Effect of a Mediterranean diet on endothelial progenitor cells and carotid intima-media thickness in type 2 diabetes: Follow-up of a randomized trial

Abstract

We assessed the long-term effects of a Mediterranean diet on circulating levels of endothelial progenitor cells (EPCs) and the carotid intima-media thickness (CIMT) in patients with type 2 diabetes. Design: This was a parallel, two-arm, single-centre trial. Methods: Two hundred and fifteen men and women with newly diagnosed type 2 diabetes were randomized to a Mediterranean diet (n ¼ 108) or a low-fat diet (n ¼ 107). The primary outcome measures were changes in the EPC count and the CIMT of the common carotid artery after the treatment period defined as the end of trial (EOT). Results: At the EOT, both the CD34þ counts had increased with the Mediterranean diet compared with the low-fat diet (p < 0.05 for both). At the EOT evaluation, there was a significant (p ¼ 0.024) difference of À0.025 mm in the CIMT favouring the Mediterranean diet. Compared with the low-fat diet, the rate of regression in the CIMT was higher in the Mediterranean diet group (51 vs. 26%), whereas the rate of progression was lower (25 vs. 50%) (p ¼ 0.032 for both). Changes in the CIMT were inversely correlated with the changes in EPC levels (CD34At the EOT, changes in levels of HbA1c, HOMA, total cholesterol, high-density lipoprotein cholesterol and systolic blood pressure were significantly greater with the Mediterranean diet than with the low-fat diet. Conclusion: Compared with a low-fat diet, a long-term trial with Mediterranean diet was associated with an increase in circulating EPCs levels and prevention of the progression of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes.

Improving the scientific rigour of nutritional recommendations for adults with type 2 diabetes: A comprehensive review of the American Diabetes Association guideline‐recommended eating patterns

“…As recommended by the ADA guidelines, we found that the Mediterranean eating pattern has demonstrated effectiveness in improving glycaemic control as well as CVD risk factors and even in reducing CVD events . This diet appears to be appropriately considered helpful for T2D management; its inclusion in the recommended eating patterns is warranted.…”

“…Among the included trials are several large‐scale studies, one with 3614 participants and one with more than 200 participants . Longer‐term studies include one lasting 12 months, one lasting 24 months, and two lasting longer than 4 years …”

“…Among the included trials are several large-scale studies, one with 3614 participants 26,27 and one with more than 200 participants. 25,33,34 Longer-term studies include one lasting 12 months, 28 one lasting 24 months, 36 and two lasting longer than 4 years. [25][26][27]33,34 As recommended by the ADA guidelines, we found that the Mediterranean eating pattern has demonstrated effectiveness in improving glycaemic control 25,28,[32][33][34][38][39][40][41][42][43] as well as CVD risk factors and even in reducing CVD events.…”

“…[32][33][34][35][36][37][38][39][40][41][42][43] One RCT found that this diet significantly improved HbA1c and body mass index in postmenopausal women with T2D, but the diet was not superior to usual care for improving blood pressure and lipids. 32 33,34 followed up Esposito 2009, 25 which was included in the ADA-cited evidence ( Table 1). Both studies found longer times to medication requirement in the Mediterranean diet arm versus the low-fat diet arm, as well as increased partial remission and improved FBG and CVD risk markers.…”

Mediterranean Diet attenuates risk of frailty and sarcopenia: New insights and future directions

“…For example, recent meta-analyses of RCTs have shown that when comparing with a variety of control diets, a Mediterranean style diet has beneficial effects on glycemic control, weight loss and cardiovascular risk factors among individuals with T2DM [160,161]. Furthermore, recent results from the long term MÉDITA trial showed that when compared with a standard low-fat diet, a Mediterranean diet ameliorates the inflammatory response and improves endothelial functioning in persons with T2DM [162,163]. Therefore, the efficacy of a MedDiet pattern in a cohort of older adults whom are vulnerable to an accelerated decline in SMM and function warrants future investigation.…”