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Advances in the Nutrition of Diabetes and Gestational Diabetes

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 September 2021) | Viewed by 50505

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Prof. Dr. Dimitrios G. Goulis

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Guest Editor

Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: male reproductive endocrinology; female reproductive endocrinology; endocrine complications of pregnancy; menopause; research methodology
Special Issues, Collections and Topics in MDPI journals

Dr. Maria G. Grammatikopoulou

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Unit of Immunonutrition & Clinical Nutrition, Department of Rheumatology & Clinical Immunology, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
Interests: vulnerable populations; pediatric patients; nutrition recommendations; dietary interventions; nutritional status; evidence-based nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutrition constitutes one of the cornerstones for the therapy of diabetes mellitus (DM). All types of DM require proper nutritional education, management, and audit. Nutritional status and dietary intake are established as contributors to type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). In addition, adherence to specific dietary regimes has been suggested to reverse DM, indicating that the role of nutrition extends beyond secondary prevention. The research on the effect of medical nutrition therapy on DM is longstanding and continuous, aiming to identify nutritional factors that could improve patient outcomes.

This Special Issue of Nutrients is focusing on the association between nutrition and all types of DM. It is designed to discuss contemporary issues that are of keen interest to both nutritionists and diabetologists. Its aim is to aggregate novel research and revisit older issues in one volume, bringing together nutritionists, dietitians, clinicians, and other health professionals, while presenting high-quality evidence and updating the existing perspective on nutrition and DM. Authors are invited to submit their work, including original research, reviews, meta-research, and opinion papers, showcasing important issues governing DM and nutrition.

We are looking forward to your submissions.

Prof. Dimitrios G. Goulis
Dr. Maria G. Grammatikopoulou
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

dietary assessment
glucose
body weight
clinical trials
pregnancy
gestational diabetes
type 2 diabetes
type 1 diabetes
dietary intervention
diet therapy
medical nutrition therapy
lifestyle intervention

Published Papers (11 papers)

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Editorial

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4 pages, 208 KiB

Open AccessEditorial

Medical Nutrition Therapy in Diabetes Mellitus: New Insights to an Old Problem

by Maria G. Grammatikopoulou and Dimitrios G. Goulis

Nutrients 2022, 14(3), 698; https://doi.org/10.3390/nu14030698 - 07 Feb 2022

Cited by 4 | Viewed by 3396

Abstract

The management of all types of diabetes mellitus (DM) has transformed during the past decade [...] Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

Research

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12 pages, 1437 KiB

Open AccessArticle

Effectiveness of Health Coaching in Diabetes Control and Lifestyle Improvement: A Randomized-Controlled Trial

by Ching-Ling Lin, Li-Chi Huang, Yao-Tsung Chang, Ruey-Yu Chen and Shwu-Huey Yang

Nutrients 2021, 13(11), 3878; https://doi.org/10.3390/nu13113878 - 29 Oct 2021

Cited by 10 | Viewed by 5862

Abstract

Background: The study aimed to look into the effectiveness of a 6-month health coaching intervention for HbA1c and healthy diet in the treatment of patients with type 2 diabetes. Methods: The study was carried out via a two-armed, randomized controlled trial that included 114 diabetic patients at a medical center in Taiwan. During the 6-month period, the intervention group had health coaching and usual care for 6 months, and the control group had usual care only. The outcome variables were HbA1c level and healthy diet for follow-up measurement in the third and sixth month. Results: The study discovered a significant decrease in HbA1c and health diet improvement after the 6-month health coaching. Patients in the intervention group decreased their daily intake of whole grains, fruits, meats and protein, and fats and oils while increasing their vegetables intake. Conclusions: Health coaching may be conducive to the blood sugar control and healthy diet of patients with type 2 diabetes. Further study on health coaching with higher-quality evidence is needed. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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17 pages, 1348 KiB

Open AccessArticle

TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus

by Efrosini Tsirou, Maria G. Grammatikopoulou, Meletios P. Nigdelis, Eleftheria Taousani, Dimitra Savvaki, Efstratios Assimakopoulos, Apostolos Tsapas and Dimitrios G. Goulis

Nutrients 2021, 13(7), 2457; https://doi.org/10.3390/nu13072457 - 18 Jul 2021

Cited by 10 | Viewed by 3518

Abstract

Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37–42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0–2.5) for all mother-infant pairs, indicating a “risk-free” pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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14 pages, 840 KiB

Open AccessArticle

Twelve-Week Mediterranean Diet Intervention Increases Citrus Bioflavonoid Levels and Reduces Inflammation in People with Type 2 Diabetes Mellitus

by Hayder A. Al-Aubaidy, Aanchal Dayan, Myrna A. Deseo, Catherine Itsiopoulos, Dina Jamil, Najah R. Hadi and Colleen J. Thomas

Nutrients 2021, 13(4), 1133; https://doi.org/10.3390/nu13041133 - 30 Mar 2021

Cited by 31 | Viewed by 5603

Abstract

The benefits of a Mediterranean Diet (MedDiet) in the management of diabetes have been reported, but the contribution of polyphenol-rich citrus fruit has not been studied widely. Here, we report the sub-study findings of a previously conducted MedDiet intervention clinical trial in patients with type 2 diabetes mellitus (T2DM), where we aimed to measure the diet intervention effects on plasma citrus bioflavonoids levels and biomarkers of inflammation and oxidative stress. We analysed plasma samples from 19 (of original 27) participants with T2DM who were randomly assigned to consume the MedDiet intervention or their usual diet for 12 weeks and then crossed over to the alternate diet. Compared with baseline, MedDiet significantly increased levels of the citrus bioflavonoids naringin, hesperitin and hesperidin (by 60%, 58% and 39%, respectively, p < 0.05) and reduced plasma levels of the pro-inflammatory cytokine IL-6 (by 49%, p = 0.016). Oxidative stress marker 8-hydroxy-2′-deoxyguanosine (8-OHdG) decreased by 32.4% (p = 0.128). Usual diet did not induce these beneficial changes. The reduced inflammatory profile of T2DM participants may, in part, be attributed to the anti-inflammatory actions of citrus bioflavonoids. Together with indications of improved oxidative stress, these findings add to the scientific evidence base for beneficial consumption of citrus fruit in the MedDiet pattern. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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14 pages, 469 KiB

Open AccessFeature PaperArticle

Cardiorespiratory Fitness Predicted by Fibrinogen and Leptin Concentrations in Children with Obesity and Risk for Diabetes: A Cross-Sectional Study and a ROC Curve Analysis

by Kyriaki Tsiroukidou, Elpis Hatziagorou, Maria G. Grammatikopoulou, Anastasios Vamvakis, Kalliopi Kontouli, Christos Tzimos, John Tsanakas and Bessie E. Spiliotis

Nutrients 2021, 13(2), 674; https://doi.org/10.3390/nu13020674 - 19 Feb 2021

Cited by 6 | Viewed by 3057

Abstract

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. The ability to exercise is affected by adiposity, and this mechanism involves low-grade chronic inflammation and homeostatic stress produced mainly in adipocytes, which can result in abnormal adipokine secretion. To date, the gold standard for cardiorespiratory fitness assessment is considered to be the maximum oxygen uptake (VO_2max). The aim of the present study was to assess the prognostic value of hematological parameters of childhood obesity, as potential predictors of cardiorespiratory fitness (VO_2max), using a sample of children and adolescents with obesity and risk for diabetes. A total of 84 clinically healthy children and adolescents were recruited, of which 21 were considered lean, 22 overweight and 41 obese, with a mean age of 12.0 ± 1.9, 11.4 ± 2.0, and 11.2 ± 2.1 years old, in each weight status category, respectively. Age and sex did not differ between groups. Hematologic testing was performed after 12 h of fasting including glucose, serum lipids, insulin, hc-CRP, adiponectin, leptin and fibrinogen levels. Cardiorespiratory capacity for exercise was assessed to determine VO_2max, using a cycle ergometer. The VO_2max was negatively correlated with progressive strength to the BMIz (−0.656, p ≤ 0.001), hs-CRP (r = −0.341, p ≤ 0.002), glucose (r = −0.404, p ≤ 0.001) and insulin levels (r = −0.348, p ≤ 0.001), the homeostasis model assessment of insulin resistance (HOMA-IR) (r = −0.345, p ≤ 0.002), as well as to the leptin (r = −0.639, p ≤ 0.001) and fibrinogen concentrations (r = −0.520, p ≤ 0.001). The multivariate analysis revealed that only leptin and fibrinogen concentrations could predict the VO_2max adjusted for the BMIz of participants. The receiver operating characteristic (ROC) curve for the diagnostic accuracy of leptin, hs-CRP and fibrinogen concentrations for the prediction of VO_2max revealed a good diagnostic ability for all parameters, with leptin being the most promising one (area under the curve (AUC): 99%). The results verify that in children with obesity, VO_2max may be predicted from hematological parameters (leptin and fibrinogen), possibly bypassing more invasive methods. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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17 pages, 324 KiB

Open AccessArticle

Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care

by Savvas Katsaridis, Maria G. Grammatikopoulou, Konstantinos Gkiouras, Christos Tzimos, Stefanos T. Papageorgiou, Anastasia G. Markaki, Triada Exiara, Dimitrios G. Goulis and Theodora Papamitsou

Nutrients 2020, 12(11), 3516; https://doi.org/10.3390/nu12113516 - 15 Nov 2020

Cited by 12 | Viewed by 4479

Abstract

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

14 pages, 493 KiB

Open AccessArticle

Effect of a Mediterranean Diet-Based Nutritional Intervention on the Risk of Developing Gestational Diabetes Mellitus and Other Maternal-Fetal Adverse Events in Hispanic Women Residents in Spain

by Verónica Melero, Nuria García de la Torre, Carla Assaf-Balut, Inés Jiménez, Laura del Valle, Alejandra Durán, Elena Bordiú, Johanna J. Valerio, Miguel A Herraiz, Nuria Izquierdo, Maria José Torrejón, Isabelle Runkle, Ana Barabash, Miguel A Rubio and Alfonso L Calle-Pascual

Nutrients 2020, 12(11), 3505; https://doi.org/10.3390/nu12113505 - 14 Nov 2020

Cited by 22 | Viewed by 4820

Abstract

Gestational diabetes mellitus (GDM) is the most frequent morbidity found in pregnancy, and it increases the risk for several maternal-fetal complications. Hispanic women are considered at high risk. The St. Carlos GDM prevention study is a randomized controlled trial (RCT) conducted from 2016–2017. Normoglycemic women were randomized at 12–14 Gestation week (WG) to an intervention group (IG) receiving recommendations based on the MedDiet (supplemented with ExtraVirgin Olive Oil/pistachios), or to a control group (CG), recommended to limit fat intake. After RCT conclusion, IG recommendations were applied to a real-world group (RW) in routine clinical practice. The primary endpoint of the current study is an assessment of the GDM rate in Hispanic participants of the aforementioned studies: 132 RCT, 128 CT, 284 RW participants. The GDM rate was lower in IG: 19/128(14.8%), p = 0.021, and RW: 38/284(13.4%), p = 0.029) than in CG: 34/132(25.8%). Adjusted RR (95%CI) for GDM: 0.72 (0.50–0.97), p = 0.037 in IG and 0.77 (0.61–0.97), p = 0.008 in RW. Rates of urinary tract infections, emergency caesarean-sections and perineal trauma were also lower in IG and RW. Other adverse outcomes were lower in IG vs. CG. In conclusion, a MedDiet-based intervention reduces the rate of GDM and several adverse maternal-fetal outcomes in Hispanic women residing in Spain. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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Review

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14 pages, 670 KiB

Open AccessReview

Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A Narrative Review

by Radzisław Mierzyński, Elżbieta Poniedziałek-Czajkowska, Maciej Sotowski and Magdalena Szydełko-Gorzkowicz

Nutrients 2021, 13(11), 3787; https://doi.org/10.3390/nu13113787 - 26 Oct 2021

Cited by 16 | Viewed by 4528

Abstract

Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder with onset or first recognition during pregnancy. GDM is associated with several adverse maternal and neonatal outcomes. Management to reduce the incidence of GDM could decrease the incidence of these complications. Modification of nutrition in the prevention of GDM is postulated. The vital issue in GDM prevention is the implementation of proper dietary patterns, appropriate physical activity, and a combination of diet and lifestyle modifications. However, intervention studies examining the effects of diet and lifestyle on GDM prevention are contradictory. The aim of this study was to review the scientific evidence on nutritional prevention strategies, including diet and supplementation of some substances such as probiotics, micro/macroelements, fiber, myoinositol, and vitamins that may be effective in reducing the risk of GDM. The presented article is a narrative review. This article indicates that certain nutritional factors may have some benefit in preventing GDM. However, further studies in a variety of populations and large groups of patients are needed. At present, no definitive conclusions can be drawn as to the best intervention in the prevention of GDM. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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14 pages, 284 KiB

Open AccessReview

Genetically Guided Mediterranean Diet for the Personalized Nutritional Management of Type 2 Diabetes Mellitus

by Kalliopi Gkouskou, Evgenia Lazou, Efstathios Skoufas and Aristides G. Eliopoulos

Nutrients 2021, 13(2), 355; https://doi.org/10.3390/nu13020355 - 25 Jan 2021

Cited by 8 | Viewed by 3927

Abstract

The current consensus for the prevention and management of type 2 diabetes mellitus (T2DM) is that high-quality diets and adherence to a healthy lifestyle provide significant health benefits. Remarkably, however, there is little agreement on the proportions of macronutrients in the diet that should be recommended to people suffering from pre-diabetes or T2DM. We herein discuss emerging evidence that underscores the importance of gene-diet interactions in the improvement of glycemic biomarkers in T2DM. We propose that we can achieve better glycemic control in T2DM patients by coupling Mediterranean diets to genetic information as a predictor for optimal diet macronutrient composition in a personalized manner. We provide evidence to support this concept by presenting a case study of a T2DM patient who achieved rapid glycemic control when adhered to a personalized, genetically-guided Mediterranean Diet. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

Other

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15 pages, 726 KiB

Open AccessSystematic Review

Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review

by Nurudeen Adesina, Huseyin Dogan, Sue Green and Fotini Tsofliou

Nutrients 2022, 14(1), 10; https://doi.org/10.3390/nu14010010 - 21 Dec 2021

Cited by 11 | Viewed by 5580

Abstract

Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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14 pages, 3818 KiB

Open AccessSystematic Review

Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus

by Maria G. Grammatikopoulou, Konstantinos Gkiouras, Georgia Polychronidou, Chrysi Kaparounaki, Kalliopi K. Gkouskou, Faidon Magkos, Lorenzo Maria Donini, Aristides G. Eliopoulos and Dimitrios G. Goulis

Nutrients 2021, 13(11), 3823; https://doi.org/10.3390/nu13113823 - 27 Oct 2021

Cited by 15 | Viewed by 4213

Abstract

Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. Τypical eating disorders (EDs) and USFEDs are common among patients with diabetes mellitus (DM), which complicates metabolic control and disease outcomes. The present systematic review summarizes the evidence on the prevalence of ON symptomatology among patients with DM. PubMed, Web of Science, Scopus, and grey literature were searched, and relevant observational studies were screened using the Rayyan software. The quality of the studies was assessed using the appraisal tool for cross-sectional studies (AXIS) and the Newcastle–Ottawa scale (NOS). Out of 4642 studies, 6 fulfilled the predefined criteria and were included in the qualitative synthesis. Most studies relied on the ORTO-15 or its adaptations to identify ON among patients with DM. No apparent sex or age differences exist regarding the prevalence of ON symptoms. None of the studies compared the prevalence of ON in patients with type 1 and type 2 DM. Most of the research was of average to good methodological quality. In conclusion, patients with DM often exhibit ON tendencies, although research is still limited regarding the etiology or mechanistic drivers behind ON and the characteristics of patients with a dual ON–DM diagnosis. Full article

(This article belongs to the Special Issue Advances in the Nutrition of Diabetes and Gestational Diabetes)

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