Effects of a Mediterranean Diet on the Development of Diabetic Complications: A Longitudinal Study From the Nationwide Diabetes Report of the National Program for Prevention and Control of Diabetes (Nppcd 2016-2020) Publisher Pubmed



Ghaemi F¹ ; Firouzabadi FD² ; Moosaie F² ; Shadnoush M³ ; Poopak A² ; Kermanchi J⁴ ; Abhari SMF⁵ ; Forouzanfar R⁶ ; Mansournia MA⁷ ; Khosravi A⁸ ; Mohajer B⁹ ; Ramandi MMA¹⁰ ; Nakhjavani M² ; Esteghamati A²
Source: Maturitas Published:2021

Abstract

Objective: To evaluate the effectiveness of a Mediterranean dietary pattern on the incidence of macrovascular and microvascular complications of diabetes, namely cardiovascular disease (CVD), diabetic foot disorders, diabetic retinopathy, nephropathy, and neuropathy. Methods: This longitudinal study was conducted among 71392 adults with diabetes who attended academic tertiary-care outpatient clinics from February 2016 to March 2020 across Iran using the National Program for Prevention and Control of Diabetes database. Among them, 22187 patients with diabetes (type 1 and type 2) completed 2–11 follow-up visits after baseline registration. The association between adherence to a Mediterranean diet and diabetic complications was assessed using pooled logistic regression models. This association was adjusted for potential confounders. The effect of time was assessed using fractional polynomials. Results: A total of 22187 participants were included in the analysis (30.22% men and 69.78% women) with either type 1 (mean age 50.7 years) or type 2 (mean age 59.9 years) diabetes. After adjustment for confounding variables, there was a negative correlation between adherence to a Mediterranean diet and the incidence of CVD among patients with type 1 diabetes (T1D) and 2 diabetes (T2D) (OR= 0.53, 95% CI: 0.37 – 0.75, p-value <0.001 and OR= 0.61, 95% CI: 0.57 – 0.89, p-value <0.001, respectively). Also, the diet had a statistically significant protective effect against incident symptomatic neuropathy (OR= 0.32, 95% CI: 0.23 – 0.43, p-value <0.001, and OR= 0.68, 95% CI: 0.64 – 0.72, p-value <0.001, respectively), nephropathy (OR= 0.42, 95% CI: 0.30 – 0.58, p-value <0.001, and OR= 0.88, 95% CI: 0.80 – 0.96, p-value= 0.007, respectively), and retinopathy (OR= 0.32, 95% CI: 0.24 – 0.44, p-value <0.001, and OR= 0.68, 95% CI: 0.61 – 0.71, p-value <0.001, respectively) in T1D and T2D. Conclusion: The Mediterranean dietary pattern is associated with a lower incidence of CVD and microvascular complications (i.e. diabetic retinopathy, nephropathy, and neuropathy) among a cohort of patients with T1D and T2D in Iran. © 2021