Abstract
Background/Objectives:
This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I diabetes (TID).
Subjects/Methods:
Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity.
Results:
In cross-sectional analyses using baseline data, for individuals with the hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl lower total cholesterol (TC) (P=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (P=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C) (P=0.004) and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dl lower TC (P=0.05), 1.6 mg/dl lower LDL-C (P=0.03) and 1.8 mg/dl lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity.
Conclusions:
Mediterranean diet may improve glycemic control and cardiovascular health in TID youth.
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References
Dahl-Jorgensen K, Larsen JR, Hanssen KF . Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment? Diabetologia 2005; 48: 1445–1453.
de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation 2014; 130: 1110–1130.
Petitti DB, Klingensmith GJ, Bell RA, Andrews JS, Dabelea D, Imperatore G et al. Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study. J Pediatr 2009; 155: 668–72.e1-3.
Laakso M, Kuusisto J . Insulin resistance and hyperglycaemia in cardiovascular disease development. Nat Rev Endocrinol 2014; 10: 293–302.
Daniels SR, Pratt CA, Hayman LL . Reduction of risk for cardiovascular disease in children and adolescents. Circulation 2011; 124: 1673–1686.
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K, American Heart Association. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 2003; 107: 1562–1566.
Mikkila V, Rasanen L, Laaksonen MM, Juonala M, Viikari J, Pietinen P et al. Long-term dietary patterns and carotid artery intima media thickness: the Cardiovascular Risk in Young Finns Study. Br J Nutr 2009; 102: 1507–1512.
Serra-Majem L, Roman B, Estruch R . Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev 2006; 64: S27–S47.
Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas MI et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006; 145: 1–11.
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; 359: 229–241.
Estruch R, Ros E, Salas-Salvadó J, Covas M, Corella D, Arós F et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.
SEARCH Study Group. SEARCH for Diabetes in Youth: a multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin Trials 2004; 25: 458–471.
Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002; 109: 45–60.
Liese AD, Bortsov A, Gunther AL, Dabelea D, Reynolds K, Standiford DA et al. Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: the SEARCH for Diabetes in Youth study. Circulation 2011; 123: 1410–1417.
Mayer-Davis EJ, Nichols M, Liese AD, Bell RA, Dabelea DM, Johansen JM et al. Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study. J Am Diet Assoc 2006; 106: 689–697.
Liese AD, Crandell JL, Tooze JA, Fangman MT, Couch SC, Merchant AT et al. Relative validity and reliability of an FFQ in youth with type 1 diabetes. Public Health Nutr 2014; 18: 428–437.
Serra-Majem L, Ribas L, Ngo J, Ortega RM, Garcia A, Perez-Rodrigo C et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 2004; 7: 931–935.
Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2005; 82: 163–173.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.
Chatterjee R, Yeh HC, Shafi T, Anderson C, Pankow JS, Miller ER et al. Serum potassium and the racial disparity in diabetes risk: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2011; 93: 1087–1091.
Singer JD . Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educ Behav Stat 1998; 23: 323–355.
Gunther AL, Liese AD, Bell RA, Dabelea D, Lawrence JM, Rodriguez BL et al. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension 2009; 53: 6–12.
Barnes TL, Crandell JL, Bell RA, Mayer-Davis EJ, Dabelea D, Liese AD . Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: the SEARCH for Diabetes in Youth Study. Nutr Diabetes 2013; 3: e91.
Baggio G, Pagnan A, Muraca M, Martini S, Opportuno A, Bonanome A et al. Olive-oil-enriched diet: effect on serum lipoprotein levels and biliary cholesterol saturation. Am J Clin Nutr 1988; 47: 960–964.
Djousse L, Arnett DK, Coon H, Province MA, Moore LL, Ellison RC . Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr 2004; 79: 213–217.
Duffey KJ, Gordon-Larsen P, Steffen LM, Jacobs DR Jr, Popkin BM . Regular consumption from fast food establishments relative to other restaurants is differentially associated with metabolic outcomes in young adults. J Nutr 2009; 139: 2113–2118.
Cadario F, Prodam F, Pasqualicchio S, Bellone S, Bonsignori I, Demarchi I et al. Lipid profile and nutritional intake in children and adolescents with type 1 diabetes improve after a structured dietician training to a Mediterranean-style diet. J Endocrinol Invest 2012; 35: 160–168.
Giannini C, Diesse L, D'Adamo E, Chiavaroli V, de Giorgis T, Di Iorio C et al. Influence of the Mediterranean diet on carotid intima-media thickness in hypercholesterolaemic children: a 12-month intervention study. Nutr Metab Cardiovasc Dis 2014; 24: 75–82.
Maahs DM, Dabelea D, D'Agostino RB Jr, Andrews JS, Shah AS, Crimmins N et al. Glucose control predicts 2-year change in lipid profile in youth with type 1 diabetes. J Pediatr 2013; 162: 101–7.e1.
Ajala O, English P, Pinkney J . Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97: 505–516.
Esposito K, Maiorino MI, Di Palo C, Giugliano D, Campanian Postprandial Hyperglycemia Study Group. Adherence to a Mediterranean diet and glycaemic control in type 2 diabetes mellitus. Diabet Med 2009; 26: 900–907.
Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013; 36: 3821–3842.
Lazarou C, Panagiotakos DB, Matalas AL . Lifestyle factors are determinants of children's blood pressure levels: the CYKIDS study. J Hum Hypertens 2009; 23: 456–463.
Mazaraki A, Tsioufis C, Dimitriadis K, Tsiachris D, Stefanadi E, Zampelas A et al. Adherence to the Mediterranean diet and albuminuria levels in Greek adolescents: data from the Leontio Lyceum ALbuminuria (3 L study). Eur J Clin Nutr 2011; 65: 219–225.
Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117–1124.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3–10.
Acknowledgements
This study was supported by research grants from the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK077949), CDC (PA Numbers 00097, DP-05-069 and DP-10-001) and NIH (DK056350) and was also supported by the Sanofi Global Scholars Program (to VWZ).
Author contributions
VWZ, APL and EJM-D designed research; VWZ and APL conducted research; VWZ and JLC analyzed data; VWZ wrote the paper; and EJM-D had primary responsibility for final content. All authors read and approved the final manuscript and contributed to the revision of the manuscript critically for important intellectual content.
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VWZ received financial support from the Sanofi Global Scholars Program. The remaining authors declare no conflict of interest.
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Zhong, V., Lamichhane, A., Crandell, J. et al. Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study. Eur J Clin Nutr 70, 802–807 (2016). https://doi.org/10.1038/ejcn.2016.8
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DOI: https://doi.org/10.1038/ejcn.2016.8
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