Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain.
Biochemical Laboratory, Reina Sofia University Hospital, Córdoba, Spain.
Clin Nutr. 2020 Feb;39(2):492-500. doi: 10.1016/j.clnu.2019.02.027. Epub 2019 Feb 21.
Our objective was to investigate the role of two healthy diets in modulating the risk of type 2 diabetes (T2DM) development associated with each prediabetes diagnosis criteria in coronary heart disease patients. Additionally, we explored the pathophysiological characteristics and the risk of developing T2DM in patients with different prediabetes criteria.
We included 462 patients from the CORDIOPREV study without T2DM at baseline: 213 had prediabetes defined by impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) (PreDM-IFG/IGT); 180 had prediabetes by isolated hemoglobin glycated plasma levels (PreDM-isolated-HbA1c), and 69 were not prediabetics (non-PreDM), according to the American Diabetes Association criteria. Patients were randomized to consume either a Mediterranean or a low-fat diet. We performed a COX proportional hazards regression analysis to determine the T2DM risk according to diet and the prediabetes criteria after a median follow-up of 60 months.
We found higher T2DM risk (HR: 2.98; 95% CI 1.27-6.98) in PreDM-IFG/IGT than in PreDM-isolated-HbA1c (HR: 2.31; 95% CI 0.97-5.49) compared with non-PreDM. Long-term consumption of a low-fat diet was associated with a lower risk of T2DM when compared to the Mediterranean diet in the PreDM-IFG/IGT group (HR: 3.20; 95% CI 0.75-13.69 versus HR: 4.70; 95% CI 1.12-19.67, respectively). Moreover, we found the highest risk of T2DM development associated with patients who had both IFG and IGT (HR: 2.15; 95% CI 1.11-4.16). Patients who had both IFG and IGT and consumed a low-fat diet had a lower T2DM risk than those who consumed a Mediterranean diet (HR: 1.53; 95% CI 0.53-4.39 versus HR: 3.33; 95% CI 1.34-8.30, respectively).
Our results suggest that the type of diet consumed may modulate the risk of T2DM development according to the prediabetes diagnosis criteria. Specifically, our study showed that the consumption of a low-fat diet was more beneficial than a Mediterranean diet in patients with IFG and IGT.
ClinicalTrials.govNCT00924937.
本研究旨在探讨两种健康饮食在调节冠心病患者中不同的糖尿病前期诊断标准与 2 型糖尿病（T2DM）发展风险之间的作用。此外，我们还探讨了不同糖尿病前期标准患者的病理生理特征和发生 T2DM 的风险。
我们纳入了 CORDIOPREV 研究中 462 例基线时无 T2DM 的患者：213 例为空腹血糖受损（IFG）和/或糖耐量受损（IGT）定义的糖尿病前期（PreDM-IFG/IGT）；180 例为单纯糖化血红蛋白血浆水平定义的糖尿病前期（PreDM-孤立性-HbA1c）；69 例为非糖尿病前期（non-PreDM），根据美国糖尿病协会标准。患者被随机分配到地中海饮食或低脂饮食组。在中位随访 60 个月后，我们采用 COX 比例风险回归分析来确定根据饮食和糖尿病前期标准的 T2DM 风险。
与 non-PreDM 相比，PreDM-IFG/IGT 患者的 T2DM 风险更高（HR：2.98；95%CI 1.27-6.98），而 PreDM-孤立性-HbA1c 患者的 T2DM 风险（HR：2.31；95%CI 0.97-5.49）较低。与地中海饮食相比，低脂饮食组长期摄入低脂饮食与 T2DM 风险降低相关（HR：3.20；95%CI 0.75-13.69 与 HR：4.70；95%CI 1.12-19.67，分别）。此外，我们发现 IFG 和 IGT 并存的患者发生 T2DM 的风险最高（HR：2.15；95%CI 1.11-4.16）。IFG 和 IGT 并存且摄入低脂饮食的患者与摄入地中海饮食的患者相比，T2DM 风险较低（HR：1.53；95%CI 0.53-4.39 与 HR：3.33；95%CI 1.34-8.30，分别）。
我们的研究结果表明，所摄入的饮食类型可能会根据糖尿病前期的诊断标准来调节 T2DM 发展的风险。具体来说，我们的研究表明，在 IFG 和 IGT 患者中，低脂饮食比地中海饮食更有益。
ClinicalTrials.govNCT00924937。
