title: Adherence to Mediterranean diet and 10-year incidence (2002-2012) of diabetes: correlations with inflammatory and oxidative stress biomarkers in the ATTICA cohort study.
abstract: BACKGROUND
  The purpose of this work was to investigate the links between oxidative stress, inflammation and coagulation and their effect on Mediterranean diet-diabetes relationship.
  
  
  METHODS
  In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study, where Athens is the major metropolis. A validated questionnaire was used to assess lifestyle and dietary factors. Adherence to Mediterranean diet was recorded using MedDietScore. Among others, oxidative stress and inflammatory biomarkers were recorded. During 2011-2012, the 10-year follow-up was performed. Diabetes incidence was defined according to the American Diabetes Association criteria.
  
  
  RESULTS
  A total of 191 incident cases of diabetes were documented, yielding an incidence of 12.9% (13.4% in men and 12.4% in women). Medium and high adherence was found to decrease diabetes risk by 49% (95% CI: 0.30, 0.88) and 62% (95% CI: 0.16, 0.88), respectively, compared with low adherence. A logarithmic trend between Mediterranean diet and diabetes incidence was also revealed (p for trend = 0.042). Individuals with abnormal waist circumference (>94 for men, >80 for women) were benefited the most. Wholegrain cereals, fruits and legumes had the greatest predictive ability. The anti-diabetic effect of Mediterranean diet correlated with measurements of tumour necrosis factor-α, homocysteine and total antioxidant capacity.
  
  
  CONCLUSIONS
  The reported results support the role of Mediterranean diet as a promising dietary tool for the primary prevention of diabetes, by attenuating inflammation and fostering total antioxidant capacity. This dietary pattern may have therapeutic potential for many cardiometabolic disorders associated with inflammation and/or oxidative stress.
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Koloverou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: D B
authors.initials: DB
authors.lastname: Panagiotakos
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Pitsavos
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: E N
authors.initials: EN
authors.lastname: Georgousopoulou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Grekas
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Christou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Chatzigeorgiou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Skoumas
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D018384:Oxidative Stress; D010349:Patient Compliance; D011446:Prospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Mediterranean diet; cohort study; inflammation; oxidative stress; risk; type 2 diabetes