Low versus High Carbohydrate Diet in Type 1 Diabetes: A 12-week

randomized open-label crossover study.

Abstract

Objectives:

To compare the effects of a low carbohydrate diet (LCD <100 grams

carbohydrate/day) and a high carbohydrate diet (HCD >250 grams carbohydrate/day) on
glycaemic control and cardiovascular risk factors in adults with type 1 diabetes.

MATERIALS AND METHODS:

In a randomized crossover study with two 12-week intervention arms separated

by a 12-week washout, 14 participants using sensor-augmented insulin pumps were
included. Individual meal plans meeting the carbohydrate criteria were made for each
study participant. Actual carbohydrate intake was entered into the insulin pumps
throughout the study.

RESULTS:

Ten participants completed the study. Daily carbohydrate intake during the two
intervention periods was (mean ± standard deviation) 98 ± 11 grams and 246 ± 34
grams, respectively. Time spent in the range 3.9-10.0 mmol/L (primary outcome) did not
differ between groups (LCD 68.6 ± 8.9% vs. HCD 65.3 ± 6.5%, P=0.316). However, time
spent <3.9 mmol/L was less (1.9 vs. 3.6%, P<0.001) and glycaemic variability (assessed
by coefficient of variation) was lower (32.7 vs 37.5%, P=0.013) during LCD. No events of
severe hypoglycaemia were reported. Participants lost 2.0 ± 2.1 kg during LCD and
gained 2.6 ± 1.8 kg during HCD (P=0.001). No other cardiovascular risk factors including
fasting levels of lipids and inflammatory markers were significantly affected.

CONCLUSIONS:

Compared with an intake of 250 grams of carbohydrate per day, restriction of

carbohydrate intake to 100 grams per day in adults with type 1 diabetes reduced time
spent in hypoglycaemia, glycaemic variability and weight with no effect on
cardiovascular risk factors. This article is protected by copyright. All rights reserved.
 Experimental sleep disruption and reward learning: moderating role of
positive affect responses.
Abstract

STUDY OBJECTIVES:

Sleep disturbances increase vulnerability for depression, but the mechanisms

underlying this relationship are not well known. We investigated the effects of
experimental sleep disruption on response bias (RB), a measure of reward learning
previously linked to depression, and the moderating role of positive affect responses.

METHODS:

Participants (N = 42) were healthy adults enrolled in a within-subject crossover

sleep disruption experiment that incorporated one night of uninterrupted sleep (US)
and one night of forced awakenings (FA) in random order. On the day following each
experimental sleep night, participants completed a probabilistic reward task to assess
RB, and the Positive and Negative Affect Schedule-X. Participants were subgrouped
according to positive affect responses: Preserved Positive Affect (i.e. positive affect
scores maintained or increased; n = 15) or Reduced Positive Affect (i.e. positive affect
scores decreased; n = 27) following FA.

RESULTS:

Contrary to our hypotheses, across participants, RB did not significantly differ

between the US and FA sleep conditions (p = .67). However, the effect of sleep condition
on RB was moderated by positive affect response (p = .01); those with preserved
positive affect showed heightened RB following FA, whereas those with reduced positive
affect showed diminished RB following FA. Changes in negative affect between US and
FA did not moderate RB.

CONCLUSION:

The inability to preserve positive affect through periods of sleep disruption may
be a marker of diminished reward learning capability. Understanding how sleep
disruption impacts positive affect responses and reward learning identifies a pathway by
which sleep disturbances may confer risk for depression.
 Executive Function Performance in Young Adults When Cycling at an
Active Workstation: An fNIRS Study.
Abstract

BACKGROUND:

This study aimed to investigate the effects of self-paced cycling at an active

workstation on executive functions and cortical activity.

METHODS:

In a crossover study design, 37 young adults (45.9% females) were randomly

assigned to the following two task conditions: (1) performing cognitive tests during
sitting, (2) performing cognitive tests while cycling at an active workstation. Executive
functions were assessed by the Stroop color and word test and the task-switching
paradigm. Cortical activity was monitored using a multi-channel functional near-infrared
spectroscopy (fNIRS) system.

RESULTS:

The behavioral results showed that there were no significant differences on the
Stroop interference effects (P = 0.66) between the sitting and the cycling conditions. In
all probability, no differences on the global switch costs (P = 0.90) and local switch costs
(P = 0.67) were observed between the sitting and the cycling conditions. For the fNIRS
results, the oxygenated hemoglobin (oxy-Hb) in response to the Stroop interference in
channels 5, 10, and 12 were decreased during the cycling condition (all Ps < 0.05, FDR-
corrected). Conversely, the oxy-Hb associated with the global switch costs in channels 3,
29, and 31 were increased during the cycling condition (all Ps < 0.05, FDR-corrected).

CONCLUSIONS:

The findings indicated that behavioral performances on executive functions were

not affected by cycling at an active workstation, while cognitive resources were
reallocated during cycling at an active workstation.
 Impact of Gas Masks on the Work of Breathing and Breathing Pattern in
Subjects with Stable COPD.
Abstract

BACKGROUND:

The gas mask constitutes the main respiratory protective equipment in a

Chemical, biological, radiological, or nuclear environment. The aim of the study was to
evaluate the impact of the gas mask on respiratory pattern, gas exchange, and indexes
of respiratory effort in patients with moderate to severe stable COPD.

METHODS:

Crossover evaluation with 3 randomized-order, 10-min conditions: at rest and

with and without a gas mask using 2 different filtered cartridges, each with a distinct
inspiratory resistance (cartridge A = 3.5 cm H2O; cartridge B = 2.2 cm H2O, both at 1
L/s). The study involved 8 subjects with COPD, and breathing patterns, indexes of
respiratory effort, and capillary blood gases were evaluated. Comparisons of these
parameters were made between the tested conditions.

RESULTS:

Mean subject age was 69 y, and mean FEV1 = 1.3 L (47% predicted). Short-term
utilization of the gas mask was associated with a significant increase in the indexes of
effort in comparison to baseline without a mask. The esophageal product-time product
significantly increased in comparison with baseline (cartridge A = 281 ± 65 cm
H2O/s/min, cartridge B = 253 ± 47 cm H2O/s/min, and baseline = 184 ± 46 cm
H2O/s/min, P < .001). There were negligible changes in the breathing pattern and gas
exchange.

CONCLUSIONS:

Indexes of respiratory effort increased slightly in subjects with stable COPD while
using a gas mask. This effect was likely related to increased inspiratory resistance when
the mask was worn. These data are reassuring for the potential short-duration use of
such protection for patients with moderate to severe COPD.
Effect of Dietary and Supplemental Omega-3 Polyunsaturated Fatty Acids
on Risk of Recurrent Gout Flares.
Abstract

OBJECTIVE:

To determine the relationship between omega-3 polyunsaturated fatty acid (n-3

PUFA) consumption (dietary or supplemental) and risk of gout flares.

METHODS:

We used data from the Boston University Online Gout Study, an internet-based,
case-crossover study conducted from 2003-2012. Participants completed questionnaires
at times of gout flares (hazard periods) and during gout flare-free periods (control
periods) regarding exposures (including supplements and diet) during the preceding 48
hours. We examined the relation of self-reported n-3 PUFA-rich supplements and fish
intake to the risk of recurrent gout flares using conditional logistic regression, adjusting
for total purine intake, diuretic use, and other urate-lowering or flare prophylactic
medications (allopurinol, non-steroidal anti-inflammatory drugs, colchicine).

RESULTS:

Of the 724 participants, 85% met the 1977 Preliminary ACR classification criteria
for acute gout. In the preceding 48 hours, 22% of participants reported some form of n-
3 PUFA consumption (supplements: 4.6%; dietary fatty fish: 19%). The adjusted odds
ratios (aOR) were 1.01 (95% CI, 0.63-1.60; p=0.98) for all three supplement types
combined and 0.74 (95% CI, 0.54-0.99; p=0.04) for ≥2 n-3 PUFA-rich fish servings.

CONCLUSIONS:

Dietary n-3 PUFA-rich fish consumption, when adjusted for total purine intake,
was associated with lower risk of recurrent gout flares, whereas n-3 PUFA
supplementation alone, as taken in a self-directed manner, was not. Consumption of
specific sources and adequate doses of n-3 PUFA for gout flare prevention warrants
further study in an adequately powered clinical trial.
Increased Hunger, Food Cravings, Food Reward, and Portion Size Selection
after Sleep Curtailment in Women Without Obesity.
Abstract

This study examined the effects of one night of sleep curtailment on hunger,
food cravings, food reward, and portion size selection. Women who reported habitually
sleeping 7⁻9 h per night, were aged 18⁻55, were not obese, and had no sleep disorders
were recruited. Sleep conditions in this randomized crossover study consisted of a
normal night (NN) and a curtailed night (CN) where time in bed was reduced by 33%.
Hunger, tiredness, sleep quality, sleepiness, and food cravings were measured. A
progressive ratio task using chocolates assessed the food reward. Participants selected
portions of various foods that reflected how much they wanted to eat at that time. The
sleep duration was measured using a single-channel electroencephalograph. Twenty-
four participants completed the study. The total sleep time was shorter during the CN (p
< 0.001). Participants reported increased hunger (p = 0.013), tiredness (p < 0.001),
sleepiness (p < 0.001), and food cravings (p = 0.002) after the CN. More chocolate was
consumed after the CN (p = 0.004). Larger portion sizes selected after the CN resulted in
increased energy plated for lunch (p = 0.034). In conclusion, the present study observed
increased hunger, food cravings, food reward, and portion sizes of food after a night of
modest sleep curtailment. These maladaptive responses could lead to higher energy
intake and, ultimately, weight gain.
The effect of intranasal oxytocin on the perception of affective touch and
multisensory integration in anorexia nervosa
Abstract

INTRODUCTION:

Anorexia nervosa (AN) is an eating disorder characterised by restriction of energy

intake, fears of gaining weight and related body image disturbances. The oxytocinergic
system has been proposed as a pathophysiological candidate for AN. Oxytocin is a
neuropeptide involved in bodily processes (eg, breast feeding) and in the onset of social
behaviours (eg, bonding). Studies investigating the effect of intranasal oxytocin (IN-OT)
in AN showed that it can improve attentional bias for high-calorie food and fat bodies
stimuli, and related stress. However, less is known about the effect of IN-OT on bodily
awareness and body image distortions, key features of the disorder linked to its
development, prognosis and maintenance. Here, we aim to investigate the effect of IN-
OT on the perception of affective, C-tactile-optimal touch, known to be impaired in AN
and on multisensory integration processes underlying a body ownership illusion (ie,
rubber hand illusion). For exploratory purposes, we will also investigate the effect of IN-
OT on another interoceptive modality, namely cardiac awareness and its relationship
with affective touch.

DESIGN, METHODS AND ANALYSIS:

Forty women with AN and forty matched healthy controls will be recruited and
tested in two separate sessions; self-administering IN-OT (40 IU) or placebo,
intranasally, in a pseudo-randomised manner. The data from this double-blind, placebo-
controlled, cross-over study will be analysed using linear mixed models that allow the
use of both fixed (treatment levels) and random (subjects) effects in the same analysis.
To address our main hypotheses, separate analyses will be run for the affective touch
task, where the primary outcome dependent variable will be the pleasantness of the
touch, and for the rubber hand illusion, where we will investigate multisensory
integration quantified as subjective embodiment towards the rubber hand. In the latter,
we will manipulate the synchronicity of touch and the size of the hand.