Effects of Indo-Mediterranean style diet and low fat diet on incidence of diabetes in acute coronary syndromes

Introduction: Obesity and diabetes are known to increase the risk of mortality due to acute coronary syndromes (ACSs). Effect of ACSs on risk of diabetes is unknown. This study examined the effect of the Mediterranean-style diet compared to a low-fat diet on incidence of obesity, diabetes and prediabetes in patients with ACSs. Subjects and Methods: A randomized, single-blind, controlled trial was carried out on 406 patients with ACSs diagnosed by WHO criteria. The intervention group received a low-energy Indo-Mediterranean diet and the control group received a fat-modified diet, according to the NCEP Step 1 diet. The main outcome measures were compliance with diets and weight loss at one year and frequency of obesity and diabetes and all-cause mortality after two years. Results: The intervention group received significantly greater amounts of Mediterranean-style foods and lower amounts of Western foods compared to the control group at one year of follow-up. The frequency of obesity and known diabetes, as well as prediabetes, was comparable in the two groups at the inception of the study. However, after 2 years, the incidence of obesity, known diabetes, as well as prediabetes (n = 55, 26.9%. vs. 11, 5.4%, P < 0.001) was significantly lower in the intervention group, compared to the reference. In contrast, the incidence of prediabetes was significantly increased in the control group compared to reference (n = 50, 20.2, vs. 58, 28.7%, P < 0.01). The incidence of prediabetes after 2 years was significantly higher in the control group compared to the intervention group (28.7% vs. 5.4%, P < 0.001). These findings were associated with a significantly greater adherence score for the Indo-Mediterranean diet in the intervention group compared to that for the diet of the control group. A greater weight loss of >0.5 kg was associated with significantly (p < 0.001) fewer cardiovascular events and less mortality, more so in the intervention group than in the control group. The total mortality was 14.7% in the intervention group and 25.2% in the control group (p < 0.01) after two years. Conclusions: The Indo-Mediterranean-style diet is effective in decreasing the incidence of known diabetes and prediabetes. However, in the control group, there is no decline in known diabetes but a significant increase in the incidence of prediabetes, compared to the reference indicating that ACSs may have predisposed subjects to prediabetes without any beneficial effect of the low-fat control diet.