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Consumption of traditional foods is decreasing amid a lifestyle transition in Greenland as incidence of type-2 diabetes (T2D) increases. In homozygous carriers of a TBC1D4 variant, conferring postprandial insulin resistance, the risk of developing T2D is markedly higher. We investigated the effects of traditional marine diets on glucose homeostasis and cardio-metabolic health in Greenlandic Inuit carriers and non-carriers of the variant. We conducted a randomized, crossover study consisting of two 4-week dietary interventions; Traditional (marine-based, low-carbohydrate) and Western (high in imported meats and carbohydrates). Oral glucose tolerance (OGTT, 2-h), 14-day continuous glucose and cardio-metabolic markers were assessed to investigate the effect of diet and genotype. Compared to the westernized diet, the Traditional diet reduced mean and maximum daily blood glucose by 0.17 mmol/L [95% CI;0.05, 0.29; P=0.006] and 0.26 mmol/L [95% CI;0.06, 0.46; P=0.010], respectively, with dose-dependency. Furthermore, it gave rise to a weight loss of 0.5 kg [95% CI; 0.09, 0.90; P=0.016] relative to the Western diet and 4% [95% CI;1, 9; P=0.018] lower LDL:HDL-cholesterol, which after adjustment for weight-loss appeared to be driven by HDL elevation (0.09 mmol/L [0.03, 0.15], P=0.006). A diet-gene interaction was indicated on insulin sensitivity in the OGTT (p=0.093), which seemed to reflect a non-significant increase of 1.4 [-0.6, 3.5] mmol/L in carrier 2-h glucose. A Traditional diet marginally improved daily glycaemic control and plasma lipid profile compared to a Western diet in Greenlandic Inuit. Possible adverse effects on glucose tolerance in carriers of the TBC1D4 variant warrants further studies of diet-gene interactions.

Iintroduction: The prevalence of cachexia in patients with chronic obstructive pulmonary disease (COPD) is high and associated with reduced quality of life, increased mortality and morbidity. We aimed to test the effect of a high protein diet combined with exercise on fat-free mass (FFM), functional capacity, symptom burden and dyspnoea. Methods: Outpatients with COPD and severe or very severe (GOLD grade III-IV) disease and malnutrition commencing pulmonary rehabilitation were randomised to a high-protein diet or standard care. FFM was measured by bio-impedance analysis (BIA), mid-upper arm circumference (MUAC) and mid-thigh circumference (MTC), peripheral muscle function by six-minute walking distance (6MWD) and handgrip strength (HGS), symptoms by the COPD Assessment Trial (CAT) and dyspnoea by the Medical Research Council dyspnoea scale and Borg scores; all at baseline and after 12 weeks. Results: Ten out of 13 randomised patients completed the trial. The intervention group was superior to the control group with respect to 6MWD (97 ± 93 m, p = 0.04) at 12 weeks. No differences were observed between the groups in HGS, anthropometrics, symptom burden or dyspnoea. Conclusion: In patients with COPD attending rehabilitation, a high protein diet combined with physical exercise had a clinically relevant effect on walking distance.

The presence of malnutrition is increasingly becoming a postdischarge problem in surgical patients. We aimed to investigate whether oral nutritional supplements combined with resistance training could minimize skeletal muscle atrophy in surgical patients after discharge. This randomized controlled study was conducted at the Department of Surgery, National Hospital of Faroe Islands from 2018 to 2020. A total of 45 patients aged 37–74 years participated and were allocated to one of three groups: diet (DI; n = 13), exercise and diet (EX + DI; n = 16), or control (CON; n = 16). The intervention period lasted 8 weeks. The intervention groups received individual dietary counselling and a protein-rich oral nutritional supplement twice a day containing 22 g of protein/day. Patients in the EX + DI group were assigned to resistance training sessions. Patients in the CON group received standard care. The primary outcome was change in lean body mass (LBM). Secondary outcomes were change in body weight, handgrip strength, quality of life, surgery-related side effects, energy and protein intake, length of stay and one-year mortality. To estimate within-group changes, linear mixed models including group–time interactions as fixed effects and patients as random effects were fitted. Within-group change in LBM was 233, 813 and 78 g in the DI, EX + DI and CON groups, respectively, with no significant between-group difference (p > 0.05). Pain score declined more (p = 0.04) in the EX + DI group compared with the CON group. Body weight, handgrip strength, quality of life and surgery-related side effects did not differ between groups. At the end of study, mean cumulative weight change in the DI and EX + DI groups was 0.4% and 1.6%, respectively, whereas the CON group experienced a weight loss of −0.6%. No significant difference in primary outcome between groups was noted. However, our results indicate some benefits from exercise and nutrition for m

Most people with cystic fibrosis (pwCF) develop pancreatic insufficiency and are treated with pancreatic enzyme replacement therapy (PERT). We aimed to describe the use of PERT and assess the correlates of PERT dose in adult pwCF. In a cross-sectional study at the Copenhagen CF Centre, the participants reported PERT intake, gastrointestinal (GI) symptoms and the use of concomitant treatments. Demographic and clinical characteristics were extracted from the Danish CF Registry. We used linear regression to assess the correlates of PERT dose per kg bodyweight (U-lipase/kg). We included 120 pwCF with a median age of 32.9 years, 46% women and 72% F508delta homozygote. The PERT dose ranged from 0 to 6160 U-lipase/kg per main meal (mean 1828; SD 1115). The PERT dose was associated with participants’ sex (men vs. women: 661; 95% CI: 302; 1020 U-lipase/kg), age (−16; 95% CI: −31; −1 U-lipase/kg per year) and weight (−45; 95% CI: −58; −31 U-lipase/kg per kg). Having less frequent constipation and being lung transplanted were also associated with a higher PERT dose. A third of participants did not take PERT for snacks, and this was associated with the frequency of diarrhoea. These findings indicate that PERT intake may be improved to reduce GI symptoms.

Background & aims: Low-energy diet replacement is an effective tool to induce large and rapid weight loss and improve metabolic health, but in the long-term individuals often experience significant weight regain. Little is known about the role of animal-based foods in weight maintenance and metabolic health. We aimed to examine longitudinal associations of animal-based foods with weight maintenance and glycaemic and cardiometabolic risk factors. We also modelled replacement of processed meat with other high-protein foods. Methods: In this secondary analysis, longitudinal data were analysed from 688 adults (26e70 years) with overweight and prediabetes after 8-week low-energy diet-induced weight loss (≥8% of initial body weight) in a 3-year, multi-centre, diabetes prevention study (PREVIEW). Animal-based food consumption, including unprocessed red meat, processed red meat, poultry, dairy products, fish and seafood, and eggs, was repeatedly assessed using 4-day food records. Multi-adjusted linear mixed models and isoenergetic substitution models were used to examine the potential associations. Results: The available-case analysis showed that each 10-g increment in processed meat, but not total meat, unprocessed red meat, poultry, dairy products, or eggs, was positively associated with weight regain (0.17 kg year-1 , 95% CI 0.10, 0.25, P < 0.001) and increments in waist circumference, HbA1c, and triacylglycerols. The associations of processed meat with HbA1c or triacylglycerols disappeared when adjusted for weight change. Fish and seafood consumption was inversely associated with triacylglycerols.

Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management only.

Personalised nutrition (PN) is an emerging field that bears great promise. Several definitions of PN have been proposed and different modelling approaches have been used to claim PN effects. We tentatively propose to group these approaches into two categories, which we term outcome-based and population reference approaches, respectively. Understanding the fundamental differences between these two types of modelling approaches may allow a more realistic appreciation of what to expect from PN interventions presently and may be helpful for designing and planning future studies investigating PN interventions.

Background and aims: Body mass index (BMI) and waist circumference (WC) are commonly used markers of cardiometabolic risk. However, sagittal abdominal diameter (SAD) has been proposed as a possibly more sensitive marker of intra-abdominal obesity. We investigated differences in how SAD, WC, and BMI were correlated with cardiometabolic risk markers. Methods and results: This cross-sectional study investigated anthropometric and metabolic baseline measurements of individuals from six trials. Multiple linear regression and (partial) correlation coefficients were used to investigate associations between SAD, WC, and BMI and cardiometabolic risk markers, including components of the metabolic syndrome as well as insulin resistance, blood lipids, and lowgrade inflammation. In total 1516 mostly overweight or obese individuals were included in the study. SAD was significantly more correlated with TG than WC for all studies, and overall increase in correlation was 0.05 (95% CI (0.02; 0.08). SAD was significantly more correlated with the markers TG and DBP 0.11 (95% CI (0.08, 0.14)) and 0.04 (95% CI (0.006, 0.07), respectively compared to BMI across all or most studies. Conclusion: This study showed that no single anthropometric indicator was consistently more strongly correlated across all markers of cardiometabolic risk. However, SAD was significantly more strongly correlated with TG than WC and significantly more strongly correlated with DBP and TG than BMI.

Background & aims: Fish-oil, rich in Omega-3 long chain polyunsaturated fatty acids (n-3 LC PUFAs), may in high doses inhibit the development or progression of cancer cachexia. However, poor compliance to oral nutritional supplements is a well-known problem. We aimed to investigate acceptability and compliance to a nutritional drink with fish-oil compared to an equivalent dose of fish-oil administered as capsules in patients receiving chemotherapy for GI tract cancers. Moreover, we aimed to investigate, if there was a difference between a nutritional drink or capsules with respect to nutritional status and side effects. Finally, we aimed to examine, if n-3 LC PUFAs affect leukocyte and platelet counts, and markers of dose-limiting toxicities of chemotherapy.Methods: We consecutively included 41 patients with advanced cancer in the controlled study. Patients were allocated (not randomized) to ingest either 10 capsules/day for four weeks or 400 mL/day of a nutritional drink with same dose of n-3 LC PUFA dose. Compliance was assessed by daily self-registration and n-3 LC PUFAs in whole blood. Side effects were assessed by 10 cm visual analog scales.Results: Compliance and daily consumption of n-3 LC PUFAs were 96.4% (94.1e99.3) and 4.8 (4.7e4.9) g/day in the capsule group and 80.8 (55.4e93.6) % and 4.0 (2.8e4.7) g/day in the group, respectively (p 0.02). We found no differences between the groups with respect to changes in whole blood n-3 LC PUFAs, weight, nutritional status, acceptability or side effects. However, in the capsule group the whole blood n-3 LC PUFAs correlated negatively with the increase in nausea (rs ¼ 0.39, p ¼ 0.05), but not in the nutritional drink group. Nausea, reduced appetite and loose stools were of greatest importance for the deviations from recommended doses. The number of capsules had a negative impact on acceptability and compliance, whereas this was mainly related

A case is a narrative and may include data, important information, text andquestions to students, and provide the basis for the analysis of complex, real world, authentic problems (Rienecker et al., 2015). The case method involves learning by doing. Case-based learning may provide students with a relevant opportunity to see theory in practice and to gain both theoretical and practical understanding of .e.g patients and prepares students for multifaceted problems that they are likely to encounter in professional practice case (Harman et al., 2015). Through case-based learning, students may acquire knowledge, skills and competences at the level of recognition and understanding as well as develop higher levels of abstraction, addressing open ended and complex problems (Rienecker et al., 2015). Students may also develop analytic, communicative and collaborative skills along with knowledge when working case-based. In their determined attempt to find solutions and reach decisions, through discussion, students apply analytical tools, reflect on their relevant experiences and draw conclusions they can relate to new situations (Centre for teaching and learning, 2019). In this assignment a new elective course in the Master of Science study study programme in Clinical Nutrition: Nutritional Therapy in Chronic Disease is evaluated with special emphasis on case-based learning.

Artiklen er baseret på resultater fra en PhD-afhandling af Grith Møller. Fokus i afhandlingen er betydningen af et øget proteinindtag hos ældre personer med prædiabetes, hvor en nyreskade i særlig grad vil have betydning.

Concerns about detrimental renal effects of a high-protein intake have been raised due to an induced glomerular hyperfiltration, since this may accelerate the progression of kidney disease. The aim of this sub-study was to assess the effect of a higher intake of protein on kidney function in pre-diabetic men and women, aged 55 years and older. Analyses were based on baseline and one-year data in a sub-group of 310 participants included in the PREVIEW project (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World). Protein intake was estimated from four-day dietary records and 24-hour urinary urea excretion. We used linear regression to assess the association between protein intake after one year of intervention and kidney function markers: creatinine clearance, estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (ACR), urinary urea/creatinine ratio (UCR), serum creatinine, and serum urea before and after adjustments for potential confounders. A higher protein intake was associated with a significant increase in UCR (p = 0.03) and serum urea (p = 0.05) after one year. There were no associations between increased protein intake and creatinine clearance, eGFR, ACR, or serum creatinine. We found no indication of impaired kidney function after one year with a higher protein intake in pre-diabetic older adults.

Type 2 diabetes (T2D) incidence and prevalence rates are increasing worldwide, which imposes human, social and economic costs. While the risk of T2D is determined by interplay of genetic and metabolic disorders, overweight and obesity are the predominant risk factors. The treatment of obesity today is primarily lifestyle modification, including moderately energy-reduced diets, increased physical activity and often behavioural strategies to facilitate adherence to the life style changes. But other strategies exist too, such as pharmacotherapy and surgery. The various strategies may be used in combination. An increased dietary protein intake has been recommended in the treatment of obesity mainly due to the high satiating effect of protein compared with other macronutrients. Results from intervention studies have shown that diets rich in protein may result in larger weight loss. However, unwanted effects of an increased protein intake on kidney function and putative colorectal cancer risk markers as well as insulin sensitivity have also been suggested. Still, the literature to date in this regard is contradictory. The overall objective of this PhD thesis was to investigate the effect of an increased protein intake, including the role of animal and plant protein in pre-diabetic, overweight or obese individuals on health outcomes: markers of kidney function and putative risk factors for colorectal cancer as well as insulin sensitivity and kidney function in healthy individuals. The thesis is based on PREVIEW data from three European population studies; NQplus, Lifelines and the Young Finns Study (paper I) as well as the large international RCT (paper II and paper III). In paper I, the aim of the study was to develop a protein diet score, based on both dietary protein quantity and source i.e. plant or animal protein. The score was used to investigate the relation to T2D-related adverse metabolic health events. A total of 76,777 healthy individuals were includ

Higher-protein diets have been advocated for body-weight regulation for the past few decades. However, the potential health risks of these diets are still uncertain. We aimed to develop a protein score based on the quantity and source of protein, and to examine the association of the score with glycated haemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR). Analyses were based on three population studies included in the PREVIEW project (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World): NQplus, Lifelines, and the Young Finns Study. Cross-sectional data from food-frequency questionnaires (n = 76,777 subjects) were used to develop a protein score consisting of two components: 1) percentage of energy from total protein, and 2) plant to animal protein ratio. An inverse association between protein score and HbA1c (slope -0.02 ± 0.01 mmol/mol, p < 0.001) was seen in Lifelines. We found a positive association between the protein score and eGFR in Lifelines (slope 0.17 ± 0.02 mL/min/1.73 m², p < 0.0001). Protein scoring might be a useful tool to assess both the effect of quantity and source of protein on health parameters. Further studies are needed to validate this newly developed protein score.

Objective: Nutrition therapy is an integral part of selfmanagement education in patients with type 2 diabetes. Carbohydrates with a low glycemic index are recommended, but the ideal amount of carbohydrate in the diet is unclear. We performed a meta-analysis comparing diets containing low to moderate amounts of carbohydrate (LCD) (energy percentage below 45%) to diets containing high amounts of carbohydrate (HCD) in subjects with type 2 diabetes. Research design and methods: We systematically reviewed Cochrane library databases, EMBASE, and MEDLINE in the period 2004–2014 for guidelines, meta-analyses, and randomized trials assessing the outcomes HbA1c, BMI, weight, LDL cholesterol, quality of life (QoL), and attrition. Results: We identified 10 randomized trials comprising 1376 participants in total. In the first year of intervention, LCD was followed by a 0.34% lower HbA1c (3.7 mmol/mol) compared with HCD (95% CI 0.06 (0.7 mmol/mol), 0.63 (6.9 mmol/mol)). The greater the carbohydrate restriction, the greater the glucose-lowering effect (R=−0.85, p<0.01). At 1 year or later, however, HbA1c was similar in the 2 diet groups. The effect of the 2 types of diet on BMI/body weight, LDL cholesterol, QoL, and attrition rate was similar throughout interventions. Limitations: Glucose-lowering medication, the nutrition therapy, the amount of carbohydrate in the diet, glycemic index, fat and protein intake, baseline HbA1c, and adherence to the prescribed diets could all have affected the outcomes. Conclusions: Low to moderate carbohydrate diets have greater effect on glycemic control in type 2 diabetes compared with high-carbohydrate diets in the first year of intervention. The greater the carbohydrate restriction, the greater glucose lowering, a relationship that has not been demonstrated earlier. Apart from this lowering of HbA1c over the short term

Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification, cardiovascular morbidity and mortality. The aim of this study was to estimate the daily dietary phosphorus intake compared with recommendations in CKD patients and to evaluate the reproducibility of the 24-h urinary phosphorus excretion. Twenty CKD patients stage 3-4 from the outpatient clinic, collected 24-h urine and kept dietary records for 3 consecutive days. The mean daily phosphorus intake was 1367±499, 1642±815 and 1426±706 mg/day, respectively (P=0.57). The mean urinary phosphorus excretion was 914±465, 954±414 and 994±479 mg/day, respectively (P=0.21). In this population of CKD patients stage 3-4 the daily phosphorus intake was above the recommended. Twenty-four-hour urinary phosphorus excretion was reproducible and the data indicate that a single 24-h urine collection is sufficient to estimate the individual phosphorus excretion.European Journal of Clinical Nutrition advance online publication, 14 December 2016; doi:10.1038/ejcn.2016.247.

Background: Hyperglycaemia and type-2-diabetes are increasing worldwide leaving a massive health- and economic burden on the individuals affected and societies. Several risk factors for the development of type-2-diabetes have been identified, with overweight and obesity, specifically abdominal obesity, being the most important ones. However, psychological stress has been acknowledged as a possible risk factor for the development of type-2-diabetes. Stress seems to play a role both indirectly by facilitating a higher energy intake leading to weight gain, but also directly through neuroendocrine mechanisms. Objective: The overall aim of this master thesis was to investigate the influence of stress on the regulation of body weight, fat mass and waist circumference from baseline (CID1) to the end of 8-week low calorie diet (LCD) period (CID2) and to investigate the influence of stress on the regulation of body weight, fat mass, waist circumference and insulin resistance during 10 months of weight maintenance (from CID2 to CID4).Method: This thesis includes data from a sub-sample of participants in the randomized controlled multi-centre trial PREVIEW, at the site-centre of Copenhagen. PREVIEW consists of two parts: An 8-week low calorie diet (LCD) followed by a 148-week weight loss maintenance period. A total of 333 participants (196 women and 137 men) with mean age 54 ± 10 years completed the LCD period and were randomly assigned to one of 4 intervention groups; high protein (25 E%) and moderate carbohydrate (45 E %) with low glycaemic index (GI), or moderate protein (15 E%) and high carbohydrate (55 E%) with medium GI. The diets were consumed ad libitum with respect to energy intake, however, the participants were instructed in self-monitoring and adjustment of meal size so as to maintain their weight loss. Moreover, the participants were randomized to one of two physical activity interventions; 75 minutes high intensity (HI) or 150 minutes moderate intensity

Cancer-related malnutrition is multifactorial and related to a bad prognosis. The aim of this study was to investigate the effect of intensive, individual dietary counseling of patients in radiotherapy and/or chemotherapy for gynecologic-, gastric-, or esophageal cancer.