title: Effect of lowering the glycemic load with canola oil on glycemic control and cardiovascular risk factors: a randomized controlled trial.
abstract: OBJECTIVE
  Despite their independent cardiovascular disease (CVD) advantages, effects of α-linolenic acid (ALA), monounsaturated fatty acid (MUFA), and low-glycemic-load (GL) diets have not been assessed in combination. We therefore determined the combined effect of ALA, MUFA, and low GL on glycemic control and CVD risk factors in type 2 diabetes.
  
  
  METHODS
  The study was a parallel design, randomized trial wherein each 3-month treatment was conducted in a Canadian academic center between March 2011 and September 2012 and involved 141 participants with type 2 diabetes (HbA1c 6.5%-8.5% [48-69 mmol/mol]) treated with oral antihyperglycemic agents. Participants were provided with dietary advice on either a low-GL diet with ALA and MUFA given as a canola oil-enriched bread supplement (31 g canola oil per 2,000 kcal) (test) or a whole-grain diet with a whole-wheat bread supplement (control). The primary outcome was HbA1c change. Secondary outcomes included calculated Framingham CVD risk score and reactive hyperemia index (RHI) ratio.
  
  
  RESULTS
  Seventy-nine percent of the test group and 90% of the control group completed the trial. The test diet reduction in HbA1c units of -0.47% (-5.15 mmol/mol) (95% CI -0.54% to -0.40% [-5.92 to -4.38 mmol/mol]) was greater than that for the control diet (-0.31% [-3.44 mmol/mol] [95% CI -0.38% to -0.25% (-4.17 to -2.71 mmol/mol)], P = 0.002), with the greatest benefit observed in those with higher systolic blood pressure (SBP). Greater reductions were seen in CVD risk score for the test diet, whereas the RHI ratio increased for the control diet.
  
  
  CONCLUSIONS
  A canola oil-enriched low-GL diet improved glycemic control in type 2 diabetes, particularly in participants with raised SBP, whereas whole grains improved vascular reactivity.
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaDivision of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, CanadaLi Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada nutritionproject@smh.ca.
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaLi Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vuksan
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Faulkner
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Livia S A
authors.initials: LS
authors.lastname: Augustin
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mitchell
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ireland
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaMedical School, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Korbua
authors.initials: K
authors.lastname: Srichaikul
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaSchool of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
authors.forename: Arash
authors.initials: A
authors.lastname: Mirrahimi
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Chiavaroli
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Blanco Mejia
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nishi
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Sahye-Pudaruth
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Darshna
authors.initials: D
authors.lastname: Patel
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Balachandran
authors.initials: B
authors.lastname: Bashyam
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Vidgen
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaDepartment of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: de Souza
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaLi Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, CanadaDepartment of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: John L
authors.initials: JL
authors.lastname: Sievenpiper
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Coveney
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaDivision of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, CanadaLi Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaClinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, CanadaDivision of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, CanadaLi Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D001794:Blood Pressure / Q000502:physiology; D002170:Canada; D002318:Cardiovascular Diseases / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D004032:Diet; D002523:Edible Grain; D002149:Energy Intake; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000074262:Rapeseed Oil; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D005229:Fatty Acids, Monounsaturated; D007004:Hypoglycemic Agents; D000074262:Rapeseed Oil