Download Consumption of a Diet Low in Advanced Glycation End Products for

CONSUMPTION OF A DIET LOW IN ADVANCED
GLYCATION END PRODUCTS FOR 4 WEEKS
IMPROVES INSULIN SENSITIVITY IN
OVERWEIGHT WOMEN
GABBY SHERER
D IA B E T E S S E LF M A N AG E M E N T E D U C AT IO N
MARY JULIUS RD, CDE, LD
NEAL KURMAS MS, RD, CDE, LD
CITATION
Budek-Mark A, Poulsen M, Andersen S, et al.
Consumption of a Diet Low in Advanced Glycation End
Products for 4 Weeks Improves Insulin Sensitivity in
Overweight Women. Diabetes Care. 2014; 37: 88-95.
ADVANCED GLYCATION END PRODUCTS (AGES)
Glycation: addition of a CHO to a Protein without an enzyme
Formed endogenously: In DM d/t increased carbonyl stress
Formed exogenously: Maillard Reaction
 btw amino acids and reducing sugars  browning
All tissues glycate, examples:
• RBC - HgbA1C
• Albumin- fructosimine measured in pregnancy d/t short half life
• Collagen- Skin Autofluorescence
RAGE on endothelial, smooth muscle, and immune system cells
leads to chronic inflammatory diseases when binding AGEs.
BACKGROUND STUDIES
Extracts of AGEs induce oxidative stress in vitro
Animals consuming diet high in AGEs show increased
insulin levels, insulin resistance, and T2DM
AGE restricted diet beneficial to glucose metabolism in
T2DM pts
OBJECTIVE
Compare the effects of high AGE and low AGE diets
along with fructose or glucose supplements on insulin
sensitivity in overweight, but otherwise healthy
women.
DESIGN
4 week- randomized
74
Low
AGE
37
Open
Double
blind
Gluc
High
AGE
37
Fruct
Gluc
Fruct
PARTICIPANTS AND SETTING
N=74
Women
Age 20-50 years
BMI 25-40 kg/m2
Waist circumference
>88 cm
Copenhagen, Denmark
Department of Nutrition,
Exercise, and Sports at
U of Copenhagen
2012
Exclusion:
Wt change >3 kg in 2 mo
Physical Activity >8h/week
Current smoking
Use of dietary supplements or
medications
Known medical condition
Vegetarianism
Pregnant/breastfeeding
Surgery to treat obesity
Menopausal
Blood donation in last 3 mo
Hypersensitivity to PABA
INTERVENTION
At baseline and after 4 weeks:
Fasting blood draws (abstain from alcohol and vigorous exercise
x 48h)
Urine collection – 3 X 80 mg PABA for compliance
Anthropometrics
OGTT
AF
Phone calls at halfway point for compliance
INTERVENTION
Both diets consisted of Danish Cuisine and similar in
nutrient content
Oral and written instruction provided
Cooking methods
Food choice list
Recipes for mandatory meals
Weighed food records for first 3 and last 3 days of
intervention
DIETS
HIGH AGE
LOW AGE
Fry, bake, roast, or grill foods
Boil or steam foods
Eat toasted bread with crust
Eat bread without a crust
Follow food choice list
Follow food choice list
Examples:
Examples:
•
•
•
•
Fried eggs
Muesli
Tortilla chips
biscuits
•
•
•
•
Boiled eggs
Oatmeal
Rice cakes
muffins
INTERVENTION
Participants provided 84 bottles monosaccharide
 20g fructose monohydrate powder
 22g glucose monohydrate powder
Consume 3 sugar supplements, dissolved in water, with
meals daily
Added sugar and sugar containing foods prohibited –
other than provided snacks
MAIN OUTCOME MEASURES
PRIMARY
SECONDARY
HOMA-IR
Glucose
Insulin
Glucagon-like peptide-1 (GLP-1)
Lipid profile
Insulin sensitivity index
Weight
BMI
Waist circumference
Waist to hip ratio
Skin autofluorescence
Urinary excretion of AGEs (CML and MG-H1)
STATISTICAL ANALYSIS
Power: of 0.80 with a 30% change in HOMA IR
 88 participants
Primary and Secondary outcomes
 Two-way ANOVA
 With covariates to adjust for baseline levels, age and changes in weight
and waist circumference from baseline
Interaction and main effects
 Means of F test
Baseline values of anthropometric and metabolic variables
 Two sample T-tests
Associations btw urinary AGEs and metabolic variables
 Means of Pearson correlation coefficients
Urinary excretion (mean ± SEM) of CML (A) and MG-H1 (B) in milligrams per 24 h
in high-AGE (black bars, n = 37) and low-AGE (white bars, n = 36) groups at
baseline and after 4 weeks of dietary intervention.
Mark A B et al. Dia Care 2014;37:88-95
Copyright © 2011 American Diabetes Association, Inc.
RESULTS
Significant decrease in wt, BMI, and waist
circumference in both groups, but more in the low AGE
group (similar at baseline)
CONCLUSIONS
Low AGE diet Improves insulin resistance in overweight
women.
Weaknesses:
•
•
•
•
•
Did not reach statistical power
OGTT at 0 and 120 min only
Change in anthropometrics
Differing diet composition
Not generalizable to men
CLINICAL IMPLICATIONS
Avoid fried foods
Avoid highly processed foods
Eat more fresh fruits and Vegetables
Low AGEs beneficial in those with DM and in
prevention of DM