Eat less fat, more fiber and vitamin C to reduce CVD risk in diabetes
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Adults newly diagnosed with type 2 diabetes had a lower long-term risk for cardiovascular disease if they had lower fat intake and higher intake of fiber and vitamin C, according to data published in Diabetic Medicine.
“This study emphasizes the importance of healthy vitamin C, fiber and fat intake, and the prevention of smoking in reducing CVD risk among people with type 2 diabetes,” Jean Strelitz, MSPH, PhD, a postdoctoral fellow in the MRC Epidemiology Unit at the University of Cambridge, United Kingdom, told Healio. “Additionally, these results support recommending those newly diagnosed with diabetes to reduce their fat intake, as this may mitigate effects of a high-fat diet on long-term CVD risk. This evidence may raise concern regarding low-carbohydrate diets in diabetes treatment, as these diets typically lead to increases in fat intake.”
Strelitz and colleagues analyzed data from 867 participants in ADDITION-Cambridge, a population-based program in which adults aged 40 to 69 years at high risk for undiagnosed diabetes were screened for type 2 diabetes. All participants in the analysis had screening-detected type 2 diabetes and were enrolled between 2002 and 2006. Data on smoking, alcohol use, physical activity, and fiber, total energy and fat intake were obtained through self-report. Plasma vitamin C was measure through fluorometric assay. Values of vitamin C, fiber and total energy intake and percentage of total energy from fat were grouped into quartiles. CVD outcomes were obtained from the date of type 2 diabetes diagnosis through Dec. 31, 2014. Non-fatal CVD events were identified from national registers, hospital and general practice records, and mortality data were obtained from the Office of National Statistics.
During the study period, participants experienced 126 CVD events, of which 31 were CVD deaths, 21 myocardial infarctions, 33 strokes, 40 revascularizations and one amputation.
Compared with those who never smoked, former smokers (HR = 1.61; 95% CI, 1.07-2.42) and current smokers (HR = 1.73; 95% CI, 1.04-2.87) had higher risks for CVD. Participants in the highest quartile of fat intake had a higher CVD risk compared with those in the lowest fat intake quartile (HR = 1.7; 95% CI, 1.02-2.85). People in the highest quartile for plasma vitamin C level had a lower risk for CVD compared with those in the lowest quartile (HR = 0.44; 95% CI, 0.22-0.87), and adults with the highest fiber intake had a lower CVD risk compared with those with the lowest fiber intake (HR = 0.6; 95% CI, 0.36-0.99).
Fat intake in the year following type 2 diabetes diagnosis modified associations with CVD. Among participants with the highest fat intake, a 6.48% increase in energy from fat was associated with a higher risk for CVD (HR = 4.2; 95% CI, 1.48-11.89), whereas a 6.48% decrease in energy from fat was not associated with CVD.
“Few studies have assessed long-term health impacts of changes in diet and other health behaviors following diabetes diagnosis, and further research is needed to support our results,” Strelitz said. “Future research incorporating data on the sources of fat intake are needed to inform dietary recommendations for people with diabetes.”
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