Realistic changes in monounsaturated fatty acids and soluble fibers are able to improve glucose metabolism

Diabetology & Metabolic Syndrome, Dec 2014

Background/objectives Cardioprotective effects of Mediterranean-style diet have been shown. Instead of excluding foods, replacement or addition may facilitate compliance with impact on glucose metabolism of individuals at cardiometabolic risk. This study investigated the effect of changing selected nutrients intake on glucose metabolism during a lifestyle intervention tailored to living conditions of prediabetic Brazilians. Subjects/methods 183 prediabetic adults treated under the Brazilian public health system underwent an 18-month intervention on diet and physical activity. Dietary counseling focused on reducing saturated fat replaced by unsaturated fatty acids. Data were collected at baseline and after follow-up. ANOVA and multiple linear regression were used to test association of changes in nutrients intake with changes in plasma glucose. Results Changes in fasting and 2-h plasma glucose but not in weight, HOMA-IR or C-reactive protein decreased after intervention across tertiles of MUFA changes (p-trend 0.017 and 0.024, respectively). Regression models showed that increase in MUFA intake was independently associated with reduction in fasting (β -1.475, p = 0.008) and 2-h plasma glucose (β -3.321, p = 0.007). Moreover, increase in soluble fibers intake was associated with decrease in fasting plasma glucose (β -1.579, p = 0.038). Adjustment for anthropometric measurements did not change the results but did after including change in insulin in the models. Conclusions Increases of MUFA and soluble fibers intakes promote benefits on glucose metabolism, independently of adiposity, during a realistic lifestyle intervention in at-risk individuals. Mechanisms mediating these processes may include mainly insulin sensitivity improvement.

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Realistic changes in monounsaturated fatty acids and soluble fibers are able to improve glucose metabolism

Diabetology & Metabolic Syndrome Realistic changes in monounsaturated fatty acids and soluble fibers are able to improve glucose metabolism Camila Risso de Barros 0 Adriana Cezaretto 0 Mara Ladeia Rodrigues Curti 0 Milena Monfort Pires 0 Luciana Dias Folchetti 0 Antonela Siqueira-Catania 0 Sandra Roberta Gouvea Ferreira 0 0 Department of Epidemiology, School of Public Health, University of Sao Paulo , Sao Paulo , Brazil Background/objectives: Cardioprotective effects of Mediterranean-style diet have been shown. Instead of excluding foods, replacement or addition may facilitate compliance with impact on glucose metabolism of individuals at cardiometabolic risk. This study investigated the effect of changing selected nutrients intake on glucose metabolism during a lifestyle intervention tailored to living conditions of prediabetic Brazilians. Subjects/methods: 183 prediabetic adults treated under the Brazilian public health system underwent an 18-month intervention on diet and physical activity. Dietary counseling focused on reducing saturated fat replaced by unsaturated fatty acids. Data were collected at baseline and after follow-up. ANOVA and multiple linear regression were used to test association of changes in nutrients intake with changes in plasma glucose. Results: Changes in fasting and 2-h plasma glucose but not in weight, HOMA-IR or C-reactive protein decreased after intervention across tertiles of MUFA changes (p-trend 0.017 and 0.024, respectively). Regression models showed that increase in MUFA intake was independently associated with reduction in fasting ( -1.475, p = 0.008) and 2-h plasma glucose ( -3.321, p = 0.007). Moreover, increase in soluble fibers intake was associated with decrease in fasting plasma glucose ( -1.579, p = 0.038). Adjustment for anthropometric measurements did not change the results but did after including change in insulin in the models. Conclusions: Increases of MUFA and soluble fibers intakes promote benefits on glucose metabolism, independently of adiposity, during a realistic lifestyle intervention in at-risk individuals. Mechanisms mediating these processes may include mainly insulin sensitivity improvement. Monounsaturated fatty acids; Fiber intake; Lifestyle intervention; Glucose metabolism - Background Obesity-related diseases, such as type 2 diabetes and cardiovascular disease, are major preventable problems which could be attenuated by a healthy diet and exercise [1,2]. However, long-term compliance with a healthy lifestyle is a challenge, particularly in emerging countries, where populations have less access to healthy foods, usually more expensive, and fewer opportunities for exercising. Dietary recommendations have emphasized reduction in fat consumption and encouraged fiber intake [3]. The deleterious effects of saturated fatty acids (SFA) on cardiovascular risk profile obfuscated the benefits of unsaturated fat, whose cardioprotective role has been reinforced in more recent publications [4,5]. Observational studies reported lower cardiovascular mortality rates in populations consuming high proportions of dietary unsaturated fatty acids and fibers [6]. Underlying mechanisms involve inflammatory mediators which interfere in glucose metabolism [7]. However, a diet rich in MUFA did not improve insulin sensitivity in healthy participants of a Nordic randomized clinical trial, except for a subgroup with a total fat intake < 37% of energy [8]. It remains unclear whether beneficial effects on glucose metabolism are independent of body weight [9,10]. Also, for cardiovascular prevention, a mixture of soluble and insoluble fibers has been recommended. High-fiber diets have been associated with benefits on glucose and lipid metabolism and may lower risk of cardiovascular events [11]. Observational and prospective studies provided evidence of improvement in insulin sensitivity [12,13] but the effect of fibers on inflammatory process is not yet well established [14]. Efficacy of the PREDIMED diet on reducing weight gain [15] and preventing cardiometabolic outcomes [16] has motivated several countries to change their eating habits. Low acceptance of this dietary pattern outside Mediterranean region was described in a Northern European population [17]. In Latinos living in South America, a better compliance with a diet rich in vegetable oil, whole grains, fruits and vegetables, could be expected considering their ancestry and local food availability. Effectiveness of interventions on quality of fat and amount of dietary fiber, tailored to public health systems of developing countries, was scarcely investigated. In general, dietary interventions imply food restrictions; instead of excluding foods, replacement or even addition may be a better strategy to achieve metabolic benefits. We hypothesized that realistic changes in Brazilian eating habits may facilitate compliance with impact on glucose metabolism of individuals at cardiometabolic risk. This study investig (...truncated)


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Camila de Barros, Adriana Cezaretto, Maíra Ladeia Curti, Milena Pires, Luciana Folchetti, Antonela Siqueira-Catania, Sandra Roberta Ferreira. Realistic changes in monounsaturated fatty acids and soluble fibers are able to improve glucose metabolism, Diabetology & Metabolic Syndrome, 2014, pp. 136, 6, DOI: 10.1186/1758-5996-6-136