Original Article

Association of Major Dietary Patterns with Cardio-metabolic Risk Factors in Type 2 Diabetic Patients

Abstract

Background: Role of dietary modifications on the treatment and management of diabetes and complications was shown by many researchers. This study was designed to examine the association of major dietary patterns with diabetes-related cardio-metabolic risk factors in Iranian diabetes.

Methods: Totally, 525 type 2 diabetic subjects with mean age 55 ± 10 yr were included in this cross-sectional study in 2014 that followed for at least two years by the Diabetes and Metabolic disease Clinic of Tehran University of Medical Sciences, Tehran, Iran. Blood samples were collected after 12 h fasting for glycemic and lipid profiles. Information on the general characteristics, anthropometric, blood pressure measurements and physical activity level was collected. Dietary data were obtained by a validated food frequency questionnaire. Dietary patterns were obtained factor analysis (principal component analysis).

Results: Three major dietary patterns retained through principal component analysis: Western like (high in sweets, fast foods, carbonated drinks, red meat, mayonnaise, nuts, refined grains, potato and visceral meat), Asian like (high in vegetables, low-fat dairy, fish, poultry and egg), and Traditional like (high in high fat dairy, oils, whole grains, vegetables and fruits). Western like dietary pattern was positively associated with fasting serum glucose (P=0.05), total cholesterol (P=0.005) and low-density lipoprotein cholesterol (P=0.008). After extensive adjustment for potential confounders, the association of serum total cholesterol and Western like dietary pattern remained significant (P=0.03).

Conclusion: Modifications in dietary pattern, especially in those who have a Western dietary pattern, may be effective in preventing or delaying diabetes-associated cardio metabolic complications.

 

 

Shaw J, Sicree R, Zimmet P (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract, 87(1):4-14.

Harati H, Hadaegh F, Saadat N, Azizi F (2009). Population-based incidence of Type 2 diabetes and its associated risk factors: results from a six-year cohort study in Iran. BMC Public Health, 9(1):186.

Williams R, Van Gaal L, Lucioni C (2002). Assessing the impact of complications on the costs of Type II diabetes. Diabetologia, 45(7):S13-S7.

Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA, et al. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ, 321(7258):405-12.

Association AD (2013). Economic costs of diabetes in the US in 2012. Diabetes Care, 36(4):1033-46.

Turner R, Holman R, Cull C, Stratton I, Matthews D, Frighi V, et al. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352(9131):837-53.

Ajala O, English P, Pinkney J (2013). Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr, 97(3):505-16.

Castaneda Gonzalez LM, Bacardi Gascon M, Jimenez Cruz A (2011). Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. Nutr Hosp, 26(6):1270-6.

Hu FB (2002). Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol, 13(1):3-9.

Jinlin F, Binyou W, Terry C (2007). A new approach to the study of diet and risk of type 2 diabetes. J Postgrad Med, 53(2):139.

Fung TT, Schulze M, Manson JE, Willett WC, Hu FB (2004). Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 164(20):2235-40.

Van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB (2002). Dietary patterns and risk for type 2 diabetes mellitus in US men. Ann Intern Med, 136(3):201-9.

Montonen J, Knekt P, Härkänen T, Järvinen R, Heliövaara M, Aromaa A, et al. (2005). Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol, 161(3):219-27.

Alhazmi A, Stojanovski E, McEvoy M, Garg M (2014). The association between dietary patterns and type 2 diabetes: a systematic review and meta‐analysis of cohort studies. J Hum Nutr Diet, 27(3):251-60.

Martínez González MÁ, de la Fuente Arrillaga C, Nunez Cordoba JM, Basterra Gortari FJ, Beunza JJ, Vazquez Z, et al. (2008). Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ, 336(7657):1348-51.

Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, et al. (2007). The association between adherence to the Mediterranean diet and fasting indices of glucose homoeostasis: the ATTICA Study. J Am Coll Nutr, 26(1):32-8.

Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. (2004). Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA, 292(12):1440-6.

Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011). The Effect of Mediterranean Diet on Metabolic Syndrome and its ComponentsA Meta-Analysis of 50 Studies and 534,906 Individuals. J Am Coll Cardiol, 57(11):1299-313.

Lim JH, Lee YS, Chang HC, Moon MK, Song Y (2011). Association between dietary patterns and blood lipid profiles in Korean adults with type 2 diabetes. J Korean Med Sci, 26(9):1201-8.

Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi F (2005). Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults. Am J Clin Nutr, 82(3):523-30.

Safari A, Shariff ZM, Kandiah M, Rashidkhani B, Fereidooni F (2013). Dietary patterns and risk of colorectal cancer in Tehran Province: a case–control study. BMC Public Health, 13(1):222.

Kelishadi R, Rabiei K, Khosravi A, Famouri F, Sadeghi M, Rouhafza H, et al. (2001). Assessment of physical activity of adolescents in Isfahan. Shahrekord Univ Med Sci, 3 (2) :27-33.

Esmaillzadeh A, Azadbakht L (2008). Major dietary patterns in relation to general obesity and central adiposity among Iranian women. J Nutr, 138(2):358-63.

Rezazadeh A, Rashidkhani B, Omidvar N (2010). Association of major dietary patterns with socioeconomic and lifestyle factors of adult women living in Tehran, Iran. Nutrition, 26(3):337-41.

Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC (2000). Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr, 72(4):912-21.

Huijbregrts PP, Feskens EJ, Kromhout D (1995). Dietary patterns and cardiovascular risk factors in elderly men: the Zutphen Elderly Study. Int J Epidemiol, 24(2):313-20.

Van Dam RM, Grievink L, Ocké MC, Feskens EJ (2003). Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population. Am J Clin Nutr, 77(5):1156-63.

Heidemann C, Schulze MB, Franco OH, van Dam RM, Mantzoros CS, Hu FB (2008). Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation, 118(3):230-7.

Shimazu T, Kuriyama S, Hozawa A, Ohmori K, Sato Y, Nakaya N, et al. (2007). Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study. Int J Epidemiol, 36(3):600-9.

Van Dam RM, Rimm EB, Willett WC, Stampfer MJ, and Hu FB (2002). Summaries for patients. Dietary patterns and the risk for type 2 diabetes in U.S. men. Ann Intern Med, 136(3):I30.

Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, et al. (2004). Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial. Diabetes Care, 27(8):1866-72.

Champagne CM (2009). The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Curr Diab Rep, 9(5):389-95.

Bajorek SA, Morello CM (2010). Effects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitus. Ann Pharmacother, 44(11):1786-92.

Tzima N, Pitsavos C, Panagiotakos DB, Skoumas J, Zampelas A, Chrysohoou C, et al. (2007). Mediterranean diet and insulin sensitivity, lipid profile and blood pressure levels, in overweight and obese people; the Attica study. Lipids Health Dis, 6:22.

Gerhard GT, Ahmann A, Meeuws K, McMurry MP, Duell PB, Connor WE (2004). Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Am J Clin Nutr, 80(3):668-73.

Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, et al. (2001). Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr, 73(1):61-7.

Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008). Adherence to Mediterranean diet and health status: meta-analysis. BMJ, 337:a1344.

Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB (2008). Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med, 168(7):713-20.

Iimuro S, Yoshimura Y, Umegaki H, Sakurai T, Araki A, Ohashi Y, et al. (2012). Dietary pattern and mortality in Japanese elderly patients with type 2 diabetes mellitus: Does a vegetable‐and fish‐rich diet improve mortality? An explanatory study. Geriatr Gerontol Int, 12(s1):59-67.

Cai H, Shu XO, Gao YT, Li H, Yang G, Zheng W (2007). A prospective study of dietary patterns and mortality in Chinese women. Epidemiology, 18(3):393-401.

Azadbakht L, Esmaillzadeh A (2009). Red meat intake is associated with metabolic syndrome and the plasma C-reactive protein concentration in women. J Nutr, 139(2):335-9.

Babio N, Sorlí M, Bulló M, Basora J, Ibarrola Jurado N, Fernández Ballart J, et al. (2012). Association between red meat consumption and metabolic syndrome in a Mediterranean population at high cardiovascular risk: Cross-sectional and 1-year follow-up assessment. Nutr Metab Cardiovasc Dis, 22(3):200-7.

Polychronopoulos E, Pounis G, Bountziouka V, Zeimbekis A, Tsiligianni I, Qira BE, et al. (2010). Dietary meat fats and burden of cardiovascular disease risk factors, in the elderly: a report from the MEDIS study. Lipids Health Dis, 9(1):30.

Tzoulaki I, Brown IJ, Chan Q, Van Horn L, Ueshima H, Zhao L, et al. (2008). Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. BMJ, 337:a258.

Peeters PH, Grobbee DE, Marx JJ, van der Schouw YT (2005). Dietary haem iron and coronary heart disease in women. Eur Heart J, 26(3):257-62.

Qi L, Van Dam RM, Rexrode K, Hu FB (2007). Heme iron from diet as a risk factor for coronary heart disease in women with type 2 diabetes. Diabetes Care, 30(1):101-6.

Erber E, Hopping BN, Grandinetti A, Park SY, Kolonel LN, Maskarinec G (2010). Dietary patterns and risk for diabetes: the multiethnic cohort. Diabetes Care, 33(3):532-8.

Park SH, Lee KS, Park HY (2010). Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III). Int J Cardiol, 139(3):234-40.

Nanri A, Mizoue T, Noda M, Takahashi Y, Kato M, Inoue M, et al. (2010). Rice intake and type 2 diabetes in Japanese men and women: the Japan Public Health Center–based Prospective Study. Am J Clin Nutr, 92(6):1468-77.

Ghassemi H, Harrison G, Mohammad K (2002). An accelerated nutrition transition in Iran. Public Health Nutr, 5(1a):149-55.

Malik VS, Popkin BM, Bray GA, Després J-P, Hu FB (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 121(11):1356-64.

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IssueVol 45 No 11 (2016) QRcode
SectionOriginal Article(s)
Published2016-12-21
Keywords
Diet Principal component analysis Diabetes mellitus type 2 Risk factors

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
SHADMAN Z, AKHOUNDAN M, POORSOLTAN N, LARIJANI B, QORBANI M, HEDAYATI M, KHOSHNIAT NIKOO M. Association of Major Dietary Patterns with Cardio-metabolic Risk Factors in Type 2 Diabetic Patients. Iran J Public Health. 45(11):1491-1500.