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Literature review diabetes and mediteranean diet

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1. Impact of a

Mediterranean Dietary Pattern and Its

Components on Cardiovascular Risk Factors, Glucose Control, and Body Weight in People with Type 2 Diabetes: A Real-Life Study

Marile na Vitale dkk

2022 (RCT)

assessmet of diet with the EPIC (European Prospective

Investigation into Cancer and Nutrition) questionnaire, and adherence to the Mediterranean diet was evaluated with the relative

Mediterranean diet score (rMED)

Support the

Mediterranean dietary model as a suitable model for type 2

diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual

component.

2. Effects of a

Mediterranean Eating Plan on the Need for GlucoseLowering Medications in

ParticipantsWith Type 2 Diabetes: A

Subgroup Analysis of the PREDIMED Trial

F Javier Basterr a- Gortari dkk

2019 RCT

participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med- EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual

randomization, and the clustering effect was taken into account in the statistical analysis assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management

a Med-EatPlan + EVOO may delay the

introduction of new- onset glucose-lowering medications. The Med- EatPlan did not result in a significantly lower need for insulin.

(2)

at enrollment and 2) insulin initiation.

3.

Isocaloric-restricted Mediterranean Diet and Chinese Diets High or Low in Plants in Adults With

Prediabetes

2022 RCT

During the 6-month trial, a 5-weekday full-feeding regimen was followed, along with mobile app- based monitoring.

Abdominal fat measurement

(magnetic resonance imaging), oral

glucose tolerance test (OGTT), and

continuous glucose monitoring (CGM) were conducted at baseline and 3 and 6 months.

With the 6-month isocaloric-restricted feeding, TJD and MD achieved comparable weight deduction and improved glucose homeostasis, whereas CD showed a higher risk for hypoglycemia.

4 Glycolysis/gluconeoge nesis- and tricarboxylic acid cycle-related metabolites,

Mediterranean diet, and type 2 diabetes

2020 We included 251 incident T2D cases and 638 noncases in a nested case-cohort study within the PREDIMED Study during median follow-up of 3.8 y.

Participants were allocated to MedDiet + extra-virgin olive oil, MedDiet + nuts, or control diet.

Plasma metabolites were measured using a targeted approach by LC-tandem MS.

We tested the associations of baseline and 1-y changes in

glycolysis/gluconeoge nesis and TCA cycle metabolites with subsequent T2D risk using weighted Cox regression models and

identified a panel of glycolysis/gluconeogen esis-related metabolites that was significantly associated with T2D risk in a Mediterranean population at high cardiovascular disease risk. A MedDiet could counteract the

detrimental effects of these metabolites.

(3)

adjusting for potential confounders. We designed a weighted score combining all these metabolites and applying the leave- one-out cross- validation approach.

5. Yearly attained adherence to

Mediterranean diet and incidence of diabetes in a large randomized trial

2023 RCT

PREDIMED (''PREvención con DIeta MEDiterránea'') was a Spanish trial including 7447 men and women at high cardiovascular risk.

We assessed 3541 participants initially free of diabetes and originally randomized to 1 of 3 diets: low-fat diet (n = 1147, control group), Mediterranean diet supplemented with extra virgin olive (n = 1154) or

Mediterranean diet supplemented with mixed nuts (n = 1240). As exposure we used actual adherence to Mediterranean diet (cumulative average), yearly assessed with the Mediterranean Diet Adherence Screener (scoring 0 to 14 points), and repeated up to 8 times (baseline and 7 consecutive follow-up years). This score was categorized into four groups: < 8, 8-< 10,

A rapid dietary

assessment tool, yearly repeated as a screener, was able to capture a strong inverse linear relationship between Mediterranean diet and type 2 diabetes.

(4)

10- < 12, and 12-14 points. The outcome was new-onset type 2 diabetes.

6. Twelve-Week Mediterranean Diet Intervention Increases Citrus Bioflavonoid Levels and Reduces Inflammation in People with Type 2 Diabetes Mellitus

2021 analysed plasma samples from 19 (of original 27)

participants with T2DM who were randomly assigned to consume the MedDiet intervention or their usual diet for 12 weeks and then crossed over to the alternate diet.

Compared with baseline, MedDiet significantly increased levels of the citrus bioflavonoids naringin, hesperitin and

hesperidin and reduced plasma levels of the pro-inflammatory cytokine IL-6.

Oxidative stress marker 8-hydroxy-2'-

deoxyguanosine (8- OHdG) decreased by 32.4%. Usual diet did not induce these

beneficial changes. The reduced inflammatory profile of T2DM participants may, in part, be attributed to the anti-inflammatory actions of citrus bioflavonoids.

7. Effectiveness of Following

Mediterranean Diet Recommendations in the Real World in the Incidence of

Gestational Diabetes Mellitus (GDM) and Adverse Maternal- Foetal Outcomes: A Prospective, Universal, Interventional Study with a Single Group.

The St Carlos Study

2019 his trial is a prospective, clinic- based, interventional study with a single group. 1066 eligible normoglycaemic women before 12 gestational weeks were assessed. 932 women (32.4 ± 5.2 years old, pre-

gestational BMI 22.5

± 3.5 kg/m2) received a motivational

lifestyle interview with emphasis on daily consumption of EVOO and nuts, were followed-up and analysed. Binary

an early MedDiet nutritional intervention reduces GDM incidence and maternal-foetal adverse outcomes and should be universally applied as 1st line therapy. GDM might not be consider as a high risk pregnancy any longer.

(5)

regression analyses were used to examine the risk for each pregnancy outcome, pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), caesarean-section, perineal trauma, preterm delivery, small (SGA) and large for gestational age (LGA), and Neonatal Intensive Care Unit admissions 8. A nutritional

biomarker score of the Mediterranean diet and incident type 2

diabetes: Integrated analysis of data from the MedLey

randomised controlled trial and the EPIC- InterAct case-cohort study

2023 6-month partial- feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised).

findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.

9 Diet-Related

Lipidomic Signatures and Changed Type 2 Diabetes Risk in a Randomized Controlled Feeding Study With

Mediterranean Diet and Traditional

Chinese or Transitional Diets

2023 231 Chinese with overweight and prediabetes in a randomized feeding trial with

Mediterranean, traditional, or transitional diets (control diet) from February to September 2019. Plasma lipidomic profiles were measured at baseline, third month, and sixth month by high-throughput targeted liquid

chromatography-mass

fish- and red meat- related lipidomic signatures sensitively reflected different diets and modified type 2 diabetes risk factors, critical for optimizing dietary patterns.

(6)

spectrometry.

10 Effects of Low- Carbohydrate versus Mediterranean Diets on Weight Loss, Glucose Metabolism, Insulin Kinetics and β- Cell Function in Morbidly Obese Individuals

2021 RCT The two dietary

regimens proved similarly effective in improving insulin resistance and fasting hyperinsulinemia, while enhancing endogenous insulin clearance and β- cell glucose sensitivity.

11 Genetic variants for prediction of

gestational diabetes mellitus and

modulation of susceptibility by a nutritional intervention based on a

Mediterranean diet

2022 2418 women from our hospital-based cohort of pregnant women screened for GDM from January 2015 to November 2017 (the San Carlos Cohort, randomized controlled trial for the prevention of GDM ISRCTN84389045 and real-world study ISRCTN13389832) were assessed for evaluation.

identify a core set of SNPs in their

association with diabetes and GDM in a large cohort of patients from two main

ethnicities from a single center. Identification of these genetic variants, even in the setting of a nutritional intervention, deems useful to design preventive and

therapeutic strategies.

12 Differential Glycemic Effects of Low- versus High-Glycemic Index Mediterranean-Style Eating Patterns in Adults at Risk for Type 2 Diabetes: The MEDGI-Carb

Randomized Controlled Trial

2022 a randomized, controlled dietary intervention, comparing high- versus low-GI diets in a multi-national (Italy, Sweden, and the United States) sample of adults at risk for type 2 diabetes

Indices of 24-h glycemic variability were reduced in the low-GI group as compared to baseline and the high-GI intervention group.

These findings suggest that low-GI foods may be an important feature within a MED-HEP.

13 East Asian diet- mimicking diet plan based on the

Mediterranean diet and the Dietary

Approaches to Stop Hypertension diet in adults with type 2 diabetes: A

2021 This was a 12-week, open-label

randomized clinical trial carried out among 60 Korean adults with type 2 diabetes having a median body mass index of 23.5 kg/m2

With the provision of ready meals, the

glycemic benefits of the investigational diet plan were demonstrable over a self-prepared food exchange system-based diet in Korean adults with established type 2

(7)

randomized controlled

trial diabetes.

14 A Modified

Mediterranean Diet Improves Fasting and Postprandial

Glucoregulation in Adults with

Overweight and Obesity: A Pilot Study

2022 Clinical trial Eleven men and women with

overweight/obesity, aged 37 ± 12 years, participated in a free- living intervention until 10% weight loss was achieved.

the modified

Mediterranean diet may induce significant improvements in body composition,

adipocytokine profile and glucose metabolism in overweight/obese individuals

15 Plasma branched chain/aromatic amino acids, enriched

Mediterranean diet and risk of type 2 diabetes:

case-cohort study within the PREDIMED Trial

2018 251 participants with incident type 2 diabetes and a random sample of 694 participants (641 participants without type 2 diabetes and 53 overlapping cases) in a case-cohort study nested within the PREvención con DIeta MEDiterránea (PREDIMED) trial.

results support that higher baseline BCAAs and their increases at 1 year were associated with higher type 2 diabetes risk. A

Mediterranean diet rich in extra-virgin olive oil significantly reduced the levels of BCAA and attenuated the positive association between plasma BCAA levels and type 2 diabetes incidence. Clinical trial number:

SRCTN35739639 ( www.controlled- trials.com ).

16 A Pilot Study on the Metabolic Impact of Mediterranean Diet in Type 2 Diabetes: Is Gut Microbiota the Key?

2021 Clinical trial

12-week single-arm pilot study, nine participants received individual nutritional counseling sessions promoting MD. Gut microbiota,

biochemical parameters, body composition, and blood pressure were assessed at baseline, 4 weeks, and 12 weeks after the intervention.

This study suggests that the Mediterranean diet is effective in

improving metabolic control of subjects with type 2 diabetes,

independently of energy intake and weight loss.

Additionally, gut microbiota changes appear to precede the changes in standard biomarkers of type 2 diabetes (HbA1c), suggesting that the effects of MD in type 2

(8)

diabetes are mediated by the gut microbiota.

In addition, the results of this study highlight the importance of gut microbiota composition, in particular gut

bacterial richness, which could be used as a new biomarker for early measurement of the effectiveness of dietary interventions in the metabolic control of type 2 diabetes.

17 The protective effect of the Mediterranean diet on endothelial

resistance to GLP-1 in type 2 diabetes: a preliminary report

2014 2 groups of type 2 diabetic patients, each consisting of twelve subjects, participated in a randomized trial for three months, following a

Mediterranean diet using olive oil or a control low-fat diet.

These data suggest that the Mediterranean diet, using olive oil, prevents the acute hyperglycemia effect on endothelial function, inflammation and oxidative stress, and improves the action of GLP-1, which may have a favorable effect on the management of type 2 diabetes, particularly for the prevention of cardiovascular disease.

18 Effect of Telemedicine Dietary Intervention for Endothelial Function in Patients with Type 2 Diabetes Mellitus on

Mediterranean Diet

2021 Patients with T2DM on the Mediterranean diet who received a weekly telephone call for 3 months

improved their endothelial function with reduction of markers of inflammation.

A prospective study enrolled 22 patients with T2DM. Patients were divided randomly into two groups: an intervention group with 12 patients (55 ± 7 years old, 6 women) and a control group with 10 patients (59 ± 10 years old, 5 women).

19 An Early

Mediterranean-Based Nutritional

Intervention during Pregnancy Reduces Metabolic Syndrome and Glucose

2023 RCT MedDiet-based

intervention early in pregnancy demonstrated persistent beneficial effects on AGR and MetS rates at 3 years postpartum.

(9)

Dysregulation Rates at 3 Years Postpartum

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

randomized trial

2018 RCT

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]

Findings show that the long-term consumption of a MedDiet rich in olive oil improves PPL and RC concentrations mainly in patients with T2D.

21 Mediterranean Diet Reduces Serum Advanced Glycation End Products and Increases Antioxidant Defenses in Elderly Adults: A Randomized Controlled Trial

2016 RCT

twenty participants (aged ≥65; 10 male, 10 female) were randomly assigned to receive, in a crossover design, three

isocaloric diets for 4- week periods each:

Mediterranean diet (38% of energy from fat: 24%

monounsaturated fatty acids (MUFA;

provided by virgin olive oil), 10%

saturated fatty acids (SFA), 4%

The present study showed that consumption of a Mediterranean diet reduces oxidant AGEs and increases

antioxidant defenses in the fasting and

postprandial states, as lower sCML and sMG levels,

higher AGER1 and Glox I, and

lower RAGE mRNA levels than with the SFA diet manifested, with an intermediate effect of the omega-3

(10)

polyunsaturated fatty acids (PUFA));

Western diet rich in saturated fat (38% of energy as fat: 12%

MUFA, 22% SFA, 4% PUFA); low-fat, high-carbohydrate diet enriched in omega-3 PUFA of vegetable origin (omega-3 diet) (28%

of energy as fat: 10%

SFA, 12% MUFA, 8% PUFA with 2%

alpha-linolenic acid).

diet.

22 A High Adherence to Six Food Targets of the Mediterranean Diet in the Late First Trimester is Associated with a Reduction in the Risk of Materno-Foetal Outcomes: The St.

Carlos Gestational Diabetes Mellitus Prevention Study

2018 RCT

A total of 874 women were stratified into three groups

according to late first- trimester compliance with six food targets:

>12 servings/week of vegetables, >12 servings/week of fruits, <2

servings/week of juice, >3

servings/week of nuts, >6 days/week consumption of extra virgin olive oil (EVOO), and ≥40 mL/day of EVOO.

There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational- age (SGA) newborns (all p < 0.05).

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