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To provide effective medical nutrition therapy (MNT) , it is necessary to consider dietary intake, which can change over time. This longitudinal study analyzed changes in the dietary intakes of Japanese patients with type 2 diabetes over a 5-year period. The JDCS is a nationwide study of Japanese patients with type 2 diabetes conducted in 1996. Participants were aged 40-70 years from outpatient clinics in 59 universities and general hospitals. Analyzed were 922 responders to a dietary survey assessed by the Food Frequency Questionnaire based on food groups at baseline and 5 years after registration. Paired samples t-test was used for analysis. Over a 5-year period, patients with type 2 diabetes maintained almost the same body mass index (BMI) (baseline: 22.9±3.0; 5 years later: 22.8±3.0 kg/m2) . Differences in energy intake, fat-to-energy ratio, and carbohydrate-to-energy ratio were small although significant. Neither the mean intake of fiber nor salt met the required intake for MNT for persons with diabetes both at baseline and after 5 years. As for food groups, there was a significant decrease in intakes of vegetables, seaweed, soybeans/soy products, and milk/dairy products. Details are shown in the Table. Results showed that Japanese patients with type 2 diabetes need to pay special attention to dietary fiber intake and salt intake on an ongoing basis. Disclosure C.Horikawa: None. R.Aida: None. C.Kamada: None. K.Fujihara: None. S.Tanaka: None. A.Araki: None. Y.Yoshimura: None. Y.Akanuma: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. Funding Japan Society for the Promotion of Science (19H04028)

Although intake of both vegetables and fruits is known to be negatively associated with obesity in people with and without diabetes, the combined effects of these two food groups including cut-off values for intake have yet to be determined. We investigated the association according to combinations of the amount of fruit and vegetable intake determined by a food frequency questionnaire among 1579 patients with type 2 diabetes (990 men, mean age 50y) registered in the Japan Diabetes Clinical Data Management Study. Logistic regression analysis was used to calculate multi-adjusted odds ratios (ORs) for obesity (BMI ≥25) . Intake of fruits and vegetables was analyzed according to quintiles. Patients in the top quintile of fruit intake (≥150g) and the top three quintiles of vegetable intake (>200g) were significantly less obese than those in the bottom quintiles. In patients above/ below the thresholds for intake of fruits and vegetables, ORs for obesity for daily fruit intake of ≥150g and for daily vegetable intake >200g vs. lower amounts significantly decreased to 0.64 (95%CI: 0.50-0.82) and 0.55 (0.44-0.68) , respectively. In addition, ORs for 4 groups of combinations of intake of vegetables and fruits above and below the threshold were calculated. The ORs were significantly reduced regardless of the amount of fruit intake if vegetable intake was >200g. ORs further decreased significantly when fruit intake was ≥150g and that of vegetables was >200g. However, when vegetable intake was 200g of vegetables per day is essential to avoid obesity regardless of the amount of fruit consumed. However, an additional effect on body weight could be expected with simultaneous fruit intake ≥150g. Disclosure M.Takeuchi: None. K.Fujihara: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. M.Hatta: None. C.Horikawa: None. Y.Takeda: None. N.Kato: n/a. M.Kato: None. H.Yokoyama: None. T.Saito: None. H.Maegawa: None.

Medical nutrition therapy and exercise therapy are the cornerstones of treatment for patients with type 2 diabetes; however, there has not been a nationwide study on the actual dietary intake and physical activity status of patients since the 2000s. We aimed to clarify this in Japanese patients with type 2 diabetes using data from the Japan Diabetes Complication and its Prevention prospective (JDCP) , a nationwide study launched in 2007. A total of 1,992 patients with type 2 diabetes, aged 40-75 years, completed either the Brief-type, self-administered Diet History Questionnaire (1,643 patients) or International Physical Activity Questionnaire (1,834 patients) , and their data were analyzed in this study. Mean daily energy intake for all participants was 1686.8 kcal/day, and the mean proportions of carbohydrate, protein, and fat comprising total energy intake were 60.2, 16.2, and 23.6%, respectively. The patients in this study had similar energy and nutrient intake status to patients in the 1996 Japan Diabetes Complications Study; however, Japanese patients still had higher carbohydrate and lower fat consumption than patients with diabetes in Western countries. Only 10.5 % of the patients had equal to or more than 20 g/day of dietary fiber and 7.5% consumed less than 6 g of salt. Weekly physical activities of male and female patients were 2344.5±2700.9 and 1948.3±2209.3 METs·min/week in women, respectively (p Disclosure C.Horikawa: None. K.Tsuda: None. J.Satoh: None. Y.Hayashino: None. N.Tajima: None. R.Nishimura: Speaker's Bureau; Abbott Diabetes, Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck & Co., Inc., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Terumo Corporation. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. Funding Japan Diabetes Society

The association between screen time (ST) , including that for smartphones, and overweight/obesity (OW/OB) in children was examined separately for boys and girls, considering the influence of lifestyle factors including diet, physical activity, and sleep time. A cross-sectional study was conducted in 2242 Japanese children (1278 girls) aged 10-14 years. OW/OB was defined by the International Obesity Task Force. Logistic regression analysis showed that only for girls, total ST (≥4h) , smartphone ST (≥3h) and non-smartphone ST (≥2h) were all independently and significantly associated with overweight/obesity compared to In Japanese girls, smartphone ST, non-smartphone ST, and total ST were all significantly associated with OW/OB. To avoid OW/OB, it is suggested to keep smartphone ST, non-smartphone ST, and total ST to Disclosure K. Fujihara: None. S.Y. Morikawa: None. H. Ishiguro: None. M.H. Yamada: None. C. Horikawa: None. Y. Ogawa: None. H. Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited.

Though excessive sodium intake is regarded as a crucial factor related to developing and worsening of diabetes complications, data on this topic in elderly patients with diabetes are sparse. We investigated the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65 - 85 years. The present analysis was conducted among Japanese patients with type 2 diabetes from outpatient clinics in 39 university and general hospitals in Japan. Data were analyzed on 912 individuals whose dietary intake at baseline was assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to diabetic retinopathy, overt nephropathy, cardiovascular disease, and all-cause mortality during 6 years. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders Mean sodium intake in quartiles ranged from 2498 mg to 5910 mg/day and more than three-quarters of participants had sodium intake more than the recommended dietary allowance by American Diabetes Association (< 2300 mg/day). After adjustment for confounders, HRs for complications in patients with sodium intake in the 2nd, 3rd, and 4th quartiles compared with sodium intake in the 1st quartile were analyzed, and no significant differences were shown between sodium intake and complications. Among patients whose vegetable intake was less than the average of 268.7 g, HRs for diabetic retinopathy in patients in the 2nd, 3rd, and 4th quartiles of sodium intake compared with the 1st quartile were 0.87 (95% CI, 0.31-2.41), 2.61 (1.00-6.83), and 3.70 (1.37-10.02), respectively. Findings indicated that high sodium intake under conditions of low vegetable intake is associated with elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes. Disclosure C. Horikawa: None. T. Moriya: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. A. Araki: None. R. Aida: None. S. Tanaka: None. C. Kamada: None. S. Tanaka: None. Y. Yoshimura: None. R. Kodera: None. K. Fujihara: None. R. Kawasaki: None. Funding Japan Society for the Promotion of Science (19H04028)

Excessive sodium intake is regarded as a crucial factor related to developing and worsening of cardiovascular disease (CVD). However, epidemiological studies on this topic in patients with type 2 diabetes are sparse. We investigated the associations between sodium intake and CVD risk in Japanese patients with type 2 diabetes from the analysis of pooled data from two nation-wide prospective longitudinal studies. Data were analyzed on 2428 individuals whose dietary intake at baseline was assessed by the Food Frequency Questionnaire based on food groups. Primary outcome was the 6-year risk of a CVD event. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders. Mean sodium intake in quartiles ranged from 2494 mg to 6166 mg/day and more than three-quarters of participants had sodium intake more than the recommended dietary allowance by American Diabetes Association (< 2300 mg/day). After adjustment for confounders, HRs for CVD in patients with sodium intake in the 2nd, 3rd, and 4th quartiles compared with sodium intake in the 1st quartile were analyzed, and no significant differences were shown between sodium intake and CVD [Q2: 0.77 (95%CI, 0.48-1.23); Q3: 1.03 (0.65-1.63); and Q4: 1.31 (0.80-2.14), trend p = 0.131]. Results of subgroup analysis according to age showed that patients aged 39 through 59 years in the higher quartiles of sodium intake compared with the 1st quartile had a significantly higher incidence of CVD [Q2: 1.37 (0.57-3.33); Q3: 1.68 (0.70-4.03); and Q4: 4.16 (1.63-10.58), trend p = 0.004]. However, no significant association between sodium intake and CVD in participants aged over 60 years. Findings indicated that high sodium intake is associated with elevated incidence of CVD in younger patients with type 2 diabetes. Disclosure C. Horikawa: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. R. Aida: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. R. Kodera: None. K. Fujihara: None. T. Moriya: None. A. Araki: None. Funding Japan Society for the Promotion of Science (19H04028)

Although both average BMI and foods vary greatly between Asian and Western countries, few studies have examined the relationship between dietary patterns and obesity in Asians. We investigated dietary patterns significantly associated with obesity in Japanese with diabetes. Cross-sectionally analyzed were 2070 Japanese with type 2 diabetes (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. Principal component analysis was performed on 20 food groups to elucidate dietary patterns significantly associated with obesity. We also divided participants into quintiles according to factor scores of each dietary pattern. The adjusted odds ratios (ORs) for obesity, defined as BMI ≥25 according to the Asian cutoff, were calculated with other covariates including energy intake. Six dietary patterns were determined from eigenvalues (≥1) and screen plots. For Factor 1, characterized by a well-balanced food group with high intake of light-colored vegetables, green and yellow vegetables, sugar, seaweed, beans, fish and seafood, fruit and potato, the OR for obesity in Quintile5 compared to Quintile1 was 0.34 (95% CI: 0.22-0.53). Conversely, that of Factor 2, characterized by high intake of seasoning and spices, sugar-sweetened beverages, rice and eggs, was 2.56 (1.69-3.89) (Table). In conclusion, a balanced diet with various food groups might help to avoid obesity in Japanese with type 2 diabetes. Disclosure M. Hatta: None. K. Fujihara: None. I. Ikeda: None. M. Takeuchi: None. R. Nedachi: None. S.Y. Morikawa: None. C. Horikawa: None. M. Kato: None. N. Kato: None. H. Maegawa: Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

Obesity is known to increase the risks of cardiovascular events and mortality in patients with diabetes. Low serum magnesium (Mg) levels are reportedly associated with obesity and incident diabetes mellitus among nondiabetic individuals. Since only a few studies have addressed the relationship between intake of Mg and obesity, we analyzed our nationwide registry of diabetic patients to determine if there was an association between intake of Mg and obesity in Japanese patients with T2DM. We analyzed data on 1891 Japanese patients with T2DM (mean age, 62 y; men, 62%) who completed a food frequency questionnaire. Obesity was defined as BMI ≥25. Associations between obesity and intake of Mg were determined by multivariate regression and quintile analyses. After adjusting for confounders including energy intake, the odds ratio (OR) for obesity was 0.93 (0.91,0.96) per 10 mg increase in Mg intake. Quintile analysis revealed a stepwise significant decrease in ORs for obesity from Q1 (lowest, ref.) to Q5 (highest) (Table). Food groups potently related to Mg intake in our patients were beans (correlation coefficients, 0.64), vegetables (0.62), and fish (0.57). These results imply that intake of Mg might be closely associated with obesity in patients with T2DM, which should have clinical relevance in nutrition therapy. Disclosure R. Nedachi: None. K. Fujihara: None. M. Hatta: None. Y. Matsubayashi: None. Y. Takeda: None. D. Ishii: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Although serum phosphate concentrations have been consistently reported to have a negative correlation with BMI, there have been some conflicting reports of the relationship of dietary intake of phosphorus with BMI. Thus, we investigated the association between phosphorus intake and obesity in Japanese patients with diabetes mellitus. Analyzed were 1891 patients with T2DM (mean age, 62 y; men, 62%) in our nationwide registry who had completed a food frequency questionnaire. Obesity was defined according to BMI >25. The association between phosphorus intake and obesity was determined by multivariate regression as well as quintile analyses. Mean daily intake of phosphorus was 996 mg in men and 977 mg in women, values that were quite close to those of the general population in Japan. Intake of phosphorus was significantly associated with decreased risk of obesity with an odds ratio (OR) of 0.90 (0.87-0.94) per 50 mg increase in phosphorus intake. Quintile analysis revealed potent negative correlations in both men and women (Table). Food groups strongly associated with phosphorus among our patients were fish (0.58), dairy products (0.54) and beans (0.52). These results imply the clinical relevance of controlling phosphorus intake as part of medical nutrition therapy for patients with T2DM. Disclosure M. Hatta: None. K. Fujihara: None. Y. Matsubayashi: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Dietary energy density (DED) is receiving increased attention reflecting recent reports of inverse associations with health outcomes. Although high DED meals are reportedly associated with low diet quality in the general population, such evidence in patients with diabetes is sparse, which led us clarify this issue in Japanese patients with T2DM. Analyzed were 1,615 outpatients with T2DM (men 62.2%) who attended 24 clinics specializing in diabetes care nationwide. Dietary habits were obtained using a food frequency questionnaire (FFQg) based on 18 food groups. DED (kcal/g) was calculated by dividing EI (kcal) from foods (excluding beverages) by weights of these foods (g). Mean DED (±SD) was 1.53±0.23 (kcal/g). Typical dietary patterns comprised of some significant food groups were extracted by principal component analysis. Pearson's correlation analysis was used to evaluate the associations between identified food patterns and DED. We could extract and validate three dietary patterns, which we labeled as “Healthy,” “Western,” and “Animal foods and confectionery.” Two patterns were significantly correlated with DED (Healthy: r=-0.48, Animal foods and confectionery: r=-0.69). A multivariate linear regression model was used to determine food groups that were independently related to DED. DED was positively associated with confectioneries (standardized β=0.19, P In conclusion, lower DED, which is related to higher intakes of vegetables and fruits was associated with a healthy diet pattern in T2DM patients. DED is a useful indicator of diet quality and could be utilized in nutritional education for people with T2DM. Disclosure Y. Takeda: None. K. Fujihara: None. M. Hatta: None. S.Y. Morikawa: None. C. Horikawa: None. D. Ishii: None. R. Nedachi: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Although cardiovascular risk and mortality increases in the presence of comorbid obesity among patients with T2D while fish intake is known to decrease such risks, the association between obesity and fish intake is only poorly understood. Thus, we aimed to clarify these possible associations, including the effects of fish-related nutrients. Analyzed were 1891 Japanese patients with T2D (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. BMI>25 was defined as obesity. Associations between obesity and intake of fish and related nutrients were analyzed by quintiles. Vitamin B12 (VB12) (correlation coefficient, 0.97), vitamin D (VD) (0.94), and long-chain omega-3 polyunsaturated fatty acids (n-3) (0.74) were significantly and potently associated with fish intake. Odds ratio (OR) for obesity was significantly decreased to approximately 0.6 in patients in Q4 (men, 80-108g; women, 77-103g) and Q5 (>108g; >103g) of fish intake compared to Q1 ( Disclosure M. Hatta: None. K. Fujihara: None. Y. Matsubayashi: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. C. Horikawa: None. N. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Diabetes self-management is an essential part of diabetes care. Although several personality traits were reportedly associated with self-management behaviors or glycemic control in Western countries, clinical evidence of such an association is still sparse, especially among Asian patients with diabetes. Thus, we aimed to clarify the associations among personality, self-management behaviors, and glycemic control in Japanese patients with T2DM. Analyzed were 510 Japanese patients with T2DM (62.2 ± 11.2 y; 57% men) with available information on personality (assessed by NEO Five-Factor Inventory), diabetes self-management activities (assessed by the Japanese version of Summary of Diabetes Self-Care Activities), body mass index (BMI), and HbA1c. Coefficient of correlation indicated that those with high scores for neuroticism, as well as low scores for conscientiousness, had lower levels of diet (neuroticism r = -0.14, P Disclosure S.Y. Morikawa: None. K. Fujihara: None. M. Hatta: None. Y. Takeda: None. D. Ishii: None. J. Yachida: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Although support from patients’ family members is essential in managing type 2 diabetes, evidence is sparse on family support for medical nutritional therapy (MNT) and habitual dietary intake. This study investigated the association between patients’ perception of family support for MNT and their dietary intake. Analyzed were 154 Japanese patients with type 2 diabetes (men, 45.5%) who completed the Food Frequency Questionnaire and Diabetes Family Behavior Checklist. Multivariate analysis of covariance was used adjusting for age, gender, BMI, duration for diabetes, HbA1c, and use of oral hypoglycemic agents and/or insulin. Participants’ mean age, duration of diabetes and HbA1c were 63.5 y, 12.7 y and 7.0%, respectively. After adjusting for confounders, positive family support, i.e., ‘Praise for following diet,’ was only significantly associated with higher fish intake (none 72.0 g/d, once a month 73.1 g/d, once a week 85.8 g/d, several times a week 97.6 g/d, and at least daily 92.1 g/d; trend p= 0.008). With greater frequency of eating at the same time as the family, salt intake was significantly higher (none 7.8 g/d, once a month 8.3 g/d, once a week 8.7 g/d, several times a week 9.3 g/d, and at least once daily 8.8 g/d; trend p= 0.037). Conversely, negative family support indicated by ‘Nags about following the diet’ was significantly associated with higher fish intake (none 70.3 g/d, once a month 84.4 g/d, once a week 84.3 g/d, several times a week 86.5 g/d, at least once daily 107.9 g/d; trend p= 0.012) and higher intake of vegetables was more frequent in those eating foods not part of the diabetic diet (none 242.1 g/d, once a month 192.1 g/d, once a week 270.4 g/d, several times a week 255.0 g/d, at least once daily 305.5 g/d; trend p= 0.027). These findings implied that patients’ perception of family support for MNT was not always associated with an ideal dietary intake to control diabetes. To facilitate diabetes treatment, sharing patient-family perceptions of MNT could be important. Disclosure C. Horikawa: None. Y. Takeda: None. M. Hatta: None. D. Ishii: None. S.Y. Morikawa: None. K. Fujihara: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Funding Japan Association for Diabetes Education and Care

Obesity is associated with deterioration of T2DM and its complications. Although low serum zinc levels are reportedly associated with obesity in nondiabetic people, clinical evidence regarding the association between dietary intake of zinc and obesity in diabetic individuals is sparse. Thus, we aimed to clarify this issue utilizing our nationwide registry of Japanese patients with diabetes. Analyzed were 1891 patients with T2DM (mean age, 62 y; men, 62%) whose data from a food frequency questionnaire were available. Obesity was defined as BMI of ≥25. The associations between obesity and intake of zinc were determined by multivariate regression as well as quintile analyses. Odds ratio (OR) for obesity was 0.74 (0.65, 0.84) per 1 mg increase in zinc intake. Quintile analysis revealed a stepwise decrease in ORs for obesity at higher quintiles. ORs in Q3-Q5 were significant compared to Q1 as the reference (Table). Food groups strongly related to zinc intake among our patients were meats (correlation coefficients, 0.64), fish (0.49), and vegetables (0.47). These results suggest close associations between zinc intake and obesity in patients with T2DM. This information would be clinically applicable for nutrition education. Disclosure R. Nedachi: None. K. Fujihara: None. M. Hatta: None. Y. Matsubayashi: None. Y. Takeda: None. D. Ishii: None. C. Horikawa: None. N. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Although obesity is closely associated with development and progression of type 2 diabetes mellitus (T2DM) and its complications, food group intake associated with obesity in diabetic patients has been very poorly investigated to date largely due to lack of large-scale databases with details on dietary intake. Thus, we aimed to determine intake of food groups by utilizing our nationwide database for people with diabetes with adjustment for confounders including energy intake. Analyzed were 1891 Japanese patients with T2DM (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. Obesity was defined by BMI>25. The associations between obesity and food groups were determined by multivariate quartile analysis. Among 15 food groups, both green and yellow and light-colored vegetables had significant negative associations with the presence of obesity among both men and women (Table). In addition, fruit and beans in men and fish in women were also negatively associated with obesity. Conversely, confectionery had positive associations with obesity in both men and women. Other food groups such as rice, meat or eggs did not show significant trends toward the presence of obesity. These results identified favorable dietary patterns for people with T2DM, which could be used for effective nutritional education to prevent obesity. Disclosure M. Hatta: None. K. Fujihara: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. S.Y. Morikawa: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Evidence for optimal dietary intake of calcium for prevention of diabetic complications is sparse although population-based cohort studies showed that calcium intake reduces the risk of type 2 diabetes (T2D). We aimed to investigate the relationship between calcium intake and the incidence of diabetes complications in Japanese patients with T2D aged 40-70 years with HbA1c ≥6.5%. This analysis was conducted as a multicenter prospective study of the incidence of and risk factors for macro- and microvascular complications among 2205 Japanese patients with T2D from outpatient clinics in 59 university and general hospitals in Japan. Analyzed were 1588 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups or a dietary record. Primary outcome was the 8-year risk of nephropathy, retinopathy, and cardiovascular disease (CVD). Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, BMI, HbA1c, smoking, energy intake, and other confounders. Mean calcium intake in quartiles ranged from 487.5 to 751 mg/day, and more than half of participants had calcium intake below the recommended daily dietary allowance in Japan (men 700 mg/d; women 650 mg/d). After adjusting for confounders, HRs of diabetic nephropathy in the 2nd, 3rd, and 4th quartiles for calcium intake compared with the 1st quartile were 1.20 (95% confidence interval 0.67-2.18, p=0.540), 0.60 (0.28-1.28, p=0.185), and 0.42 (0.18-0.97, p=0.024), respectively. There were no significant associations of calcium intake with retinopathy and CVD in the 2nd to 4th quartiles relative to the 1st quartile (retinopathy: 1.15 (0.81-1.64, p=0.441), 1.14 (0.78-1.68, p=0.491), and 0.93 (0.59-1.46, p=0.809); CVD: 0.86 (0.51-1.44, p=0.558), 0.92 (0.53-1.61, p=0.763), and 0.81 (0.42-1.53, p=0.508). Findings suggested an association of high calcium intake with a lower incidence of diabetes nephropathy in Japanese patients with T2D. Disclosure C. Horikawa: None. R. Aida: None. S. Tanaka: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. A. Araki: Speaker's Bureau; Self; Dainippon Sumitomo Parma Co. Ltd., Merck & Co., Inc., Tanabe Mitsubishi Pharma Corporation. T. Moriya: None. S. Katayama: None. Y. Akanuma: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Funding Japan Society for the Promotion of Science; Japan Ministry of Health, Labour and Welfare

Evidence for optimal dietary intake of vitamin D for prevention of diabetic complications is sparse although associations between low vitamin D intake and high incidence of diabetes and vitamin D supplementation and improvement in insulin resistance were reported. We aimed to investigate the relationship between vitamin D intake and the incidence of diabetes complications in Japanese patients with type 2 diabetes aged 40-70 years with HbA1c≥6.5%. The present analysis was conducted as a multicenter prospective study on the incidence of and risk factors for macro- and microvascular complications among 22Japanese patients with type 2 diabetes from outpatient clinics in 59 university and general hospitals in Japan.Analyzed were 1516 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups. Primary outcome was the 8-year risk of nephropathy, retinopathy, and cardiovascular disease (CVD). Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders. Mean vitamin D intake in quartiles ranged from 5.4 to 18.7μg/day. After adjusting for confounders, HRs of diabetic nephropathy in the 2nd, 3rd, and 4th quartiles for vitamin D intake compared with the 1st quartile were 0.7 (95% confidence interval 0.4-1.3, p=0.29), 1.2 (0.6-2.2, p=0.61), and 0.33 (0.14-0.79, p=0.01), respectively. There was no significant associations of vitamin D intake with retinopathy and CVD in the 2nd to 4th quartiles relative to the first quartile (retinopathy: 1.2 (0.9-1.6, 0.4), 0.8 (0.5-1.2, p=0.23), and 0.7 (0.5-1.0, p=0.08); CVD: 1.1 (0.7-1.7, p=0.83), 1.2 (0.7-2.0, p=0.62), and 0.7 (0.4-1.3, p=0.22)). Findings suggested that high vitamin D intake was associated with a lower incidence of diabetes nephropathy among Japanese patients with type 2 diabetes. Disclosure C. Horikawa: None. R. Aida: None. S. Tanaka: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. A. Araki: None. T. Moriya: None. S. Katayama: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..

Vitamin B6 has been expected to prevent the progression of diabetic retinopathy. Previous studies reported that treatment with vitamin B6 protected against capillary dropout in a mouse model of diabetes and low serum vitamin B6 levels were associated with retinal vein occlusion in healthy individuals. However, data on this topic in patients with diabetes are sparse. As part of a nationwide cohort study we investigated the relationship between vitamin B6 intake and the incidence of diabetic retinopathy in Japanese patients with type 2 diabetes aged 40-70 years with HbA1c≥6.5%. The present analysis was conducted among 22Japanese patients with type 2 diabetes from outpatient clinics in 59 university and general hospitals in Japan. Analyzed were 1516 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups. Primary outcome was the 8-year risk of a diabetic retinopathy event. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders. Mean vitamin B6 intake in quartiles ranged from 0.9 to 2.0 mg/day and half of participants had vitamin B6 intake less than the recommended dietary allowance according to dietary reference intakes in Japan (males 1.4 mg/day; females 1.2 mg/day). Patients in higher quartiles included those with significantly high energy, vegetable, meat and fish intakes (p for trend< 0.01, < 0.01, < 0.01, and < 0.01, respectively). After adjusting for confounders, hazard ratios for diabetic retinopathy in the 2nd, 3rd, and 4th quartiles of vitamin B6 intake compared with the 1st quartile were 1.2 (95% confidence interval 0.8-1.7, p=0.36), 0.9 (0.6-1.3, p=0.51), and 0.51 (0.31-0.88, p=0.01), respectively. We clarified that the decreased incidence of diabetic retinopathy in Japanese patients with type 2 diabetes was associated with high vitamin B6 intake. Disclosure C. Horikawa: None. R. Aida: None. S. Tanaka: None. Y. Yoshimura: None. R. Kawasaki: None. T. Moriya: None. A. Araki: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..

Although the importance of support of patients by family members is emphasized for diabetes care, evidence of achieving adequate glycemic control (GC) through instructing family members to help in self-management care of diabetes patients has not been established. This meta-analysis assessed the effect of family-oriented diabetes programs on GC. The pooled A1C change shown in 31 studies that were retrieved from systematic literature searches for clinical trials presenting data on the net effect of family education on the reduction in glycohemoglobin A1C (A1C) (i.e., difference in A1C change between intervention groups involving family members and that not involving family members [control group]) was -0.45% (PP Disclosure S. Kodama: None. K. Fujihara: None. H. Ishiguro: Research Support; Self; MSD K.K., Sanofi K.K., Eli Lilly and Company. C. Horikawa: None. Y. Yachi: None. M. Ishizawa: None. S. Matsunaga: None. S. Tanaka: None. K. Kato: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..

DED, defined as the ratio of energy intake (EI) to food weight, is receiving increased attention reflecting recent reports of its associations with elevated risks for obesity and T2DM in general populations. However, only a few studies have investigated the associations between DED and metabolic variables in patients with established diabetes, which led us to analyze the association between DED and obesity in Japanese patients with T2DM. Cross-sectionally investigated were 1,576 outpatients with T2DM (men 60.8%) who attended 26 clinics having diabetes specialists. Dietary habits were obtained by the Food Frequency Questionnaire based on food groups (FFQg). DED (kcal/g) was calculated by dividing EI (kcal) from foods (excluding beverages) by these food weights (g) and was categorized into tertiles (low (L), In conclusion, higher DED, which is related to higher fat intake, was strongly associated with a greater chance of having obesity in T2DM patients regardless of EI. Therefore, DED is critical in assessing diet quality and has clinical relevance in obesity management of patients with T2DM. Disclosure Y. Takeda: None. K. Fujihara: None. S.Y. Morikawa: None. C. Horikawa: None. M. Hatta: None. D. Ishii: None. R. Hirasawa: None. Y. Yachi: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..

OBJECTIVE Foods rich in fiber, such as vegetables and fruits, prevent cardiovascular disease (CVD) among healthy adults, but such data in patients with diabetes are sparse. We investigated this association in a cohort with type 2 diabetes aged 40–70 years whose HbA1c values were ≥ 6.5% in Japan Diabetes Society values. RESEARCH DESIGN AND METHODS In this cohort study, 1,414 patients were analyzed after exclusion of patients with history of CVDs and nonresponders to a dietary survey. Primary outcomes were times to stroke and coronary heart disease (CHD). Hazard ratios (HRs) of dietary intake were estimated by Cox regression adjusted for systolic blood pressure, lipids, energy intake, and other confounders. RESULTS Mean daily dietary fiber in quartiles ranged from 8.7 to 21.8 g, and mean energy intake ranged from 1,442.3 to 2,058.9 kcal. Mean daily intake of vegetables and fruits in quartiles ranged from 228.7 to 721.4 g. During the follow-up of a median of 8.1 years, 68 strokes and 96 CHDs were observed. HRs for stroke in the fourth quartile vs. the first quartile were 0.39 (95% CI 0.12–1.29, P = 0.12) for dietary fiber and 0.35 (0.13–0.96, P = 0.04) for vegetables and fruits. There were no significant associations with CHD. The HR per 1-g increase was smaller for soluble dietary fiber (0.48 [95% CI 0.30–0.79], P < 0.01) than for total (0.82 [0.73–0.93], P < 0.01) and insoluble (0.79 [0.68–0.93], P < 0.01) dietary fiber. CONCLUSIONS Increased dietary fiber, particularly soluble fiber, and vegetables and fruits were associated with lower incident stroke but not CHD in patients with type 2 diabetes.

OBJECTIVE The association between habitual physical activity (PA) and lowered risk of all-cause mortality (ACM) and cardiovascular disease (CVD) has been suggested in patients with diabetes. This meta-analysis summarizes the risk reduction in relation to PA, focusing on clarifying dose-response associations. RESEARCH DESIGN AND METHODS Electronic literature searches were conducted for cohort studies that examined relative risk (RR) of ACM or CVD in relation to PA in patients with diabetes. For the qualitative assessment, RR for the highest versus the lowest PA category in each study was pooled with a random-effects model. We added linear and spline regression analyses to assess the quantitative relationship between increases in PA and ACM and CVD risk. RESULTS There were 17 eligible studies. Qualitatively, the highest PA category had a lower RR [95% CI] for ACM (0.61 [0.52–0.70]) and CVD (0.71 [0.60–0.84]) than the lowest PA category. The linear regression model indicated a high goodness of fit for the risk of ACM (adjusted R2 = 0.44, P = 0.001) and CVD (adjusted R2 = 0.51, P = 0.001), with the result that a 1 MET-h/day incrementally higher PA was associated with 9.5% (5.0–13.8%) and 7.9% (4.3–11.4%) reductions in ACM and CVD risk, respectively. The spline regression model was not significantly different from the linear model in goodness of fit (P = 0.14 for ACM risk; P = 0.60 for CVD risk). CONCLUSIONS More PA was associated with a larger reduction in future ACM and CVD risk in patients with diabetes. Nevertheless, any amount of habitual PA was better than inactivity.