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Purpose. En Balance, a culturally sensitive diabetes education program, improves glycemic control in Hispanics with type 2 diabetes. The program emphasized diet, physical activity, and other factors important for glycemic control. However, the individual contributions of these education factors are unclear. The purpose of this study is to assess the contribution of physical activity to the success of En Balance in improving the health of Mexican Americans with type 2 diabetes. Methods. A retrospective study was conducted with plasma samples collected pre- and post-3-month study. Samples from 58 (18 males and 40 females) Hispanic subjects with type 2 diabetes were analyzed for the concentration of kynurenines, known to decrease in response to exercise. After three months, health outcomes for the active group (decreased kynurenines) and the rest of the cohort were evaluated by paired Wilcoxon signed-rank test. Results. Half of the subjects had increased kynurenine levels at the end of the educational program. We found that the subjects in the active group with decreased kynurenine concentrations displayed statistically greater improvements in fasting blood glucose, A1C, cholesterol, and triglycerides despite weight loss being higher in the group with increased kynurenine concentrations. Conclusions. En Balance participants with decreased kynurenine levels had significantly improved glycemic control. These data suggest that physical activity significantly contributes to the success of the En Balance education program. This analysis indicates that diabetes public health educators should emphasize the benefit of physical activity on glycemic control even in the absence of major weight loss.

High levels of serum long chain saturated fatty acids (LCSFAs) have been associated with inflammation in type 2 diabetes. Dietary SFAs can promote inflammation, the secretion of IgG antibodies, and secretion of the proinflammatory cytokine IL-1β. This study characterizes anti-LCSFA IgG antibodies from patients with type 2 diabetes. Serum samples from several cohorts with type 2 diabetes were analyzed for the presence of anti-LCSFA IgG, the cytokine IL-1β, and nonesterified fatty acids. Anti-LCSFA IgG was isolated from patient samples and used for in vitro characterization of avidity and specificity. A cohort participating in En Balance, a diabetes health education program that improved diabetes management, tested positive for anti-LCSFA IgG. Following the 3-month program, the cohort showed a significant reduction in anti-LCSFA IgG levels. Anti-LCSFA antibodies isolated from these patients demonstrated high avidity, were specific for long chain SFAs, and correlated with serum fatty acids in patients with managed type 2 diabetes. Interestingly, anti-LCSFA IgG neutralized PA-induced IL-1β secretion by dendritic cells. Our data shows that nonesterified SFAs are recognized by IgG antibodies present in human blood. The identification of anti-LCSFA IgG antibodies in human sera establishes a basis for further exploration of lipid induced immune responses in diabetic patients.

We evaluated the changes in apolipoproteins, glycemic status, and body composition after 3 months using a culturally sensitive diabetes education program, En Balance, in diabetic Hispanics. Thirty-four (9 males, 25 females) Hispanic diabetics participated in the En Balance program over three months. Body composition was determined by dual energy X-ray absorptiometry (DXA), fasting plasma glucose (FPG), A1c, and apolipoproteins (Apo) measured after 3 months participation. Differences were analyzed using paired t testing and relationships between changes in Apo, A1c, total cholesterol, body mass index and body composition by Spearman correlations. Completion of En Balance resulted in a significant reduction in weight (80.31 +/- 1.97 kg vs 81.25 +/- 17.97 kg, P = .015), FPG (143.21 +/- 57.8 mg/dL vs 166.41 +/- 65.9 mg/dL P = .003), and A1c (7.08 +/- 1.6% vs 7.87 +/- 2.0%, P = < .001). DXA demonstrated reduction in total fat (29.54 +/- 10.0 kg vs 30.24 +/- 11.80 kg, P = < .001) and trunk fat (15.09 +/- 5.6 kg vs 16.87 +/- 5.4 kg, P = .001). High density lipoprotein significantly increased (48.85 +/- 11.4 vs 44.65 +/- 8.8, P = .002) and total serum cholesterol/high density lipoprotein ratio decreased (3.87 +/- .98 vs 4.35 +/- 1.0, P = .001). There were significant correlations at three months between changes in Apo A1 and A2 (r = .559, P < .001), Apo E and total cholesterol (r = .746, P < .001), between A1c and FPG (r = .563, P = .001) and BMI and body weight (r = .732, P < .001). The En Balance program improved body composition, A1c, FPG, total cholesterol/HDL ratio and HDL. If these trends can be sustained, En Balance may serve as a unique educational paradigm for improving type 2 diabetes in Hispanics.

To determine whether dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican-Americans with type 2 diabetes. Forty volunteers with type 2 diabetes enrolled in the \"En Balance-PLUS\" program, which provided weekly nutrition-diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)-200 mg eicosapentaenoic acid over 3 months. The study assessed self-reported neuropathic pain symptoms pre/postintervention using the short-form McGill Pain Questionnaire (SF-MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3-month metabolomic analysis of plasma samples. A total of 26 participants self-reported neuropathic pain symptoms at baseline. After 3 months of omega-3 PUFA supplementation, participants reported significant improvement in SF-MPQ scores (sensory, affective, and visual analogue scale; <0.001, =0.012, and <0.001, respectively). Untargeted metabolomic analysis revealed that participants in the moderate-high SF-MPQ group had the highest relative plasma sphingosine levels at baseline compared to the low SF-MPQ group ( =0.0127) and the nonpain group ( =0.0444). Omega-3 PUFA supplementation increased plasma DHA and reduced plasma sphingosine levels in participants reporting neuropathic pain symptoms ( <0.001 and <0.001, respectively). Increased plasma DHA levels significantly correlated with improved SF-MPQ sensory scores ( =0.425, =0.030). Improved SF-MPQ scores, however, did not correlate with clinical/laboratory parameters. The data suggest that omega-3 PUFAs dietary supplementation may reduce neuropathic pain symptoms in individuals with type 2 diabetes and correlates with sphingosine levels in the plasma.

Studies consistently show the beneficial effects of eating nuts, but as high-energy foods, their regular consumption may lead to weight gain. We tested if daily consumption of walnuts (approximately 12% energy intake) for 6 months would modify body weight and body composition in free-living subjects. Ninety participants in a 12-month randomized cross-over trial were instructed to eat an allotted amount of walnuts (28–56g) during the walnut-supplemented diet and not to eat them during the control diet, with no further instruction. Subjects were unaware that body weight was the main outcome. Dietary compliance was about 95% and mean daily walnut consumption was 35g during the walnut-supplemented diet. The walnut-supplemented diet resulted in greater daily energy intake (557kJ (133kcal)), which should theoretically have led to a weight gain of 3·1kg over the 6-month period. For all participants, walnut supplementation increased weight (0·4 (se 0·1) kg), BMI (0·2 (se 0·1) kg/m2), fat mass (0·2 (se 0·1) kg) and lean mass (0·2 (se 0·1) kg). But, after adjusting for energy differences between the control and walnut-supplemented diets, no significant differences were observed in body weight or body composition parameters, except for BMI (0·1 (se 0·1) kg/m2). The weight gain from incorporating walnuts into the diet (control→walnut sequence) was less than the weight loss from withdrawing walnuts from the diet (walnut→control sequence). Our findings show that regular walnut intake resulted in weight gain much lower than expected and which became non-significant after controlling for differences in energy intake.

Background: Omega-3 polyunsaturated fatty acids (PUFAs) have been proposed to improve chronic neuroinflammatory diseases in peripheral and central nervous systems. For instance, docosahexaenoic acid (DHA) protects nerve cells from noxious stimuli in vitro and in vivo. Recent reports link PUFA supplementation to improving painful diabetic neuropathy (pDN) symptoms, but cellular mechanisms responsible for this therapeutic effect are not well understood. The objective of this study is to identify distinct cellular pathways elicited by dietary omega-3 PUFA supplementation in patients with type 2 diabetes mellitus (T2DM) affected by pDN. Methods: Forty volunteers diagnosed with type 2 diabetes were enrolled in the “En Balance-PLUS” diabetes education study. The volunteers participated in weekly lifestyle/nutrition education and daily supplementation with 1000 mg DHA and 200 mg eicosapentaenoic acid. The Short-Form McGill Pain Questionnaire validated clinical determination of baseline and post-intervention pain complaints. Laboratory and untargeted metabolomics analyses were conducted using blood plasma collected at baseline and after three months of participation in the dietary regimen. The metabolomics data were analyzed using random forest, hierarchical clustering, ingenuity pathway analysis, and metabolic pathway mapping. Results: The data show that metabolites involved in oxidative stress and glutathione production shifted significantly to a more anti-inflammatory state post supplementation. Example of these metabolites include cystathionine (+90%), S-methylmethionine (+9%), glycine cysteine-glutathione disulfide (+157%) cysteinylglycine (+19%), glutamate (−11%), glycine (+11%), and arginine (+13.4%). In addition, the levels of phospholipids associated with improved membrane fluidity such as linoleoyl-docosahexaenoyl-glycerol (18:2/22:6) (+253%) were significantly increased. Ingenuity pathway analysis suggested several key bio functions associated with omega-3 PUFA supplementation such as formation of reactive oxygen species (p = 4.38 × 10−4, z-score = −1.96), peroxidation of lipids (p = 2.24 × 10−5, z-score = −1.944), Ca2+ transport (p = 1.55 × 10−4, z-score = −1.969), excitation of neurons (p = 1.07 ×10−4, z-score = −1.091), and concentration of glutathione (p = 3.06 × 10−4, z-score = 1.974). Conclusion: The reduction of pro-inflammatory and oxidative stress pathways following dietary omega-3 PUFA supplementation is consistent with the promising role of these fatty acids in reducing adverse symptoms associated with neuroinflammatory diseases and painful neuropathy.

The alanine to threonine amino acid substitution at codon 54 (Ala54Thr) of the intestinal fatty acid binding protein (FABP2) has been associated with elevated levels of insulin and blood glucose as well as with dyslipidemia. The aim of this study was to characterize the effect of this FABP2 polymorphism in Mexican-Americans with type 2 diabetes (T2D) in the context of a three-month intervention to determine if the polymorphism differentially modulates selected clinical outcomes. For this study, we genotyped 43 participant samples and performed post-hoc outcome analysis of the profile changes in fasting blood glucose, HbA1c, insulin, lipid panel and body composition, stratified by the Ala54Thr polymorphism. Our results show that the Thr54 allele carriers (those who were heterozygous or homozygous for the threonine-encoding allele) had lower HDL cholesterol and higher triglyceride levels at baseline compared to the Ala54 homozygotes (those who were homozygous for the alanine-encoding allele). Both groups made clinically important improvements in lipid profiles and glycemic control as a response to the intervention. Whereas the Ala54 homozygotes decreased HDL cholesterol in the context of an overall total cholesterol decrease, Thr54 allele carriers increased HDL cholesterol as part of an overall total cholesterol decrease. We conclude that the Ala54Thr polymorphism of FABP2 modulates HDL cholesterol in Mexican-Americans with T2D and that Thr54 allele carriers may be responsive in interventions that include dietary changes.

The authors evaluated the changes in apolpoproteins, glycemic status and body composition after 3 months using a cultural sensitive diabetes education program, En Balance, in diabetic Hispanics. Thirty-four Hispanic diabetics participated in the En Balance program over three months. Body composition was measured after three months and differences were analyzed. The results show the En Balance program improved body composition, A!c, FPG, total cholesterol/HDL ratio and HDl. If these trends can be sustained, En Balance may serve as a unique educational paradigm for improving type 2 diabetes in Hispanics.

Forty-five obese postmenopausal Caucasian women were treated with phentermine hydrochloride (Fastin®) and a 1200 kcal diet for weight reduction. Total and regional body composition changes were measured by dual-energy X-ray absorptiometry (DXA) and by anthropometry at 3-mo intervals over 9 mo. Plasma lipids, and serum insulin and leptin were measured. After 3 mo, Fastin® therapy produced a 6.8 kg weight loss (P < 0.01), and DXA-assessed fat and lean mass losses (P < 0.01) of 11.9 and 3.0%. respectively. DXA-estimated regional composition revealed respective fat mass losses of 14.1 and 11.9%. From abdomen and thighs, suggesting primarily subcutaneous and central fat depot losses. DXA reliability was assessed by same-day duplicate measurements ( n = 10) calculated using old (version 8.1a) and new (version 8.21) analysis software. A 1.5% between-duplicate difference in lean mass was obtained with the old software; the new software yielded 1.1, 1.4 and 1.6% differences between duplicates for fat, lean and leg lean masses, respectively. CVs ranged from 1.7% for bone mineral content to 12.0% for arm fat mass for both versions. The new software produced higher values for all variables, except arm fat and lean masses than the old software. Except for a 1.9% trunk fat loss detected with the old software, magnitude of body composition changes over 3 mo in 21 weight-stable subjects was the same. The new software estimated total weight more accurately and with less variability than the old software. Fastin®-treated women lost (P < 0.01) 10% of their baseline body weight over 9 mo which correlated with a 20% reduction (P < 0.01) in serum leptin concentration. Plasma HDL-cholesterol concentration increased (P < 0.01) by 15% over 9 mo while total- and LDL-cholesterol and triglycerides decreased 14.2 (P < 0.01), 25.4 (P < 0.01) and 12.2% (P < 0.05), respectively. Serum insulin was unaffected by weight reduction. These data suggest that Fastin® therapy was effective in reducing weight, and in producing a healthier body fat distribution and plasma lipid profile, thereby lowering cardiovascular disease risk in obese postmenopausal women. The DXA instrument (Holologic QDR-4500A. Hologic Inc. Waltham, MA) gave reproducible estimates of composition change in this population regardless of the software version used.

This study of rural mothers and health workers in Eastern Zambia illustrates the use of traditional medicines in the treatment of common illnesses, and the seeking of services from traditional healers. It provides a better understanding of knowledge, beliefs, and practices in the field of traditional medicine, and explores the relationship of common cultural-bound beliefs (Thola, Chibele, Chibambala, Chisi, and Njisi) with feeding practices during pregnancy and early childhood related to diarrheal diseases. In addition, it identifies factors that influence a mother's choice about the use or avoidance of certain foods. This qualitative research process encourages a culturally sensitive community-based approach to creating appropriate health promotion messages and program activities.