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Interventions and public health nutrition

Do improvements in dietary behaviour contribute to cardiovascular risk factor reduction over and above cardio-protective medication in newly diagnosed diabetes patients?

European Journal of Clinical Nutrition volume 68, pages 1113–1118 (2014)Cite this article

Subjects

Abstract

Background/Objectives:

A healthy diet is an integral component of successful diabetes management. However, the comparative importance of adopting a healthy diet for cardiovascular risk factor reduction over and above medication use among newly diagnosed diabetes patients remains unclear.

Subjects/Methods:

We computed a dietary score consistent with American Diabetes Association and Diabetes UK recommendations in 574 newly diagnosed diabetes patients by summing standardised values for the intake of total energy, saturated fat, sodium, fibre and plasma vitamin C. In linear regression analyses, stratified by cardio-protective medication use (yes/no), we quantified the comparative longitudinal associations of baseline diet and change in diet over 1 year with change in blood pressure, HbA1c and lipids.

Results:

Baseline diet was generally not predictive of change in cardiovascular risk factor levels at 1 year. In contrast, dietary change over 1 year among patients prescribed and not prescribed cardio-protective medication after baseline was associated with comparative (p-interaction all ⩾0.95) reductions in diastolic blood pressure (−2.38 vs −2.93 mm Hg, respectively) and triglycerides (−0.31 vs −0.21 mmol/l, respectively), independent of potential confounding factors and change from baseline to follow-up in physical activity and smoking status.

Conclusions:

Modest dietary change over the first year following diagnosis of diabetes was associated with reductions in blood pressure and triglycerides, over and above the effects of cardio-protective medication. Our findings support the notion that dietary change should be viewed as an integral component of successful diabetes self-management, irrespective of medication use.

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Acknowledgements

ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no.: G061895), the Medical Research Council (grant reference no.: G0001164), the NIHR Health Technology Assessment Programme (grant reference no.: 08/116/300), National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and the National Institute for Health Research. SJG receives support from the Department of Health NIHR Programme Grant funding scheme [RP-PG-0606-1259]. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. Bio-Rad provided equipment for HbA1c testing during the screening phase. We are grateful to the ADDITION-Cambridge independent trial steering committee (Nigel Stott (Chair), John Weinman, Richard Himsworth and Paul Little). Aside from the authors, the ADDITION-Cambridge study team has included Rebecca Abbott, Amanda Adler, Judith Argles, Gisela Baker, Rebecca Bale, Roslyn Barling, Daniel Barnes, Mark Betts, Sue Boase, Clare Boothby, Sandra Bovan, Ryan Butler, Parinya Chamnan, Sean Dinneen, Pesheya Doubleday, Sue Emms, Mark Evans, Tom Fanshawe, Francis Finucane, Philippa Gash, Julie Grant, Wendy Hardeman, Robert Henderson, Susie Hennings, Muriel Hood, Garry King, Ann-Louise Kinmonth, Georgina Lewis, Christine May Hall, Joanna Mitchell, Richard Parker, Nicola Popplewell, A. Toby Prevost, Emanuella De Lucia Rolfe, Lincoln Sargeant, Megan Smith, Stephen Sutton, Nicholas Wareham, Liz White, Fiona Whittle and Kate Williams. We thank the Cambridge University Hospitals NHS Foundation Trust Department of Clinical Biochemistry and the NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory for carrying out the biochemical assays, and the following groups within the MRC Epidemiology Unit: data management (Adam Dickinson), information technology (Iain Morrison), technical (Matt Sims) and field epidemiology (Paul Roberts, Kim Mwanza and James Sylvester). ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no.: G061895), the Medical Research Council (grant reference no.: G0001164), the NIHR Health Technology Assessment Programme (grant reference no.: 08/116/300), National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and the National Institute for Health Research.

AUTHOR CONTRIBUTIONS

AJMC, RKS and SJG conceived and designed the study question. SJG and RKS acquired the data. AJMC analysed the data. AJMC, DS, GHL, SJG and RKS interpreted the data and wrote the paper. AJMC, RKS and SJG had primary responsibility for the final content of the paper. All authors critically revised the paper for important intellectual content and have approved the final version.

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Authors and Affiliations

  1. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK

    A J M Cooper, D Schliemann, G H Long, S J Griffin & R K Simmons

  2. Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK

    S J Griffin

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  1. A J M Cooper
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Correspondence to R K Simmons.

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Cooper, A., Schliemann, D., Long, G. et al. Do improvements in dietary behaviour contribute to cardiovascular risk factor reduction over and above cardio-protective medication in newly diagnosed diabetes patients?. Eur J Clin Nutr 68, 1113–1118 (2014). https://doi.org/10.1038/ejcn.2014.79

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