Objective To assess the relation between adherence to a Mediterranean diet and the incidence of diabetes among initially healthy participants.Design Prospective cohort study with estimates of ...relative risk adjusted for sex, age, years of university education, total energy intake, body mass index, physical activity, sedentary habits, smoking, family history of diabetes, and personal history of hypertension.Setting Spanish university department.Participants 13 380 Spanish university graduates without diabetes at baseline followed up for a median of 4.4 years.Main outcome measures Dietary habits assessed at baseline with a validated 136 item food frequency questionnaire and scored on a nine point index. New cases of diabetes confirmed through medical reports and an additional detailed questionnaire posted to those who self reported a new diagnosis of diabetes by a doctor during follow-up. Confirmed cases of type 2 diabetes.Results Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes. The incidence rate ratios adjusted for sex and age were 0.41 (95% confidence interval 0.19 to 0.87) for those with moderate adherence (score 3-6) and 0.17 (0.04 to 0.75) for those with the highest adherence (score 7-9) compared with those with low adherence (score <3). In the fully adjusted analyses the results were similar. A two point increase in the score was associated with a 35% relative reduction in the risk of diabetes (incidence rate ratio 0.65, 0.44 to 0.95), with a significant inverse linear trend (P=0.04) in the multivariate analysis.Conclusion Adherence to a Mediterranean diet is associated with a reduced risk of diabetes.
Meat consumption has been consistently associated with the risk of diabetes in different populations. The aim of our study was to investigate the incidence of type 2 diabetes according to baseline ...total meat consumption in a longitudinal assessment of a middle-aged Mediterranean population.
We followed 18,527 participants (mean age: 38 years, 61% women) in the SUN Project, an open-enrolment cohort of a highly educated population of middle-class Spanish graduate students. All participants were initially free of diabetes. Diet was assessed at baseline using a semi-quantitative food frequency questionnaire of 136-items previously validated. Incident diabetes was defined according to the American Diabetes Association's criteria.
We identified 146 incident cases of diabetes after a maximum of 14 years of follow-up period (mean: 8.7 years). In the fully adjusted model, the consumption of ≥3 servings/day of all types of meat was significantly associated with a higher risk of diabetes (HR: 1.85; 95% CI: 1.03-3.31; p for trend = 0.031) in comparison with the reference category (<2 servings/day). When we separated processed from non-processed meat, we observed a non-significant higher risk associated with greater consumption of processed meat and a non-significant lower risk associated with non-processed meat consumption (p for trend = 0.123 and 0.487, respectively). No significant difference was found between the two types of meat (p = 0.594).
Our results suggest that meat consumption, especially processed meat, was associated with a higher risk of developing diabetes in our young Mediterranean cohort.
Summary Background & aims There is scarce evidence from long-term prospective studies relating the consumption of fried foods with the incidence of Metabolic Syndrome (MS). The aim of this study was ...to assess the association between fried food consumption and the incidence of MS. Methods We followed 8289 participants (2813 men and 5476 women, mean age = 35.9 y, SD = 10.4) during a median period of 8.3-y. They were initially free of any MS criteria. MS was defined according to the American Heart Association and the International Diabetes Federation criteria as outlined in the harmonized definition for MS. Each component of the MS was assessed at the 6th and 8th-y of follow-up. The outcome was defined as the presence of ≥3 of the components of MS after ≥6 years of follow-up. Results During 65335 person-years, 420 incident cases of MS were identified. Frequent consumption of fried foods was not associated with the incidence of MS HR = 0.98 (95% CI: 0.77–1.26) p for trend = 0.862. However, two components of the MS, central adiposity and high blood pressure were positively associated with fried food consumption HR for consumption >4 times/week compared with ≤2 times/week = 1.10 (95% CI: 1.01–1.19) ( p for trend 0.022) and HR = 1.16 (95% CI: 1.02–1.32) ( p for trend 0.011), respectively after multivariable adjustment. Conclusions In this Mediterranean cohort of relatively young adults, frequent consumption of fried foods was not associated with MS. Two out of five components of MS (central adiposity and high blood pressure) were positively associated with frequent fried food consumption.
Summary Background Eggs are a major source of dietary cholesterol and their consumption has been sometimes discouraged. A relationship between egg consumption and the incidence of cardiovascular ...disease (CVD) has been suggested to be present exclusively among patients with type-2 diabetes. Aims To assess the association between egg consumption and CVD in a large Mediterranean cohort where approximately 50% of participants had type 2 diabetes. Methods We prospectively followed 7216 participants (55–80 years old) at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) study for a mean of 5.8 years. All participants were initially free of CVD. Yearly repeated measurements of dietary information with a validated 137-item food-frequency questionnaire were used to assess egg consumption and other dietary exposures. The endpoint was the rate of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes). Results A major cardiovascular event occurred in 342 participants. Baseline egg consumption was not significantly associated with cardiovascular events in the total population. Non-diabetic participants who ate on average >4 eggs/week had a hazard ratio (HR) of 0.96 (95% confidence interval, 0.33–2.76) in the fully adjusted multivariable model when compared with non-diabetic participants who reported the lowest egg consumption (<2 eggs/week). Among diabetic participants, the HR was 1.33 (0.72–2.46). There was no evidence of interaction by diabetic status. HRs per 500 eggs of cumulative consumption during follow-up were 0.94 (0.66–1.33) in non-diabetics and 1.18 (0.90–1.55) in diabetics. Conclusions Low to moderated egg consumption was not associated with an increased CVD risk in diabetic or non-diabetic individuals at high cardiovascular risk. This trial was registered at controlled-trials.com as ISRCTN35739639.
Abstract Background and aims The consumption of fried foods is believed to be linked with obesity and higher weight gain, however, the evidence from long-term randomized trials or prospective ...epidemiological studies is scarce. Therefore, the aim of our study was to prospectively evaluate the association between the consumption of fried foods and weight change and the incidence of overweight/obesity in a Mediterranean cohort. Methods and results Prospective cohort study of 9850 men and women with a mean age of 38.1 years (SD 11.4) were followed-up for a median of 6.1 years to assess average yearly change in body weight, and incidence of overweight/obesity. The consumption of fried foods was associated with higher weight gain, but the differences were of small magnitude and statistically non-significant. The incidence of overweight/obesity during follow-up was also assessed in the subset of 6821 participants with initial body mass index <25 kg/m2 (initially free of overweight/obesity), after adjusting for potential confounders, the odds ratio for developing overweight/obesity among participants who consumed fried foods >4 times/week was 1.37 (95% confidence interval: 1.08 to 1.73) in comparison with those who consumed fried foods <2 times/week ( p for trend = 0.02). Conclusion In this Mediterranean prospective cohort, a more frequent consumption of fried foods at baseline was associated with a higher risk of subsequently developing overweight/obesity during follow-up.
Vitamin D deficiency has been associated with multiple chronic diseases, including metabolic disorders such as insulin resistance and type 2 diabetes (T2D). The aim of the study was to analyze the ...association between validated predicted serum vitamin D status and the risk of developing T2D in a large prospective cohort based on a Mediterranean population.
The SUN project is a prospective and dynamic Spanish cohort that gathers university graduates who have answered lifestyle questionnaires, including a validated Food Frequency Questionnaire. The association between predicted serum vitamin D and the risk of T2D was assessed through Cox regression models according to quartiles (Q) of predicted vitamin D at baseline. The models were adjusted for potential confounders and sensitivity analyses were performed to ensure the robustness of our findings.
Our study included a total of 18,594 participants and after a total follow-up of 238,078 person-years (median follow-up of 13.5 years), 209 individuals were diagnosed with incident T2D. We found a significant inverse association between predicted levels of serum vitamin D and the risk of developing T2D, after adjusting for potential confounders and performing different sensitivity analyses (hazard ratio Q4 vs. Q1: 0.48, 95% CI 0.26-0.88; p for trend = 0.032).
The outcomes suggest that higher levels of vitamin D at baseline may be associated with a reduced risk of developing T2D.
The relationship between juice consumption and type 2 diabetes (T2D) has not been widely evidenced. Our aims were to prospectively evaluate the associations with T2D incidence of: 1) isovolumetric ...substitution of a water serving/day for one of fruit juice (different types), and of fresh fruit juice for its bottled version; 2) consumption of total, fresh or bottled juice; 3) energy intake from juices.
We followed 17,518 adults without T2D at baseline. Beverage consumption was assessed at baseline through a validated food-frequency questionnaire. The outcome was T2D incidence, according to American Diabetes Association's criteria. During a median follow-up of 10.2 years, 142 incident cases of T2D were identified. In substitution models, the substitution of water for bottled juice was associated with a lower T2D incidence, and also if the replacement was done by fresh juice, or especially fresh orange juice HR 0.75 (95% CI 0.57–0.99), 0.65 (95% CI 0.43–0.98) and 0.56 (95% CI 0.34–0.92); respectively. Each additional serving/day of bottled juice was directly associated with T2D incidence HR 1.33 (95% CI 1.01–1.75). No significant association was observed for energy coming for bottled juice HR 1.74 (95% CI 0.94–3.20).
Our results suggest that isovolumetric substitution of water or fresh juice for bottled juice was inversely associated with T2D incidence in a long-term prospective study. Thus, these substitutions could be useful to tackle the diabetes epidemic.
•A water serving/day instead of bottled juice could decrease diabetes incidence.•The same effect was observed when it is replaced by fresh juice.•Each additional serving per day of bottled juice would increase diabetes risk.•Energy coming from juices would not be associated with diabetes risk.
A higher heart rate has been related to an increase of total and cardiovascular mortality. The aim of this study was to assess the relation between adherence to the Mediterranean diet and heart rate.
...The SUN project is an ongoing multipurpose cohort study based on university graduates from Spain.
This cross-sectional study included 15,863 participants of the SUN project. Adherence to the Mediterranean dietary pattern was assessed through a validated 136-item food frequency questionnaire and calculated according to the 9-point score proposed by Trichopoulou. Multiple linear regression models were fitted to assess the relationship between adherence to the Mediterranean dietary pattern and heart rate and 95% confidence intervals were calculated.
The multivariable-adjusted models revealed that participants with a high adherence (7--9 points) to the Mediterranean dietary pattern had a heart rate 2.2 bpm (95% CI 1.4-3.1) lower than participants with a low adherence (0--2 points).
Adherence to the Mediterranean dietary pattern seems to be related to a lower heart rate.
Objectives
To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other ...metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up.
Methods
n
= 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control.
Results
The presence of T2D increased the likelihood of higher levels of depressive symptoms (
χ
2
= 15.84,
p
= 0.001). Polynomial contrast revealed a positive linear relationship (
χ
2
= 13.49,
p
= 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-
χ
2
= 24.06,
df
= 3,
p
< .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up.
Conclusions
This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short–medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.
To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications. We hypothesized that a nutritional intervention based on the ...Mediterranean diet (MedDiet) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet.
This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter randomized nutritional intervention trial conducted in a population at high cardiovascular risk. Individuals with type 2 diabetes who were free of microvascular complications at enrollment (n = 3,614, aged 55-80 years) were randomly assigned to one of three dietary interventions: MedDiet supplemented with extravirgin olive oil (MedDiet+EVOO), MedDiet supplemented with mixed nuts (MedDiet+Nuts), or a low-fat control diet. Two independent outcomes were considered: new onset of diabetic retinopathy and nephropathy. Hazard ratios (HRs) were calculated using multivariable-adjusted Cox regression.
During a median follow-up of 6.0 years, we identified 74 new cases of retinopathy and 168 of nephropathy. Compared with the control diet, multivariable-adjusted HRs for diabetic retinopathy were 0.56 (95% CI 0.32-0.97) for the MedDiet+EVOO and 0.63 (0.35-1.11) for the MedDiet+Nuts. No between-group differences were found for nephropathy. When the yearly updated information on adherence to the MedDiet was considered, the HR for retinopathy in the highest versus the lowest quintile was 0.34 (0.13-0.89; P = 0.001 for trend). No significant associations were found for nephropathy.
A MedDiet enriched with EVOO may protect against diabetic retinopathy but not diabetic nephropathy.
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