Long-term consumption of a Mediterranean diet improves postprandial lipemia in patients with type 2 diabetes: the Cordioprev randomized trial

Authors: GOMEZ-MARIN, BEATRIZ - University Hospital Reina Sofia; GOMEZ-DELGADO, FRANCISCO - University Hospital Reina Sofia; LOPEZ-MORENO, JAVIER - University Hospital Reina Sofia; ALCALA-DIAZ, JUAN - University Hospital Reina Sofia; JIMENEZ-LUCENA, ROSA - University Hospital Reina Sofia; TORRES-PENA, JOSE - University Hospital Reina Sofia; GARCIA-RIOS, ANTONIO - University Hospital Reina Sofia; ORTIZ-MORALES, ANA - University Hospital Reina Sofia; YUBERO-SERRANO, ELENA - University Hospital Reina Sofia; MALAGON, MARIA DEL MAR - Instituto De Salud Carlos Iii; Lai, Chao Qiang; DELGADO-LISTA, JAVIER - University Hospital Reina Sofia; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LOPEZ-MIRANDA, JOSE - University Hospital Reina Sofia; PEREZ-MARTINEZ, PABLO - University Hospital Reina Sofia

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/1/2018
Publication Date: 11/23/2018
Citation: Gomez-Marin, B., Gomez-Delgado, F., Lopez-Moreno, J., Alcala-Diaz, J.F., Jimenez-Lucena, R., Torres-Pena, J.D., Garcia-Rios, A., Ortiz-Morales, A.M., Yubero-Serrano, E.M., Malagon, M., Lai, C., Delgado-Lista, J., Ordovas, J.M., Lopez-Miranda, J., Perez-Martinez, P. 2018. Long-term consumption of a Mediterranean diet improves postprandial lipemia in patients with type 2 diabetes: the Cordioprev randomized trial. American Journal of Clinical Nutrition. 108:963-970. https://doi.org/10.1093/ajcn/nqy144.
DOI: https://doi.org/10.1093/ajcn/nqy144

Interpretive Summary: Humans spend most their lives in the non-fasting state. Excessive levels of blood fats during the non-fasting state have been reported to be atherogenic. Patients with type 2 diabetes (T2D) have both elevated non-fasting levels of triglycerides, one of the circulating fats, and increased cardiovascular risk. Our goal was to elucidate whether the long-term consumption of two healthy dietary patterns is associated with an improvement in non-fasting triglycerides levels in patients with T2D. We selected patients from the Cordioprev study who underwent oral fat load tests (FLTs) at baseline and the 3-years follow-up (241 patients with and 316 patients without T2D). Subjects were randomly assigned to receive either a Mediterranean diet rich in olive oil (MedDiet; 35% of calories from fat [22% monounsaturated fatty acids (MUFAs)] and 50% from carbohydrates) or a low-fat (LF) diet [<30% fat (12-14% MUFAs) and 55% of calories from carbohydrates]. Lipids were measured in serial bloods drawn at 0, 1, 2, 3, and 4 h after the FLT. Our results show that after three years of dietary intervention, patients with T2D showed an improvement in their non-fasting triglycerides compared with baseline. However, when the patients were analyzed based on the type of dietary intervention, those T2D patients randomly assigned to the MedDiet presented a reduction in non-fasting triglycerides compared with baseline; whereas we did not observe significant differences for T2D patients randomly assigned to the LF diet or in patients without T2D regardless of the dietary intervention. In summary, our findings show that the long-term consumption of a MedDiet rich in olive oil improves non-fasting lipids mainly in patients with T2D, thus potentially reducing their cardiovascular risk.

Technical Abstract: Background: Patients with type 2 diabetes (T2D) have an elevated postprandial lipemia (PPL) that has been associated with increased cardiovascular risk. Objective: We aimed to analyze whether the long-term consumption of 2 healthy dietary patterns is associated with an improvement in PPL and remnant cholesterol (RC) concentrations in patients with T2D. Design: We selected patients from the Cordioprev study who underwent oral fat load tests (FLTs) at baseline and the 3-y follow-up (241 patients with and 316 patients without T2D). Subjects were randomly assigned to receive either a Mediterranean diet rich in olive oil (MedDiet; 35% of calories from fat [22% monounsaturated fatty acids (MUFAs)] and 50% from carbohydrates) or a low-fat (LF) diet [<30% fat (12-14% MUFAs) and 55% of calories from carbohydrates]. Lipids were measured in serial bloods drawn at 0, 1, 2, 3, and 4 h after the FLT. Results: After 3 y of dietary intervention, patients with T2D showed an improvement in their PPL measured as postprandial triglycerides (TGs) (P < 0.0001), TG area under the curve (AUC) (P = 0.001), and TG-rich lipoproteins (TRLs-TG; P = 0.001) compared with baseline. Subgroup analysis, based on the type of dietary intervention, showed that those T2D patients randomly assigned to the MedDiet presented a reduction in the TG AUC of 17.3% compared with baseline (P = 0.003). However, there were no differences for T2D patients randomly assigned to the LF diet (P > 0.05) or in patients without T2D (P > 0.05) regardless of the dietary intervention. In addition, the MedDiet induced a significant improvement in the RC AUC in patients with T2D (P = 0.04). However, there was no significant improvement in those following the LF diet. Conclusions: Our findings show that the long-term consumption of a MedDiet rich in olive oil improves PPL and RC concentrations mainly in patients with T2D.