Association of adherence to a mediterranean diet with glycemic control and cardiovascular risk factors in youth with type i diabetes: the search nutrition ancillary study

ABSTRACT BACKGROUND/OBJECTIVES: This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I

diabetes (TID). SUBJECTS/METHODS: Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (_N_=793), 1-year (_N_=512) and

5-year follow-up visits (_N_=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to

determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity. RESULTS: In cross-sectional analyses using baseline data, for individuals with the

hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (_P_=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl

lower total cholesterol (TC) (_P_=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (_P_=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C)

(_P_=0.004) and 0.07 lower LDL-C/HDL-C ratio (_P_=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (_P_=0.07), 1.8 mg/dl lower

TC (_P_=0.05), 1.6 mg/dl lower LDL-C (_P_=0.03) and 1.8 mg/dl lower non-HDL-C (_P_=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both

cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses

(_P_=0.009). Mediterranean diet was not associated with obesity. CONCLUSIONS: Mediterranean diet may improve glycemic control and cardiovascular health in TID youth. Access through your

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supported by research grants from the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK077949), CDC (PA Numbers 00097, DP-05-069 and DP-10-001) and NIH (DK056350)

and was also supported by the Sanofi Global Scholars Program (to VWZ). AUTHOR CONTRIBUTIONS VWZ, APL and EJM-D designed research; VWZ and APL conducted research; VWZ and JLC analyzed data;

VWZ wrote the paper; and EJM-D had primary responsibility for final content. All authors read and approved the final manuscript and contributed to the revision of the manuscript critically

for important intellectual content. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA V W Zhong, A P Lamichhane, B A

Tzeel & E J Mayer-Davis * School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA J L Crandell * Department of Nutritional Sciences,

University of Cincinnati, Cincinnati, OH, USA S C Couch * Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA A D Liese * Department of Health

Sciences, Furman University, Greenville, SC, USA N S The * Department of Epidemiology, University of Colorado, Denver, CO, USA D Dabelea * Department of Research and Evaluation, Kaiser

Permanente Southern California, Pasadena, CA, USA J M Lawrence * Department of Medicine, University of Washington, Seattle, WA, USA S M Marcovina * Seattle Children's Hospital, Seattle,

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1 (DOC 40 KB) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Zhong, V., Lamichhane, A., Crandell, J. _et al._ Association of adherence to a

Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study. _Eur J Clin Nutr_ 70, 802–807 (2016).

https://doi.org/10.1038/ejcn.2016.8 Download citation * Received: 03 August 2015 * Revised: 20 December 2015 * Accepted: 17 January 2016 * Published: 24 February 2016 * Issue Date: July 2016

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