The diet of diabetic patients in Spain in 2008-2010: accordance with the main dietary recommendations--a cross-sectional study

Determinants of adherence to the Mediterranean diet among individuals with type 2 diabetes mellitus living in Mediterranean countries: a systematic review

Background

Patients with type 2 diabetes mellitus (T2DM) are often encouraged to adopt a healthy diet, such as the Mediterranean Diet (MD) yet limited evidence exists about adherence. An increased shift toward a "Western" dietary pattern was observed.

Objective

This systematic review aims to gain insight into the various factors that may enhance or reduce adherence to the MD in patients with T2DM residing in Mediterranean countries.

Method

We retrieved published studies from 2000 to 2023 from PubMed, Cochrane, Embase, CINAHL, Web of Science, Medline, and PsycINFO databases. The criteria for inclusion included individuals residing in Mediterranean countries aged 18+ with T2DM who underwent assessment using a validated MD scoring tool. We included 17 studies, with participant numbers ranging from 106 to 7,447.

Results

Compliance with the MD was moderate, with the most significant determinants of adherence being age, physical activity, body mass index (BMI), marital status, and educational level. However, limited information is available on psychological and economic determinants.

Conclusion

Various factors, especially sociodemographic ones, influence adherence to the MD among patients with T2DM. Future research should explore economic and psychological factors that may significantly impact adherence.

Systematic review register

Prospero: CRD42023396094.

Knowledge, Attitudes, and Behaviors around Dietary Fats among People with Type 2 Diabetes: A Systematic Review

This systematic review assesses the knowledge, attitudes, and behaviors (KAB) surrounding dietary fat intake among people with type 2 diabetes mellitus (T2DM) and healthcare professionals. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases were searched to identify studies published between 1995 and 2023 reporting people with T2DM or healthcare professionals that measured KAB towards dietary fat. This work was registered at PROSPERO (CRD42020140247). Twenty-four studies were included. Studies assessed knowledge of people with T2DM and reported poor nutrition knowledge regarding the health effect of fat consumption. Two opposing attitudes towards dietary fat was reported: (1) dietary fat should be limited, (2) promoted dietary fat intake through a low-carbohydrate diet. Participants reported behaviors of limiting fat intake, including trimming visible fat or choosing lower-fat alternatives. Total fat intake ranged between 10 and 66% of participants' total energy intake, while saturated fat intake ranged between 10 and 17%. People with T2DM reported poor knowledge of dietary fats in particular, and they were frequently unable to identify high-fat food. Attitudes towards dietary fat were heterogenous, and regarding behaviors, saturated fat intake was higher than recommended. Future studies should assess the KAB of people with T2DM based on dietary fat subtypes.

Integration of USDA Food Classification System and Food Composition Database for Image-Based Dietary Assessment among Individuals Using Insulin

New imaging technologies to identify food can reduce the reporting burden of participants but heavily rely on the quality of the food image databases to which they are linked to accurately identify food images. The objective of this study was to develop methods to create a food image database based on the most commonly consumed U.S. foods and those contributing the most to energy. The objective included using a systematic classification structure for foods based on the standardized United States Department of Agriculture (USDA) What We Eat in America (WWEIA) food classification system that can ultimately be used to link food images to a nutrition composition database, the USDA Food and Nutrient Database for Dietary Studies (FNDDS). The food image database was built using images mined from the web that were fitted with bounding boxes, identified, annotated, and then organized according to classifications aligning with USDA WWEIA. The images were classified by food category and subcategory and then assigned a corresponding USDA food code within the USDA's FNDDS in order to systematically organize the food images and facilitate a linkage to nutrient composition. The resulting food image database can be used in food identification and dietary assessment.

Differences in Dietary Intake Exist among U.S. Adults by Diabetic Status Using NHANES 2009-2016

The objective was to determine the most frequently consumed food items, food subcategories, and food categories, and those that contributed most to total energy intake for the group of U.S. adults reporting taking insulin, those with type 2 diabetes (T2D) not taking insulin, and those without diabetes. Laboratory tests and questionnaires of the National Health and Nutrition Examination Survey 2009-2016 classified 774 participants reporting taking insulin, 2758 participants reporting T2D not taking insulin, and 17,796 participants without diabetes. Raw and weighted frequency and energy contributions of each food item, food subcategory, and food category were calculated and ranked. Comparisons among groups by broad food category used the Rao-Scott modified chi-square test. Soft drinks ranked as the 8th and 6th most consumed food subcategory of participants with T2D not taking insulin and those without diabetes, and contributed 5th and 2nd most to energy, respectively. The group reporting taking insulin is likely to consume more protein foods and less soft drink compared to the other two groups. Lists of the most frequently reported foods and foods contributing most to energy may be helpful for nutrition education, prescribing diets, and digital-based dietary assessment for the group reporting taking insulin.

The salivary proteome reflects some traits of dietary habits in diabetic and non-diabetic older adults

PURPOSE

Objective markers of usual diet are of interest as alternative or validating tools in nutritional epidemiology research. The main purpose of the work was to assess whether saliva protein composition can reflect dietary habits in older adults, and how type 2 diabetes impacted on the saliva-diet correlates.

METHODS

214 participants were selected from 2 European cohorts of community-dwelling older adults (3C-Bordeaux and Seniors-ENRICA-2), using a case-control design nested in each cohort. Cases were individuals with type 2 diabetes. Dietary information was obtained using the Mediterranean Diet Adherence Screener (MEDAS). Saliva was successfully obtained from 211 subjects, and its proteome analyzed by liquid chromatography-tandem mass spectrometry.

RESULTS

The relative abundance of 246 saliva proteins was obtained across all participants. The salivary proteome differed depending on the intake level of some food groups (especially vegetables, fruits, sweet snacks and red meat), in a diabetic status- and cohort-specific manner. Gene Set Enrichment Analysis suggested that some biological processes were consistently affected by diet across cohorts, for example enhanced platelet degranulation in high consumers of sweet snacks. Minimal models were then fitted to predict dietary variables by sociodemographic, clinical and salivary proteome variables. For the food group «sweet snacks», selected salivary proteins contributed to the predictive model and improved its performance in the Seniors-ENRICA-2 cohort and when both cohorts were combined.

CONCLUSION

Saliva proteome composition of elderly individuals can reflect some aspects of dietary patterns.

Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

BACKGROUND

Diet is central to the management of type 2 diabetes mellitus (T2DM). Depending on the stage of the disease at which the recommended diet is initiated, optimal adherence can reduce HbA1c by about 1 to 2%. However, evidence on eating behavior is generally scarce including in Ethiopia. The present study aimed to assess the eating behavior of adults with T2DM in North Ethiopia.

METHODS

This cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Socio-demographic variables were collected using structured questionnaires; an asset-based wealth index was used to determine socioeconomic status. Three dimensions of eating behavior were assessed using Likert-type items: food selection, meal planning and calorie recognition. Raw Likert scores in each dimension were transformed to percent scales to maximum (%SM). Participants' behavior in each dimension was categorized into healthy and unhealthy taking 66.7% SM score as a cutoff. Overall eating behavior was determined by aggregating ranks scored in the three dimensions. Correlates of overall eating behavior were identified using Chi-square test and multinomial logistic regression with statistical significance set at P-value < 0.05.

RESULT

Only 1% of the participants had overall healthy eating behavior. Yet, overall unhealthy eating was apparent in 54.4%. By dimensions, healthy eating behaviors in food selection, meal planning and calorie recognition were seen in 43.5, 7.4 and 2.9% participants, respectively. Factors that were positively associated with having healthy eating behavior in one dimension relative to unhealthy in all were: receiving nutrition education [AOR 1.73; CI 1.09, 2.74], female gender [AOR 1.78; CI 1.03, 3.08] & being in 26-44 age category [AOR 3.7; CI 1.56, 8.85]. But, being in the poor [AOR 0.42; CI 0.16, 1.32] or average [AOR 0.54; CI 0.19, 1.55] socioeconomic strata were negatively associated. However, only receiving nutrition education [AOR 3.65; CI 1.31, 10.18] was significantly associated with having healthy behavior in two eating dimensions over unhealthy in all.

CONCLUSION

In North Ethiopia, the overall eating behavior of adults with T2DM is extremely poor. Diverse and integrated approaches including nutrition education during consultation should be implemented to address the gap.

A New Instrument for Measuring Dietary Knowledge in Patients With Diabetes: Psychometric Testing of the CoNOCidiet-Diabetes

PURPOSE

To determine the psychometric properties of the CoNOCidiet-Diabetes, a new instrument based on nursing outcome "Knowledge: prescribed diet."

METHODS

Methodological design. The participant were 359 patients diagnosed with diabetes visiting 27 primary healthcare centers in Spain. Reliability (internal consistency and test-retest), validity (convergent criterion validity, concurrent content validity and known-groups validity), and sensitivity to change was tested.

FINDINGS

CoNOCidiet-Diabetes has shown evidence of acceptable psychometric properties as instrument but some items should be revised.

CONCLUSIONS

This research provides a new instrument developed to specifically measure dietary knowledge in individuals with diabetes.

IMPLICATIONS

For nursing practice: The literalness of the CoNOCidiet-Diabetes with the nursing outcome "Knowledge: prescribed diet" facilitate its measurement using the patient's statements.

Nutrients Intake in Individuals with Hypertension, Dyslipidemia, and Diabetes: An Italian Survey

The aim of this study is to evaluate whether nutrients intake in an Italian adult population receiving pharmacological treatment for hypertension, dyslipidemia, and diabetes are within the recommended values proposed by dietary guidelines. Cross-sectional data from the Cardiovascular Epidemiology Observatory/Health Examination Survey in 8462 individuals 35–79 years were used. Food consumption was assessed with a self-administered semi-quantitative food frequency questionnaire. Dietary sodium and potassium intakes were measured in 24-hour urine collection. Recommendations from WHO were used for salt and potassium intakes, those from the Diabetes and Nutrition Study Group for diabetes, and those from the European Society of Cardiology for hypertension and dyslipidemia. Salt intake in urine collection of participants receiving treatment for hypertension was 11.1 ± 4.0 g/day for men and 8.6 ± 3.3 g/day for women, higher than recommended. In participants treated for dyslipidemia, mean saturated fat intake was 11.4% and 11.6% total Kcal in men and women respectively, higher than recommended, while cholesterol intake was higher only in men (365.9 ± 149.6 mg/day). In both men and women receiving treatment for diabetes, mean intake of saturated fats (12.3% and 12.2% of total Kcal), simple carbohydrates (17.5% and 19.8% of total Kcal) and cholesterol (411.0 ± 150.4 and 322.7 ± 111.1 mg/day) were above the recommendations, while fiber intake was below (19.5 ± 6.3 and 17.5 ± 6.2 mg/day). Overall, 70% to 80% of participants treated for these conditions received advice from family doctors on dietary management; however, nutrition is far from being optimal.

Food sources of sodium, saturated fat, and added sugar in the Physical Activity and Nutrition for Diabetes in Alberta (PANDA) trial

Diabetic patients may find it difficult to achieve recommended nutrient intakes embedded within dietary guidelines. The objective of this analysis was to document total sodium, saturated fat, and added sugar intake as well as the main food sources of these nutrients in Canadian adults with type 2 diabetes before and after an intervention focused on healthy eating. Participants were enrolled in a single-arm dietary intervention trial designed to improve glycemic control and adherence to dietary recommendations. A 4-week menu plan and recipes were provided for participants along with a 6-week educational curriculum. Three repeated 24-h dietary recalls were collected at baseline and 3 months. Food sources of sodium, saturated fat, and added sugar were a secondary outcome derived from the dietary recalls. After 3 months, there was a reduction (p < 0.05) in sodium intake of 561 mg/day, which was mainly due to reduced consumption of processed meats, soups, and condiments. Significantly lower intake of processed meat contributed to -2.9 g/day saturated fat intake (p < 0.1) while added sugar intake declined by 7 g/day (p < 0.1), which was due to lower consumption of baked goods/desserts and chocolate (both p < 0.05). The intervention was beneficial for type 2 diabetes patients in terms of changing dietary habits. However, the majority of the participants still exceeded the dietary guidelines for sodium and saturated fat. In addition to the efforts of individuals and their healthcare providers, strategies to increase the nutritional quality of prepared foods could provide widespread benefits.

Compliance with Nutritional and Lifestyle Recommendations in 13,000 Patients with a Cardiometabolic Disease from the Nutrinet-Santé Study

BACKGROUND

A healthy diet has been shown to prevent cardiovascular diseases complications. The objective of this study was to assess dietary intakes and compliance with nutritional and lifestyle recommendations in French adults diagnosed with hypertension, diabetes, dyslipidaemia or cardiovascular disease compared with healthy individuals.

METHODS

Data was collected from 26,570 subjects aged 35 to 70 years (13,285 patients and 13,285 controls matched by sex and age) of the French cohort NutriNet-Santé. Dietary intakes were assessed using three 24-h records. Mean food and nutrient intakes of patients were compared to those of healthy subjects using multivariable mixed logistic and linear regressions.

RESULTS

Compared to healthy controls, adults reporting cardiometabolic diseases had lower intakes of sweetened products, higher intakes of fish and seafood and a better compliance with dairy products. However, overall, they reported unhealthier lifestyles and dietary habits. Indeed, they were less often physically active and had similar habits regarding alcohol and tobacco consumption. They also had lower intakes of fruit, higher intakes of meat, processed meat and added fats. It is noteworthy that diabetic subjects tended to show the highest compliance with certain dietary recommendations (vegetables, pulses and whole grain products).

CONCLUSION

Our study brings into focus the fact that some nutritional aspects still need to be improved among individuals with a cardiometabolic disease. We should encourage higher intakes of fruits and vegetables, whole grain products, and lower intakes of meat and sodium, as well as healthy lifestyle (physical activity, no-smoking and limited intake of alcohol) in order to encourage a healthier management after being diagnosed.

Adherence to Mediterranean Diet Pattern among Spanish Adults Attending a Medical Centre: Nondiabetic Subjects and Type 1 and 2 Diabetic Patients

OBJECTIVE

To identify adherence to Mediterranean diet among two groups of Spanish adults: diabetic patients and nondiabetic subjects.

METHODS

Adherence to Mediterranean diet was measured by a 14-item screener (scale: 0-14; ≤5: low, 6-9: moderate, and ≥10: high) in 351 volunteers.

RESULTS

Mean age was 50.97 ± 12.58 in nondiabetics (n = 154) and 59.50 ± 13.34 in diabetics (n = 197). The whole sample scored 8.77 ± 1.82. Score was 9.19 ± 1.84 in nondiabetic females (n = 58) and 8.15 ± 1.79 in diabetic females (n = 85) (p = 0.003), due to lower consumption of olive oil (p = 0.005) and nuts (p = 0.000). Type 2 diabetic males (n = 79; 8.76 ± 1.88) consumed less olive oil than healthy males (n = 28; 9.36 ± 1.59) (p = 0.046). Up to 30-year-old nondiabetics scored lower than more than 60-year-old nondiabetics (8.40 ± 1.5 versus 9.74 ± 2.03; p = 0.047). The youngest ate less olive oil (p = 0.002) and more pastries (p = 0.007).

CONCLUSIONS

The sample presented moderate adherence to Mediterranean diet in all subgroups. Scientific evidence about the benefits of Mediterranean diet, olive oil, and nuts supports the recommendation to increase consumption of olive oil and nuts in diabetic women and of daily olive oil in type 2 diabetic men, reducing consumption of red meat, butter, and pastries, and to promote Mediterranean diet among the youngest of the sample studied.

Effectiveness of a Lifestyle Intervention in Patients with Type 2 Diabetes: The Physical Activity and Nutrition for Diabetes in Alberta (PANDA) Trial

Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy guidelines into their daily lives. The menu plan focused on recipes and foods that were accessible, available and acceptable to Albertans. The objective was to evaluate the effectiveness of the intervention on blood glucose control and dietary adherence and quality among patients with T2D. Participants with T2D (n = 73) enrolled in a single-arm incorporating interactive education based on a four-week menu plan that incorporated the recommendations of the CDA nutrition therapy guidelines. Post-intervention follow-up was conducted at three and six months. After three months, there were beneficial changes in A1c (-0.7%), body mass index (BMI, -0.6 kg/m²), diastolic blood pressure (-4 mmHg), total cholesterol (-63 mg/dL), HDL- (+28 mg/dL) and LDL-cholesterol (-89 mg/dL), Healthy Eating Index (+2.1 score) and perceived dietary adherence (+8.5 score) (all p < 0.05). The significant improvements in A1c, BMI and lipids were maintained at six months. The PANDA menu plan intervention was effective in improving glycemic control and diet quality. The results suggest that a dietary intervention incorporating interactive education sessions focused on menu planning with familiar, accessible foods may be effective for diabetes management.

On the problem of type 2 diabetes-related mortality in the Canary Islands, Spain. The DARIOS Study

AIMS

To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions.

METHODS

In a cross-sectional study of 28,887 participants aged 35-74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions.

RESULTS

Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p<0.001) and women (9.5 versus Madrid; p<0.001). Excess mortality was prevalent from the age of 45 years and above.

CONCLUSIONS

Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response.

Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus

OBJECTIVETo determine if there is a relationship between adherence to nutritional recommendations and sociodemographic variables in Brazilian patients with type 2 diabetes mellitus.METHODSCross-sectional observational study using a stratified random sample of 423 individuals. The Food Frequency Questionnaire (FFQ) was used, and the Fisher's exact test was applied with 95% confidence interval (p<0.05).RESULTSOf the 423 subjects, 66.7% were women, mean age of 62.4 years (SD = 11.8), 4.3 years of schooling on average (SD = 3.6) and family income of less than two minimum wages. There was association between the female gender and adherence to diet with adequate cholesterol content (OR: 2.03; CI: 1.23; 3.34), between four and more years of education and adherence to fractionation of meals (OR: 1 92 CI: 1.19; 3.10), and income of less than two minimum wages and adherence to diet with adequate cholesterol content (OR: 1.74; CI: 1.03, 2.95).CONCLUSIONAdherence to nutritional recommendations was associated with the female gender, more than four years of education and family income of less than two minimum wages.

Lost in translation: dietary management of cardiovascular risk factors is seldom implemented

OBJECTIVE

To assess dietary management of cardiovascular risk factors (CVRFs) in the general population.

METHOD

Cross-sectional study conducted between 2009 and 2012 on 4811 participants (2567 women, 58±11years) living in Lausanne, Switzerland.

RESULTS

Sixteen percent of participants diagnosed with overweight/obesity reported a slimming diet. Slimming diet was associated with diagnosis of hypertension: Odds ratio and (95% confidence interval): 0.61 (0.40-0.93); older age [0.84 (0.58-1.21), 0.79 (0.53-1.18) and 0.47 (0.27-0.81) for [50-60[, [60-70[ and [70+ years, respectively]; female gender [1.84 (1.36-2.48)] and diagnosis of diabetes [2.16 (1.13-4.12)]. Only 8% of participants diagnosed with hypertension reported a low-salt diet. Low-salt diet was associated with antihypertensive drug treatment [2.17 (1.28-3.68)] and diagnosis of diabetes [2.72 (1.26-5.86)]. One-third of participants diagnosed with dyslipidemia reported a low-fat diet. Low-fat diet was associated with female gender [1.47 (1.17-1.86)]; older age [1.29 (0.89-1.87), 1.71 (1.18-2.48) and 2.01 (1.33-3.03) for [50-60[, [60-70[ and [70+ years, respectively]; hypolipidemic drug treatment [OR=1.68 (1.29-2.18)]; current smoking [0.70 (0.51-0.96)] and obesity [0.67 (0.45-1.00)]. Approximately half of participants diagnosed with diabetes reported an antidiabetic diet. Antidiabetic diet was associated with current smoking [0.44 (0.22-0.88)] and antidiabetic drug treatment [OR=3.26 (1.81-5.86)].

CONCLUSION

Dietary management of CVRFs is seldom implemented in Switzerland.

Fat- and fiber-related diet behavior among type 2 diabetes patients from distinct regions

PURPOSE

Diet and eating habits are of key importance in patients with type 2 diabetes mellitus (T2DM). The purpose of this comparative study was to analyze fat- and fiber-related behavior (FFB) in patients with T2DM from distinct cultural areas.

PATIENTS AND METHODS

Observational study was carried out in the Czech Republic (CR) (n=200), the US (n=207), and Yemen (n=200). Patients completed the Fat- and Fiber-related Diet Behavior Questionnaire (FFBQ).

RESULTS

Differences in all aspects of FFB among countries were found (P<0.05). The best fat-related behavior reported was from patients from the CR. Patients from the US showed the worst fat-related behavior in total. On the other hand, patients from the US reported the best fiber-related behavior. Patients from Yemen reached the worst scores in all fat-related domains. Patients from all studied countries reported the best results in the "modify meat" and "avoid fat as flavoring" and the worst in the "substitute high fiber" subscales.

CONCLUSION

Professionals involved in the diet education of T2DM patients should be aware of the specificity of diet in their country when advising patients keeping general recommendations. We suggest them to be as specific as possible and concentrate on fiber-related behavior.

Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study

OBJECTIVE

The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes.

METHODS

A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures.

RESULTS

Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p<0.05). There were significant reductions (p<0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p<0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions.

CONCLUSIONS

Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.

The effect of the macrobiotic Ma-Pi 2 diet vs. the recommended diet in the management of type 2 diabetes: the randomized controlled MADIAB trial

Background

Diet is an important component of type 2 diabetes therapy. Low adherence to current therapeutic diets points out to the need for alternative dietary approaches. This study evaluated the effect of a different dietary approach, the macrobiotic Ma-Pi 2 diet, and compared it with standard diets recommended for patients with type 2 diabetes.

Methods

A randomized, controlled, open-label, 21-day trial was undertaken in patients with type 2 diabetes comparing the Ma-Pi 2 diet with standard (control) diet recommended by professional societies for treatment of type 2 diabetes. Changes in fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) were primary outcomes. HbA_1c, insulin resistance (IR), lipid panel and anthropometrics were secondary outcomes.

Results

After correcting for age, gender, BMI at baseline, and physical activity, there was a significantly greater reduction in the primary outcomes FBG (95% CI: 1.79; 13.46) and PPBG (95% CI: 5.39; 31.44) in those patients receiving the Ma-Pi 2 diet compared with those receiving the control diet. Statistically significantly greater reductions in the secondary outcomes, HbA_1c (95% CI: 1.28; 5.46), insulin resistance, total cholesterol, LDL cholesterol and LDL/HDL ratio, BMI, body weight, waist and hip circumference were also found in the Ma-Pi 2 diet group compared with the control diet group. The latter group had a significantly greater reduction of triglycerides compared with the Ma-Pi 2 diet group.

Conclusions

Intervention with a short-term Ma-Pi 2 diet resulted in significantly greater improvements in metabolic control in patients with type 2 diabetes compared with intervention with standard diets recommended for these patients.

Trial registration

Current Controlled Trials ISRCTN10467793.

Adherence to lifestyle recommendations is associated with improved glycemic control and improved blood lipid levels in Korean adults with type 2 diabetes

We explored the association between the degree of adherence to recommendations and diabetes management in Korean adults who had type 2 diabetes for an average of 8 years. Subjects who met five or more lifestyle recommendations showed significantly lower blood lipid parameters and glycated hemoglobin than those who did not.

Food sources of sodium, saturated fat and added sugar in the Spanish hypertensive and diabetic population

OBJECTIVES

Previous research has shown that the diet of hypertensive and diabetic patients has a low accordance with the main nutritional recommendations, mostly due to the high intake of sodium, saturated fat and added sugars. This is the first study to identify the main food sources of these nutrients in these patients.

METHODS

Cross-sectional study conducted in 2008-2010 in a representative sample of the Spanish adult population, including 2323 patients with hypertension and 635 with diabetes. The habitual diet was assessed using a validated diet history. The intake of sodium, saturated fat and added sugars was estimated with Spanish food composition tables.

RESULTS

The hypertensive and diabetic population showed, respectively, an intake of 2.9 and 3.1 g/day of sodium, 26 and 26 g/day of saturated fat, and 33 and 24 g/day of added sugar. In hypertensive and diabetic patients, respectively, most sodium intake came from bread (35%, 34%), raw-cured sausages (15%, 15%), cooked sausages (6%, 7%), and soup (5%, 6%). The main sources of saturated fat were cured cheese (13%, 13%), bakery products (12%, 11%), red meat (10%, 11%), raw-cured sausages (8%, 9%) and whole milk (4%, 4%). The food groups that most contributed to added sugar intake were sugar directly added to coffee and other beverages (27%, 19%), bakery products (15%, 19%), sugary soft drinks (10%, 13%), and whole yogurt (9%, 12%). The main food sources of nutrients were similar in all sex and age groups.

CONCLUSIONS

In patients with hypertension and diabetes, the intake of sodium, saturated fat and added sugar can be substantially reduced by prioritizing low-salt varieties of bread, reducing the consumption of bakery products and sausages, replacing cured cheese and other whole dairy products by low-fat products, using non-sugary sweeteners, and substituting sugar-free soft drinks, or plain water, for sugary sodas.

Associations of the FTO rs9939609 and the MC4R rs17782313 polymorphisms with type 2 diabetes are modulated by diet, being higher when adherence to the Mediterranean diet pattern is low

BACKGROUND

Although the fat mass and obesity (FTO) and melanocortin-4 receptor (MC4R) genes have been consistently associated with obesity risk, the association between the obesity-risk alleles with type 2 diabetes is still controversial. In some recent meta-analyses in which significant results have been reported, the associations disappeared after adjustment for body mass index (BMI). However gene-diet interactions with dietary patterns have not been investigated. Our main aim was to analyze whether these associations are modulated by the level of adherence to the Mediterranean Diet (MedDiet).

METHODS

Case-control study in 7,052 high cardiovascular risk subjects (3,430 type 2 diabetes cases and 3,622 non-diabetic subjects) with no differences in BMI. Diet was assessed by validated questionnaires. FTO-rs9939609 and MC4R-rs17782313 were determined. An aggregate genetic score was calculated to test additive effects. Gene-diet interactions were analyzed.

RESULTS

Neither of the polymorphisms was associated with type 2 diabetes in the whole population. However, we found consistent gene-diet interactions with adherence to the MedDiet both for the FTO-rs9939609 (P-interaction=0.039), the MC4R-rs17782313 (P-interaction=0.009) and for their aggregate score (P-interaction=0.006). When adherence to the MedDiet was low, carriers of the variant alleles had higher type 2 diabetes risk (OR=1.21, 95%CI: 1.03-1.40; P=0.019 for FTO-rs9939609 and OR=1.17, 95%CI:1.01-1.36; P=0.035 for MC4R-rs17782313) than wild-type subjects. However, when adherence to the MedDiet was high, these associations disappeared (OR=0.97, 95%CI: 0.85-1.16; P=0.673 for FTO-rs9939609 and OR=0.89, 95%CI:0.78-1.02; P=0.097 for MC4R-rs17782313). These gene-diet interactions remained significant even after adjustment for BMI. As MedDiet is rich in folate, we also specifically examined folate intake and detected statistically significant interaction effects on fasting plasma glucose concentrations in non-diabetic subjects. However these findings should be interpreted with caution because folate intake may simply reflect a healthy dietary pattern.

CONCLUSIONS

These novel results suggest that the association of the FTO-rs9939609 and the MC4R-rs17782313 polymorphisms with type 2 diabetes depends on diet and that a high adherence to the MedDiet counteracts the genetic predisposition.