الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The term diabetes mellitus describes a complex metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both.There is an increased prevalence of diabetes all over the world, and most people with diabetes will die or be disabled as a consequence of vascular complications. Subjects with type2 DM are more susceptible to macrovascular and microvascular diseases. AGEs play an important role in diabetes complications.
AGEs can be formed within the organism (endogenous source) or can originate from exogenous sources. Although AGEs are better known as by-products of hyperglycemia, they also form within food during heat-enhanced cooking,which include high lipid and protein content, low water content during cooking, elevated pH and the application of high temperature over a short time period. Kinetic studies have demonstrated that approximately 10–30% of dietary AGEs consumed are intestinally absorbed. These dietary AGEs represent an important source for circulating AGEs under in vivo conditions. Moreover, smoking also serves as an additional exogenous source of AGEs.
Under physiologic conditions, AGEs accumulate with age, but their accumulation seems to be exacerbated by some pathologic conditions: diabetes mellitus, renal failure, cardiovascular disease, Alzheimer’s disease, rheumatoid arthritis, and others. In these conditions, AGEs do not seem to be innocent bystanders, but rather contribute to pathophysiologic alterations.
Several studies found that restriction of dietary AGEs was accompanied by a fall in circulating AGEs and a decrease in markers of oxidative stress, inflammation, endothelial dysfunction and insulin resistance in subjects with diabetes mellitus, renal failure as well as in healthy persons. Since changing the cooking method (e.g. reducing temperature, increasing humidity, decreasing the pH) is highly effective in influencing the amount of AGEs contained in food, this might represent a simple, meaningful and cost-effective intervention against the AGEs burden. Physical exercise,use of herbs, spices and condiments that improve taste of food also have antiglycation effect. In addition to therapeutics which inhibit the accumulation of endogenous AGEs.
The general objective of the present study was to study dietary advanced glycation end product intake in Type 2 Diabetes Mellitus and its relation with diabetic complications.
A sample of 110 subjects with diabetes above 40 years was randomly selected from patients attending Diabetes Specialist Center at the General Ophthalmic Hospital in Alexandria and data was collected in the period of May 2017 till August 2017 and data was collected using predesigned interviewing questionnaire .The questionnaire consisted of the following parts: socio-demographic characteristics ,medical history and thedietary intake data was collected using the food frequency techniquewhere the frequency of consumption of all food groups and beverages was recorded during three months . Food nutrient intake analysis was done using the Egyptian food composition tables to get the dietary composition in terms of energy and macronutrients with special emphasis on AGE content.These dietary AGEs were analyzed according to the database published by Uribarri et al.Blood pressure was measured for studied cases in addition to anthropometric measurements such as height,weight and waist circumference. Serum samples were collected and analyzed for fasting blood glucose, Hemoglobin A1c and CRP.Finally the collected data was subjected to statistical analysis by the use of suitable technique to achieve the objectives of the study. The results of the study can be summarized as the follow:
• Higher dAGE intake was significantly correlated with high protein and fat intake in diet.
• Dietary AGE intake is positively correlated with fasting blood glucose in type 2 Diabetics.
• Also, the findings of the present study indicate that persons with type 2DM who consumed high AGEs in diet showed high SBP, DBP and there was a weak significant positive correlation between the amount of AGE consumed and SBP and DBP.
• All diabetics with high AGE intake showed a positive CRP test, thus dAGEs might contribute significantly to inflammation in diabetes and diabetic complications.
• Higher dietary AGE consumption is correlated with higher severity of diabetic complications.
The diet is a major, unrecognized source of AGEs and the modern food environment can act as a significant source of AGEs and AGEs contribute significantly to inflammation in diabetes and diabetic complications. So the most important recommendations are:
Reducing food-derived AGEs by different methods such as dietary restriction of AGEs containg foods, changing method of cooking, and use of acidic marinades.
Dietary assessment of diabetics in relation to AGEs consumption.
Lifestyle modification is corner stone in prevention and management of type 2DM and should include both dietary and physical activity pattern changes to decrease AGEs.