Evaluation of the relationship between nutrition and the risk of fatal outcomes from cardiovascular diseases in people with type 2 diabetes

Aim. To evaluate the relationship between nutrition and the risk of fatal outcomes from cardiovascular diseases in individuals with type 2 diabetes mellitus (T2DM).

Materials and methods. The baseline study was conducted within the HAPIEE project in 2002–2005. The followup period for the observed cohort, including individuals with T2DM, lasted from 2003–2005 to December 31, 2018 and reached on average 12.8 years (1.1 ± 16.0 years). Within the study, 2 groups were formed: the treatment group which included persons with T2DM who “developed fatal events” and the control group which encompassed individuals with T2DM who “did not develop fatal events” during the follow-up. The treatment group included 207 people (107 men, 100 women), the average age for both sexes was 62.4 ± 5.9 years; the control group consisted of 474 people (177 men, 297 women), the average age for both sexes was 58.1 ± 6.6 years. The data on actual nutrition were obtained from a survey of the participants using the Food Frequency Questionnaire and included information on consumption of 147 foods. Statistical processing of the data was carried out using the SPSS 13.0 software package. The data were presented as M ± SD, where M is the arithmetic mean and SD is the standard deviation. An analysis of the association between nutrition and the risk of death from cardiovascular diseases was performed using the Cox regression model. The differences were considered statistically significant at p < 0.05.

Results. In the studied sample, we identified a significant relationship between the consumption of a number of foods and the risk of death from cardiovascular diseases in people with T2DM over a 15-year follow-up. It was shown that increased consumption of fruits (by 80 g / day) and nuts (by 2 g / day) was significantly associated with a decreased risk of death in men: hazard ratio (HR) = 0.726, p = 0.044 and HR = 0.826, p = 0.011, respectively. Increased consumption of eggs in men (by 50 g / day) was associated with an increased risk of death: HR = 1.728, p = 0.003. In women, a decreased risk of death was observed only with the consumption of meat products: HR = 0.786, p = 0.036.

Conclusion. The results of the study showed a clear relationship between the consumption of a number of foods and the risk of death from cardiovascular diseases. Thus, increased consumption of fruits, nuts, and meat products was significantly associated with a decreased risk of death from cardiovascular diseases in people with T2DM, while the consumption of eggs and dairy products, on the contrary, was associated with an increased risk of mortality. These data indicate the importance of dietary control in individuals with carbohydrate metabolism disorders.

1. Дедов И.И., Шестакова М.В., Викулова О.К., Исаков М.А, Железнякова А.В. Атлас регистра сахарного диабета Российской Федерации. Статус 2018 г. Сахарный диабет. 2019;22(S2-2):4–61. DOI: 10.15829/1560-4071-2020-3822.

2. Асфандиярова Н.С. Смертность при сахарном диабете 2 типа. Сахарный диабет. 2015;18(4):12–21. DOI: 10.14341/DM7186.

3. Рымар О.Д., Щербакова Л.В., Щетинина А.О., Мустафина С.В., Симонова Г.И., Рагино Ю.И. и др. Базовые клинико-лабораторные показатели при сахарном диабете 2 типа и риск сердечно-сосудистой смерти. Российский кардиологический журнал. 2020;25(4):46–53. DOI: 0.15829/1560-4071-2020-3822.

4. Mirmiran P., Bahadoran Z, Azizi F. Functional foods-based diet as a novel dietary approach for management of type 2 diabetes and its complications: A review. World J. Diabetes. 2014;5(3):267–281. DOI: 10.4239/wjd.v5.i3.267.

5. Алгоритмы специализированной медицинской помощи больным сахарным диабетом; под редакцией И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова (9-й выпуск). Сахарный диабет. 2019;22(1,спецвып.):1–112. DOI: 10.14341/DM221S1.

6. Кунцевич А.К., Мустафина С.В., Малютина С.К., Веревкин Е.Г., Рымар О.Д. Популяционное исследование питания городского населения при сахарном диабете 2 типа. Сахарный диабет. 2015;18(4):59–65. DOI: 10.14341/DM7174.

7. Peasey A., Bobak M., Kubinova R., Malyutina S., Pajak A., Tamosiunas A. et al. Determinants of cardiovascular disease and other non-communicable of diseases in Central and Eastern Europe: Rational and design of the HAPIEE Study. BMC Public Health. 2006;6:255. DOI: 10.1186/1471-2458-6-255.

8. Brunner E., Stallone D., Juneja M., Bingham S., Marmot M. Dietary assessment in Whitehall II: comparison of 7 d diet diary and food frequency questionnaire and validity against biomarkers. Br. J. Nutr. 2001;86(3):405–414. DOI: 10.1079/bjn2001414.

9. Boylan S., Welch A., Pikhart H., Malyutina S., Pajak A., Kubinova R. et al. Dietary habits in three Central and Eastern European countries: the HAPIEE study. BMC Public Health. 2009;9:439. DOI: 10.1186/1471-2458-9-439.

10. Nothlings U., Schulze M.B.,Weikert C., Boeing H., van der Schouw Y.T., Bamia C. et al. Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a european diabetic population. Journal of Nutrition. 2008;138(4):775–781. DOI:10.1093/jn/138.4.775.

11. Liu G., Guasch-Ferré M., Hu Y., Li Y., Hu F.B., Rimm E.B. et al. Nut consumption in relation to cardiovascular disease incidence and mortality among patients with diabetes mellitus. Circulation Research. 2019;124(6):920–929. DOI: 10.1161/CIRCRESAHA.118.314316.

12. Kris-Etherton P.M., Hu F.B., Ros E., Sabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: Multiple potential mechanisms. Journal of Nutrition. 2008;138(9):1746S–1751S. DOI:с10.1093/jn/138.9.1746S.

13. Aune D., Giovannucci E., Boffetta P., Fadnes L.T., Keum N., Norat T. et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality – a systematic review and dose-response meta-analysis of prospective studies. Ins. J. Epidemiol. 2017;46(3):1029–1056. DOI:10.1093/ije/dyw319.

14. Kwok C.S., Gulati M., Erin D., Michos E.D., Jessica Potts J., Wu P. et al. Dietary components and risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses. European Journal of Preventive Cardiology. 2019;26(13):1415–1429. DOI: 10.1177/2047487319843667.

15. Aune D., Keum N., Giovannucei E., Fadnes L.T., Boffetta P., Greenwood D.C. et al. Nut consumption and risk of cardiovascular disease, total cancer, all-cause and causespecific mortality: a systematic review and dose-response meta-analysis of prospective studies. BMC Med. 2016;14(1):207. DOI: 10.1186/s12916-016-0730-3.

16. Rohrmann S., Overvad K., Bueno-de-Mesquita H.B., Jakobsen M.U., Egeberg R., Tjonneland A. et al. Meat consumption and mortality – results from the European prospective investigation into cancer and nutrition. BMC Medicine. 2013;11:63. DOI: 10.1186/1741-7015-11-63.

17. Etermadi A., Sinha R., Ward M.H., Graubard B.I., InoueChoi M., Dawsey S.M. et al. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ. 2017;357:j1957. DOI: 10.1136/bmj.j1957.

18. Virtanen H.E.K., Voutilainen S., Koskinen T.T., Mursu J., Kokko P., Ylilauri M.P.T. et al. Dietary proneins and protein sources and risk of death: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am. J. Clin. Nutr. 2019;109(5):1462–1471. DOI: 10.1093/ajcn/nqz025.

19. Budhathoki S., Sawada N., Iwasaki M., Yamaji T., Goto A., Kotemori A. et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort S. JAMA Intern. Med. 2019;179(11):1509–1518. DOI: 10.1001/jamainternmed.2019.2806.

20. Djousse L., Gaziano J.M. Egg Consumption and Cardiovascular Disease and Mortality The Physicians’ Health Study. Am. J. Clin. Nutr. 2008;87(4):964–969. DOI: 10.1093/AJCN/87.4.964.

21. Zhong V.W., Horn L.V., Cornelis M.C., Wilkins J.T., Ning H. et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–1095. DOI: 10.1001/jama.2019.1572.