Abbreviations: CAD, coronary artery disease; IVRT, isovolumetric relaxation time; LVDD, left ventricular diastolic dysfunction; MET, metabolic equivalent; PST, posterior wall thickness; PVa, pulmonary reversed A wave velocity; PVd, pulmonary D wave velocity; PVs, pulmonary S wave velocity.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Diastolic Dysfunction in Normotensive Men With Well-Controlled Type 2 DiabetesImportance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathyOBJECTIVE -Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes.RESEARCH DESIGN AND METHODS -We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of left ventricular filling.RESULTS -LVDD was found in 28 subjects (60%), of whom 13 (28%) had a pseudonormal pattern of ventricular filling and 15 (32%) had impaired relaxation. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control.CONCLUSIONS -LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of ventricular filling.

It has been suggested that the current dietary recommendations (low-fat-high-carbohydrate diet) may promote the intake of sugar and highly refined starches which could have adverse effects on the metabolic risk profile. We have investigated the short-term (6-d) nutritional and metabolic effects of an ad libitum low-glycaemic index-low-fat-high-protein diet (prepared according to the Montignac method) compared with the American Heart Association (AHA) phase I diet consumed ad libitum as well as with a pair-fed session consisting of the same daily energy intake as the former but with the same macronutrient composition as the AHA phase I diet. Twelve overweight men (BMI 33 : 0 (SD 3 : 5) kg/m 2 ) without other diseases were involved in three experimental conditions with a minimal washout period of 2 weeks separating each intervention. By protocol design, the first two conditions were administered randomly whereas the pair-fed session had to be administered last. During the ad libitum version of the AHA diet, subjects consumed 11695 : 0 (SD 1163 : 0) kJ/d and this diet induced a 28 % increase in plasma triacylglycerol levels (1 : 77 (SD 0 : 79) v. 2 : 27 (SD 0 : 92) mmol/l, P,0 : 05) and a 10 % reduction in plasma HDL-cholesterol concentrations (0 : 92 (SD 0 : 16) v. 0 : 83 (SD 0 : 09) mmol/l, P,0 : 01) which contributed to a significant increase in cholesterol:HDL-cholesterol ratio (P,0 : 05), this lipid index being commonly used to assess the risk of coronary heart disease. In contrast, the lowglycaemic index-low-fat-high-protein diet consumed ad libitum resulted in a spontaneous 25 % decrease (P,0 : 001) in total energy intake which averaged 8815 : 0 (SD 738 : 0) kJ/d. As opposed to the AHA diet, the low-glycaemic index-low-fat-high-protein diet produced a substantial decrease (235 %) in plasma triacylglycerol levels (2 : 00 (SD 0 : 83) v. 1 : 31 (SD 0 : 38) mmol/l, P,0 : 0005), a significant increase (+1 : 6 %) in LDL peak particle diameter (251 (SD 5) v. 255 (SD 5) Å , P,0 : 02) and marked decreases in plasma insulin levels measured either in the fasting state, over daytime and following a 75 g oral glucose load. During the pair-fed session, in which subjects were exposed to a diet with the same macronutrient composition as the AHA diet but restricted to the same energy intake as during the low-glycaemic index-low-fat-high-protein diet, there was a trend for a decrease in plasma HDL-cholesterol levels which contributed to the significant increase in cholesterol:HDLcholesterol ratio noted with this condition. Furthermore, a marked increase in hunger (P,0 : 0002) and a significant decrease in satiety (P,0 : 007) were also noted with this energy-restricted diet. Finally, favourable changes in the metabolic risk profile noted with the ad libitum consumption of the low-glycaemic index-low-fat-high-protein diet (decreases in triacyglycerols, lack of increase in cholesterol:HDL-cholesterol ratio, increase in LDL particle size) were significantly different from the response of these variables to the AHA phase I diet. T...

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