Mediterranean Diet, Retinopathy, Nephropathy, and Microvascular Diabetes Complications: A Post Hoc Analysis of a Randomized Trial
Open accessAbstract
OBJECTIVE: To date no clinical trials have evaluated the role of dietary patterns on the incidence of microvascular diabetes complications. We hypothesized that a nutritional intervention based on the Mediterranean diet (MedDiet) would have greater protective effect on diabetic retinopathy and nephropathy than a low-fat control diet. RESEARCH DESIGN AND METHODS: This was a post hoc analysis of a cohort of patients with type 2 diabetes participating in the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter randomized nutritional intervention trial conducted in a population at high cardiovascular risk. Individuals with type 2 diabetes who were free of microvascular complications at enrollment (n = 3,614, aged 55–80 years) were randomly assigned to one of three dietary interventions: MedDiet supplemented with extravirgin olive oil (MedDiet+EVOO), MedDiet supplemented with mixed nuts (MedDiet+Nuts), or a low-fat control diet. Two independent outcomes were considered: new onset of diabetic retinopathy and nephropathy. Hazard ratios (HRs) were calculated using multivariable-adjusted Cox regression. RESULTS: During a median follow-up of 6.0 years, we identified 74 new cases of retinopathy and 168 of nephropathy. Compared with the control diet, multivariable-adjusted HRs for diabetic retinopathy were 0.56 (95% CI 0.32–0.97) for the MedDiet+EVOO and 0.63 (0.35–1.11) for the MedDiet+Nuts. No between-group differences were found for nephropathy. When the yearly updated information on adherence to the MedDiet was considered, the HR for retinopathy in the highest versus the lowest quintile was 0.34 (0.13–0.89; P = 0.001 for trend). No significant associations were found for nephropathy. CONCLUSIONS: A MedDiet enriched with EVOO may protect against diabetic retinopathy but not diabetic nephropathy.
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Increased adherence to the Mediterranean diet has been associated with lower risk of developing diabetic retinopathy among patients with type 2 diabetes.
“Increased adherence to MD has been associated with lower risk of developing diabetic retinopathy (HR 0.34; 95% CI 0.13 to 0.89; p = 0.001 for trend) among 3614 patients with type 2 diabetes (aged 55–80 years) from the PREvención con DIeta MEDiterránea (PREDIMED) study [70].”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [70]
The benefits of Mediterranean diets were greater than low-fat diets in diabetic retinopathy, but no significant differences were found in diabetic nephropathy.
“In addition, a study has also found that the benefits of Mediterranean diets were greater than low-fat diets in diabetic retinopathy, but no significant differences were found in diabetic nephropathy (160).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [160]
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- Authors
- Díaz-López, A., Babio, N., Martínez-González, M. A., Corella, D., Amor, A. J., Fitó, M., Estruch, R., Arós, F., Gómez-Gracia, E., Fiol, M., Lapetra, J., Serra-Majem, L., Basora, J., Basterra-Gortari, F. J., Zanon-Moreno, V., Muñoz, M. Á., Salas-Salvadó, J., & the PREDIMED Study Investigators
- Affiliations
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Universitat de València (ES)
- Instituto de Salud Carlos III (ES)
- Andalusian Health Service (ES)
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-09-13
- Volume
- 38
- Issue
- 11
- Pages
- 2134-2141
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1657804332
- Cited by
- 147
- References
- 42
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 15 · 2023: 13 · 2022: 8 · 2021: 18 · 2020: 15 · 2019: 20 · 2018: 14 · 2017: 13 · 2016: 10 · 2014: 1
- FWCI
- 13.20
- Type
- journal article
- Language
- en
- Update notices
- correction (2018-10-01)
- Open access
- green
- hdl.handle.net
- Licence
- cc-by
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Rovira & Virgili repository (submittedVersion, cc-by)
- Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- Mediterranean diet, diabetic retinopathy, diabetic nephropathy, microvascular complications, type 2 diabetes, dietary intervention, mixed nuts, PREDIMED trial, dietary adherence
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Retinopathy, Female, Humans, Male, Middle Aged, Nuts, Risk Factors, Incidence, Diet, Mediterranean, Microvessels
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