Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1942
Peer-review started: May 6, 2021
First decision: June 24, 2021
Revised: July 1, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 15, 2021
Processing time: 192 Days and 22.2 Hours
In recent years, major diabetic organizations started to strongly advocate the use of the Mediterranean diet (MD) over other diets in patients with diabetes mellitus (DM) because of its beneficial effects on glycaemic control and cardiovascular (CV) risk factors. Evidence suggests that CV risk may be assessed using tissue levels of advanced glycation endproducts (AGEs) in patients with DM.
As DM prevalence is constantly rising in well-developed countries, there is an urgent need to mitigate the poor outcomes of this disease. Regarding the importance of diet in this setting, we endeavoured to bring further evidence with respect to the benefits of the use of the MD in patients with DM.
The main objective of this study was to examine the association between adherence to the MD, assessed by MD serving score (MDSS) and CV risk, assessed by AGEs skin levels, in patients with DM type II. Additionally, we examined the association between anthropometric characteristics, glycaemic control, and physical activity with AGEs levels among patients with DM type 2
In this study, we employed the Croatian version of the 14-item MDSS questionnaire to assess adherence to the MD. On the other hand, in order to compare adherence to CV risk, we used skin autofluorescence-based AGE Reader that measures AGEs skin levels.
The present study demonstrated that patients with diabetes who have none or limited CV risk adhere more to the MD than patients who have either increased or definite CV risk. In addition, we showed that the subgroup of patients with diabetes with better glycaemic control adheres better to the MD than the subgroup of patients with worse glycaemic control. Altogether, these results are generally in line with the available data. It remains to be answered why adherence to MD is so low, despite being undoubtedly beneficial.
By bringing additional data about the association of the MD with CV outcomes, this study addresses the need to implement novel strategies that will lead to better MD adherence in patients with diabetes.
In future studies, the highlight should be placed further delineation off mechanisms by which MD exerts its favourable effects to establish the optimal dietary pattern. Furthermore, psychological studies could be important in this setting, as the main problem of MD is low adherence. Namely, psychological studies may give a deeper insight into non-adherence, thus facilitating the resolution of this issue.