“Anti-Inflammatory” Diet May Improve Postprandial Glucose, Cardiovascular Health CME/CE

“Anti-Inflammatory” Diet May Improve Postprandial Glucose, Cardiovascular Health CME/CE

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD

Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.

Release Date: January 23, 2008Valid for credit through January 23, 2009

Credits Available

Physicians – maximum of 0.25 AMA PRA Category 1 Credit(s) for physicians;
Family Physicians – up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses – 0.25 nursing contact hours (None of these credits is in the area of pharmacology)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.


The content of this CME activity, “‘Anti-Inflammatory’ Diet May Improve Postprandial Glucose and Cardiovascular Health,” was developed by the faculty.

To participate in this activity: 1) review the target audience, learning objectives and author disclosures, 2) study the education content 3) answer the posttest and evaluation 4) view/print certificate View details

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Describe the clinical importance of postprandial glucose and lipid levels.
  2. Identify dietary recommendations to reduce postprandial glucose and lipid levels.
Authors and Disclosures
Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Charles Vega, MD
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

January 23, 2008 — Dietary and lifestyle strategies for improving postprandial glucose, lipid profile, markers of inflammation, and cardiovascular health are reviewed in a state-of-the-art paper reported in the January 22 issue of the Journal of the American College of Cardiology.

“The highly processed, calorie-dense, nutrient-depleted diet favored in the current American culture frequently leads to exaggerated supraphysiological post-prandial spikes in blood glucose and lipids,” write James H. O’Keefe, MD, from the Mid America Heart Institute and University of Missouri–Kansas City, and colleagues. “This state, called post-prandial dysmetabolism, induces immediate oxidant stress, which increases in direct proportion to the increases in glucose and triglycerides after a meal. The transient increase in free radicals acutely triggers atherogenic changes including inflammation, endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity.”

Even in individuals without diabetes, postprandial dysmetabolism independently predicts future cardiovascular events. Dietary improvements are associated with dramatic and immediate benefits in postprandial dysmetabolism.

To attenuate the increase in glucose, triglycerides, and inflammation after a meal, the review authors recommend a diet rich in minimally processed, high-fiber, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts. Other dietary interventions that can significantly ameliorate postprandial dysmetabolism include intake of lean protein, vinegar, fish oil, tea, and cinnamon. Additional benefits may result from calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol.

Specific recommendations to improve postprandial glucose and triglycerides are as follows:

  • Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts.
  • At all 3 meals, consume lean protein.
  • Eat approximately 1 handful of nuts daily (using a closed fist), consumed with vegetables, grains, berries, or other fruits.
  • Eat salad daily, consisting of leafy greens with dressing of vinegar and virgin olive oil.
  • Avoid highly processed foods and beverages, particularly those containing sugar, high-fructose corn syrup, white flour, or trans fats.
  • Limit portion sizes to modest quantities.
  • Maintain normal weight and avoid overweight or obesity. Waist circumference should be less than one half of height in inches.
  • Perform physical activity for at least 30 minutes or more daily, of at least moderate intensity.
  • For those with no history of substance abuse, consuming 1 alcoholic beverage before or with an evening meal may be considered.

“Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk,” the review authors write. “This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes.”

J Am Coll Cardiol. 2008;51:249-255.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

  1. Describe the clinical importance of postprandial glucose and lipid levels.
  2. Identify dietary recommendations to reduce postprandial glucose and lipid levels.

Clinical Context

Approximately one third of Americans are thought to have abnormal glucose homeostasis, and poor diet is a major contributor to this phenomenon. Beyond overt diabetes, glucose intolerance has important clinical implications, as there is a direct linear relationship between glucose levels after a glucose challenge test and the risks for cardiovascular death and all-cause mortality.

Diet also significantly contributes to hyperlipidemia, and a single meal high in saturated fat can immediately raise serum triglyceride levels, oxidative stress, and intravascular inflammation. These factors help explain why some research has suggested that postprandial triglyceride levels are better predictors of cardiovascular risk than fasting triglyceride levels. At the same time, significant reductions in triglyceride levels of 20% to 40% can reduce the risk for coronary artery disease by as much as 40%.

There is good evidence regarding dietary interventions that can prevent hyperglycemia and hyperlipidemia. The current review summarizes the best dietary approaches to achieve these goals.

Study Highlights

  • The glycemic index of a food is defined as the incremental increase in the area under the postprandial glucose curve after ingestion of 50 g of a specific amount of food vs that associated with 50 g of oral glucose. Ideal carbohydrates with a low glycemic index include green leafy vegetables such as broccoli and spinach and fruits such as grapefruits and cherries.
  • Excess intake of processed carbohydrates leads to a vicious cycle of transient spikes in blood glucose levels, increased insulin production, and reactive hypoglycemia.
  • Berries, dark chocolate, red wine, tea, and pomegranates reduce postprandial oxidant stress and inflammation.
  • When paired with a high-glycemic-index meal, cinnamon slows gastric emptying and reduces postprandial glucose excursion.
  • Nuts also slow gastric emptying and can reduce the impact of high-glycemic-index carbohydrates by as much as half. Nuts also reduce postprandial oxidative protein damage, and consumption of nuts at least 5 times weekly can reduced the risks for coronary artery disease and diabetes by 20% to 50%.
  • Vinegar can reduce postprandial glycemia and promotes satiety.
  • Lean protein reduces postprandial glucose excursion and improves satiety. Such protein includes egg whites, game meat, skinless poultry breast meat, and whey protein or other nonfat dairy protein.
  • Drinking 0.5 to 1 alcoholic drink per day for women and 1 to 2 alcoholic drinks per day for men can reduce cardiovascular risk, and 1 to 2 drinks before a meal can reduce postprandial glucose and insulin levels. However, higher levels of drinking can impair glucose metabolism.
  • Exercise acutely lowers glucose and triglyceride levels in a dose-dependent fashion.

Pearls for Practice

  • There is a linear relationship between impaired glucose tolerance and mortality, and a fatty meal can lead to immediate increases in serum triglyceride levels. However, reducing triglyceride levels can reduce the risk for coronary artery disease by as much as 40%.
  • The current review recommends foods with a low glycemic index such as vegetables and fruits. Other recommended foods include nuts, cinnamon, vinegar, egg whites, and whey protein.

Which of the following statements about postprandial glucose and lipid levels is most accurate?
Glucose intolerance does not promote an increase in the risk for all-cause mortality
Levels of serum triglycerides generally remain stable immediately after a meal high in saturated fat
Only elevated fasting levels of triglycerides have been associated with an increased risk for cardiovascular events
A significant reduction in serum triglyceride levels can reduce the risk for coronary artery disease by 40%
All of the following foods were explicitly recommended in the current review by O’Keefe and colleagues except:
Whole eggs
Cinnamon
Vinegar
Nuts

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

FOLLOW THESE STEPS TO EARN CME/CE CREDIT*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing “Edit Your Profile” at the top of your Medscape homepage.

<!–There is no fee for participation in this continuing medical education activity. This online, self-study activity is formatted to include text, graphics, and may include other multi-media features.

Participation in this self-study activity should be completed in approximately 0.250.250.25 hours. To successfully complete this activity and receive credit, participants must follow these steps online during the period from January 23, 2008 through January 23, 2009.

  1. Make sure you have provided your professional degree in your profile. Your degree is required in order for you to be the issued the appropriate credit. If you haven’t, click here. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
  2. Read the target audience, learning objectives, and author disclosures.
  3. Study the educational activity online or printed out.
  4. Read, complete, and submit online answers to the post test questions. Participants must receive a test score of 100%, to receive a certificate. We suggest you complete the optional online evaluation upon successful completion of the activity.
  5. To enter your answers to the post test and/or evaluation, click “submit.”
  6. After submitting the post test and receiving a test score of 100%, you may access your online certificate by selecting “View/Print Certificate” on the screen. You may print the certificate, but you cannot alter the certificate. Your credits will be tallied and saved in the CME Tracker.

–> *The credit that you receive is based on your user profile.

Target Audience

This article is intended for primary care clinicians, cardiologists, endocrinologists, and other specialists who care for patients at risk for cardiovascular disease.

Goal

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Accreditation Statements

For Physicians

Medscape

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/07. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.

AAFP Accreditation Questions


For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: CME@medscape.net. For technical assistance, contact CME@webmd.net.
For Nurses

This Activity is sponsored by Medscape Continuing Education Provider Unit.

Medscape is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; None of these credits is in the area of pharmacology.

Provider Number: 6FDKKC-PRV-05


For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: CME@medscape.net. For technical assistance, contact CME@webmd.net.


Authors and Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

News Author

Laurie Barclay, MD
is a freelance reviewer and writer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.

Brande Nicole Martin
is the News CME editor for Medscape Medical News.

Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Medscape Medical News 2008. ©2008 Medscape
Advertisements

About this entry