Angela Albarosa Rivellese

Background/Objectives: Dietary fibers from cereals promote the production of short-chain fatty acids (SCFA), which have been linked to improved glucose and lipid metabolism, reduced inflammation, and decreased oxidative stress. Wheat aleurone, a bran fraction enriched in fermentable fibers and bioactive compounds, may enhance SCFA production, but clinical evidence remains limited. This study investigated whether a wheat aleurone-rich diet, compared with a refined wheat diet, modulates circulating SCFA concentrations and their relationship with oxidative stress in individuals at elevated cardio-metabolic risk. Methods: In a randomized, cross-over trial, 23 adults with abdominal obesity and at least one additional metabolic syndrome feature consumed isoenergetic diets enriched with wheat aleurone or refined wheat for 8 weeks. Fasting and postprandial serum SCFA concentrations were measured over 3 h following standardized test meals using the gas chromatography method. Urinary 8-isoprostane excretion was assessed as a biomarker of oxidative stress using the ELISA method. SCFA values are reported as changes (increase/decrease) from fasting values, calculated by subtracting the fasting value from that of each time point. Results: Compared with refined wheat, the wheat aleurone diet significantly increased postprandial butyrate response (p = 0.005, time × meal interaction), with higher values observed at 150 min (p = 0.027) and 180 min (p = 0.001). The mean change in postprandial butyrate was also greater after the wheat aleurone diet (+0.95 ± 1.92 vs. −0.32 ± 2.01 µmol/L; p = 0.040). Importantly, butyrate at 180 min was inversely correlated with urinary 8-isoprostane (r = −0.618, p = 0.019). No significant differences were found for acetate or propionate. Conclusions: A wheat aleurone-rich diet enhances postprandial butyrate production and is associated with lower oxidative stress, suggesting a role of butyrate in mediating the antioxidant benefits of wheat aleurone in individuals with cardio-metabolic risk. This study is registered under ClinicalTrials.gov Identifier no. NCT02150356.

Background: Endothelial dysfunction is recognized as an early modification involved in the pathogenesis of vascular diseases. Evidence suggests that the Mediterranean Diet (MD) is associated with endothelial function improvement and, in turn, plays an important role in atherosclerosis development and progression. Objectives: To evaluate both acute and sustained effects of the MD on endothelial function in patients with high cardiometabolic risk. Methods: A total of 25 subjects were randomly assigned to either the MD group or the Control Diet (CD) group according to a single-blind, parallel-group study design. Endothelial function was evaluated through non-invasive flow-mediated dilation (FMD) measurements at baseline (T0) and after 8 weeks (Tw8) of the MD or CD intervention, under both 12 h fast condition (fasting) and 2 h post-meal resembling the assigned diet (2 h). Assessments were conducted by a blinded sonographer. Results: FMD at T0-fasting was similar between MD and CD groups (6.11% ± 0.67 vs. 7.90% ± 1.65; p = 0.266). A significant difference in FMD between MD and CD groups was observed at T0-2h (12.14% ± 1.93 vs. 4.01% ± 1.03; p = 0.004), T8w-fasting (9.76% ± 1.18 vs. 5.03% ± 0.89; p = 0.008), and T8w-2h (8.99% ± 1.22 vs. 3.86% ± 0.52; p = 0.003). Oral glucose insulin sensitivity (OGIS) at T0 correlated with FMD percent changes from T0-fasting to T0-2h (r = 0.414, p = 0.044). After adjusting for age, gender, and OGIS, MD was an independent predictor of percent changes in FMD from T0-fasting to T0-2h (β: −0.582, p = 0.003), from T0-fasting to T8w-fasting (β: −0.498, p = 0.013), and from T0-fasting to T8w-2h (β: −0.479, p = 0.018). Conclusions: Adherence to the MD may improve endothelial function in both the short- and medium-term among patients at high cardiometabolic risk.

Aims: To investigate clusters of adipose tissue dysfunction, that is, with adipose tissue insulin resistance (ADIPO‐IR) and large waist circumference (WC), identify a worse lipidomic profile characterised by a high proportion of lipids rich in saturated fatty acids (SFA).Materials and Methods: Hierarchical clustering based on WC and ADIPO‐IR (calculated as fasting plasma non‐esterified fatty acids times fasting plasma insulin, FFA×INS), was performed in 192 adults with overweight/obesity and type 2 diabetes (T2D) treated with metformin (HbA1c = 7.8%). Free fatty acid composition and lipidomic profile were measured by mass spectrometry (GC‐MS and LC‐MSQTOF). Indexes of fatty acid desaturation (stearoyl‐coA desaturase‐1 activity, SCD1₁₆ = palmitoleic acid/palmitic acid and SCD1₁₈ = oleic acid/stearic acid) and of insulin resistance (HOMA‐IR) were also calculated.Results: Three clusters were identified: CL1 (ADIPO‐IR = 4.9 ± 2.4 and WC = 96±7 cm, mean ± SD), CL2 (ADIPO‐IR = 6.5 ± 2.5 and WC = 114 ± 7 cm), and CL3 (ADIPO‐IR = 15.0 ± 4.7 and WC = 107 ± 8 cm). Insulin concentrations, ADIPO‐IR, and HOMA‐IR significantly increased from CL1 to CL3 (all p < 0.001), while fasting glucose concentrations, HbA1c, dietary lipids and caloric intake were similar. Moreover, CL3 showed significantly higher concentrations of monounsaturated free fatty acids, oleic and palmitoleic acids, triglycerides (TAG) rich in saturated FA and associated with de novo lipogenesis (i.e., TAG 46–50), higher SCD1_16, SCD1₁₈, ceramide (d18:0/18:0), and phosphatidylcholine aa(36:5) compared with CL1/CL2 (all p < 0.005).Conclusions: High ADIPO‐IR and large WC identify a worse lipid profile in T2D characterised by complex lipids rich in SFA, likely due to de novo synthesis given higher plasma monounsaturated FFA and increased desaturase activity indexes.Registration Number Trial: ID NCT00700856 https://clinicaltrials.gov.

Background. High blood concentrations of triglycerides (TG) in the postprandial period have been shown to be more closely associated with the risk of cardiovascular disease (CVD) than fasting values in individuals with type 2 diabetes (T2D). Dietary changes are the primary determinants of postprandial lipid responses. Methods. We investigated the effects of an isocaloric multifactorial diet, rich in n-3 PUFA, MUFA, fiber, polyphenols, and vitamins, compared to an isocaloric diet, containing the same amount of MUFA, on the postprandial lipid response in T2D individuals. Following a randomized, controlled, parallel group design, 43 (25 male/18 female) T2D individuals were assigned to an isocaloric multifactorial (n = 21) or a MUFA-rich diet (n = 22). At the beginning and after the 8 weeks of dietary intervention, the concentrations of plasma triglycerides, total cholesterol, HDL cholesterol, and non-HDL cholesterol were detected at fasting and over a 4-h test meal with the same composition as the prescribed diet. Results. The concentrations of fasting plasma triglycerides, total cholesterol, HDL cholesterol, and non-HDL cholesterol did not change after both diets. Compared with the MUFA diet, the 8-week multifactorial diet significantly lowered the postprandial response, which was evaluated as the incremental area under the curve (iAUC), of triglycerides by 33% (64 ± 68 vs. 96 ± 50 mmol/L·240 min, mean ± SD, respectively, p = 0.018), total cholesterol by 105% (−51 ± 33 vs. −25 ± 29, p = 0.013), and non-HDL cholesterol by 206% (−39 ± 33 vs. −13 ± 23, p = 0.013). Conclusions. In T2D individuals, a multifactorial diet, characterized by several beneficial components, improved the postprandial lipid response compared to a MUFA diet, generally considered a healthy diet being reduced in saturated fat, and probably contributed to the reduction of cardiovascular risk.

Background and objectives: Sleep disorders are bidirectionally linked with eating behaviors and glucose metabolism, and this could be clinically relevant in type 1 diabetes (T1D). We investigated the relationship between dietary habits and sleep quality in T1D. Methods: According to a cross-sectional design, T1D patients, 60 men and 60 women, aged 19–79, using continuous glucose monitoring (CGM) filled-in a 7-day food diary and completed the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire on dietary habits and the Pittsburgh Sleep Quality Index (PSQI) questionnaire on sleep quality. Blood glucose values over 6 h after dinner were registered for one week. Differences in dietary habits and blood glucose were compared between the participants with good/bad quality, long/short duration, and long/short onset latency of sleep. Results: Bad sleepers (n = 84) were twice as prevalent as good sleepers (n = 36) and had significantly higher intake of fat than good sleepers, in particular at dinner time (30.7 ± 10.7 vs. 24.0 ± 10.5 g, p = 0.004). Short sleepers had significantly higher usual intake (g/1000 kcal) of coffee and tea (88.7 ± 70.9 vs. 62.0 ± 35.6), alcoholic beverages (46.6 ± 50.4 vs. 28.9 ± 31.5), and carbonated soft beverages (21.0 ± 37.5 vs. 9.3 ± 17.2) (p < 0.05 for all). Compared with the short sleep onset latency participants, the long sleep onset latency participants had significantly higher intake of fat at dinner time (41.8 ± 7.4 vs. 38.1 ± 9.1% total energy, p = 0.029). No differences in post-dinner blood glucose were detected between the participants with bad or good sleep quality. Discussion: Sleep disruption is common in T1D and is associated with unhealthy dietary choices, especially at dinner time, independently of post-dinner blood glucose control.

Background: Evidence on the risk of sarcopenia and associated factors in older adults with type 2 diabetes (T2D) is lacking. We evaluate (1) the proportion of patients at risk of sarcopenia in older adults with T2D; and (2) the factors associated with the risk of sarcopenia. Methods: We conducted a cross-sectional study on T2D patients over 65 years referred to our outpatient clinic and who carried out the yearly complication assessment visit. Eligible patients were administered questionnaires during phone interviews for the risk evaluation of sarcopenia (SARC-F), the risk evaluation of malnutrition (Mini Nutritional Assessment Short Form (MNA^®-SF)), the adherence to the Mediterranean diet (MEDI-quest), and the evaluation of physical activity (the International Physical Activity Questionnaire short form). Results: A total of 138 patients were included in the study, and 12 patients (8.7% (95% CI 4.6–14.7)) were at risk of sarcopenia. The mean SARC-F score was significantly higher in women compared with men (2.1 ± 1.8 vs. 0.9 ± 1.4, respectively; p < 0.001). The majority of patients identified at risk of sarcopenia compared with those not at risk were women (75% vs. 30%, respectively; p = 0.003), had a higher proportion of neuropathy (50% vs. 19%, respectively; p = 0.027), a lower mean MNA^®-SF score (11.6 ± 1.5 vs. 13.0 ± 1.4, respectively; p = 0.001), a lower mean MEDI-quest score (5.2 ± 1.5 vs. 5.9 ± 1, respectively; p = 0.037), and were more inactive (92% vs. 61%, respectively; p = 0.032). Conclusions: In a sample of older adults with T2D, the risk of sarcopenia was identified in 8.7% (95% CI: 4.6–14.7) of the sample, and the main factors associated were female gender, neuropathy, a lower MNA^®-SF score, low adherence to the Mediterranean diet, and low physical activity.

Background: Our aims were to evaluate the relationship of habitual legume consumption with blood pressure (BP) control in a large cohort of people with T2D and hypertension, and to investigate whether specific nutritional components of legumes or other foods may contribute to regulate BP levels. Methods: We studied 1897 participants with T2D and hypertension. Dietary habits were assessed through a validated food frequency questionnaire. Sex-specific quartiles of legume consumption were created. Results: Higher legume consumption was associated with a lower intake of energy, carbohydrates, glycaemic load, alcohol, and sodium, and a significantly greater intake of proteins, fat, monounsaturated, polyunsaturated, fibre, potassium, and polyphenols. Significantly lower systolic and diastolic BP values were observed in the highest vs. lowest quartile of legume consumption (132.9 ± 6.7 vs. 137.3 ± 7.0 mmHg, p < 0.001; 78.9 ± 4.1 vs. 81.0 ± 4.2 mmHg, p = 0.002; respectively), as well as the proportion of people meeting the treatment targets (61.3% vs. 37.4% and 71.3% vs. 52.4%, respectively, p < 0.01). This association was independent from other foods whose consumption is associated with the high legume intake. Conclusions: In people with T2D and hypertension, three servings of legumes per week are associated with significantly better BP control. This gives further support to current dietary guidelines in recommending the frequent consumption of legumes, as a “ready-to-use” dietary strategy to achieve optimal BP control.