An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Participants
2.3. Sample Size Calculation
2.4. Intervention
2.5. Outcomes
2.5.1. Glycated Hemoglobin (HbA1c)
2.5.2. Depression
2.5.3. Anthropometric Measurements
2.5.4. Dietary Record
2.5.5. Fasting GLP-1 Concentration
2.5.6. Gut Microbiota
2.6. Statistical Analysis
3. Results
3.1. Study Participants
3.2. Dietary Adherence
3.2.1. Proportions of Calories from Three Macro-Nutrients the Patients Consumed
3.2.2. Almond Adherence
3.3. Effect of a-LCD on Glycated Hemoglobin (HbA1c)
3.4. Effect of a-LCD on the Changes of Anti-Diabetics
3.5. Effect of a-LCD on Weight and BMI
3.6. Effect of a-LCD on Depression
3.7. Fasting Plasma GLP-1 Concentration
3.8. Gut Microbiota
3.8.1. Alpha-Adversity
3.8.2. Beta-Diversity
3.8.3. The Comparison of the Composition of Gut Microbiota in the Two Groups
4. Discussion
4.1. Effect of a-LCD on Glycemic Control and Anti-Diabetics
4.2. Effect of a-LCD on Weight and BMI
4.3. Effect of a-LCD on Depression Score
4.4. Effect of a-LCD on Regulation of Gut Microbiota and GLP-1 Expression
5. Conclusions
6. Limitations
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | a-LCD (n = 22) | LFD (n = 23) | t/χ2/Z | p | |
---|---|---|---|---|---|
x ± SD/n(%)/ M (P25,P50) | x ± SD/n(%)/ M (P25,P50) | ||||
Demographic data | |||||
Age (years) | 73.55 ± 4.99 | 70.48 ± 5.91 | −1.877 a | 0.067 | |
Gender-male | 9 (40.9%) | 11 (47.8%) | 0.218 b | 0.641 | |
Marital status (married) | 20 (90.9%) | 21 (91.3%) | 0.002 c | 0.963 | |
Education | Primary and below | 2 (9.1%) | 2 (8.7%) | 4.037 b | 0.258 |
Journal high school | 4 (18.2%) | 10 (43.5%) | |||
Technical and senior high school | 11 (50.0%) | 9 (39.1%) | |||
Journal college school and above | 5 (22.7%) | 2 (8.7%) | |||
Payment | Medical insurance | 22 (100%) | 21 (91.3%) | 2.002 c | 0.157 |
Monthly income (thousand yuan) | <2 | 0 (0%) | 3 (13.0%) | 3.950 b | 0.139 |
2~5 | 19 (86.4%) | 15 (65.2%) | |||
≥5 | 3 (13.6%) | 5 (21.7%) | |||
Occupation status | Retire | 22 (100%) | 22 (95.7%) | 0.978 c | 0.323 |
On the job | 0 (0%) | 1 (4.3%) | |||
Residential status | Living by oneself | 2 (9%) | 2 (8%) | 0.311 b | 0.856 |
Living with spouse | 19 (86%) | 19 (83%) | |||
Living with children | 1 (5%) | 2 (9%) | |||
Exercise intensity (d) | Low intensity | 19 (86.4%) | 18 (78.3%) | 0.505 b | 0.477 |
Moderate intensity | 3 (13.6%) | 5 (21.7%) | |||
Exercise time/(minute) | 315.00(210.00,420.00) | 360.00(210.00,420.00) | −0.537 d | 0.591 | |
Clinical data | |||||
Smoking (Yes) | 1 (4.5%) | 2 (8.7%) | 0.311 c | 0.577 | |
Drinking (Yes) | 4 (18.2%) | 3 (13.0%) | 0.226 c | 0.634 | |
Diabetes duration (years) | 14.18 ± 7.06 | 15.65 ± 7.02 | 0.700 a | 0.487 | |
Family history of diabetes (Yes) | 12 (54.5%) | 11 (47.8%) | 0.203 b | 0.652 | |
Diabetic complication (Yes) | 9 (40.9%) | 11 (59.3%) | 0.573 b | 0.449 | |
Accompanying disease (Yes) | 16 (72.7%) | 17 (73.9%) | 0.008 b | 0.928 | |
Therapy method | None | 1 (4.5%) | 1 (4.3%) | 1.825 b | 0.610 |
Only Hypoglycemic drugs | 12 (54.5%) | 14 (60.9%) | |||
Only Insulin | 1 (4.5%) | 3 (13.0%) | |||
Hypoglycemic drugs + insulin | 8 (36.4%) | 5 (21.7%) | |||
Number of combination medication | 0 | 2 (8.7%) | 4 (14.8%) | 5.022 b | 0.170 |
1 | 8 (34.8%) | 4 (14.8%) | |||
2 | 13 (56.5%) | 16 (59.3%) | |||
3 | 0 (0%) | 3 (11.1%) |
Variables | a-LCD (n =22) | LFD (n =23) | t | p | |
---|---|---|---|---|---|
Baseline | Total calorie intake/day | 1686.34 ± 231.25 | 1781.91 ± 280.91 | −1.232 | 0.184 |
Carbohydrate-calorie (Kcal) | 974.95 ± 148.22 | 1007.61 ± 136.32 | −0.761 | 0.504 | |
Fat-calorie (Kcal) | 406.76 ± 143.88 | 478.29 ± 149.97 | −1.614 | 0.085 | |
Protein-calorie (Kcal) | 318.45 ± 63.19 | 292.38 ± 65.12 | 1.348 | 0.524 | |
Third month | Total calorie intake/day | 1642.08 ± 227.74 | 1764.77 ± 297.40 | −1.536 | 0.114 |
Carbohydrate-calorie (Kcal) | 673.14 ± 91.80 | 1042.10 ± 195.41 | −8.016 | <0.01 ** | |
Fat-calorie (Kcal) | 648.19 ± 128.93 | 433.01 ± 137.39 | 5.357 | <0.01 ** | |
Protein-calorie (Kcal) | 372.03 ± 64.45 | 288.94 ± 64.34 | 1.962 | 0.067 |
Study Period | a-LCD (n =22) | LFD (n =23) | t/F | p |
---|---|---|---|---|
Baseline | 7.67 ± 1.60 | 7.54 ± 1.31 | −0.287 a | 0.776 |
Third month | 6.85 ± 1.02 (adjusted:6.77 ± 0.13) | 7.37 ± 1.29 (adjusted:7.44 ± 0.12) | 14.111 b | <0.01 ** |
t | 4.081 c | 2.614 c | ||
p | <0.01 ** | 0.016 * |
a-LCD (n = 22) | LFD (n = 23) | χ2 | p | |
---|---|---|---|---|
Reduction | 3 (14%) | 5 (22%) | 0.019 | 0.889 |
No change | 19 (86%) | 18 (78%) |
Variables | a-LCD (n = 22) | LFD (n = 23) | t | p | |
---|---|---|---|---|---|
Weight (Kg) | Baseline | 66.60 ± 8.81 | 63.07 ± 12.88 | 0.784 a | 0.459 |
Third month | 59.34 ± 8.90 | 62.58 ± 13.12 | 0.967 a | 0.339 | |
t | 2.164 b | 1.397b | |||
p | 0.042 * | 0.176 | |||
BMI (Kg/m2) | Baseline | 23.53 ± 2.33 | 23.69 ± 2.83 | 0.216 | 0.830 |
Third month | 23.02 ± 2.45 | 23.53 ± 3.04 | 0.641 | 0.524 | |
t | −2.261 | −1.283 | |||
p | 0.034 * | 0.211 |
Study Period | a-LCD (n = 22) | LFD (n = 23) | t/F | p |
---|---|---|---|---|
Baseline | 48.41 ± 8.05 | 49.57 ± 8.46 | 0.471 a | 0.640 |
Third month | 42.07 ± 5.80(adjusted:42.58 ± 0.89) | 48.65 ± 7.69(adjusted:48.16 ± 0.87) | 19.308 b | <0.01 ** |
t | 6.196 c | 0.838 c | ||
p | <0.01 ** | 0.411 |
Study Period | a-LCD (n =22) | LFD (n =23) | Z | p |
---|---|---|---|---|
Baseline | 1.381 (0.697,3.157) | 1.190 (0.804,1.896) | −0.409 | 0.683 |
Third month | 1.092 (0.886,2.671) | 0.630 (0.261,1.997) | −2.396 | 0.017 * |
Z | −0.221 | −1.339 | ||
p | 0.833 | 0.162 |
Phylum | Genus | Study Period | a-LCD (n =22) | LFD (n =23) | Z | p(adj. val.) |
---|---|---|---|---|---|---|
Firmicutes | Baseline | 0.389 (0.283,0.729) | 0.544 (0.455,0.671) | −1.317 | 0.188 (0.194) | |
Third month | 0.580 (0.371,0.672) | 0.684 (0.561,0.778) | −2.317 | 0.021 * (0.026) | ||
Z | −1.282 | −2.281 | ||||
p(adj. val.) | 0.200 (0.213) | 0.023 * (0.038) | ||||
Roseburia | Baseline | 0.002 (0.000,0.005) | 0.009 (0.005,0.024) | −1.892 | <0.01 ** (<0.01) | |
Third month | 0.005 (0.000,0.006) | 0.000 (0.000,0.001) | −2.626 | <0.01 ** (<0.01) | ||
Z | −2.193 | −4.075 | ||||
p(adj. val.) | 0.028 * (0.021) | <0.01 ** (<0.01) | ||||
Eubacterium | Baseline | 0.008 (0.004,0.0220) | 0.037 (0.018,0.070) | −3.747 | <0.01 ** (<0.01) | |
Third month | 0.026 (0.004,0.057) | 0.042 (0.024,0.099) | −2.082 | 0.037 * (0.073) | ||
Z | −2.678 | −1.734 | ||||
p(adj. val.) | <0.01 ** (0.013) | 0.083 (0.052) | ||||
Ruminococcus | Baseline | 0.017 (0.011,0.033) | 0.020 (0.005,0.037) | −0.829 | 0.470 (0.407) | |
Third month | 0.026 (0.005,0.044) | 0.005 (0.000,0.019) | −2.015 | 0.044 * (0.073) | ||
Z | −0.341 | −2.312 | ||||
p | 0.733 (0.308) | 0.021 * (0.020) | ||||
Lactobacillus | Baseline | 0.007 (0.003,0.049) | 0.005 (0.002,0.012) | −1.420 | 0.156 (0.223) | |
Third month | 0.007 (0.000,0.068) | 0.000 (0.000,0.047) | −1.666 | 0.096 (0.245) | ||
Z | −1.150 | −0.973 | ||||
p(adj. val.) | 0.130 (0.073) | 0.330 (0.167) | ||||
Bacteroidetes | Baseline | 0.249 (0.120,0.323) | 0.110 (0.072,0.180) | −2.793 | <0.01 ** (0.011) | |
Third month | 0.151 (0.061,0.256) | 0.108 (0.042,0.236) | −0.591 | 0.555 (0.415) | ||
Z | −2.451 | −1.004 | ||||
p(adj. val.) | 0.014 * (0.016) | 0.361 (0.188) | ||||
Bacteroides | Baseline | 0.144 (0.057,0.256) | 0.047 (0.023,0.119) | −3.244 | <0.01 ** (<0.01) | |
Third month | 0.064 (0.027,0.106) | 0.057 (0.009,0.085) | −0.978 | 0.328 (0.364) | ||
Z | −2.354 | −0.335 | ||||
p(adj. val.) | 0.019 * (0.013) | 0.735 (0.308) |
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Ren, M.; Zhang, H.; Qi, J.; Hu, A.; Jiang, Q.; Hou, Y.; Feng, Q.; Ojo, O.; Wang, X. An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients 2020, 12, 3036. https://doi.org/10.3390/nu12103036
Ren M, Zhang H, Qi J, Hu A, Jiang Q, Hou Y, Feng Q, Ojo O, Wang X. An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients. 2020; 12(10):3036. https://doi.org/10.3390/nu12103036
Chicago/Turabian StyleRen, Mengxiao, Huaiyu Zhang, Jindan Qi, Anni Hu, Qing Jiang, Yunying Hou, Qianqian Feng, Omorogieva Ojo, and Xiaohua Wang. 2020. "An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial" Nutrients 12, no. 10: 3036. https://doi.org/10.3390/nu12103036