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Effects of a Mediterranean diet on the development of diabetic complications: A longitudinal study from the nationwide diabetes report of the National Program for Prevention and Control of Diabetes (NPPCD 2016-2020)

      Highlights

      • Patients with type 1 or type 2 diabetes and adherent to a Mediterranean diet had a lower incidence of cardiovascular disease.
      • Patients with diabetes on a Mediterranean diet were at lower risk of retinopathy, nephropathy, and neuropathy.
      • A Mediterranean diet had no significant effect on the incidence of diabetic foot complications.
      • A Mediterranean diet has a protective effect against the development of diabetic macro- and microvascular complications.

      Abstract

      Objective

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

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