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Mediterranean Diet Can Protect Against Diabetes

Strict adherence to a traditional Mediterranean diet yielded an 83% relative reduction in the risk of developing type 2 diabetes, a prospective study found. Even moderate adherence was associated with a 59% relative reduction in diabetes risk, Miguel Martínez-González, M.D., Ph.D., of the University of Navarra here, and colleagues reported online in BMJ.

Many studies have shown that the Mediterranean diet has a protective role in cardiovascular disease, but little is known about its role in preventing diabetes in healthy people, the researchers said.

Typically, the diet is characterized by high intake of fiber and vegetable fat, low intake of trans-fatty acids and saturated fats, and a moderate intake of alcohol. It also makes abundant use of olive oil for cooking, frying, spreading on bread, or in dressing salads, which leads to a high ratio of monounsaturated fatty acids to saturated fatty acids.  Fruits, nuts, grains, legumes, and fish are also featured, whereas consumption of meat and dairy products is relatively low.

In addition to having a long tradition of use without evidence of harm, a Mediterranean diet is highly palatable, and people are likely to comply with it, the researchers said.

Diets rich in monounsaturated fatty acids improve lipid profiles as well as insulin resistance and glycemic control in people with diabetes, they wrote. This suggested that following a Mediterranean diet might protect against developing diabetes.
To find out, the researchers conducted the SUN (Seguimiento Universidad de Navarra) prospective cohort study, which included 13,380 university graduates and registered nurses from Spanish provinces. None had diabetes at baseline. Participants were followed for a median 4.4 years.

Dietary habits were assessed at baseline with a validated 136-item food frequency questionnaire and were scored on a nine-point index.  New cases of diabetes were confirmed through medical reports and an additional detailed questionnaire posted to those who reported a new diagnosis of diabetes by a doctor during follow-up. The main outcome was confirmed cases of type 2 diabetes.

Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes, the researchers found.  The incidence rate ratio adjusted for sex and age was 0.41 for those with moderate adherence (score 3-6) compared with those with low adherence (score <3). For those with the highest adherence, scoring 7 to 9, the rate ratio was 0.17. 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, with a significant inverse linear trend in the multivariate analysis.

Interestingly, the researchers said, those with high adherence to the diet (score > 6) also had a higher baseline prevalence of most risk factors for diabetes. They were older, had a higher BMI, a higher total energy intake, were more likely to have high blood pressure or a family history of diabetes, and were more likely to be former smokers.

These individuals would have been expected to be at greater risk for diabetes, but actually their risk was lower. It is possible that the diet may have provided substantial protection, the researchers wrote.

The study suggests that substantial protection against diabetes can be achieved by following the traditional Mediterranean diet, they said.
Practice Pearls:

  • Explain to interested patients that the traditional Mediterranean diet, known to be protective for cardiovascular disease, may also help prevent diabetes.
  • Explain that the diet includes a high intake of fiber and vegetable fat, low intake of trans-fatty acids, moderate alcohol consumption, with abundant use of olive oil, plus vegetables, fruits, nuts, cereals, and legumes, instead of meat and dairy products

Martínez-González MA, et al "Adherence to Mediterranean diet and risk of developing diabetes: A prospective cohort study" BMJ 2008:
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FACT:
Drinking Juice Not Associated With Being Overweight in Children: Children who drink 100-percent juice are no more likely to be overweight and may have a better overall nutrient intake than children who do not drink juice, according to a report Data was analyzed data from a group of 3,618 children age 2 to 11 and on average, the children drank 4.1 fluid ounces of juice per day, which contributed an average of 58 calories to their diet. There was no association between drinking juice and being overweight.  Arch Pediatr Adolesc Med. 2008;162[6]:557-565

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