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The Effect of a Vegetarian vs Conventional Hypocaloric Diabetic Diet on Thigh Adipose Tissue Distribution in Subjects with Type 2 Diabetes: A Randomized Study

Kahleova, Hana, Klementova, Marta, Herynek, Vit, Skoch, Antonin, Herynek, Stepan, Hill, Martin, Mari, Andrea, Pelikanova, Terezie
Journal of the American College of Nutrition 2017 v.36 no.5 pp. 364-369
adipose tissue, blood glucose, body mass index, confidence interval, diabetic diet, glucose, glycohemoglobin, hyperinsulinemia, insulin resistance, intramuscular fat, islets of Langerhans, lipid metabolism, magnetic resonance imaging, mathematical models, noninsulin-dependent diabetes mellitus, regression analysis, subcutaneous fat, test meals, tissue distribution, triacylglycerols, vegetarian diet
Objective : The aim of our study was to compare the effects of a vegetarian and a conventional diet on thigh adipose tissue distribution in subjects with type 2 diabetes (T2D). Methods : Seventy-four subjects with T2D were randomly assigned to either follow a vegetarian diet (V, n = 37) or a control group who followed an isocaloric conventional anti-diabetic diet (C, n = 37). Both diets were calorie restricted (−500 kcal/day). To measure insulin sensitivity, the hyperinsulinemic (1 ⁻¹.min ⁻¹) isoglycemic clamp was conducted. β-Cell function was assessed using a mathematical model after a test meal. Magnetic resonance imaging of the thigh was performed. All subjects were examined at 0, 3, and 6 months. Statistical analyses were performed using repeated measures analysis of variance and a multivariate regression model. Results : Greater reduction was observed in total leg area in V (−13.6 cm ² [95% confidence interval [CI], −14.2 to −12.9] in V vs −9.9 cm ² [95% CI, −10.6 to −9.2] in C; Gxt p < 0.001). The reduction in subcutaneous fat was comparable in response to both diets (Gxt, p = 0.64). Subfascial fat was reduced only in response to a vegetarian diet (−0.82 [95% CI, −1.13 to −0.55] cm ² in V vs −0.44 [95% CI, −0.78 to +0.02] cm ² in C; Gxt, p = 0.04). The reduction in intramuscular fat tended to be greater in response to a vegetarian diet (−1.78 [95% CI, −2.26 to −1.27] cm ² in V vs −0.57 [95% CI, −1.06 to −0.09] cm ² in C; Gxt, p = 0.12). Changes in subcutaneous and subfascial fat correlated with changes in glycated hemoglobin (HbA1c), fasting plasma glucose, and β-cell insulin sensitivity. After adjustment for changes in body mass index (BMI), correlations remained significant for changes in fasting plasma glucose and β-cell insulin sensitivity and with changes in triglycerides. Conclusions : Our data indicate the importance of both subcutaneous and subfascial fat in relationship to glucose and lipid metabolism. Abbreviations: BMI , body mass index; C , control group; FPG , fasting plasma glucose; Gxt , interaction between group and time; HbA1c , glycated hemoglobin; MCR , metabolic clearance rate of glucose; OPLS , orthogonal projections to latent structure; T2D , type 2 diabetes; V , vegetarian group