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PubMed1997

Dietary fat intake and the risk of coronary heart disease in women.

BACKGROUND: The relation between dietary intake of specific types of fat, particularly trans unsaturated fat and the risk of coronary disease remains unclear. We therefore studied this relation in women enrolled in the Nurses' Health Study. METHODS: We prospectively studied 80,082 women who were 34 to 59 years of age and had no known coronary disease, stroke, cancer, hypercholesterolemia, or diabetes in 1980. Information on diet was obtained at base line and updated during follow-up by means of validated questionnaires. During 14 years of follow-up, we documented 939 cases of nonfatal myocardial infarction or death from coronary heart disease. Mutivariate analyses included age, smoking status, total energy intake, dietary cholesterol intake, percentages of energy obtained from protein and specific types of fat, and other risk factors. RESULTS: Each increase of 5 percent of energy intake from saturated fat, as compared with equivalent energy intake from carbohydrates, was associated with a 17 percent increase in the risk of coronary disease (relative risk, 1.17; 95 percent confidence interval, 0.97 to 1.41; P=0.10). As compared with equivalent energy from carbohydrates, the relative risk for a 2 percent increment in energy intake from trans unsaturated fat was 1.93 (95 percent confidence interval, 1.43 to 2.61; P<0.001); that for a 5 percent increment in energy from monounsaturated fat was 0.81 (95 percent confidence interval, 0.65 to 1.00; P=0.05); and that for a 5 percent increment in energy from polyunsaturated fat was 0.62 (95 percent confidence interval, 0.46 to 0.85; P= 0.003). Total fat intake was not signficantly related to the risk of coronary disease (for a 5 percent increase in energy from fat, the relative risk was 1.02; 95 percent confidence interval, 0.97 to 1.07; P=0.55). We estimated that the replacement of 5 percent of energy from saturated fat with energy from unsaturated fats would reduce risk by 42 percent (95 percent confidence interval, 23 to 56; P<0.001) and that the replacement of 2 percent of energy from trans fat with energy from unhydrogenated, unsaturated fats would reduce risk by 53 percent (95 percent confidence interval, 34 to 67; P<.001). CONCLUSIONS: Our findings suggest that replacing saturated and trans unsaturated fats with unhydrogenated monounsaturated and polyunsaturated fats is more effective in preventing coronary heart disease in women than reducing overall fat intake.

Adult↗

PubMed2002

Use of energy-dense formula for treating infants with non-organic failure to thrive.

OBJECTIVE: To evaluate if simply increasing the energy density of the formula will lead to increased energy intake and weight gain in infants with non-organic failure to thrive. DESIGN: In this hospital-based trial, 15 infants (mean age, 7.6+/-1.4 months) with non-organic failure to thrive were fed a regular strength formula (2.8 kJ/ml) for 3 days and then switched to the same formula with a higher energy density (4.18 kJ/ml) for 3 days after a 2 day 'wash-out' period. Daily nude weights and energy intakes were recorded for the two 3 day periods. RESULTS: During feeding with the higher density formula, nine (60%) infants had a significant increase in their energy intake and weight gain (both P<0.02); four (27%) showed no change in energy intake and self-regulated their intake by decreasing the volume of feeds consumed to maintain energy intake; and two (13%) infants consumed a significantly reduced amount of energy (P<0.02). CONCLUSION: Increasing the energy density of the formula may provide a useful intervention to increase the weight gain and energy intake of most infants with non-organic failure to thrive.

Analysis of Variance↗

PubMed2003

Effects of sugar intake on body weight: a review.

Weight reduction programmes are mainly focused on reducing intake of fat and sugar. In this review we have evaluated whether the replacement of dietary (added) sugar by low-energy sweeteners or complex carbohydrates contributes to weight reduction. In two experimental studies, no short-term differences in weight loss were observed after use of aspartame as compared to sugar in obese subjects following a controlled energy-restricted diet. However, consumption of aspartame was associated with improved weight maintenance after a year. In two short-term studies in which energy intake was not restricted, substitution of sucrose by artificial sweeteners, investigated mostly in beverages, resulted in lower energy intake and lower body weight. Similarly, two short-term studies, comparing the effect of sucrose and starch on weight loss in obese subjects did not find differences when the total energy intake was equal and reduced. An ad libitum diet with complex carbohydrates resulted in lower energy intake compared to high-sugar diets. In two out of three studies, this was reflected in lower body weight in subjects consuming the complex carbohydrate diet. In conclusion, a limited number of relatively short-term studies suggest that replacing (added) sugar by low-energy sweeteners or by complex carbohydrates in an ad libitum diet might result in lower energy intake and reduced body weight. In the long term, this might be beneficial for weight maintenance. However, the number of studies is small and overall conclusions, in particular for the long term, cannot be drawn.

Aspartame↗

PubMed2003

Longitudinal evaluation of energy expenditure in preterm infants with birth weight less than 1000 g.

The aim of the present study was to obtain serial values of O2 consumption (VO2), CO2 production (VCO2) and energy expenditure (EE) in healthy but extremely-low-birth-weight infants (birth weight <1000 g), during the first 5 weeks after birth. A total of seventeen spontaneously breathing and appropriate-for-gestational-age (birth weight and body length above the 10th and below the 90th percentile) preterm infants with gestational age 25-28 weeks and birth weight 590-990 g were enrolled in the study. Calorimetry was performed using an open-circuit calorimeter on days 6, 12, 18, 24, 30 and 36 of postnatal life. During the 5 weeks of observation, VO2 increased from 4.7 (SD 0.5) to 9.1 (SD 1.0) ml/kg per min, VCO2 from 4.5 (SD 0.4) to 8.3 (SD 0.6) ml/kg per min and EE from 115 (SD 12) to 310 (SD 71) kJ/kg per d. The energy intake was always higher than EE, even at days 6 and 12. The RER decreased from 0.99 (SD 0.09) at day 12 to 0.91 (SD 0.05) at day 30. On all study days, there were highly significant positive correlations between energy intake and weight gain, EE and weight gain, and EE and energy intake (P<0.05). Multiple regression analysis showed that on most study days EE was more affected by energy intake than by weight gain. We conclude that in healthy preterm infants with birth weight <1000 g, EE increases by about 150 % in the first 5 weeks after birth, and that the EE values are related to energy intake and weight gain independent of postnatal age.

Calorimetry↗

PubMed2002

[Frequency intake and energy value of breakfast consumed by school youth].

The aim of study was evaluation of frequency intake and energy value of breakfast consumed by high school youth. The group of 126 pupils aged 16-18 years was investigated. Frequency intake was estimated using questionnaire and energy value by 24 hours recall method. The irregularity in breakfast intake as well as changing energy value of them has been shown.

Adolescent↗

PubMed2002

Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children.

BACKGROUND: There is no consensus regarding the optimal enteral formula in patients with neonatal short bowel syndrome. The common practice in many centers is to give a semielemental diet. METHODS: To test the hypothesis that hydrolyzed protein is not superior to standard formula in promoting growth and development of children with short bowel syndrome, 10 children aged 4.08 +/- 2.45 months (mean +/- SD) underwent a prospective, randomized, crossover, double-blind study lasting 60 days (with crossover on day 31). Two enteral formulas, which differed only with respect to the nitrogen form-hydrolyzed and nonhydrolyzed whey protein-were used. The endpoints of the study were nitrogen balance and intestinal permeability measured by the sugar absorption test (lactulose/mannitol excretion ratio). RESULTS: Energy intake from enteral formula in patients fed hydrolyzed and nonhydrolyzed formula was the same and amounted to about 31% of total intake. The ratio of total energy intake (enteral and parenteral) to resting energy expenditure was 1.7 +/- 0.5 and 1.5 +/- 0.3 in patients fed hydrolyzed and non hydrolyzed formula respectively. Nitrogen balance was 0.28 +/- 0.05 g/kg/d and 0.29 +/- 0.05 g/kg/day, respectively. Lactulose/mannitol ratio before the study was 0.85 +/- 0.85 and after hydrolyzed and nonhydrolyzed formula was 0.59% +/- 0.51% and 0.69% +/- 0.72%, respectively. CONCLUSION: Intestinal permeability, energy, and nitrogen balance in short bowel syndrome were not influenced in the short term by hydrolysis of the enteral nitrogen source.

Cross-Over Studies↗

PubMed2001

The effect of physiological levels of glucagon-like peptide-1 on appetite, gastric emptying, energy and substrate metabolism in obesity.

OBJECTIVE: Peripheral infusions of glucagon-like peptide-1 (GLP-1) in humans have been shown to inhibit gastrointestinal motility and decrease hunger and energy intake. However, these investigations used supraphysiological doses. The objective of this study was to investigate the effects of a GLP-1 infusion in a physiological dose on appetite sensations, energy intake, gastric emptying, energy and substrate metabolism. METHODS: Eighteen obese men participated in the placebo-controlled, randomized, single-blinded, cross-over study with infusion of GLP-1 or saline. Resting metabolic rate (RMR) and substrate oxidations were measured by ventilated hood before and after an energy-fixed breakfast. Gastric emptying was measured using paracetamol as a marker. Visual analogue scales were used to assess appetite sensations, thirst and comfort throughout the experiment and palatability of the test meals. Blood was sampled for analysis of hormones (GLP-1, GLP-2, glucose-dependent insulinotropic polypeptide (GIP), insulin, glucagon), and substrates (glucose, lactate, non-esterified fatty acids (NEFA), triacylglycerol (TAG)). Ad libitum energy intake at lunch was registered. RESULTS: Following the breakfast, GLP-1 infusion suppressed ratings of hunger and prospective food consumption (P<0.05), whereas all other subjective ratings and ad libitum energy intake were unaffected. RMR, carbohydrate oxidation and gastric emptying rate were lower during the GLP-1 infusion compared with the saline infusion (P<0.001, P<0.05, P<0.0001, respectively). All plasma hormone and substrate profiles, except NEFA, were significantly reduced by GLP-1 (P<0.0001). CONCLUSION: It is concluded that GLP-1 in physiological concentrations powerfully reduces the rate of entry of nutrients into the circulation by a reduction of gastric emptying rate in obese subjects. The effect of GLP-1 on appetite and food intake may be beneficial in weight reduction.

Adult↗

PubMed1999

Opposite effects on feeding of suprachiasmatic nucleus neuropeptide Y administration in rats.

The effects of injecting or infusing neuropeptide Y (NPY) into the suprachiasmatic nucleus of rats on patterns of individual macronutrient and water intake were examined during the following 2 h and also across 12 and 24 h light/dark cycles. Increased total energy intake (218 and 170%) and energy intake from the dextrin/sucrose diet (499 and 247%) were observed in the 2 h following injection of 100 pmol NPY at early light and early dark, respectively, and in the following 24 h (total energy: 67%, dextrin/sucrose: 73%). Nocturnal casein energy intake was also increased (258%) following NPY injection. Continuous infusion of 10 pmol/h of NPY suppressed nocturnal total energy (36%) and dextrin/sucrose intake (36%) as well as 24 h energy intake from casein (43%). These results demonstrate divergent effects of NPY subsequent to different mode of administration.

Animals↗

PubMed2001

Biased over- or under-reporting is characteristic of individuals whether over time or by different assessment methods.

Seven studies with repeated measurements of energy intake and/or nitrogen intake were examined to determine whether misreporting is characteristic of some persons or occurs randomly. Four of the studies were validated by doubly labeled water measurements of energy expenditure. Reporting validity was expressed as the ratio of energy intake to energy expenditure. Ratios were consistently below the expected value of 1.0 for some subjects and consistently above 1.0 for others, indicating characteristic reporting validity within subjects. Two year-long studies provided 4 to 12 measurements and a total number of days sufficient to measure individual habitual intake. Subjects mean energy intake to basal metabolic rate (BMR) ratios were < 1.35 in 45% and 47% and < 1.35 at every measurement in 25% of subjects. This indicated persistent underreporting over time, because 1.35 x BMR is the minimum energy expenditure compatible with a normally active lifestyle. Three of the studies used more than 1 assessment method (validated by doubly labeled water and/or urinary nitrogen excretion). There was a tendency for persons determined to be underreporters by 1 method to be also underreporters when tested by other methods. We conclude that biased over- or underreporting is characteristic of some persons. Thus, repeat measurements do not necessarily provide valid measures of individual intake, extreme intakes may reflect under- and overreporting rather than true low or high intakes, and subjects most prone to reporting bias may be repeatedly misclassified in quantiles of the distribution. This presents a challenge to dietitians nutritionists, and statisticians both for the design of surveys and the handling of flawed data.

Adolescent↗

PubMed2000

Energy balance, viral burden, insulin-like growth factor-1, interleukin-6 and growth impairment in children infected with human immunodeficiency virus.

OBJECTIVE: To determine the relationship between energy metabolism and growth abnormalities in HIV-infected children and to assess clinical or laboratory characteristics which may be contributing factors to their growth impairment. DESIGN: A comparative study. METHODS: We measured energy intake by inpatient calorie count/outpatient 24 h food recalls, resting energy expenditure by indirect calorimetry, total energy expenditure by the doubly-labeled water technique, iron metabolism, protein metabolism, and lipid metabolism markers as well as CD4 count, viral load, insulin-like growth factor-1 (IGF-1), serum interleukin-6 (IL-6), and whole blood stimulated IL-6 levels in prepubertal congenitally HIV-infected children with normal and impaired growth patterns. RESULTS AND CONCLUSIONS: Differences in energy expenditures were not found between normal and growth-impaired HIV-infected children. Energy intake but not energy expenditure was significantly reduced when HIV-infected children were compared to expected normal values for age and gender. Advanced HIV clinical disease, severe immune suppression, increased viral burden, increased IL-6 activity, decreased total serum protein, and decreased IGF-1 levels were more likely to be found in HIV-infected children with growth impairment in comparison with HIV-infected children with normal growth.

Adolescent↗

PubMed2003

Did fat intake in the United States really decline between 1989-1991 and 1994-1996?

The objectives of this study were to determine changes in fat and energy intakes in the United States between 1989-1991 and 1994-1996, and to examine the implications of expressing fat intake in grams vs as a percent of total energy intake. The source of data was the Continuing Survey of Food Intake by Individuals. The results suggest that intake of energy rose between the 2 time periods, primarily due to higher carbohydrate intake. There was also a modest increase in fat intake. However fat intake, as a percent of total energy, declined. The higher energy intakes were primarily from beverages, especially soft drinks, food mixtures, grain snacks, and pastries. The primary sources of higher fat intakes were meat mixtures, vegetables, and some categories of the grain group. Similar trends in the Food Supply Series suggested that the changes observed were not entirely due to changes in survey methodology. Because the increase in fat intake was masked by the increase in energy intake, we conclude that assessing trends in fat intake as a percent of energy consumption can be misleading, unless information on total energy and fat intake, in grams, is also provided. These preliminary findings should be interpreted cautiously until they are confirmed by formal secular trend analyses.

Adolescent↗

PubMed1987

Dietary intake of individuals interested in eating a healthy diet: a validated study of intake before and after dietary advice.

The food intake of 37 adult volunteers (12 M, 25 F) interested in eating a healthy diet was measured on two occasions by the 7-day weighed record method. In week 1 subjects consumed their habitual diet and in week 2 attempted to follow dietary recommendations (DR). Intakes were compared with recommended dietary allowances (RDA) and with dietary guidelines (DG). Validation of recorded energy intakes against changes in body weight, and sodium, potassium and nitrogen intakes against urine excretions suggested reliable dietary records in both study weeks. Mean dietary intakes in week 1 met the RDA for all nutrients studied except for energy (which was close) and zinc (in females only). Daily energy intake was 2160 kcal (9.04 MJ) in week 1 and 1810 kcal (7.56 MJ) in week 2, and subjects lost weight during week 2. Absolute intakes of vitamins and minerals were similar in both study weeks, thus increasing nutrient density in week 2 and suggesting improved dietary quality. Mean dietary intakes in week 1 conformed more closely to DG than commonly reported and changed in the direction recommended in week 2. Mean daily intakes in week 1 and week 2 respectively were: fibre, 31 and 34 g; sodium 114 and 90 mmol; Na:K ratio, 1.37 and 1.10; alcohol, 3.3 and 2.3 per cent of total energy; fat, 38.7 and 34.2 per cent of food energy or 37.4 and 33.4 per cent of total energy. Intake of fibre increased with respect to energy but sodium intake per unit energy did not decrease. Energy intake was positively related to sodium, fibre and zinc intakes and influenced ease of conformity to DR for these nutrients. It is concluded that our motivated subjects were able to make short-term dietary changes consistent with DR. Whether or not these changes continue in the long term is the subject of a follow-up study.

Adult↗

PubMed1997

Altered secretion of LH does not explain seasonal effects on early pregnancy in gilts.

This work was undertaken to study the effects of energy intake and gut fill on LH secretion in the early pregnant gilt to investigate the role of the hypothalamo-pituitary-gonadal axis in the seasonal disruption of pregnancy. Four groups of mated gilts (N = 23 in total) were individually housed and fed four different energy levels (23, 46, 47 and 55 megajoules digestible energy per day, MJ DE day-1) for two weeks after mating during the season identified as a period of increased rate of early pregnancy failures from January till April (summer-autumn). The energy content of base feed (13 MJ kg-1) was increased by means of adding a fat supplement (soybean oil) to the feed of two groups of gilts, while the other two groups were given different levels of the basic feed. The groups gained weight and backfat according to energy intake levels during the two-week period. Frequent blood samples (15-min interval) collected on day 14 revealed a significant treatment effect on LH pulse amplitude: the group on the highest energy intake level (55 MJ DE day-1) had higher LH pulse amplitude compared with the other groups (1.01 +/- 0.04, 0.74 +/- 0.04, 0.72 +/- 0.08 and 0.66 +/- 0.05 ng ml-1 in the descending order of energy intake, P < 0.01). There was no effect of energy intake on LH pulse frequency, mean level, area under the curve or mean nadir (P > 0.10). Plasma insulin concentrations tended to increase (P < 0.08) in each group with time after feeding, but no significant differences between the treatment groups were found. Plasma free fatty acid (FFA) concentrations were decreased 1 h after feeding (P < 0.05) in all but the group on 55 MJ DE day-1. This group also had higher postprandial FFA concentrations in comparison with other groups (P < 0.05). In conclusion, these results show that energy density of feed and energy intake have little effect on LH secretion in the early pregnant gilt. Protective effect of high feeding level against seasonal disruption of pregnancy appears to be mediated by mechanisms other than an alteration in LH secretion.

Animals↗

PubMed1996

Dietary factors and risk of colon cancer: a prospective study of 50,535 young Norwegian men and women.

The relationship of meat, fish, fat, fibre or calcium consumption to the risk of colon cancer was examined in a prospective study conducted by the Norwegian National Health Screening Service. Between 1977 and 1983, 50,535 Norwegian men and women aged 20-54 attended the health screening and completed a semi-quantitative questionnaire about food frequency. During a mean follow-up of 11.4 years, 143 cases of colon cancer were identified for analyses through a link with the Norwegian Cancer Registry. The relative risk of colon cancer was 3.5 (95% CI, 1.02-11.9) in women who consumed sausages as their main meal five or more times a month, compared with the risk in those who reported a consumption frequency of less than once a month. There was an increase in the relative risk with increasing frequency of consumption (P for linear trends = 0.03). Among men, the association was not statistically significant, but the trend was in the same direction as that of the women. The frequency of consuming meat meals in general, including meat stews, roasted meat, meat balls, fish or milk, was not associated with a risk of colon cancer. No trends in relative risks of colon cancer were found to be associated with intake of total energy intake or with energy-adjusted intake of total fat, saturated fat, monounsaturated fat, dietary fibre or calcium. In conclusions, this prospective study provided no evidence of association between intake of meat, fish, fat, energy, fibre or calcium and risk of colon cancer, although an increased risk with frequent consumption of sausages was suggested.

Adult↗

PubMed1982

Effects of dietary nutrient density on broiler performance at low and moderate environmental temperatures.

Three broiler finishing rations with calculated metabolizable energy values (ME) of 3175, 3250, and 3325 kcal/kg and constant lysine and sulfur-bearing amino acid: energy ratios were evaluated at two environmental temperatures. Broiler chickens were reared from 3 to 7 weeks in either an 18.3 or 26.7 C temperature. At the 18.3 C temperature, 7-week body weights increased linearly 3.1% as energy level increased from lowest to highest level. Feed:gain ratio decreased linearly 5.0% as energy level increased from lowest to highest. At the 26.7 C temperature, no significant differences were found in 7-week body weights due to energy level of the diet. Feed:gain ratio decreased 3.2% as energy level increased from lowest to highest, but the response was not linear. Energy intake increased as dietary energy was increased in the cool temperature; energy intake was less in the warm temperature and did not change appreciably as dietary energy changed. Because lysine and methionine plus cystine were tied to dietary energy by a fixed ratio, the pattern for intake of these amino acids was the same as for energy. It appears that the procedures used to formulate the diets do not give uniform results for the range of environmental temperatures and energy levels tested.

Animals↗

PubMed1980

Comparison of energy and nutrient intakes in women with high and low blood pressure levels.

The present study found no link between the intake of energy and various nutrients, on the one hand, and high or low blood pressure (BP) in women, on the other. Sixty women not on treatment for hypertension were selected from a defined population and examined, applying the duplicate portion technique, with respect to the relationships between BP and the intake of energy and nutrients. They were selected from above the 95th percentile for BP (group A) and from below the 30th (group B). The two groups were age-matched. The food sampling comprised six days, divided into three periods of two consecutive days within a period of four weeks. Twenty-four hour urine specimens were collected in each period and on two other occasions. The mean values for intake of energy, fat, protein, carbohydrates, minerals and electrolytes did not differ between the two groups despite the large differences in BP and obesity. The mean values for urinary excretion of minerals, electrolytes and nitrogen (calculated as crude protein) did not differ between groups. The present findings for the effect of salt on BP do not justify restriction of the salt intake as a means for decreasing BP in the population.

Adult↗

PubMed1989

Dietary habits and prognostic factors in breast cancer.

The relationship between dietary habits and prognostic factors for breast cancer was studied in 240 women aged 50-65 years who had surgery for breast cancer between 1983 and 1986. A dietary history interview was conducted within the 4 months following resection of the primary tumor. In the stepwise multivariate analysis, the multiple-odds ratio (OR) for having a tumor greater than or equal to 20 mm in diameter was 0.95 (95% confidence interval, 0.91-0.99) for each 1-g increase in fiber intake per 10 MJ of energy intake. Compared with patients having tumors poor in estrogen receptor (ER), those having ER-rich tumors (greater than or equal to 0.10 fmol/microgram of DNA) were older (P less than .01) and reported carbohydrate intake yielding higher E% (percentage of total energy intake) (P less than .01) and higher retinol intake per 10 MJ (P less than .05). The OR for having an ER-rich tumor was 1.58 (95% confidence interval, 1.08-2.31) for each 1-mg increase in retinol intake per 10 MJ; 1.09 (95% confidence interval, 1.02-1.16) for each additional year of age; and 1.08 (95% confidence interval, 1.02-1.13) for each 1% increment in E% from carbohydrates. These results suggest that the dietary patterns of the western world (e.g., high fat intake and low intake of carbohydrates and fiber) affect certain prognostic factors in breast cancer, such as tumor size and ER content of the tumor.

Age Factors↗

PubMed1992

Dietary recommendations for people with diabetes: an update for the 1990s. Nutrition Subcommittee of the British Diabetic Association's Professional Advisory Committee.

The broad principles of the 1982 British Diabetic Association dietary recommendations remain valid. For the overweight, reduction in energy intake remains the most important aim. Carbohydrate should make up about 50-55% of the dietary energy intake, the majority of this coming from complex sources, preferably foods naturally high in dietary fibre or hydrolysis resistant starch. Up to 25 g of added sucrose may be allowed, provided it is part of a diet low in fat and high in fibre, and that it substitutes for an isocaloric amount of fat or high glycaemic index food or other nutritive sweeteners. Some high-carbohydrate diets have been shown to worsen blood glucose control and serum lipid abnormalities. Some previous recommendations for fibre intake have proved unrealistically high and of limited value. A modest increase to 30 g day-1, concentrating on soluble fibre, is recommended. Reduction of fat intake to 30-35% of energy intake remains an important goal which should help to reduce the incidence of cardiovascular disease in people with diabetes and aid weight loss. Of this only 10% of total energy should be saturated fat, 10% polyunsaturated fat, and 10-15% may be mono-unsaturated fat. The latter has been shown to provide a useful alternative energy source which may have beneficial effects on blood glucose control and serum lipids. Cholesterol intake should not exceed 300 mg day-1. Protein should comprise about 10-15% of energy intake. Reduction in intake of protein and associated nutrients may help to slow down progression of nephropathy. Limitation of salt intake to 6 g day-1 is recommended. Reduction in fat intake may be relatively more important in Type 2 diabetic patients, whereas limitation in protein intake may be more important in Type 1 diabetes.

Adolescent↗