An Okinawan-based Nordic diet improves anthropometry, metabolic control, and health-related quality of life in Scandinavian patients with type 2 diabetes: a pilot trial.
BACKGROUND
Our hypothesis was that a modified diet would improve blood glucose control with beneficial impact on weight management and overall health in established diabetes.


OBJECTIVE
This prospective interventional study investigated the clinical effect of an Okinawan-based Nordic diet on anthropometry, metabolic control, and health-related quality of life (HRQoL) in Scandinavian type 2 diabetes patients.


METHODS
Food was prepared and delivered to 30 type 2 diabetes patients. Clinical information along with data on HRQoL, blood samples, and urine samples were collected during 12 weeks of diet interventions, with follow-up 16 weeks after diet completion.


RESULTS
After 12 weeks of dietary intervention, a reduction in body weight (7%) (p<0.001), body mass index (p<0.001), and waist circumference (7.0 cm) (p<0.001) was seen. Improved levels of proinsulin (p=0.005), insulin (p=0.011), and fasting plasma glucose (p<0.001) were found already after 2 weeks; these improved levels remained after 12 weeks when lowered levels of C-peptide (p=0.015), triglycerides (p=0.009), total cholesterol (p=0.001), and low-density lipoprotein-cholesterol (p=0.041) were also observed. Insulin resistance homeostasis model assessment for insulin resistance was lowered throughout the study, with a 20% reduction in hemoglobin A1c levels (p<0.001) at week 12, despite reduced anti-diabetes treatment. Lowered systolic blood pressure (9.6 mmHg) (p<0.001), diastolic blood pressure (2.7 mmHg) (p<0.001), and heart and respiratory rates (p<0.001) were accompanied by decreased cortisol levels (p=0.015) and improvement in HRQoL. At follow-up, increased levels of high-density lipoprotein-cholesterol were found (p=0.003).


CONCLUSIONS
This interventional study demonstrates a considerable improvement of anthropometric and metabolic parameters and HRQoL in Scandinavian type 2 diabetes patients when introducing a modified Okinawan-based Nordic diet, independently of exercise or other interventions. Through these dietary changes, anti-diabetes treatment could be decreased or cancelled.
Department of Clinical Sciences, Division of Internal Medicine, Lund University, Lund, Sweden.|Skåne University Hospital, Malmö, Sweden; ghassan.darwiche@med.lu.se.
Gassan
G
Darwiche
Department of Laboratory Medicine, Division of Clinical Chemistry & Pharmacology, Lund University, Lund, Sweden.|Skåne University Hospital, Lund, Sweden.
Peter
P
Höglund
Department of Clinical Sciences, Division of Internal Medicine, Lund University, Lund, Sweden.|Skåne University Hospital, Malmö, Sweden.
Bodil
B
Roth
Skåne University Hospital, Lund, Sweden.|Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden.
Ewa
E
Larsson
Skåne University Hospital, Lund, Sweden.|Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden.
Trygve
T
Sjöberg
Skåne University Hospital, Lund, Sweden.|Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden.
Björn
B
Wohlfart
Skåne University Hospital, Lund, Sweden.|Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden.
Stig
S
Steen
Department of Clinical Sciences, Division of Internal Medicine, Lund University, Lund, Sweden.|Skåne University Hospital, Malmö, Sweden.
Bodil
B
Ohlsson
Nordic diet; Okinawan diet; anthropometry; interventional study; metabolic control; quality of life; type 2 diabetes
J Am Coll Nutr. 2010 Aug;29(4):365-72
21041811
Pediatrics. 1995 Nov;96(5 Pt 2):1010-4
7494672
J Intern Med. 2011 Feb;269(2):150-9
20964740
Diabetologia. 2006 Feb;49(2):289-97
16391903
Diabetes Care. 2008 Jan;31 Suppl 1:S61-78
18165339
Ann N Y Acad Sci. 2002 Jun;966:290-303
12114286
J Nutr. 2009 Mar;139(3):576-81
19158230
Diabetes Care. 2003 Aug;26(8):2261-7
12882846
Nutr Res. 2016 Apr;36(4):359-68
27001281
Am J Clin Nutr. 2008 Oct;88(4):1119-25
18842802
Neuroendocrinology. 2008;87(4):193-205
18285679
Mech Ageing Dev. 2014 Mar-Apr;136-137:148-62
24462788
Diabetes Care. 1998 Dec;21(12):2191-2
9839117
Asia Pac J Clin Nutr. 2001;10(2):165-71
11710359
Am J Clin Nutr. 2000 Apr;71(4):921-30
10731498
Ann Intern Med. 1995 Apr 1;122(7):481-6
7872581
Diabetes Care. 1997 Aug;20(8):1252-5
9250449
J Cell Mol Med. 2012 Apr;16(4):927-35
21707916
Am J Clin Nutr. 2009 Sep;90(3):664-71
19625685
Diabetes Care. 2011 Jul;34(7):1481-6
21593294
Br J Nutr. 2013 Jul 28;110(2):384-90
23181989
Obes Res. 1998 Sep;6 Suppl 2:51S-209S
9813653
Diab Vasc Dis Res. 2014 May;11(3):133-73
24800783
Health Econ. 1993 Oct;2(3):217-27
8275167
Eur J Cancer Prev. 2001 Dec;10(6):489-99
11916347
Nat Rev Endocrinol. 2009 Jul;5(7):374-81
19488073
Arterioscler Thromb Vasc Biol. 2004 Mar;24(3):540-5
14707040
BMJ. 2002 Jun 15;324(7351):1417
12065262
Nutrients. 2010 Dec;2(12):1266-89
22254008
Diabetes. 2010 Sep;59(9):2160-3
20547981
Aust N Z J Public Health. 2013 Aug;37(4):345-9
23895477
J Am Coll Nutr. 2009 Aug;28 Suppl:500S-516S
20234038
Curr Opin Cardiol. 1996 Sep;11(5):490-5
8889375
Am J Clin Nutr. 2008 Mar;87(3):627-37
18326601
Lancet. 2014 Jun 7;383(9933):1999-2007
24910231
Diabet Med. 2004 Oct;21(10):1149-53
15384965
Lancet. 2004 Sep 11-17;364(9438):937-52
15364185
Am J Clin Nutr. 2010 Apr;91(4):913-22
20147467
J Intern Med. 1996 Jun;239(6):489-97
8656142
J Clin Endocrinol Metab. 2002 Aug;87(8):3984-8
12161547
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
Med Hypotheses. 1994 May;42(5):307-12
7935072
J Am Coll Cardiol. 2008 Jan 22;51(3):249-55
18206731
Obes Rev. 2001 Aug;2(3):173-82
12120102
Physiol Behav. 1999 Aug;67(2):299-306
10477062
J Nutr. 2008 Apr;138(4):732-9
18356328
Ann N Y Acad Sci. 2007 Oct;1114:434-55
17986602
J Am Diet Assoc. 2004 Oct;104(10):1570-6
15389416
Gut. 1995 Jun;36(6):825-30
7615267