Anti-Infammatory diet Improve Postprandi
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Medscape Medical News
"Anti-Inflammatory" Diet May Improve Postprandial Glucose, Cardiovascular Health CME/CE
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD
Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.
Release Date: January 23, 2008
Authors and Disclosures
Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Charles Vega, MD
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
January 23, 2008 — Dietary and lifestyle strategies for improving postprandial glucose, lipid profile, markers of inflammation, and cardiovascular health are reviewed in a state-of-the-art paper reported in the January 22 issue of the Journal of the American College of Cardiology.
"The highly processed, calorie-dense, nutrient-depleted diet favored in the current American culture frequently leads to exaggerated supraphysiological post-prandial spikes in blood glucose and lipids," write James H. O'Keefe, MD, from the Mid America Heart Institute and University of Missouri–Kansas City, and colleagues. "This state, called post-prandial dysmetabolism, induces immediate oxidant stress, which increases in direct proportion to the increases in glucose and triglycerides after a meal. The transient increase in free radicals acutely triggers atherogenic changes including inflammation, endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity."
Even in individuals without diabetes, postprandial dysmetabolism independently predicts future cardiovascular events. Dietary improvements are associated with dramatic and immediate benefits in postprandial dysmetabolism.
To attenuate the increase in glucose, triglycerides, and inflammation after a meal, the review authors recommend a diet rich in minimally processed, high-fiber, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts. Other dietary interventions that can significantly ameliorate postprandial dysmetabolism include intake of lean protein, vinegar, fish oil, tea, and cinnamon. Additional benefits may result from calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol.
Specific recommendations to improve postprandial glucose and triglycerides are as follows:
* Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts.
* At all 3 meals, consume lean protein.
* Eat approximately 1 handful of nuts daily (using a closed fist), consumed with vegetables, grains, berries, or other fruits.
* Eat salad daily, consisting of leafy greens with dressing of vinegar and virgin olive oil.
* Avoid highly processed foods and beverages, particularly those containing sugar, high-fructose corn syrup, white flour, or trans fats.
* Limit portion sizes to modest quantities.
* Maintain normal weight and avoid overweight or obesity. Waist circumference should be less than one half of height in inches.
* Perform physical activity for at least 30 minutes or more daily, of at least moderate intensity.
* For those with no history of substance abuse, consuming 1 alcoholic beverage before or with an evening meal may be considered.
"Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk," the review authors write. "This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes."
J Am Coll Cardiol. 2008;51:249-255.
Clinical Context
Approximately one third of Americans are thought to have abnormal glucose homeostasis, and poor diet is a major contributor to this phenomenon. Beyond overt diabetes, glucose intolerance has important clinical implications, as there is a direct linear relationship between glucose levels after a glucose challenge test and the risks for cardiovascular death and all-cause mortality.
Diet also significantly contributes to hyperlipidemia, and a single meal high in saturated fat can immediately raise serum triglyceride levels, oxidative stress, and intravascular inflammation. These factors help explain why some research has suggested that postprandial triglyceride levels are better predictors of cardiovascular risk than fasting triglyceride levels. At the same time, significant reductions in triglyceride levels of 20% to 40% can reduce the risk for coronary artery disease by as much as 40%.
There is good evidence regarding dietary interventions that can prevent hyperglycemia and hyperlipidemia. The current review summarizes the best dietary approaches to achieve these goals.
Study Highlights
* The glycemic index of a food is defined as the incremental increase in the area under the postprandial glucose curve after ingestion of 50 g of a specific amount of food vs that associated with 50 g of oral glucose. Ideal carbohydrates with a low glycemic index include green leafy vegetables such as broccoli and spinach and fruits such as grapefruits and cherries.
* Excess intake of processed carbohydrates leads to a vicious cycle of transient spikes in blood glucose levels, increased insulin production, and reactive hypoglycemia.
* Berries, dark chocolate, red wine, tea, and pomegranates reduce postprandial oxidant stress and inflammation.
* When paired with a high-glycemic-index meal, cinnamon slows gastric emptying and reduces postprandial glucose excursion.
* Nuts also slow gastric emptying and can reduce the impact of high-glycemic-index carbohydrates by as much as half. Nuts also reduce postprandial oxidative protein damage, and consumption of nuts at least 5 times weekly can reduced the risks for coronary artery disease and diabetes by 20% to 50%.
* Vinegar can reduce postprandial glycemia and promotes satiety.
* Lean protein reduces postprandial glucose excursion and improves satiety. Such protein includes egg whites, game meat, skinless poultry breast meat, and whey protein or other nonfat dairy protein.
* Drinking 0.5 to 1 alcoholic drink per day for women and 1 to 2 alcoholic drinks per day for men can reduce cardiovascular risk, and 1 to 2 drinks before a meal can reduce postprandial glucose and insulin levels. However, higher levels of drinking can impair glucose metabolism.
* Exercise acutely lowers glucose and triglyceride levels in a dose-dependent fashion.
Pearls for Practice
* There is a linear relationship between impaired glucose tolerance and mortality, and a fatty meal can lead to immediate increases in serum triglyceride levels. However, reducing triglyceride levels can reduce the risk for coronary artery disease by as much as 40%.
* The current review recommends foods with a low glycemic index such as vegetables and fruits. Other recommended foods include nuts, cinnamon, vinegar, egg whites, and whey protein.
Which of the following statements about postprandial glucose and lipid levels is most accurate?
Glucose intolerance does not promote an increase in the risk for all-cause mortality
Levels of serum triglycerides generally remain stable immediately after a meal high in saturated fat
Only elevated fasting levels of triglycerides have been associated with an increased risk for cardiovascular events
A significant reduction in serum triglyceride levels can reduce the risk for coronary artery disease by 40%
All of the following foods were explicitly recommended in the current review by O'Keefe and colleagues except:
Whole eggs
Cinnamon
Vinegar
Nuts
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News Author
Laurie Barclay, MD
is a freelance reviewer and writer for Medscape.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
CME Author
Charles P. Vega, MD
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Medscape Medical News 2008. ©2008 Medscape
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