Effect of a Mediterranean diet on endothelial progenitor cells and carotid intima-media thickness in type 2 diabetes: follow-up of a randomized trial
Abstract
We assessed the long-term effects of a Mediterranean diet on circulating levels of endothelial progenitor cells (EPCs) and the carotid intima-media thickness (CIMT) in patients with type 2 diabetes. This was a parallel, two-arm, single-centre trial. Two hundred and fifteen men and women with newly diagnosed type 2 diabetes were randomized to a Mediterranean diet (n = 108) or a low-fat diet (n = 107). The primary outcome measures were changes in the EPC count and the CIMT of the common carotid artery after the treatment period defined as the end of trial (EOT). At the EOT, both the CD34+KDR+ and CD34+KDR+CD133+ counts had increased with the Mediterranean diet compared with the low-fat diet (p < 0.05 for both). At the EOT evaluation, there was a significant (p = 0.024) difference of −0.025 mm in the CIMT favouring the Mediterranean diet. Compared with the low-fat diet, the rate of regression in the CIMT was higher in the Mediterranean diet group (51 vs. 26%), whereas the rate of progression was lower (25 vs. 50%) (p = 0.032 for both). Changes in the CIMT were inversely correlated with the changes in EPC levels (CD34+KDR+, r = −0.24, p = 0.020; CD34+KDR+CD133+, r = −0.28, p = 0.014). At the EOT, changes in levels of HbA1c, HOMA, total cholesterol, high-density lipoprotein cholesterol and systolic blood pressure were significantly greater with the Mediterranean diet than with the low-fat diet. Compared with a low-fat diet, a long-term trial with Mediterranean diet was associated with an increase in circulating EPCs levels and prevention of the progression of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes.
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Our findings corroborate previous evidence indicating that HbA1c levels can be significantly reduced on both a ketogenic diet and a Mediterranean diet, especially if the diet is restricted in added sugars and refined carbohydrates.
“Our findings corroborate previous evidence indicating that HbA1c levels can be significantly reduced on both a ketogenic diet (35–38) and a Mediterranean diet (39–44), especially if the diet is restricted in added sugars and refined carbohydrates (2).”
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- Authors
- Maiorino, M. I., Bellastella, G., Petrizzo, M., Gicchino, M., Caputo, M., Giugliano, D., & Esposito, K.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Maiorino, Maria Ida
- ORCID
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-10-27
- Volume
- 24
- Issue
- 4
- Pages
- 399-408
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W2546207924
- Cited by
- 77
- References
- 25
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 6 · 2020: 5 · 2019: 16 · 2018: 13 · 2017: 5
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- Mediterranean diet, endothelial progenitor cells, carotid intima-media thickness, type 2 diabetes, low-fat diet, subclinical atherosclerosis, CD34+/KDR+ cells, CD133, atherosclerosis regression, newly diagnosed diabetes, cardiovascular risk factors
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Outcome Assessment, Health Care, Diet, Fat-Restricted, Diet, Mediterranean, Carotid Intima-Media Thickness, Endothelial Progenitor Cells
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