Advertisement

Association between Cardiometabolic Profile and Dietary Characteristics among Adults with Type 1 Diabetes Mellitus

      Abstract

      Background

      The Mediterranean-style dietary pattern has been associated with several cardiometabolic benefits, yet no study has assessed the potential benefits of this diet in adults with type 1 diabetes mellitus (T1DM).

      Objective

      The objective of the present study was to examine the association between cardiometabolic profile and alignment of the diet with 1) Canadian nutrient recommendations for T1DM in terms of fat, protein, carbohydrate, saturated fat, dietary fiber, and sodium and 2) a Mediterranean-style dietary pattern among adults with T1DM.

      Design/participants/setting

      This is a cross-sectional analysis including 118 adults with T1DM recruited between 2011 and 2013 in Montreal, Canada.

      Statistical analyses

      Body mass index (calculated as kg/m2), waist circumference, truncal fat percentage (dual-energy x-ray absorptiometry), blood pressure, and lipid profile values were measured. Insulin sensitivity was estimated (estimated glucose disposal rate). A 3-day food record was completed and physical activity was measured with a motion sensor. Differences for the cardiometabolic profile between groups with a diet meeting the Canadian nutrient recommendations for T1DM (percentage of energy from fat, protein, carbohydrate, saturated fat, as well as grams of dietary fiber and milligrams of sodium) or not were examined with general linear models. A Mediterranean diet score was calculated (range=0 to 44) and Pearson correlations between this score and cardiometabolic variables were computed. Significance was set at P≤0.05.

      Results

      Participants’ mean±standard deviation age was 44.3±12.3 years, glycated hemoglobin was 8.0%±1.1%, and Mediterranean diet score was 20.2±5.0. Having a diet that meets at least three nutritional recommendations was associated with a lower truncal fat percentage (28.0% vs 32.2%; P=0.01) only. In contrast, the Mediterranean diet score was inversely correlated with body mass index (r=−0.30, P=0.002), waist circumference (r=−0.31, P=0.002), truncal fat percentage (r=−0.38, P<0.001), systolic (r=−0.20, P=0.03) and diastolic blood pressure (r=−0.23, P=0.01), and was directly correlated with estimated glucose disposal rate (r=0.22, P=0.03), after adjustments for energy intake, sex, and age. The association with estimated glucose disposal rate was no longer significant (P=0.055) after adjustment for physical activity level.

      Conclusions

      These results suggest that a higher Mediterranean diet score in the context of T1DM is associated with a favorable cardiometabolic profile. Further research is needed to confirm these findings.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Booth G.
        • Cheng A.Y.
        • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
        Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and the management of diabetes in Canada.
        Can J Diabetes. 2013; 37: S4-S7
      1. Otten J.J.H.J. Meyers L. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. National Academy Press, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, Washington, DC2006
      2. Health Canada. Food and nutrition−Sodium in Canada. http://www.hc-sc.gc.ca/fn-an/nutrition/sodium/index-eng.php. Accessed April 10, 2015.

        • Franz M.J.
        • Boucher J.L.
        • Green-Pastors J.
        • Powers M.A.
        Evidence-based nutrition practice guidelines for diabetes and scope and standards of practice.
        J Am Diet Assoc. 2008; 108: S52-S58
        • Evert A.B.
        • Boucher J.L.
        • Cypress M.
        • et al.
        Nutrition therapy recommendations for the management of adults with diabetes.
        Diabetes Care. 2013; 36: 3821-3842
        • Ryden L.
        • Grant P.J.
        • et al.
        • Authors/Task Force Members
        ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).
        Eur Heart J. 2013; 34: 3035-3087
        • Willett W.C.
        • Sacks F.
        • Trichopoulou A.
        • et al.
        Mediterranean diet pyramid: A cultural model for healthy eating.
        Am J Clin Nutr. 1995; 61: 1402S-1406S
        • Bach A.
        • Serra-Majem L.
        • Carrasco J.L.
        • et al.
        The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: A review.
        Public Health Nutr. 2006; 9: 132-146
        • Goulet J.
        • Lapointe A.
        • Lamarche B.
        • Lemieux S.
        Effect of a nutritional intervention promoting the Mediterranean food pattern on anthropometric profile in healthy women from the Quebec city metropolitan area.
        Eur J Clin Nutr. 2007; 61: 1293-1300
        • Lapointe A.
        • Goulet J.
        • Couillard C.
        • et al.
        A nutritional intervention promoting the Mediterranean food pattern is associated with a decrease in circulating oxidized LDL particles in healthy women from the Quebec City metropolitan area.
        J Nutr. 2005; 135: 410-415
        • Richard C.
        • Couture P.
        • Desroches S.
        • Lamarche B.
        Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome.
        Obesity. 2013; 21: 51-57
        • Kastorini C.M.
        • Milionis H.J.
        • Esposito K.
        • et al.
        The effect of Mediterranean diet on metabolic syndrome and its components: A meta-analysis of 50 studies and 534,906 individuals.
        J Am Coll Cardiol. 2011; 57: 1299-1313
        • Goulet J.
        • Lapointe A.
        • Lemieux S.
        • Lamarche B.
        Mediterranean diet and cardiovascular disease.
        Curr Nutr Food Sci. 2006; 2: 265-273
        • Cadario F.
        • Prodam F.
        • Pasqualicchio S.
        • 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
        • Laing S.P.
        • Swerdlow A.J.
        • Slater S.D.
        • et al.
        Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes.
        Diabetologia. 2003; 46: 760-765
        • Desjardins K.
        • Brazeau A.S.
        • Strychar I.
        • et al.
        Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.
        Diabetes Res Clin Pract. 2014; 106: 420-427
        • Ellis K.J.
        Selected body composition methods can be used in field studies.
        J Nutr. 2001; 131: 1589S-1595S
        • American College of Sports Medicine
        ACSM's Guidelines for Exercise Testing and Prescription.
        8th ed. Lippincott Williams & Wilkins, Philadelphia, PA2009
        • World Health Organization, Food and Agriculture Organization of the United Nations, United Nations University
        Human energy requirements; Report of a Joint FAO/WHO/UNU Expert Consultation, Rome Italy, 17–24 October 2001.
        WHO, Geneva2004
        • Williams K.V.
        • Erbey J.R.
        • Becker D.
        • et al.
        Can clinical factors estimate insulin resistance in type 1 diabetes?.
        Diabetes. 2000; 49: 626-632
        • Goulet J.
        • Lamarche B.
        • Nadeau G.
        • Lemieux S.
        Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women.
        Atherosclerosis. 2003; 170: 115-124
        • Brazeau A.S.
        • Leroux C.
        • Mircescu H.
        • Rabasa-Lhoret R.
        Physical activity level and body composition among adults with type 1 diabetes.
        Diabet Med. 2012; 29: e402-e408
        • Leroux C.
        • Gingras V.
        • Desjardins K.
        • et al.
        In adult patients with type 1 diabetes healthy lifestyle associates with a better cardiometabolic profile.
        Nutr Metab Cardiovasc Dis. 2015; 25: 444-451
        • Snell-Bergeon J.K.
        • Chartier-Logan C.
        • Maahs D.M.
        • et al.
        Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium.
        Diabetologia. 2009; 52: 801-809
        • Soedamah-Muthu S.S.
        • Chaturvedi N.
        • Fuller J.H.
        • et al.
        Do European people with type 1 diabetes consume a high atherogenic diet? 7-year follow-up of the EURODIAB Prospective Complications Study.
        Eur J Nutr. 2012; 52: 1701-1710
        • Delahanty L.M.
        • Nathan D.M.
        • Lachin J.M.
        • et al.
        Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial.
        Am J Clin Nutr. 2009; 89: 518-524
      3. Guarriguet D. Overview of Canadians' Eating Habits. 2004. http://publications.gc.ca/Collection/Statcan/82-620-M/82-620-MIE2006002.pdf. Accessed April 10, 2015.

        • Shai I.
        • Schwarzfuchs D.
        • Henkin Y.
        • et al.
        Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.
        N Engl J Med. 2008; 359: 229-241
        • Esposito K.
        • Kastorini C.M.
        • Panagiotakos D.B.
        • Giugliano D.
        Mediterranean diet and weight loss: Meta-analysis of randomized controlled trials.
        Metab Syndr Relat Disord. 2011; 9: 1-12
        • Esposito K.
        • Marfella R.
        • Ciotola M.
        • et al.
        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
        • Sola R.
        • Fito M.
        • Estruch R.
        • et al.
        Effect of a traditional Mediterranean diet on apolipoproteins B, A-I, and their ratio: A randomized, controlled trial.
        Atherosclerosis. 2011; 218: 174-180
        • Psaltopoulou T.
        • Naska A.
        • Orfanos P.
        • et al.
        Olive oil, the Mediterranean diet, and arterial blood pressure: The Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study.
        Am J Clin Nutr. 2004; 80: 1012-1018
        • Esposito K.
        • Ciotola M.
        • Giugliano D.
        Mediterranean diet, endothelial function and vascular inflammatory markers.
        Public Health Nutr. 2006; 9: 1073-1076
        • Estruch R.
        Anti-inflammatory effects of the Mediterranean diet: The experience of the PREDIMED study.
        Proc Nutr Soc. 2010; 69: 333-340
        • Salas-Salvado J.
        • Garcia-Arellano A.
        • Estruch R.
        • et al.
        Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease.
        Eur J Clin Nutr. 2008; 62: 651-659
        • Estruch R.
        • Ros E.
        • Salas-Salvado J.
        • et al.
        Primary prevention of cardiovascular disease with a Mediterranean diet.
        N Engl J Med. 2013; 368: 1279-1290
        • Barnes T.L.
        • Crandell J.L.
        • Bell R.A.
        • et al.
        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
      4. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial.
        Diabetes Care. 2001; 24: 1711-1721
        • Jacob A.N.
        • Salinas K.
        • Adams-Huet B.
        • Raskin P.
        Potential causes of weight gain in type 1 diabetes mellitus.
        Diabetes Obes Metab. 2006; 8: 404-411
        • Purnell J.Q.
        • Hokanson J.E.
        • Marcovina S.M.
        • et al.
        Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: Results from the DCCT. Diabetes Control and Complications Trial.
        JAMA. 1998; 280: 140-146
        • Kilpatrick E.S.
        • Rigby A.S.
        • Atkin S.L.
        Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “Double diabetes” in the Diabetes Control and Complications Trial.
        Diabetes Care. 2007; 30: 707-712
        • Rodrigues T.C.
        • Canani L.H.
        • Gross J.L.
        Metabolic syndrome, insulin resistance and cardiovascular disease in type-1 diabetes mellitus.
        Arq Bras Cardiol. 2010; 94: 134-139
        • Thorn L.M.
        • Forsblom C.
        • Waden J.
        • et al.
        Metabolic syndrome as a risk factor for cardiovascular disease, mortality, and progression of diabetic nephropathy in type 1 diabetes.
        Diabetes Care. 2009; 32: 950-952
        • Leroux C.
        • Brazeau A.S.
        • Gingras V.
        • et al.
        Lifestyle and cardiometabolic risk in adults with type 1 diabetes: A review.
        Can J Diabetes. 2014; 38: 62-69
        • Thompson F.E.
        • Byers T.
        Dietary assessment resource manual.
        J Nutr. 1994; 124: 2245S-2317S

      Biography

      V. Gingras is a doctoral student, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      C. Leroux is a research assistant, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      K. Desjardins is a research assistant, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      V. Savard is a master's student, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      R. Rabasa-Lhoret is an endocrinologist and full professor, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      I. Strychar is a full professor and an invited researcher, Institut de Recherches Cliniques de Montréal, Department of Nutrition, University of Montreal, Québec, Canada.

      Biography

      S. Lemieux is full professor, Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada.