| Part 1 The relationship between the carbohydrate intake and the occurrence of depression and glycometabolism control in patients with type 2 diabetes mellitusObjectives:This study aimed to understand the current status of carbohydrate intake,the occurrence of depression and glycometabolism control in patients with type 2 diabetes mellitus(T2DM),then to explore the relationship between carbohydrate intake and occurrence of depression and glycemic control in patients with T2DM,so as to provide a research basis for formulating a dietary regimen that is beneficial to both reducing glycometabolism and improving depressive symptoms in patients with T2DM.Methods:This part is a cross-sectional study.According to the convenient sampling method,a total of 238 T2DM patients who conformed the inclusion and exclusion standards were selected.Demographic and clinical data of T2DM patients were collected using general information questionnaire;three days dietary records were used to collect the diet of the patients,the intake of three macronutrients of the patients were calculated by nutrition software,and then low carbohydrate diet(LCD)score was calculated to help understand the carbohydrate intake status of T2DM patients,the higher the LCD score,the lower the carbohydrate intake.In this study,the LCD scores were divided into four groups from low to high by quartile method:Q1,Q2,Q3 and Q4.Meanwhile,depression score was assessed through PROMIS short form-Depression,glycosylated hemoglobin(HbAlc),fasting blood glucose(FBG)and 2 hrs postprandial plasma(2hPG)levels were collected.Multivariate Logistic regression analysis was used to explore the relationship between carbohydrate intake and occurrence of depression and glycemic control in T2DM patients.Results:1.Demographic and clinical data of patientsA total of 238 patients with T2DM were included in this study,ranging in age from 30 to 88 years old,with an average age of(65.5±10.82)years old.Among them,138(57.6%)were males,it is suggested that this study mainly consisted of elderly men.The mean duration of diabetes was(13.75±7.63)years.2.Current status of carbohydrate intake in this studyIn this study,the LCD scores were divided into four groups from low to high by quartile method:Q1,Q2,Q3 and Q4,LCD scores were(<10.0),(10.0～16.0),(16.1～22.0)and(>22.1)points,respectively;carbohydrate intake were(299.81±125.01)g,(256.90±74.4)g,(233.5±60.06)g and(194.23±67.61)g,respectively;the percentage of the calories from carbohydrate were 68%,61%,53%and 44%,respectively.3.The relationship between carbohydrate intake and the occurrence of depression in patients with T2DMAfter adjusting for depression-related demographic,clinical,and mutrient indicators,the higher LCD score and the lower carbohydrate intake are the protective factor for the occurrence of depression in T2DM patients,taking Q1 group as a reference,the risk of depression in Q2～Q4 groups were(OR=0.172,95CI%=0.063～0.468,P<0.01),(OR=0.200,95CI%=0.071～0.563,P<0.01)and(OR=0.019,95CI%=0.002～0.173,P<0.01),respectively.4.The relationship between carbohydrate intake and glycemic control in patients with T2DMAfter adjusting the demographic,clinical and nutrient indicators related to HbAlc,FBG and 2hPG,the results showed that taking Q1 group as a reference,the OR(95CI%)of HbAlc control in Q2～Q4 were(OR=0.378,95CI%=0.126^1.133,P=0.082),(OR=0.291,95CI%=0.100～0.845,P=0.023)and(OR=0.051,95CI%=0.016～0.162,P<0.01),respectively;taking Q1 group as a reference,the OR(95CI%)of FBG control in Q2～Q4 were(OR=1.115,95CI%=0.414～3.004,P=0.829),(OR=0.909,95CI%=0.350～2.365,P=0.846)and(OR=0.296,95CI%=0.114～0.769,P=0.012),respectively;taking Q1 group as a reference,the OR(95CI%)of 2hPG control in Q2～Q4 were(OR=0.331,95CI%=0.085～1.291,P=0.111),(OR=0.298,95CI%=0.075～1.177,P=0.084)and(OR=0.065,95CI%=0.017-0.254,P<0.01),respectively,which indicated that the higher LCD score and the lower carbohydrate intake are the protective factors for HbA1c,FBG,and 2hPG control in patients with T2DM.Conclusions:The higher LCD score,the lower carbohydrate intake are the protective factor for the occurrence of depression and glycemic control in T2DM patients.Part 2 The effect of Almond based low-carbohydrate dietary intervention on the improvement of depression and glycometabolism levels in patients with type 2 diabetes mellitusObjectives:This study aimed to explore the effect of almond-based low carbohydrate diet(aLCD)intervention on depression,glycometabolism level and fasting glucagon-like peptide(GLP-1)in T2DM patients.In order to provide a scientific and reasonable diet regimen for diabetic patients with depression.Methods:This study is a prospective randomized controlled study.T2DM who met the inclusion and exclusion criteria were selected by the method of convenient sampling,and they were randomly divided into the aLCD group(n=22)and the low fat diet(LFD)group(n=23)according to the random number table generated by SPSS 25.0.The LFD group received low-fat diet education,the aLCD group received almond-based low carbohydrate diet education,the key content of it as follow:on the basis of the LFD,56g/d(1 bag/d)almond was used to replace 150g/d the staple food that rich in carbohydrate,which was named aLCD regimen.The intervention lasted for 12 weeks,and the frequency of weekly follow-up was maintained as planned.At the 12 weeks,patients in both groups were measured:(1)dietary adherence;(2)almond eating compliance of aLCD group,eating ≥4 bags/week means good compliance;patients in two groups were compared:(1)depression scores;(2)glycometabolism levels including:HbAlc,FBG and 2hPG;(3)fasting GLP-1 level.Results:1.Dietary AdherenceThe result indicated that the frequency of almond consumption in the aLCD group was maintained with 6 bags/week.At the 12 weeks,when compared to the LFD group,the calories from carbohydrate decreased significantly and calories from fat increased significantly in the aLCD group(P<0.01).Furthermore,the percentage of the calories from carbohydrate is 40%in the aLCD group,and the percentage of the calories from fat is 25%in the LFD group,which indicated that the aLCD and LFD group conform the criterion of LCD and LFD,respectively.2.The effect of aLCD on depression score in T2DM patients(1)At the 12 weeks,the result of covariance analysis showed that the depression score in the aLCD group was significantly lower than that in the LFD group(P<0.01).(2)Compared to the baseline,the depression score in the aLCD group was significantly decreased at the 12 weeks(P<0.01);but there were no significant changes of depression score in the LFD group(P>0.05).(3)Intention to treat analysis:The baseline depression scores of the excluded patients were used to supplement their depression scores after the intervention for intention analysis.The results showed that after 12 weeks of intervention,the depression scores in the aLCD group were significantly lower than that in the LFD group(P<0.01).Compared to the baseline,the depression score in the aLCD group was significantly decreased at the 12 weeks(P<0.01);but there were no significant changes in depression score of the LFD group(P>0.05).3.The effect of aLCD on glycometabolism level in T2DM patients(1)At the 12 weeks,the result of covariance analysis showed that the HbA1c level in aLCD group was significantly lower than that in LFD group(P<0.01),but there was no significant difference in FBG and 2hPG levels between the two groups(P>0.05).(2)Compared to the baseline,the HbAlc(aLCD:P<0.01;LFD:P<0.05)and 2hPG(aLCD:P<0.05;LFD:P<0.01)levels in both the aLCD and LFD groups were significantly decreased at the 12 weeks;in addition,the FBG level in the aLCD group was significantly decreased at the 12 weeks(P<0.01),while there was no significant difference in the LFD group(P>0.05).4.The effect of aLCD on fasting GLP-1 levels in T2DM patients(1)At the 12 weeks,the GLP-1 level in the aLCD group was significantly higher than that in the LFD group(P<0.05).(2)Compared to the baseline,the GLP-1 level in both the aLCD and LFD were no significant difference at the 12 weeks(P>0.05).Conclusions:The 12 weeks aLCD intervention significantly improved the depression score and HbA1c level of T2DM patients,and maintained the fasting GLP-1 secretion.Therefore,aLCD is a dietary regimen that may improve depression and glucose metabolism by maintaining fasting GLP-1 secretion in T2DM patients. |
PDF Full Text Request