Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt

Abdou, Marise; Hafez, Mona; Anwar, Ghada M.; Fahmy, Wafaa A; Alfattah, Naglaa Mohammed Abd; Salem, Rania Ibrahim; Arafa, Noha

doi:10.1016/j.dsx.2020.11.020

Cited by 17 publications

(28 citation statements)

References 22 publications

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“…Both LPHF and HPHF increased the levels of T-CHO, L-CHO, and H-CHO in plasma, which was partly attributed to the high-fat contents. In accordance with a recent study conducted in Egypt [ 44 ], the plasma glucose levels were dramatically increased in the HPHF groups, compared to the Con and LPHF groups. Training lowered the plasma glucose in the HPHF groups, showing that regular training was favorable for blood glucose management in healthy individuals [ 45 ].…”

Section: Discussionsupporting

confidence: 91%

A Low-Protein High-Fat Diet Leads to Loss of Body Weight and White Adipose Tissue Weight via Enhancing Energy Expenditure in Mice

Rang

Jiao

et al. 2021

Metabolites

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Obesity has become a worldwide health problem over the past three decades. During obesity, metabolic dysfunction of white adipose tissue (WAT) is a key factor increasing the risk of type 2 diabetes. A variety of diet approaches have been proposed for the prevention and treatment of obesity. The low-protein high-fat diet (LPHF) is a special kind of high-fat diet, characterized by the intake of a low amount of protein, while compared to typical high-fat diet, may induce weight loss and browning of WAT. Physical activity is another effective intervention to treat obesity by reducing WAT mass, inducing browning of WAT. In order to determine whether an LPHF, along with exercise enhanced body weight loss and body fat loss as well as the synergistic effect of an LPHF and exercise on energy expenditure in a mice model, we combined a 10-week LPHF with an 8-week forced treadmill training. Meanwhile, a traditional high-fat diet (HPHF) containing the same fat and relatively more protein was introduced as a comparison. In the current study, we further analyzed energy metabolism-related gene expression, plasma biomarkers, and related physiological changes. When comparing to HPHF, which induced a dramatic increase in body weight and WAT weight, the LPHF led to considerable loss of body weight and WAT, without muscle mass and strength decline, while it exhibited a risk of liver and pancreas damage. The mechanism underlying the LPHF-induced loss of body weight and WAT may be attributed to the synergistically upregulated expression of Ucp1 in WAT and Fgf21 in the liver, which may enhance energy expenditure. The 8-week training did not further enhance weight loss and increased plasma biomarkers of muscle damage when combined with LPHF. Furthermore, LPHF reduced the expression of fatty acid oxidation-related genes in adipose tissues, muscle tissues, and liver. Our results indicated that an LPHF has potential for obesity treatment, while the physiological condition should be monitored during application.

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Section: Discussionsupporting

confidence: 91%

A Low-Protein High-Fat Diet Leads to Loss of Body Weight and White Adipose Tissue Weight via Enhancing Energy Expenditure in Mice

Rang

Jiao

et al. 2021

Metabolites

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“…After exclusion of entirely adult study populations and non-relevant publications (n = 189), a total of 27 available articles and the ISPAD guidelines [4] remained for analysis (see Tables 1 and 2). 2× carbohydrates only//LP to HP 10 g/0 g/0 g//20 g/0 g/0 g//0 g/0 g/0 g//0 g/0 g/12.5 g//0 g/0 g/25 g //0 g/0 g/50 g//0 g/0 g/75 g// 0 g/0 g/100 g Out of the 20 original articles, nine publications [10,[19][20][21][27][28][29][30][31] investigated a paediatric population (<18 years old) only with a total number of 525 participants. Two of these articles (total number of 274 children) feature a questionnaire about dietary habits of diabetic children only and had no focus on blood sugar or bolus insulin following high fat and/or high protein meals [19,20].…”

Section: Methodsmentioning

confidence: 99%

“…Evans et al defined high protein as 60 g total, while Paterson et al defined high protein as 50 g and Smart et al defined 40 g of protein as high [21,33,38]. Abdou et al used a stratification according to age that defined high protein as 53 g (age 6-10 years), 61.9 g (10-14 years), 71.5 g (14-19 years) [28].…”

Section: Amount Of Protein Studiedmentioning

confidence: 99%

“…Glycaemic responses to high fat meals (and low protein) have been described as initially reducing glucose levels within the first 1-2 h, followed by elevated levels of up to 5 h [21,25]. This is explained by delayed gastric emptying, inducing gluconeogenesis, direct effect of free fatty acids and the influence of fat on hormones [28]. The two high fat (and low protein) articles contradict these findings.…”

Section: Fat As Predominant Macronutrient Glycaemic Responsementioning

confidence: 99%

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The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

et al. 2021

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Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.

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“…According to recommendations, to optimize postprandial glucose levels, other variables should be considered, including glycemic index, fat, protein and fiber intake [ 4 ]. It has been demonstrated that meals with high content of fat or protein lead to a delayed and prolonged increase in postprandial glycaemia, from 2 to 6 h after the meal, with small variations in ranges depending on the study considered [ 33 , 34 , 35 , 36 ]. An additive effect was reported when consuming high fat and high protein meals together [ 33 ].…”

Section: Fat Intake and Glycemic Controlmentioning

confidence: 99%

Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

2021

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Nutrition therapy is a cornerstone of type 1 diabetes (T1D) management. Glycemic control is affected by diet composition, which can contribute to the development of diabetes complications. However, the specific role of macronutrients is still debated, particularly fat intake. This review aims at assessing the relationship between fat intake and glycemic control, cardiovascular risk factors, inflammation, and microbiota, in children and adolescents with T1D. High fat meals are followed by delayed and prolonged hyperglycemia and higher glycated hemoglobin A1c levels have been frequently reported in individuals with T1D consuming high amounts of fat. High fat intake has also been associated with increased cardiovascular risk, which is higher in people with diabetes than in healthy subjects. Finally, high fat meals lead to postprandial pro-inflammatory responses through different mechanisms, including gut microbiota modifications. Different fatty acids were proposed to have a specific role in metabolic regulation, however, further investigation is still necessary. In conclusion, available evidence suggests that a high fat intake should be avoided by children and adolescents with T1D, who should be encouraged to adhere to a healthy and balanced diet, as suggested by ISPAD and ADA recommendations. This nutritional choice might be beneficial for reducing cardiovascular risk and inflammation.

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Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt

Cited by 17 publications

References 22 publications

A Low-Protein High-Fat Diet Leads to Loss of Body Weight and White Adipose Tissue Weight via Enhancing Energy Expenditure in Mice

A Low-Protein High-Fat Diet Leads to Loss of Body Weight and White Adipose Tissue Weight via Enhancing Energy Expenditure in Mice

The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

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