Association of differing dietary, metabolic, and clinical risk factors with macrovascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. I.

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.