Study is the first to show higher dietary acid load increases risk of diabetes ( Up to 56% Increased Risk )

Contact: Dr Guy Fagherazzi Guy.FAGHERAZZI@gustaveroussy.fr 33-142-116-140 Diabetologia

A study of more than 60 000 women has shown that higher overall acidity of the diet, regardless of the individual foods making up that diet, increases the risk of type 2 diabetes. The study, the first large prospective study to demonstrate these findings, is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Guy Fagherazzi and Dr Françoise Clavel-Chapelon, Center for Research in Epidemiology and Population Health, INSERM, Paris, France, and colleagues.

A western diet rich in animal products and other acidogenic foods can induce an acid load that is not compensated for by fruit and vegetables; this can cause chronic metabolic acidosis and lead to metabolic complications. Most importantly from a blood-sugar control perspective, increasing acidosis can reduce the ability of insulin to bind at appropriate receptors in the body, and reduce insulin sensitivity. With this in mind, the authors decided to analyse whether increased acidosis caused by dietary acid loads increased the risk of type 2 diabetes.

A total of 66,485 women from the E3N study (the French Centre of the European Prospective Investigation into Cancer and Nutrition, a well-known ongoing epidemiological study) were followed for new diabetes cases over 14 years. Their dietary acid load was calculated from their potential renal acid load (PRAL) and their net endogenous acid production (NEAP) scores, both standard techniques for assessing dietary acid consumption from nutrient intake.

During follow-up, 1,372 new cases of incident type 2 diabetes occurred. In the overall population, those in the top 25% (quartile) for PRAL had a 56% increased risk of developing type 2 diabetes compared with the bottom quartile. Women of normal weight (BMI of 25 and under) had the highest increased risk (96% for top quartile versus bottom) while overweight women (BMI 25 and over) had only a 28% increased risk (top quartile versus bottom). NEAP scores showed a similar increased risk for higher acid load.

The authors say: “A diet rich in animal protein may favour net acid intake, while most fruits and vegetables form alkaline precursors that neutralise the acidity. Contrary to what is generally believed, most fruits such as peaches, apples, pears, bananas and even lemons and oranges actually reduce dietary acid load once the body has processed them. In our study, the fact that the association between both PRAL and NEAP scores and the risk of incident type 2 diabetes persisted after adjustment for dietary patterns, meat consumption and intake of fruit, vegetables, coffee and sweetened beverages suggests that dietary acids may play a specific role in promoting the development of type 2 diabetes, irrespective of the foods or drinks that provide the acidic or alkaline components.”

They conclude: “We have demonstrated for the first time in a large prospective study that dietary acid load was positively associated with type 2 diabetes risk, independently of other known risk factors for diabetes. Our results need to be validated in other populations, and may lead to promotion of diets with a low acid load for the prevention of diabetes. Further research is required on the underlying mechanisms.”

Insulin ‘still produced’ in most people with type 1 diabetes

Contact: Louise Vennells l.vennells@exeter.ac.uk 44-077-685-11866 Diabetologia

New technology has enabled scientists to prove that most people with type 1 diabetes have active beta cells, the specialised insulin-making cells found in the pancreas. Type 1 diabetes occurs when the body’s immune system destroys the cells making insulin, the substance that enables glucose in the blood to gain access to the body’s cells.

It was previously thought that all of these cells were lost within a few years of developing the condition. However, new research led by the University of Exeter Medical School, which has been funded by Diabetes UK and published in Diabetologia (the journal of the European Association for the Study of Diabetes), shows that around three quarters of patients with the condition possess a small number of beta cells that are not only producing insulin, but that they are producing it in response to food in the same way as someone without the condition. The study, which was supported by the National Institute for Health Research, through the Exeter Clinical Research Facility, tested 74 volunteers. Researchers measured how much natural insulin they produced and whether it responded to meals, a sign that the cells are healthy and active. They found that 73 per cent produced low levels of insulin, and that this occurred regardless of how long the patient was known to have diabetes. Researchers studied the response of the insulin production to a meal to prove that the low level insulin production was coming from working beta cells.

Dr Richard Oram, of the University of Exeter Medical School, who led the study, said: “It’s extremely interesting that low levels of insulin are produced in most people with Type 1 Diabetes, even if they’ve had it for 50 years. The fact that insulin levels go up after a meal indicates these remaining beta cells can respond to a meal in the normal way – it seems they are either immune to attack, or they are regenerating. The researchers used new technologies which are able to detect far lower levels of insulin than was previously possible. The levels are so low that scientists had previously thought no insulin was produced.”

Dr Matthew Hobbs, Head of Research for Diabetes UK, said: “We know that preserving or restoring even relatively small levels of insulin secretion in Type 1 diabetes can prevent hypoglycaemia (low glucose levels) and reduce complications and therefore much research has focused on ways to make new cells that can be transplanted into the body. This research shows that some of a person’s own beta cells remain and therefore it may be possible to regenerate these cells in the future.  It is also possible that understanding why some people keep insulin production whilst others lose it may help answer key questions about the biology of Type 1 diabetes and help advance us towards a cure for the disease.”

Type 1 diabetes affects around 200,000 people in the UK alone. The disease commonly starts in childhood and causes the body’s own immune system to attack and destroy the insulin-producing cells in the pancreas, leaving the patient dependent on life-long insulin injections.

Dr Oram said: “We are now able to study this area in much more detail. By studying differences between those who still make insulin and those who do not, we may help work out how to preserve or replenish beta cells in type 1 diabetes. It could be a key step on the road to therapies which protect beta cells or encourage them to regenerate.

“The next step is a much larger-scale study, to look at the genetics and immune systems of people still making insulin, and to answer the important question of whether the complications of Type 1 Diabetes are reduced in people with low levels of insulin.”

One of the participants, Alex Nesbitt, 56, was diagnosed with Type 1 Diabetes 36 years ago, and is monitored by an insulin pump which is permanently attached to his body. He said the condition was “trying in the extreme”, particularly because of the stigma attached to the condition. He said: “For a very long time, people have believed that if you have Type 1 Diabetes, that’s the end of your insulin production. This study raises some major questions about whether that’s actually the case. It’s very exciting for current opinion to be challenged in this way, and I’m fascinated to know what difference it will mean for the future.”

Study shows drinking one 12oz sugar-sweetened soft drink a day can increase the risk of type 2 diabetes by 22 percent

Contact: Sam Wong Press Office sam.wong@imperial.ac.uk 44-020-759-42198 Diabetologia

Drinking one (or one extra)* 12oz serving size of sugar-sweetened soft drink a day can be enough to increase the risk of developing type 2 diabetes by 22%, a new study suggests. The research is published in  Diabetologia (the journal of the European Association for the Study of Diabetes) and comes from data in the InterAct consortium**. The research is by Dr Dora Romaguera, Dr Petra Wark and Dr Teresa Norat, Imperial College London, UK, and colleagues.

Since most research in this area has been conducted in North American populations, the authors wanted to establish if a link between sweet beverage consumption and type 2 diabetes existed in Europe. They used data on consumption of juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks collected across eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC study; UK, Germany, Denmark, Italy, Spain, Sweden, France, Italy, Netherlands)***, covering some 350,000 participants.

As part of the InterAct project, the researchers did a study which included 12,403 type 2 diabetes cases and a random sub-cohort of 16,154 identified within EPIC. The researchers found that, after adjusting for confounding factors, consumption of one 12oz (336ml) serving size of sugar-sweetened soft drink per day increased the risk of type 2 diabetes by 22%. This increased risk fell slightly to 18% when total energy intake and body-mass index (BMI) were accounted for**** (both factors that are thought to mediate the association between sugar-sweetened soft drink consumption and diabetes incidence). This could indicate that the effect of sugar-sweetened soft drink on diabetes goes beyond its effect on body weight.

The authors also observed a statistically significant increase in type 2 diabetes incidence related to artificially sweetened soft drink consumption, however this significant association disappeared after taking into account the BMI of participants; this probably indicates that the association was not causal but driven by the weight of participants (i.e. participants with a higher body weight tend to report higher consumption of artificially sweetened drinks, and are also more likely to develop diabetes). Pure fruit juice and nectar***** consumption was not significantly associated with diabetes incidence, however it was not possible using the data available to study separately the effect of 100% pure juices from those with added sugars.

The authors say the increased risk of diabetes among sugar-sweetened soft drink consumers in Europe is similar to that found in a meta-analysis of previous studies conducted mostly in North America (that found a 25% increased risk of type 2 diabetes associated with one 12 oz daily increment of sugar-sweetened beverage consumption).

Dr Romaguera concludes: “Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population.”

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Notes to editors:

*The increased risk of 22% is for each extra 12oz sugar sweetened drink, so would apply to someone who had 1 drink versus someone who had 0, or someone who had 2 drinks versus someone who had 1, etc.

**The InterACT consortium is investigating, among other things, nutritional factors and physical activity to study the association of nutritional, dietary and physical activity behaviours with incident diabetes in the nested case-cohort study and to contribute to the analysis of gene-lifestyle interaction. It is a sub-division of the EPIC study, which was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases.

***The centres involved were France, Italy, Spain, Denmark, UK (Oxford, Cambridge), Netherlands (Bilthoven, Utrecht), Germany (Heidelberg, Potsdam), Sweden (Umea, Malmo)

****Extra info from Dr Romaguera:  The 22% figure is used as the top line because it is widely accepted by the scientific community that these models should not be adjusted for BMI. In the meta-analysis comparison with other studies from the USA, the risk is those studies is NOT adjusted by BMI. That makes it possible to compare the two sets of results (25% increased risk in North American studies versus 22% in Europe).

*****nectars (UK and USA definition) are fruit juices that have been diluted to some extent and may contain additives (sugar or sweeteners)

Vitamin B1 could reverse early-stage kidney disease in diabetes patients

2008 study posted for filing

Contact: Kelly Parkes-Harrison
k.e.parkes@warwick.ac.uk
44-078-245-40863
University of Warwick

Researchers at the University of Warwick have discovered high doses of thiamine – vitamin B1 – can reverse the onset of early diabetic kidney disease.

Kidney disease, or diabetic nephropathy, develops progressively in patients with type 2 diabetes. Early development of kidney disease is assessed by a high excretion rate of the protein albumin from the body in the urine, known as microalbuminuria.

The research is led by Dr Naila Rabbani and Professor Paul J Thornalley at Warwick Medical School, University of Warwick, in collaboration with researchers at the University of Punjab and Sheik Zaid Hospital, Lahore, Pakistan.

The team has discovered taking high oral doses of thiamine can dramatically decrease the excretion of albumin and reverse early stage kidney disease in type 2 diabetes patients.

In a paper published online in the journal Diabetologia, the team show 300 mg of thiamine taken orally each day for three months reduced the rate of albumin excretion in type 2 diabetes patients. The albumin excretion rate was decreased by 41% from the value at the start of the study. The results also showed 35% of patients with microalbuminuria saw a return to normal urinary albumin excretion after being treated with thiamine.

Forty patients with type 2 diabetes aged between 35 and 65 years old took part in the trial. They were randomly assigned a placebo or 3 x 100mg tablets of thiamine a day for three months.

The Warwick research group has already conclusively proven that type 2 diabetes patients have a thiamine deficiency. In an earlier study led by Professor Paul Thornalley at Warwick Medical School, the research team showed that thiamine deficiency could be key to a range of vascular problems for diabetes patients.

Dr Rabbani said: “This study once again highlights the importance of Vitamin B1 and we need to increase awareness. Professor Thornalley and I are planning a foundation at the University of Warwick to further education and research in thiamine deficiency.”

 

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Notes to editors

This study was funded by the Pakistan Higher Education Commission and Dr Rabbani holds a research fellowship with the British Heart Foundation, based at Warwick Medical School.

The paper appears in Diabetologia and is available online at http://www.springerlink.com/content/51l034044218455j/?p=814d61fe534b49ebbea262b559224387&pi=2

The previous study led by Professor Paul Thornalley appeared in Diabetologia in August 2007. It is available online at http://www.springerlink.com/content/r4723142882735l5/?p=de1637f799b94f9eaf1affc684404efb&pi=1

For more information or to speak to Professor Thornalley contact Kelly Parkes-Harrison, Communications Officer, University of Warwick, +44 (0)2476 150483, +44 (0)7824 540863, k.e.parkes@warwick.ac.uk