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AIMS To test the effect of energy restriction with maintained protein intake on body composition and on insulin sensitivity of glucose and protein metabolism in adults with type 2 diabetes (T2D). MATERIALS AND METHODS After 3 days of an isoenergetic diet with 1.2 g/kg/d protein, obese adults with T2D (three women, two men) followed a 5-week diet providing 60% of energy requirements with 45% carbohydrate, and with protein maintained at pre-intervention level. Isotopic tracers were used to quantify whole-body glucose (3-3 H-glucose) and protein (13 C-leucine) metabolism pre- (day 4) and post-intervention (day 39), in the postabsorptive state and during a hyperinsulinaemic, isoglycaemic, isoaminoacidaemic clamp. Body composition was measured using dual-energy x-ray absorptiometry. RESULTS After energy restriction, 6% weight loss occurred via total body (11%) and visceral fat losses (25%), but lean mass was preserved. Fasting glucose level, serum insulin level, homeostatic model assessment of insulin resistance index and C-peptide level decreased significantly (29%, 38%, 54% and 38%, respectively) as did other cardiometabolic risk factors. Between clamp studies, postabsorptive protein turnover and oxidation rates decreased (12% and 32%), resulting in less negative net balance, consistent with protein conservation. The rates of glucose turnover decreased, and glucose metabolic clearance rate improved (24%). During the clamp, protein flux was lower (9%) and breakdown suppressed (12%), and net balance became less negative but not different. Although glucose turnover did not differ, metabolic clearance improved by 47%. CONCLUSIONS In obese adults with T2D, an energy-restricted diet with maintained protein intake of ~1.2 g/kg/d improved the kinetics of protein metabolism (particularly in the postabsorptive state), and preserved lean body mass and increased glucose metabolic clearance rate.

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world This pilot-study tested the effect of culturally-tailored education targeting diabetes self-care on glycaemia and cardiovascular risk factors of Lebanese with type 2 diabetes (T2DM). Methods: A sample of 27 adults (Age: 61±10yrs, 59% males, HbA1c:8.98±1.38%) with T2DM was recruited from primary health care centers in Beirut. Participants received culturally tailored, multidisciplinary education. Scales assessing self-care, social support, fatalism, and diabetes knowledge, as well as anthropometric measures, and blood samples were collected at baseline, 3-months and 6-months post- intervention. Results: Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic level (HbA1c:-0.5%; FPG: -38 mg/dl), and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29). Waist circumference decreased at 6 months compared to 3 months (p

OBJECTIVES: Colic and allergy symptoms are problems encountered in the exclusively-breastfed newborn and are thought to be triggered by inflammatory responses in the gut. Maternal diet, especially cow's milk intake, has been associated with infantile colic and allergies, but no study examined the effect of Mediterranean diet. Thus, this study aims to investigate whether maternal adherence to a dairy-free Mediterranean diet, known for is anti-inflammatory properties, reduces colic and allergy symptoms in exclusively-breastfed infants. METHODS: Exclusively breastfeeding healthy primiparous women were recruited during their pregnancy third trimester and were randomly assigned to receive an education on dairy-free Mediterranean diet or no education (control group). Mother-infant pairs were followed up for 2 months postpartum and adherence to the diet was confirmed through 24 hour recalls. Data on infant fussing & crying using validated “Daily Crying Diary” (Barr, et al., 1988) and allergy symptoms using validated CDC's “Breastfeeding and Infant Feeding Practices postnatal questionnaire” (Centers for Disease Control and Prevention, 2017) were collected on weeks 2, 4 and 7 postpartum. Infant stool samples were also collected to test for blood, pH, and eosinophil cationic protein as estimates of the degree of inflammation in the gut. RESULTS: Preliminary data from 10 mother-infant pairs showed that there was no group differences in the weights of the mothers and infants and number of allergy symptoms throughout the study. Colic (defined by the “Wessel Criteria” as crying episodes that last for >3 hours per day, for ≥3 days per week and for ≥3 weeks) was not observed in any infant. Findings from “Daily Crying Diaries” revealed that maternal adherence to dairy-free Mediterranean diet was associated with significantly lower average daily crying compared to controls (0.28 vs. 1.10 hours/d) in infants. Results on infant stool blood, pH, and eosinophil cationic protein are still pending. CONCLUSIONS: Maternal adherence to a dairy-free Mediterranean diet did not affect allergy symptoms but decreased fussing and crying in exclusively breastfed infants. Mechanisms of action still remain to be determined. FUNDING SOURCES: Lebanese American University.

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is ‘a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness’.Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM.Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalis...

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students. The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions. In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating. Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Optimal diabetes management requires daily activities of self-care. Thus, understanding the sociodemographic determinants of diabetes self-care is crucial to improve diabetes control. The aim of this study is to compare diabetes self-care activities and their determinants in 2 populations of Arabs with type 2 diabetes (T2DM) living in their country of origin (Lebanon) or in the United States (U.S.). A total of 334 patients (59 ± 13 years; 52.1% M) living in Lebanon and 181 patients (62 ± 12 years; 52.5% M) living in the U.S. were recruited. Diabetes self-care activities were assessed using Summary of Diabetes Self-Care Activities Assessment (SDSCA); dimensions of diabetes distress were measured with the Diabetes Distress Scale (T1-DDS). Half of the population in Lebanon were employed, 61.6% had health insurance and 42.3% were smokers; while among those living in the U.S., 23.7% were employed, 96.1% had health insurance and 26.5% were smokers. There were no significant group differences for gender, marital status and education. Compared to those in Lebanon, patients living in the U.S. had significantly higher mean scores on various SDSCA subscales, including general diet (t = 5.24, p < 0.001), exercise (t = 3.31, p = 0.001), blood glucose testing (t = 4.41, p < 0.001), and foot care (t = 8.84, p < 0.001) indicating better diabetes self-care. Multiple regression analyses showed that total SDSCA scores correlated significantly with age (β= 0.06, p = 0.015) and education (β= 3.02, p=0.006) in patients living in Lebanon; whereas predictors of total SDSCA scores among participants living in the U.S. were education (β= 8.46, p = 0.005) and management distress subscale of T1-DDS (β= - 2.92, p < 0.001). In conclusion, Arab patients with T2DM living in the U.S. showed better diabetes self-care activities compared to those living in their country of origin. Predictors of self-care varied between the 2 populations. Further exploring other determinants is warranted. Disclosure O.A. Sukkarieh-Haraty: None. L. Jaber: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None.

Background: Enhancing diabetes self-care is known to improve glycemic control of patients with type 2 diabetes mellitus (T2DM). According to American Diabetes Association guidelines, a multidisciplinary and culturally appropriate intervention is needed for optimal diabetes self-care and glycemic outcomes. There is no published study that evaluated an educational intervention targeting diabetes self-care and glycemic outcomes in Lebanese patients with T2DM. Aim: The aim of this pilot-study was to test the effect of culturally-tailored educational program targeting diabetes self-care on glycemic control of Lebanese patients with T2DM, of low socioeconomic status. Methods: A sample of 27 adults (Age: 61±10 years, 59% males, A1C: 8.98±1.38%) diagnosed with T2DM for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on American Diabetes Association’s National Standards for Diabetes Self-Management Education and Support. Summary of Diabetes Self-Care Activities (SDSCA), Social Support Scale (SS), Diabetes Fatalism Scale (DFS), and Diabetes Knowledge Test (DKT), as well as blood samples (HbA1c, Fasting Plasma Glucose) were collected at baseline and three months post-intervention. Results: Results revealed improvements in various diabetes self-care activities (Diet and Self-Monitoring Blood Glucose) after 3 months, which was reflected in a significant decrease in glycaemia (A1C: -0.6%; Fasting Plasma Glucose: -35 mg/dl; p Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving glycemic control and diabetes self-care behavior of Lebanese patients with T2DM. It sets the stage for larger scale implementation with more representative sample. Disclosure O. Sukkarieh-Haraty: None. M. Bassil: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care, and is known to reduce cardiovascular risk factors of patients with type 2 diabetes (T2D) (American Diabetes Association [ADA], 2017). According to ADA, effective DSME is multidisciplinary, patient-centered, as well as age and culturally appropriate (ADA, 2017). Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world. Aims: The aim of this pilot-study was to test the effect of the first culturally-tailored educational program targeting diabetes self-care on cardiovascular risk factors of Lebanese patients with T2D. Methods: A sample of 27 adults (Age: 61±10 years, 59% M, A1C: 8.98±1.38%) diagnosed with T2D for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on ADA’s National Standards for Diabetes Self-Management Education and Support. Anthropometric measures (weight, height, BMI, waist circumference, body fat mass and fat-free mass) and blood samples (Triglycerides, Total, LDL and HDL cholesterol) were collected at baseline, 3 months and 6 months post-intervention. Results: Waist circumference (107.52±12.91 vs. 106.59±12.01) and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29) decreased at 6 months post-intervention (p=0.02). Discussion and Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving body adiposity and blood lipids of Lebanese patients with T2D, and thus reducing their cardiovascular risk factors. It sets the stage for larger scale implementation with more representative sample. Disclosure M. Bassil: None. O. Sukkarieh-Haraty: None. J.L. Abi Kharma: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

Introduction Exposure of newborns to toxic metals is of special interest due to their reported contamination in breast milk and potential harm. The aim of this study was to assess the occurrence and factors associated with lead, cadmium and arsenic contamination in breast milk collected from lactating mothers in Lebanon. Methods A total of 74 breast milk samples were collected from primaparas according to guidelines set by the World Health Organization. A survey was administered to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semi-quantitative food frequency questionnaire. The milk samples were analyzed for the presence of arsenic, cadmium and lead using microwave-assisted digestion and atomic absorption spectrophotometry. Results Arsenic contamination was found in 63.51% of breast milk samples (mean 2.36 ± 1.95 μg/L) whereas cadmium and lead were detected in 40.54% and 67.61% of samples respectively (means 0.87 ± 1.18 μg/L and 18.18 ± 13.31 μg/L). Regression analysis indicated that arsenic contamination was associated with cereal and fish intake (p = 0.013 and p = 0.042 respectively). Residence near cultivation activities (p = 0.008), smoking status before pregnancy (p = 0.046), potato consumption (p = 0.046) and education level (p = 0.041) were associated with lead contamination. Cadmium contamination was significantly associated with random smoke exposure (p = 0.002). Conclusion Our study is the first in Lebanon to report toxic metal contamination in breast milk. Although estimated weekly infant intake of these metals from breast milk was found to be lower than the limit set by international guidelines, our results highlight the need for developing strategies to protect infants from exposure to these hazardous substances.

Objective In insulin-resistant states, resistance of protein anabolism occurs concurrently with that of glucose, but can be compensated for by abundant amino acid (AA) provision. This effect and its mechanism were sought in obesity. Methods Pancreatic clamps were performed in 8 lean and 11 obese men, following 5-h postabsorptive, 3-h infusions of octreotide, basal glucagon, and growth hormone, with clamped postprandial-level insulin, glucose, and AA. Whole-body [1-13C]-leucine and [3-3H]-glucose kinetics, skeletal muscle protein (2H5-phenylalanine) fractional synthesis rates, and insulin signaling were determined. Results Clamp Δ insulin and Δ branched-chain AA did not differ; fasting glucagon and growth hormone were maintained. Glucose uptake was 20% less in obese concurrent with less AktSer473, but also less IRS-1Ser636/639 phosphorylation. Stimulation of whole-body, myofibrillar, and sarcoplasmic protein synthesis was similar. Whole-body protein catabolism suppression tended to be less (P=0.06), resulting in lesser net balance (1.09 ± 0.07 vs. 1.31 ± 0.08 μmol [kg FFM−1] min−1, P = 0.048). Increments in muscle S6K1Thr389 phosphorylation were less in the obese, but 4E-BP1Ser65 did not differ. Conclusions Hyperaminoacidemia with hyperinsulinemia stimulated protein synthesis (possibly via nutrient signaling) normally in obesity, but suppression of proteolysis may be compromised. Whether long-term high protein intakes could compensate for the insulin resistance of protein anabolism remains to be determined.

Purpose of review Protein anabolism is abnormal in human type 2 diabetes (T2DM). We review studies of anabolic stimuli that identify potential causes. If uncorrected, and combined with aging effects, they will compromise muscle function and mass. Knowing causes can guide studies of preventive and treatment measures. Recent findings T2DM accelerates age-related decreases in muscle mass. This could be related to insulin resistance of whole-body protein anabolism demonstrated in hyperglycemic obese men. In contrast, their protein anabolic response to hyperaminoacidemia suggested that ample amino acid administration, especially branched chain amino acids might overcome such insulin resistance. One study of chronic leucine supplementation in elderly T2DM patients did not increase muscle mass. However, they lacked sarcopenia and had adequate dietary protein intake, so may be atypical. Exercise induced similar increases in muscle protein synthesis, mass and strength in healthy and T2DM patients suggesting that physical activity might also overcome insulin resistance of protein anabolism. Summary Muscle protein anabolism in T2DM is resistant to the action of insulin but perhaps not to amino acid supply or exercise. Whether leucine supplementation improves muscle mass and function in persons with T2DM (especially elderly) with reduced protein intake or muscle mass needs to be determined.

Aims/hypothesis Hyperaminoacidaemia attenuates glucose disposal during hyperinsulinaemic clamps in healthy lean individuals, an effect thought to be mediated by negative feedback on insulin signalling, downstream of the mammalian target of rapamycin (mTOR) signalling pathway. This has been interpreted as amino acids causing insulin resistance in healthy people, and contributing to it in type 2 diabetes. However, the effect of hyperaminoacidaemia on glucose disposal in type 2 diabetic individuals remains to be determined. Methods Eight obese men with type 2 diabetes underwent a two-step hyperinsulinaemic–hyperglycaemic (8 mmol/l) clamp, first with amino acids at postabsorptive concentrations, followed by postprandial concentrations. Wholebody glucose turnover was assessed using D-[3- 3 H]glucose. Vastus lateralis biopsies were obtained at baseline and during each step of the clamp to determine the phosphorylation states of AKT, mTOR, ribosomal protein (rp) S6, and insulin receptor substrate (IRS)-1. Results Rates of glucose infusion (1.30±0.19 vs 1.15± 0.13 mmol/min), endogenous glucose production (0.48±0.06 vs 0.53±0.05 mmol/min) and disposal (1.24±0.17 vs 1.17± 0.14 mmol/min) did not differ between postabsorptive and postprandial amino acid concentrations (p>0.05). Whereas phosphorylation of AKT Ser473 , AKT Thr308 mTOR Ser2448 and rpS6 Ser235/236 increased (p

Reduced 24h net protein balance in hyperglycemic T2D was explained by less protein accretion during hyperinsulinemic euglycemic, isoaminoacidemic (isoAA) clamps. We tested whether protein anabolism...

BASSIL, MAYA S., NAHLA HWALLA, AND OMAR A. OBEID. Meal pattern of male rats maintained on histidine-, leucine-, or tyrosine-supplemented diet. Obesity. 2007;15: 616–623. Objective: Food intake is known to be affected by macronutrient composition of the diet, and protein manipulation has been reported to alter food intake, but the effect of individual amino acids on eating behavior has not been fully studied. This study investigated the effect of diet supplementation with three individual amino acids on meal pattern in male rats. Research Methods and Procedures: Thirty-two SpragueDawley rats were randomly divided into four equal groups and fed control diet or histidine (5%)-, leucine (5%)-, or tyrosine (5%)-supplemented diet for 2 weeks and were monitored for their meal pattern. Results: Total food intake and feeding rate of the different groups were not affected, although other components of meal pattern were altered. Histidine supplementation reduced diurnal meal size by 42% (p 0.05), whereas that of leucine increased nocturnal meal size by 35% (p 0.05). Tyrosine supplementation increased food intake of the nocturnal period and decreased that of the diurnal period. Both histidine and tyrosine supplementation elevated fasting plasma insulin levels and suppressed fasting glucose significantly. Discussion: Individual amino acids were found to alter

Background: Phosphorus status is inversely correlated with body weight; however, the effect of phosphorus supplementation on body weight in a controlled design has not been studied. Methods: This is a double-blind, randomized, placebo-controlled trial of 63 adults aged 18–45 years with a body mass index (BMI) of ⩾25 kg m−2 and normal kidney function at the American University of Beirut. Participants were randomly assigned to the placebo or phosphorus group where daily placebo or phosphorus supplements were ingested with three main meals (breakfast, lunch and dinner) for a period of 12 weeks. Primary outcomes were changes in anthropometric measures, blood metabolites (including lipid profile, glucose and insulin) and subjective appetite scores. The trial is registered with Clinical Trial.gov, NCT02329990. Results: Body weight was significantly lower in the phosphorus group when compared with the placebo group (−0.65 kg (95% confidence interval (CI) −1.69 to 0.40) vs 1.13 kg (95% CI 0.19 to 2.06), P=0.01). Similarly, BMI and waist circumference were significantly lower in the phosphorus group when compared with the placebo group (−0.24 kg m−2 (95% CI −0.59 to 0.12) vs 0.42 kg m−2 (95% CI 0.05 to 0.78), P=0.01; −3.62 cm (95% CI−4.90 to −2.33) vs 0.38 cm ( 95% CI−0.44 to 1.20), P Conclusions: Phosphorus supplementation for 12 weeks significantly decreases body weight, BMI, waist circumference and subjective appetite scores. These findings support a promising role of the mineral phosphorus in the prevention and management of obesity, especially abdominal adiposity. The exact mechanisms of action and longer-term effects still need to be elucidated.

Background Salvia libanotica (S. Libanotica) is a commonly used herb in folk medicine in Lebanon and the Middle East. The present study aimed to assess the scientific basis for the therapeutic use of S. libanotica in glycemia and to evaluate its effects on lipemia and abdominal fat. Methods Animals were fed a high-fat diet and allocated into a control and three experimental groups (GI, GII and GIII) receiving incremental doses of the plant water extract in drinking water (50, 150 and 450 mg/Kg body weight respectively) for six weeks. Results The intake of S. libanotica extract was associated with a significant decrease in fasting serum glucose (102.9 ± 10.8 in GII and 87.5 ± 6.4 in GIII vs. 152.1 ± 7.9 mg/dl in controls) and a two fold increase in fasting serum insulin (GIII) and liver glycogen content (GII and GIII). Group III also had better glucose tolerance following intraperitoneal glucose challenges. Additionally, the plant extract intake produced a significant improvement in serum HDL (34.4 ± 2.4 in GIII vs. 27.2 ± 1.9 mg/dl in controls) and HDL/LDL cholesterol ratio (2.79 ± 0.32 in GII and 3.02 ± 0.31 in GIII vs. 1.74 ± 0.18 in controls), as well as a decrease in abdominal fat. Conclusion The current study is the first to demonstrate that the chronic intake of S. libanotica infusion helps in the prevention of high fat-induced hyperglycemia and dyslipidemia. This supports the plant use as a remedy for the prevention of type 2 diabetes and cardiovascular diseases.