Aims/hypothesis
The aim was to conduct a systematic review and meta-analysis of randomised controlled clinical trials assessing the effect of probiotic, prebiotic or synbiotic supplementation on gut ...microbiota and glucose control and lipid levels in individuals with diabetes.
Methods
MEDLINE, EMBASE and the Cochrane Library were searched. The eligibility criteria for the studies was involvement of participants with a diagnosis of type 1 or type 2 diabetes. Metabolic outcomes (glucose control, insulinaemia, and lipid profile) of any probiotic, prebiotic or synbiotic supplementation related to modification of gut microbiota (prebiotics, probiotics and synbiotics) were analysed. We provided a narrative synthesis and meta-analysis of the findings on metabolic outcomes from the studies. Metabolic outcomes were extracted post-intervention and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. We pooled the results using a random-effects meta-analysis. The meta-analysis was conducted using Review Manager (RevMan) software.
Results
After the removal of duplicates and ineligible studies, 5219 studies were retained for review of titles and abstracts. The number of articles was reduced to 130 by review, for which the full-text articles were obtained and reassessed, 38 of which were included in the final meta-analysis. Overall, the use of prebiotics, probiotics or synbiotics reduced HbA
1c
levels, but did not reach the threshold for significance (−2.17 mmol/mol, 95% CI −4.37, 0.03;
p
= 0.05, −0.20%, 95% CI −0.40 to 0.00;
p
= 0.05,
I
2
= 66%) and had no effect on LDL-cholesterol levels (−0.05 mmol/l; 95% CI −0.14, 0.05,
p
= 0.35,
I
2
= 37%). However, their consumption decreased levels of fasting blood glucose (−0.58 mmol/l; 95% CI −0.86, −0.30;
p
< 0.01,
I
2
= 60%), total cholesterol (−0.14 mmol/l; 95% CI −0.26, −0.02,
p
= 0.02,
I
2
= 39%), triacylglycerols (−0.11 mmol/l; 95% CI −0.20, −0.02,
p
= 0.01,
I
2
= 21%) and insulinaemia (−10.51 pmol/l; 95% CI −16.68,−4.33,
p
< 0.01,
I
2
= 74%), and increased HDL-cholesterol levels (0.04 mmol/l; 95% CI 0.01, 0.07,
p
< 0.01,
I
2
= 24%).
Conclusions/interpretation
In individuals with diabetes mellitus, supplementation with probiotics, prebiotics or synbiotics improved metabolic variables, although the magnitude of this effect is low. Our results suggest that consumption of probiotics, prebiotics or synbiotics may be a potential adjuvant treatment for improving metabolic outcomes.
Registration
PROSPERO ID CRD42017080071.
Graphical abstract
Background
The ideal nutritional approach for weight regain after bariatric surgery remains unclear.
Objective
The objective of this study is to assess the effect of whey protein supplementation on ...weight loss and body composition of women who regained weight 24 or more months after bariatric surgery.
Methods
This is a 16-week open-label, parallel-group, randomized controlled trial of women who regained at least 5 % of their lowest postoperative weight after a Roux-en-Y gastric bypass (RYGB). A total of 34 participants were treated with hypocaloric diet and randomized (1:1) to receive or not supplementation with whey protein, 0.5 g/kg of the ideal body weight. The primary outcomes were changes in body weight, fat free mass (FFM), and fat mass (FM), evaluated by tetrapolar bioelectrical impedance analysis (BIA). Secondary outcomes included resting energy expenditure, blood glucose, lipids, adiponectin, interleukin 6 (IL-6), and cholecystokinin levels. Statistical analyses included generalized estimating equations adjusted for age and physical activity.
Results
Fifteen patients in each group were evaluated: mean age was 45 ± 11 years, body mass index (BMI) was 35.7 ± 5.2 kg/m
2
, and time since surgery was 69 ± 23 months. Protein intake during follow-up increased by approximately 75 % in the intervention group (
p =
0.01). The intervention group presented more body weight loss (1.86 kg,
p
= 0.017), accounted for FM loss (2.78,
p
= 0.021) and no change in FFM, as compared to controls (gain of 0.42 kg of body weight and 0.6 kg of FM). No differences in secondary outcomes were observed between groups.
Conclusions
Whey protein supplementation promoted body weight and FM loss in women with long-term weight regain following RYGB.
Dietary factors play a role in modulating chronic inflammation and in the development of CVD. We aimed to investigate the association between the dietary inflammatory index (DII) and cardiometabolic ...risk factors among adolescents. A total of 31 684 Brazilian adolescents (aged 12-17 years) from the Study of Cardiovascular Risks in Adolescents (ERICA) were included. Dietary intake was assessed using a 24-h dietary recall. The energy-adjusted dietary inflammatory index (E-DII) score was calculated based on data for twenty-five available nutrients. The anthropometric profile, blood pressure, lipid profile, glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and glycated Hb were measured. Poisson regression models were used to examine the associations between sex-specific quartiles of the E-DII and cardiometabolic risk factors. In the energy-adjusted models, when comparing a high pro-inflammatory diet (quartile 4) with an anti-inflammatory diet (quartile 1), there was a positive association with high HOMA-IR among boys (prevalence ratios (PR)
= 1·37, 95 % CI: 1·04, 1·79); and with high fasting glucose (PR
= 1·96, 95 % CI: 1·02, 3·78), high TAG (PR
= 1·92, 95 % CI: 1·06, 3·46), low HDL-cholesterol (PR
= 1·16, 95 % CI: 1·02, 1·32) and high LDL-cholesterol (PR
= 1·93, 95 % CI: 1·12, 3·33) among girls. Additionally, a moderately pro-inflammatory diet was positively associated with high HOMA-IR (PR
= 1·14, 95 % CI: 1·02, 1·29) among girls and high total cholesterol (PR
= 1·56, 95 % CI: 1·20, 2·01) among boys. In conclusion, this study provides new evidence on the association between inflammatory diets with cardiometabolic risk factors among adolescents.
The prevalence of meeting movement guidelines is low in developed countries; however there is a lack of data among medium-income countries, including Brazil. We evaluated the prevalence and ...correlates of meeting physical activity, screen time, and sleep guidelines in Brazilian adolescents. Employing a cross-sectional design, Brazilian adolescents (aged 12-17) were surveyed about their physical activity levels, sleep, and screen time. The data was collected at schools through a self-administered questionnaire using a Personal Digital Assistant for entering the data. Poisson regression models were used to examine the associations between correlates (sex, age, socioeconomic status, region, skin colour and shift of school) and meeting movement guidelines. A total of 58,535 adolescents were included. Although only 8.7% of adolescents met all three movement guidelines, the prevalence of those who met physical activity, screen time and sleep duration guidelines was 46.4%, 42.5% and 40%, respectively. Moreover, male sex, age 14-15 years old, non-white skin colour, afternoon shift of school and living in the Northern and Northeastern regions were associated with a higher prevalence of meeting all movement guidelines. The prevalence of adolescents who met all three movement guidelines was low among Brazilian adolescents. Adolescents living in less developed regions show greater adherence to movement guidelines, suggesting a possible impact of the urbanization process on these behaviours. Novelty bullets: - The prevalence of Brazilian adolescents whom met all three movement behaviours guidelines was around 9%. - Among all adolescents, 40% met only one movement guideline.
The disclosure in the media of a benefit with the use of dexamethasone in patients with COVID-19 infection sets precedents for self-medication and inappropriate use of corticosteroids.
This is a ...critical interpretive synthesis of the data available in the literature on the effects of the use of corticosteroids and the impact that their indiscriminate use may have on patients with diabetes. Reviews and observational and experimental studies published until June 18, 2020 were selected.
Corticosteroids are substances derived from cholesterol metabolism that interfere with multiple aspects of glucose homeostasis. Interactions between corticoid receptors and target genes seem to be among the mechanisms responsible for the critical functions of glucocorticoids for survival and anti-inflammatory effects observed with these medications. Corticosteroids increase hepatic gluconeogenesis, reduce peripheral use of glucose and increase insulin levels. Previous studies have shown that glucocorticoids have a pro-adipogenic function, increasing deposition of abdominal fat, and lead to glucose intolerance and hypertriglyceridemia. In addition, these drugs play a role in controlling liver metabolism and can lead to the development of hepatic steatosis. Glucocorticoids reduce the recruitment of osteoblasts and increase the number of osteoclasts, which results in increased bone resorption and greater bone fragility. Moreover, these medications cause water and sodium retention and increase the response to circulating vasoconstrictors, which results in increased blood pressure levels. Chronic or high-dose use of corticosteroids can, by itself, lead to the onset of diabetes. For those who were already diagnosed with diabetes, studies show that chronic use of corticosteroids leads to a 94% higher risk of hospitalization due to diabetes complications. In addition to the direct effects on glycemic control, the effects on arterial pressure control, lipids and bone metabolism also have a potential for severe consequences in patients with diabetes.
Fear and uncertainty toward a potentially serious infection may lead people to self-medication and the inappropriate and abusive use of corticosteroids. More than ever, it is necessary for health professionals to be alert and able to predict damages related to the use of these drugs, which is the first step to minimize the potential damages to come.
The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence ...and associated factors for dissatisfaction with body weight among Brazilian adolescents.
Students aged 12–17 years participating in the Study of Cardiovascular Risk in Adolescents (“ERICA”), a multicenter, cross-sectional, school-based country-wide study, were included (n=71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models.
Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0–46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3.
Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.
A finalidade deste estudo foi avaliar a concordância e os fatores de risco para subestimação e superestimação entre o estado nutricional e a autoimagem corporal e para avaliar a prevalência e os fatores associados à insatisfação com o peso corporal entre adolescentes brasileiros.
Foram incluídos estudantes entre 12 e 17 anos que participavam do Estudo de Riscos Cardiovasculares em Adolescentes (“ERICA”), um estudo multicêntrico, transversal, nacional e de base escolar (n=71.740). As variáveis analisadas como covariáveis foram sexo, idade, cor da pele, situação socioeconômica e transtornos mentais comuns (triados pelo Questionário de Saúde Geral, QSG-12). A regressão logística multinomial foi usada para explorar a associação entre as covariáveis e as combinações entre a autoimagem corporal e o índice de massa corporal (concordância, subestimação e superestimação). As associações entre a insatisfação com o peso corporal e as variáveis de exposição foram investigadas com os modelos multivariáveis de regressão de Poisson.
Aproximadamente 66% dos estudantes associaram corretamente seu índice de massa corporal com o peso autopercebido (o coeficiente kappa foi 0,38 para meninos e 0,35 para meninas). A concordância foi maior entre jovens e adolescentes de baixa renda. Sexo masculino, adolescentes mais velhos e um escore QSG 12 ≥3 foram associados à superestimação do peso. A prevalência de insatisfação com o peso corporal foi 45,0% (IC de 95%: 44,0-46,0), maior entre meninas, adolescentes mais velhos, aqueles abaixo do peso ou com sobrepeso/obesidade, fisicamente inativos e com QSG-12 ≥3.
A maior parte da amostra associou corretamente sua imagem corporal de acordo com o índice de massa corporal. Estudantes com distorção da autoimagem corporal e aqueles insatisfeitos com seu peso foram mais propensos a apresentar rastreamento positivo para transtornos mentais comuns.
This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of ...pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic. Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate. For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions. For analyses, a hierarchical testing strategy was performed. A total of 764 participants were included in the study. Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI, 1.10 to 2.53) and for their child (OR 2.28; 95% CI, 1.54 to 3.38) when compared to the non-diabetes group. The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years. Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI, 1.70 to 3.47), particularly in those aged under 12 years old. There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years. Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.
In patients with diabetes, the prevalence of depression and anxiety symptoms is about two to four times greater than in the general population. The association between diabetes and mental health ...disorders could be exacerbated in a stressful environment, and psychological distress could increase depressive symptoms and cause adverse diabetes outcomes.
To assess the prevalence of mental health disorders in patients with diabetes during the social distancing period due to COVID-19 pandemic.
This is a cross-sectional study developed to assess the impact of social distancing on a cohort of adults with type 1 (n = 52) and type 2 diabetes (n = 68) in Brazil. Inclusion criteria involved having an HbA1c test collected in the past 3 months and having a valid telephone number in electronic medical records. The primary outcome was the prevalence of minor psychiatric disorders, assessed by survey (SRQ-20). Secondary outcomes included the prevalence of diabetes related emotional distress, eating and sleeping disorders, all assessed by validated surveys at the moment of the study. Statistical analyses included unpaired
-test for continuous variables and
test for categorical variables.
Overall (n = 120), participants had a mean age of 54.8 ± 14.4 years-old, and HbA1c of 9.0 ± 1.6% (75 ± 17.5 mmol/mol); 93% of patients showed signs of current mental suffering based on the surveys measured. Almost 43% of patients showed evidence of significant psychological distress, with a significant greater tendency in patients with type 2 diabetes. The presence of diabetes related emotional distress was found in 29.2% of patients; eating disorders in 75.8%; and moderate/severe sleeping disorders in 77.5%.
We found a high prevalence of evidence of psychological distress among patients with diabetes during the COVID-19 pandemic and this highlights the need for mental health access and support for patients with type 1 and type 2 diabetes.
Excessive screen time has been associated with metabolic syndrome (MetS) among adolescents; however, snack intake in front of screens may play a role in this association. Therefore, our objective was ...to investigate the association between screen-based sedentary time with MetS and whether this association is modified by unhealthy snack intake in front of screens.
This study was a nationwide, cross-sectional, school-based survey in Brazil including adolescents aged 12 to 17 years. The frequency of snack consumption in front of screen and screen-based sedentary time (TV view, computers and videogames use) were self-reported. Thereafter, screen time was categorized (≤2, 3-5 and ≥ 6 h/day); snack consumption in front of screens was dichotomized. Metabolic syndrome diagnosis was defined based on the International Diabetes Federation criteria. Associations between screen time and MetS were investigated using logistic regression in overall sample and after stratification by snack intake in front of screens.
A total of 33,900 adolescents were included in the analysis. The final adjusted model, which included sociodemographic data, physical activity, and energy intake, showed that adolescents who spent ≥6 h/day in front of screens had an increased odds ratio for MetS (OR = 1.68, 95%CI: 1.03-2.74). However, after stratifying the sample according to reported snack intake, the association between higher screen-based sedentary time and MetS remained significant only for adolescents who reported consumption of snacks in front of screens.
Longer screen-based sedentary times were directly associated with MetS. However, this association seems to be modified by reported snack intake in front of screens.
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