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Diet Quality and Risk of Cardiometabolic and Diabetes

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Diabetes".

Deadline for manuscript submissions: closed (27 June 2023) | Viewed by 27078

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Dr. Giuseppe Della Pepa

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1. Institute of Clinical Physiology, National Research Council-CNR, Cardiometabolic Risk Unit, 56124 Pisa, Italy
2. Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
Interests: dietary intervention; type 2 diabetes; dyslipidaemia; metabolic syndrome; NAFLD
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Dear Colleagues,

Cardiometabolic risk factors and type 2 diabetes are the largest contributors to the global disease burden and for disease-related mortality. Visceral obesity drives the progression of multiple cardiometabolic risk factors and type 2 diabetes, and behavioural lifestyle weight loss interventions are important strategies for the prevention of these metabolic alterations.

Despite the consistent evidence that the larger the body weight loss, the greater the preventive effect on cardiometabolic risk factors or diabetes, too radical strategies might be unfeasible on a large scale and the long-term maintenance of weight reduction following restricted calorie diets represents a major challenge.

Changes in diet composition acting on nutrient quality, independently of changes in energy intake, may be effective on cardiometabolic and diabetes risk prevention, offering a more feasible and safe alternative treatment to energy restriction.

The aim of the present Special Issue is to summarize recent evidence on “Diet Quality and Risk of Cardiometabolic and Diabetes”. More specifically, the impact of diet quality in terms of micro or macronutrient composition, beyond the effect on diet restriction, on the prevention of cardiometabolic and diabetes risk, as well as diabetes management, will be discussed. Personalized quality dietary interventions for cardiometabolic health and diabetes prevention, as well as possible underlying mechanisms, will also be addressed in this Special Issue.

This Special Issue welcomes submissions of original research and reviews of the scientific literature, including systematic reviews and meta-analyses.

Dr. Giuseppe Della Pepa
Guest Editor

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Keywords

isocaloric diet
dietary quality
macronutrient/micronutrient composition
dietary intervention
visceral fat
cardiometabolic risk
insulin resistance
hypertension
dyslipidaemia
cardiovascular diseases
endothelial function
type 2 diabetes
metabolic syndrome

Published Papers (10 papers)

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Research

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11 pages, 925 KiB

Open AccessArticle

Inverse Association between Oxidative Balance Score and Incident Type 2 Diabetes Mellitus

by Yu-Jin Kwon, Hye-Min Park and Jun-Hyuk Lee

Nutrients 2023, 15(11), 2497; https://doi.org/10.3390/nu15112497 - 27 May 2023

Cited by 7 | Viewed by 1393

Abstract

Mitigating the risk of type 2 diabetes mellitus (T2DM) can be achieved through the maintenance of a healthy weight, the adoption of a healthy diet, and engaging in regular physical activity. The oxidative balance score (OBS), an integrated measure of pro- and antioxidant exposure conditions, represents an individual’s overall oxidative balance status. This study aimed to evaluate the association between OBS and T2DM incidence using data from a large, community-based, prospective cohort study. Data from 7369 participants aged 40–69 years who engaged in the Korean Genome and Epidemiology Study (KoGES) were analyzed. The hazard ratio (HR) and 95% confidence interval (CI) for T2DM incidence of sex-specific OBS tertile groups were calculated using univariable and multivariable Cox proportional hazard regression analyses. During the mean 13.6-year follow-up period, 908 men and 880 women developed T2DM. The fully-adjusted HR (95% CI) for incident T2DM of the middle and highest tertile groups, compared with the referent lowest tertile group, were 0.86 (0.77–1.02) and 0.83 (0.70–0.99) in men and were 0.94 (0.80–1.11) and 0.78 (0.65–0.94) in women, respectively. Individuals with a high OBS are at lower risk for the development of T2DM. This implies that lifestyle modification with more antioxidant properties could be a preventive strategy for T2DM. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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14 pages, 1122 KiB

Open AccessArticle

Effects of a Web-Based Weight Loss Program on the Healthy Eating Index-NVS in Adults with Overweight or Obesity and the Association with Dietary, Anthropometric and Cardiometabolic Variables: A Randomized Controlled Clinical Trial

by Jan Kohl, Judith Brame, Pascal Hauff, Ramona Wurst, Matthias Sehlbrede, Urs Alexander Fichtner, Christoph Armbruster, Iris Tinsel, Phillip Maiwald, Erik Farin-Glattacker, Reinhard Fuchs, Albert Gollhofer and Daniel König

Nutrients 2023, 15(1), 7; https://doi.org/10.3390/nu15010007 - 20 Dec 2022

Cited by 2 | Viewed by 2583

Abstract

This randomized, controlled clinical trial examined the impact of a web-based weight loss intervention on diet quality. Furthermore, it was investigated whether corresponding changes in diet quality were associated with changes in measures of cardiovascular risk profile. Individuals with a body mass index (BMI) of 27.5 to 34.9 kg/m² and an age of 18 to 65 y were assigned to either an interactive and fully automated web-based weight loss program focusing on dietary energy density (intervention) or a non-interactive web-based weight loss program (control). Examinations were performed at baseline (t0), after the 12-week web-based intervention (t1), and after an additional 6 (t2) and 12 months (t3). Based on a dietary record, the Healthy Eating Index-NVS (HEI-NVS) was calculated and analyzed using a robust linear mixed model. In addition, bootstrapped correlations were performed independently of study group to examine associations between change in HEI-NVS and change in dietary, anthropometric, and cardiometabolic variables. A total of n = 153 participants with a mean BMI of 30.71 kg/m² (SD 2.13) and an average age of 48.92 y (SD 11.17) were included in the study. HEI-NVS improved significantly in the intervention group from baseline (t0) to t2 (p = 0.003) and to t3 (p = 0.037), whereby the course was significantly different up to t2 (p = 0.013) and not significantly different up to t3 (p = 0.054) compared to the control group. Independent of study group, there was a significant negative association between change in HEI-NVS and dietary energy density. A higher total score in HEI-NVS did not correlate with improvements in cardiovascular risk profile. The interactive and fully automated web-based weight loss program improved diet quality. Independent of study group, changes in HEI-NVS correlated with changes in energy density, but there was no association between improvements in HEI-NVS and improvements in cardiovascular risk profile. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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10 pages, 292 KiB

Open AccessArticle

Association between Diet Quality and Index of Non-Alcoholic Steatohepatitis in a Large Population of People with Type 2 Diabetes: Data from the TOSCA.IT Study

by Marilena Vitale, Giuseppe Della Pepa, Giuseppina Costabile, Lutgarda Bozzetto, Paola Cipriano, Stefano Signorini, Valerio Leoni, Gabriele Riccardi, Olga Vaccaro and Maria Masulli

Nutrients 2022, 14(24), 5339; https://doi.org/10.3390/nu14245339 - 15 Dec 2022

Cited by 1 | Viewed by 2440

Abstract

Background: There are still open questions with respect to the optimal dietary treatment in patients with type 2 diabetes (T2D) and coexisting non-alcoholic steatohepatitis (NASH). The aim of this study is to investigate, in patients with T2D, the association between NASH, dietary component intake, food groups and adherence to the Mediterranean diet. Methods: Cross-sectional analysis of 2026 people with T2D (1136 men and 890 women). The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. NASH was identified by the Index Of NASH (ION). Based on the cluster analysis two dietary patterns were identified: the NASH and the NO-NASH pattern. Results: The macronutrient composition of the diet was similar in the two patterns. However, the NASH pattern compared with the NO-NASH pattern was characterized by a significantly lower content of fibre (p < 0.001), β-carotene (p < 0.001), vitamin C (p < 0.001), vitamin E (p < 0.001), polyphenols (p = 0.026) and antioxidant capacity (p < 0.001). With regard to food consumption, the NASH pattern compared with NO-NASH pattern was characterized by higher intake of rice (p = 0.021), potatoes (p = 0.013), red (p = 0.004) and processed meat (p = 0.003), and a lower intake of wholegrain bread (p = 0.019), legumes and nuts (p = 0.049), vegetables (p = 0.047), fruits (p = 0.002), white meat (p = 0.001), fatty fish (p = 0.005), milk and yogurt (p < 0.001). Conclusions: NO-NASH dietary pattern was characterized by a food consumption close to the Mediterranean dietary model, resulting in a higher content of polyphenols, vitamins, and fibre. These finding highlight the potential for dietary components in the prevention/treatment of NASH in people with T2D. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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9 pages, 608 KiB

Open AccessArticle

Dietary Isorhamnetin Intake Is Associated with Lower Blood Pressure in Coronary Artery Disease Patients

by Joanna Popiolek-Kalisz, Piotr Blaszczak and Emilia Fornal

Nutrients 2022, 14(21), 4586; https://doi.org/10.3390/nu14214586 - 01 Nov 2022

Cited by 8 | Viewed by 1555

Abstract

Background: Recent studies suggest the positive role of flavonols on blood pressure (BP) values, although there are not many conducted on humans. The aim of this study was to examine the relationship between flavonol intake and their main sources of consumption, and systolic (SBP) and diastolic (DBP) BP values in coronary artery disease (CAD) patients. Methods and results: forty CAD patients completed a food-frequency questionnaire dedicated to flavonol-intake assessment. The analysis revealed significant correlation between isorhamnetin intake and SBP values—absolute (R: −0.36; 95% CI: −0.602 to −0.052; p = 0.02), and related to body mass (R: −0.38; 95% CI: −0.617 to −0.076; p = 0.02. This effect was observed in male participants (R: −0.65; 95% CI: −0.844 to −0.302; p = 0.001 and R: −0.63; 95% CI: −0.837 to −0.280; p = 0.002 respectively), but not in female patients. The main contributors were onions, tomatoes, blueberries, apples, tea, coffee and wine. White onion (R: −0.39; 95% CI: −0.624 to −0.088; p = 0.01) consumption was inversely correlated with SBP, and tomato consumption (R: −0.33; 95% CI: −0.581 to −0.020; p = 0.04) with DBP. The comparison between patients with BP < 140 mmHg and ≥140 mmHg revealed significant differences in white onion (p = 0.01) and blueberry (p = 0.04) intake. Conclusions: This study revealed the relationship between long-term dietary isorhamnetin intake and SBP values. The analysis of specific food intake showed that onion, tomato and blueberry consumption could impact BP values. This may suggest that a dietary approach which includes a higher intake of isorhamnetin-rich products could possibly result in BP lowering in CAD patients. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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11 pages, 2001 KiB

Open AccessArticle

The Relationship between Dietary Patterns and High Blood Glucose among Adults Based on Structural Equation Modelling

by Yuanyuan Wang, Wei Xie, Ting Tian, Jingxian Zhang, Qianrang Zhu, Da Pan, Dengfeng Xu, Yifei Lu, Guiju Sun and Yue Dai

Nutrients 2022, 14(19), 4111; https://doi.org/10.3390/nu14194111 - 03 Oct 2022

Cited by 4 | Viewed by 1850

Abstract

The aim of this study was to examine the association between dietary patterns and high blood glucose in Jiangsu province of China by using structural equation modelling (SEqM). Methods: Participants in this cross-sectional study were recruited through the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance Program in Jiangsu province using a multistage stratified cluster random sampling method. Dietary patterns were defined by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was used to test the fitness of EFA. SEqM was used to investigate the association between dietary patterns and high blood glucose. Results: After exclusion, 3137 participants with complete information were analysed for this study. The prevalence of high blood glucose was 9.3% and 8.1% in males and females, respectively. Two dietary patterns: the modern dietary pattern (i.e., high in red meats and its products, vegetables, seafood, condiments, fungi and algae, main grains and poultry; low in other grains, tubers and preserves), and the fruit–milk dietary pattern (i.e., high in milk and its products, fruits, eggs, nuts and seeds and pastry snacks, but low in vegetable oils) were established. Modern dietary pattern was found to be positively associated with high blood glucose in adults in Jiangsu province (multivariate logistic regression: OR = 1.561, 95% CI: 1.025~2.379; SEqM: β = 0.127, p < 0.05). Conclusion: The modern dietary pattern—high intake of red meats—was significantly associated with high blood glucose among adults in Jiangsu province of China, while the fruit–milk dietary pattern was not significantly associated with high blood glucose. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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15 pages, 1017 KiB

Open AccessArticle

Diet Quality Is Associated with Glucose Regulation in a Cohort of Young Adults

by Elizabeth Costello, Jesse Goodrich, William B. Patterson, Sarah Rock, Yiping Li, Brittney Baumert, Frank Gilliland, Michael I. Goran, Zhanghua Chen, Tanya L. Alderete, David V. Conti and Leda Chatzi

Nutrients 2022, 14(18), 3734; https://doi.org/10.3390/nu14183734 - 10 Sep 2022

Cited by 11 | Viewed by 2488

Abstract

Young-onset type 2 diabetes and prediabetes is a growing epidemic. Poor diet is a known risk factor for T2D in older adults, but the contribution of diet to risk factors for T2D is not well-described in youth. Our objective was to examine the relationship of diet quality with prediabetes, glucose regulation, and adiposity in young adults. A cohort of young adults (n = 155, age 17–22) was examined between 2014–2018, and 89 underwent a follow-up visit from 2020–2022. At each visit, participants completed diet and body composition assessments and an oral glucose tolerance test. Adherence to four dietary patterns was assessed: Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), Mediterranean diet, and Diet Inflammatory Index (DII). Regression analyses were used to determine adjusted associations of diet with risk for prediabetes and adiposity. Each one-point increase in DASH or HEI scores between visits reduced the risk for prediabetes at follow-up by 64% (OR, 95% CI: 0.36, 0.17–0.68) and 9% (OR, 95% CI: 0.91, 0.85–0.96), respectively. The DASH diet was inversely associated with adiposity, while DII was positively associated with adiposity. In summary, positive changes in HEI and DASH scores were associated with reduced risk for prediabetes in young adults. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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13 pages, 1044 KiB

Open AccessArticle

Dietary Plant Sterols and Phytosterol-Enriched Margarines and Their Relationship with Cardiovascular Disease among Polish Men and Women: The WOBASZ II Cross-Sectional Study

by Anna Maria Witkowska, Anna Waśkiewicz, Małgorzata Elżbieta Zujko, Alicja Cicha-Mikołajczyk, Iwona Mirończuk-Chodakowska and Wojciech Drygas

Nutrients 2022, 14(13), 2665; https://doi.org/10.3390/nu14132665 - 27 Jun 2022

Cited by 12 | Viewed by 2393

Abstract

Dietary cholesterol has been suggested to increase the risk of cardiovascular disease (CVD). Phytosterols, present in food or phytosterol-enriched products, can reduce cholesterol available for absorption. The present study aimed to investigate the association between habitual intake of total and individual plant sterols (β-sitosterol, campesterol, and stigmasterol) or a diet combined with phytosterol-enriched products and CVD in a cross-section of Polish adults, participants of the Multicenter National Health Survey II (WOBASZ II). Among men (n = 2554), median intakes of plant sterols in terciles ranged between 183–456 mg/d and among women (n = 3136), 146–350 mg/d in terciles. The intake of phytosterols, when consumed with food containing phytosterols, including margarine, ranged between 184–459 mg/d for men and 147–352 mg/d for women. Among both men and women, beta-sitosterol intake predominated. Plant sterol intake was lower among both men and women with CVD (p = 0.016) compared to those without CVD. Diet quality, as measured by the Healthy Diet Index (HDI), was significantly higher in the third tercile of plant sterol intake for both men and women and the entire study group (p < 0.0001). This study suggests that habitual dietary intake of plant sterols may be associated with a lower chance of developing CVD, particularly in men. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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13 pages, 2661 KiB

Open AccessArticle

Dietary Inflammation Index and Its Association with Long-Term All-Cause and Cardiovascular Mortality in the General US Population by Baseline Glycemic Status

by Sheng Yuan, Chenxi Song, Rui Zhang, Jining He and Kefei Dou

Nutrients 2022, 14(13), 2556; https://doi.org/10.3390/nu14132556 - 21 Jun 2022

Cited by 13 | Viewed by 2854

Abstract

Dietary inflammatory potential has been proven to be correlated with the incidence of diabetes and cardiovascular diseases. However, the evidence regarding the impact of dietary inflammatory patterns on long-term mortality is scarce. This cohort study aims to investigate the dietary inflammatory pattern of the general US individuals by baseline glycemic status and to estimate its association with long-term mortality. A total of 20,762 general American adults with different glycemic statuses from the National Health and Nutrition Examination Survey were included. We extracted 24-h dietary information, and the dietary inflammatory index (DII) was calculated. The outcomes were defined as 5-year all-cause and cardiovascular mortality. Compared with the normoglycemia group, individuals with prediabetes and type 2 diabetes had higher DII scores (overall weighted p < 0.001). Compared with low DII scores, participants with high DII scores were at a higher risk of long-term all-cause mortality (HR: 1.597, 95% CI: 1.370, 1.861; p < 0.001) and cardiovascular mortality (HR: 2.036, 95% CI: 1.458, 2.844; p < 0.001). The results were stable after adjusting for potential confounders. Moreover, the prognostic value of DII for long-term all-cause mortality existed only in diabetic individuals but not in the normoglycemia or prediabetes group (p for interaction = 0.006). In conclusion, compared to the normoglycemia or prediabetes groups, participants with diabetes had a higher DII score, which indicates a greater pro-inflammatory potential. Diabetic individuals with higher DII scores were at a higher risk of long-term all-cause and cardiovascular mortality. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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19 pages, 5901 KiB

Open AccessReview

Potential Benefits of Selenium Supplementation in Reducing Insulin Resistance in Patients with Cardiometabolic Diseases: A Systematic Review and Meta-Analysis

by Jiahui Ouyang, Yajie Cai, Yewen Song, Zhuye Gao, Ruina Bai and Anlu Wang

Nutrients 2022, 14(22), 4933; https://doi.org/10.3390/nu14224933 - 21 Nov 2022

Cited by 8 | Viewed by 3236

Abstract

Background: Selenium is a trace element that has been reported to be effective in regulating glucose and lipid metabolism. However, there is conflicting evidence from different clinical trials of selenium supplementation in treating cardiometabolic diseases (CMDs). Objective: This meta-analysis aimed to identify the effects of selenium supplementation on insulin resistance, glucose homeostasis, and lipid profiles in patients with CMDs. Methods: Randomized controlled trials (RCTs) of selenium supplementation for treating CMDs were screened in five electronic databases. Insulin levels, homeostatic model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), and glycosylated hemoglobin A1C (HbA1c) were defined as the primary outcome markers, and lipid profiles were considered the secondary outcome markers. Results: Ten studies involving 526 participants were included in the meta-analysis. The results suggested that selenium supplementation significantly reduced serum insulin levels (standardized men difference [SMD]: −0.53; 95% confidence interval [CI] [−0.84, −0.21], p = 0.001, I² = 68%) and HOMA-IR (SMD: −0.50, 95% CI [−0.86, −0.14], p = 0.006, I² = 75%) and increased high-density lipoprotein cholesterol (HDL-C) levels (SMD: 0.97; 95% CI [0.26, 1.68], p = 0.007, I² = 92%), but had no significant effect on FPG, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C). Conclusion: Current evidence supports the beneficial effects of selenium supplementation on reducing insulin levels, HOMA-IR, and increasing HDL-C levels. Selenium supplementation may be an effective strategy for reducing insulin resistance in patients with CMDs. However, more high-quality clinical studies are needed to improve the certainty of our estimates. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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13 pages, 1587 KiB

Open AccessEditor’s ChoiceSystematic Review

Adherence to the DASH Diet and Risk of Hypertension: A Systematic Review and Meta-Analysis

by Xenophon Theodoridis, Michail Chourdakis, Lydia Chrysoula, Violeta Chroni, Ilias Tirodimos, Konstantina Dipla, Eugenia Gkaliagkousi and Areti Triantafyllou

Nutrients 2023, 15(14), 3261; https://doi.org/10.3390/nu15143261 - 24 Jul 2023

Cited by 13 | Viewed by 5331

Abstract

The aim of this study was to assess the effect of the level of adherence to the DASH diet on hypertension risk by conducting a systematic review and meta-analysis. A systematic literature search was performed. Two independent investigators performed the study selection, data abstraction, and assessment of the included studies. The meta-analysis was performed separately with the adjusted hazard (HR) or incident rate ratios (IRR) and the odds ratios (OR) of the highest compared to the lowest DASH diet adherence scores using a random effects model. A total of 12 studies were included in the qualitative and quantitative synthesis. When cohort studies reporting HR were pooled together, high adherence to the DASH diet was associated with a lower risk of hypertension (HR: 0.81, 95% CI 0.73–0.90, I² = 69%, PI 0.61–1.08) compared to the low adherence. When cross-sectional studies reporting OR were combined, high adherence to the DASH diet was also related to a lower risk of hypertension (OR: 0.80, 95% CI 0.70–0.91, I² = 81%, PI 0.46–1.39). The findings suggest that high adherence to the DASH diet has a positive effect on reducing hypertension risk compared to low adherence. These data strengthen and are in line with all hypertension guidelines, indicating that lifestyle changes should start early even in populations with normal blood pressure. Full article

(This article belongs to the Special Issue Diet Quality and Risk of Cardiometabolic and Diabetes)

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