title: A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: the Sysdimet study.
abstract: OBJECTIVE
  Low-grade inflammation and endothelial dysfunction may play a role in the pathogenesis of type 2 diabetes and cardiovascular disease. We evaluated whether a diet high in fatty fish, bilberries and wholegrain products (Healthy Diet) improves biomarkers reflecting inflammation and endothelial dysfunction in individuals with impaired glucose metabolism.
  
  
  METHODS
  We recruited individuals with impaired glucose metabolism and features of the metabolic syndrome into a 12 week, parallel design, dietary intervention trial conducted at the Department of Clinical Nutrition, University of Eastern Finland (Kuopio, Finland). Randomisation was performed by matching according to sex and medians of age, BMI and fasting plasma glucose of the study population at screening. The primary endpoint in the present study was the change in plasma inflammatory markers and the measurements were performed blinded to group assignment. High-sensitivity (hs) C-reactive protein (CRP) and E-selectin responses were also analysed separately in participants not using statins (n = 76).
  
  
  RESULTS
  Altogether, 131 individuals were assigned to either the Healthy Diet (n = 44), a whole-grain-enriched diet (WGED) (n = 42) or a control (n = 45) diet, and 104 participants (mean ± SD: age 59 ± 7 years; BMI 31.1 ± 3.5 kg/m(2)) who had completed the study, were analysed (Healthy Diet n = 36, WGED n = 34 and control diet n = 34). Plasma E-selectin decreased only in the Healthy Diet group. This occurred in all group participants (p < 0.05) and also after excluding participants using statins (p < 0.05). Plasma hsCRP levels decreased in the Healthy Diet (median -17%, p < 0.05) and WGED (median -27%, p < 0.01) groups in participants not using statins. Controlling for confounding factors, including BMI or insulin sensitivity, did not alter the results. A greater increase in plasma concentration of very-long-chain n-3 fatty acids and in the intake of fibre during the study was associated with a greater decrease in plasma E-selectin (p < 0.05). The intake of test breads consumed during the Healthy Diet and WGED interventions was inversely associated with the change in hsCRP levels (p < 0.001).
  
  
  CONCLUSIONS
  Our results suggest that the combined effect of fatty fish, bilberries and wholegrain products may improve endothelial dysfunction and inflammation in overweight and obese individuals at high risk of developing diabetes.
authors.affiliation: Department of Clinical Nutrition/Food and Health Research Centre, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, FIN-70211 Kuopio, Finland. Vanessa.Laaksonen@uef.fi
authors.forename: V D F
authors.initials: VD
authors.lastname: de Mello
authors.forename: U
authors.initials: U
authors.lastname: Schwab
authors.forename: M
authors.initials: M
authors.lastname: Kolehmainen
authors.forename: W
authors.initials: W
authors.lastname: Koenig
authors.forename: M
authors.initials: M
authors.lastname: Siloaho
authors.forename: K
authors.initials: K
authors.lastname: Poutanen
authors.forename: H
authors.initials: H
authors.lastname: Mykkänen
authors.forename: M
authors.initials: M
authors.lastname: Uusitupa
mesh_terms: D000368:Aged; D000818:Animals; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D004043:Dietary Fiber / Q000008:administration & dosage / Q000032:analysis; D019040:E-Selectin / Q000097:blood; D002523:Edible Grain / Q000737:chemistry; D004730:Endothelium, Vascular / Q000276:immunology / Q000503:physiopathology*; D015525:Fatty Acids, Omega-3 / Q000032:analysis / Q000627:therapeutic use*; D005260:Female; D005387:Finland; D005399:Fishes; D005638:Fruit; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000178:diet therapy* / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000178:diet therapy / Q000276:immunology / Q000503:physiopathology; D008875:Middle Aged; D017747:Seafood / Q000032:analysis; D029800:Vaccinium myrtillus
chemical_list: D015415:Biomarkers; D004043:Dietary Fiber; D019040:E-Selectin; D015525:Fatty Acids, Omega-3; C546936:SELE protein, human; D002097:C-Reactive Protein