title: A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease.
abstract: OBJECTIVE
  Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management.
  
  
  METHODS
  30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls.
  
  
  RESULTS
  Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 ± 0.8 vs 1.6 ± 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 ± 2.7 vs 7.9 ± 4 μmol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 ± 3.8% to 6.5 ± 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes.
  
  
  CONCLUSIONS
  Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. Clinical Trials registry number NCT00462436.
authors.affiliation: Supply Chain and Support Services, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: mkeith@gardencityfht.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Keith
authors.affiliation: Heart and Vascular Program, St. Michael's Hospital, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuliszewski
authors.affiliation: Heart and Vascular Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Liao
authors.affiliation: Supply Chain and Support Services, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Valentina
authors.initials: V
authors.lastname: Peeva
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Mavra
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Tran
authors.affiliation: Supply Chain and Support Services, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sorokin
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Jenkins
authors.affiliation: Heart and Vascular Program, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Errett
authors.affiliation: Heart and Vascular Program, St. Michael's Hospital, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Leong-Poi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications / Q000178:diet therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000178:diet therapy*; D018752:Diet, Fat-Restricted; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010349:Patient Compliance; D010865:Pilot Projects; D012307:Risk Factors; D030262:Soybean Proteins / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004041:Dietary Fats; D004043:Dietary Fiber; D030262:Soybean Proteins; D006710:Homocysteine
keywords: Cardiovascular risk; Diabetes; Dietary portfolio; Endothelial function; Endothelial progenitor cells; LDL cholesterol