Department of transplantation & disease management, Deputy of Health, Ministry of Health and Medical Education (MOHME), Tehran, Iran.
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Maturitas. 2021 Nov;153:61-67. doi: 10.1016/j.maturitas.2021.08.003. Epub 2021 Aug 28.
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.
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.
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.
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.
评估地中海饮食模式对糖尿病大血管和微血管并发症（即心血管疾病（CVD）、糖尿病足疾病、糖尿病视网膜病变、肾病和神经病变）发生的影响。
本纵向研究纳入了 2016 年 2 月至 2020 年 3 月期间在伊朗的学术三级保健门诊就诊的 71392 名糖尿病成人患者，使用国家糖尿病预防和控制计划数据库进行研究。其中，22187 名糖尿病（1 型和 2 型）患者在基线登记后完成了 2-11 次随访。采用汇总逻辑回归模型评估了地中海饮食与糖尿病并发症之间的相关性。该相关性在调整了潜在混杂因素后进行评估。采用分数多项式评估时间的影响。
共有 22187 名参与者（30.22%为男性，69.78%为女性）纳入分析，其中 1 型（平均年龄 50.7 岁）或 2 型（平均年龄 59.9 岁）糖尿病患者。在调整混杂变量后，与 1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者 CVD 发生率呈负相关（T1D：OR=0.53，95%CI：0.37-0.75，p<0.001；T2D：OR=0.61，95%CI：0.57-0.89，p<0.001）。此外，该饮食对症状性神经病变（T1D：OR=0.32，95%CI：0.23-0.43，p<0.001；T2D：OR=0.68，95%CI：0.64-0.72，p<0.001）、肾病（T1D：OR=0.42，95%CI：0.30-0.58，p<0.001；T2D：OR=0.88，95%CI：0.80-0.96，p=0.007）和视网膜病变（T1D：OR=0.32，95%CI：0.24-0.44，p<0.001；T2D：OR=0.68，95%CI：0.61-0.71，p<0.001）的发生率也具有统计学意义的保护作用。
在伊朗的 T1D 和 T2D 患者队列中，地中海饮食模式与 CVD 发生率以及微血管并发症（即糖尿病视网膜病变、肾病和神经病变）的发生率较低有关。
