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Lipids and Atherosclerosis Research Unit, University Hospital Reina Sofía (HURS), (J.A.P., A.G.S., E.S., I.R., P.P.-M., J.L.-M., F.P.-J.)
Ciber Fisiopatología Obesidad y Nutrición (CB06/03) Instituto Salud Carlos III (J.A.P., P.P.-M., J.L.-M., F.P.-J.)
University of Córdoba, School of Medicine (F.J.B., A.E.)
Biochemical Laboratory Service, HURS (M.J.M.), Cordoba, SPAIN
Departments of Clinical Biochemistry and Medicine, University of Cambridge Addenbrooke's Hospital, Cambridge (A.V.-P.), ENGLAND
Address correspondence to: Juan A. Paniagua González, MD, PhD, and F° Pérez Jiménez, MD, PhD, Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía. Avda Menéndez Pidal, s/n. 14004, Córdoba. SPAIN. E-mail: japaniaguag{at}yahoo.es and md1pejif{at}uco.e
Objective: To study the effects of three weight-maintenance diets with different macronutrient composition on carbohydrate, lipid metabolism, insulin and incretin levels in insulin-resistant subjects.
Methods: A prospective study was performed in eleven (7 W, 4 M) offspring of obese and type 2 diabetes patients. Subjects had a BMI > 25 Kg/m2, waist circumference (men/women) > 102/88, HBA1c < 6.5% and were regarded as insulin-resistant after an OGTT (Matsuda ISIm <4). They were randomly divided into three groups and underwent three dietary periods each of 28 days in a crossover design: a) diet high in saturated fat (SAT), b) diet rich in monounsaturated fat (MUFA; Mediterranean diet) and c) diet rich in carbohydrate (CHO).
Results: Body weight and resting energy expenditure did not changed during the three dietary periods. Fasting serum glucose concentrations fell during MUFA-rich and CHO-rich diets compared with high-SAT diets (5.02 ± 0.1, 5.03 ± 0.1, 5.50 ± 0.2 mmol/L, respectively. Anova < 0.05). The MUFA-rich diet improved insulin sensitivity, as indicated by lower homeostasis model analysis-insulin resistance (HOMA-ir), compared with CHO-rich and high-SAT diets (2.32 ± 0.3, 2.52 ± 0.4, 2.72 ± 0.4, respectively, Anova < 0.01). After a MUFA-rich and high-SAT breakfasts (443 kcal) the postprandial integrated area under curve (AUC) of glucose and insulin were lowered compared with isocaloric CHO-rich breakfast (7.8 ± 1.3, 5.84 ± 1.2, 11.9 ± 2.7 mmol · 180 min/L, Anova < 0.05; and 1004 ± 147, 1253 ± 140, 2667 ± 329 pmol · 180 min/L, Anova <0.01, respectively); while the integrated glucagon-like peptide-1 response increased with MUFA and SAT breakfasts compared with isocaloric CHO-rich meals (4.22 ± 0.7, 4.34 ± 1.1, 1.85 ± 1.1, respectively, Anova < 0.05). Fasting and postprandial HDL cholesterol concentrations rose with MUFA-rich diets, and the AUCs of triacylglycerol fell with the CHO-rich diet. Similarly fasting proinsulin (PI) concentration fell, while stimulated ratio PI/I was not changed by MUFA-rich diet.
Conclusions: Weight maintenance with a MUFA-rich diet improves HOMA-ir and fasting proinsulin levels in insulin-resistant subjects. Ingestion of a virgin olive oil-based breakfast decreased postprandial glucose and insulin concentrations, and increased HDL-C and GLP-1 concentrations as compared with CHO-rich diet.
Key words: Mediterranean diet, insulin resistance, glucose metabolism, GLP-1, proinsulin
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  M A Martinez-Gonzalez, C d. l. Fuente-Arrillaga, J M Nunez-Cordoba, F J Basterra-Gortari, J J Beunza, Z Vazquez, S Benito, A Tortosa, and M Bes-Rastrollo Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study BMJ, June 14, 2008; 336(7657): 1348 - 1351. [Abstract] [Full Text] [PDF]
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