According to a Florida study published in
the Nutrition Journal, macronutrients may play a key role in arterial health
for individuals with diabetes; thus, modifying the diet for macronutrient balance may prevent associated
Diabetes is a global epidemic. Cardiovascular disease
(CVD), especially heart disease and stroke, is the most prevalent complication
of diabetes. It is known that arterial stiffening leads to CVD in diabetic
people. This stiffening of the artery, due to high blood pressure
(hypertension) or fatty deposits on the walls of the arteries
(atherosclerosis), causes elevated pulse pressure on the arteries known as the
arterial pulse pressure (APP). APP is
measured as the numeric difference between the systolic and diastolic blood
pressure. For example, if your blood pressure is 120 / 80 mm Hg, then your APP
is 40, which is considered a healthy pulse pressure. A high APP is indicative of increased arterial stiffness which is
an indicator of CVD associated with complications of diabetes. This CVD, in turn, is associated
with endothelial dysfunction.
the inner lining of the blood vessels (arteries). Endothelial cells control
vascular relaxation and contraction as well as release of enzymes that control
blood clotting and immune function. Endothelial
dysfunction (when the endothelial cells are not working properly) can predict
stroke and heart attacks due to the inability of the arteries to dilate fully.
The dysfunction may be a result of high blood pressure, diabetes, high
cholesterol and smoking. So, arterial pulse pressure (APP) may be a
feasible method for screening endothelial function and arterial health of an
A study was
conducted by Joan A. Vaccaro and Fatma G. Huffman to assess APP and its
association with macronutrient by diabetes status for a multiethnic sample
involving 892 Mexican Americans, 1059 black non-Hispanics, and 2473 white
There were a
number of reasons why the researchers chose to do this study.
1. Although the
role of diet in the prevention of high blood pressure has been established, the
role of diet on APP has not been determined.
agree that the proportion and type of macronutrients may be associated with
arterial health. However, there is no consensus regarding the type and
proportion of macronutrient for persons with diabetes. The American Diabetes
Association advocates a high fiber - high carbohydrate diet for diabetes while
some clinical studies found high protein - low carbohydrate diet to be useful.
clinical trials reported that proportion of calories from carbohydrates have an
effect on high blood pressure. But few studies compare these effects for
persons with type-2 diabetes.
4. Again, some
studies found that diets high in carbohydrates and low in mono-unsaturated
fatty acids (MUFA) were associated with higher blood pressure. But most
Mediterranean studies indicated that MUFA intake was inversely associated with
blood pressure. It is noteworthy that virgin olive oil, sunflower, safflower and canola oil are
the primary sources of MUFA.
The results of
the current study showed that -
* Lower intake of carbohydrates
and mono-unsaturated fatty acids (MUFA) were associated with higher arterial
pulse pressure (APP) for diabetic people as compared with persons without
diabetes, independent of ethnicity.
* Poly-unsaturated fatty acids
were not associated with APP.
* Endothelial function in diabetic
individuals was not significantly altered by a MUFA-rich meal but it was
impaired by a meal high in saturated fatty acids. This means that MUFA,
in the form of olive oil, may have a protective effect on endothelial function
in people with type-2 diabetes. Olive oil contains many polyphenols in
different amounts and types and these polyphenols may play a role in enhancing
endothelial function by promoting the formation of nitric oxide.
The study thus
concluded that lower arterial pulse
pressure can be attained by replacing saturated fats with carbohydrates and
mono-unsaturated fatty acids (MUFA) in people with diabetes.
however had its limitations, in the sense
* Diabetes diagnosis was by self-report and not by medical records. The American
Diabetes Society and the World Health Organization, however, endorse the
determination of self-reported diabetes.
* The data did not include ethnic groups such as Asians and Hispanics
other than Mexican Americans.
* The sources of MUFA were not quantified in this study, so the
variations in anti-oxidant properties may have influenced the association of
MUFA with arterial pulse pressure.
suggest further intervention and prospective studies to confirm the
associations of arterial pulse pressure (APP) with diabetes, race and diet.
Vaccaro JA, Huffman FG. Monounsaturated fatty acid, carbohydrate intake, and diabetes status are associated with arterial pulse pressure. Nutr J. 2011 Nov