Low advanced glycation end product diet improves the lipid and inflammatory profiles of prediabetic subjects.

BACKGROUND: Prediabetes is associated with risk for cardiovascular disease, and the first step in its management emphasizes lifestyle and diet modifications; however, modern diets are high in advanced glycation end products (dAGEs), derived from processing methods that exert a pivotal role in promoting atherosclerotic risk. OBJECTIVE: We studied the effect of low vs standard dAGE diets (L-dAGEs vs S-dAGEs) on lipid profile, inflammation, and cardiovascular risk in prediabetic subjects. METHODS: A 24-week randomized dietary intervention was conducted on 62 prediabetic subjects. We evaluated lipid profile, endogenous secretory receptors for AGEs, high-sensitivity C-reactive protein, arterial stiffness, and intima-media thickness. RESULTS: After 24 weeks, patients with L-dAGEs showed a significant reduction of total cholesterol, apolipoprotein B, and low-density lipoprotein compared with controls (5.26 ± 1.09 vs 5.53 ± 0.87 mmol/L, P < .05; 0.77 ± 0.25 vs 1.16 ± 0.13 mmol/L, P < .05; and 3.53 ± 0.93 vs 3.68 ± 0.7 mmol/L, P < .05); with respect to baseline, high-sensitivity C-reactive protein levels were significantly reduced in the L-dAGEs group (0.21 [0.11-0.69] vs 0.12 [0.08-0.48] mg/dL, P < .05) but not in the S-dAGEs group. Endogenous secretory receptor for AGEs was similar in both the groups at baseline and at the 24-week follow-up. With respect to baseline, L-dAGE patients showed a significative reduction of intima-media thickness (0.77 [0.73-0.81] vs 0.73 [0.70-0.75] mm, P < .05). We did not observe the same reduction in S-dAGEs. No difference in arterial stiffness was found from baseline to follow-up in both the groups. CONCLUSIONS: L-dAGEs improved the lipid and inflammatory profiles of prediabetic subjects and seemed to reduce atherosclerotic burden compared with a standard diet. Further studies are needed to recommend this dietary regimen for prevention of cardiovascular risk in prediabetes.

Cardiovascular risk profile in subjects with prediabetes and new-onset type 2 diabetes identified by HbA(1c) according to American Diabetes Association criteria.

OBJECTIVE: We investigated the cardiovascular risk profile in subjects with prediabetes and new-onset type 2 diabetes identified by glycated hemoglobin A1c (HbA(1c)) according to the new American Diabetes Association criteria. RESEARCH DESIGN AND METHODS: Arterial stiffness, intima-media thickness (IMT), soluble receptor for advanced glycation end products (sRAGEs), and oral glucose tolerance test (OGTT) were evaluated in 274 subjects without a previous history of diabetes. The subjects were stratified into three groups according to the HbA(1c) levels. RESULTS: The subjects with prediabetes (n = 117, HbA(1c) 5.7-6.4% [39-46 mmol/mol]) showed a higher augmentation (Aug), augmentation index (AugI), and IMT compared with those with lower HbA1c; however, these values were similar to those of subjects with HbA(1c) >6.5% (48 mmol/mol). When we further analyzed the subjects with prediabetes but included only subjects with normal glucose tolerance (NT) in the analysis, AugI and IMT still remained significantly higher than their levels in control subjects with HbA(1c) <5.7% (39 mmol/mol). After multiple regression analyses including several cardiovascular risk factors, only HbA(1c), age, and sRAGE were significantly correlated with the IMT, whereas age and 1-h postload glucose were the major determinants of AugI. CONCLUSIONS: Our data show that subjects with prediabetes according to HbA1c, but with both NT according to the OGTT and normal fasting glycemia, have an altered IMT and AugI. These data suggest that a simple, reproducible, and less expensive marker such as HbA1c may be better able to identify prediabetic subjects at high cardiovascular risk compared with fasting glycemia or OGTT alone.