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Patient empowerment and the Mediterranean diet as a possible tool to tackle prediabetes associated with overweight or obesity: a pilot study

  • Giovanna MuscogiuriEmail author
  • Luigi Barrea
  • Carolina Di Somma
  • Barbara Altieri
  • Martina Vecchiarini
  • Francesco Orio
  • Tiziana Spinosa
  • Annamaria Colao
  • Silvia Savastano
Original Article

Abstract

Aim

The objective of this study was to investigate the effect of implementation of short-term patient empowerment as applied to Mediterranean diet (MD) adherence on metabolic and anthropometric parameters in prediabetic overweight or obese subjects.

Methods

The sample included 42 subjects with prediabetes, aged 18–75 years and with body mass index (BMI) > 25 kg/m2, who received dietary advice on MD by nutritionists during session groups every 2 weeks for 4 months. Data on energy caloric intake and macronutrient consumption were collected using a 7-day food diary record. Adherence to MD was investigated through the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. No advice was given regarding caloric restriction and physical activity. At baseline and at the end of the study, each subject underwent anthropometric, metabolic, and nutritional assessments.

Results

Approximately 40.5% of subjects had achieved restoration of normal glucose tolerance by the end of the study. Fasting plasma glucose, glycated hemoglobin (HbA1C), BMI, waist circumference, blood pressure, visceral adiposity index, triglycerides, and total and LDL cholesterol levels were significantly decreased, while HDL cholesterol had significantly increased by the end of the study. The subjects significantly increased adherence to MD, as assessed by the PREDIMED questionnaire at follow-up. A reduction of prevalence of the metabolic syndrome was also reported. Interestingly, the PREDIMED score correlated with HbA1C values at follow-up, after adjusting for BMI and total caloric intake.

Conclusions

Implementation of short-term patient empowerment as applied to MD adherence was shown to improve anthropometric and metabolic parameters in prediabetic overweight or obese subjects. This is of considerable importance, given that diet must be the cornerstone of treatment in patients at high risk of developing type 2 diabetes.

Keywords

Prediabetes Mediterranean diet Type 2 diabetes Overweight Obesity Empowerment 

Notes

Compliance with ethical standards

The work was conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans and was approved by the Ethical Committee of the University of Naples “Federico II” Medical School (n. 05/14). The purpose of the protocol was explained to all patients, and written informed consent was obtained.

References

  1. 1.
    Menke A, Casagrande S, Geiss L, Cowie CC (2015) Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA 314(10):1021–1029PubMedCrossRefGoogle Scholar
  2. 2.
    Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403PubMedCrossRefGoogle Scholar
  3. 3.
    DeFronzo RA, Tripathy D, Schwenke DC et al (2011) Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med 364(12):1104–1115PubMedCrossRefGoogle Scholar
  4. 4.
    Standard of medical care in diabetes (2017) Diabetes Care. 40(Supplement 1)Google Scholar
  5. 5.
    Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D (2010) Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis. Metab Syndr Relat Disord 8(6):471–476PubMedCrossRefGoogle Scholar
  6. 6.
    Barrea L, Tarantino G, Somma CD et al (2017) Adherence to the Mediterranean diet and circulating levels of sirtuin 4 in obese patients: a novel association. Oxidative Med Cell Longev 2017:6101254CrossRefGoogle Scholar
  7. 7.
    Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM et al (2008) Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 336(7657):1348–1351PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Esposito K, Maiorino MI, Ciotola M et al (2009) Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 151(5):306–314PubMedCrossRefGoogle Scholar
  9. 9.
    Salas-Salvado J, Bullo M, Babio N et al (2011) Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 34(1):14–19PubMedCrossRefGoogle Scholar
  10. 10.
    Esposito K, Chiodini P, Maiorino MI et al (2015) A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 163 patients. BMJ Open 5(2):e005892PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Steinsbekk A, Rygg LO, Lisulo M, Rise MB, Fretheim A (2012) Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 12:213PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Duke SA, Colagiuri S, Colagiuri R (2009) Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 1:CD005268Google Scholar
  13. 13.
    Jarvis J, Skinner TC, Carey ME, Davies MJ (2010) How can structured self-management patient education improve outcomes in people with type 2 diabetes? Diabetes Obes Metab 12(1):12–19PubMedCrossRefGoogle Scholar
  14. 14.
    Barrea L, Muscogiuri G, Macchia PE et al (2017) Mediterranean diet and phase angle in a sample of adult population: results of a pilot study. Nutrients 9(2)Google Scholar
  15. 15.
    Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E et al (2012) A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 7(8):e43134PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Welch AA, McTaggart A, Mulligan AA et al (2001) DINER (Data Into Nutrients for Epidemiological Research) - a new data-entry program for nutritional analysis in the EPIC-Norfolk cohort and the 7-day diary method. Public Health Nutr 4(6):1253–1265PubMedCrossRefGoogle Scholar
  17. 17.
    Goulet J, Nadeau G, Lapointe A, Lamarche B, Lemieux S (2004) Validity and reproducibility of an interviewer-administered food frequency questionnaire for healthy French-Canadian men and women. Nutr J 3:13PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Turconi G, Guarcello M, Berzolari FG, Carolei A, Bazzano R, Roggi C (2005) An evaluation of a colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys. Eur J Clin Nutr 59(8):923–931PubMedCrossRefGoogle Scholar
  19. 19.
    Amato MC, Giordano C, Pitrone M, Galluzzo A (2011) Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis 10:183PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Amato MC, Giordano C (2014) Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol 2014:730827PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Sigurdardottir AK, Jonsdottir H (2008) Empowerment in diabetes care: towards measuring empowerment. Scand J Caring Sci 22(2):284–291PubMedCrossRefGoogle Scholar
  22. 22.
    Raballo M, Trevisan M, Trinetta AF et al (2012) A study of patients’ perceptions of diabetes care delivery and diabetes: propositional analysis in people with type 1 and 2 diabetes managed by group or usual care. Diabetes Care 35(2):242–247PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Cheng L, Sit JWH, Choi KC et al (2017) Effectiveness of a patient-centred, empowerment-based intervention programme among patients with poorly controlled type 2 diabetes: a randomised controlled trial. Int J Nurs Stud 79:43–51PubMedCrossRefGoogle Scholar
  24. 24.
    Macedo MML, Cortez DN, Santos JCD, Reis IA, Torres HC (2017) Adherence to self-care practices and empowerment of people with diabetes mellitus: a randomized clinical trial. Rev Esc Enferm USP 51:e03278PubMedCrossRefGoogle Scholar
  25. 25.
    Martinez-Gonzalez MA, Salas-Salvado J, Estruch R et al (2015) Benefits of the Mediterranean diet: insights from the PREDIMED study. Prog Cardiovasc Dis 58(1):50–60PubMedCrossRefGoogle Scholar
  26. 26.
    Wainstein J, Ganz T, Boaz M et al (2012) Olive leaf extract as a hypoglycemic agent in both human diabetic subjects and in rats. J Med Food 15(7):605–610PubMedCrossRefGoogle Scholar
  27. 27.
    de Bock M, Derraik JG, Brennan CM et al (2013) Olive (Olea europaea L.) leaf polyphenols improve insulin sensitivity in middle-aged overweight men: a randomized, placebo-controlled, crossover trial. PLoS One 8(3):e57622PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Chiva-Blanch G, Urpi-Sarda M, Ros E et al (2013) Effects of red wine polyphenols and alcohol on glucose metabolism and the lipid profile: a randomized clinical trial. Clin Nutr 32(2):200–206PubMedCrossRefGoogle Scholar
  29. 29.
    Kang I, Buckner T, Shay NF, Gu L, Chung S (2016) Improvements in metabolic health with consumption of ellagic acid and subsequent conversion into urolithins: evidence and mechanisms. Adv Nutr 7(5):961–972PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Mora-Cubillos X, Tulipani S, Garcia-Aloy M, Bullo M, Tinahones FJ, Andres-Lacueva C (2015) Plasma metabolomic biomarkers of mixed nuts exposure inversely correlate with severity of metabolic syndrome. Mol Nutr Food Res 59(12):2480–2490PubMedCrossRefGoogle Scholar
  31. 31.
    Schroder H, Marrugat J, Vila J, Covas MI, Elosua R (2004) Adherence to the traditional mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 134(12):3355–3361PubMedCrossRefGoogle Scholar
  32. 32.
    Ledikwe JH, Blanck HM, Khan LK et al (2005) Dietary energy density determined by eight calculation methods in a nationally representative United States population. J Nutr 135(2):273–278PubMedCrossRefGoogle Scholar
  33. 33.
    Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ (2000) Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 342(19):1392–1398PubMedCrossRefGoogle Scholar
  34. 34.
    McIntosh M, Miller C (2001) A diet containing food rich in soluble and insoluble fiber improves glycemic control and reduces hyperlipidemia among patients with type 2 diabetes mellitus. Nutr Rev 59(2):52–55PubMedCrossRefGoogle Scholar
  35. 35.
    Pamnani MB, Bryant HJ, Clough DL, Schooley JF (2003) Increased dietary potassium and magnesium attenuate experimental volume dependent hypertension possibly through endogenous sodium-potassium pump inhibitor. Clin Exp Hypertens 25(2):103–115PubMedCrossRefGoogle Scholar
  36. 36.
    Herrera MD, Perez-Guerrero C, Marhuenda E, Ruiz-Gutierrez V (2001) Effects of dietary oleic-rich oils (virgin olive and high-oleic-acid sunflower) on vascular reactivity in Wistar-Kyoto and spontaneously hypertensive rats. Br J Nutr 86(3):349–357PubMedCrossRefGoogle Scholar

Copyright information

© Hellenic Endocrine Society 2019

Authors and Affiliations

  • Giovanna Muscogiuri
    • 1
    Email author
  • Luigi Barrea
    • 1
  • Carolina Di Somma
    • 2
  • Barbara Altieri
    • 1
  • Martina Vecchiarini
    • 3
  • Francesco Orio
    • 4
  • Tiziana Spinosa
    • 5
  • Annamaria Colao
    • 1
  • Silvia Savastano
    • 1
  1. 1.Department of Clinical Medicine and SurgeryUniversity “Federico II”NaplesItaly
  2. 2.IRCCS SDN NapoliNaplesItaly
  3. 3.University “Federico II”NaplesItaly
  4. 4.University ParthenopeNaplesItaly
  5. 5.U.O. Assistenza Sanitaria di Base ASL Napoli 1 CentroNaplesItaly

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