World Journal of Nutrition and Health, 2017, Vol. 5, No.

1, 6-13
Available online at http://pubs.sciepub.com/jnh/5/1/2
©Science and Education Publishing
DOI:10.12691/jnh-5-1-2

Dietary Habits and Biochemical Parameters Evolution in

Type 1 Diabetic Patients after Health Care Orientations
Fatima Zohra Bouazza1, Hafida Merzouk1,*, Fatima Zohra Chiali1, Samia Bouamama1,
Meriem Saker1, Sid Ahmed Merzouk2, Meriem Merad3
1
Laboratory of Physiology, Physiopathology, and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life
Sciences, Earth and Universe, Tlemcen, Algeria
2
Department of Technical Sciences, Faculty of Engineering, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
3
Diabetic House, Polyclic, Tlemcen University Hospital Center, Tlemcen 13000, Algeria
*Corresponding author: hafidamerzouk_2@hotmail.com

Abstract Type 1 diabetes is a chronic illness that requires a holistic approach in terms of care to prevent long-
term complications. Nutritional management is an important component of modern diabetes treatment. In this study,
healthful eating practices were advised to diabetic patients recruited at the establishment of Public Health and at the
endocrinology department of Tlemcen University Hospital Center (West Algeria) and beneficial effects on glucose
and lipid levels and on oxidative stress parameters were evaluated after 3-years of follow-up. At baseline, the results
provide evidence that glucose, lipid metabolism and oxidant/antioxidant status are altered in type 1 diabetic patients.
These metabolic abnormalities were associated to at risk dietary habits such as high intakes of simple carbohydrates,
fat and cholesterol and low intakes of proteins, vitamin and fiber. Nutritional management improved dietary
consumption and induced a decrease in metabolic abnormalities linked to diabetes after 3 years of follow-up.
Keywords: type 1 diabetes, nutritional management, dietary consumption, oxidative stress, metabolic parameters,
follow up study.
Cite This Article: Fatima Zohra Bouazza, Hafida Merzouk, Fatima Zohra Chiali, Samia Bouamama, Meriem
Saker, Sid Ahmed Merzouk, and Meriem Merad, “Dietary Habits and Biochemical Parameters Evolution in Type
1 Diabetic Patients after Health Care Orientations.” World Journal of Nutrition and Health, vol. 5, no. 1 (2017):
6-13. doi: 10.12691/jnh-5-1-2.

complications such as atherosclerosis, a major cause of

1. Introduction
Type 1 Diabetes (T1D) is caused by the autoimmune
destruction of pancreatic beta (β) cells, resulting in severe
insulin deficiency [1,2]. It is the predominant form of
diabetes during childhood and adolescence but can be
present in adulthood, with typical symptoms of polyuria,
polydipsia, and weight loss. [3]
T1D is usually considered as a multifactorial disease in
which environmental risk factors trigger an immune-
mediated destruction of the pancreatic beta cells in
genetically susceptible persons. [4] T1D is a metabolic
disorder characterized by chronic hyperglycemia and other
disturbances of carbohydrate, lipid and protein
metabolism. [5] It is also associated to other disorders
such as mild kidney disease, endothelial dysfunction and
oxidative stress [5,6].
Oxidative stress is defined as an imbalance between
prooxidants and antioxidants and is often associated with
free radical overproduction and/or defective physiological
defence mechanisms. [7] T1D is associated with increased
oxidative stress and free radical production. [8,9]
Increased production of reactive oxygen species as well as
reduced antioxidant defense mechanisms have been
suggested to play a role in the development of diabetic
morbidity and mortality in these patients. [7] Several
mechanisms are implicated in the increased oxidative
stress in diabetes mellitus: hyperglycemia, oxygen free
radical generation due to nonenzymatic protein
glycosylation, glucose autooxidation and glycation
products, changes in antioxidant defense systems, lipid
alterations and oxidizability of lipoproteins. [6]
T1D is a chronic illness that requires a holistic
approach in terms of care to prevent both acute and
long-term complications. Nutritional management for
diabetic patients has been evolving for several years as the
pathophysiological basis of the complications incurred
from diabetes become more explicit.
Medical nutrition therapy (MNT) is actually included in
diabetes treatment. It is important in preventing diabetes,
managing existing diabetes, and preventing or slowing the
rate of development of diabetes complications. MNT is an
important component of self-management education.
MNT included advices to patients and their families about
healthful eating practices to achieve glycemic control and
to avoid complications such obesity, dyslipidemia,
cardiovascular disease and hypertension. [10,11,12,13]
MNT for diabetics includes dietary interventions and
physical activity. Making healthy food choices every day
has both immediate and long-term effects. With education,
practice, and assistance from a dietitian and/or a diabetes
 World Journal of Nutrition and Health
educator, it is possible for diabetic patients to eat well and
control diabetes.
There is no optimal diet for diabetic patients and
recommendations include low carbohydrate diet,
consumption of low–glycemic index foods, reduction in
dietary cholesterol and saturated fats, increase fruits,
vegetables, and whole grains intake [13,14]. In addition to
the macronutrients, micronutrients are an important
component of a balanced diet. Diabetic patients are
usually micronutrient deficient because of poor dietary
choices. [15]
The so-called Mediterranean diet may be an option,
with beneficial effects in diabetes. [16,17] However,
despite these recommendations, it is known that many
T1D patients do not consume a healthful diet [11,15,18].
It is therefore of great interest to educate people with
T1D in having a good balanced and healthy diet to obtain
optimal glycemic control and to prevent the development
of diabetes complications.
The aim of this study was to determine how nutritional
education of type 1 diabetic patients can have beneficial
effects on glucose and lipid levels and on oxidative stress
after 3-years of follow-up.
2. Methods
2.1. Participants and Protocol
40 men with T1D aged between 20 and 40 years were
included in this study and followed up during 3 years.
These patients were recruited at the Public Health
establishment and at the endocrinology department of
Tlemcen University Hospital Center (West Algeria) where
they were routinely examined by their treating physician
and all had insulin treatment. For the purpose of
comparison, 50 nondiabetic men, with similar age range,
were recruited as controls. The participation in this
study was voluntary and all participants were informed
about the goals of the work in progress and gave their
written consent. The study was performed according to the
Declaration of Helsinki. The study was approved by the
Tlemcen Hospital Committee for Research on Human
Subjects. The characteristics of the study population are
given in Table 1.
All the patients completed the 3-year follow-up. Each
patient was reviewed at 1 month, and six monthly
thereafter until the last visit (3 years). At each visit,
physical examination was carried out. Anthropometric
measurements (height, weight, BMI) were conducted for
all participants.
For the pourpose of this study, at baseline, dietary
advices were provided to all participants and included a
balanced diet, a high intake of fruits especially citrus fruits
such as oranges and grapefruit, vegetables that have few
carbohydrates but are rich in vitamins, minerals, fiber, and
phytochemicals, and whole grains, a high intake of olive
oil and fish but a low intake of saturated lipids, dairy
products, meat, and sugar sweetened products. [17]
Recommendations on eating smaller meals and
progressively snacking throughout the day can make
blood sugar easier to monitor and prevent levels from
peaking. The coordination between nutrition and insulin
7
treatment in diabetic patients was made by their
physicians. Regular and moderate physical activity
advices were also provided.
A diatery questionnary was given to participants at the
beginning of the study and throughout the follow up. The
24 hours (h) multiple pass recall (MPR) was performed as
described by Touvier et al., [19] basically consisting of a
list of foods and drinks consumed, a detailed description
and a review with the interviewer probing for information
on food details. Estimation of consumption is obtained by
appropriate questions regarding food identification,
preparation and ingredients, portion sizes and the use of
household implements. In this study, the 24 h MPR was
administered on three separate occasions to include one
weekend day and two weekdays. Values for energy intake
and nutrients were derived from intake records using the
nutritional analysis program with database of food
composition (REGAL Windows, France).
2.2. Blood Samples
At baseline and at 3-year follow up, fasting venous
blood samples were collected by venipuncture into
heparinized tubes and were centrifuged. Plasma was
separated for biochemical parameters, Vitamin C and free
radical determinations. The remaining erythrocytes were
washed in isotonic saline and hemolyzed by the addition
of cold distilled water and the cell debris was removed by
cetrifugation (2000g for 15 minutes). The hemolysates
were assayed for antioxidant / oxidant markers.
2.3. Determination of Biochemical
Parameters
Plasma glucose, cholesterol and triglycerides were
measured using enzymatic colorimetric methods using
appropriate kits (BioAssay Systems, Hayward, CA, USA).
LDL-cholesterol was assayed by precipitation and
quantitative colorimetric methods using specific kits
(Crystal Chem, Downers Grove, IL, USA). The
determination of glycated hemoglobin (HbA1c) was
carried out using Human Hemoglobin A1c kit (Crystal
Chem, USA).
2.4. Determination of Oxidant/Antioxidant
Status Markers
Plasma nitric oxide (NO) was determined by the
colorimetric method of Griess as described by Guevara et
al. [20] The determination of plasma superoxide anion O2.-
was based on nitro blue tetra- zolium (NBT) reduction in
mono formazan by O2.-. [21] Erythrocyte malondialdehyde
(MDA), a marker of lipid peroxydation, was estimated by
the method using thiobarbituric acid (TBA) (Sigma
Aldrich kit; St. Louis, MO, USA). Erythrocyte carbonyl
proteins, resulting from a covalent modification induced
by radical derivatives or reactive oxygen species, were
highlighted by a reaction with dinitrophenylhydrazine
(DNPH) to form a dinitrophenylhydrazone adducts
(Sigma Aldrich Kit).
Plasma vitamin C levels were estimated using Folin
phenol reagent in an acidic range of pH, after
deproteinization with trichloroacetic acid. [22] Erythrocyte
8 World Journal of Nutrition and Health

catalase (CAT EC 1.11.1.6) activity was measured by
spectrophotometric analysis of the rate of hydrogen
peroxide decomposition at 240 nm (Sigma Aldrich kit).
Erythrocyte reduced glutathione (GSH) levels were
assayed by a colorimetric method based on the reduction
of 5,5-dithiobis- (2-nitrobenzoic) acid by GSH to generate
2-nitro-5-thiobenzoic acid, according a Sigma Aldrich kit.
Erythrocyte superoxide dismutase (SOD) activity was
measured by utilizing Dojindo's highly water-soluble
tetrazolium salt (Sigma Aldrich kit).
2.5. Statistical Analysis
The results are expressed as the mean ± standard
deviation (SD). Statistical analysis between diabetics and
controls was carried out using STATISTICA 4.1 program
(StatSoft, Tulsa, OK). The significance of the differences
between two groups (diabetic versus control at baseline or
at 3-years follow up; or baseline versus 3-years follow up
in each group) was determined by Student’s t-test after
analysis of variance.
3. Results
3.1. Characteristics of the Study Population
Table 1 showed no significant difference of BMI
between controls and diabetic patients during the
study. Nutritional recommendations had no effects on
BMI in etheir control or diabetic group. Physical activity
habits were moderate in all participants and did not
change after 3 years. At baseline, plasma glucose, TC, TG,
LDL-C and HbA1C levels were significantly increased in
diabetic patients compared to control values (Table 1).
Significant differences were found for plasma glucose,
TC, TG, LDL-C and HbA1C between diabetic patients at
baseline and after 3 years, showing a reduction after
nutritional advices. It is important to note that lipid levels
were normalized in diabetic patients to control values after
3-years follow up. However, glycemia and HbA1C levels
remained high in diabetic patients compared to controls.
3.2. Oxidant Status Markers
At baseline, plasma NO and O2.- levels were
significantly raised in all diabetic patients in comparison
to controls (Table 2). Similarly, erythrocyte MDA and
carbonyl protein levels were significantly increased in
diabetic patients compared to controls. On the other hand,
values of these oxidant markers decreased in a meaningful
way after the 3-years follow up in all diabetic patients
compared to initial values. However, they remained
significantly higher than control values.
3.3. Antioxidant Markers
Initially, plasma vitamin C and erythrocyte GSH
concentrations were reduced in diabetic patients compared
to their controls (Figure 1). After nutritional advices, a rise
in vitamin C and GSH levels was observed in the diabetic
group, reaching the control values after 3 years.

Table 1. Characteristics of the study population

Controls Type 1 diabetic patients
Characteristics
Initial After 3 years Initial After 3 years
Number 50 50 40 40
Gender Male Male Male Male
Race Caucasian Caucasian Caucasian Caucasian
Age (years) 25 ± 3 30 ± 3 26 ± 2 31 ± 2
Weight (kg) 70.14 ± 2.11 69.33 ± 3.14 69.34 ± 3.86 66.24 ± 2.20
Height (m) 1.70 ± 0.33 1.73 ± 0.27 1.69 ± 0.22 1.72 ± 0.21
BMI (kg/m²) 24.22 ± 1.02 23.18 ± 1.33 24.32 ± 1.04 22.38 ± 1.11
Smoking (%) 12 ± 2.09 10± 3.04 15 ± 1.12 17 ± 2.13
Duration T1D(y) - - 9±2 12± 2
Treatment - - Insulin Insulin
Glucose (g/L) 0.93 ± 0.06 0.95 ± 0.04 1.91 ± 0.17* 1.32 ± 0.12*†
Hb A1C (%) 4.34 ± 0.24 4.33 ± 0.26 8.45 ± 0.25* 6.37±0.20*†
TC (g/L) 1.56 ± 0.18 1.68 ± 0.21 2.14 ± 0.27* 1.70±0.15†
TG (g/L) 0.60 ± 0.05 0.71 ± 0.07 1.49 ± 0.22* 0.88 ±0.11†
LDL-C (g/L) 0.94 ± 0.04 0.98 ± 0.06 1.38 ± 0.15* 1.05 ±0.08†
Values are means ± SD. BMI: body mass index (Kg/m2); TC: total cholesterol; TG: triglycerides. Statistical comparison between diabetic patients and
controls was made by Student’s t-test: * P < 0.001 diabetic patients versus controls at each time. † P < 0.01 diabetic patients at initial versus diabetic
patients after 3 years.

Table 2. Oxidant markers in the study population

Controls Type 1 diabetic patients
Parameters
Initial After 3 years Initial After 3 years
NO (µmol/L) 14.25± 2.48 12.53± 2.33 42.22 ± 4.25* 24.32± 2.15*†
O2-. (µmol/L) 2.87 ± 0.27 3.05 ± 0.41 6.74 ± 0.58* 4.52 ± 0.30*†
MDA (µmol/L) 2.57 ± 0.36 2.86 ± 0.42 7.05 ± 0.44* 4.68 ± 0.27*†
CP (µmol/L) 1.24 ± 0.15 1.31 ± 0.13 3.61 ± 0.30* 2.13 ± 0.11*†
Values are means ± SD. CP: carbonyl proteins; MDA: malondialdehyde; NO: nitric oxide; O2.-: superoxide anion. Statistical comparison between
diabetic patients and controls was made by Student’s t-test:
* P < 0.001 diabetic patients versus controls at each time.
† P < 0.01 diabetic patients at initial versus diabetic patients after 3 years.
 World Journal of Nutrition and Health 9

At baseline, erythrocyte antioxidant enzyme activities 3-year follow up, these enzymes activities increased in the
(Catalase and SOD) were found to be significantly decreased diabetic group compared to the initial values, but remained
in diabetic patients versus controls (Figure 2). After the lower than the control antioxidant enzyme activities.

Values are means ± SD. GSH: reduced glutathione. Statistical comparison between diabetic patients and
controls was made by Student’s t-test:
* P < 0.001 diabetic patients versus controls at each time.
† P < 0.01 diabetic patients at initial versus diabetic patients after 3 years.
Figure 1. Plasma vitamin C and erythrocyte GSH concentrations in the study population

Values are means ± SD. SOD: superoxide dismutase. Statistical comparison between diabetic patients and
controls was made by Student’s t-test:
* P < 0.001 diabetic patients versus controls at each time.
† P < 0.01 diabetic patients at initial versus diabetic patients after 3 years.
Figure 2. Antioxidant enzyme activities in the study population
10 World Journal of Nutrition and Health

Table 3. Daily consumption of nutrients

Controls Type 1 diabetic patients
Initial After 3 years Initial After 3 years
Energy (Kcal/day) 2214 ± 135 2450 ± 256 2158 ± 163 2200 ± 158
Proteins (%) 18.52 ± 2.47 20.03 ± 2.26 11.04 ± 1.13* 17.13 ± 2.03†
Total Carbohydrate (%) 47.56 ± 2.11 45.64 ± 2.34 51.75 ± 2.33* 46.45 ± 2.04†
Simple carbohydrate (%) 20.08 ± 1.47 19.74 ± 1.58 29.25 ± 1.11* 20.14 ± 1.30†
Complex carbohydrate(%) 27.48 ± 1.65 25.86 ± 2.03 22.50 ± 1.04* 26.48 ± 1.37†
Fibers (g/ day) 27.84 ± 3.16 29.45 ± 3.44 19.74 ± 1.38* 25.88 ± 3.64†
Total lipids (%) 33.87 ± 1.43 34.27 ± 1.50 37.64 ± 1.47* 32.46 ± 2.11†
Saturated fatty acids (%) 10.02 ± 1.44 9.54 ± 1.36 16.55 ± 1.05* 10.53 ± 1.08†
Polyunsaturated fatty acids (%) 8.15 ± 0.75 9.27 ± 0.66 6.12 ± 0.51* 10.04 ± 1.11†
Cholesterol (mg/ day) 336.78 ± 24.11 300.64 ± 28 489.38 ± 35.47* 345.83 ± 30†
Sodium (mg/day) 2890.25 ± 137 2765.37 ± 150 3254 ± 177* 2766.54 ± 148†
Calcium (mg/ day) 557.24 ± 36.20 566.41 ± 40 507.88 ± 58.27 548.27 ± 40.34
Vitamin E (mg/ day) 8.92 ± 1.37 9.53 ± 1.12 10.43 ± 1.56 10.02 ± 1.54
Vitamin C (mg/ day) 78.24 ± 5.12 80.43 ± 4.88 53.74 ± 3.48* 89.46 ± 6.27†

Values are means ± SD. Statistical comparison between diabetic patients and controls was made by Student’s t-test: * P < 0.001 diabetic patients versus
controls at each time.
† P < 0.01 diabetic patients at initial versus diabetic patients after 3 years.

3.4. Daily Consumption of Nutrients in
the Study Population
As shows in Table 3, there was no significant difference
in daily energy intake of diabetic patients and controls at
each time. However, the qualitative composition of
nutritional intake was altered in diabetic patients at
baseline. Protein intake was decreased while total
carbohydrate, simple carbohydrate, total lipid and
saturated fatty acid intakes, expressed as percentages of
total energy intake, were significantly increased in
diabetic patients compared to controls at baseline. Indeed,
complex carbohydrate and polyunsaturated fatty acid
proportions were reduced in the diabetic group compared
to the control group at baseline. After nutritional
management, a correction of daily nutrient consumption
was observed in diabetic patients who showed protein,
lipid and carbohydrate intakes similar to those observed in
controls after 3-years follow-up (Table 3).
Additionally, significant reduction in fiber and vitamin
C intakes and significant increase in cholesterol and
sodium intakes were found in diabetic patients compared
to control subjects at baseline. All these nutrient intakes
were corrected in diabetic patients and joined control
values after 3 years of the study.
4. Discussion
In our study, T1D patients were treated with insulin but
presented altered metabolic control mainly due to
inadequate dietary habits. Nutritional recommendations
were given to these patients who showed a good
compliance to the program. The main findings of this
study were that nutritional advices induced a decrease in
metabolic abnormalities linked to diabetes after 3 years of
follow-up.
At baseline, our results provide evidence that glucose,
lipid metabolism and oxidant/antioxidant status are altered
in T1D. In this study, all diabetic patients had increased
plasma glucose concentrations compared with control
values, reflecting probably an insulin deficiency state.
High fasting glucose levels were associated to high
HbA1c amounts reflecting bad diabetic control despite
insulin treatment in these patients, in agreement with
previous studies. [23,24,25] HbA1c is a biomarker of long
term glucose control that reflects blood glucose
concentrations over the previous 6 to 8 weeks. [11] In
agreement with previous studies, [5,6,8] diabetic patients
showed altered lipid concentrations and qualitative
changes of lipoprotein fractions such as high plasma
cholesterol, triglyceride and LDL-C levels compared to
controls. The association between diabetes and
hyperlipidaemia is well established, contributing to the
risk of coronary artery disease [26,27]. In addition,
increased levels of TG, TC and LDL-C are influenced by
the increase of blood HbA1c and glucose concentrations.
Our baseline data provide convincing evidence for
altered plasma and erythrocyte antioxidant/oxidant status
in T1D patients. Oxidative stress in diabetic patients is
induced by a decrease in the antioxidant defense system
and by an elevation in free radical production. In fact, all
diabetic patients present high levels of oxidant markers
(NO, O2.-, MDA and CP) and low concentrations of
antioxidants (vitaminC, catalase, SOD, GSH). The same
results were observed in other studies [6,8,9,28,29]. The
role of hyperglycemia to induce synthesis of reactive
oxygen species by glucose oxidation leading to an
increased production of advanced glycosylation end
products, as well as inflammation and oxidative stress has
been proposed as a possible mechanism in the
pathogenesis of endothelial dysfunction (ED) and other
metabolic disturbances. [30] The interaction between C-
peptide, nitric oxide and endothelial dysfunction has been
identified in T1D [30,31]. In our study, low levels of
vitamin C could reflect its high utilisation rate, suggesting
that this vitamin may be used to reduce oxidative stress in
diabetic patients, as previously reported [32].
 World Journal of Nutrition and Health
Indeed, as observed in our study, the poor glycemic
control in diabetic patients is associated with the
diminution of protective antioxidant enzyme activities
which could increase cell vulnerability to oxygen radical
attack, and thus increase diabetic complications.
In our study, the nutritional recommendations allowed
an improvement in metabolic parameters and alleviated
oxidative stress in diabetic patients after 3-years follow-up.
Our results on baseline dietary habits in T1D patients
revealed higher intakes of simple carbohydrates, fat,
saturated fat and cholesterol and lower intakes of proteins,
unsaturated fat and fiber than control values. The same
findings were reported previously among adults with T1D.
[12,33] Indeed, diabetic patients had increased intake of
sodium and decreased intake of vitamin C. It has been
recently confirmed that the consumption of high amounts
of refined carbohydrates in food and beverage increases
the risk of dyslipidaemia. [34,35] An epidemiological
analysis found an association between diabetes prevalence
and sugar availability. [36] Moreover, chronic consumption
of a Western diet, characterized by foods rich in sugar and
abundant in total and saturated fat, has been suggested to
play a role in the development of diabetes. [37] Dietary
fats affected glycemic control in T1D patients. [38] Large
carbohydrate meals may contribute to poorer outcomes,
through impact on late postprandial glycemia and Hb A1C.
[39] Previous studies have shown that people with T1D
had a high saturated fat intake and a low fiber, fruits and
vegetables intakes, which could increase the risk of the
development of atherosclerosis. [40] A high sodium intake
has been associated with an increased risk of mortality in
diabetic patients. [41]
In our study, after 3-years of nutritional advices, daily
macronutrient and micronutrient consumption in diabetic
patients was improved and was similar to that found in
controls. Compared to baseline nutrition, diabetic patients
increased their protein, fiber, polyunsaturated fatty acids
and vitamin C intakes and reduced their simple carbohydrate,
saturated fatty acid, cholesterol and sodium intakes. Globally,
metabolic abnormalities of type 1 diabestes observed at
baseline were improved after nutritional advices.
There are several studies suggesting that diet can play
an important role in treating the complications of diabetes.
[42,43] It is well documented that medical nutrition
therapy favors the reduction of glucose and glycated
hemoglobin levels. [42] Previous studies from Sweden in
which individuals were instructed to consume low
carbohydrates diets for up to four years found a significant
decrease in HbA1c, dramatic reduction in hypoglycemic
episodes, and improvement in lipid profiles in those with
good adherence [44,45]. Other studies have found that
legume intake had a positive effect on HbA1c in women.
Legumes are composed of various nutrients, including
complex carbohydrates, vegetable protein, dietary fiber,
oligosaccharides, and minerals. Legumes rich in complex
carbohydrates and fibers are considered foods with low
glycemic index, which are thought to be beneficial to
patients with diabetes [11].
Other studies have linked dietary intervention with
better glycemic control and lower levels of triglycerides
and LDL cholesterol. [46] A previous study indicated that
there is potential of reducing HbA1c levels and CVD risk
by increasing dietary fiber. [47] Due to the recognized
11
beneficial effects of dietary fiber intake in people with
diabetes, higher intakes are recommended for adults with
diabetes [48,49].
Management of hyperlipidemia requires a reduction in
saturated fat intake and an increase in dietary sources of
both soluble fiber and anti-oxidants. [50] Polyunsaturated
fats (PUFAs) should be included in the diet. These fatty acids
improve lipid profile, modify platelet aggregation and decrease
cardiovascular mortality in people with diabetes [51].
Both the quantity and quality (high biological value) of
protein intake must be optimized to meet requirements for
essential amino acids, necessitating adequate clinical and
laboratory monitoring of nutritional status in the individual
with diabetes and cardiovascular diseases. [52]
Indeed, optimum vitamin, mineral and antioxidant intake
should be maintained for general health and cardiovascular
protection. In our study, after 3 years of nutritional
advices, we note that antioxidant markers (Vitamin C,
GSH, SOD and Catalase) are increased with decreasing
oxidant markers (NO, O2, MDA and CP) in these diabetic
patients compared to baseline values. These changes in
redox status are probably due to decreased ROS
production following glucose and lipid improvement, and
also eating habit changes. Our results of the daily intake of
vitamin C showed a significant increase compared to
baseline values. However, redox status remained altered in
diabetic patients who were still exposed to oxidative stress.
Other recommendations such as moderate exercise
training or antioxidant supplementation are then necessary
to improve redox homeostasis.
5. Conclusion
Nutritional recommendations to patients with diabetes
type 1 induced an improvement in glycemic control and
lipid profile and subsequently a reduction in ROS
generation which could help to prevent diabetic long-term
complications. However, these diabetic patients were still
subjected to oxidative stress after 3-years follow-up.
Future interventions that target physical activity and
dietary treatment assessed on an individual basis may be
effective strategies to decrease all metabolic alterations in
type 1 diabetes.
Acknowledgments
This work was supported by the Algerian Research
Project from the Algerian Health investigation office
(ATRSS) on diabetes in Algeria.
Disclosure
None declared.
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