Comparative effect of two Mediterranean diets versus a low-fat diet on glycaemic control in individuals with type 2 diabetes

Lasa, Arrate; Miranda, Jonatan; Bulló, Mònica; Casas, Rosa; Salas‐Salvadó, Jordi; Larretxi, Idoia; Estruch, Ramón; Ruı́z-Gutı́errez, Valentina; Portillo, Marı́a P.

doi:10.1038/ejcn.2014.1

Cited by 162 publications

(103 citation statements)

References 40 publications

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“…pharmacological treatment in newly diagnosed type 2 diabetes (3,24). The speed of the glucose-lowering effect using the TeLiPro approach was comparable with that observed after bariatric surgery (25).…”

Section: Discussionmentioning

confidence: 70%

Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial

et al. 2017

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OBJECTIVELifestyle interventions are the foundation of treatment in newly diagnosed type 2 diabetes. However, their therapeutic potential in advanced disease stages is unknown. We evaluated the efficacy of the Telemedical Lifestyle intervention Program (TeLiPro) in improving metabolic control in advanced-stage type 2 diabetes. RESEARCH DESIGN AND METHODSIn this single-blind, active comparator, intervention study, patients with type 2 diabetes (with glycated hemoglobin [HbA 1c ] ‡7.5% [58.5 mmol/mol]), and BMI ‡27 kg/m 2 and on ‡2 antidiabetes medications) were recruited in Germany and randomized 1:1 using an electronically generated random list and sealed envelopes into two parallel groups. The data analyst was blinded after assignment. The control group (n = 100) got weighing scales and step counters and remained in routine care. The TeLiPro group (n = 102) additionally received telemedical coaching including medicalmental motivation, a formula diet, and self-monitored blood glucose for 12 weeks. The primary end point was the estimated treatment difference in HbA 1c reduction after 12 weeks. All available values per patient (n = 202) were analyzed. Analyses were also performed at 26 and 52 weeks of follow-up. RESULTSHbA 1c reduction was significantly higher in the TeLiPro group (mean 6 SD 21.1 6 1.2% vs. 20.2 6 0.8%; P < 0.0001). The estimated treatment difference in the fully adjusted model was 0.8% (95% CI 1.1; 0.5) (P < 0.0001). Treatment superiority of TeLiPro was maintained during follow-up (week 26: 0.6% [95% CI 1.0; 0.3], P = 0.0001; week 52: 0.6% [0.9; 0.2], P < 0.001). The same applies for secondary outcomes: weight (TeLiPro 26.2 6 4.6 kg vs. control 21.0 6 3.4 kg), BMI (22.1 6 1.5 kg/m 2 vs. 20.3 6 1.1 kg/m 2 ), systolic blood pressure (25.7 6 15.3 mmHg vs. 21.6 6 13.8 mmHg), 10-year cardiovascular disease risk, antidiabetes medication, and quality of life and eating behavior (P < 0.01 for all). The effects were maintained longterm. No adverse events were reported. CONCLUSIONSIn advanced-stage type 2 diabetes, TeLiPro can improve glycemic control and may offer new options to avoid pharmacological intensification.

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Section: Discussionmentioning

confidence: 70%

Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial

et al. 2017

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“…After stage 1 screening, 53 records underwent full-text screening. Overall, 28 studies were included in the meta-analysis with 24 for MUFA vs. CHO diets (13–37), totaling 1,460 participants, and 4 for MUFA vs. PUFA diets (38–41), totaling 44 participants. The number of available comparisons for MUFA vs. CHO diets was 28 as some trials had more than two arms.…”

Section: Resultsmentioning

confidence: 99%

Metabolic Effects of Monounsaturated Fatty Acid–Enriched Diets Compared With Carbohydrate or Polyunsaturated Fatty Acid–Enriched Diets in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

et al. 2016

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OBJECTIVEDietary interventions in patients with type 2 diabetes (T2D) are important for preventing long-term complications. Although a healthy diet is crucial, there is still uncertainty about the optimal macronutrient composition. We performed a meta-analysis comparing diets high in cis-monounsaturated fatty acids (MUFA) to diets high in carbohydrates (CHO) or in polyunsaturated fatty acids (PUFA) on metabolic risk factors in patients with T2D.RESEARCH DESIGN AND METHODSWe systematically reviewed PubMed, MEDLINE, and Cochrane databases and prior systematic reviews and meta-analyses to identify interventions assessing HbA1c, fasting plasma glucose and insulin, LDL and HDL cholesterol, triglycerides, body weight, or systolic/diastolic blood pressure. Meta-analyses were conducted using both fixed- and random-effects models to calculate the weighted mean difference (WMD) and 95% CI.RESULTSWe identified 24 studies totaling 1,460 participants comparing high-MUFA to high-CHO diets and 4 studies totaling 44 participants comparing high-MUFA to high-PUFA diets. When comparing high-MUFA to high-CHO diets, there were significant reductions in fasting plasma glucose (WMD −0.57 mmol/L [95% CI −0.76, −0.39]), triglycerides (−0.31 mmol/L [−0.44, −0.18]), body weight (−1.56 kg [−2.89, −0.23]), and systolic blood pressure (−2.31 mmHg [−4.13, −0.49]) along with significant increases in HDL cholesterol (0.06 mmol/L [0.02, 0.10]). When high-MUFA diets were compared with high-PUFA diets, there was a significant reduction in fasting plasma glucose (−0.87 mmol/L [−1.67, −0.07]). All of the outcomes had low to medium levels of heterogeneity, ranging from 0.0 to 69.5% for diastolic blood pressure (Phet = 0.011).CONCLUSIONSOur meta-analysis provides evidence that consuming diets high in MUFA can improve metabolic risk factors among patients with T2D.

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“…Adherence to a Mediterranean-style diet appears to mitigate insulin resistance 12, 13 , systemic inflammation 14 , and oxidative stress 15 , features linked to alterations in metabolically relevant regional fat depots. In a seminal study of dietary associations with precise imaging-defined measures of regional adiposity in Framingham, Molenaar and colleagues demonstrated that higher dietary quality (by the 2005 Dietary Guidelines Adherence Index) was associated with lower subcutaneous and visceral fat 16 , though specific food groups were not explored 17, 18 .…”

Section: Introductionmentioning

confidence: 99%

Diet and adipose tissue distributions: The Multi-Ethnic Study of Atherosclerosis

Shah

Murthy

Allison

et al. 2016

Nutrition, Metabolism and Cardiovascular Diseases

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Background and Aims Dietary quality affects cardiometabolic risk, yet its pathways of influence on regional adipose tissue depots involved in metabolic and diabetes risk are not well established. We aimed to investigate the relationship between dietary quality and regional adiposity. Methods and Results We investigated 5,079 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) who had food-frequency questionnaires and measurement of pericardial fat and hepatic attenuation at the baseline study visit in MESA, as well as a subgroup with imaging for visceral and subcutaneous fat (N=1,390). A dietary quality score (DietQuality) was constructed to include established food group constituents of a Mediterranean-type diet. Linear models estimated associations of dietary score as well as its constituents with regional adiposity. Baseline mean age was 61 (±10) years, and approximately half of the participants (47%) were male. Those with a higher DietQuality score were generally older, female, with a lower body mass index, C-reactive protein, and markers of insulin resistance. After adjustment, a higher DietQuality score was associated with lower visceral fat (lowest vs. highest dietary score quartile: 523.6 vs. 460.5 cm2/m; P<0.01 for trend), pericardial fat (47.5 vs. 41.3 cm3/m; P<0.01 for trend), lesser hepatic steatosis (by hepatic attenuation; 58.6 vs. 60.7 Hounsfield units; P<0.01 for trend), but not subcutaneous fat (P=0.39). Greater fruits, vegetables, whole grains, seeds/nuts and yogurt intake were associated with decreased adiposity, while red/processed meats were associated with greater regional adiposity. Conclusion A higher quality diet pattern is associated with less regional adiposity, suggesting a potential mechanism of beneficial dietary effects on diabetes, metabolic, and cardiovascular risk.

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Comparative effect of two Mediterranean diets versus a low-fat diet on glycaemic control in individuals with type 2 diabetes

Cited by 162 publications

References 40 publications

Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial

Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial

Metabolic Effects of Monounsaturated Fatty Acid–Enriched Diets Compared With Carbohydrate or Polyunsaturated Fatty Acid–Enriched Diets in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Diet and adipose tissue distributions: The Multi-Ethnic Study of Atherosclerosis

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