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* New English Study of Type 2 Diabetes


* Food Allergies


* Scientific Integrity Principles Outlined



The National Health System (NHS) in England hopes to find out if a weight management program works well enough to reverse type 2 diabetes. In a radical approach, thousands of people will receive help to battle type 2 diabetes and obesity with a structured program that includes a liquid diet of just over 800 calories a day for 3 months and a follow-up support period. The NHS program-which will be piloted in up to 5000 people in England-comes on the heels of the Diabetes UK-funded DiRECT (Diabetes Remission Clinical Trial) study, in which nearly half of type 2 diabetes patients who went on a similar diet plan achieved remission at 1 year.


Controlled trials such as DiRECT claimed to show that insulin-producing cells of the pancreas could be rebooted once remission had been achieved. If confirmed, this will be an important observation because previously it was assumed that beta cell function, once lost, probably could never be recovered.


In the DiRECT study, remission of type 2 diabetes was defined as achieving a hemoglobin A1c less than 6.5% without using antidiabetic drugs for at least 2 months. The effect was tied mainly to weight loss. DIRECT study participants, who had type 2 diabetes for up to 6 years and were not receiving insulin, were randomized to either a weight management program provided by dietitians or trained nurses (n = 149) or a control group that followed guideline-based best practices (n = 149). Participants in the intervention group stopped all antidiabetic and antihypertensive drugs at the start of the study and replaced their regular food habits with a liquid diet of about 825 to 850 calories a day for 3 to 5 months. After that, they were reintroduced to more usual food for 2 to 8 weeks, followed by a structured weight loss maintenance program. At 12 months, 46% of the intervention group had achieved remission of type 2 diabetes and had dropped an average of 10 kg (22 lb) compared with 1 kg (2.2 lb) in controls. Remission occurred in 86% of the patients who had lost 15 kg (33 lb) or more. DiRECT and other research results emphasize the importance of excess body fat in type 2 diabetes. Behavioral support was an integral part of DIRECT. Follow-up support will also be a core component of the NHS program, but it remains to be seen if there will be enough of it and whether people will stick to the low-calorie diet long enough to make this scaled-up program a success. Fingers crossed!


Source: Diabetes UK Accessed February 20, 2019.



The American Association of Clinical Endocrinologists and the American College of Endocrinology recently issued a position statement on supplements and bone health. Three critical nutrients for bone health are calcium, vitamin D, and protein, and diets that are inadequate in one may well also be inadequate in other nutrients important to skeletal health. It concludes that optimal nutritional status for bone health is best obtained by consuming a healthful diet and will likely not be met by single nutrient supplementation. Fortification is also a strategy that deserves attention.


It comes as no surprise to learn that the desire to maintain health, including bone health, into old age is one motivation that has led to almost one-half of our population and 70% of older adults in the United States[1] and up to 26% in Europe[2] to use dietary supplements. Dietary supplements areas to use in randomized controlled trials that can assess a single nutrient. However, in nutrient studies, it is more difficult to account for the impact of food and food fortification on bone health outcomes. Accurately quantifying the effect of an individual nutrient on bone health is confounded by methodological issues and the time lag involved in assessment outcomes many years later. There are also multiple challenges involved in defining what optimal nutrition for bone health is and in defining nutritional adequacy. Baseline nutrient assessment can also be challenging because daily food consumption fluctuates. Furthermore, interactions between several nutrients in food, rather than provision of a single nutrient as a supplement, may have important effects. Finally, it seems implausible that a single nutrient amount is optimal for all individuals, regardless of gender, age, ethnicity, body size, and comorbidities. Thus, it is unrealistic to expect systematic reviews or meta-analyses to provide a simple "one size fits all" definition of optimal nutritional status for skeletal health. The position statement outlines current understanding of optimal nutrition to maximize bone gain, minimize bone loss, and reduce fragility and fracture risk until future studies provide more clarity. The World Health Organization and the Food and Agricultural Organization of the United Nations, as "the practice of deliberately increasing the content of an essential micronutrient, that is, vitamins or minerals in a food, irrespective of whether the nutrients were originally in the food before processing or not, so as to provide a health benefit with minimal risk to health." Food fortification delivers essential nutrients to large segments of the population without requiring radical changes in food consumption patterns. Foods used as fortification vehicles vary from country to country, but they generally include cereals and cereal-based products, milk and dairy products, fats and oils, tea and other beverages, and condiments. The position statement is less laudatory toward dietary supplements. It concludes that the notion that there are benefits of individual high-dose micronutrient supplementation among well-nourished individuals is highly debatable in general and also for skeletal health. The provision of excess nutrients beyond their threshold of benefit in people who are already replete may not produce a greater response.


Source: Hurley DL, Binkley N, Camacho PM, et al. The use of vitamins and minerals in skeletal health: American Association of Clinical Endocrinologists and the American College of Endocrinology position statement. Endocr Pract 2018;24(10):915-924.



Scientific integrity transcends the boundaries of scientific disciplines, since it is the responsibility of everyone to foster and promote a culture of scientific integrity. Yet, issues with scientific integrity continue to be widespread, despite work in this area that has gone on for decades. In 2017, the timing was right to bring together multiple sectors to agree upon a set of principles and best practices that could be used broadly across all scientific disciplines as a mechanism for enhancing community consensus on scientific integrity standards.


The Scientific Integrity Consortium that resulted from that effort represented 4 US and 3 Canadian government agencies, 11 professional societies, 6 universities, and 3 nonprofit scientific organizations and gleaned input from individual sectors and scientific disciplines. Many of the existing efforts are summarized in an open access catalog, which was compiled by the International Life Sciences Institute and is being updated yearly1 and a prior document prepared by the American Society for Microbiology.2


Table 1 shows the result of the consortium's efforts-2 principles and 9 best practices to help strengthen scientific integrity policies that are already in place, to aid in the development of new policies, and to raise the importance of creating a culture in the scientific community that upholds scientific integrity. Opportunities for integrating these principles and best practices into teaching and learning materials, informing policy development in this area, and influencing the development of standards by academic institutions, scientific organizations, and relevant government agencies are now being sought.


The entire document elaborating on each of the principles and practices is available free Open Access for download from the journal Science and Engineering Ethics (access at


1. Kretser A, Murphy D, Dwyer J. Scientific integrity resource guide: efforts by federal agencies, foundations, nonprofit organizations, professional societies, and academia in the United States. Crit Rev Food Sci Nutr 2017;57(1), 163-180.


2. Casadevall A, Ellis LM, Davies EW, McFall-Ngai M, Fang FC. A framework for improving the quality of research in the biological sciences. mBio 2016;7(4), e01256-16, DOI: 10.1128/mBio.01256-16.