Skip to main content

Mediterranean diet for type 2 diabetes: cardiometabolic benefits

Endocrine volume 56, pages 27–32 (2017)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. M. Ezzati, E. Riboli, Behavioral and dietary risk factors for noncommunicable diseases. N. Engl. J. Med. 369, 954–964 (2013)

    CAS  Article  PubMed  Google Scholar 

  2. US Burden of Disease Collaborators, The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. J. Am. Med. Assoc. 310, 591–608 (2013)

    Article  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  4. E.N. Georgousopoulou, C. Pitsavos, M. Yannakoulia, D.B. Panagiotakos, The role of dietary patterns’ assessment in the predictive ability of cardiovascular disease risk estimation models: a review. Int. J. Food Sci. Nutr. 65, 3–8 (2014)

    CAS  Article  PubMed  Google Scholar 

  5. Dietary Guidelines for Americans (2015–2020, 8th edn.), http://health.gov/dietaryguidelines/2015/guidelines/chapter-1/summary/. Accessed 6 June 2016

  6. W.C. Willett, F. Sacks, A. Trichopoulou, G. Drescher, A. Ferro-Luzzi, E. Helsing, D. Trichopoulos, Mediterranean diet pyramid: a cultural model for healthy eating. Am. J. Clin. Nutr. 61, 1402S–1406S (1995)

    CAS  PubMed  Google Scholar 

  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)

    Article  PubMed  Google 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)

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. K. Esposito, A. Pontillo, C. Di Palo, G. Giugliano, M. Masella, R. Marfella, D. Giugliano, Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. J. Am. Med. Assoc. 289, 1799–1804 (2003)

    CAS  Article  Google 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)

    CAS  Article  Google 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)

    Article  PubMed  Google Scholar 

  12. B.V. Howard, L. Van Horn, J. Hsia et al., Low-fat dietary pattern and risk of cardiovascular disease: the women’s health initiative randomized controlled dietary modification trial. J. Am. Med. Assoc. 295, 655–666 (2006)

    CAS  Article  Google 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)

    Article  PubMed  Google Scholar 

  14. E. Koloverou, K. Esposito, D. Giugliano, D. Panagiotakos, The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metabolism 63, 903–911 (2014)

    CAS  Article  PubMed  Google Scholar 

  15. K. Esposito, P. Chiodini, M.I. Maiorino, G. Bellastella, D. Panagiotakos, D. Giugliano, Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine 47, 107–116 (2014)

    CAS  Article  PubMed  Google Scholar 

  16. L. Schwingshackl, B. Missbach, J. König, G. Hoffmann, Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 18, 1292–1299 (2015)

    Article  PubMed  Google 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)

    Article  PubMed  Google 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)

    Article  PubMed  Google 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)

    Article  Google Scholar 

  20. O. Ajala, P. English, J. Pinkney, Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am. J. Clin. Nutr. 97, 505–516 (2013)

    CAS  Article  PubMed  Google Scholar 

  21. P. Carter, F. Achana, J. Troughton, L.J. Gray, K. Khunti, M.J. Davies, A Mediterranean diet improves HbA1c but not fasting blood glucose compared to alternative dietary strategies: a network meta-analysis. J. Hum. Nutr. Diet. 27, 280–297 (2014)

    CAS  Article  PubMed  Google Scholar 

  22. R. Huo, T. Du, Y. Xu, W. Xu, X. Chen, K. Sun, X. Yu, Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur. J. Clin. Nutr. 69, 1200–1208 (2015)

    CAS  Article  PubMed  Google Scholar 

  23. K. Esposito, M.I. Maiorino, G. Bellastella, P. Chiodini, D. Panagiotakos, D. Giugliano, A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 5, e008222 (2015)

    Article  PubMed  PubMed Central  Google 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)

    CAS  Article  PubMed  Google Scholar 

  25. K. Esposito, M.I. Maiorino, M. Petrizzo, G. Bellastella, D. Giugliano, The effects of Mediterranean diet on need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow up of a randomized trial. Diabetes Care 37, 1824–1830 (2014)

    CAS  Article  PubMed  Google Scholar 

  26. C.-M. Kastorini, H.J. Milionis, K. Esposito, D. Giugliano, J.A. Goudevenos, D.B. Panagiotakos, The effect of Mediterranean diet on metabolic syndrome and its components. A meta-analysis of 50 studies and 534,906 individuals. J. Am. Coll. Cardiol. 57, 1299–1313 (2011)

    CAS  Article  PubMed  Google Scholar 

  27. K. Esposito, C.-M. Kastorini, D.B. Panagiotakos, D. Giugliano, Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab. Syndr. Relat. Disord. 9, 1–12 (2011)

    Article  PubMed  Google 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)

    CAS  Article  PubMed  Google Scholar 

  29. K. Esposito, D. Giugliano, Mediterranean diet for primary prevention of cardiovascular disease. N. Engl. J. Med. 369, 674–675 (2013)

    PubMed  Google Scholar 

  30. P.C. Calder, N. Ahluwalia, F. Brouns et al., Dietary factors and low-grade inflammation in relation to overweight and obesity. Br. J. Nutr. 106(Suppl. 3), S5–S78 (2011)

    CAS  Article  PubMed  Google Scholar 

  31. M. Ryan, D. McInerney, D. Owens, P. Collins, A. Johnson, G.H. Tomkin, Diabetes and the Mediterranean diet: a beneficial effect of oleic acid on insulin sensitivity, adipocyte glucose transport and endothelium dependent vasoreactivity. Q. J. Med. 93, 85–91 (2000)

    CAS  Article  Google Scholar 

  32. C. Chrysohoou, D.B. Panagiotakos, C. Pitsavos, U.N. Das, C. Stefanadis, Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA study. J. Am. Coll. Cardiol. 44, 152–158 (2004)

    Article  PubMed  Google Scholar 

  33. C. Pitsavos, D.B. Panagiotakos, N. Tzima, C. Chrysohoou, M. Economou, A. Zampelas, C. Stefanadis, Adherence to the Mediterranean diet is associated with total antioxidant capacity in healthy adults: the ATTICA study. Am. J. Clin. Nutr. 82, 694–699 (2005)

    CAS  PubMed  Google Scholar 

  34. D. Giugliano, K. Esposito, Mediterranean diet and metabolic diseases. Curr. Opin. Lipidol. 19, 63–68 (2008)

    CAS  PubMed  Google Scholar 

  35. X. Wang, W. Bao, J. Liu, Y.Y. Ouyang, D. Wang, S. Rong, X. Xiao, Z.L. Shan, Y. Zhang, P. Yao, L.G. Liu, Inflammatory markers and risk of type 2 diabetes. A systematic review and meta-analysis. Diabetes Care 36, 166–175 (2013)

    CAS  Article  PubMed  Google Scholar 

  36. L. Schwingshackl, G. Hoffman, Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr. Metab. Cardiovasc. Dis. 24, 929–939 (2014)

    CAS  Article  PubMed  Google 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)

    Article  PubMed  Google Scholar 

  38. M.I. Maiorino, G. Bellastella, M. Petrizzo, L. Scappaticcio, D. Giugliano, K. Esposito, Anti-inflammatory effect of mediterranean diet in type 2 diabetes is durable: 8-year follow-up of a controlled trial. Diabetes Care 39, e44–e45 (2016)

    Article  PubMed  Google 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

  41. K. Esposito, D. Giugliano, Diet and inflammation: a link to metabolic and cardiovascular diseases. Eur. Heart. J. 27, 15–20 (2006)

    Article  PubMed  Google Scholar 

  42. K. Esposito, D. Giugliano, Healthy lifestyle for metabolic health: no more excuse!. Endocrine 46, 176–178 (2014)

    CAS  Article  PubMed  Google Scholar 

  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

Download references

Acknowledgments

This work was supported in part by the “Associazione Salute con Stile”.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy

    Katherine Esposito

  2. Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy

    Maria Ida Maiorino, Giuseppe Bellastella & Dario Giugliano

  3. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

    Demosthenes B. Panagiotakos

Authors
  1. Katherine Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Ida Maiorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Bellastella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Demosthenes B. Panagiotakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dario Giugliano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine Esposito.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Esposito, K., Maiorino, M.I., Bellastella, G. et al. Mediterranean diet for type 2 diabetes: cardiometabolic benefits. Endocrine 56, 27–32 (2017). https://doi.org/10.1007/s12020-016-1018-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-016-1018-2

Keywords

  • Mediterranean diet
  • Cardiometabolic risk
  • Type 2 diabetes
  • Glycemic control
  • Cardiovascular events