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This feasibility study explored the use of an evolutionary mismatch narrative in nutritional education intervention aiming to reduce ultra-processed foods in the diets of veterans with type 2 diabetes and improve diabetic outcomes. Ultra-processed foods are foods that are primarily manufactured through industrial processes. These foods are high in calories but low in nutritional content. Diets high in these foods have been linked to increased health risks. One of the major health risks is type 2 diabetes. Type 2 diabetes is a chronic disease that is developed when cells become unable to properly utilize insulin. Over time this may lead to additional health conditions such as nerve damage, cardiovascular disease, and renal disease. Evolutionary mismatch narrative nutritional intervention offers a different approach to nutritional education to help reduce ultra-processed foods in diets. This study was a randomized controlled feasibility study at the Phoenix VA. Eleven participants were enrolled and randomly selected to be given either an evolutionary mismatch narrative education intervention or general nutritional education about ultra-processed foods. 24-hour diet recalls and blood chemistry were collected and analyzed. Blood chemistry provided diabetes related measurements which included glucose, HbA1c, insulin, HOMA-IR, and C-reactive protein. Statistically significant findings in this study included percentage of ultra-processed foods decreasing for both control and experimental groups from week 0 to week 4 (p=0.014), and C-reactive protein levels between the control and experimental groups (p=0.042). However, baseline C-reactive protein concentrations were lower in the experimental group such that normalizing for group differences at baseline revealed no significant difference in C-reactive protein change between interventions (p = 1.000). There were no other statistically significant values regarding diabetes related measurements. The results from this study suggest that nutritional education in general may help decrease ultra-processed food consumption.
Assessment of DNA methylation was performed on human skeletal muscle and blood using reduced representation bisulfite sequencing (RRBS) for high-throughput identification and pyrosequencing for site-specific confirmation. Sorbin and SH3 homology domain 3 (SORBS3) was identified in skeletal muscle to be increased in methylation (+5.0 to +24.4 %) in the promoter and 5’untranslated region (UTR) in the obese participants (n= 10) compared to lean (n=12), and this finding corresponded with a decrease in gene expression (fold change: -1.9, P=0.0001). Furthermore, SORBS3 was demonstrated in a separate cohort of morbidly obese participants (n=7) undergoing weight-loss induced by surgery, to decrease in methylation (-5.6 to -24.2%) and increase in gene expression (fold change: +1.7; P=0.05) post-surgery. Moreover, SORBS3 promoter methylation was demonstrated in vitro to inhibit transcriptional activity (P=0.000003). The methylation and transcriptional changes for SORBS3 were significantly (P≤0.05) correlated with obesity measures and fasting insulin levels. SORBS3 was not identified in the blood methylation analysis of lean (n=10) and obese (n=10) participants suggesting that it is a muscle specific marker. However, solute carrier family 19 member 1 (SLC19A1) was identified in blood and skeletal muscle to have decreased 5’UTR methylation in obese participants, and this was significantly (P≤0.05) predicted by insulin sensitivity.
These findings suggest SLC19A1 as a potential blood-based biomarker for obese, insulin resistant states. The collective findings of SORBS3 DNA methylation and gene expression present an exciting novel target in skeletal muscle for further understanding obesity and its underlying insulin resistance. Moreover, the dynamic changes to SORBS3 in response to metabolic improvements and weight-loss induced by surgery.