Rationale and Objective: The Mediterranean diet (MeDiet) has beneficial effects on cardiovascular risk factors. We analyzed the association between adherence of a MeDiet in patients with type 2 diabetes mellitus (T2DM) and levels of HbA1c. Patients and Methods: This was a cross-sectional study in individuals with T2DM participating in the PREDIMED trial at the centre of Pamplona. Information on diet was collected with a validated 14 point scale of adherence to the MeDiet and blood samples were obtained to assess HbA1c levels. Results: We studied 383 participants with T2DM, 53.4% women (mean age 69 ± 6 years). HbA1c data were available in 262 cases (mean 6.9 ± 1.5%). Although there was a potential inverse non-significant association between adherence to MeDiet and HbA1c levels after adjusting for age and sex, it was not statistically significant. Multivariate analysis additionally adjusted for physical activity, smoking, time of evolution of the T2DM, body mass index and insulin treatment found similar findings (OR = 0.69, 95% CI 0.17–2.83). Conclusions: Although we found not enough evidence to support that a MeDiet is associated with lower levels of HbA1c in patients with T2DM, our results suggested an inverse trend. Future studies with larger sample size are necessary.

1.
American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes. A position statement of the American Diabetes Association. Diabetes Care 2008;31:S61–S78.
2.
Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D: Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995;61:1402S–1406S.
3.
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440–1446.
4.
Mantzoros CS, Williams CJ, Manson JE, Meigs JE, Hu FB: Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women. Am J Clin Nutr 2006;84:328–335.
5.
Martínez-González MA, Corella D, Salas-Salvadó J, Ros E, Covas MI, Fiol M, et al: Cohort Profile: design and methods of the PREDIMED study. International Journal of Epidemiology 2010 Dec 20. [Epub ahead of print]. doi:10.1093/ije/dyq250
6.
Núñez-Córdoba JM, Valencia-Serrano F, Toledo E, Alonso A, Martínez-González MA: The Mediterranean diet and incidence of hypertension. The Seguimiento Universidad de Navarra (SUN) study. Am J Epidemiol 2009;169:339–346.
7.
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440–1446.
8.
Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C: Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults. The ATTICA study. J Am Coll Cardiol 2004;44:152–158.
9.
Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N, Willett WC, Hu FB: Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2005;82:163–173.
10.
Panagiotakos DB, Dimakopoulou K, Katsouyanni K, Bellander T, Grau M, Koenig W, Lanki T, Pistelli R, Schneider A, Peters A; Airgene Study Group: Mediterranean diet and inflammatory response in myocardial infarction survivors. Int J Epidemiol 2009;38:856–866.
11.
Fito M, Guzens M, Corella D, et al: Effect of a traditional Mediterranean diet in lipoprotein oxidation: a randomized controlled trial. Arch Intern Med 2007;167:1195–1203.
12.
Martínez-González MA, de la Fuente-Arrillaga C, Nuñez-Córdoba JM, Basterra-Gortari FJ, Beunza JJ, Vázquez Z, et al: Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.BMJ 2008;336:1348–1351.
13.
Sánchez-Taínta A, Estruch R, Bulló M, Corella D, Gómez-Gracia E, Fiol M, Algorta J, Covas MI, Lapetra J, Zazpe I, Ruiz-Gutiérrez V, Ros E, Martínez-González MA; PREDIMED Group: Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil 2008;15:589–593.
14.
Martín-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernández-Rodriguez JC, Salvini S, Willet WC: Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 1993;22:512–519.
15.
Elosua R, Marrugat J, Molina L, Pons S, Pujol E: Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish men. The MARATDON Investigators. Am J Epidemiol 1994;139:1197–1209.
16.
Franch Nadal J, Artola Menéndez S, Díez Espino J, Mata Cases M; en representación de la Red de Grupos de Estudio de la Diabetes en Atención Primaria de la Salud: The evolution of quality care indicators of patients with type 2 diabetes in the Spanish primary care (1996–2007). The RedGEDAPS quality of care program. Med Clin (Barc) 2010;135:600–607.
17.
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD): 1999. Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr 2000;54:353–355.
18.
The Diabetes and Nutrition Study Group of the Spanish Diabetes Association: Diabetes Nutrition and Complications Trial. Trends in nutritional pattern between 1993 and 2000 and targets of diabetes treatment in a sample of Spanish people with diabetes. Diabetes Care 2004;27:984–987.
19.
Thanopoulou A, Karamanos B, Angelico F, Assaad-Khalil S, Barbato A, Del Ben M, Djordjevic P, Dimitrijevic-Sreckovic V, Gallotti C, Katsilambros N, Migdalis I, Mrabet M, Petkova M, Roussi D, Tenconi MT; Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD): Nutritional habits of subjects with type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD). Diabetologia 2004;47:367–376.
20.
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.
21.
Due A, Larsen TM, Hermansen K, Stender S, Holst JJ, Toubro S, Martinussen T, Astrup A: Comparison of the effects on insulin resistance and glucose tolerance of 6-mo high-monounsaturated-fat, low-fat, and control diets. Am J Clin Nutr 2008;87:855–862.
22.
Itsiopoulos C, Brazionis L, Kaimakamis M, Cameron M, Best JD, O’Dea K, Rowley K: Can the Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomized cross-over study. Nutr Metab Cardiovasc Dis, in press.
23.
Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, Petrizzo M, Saccomanno F, Beneduce F, Ceriello A, Giugliano D: Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 2009;151:306–314.
24.
Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C: The association between adherence to the Mediterranean diet and fasting indices of glucose homeostasis: the ATTICA Study. J Am Coll Nutr 2007;26:32–38.
25.
Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E: Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with type 2 diabetes mellitus. Diabet Med 2004;21:142–149.
26.
Vessby B, Uusitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, Nälsén C Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB, Storlien LH; KANWU Study: Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU Study. Diabetologia 2001;44:312–319.
27.
Carluccio MA, Siculella L, Ancora MA, Massaro M, Scoditti E, Storelli C, Visioli F, Distante A, De Caterina R: Olive oil and red wine antioxidant polyphenols inhibit endothelial activation: antiatherogenic properties of Mediterranean diet phytochemicals. Arterioscler Thromb Vasc Biol 2003;23:622–629.
28.
Rallidis LS, Lekakis J, Kolomvotsou A, Zampelas A, Vamvakou G, Efstathiou S, Dimitriadis G, Raptis SA, Kremastinos DT: Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr 2009;90:263–268.
29.
Visioli F, Bellomo G, Galli C: Free radical-scavenging properties of olive oil polyphenols. Biochem Biophys Res Commun 1998;247:60–64.
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