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Low-AGE diet associated with insulin resistance in adults with obesity, metabolic syndrome
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Adults with obesity and metabolic syndrome randomly assigned to a diet low in advanced glycation end products saw improvements in insulin resistance, oxidative stress, inflammation and body weight vs. those assigned to a control diet, according to recent findings.
“While food AGEs are prevalent, particularly in Western diets, our study showed that avoiding foods high in AGEs could actually reverse the damage that had been done,” Helen Vlassara, MD, professor emeritus of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, said in a press release. “This can provide us with new clinical approaches to prediabetes, potentially helping protect certain at-risk individuals from developing full diabetes and its devastating consequences.”
In a randomized controlled trial, Vlassara and colleagues analyzed data from 138 adults aged at least 50 years with obesity and at least two of the five criteria for metabolic syndrome. Participants completed a 3-day AGE food record; those whose daily intake was at least 12 AGE-equivalents daily were included in the study. Researchers assigned 77 participants to a low-AGE diet for 12 months; 61 were assigned to their usual diet as controls. The low-AGE diet group prepared their own food at home following instructions on how to reduce dietary AGE intake by modifying cooking time and temperature without changing the quantity, quality or composition of food. The low-AGE cohort was instructed to avoid frying, baking or grilling, and instead prepare food by boiling, poaching, stewing or steaming; participants attended an in-person interview with a dietician every 3 months to review instructions and food records. Primary outcome was the diet’s effect on homeostasis model assessment of insulin resistance (HOMA-IR).
Researchers found that the low-AGE diet improved insulin resistance, with HOMA-IR decreasing in 80% of low-AGE participants vs. 31% of controls. Results persisted after adjustment for baseline BMI, intake of calories, protein, carbohydrates and fat, as well as age, sex and race.
Both diets were associated with modest weight loss, which reached significance only in the low-AGE group.
“Of note, markers of insulin resistance (HOMA and fasting plasma insulin), as well as serum AGEs and markers of oxidative stress and inflammation, including 8-isoprostanes, RAGE and TNF, were reduced even in those participants on the [low-AGE] diet who did not lose body weight (n = 12),” the researchers wrote. “By comparison, there were no such end-of-study changes in participants on the [control] diet who lost weight (n =25).”
At 12 months, controls had higher levels of AGEs and more markers of insulin resistance than at baseline, according to researchers.
“Elevated serum AGEs in individuals can be used as a marker to diagnose and treat ‘at risk’ obesity in patients,” Jaime Uribarri, MD, professor of medicine at the Icahn School of Medicine at Mount Sinai, said in a press release. “Even without losing a significant amount of weight, a reduced-AGE diet can help prevent diabetes in these patients.”
The researchers also found a positive effect on six key genes associated with the regulation of oxidant stress and inflammation. Four of these had been found to be suppressed at the baseline blood and urine analysis, but were markedly increased at the end, including anti-inflammatory SIRT1 and adiponectin, as well as the receptor for the removal of AGEs, AGER1, and glyoxalase-1. –by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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