Dietary antioxidant capacity is inversely associated with diabetes biomarkers: The ATTICA study

doi:10.1016/j.numecd.2009.11.005

Nutrition, Metabolism and Cardiovascular Diseases

Volume 21, Issue 8, August 2011, Pages 561-567

https://doi.org/10.1016/j.numecd.2009.11.005 Get rights and content

Abstract

Background and aims

Elevated dietary antioxidant activity has been regarded as providing potential benefits to health. The present work aimed at evaluating the association of glycemic indices with total dietary antioxidant capacity in healthy adults.

Methods and results

The ATTICA study consisted of men and women, randomly selected from all areas of Attica region in Greece. In this work, a random sub-sample from the ATTICA study's database was studied, consisting of 551 men (41 ± 11 years) and 467 women (38 ± 11 years), with complete nutritional and biochemical information. Dietary habits were evaluated using a validated food-frequency questionnaire. The dietary antioxidant capacity was based on published values for Italian foods measured by three different assays: ferric-reducing antioxidant power (FRAP), total radical-trapping antioxidant parameter (TRAP) and Trolox equivalent antioxidant capacity (TEAC). Inverse, age–energy adjusted correlations were observed between FRAP and log-glucose (r = −0.149, p = 0.001), log-insulin (r = −0.221, p = 0.001) and log-HOMA-IR (r = −0.186, p = 0.001) concentration, as well as with TRAP and TEAC. After controlling for age, gender, body mass index, physical activity status, smoking habits and energy intake, multi-adjusted analysis confirmed the previous relationships only among participants who were not on the Mediterranean dietary pattern.

Conclusions

Although more prospective studies are required, the data presented support the view that dietary modification towards higher consumption of antioxidants should be implemented in public health strategies, in order to better control glycemic markers in individuals, and prevent the development of diabetes at the population level.

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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Dietary antioxidant capacity is inversely associated with diabetes biomarkers: The ATTICA study

Abstract

Background and aims

Methods and results

Conclusions

Introduction

Section snippets

Study sample

Results

Discussion

Conclusion

Acknowledgments

Free Radic Biol Med

Am J Clin Nutr

Nutr Metab Cardiovasc Dis

Prev Med

J Nutr

Free Radic Biol Med

Anal Biochem

Biomed Pharmacother

Am J Clin Nutr

Global prevalence of diabetes: estimates for the year 2000 and projections for 2030

Diabetes Care

The epidemiology of type 2 diabetes mellitus in Greek adults: the ATTICA study

Diabet Med

Five-year incidence of type 2 diabetes mellitus among cardiovascular disease-free Greek adults: findings from the ATTICA study

Vasc Health Risk Manag

Finnish diabetes prevention study group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

N Engl J Med

Diabetes prevention program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

N Engl J Med

Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women

JAMA

Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men

Am J Epidemiol

Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort

J Intern Med

Oxidative stress, antioxidant status and DNA damage in patients with impaired glucose regulation and newly diagnosed type 2 diabetes

Clin Sci (Lond)

Total antioxidant capacity of the diet is inversely and independently related to plasma concentration of high-sensitivity C-reactive protein in adult Italian subjects

Br J Nutr

Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited

Arterioscler Thromb Vasc Biol