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In a recent cross-sectional study published in the journal Nutrition, metabolism and cardiovascular disease, German researchers evaluated the association between adherence to dietary patterns and cardiovascular risk factors, renal function, and neurological disorders among different diabetes endotypes. They found small differences in the association between adherence and complications between diabetes endotypes, suggesting that there is insufficient evidence for endotype-specific dietary recommendations.
study: The association between dietary patterns and diabetes-related comorbidities varies by diabetes endotype. Image credit: nobeastsofierce / Shutterstock
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People with diabetes face increased morbidity and mortality from complications such as kidney disease, cardiovascular disease, and neurological disorders. To manage these risks, diets such as the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH), and plant-based diets are recommended. The Mediterranean and DASH diets have been shown to have beneficial effects on blood pressure and lipids in patients with type 2 diabetes (T2D), but evidence regarding plant-based diets is still emerging. However, studies on their effects on renal function and neurological disorders are limited and contradictory. Research on dietary patterns has focused on T1D and T2D, and potential differences between diabetic endotypes with different risks of complications have been overlooked.
To address this gap, the researchers in this study focused on improving adherence to a specific diet and developing severe autoimmune diabetes (SAID), severe insulin-resistant diabetes (SIRD), and severe insulin-deficiency diabetes (SIDD). , mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD).
About research
This study included 765 people from the German Diabetes Study (GDS) based on diabetes diagnosis according to American Diabetes Association criteria. The average age of participants was 48.7 years, and 62.1% were male. They were enrolled between 2012 and 2021, had a known disease duration of less than 12 months at baseline, or participated in a 5-year follow-up and provided food frequency questionnaire (FFQ) data. .
Participants underwent the same tests at both time points to ensure comparability. The participant reported his usual consumption pattern of 148 food items over the past 12 months. Nutrient and food group intakes and average daily total energy were calculated using German food standards and nutrient databases. Additionally, the specificities required for assignment to diabetic endotypes include BMI (body mass index), HOMA2-B (homeostasis model assessment), HOMA2-IR (HOMA2 insulin resistance), HbA1c (glycated hemoglobin), and GADA (glutamate). variables were collected. acid decarboxylase antibody) levels. Outcome variables related to cardiovascular risk factors, renal function, and neurological disorders were assessed, along with covariates such as age, gender, smoking status, educational level, and use of medications (hyperglycemic, lipid-lowering, antihypertensive). I did.
Analyzes included assignment of diabetes endtype, comparison of dietary pattern adherence, evaluation of associations with outcome variables, interaction analysis using multivariable linear regression and logistic regression, and sensitivity analysis.
Results and discussion
Of the total participants, 35.3% had SAID endotype, 2.4% had SIDD, 5.4% had SIRD, 27.6% had MOD, and 29.2% had MARD endotype. Dietary intake differed by diabetes endotype, with differences observed in the frequency of food group intake, with SAID having higher intakes of meat and dairy products, and MOD having higher intakes of red meat and processed meat. Differences in dietary pattern adherence were observed between diabetes endotypes, particularly in adherence to the Healthy Plant-Based Diet Index (hPDI), with SIDD and MOD showing the lowest adherence and MARD showing the highest adherence. I did. The results were consistent when considering only those who were newly diagnosed or whose total daily energy intake was considered reasonable.
Adherence to dietary patterns showed variable associations with cardiovascular risk factors and neuropathy-related outcomes across different diabetes endotypes. Of note, hPDI was inversely correlated with low-density lipoprotein and total cholesterol in SAID patients. Among SIRD patients, greater adherence to hPDI was associated with lower diastolic blood pressure. Additionally, adherence to multiple dietary patterns in MARD patients was found to be inversely correlated with high-sensitivity C-reactive protein concentrations. Furthermore, greater adherence to a specific dietary pattern was associated with lower odds of peripheral neuropathy and cardiovascular autonomic neuropathy in certain endotypes, such as MARD and SAID.
Overall, this study has benefited from detailed phenotyping and comprehensive derivation of dietary patterns, taking into account the synergistic effects of individual nutrients and foods. However, the recruitment strategy of this study may limit generalizability due to underrepresentation of specific diabetic endotypes. Furthermore, reliance on self-reported dietary intake and potential confounding by lifestyle factors may influence results, and alternative diabetes classification methods may yield different results.
conclusion
In conclusion, the researchers were able to identify subtle differences in dietary patterns between different diabetes endotypes, with healthier diets in MARD patients and less healthy diets in SIDD and MOD patients. was suggested. Furthermore, the association between dietary pattern adherence and diabetes-related outcomes varied by endotype. In the future, longitudinal studies and randomized controlled trials may help comprehensive evaluation of the relationship between nutrition and diabetes-related complications within these endotypes. This will help determine the utility of the chosen diabetes reclassification approach in identifying groups that may benefit from customized nutritional interventions.
