Document Type : Original Article(s)

Authors

1 Department of Cardiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran

3 Physiology Research Center AND Department of Neurology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

4 Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran

Abstract

BACKGROUND: This study was conducted to establish the comparative effects of carbohydrate versus fat restriction on metabolic indices in Type 2 diabetic (T2D) patients with coronary heart disease (CHD). METHODS: This randomized, clinical trial was done among 56 overweight persons with T2D and CHD aged 40-85 years old. The patients were randomly allocated to take either a high-carbohydrate (HC) diet (60-65% carbohydrates and 20-25% fats) (n = 28) or a restricted carbohydrate (RC) diet (43-49% carbohydrate and 36-40% fats) (n = 28) for 8 weeks to determine metabolic status. RESULTS: After 8 weeks of treatment, RC diet decreased fasting plasma glucose (FPG) (−11.5 ± 28.3 vs. +7.0 ± 26.9 mg/dl, P = 0.010) and high-sensitivity C-reactive protein (hs-CRP) (−564.3 ± 1280.1 vs. +286.1 ± 1789.2 ng/ml, P = 0.040) compared with a HC diet. Moreover, compared with a HC diet, RC diet increased total antioxidant capacity (TAC) (+274.8 ± 111.5 vs. +20.2 ± 82.5 mmol/l, P < 0.001) and glutathione (GSH) levels (+51.6 ± 111.5 vs. −32.6 ± 88.5 µmol/l, P = 0.003). No significant alterations between the two groups were found in terms of their effect on other metabolic profiles. CONCLUSION: RC diet in overweight T2D with CHD had beneficial effects on FPG, hs-CRP, TAC, and GSH values. 

Keywords

  1. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87(3): 293-301.
  2. Ades PA, Savage PD. Potential benefits of weight loss in coronary heart disease. Prog Cardiovasc Dis 2014; 56(4): 448-56.
  3. Garcia-Bailo B, El-Sohemy A, Haddad PS, Arora P, Benzaied F, Karmali M, et al. Vitamins D, C, and E in the prevention of type 2 diabetes mellitus: modulation of inflammation and oxidative stress. Biologics 2011; 5: 7-19.
  4. Kotur-Stevuljevic J, Memon L, Stefanovic A, Spasic S, Spasojevic-Kalimanovska V, Bogavac-Stanojevic N, et al. Correlation of oxidative stress parameters and inflammatory markers in coronary artery disease patients. Clin Biochem 2007; 40(3-4): 181-7.
  5. Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J 2013; 34(31): 2436-43.
  6. von Bibra H, St John Sutton M, Schuster T, Ceriello A, Siegmund T, Schumm-Draeger PM. Oxidative stress after a carbohydrate meal contributes to the deterioration of diastolic cardiac function in nonhypertensive insulin-treated patients with moderately well controlled type 2 diabetes. Horm Metab Res 2013; 45(6): 449-55.
  7. Zhang X, Yan SM, Zheng HL, Hu DH, Zhang YT, Guan QH, et al. A mechanism underlying hypertensive occurrence in the metabolic syndrome: cooperative effect of oxidative stress and calcium accumulation in vascular smooth muscle cells. Horm Metab Res 2014; 46(2): 126-32.
  8. Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J 2008; 42(4): 256-63.
  9. Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr 2007; 86(4): 946-51.
  10. Parillo M, Rivellese AA, Ciardullo AV, Capaldo B, Giacco A, Genovese S, et al. A high-monounsaturated-fat/low-carbohydrate diet improves peripheral insulin sensitivity in non-insulin-dependent diabetic patients. Metabolism 1992; 41(12): 1373-8.
  11. Jonasson L, Guldbrand H, Lundberg AK, Nystrom FH. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Ann Med 2014; 46(3): 182-7.
  12. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Sato M, et al. Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis. Diabetes Care 2009; 32(5): 959-65.
  13. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005; 111(11): 1448-54.
  14. Kasim-Karakas SE, Tsodikov A, Singh U, Jialal I. Responses of inflammatory markers to a low-fat, high-carbohydrate diet: effects of energy intake. Am J Clin Nutr 2006; 83(4): 774-9.
  15. Rajaie S, Azadbakht L, Saneei P, Khazaei M, Esmaillzadeh A. Comparative effects of carbohydrate versus fat restriction on serum levels of adipocytokines, markers of inflammation, and endothelial function among women with the metabolic syndrome: a randomized cross-over clinical trial. Ann Nutr Metab 2013; 63(1-2): 159-67.
  16. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32(9 Suppl): S498-S504.
  17. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37(Suppl 1): S81-S90.
  18. Welles CC, Whooley MA, Karumanchi SA, Hod T, Thadhani R, Berg AH, et al. Vitamin D deficiency and cardiovascular events in patients with coronary heart disease: data from the Heart and Soul Study. Am J Epidemiol 2014; 179(11): 1279-87.
  19. Pisprasert V, Ingram KH, Lopez-Davila MF, Munoz AJ, Garvey WT. Limitations in the use of indices using glucose and insulin levels to predict insulin sensitivity: impact of race and gender and superiority of the indices derived from oral glucose tolerance test in African Americans. Diabetes Care 2013; 36(4): 845-53.
  20. Tatsch E, Bochi GV, Pereira Rda S, Kober H, Agertt VA, de Campos MM, et al. A simple and inexpensive automated technique for measurement of serum nitrite/nitrate. Clin Biochem 2011; 44(4): 348-50.
  21. Benzie IFF, Strain JJ. The ferric reducing ability of plasma (FRAP) as a measure of antioxidant power: The FRAP assay. Anal Biochem 1996; 239(1): 70-6.
  22. Beutler E, Gelbart T. Plasma glutathione in health and in patients with malignant disease. J Lab Clin Med 1985; 105(5): 581-4.
  23. Janero DR. Malondialdehyde and thiobarbituric acid-reactivity as diagnostic indices of lipid peroxidation and peroxidative tissue injury. Free Radic Biol Med 1990; 9(6): 515-40.
  24. Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009; 44(4): 297-309.
  25. Lachin JM. Fallacies of last observation carried forward analyses. Clin Trials 2016; 13(2): 161-8.
  26. Mirhashemi SM, Najafi V, Raygan F, Asemi Z. The effects of coenzyme Q10 supplementation on cardiometabolic markers in overweight type 2 diabetic patients with stable myocardial infarction: A randomized, double-blind, placebo-controlled trial. ARYA Atheroscler 2016; 12(4): 158-65.
  27. Zarei M, Farahnak Z, Hosseinzadeh-Attar MJ, Javanbakht MH, Hosseinzadeh P, Derakhshanian H, et al. Lipid peroxidation and antioxidant enzymes activity in controlled and uncontrolled Type 2 diabetic patients. ARYA Atheroscler 2016; 12(3): 118-23.
  28. Ballard KD, Quann EE, Kupchak BR, Volk BM, Kawiecki DM, Fernandez ML, et al. Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins. Nutr Res 2013; 33(11): 905-12.
  29. Hickey JT, Hickey L, Yancy WS, Hepburn J, Westman EC. Clinical use of a carbohydrate-restricted diet to treat the dyslipidemia of the metabolic syndrome. Metab Syndr Relat Disord 2003; 1(3): 227-32.
  30. Forsythe CE, Phinney SD, Fernandez ML, Quann EE, Wood RJ, Bibus DM, et al. Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008; 43(1): 65-77.
  31. McLaughlin T, Carter S, Lamendola C, Abbasi F, Yee G, Schaaf P, et al. Effects of moderate
  32. variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am J Clin Nutr 2006; 84(4): 813-21.
  33. Barbosa KB, Volp AC, Marques-Rocha JL, Ribeiro SM, Navarro-Blasco I, Zulet MA, et al. Low energy and carbohydrate intake associated with higher total antioxidant capacity in apparently healthy adults. Nutrition 2014; 30(11-12): 1349-54.
  34. Skalicky J, Muzakova V, Kandar R, Meloun M, Rousar T. Oxidative stress and metabolic syndrome in obese adults with and without controlled diet restriction. Bratisl Lek Listy 2009; 110(3): 152-7.
  35. Rankin JW, Turpyn AD. Low carbohydrate, high fat diet increases C-reactive protein during weight loss. J Am Coll Nutr 2007; 26(2): 163-9.
  36. Lee JY, Zhao L, Youn HS, Weatherill AR, Tapping R, Feng L, et al. Saturated fatty acid activates but polyunsaturated fatty acid inhibits Toll-like receptor 2 dimerized with Toll-like receptor 6 or 1. J Biol Chem 2004; 279(17): 16971-9.