Dietary advanced glycation end-products exacerbate oxidative stress in patients with diabetic foot ulcers

Background: This study examined the association between advanced glycation end-products (AGE) and serum markers of oxidative stress and inflammation in diabetic patients with or without diabetic foot ulcers. Methods: Eighty-two adult participants were recruited and assigned to one of three groups: 1) non-diabetic control; 2) diabetic participants without foot ulcers (DM); and 3) diabetic participants with foot ulcers (DFU). Demographical data, 24 hour food recalls, and blood samples were collected from each participant. Both dietary and serum AGE were evaluated as well astumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and thiobarbituric acid reactive substances (TBARS). Results: The diabetic participants had significantly higher levels of dietary AGE, serum AGE, TNF-α, CRP, and TBARS compared to non-diabetic controls. TBARS were significantly higher in DFU than DM. Serum AGE and TBARS were significantly correlated with dietary AGE. Serum TBARS strongly predicted the duration of DFU (R2=0.52). Conclusions: Individuals with DFU had the highest levels of both dietary and serum AGE. Because dietary AGE causes a rise in serum AGE concentration, it is important to reduce the intake of foods containing AGE by promoting appropriate dietary choices in this population.