Optimal energy distribution of carbohydrate intake for Japanese elderly patients with type 2 diabetes: The Japanese Elderly Intervention Trial

Abstract

Aim:In diet therapy for diabetes, optimal energy intake and the energy distribution of macronutrients (protein : fat : carbohydrate [PFC] energy ratio) are important. We aimed to clarify the correlation between the PFC energy ratio and metabolic parameters including glycated hemoglobin A1c (HbA1c) and triglycerides in Japanese elderly patients with type 2 diabetes mellitus aged 65 years or older.Methods: Participants were 1173 diabetic patients aged 65 years or older with serum HbA1c level of м7.4% enrolled in the Japanese Elderly Diabetes Intervention Trial (J-EDIT). The participants were divided into four groups by the percentage of total energy intake (%E) of carbohydrate (C1: less than 55%E, C2: 55%E or more and less than 60%E, C3: 60%E or more and less than 65%E, and C4: 65%E or more). Relations of %E of carbohydrate to HbA1c and other metabolic parameters, energy intake and nutritional intake were examined. Furthermore, the subjects were divided into four categories by HbA1c levels by quartile method (Q1: less than 7.90%, Q2: 7.90% or more and less than 8.30%, Q3: 8.30% or more and less than 8.80%, Q4: 8.80% or more). Relations of HbA1c to other metabolic parameters, energy intake and nutritional intake were examined. Results:The mean HbA1c levels in the four groups were C1: 8.40%, C2: 8.50%, C3: 8.41% and C4: 8.36% in men, and C1: 8.51%, C2: 8.47%, C3: 8.35% and C4: 8.52% in women, respectively. There were no significant differences and linear trend in HbA1c levels across groups. The mean triglyceride levels were in the range of 122-128 mg/dL in men from C1 to C3, although it was significantly higher in C4 (177 mg/dL). The mean triglyceride levels were in the range of 128-136 mg/dL in women from C1 to C3, although it was significantly higher in Q4 (150 mg/dL). Amounts of protein and fat intakes decreased with an increase of %E of carbohydrate, although amount of carbohydrate intake did not change significantly. As a result, %E of protein and fat, and energy intake decreased in both men and women with an increase in %E of carbohydrate. Among the four quartiles divided by HbA1c levels, there were no significant differences in energy intake and PFC energy ratio. Conclusions:The present study suggests that, within the range studied, the carbohydrate energy ratio has no correlation with HbA1c levels. However, serum triglyceride levels increased and high-density lipoprotein cholesterol levels decreased significantly, with an increase of %E of carbohydrate in men, and the same tendencies were observed in women. Furthermore, in patients with 65%E or more of carbohydrate, serum triglyceride levels exceeded 150 mg/dL, which is the recommended treatment target for diabetic patients. These results suggest that the ideal %E of carbohydrate for Japanese elderly type 2 diabetes is less than 65. The lower limit of %E of carbohydrate could not be determined from the present study. Geriatr Gerontol Int 2012; 12 (Suppl. 1): 41-49.

Dietary intake in Japanese patients with type 2 diabetes: Analysis from Japan Diabetes Complications Study

“…The proportions of protein, fat and carbohydrate as percentages of energy supply in the JDCS patients were similar to those reported in elderly Japanese type 2 diabetic patients (fat/carbohydrate: 25.6/59.0%), the general Japanese population (25.8/59.3%), and a comprehensive picture of the pattern of the country's food supply reported in the FAO Balance Sheet (27.3/59.5%). Furthermore, according to the report of the FAO in 1996, fat and carbohydrate as percentages of energy supply in the USA, European region, Spain, Korea, and South Africa were 34.5/53.1%, 33.5/54.4%, 39.5/47.5%, 20.0/68.9%, and 22.0/67.7%, respectively.…”

“…Thus, it is necessary to determine and assess dietary patterns in diabetes patients. However, there have been no large-scale studies of dietary patterns in nationwide settings from Asian regions except a recent study of elderly diabetic patients 2 [3][4][5][6] .…”

Instant noodle consumption is associated with cardiometabolic risk factors among college students in Seoul

“…We are unable to provide a mechanistic interpretation of these findings but it is probably due to the large amounts of carbohydrates and fat contained in instant noodles. Excess carbohydrate intake is known to increase triglyceride levels [20]. …”

Impact of High-Carbohydrate Diet on Metabolic Parameters in Patients with Type 2 Diabetes

“…Kamada C et al performed a study to assess the correlation between the C:F:P energy ratio and HbA1c and TG in 1173 Japanese elderly patients with T2DM, aged 65 years or older [32]. They divided participants into four groups by the % of total energy intake of carbohydrate (C1: <55%; C2: 55%≤, <60%; C3: 60≤, <65%; C4: ≥65%).…”