Summary
In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than the quantity of these macronutrients. Diets rich in whole grains, fruits, vegetables, legumes, nuts, moderate in alcohol consumption, and lower in refined grains, red/processed meats, and sugar-sweetened beverages have demonstrated to reduce diabetes risk and improve glycemic control and blood lipids in patients with diabetes. Several healthful dietary patterns emphasizing the overall diet quality can be adapted to appropriate personal and cultural food preferences and calorie needs for weight control and diabetes prevention and management. Although considerable progress has been made in developing and implementing evidence-based nutrition recommendations in developed countries, concerted global efforts and policies are warranted to alleviate regional disparities.
RESEARCH DESIGN AND METHODS -Analyses were conducted on the cohort of the Massachusetts Male Aging Study, a population-based random sample of men aged 40-70. Of the 1,709 men enrolled in 1987-1989 (T 1 ), 1,156 were followed up 7-10 years later (T 2 ). Te s t o st e rone and SHBG levels at T 1 w e re used to predict new cases of diabetes between T 1 and T 2 . R E S U LT S -After controlling for potential confounders, diabetes at follow-up was pre d i c t e d jointly and independently by lower baseline levels of free testosterone and SHBG. The odds ratio for future diabetes was 1.58 for a decrease of 1SD in free testosterone (4 ng/dl) and 1.89 for a 1SD decrease in SHBG (16 nmol/l), both significant at P 0 . 0 2 .C O N C L U S I O N S -Our prospective findings are consistent with previous, mainly cro s ssectional re p o rts, suggesting that low levels of testosterone and SHBG play some role in the development of insulin resistance and subsequent type 2 diabetes. Diabetes Care 2 3 :4 9 0-494, 2000
Res. 2003;11:1048 -1054. Objective: To study the effect of weight loss in response to a lifestyle modification program on the circulating levels of adipose tissue derived cytokines (adipokines) in obese individuals with insulin resistance. Research Methods and Procedures: Twenty-four insulinresistant obese subjects with varying degrees of glucose tolerance completed a 6-month program consisting of combined hypocaloric diet and moderate physical activity. Adipokines [leptin, adiponectin, resistin, tumor necrosis factor-␣ (TNF-␣), interleukin-6 (IL-6)] and highly sensitive C-reactive protein were measured before and after the intervention. Insulin sensitivity index was evaluated by the frequently sampled intravenous glucose tolerance test. Results: Participants had a 6.9 Ϯ 0.1 kg average weight loss, with a significant improvement in sensitivity index and reduction in plasma leptin (27.8 Ϯ 3 vs. 23.6 Ϯ 3 ng/mL, p ϭ 0.01) and IL-6 (2.75 Ϯ 1.51 vs. 2.3 Ϯ 0.91 pg/mL, p ϭ 0.012). TNF-␣ levels tended to decrease (2.3 Ϯ 0.2 vs. 1.9 Ϯ 0.1 pg/mL, p ϭ 0.059). Adiponectin increased significantly only among diabetic subjects. The reductions in leptin were correlated with the decreases in BMI (r ϭ 0.464, p Ͻ 0.05) and with changes in highly sensitive C-reactive protein (r ϭ 0.466, p Ͻ 0.05). Discussion: Weight reduction in obese individuals with insulin resistance was associated with a significant decrease in leptin and IL-6 and a tendency toward a decrease in circulating TNF-␣, whereas adiponectin was increased only in diabetic subjects. Further studies are needed to elucidate the relationship between changes of adipokines and the health benefits of weight loss.
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