Energy Balance and Macronutrient Distribution in Relation to CRP and HbA1c Levels Among Patients with Type 2 Diabetes

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1 Energy Balance and Macronutrient Distribution in Relation to CRP and HbA1c Levels Among Patients with Type 2 Diabetes Hiba Bawadi, PhD, CNS, FACN

2 OUTLINE Background and definitions Research Objective Methods Results and discussion Limitations Conclusion

4 Background and Definitions Obesity and diabetes are states of inflammation associated with elevated circulation of inflammatory mediators. Excess adiposity and oxidative stress, induced by feeding, may also lead to a state of low-grade inflammation.

5 Background and Definitions Energy Balance

6 Background and Definitions Glycemic Control Having close-to normal levels of blood sugar in a person with diabetes mellitus HbA1c < 7% (ADA, 2009)

7 Background and Definitions Macronutrient Distribution Contribution of carbohydrates, protein, and fat to energy consumed. Fat (20-35%) Protein (10-35%) Carbohydrates (45-65%) (FNB, IOM, 2002)

8 Background and Definitions C-reactive protein (CRP) is an acute-phase plasma protein ; inflammatory biomarker

9 yes yes yes yes yes yes NO NO N=1500 Sampling: convenient Participants selection Methods Were you told by the doctor that you have type 2 diabetes? Yes Were you diagnosed for more than a year? Yes Do you have any of the following medical conditions? Rheumatoid arthritis; Cancer ; Heart disease; Diabetic foot NO Do you have any recent active inflammation? NO Do you have any recent surgeries? NO Did you recently take NSAIDs on regular bases? NO If you are a woman; are you pregnant? NO N=198 If you are a woman; are you on OCPs?

10 Methods Anthropometrics Following World Health Organization procedures: Weight (kg) Height (cm) BMI (kg/m 2 ) Waist circumference (cm) Body fat distribution (TANITA, BC-418) Total subcutaneous body fat % Truncal subcutaneous fat %

11 Methods Blood samples Collected by a registered nurse Analyzed at KAUH laboratory

12 Dietary data Methods Validated semi-quantitative FFQ 109 items Completed through structured interviews Food models to help portion size estimation Total calorie intake and macronutrients analyzed by ESHA food processor SQL (version )

13 Results and Discussion N=1500

14 Results and Discussion

15 Results and Discussion P< Negative Energy Balance Positive Energy Balance 6. 5 hs-crp mg/l HbA1c %

16 Petelin et al., 2014 a clinical trial that induced weight loss by negative energy balance and were able to show a lowered inflammation and decreased insulin levels among the participants

17 Results and Discussion 3

18 Oxidative stress Systemic Inflammation Hydroperoxides FA Pro-Oxidant load Dietary fat & Systemic inflammation illustration (Sies et al., 2005, Esposito et al., 2002)

19 High Proteins Advanced Glycation end Products Inflammatory mediators Insulin resistance Dietary protein & Systemic inflammation illustration (Vlassara et al., 2002, Uribarri et al., 2003)

20 Limitations The cross-sectional design The lengthy questionnaire and extended patient interview time Energy expenditure was estimated using predictive equations.

21 Conclusions Positive energy balance might be associated with elevated hs- CRP among patients with poorly controlled diabetes. Dietary fats and proteins seemed to be associated with higher hs-crp levels among subjects with poor glycemic control. Energy balance may play a role in the low-grade inflammatory processes underlying obesity-related conditions and particularly diabetes.

22 Acknowledgements Organizing committee My team : Rami Katkhouda ; Dr. Ahmad Alhaifi; Dr. Reema Tayyem, Mrs. Cosette Fakih Elkhouri, Ms. Ziena Jamal JUST

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