Ruth Blanco-Rojo1,2,3,4, Juan F Alcala-Diaz1,2,3,4, Suzan Wopereis5, Pablo Perez-Martinez1,2,3,4, Gracia M Quintana-Navarro1,2,3,4, Carmen Marin1,2,3,4, Jose M Ordovas6,7, Ben van Ommen5, Francisco Perez-Jimenez1,2,3,4, Javier Delgado-Lista1,2,3,4, Jose Lopez-Miranda8,9,10,11. 1. Lipids and Atherosclerosis Research Unit, Reina Sofia University Hospital, Avda Menendez Pidal, s/n, 14004, Cordoba, Spain. 2. Nutrigenomics and Metabolic Syndrome, Maimonides Institute for Biomedical Research at Cordoba (IMIBIC), Cordoba, Spain. 3. Department of Medicine, University of Cordoba, Cordoba, Spain. 4. CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN). 5. TNO, Zeist, the Netherlands. 6. Nutrition and Genomics Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. 7. IMDEA Food Institute, Madrid, Spain. 8. Lipids and Atherosclerosis Research Unit, Reina Sofia University Hospital, Avda Menendez Pidal, s/n, 14004, Cordoba, Spain. jlopezmir@uco.es. 9. Nutrigenomics and Metabolic Syndrome, Maimonides Institute for Biomedical Research at Cordoba (IMIBIC), Cordoba, Spain. jlopezmir@uco.es. 10. Department of Medicine, University of Cordoba, Cordoba, Spain. jlopezmir@uco.es. 11. CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), . jlopezmir@uco.es.
Abstract
AIMS/HYPOTHESIS: The aim of the study was to determine whether basal insulin resistance (IR) phenotype (muscle and/or liver) determines the effect of long-term consumption of a Mediterranean diet or a low-fat diet on tissue-specific IR and beta cell function. METHODS: The study was performed in 642 patients included in The effect of an olive oil rich Mediterranean dieton type 2 diabetes mellitus risk and incidence study (CORDIOPREV-DIAB). A total of 327 patients were randomised to a Mediterranean diet (35% fat; 22% from monounsaturated fatty acids) and 315 to a low-fat diet (<28% fat). At baseline, the patients were classified into four phenotypes according to the type of IR: (1) no IR; (2) muscle IR; (3) liver IR; (4) muscle + liver IR. The hepatic insulin resistance index (HIRI), muscular insulin sensitivity index (MISI) and disposition index were analysed at baseline and after 2 years of follow-up. RESULTS: At baseline, 322 patients presented no IR, 106 presented muscle IR, 109 presented liver IR, and 105 presented muscle + liver IR. With both dietary interventions, HIRI decreased in all patients (p < 0.001) and MISI increased in muscle IR and muscle + liver IR patients (p < 0.01). Long-term intake of the Mediterranean diet increased the disposition index and insulinogenic index in the muscle IR patients (p = 0.042 and p = 0.044, respectively) and the disposition index in the muscle + liver IR patients (p = 0.048), whereas the low-fat diet increased the disposition index in the liver IR patients (p = 0.017). CONCLUSIONS/ INTERPRETATION: Although both diets improve insulin sensitivity, there are differences based on basal IR phenotypes. Moreover, according to insulinogenic and disposition index data, a low-fat diet might be more beneficial to patients with liver IR, whereas patients with muscle IR and muscle + liver IR might benefit more from a Mediterranean diet. Trial registration ClinicalTrials.gov NCT00924937 FUNDING: The study was supported by the Ministerio de Economia y Competitividad (AGL2012/39615) and by the Ministerio de Ciencia e Innovacion (PIE14/00005 and PI13/00023).
RCT Entities:
AIMS/HYPOTHESIS: The aim of the study was to determine whether basal insulin resistance (IR) phenotype (muscle and/or liver) determines the effect of long-term consumption of a Mediterranean diet or a low-fat diet on tissue-specific IR and beta cell function. METHODS: The study was performed in 642 patients included in The effect of an olive oil rich Mediterranean diet on type 2 diabetes mellitus risk and incidence study (CORDIOPREV-DIAB). A total of 327 patients were randomised to a Mediterranean diet (35% fat; 22% from monounsaturated fatty acids) and 315 to a low-fat diet (<28% fat). At baseline, the patients were classified into four phenotypes according to the type of IR: (1) no IR; (2) muscle IR; (3) liver IR; (4) muscle + liver IR. The hepatic insulin resistance index (HIRI), muscular insulin sensitivity index (MISI) and disposition index were analysed at baseline and after 2 years of follow-up. RESULTS: At baseline, 322 patients presented no IR, 106 presented muscle IR, 109 presented liver IR, and 105 presented muscle + liver IR. With both dietary interventions, HIRI decreased in all patients (p < 0.001) and MISI increased in muscle IR and muscle + liver IR patients (p < 0.01). Long-term intake of the Mediterranean diet increased the disposition index and insulinogenic index in the muscle IR patients (p = 0.042 and p = 0.044, respectively) and the disposition index in the muscle + liver IR patients (p = 0.048), whereas the low-fat diet increased the disposition index in the liver IR patients (p = 0.017). CONCLUSIONS/ INTERPRETATION: Although both diets improve insulin sensitivity, there are differences based on basal IR phenotypes. Moreover, according to insulinogenic and disposition index data, a low-fat diet might be more beneficial to patients with liver IR, whereas patients with muscle IR and muscle + liver IR might benefit more from a Mediterranean diet. Trial registration ClinicalTrials.gov NCT00924937 FUNDING: The study was supported by the Ministerio de Economia y Competitividad (AGL2012/39615) and by the Ministerio de Ciencia e Innovacion (PIE14/00005 and PI13/00023).
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