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Context: Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations.Objective: To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes.Design, Setting, and Participants: A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007.Intervention: High-cereal fiber or low-glycemic index dietary advice.Main Outcome Measures: Absolute change in glycated hemoglobin A(1c) (HbA(1c)), with fasting blood glucose and cardiovascular disease risk factors as secondary measures.Results: In the intention-to-treat analysis, HbA(1c) decreased by -0.18% absolute HbA(1c) units (95% confidence interval [CI], -0.29% to -0.07%) in the high-cereal fiber diet compared with -0.50% absolute HbA(1c) units (95% CI, -0.61% to -0.39%) in the low-glycemic index diet (P < .001). There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL (95% CI, -0.9 to 0.5 mg/dL) in the high-cereal fiber diet (P = .005). The reduction in dietary glycemic index related positively to the reduction in HbA(1c) concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = -0.19, P = .009).Conclusion: In patients with type 2 diabetes, 6-month treatment with a low-glycemic index diet resulted in moderately lower HbA(1c) levels compared with a high-cereal fiber diet. Trial Registration clinicaltrials.gov identifier: NCT00438698. [ABSTRACT FROM AUTHOR]

Objective: To analyse the association between macronutrient intake and body mass index (BMI).Design: A series of hospital-based case-control studies.Settings: Selected teaching and general hospitals in several Italian regions.Subjects: A total of 6619 subjects from the comparison groups of the case-control studies were included in the analysis.Methods: We obtained data from a validated 78-item food-frequency questionnaire submitted between 1991 and 2002. For various macronutrients, the partial regression coefficient (variation of BMI (kg m(-2)) per 100 kcal increment of energy intake) was derived from multiple linear regression models, after allowance for age, study centre, education, smoking habits, number of eating episodes and mutual adjustment for macronutrients.Results: BMI was directly associated with protein intake among women only (beta = 0.68) and with unsaturated fats in both genders (for monounsaturated fats beta = 0.27 for men and 0.26 for women; for polyunsaturated fats beta = 0.27 for men and 0.54 for women), and inversely related to carbohydrates (beta = -0.05 for men and -0.21 for women) and number of eating episodes in both genders (beta = -0.42 for men and -0.61 for women) and to saturated fats among women only (beta = -0.57).Conclusions: These results confirm and provide convincing evidence that, after allowance for selected covariates including total energy intake, a protein-rich diet is not inversely related to BMI, and a carbohydrate-rich diet is not directly related to BMI. [ABSTRACT FROM AUTHOR]

Italy and worldwide are experiencing an outbreak of a new coronavirus-related disease, named COVID-19, declared by the WHO COVID-19 a pandemic. The fragility of cancer patients is well-known, with many cases affecting aged patients or those with several comorbidities that frequently result in a loss of independency and functionality. Therefore, cancer patients have been greatly affected by this health emergency and, due to their vulnerability to COVID-19, oncologic patient visits have been often delayed or canceled leading to possible under-treatment. Different solutions can be adopted for reducing travels to cancer screening centers and the overall impact of cancer screening visits. As a consequence, it has been recommended that, when possible, the follow-up visits for cancer patients treated with oral anticancer drugs could be performed telematically. Furthermore, many patients refuse hospital visits, even if necessary, because of fear of contagion. Moreover, in some regions in Italy even the very first non-urgent visits have been postponed with the consequent delay in diagnosis, which may negatively affect disease prognosis. For these reasons, new approaches are needed such as the telemedicine tool. Throughout organized and appropriate tools, it would be possible to manage patients' visits and treatments, to avoid the dangerous extension of waiting lists when the standard activities will resume. In this context, a number of hospital visits can be substituted with visits at small local health centers, and general practitioners'office, taking in turn, advantage of well-defined telemedicine path which will be developed in the post-emergency phase., (Copyright © 2020 Crispo, Montagnese, Perri, Grimaldi, Bimonte, Augustin, Amore, Celentano, Di Napoli, Cascella and Pignata.)

Hyperglycemia and hyperinsulinemia may play a role in breast carcinogenesis and prediabetes and diabetes have been associated with increased breast cancer (BC) risk. However, whether BC molecular subtypes may modify these associations is less clear. We therefore investigated these associations in all cases and by BC molecular subtypes among women living in Southern Italy. Cases were 557 patients with non-metastatic incident BC and controls were 592 outpatients enrolled during the same period as cases and in the same hospital for skin-related non-malignant conditions. Adjusted multivariate logistic regression models were built to assess the risks of developing BC in the presence of prediabetes or diabetes. The analyses were repeated by strata of BC molecular subtypes: Luminal A, Luminal B, HER2+, and Triple Negative (TN). Prediabetes and diabetes were significantly associated with higher BC incidence after controlling for known risk factors (OR = 1.94, 95% CI 1.32-2.87 and OR = 2.46, 95% CI 1.38-4.37, respectively). Similar results were seen in Luminal A and B while in the TN subtype only prediabetes was associated with BC (OR = 2.43, 95% CI 1.11-5.32). Among HER2+ patients, only diabetes was significantly associated with BC risk (OR = 3.04, 95% CI 1.24-7.47). Furthermore, when postmenopausal HER2+ was split into hormone receptor positive versus negative, the association with diabetes remained significant only in the former (OR = 5.13, 95% CI 1.53-17.22). These results suggest that prediabetes and diabetes are strongly associated with BC incidence and that these metabolic conditions may be more relevant in the presence of breast cancer molecular subtypes with positive hormone receptors. J. Cell. Physiol. 232: 1144-1150, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective: To assess associations between dietary intake and carotid intima media thickness (CIMT) by carotid ultrasound (CUS), a surrogate marker of cardiovascular disease (CVD) risk, in those with type 2 diabetes., Design: Cross-sectional analysis of baseline data from 325 participants from three randomised controlled trials collected in the same way., Setting: Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada., Participants: 325 participants with type 2 diabetes, taking oral antidiabetic agents, with an HbA1c between 6.5% and 8.0% at screening, without a recent cardiovascular event., Main Outcome Measures: CIMT by CUS and associations with dietary intake from 7-day food records, as well as anthropometric measures and fasting serum samples., Results: CIMT was significantly inversely associated with dietary pulse intake (β=-0.019, p=0.009), available carbohydrate (β=-0.004, p=0.008), glycaemic load (β=-0.001, p=0.007) and starch (β=-0.126, p=0.010), and directly associated with total (β=0.004, p=0.028) and saturated (β=0.012, p=0.006) fat intake in multivariate regression models adjusted for age, smoking, previous CVD event, blood pressure medication, antidiabetic medication and ultrasonographer., Conclusions: Lower CIMT was significantly associated with greater consumption of dietary pulses and carbohydrates and lower total and saturated fat intake, suggesting a potential role for diet in CVD risk management in type 2 diabetes. Randomised controlled trials are anticipated to explore these associations further., Trial Registration Number: NCT01063374., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Mechanisms influencing breast cancer (BC) development and recurrence include hyperglycemia, hyperinsulinemia, high insulin-like growth factor-1, high circulating estrogen, inflammation and impaired cellular differentiation/apoptosis. A lifestyle program that targets all the above mechanisms may be warranted. Low glycemic index (GI) foods produce lower post-prandial glucose and insulin responses and have been associated with lower BC risk. Moderate physical activity post-diagnosis reduces BC recurrence and mortality, partly explained by reduced insulin and estrogen levels. Vitamin D increases cell differentiation/apoptosis and high serum vitamin D levels improve BC survival. Yet no trial has evaluated the combined effect of a low GI diet, moderate physical activity and vitamin D supplementation on BC recurrence in the context of a Mediterranean lifestyle setting., Methods: Women (30-74 yr) who had undergone surgery for primary histologically confirmed BC (stages I-III) within the previous 12 months, in cancer centres in Italy, will be randomized to follow, for a maximum of 33 months, either a high intensity treatment (HIT) composed of low GI diet + exercise + vitamin D (60 ng/mL serum concentration) or a lower intensity treatment (LITE) with general advice to follow a healthy diet and exercise pattern + vitamin D to avoid insufficiency. Both interventions are on a background of a Mediterranean diet. Considering a 20% recurrence rate within 3 years for BC cases and a predicted rate of 10% in the HIT group, with power of 80% and two-sided alpha of 0.05, the subject number required will be 506 (n = 253 in each arm). Clinic visits will be scheduled every 3 months. Dietary and exercise counselling and vitamin D supplements will be given at each clinic visit when blood samples, anthropometric measures and 7-day food records will be collected., Discussion: DEDiCa study aims to reduce BC recurrence in women with BC using a lifestyle approach with additional vitamin D and to investigate possible cardio-metabolic benefits as well as epigenetic modifications according to lifestyle changes. Given the supporting evidence and safety of the components of our intervention we believe it is feasible and urgent to test it in cancer patients., Trial Registration: May 11, 2016; NCT02786875 ., Eudract Number: 2015-005147-14.

Introduction: Type 2 diabetes (T2DM) produces macrovascular and microvascular damage, significantly increasing the risk of cardiovascular disease (CVD), renal failure and blindness. As rates of T2DM rise, the need for effective dietary and other lifestyle changes to improve diabetes management become more urgent. Low-glycaemic index (GI) diets may improve glycaemic control in diabetes in the short term; however, there is a lack of evidence on the long-term adherence to low-GI diets, as well as on the association with surrogate markers of CVD beyond traditional risk factors. Recently, advances have been made in measures of subclinical arterial disease through the use of MRI, which, along with standard measures from carotid ultrasound (CUS) scanning, have been associated with CVD events. We therefore designed a randomised, controlled, clinical trial to assess whether low-GI dietary advice can significantly improve surrogate markers of CVD and long-term glycaemic control in T2DM., Methods and Analysis: 169 otherwise healthy individuals with T2DM were recruited to receive intensive counselling on a low-GI or high-cereal fibre diet for 3 years. To assess macrovascular disease, MRI and CUS are used, and to assess microvascular disease, retinal photography and 24-hour urinary collections are taken at baseline and years 1 and 3. Risk factors for CVD are assessed every 3 months., Ethics and Dissemination: The study protocol and consent form have been approved by the research ethics board of St. Michael's Hospital. If the study shows a benefit, these data will support the use of low-GI and/or high-fibre foods in the management of T2DM and its complications., Trial Registration Number: NCT01063374; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objectives: Pulses are low glycemic index (GI) foods and have been associated with reduced risk of heart disease, diabetes and some cancers. However the blood glucose and insulin responses of hummus, a food containing chickpea, have not been thoroughly tested., Methods: Ten healthy subjects each consumed 11 breakfast study meals in randomized order over a period of 15 weeks. Hummus was consumed alone at three doses (2.7 g, 10.8 g and 25 g available carbohydrate [avCHO] portions) and with 50 g avCHO from white bread at three doses (2.7 g, 5.4 g and 10.8 g avCHO portions). The responses elicited by hummus alone were compared with 25 g avCHO portions of white bread, while those after hummus plus white bread were compared with 50 g avCHO from white bread. Plasma glucose and serum insulin responses were monitored over two hours and the GI and insulin index (II) calculated using standard methodology., Results: The GI and II of hummus were 15 ± 3 and 52 ± 13, respectively, and were significantly lower than white bread (P < 0.05). The glucose and insulin incremental area under the curve (IAUC) for hummus alone were significantly lower than white bread except for insulin IAUC of hummus 25 g avCHO. The peak rise of blood glucose and insulin after hummus were significantly lower than after white bread. Glucose and insulin IAUC after adding hummus to bread did not differ significantly from white bread alone. However the blood glucose 45 min after adding 25 g avCHO from hummus to white bread was significantly lower while at 120 min it was significantly higher than after white bread alone., Conclusions: This study demonstrated that, similar to chickpeas, hummus has a very low GI and II. Postprandial glucose responses were 4 times less than that of white bread and did not compromise insulin levels.

Breast cancer (BC) is the most common malignant tumor in women, obesity is associated with increased BC incidence and mortality and high levels of circulating insulin may negatively impact on cancer incidence. In the present study, we investigated whether the strength of several anthropometric and metabolic parameters varies between BC molecular subtypes. Eligible cases were 991 non-metastatic BC patients recruited between January 2009 and December 2013. Anthropometric, clinical and immunohistochemical features were measured. Multivariate logistic regression models were built to assess HER2 positive BC risk, comparing (a) triple positive (TP) with luminal A, luminal B and triple negative (TN) and (b) HER2-enriched group with luminal A, luminal B and TN. We stratified patients in pre- and post-menopause: significant differences emerged for luminal A in relation to age: they were more likely to be older compared to other groups. Among postmenopausal patients, the adjusted multivariate analysis showed that high BMI and high waist circumference were inversely correlated to TP subtype when compared to luminal B (OR=0.48 and OR=0.49, respectively). Conversely, HOMA-IR was a risk factor for TP when compared to luminal A and TN (OR=2.47 and OR=3.15, respectively). Our findings suggest a potential role of higher abdominal fat in the development of specific BC molecular subtypes in postmenopausal women. Moreover, they support a potential role of insulin resistance in the development of HER2 positive BC, although this role appears to be stronger when hormone receptors are co-expressed, suggesting a difference in the etiology of these two BC subtypes., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background and Aim: Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatments from the same study to assess the effect over time on systolic, diastolic and mean arterial pressure (MAP), and the relation to sodium (Na(+)), potassium (K(+)), and portfolio components., Methods and Results: 241 participants with hyperlipidemia, from four academic centers across Canada were randomized and completed either a DASH-type diet (control n = 82) or a dietary portfolio that included, soy protein, viscous fibers and nuts (n = 159) for 24 weeks. Fasting measures and 7-day food records were obtained at weeks 0, 12 and 24, with 24-h urines at weeks 0 and 24. The dietary portfolio reduced systolic, diastolic and mean arterial blood pressure compared to the control by 2.1 mm Hg (95% CI, 4.2 to -0.1 mm Hg) (p = 0.056), 1.8 mm Hg (CI, 3.2 to 0.4 mm Hg) (p = 0.013) and 1.9 mm Hg (CI, 3.4 to 0.4 mm Hg) (p = 0.015), respectively. Blood pressure reductions were small at 12 weeks and only reached significance at 24 weeks. Nuts, soy and viscous fiber all related negatively to change in mean arterial pressure (ρ = -0.15 to -0.17, p ≤ 0.016) as did urinary potassium (ρ = -0.25, p = 0.001), while the Na(+)/K(+) ratio was positively associated (ρ = 0.20, p = 0.010)., Conclusions: Consumption of a cholesterol-lowering dietary portfolio also decreased blood pressure by comparison with a healthy DASH-type diet. CLINICAL TRIAL REG. NO.: NCT00438425, clinicaltrials.gov., (Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Scope: To obtain an up-to-date quantification of the association between dietary glycemic index (GI) and glycemic load (GL) and the risk of cancer., Methods and Results: We conducted a systematic review and meta-analysis of observational studies updated to January 2015. Summary relative risks (RRs) were derived using random effects models. Seventy-five reports were evaluated in the systematic review (147,090 cases), and 72 were included in the meta-analyses by cancer site. Considering hormone-related cancers, summary RRs comparing the highest versus the lowest GI and GL intake were, respectively, 1.05 and 1.07 for breast, 1.13 and 1.17 for endometrial, 1.11 and 1.19 for ovarian, and 1.06 and 1.04 for prostate cancers. Considering digestive-tract cancers, summary RRs for GI and GL were, respectively, 1.46 and 1.25 for esophageal (squamous cell carcinoma), 1.17 and 1.10 for stomach, 1.16 (significant) and 1.10 for colorectal, 1.11 and 1.14 for liver, and 1.10 and 1.01 for pancreatic cancers. In most of these meta-analyses, significant heterogeneity among studies was observed. In subgroup analyses, case-control studies and studies from Europe tended to estimate higher RRs., Conclusion: High-GI and high-GL diets are related to moderately increased risk of cancer at several common sites., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Consumption of almonds has been shown to be associated with a decreased risk of CHD, which may be related to their fatty acid (FA) composition. However, the effect of almond consumption on the serum FA composition is not known. Therefore, in the present study, we investigated whether almond consumption would alter the serum FA profile and risk of CHD, as calculated using Framingham's 10-year risk score, in a dose-dependent manner in hyperlipidaemic individuals when compared with a higher-carbohydrate control group using dietary interventions incorporating almonds. A total of twenty-seven hyperlipidaemic individuals consumed three isoenergetic (mean 1770 kJ/d) supplements during three 1-month dietary phases: (1) full-dose almonds (50-100 g/d); (2) half-dose almonds with half-dose muffins; (3) full-dose muffins. Fasting blood samples were obtained at weeks 0 and 4 for the determination of FA concentrations. Almond intake (g/d) was found to be inversely associated with the estimated Framingham 10-year CHD risk score (P= 0·026). In both the half-dose and full-dose almond groups, the proportions of oleic acid (OA) and MUFA in the TAG fraction (half-almond: OA P= 0·003; MUFA P= 0·004; full-almond: OA P< 0·001; MUFA P< 0·001) and in the NEFA fraction (half-almond: OA P= 0·01; MUFA P= 0·04; full-almond: OA P= 0·12; MUFA P= 0·06) increased. The estimated Framingham 10-year CHD risk score was inversely associated with the percentage change of OA (P= 0·011) and MUFA (P= 0·016) content in the TAG fraction. The proportions of MUFA in the TAG and NEFA fractions were positively associated with changes in HDL-cholesterol concentrations. Similarly, the estimated Framingham 10-year CHD risk score was inversely associated with the percentage change of OA (P= 0·069) and MUFA content in the NEFA fraction (P= 0·009). In conclusion, the results of the present study indicate that almond consumption increases OA and MUFA content in serum TAG and NEFA fractions, which are inversely associated with CHD lipid risk factors and overall estimated 10-year CHD risk.

Objective: To assess the effect of dietary pulses (beans, peas, chickpeas, lentils) on acute satiety and second meal intake, a systematic review and meta-analysis was conducted., Methods: MEDLINE, EMBASE, CINAHL, and the Cochrane Registry (through May 6, 2013) were searched for acute controlled trials examining the effect of dietary pulses on postprandial satiety or second meal intake compared with isocaloric controls. Two independent reviewers extracted data and assessed methodological quality and risk of bias. Data were pooled by generic inverse variance random effects models and expressed as ratio of means (RoMs) for satiety and mean differences (MDs) for second meal food intake, with 95% confidence intervals (95% CIs). Heterogeneity was assessed (Q statistic) and quantified (I(2) statistic). Protocol registration: clinicaltrials.gov identifier, NCT01605422., Results: Nine trials met the eligibility criteria. Dietary pulses produced a 31% greater satiety incremental area under the curve (IAUC) (RoM = 1.31, 95% CI: 1.09 to 1.58, P = 0.004; Phet = 0.96; I(2)  = 0%) without affecting second meal intake (MD = -19.94, 95% CI: -75-35, P = 0.48; Phet = 0.01; I(2)  = 63%). Our data are limited by the small sample sizes, narrow participant characteristics and significant unexplained heterogeneity among the available trials., Conclusions: Pooled analyses show that dietary pulses contribute to acute satiety but not second meal intake., (Copyright © 2014 The Authors. The Obesity Society.)

Background and Aims: Nut consumption has been associated with decreased risk of coronary heart disease (CHD) and type 2 diabetes which has been largely attributed to their healthy fatty acid profile, yet this has not been ascertained. Therefore, we investigated the effect of nut consumption on serum fatty acid concentrations and how these relate to changes in markers of glycemic control and calculated CHD risk score in type 2 diabetes., Methods and Results: 117 subjects with type 2 diabetes consumed one of three iso-energetic (mean 475 kcal/d) supplements for 12 weeks: 1. full-dose nuts (50-100 g/d); 2. half-dose nuts with half-dose muffins; and 3. full-dose muffins. In this secondary analysis, fatty acid concentrations in the phospholipid, triacylglycerol, free fatty acid, and cholesteryl ester fractions from fasting blood samples obtained at baseline and week 12 were analyzed using thin layer and gas chromatography. Full-dose nut supplementation significantly increased serum oleic acid (OA) and MUFAs compared to the control in the phospholipid fraction (OA: P = 0.036; MUFAs: P = 0.024). Inverse associations were found with changes in CHD risk versus changes in OA and MUFAs in the triacylglycerol (r = -0.256, P = 0.011; r = -0.228, P = 0.024, respectively) and phospholipid (r = -0.278, P = 0.006; r = -0.260, P = 0.010, respectively) fractions. In the cholesteryl ester fraction, change in MUFAs was inversely associated with markers of glycemic control (HbA1c: r = -0.250, P = 0.013; fasting blood glucose: r = -0.395, P < 0.0001)., Conclusion: Nut consumption increased OA and MUFA content of the serum phospholipid fraction, which was inversely associated with CHD risk factors and 10-year CHD risk., Clinical Trial Reg No: NCT00410722, clinicaltrials.gov., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent., Objective: To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes., Data Sources: MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014., Study Selection: Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR., Data Extraction and Synthesis: Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2)., Results: Twelve trials (n = 450) were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003) and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03) compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts., Limitations: Majority of trials were of short duration and poor quality., Conclusions: Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates., Trial Registration: ClinicalTrials.gov NCT01630980.

Objective: To provide a broader evidence summary to inform dietary guidelines of the effect of tree nuts on criteria of the metabolic syndrome (MetS)., Design: We conducted a systematic review and meta-analysis of the effect of tree nuts on criteria of the MetS., Data Sources: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library (through 4 April 2014)., Eligibility Criteria for Selecting Studies: We included relevant randomised controlled trials (RCTs) of ≥3 weeks reporting at least one criterion of the MetS., Data Extraction: Two or more independent reviewers extracted all relevant data. Data were pooled using the generic inverse variance method using random effects models and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I(2) statistic. Study quality and risk of bias were assessed., Results: Eligibility criteria were met by 49 RCTs including 2226 participants who were otherwise healthy or had dyslipidaemia, MetS or type 2 diabetes mellitus. Tree nut interventions lowered triglycerides (MD=-0.06 mmol/L (95% CI -0.09 to -0.03 mmol/L)) and fasting blood glucose (MD=-0.08 mmol/L (95% CI -0.16 to -0.01 mmol/L)) compared with control diet interventions. There was no effect on waist circumference, high-density lipoprotein cholesterol or blood pressure with the direction of effect favouring tree nuts for waist circumference. There was evidence of significant unexplained heterogeneity in all analyses (p<0.05)., Conclusions: Pooled analyses show a MetS benefit of tree nuts through modest decreases in triglycerides and fasting blood glucose with no adverse effects on other criteria across nut types. As our conclusions are limited by the short duration and poor quality of the majority of trials, as well as significant unexplained between-study heterogeneity, there remains a need for larger, longer, high-quality trials., Trial Registration Number: NCT01630980., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: Despite their independent cardiovascular disease (CVD) advantages, effects of α-linolenic acid (ALA), monounsaturated fatty acid (MUFA), and low-glycemic-load (GL) diets have not been assessed in combination. We therefore determined the combined effect of ALA, MUFA, and low GL on glycemic control and CVD risk factors in type 2 diabetes., Research Design and Methods: The study was a parallel design, randomized trial wherein each 3-month treatment was conducted in a Canadian academic center between March 2011 and September 2012 and involved 141 participants with type 2 diabetes (HbA1c 6.5%-8.5% [48-69 mmol/mol]) treated with oral antihyperglycemic agents. Participants were provided with dietary advice on either a low-GL diet with ALA and MUFA given as a canola oil-enriched bread supplement (31 g canola oil per 2,000 kcal) (test) or a whole-grain diet with a whole-wheat bread supplement (control). The primary outcome was HbA1c change. Secondary outcomes included calculated Framingham CVD risk score and reactive hyperemia index (RHI) ratio., Results: Seventy-nine percent of the test group and 90% of the control group completed the trial. The test diet reduction in HbA1c units of -0.47% (-5.15 mmol/mol) (95% CI -0.54% to -0.40% [-5.92 to -4.38 mmol/mol]) was greater than that for the control diet (-0.31% [-3.44 mmol/mol] [95% CI -0.38% to -0.25% (-4.17 to -2.71 mmol/mol)], P = 0.002), with the greatest benefit observed in those with higher systolic blood pressure (SBP). Greater reductions were seen in CVD risk score for the test diet, whereas the RHI ratio increased for the control diet., Conclusions: A canola oil-enriched low-GL diet improved glycemic control in type 2 diabetes, particularly in participants with raised SBP, whereas whole grains improved vascular reactivity., (© 2014 by the American Diabetes Association.)

Background/objective: Nut consumption has been found to decrease risk of coronary heart disease and diabetes and to promote healthy body weights possibly related to their favorable macronutrient profile. We therefore assessed the effect of pistachios on postprandial glucose and insulin levels, gut hormones related to satiety and endothelial function., Subjects/methods: In this randomized crossover study, 20 subjects with metabolic syndrome consumed five study meals over 5-10 weeks. The meals differed in fat type and quantity, but were matched according to available carbohydrates (CHOs). Three meals had 50 g available CHO: white bread (WB50g), white bread, butter and cheese (WB+B+Ch) and white bread and pistachios (WB+P). Two meals had 12 g available CHO: white bread (WB12g) and pistachios (P)., Results: Within each group of available CHO meals, postprandial glucose levels were the highest following the white bread-only meals, and glucose response was significantly attenuated when butter and cheese or pistachios were consumed (P<0.05). Postprandial insulin levels were highest after the WB+B+Ch meal (P<0.05), but did not differ between the white bread-only and pistachio meals. Both endothelial function (reactive hyperemia index) and arterial stiffness (augmentation index) significantly increased after the white bread-only meals compared with the WB+B+Ch meal (all P<0.05). Insulin secretagogue levels were higher when butter and cheese or pistachios were consumed than when white bread only was consumed (P<0.05)., Conclusions: Compared with white bread, pistachio consumption reduced postprandial glycemia, increased glucagon-like-peptide levels and may have insulin-sparing properties. These effects could be beneficial for individuals with diabetes and metabolic syndrome.

A number of meta-analyses of cohort studies have assessed the impact of glycemic load (GL) and glycemic index (GI) on cardiovascular outcomes. The picture that emerges is that for women, a significant association appears to exist between the consumption of high GL/GI diets and increased cardiovascular disease (CVD) risk. This association appears to be stronger in those with greater adiposity and possibly in those with diabetes, although these findings are not uniform. There is also an indication that raised CRP levels may be reduced, which has special implications for women whose CRP levels, as an emerging CVD risk factor, may be higher than men. For men, the situation is not as clear-cut. Although some studies show association, the meta-analyses have not demonstrated a significant direct association with CVD, despite current evidence that risk factors, including LDL-C, may be reduced on low-GI diets. Moreover, in a recent meta-analysis, increases in dietary GL have been associated with increased risk of diabetes, another CVD risk factor, in both men and women. Studies in men expressing relative risk of CVD in relation to GL and GI, with corresponding confidence intervals, are needed to provide the necessary power for future meta-analyses on this topic.

Background: Carbohydrate foods with high glycemic and insulinemic potential may influence cancer risk possibly through the insulin/growth-factor axis. Two staple carbohydrate foods of the Mediterranean diet, bread and pasta, have different glycemic and insulinemic responses and hence may affect cancer risk differently., Materials and Methods: We studied the association of bread and pasta with breast and colorectal cancer risk using data from two Italian case-control studies. These studies included 2569 women with histologically confirmed breast cancer and 1953 men and women with colorectal cancer. Controls were 2588 and 4154, respectively, admitted to the same hospitals as cases for acute, non-neoplastic conditions. Multivariate odds ratios (ORs) were obtained after allowance for relevant confounding factors., Results: The ORs of breast cancer for the highest versus the lowest quintile were 1.28 (95% confidence interval, CI: 1.03-1.58, P-trend = 0.0342) for bread and 1.07 (95% CI: 0.88-1.31, P-trend = 0.7072) for pasta. The association with bread remained virtually unchanged with postmenopause and overweight. The ORs of colorectal cancer in women for the highest versus the lowest quintile were 2.02 (95% CI: 1.46-2.80, P-trend = 0.0002) for bread and 1.37 (95% CI: 1.00-1.88, P-trend = 0.0164) for pasta. The associations remained significant only for bread in strata of menopausal status and in women with overweight. No significant associations were seen in men for either bread or pasta., Conclusions: Overall, these two cancer case-control studies showed stronger positive associations with bread than pasta in women, particularly if overweight, suggesting possible hormonal-related mechanisms.

Aims/hypothesis: The role of diet in the prevention of diabetes remains uncertain. The aim of this study was to investigate two different dietary aspects, i.e. adherence to the Mediterranean diet and glycaemic load (GL), in relation to diabetes occurrence., Methods: We analysed data from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). From a total of 22,295 participants, actively followed for a median of 11.34 years, 2,330 cases of incident type 2 diabetes were recorded. All participants completed a validated, interviewer-administered semi-quantitative food frequency questionnaire at enrolment. From this information, we calculated a ten point Mediterranean diet score (MDS), reflecting adherence to the traditional Mediterranean diet, as well as the dietary GL. We estimated HRs and the corresponding 95% CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders., Results: A higher MDS was inversely associated with diabetes risk (HR 0.88 [95% CI 0.78, 0.99] for MDS ≥ 6 vs MDS ≤ 3). GL was positively associated with diabetes (HR 1.21 [95% CI 1.05, 1.40] for the highest vs the lowest GL quartile). A significant protection of about 20% was found for a diet with a high MDS and a low GL., Conclusions/interpretation: A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.

Background: Dietary glycemic index (GI) and glycemic load (GL) have been related to the risk of selected cancers, but the issue remains open., Patients and Methods: Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces for incident, histologically confirmed cases of the stomach (n=1182), colon (n=1727), rectum (n=1447), liver (n=309), pancreas (n=628), lung (n=3341), breast (n=2362), ovary (n=442), prostate (n=1799), testis (n=686), kidney (n=1345), bladder (n=1029), brain (n=1009), non-Hodgkin's lymphomas (NHL, n=1666), leukemias (n=1069), multiple myelomas (n=343), and 5039 population controls. Dietary information on eating habits 2 years before participants' enrollment in the study was obtained using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) and 95% confidence intervals (CI) were derived by unconditional logistic regression including recognized confounding factors., Results: Dietary GI was positively associated with the risk of prostate cancer (OR, 1.26 for the highest versus the lowest quartile). A higher dietary GL significantly increased the risk of colorectal (OR, 1.28), rectal (OR, 1.44) and pancreatic (OR, 1.41) cancers. No other significant associations were found., Conclusions: Our findings suggest that a diet high in GI and GL is associated with increased risk of selected cancers.

Carbohydrates and the dietary glycemic index (GI) influence insulin secretion and insulin-like growth factors, and may exert relevant effects on obesity and diabetes, both of which are important risk factors for endometrial cancer. We studied the association between dietary GI and glycemic load (GL) and endometrial cancer using data from an Italian case-control study. This included 454 women with histologically confirmed endometrial cancer and 908 controls admitted to the same hospitals for acute, non-neoplastic conditions. Multivariate odds ratios were obtained after allowance for major potential confounding factors, including noncarbohydrate energy intake. We updated a meta-analysis on this issue, including a recent US cohort study, which contributed about a quarter of all cases, besides our case-control study. In the case-control study, the odds ratios of endometrial cancer for the highest versus the lowest quintile were 1.03 [95% confidence interval (CI): 0.67-1.58] for GI and 1.01 (95% CI: 0.64-1.61) for GL. No heterogeneity was found across the strata of diabetes and other selected covariates. The summary risk estimate of endometrial cancer for the highest versus the lowest GI level, obtained from the meta-analysis, was 1.09 (95% CI: 0.92-1.29). The corresponding risk estimate for GL was 1.19 (95% CI: 1.06-1.34). The case-control study showed no association between dietary GI and GL and the risk of endometrial cancer overall and in the strata of relevant covariates, whereas the meta-analysis supported an increased risk for high GL, but not GI.

Background: Legumes, including beans, chickpeas, and lentils, are among the lowest glycemic index (GI) foods and have been recommended in national diabetes mellitus (DM) guidelines. Yet, to our knowledge, they have never been used specifically to lower the GI of the diet. We have therefore undertaken a study of low-GI foods in type 2 DM with a focus on legumes in the intervention., Methods: A total of 121 participants with type 2 DM were randomized to either a low-GI legume diet that encouraged participants to increase legume intake by at least 1 cup per day, or to increase insoluble fiber by consumption of whole wheat products, for 3 months. The primary outcome was change in hemoglobin A1c (HbA1c) values with calculated coronary heart disease (CHD) risk score as a secondary outcome., Results: The low-GI legume diet reduced HbA1c values by -0.5% (95% CI, -0.6% to -0.4%) and the high wheat fiber diet reduced HbA1c values by -0.3% (95% CI, -0.4% to -0.2%). The relative reduction in HbA1c values after the low-GI legume diet was greater than after the high wheat fiber diet by -0.2% (95% CI, -0.3% to -0.1%; P < .001). The respective CHD risk reduction on the low-GI legume diet was -0.8% (95% CI, -1.4% to -0.3%; P = .003), largely owing to a greater relative reduction in systolic blood pressure on the low-GI legume diet compared with the high wheat fiber diet (-4.5 mm Hg; 95% CI, -7.0 to -2.1 mm Hg; P < .001)., Conclusion: Incorporation of legumes as part of a low-GI diet improved both glycemic control and reduced calculated CHD risk score in type 2 DM.

Background: Glycemic index (GI) and glycemic load (GL) have been associated with coronary heart disease (CHD) risk in some but not all cohort studies. We therefore assessed the association of GI and GL with CHD risk in prospective cohorts., Methods and Results: We searched MEDLINE, EMBASE, and CINAHL (through April 5, 2012) and identified all prospective cohorts assessing associations of GI and GL with incidence of CHD. Meta-analysis of observational studies in epidemiology (MOOSE) methodologies were used. Relative measures of risk, comparing the group with the highest exposure (mean GI of cohorts=84.4 GI units, range 79.9 to 91; mean GL of cohorts=224.8, range 166 to 270) to the reference group (mean GI=72.3 GI units, range 68.1 to 77; mean GL=135.4, range 83 to 176), were pooled using random-effects models, expressed as relative risk (RR) with heterogeneity assessed by χ(2) and quantified by I(2). Subgroups included sex and duration of follow-up. Ten studies (n=240 936) were eligible. Pooled analyses showed an increase in CHD risk for the highest GI quantile compared with the lowest, with RR=1.11 (95% confidence interval [CI] 0.99 to 1.24) and for GL, RR=1.27 (95% CI 1.09 to 1.49), both with evidence of heterogeneity (I(2)>42%, P<0.07). Subgroup analyses revealed only a significant modification by sex, with the female cohorts showing significance for GI RR=1.26 (95% CI 1.12 to 1.41) and for GL RR=1.55 (95% CI 1.18 to 2.03)., Conclusions: High GI and GL diets were significantly associated with CHD events in women but not in men. Further studies are required to determine the relationship between GI and GL with CHD in men.

Background and Aims: The intake of nuts has been linked to a reduced risk of cardiovascular disease (CVD) and diabetes in large cohort studies. One potential contributing mechanism may be the ability of nuts to improve post-meal glycemic response. We, therefore, examined the effect of nuts alone and in combination with white bread on postprandial glycemia., Methods and Results: 30, 60 and 90 g (approximately 1, 2 and 3 ounces) of mixed nuts were consumed with and without 50 g available carbohydrate from white bread by 10-14 normoglycemic and 5-10 type 2 diabetic subjects. Glycemic response (GR) was assessed by calculating the incremental area under the 2 h blood glucose curve. All three doses of mixed nuts, when fed alone, significantly reduced the glycemic response in both normoglycemic and diabetic patients. Furthermore, in the normoglycemic subjects, adding nuts to white bread progressively reduced the GR of the meal by 11.2 ± 11.6%, 29.7 ± 12.2% and 53.5 ± 8.5% for the 30, 60, and 90 g doses (P = 0.354, P = 0.031 and P < 0.001, respectively), while in subjects with type 2 diabetes, the effect was half of that seen in the non-diabetic subjects (P = 0.474, P = 0.113 and P = 0.015, respectively)., Conclusion: Nuts alone have little effect on post-meal blood glucose response. Furthermore, when taken with bread, nuts progressively reduce the glycemic response in a dose-dependent manner. While these findings support a short-term benefit for nuts in postprandial glucose response, more studies are required to determine whether these acute benefits result in long-term improvements in glycemic control., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Almonds, together with other nuts, reduce serum cholesterol levels and may reduce the risk of coronary heart disease. There is much current interest in the relation of coronary heart disease to postprandial events. We have therefore assessed the effects of varying amounts of almonds on the postprandial blood glucose response to a carbohydrate meal. Our aim was to assess the effect of adding almonds to a bread meal. Nine healthy volunteers (2 women, 7 men; mean age, 27.8 years; mean body mass index, 22.9 kg/m2) were randomly fed with 3 test meals and 2 white bread control meals on separate days. Subjects were fed the meals after a 10- to 12-hour overnight fast. Each meal contained 50 g of available carbohydrate from white bread eaten alone or with 30, 60, or 90 g ( approximately 1, 2, or 3 oz) of almonds. Capillary finger-prick blood samples for glucose analysis were obtained at 0, 15, 30, 45, 60, 90, and 120 minutes. Glycemic responses were assessed by calculating the incremental area under the 2-hour blood glucose curve. The addition of almonds to white bread resulted in a progressive reduction in the glycemic index of the composite meal in a dose-dependent manner for the 30-g (105.8 +/- 23.3), 60-g (63.0 +/- 9.0), and 90-g (45.2 +/- 5.8) doses of almonds (r = -0.524, n = 36, P = .001). We conclude that, in addition to lowering serum cholesterol levels, almonds may also reduce the glycemic impact of carbohydrate foods with which they are eaten.

Objective: To explore the relation between a wide range of alcohol consumptions and levels of the components of insulin-like growth factor system (IGFs) and adiponectin in humans., Design: A cross-sectional study using controls from a case-control study on ovarian and endometrial cancer., Settings: The study included women hospitalized between 1999 and 2002 in Pordenone, Italy., Subjects: One hundred and eight cancer-free (controls) with a median age of 61 years (range 29-79 years), admitted for acute conditions unrelated to gynecologic, hormonal or metabolic disorders or diseases leading to dietary modifications., Interventions: Levels of IGF-I (total and free), total IGF-II, IGF-binding protein 1 (IGFBP-1), IGFBP-3 and adiponectin were individually measured, and their distributions across strata of alcohol consumption were tested by the Kruskal-Wallis statistic., Results: Median concentrations of total IGF-I were higher (P<0.01) in women reporting low (151 ng/ml) or no alcohol consumption (134 ng/ml) compared to drinkers of 12-23 g/day (103 ng/ml) or >or=24 g/day (118 ng/ml). Median concentrations were higher (P=0.05) for IGFBP-3 in non-drinkers (2333 ng/ml) and in light drinkers (2647 ng/ml) compared to drinkers of >or=24 g/day (2090 ng/ml). No statistically significant difference emerged for other IGFs across levels of alcohol intakes. Adiponectin was slightly lower for non-drinkers, compared to all drinkers categories., Conclusions: Our study suggests that alcohol consumption is related to circulating levels of components of the IGF system and adiponectin. These results may have a potential impact on the prevention of several chronic diseases., Sponsorship: Italian Association for Research on Cancer, Milan, Italy, and Italian League against Tumours, Milan, Italy.

Strategies that decrease postprandial glucose excursions, including digestive enzyme inhibition, and low glycemic index diets result in lower diabetes incidence and coronary heart disease (CHD) risk, possibly through lower postprandial oxidative damage to lipids and proteins. We therefore assessed the effect of decreasing postprandial glucose excursions on measures of oxidative damage. Fifteen healthy subjects ate 2 bread control meals and 3 test meals: almonds and bread; parboiled rice; and instant mashed potatoes, balanced in carbohydrate, fat, and protein, using butter and cheese. We obtained blood samples at baseline and for 4 h postprandially. Glycemic indices for the rice (38 +/- 6) and almond meals (55 +/- 7) were less than for the potato meal (94 +/- 11) (P < 0.003), as were the postprandial areas under the insulin concentration time curve (P < 0.001). No postmeal treatment differences were seen in total antioxidant capacity. However, the serum protein thiol concentration increased following the almond meal (15 +/- 14 mmol/L), indicating less oxidative protein damage, and decreased after the control bread, rice, and potato meals (-10 +/- 8 mmol/L), when data from these 3 meals were pooled (P = 0.021). The change in protein thiols was also negatively related to the postprandial incremental peak glucose (r = -0.29, n = 60 observations, P = 0.026) and peak insulin responses (r = -0.26, n = 60 observations, P = 0.046). Therefore, lowering postprandial glucose excursions may decrease the risk of oxidative damage to proteins. Almonds are likely to lower this risk by decreasing the glycemic excursion and by providing antioxidants. These actions may relate to mechanisms by which nuts are associated with a decreased risk of CHD.

Dietary carbohydrates have different glycemic and insulinemic potentials depending on type (glycemic index, GI) and amount (glycemic load, GL) of carbohydrate consumed or both. Insulin in turn has been implicated as a risk factor for several cancers, including that of the prostate. We assessed the relationship of GI and GL with prostate cancer risk in a multicenter case-control study. Cases and controls were recruited between 1991 and 2002 in the network of major teaching and general hospitals in 4 Italian areas. Cases were 1,204 men (age range 46-74 years) admitted for incident, histologically confirmed prostate cancer. Controls were 1,352 men (age range 46-74 years) admitted for acute, nonmalignant conditions unrelated to long-term modifications of diet. ORs of prostate cancer and the corresponding 95% CIs were derived using unconditional multiple logistic regression, including terms for age, study center, education, family history of prostate cancer, smoking, body mass index, physical activity, alcohol consumption, intake of energy, fiber and lycopenes. Compared to the lowest quintile of GI, the ORs were 1.23, 1.24, 1.47 and 1.57 for subsequent levels of GI. The corresponding values for GL were 0.91, 1.00, 1.20 and 1.41. No heterogeneity was found among strata of selected covariates. We found direct relations between dietary GI and GL and prostate cancer risk. Correcting for potential confounding factors did not substantially modify these associations.

Background: The apparent favorable effect of alcohol on the risk of acute myocardial infarction (MI) may be related to its hypoinsulinemic effect when consumed with meals. We studied how the timing of alcohol consumption in relation to meals might affect the risk of MI in a population with relatively high regular alcohol consumption., Methods: We conducted a case-control study between 1995 and 1999 in Milan, Italy. Cases were 507 subjects with a first episode of nonfatal acute MI, and controls were 478 patients admitted to hospitals for other acute diseases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multiple logistic regression models., Results: Compared with nondrinkers, an inverse trend in risk was observed when alcohol was consumed during meals only (for > or =3 drinks per day: OR = 0.50; 95% CI = 0.30-0.82). In contrast, no consistent trend in risk was found for subjects drinking outside of meals (for > or =3 drinks per day: 0.98; 0.49-1.96). The pattern of risk was similar when we considered people who drank only wine., Conclusions: Alcohol drinking during meals was inversely related with risk of acute MI, whereas alcohol drinking outside meals only was unrelated to risk.

It was initially hypothesized that resistant starches, i.e., starch that enters the colon, would have protective effects on chronic colonic diseases, including reduction of colon cancer risk and in the treatment of ulcerative colitis. Recent studies have confirmed the ability of resistant starch to increase fecal bulk, increase the molar ratio of butyrate in relation to other short-chain fatty acids, and dilute fecal bile acids. However the ability of resistant starch to reduce luminal concentrations of compounds that are damaging to the colonic mucosa, including fecal ammonia, phenols, and N-nitroso compounds, still requires clear demonstration. As such, the effectiveness of resistant starch in preventing or treating colonic diseases remains to be assessed. Nevertheless, there is a fraction of what has been termed resistant (RS1) starch, which enters the colon and acts as slowly digested or lente carbohydrate in the small intestine. Foods in this class are low glycemic index and have been shown to reduce the risk of chronic disease. They have been associated with systemic physiological effects such as reduced postprandial insulin levels and higher HDL cholesterol levels. Consumption of low glycemic index foods has been shown to be related to reductions in risk of coronary heart disease and Type 2 diabetes. Type 2 diabetes has in turn been related to a higher risk of colon cancer. If carbohydrates have a protective role in colon cancer prevention this may lie partly in the systemic effects of low glycemic index foods. The colonic advantages of different carbohydrates, varying in their glycemic index and resistant starch content, therefore, remain to be determined. However, as recent positive research findings continue to mount, there is reason for optimism over the possible health advantages of those resistant starches, which are slowly digested in the small intestine.

Background: Dietary carbohydrates have been directly associated with gastric cancer risk and have been considered general indicators of a poor diet. However, elevated levels of glucose and insulin elicited by consumption of high amounts of refined carbohydrates may stimulate mitogenic and cancer-promoting insulin-like growth factors (IGF). Glycemic index (GI) and glycemic load (GL), which represent indirect measures of dietary insulin demand, were analysed to understand further the association between carbohydrates and gastric cancer., Patients and Methods: Data were derived from a hospital-based case-control study on gastric cancer, conducted in Italy between 1985 and 1997, including 769 cases with incident, histologically confirmed gastric cancer and 2081 controls admitted to the same hospital network as cases for acute, non-neoplastic diseases. All subjects were interviewed using a reproducible food frequency questionnaire., Results: The multivariate odds ratios (OR) for subsequent quartiles of dietary GL were 1.44 [95% confidence interval (CI) 1.11-1.87], 1.62 (95% CI 1.24-2.12) and 1.94 (95% CI 1.47-2.55). No consistent pattern of risk was seen with GI. The associations were consistent in different strata of age, education and body mass index, and were stronger in women., Conclusions: This study supports the hypothesis of a direct association between GL and gastric cancer risk, thus providing an innovative interpretation, linked to excess circulating insulin and related IGFs, for the association between carbohydrates and risk of gastric cancer.

Circulating levels of adiponectin, a hormone with insulin-sensitizing properties, are decreased in conditions related to obesity and hyperinsulinemia, which are recognized risk factors for endometrial cancer. Eighty-seven cases with incident, histologically confirmed endometrial cancer and 132 controls admitted for acute, nonneoplastic diseases were interviewed in northeastern Italy between 1999 and 2002, and blood samples were collected. Levels of adiponectin were evaluated in samples by means of a RIA. An inverse association with endometrial cancer risk emerged for plasma adiponectin levels [odds ratio (OR), 0.42; 95% confidence interval, 0.19-0.94] when comparing the highest vs. the lowest tertiles. Similar results emerged for serum adiponectin (OR, 0.30; 95% confidence interval, 0.14-0.68). The association was stronger in pre- than in postmenopausal women, but no significant heterogeneity was observed across strata of body mass index (BMI) or parity. BMI and adiponectin showed independent effects on the risk of endometrial cancer according to a multiplicative model (OR, 6.45 in the highest level of BMI and in the lowest one of adiponectin).

Background: Components of the insulin-like growth factor (IGF) system have been associated with several cancers, but very few studies are available for ovarian cancer., Methods: A case-control study conducted between 1999 and 2003 in Italy, including a total of 59 women with incident, histologically confirmed ovarian cancer and 108 controls admitted to the same hospital network as cases, for acute non-neoplastic diseases. All subjects were interviewed using a validated questionnaire., Results: After adjustment for potential confounders, the multivariate odds ratios for the highest versus the lowest tertile of various IGF components were 0.6 (95% confidence interval, CI: 0.2-1.4) for free IGF-I, 0.4 (CI: 0.1-1.5) for total IGF-I, 2.6 (CI: 0.9-6.9) for IGF-binding protein (IGFBP)-1, and 0.2 (CI: 0.0-0.6) for IGFBP-3., Conclusions: This study suggests a protective role of IGFBP-3 and a positive association of IGFBP-1 with ovarian cancer. The complex role of the IGF system in ovarian carcinogenesis deserves further clarification.

Objective: The insulin-like growth factor (IGF) system has been related to cell proliferation, obesity, diabetes, hyperinsulinemia and endometrial cancer risk. We used data from a case-control study conducted in Italy to provide additional information on the relation between the IGF system and endometrial cancer., Methods: A case-control study was conducted between 1999 and 2002 in Italy, including a total of 73 women with incident, histologically confirmed endometrial cancer and 108 controls admitted to the same hospital network for acute, nonneoplastic diseases. All subjects were interviewed using a validated questionnaire., Results: The odds ratios for endometrial cancer comparing the highest versus the lowest tertile of various IGF components were as follows: 0.5 [95% confidence interval (CI) 0.2-1.2] for free IGF-I, 1.1 (95% CI 0.5-2.6) for total IGF-I, 1.2 (95% CI 0.6-2.6) for total IGF-II, 2.4 (95% CI 1.0-5.9) for IGF binding protein (IGFBP)-1 and 0.8 (95% CI 0.4-2.0) for IGFBP-3. Further allowance for all IGF components in the model did not modify the results. The direct relation with IGFBP-1 was stronger and limited to heavier and older women., Conclusions: The present findings suggest a limited effect of the IGF system on endometrial cancer risk. Increasing IGFBP-1 levels seem to be associated with endometrial cancer risk in older women and in women with a higher body mass index., (Copyright 2004 S. Karger AG, Basel)

Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.

Background: The ability of dietary carbohydrates to affect blood glucose and insulin levels by dietary carbohydrates is best measured by the glycemic index (GI) and glycemic load (GL) which have been directly associated with risk of several chronic conditions, including cancer., Patients and Methods: Three case-control studies were conducted between 1992 and 2000 in Italy. The first one included 598 hospital patients with incident, histologically confirmed oral and pharyngeal cancer and 1491 controls admitted to the same hospital networks for acute, non-neoplastic diseases; the second study included 304 subjects with squamous cell oesophageal cancer and 743 controls; the third one included 460 cases with laryngeal cancer and 1088 controls. All subjects were interviewed using a validated food frequency questionnaire., Results: The odds ratios (OR) of upper aero-digestive tract neoplasms for the highest versus the lowest quintile of dietary GI and GL were 1.5 (95% confidence interval [CI]: 1.1-2.0) and 1.8 (95% CI: 1.1-2.9), respectively. The associations were in the same direction for various cancer sites. The ORs were apparently stronger in women, in those with high body mass index and reporting low alcohol consumption., Conclusions: This study supports the hypothesis that high dietary GI and GL are associated with cancers of the upper aero-digestive tract.

Objectives: To assess the relation between selected carbohydrate foods, dietary glycaemic load and glycaemic index, and the risk of non-fatal acute myocardial infarction in a population with a high intake of refined carbohydrates., Design and Setting: Hospital based case-control study conducted in Milan, Italy, between 1995 and 1999., Patients: 433 non-diabetic subjects with a first episode of non-fatal acute myocardial infarction, and 448 controls admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential risk factors for acute myocardial infarction., Methods: Information was collected by interviewer administered questionnaires. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple logistic regression models., Results: Compared with patients in the lowest tertile of intake, the multivariate OR for those in the highest tertile was 1.00 for bread, 1.27 for pasta and rice, 1.38 for soups, 0.78 for potatoes, 0.97 for desserts, and 1.00 for sugar. The OR for the highest tertile of score was 1.08 for glycaemic load and 1.38 for glycaemic index. None of the estimates was significant. A significant association with acute myocardial infarction risk was found for glycaemic index in patients aged > or = 60 years (OR 1.81, 95% CI 1.07 to 3.07 for the highest tertile of score compared with the lowest) and in those with a body mass index > or = 25 kg/m2 (OR 2.02, 95% CI 1.21 to 3.34)., Conclusions: In this Italian population high glycaemic load and glycaemic index were not strongly associated with acute myocardial infarction risk, but slightly increased odds ratios were observed for glycaemic index in elderly people and in association with overweight.

Glycemic index (GI) and glycemic load (GL) are measures of the metabolic effects of dietary carbohydrates. The higher their value, the greater the glucose and insulin responses. Raised insulin levels are associated with endometrial cancer and with its risk factors including obesity, diabetes and hypertension. To study the role of the GI and GL we analyzed the data of two hospital-based case-control studies on endometrial cancer conducted between 1988-98 in Italy and Switzerland, including a total of 410 women with incident, histologically confirmed endometrial cancer and 753 controls admitted for acute, non-neoplastic diseases. A food frequency questionnaire was used to assess the subjects usual diet and to derive estimates of dietary GI and GL. The odds ratios (OR) of endometrial cancer, after adjustment for major risk factors, for the highest versus the lowest quintile of dietary GI and GL were 2.1 (95% confidence interval [CI] = 1.4-3.2) and 2.7 (95% CI = 1.8-4.2), respectively. The associations were stronger in older women, in those with higher body mass index and in hormone replacement therapy users. Our study supports the hypothesis of a direct association between GI and endometrial cancer risk., (Copyright 2003 Wiley-Liss, Inc.)

Objective: To determine the effect of high-protein diets, which have recently been promoted for their health benefits, on urinary calcium losses and bone turnover in older subjects., Design: Randomized controlled cross-over study., Setting: Teaching hospital and university., Subjects: Twenty hyperlipidemic men and postmenopausal women (age 56+/-2 y) completed the study., Intervention: One-month test and control phases during which subjects consumed equi-energy metabolic diets high in calcium (1578 and 1593 mg/day, respectively). On the test diet 11% of total dietary energy from starch in the control bread was replaced by protein (wheat gluten), resulting in 27% of energy from protein on the test diet vs 16% on the control diet., Main Outcome Measure: Urinary calcium excretion., Results: Compared with the control diet, at week 4, the test diet increased mean (+/-s.e.m.) 24 h urinary output of calcium (139+/-15 vs 227+/-21 mg, P=0.004). The treatment difference in urinary calcium loss correlated with the serum anion gap as a marker of metabolic acid production (r=0.57, P=0.011). Serum calcium levels were marginally lower 2.41+/-0.02 vs 2.38+/-0.02 mmol/l (P=0.075), but there was no significant treatment difference in calcium balance, possibly related to the high background calcium intake on both diets., Conclusion: In the presence of high dietary calcium intakes the vegetable protein gluten does not appear to have a negative effect on calcium balance despite increased urinary calcium loss.