Comparison of Two Calorie-Reduced Diets of Different Carbohydrate and Fiber Contents and a Simple Dietary Advice Aimed to Modify Carbohydrate Intake on Glycemic Control and Inflammatory Markers in Type 2 Diabetes: A Randomized Trial

Objectives: The aim of this study was to compare the effect of a simple dietary advice with two energy-restricted diets with different carbohydrate and fiber contents on anthropometric, biochemical, and inflammatory markers over an 8-wk intervention period in individuals with diabetes. Methods: Forty-seven patients with type 2 diabetes (31 women and 16 men; age: 52.9 +/- 8.0 years, body mass index: 29.5 +/- 4.9 kg.m(-2)) completed an 8-wk randomized intervention trial that compared a simple dietary advice aimed to modulate carbohydrate intake (n = 13) with the two calorie-restricted (CR) diets (25% caloric restriction from total energy requirements) differing with regard to carbohydrate and fiber content, one with higher fiber (CRHF) containing 55% energy from carbohydrate plus a tablespoon of psyllium powder (n = 18) and the other with lower carbohydrate (CRLC) containing 40% energy from carbohydrate plus placebo powder (n = 16). Weight, plasma concentrations of glucose, insulin, lipids, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were determined at baseline and after 8 weeks. Results: The mean change of body weight and plasma lipids were not different between the groups. Fasting plasma insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) were significantly lower in the CRHF group (changes from baseline values in simple advice, CRHF, and CRLC were 1.3 +/- 1.9,-1.0 +/- 1.2, and 0.3 +/- 3.1 mu IL/mL for insulin and 0.5 +/- 0.7,-0.3 +/- 0.6, and 0.2 +/- 0.9 for HOMA-IR, respectively). The levels of IL-6 significantly decreased in the CRHF and CRLC groups (changes from baseline values in simple advice, CRHF, and CRLC were 7.5 +/- 6.8,-1.2 +/- 4.7, and-4.2 +/- 5.6 pg/mL, respectively). TNF-alpha levels were significantly lower only in the CRHF compared to the advice group (P < 0.05). Conclusions: Our results suggest that in comparison with simple advice to modify carbohydrate intake, a calorie-restricted, moderate carbohydrate diet supplemented with psyllium has better effects on plasma insulin and pro-inflammatory cytokines in patients with type 2 diabetes.