Mediterranean Diet and Diabetes' prevention

mediterranean diet & diabetes

INTRODUCTION

Diabetes mellitus is a metabolic disease characterized by hyperglycemia and occurs:

• when the pancreas cannot produce enough insulin

or

• when the body cannot use it effectively.

The disease tends to take on the character of an epidemic, since it is estimated that by 2035 a total of 592 million people worldwide will have fallen ill.Although genetic and environmental factors have been blamed for the onset and progression of type-2 DM, the rapid spread of the disease in recent years is mainly attributed to changes in modern lifestyles, such as increased consumption of refined unhealthy foods and lack of physical exercise.

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The classification currently used is based on both the etiology and the pathogenesis of disease and is useful in the clinical assessment of disease and for deciding the required therapy. According to this classification, diabetes can be divided into four main types or categories:

• type 1 diabetes mellitus (T1DM),
• type 2 diabetes mellitus (T2DM),
• gestational diabetes mellitus (GDM), and
• diabetes caused or associated with certain specific conditions, pathologies, and/or disorders.

Hyperglycemia and its associated carbohydrate, fat, and protein metabolic dysfunctions affect multiple organs of the body and disrupt their normal functioning.

Symptoms of DM:

• hyperglycemia
• polyuria
• polydipsia
• weight loss often accompanied by overeating
• vision

Jannasch, F.; Kröger, J.; Schulze, M.B. Dietary Patterns and Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Prospective Studies. J. Nutr. 2017, 147, 1174–1182.

Type 2 is preventable.

Prevention

Given the life-threatening consequences of DM, which can lead to disability or even premature death, prevention of the disease is considered important for public health.Regarding dietary habits, various dietary patterns have been associated with a reduction in the risk of developing DM, such as the DASH diet ( Dietary Approach to Stop Hypertension), the diet recommended by the AHEI (Alternative Health Eating Index ) and the GFPI (German Food Pyramid Index) and of course the Mediterranean Diet.

Obesity increases the risk of developing type 2 diabetes. Maintaining a healthy weight through a balanced diet and regular physical activity can help prevent or manage diabetes by reducing strain on the body's ability to regulate blood sugar levels. Medical nutrition therapy, such as modest weight loss through calorie reduction, can improve insulin resistance and diabetes symptoms.

The role of different MEDITERRANEAN foods on glucose and insulin response

Food components Fat and protein Dietary fiber Antinutrients Organic acids

Food factors that influence glycemic response

Nature of the monosaccharide components Glucose Fructose Galactose Nature of the starch Amylose Amylopectin Starch-nutrient interaction Resistant starch Cooking or food processing Degree of gelatinization of starch Particle size Food form Cellular structurec acids

Apart from the general Mediterranean diet pattern, the scientific community has investigated the effect of certain specific components such as olive oil.

unsaturated fatty acids

Replacing saturated and trans fatty acids with polyunsaturated and monounsaturated fatty acids is associated with an increase in insulin sensitivity, and thus a reduced risk of DM

Fish, especially fatty fish like salmon, mackerel, and sardines, are integral to the Mediterranean diet.

These fish are rich in omega-3 fatty acids, which have been associated with improved metabolic health. Consuming fish regularly can also help maintain a healthy weight, another critical factor in diabetes prevention.

Poultry, eggs, and legumes are other sources of lean protein that fit well within this dietary framework.

Legumes, such as lentils, chickpeas, and beans, are particularly noteworthy for their low glycemic index and high fiber content, making them ideal for managing blood sugar levels.

NATURAL FIBER-RICH FOOD

A diet based on natural fiber-rich food reduced the glycemic response by 40 %compared with a control diet enriched with either guar or hydrolyzed guar . The fiber rich and guarenriched diet slows gastric emptying (50 %) but only the natural fiber-rich diet was effective in reducing postprandial plasma glucose concentration.

The effects exerted by the Mediterranean diet on T2D could probably be attributed to its anti-inflammatory/antioxidant compounds. It is known that individuals with diabetes have significantly lower levels of ascorbic acid, β-carotene, and α-tocopherol/cholesterol ratio than non-diabetic ones.The consumption of this diet raises plasma levels of diet-derived plasma antioxidants, increases both the plasma ferric reducing antioxidant potential and the total radical-trapping antioxidant parameter, lowers c-reactive protein levels, and prevents the acute hyperglycemia effect on inflammation, oxidative stress, and endothelial function.

anti-inflamatory and​​ antioxidants compounds

Beyond food choices, the Mediterranean lifestyle emphasizes physical activity and social connections. Regular exercise is vital for maintaining a healthy weight and improving insulin sensitivity. Engaging in physical activities, such as walking, swimming, or cycling, can significantly reduce the risk of developing Type 2 diabetes. Social interactions during meals are also a key component of the Mediterranean lifestyle. Sharing food with family and friends encourages mindful eating, which can prevent overeating and promote a healthier relationship with food.

PHYSICAL ACTIVITY & SOCIETAL FACTORS

Could you find more evidence?

The ATTICA study described that adherence to the Mediterranean diet was linked to improved fasting glucose homeostasis, insulin levels, and a better insulin resistance index (HOMA) in both normoglycemic individuals and diabetic participants. Those who had a high score of Mediterranean diet adherence presented 15% lowered basal glucose and insulin, and a 27% increased HOMA index

evidence on mediterranean

diet prevention role

A meta-analysis involving eight cohort studies with a total of 122,810 individuals found that higher adherence to the Mediterranean diet was associated with a 19% lower risk of suffering type 2 diabetes, highlighting the long-term protective effects of the Mediterranean diet. This study analyzed whether diet protection against diabetes appeared to be more marked in European populations than North American ones. It also highlighted the long-term protective effect of the Mediterranean diet, referring to follow-up studies of more than 10 years.

19%

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