Findings from a recent publication in JAMA Network Open suggest that adoption of the Mediterranean diet (MED) may reduce the risk of developing type 2 diabetes.1
Over the course of this prospective cohort study, Ahmad and colleagues found that higher baseline Mediterranean diet intake among 25,317 healthy women was associated with a 30 percent relative risk reduction in type 2 diabetes.1 The mean age of the study participants was 52.9 years and the mean follow-up was 19.8 years. The authors attributed the decreased risk of diabetes to biomarkers of insulin resistance, body mass index (BMI), lipoprotein metabolism and inflammation. Of note, a subgroup analysis of BMI showed that the decreased incidence of type 2 diabetes was only associated with study participants who had a weight above normal (BMI greater than or equal to 25 kg/m2).1
The Mediterranean diet (rich in fruits, vegetables, legumes, nuts and seeds) uses olive oil as the predominant oil, and includes moderate amounts of fish and dairy products while limiting intake of red and processed meats and sweets.1 Previous studies have demonstrated promising results with respect to the potential benefits of the Mediterranean diet on diabetes, metabolism, inflammation and cardiovascular risk, yet little is known about the underlying biological pathways.2-5
In regard to the impact of nutrition and diet on diabetic ulcer healing, Armstrong and coworkers previously reported that the addition of an oral nutritional supplement, consisting of arginine, glutamine and β-hydroxy-β-methylbutyrate, improved ulcer healing in patients with poor limb perfusion and/or low albumin levels, but did not significantly impact patients without ischemia or those with normal albumin.6 However, a recent Cochrane review found minimal evidence that nutritional interventions improve diabetic foot ulcer healing.7 The Cochrane review included nine randomized controlled trials (RCT) with a total of 629 participants who met criteria for inclusion in the meta-analysis.7
Further studies are necessary to evaluate the impact of diet and nutrition on diabetes and ulcer healing. Understanding the mechanisms of disease progression is a step in the right direction. A better understanding of what, if any, dietary and nutritional recommendations to give patients at risk for diabetes and its complications may go a long way toward limb preservation.
Dr. Isaac is the Director of Research with Foot & Ankle Specialists of the Mid-Atlantic (FASMA). He is a Diplomate of the American Board of Foot and Ankle Surgery.
1. Ahmad S, Demler OV, Sun Q, et al. Association of the Mediterranean diet with onset of diabetes in the women’s health study. JAMA Netw Open. 2020;3(11):e2025466.
2. Babio N, Bulló M, Salas-Salvadó J. Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutr. 2009;12(9A):1607-1617.
3. Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015;69(11):1200-1208.
4. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299-1313.
5. Salas-Salvadó J, Bulló M, Estruch R, et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med. 2014;160(1):1-10.
6. Armstrong DG, Hanft JR, Driver VR, et al. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabet Med. 2014 Sep;31(9):1069-1077.
7. Moore ZE, Corcoran MA, Patton D. Nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Data System Rev. 2020;(7):CD011378.