A Mediterranean-style eating pattern can also prevent diabetes outside the Mediterranean setting

Those who live and eat the Mediterranean way have a lower risk to develop type 2 diabetes and coronary heart disease. A Mediterranean diet is thus recommended as preventative measure in the US. However, will a Mediterranean-style eating pattern without the famous Mediterranean lifestyle have the same positive effects? The ARIC (Atherosclerosis Risk in Communities) study examined this question and found an inverse relation between the Mediterranean-style eating pattern scores and the risk of type 2 diabetes.

A Mediterranean-style eating pattern (Mediterranean pattern) is one of the eating patterns recommended by the American Heart Association, American College of Cardiology, and the Dietary Guidelines for Americans to reduce chronic disease risk. While there are cultural variations in the foods and beverages included in a Mediterranean pattern, overall, it is largely plant-based, relatively high in olive oil and seafood, but low in dairy, red meat, and refined grains.

However, it is unclear, if a Mediterranean pattern, independent of a Mediterranean lifestyle, can reduce diabetes risk in US adult populations. Mediterranean and European populations tend to be less racially and ethnically heterogeneous, have lower body mass indexes (BMI), be less sedentary, have larger social networks, and place a greater emphasis on rest and sleep compared to the general U.S. population. In Mediterranean and other European settings, adherence to a Mediterranean pattern is consistently associated with a reduced risk of diabetes. The authors of the ARIC study explored whether potential benefits of a Mediterranean pattern are translatable to heterogeneous populations which place less emphasis on ideologies and behaviors of Mediterranean-like cultures. In this prospective study, they investigated the association of a Mediterranean eating pattern and the diabetes risk among 12,000 participants during a follow-up of 22 years.

They used alternate Mediterranean Diet (aMed) scores to assess Mediterranean pattern adherence of the study participants. The aMed scoring system assigns 1 point for above the study group’s average intake of total vegetables, total fruit, whole grains, nuts, legumes, fish, and ratio of monounsaturated fatty acids to saturated fatty acids (MUFA:SFA). The moderate intake of alcoholic beverages (5–15 g/day for females and 10–25 g/day for males) also receives 1 point. Scores range from 0 to 9 points and higher scores presume higher adherence to a Mediterranean pattern.

The results showed that higher Mediterranean-style eating pattern scores were associated with a significantly reduced risk of type 2 diabetes. When the researchers examined which food factors were related to a reduced diabetes risk, they found that besides fish, vegetables and fruit, a higher nut and legume intake (8% respectively) and moderate consumption of alcoholic beverages (17%) were the main drivers of the reduced diabetes risk.

An eating pattern high in fruits, vegetables, wholegrains, legumes, nuts, and fish, and moderate in alcoholic beverages, similar to the Mediterranean-style eating pattern assessed in this analysis, was associated with an overall lower risk of diabetes in a community-based U.S. population.

O’Connor LE et al , 2020, Adherence to a Mediterranean-style eating pattern and risk of diabetes in a US prospective cohort study, Nutrition & Diabetes, 10:8; https://doi.org/10.1038/s41387-020-0113-x

For more information about this article, read the scientific abstract here.