Abstract. Skipping breakfast or irregular breakfast is associated with poor glycemic control. However, a relationship between the timing of dinner and glycemic control in people with type 2 diabetes remains indefinite. Therefore, we investigated the relationship between late-night-dinner and glycemic control in people with type 2 diabetes. We performed questionnaire survey for lifestyle factors in this cross-sectional study. We defined having dinner later than eight pm as late-night-dinner. We examined the differences in clinical and metabolic parameters between those who have late-night-dinner and those who do not have. We also examined the relationship between late-night-dinner and HbA1c, using multiple regression analysis. Ninetyfive people (23.2%) had a late-night-dinner, among 409 people with type 2 diabetes. Metabolic parameters (mean (SD) or median (interquartile range)) of people with late-night-dinner were worse than those of without, including body mass index (BMI) (24.4 (4.0) vs. 23.2 (3.4) kg/m 2 , p = 0.006), triglycerides (1.5 (1.1-2.1) vs. 1.2 (0.8-1.7) mmol/L, p < 0.001), HDLcholesterol (1.4 (0.4) vs. 1.6 (0.4) mmol/L, p = 0.004) and hemoglobin A1c (58.1 (13.3) vs. 55.2 (10.2) mmol/mol, (7.5 (1.2) vs. 7.2 (0.9) %), p = 0.023)). Late-night-dinner (standardized regression coefficient = 0.13, p = 0.028) was associated with hemoglobin A1c after adjusting for age, BMI, sex, duration of diabetes, smoking, exercise, alcohol, snacking after dinner, nighttime sleep duration, time from dinner to bedtime, skipping breakfast, and medication for diabetes. Late-night-dinner is independently associated with poor glycemic control in people with type 2 diabetes.

Background Energy intake is important for the maintenance of muscle mass. The relationship between energy intake and sarcopenia in elderly patients with type 2 diabetes (T2D) has been unclear. Methods Using a brief‐type self‐administered diet history questionnaire we assessed habitual food and nutrient intake of patients with T2D aged ≥65 years, all of whom were Japanese and physically active, taking part in the KAMOGAWA‐DM cohort study. Patients' body composition was evaluated by bioimpedance analysis. Sarcopenia was defined as having both a grip strength of <26 kg for men and <18 kg for women and a skeletal muscle mass index of <7.0 kg/m2 for men and <5.7 kg/m2 for women. Logistic regression analyses were used to investigate the effect of energy intake on the presence of sarcopenia in this cross‐sectional study of 391 patients (205 men, 186 women). Results Fifty‐five patients (14.1%) were diagnosed as having sarcopenia. Energy intake was significantly lower in patients with sarcopenia than without sarcopenia (mean  ±  SD [n = 366] 1498.8 ± 389.4 vs 1786.2 ± 706.7 kcal/d, respectively; P = 0.016). After adjusting for age, sex, exercise, smoking status, HbA1c, and body mass index, patients' energy intake (per 100 kcal) was negatively associated with the presence of sarcopenia (odds ratio 0.86; 95% confidence interval 0.78‐0.95; P = 0.001). Conclusion Energy intake was negatively associated with the presence of sarcopenia in elderly patients with T2D.

Aim Death as a result of pneumonia is an important issue in patients with diabetes. Tongue pressure is associated with swallowing function, which has a close association with aspiration pneumonia. However, no previous studies have shown the association between sarcopenia and tongue pressure in older patients with type 2 diabetes. Methods In the present cross‐sectional study, we investigated body composition, handgrip strength and tongue pressure. Skeletal muscle mass index (kg/m2) was defined as appendicular muscle mass / the square of the height. Sarcopenia was defined when both handgrip strength <26 kg for men and <18 kg for women, and the skeletal muscle mass index <7.0 kg/m2 for men and <5.7 kg/m2 for women existed. Results Among 144 patients (82 men, 71.4 years [SD 6.7 years]), 11.8% had sarcopenia. Tongue pressure was associated with skeletal muscle mass index and handgrip strength (r = 0.361, P < 0.001 and r = 0.387, P < 0.001, respectively, in men; and r = 0.300, P = 0.018 and r = 0.538, P < 0.001, respectively, in women). Tongue pressure was associated with the prevalence of sarcopenia after adjusting for covariates (OR 3.83, 95% CI 1.06–13.9, P = 0.041). According to the receiver operating characteristic curve analysis, the optimal cut‐off value of handgrip strength for the presence of low tongue pressure was 27.7 kg (AUC 0.70, 95% CI 0.53–0.83, sensitivity 0.78, specificity 0.64) in men and 18.3 kg (AUC 0.71, 95% CI 0.54–0.84, sensitivity 0.82, specificity 0.54) in women. Conclusions Sarcopenia, especially handgrip strength, is associated with tongue pressure in older patients with type 2 diabetes. We should consider a decrease of swallowing function when examining patients with sarcopenia. Geriatr Gerontol Int 2019; 19: 153–158.

Omega 3 fatty acids intake is important to maintain muscle mass. However, the relationship between omega 3 fatty acids intake and sarcopenia in elderly patients with type 2 diabetes has been unclear. We used the brief type self administered diet history questionnaire for the assessment of habitual food and nutrient intake. Body composition of patients was evaluated using bio impedance analysis. To investigate the effect of energy intake on the presence of sarcopenia, we performed logistic regression analyses. Among the patients, 45 patients (13.2%) were diagnosed as sarcopenia. Patients with sarcopenia were aged [74.2 (5.7) vs 71.4 (5.9) years, p = 0.003] and lower body mass index [21.2 (3.5) vs 24.3 (4.6) kg/m 2 , p<0.001] than those without. In addition, omega 3 fatty acids intake of patients with sarcopenia was lower than that without [2.6 (1.0) vs 3.0 (1.2) kcal/day, p = 0.046]. Omega 3 fatty acids intake was negatively associated with the presence of sarcopenia (odds ratio: 0.29, 95% confidence interval: 0.14-0.60, p<0.001) after adjusting for age, sex, exercise, smoking status, diabetes duration, hemoglobin A1c, energy intake, protein intake, fat intake and omega 3 fatty acids intake. Omega 3 fatty acids intake was negatively associated with the presence of sarcopenia in elderly patients with type 2 diabetes.

Background/Aims Protein intake is important for maintaining muscle mass in general population. However, it remains to be elucidated the association between dietary protein intake and skeletal muscle mass in elderly patients with type 2 diabetes. Methods In this cross-sectional study of 168 elderly patients with type 2 diabetes, we investigated the relationship between skeletal muscle index (SMI) and protein intake. Bioimpedance analysis was used for measurement for skeletal muscle mass (kg) and SMI (%), which was defined as skeletal muscle mass (kg)/total body weight (kg) × 100. Habitual food and nutrient intake were estimated by a questionnaire. Results Protein intake was independently correlated with SMI after adjusting for age, hemoglobin A1c, C-peptide index, exercise, smoking, insulin treatment, total energy intake, and C-reactive protein (standardized regression coefficient = 0.664, P < 0.001 in men and standardized regression coefficient = 0.516, P = 0.005 in women). Additionally, the animal protein to vegetable protein ratio was negatively correlated with SMI after adjusting for covariates in men (standardized regression coefficient = −0.339, P = 0.005). Conclusions We found that total protein intake, especially vegetable protein intake, was positively associated with skeletal muscle mass in elderly patients with type 2 diabetes.

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Association between heart failure and sarcopenia has been reported, however, the association between sarcopenia and brain natriuretic peptide (BNP) is unclear. Thus, we investigated the association between sarcopenia and BNP in type 2 diabetic patients without heart failure. In this cross-sectional study, skeletal muscle mass index (SMI, kg/m 2) was calculated as appendicular muscle mass, measured by bioimpedance analyzer, by the square of the height. Sarcopenia was defined as having both handgrip strength of <26 kg for men and <18 kg for women, and SMI of <7.0 kg/m 2 for men and <5.7 kg/m 2 for women. To investigate the impact of BNP levels on the presence of sarcopenia, propensity-score matching analysis was used to remove the bias of confounding variables, including age, sex, duration of diabetes, body mass index, exercise, systolic blood pressure, smoking status, hemoglobin A1c, creatinine, energy and protein intake. The area under the curve (AUC) of BNP levels for the presence of sarcopenia was calculated by the receiver operating characteristic curve (ROC). Among 433 patients (236 men and 65.4 (11.1) years), 32 patients (7.4%) were diagnosed as sarcopenia. In the propensity-matched 58 patients, BNP levels (Δ10 pg/mL incremental) were associated with the presence of sarcopenia by logistic regression analysis, (odds ratio: 1.56, 95% confidence interval: 1.14-2.13, p = 0.002). The optimal cutoff point of BNP levels for sarcopenia is 27.3 pg/mL (AUC 0.777, 95%CI, 0.691-0.863, sensitivity = 0.813, specificity = 0.736, p < 0.001). In conclusion, BNP levels were associated with sarcopenia in type 2 diabetic patients without heart failure.

Background/Aims: The effect of low carbohydrate diet on human health is still controversial. Whole grain, which is carbohydrate rich in fiber, has protective effects on human health. Thus, we assumed that intake of carbohydrate to fiber ratio has an important role in human health. Methods: This is a post-hoc analysis of a cross-sectional study of 164 patients with type 2 diabetes. Habitual food and nutrient intake were assessed and estimated by a self-administered diet history questionnaire. Intake of carbohydrate to fiber ratio was defined as carbohydrate (g)/fiber intake (g). Logistic regression analyses were performed to reveal the association between intake of carbohydrate to fiber ratio and metabolic syndrome (MetS). Results: Intake of carbohydrate to fiber ratio has closely associated with metabolic parameters, including triglycerides (r = 0.21, p = 0.007) and high-density lipoprotein cholesterol (r = –0.23, p = 0.003). Intake of carbohydrate to fiber ratio was associated with MetS (OR 1.06 [95% CI 1.00–1.13], p = 0.047) after adjusting for covariates, whereas carbohydrate intake (1.00 [0.99–1.01], p = 0.752) or carbohydrate energy/total energy (1.00 [0.94–1.07], p = 0.962) was not associated with MetS. Conclusions: Intake of carbohydrate to fiber ratio was associated with MetS, whereas carbohydrate intake was not.