Mediterranean diet for type 2 diabetes: cardiometabolic benefits
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Dietary patterns influence various cardiometabolic risk factors, including body weight, lipoprotein concentrations, and function, blood pressure, glucose–insulin homeostasis, oxidative stress, inflammation, and endothelial health. The Mediterranean diet can be described as a dietary pattern characterized by the high consumption of plant-based foods, olive oil as the main source of fat, low-to-moderate consumption of fish, dairy products and poultry, low consumption of red and processed meat, and low-to-moderate consumption of wine with meals. The American Diabetes Association and the American Heart Association recommend Mediterranean diet for improving glycemic control and cardiovascular risk factors in type 2 diabetes. Prospective studies show that higher adherence to the Mediterranean diet is associated with a 20–23 % reduced risk of developing type 2 diabetes, while the results of randomized controlled trials show that Mediterranean diet reduces glycosylated hemoglobin levels by 0.30–0.47 %, and is also associated with a 28–30 % reduced risk for cardiovascular events. The mechanisms by which Mediterranean diet produces its cardiometabolic benefits in type 2 diabetes are, for the most, anti-inflammatory and antioxidative: increased consumption of high-quality foods may cool down the activation of the innate immune system, by reducing the production of proinflammatory cytokines while increasing that of anti-inflammatory cytokines. This may favor the generation of an anti-inflammatory milieu, which in turn may improve insulin sensitivity in the peripheral tissues and endothelial function at the vascular level and ultimately act as a barrier to the metabolic syndrome, type 2 diabetes and development of atherosclerosis.
KeywordsMediterranean diet Cardiometabolic risk Type 2 diabetes Glycemic control Cardiovascular events
This work was supported in part by the “Associazione Salute con Stile”.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.C.J. Murray, M.A. Richards, J.N. Newton, K.A. Fenton, H.R. Anderson, C. Atkinson, D. Bennett, E. Bernabé, H. Blencowe, R. Bourne, T. Braithwaite, C. Brayne, N.G. Bruce, T.S. Brugha, P. Burney, M. Dherani, H. Dolk, K. Edmond, M. Ezzati, A.D. Flaxman, T.D. Fleming, G. Freedman, D. Gunnell, R.J. Hay, S.J. Hutchings, S.L. Ohno, R. Lozano, R.A. Lyons, W. Marcenes, M. Naghavi, C.R. Newton, N. Pearce, D. Pope, L. Rushton, J.A. Salomon, K. Shibuya, T. Vos, H. Wang, H.C. Williams, A.D. Woolf, A.D. Lopez, A. Davis, UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 381, 997–1020 (2013)CrossRefPubMedGoogle Scholar
- 5.Dietary Guidelines for Americans (2015–2020, 8th edn.), http://health.gov/dietaryguidelines/2015/guidelines/chapter-1/summary/. Accessed 6 June 2016
- 7.A.B. Evert, J.L. Boucher, M. Cypress, S.A. Dunbar, M.J. Franz, E.J. Mayer-Davis, J.J. Neumiller, R. Nwankwo, C.L. Verdi, P. Urbanski, W.S. Yancy Jr., Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 37(Suppl. 1), S120–S143 (2014)CrossRefPubMedGoogle Scholar
- 8.C.S. Fox, S. Hill Golden, C. Anderson, G.A. Bray, L.E. Burke, I.H. de Boer, P. Deedwania, R.H. Eckel, A.G. Ershow, J. Fradkin, S.E. Inzucchi, M. Kosiborod, R.G. Nelson, M.J. Patel, M. Pignone, L. Quinn, P.R. Schauer, E. Selvin, D.K. Vafiadis, Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 38, 1777–1803 (2015)CrossRefPubMedPubMedCentralGoogle Scholar
- 10.K. Esposito, R. Marfella, M. Ciotola, C. Di Palo, F. Giugliano, G. Giugliano, M. D’Armiento, F. D’Andrea, D. Giugliano, Effect of Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. J. Am. Med. Assoc. 292, 1440–1446 (2004)CrossRefGoogle Scholar
- 11.R. Estruch, M.A. Martinez-Gonzalez, D. Corella, J. Salas-Salvado, V. Ruiz- Gutierrez, M.I. Covas, M. Fiol, E. Gomez-Gracia, M.C. Lopez-Sabater, E. Vinyoles, F. Aros, M. Conde, C. Lahoz, J. Lapetra, G. Saez, E. Ros, PREDIMED study investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann. Intern. Med. 145, 1–11 (2006)CrossRefPubMedGoogle Scholar
- 13.L.F. Tinker, D.E. Bonds, K.L. Margolis, J.E. Manson, B.V. Howard, J. Larson, M.G. Perri, S.A. Beresford, J.G. Robinson, B. Rodriguez, M.M. Safford, N.K. Wenger, V.J. Stevens, L.M. Parker, Women’s health initiative. Low-fat dietary pattern and risk of treated diabetes mellitus in postmenopausal women: the women’s health initiative randomized controlled dietary modification trial. Arch. Intern. Med. 168, 1500–1511 (2008)CrossRefPubMedGoogle Scholar
- 17.L. Salas-Salvado, M. Bullo, R. Estruch, E. Ros, M.I. Covas, N. Ibarrola-Jurado, D. Corella, F. Aros, E. Gomez-Gracia, V. Ruiz-Gutierrez, D. Romaguera, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pinto, J. Basora, M.A. Munoz, J.V. Sorli, M.A. Martinez-Gonzalez, Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann. Intern. Med. 160, 1–10 (2014)CrossRefPubMedGoogle Scholar
- 18.E.M. Cespedes, F.B. Hu, L. Tinker, B. Rosner, S. Redline, L. Garcia, M. Hingle, L. Van Horn, B.V. Howard, E.B. Levitan, W. Li, J.E. Manson, L.S. Phillips, J.J. Rhee, M.E. Waring, M.L. Neuhouser, Multiple healthful dietary patterns and type 2 diabetes in the women’s health initiative. Am. J. Epidemiol. 183, 622–633 (2016)CrossRefPubMedGoogle Scholar
- 19.N. Babio, E. Toledo, R. Estruch, E. Ros, M.A. Martínez-González, O. Castañer, M. Bulló, D. Corella, F. Arós, E. Gómez-Gracia, V. Ruiz-Gutiérrez, M. Fiol, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pintó, J. Basora, J.V. Sorlí, J. Salas-Salvadó, PREDIMED study investigators, Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. Can. Med. Assoc. J. 186, E649–E657 (2014)CrossRefGoogle Scholar
- 24.K. Esposito, P. Chiodini, G. Bellastella, M.I. Maiorino, D. Giugliano, Proportion of patients at HbA1c target <7 % with eight classes of antidiabetic drugs in type 2 diabetes: systematic review of 218 randomized controlled trials with 78 945 patients. Diabetes Obes. Metab. 14, 228–233 (2012)CrossRefPubMedGoogle Scholar
- 28.R. Estruch, E. Ros, J. Salas-Salvadó, M.I. Covas, D. Corella, F. Arós, E. Gómez-Gracia, V. Ruiz-Gutiérrez, M. Fiol, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pintó, J. Basora, M.A. Muñoz, J.V. Sorlí, J.A. Martínez, M.A. Martínez-González, PREDIMED study investigators, primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 368, 1279–1290 (2013)CrossRefPubMedGoogle Scholar
- 37.K. Esposito, M.I. Maiorino, M. Ciotola, C. Di Palo, P. Scognamiglio, M. Gicchino, M. Petrizzo, F. Saccomanno, F. Beneduce, A. Ceriello, D. Giugliano, 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, 306–314 (2009)CrossRefPubMedGoogle Scholar
- 39.M.I. Maiorino, G. Bellastella, M. Petrizzo, L. Scappaticcio, D. Giugliano, K. Esposito, Mediterranean diet cools down the inflammatory milieu in type 2 diabetes: the MÉDITA randomized controlled trial. Endocrine (2016). doi: 10.1007/s12020-016-0881-1
- 40.M.I. Maiorino, G. Bellastella, D. Giugliano, K. Esposito. Cooling down inflammation in type 2 diabetes: how strong is the evidence for cardiometabolic benefit? Endocrine (2016). doi: 10.1007/s12020-016-0993-7
- 43.C. Gazzaruso, M. Fodaro, A. Coppola, Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications? Endocrine (2016). doi: 10.1007/s12020-016-0947-0