title: Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study.
abstract: This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I diabetes (TID).
  
  
  
  Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity.
  
  
  
  In cross-sectional analyses using baseline data, for individuals with the hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl lower total cholesterol (TC) (P=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (P=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C) (P=0.004) and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dl lower TC (P=0.05), 1.6 mg/dl lower LDL-C (P=0.03) and 1.8 mg/dl lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity.
  
  
  
  Mediterranean diet may improve glycemic control and cardiovascular health in TID youth.
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: V W
authors.initials: VW
authors.lastname: Zhong
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Lamichhane
authors.affiliation: School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Crandell
authors.affiliation: Department of Nutritional Sciences, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Couch
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Liese
authors.affiliation: Department of Health Sciences, Furman University, Greenville, SC, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: The
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Tzeel
authors.affiliation: Department of Epidemiology, University of Colorado, Denver, CO, USA.
authors.forename: D
authors.initials: D
authors.lastname: Dabelea
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Lawrence
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Marcovina
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Kim
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.|Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayer-Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D009765:Obesity; D010349:Patient Compliance; D012307:Risk Factors; D044465:White People; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D008055:Lipids; D008074:Lipoproteins