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Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala. (Allmänmedicin)ORCID iD: 0000-0002-2432-3846
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.ORCID iD: 0000-0002-1680-1000
2014 (English)In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 46, no 3, 182-187 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Inflammation may play an important role in type 2 diabetes. It has been proposed that dietary strategies can modulate inflammatory activity.

METHODS: We investigated the effects of diet on inflammation in type 2 diabetes by comparing a traditional low-fat diet (LFD) with a low-carbohydrate diet (LCD). Patients with type 2 diabetes were randomized to follow either LFD aiming for 55-60 energy per cent (E%) from carbohydrates (n = 30) or LCD aiming for 20 E% from carbohydrates (n = 29). Plasma was collected at baseline and after 6 months. C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1Ra), IL-6, tumour necrosis factor receptor (TNFR) 1 and TNFR2 were determined.

RESULTS: Both LFD and LCD led to similar reductions in body weight, while beneficial effects on glycaemic control were observed in the LCD group only. After 6 months, the levels of IL-1Ra and IL-6 were significantly lower in the LCD group than in the LFD group, 978 (664-1385) versus 1216 (974-1822) pg/mL and 2.15 (1.65-4.27) versus 3.39 (2.25-4.79) pg/mL, both P < 0.05.

CONCLUSIONS: To conclude, advice to follow LCD or LFD had similar effects on weight reduction while effects on inflammation differed. Only LCD was found significantly to improve the subclinical inflammatory state in type 2 diabetes.

Place, publisher, year, edition, pages
Informa Healthcare, 2014. Vol. 46, no 3, 182-187 p.
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:liu:diva-107718DOI: 10.3109/07853890.2014.894286ISI: 000335584000011PubMedID: 24779961OAI: oai:DiVA.org:liu-107718DiVA: diva2:726969
Available from: 2014-06-19 Created: 2014-06-19 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Trials of Diets for Treatment of Diabetes: A comparison of diets for treatment of type 2 diabetes, aspects on long and short term effects
Open this publication in new window or tab >>Trials of Diets for Treatment of Diabetes: A comparison of diets for treatment of type 2 diabetes, aspects on long and short term effects
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients.

Methods

A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed.

To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed.

Results

There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only.

In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP).

Conclusions

In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative.

In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 48 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1441
Keyword
Dietary intervention, type 2 diabetes, low-carbohydrate diet, blood glucose, blood lipids, insulin, body mass index, quality of life, inflammation, cytokine
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-116691 (URN)10.3384/diss.diva-116691 (DOI)978-91-7519-140-9 (ISBN)
Public defence
2015-05-13, Linden, Ingång 65, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2015-04-01Bibliographically approved

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Jonasson, LenaGuldbrand, HansLundberg, Anna KNyström, Fredrik H

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Division of Cardiovascular MedicineFaculty of Health SciencesDepartment of Cardiology in LinköpingDivision of Community MedicinePrimary Health Care in MotalaDepartment of Endocrinology
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