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Body weight, cho­les­terol, blood pres­sure (BP), glucose/insulin status and func­tion, oxida­tive stress and inflam­ma­tion are all car­diometa­bolic risk fac­tors that can be influ­enced by an individual’s choice of dietary pat­tern. The Mediterranean diet (MedDiet) is con­sid­ered one of the health­i­est dietary pat­terns and is char­ac­ter­ized by high con­sump­tion of veg­eta­bles, fruit, olive oil, nuts, seeds, fish and poul­try.

Currently, the world is expe­ri­enc­ing epi­demic pro­por­tions of indi­vid­u­als diag­nosed with type 2 dia­betes. Type 2 dia­betes is pre­dom­i­nantly a lifestyle dis­ease and a meta­bolic con­di­tion that is accom­pa­nied by many of the above meta­bolic fac­tors, which greatly increases the risk of car­dio­vas­cu­lar issues. According to the American Heart Association, “at least 68 per­cent of people age 65 or older with dia­betes die from some form of heart dis­ease; and 16 per­cent die of stroke.”

In recent years, an impor­tant advance­ment in nutri­tional sci­ence has rec­og­nized that an indi­vid­u­al’s dietary pat­tern is more impor­tant than selec­tive nutri­ents. A dietary pat­tern filled with many com­bi­na­tions of nutri­ents and com­pounds, such as the MedDiet pat­tern, can pro­vide an over­all syn­er­gis­tic effect that can greatly reduce health risks and pro­vide ben­e­fi­cial health advan­tages.

A recent review in Endocrine, looked at the MedDiet pat­tern in rela­tion to a vari­ety of car­diometa­bolic fac­tors for type 2 dia­betes risk and treat­ment and, com­pared to con­trol diets, has found the fol­low­ing:

For pre­ven­tion of type 2 dia­betes, a higher adher­ence to the MedDiet pat­tern can reduce the risk of type 2 dia­betes by 18 – 40 per­cent. For those fol­low­ing a MedDiet, the prob­a­bil­ity of remis­sion of the meta­bolic syn­drome is 34 – 74 per­cent. In rela­tion to glycemic con­trol, com­pared to con­trol diets the MedDiet reduced Hba1c by 0.30 – 0.47 per­cent. And fol­low­ing a MedDiet with car­bo­hy­drate con­tent below 50 per­cent, patients saw a higher rate of com­plete remis­sion 14.7 per­cent at year one, 5 per­cent at year six, com­pared to 4 and zero per­cent for a low-fat diet.

In rela­tion to car­dio­vas­cu­lar risk fac­tors, over­all the stud­ies show a decreased waist cir­cum­fer­ence of 42 cm, decreased total cho­les­terol of 5.4 to 8.9 mg/dl, decreased triglyc­erides of 6.14 mg/dl, increased HDL cho­les­terol of 1.17 mg/dl, decreased sys­tolic BP by 2.35 mmHg, and decreased dias­tolic BP by 1.5 mmHg. Following a MedDiet reduces over­all body weight by 0.29 to 2.2 kg com­pared to con­trol diets. Overall people who follow a MedDiet over an aver­age period of 4.8 years have a 28 – 30 per­cent reduced risk of clin­i­cal car­dio­vas­cu­lar events such as myocar­dial infarc­tion, stroke and death.

The pro­posed mech­a­nisms for the ben­e­fi­cial effects of the MedDiet on type 2 dia­betes car­diometa­bolic risk fac­tors are the anti-inflam­ma­tory and antiox­ida­tive nature of the dietary pat­tern. The switch from low-qual­ity food sources such as refined sugars, starches, trans fats, and high-calo­rie foods; to high-qual­ity food sources that con­tain fiber, vit­a­mins, min­er­als, and polyphe­nols, influ­ences the immune system in a ben­e­fi­cial way, reduc­ing oxida­tive stress and the inflam­ma­tory cas­cade.

Inflammation is linked to increased insulin resis­tance, which is not only a pre­cur­sor to type 2 dia­betes diag­no­sis, but is an ongo­ing chal­lenge facing those already diag­nosed with dia­betes as well. Many stud­ies have shown that the cir­cu­la­tion of proin­flam­ma­tory mol­e­cules is reduced in those who con­sume a MedDiet pat­tern, which may, in turn, improve insulin sen­si­tiv­ity and endothe­lial func­tion at the vas­cu­lar level. Improvements in endothe­lial func­tion have also been shown in dia­bet­ics that follow a MedDiet pat­tern.

Another inter­est­ing point is that the ben­e­fits achieved by those fol­low­ing a MedDiet pat­tern appear to be sus­tained ben­e­fits com­pared to those fol­low­ing con­trol diets such as low-fat diets.

• American Heart Association


• Endocrine