recruited in Toa Payoh Polyclinic from 2012 to 2013. Participants were educated by the Dietitian on optimal food, carbohydrate, vegetable, fruit portions and cooking methods and they were taught to record three days PFR using their smartphones. The first Dietitian appointment entailed only traditional Diet-Recall history. At the second Dietitian visit, Diet recall history was taken followed by viewing the PFR. Dietitian highlighted discrepancies and re-affirmed accuracy, using the visual aid as reference and educational tool, ending with a Questionnaire survey. Analysis was carried using STATA SE version 12. Result: 49 patients completed the study, with 32.7% females (n = 16) and 67.4% males (n = 33), with only 5.8% (n = 3) drop-out rate. We found that only 71.4% and 48.9% of the participants accurately reported their vegetable and fruit portion respectively when verified with PFR, with 28.6% over-reporting their vegetable intake and 44.9% over-reporting their fruit intake. Only 36.7% accurately described their cooking method with 63.2% unaware that their meals were too oily. Results of the questionnaire showed that 63.3% of the participants became more aware of their food choices. When compared with diet recall, 61.2% preferred PFR and 75.5% clearly identified dietary improvements and learned better food portion estimation. 51.3% would continue to take photos of the food when requested. Results of the questionnaire showed that 63.3% of the participants became more aware of their food choices. When compared with diet recall, 61.2% preferred PFR and 75.5%