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Gesundheit – gemeinsam. Kooperationstagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP), Deutschen Gesellschaft für Epidemiologie (DGEpi), Deutschen Gesellschaft für Medizinische Soziologie (DGMS) und der Deutschen Gesellschaft für Public Health (DGPH)

08.09. - 13.09.2024, Dresden

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Cross-sectional association between substitution of carbohydrates with protein/fat and subcutaneous, visceral and liver adipose tissue volume in recent-onset diabetes

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  • Alexander Lang - Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
  • Edyta Szczerba - Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
  • Yuliya Kupriyanova - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
  • Janina Goletzke - Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
  • Katharina Weber - Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
  • Anette E. Buyken - Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
  • Sabine Kahl - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
  • Oana-Patricia Zaharia - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany; Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
  • Christian Herder - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany; Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
  • Vera B. Schrauwen-Hinderling - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
  • Oliver Kuß - Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany; Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Robert Wagner - Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany; Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
  • Michael Roden - Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
  • Sabrina Schlesinger - Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany

Gesundheit – gemeinsam. Kooperationstagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP), Deutschen Gesellschaft für Epidemiologie (DGEpi), Deutschen Gesellschaft für Medizinische Soziologie (DGMS) und der Deutschen Gesellschaft für Public Health (DGPH). Dresden, 08.-13.09.2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. DocAbstr. 753

doi: 10.3205/24gmds839, urn:nbn:de:0183-24gmds8390

Published: September 6, 2024

© 2024 Lang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Diets restricted in carbohydrates may be beneficial for diabetes management. But reducing carbohydrates without restricting total energy intake leads to compensatory increased intake of protein and fat. However, the quality of these nutrients is crucial, as it can influence accumulation of adipose tissue and lipid content. Thus, we aimed to examine the association of isocaloric substitutions of carbohydrates with fat and protein with subcutaneous (SAT) and visceral adipose tissue volumes (VAT) and hepatic lipid content (HLC) in individuals with recent-onset type 1 (T1D) and type 2 diabetes (T2D).

Methods: This cross-sectional analysis includes participants with T1D (n=150) or T2D (n=182), recruited from the prospective observational German Diabetes Study (GDS). Dietary macronutrient intake was derived from dietary information, as assessed with a validated food frequency questionnaire. SAT and VAT were measured with magnetic resonance (MR) imaging, while HLC with 1H MR spectroscopy. Isocaloric substitution analyses based on multivariable linear regression models were conducted to examine the replacement of carbohydrates in energy percentage (En%) with total fat, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA) and protein in regard to SAT, VAT and HLC. Taking the quality of carbohydrates into account, we also investigated the substitution of higher glycemic index (GI) carbohydrates with low GI carbohydrates and subtypes of MUFA, PUFA, SFA and protein.

Results: Macronutrient intake was comparable between diabetes types, both reporting relatively low carbohydrate (T1D: 37 En%, T2D: 36 En%) and high fat intake (T1D: 45 En%, T2D: 46 En%). In individuals with T1D, substituting carbohydrates with total fat was not associated with SAT, while substituting carbohydrates with protein was associated with higher SAT [β (95% CI) per 5 En%: 3100 cm³ (25, 6200)]. Replacing carbohydrates with fat or protein did not associate with VAT and HLC in T1D. In individuals with T2D, replacing carbohydrates with total fat or protein showed no association with SAT and VAT. However, substituting carbohydrates with MUFA was associated with higher VAT [1200 cm³ (230, 2200)], while substituting carbohydrates with PUFA was associated with lower VAT in T2D [-970 cm³ (-1900, -40)]. For HLC, similar findings were observed in T2D, when replacing carbohydrates with PUFA [-3.3% (-6.9, 0.4)]. In contrast, replacing carbohydrates with SFA was associated with higher HLC [2.4% (-0.6, 5.4)]. In more detailed analyses, replacing higher GI carbohydrates with even-chain SFA (C14:0, C16:0, C18:0) was associated with higher HLC, whereas a replacement with very-long-chain SFA (C20:0, C22:0, C24:0) or odd-chain SFA (C15:0, C17:0) was linked to lower HLC. Likewise, substituting carbohydrates with protein was associated with lower HLC in T2D [-2.4% (-4.9, 0.0)], mainly driven by plant-based protein.

Conclusions: These findings suggest that not only diets restricted in carbohydrates, but also the quality of nutrients substituted for those carbohydrates, may be crucial for the accumulation of adipose tissue and lipid content in individuals with T2D. Specifically the integration of PUFAs, very-long-chain and odd-chain SFAs, and plant-based proteins seems to be beneficial in regard to VAT and HLC.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.