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Dietary habits and nutritional biomarkers in Italian type 1 diabetes families: evidence of unhealthy diet and combined-vitamin-deficient intakes

European Journal of Clinical Nutrition volume 59, pages 114–122 (2005)Cite this article

Abstract

Objective: Nutritional status and lifestyle can have profound effects on health. To analyse behaviour patterns in population subgroups of public health importance, we compared lifestyle, dietary intake of energy and selected nutrients, and nutritional biomarkers of type 1 diabetes (T1DM) patients and nondiabetic first-degree relatives against control subjects with no family history of T1DM.

Design: A cross-sectional study.

Setting: Department of Internal Medicine, University of Pisa, Italy.

Subjects: A total of 209 individuals including 38 type 1 patients, 76 relatives, and 95 healthy subjects.

Interventions: We used the European Prospective Investigation of Cancer and Nutrition questionnaires to assess dietary intake and lifestyle. Anthropometric indices and nutritional biomarkers (such as plasma levels of albumin, iron, lipids, homocysteine, vitamin B9 and vitamin B12 as well as urinary outputs of nitrogen, sodium and potassium) were evaluated.

Results: Emerging health issues:

(1) In total, 45% of controls were overweight. Increasing age was associated with increasing body mass and decreasing activity in sport in front of an unchanged energy intake.

(2) The distribution of energy sources was incorrect. The proportion of caloric intake derived from total fat and cholesterol did not match general guidelines. Total dietary fibre consumption was assessed to be adequate (25 g/day) in only 27% of all the participants.

(3) Estimated daily intakes of water-soluble vitamin B9 and fat-soluble vitamin D and vitamin E were deficient in comparison with dietary reference intakes.

(4) The prevalence of adoption and maintenance of healthful eating and physical activity habits was higher in women and T1DM patients (probably as a consequence of the medical educational intervention). On the contrary, supportiveness of the family in term of changing the undesirable behaviours at home seemed to fail.

Conclusions: This study provides first evidence indicating unhealthy dietary behaviours, which could even predispose to the development of diabetes and cardiovascular complications, in subjects living in Pisa. The combination of vitamin B9 and vitamin E deprivation could be deleterious for endothelial function, since these antioxidants have been implicated in the modulation of nitric oxide and eicosanoid signalling.

Sponsorship: This study was supported by a grant from the Ministry of Education, University and Research, Italy.

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References

  • Akerblom HK, Vaarala O, Hyoty H, Ilonen J & Knip M (2002): Environmental factors in the etiology of type 1 diabetes. Am. J. Med. Genet. 115, 18–29.

    Article  Google Scholar 

  • American Diabetes Association (2003): Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diab. Care 26, S51–S61.

  • Beales PE, Burr LA, Webb GP, Mansfield KJ & Pozzilli P (1999): Diet can influence the ability of nicotinamide to prevent diabetes in non-obese diabetic mouse: preliminary study. Diabetes Metab. Res. Rev. 15, 21–28.

    Article  CAS  Google Scholar 

  • Bingham SA, Day NE, Luben R, Ferrari P, Slimani N, Norat T, Clavel-Chapelon F, Kesse E, Nieters A, Boeing H, Tjønneland A, Overvad K, Martinez C, Dorronsoro M, Gonzalez CA, Key TJ, Trichopoulou A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita HB, Peeters PHM, Berglund G, Hallmans G, Lund E, Skeie G, Kaas R & Riboli E (2003): Dietary fiber in food and protection against colorectal cancer in the European Prospective Investigation of Cancer and Nutrition (EPIC): an observational study. Lancet 361, 1496–1501.

    Article  Google Scholar 

  • Challem JJ (1999): Toward a new definition of essential nutrients: is it now time for a third ‘vitamin’ paradigm? Med. Hypotheses 52, 417–422.

    Article  CAS  Google Scholar 

  • Das UN (2003): Folic acid says NO to vascular diseases. Nutrition 19, 686–692.

    Article  CAS  Google Scholar 

  • Decarli A, Franceschi S, Ferraroni M, Gnagnarella P, Parpinel M, La Vecchia C, Negri E, Salvini S, Falcini F & Giacosa A (1996): Validation of a food-frequency questionnaire to assess dietary intakes in cancer studies in Italy. Results for specific nutrients. Ann. Epidemiol. 6, 110–118.

    Article  CAS  Google Scholar 

  • Dhein S, Kabat A, Olbrich A, Rosen P, Schroder H & Mohr FW (2003): Effect of chronic treatment with vitamin E on endothelial dysfunction in a type 1 in vivo diabetes mellitus model and in vitro. J. Pharmacol. Exp. Ther. 305, 114–122.

    Article  CAS  Google Scholar 

  • Fonseca V, Guba SC & Fink LM (1999): Hyperhomocysteinemia and the endocrine system: implications for atherosclerosis and thrombosis. Endocr. Rev. 20, 738–759.

    Article  CAS  Google Scholar 

  • Food and Nutrition Board, Institute of Medicine (2002) Dietary reference intakes for energy, carbohydrate, fiber, fatty, fatty acids, cholesterol, protein and amino acids, accessed viawww.nap.edu.

  • Food and Nutrition Board, Institute of Medicine (2003) Dietary reference intakes: applications in dietary planning, accessed viawww.nap.edu.

  • Franceschi S, Barbone F, Negri E, Decarli A, Ferraroni M, Filiberti R, Giacosa A, Gnagnarella P, Nanni O, Salvini S & La Vecchia C (1995): Reproducibility of an Italian food frequency questionnaire for cancer: results for specific nutrients. Ann. Epidemiol. 5, 69–75.

    Article  CAS  Google Scholar 

  • Franceschi S, Negri E, Salvini S, Decarli A, Ferraroni M, Filiberti R, Giacosa A, Talamini R, Amadori D, Panarello G & La Vecchia C (1993): Reproducibility of an Italian food frequency questionnaire for cancer studies: results for specific food items. Eur. J. Cancer 29A, 2298–2305.

    Article  CAS  Google Scholar 

  • Giampietro O, Virgone E, Carneglia L, Griesi E, Calvi D & Matteucci E (2002): Anthropometric indices of school children and familiar risk factors. Prev. Med. 35, 492–498.

    Article  Google Scholar 

  • Glasgow RE & Osteen VL (1992): Evaluating diabetes education. Are we measuring the most important outcomes? Diab. Care 15, 1423–1432.

    Article  CAS  Google Scholar 

  • Harbige LS (1996): Nutrition immunity with emphasis on infection and autoimmune disease. Nutr. Health 10, 285–312.

    Article  CAS  Google Scholar 

  • Harris JA & Benedict FG (1919): A Biomedic Study of Basal Metabolism in Men. Canergie Institute, Washington, Publication 279.

    Google Scholar 

  • Heerstrass DW, Ocké MC, Bueno-de-Mesquita HB, Peeters PHM & Seidell JC (1998): Underreporting of energy, protein and potassium intake in relation to body mass index. Int. J. Epidemiol. 27, 186–193.

    Article  CAS  Google Scholar 

  • Institute of Medicine (1997) Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride, accessed viawww.nap.edu.

  • Institute of Medicine (1998) Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline, accessed viawww.nap.edu.

  • Institute of Medicine (2000) Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids, accessed viawww.nap.edu.

  • Isaksson B (1980): Urinary nitrogen output as a validity test in dietary surveys. Am. J. Clin. Nutr. 33, 4–5.

    Article  CAS  Google Scholar 

  • Kesse E, Clavel-Chapelon F, Slimani N, van Liere M & E3N Group (2001): Do eating habits differ according to alcohol consumption? Results of a study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC). Am. J. Clin. Nutr. 74, 322–327.

    Article  CAS  Google Scholar 

  • Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St Jeor S, Suttie J, Tribble DL & Bazzarre TL (2000): AHA dietary guidelines. Revision 2000: a statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation 102, 2296–2311.

    Article  Google Scholar 

  • Kroke A, Klipstein-Grobusch K, Voss S, Möseneder J, Thielecke F, Noack R & Boeing H (1999): Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation of Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am. J. Clin. Nutr. 70, 439–447.

    Article  CAS  Google Scholar 

  • Lipton RB, Drum M, Li S & Choi H (1999): Social environment and year of birth influence type 1 diabetes risk for African-American and Latino children. Diab. Care 22, 78–85.

    Article  CAS  Google Scholar 

  • Littorin B, Sundkvist G, Nyström L, Carlson A, Landin-Olsson M, stman J, Arnqvist HJ, Björk E, Blohmé G, Bolinder J, Eriksson JW, Scherstén B & Wibell L (2001): Family Characteristics and life events before the onset of autoimmune type 1 diabetes in young adults. A nationwide study. Diab. Care 24, 1033–1037.

    Article  CAS  Google Scholar 

  • Maejima K, Nakano S, Himeno M, Tsuda S, Makiishi H, Ito T, Nakagawa A, Kigoshi T, Ishibashi T, Nishio M & Uchida K (2001): Increased basal levels of plasma nitric oxide in Type 2 diabetic subjects. Relatioship to microvascular complications. J. Diabetes Complic. 15, 135–143.

    Article  CAS  Google Scholar 

  • Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF & Turner RC (1985): Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412–419.

    Article  CAS  Google Scholar 

  • Mitchell BD, Rainwater DL, Hsueh W-C, Kennedy AJ, Stern MP & Maccluer JW (2003): Familial aggregation of nutrient intake and physical activity: results from the San Antonio Family Heart Study. Ann. Epidemiol. 13, 128–135.

    Article  Google Scholar 

  • Morris CD & Carson S (2003): Routine vitamin supplementation to prevent cardiovascular disease: a summary of evidence for the U.S. preventive task force. Ann. Intern. Med. 139, 56–70.

    Article  CAS  Google Scholar 

  • Pala V, Sieri S, Palli D, Salvini S, Berrino F, Bellegotti M, Frasca G, Tumino R, Sacerdote C, Fiorini L, Celentano E, Galasso R & Krogh V (2003): Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori. 89, 594–607.

    Article  Google Scholar 

  • Pasanisi P, Berrino F, Bellati C, Sieri S & Krogh V (2002): Validity of the Italian EPIC Questionnaire to Assess Past Diet IARC Scientific Publications, Vol 156, pp 41–44. Lyon, France: IARC.

    Google Scholar 

  • Pisani P, Faggiano F, Krogh V, Palli D, Vineis P & Berrino F (1997): Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int. J. Epidemiol. 26, S152–S160.

    Article  Google Scholar 

  • Pociot F & McDermott MF (2002): Genetics of type 1 diabetes mellitus. Genes Immun. 3, 235–249.

    Article  CAS  Google Scholar 

  • Riboli E & Kaaks R (1997): The EPIC project: rationale and study design. Int. J. Epidemiol. 26, S6–S14.

    Article  Google Scholar 

  • Salvini S, Parpinel M, Gnagnarella P, Maisonneuve P & Turrini A (1998): Banca dati di composizione degli alimenti per studi epidemiologici in Italia. Italy: Istituto Europeo di Oncologia.

    Google Scholar 

  • Salvini S, Saieva C, Sieri S, Vineis P, Panico S, Tumino R & Palli D (2002): Physical Activity in the EPIC Cohort in Italy IARC Scientific Publications, Vol 156, pp 267–269. Lyon, France: IARC.

    Google Scholar 

  • Seshadri N & Robinson K (2000): Homocysteine, B vitamins, and coronary artery disease. Med. Clin. North Am. 84, 215–237.

    Article  CAS  Google Scholar 

  • Soinio M, Laakso M, Lehto S, Hakala P & Ronnemaa T (2003): Dietary fat predicts coronary heart events in subjects with type 2 diabetes. Diab. Care 26, 619–624.

    Article  Google Scholar 

  • Trichopoulou A & Naska A (2003): DAFNE III Group. European food availability databank based on household budget surveys: the Data Food Networking initiative. Eur. J. Public Health 13 (3 Suppl), 24–28.

    Article  Google Scholar 

  • Verhaar MC, Stroes E & Rabelink TJ (2002): Folates and cardiovascular disease. Arterioscler. Thromb. Vasc. Biol. 22, 6–13.

    Article  CAS  Google Scholar 

  • Wing RR, Goldstein MG, Acton KJ, Birch LL, Jakicic JM, Sallis JF, Smith-West D, Jeffery RW & Surwit RS (2001): Behavioral science research in diabetes. Diab. Care 24, 117–123.

    Article  CAS  Google Scholar 

  • Zella JB & DeLuca HF (2003): Vitamin D and autoimmune diabetes. J. Cell Biochem. 88, 216–222.

    Article  CAS  Google Scholar 

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Acknowledgements

We gratefully thank Dr S Salvini, Dr D Palli, and Dr G Cordopatri of the Centro per lo Studio e la Prevenzione Oncologica (CSPO), Scientific Institute of Tuscany, Florence, Italy, for their assistance with EPIC questionnaires.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Pisa, Italy

    E Matteucci, S Passerai, F Fagnani, I Evangelista & O Giampietro

  2. Dietary Service, Azienda Ospedaliera Pisana, Italy

    M Mariotti

  3. Laboratory of Clinical Chemistry and Microbiology I, Azienda Ospedaliera Pisana, Italy

    L Rossi

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  1. E Matteucci
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  2. S Passerai
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Correspondence to E Matteucci.

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Guarantor: E Matteucci.

Contributors: EM was principal investigator, data analyst and main writer. OG was involved in obtaining funding, the concept of the study and the discussion of main hypotheses. MM and SP conducted the dietary investigation. FF, IE, and LR performed biochemical analyses.

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Matteucci, E., Passerai, S., Mariotti, M. et al. Dietary habits and nutritional biomarkers in Italian type 1 diabetes families: evidence of unhealthy diet and combined-vitamin-deficient intakes. Eur J Clin Nutr 59, 114–122 (2005). https://doi.org/10.1038/sj.ejcn.1602047

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  • DOI: https://doi.org/10.1038/sj.ejcn.1602047

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