Dietary antioxidant capacity is inversely associated with diabetes biomarkers: The ATTICA study
Introduction
According to the World Health Organization, approximately 150 million people have diabetes mellitus worldwide, and this number may double by the year 2025 due to population growth, ageing, unhealthy diet, obesity and sedentary lifestyle [1]. In Greece, based on previous reports from the ATTICA study, it has been reported that about 8% of men and 6% of women have diabetes mellitus [2], and these rates are increasing by 1.16% per year in men and by 1.06% in women [3]. Genetic and environmental factors combined contribute to the pathogenesis of diabetes, which in turn negatively affects the life expectancy and quality of life of diabetic people worldwide [4]. Nutritional parameters, together with obesity and specific anthropometric characteristics, as well as lifestyle, for example physical inactivity and smoking, have also been found to promote diabetes epidemics and contribute to diabetes health consequences [5], [6], [7], [8].
Recent research has suggested that oxidative stress is related to diabetes, although the exact impact of this association has still to be determined, as well as whether oxidative stress contributes directly, emerges as a concomitant event or is a consequence of diabetes sequelae [9]. It has been hypothesized that a diet characterized by a high antioxidant capacity could be inversely related to the development of diabetes. Total antioxidant capacity (TAC) measurement has been introduced, in order to capture the antioxidant activities of single dietary compounds altogether, as well as their potential synergistic and redox interactions [10], [11]. Total dietary antioxidant capacity has been found to be inversely related to markers of inflammation, such as high-sensitivity C reactive protein [12], suggesting that inflammation and oxidative stress are interrelated [13].
In this context, the aim of the present work was to evaluate the relationship between glycemic indices (i.e., glucose, insulin and insulin resistance) and dietary antioxidant intake, in apparently healthy adults as well as in adults with diabetes.
Section snippets
Study sample
The ATTICA epidemiological study [14] was carried out in the province of Attica (78% urban and 22% rural) in Greece from May 2001 to December 2002. During this time, 4056 inhabitants from Attica were randomly selected to enrol in the study and 3042 of them agreed to participate (75% participation rate). The volunteers had had no cold or flu, acute respiratory infection, dental problems or any type of surgery in the past week and had no history of cardiovascular disease. For the purposes of this
Results
The prevalence of IFG and diabetes was 24.9% and 6.2% in men, and 14.1% and 2.1% in women, respectively (p < 0.001 for gender comparisons). In Table 1, the main descriptive characteristics of the participants are demonstrated separately for non-diabetic, IFG and diabetic participants. As can be seen, diabetic participants are older than non-diabetic participants (i.e., normal and IFG), with a higher percentage of obesity, hyperlipidemia and hypertension. Reported dietary intake of fruits was
Discussion
The results of the present work suggest that higher total dietary antioxidant intake is correlated with lower levels of glycemic indices in healthy individuals, as well as in pre-diabetic and diabetic ones. However, this correlation persisted only in those who, although having a high antioxidant intake, scored low in the Mediterranean diet scale used, suggesting that those who exhibit an unhealthy dietary pattern could benefit from guidance to foods with antioxidant potential. Also, the
Conclusion
The findings of the present study support the hypothesis that dietary antioxidants are associated with improved glycemic biomarkers in healthy adults, as well as in diabetic patients. However, in order to state a robust cause and effect relationship, more data are needed from prospective studies. Despite these considerations, and based on the findings discussed above, dietary modification towards higher consumption of antioxidants could be implemented in public health strategies, in order to
Acknowledgments
The authors would like to thank all of the participants in the ATTICA study, and the field investigators: Dr John Skoumas, Dr Christina Chrysohoou, Dr Natasa Katinioti, Dr Spiros Vellas, Dr Efi Tsetsekou, Dr Constantina Massoura, Dr Lambros Papadimitriou, Dr Akis Zeimbekis, and Dr Ioanna Papaioannou, for the physical examination of the participants; the laboratory team: Dr Marina Toutouza, Dr Carmen Vasiliadou, Dr Manolis Economou, Ms Konstadina Tselika, Ms Sia Poulopoulou; the dieticians: Mr
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