Dietary Fibre and Cardiovascular Risk in Diabetes Mellitus


Dietary Fibre and Cardiovascular Risk in Diabetes Mellitus

The two main types of diabetes mellitus are diabetes type 1 (T1D) and diabetes type 2 (T2D). T2D is the most common form of diabetes mellitus. It accounts for 90% of the cases. The incidence of T2D increases by age. T2D is characterized by increased insulin resistance and decreased insulin sensitivity, as a result of obesity and physical inactivity, amplified by genetic susceptibility and advancing age. T1D accounts for 5-10% of the cases, and is usually diagnosed at a young age. T1D is characterized by complete β-cell destruction and no insulin production, making patients completely depending on life-long insulin treatment. Immunotherapy to protect remaining insulin-producing β-cells can slow disease progression and need for insulin, but is not yet a cure for type 1 diabetes.

People with diabetes mellitus have an increased risk of acute or chronic complications. The major chronic complication is cardiovascular disease (CVD), with a 2-3 fold increased risk for T2D and a 4-8 fold increased risk for T1D. CVD is caused by atherosclerosis, resulting from chronic inflammation and injury to the arterial wall in the vascular system. Hyperglycaemia and insulin resistance in diabetes mellitus enhance endothelial cell dysfunction and oxidative stress, causing an accelerated development of atherosclerosis.

Evidence from prospective cohort studies suggests an association between dietary fibre and cardiovascular disease risk in diabetic patients. However, this is based on only a few studies and research in more populations is needed. Results from trials on the effects of DF on CVD risk factors are inconsistent, and different CVD risk factors are affected in each study. Plasma glucose, glycated haemoglobin and plasma lipid levels are important predictors for CVD, and showed to be improved with high DF intake. Other risk factors, blood pressure, body weight and inflammation, tend to improve, but additional trials are needed to provide a reliable association.

This review shows that it is feasible in the long-term to increase dietary fibre intake with natural food products to levels beneficial for diabetic patients. In T2D, certain types of cereal fibre had a plasma lipid and glucose level lowering effect. Legumes might even have stronger effects, presumably because of high soluble fibre content. More research is needed on the potential effects of low glycaemic index, fibre rich vegetables and fruits, especially in T1D patients. An association between DF and CVD risk was reported in one cohort study, and combining this study with data of new trials might support a statement about DF and CVD risk in T1D patients in the future.

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Aaron Province
Managing editor | Journal of Food and Clinical Nutrition