Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2021; 12(11): 1942-1956
Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1942
Adherence to Mediterranean diet and advanced glycation endproducts in patients with diabetes
Marko Grahovac, Marko Kumric, Marino Vilovic, Dinko Martinovic, Ante Kreso, Tina Ticinovic Kurir, Josip Vrdoljak, Karlo Prizmic, Joško Božić
Marko Grahovac, Department of Pharmacology, University of Split School of Medicine, Split 21000, Croatia
Marko Kumric, Marino Vilovic, Dinko Martinovic, Ante Kreso, Tina Ticinovic Kurir, Josip Vrdoljak, Karlo Prizmic, Joško Božić, Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
Tina Ticinovic Kurir, Department of Endocrinology, University Hospital of Split, Split 21000, Croatia
Author contributions: Grahovac M, Kumric M, Vilovic M, Ticinovic Kurir T, Martinovic D and Božić J for conceptualization, original draft preparation, and supervision; Grahovac M, Kreso A, Prizmic K, Vrdoljak J and Vilovic M for review of literature and visualization; all authors contributed to the final draft of the manuscript, have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of University of Split School of Medicine on November 29th, 2018. (Class 003-08/18-03/0001, No. 2181-198-03-04-L8-0059).
Informed consent statement: All study participants provided informed written consent prior to the study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joško Božić, MD, PhD, Associate Professor, Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split 21000, Croatia. jbozic@mefst.hr
Received: May 6, 2021
Peer-review started: May 6, 2021
First decision: June 24, 2021
Revised: July 1, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 15, 2021
Abstract
BACKGROUND

In recent years, American Diabetes Association started to strongly advocate the Mediterranean diet (MD) over other diets in patients with diabetes mellitus (DM) because of its beneficial effects on glycemic control and cardiovascular (CV) risk factors. Tissue levels of advanced glycation endproducts (AGEs) emerged as an indicator of CV risk in DM. Skin biopsy being invasive, the use of AGE Reader has been shown to reflect tissue AGEs reliably.

AIM

To examine the association between adherence to MD and AGEs in patients with DM type II.

METHODS

This cross-sectional study was conducted on 273 patients with DM type II. A survey questionnaire was composed of 3 separate sections. The first part of the questionnaire included general data and the habits of the participants. The second part aimed to assess the basic parameters of participants’ diseases and associated conditions. The third part of the questionnaire was the Croatian version of the 14-item MD service score (MDSS). AGEs levels and associated CV risk were measured using AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands).

RESULTS

A total of 27 (9.9%) patients fulfilled criteria for adherence to MD, with a median score of 8.0 (6.0-10.0). Patients with none/limited CV risk had significantly higher percentage of MD adherence in comparison to patients with increased/definite CV risk (15.2% vs 6.9%, P = 0.028), as well as better adherence to guidelines for nuts (23.2% vs 12.6%, P = 0.023) and legumes (40.4% vs 25.9%, P = 0.013) consumption. Higher number of patients with glycated hemoglobin (HbA1c) < 7% adhered to MD when compared to patients with HbA1c > 7% (14.9% vs 7.3%, P = 0.045). Moreover, those patients followed the MDSS guidelines for eggs (33.0% vs 46.8%, P = 0.025) and wine (15.6% vs 29.8%, P = 0.006) consumption more frequently. MDSS score had significant positive correlation with disease duration (r = 0.179, P = 0.003) and negative correlation with body mass index (BMI) values (r = -0.159, P = 0.008). In the multiple linear regression model, BMI (β ± SE, -0.09 ± 0.04, P = 0.037) and disease duration (β ± SE, 0.07 ± 0.02, P < 0.001) remained significant independent correlates of the MDSS score. Patients with HbA1c > 7% think that educational programs on nutrition would be useful for patients in significantly more cases than patients with HbA1c < 7% (98.9% vs 92.6%, P = 0.009).

CONCLUSION

Although adherence to MD was very low among people with diabetes, we demonstrated that adherence to MD is greater in patients with lower CV risk, longer disease duration, and well-controlled glycaemia.

Keywords: Mediterranean diet, Cardiovascular disease, Diabetes mellitus, Advanced glycation endproducts, Dietary habits, Atherosclerosis

Core Tip: Recently, American Diabetes Association started to advocate the use of the Mediterranean diet (MD) over other diets because of its beneficial effects on glycaemic control and cardiovascular (CV) risk factors. In this cross-sectional study, we demonstrated an association between adherence to the MD and CV risk in patients with diabetes mellitus (DM) type II by measuring advanced glycation endproducts. In addition, we found that adherence to MD is very low in diabetics, especially among individuals with poorly controlled glycaemia. Finally, the duration of DM independently predicted better adherence to MD, whereas body mass index predicted poorer adherence.