American Journal of Clinical Nutrition最新文献

{"title":"The timing of macronutrient and major food group intake and associations with mortality among US adults, 1999-March 2020: a serial cross-sectional study.","authors":"Yanbo Zhang, Sarah Alver, Zhilei Shan, Yasmin Mossavar-Rahmani, Jie Hu, Ju Zhang, Marie-Pierre St-Onge, Robert Kaplan, Xiaonan Xue, Qibin Qi","doi":"10.1016/j.ajcnut.2025.10.014","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.014","url":null,"abstract":"<p><strong>Background: </strong>Eating timing has been increasingly linked to health, yet national trends in macronutrient/food group timing and their health implications remain unclear.</p><p><strong>Objective: </strong>To characterize trends in timing of energy, macronutrient, and food group intake among US adults and examine their associations with mortality.</p><p><strong>Methods: </strong>In this serial cross-sectional study of adults aged ≥20 years with ≥1 valid 24-hour dietary recall (National Health and Nutrition Examination Survey, 1999-March 2020), we examined secular trends in timing of energy, macronutrients, and major food group intake. Associations with mortality (through December 2019) were examined using Cox models.</p><p><strong>Results: </strong>Among 50,264 adults, evening (6-10pm) accounted for the highest daily energy intake (weighted mean proportions across years, 31.9%-33.3%), followed by noon (10am-2pm, 24.7%-26.8%), afternoon (2-6pm, 19.9%-21.8%), morning (6-10am, 13.5%-14.9%), and overnight (10pm-6am, 5.6%-6.5%); midnight (10-2am) eating occurred in 23.4%-28.0% of the population. Macronutrient and food groups followed similar patterns, except whole grain (peaked in the morning) and fruit, egg, and dairy intake (more evenly distributed). Over years, noon and midnight energy intake proportions declined, while afternoon proportion increased; secular trends varied by macronutrients/food groups. Fasting started at 8:34-8:51pm and ended at 8:41-8:52am; intake midpoint was 2:38-2:48pm; intake duration was 11.9-12.2 hours. Male, non-Hispanic black, and socioeconomically disadvantaged groups had greater midnight intake proportions and later intake midpoints. Reallocating 5% of daily energy to midnight was associated with higher cardiovascular mortality (HR, 1.09; 95% CI, 1.02,1.17), driven by carbohydrates; reallocating 5% to predawn (2-6am) was associated with higher cancer mortality (1.22;1.05,1.41), driven by proteins. Each 1-hour delay in fasting and intake midpoint was associated with an 8%-9% higher cardiovascular mortality.</p><p><strong>Conclusion: </strong>Overnight intake and delayed eating timing are prevalent among US adults, especially among socioeconomically disadvantaged groups, and were associated with higher mortality, particularly for specific macronutrients/foods, supporting eating timing recommendations integrating food composition.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Customized Multimodal Diabot-GPT-4o Enhances Accuracy of Image-Based Dietary Assessments in Dietetic Trainees in Taiwan: Validation Against Weighed Food Records.","authors":"Yu Jie Chen, Chun-Chao Chang, Yen Nhi Hoang, Annie W Lin, Wen-Ling Lin, Cheng-Yu Lin, Ellyn Patricia, Janice Clarisa Tissadharma, Jovan Kuanca, Natasya Nobelta, Kimberly Alecia Theo, Dang Khanh Ngan Ho, Pin-Hui Wei, Jung-Su Chang","doi":"10.1016/j.ajcnut.2025.10.013","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.013","url":null,"abstract":"<p><strong>Background: </strong>Automated image-based dietary assessments (IBDAs) using multimodal artificial intelligence (AI) chatbots show strong potential. However, sources of error at the human-AI interface in real-world use remain unclear.</p><p><strong>Objective: </strong>In this study, we validated a GPT-4o-powered chatbot for automated IBDAs and identified key sources of error in free-living settings.</p><p><strong>Methods: </strong>In total, 714 food images were collected from 3-day weighed food records (WFRs) across 171 days from 57 young adults. Images were analyzed using four AI configurations: Diabot (DB), DBFN (customized GPT-4o), 4o, and 4oFN (non-customized), where \"FN\" indicates inclusion of the food name input. Portion sizes and nutrient estimates were compared to WFRs using Bland-Altman plots with equivalence testing at ±10%, ±15%, and ±20% bounds.</p><p><strong>Results: </strong>Using images alone, DB recognized 74% of food items versus 59% for 4o. All AI configurations provided accurate estimates of portion sizes (±10%-15%, coefficient of variation (CV): 13%), energy (±10%-20%, CV: 14%), and carbohydrates (±15%-20%, CV: 15%), but showed less consistency for fats (±10%-22%, CV: 24%) and proteins (±10%->20.2%, CV: 18%). The custom DBFN outperformed 4oFN, achieving higher accuracy across more nutrients within the ±10% (weight, energy, fats, saturated fats, potassium, and magnesium), ±15% (proteins and sodium), and ±20% (carbohydrates and calcium) bounds and achieved the highest agreement with WFRs (Spearman ρ = 0.863-0.662; Lin's concordance correlation coefficient = 0.874-0.540). Common errors at the human-AI interface included inaccurate portion size estimates, obscured food visibility in images, poorly constructed prompts, omission or intrusion errors, and system-specific limitations such as processing overload and configuration inconsistencies.</p><p><strong>Conclusions: </strong>Customized AI chatbots improved automated IBDAs, yet accuracy depends on clear images for food visibility and portion-size fidelity. Standardized AI-input procedures (FN, cooking state, prompt structure, and configuration) and expert oversight to detect and correct AI hallucinations (fabricated items, units, or quantities) remain essential for reliable, interpretable estimates.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized trial modeling the effects of solutions with low to moderate glycerol and sodium concentrations on fluid balance in healthy, active adults.","authors":"Lindsay B Baker, J Matthew Hinkley, Michal Ozga, Shelby L Alfred, James R Merritt, Peter John D De Chavez","doi":"10.1016/j.ajcnut.2025.10.011","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.011","url":null,"abstract":"<p><strong>Background: </strong>Ingestion of beverages with glycerol and electrolytes promote fluid retention and fluid balance; however, more research is needed to determine the effects of low to moderate concentrations of these osmolytes.</p><p><strong>Objective: </strong>To evaluate the impact of 0-4.6% glycerol (GLY) and 0-55 mM sodium (SOD) on fluid balance in healthy, active, euhydrated adults.</p><p><strong>Methods: </strong>Thirty-seven participants (n=22 male; n=15 female; 30±8 y; 75.5±12.4 kg) consumed 28-oz of beverage followed by urine and body mass measurements for 210 min. In a double blind, randomized, incomplete block, response surface design, each participant completed 3 trials, where they drank one of six beverages [0% GLY, 0 mM SOD (placebo); 0% GLY, 27.5 mM SOD; 0% GLY, 55 mM SOD; 2.3% GLY, 27.5 mM SOD; 4.6% GLY, 0 mM SOD; 4.6% GLY, 55 mM SOD]. A response surface regression model was fitted to predict the effects of glycerol, sodium, and time on fluid balance (% change in body mass from baseline). 95% confidence intervals were used to compare predicted mean outcomes.</p><p><strong>Results: </strong>Glycerol (p<0.001), sodium (p<0.001), and time (p<0.001) were significant terms in the model (adjusted r²=0.81). There were significant interactions for glycerol by time (p=0.001) and sodium by time (p<0.001). At 210 min, fluid balance was predicted to be greater with ingestion of ≥1.5% glycerol alone (-0.55±0.07% to -0.40±0.06%) or ≥25 mM sodium alone (-0.58±0.05% to -0.21±0.06%) versus placebo (-0.69±0.06%), and with ingestion of ≥0.75% glycerol plus ≥15 mM sodium (-0.57±0.04% to 0.05±0.06%) versus placebo (-0.69±0.06%).</p><p><strong>Conclusion: </strong>Relatively low concentrations of glycerol by itself (≥1.5%) or in combination with electrolytes (≥0.75% glycerol plus ≥15 mM sodium) promoted better fluid balance than placebo. These results help inform the minimum concentrations of glycerol and/or sodium needed to promote fluid balance in healthy, active individuals; however, future research is needed to verify the model's predictions.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov: NCT06185595.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Impact of dietary cholesterol from eggs and saturated fat on LDL cholesterol levels: a randomized cross-over study\" Am J Clin Nutr 122 (2025) 83-91.","authors":"Sharayah Carter, Alison M Hill, Catherine Yandell, Lisa Wood, Alison M Coates, Jonathan D Buckley","doi":"10.1016/j.ajcnut.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.009","url":null,"abstract":"","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra processed food consumption by urbanization level among US youth and adults: Cross-Sectional Analysis of NHANES 2013-March 2020.","authors":"Nicholas Ansai, Anne Williams, Samuel D Emmerich, Kirsten A Herrick, Edwina A Wambogo, Euridice Martínez Steele, Cynthia L Ogden","doi":"10.1016/j.ajcnut.2025.10.010","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.010","url":null,"abstract":"<p><strong>Objective: </strong>To describe the mean contribution to total energy and total gram intakes from ultra processed foods (UPF), unprocessed or minimally processed foods (MPF), other Nova categories and subcategories by urbanization level among US youth and adults.</p><p><strong>Methods: </strong>Cross-sectional data from the National Health and Nutrition Examination Survey from 2013-March 2020 were analyzed. The mean percent of total energy and total gram intakes from Nova categories (MPF, processed culinary ingredients (PCI), processed foods (PF), and UPF) were estimated by urbanization (non-metropolitan statistical areas (non-MSAs, n=3,976), small to medium MSAs (n=9,170), and large MSAs (n=14,637)) for youth 2-19 years and adults 20 and older. Trends by urbanization were assessed using orthogonal contrasts in linear regression models adjusted for sex, age, race/Hispanic origin, and income. Day 1 dietary sample weights accounted for differential probabilities of selection, nonresponse, noncoverage and day of the week.</p><p><strong>Results: </strong>Among youth, there was no trend in MPF or UPF as a percent of energy by urbanization level. As a percent of grams, MPF increased and UPF decreased with higher urbanization level. After adjustment for sex, age, race and Hispanic origin, and income, only the trend in the percent of grams from MPF remained. Among adults, as both a percent of energy and a percent of grams, MPF increased and UPF decreased with higher urbanization level. These trends remained significant after adjustment for covariates.</p><p><strong>Conclusions: </strong>Adults in rural areas consumed more UPF and less MPF than those in urban areas in terms of both energy and grams. There were few significant differences by urbanization among youth.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Comprehensive Lifestyle Interventions on Plasma Branched-Chain Amino Acid Concentrations: A Randomized Trial.","authors":"Yu Jin Lim, Rob M van Dam","doi":"10.1016/j.ajcnut.2025.10.008","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.008","url":null,"abstract":"<p><strong>Background: </strong>Elevated plasma branched-chain amino acid (BCAA) concentrations are associated with a higher risk of type 2 diabetes and cardiovascular diseases. Lifestyle interventions have been proposed as a strategy to manage plasma BCAA concentrations, but evidence of their effectiveness is limited.</p><p><strong>Objective: </strong>We investigated the effects of comprehensive lifestyle interventions on plasma BCAA concentrations over six months and associations between changes in Body Mass Index (BMI), physical fitness, and dietary factors and plasma BCAA changes METHODS: The PREMIER study was a randomized trial of the effects of behavioral lifestyle interventions. The interventions included counseling on diet, exercise, and weight loss ('Established'), a similar intervention with additional guidance to follow Dietary Approaches to Stop Hypertension ('Established plus DASH'), and an advice-only control group. We analyzed data from 713 male and female adult participants during the 6-month intervention period. Data and biospecimens were obtained through the NHLBI BioLINCC repository, and plasma BCAA concentrations were measured using NMR spectroscopy. Multiple linear regression was used to assess the association between intervention groups and BCAA concentrations.</p><p><strong>Results: </strong>The Established (-7.19 μmol/L; 95% CI 17.45, 3.08) and Established plus DASH (-8.70 μmol/L; 95% CI -18.95, 1.55) interventions were associated with non-significant decreases in BCAA concentrations compared with the control group. Changes in BMI were correlated with changes in BCAA concentrations during the trial (partial Pearson r=0.24, p<0.001). Although changes in fitness and fiber intake were also significantly correlated with changes in BCAA concentrations, adjustment for BMI attenuated these correlations. Changes in the DASH and healthy plant-based diet indices and BCAA and protein intakes were not significantly correlated with plasma BCAA changes.</p><p><strong>Conclusion: </strong>Weight loss resulting from lifestyle interventions was associated with reductions in plasma BCAA concentrations. Improvements in fitness and diet composition were not associated with changes in BCAA concentrations independent of weight loss.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/study/NCT00000616).</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the golden egg lost its luster?","authors":"Christine P Stewart","doi":"10.1016/j.ajcnut.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.09.021","url":null,"abstract":"","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between domestic water hardness and the risk of experiencing fifteen different cardiovascular events: A prospective cohort study of 324,136 UK Biobank participants.","authors":"Sicheng Li, Hanwen Zhou, Jiajin Chen, Wenpan Xian, Yuqin Zhang, Yan Wang","doi":"10.1016/j.ajcnut.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.004","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated domestic water hardness (DWH)-cardiovascular disease (CVD) associations, but the results are inconsistent, and investigations of specific CVD subtypes are scarce.</p><p><strong>Objective: </strong>We aimed to investigate the individual and combined associations of DWH with CVD and its subtypes.</p><p><strong>Methods: </strong>This cohort study included UK Biobank participants whose address codes were used to obtain DWH data (calcium carbonate [CaCO₃], calcium [Ca], and magnesium [Mg]) from water supply companies. Incident CVD events were identified via International Classification of Diseases-Tenth Revision codes. The individual and combined associations between DWH exposure and incident CVD events were evaluated via Cox proportional hazards regression and quantile G-computation, respectively.</p><p><strong>Results: </strong>During a median follow-up period of over 13.41 years, 5,780 CVD deaths and 60,184 CVD cases were identified among 324,136 participants (mean±standard deviation age=55.76±8.08 years; female proportion=53.95%). U-shaped associations were observed between CaCO₃ and CVD death (P-nonlinear=0.024) and between Ca and CVD (P-nonlinear=0.008). Each log-transformed Mg interquartile range increase was associated with decreased CVD risk (hazard ratio [HR]=0.978, 95% confidence interval [CI]=0.961‒0.996). DWH was linearly and nonlinearly associated with seven CVD subtypes (chronic rheumatic heart diseases, ischemic heart diseases, nonrheumatic valve disease, myocarditis and cardiomyopathy, arrhythmias, heart failure, and cerebral infarction). Combined DWH exposure was associated with increased chronic rheumatic heart disease risk (HR=1.070, 95% CI=1.011‒1.133), with Mg having the largest negative weight of 1.000 and Ca having the largest positive weight of 0.908.</p><p><strong>Conclusions: </strong>DWH was associated with cardiovascular health, including nine CVD events. Specifically, higher concentrations of Mg and moderate levels of CaCO₃ and Ca were associated with lower CVD risk. Combined DWH was associated with increased chronic rheumatic heart disease risk.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal and preschool micronutrient supplementation and behavioral outcomes in school aged children in Nepal - a cohort study.","authors":"Parul Christian, Eleonor Zavala, Kristen Hurley, Subarna K Khatry, Steven C LeClerq, Lee Shu Fune Wu, James Tielsch, Joanne Katz, Laura E Murray-Kolb","doi":"10.1016/j.ajcnut.2025.10.006","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.006","url":null,"abstract":"<p><strong>Background: </strong>Few studies examine behavioral difficulties among children in low-income countries or the influence of early-life nutrition interventions.</p><p><strong>Objective: </strong>We examined the effect of micronutrient supplementation done as part of two randomized trials during pregnancy or in early preschool age on behavioral outcomes among school-age children in rural Nepal.</p><p><strong>Methods: </strong>Children 7-9 years of age were enrolled in a cohort follow-up study in which the Conners Rating Scale-Revised was administered to their parents and teachers. These children were offspring of participants in a cluster-randomized trial during pregnancy receiving daily iron-folic acid, iron-folic acid+ zinc or multiple micronutrients, compared with a control (all groups received vitamin A). These children between 12 and 35 months of age also received daily placebo, iron-folic acid, zinc alone, or iron-folic acid+zinc in a separate randomized trial. Factor analysis identified two attention deficit hyperactivity disorder (ADHD)-related behaviors for parent scores (hyperactivity/oppositional and inattention) and two for teacher scores (hyperactivity and inattention). Using mixed effects linear regression analysis, we analyzed the effect of early life supplementation on behavioral domains in schoolchildren (n=1255).</p><p><strong>Results: </strong>Exposure to prenatal iron-folic acid resulted in lower oppositionality/hyperactivity and inattention scores in children assessed via parental ratings in both unadjusted and adjusted analysis. Iron-folic acid with zinc reversed the positive effect seen with iron-folic acid. Multiple micronutrient supplementation resulted in a lower oppositionality and/or hyperactivity score, using parent and teacher ratings in the adjusted analysis. All three supplement groups in the preschool trial reduced child inattention when assessed by parents. Based on teacher ratings, groups that had received iron-folic acid alone or with zinc during preschool had reduced scores of hyperactivity in both unadjusted and adjusted analysis.</p><p><strong>Conclusion: </strong>Our study shows potential benefit of early life exposure to micronutrient supplementation for child related behavior outcomes in a South Asian setting where inadequate diets and nutrition deficiencies exist.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing glycemic variability in type 2 diabetes using simple dietary and culinary recommendations to modulate starch digestibility: a randomized controlled trial.","authors":"Maëliss Chisbert, Anne-Laure Castell, Laurie Van Den Berghe, Anne-Esther Breyton, Nathalie Feugier, Charlotte Cuerq, Karim Chikh, Olivier Brack, Martine Laville, Aurélie Goux, Alexandra Meynier, Sophie Vinoy, Julie-Anne Nazare","doi":"10.1016/j.ajcnut.2025.10.007","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.10.007","url":null,"abstract":"<p><strong>Background: </strong>In type 2 diabetes (T2D), postprandial glycemic excursions significantly contribute to glycemic variability (GV) and cardiovascular risk. As starch is the main carbohydrate source controlling its digestibility in the daily diet to promote a gradual glucose release, represents a promising nutritional strategy to reduce GV and improve glycemic control.</p><p><strong>Objective: </strong>We investigated the feasibility and efficiency of a 3-month dietary intervention emphasizing Slowly Digestible Starch (SDS) through commercial starchy product supply and dietary and culinary counseling, on GV, glycemic control and cardiometabolic profile in patients with T2D with suboptimal control.</p><p><strong>Methods: </strong>In a randomized, parallel, single-blind, controlled trial, 51 patients with T2D completed a 12-week high-SDS (H-SDS) or low-SDS (L-SDS) diet. Participants received commercial starchy products either high or low in SDS content, with specific dietary/culinary counseling. MAGE (Mean Amplitude of Glycemic Excursions) and other intra- and inter-day GV parameters were assessed by CGMS (Continuous Glucose Monitoring System), as well as glycemic control and cardiometabolic parameters.</p><p><strong>Results: </strong>Compared to the L-SDS diet, the H-SDS diet significantly lowered MAGE over 12 weeks (β = 30.4 [95% CI: 12.4 to 48.5]; p = 0.0025) and other intra and inter-day GV parameters (standard deviation, coefficient of variation, CONGAs (Continuous Overall Net Glycemic Action), MODD (Mean of Daily Differences) with 96% compliance throughout the study. HbA1c decreased in both groups, with a trend toward a greater reduction in the H-SDS group (β = 0.3 [95% CI: 0.05 to 0.47]; p = 0.0981]), where HbA1c fall below the 7% target. Other cardiometabolic markers were similar between diets.</p><p><strong>Conclusions: </strong>Modulating starch digestibility represents an effective and accessible strategy for enhancing GV and thus glycemic management in T2D, allowing patients with suboptimal glycemic control to reach recommended glycemic targets. This trial was registered at ClinicalTrials.gov (identifier: NCT03847701; registered on February 18, 2019): https://clinicaltrials.gov/study/NCT03847701.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}