Efficacy of Mediterranean Diet on Blood Biochemical Factors in Type II Diabetic Patients: A Randomized Controlled Trial
Introduction: Diabetes mellitus is one of the most common endocrinologic disorder and the seventh cause of mortality worldwide. In Mediterranean dietary, consumption of plant source food such as vegetables, fruits, seeds, beans etc. is much emphasized. There are many studies showed that this regimen can decrease the risk of cardiovascular disease and factors associated in diabetes mellitus. Therefore, in this study we investigated the efficacy of this regimen on blood biochemical factors in diabetic patients referred to diabetes clinic in Gorgan.
Methods: This was a clinical trial study in which 228 well-controlled type 2 diabetes mellitus patients between 40-60 years were included in the study. They were randomly assigned to two different groups: control and Mediterranean educational intervention group. They followed up for 6 months and before and after the intervention, we evaluated the glycemic and lipid profile and physiological parameters in them. Data were analyzed by SPSS software.
Results: Totally 228 patients with diabetes mellitus type II between 40 to 60 years old were recruited. The mean age of patients was 57.3±9.28 years old. Majority of participants were female (77.2%) with elementary level of literacy (77.6%). The mean of fasting blood glucose was 192.50± 64.17 mg/dL in intervention group versus 208.48 ± 87.90 mg/dL in control group (P>0.05). This index was changed to 165.49± 50.39 mg/dL in intervention group which was significantly lower than the amount in control group (P<0.001). A clinically and statistically significant fall in HbA1c was observed in intervention group rather than control group (P<0.001).
Conclusion: The present study represented a significant relationship between Mediterranean dietary intervention and both anthropometric and laboratory findings in patients with type 2 diabetes mellitus. We showed that this dietary could significantly lower the FBS, HbA1c, and LDL. Although we showed this meaningful difference, it should be more evaluated in Iranian race people to investigate more in this topic.
Rani V, Deep G, Singh RK, Palle K, Yadav UC. Oxidative stress and metabolic disorders: pathogenesis and therapeutic strategies. Life sciences. 2016;148:183-93.
Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ open. 2015;5(8):e008222.
Organization WH. Global report on diabetes: World Health Organization; 2016.
Rimm EB, Stampfer MJ. Diet, lifestyle, and longevity—the next steps? Jama. 2004;292(12):1490-2.
Sleiman D, Al-Badri MR, Azar ST. Effect of Mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review. Frontiers in public health. 2015;3:69.
Mohseni F, Farhangi MA, Farajnia S, Khoshbaten M, Ajourlou E, Kakaei F. Adherence to Mediterranean nutrition pattern in patients with non-alcoholic fatty liver disease: Relationship with metabolic risk factors and-UCP2-866G/a gene polymorphisms. Current Topics in Nutraceuticals Research. 2016;14(1):49.
Tur JA, Romaguera D, Pons A. The Diet Quality Index-International (DQI-I): is it a useful tool to evaluate the quality of the Mediterranean diet? British journal of nutrition. 2005;93(03):369-76.
Georgoulis M, Kontogianni M, Margariti A, Tiniakos D, Fragopoulou E, Zafiropoulou R, et al. Associations between dietary intake and the presence of the metabolic syndrome in patients with non‐alcoholic fatty liver disease. Journal of Human Nutrition and Dietetics. 2015;28(4):409-15.
Gerber M. The comprehensive approach to diet: a critical review. The Journal of nutrition. 2001;131(11):3051S-5S.
Martínez-González MÁ, Sánchez-Villegas A. Review: The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern? European journal of epidemiology. 2004;19(1):9-13.
Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a mediterranean-style diet on cardiovascular risk factorsa randomized trial. Annals of internal medicine. 2006;145(1):1-11.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. New England Journal of Medicine. 2003;348(26):2599-608.
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. Jama. 2004;292(12):1440-6.
Psaltopoulou T, Ilias I, Alevizaki M. The role of diet and lifestyle in primary, secondary, and tertiary diabetes prevention: a review of meta-analyses. Rev Diabet Stud. 2010;7(1):26-35.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.
Itsiopoulos C, Brazionis L, Kaimakamis M, Cameron M, Best JD, O’Dea K, et al. Can the Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomized cross-over study. Nutrition, Metabolism and Cardiovascular Diseases. 2011;21(9):740-7.
Committee DGA. Scientific report of the 2015 dietary guidelines advisory committee. Washington (DC): USDA and US Department of Health and Human Services. 2015.
Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet. 2014;383(9933):1999-2007.
Esposito K, Chiodini P, Maiorino MI, Bellastella G, Panagiotakos D, Giugliano D. Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Springer; 2014.
Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-Style Diet on Cardiovascular Risk FactorsA Randomized TrialMediterranean Diet and Cardiovascular Risk Factors. Annals of internal medicine. 2006;145(1):1-11.
Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, et al. Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 DiabetesA Randomized Trial. Annals of internal medicine. 2009;151(5):306-14.
Hodge A, English D, Itsiopoulos C, O’Dea K, Giles G. Does a Mediterranean diet reduce the mortality risk associated with diabetes: evidence from the Melbourne Collaborative Cohort Study. Nutrition, Metabolism and Cardiovascular Diseases. 2011;21(9):733-9.
Garg A. High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis. The American journal of clinical nutrition. 1998;67(3):577S-82S.
Barona J, Jones JJ, Kopec RE, Comperatore M, Andersen C, Schwartz SJ, et al. A Mediterranean-style low-glycemic-load diet increases plasma carotenoids and decreases LDL oxidation in women with metabolic syndrome. The Journal of nutritional biochemistry. 2012;23(6):609-15.
Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;2008(359):229-41.