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Title: Mediterranean diet reduces the adverse effect of the TCF7L2-rs7903146 polymorphism on cardiovascular risk factors and stroke incidence: A randomized controlled trial in a high-cardiovascular-risk population
Authors: Corella, Dolores
Carrasco, Paula
Sorlí, Jose V.
Estruch, Ramón
Rico-Sanz, Jesús
Martínez-González, Miguel Ángel
Salas-Salvadó, Jordi
Covas, M. Isabel
Coltell, Oscar
Arós, Fernando
Lapetra, José
Serra-Majem, Lluís 
Ruiz-Gutiérrez, Valentina
Warnberg, Julia
Fiol, Miquel
Pintó, Xavier
Ortega-Azorín, Carolina
Muñoz, Miguel Ángel
Martínez, J. Alfredo
Gómez-Gracia, Enrique
González, José I.
Ros, Emilio
Ordovás, José M.
Keywords: Tcf7L2 Gene
Glycemic Index
Carbohydrate, et al
Issue Date: 2013
Publisher: 0149-5992
Journal: Diabetes Care 
Abstract: OBJECTIVETranscription factor 7-like 2 (TCF7L2) polymorphisms are strongly associated with type 2 diabetes, but controversially with plasma lipids and cardiovascular disease. Interactions of the Mediterranean diet (MedDiet) on these associations are unknown. We investigated whether the TCF7L2-rs7903146 (C>T) polymorphism associations with type 2 diabetes, glucose, lipids, and cardiovascular disease incidence were modulated by MedDiet.RESEARCH DESIGN AND METHODSA randomized trial (two MedDiet intervention groups and a control group) with 7,018 participants in the PREvencion con DIetaMEDiterranea study was undertaken and major cardiovascular events assessed. Data were analyzed at baseline and after a median follow-up of 4.8 years. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HRs) for cardiovascular events.RESULTSThe TCF7L2-rs7903146 polymorphism was associated with type 2 diabetes (odds ratio 1.87 [95% CI 1.62-2.17] for TT compared with CC). MedDiet interacted significantly with rs7903146 on fasting glucose at baseline (P interaction = 0.004). When adherence to the MedDiet was low, TT had higher fasting glucose concentrations (132.3 3.5 mg/dL) than CC+CT (127.3 +/- 3.2 mg/dL) individuals (P = 0.001). Nevertheless, when adherence was high, this increase was not observed (P = 0.605). This modulation was also detected for total cholesterol, LDL cholesterol, and triglycerides (P interaction < 0.05 for all). Likewise, in the randomized trial, TT subjects had a higher stroke incidence in the control group (adjusted HR 2.91 [95% CI 1.36-6.19]; P = 0.006 compared with CC), whereas dietary intervention with MedDiet reduced stroke incidence in TT homozygotes (adjusted HR 0.96 [95% CI 0.49-1.87]; P = 0.892 for TT compared with CC).CONCLUSIONSOur novel results suggest that MedDiet may not only reduce increased fasting glucose and lipids in TT individuals, but also stroke incidence.
ISSN: 0149-5992
DOI: 10.2337/dc13-0955
Source: Diabetes Care[ISSN 0149-5992],v. 36, p. 3803-3811
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