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Science, Technology and Medicine open access publisher.Publish, read and share novel research. Nutritional Therapy in Diabetes: Mediterranean DietPablo Perez-Martinez1, Antonio Garcia-Rios1, Javier Delgado-Lista1, Francisco Perez-Jimenez 1 and Jose Lopez-Miranda1[1] Department of Medicine, IMIBIC, Hospital Universitario Reina Sofia,Universidad de Cordoba and CIBEROBN Instituto de Salud Carlos III, Madrid, Spain1. In the metabolism of those who are not diabetic, sufficient insulin is released to metabolize the glucose. In type 1 diabetes, the body hardly produces insulin and is dependent on the supply of insulin through injections or pumps.
The short acting insulin acts like phase 1 insulin and the long acting insulin like phase 2 insulin. If there is sufficient gap between two meals, the body gets some time to process the blood glucose levels.
About Speaking of DiabetesSpeaking of Diabetes is produced by Joslin Diabetes Center for people with diabetes and those who care for them.. Joslin Diabetes Center, a teaching and research affiliate of Harvard Medical School, is a one-of-a-kind institution on the front lines of the world epidemic of diabetes - leading the battle to conquer diabetes in all forms through cutting-edge research and innovative approaches to clinical care and education.
This entry was posted in Diabetes Day2Day, Insulin and tagged exercise and insulin injections, injection sites, insulin injections. When it comes to injecting insulin, the stomach, the buttocks, the back of the arm and the thigh have something in common.
If injected directly into muscle, aside from being painful, it will be absorbed much too rapidly. Each of these approved areas absorbs insulin at a slightly different rate, and knowing this can help you make the best decision about where to inject depending on your blood glucose. For example if your blood glucose is low before a meal, you may want to inject into the buttock area because insulin is absorbed most slowly here. Injecting insulin into the same site over and over again can lead to the fat below the skin becoming hard and lumpy. Inject at least 4 inches (or approximately one hand-width) above the knee and at least 4 inches down from the top of the leg.
Inject into the fatty tissue in the back (not the side) of the arm between the shoulder and the elbow.
To make sure that your insulin is absorbed consistently, it may be best to give all injections in one or two areas of the body and rotate where you inject the insulin within that site for a period of time.
Hot temperatures tend to increase insulin absorption, while cold temperatures can decrease absorption.
To the Point: Six Simple Tips to Overcome a Fear of NeedlesAsk Joslin: Lumps Near Injection SitesIs There A Better Way To Give an Insulin Injection? We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you.
The concentration of long chain polyunsaturated fatty acid (LCPUFA) in the fetal brain increases dramatically from the third trimester until 18 months of life. Physiologically, the fetus may synthesize some saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) de novo from glucose (Nelson, 1992).
The placenta, like other tissues, may capture non-esterified fatty acids (NEFA) and fatty acids released from maternal lipoproteins by local endothelial lipases (EL). The LPL enzyme has classically been described as being involved in fatty acid uptake in many tissues, including adipose tissue, muscle, and placental tissue. BeWo cells incubated with a p-FABPpm antibody reduced their uptake of DHA and AA by 64 and 68%, respectively, while OA uptake was only reduced by 32% (Campbell et al., 1997). LCPUFA could themselves have an important regulatory function in fatty acid trophoblast uptake and metabolism through the direct modification of intracellular acyl-CoA-synthetase gene expression (Johnsen et al., 2009), which could also influence LCPUFA biomagnification in comparison with other fatty acids.
Once the fatty acids are in the cytosol, they bind to cytosolic fatty acid-binding proteins (FABP) for movement. Fatty acid-binding protein structure-function studies suggest that the three-dimensional changes that result from fatty acid binding may determine the particular function of the FABP (Storch and McDermott, 2009). Non-esterified fatty acids can be oxidized within trophoblast or re-esterified and stored as TG and other lipid fractions in the placental cells.
The basic structure of the LD is similar to that of lipoproteins: a hydrophobic core of neutral lipids (TG and CE) surrounded by a membrane monolayer of PL with associated coat proteins.
Lipid droplets exhibit a marked heterogeneity regarding size, cellular location, and associated protein composition within a given cell or between different tissues.
PAT proteins protect the neutral lipids stored in the LD from hydrolysis by cytoplasmatic lipases. Adipophilin is expressed in human villous trophoblast, where it inhibits the process of lipolysis (Bildirici et al., 2003).
DHA might regulate its own metabolic intracellular metabolism, through the control of lipolysis.
The current evidence suggests that intracellular TG hydrolysis occurs in a sequential way that involves different lipases.
Adipose triglyceride lipase selectively performs the first step in TG hydrolysis, resulting in the formation of diacylglycerol (DG) and NEFA. Once in the fetal circulation, the fatty acids bind to α-fetoprotein and reach the liver where they are re-esterified and exported to the fetal circulation within the lipoproteins (mainly as TG). Diabetes is an incurable condition in which the body cannot control blood sugar levels, because of problems with the hormone insulin. Under normal circumstances, the hormone insulin, which is made by your pancreas, carefully regulates how much glucose is in the blood. After a meal, the amount of glucose in your blood rises, which triggers the release of insulin.
Type 1 diabetes is an autoimmune condition, and the immune system attacks the cells of the pancreas. The exact mechanisms that lead to Type 2 diabetes are not fully understood, but an underlying genetic susceptibility is usually present.
Gestational Diabetes - During pregnancy, some women experience heightened blood sugar levels and can't produce enough insulin to absorb it all.
Maturity onset diabetes of the young (MODY) - Caused by a mutation in a single gene and is also very rare. If people living with Type 1 diabetes don't receive treatment they can develop very high blood sugar levels - hyperglycaemia - within days. At the same time, the body starts breaking down fat for fuel to counter the low levels of sugar available to the cells. Those with Type 1 can also suffer a dangerous complication of treatment known as hypoglycaemia, which can cause a coma.
If treatment doesn't effectively control high blood sugar levels, it leaves a person with diabetes more vulnerable to infections. Type 2 diabetes tends to develop more gradually, which is one of the reasons why medical professionals think that so many cases go undiagnosed.
In the long-term, diabetes raises the risk of many conditions, including peripheral vascular disease (when the arteries to the extremities are damaged by atherosclerosis) and peripheral nerve damage. Auto-suggest helps you quickly narrow down your search results by suggesting possible matches as you type.
It turns out that the A1C, fasting plasma glucose, and the oral glucose tolerance test each catch slightly different groups of people, but any one of them is sufficient for diagnosis, regardless of what the others may indicate.
This site was created by Christian Sosa in fulfillment of requirements for the course CSS 335: Latino Health Issues taught by Dr. Vitamin D and Diabetes Vitamin D deficiency diabetes treatment in south africa and dia-betes have one major trait in common: both are pandemic. Glargine is a long acting insulin that is type 2 diabetes diet what not to eat injected once a day. Just try low fat diabetic meals recipes and relax focus on what is working for you at this point and slowly work your way up to fucking. IntroductionDiabetes mellitus is a chronic illness which has an outstanding impact on public health due to its increasing prevalence, poor prognosis, and due to the high impact on cardiovascular health. Garg, 1998High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis. This is either because there is insufficient insulin (type 1 diabetes) or the body becomes resistant to the insulin that is being produced. The amount of insulin delivered should match the amount and timings of glucose that enters the blood stream, for this mechanism to duplicate that what occurs in the body. Practically, there is often not a correct co ordination between the insulin delivery and glucose entry into the blood.
But consumption of carbohydrates too soon, will release even more glucose and strain the metabolic system. The insulin may reach your blood stream before your digestive system has the time to release glucose from the food you eat. In general, insulin is more quickly absorbed from the stomach followed by the arm, the thigh, and the buttocks. On the other hand, if you are hyperglycemic the stomach may be the best choice as it has the fastest absorption rate. Aside from being unsightly, it can change the way your insulin is absorbed so you won’t easily know when the insulin will start working or peak.
For example, inject your morning insulin in your stomach and your evening insulin in your thigh.
It’s best not to inject in your arm or thigh if you have just exercised or plan to exercise (your arms would absorb insulin quickly if you were doing a set of bicep curls, for instance). Be careful about injecting insulin after taking a hot shower, a bath or being out in the cold. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Several studies have shown an association between the percentage of maternal plasma docosahexaenoic acid (DHA) during gestation and development of cognitive functions in the neonate. The concentration of individual fatty acids increases during gestation, although the extent differs between acids. However, the fetus depends on the placental supply of maternal EFA and LCPUFA (especially arachidonic acid, AA, and DHA).
The difference in NEFA concentration between the maternal and fetal circulation increases during gestation and, at the time of delivery, the maternal NEFA concentration is approximately three times that of the fetus (Haggarty, 2004). At the end of pregnancy, EL continues to be expressed while LPL is virtually absent in the trophoblast.
Part of the phospholipase A2 type II is secreted to the placental extracellular compartment, where it continues to be active, not only intracellularly, but also extracellularly (Rice et al., 1998). These proteins are located in the syncytiotrophoblast basal and microvillus membrane, except for p-FABPpm, which has only been reported in the microvillus membrane (Campbell et al., 1998).
In mammals, FABPs are believed to act in the cytoplasmic compartment by means of specific interactions with subcellular organelles, including the endoplasmic reticulum, mitochondria, lipid droplets (LDs), and peroxisomes. Potential functions of fatty acid-binding proteins (FABPs) in intracellular fatty acid disposition.
As in other cells, excessive cellular concentrations of NEFA are toxic and, to avoid toxicity, fatty acids are esterified with glycerol, and the resulting TG deposited in LDs. While lipoproteins and LDs both contribute to neutral lipid trafficking, their functions are different. Recent advances in our understanding of LD formation and function have emphasized the importance of LD-associated proteins, the so-called PAT family. It is known that only perilipin, among mammal PAT proteins, changes its activity depending on whether it has been phosphorylated by protein kinase A (PKA) or not.
On the other hand, adipophilin would impair the lipolysis, preventing the association of these lipases to LD, although the regulation of this mechanism remains to be elucidated (Bickel et al., 2009).
LCPUFA are more efficient at stimulating the expression of adipophilin mRNA in BeWo cells than short chain fatty acids (Tobin et al., 2006). The principal TG-catabolic enzymes are the HSL and ATGL (reviewed in adipocytes by Zimmermann et al., 2009).
However, to date, ATGL has not been identified in the placenta, although its possible involvement in the regulation of the placental transfer of fatty acids, cannot be excluded. The most efficient system to transport lipids from tissues to blood involves the synthesis and secretion of apoB-containing lipoproteins. Insulin stimulates cells all over your body to absorb enough glucose from the blood to provide the energy, or fuel, that they need. It tends to affect people before the age of 40, and often follows a trigger such as a viral infection. In most cases it develops between the 14th and 26th week of pregnancy, known as the second trimester, and disappears after the baby is born.
Because there is no insulin to drive the sugar from the blood into the cells, the kidneys try to remove the excess glucose. This leads to toxic levels of acids building up in the blood - a life-threatening condition known as ketoacidosis. This occurs when blood sugar levels fall dangerously low as a result of taking too much insulin, or sometimes by skipping a meal. Over time it can also damage the small blood vessels and nerves throughout the body, including the smaller vessels at the back of the eye, which can result in blindness, and the kidneys, leading to kidney failure.
There are various natural remedies for diabetes that will help you control your blood sugar level.
Such is its importance, that diabetes is actually considered an independent predictor of cardiovascular disease (which includes coronary heart disease and stroke).
Diabetes has a profound impact on almost all the functions of the body. Diabetes does have a significant affect on metabolism too. However due to resistance all the insulin is not used properly to metabolize the glucose that enters the blood stream.
In type 2 diabetics, they are often obese people and are used to eating large amounts of food.
This variability is most prominent with NPH and regular insulin and not as much a factor with the rapid acting insulins. All materials contained on this site are protected by United States copyright law and may be used for personal, noncommercial use only. Since only very low levels of LCPUFA are synthesized in the fetus and placenta, their primary source for the fetus is the maternal circulation.
This period, therefore, is critical for the materno-fetal provision of LCPUFA to the developing central nervous system. The maternal hyperlipidemia that occurs during gestation also contributes fatty acids to the fetus, following their release from the maternal lipoproteins by the placental lipoprotein lipase (LPL) and EL (Figure 2). However, in placental vessels, increased expression of both enzymes has been observed (Gauster et al., 2007). This study demonstrated that the placental LPL activity was reduced by 47% in IUGR, but increased by 39% in IDDM with respect to the controls. Nevertheless, the existence of p-FABPpm has only been demonstrated by Dutta-Roy’s group and has not even been genetically sequenced, so that more evidence concerning the structure and function of this protein in the placenta is needed.
Furthermore, FATP4 expression was significantly correlated with the DHA in the PL of fetal blood. Therefore, DHA may modulate fatty acid carrier expression through activation of RXR signaling pathways in the placenta, brain or other tissue, and thus alter the expression of adipophilin, acyl-CoA-synthetase, or other enzymes related to lipid metabolism. Lipoproteins participate in extracellular lipid trafficking, while LDs are confined to the cytoplasm, where they mediate intracellular lipid storage, and metabolism.
PAT is a family of proteins who were initially constituted by three members: Perilipin (with 3 isoforms A, B, C), Adipophilin (or adipocyte differentiation-related protein, ADRP), and tail-interacting protein of 47 kDa (TIP47). Nevertheless, in contrast to adipocytes and monocytes, trophoblast cells are not specialized for lipid storage, and the role of the PAT family (especially, adipophilin, perilipin) in the trophoblasts might even differ from their role in other cell types.
These lipoproteins can contain large amounts of TG and also act as carriers of essential lipids (lipophilic vitamins and glycolipids; Davis, 1999). It can also be produced by carbohydrates such as potatoes, pasta or bread when they are digested and broken down. In Type 2 diabetes, either the pancreas cells do not make enough insulin, or the body's cells do not react properly to it.
The condition is then triggered by lifestyle factors - such as obesity - and it usually appears in people over the age of 40.


The brain requires a constant supply of glucose from the blood otherwise it can't function properly. Best Diet Chart For Diabetic Patient In Uk diabetes and depression: Coping with the two conditions. Researchers have extensively investigated the possible effects of vitamin E supplementation on the cardiac autonomic nervous system in patients with type 2 diabetes and cardiac autonomic neuropathy. The Sermon on the Mount is a mixed bag with some salutary advice (instructions to be merciful pure in heart and seek peace) and some verses that are utterly impractical for life in the real world (for the poor to accept their lot in life thoughtcrime injunctions and edicts to agree with litigious adversaries but to name a few). It fluctuates sometimes extremely though this can be compensated by observing the average reading over time. Mixing insulin in vials or in pre-drawn syringes is an acceptable approach to customize insulin treatment and minimize injections.
Moreover, the cardiovascular risk of individuals with diabetes is considered to be equivalent to the risk of nondiabetic individuals with pre-existing cardiovascular diesease. Lemberg, 2002High-sensitivity C-reactive protein is the most effective prognostic measurement of acute coronary events.
Both in vitro and human in vivo studies using labeled fatty acids have shown preferential transfer of LCPUFA from the placenta to the fetus compared with other fatty acids, although the mechanisms involved are still uncertain.
This cannot be explained simply by the modification of dietary habits, and the most accepted hypothesis is its enhanced mobilization from the maternal adipose tissue depots, although an increase in the activity of the enzymes involved in fatty acid synthesis, particularly the synthesis of DHA, in the mother cannot be excluded. As regards LCPUFA, neither the placenta nor the fetus possesses sufficient desaturase activity to synthesize these fatty acids (Chambaz et al., 1985), which are considered essential nutrients for the fetus. In the literature, this is the most widely accepted mechanism to explain the placental fatty acid uptake process. These data suggest that FATP4 could be involved in the selective placental transport of DHA and so of n−3 LCPUFA. Nine FABP have been identified in mammals, with different tissue expression patterns and with common and specific functions (Storch and Corsico, 2008). FABPs are also likely to function in the nucleus through the delivery of specific ligands to nuclear transcription factors, such as the peroxisome proliferators-activated receptors (PPAR; reviewed by Storch and Corsico, 2008).
The differential fatty acid processing inside the placenta may also affect the rate of fatty acid transfer to the fetal circulation. Together with membrane bilayers, LDs represent one of the two major intracellular lipid reservoirs (Ackerman et al., 2007).
However, upon phosphorylation, the role of perilipin A shifts from storage to the mobilization of stored neutral lipids, promoting lipolysis. Better knowledge of the activity of these proteins in the placenta would improve our understanding of the fatty acid transport process in this tissue. It is activated through phosphorylation, which may be mediated by several hormones including catecholamines, growth hormone, serotonin, and glucagon, while insulin inactivates it by dephosphorylation. Many health problems like diabetes stem from the lack of movement and over availability of food to truly be healthy we should be moving non-stop all the time. Insulin is released into the bloodstream by the pancreas after we eat to regulate healthy blood sugar levels. Managing diabetes is made easier with diabetic supplies including insulin supplies and blood glucose monitors available through Liberty Medical.
A person with this type of diabetes must inject exogenous insulin Types of Insulin: Currently insulin is derived from recombinant (human) sources. This can become a limiting Best Diet Chart For Diabetic Patient In Uk factor in patients who are insulin resistant and require large doses given controlling diabetes by antioxidant several times per day. Following this line of thinking Dr Patients who need help managing their diabetes receive expert compassionate care at the Diabetes Management Program at North Shore Medical Center. Therefore, persons with diabetes mellitus have an increased susceptibility to atherosclerosis and an increased prevalence of ahterogenic risk factors, notably hypertension, obesity, and anormal lipids. You may not alter or remove any trademark, copyright or other notice from copies of the content. The placenta takes up circulating maternal non-esterified fatty acids (NEFA) and fatty acids released mainly by maternal lipoprotein lipase and endothelial lipase. The placenta also partly regulates the mobilization of fatty acids from adipose tissue through leptin secretion to the maternal and fetal circulation (Haggarty, 2004), although a leptin resistance situation is produced at the end of pregnancy.
Although endogenous synthesis is likely to be higher in preterm than in term infants (Uauy et al., 2000), the amount of LCPUFA produced from EFA is insufficient to match the in utero accretion rate (Lapillonne and Jensen, 2009). The mechanisms involved in the preferential transfer of DHA across the placenta is a major issue that needs to be better understood to allow for the design of further nutritional strategies to improve fatty acid availability to the fetus. Thus, after binding to these receptors, some lipoproteins can undergo endocytosis to provide cholesterol to the placenta; this last mechanism could also provide fatty acids to placental tissue once they are released by the intracellular lipases, although the relevance of this mechanism for the placental uptake of fatty acids is still uncertain. FATP is a family of proteins that presents acyl-coA-synthetase activity and may directly translocate free fatty acids across the membrane and also direct acyl-CoA conversion (Jia et al., 2007), facilitating their metabolism within the cells.
However, the presence of A-FABP in macrophages has been described (Storch and Corsico, 2008), and it would be interesting to know the localization of A-FABP in the placenta (trophoblast or macrophages).
HSL has been shown to exhibit broad substrate specificity, and is capable of hydrolyzing cholesterylester, tri-, di-, and mono-acylglycerol, retinyl ester, and numerous water soluble ester substrates.
He has 8 siblings and a huge extended family, and no one has ever had diabetes (not even Type 2), cancer, etc. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world.
I would have gladly bought multiple items from him, but due to the cost I wasn't able to buy anything more than 2 CDs of Qigong music. This compendium of the abnormalities can be found in people with metabolic syndrome (MetS) which is now regarded as a prelude to diabetes and such as diabetes, MetS is a substantial predictor of cardiovascular disease and all-cause mortality(Ford, et al. Giugliano, 2010Prevention and control of type 2 diabetes by Mediterranean diet: a systematic review. Giugliano, 2009bAdherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus. The excess insulin produce by beta cells in response to phase 2 also causes insulin resistance. These NEFA may enter the cell by passive diffusion or by means of membrane carrier proteins. Hence, these studies support the hypothesis that alterations in LPL contribute to changes in the transport of the fatty acids to the fetus and, consequently may modify its growth (Magnusson et al., 2004). The last step of the lipolysis is accomplished by monoglyceride lipase (MGL), which hydrolyses monoglycerides to form glycerol and to release a free fatty acid.
If he isn't showing any signs of being T1, I wouldn't be too concerned about it, especially with what his A1c is currently. Chromium is a mineral supplement So should diabetic people take diabetes drugs and alcohol chromium?
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2002).Morbidity and mortality from these chronic diseases in the general population have a multifactorial origin, resulting from the interaction between genetic background and environmental factors. Jialal, 2008High-fat, energy-dense, fast-food-style breakfast results in an increase in oxidative stress in metabolic syndrome. Dietz, 2002Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. The phase 2 insulin is released when the pancreas produces new insulin. When the blood sugar level falls down, glucagon is released to convert the glycogen to glucose.
Once in the cytosol, NEFA bind to cytosolic fatty acid-binding proteins for transfer to the fetal circulation or can be oxidized within the trophoblasts, and even re-esterified and stored in lipid droplets. To assess whether to take chromium patients Insulin injections are nothing that they are afraid of even if anyone else is that are fearful of needles.
Among the latter, diet is probably the most relevant factor in order to prevent acute complications and to reduce the risk of long-term complications.
Tinahones, 2008Fat overload aggravates oxidative stress in patients with the metabolic syndrome. Stefanadis, 2004Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. Astrup, 2008Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6mo randomized, controlled trial. Similarly, lyso-phosphatidylcholine seems to deliver 13C-DHA more efficiently to erythrocytes than NEFA (Brossard et al., 1997). While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Thus, it has been demonstrated that medical nutrition therapy is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. Willett, 2007Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. The placental transfer of LCPUFA during pregnancy seems to be a key factor in the neurological development of the fetus.
Furthermore, some authors have also suggested that maternal erythrocytes, which take lyso-PL into their membranes, may be a potential store of LCPUFA, and a vehicle for their transport to the placenta (Ghebremeskel et al., 2000).
Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so. If he is noticing that he gets very sleepy after eating, that is a red flag.I went through this period for months and the doctor recognized the symptoms and kept cheking my fasting glucose and it was always normal. Another great analogy: when an Alzheimer's patient starts attacking people because they feel unsafe and confused due to the breakdown in cognitive function, no one says "wow your grandpa is a horrible person". The basis of what constitutes optimal nutrition has been the subject of decades of research spanning the whole range of study designs, from ecological studies to in vitro modulation of gene expression.
Giugliano, 2004Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.
Increased knowledge of the factors that modify placental transfer of fatty acids would contribute to our understanding of this complex process.
Gonzalez-Correa, 2010Virgin olive oil administration improves the effect of aspirin on retinal vascular pattern in experimental diabetes mellitus.
Fuentes, et al.2008Chronic dietary fat intake modifies the postprandial response of hemostatic markers to a single fatty test meal. Marrugat, al, 2007Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Perez-Jimenez, 2008Chronic effects of a high-fat diet enriched with virgin olive oil and a low-fat diet enriched with alpha-linolenic acid on postprandial endothelial function in healthy men. Ordovas, et al.2001Mediterranean and low-fat diets improve endothelial function in hypercholesterolemic men.
Be sure to smile at a stranger when out and about, that may be the only smile they get that day. Thus, the MedDiet pattern is built on the basis of a consumption of fat primarily from foods high in MUFA (olive oil as the principal source of fat), and emphasizes the consumption of fruits, vegetables, legumes, nuts, and fish, as well as a moderate consumption of alcohol. In this regard, the MedDiet pattern has been associated with higher survival due to lower all cause mortality(Knoops, et al. A recent meta-analysis of prospective studies based on 1.5 million subjects and 40,000 fatal and non-fatal events showed that a greater adherence to this dietary pattern was significantly associated with a reduction of overall mortality, cardiovascular mortality, cancer incidence and cancer mortality, and incidence of Alzheimer’s disease and Parkinson’s disease(Sofi, et al.
T1's and T2's cross post on these forums, and it is imperative that we all know which type one is. In addition, a recently cross-sectional assessment of baseline data from a cohort of high-risk participants in the PREDIMED study, a large-scale feeding trial of primary cardiovascular prevention(Sanchez-Tainta, et al.
2008), showed that adherence to the MedDiet was inversely associated with the clustering of diabetes mellitus, obesity, hypertension and hypercholesterolemia. Type 1 and Type 2 are two totally absolute different diseases with different causes, thus making self-management very different.
The follow-up of large cohorts of healthy populations living in Mediterranean countries, such as the Greek EPIC(Psaltopoulou, et al.
2009) study cohorts, are providing new information suggesting that increasing adherence to the MedDiet relates to a reduced prevalence of risk phenotypes. In this regard, the MedDiet pattern is being reconsidered as the one of the more holistic approaches for the control of metabolic diseases including at the same time salutary and pleasure components. In this regard, pioneering nutritional strategies, such as nutraceuticals, have been developed aimed at reducing the main metabolic risk factors and promoting cardiovascular health. In this context, a growing body of clinical evidence has demonstrated positive cardiovascular effects associated with olive oil, antioxidants, and polyphenols intake.
Traditionally, many beneficial properties associated with olive oil have been ascribed to its high oleic acid content. Olive oil, however, can be considered a functional food that, besides having high-MUFA content, contains other minor components with biological properties(Perez-Jimenez, et al. Thus, phenolic compounds have shown antioxidant and antiinflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties(Lopez-Miranda, et al. Therefore, all those evidences suggest that MedDiet could serve as an antiinflammatory dietary pattern, which could help fighting diseases that are related to chronic inflammation, such as MetS and type 2 diabetes. In this context, it has been clearly demonstrated that many components of the MedDiet have been considered to be important in the treatment and modulation of cardiometabolic diseases.
In the present chapter, we review the state of the art illustrating the relationship between MedDiet rich in olive oil and metabolic diseases, including MetS and diabetes mellitus and to discuss potential mechanisms by which this food can help in disease prevention and treatment.2. Mediterranean diet and diabetesIn the last decade the incidence of conditions associated with insulin resistance, including metabolic syndrome and diabetes mellitus, is increasing rapidly worldwide. Although pharmacological interventions are available for minimizing or delaying the comorbidities associated with insulin resistance and the metabolic syndrome, as well as diabetes, initial management for the vast majority of the affected population remains focused on lifestyle modification, consisting of sustainable changes in dietary habits and physical activity. Lifestyle modification, in particular recommendations to follow an appropriate dietary pattern, has generally been accepted as a cornerstone of treatment for people with these conditions, with the expectation that an appropriate intake of energy and nutrients will improve glycaemic control and will reduce the risk of complications. The factors that regulate body fat distribution, insulin resistance, and associated metabolic disturbances are not fully understood. Nevertheless, increasing scientific evidence suggests that dietary habits may be an important environmental factor regulating glucose and fat metabolism(Phillips, et al.
Epidemiological studies indicate that Western-style dietary patterns promote the MetS, while diets rich in vegetables, fruits, grains, fish and low-fat dairy products have a protective role(Esmaillzadeh, et al. In the same line, two studies in Southern European populations showed that a greater adherence to the MedDiet was associated with reduced prevalence (Panagiotakos, et al. To date, several feeding trials have assessed the effect of dietary patterns on the metabolic syndrome status (Azadbakht, et al. These studies used a behavioral program to implement a relatively low-fat MedDiet(Esposito et al. 2004), intensive lifestyle intervention with inclusion of a vegetable-rich diet restricted in animal fat (Orchard et al.
2005) used energy-restricted diets that led to some degree of weight loss, while one study(Salas-Salvado et al. In all these studies, a decreased prevalence of metabolic syndrome was shown in the intervention groups. Moreover, in a subgroup of this study including the Reus PREDIMED Centre some components of the MedDiet, such as olive oil, legumes and red wine were associated with lower prevalence of MetS (Babio, et al.
On the other hand, results of a study in overweight, insulin-resistant patients also suggest that, by comparison with a low-fat diet, a MUFA-rich diet prevents the redistribution of body fat from peripheral to visceral adipose tissue without affecting total body weight(Paniagua, et al. 2010).Because diabetes is a frequent outcome in patients with sustained MetS, it is reasonable to assume that the MedDiet might also prevent the development of diabetes in predisposed persons or beneficially influence the metabolic abnormalities associated with the diabetic status(Giugliano and Esposito 2008).
In this context, two prospective studies from Southern European cohorts suggest a lower incidence of diabetes with increasing adherence to the MedDiet in previously healthy persons(Martinez-Gonzalez, et al. In contrast, in the absence of weight loss, the low-fat diet used in the Women’s Health Initiative trial(Tinker, et al. Furthermore, in the set of the PREDIMED study, it has been tested the effects of two MedDiet interventions versus a low-fat diet on incidence of diabetes. Interestingly, when the two MedDiet groups were pooled and compared with the control group, diabetes incidence was reduced by 52%.
In all study arms, increased adherence to the MedDiet was inversely associated with diabetes incidence.
It is also important to highlight that diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity.
These results extend those of prior studies showing that lifestyle interventions can substantially reduce the incidence of diabetes in individuals at high risk(Knowler, et al. However, in these studies, the interventions consisted of advice on a calorie-restricted diet plus physical activity and, except for one study(Ramachandran et al.


2006), weight loss was a major driving force in reducing the incidence of diabetes(Salas-Salvado, et al. 2011).Diets high in SFA consistently impair both insulin sensitivity and blood lipids, while substituting carbohydrates or MUFA for SFA reverts these abnormalities(Riccardi, et al. Postprandial lipemia and glucose homeostasis are also improved after meals containing MUFA from olive oil compared to meals rich in SFA(Lopez, et al. Thus, an examination of the association of dietary and membrane fatty acids with insulin secretion in the cross-sectional Pizarra study(Rojo-Martinez, et al. 2006) showed that dietary MUFA contributed to the variability of ?-cell function, with a favorable relationship of MUFA with ?-cell insulin secretion, independently of the level of insulin resistance.The question as to what was the best nutrient to replace energy sources from SFA in the diabetic diet, carbohydrates or MUFA, was also hotly debated. Since the late 1980’s, many feeding trials have compared the effects of isoenergetic high carbohydrates (CHO) and high MUFA diets on insulin sensitivity in healthy subjects and on glycemic and lipid control in diabetic patients(Garg 1998; Ros 2003). Garg’s meta-analysis(Garg 1998) favored high MUFA diets, but most of the studies reviewed therein were performed with metabolic diets having wide differences in total fat content between the two experimental diets, ranging from 15% to 25% of energy. Nevertheless, high MUFA diets generally had more favorable effects on proatherogenic alterations associated with the diabetic status, such as dyslipidemia, postprandial lipemia, small LDL, lipoprotein oxidation, inflammation, thrombosis, and endothelial dysfunction(Ros 2003). Although we will discuss this point later, of particular interest is the ability of the olive oil-rich MedDiet to improve mild systemic inflammation, as shown by the reduction of C-reactive protein and inflammatory cytokines in the study of Esposito et al.(Esposito et al. 2006) in diabetic patients and other subjects at high risk for coronary heart disease (CHD). In addition, in a cross-sectional analysis of a population of type 2 diabetic patients, the adherence to a MedDiet was inversely associated with glycosylated haemoglobin and postprandial glucose levels during free living conditions, independent of age, adiposity, energy intake, physical activity and other potential confounders(Esposito, et al. This association was apparent even although no strong associations were evident for each of the components of the MedDiet score, except for a modest association with whole grains and the ratio of MUFA to saturated lipids. However its cross-sectional nature does not allow us to make inference about cause and effect.
Furthermore a systematic review of the available studies confirmed that adopting a MedDiet may help to prevent type 2 diabetes, and also improve glycaemic control and cardiovascular risk in persons with established diabetes(Esposito, et al. 2010).Despite the beneficial effect attributed to the MedDiet, the American Diabetes Association (ADA) recommends that patients with newly diagnosed type 2 diabetes be treated with pharmacotherapy as well as lifestyle changes(Nathan, et al. The rationale for combination therapy is presumably that each form of treatment alone is imperfect.
Lifestyle changes are often inadequate because patients do not lose weight or regain weight or their diabetes worsens independent of weight. After 4 years, they found that the MedDiet delayed the need for antihyperglycemic drug therapy.
There were no differences in the degree to which participants in each group increased their physical activity or decreased their caloric intake, so the effect seems specific to the MedDiet and is probably, although not exclusively, linked to its ability to induce greater weight loss, in accord with results of a recent trial(Shai, et al.
The between-group difference in the proportion of people needing antihyperglycemic drug therapy increased over the course of the trial and favored the MedDiet, whereas the between-group differences in weight loss decreased. 2008), and this component of the diet might explain the favorable effect of the MedDiet on the need for drug therapy.
In summary, although more data are mandatory, there is good scientific support for MedDiet diets, especially those based on olive oil, as an alternative approach to low-fat diets for the medical nutritional therapy in MetS and diabetes.3.
Protective mechanisms of mediterranean diet Several mechanistic links offer potential explanations of protective effect of the MedDiet on type 2 diabetes. Excessive oxidative stress and inflammation are closely associated with the pathogenesis of many human diseases (such obesity, MetS, diabetes, cardiovascular diseases, neurodegenerative diseases and aging). The potential reversal of those conditions can be achieved by reducing the levels of inflammation through the consumption of an anti-inflammatory dietary pattern.
Usually this may occur through the reduction of systemic vascular inflammation and endothelium dysfunction without having a drastic effect on body weight.
Phenolic compounds are the focus of intense research in the last years, due to the biological properties that they have proven, mainly as potent antioxidants and anti-inflammatory agents; therefore, they can modulate signal transduction pathways to elicit their beneficial effects in human diseases. It is of note that phenols are not uniquely represented in olive oil in the traditional MedDiet, but also in other classic foods, such as wine, fruits and vegetables. Beyond this, epidemiological and interventional studies have revealed a protective effect of the MedDiet against mild chronic inflammation and its metabolic complications (Chrysohoou, et al. Inflammation and oxidative stressThe origins of heightened inflammatory activity in diabetes are diverse. In type 1 diabetes, islet inflammation is thought to be a local phenomenon driven by a focal autoimmune attack on islet antigens. By contrast, in type 2 diabetes, activation of inflammation results from systemic etiologic factors, such as central obesity and insulin resistance.
Ultimately inflammatory mediators activate a series of receptors and transcription factors such as NF-?b, toll-like receptors, c-Jun amino terminal kinase, and the receptor for advanced glycation end products, which lead to ?-cell dysfunction and apoptosis, impaired insulin signaling in insulin-sensitive tissues, systemic endothelial dysfunction, and altered vascular flow.
NF-?B is a pleiotropic transcription factor activated by low levels of reactive oxygen species (ROS) and inhibited by antioxidants(Mantena and Katiyar 2006). This factor regulates the expression of several cytokines, chemokines, cell adhesion molecules, immunoreceptors and inflammatory enzymes(Piva, et al.
2006), molecules that are involved in disease such as atherosclerosis and insulin resistance. Certain stimuli result in the phosphorylation, ubiquitination and subsequent degradation of I?B proteins thereby enabling translocation of this transcription factor into the nucleus.
In this context, an interesting aspect was the demonstration that supplementing an endothelial cell culture with oleic acid reduces the transcriptional activation of this factor in these cells, similar to what is done by ?-linolenic acid, and the opposite of the inflammatory effect of linoleic acid. Both linoleic and stearic fatty acids activated endothelial cells more markedly than did either oleic or linolenic fatty acids.
Also, compared with control cultures, treatment with stearic and linoleic acids decreased glutathione concentrations, which suggested an increase in cellular oxidative stress. Previous studies have confirmed that fat consumption induced the activation of inflammatory markers(Jellema, et al. In this regard, Bellido and Perez-Martinez have previously demonstrated that the MedDiet, enriched in virgin olive oil, attenuated peripheral blood mononuclear cells (PBMCs) NF-?B activation compared with a Western SFA rich diet, and the effect of an n-3 PUFA-enriched diet was intermediate in young healthy population(Bellido, et al. These findings suggest that virgin olive oil could be a possible contributor to prevent the activation of NF-?B system, within the frame of the MedDiet.
Besides olive oil, the MedDiet contents other source of potentially cardioprotective nutrients from fruits and vegetables which could also enhance this beneficial effect. In contrast, the opposite effect has been observed after the chronic intake of a Western diet rich in saturated fatty acids, corroborating previous data after the acute intake of a butter meal. The effect of a high CHO diet enriched in n-3 fatty acids on the NF-?B activation was intermediate. In this sense, previous data have suggested that n-3 ?-linolenic acid found mainly in plants and walnuts may reduce cardiovascular risk through a variety of biological mechanisms, including inhibiting vascular inflammation.
2007) explored the effects of an extra-virgin olive oil extract, particularly rich in minor polar compounds, on NF-?B translocation in monocytes and monocyte-derived macrophages isolated from healthy volunteers. In a concentration-dependent manner, olive oil extract inhibited p50 and p65 NF-?B translocation in both un-stimulated and phorbol-myristate acetate challenged cells, being particularly effective on the p50 subunit. Interestingly, this effect occurred at concentrations found in human plasma after nutritional ingestion of virgin olive oil and was quantitatively similar to the effect exerted by ciglitazone, a PPAR-? ligand. However, olive oil extract did not affect PPAR-? expression in monocytes and monocye-derived macrophages(Brunelleschi et al. On the other hand, NF-?B has been shown to regulate the expression of several adhesion molecules in response to inflammatory stimuli, including P-selectin, E-selectin, intercellular adhesion molecule 1 (ICAM-1) and cell adhesion molecule 1(VCAM-1)(Ghosh, et al.
1999) observed, in an endothelial cell culture model, that the incorporation of oleic acid into cellular membrane lipids reduced the expression of VCAM-1. Furthermore, it has been observed that the expression of VCAM-1 and E-selectin in human umbilical vascular endothelial cells (HUVECs), following the addition of minimally oxidised LDL, was less with LDL obtained from persons who had followed a diet rich in olive oil than from persons whose diet was rich in saturated fat(Bellido, et al. This anti-inflammatory action of MUFA also explains the fact that the enrichment of LDL particles with oleic acid, during the consumption of different types of diet, reduces their capacity to induce monocyte chemotaxis and adhesion.
In accordance with these results, a previous study has shown that LDL obtained from a MUFA-rich diet induced a lower rate of monocyte adhesion to endothelial cells(Mata, et al. The mechanism by which LDL from carbohydrate and MedDiets induces a lower expression of VCAM-1 and E-selectin is unknown; however several hypotheses have been suggested, for instance, the interaction of mononuclear leukocytes with vascular endothelial cells is most likely mediated by a complex amalgam of interacting regulatory signals in the inflammatory response characteristic of early atherogenesis. In another study including healthy subjects, virgin olive oil reduced plasma levels of ICAM-1(Bellido et al. This anti-inflammatory effect has also been observed in MetS patients who modified their diet for two years. In the group that followed a MedDiet model, the prevalence of this syndrome was reduced, improved insulin sensitivity and lowered the levels of C-reactive protein (CRP) and interleukin 6, 7 and 18.
Compared with participants in the low-fat group, after 3 months those in the MedDiet groups had decreased levels of C-reactive protein.
Moreover, people who eat the MedDiet that includes virgin olive oil reduce their levels of oxidized LDL, as suggested by the results of a subgroup analysis of the PREDIMED study carried out in 372 participants at high risk for cardiovascular disease, including diabetes(Fito, et al.
Furthermore new data suggest that virgin olive oil intake was associated with higher levels of plasma antioxidant capacity after 3 years of intervention(Razquin, et al. In summary, based in the above evidences presented, we could assume that the MedDiet rich in nutrients with favorable anti-inflammatory properties may protect from metabolic diseases that are related to chronic inflammation and overproduction of reactive oxygen species, such as MetS and diabetes. Postprandial stateWhen explaining possible mechanisms is important to recall that fasting is not the typical physiological state of the modern human being, which spends most the time in the postprandial state.
Therefore, the assessment of the postprandial lipemic response may be more relevant to identify disturbances in metabolic pathways related to inflammation and oxidative stress than measures taken in the fasting state. With regard to the postprandial state, several previous studies have demonstrated that a breakfast enriched in saturated fat resulted in an increase in biomarkers of inflammation and oxidative stress(Cardona, et al. In this regard, the identification of increased expression of TNF-?, a proinflammatory cytokine, in the adipose tissue of obese mice and humans has been correlated with the degree of adiposity and associated with insulin resistance. This fact is crucial given than insulin resistance will drive towards an increase in oxidative stress, endothelial dysfunction and impairments in lipoprotein metabolism and blood pressure.
However, the effects of the three fatty breakfasts on the plasma concentrations of these proinflammatory parameters showed no significant differences.
The fact that we only found differences in the expression of TNF-? at mRNA levels in PBMCs following the intake of the three breakfasts may be due to that the synthesis and secretion processes of these proteins do not happen simultaneously, and to the short half-life of cytokines(Futterman and Lemberg 2002; Kishimoto 2005).
Endothelial functionIn the last years another interesting observation is that dietary fat may affect the endothelium(Berry, et al. Several studies have shown that the acute administration of a high-fat meal induces a transitory disruption of endothelial function. Moreover, the effect of chronic consumption of a high-fat diet on endothelial function has also been evaluated. One study showed that a Mediterranean-style diet administered during 28 days to healthy subjects, attenuated plasma markers of endothelial activation, suggesting an improvement in endothelial function(Perez-Jimenez et al. Similarly, the chronic consumption of low-fat diets and Mediterranean-style diets improve endothelial function compared to a high-fat Western-type diet in hypercholesterolemic patients(Fuentes, et al. On the other hand, previous studies also demonstrated that postprandial lipemia induces endothelial dysfunction(Anderson, et al.
This study demonstrated that the endothelium-dependent vasodilatory response was greater after the ingestion of the high-MUFA diet. Moreover this diet also induced lower postprandial sVCAM-1 levels and higher bioavailability of NOx compared with the other two diets(Fuentes et al.
Therefore, those data carried out in the postprandial state support previous evidences suggesting that dietary patterns similar to those of the Mediterranean-style diet exert positive effects on components of the MetS and other conditions associated with, including endothelial dysfunction(Esposito, et al. In addition, this diet induced lower postprandial plasma levels of lipoperoxides, protein carbonyls concentration and superoxide dismutase activity compared to subjects adhering to the other three diets(Perez-Martinez, et al.
Furthermore, postprandial plasma hydrogen peroxide levels were unfavourable increased during the high-SFA diet compared to the other three diets(Perez-Martinez et al. These findings suggest that the postprandial state is important for understanding possible cardio-protective effects associated with the MedDiet particularly in subject with the MetS. In addition, these findings support recommendations to consume a high MUFA diet as a useful tool to prevent cardiovascular diseases in MetS patients. CoagulationBoth endothelial cells and macrophages contribute to the generation of altered vasoreactivity and a procoagulant state through increased expression of plasminogen activator inhibitor (PAI)-1 and tissue factor and through platelet activation and acute phase reactions that increase levels of coagulation factors such as fibrinogen and factor VIII. Many of these molecules enter the circulation at levels that correlate with the degree of inflammatory activity. It has been well stablished that consumption of MedDiet as a dietary pattern, and virgin olive oil as it main fat source, is accompanied by a decrease in thrombogenesis, combining a decrease in coagulation factors and by platelet aggregation (Delgado-Lista, et al. In other words, adhering to MedDiet may act as a prophylaxis for the appearance of thrombotic driven cardiovascular events.
Reinforcing this hypothesis, some authors have recently published in vitro and animal studies in which they show antiaggregant properties of virgin olive oil comparable in efficacy to those of acetylsalicylic acid (ASA). Even more, virgin olive oil and ASA, when in combination, act synergically to further inhibit platelet activation and aggregation(6, 10). Although the cited studies have been realized mostly in healthy persons, diabetic persons may also benefit from the antithrombogenic effects of MedDiet. As an example, Rasmussen et al showed how non-insulin dependent diabetic patients who were fed a MUFA-rich diet for three weeks decreased their von Willebrand factor (an important procoagulant factor) when compared to a carbohydrate-rich diet. The same authors, in an elegant design, compared the effects of two diets similar in carbohydrate and protein content, one rich in MUFA (30 energy %) and one rich in polyunsaturated fatty acids (PUFA) (30 energy %).
NutrigenomicsIt has been recently demonstrated the effects that phenolic fraction of olive oil exert at transcriptional level in vivo.
To this end, two virgin olive oil-based breakfasts with high and low content of phenolic compounds were administered to 20 MetS patients following a double blinded, randomized, crossover design. They demonstrated that intake of virgin olive oil rich in phenol compounds is able to repress in vivo expression of several pro-inflammatory genes, thereby switching activity of peripheral blood mononuclear cells to a less deleterious inflammatory profile. In the same context, the consumption of a MedDiet with virgin olive oil, rich in polyphenols, decreased plasma oxidative and inflammatory status and the gene expression related with both inflammation (INF-gamma, Rho GTPase-activating protein15, and interleukin-7 receptor) and oxidative stress (adrenergic beta(2)-receptor) in PBMCs from healthy volunteers(Konstantinidou, et al. Moreover the same authors demonstrated the hypothesis that 3 weeks of nutritional intervention with virgin olive oil supplementation, at doses common in the MedDiet, can alter the expression of genes related to atherosclerosis development and progression(Khymenets, et al.
2010) have confirmed in a population at high cardiovascular risk, that the MedDiet rich in olive oil influences expression of key genes involved in vascular inflammation, thrombosis and, in general, on atherosclerosis susceptibility.
Moreover, it has been previously demonstrated in mice that olive oil up-regulates uncoupling protein (UCP) genes in brown adipose tissue and skeletal muscle(Rodriguez, et al. 2002), which is important given that UCP have been related with the regulation of body fat in mammals across its participation on the system of thermogenesis(Cypess, et al. It is well reported that mitochondrial biogenesis could, in part, underlie the central role of adipose tissue in the control of whole-body metabolism and the actions of some insulin sensitizers and that mitochondrial dysfunction might be an important contributing the symptoms of MetS(Wilson-Fritch, et al. These data suggest that HT is able to promote mitochondrial function by stimulating mitochondrial biogenesis. This mitochondrial targeting property may provide a possible mechanism for the efficacy of the MedDiet for lowering the risk of cardiovascular disease and also suggests that HT may be used as a therapeutic intervention for preventing and treating diabetes mellitus and obesity(Hao, et al. Summary and future directionBecause unhealthy eating habits and a sedentary lifestyle are among the strongest risk factors for metabolic syndrome and type 2 diabetes, modification of eating habits and physical activity constitutes an important component of any successful management program.
In this chapter we reviewed the state of the art illustrating the relationship between MedDiet rich in olive oil and metabolic diseases, and to discuss potential mechanisms by which this food can help in disease prevention and treatment.
Epidemiological and intervention studies indicate that MedDiet, thanks to its set of benefits, may protect from metabolic diseases that are related to chronic inflammation and overproduction of reactive oxygen species, such as MetS and diabetes.
However, despite the significant advances of the last years, the final proof about the specific mechanisms and contributing role of the different dietary models and nutrients to its beneficial effects requires further investigations.
In the future, the integrated application of approaches that are becoming available in functional genomics, metabonomics, lipidomics, microbiota, cronobiology, proteomic techniques, and bioinformatics analysis, will lead to a more highly integrated understanding of its positive effects on health.
In this context the recent advances in human nutrigenomics and nutrigenetics, two fields with distinct approaches to elucidate the interaction between diet and genes but with a common ultimate goal to optimize health through the personalization of diet, will provide powerful approaches to unravel the complex relationship between nutritional molecules, genetic polymorphisms, and the biological system as a whole. On the other hand efforts should be put into identifying those micronutrients in olive oil that have the greatest beneficial effects on health.
In conclusion after decades of epidemiological, clinical and experimental research, it has become clear that consumption of Mediterranean dietary patterns rich in olive oil have a profound influence on health outcomes. Thus, there is good scientific support for recommend MedDiets, especially those based on olive oil, as an alternative approach for the medical nutritional therapy in obesity, MetS and diabetes.5. AcknowledgementsCiber Fisiopatologia Obesidad y Nutricion, CIBEROBN, is an initiative of ISCIII government of Spain. Also supported by Centro de Excelencia Investigadora en Aceite de Oliva y Salud (CEAS) and FEDER, Fondo Social Europeo.



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