Diet and postprandial risk markers for complications in type 2 diabetes

<p>The period after a meal is complex with fluctuation in blood glucose, lipids and other metabolic responses. This may induce and/or increase inflammation and contribute to future development of diabetic complications. Prevention of complications include well-controlled disease management, including diet. There are however gaps in the literature for dietary recommendations in diabetes, and whether those with type 2 diabetes (T2D) make dietary changes. The aims of this doctoral thesis were: 1) To study the acute effects of fructose loading on levels of serum uric acid, metabolic and inflammatory markers using isocaloric drinks; Coca-Cola (17.5 g fructose), blueberry drink (18 g fructose) and a pure fructose drink (35 g fructose), without and with a pizza. 3) To study the acute effect of meals with different compositions of high carbohydrate (HC) (52E%), HC & fibers (50E%, 15 g), low carbohydrate (LC, 32E%)+high fat (HF) (50E%) and LC (28E%)+high protein (HP) (41E%) on metabolic and inflammatory markers 4) Examine possible changes in fruits and vegetables consumption.</p><p>The effects of acute fructose loading on levels of serum uric acid were examined in T2D (n=7), chronic kidney disease (n=3) and healthy subjects (HS) (n=6). Serum uric acid increased over time following fructose loading. The highest response was observed following fructose drink, and the lowest following the blueberry drink (p<0.05). The effect of acute fructose loading on glucose, insulin and inflammatory markers were examined in T2D and HS. The response in glucose and insulin was greater following Coca-Cola (p<0.05). MCP-1 decreased in both groups following blueberry drink and Coca-Cola (T2D; p=0.02, HS; p=0.03), probably secondary to the insulin response. The results suggests that drinks with added fructose should be avoided, and that blueberry is protective on uric acid and glucose response.</p><p>The effect of meal composition on metabolic and inflammatory markers were examined in T2D and HS. HC meals induced the highest response in glucose and insulin, and LC+HF in triglycerides (p<0.05). The inflammatory marker VCAM-1 decreased following LC+HP meal (T2D; p=0.03, HS; p=0.003), while ICAM-1 decreased following LC+HF (p=0.02) in T2D and following LC+HP (p=0.03) in HS. PAI-1 decreased following HC (T2D; p=0.04, HS; p=0.006) and LC+HP (T2D; p=0.03, HS; p=0.01) and in T2D also following LC+HF (p=0.04). The responses did not differ between meals, probably due to the healthy composition of meals. Thus, LC meals with a healthy composition of fibers, vegetables, berries, mono and poly- unsaturated fat and plant-based proteins could be recommended to subjects with T2D.</p><p>Possible changes in intake of fruits and vegetables consumption over time was explored in a prospective cohort of men using food frequency questionnaires in 1997 and 2009. 1 741 men developed T2D and 22 212 remained free from diabetes. Increased intake of fruit and vegetables was greater among those who developed T2D (1.6 servings/week, 95% CI 1.08; 2.03) compared to those remained free from diabetes (0.7 servings/week, 95% 0.54; 0.84). Although improvements in consumption were observed, only 36% of those with T2D consumed ≥5 servings per day in 2009. Thus, there is a need for nutritional education in T2D.</p><h3>List of scientific papers</h3><p>I. C Olofsson, B Anderstam, AC Bragfors-Helin, M Eriksson, AR Qureshi, B Lindholm, A Hilding, W Wiczkowski, N Orsini, P Stenvinkel, N Rajamand Ekberg. Effects of acute fructose loading on levels of serum uric acid – a pilot study. Eur J Clin Invest. 2019;49:e13040. <br><a href="https://doi.org/10.1111/eci.13040">https://doi.org/10.1111/eci.13040</a><br><br> </p><p>II. C Olofsson, M Eriksson, AC Bragfors-Helin, B Anderstam, N Orsini, P Stenvinkel, N Rajamand Ekberg. Effects of acute fructose loading on markers of inflammation. [Submitted]</p><p>III. C Olofsson, I-L Andersson, O Torffvit, K Brismar, N Rajamand Ekberg. Effect of meal composition on metabolic and inflammatory markers in type 2 diabetes and healthy controls. [Manuscript]</p><p>IV. C Olofssson, A Discacciati, A Åkesson, N Orsini, K Brismar, A Wolk. Changes in fruit, vegetable and juice consumption after the diagnosis of type 2 diabetes: a prospective study in men. Br J Nutr. 2017; 117(5): 712-719. <br><a href="https://doi.org/10.1017/S0007114516002257">https://doi.org/10.1017/S0007114516002257</a><br><br> </p>