Lorenzo Scappaticcio

Anti-inflammatory Effect of Mediterranean Diet in Type 2 Diabetes Is Durable: 8-Year Follow-up of a Controlled Trial

There is increasing evidence that plasma markers of low-grade inflammation modulate the risk of developing type 2 diabetes: for each 1 log mg/L increment in C-reactive protein (CRP) levels, there is a 26% increased risk (1), and for each 1 log μg/mL increment in adiponectin levels, there is a 28% decreased risk (2). However, the Mediterranean diet is able to reduce the incidence of future diabetes by 19–23% (3). Using the data of a randomized trial (MEditerranean DIet and Type 2 diAbetes [MEDITA]) (4), we investigated 1 ) whether the Mediterranean diet has a durable effect on circulating levels of CRP and adiponectin in subjects with newly diagnosed type 2 diabetes and 2 ) whether the changes in these inflammatory markers influenced the development of diet failure. In a two-arm, single-center trial, 215 men and women with newly diagnosed type 2 diabetes were randomized to …

Insights into the relationships between diabetes, prediabetes, and cancer

Diabetes mellitus and cancer are two growing health problems. They have in common many modifiable risk factors including sex, age, obesity, physical activity, diet, alcohol, and smoking, and have a long latency before overtly manifesting. Patients with diabetes experience a roughly 20–25% higher cancer incidence compared to individuals without diabetes, and it depends on cancer site. Moreover, patients with diabetes who further develop cancer have increased early and late mortality in comparison with cancer patients without diabetes. Prediabetes and metabolic syndrome are also related to an increased risk of developing and die from cancer. Possible mechanisms linking diabetes and prediabetes with cancer include hyperglycemia (endogenous or exogenous), hyperinsulinemia, and alterations of insulin-like growth factor system, chronic subclinical inflammation, abnormalities in sex hormone metabolism, and adipokines. It becomes crucial to define the right orientation of the associations between diabetes and cancer in order to identify the modifiable pathogenic mechanisms. The common soil hypothesis claims that prediabetes and diabetes, as well as metabolic syndrome, may be considered a surrogate sign for dietary risk factors of cancer. The clepsydra of foods may help choose foods associated with healthy benefit while avoiding foods associated with harm, including cancer.

Primary Prevention of Sexual Dysfunction With Mediterranean Diet in Type 2 Diabetes: The MÈDITA Randomized Trial

Type 2 diabetes has been associated with sexual dysfunction in men and women (1). Erectile dysfunction (ED) is a marker of significantly increased risk of cardiovascular disease and all-cause mortality in men with diabetes and the general population; however, no data support a clear role for female sexual dysfunction (FSD) as a predictor of future cardiovascular events in women with diabetes. There is some evidence from clinical trials that sexual dysfunction is amenable to amelioration with interventions based on diet and lifestyle modification in men and women (2). Using the data of the MEditerranean DIet and Type 2 diAbetes (MEDITA) randomized trial (3), we investigated the long-term effect of Mediterranean diet on 1 ) incident ED and FSD in people with type 2 diabetes and 2 ) combined incidence of sexual dysfunction (men or women) with worsening of sexual function in those participants with sexual dysfunction at baseline. Participants in the two-arm, single-center MEDITA trial were randomly assigned to a Mediterranean diet ( n = 108) or a low-fat …

Free and fixed-ratio combinations of basal insulin and GLP-1 receptor agonists versus basal insulin intensification in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

A meta‐analysis is presented of randomized controlled trials (RCTs) comparing free or fixed combinations of a glucagon‐like peptide‐1 receptor agonist plus basal insulin versus insulin intensification on metabolic control in patients with type 2 diabetes. Electronic databases were searched for RCTs assessing changes in HbA1c, proportion of patients at HbA1c target of <7% (53 mmol/mol), hypoglycaemia and body weight. A random‐effect model was used to calculate the weighted mean difference (WMD) or relative risk (RR) with 95% CI. Eleven RCTs were identified, lasting 24–30 weeks and involving 6176 patients. In the overall analysis, the combination therapy led to a mean HbA1c decrease significantly greater than insulin up‐titration (WMD −0.53%, 95% CI, −0.66, −0.40%, P < 0.001), more patients at HbA1c target (RR 1.69, 95% CI, 1.42, 2.00, P < 0.001), similar hypoglycaemic events (RR 0.97, 95% CI, 0.84, 1.12, P = 0.114), and reduction in body weight (WMD −1.9, 95% CI −2.3, −1.4, P < 0.001), with heterogeneity (I2 > 71%, P < 0.001). Results did not differ in either the free or fixed combination subgroups. Combination strategies, either free or fixed, represent a good option for intensifying basal insulin therapy in patients with type 2 diabetes who need amelioration of glycaemic control.

Metabolic syndrome and cancer: “The common soil hypothesis”

Metabolic syndrome (MetS) and cancer share many modifiable risk factors including age, genetic factors, obesity, physical inactivity, unhealthy diet, alcohol, smoking, endocrine disruptors exposure, circadian clock disturbances, and air pollution. MetS is closely linked to cancer, as it increases cancer risk and cancer-related mortality; moreover, cancer survivors have an increased risk of MetS. Elucidating the mechanisms linking MetS to cancer is important to prevent or delay these two conditions. Possible mechanisms explaining the relationship between MetS and cancer include hyperinsulinemia and alterations of insulin-like growth factor system, chronic subclinical inflammation, abnormalities in sex hormones metabolism and adipokines, hyperglicemia, alterations in both gene expression and hormonal profile by endocrine disruptors and air pollution, desynchronization of circadian clock. The common soil hypothesis claims that MetS may be considered a surrogate marker for dietary risk factors of cancer, and a warning sign for susceptible individuals exposed to an unhealthy diet. The common soil hypothesis and the clepsydra of foods represent a theoretical substrate to preventive intervention strategies against the pandemics of MetS and cancer: adherence to healthy dietary patterns is associated with a reduced risk of MetS, and improvement of the quality of diet is consistently associated with a reduction in cancer-related mortality.