Effect of a Mediterranean diet on endothelial progenitor cells and carotid intima-media thickness in type 2 diabetes: Follow-up of a randomized trial

Abstract

Background

We assessed the long-term effects of a Mediterranean diet on circulating levels of endothelial progenitor cells (EPCs) and the carotid intima-media thickness (CIMT) in patients with type 2 diabetes.

Design

This was a parallel, two-arm, single-centre trial.

Methods

Two hundred and fifteen men and women with newly diagnosed type 2 diabetes were randomized to a Mediterranean diet (n = 108) or a low-fat diet (n = 107). The primary outcome measures were changes in the EPC count and the CIMT of the common carotid artery after the treatment period defined as the end of trial (EOT).

Results

At the EOT, both the CD34⁺KDR⁺ and CD34⁺KDR⁺CD133⁺ counts had increased with the Mediterranean diet compared with the low-fat diet (p < 0.05 for both). At the EOT evaluation, there was a significant (p = 0.024) difference of −0.025 mm in the CIMT favouring the Mediterranean diet. Compared with the low-fat diet, the rate of regression in the CIMT was higher in the Mediterranean diet group (51 vs. 26%), whereas the rate of progression was lower (25 vs. 50%) (p = 0.032 for both). Changes in the CIMT were inversely correlated with the changes in EPC levels (CD34⁺KDR⁺, r = −0.24, p = 0.020; CD34⁺KDR⁺CD133⁺, r = −0.28, p = 0.014). At the EOT, changes in levels of HbA1c, HOMA, total cholesterol, high-density lipoprotein cholesterol and systolic blood pressure were significantly greater with the Mediterranean diet than with the low-fat diet.

Conclusion

Compared with a low-fat diet, a long-term trial with Mediterranean diet was associated with an increase in circulating EPCs levels and prevention of the progression of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes.

Keywords

Mediterranean diet type 2 diabetes endothelial progenitor cells carotid intima-media thickness

Get full access to this article

View all access options for this article.

References

Fox

Golden

Anderson

et al.

Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2015; 38: 1777–1803.

Estruch

Ros

Salas-Salvadó

et al.

Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.

Anand

Hawkes

de Souza

et al.

Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system: a report from the workshop convened by the World Heart Federation. J Am Coll Cardiol 2015; 66: 1590–1614.

Esposito

Marfella

Ciotola

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.

Giugliano

Ceriello

Esposito

. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 2006; 48: 677–685.

Howangyin

Silvestre

. Diabetes mellitus and ischemic diseases: molecular mechanisms of vascular repair dysfunction. Arterioscler Thromb Vasc Biol 2014; 34: 1126–1135.

Lev

Singer

Leshem-Lev

et al.

Effect of intensive glycaemic control on endothelial progenitor cells in patients with long-standing uncontrolled type 2 diabetes. Eur J Prev Cardiol 2014; 21: 1153–1162.

Esposito

Maiorino

Ciotola

et al.

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.

Lorenz

Price

Robertson

et al.

Carotid intima-media thickness progression and risk of vascular events in people with diabetes: results from the PROG-IMT collaboration. Diabetes Care 2015; 38: 1921–1929.

10.

Esposito

Maiorino

Petrizzo

et al.

The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 2014; 37: 1824–1830.

11.

Trichopoulou

Costacou

Bamia

et al.

Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

12.

Esposito

Ciotola

Maiorino

et al.

Circulating CD34⁺KDR⁺ endothelial progenitor cells correlate with erectile function and endothelial function in overweight men. J Sex Med 2009; 6: 107–114.

13.

Esposito

Ciotola

Carleo

et al.

Post-meal glucose peaks at home associate with carotid intima-media thickness in type 2 diabetes. J Clin Endocrinol Metab 2008; 93: 1345–1350.

14.

Werner

Kosiol

Schiegl

et al.

Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med 2005; 353: 999–1007.

15.

Fadini

de Kreutzenberg

Coracina

et al.

Circulating CD34⁺ cells, metabolic syndrome and cardiovacsular risk. Eur Heart J 2006; 27: 2247–2255.

16.

Fadini

Coracina

Baesso

et al.

Peripheral blood CD34+KDR+ endothelial progenitor cells are determinants of subclinical atherosclerosis in middle-aged general population. Stroke 2006; 37: 2277–2282.

17.

Coll

Feinstein

. Carotid intima-media thickness measurements: techniques and clinical relevance. Curr Atheroscler Rep 2008; 10: 444–450.

18.

Murie-Fernandez

Irimia

Toledo

et al.

Carotid intima-media thickness changes with Mediterranean diet: a randomized trial (PREDIMED-Navarra). Atherosclerosis 2011; 219: 158–162.

19.

Sala-Vila

Romero-Mamani

Gilabert

et al.

Changes in ultrasound-assessed carotid intima-media thickness and plaque with a Mediterranean diet: a substudy of the PREDIMED trial. Arterioscler Thromb Vasc Biol 2014; 34: 439–445.

20.

Wing

Bolin

Brancati

et al.

Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145–154.

21.

Esposito

Maiorino

Bellastella

et al.

A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 2015; 5: e008222–e008222.

22.

Estruch

Martinez-Gonzalez

Corella

et al.

Effect of high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomized controlled trial. Lancet Diabetes Endocrinol. Epub ahead of print 6 June 2016. DOI: 10.1016/S2213-8587(16)30085-7.

23.

Mena

PM-P

Sacanella

Vazquez-Angell

et al.

Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr 2009; 89: 248–256.

24.

Esposito

Kastorini

C-M

Panagiotakos

et al.

Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 2011; 9: 1–12.

25.

Llorente-Cortés

Estruch

Mena

et al.

Effect of Mediterranean diet on the expression of proatherogenic genes in a population at high cardiovascular risk. Atherosclerosis 2010; 208: 442–450.

26.

Marin

Ramirez

Delgado-Lista

et al.

Mediterranean diet reduced endothelial damage and improves the regenerative capacity of endothelium. Am J Clin Nutr 2011; 93: 267–274.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.18 MB