Editorial: Impact of Mediterranean Diet on Type 2 Diabetes Risk

This editorial critically analyzes a research paper that investigates the relationship between the Mediterranean diet, glycemic load, and the incidence of type 2 diabetes. The study, based on the Greek cohort of the EPIC study, explores how dietary factors influence the risk of developing type 2 diabetes mellitus. The author discusses the methodology, which involved a cohort study using questionnaires and statistical analysis to assess food consumption and adherence to the Mediterranean diet. The editorial highlights key findings, such as the association between the Mediterranean diet and a lower risk of diabetes, and contrasts it with the high risk associated with a high glycemic load diet. The strengths of the research, including the focus on a general population and the beneficial effects of olive oil, are discussed. The limitations, such as the lack of inclusion of diabetic individuals and the inability to follow-up on participants' weight changes, are also explored. The editorial concludes by emphasizing the dietary characteristics of the Mediterranean diet, such as olive oil and vegetables, and their role in diabetes control, while also acknowledging the need for further research to fully understand the mechanisms involved.

Running head: EDITORIAL
Editorial on Research Paper
Name of the Student
Name of the University
Author Note

EDITORIAL
Name of the Paper: Mediterranean diet and glycaemic load in relation to incidence of type 2
diabetes: results from the Greek cohort of the population-based European Prospective
Investigation into Cancer and Nutrition (EPIC)
Name of the Authors: M. Rossi, F. Turati, P. Lagiou, D. Trichopoulos, L. S. Augustin, C.
La Vecchia & A. Trichopoulou
Date of Publication: July 2013
Publisher: Diabetologia 56(11):2405-13

EDITORIAL
Type 2 Diabetes Mellitus a life style disease is considered as 21st century epidemic. In
type 2 Diabetes Mellitus, the body develops a resistance against insulin (Tuomilehto et al.,
2012). However, the beta cells of pancreas produce adequate insulin in response to the
glucose level in the blood but, due to insulin resistance, the insulin receptors located on the
cell becomes unresponsive and thus failure in the uptake o glucose. This prevention in the
glucose transport inside the cell increases the blood glucose level and thus generating the
symptoms of diabetes. Obesity or overweight is considered as the most important factor
behind the occurrence of type 2 diabetes mellitus (Chen, Magliano & Zimmet, 2012). This
obesity is driven by the diet chart and the lifestyle maintained. Many studies conducted so far
have emphasized on the concept of healthy eating in order to fight back against type 2
diabetes mellitus (Kaczmarczyk, Miller & Freund, 2012). Mediterranean diet is a kind of
traditional diet practiced in the Mediterranean countries. The diet emphasis on the
consumption of vegetables and use of olive oil and recommend restricted or moderate
consumption of protein or meat (Estruch et al., 2013).
This study conducted by Rossi et al, (2013) aims the role of diet in the prevention of
type 2 diabetes mellitus. For doing this, they have undergone a comparative study in between
the Mediterranean diet and Glycaemic Load (GL) in relation to development of the
susceptibility of the type 2 diabetes mellitus. The significance of the study lies in the fact that
it will lead to the elucidation of how the carbohydrates consumption increases the
susceptibility of the type 2 diabetes mellitus and how maintenance of Mediterranean diet,
lowers the risk of type 2 diabetes mellitus.
Relevance of the Research Questions: The aim of the study conducted in
Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results
from the Greek cohort of the population-based European Prospective Investigation into
Cancer and Nutrition (EPIC) is to investigate the dietary aspect on development of type 2

EDITORIAL
Diabetes Mellitus. For doing this, the Rossi and his team of researchers have chosen two
specific diet plan. One is Mediterranean diet and Glycaemic Load (carbohydrate rich diet).
Currently Type 2 Diabetes Mellitus is considered as a life style disease. It is common
in people who lead a sedentary life or are obese (Look AHEAD Research Group, 2013). Now
sedentary life is something over which the present generation of the corporate world has no
control. Their job profile, forced them to lead a sedentary mode of life for 8 to 9 hours at a
stretch. However, to erect a protective shield against Type 2 Diabetes Mellitus, one can
control or maintain a strict diet plan. This research paper tries to elucidate that how limited
protein intake (meat protein) and increase consumption of vegetables and olive oil decreases
the risk of developing Type 2 Diabetis Mellitus. The paper also sheds light on the fact that
how consumption of carbohydrate makes a person more susceptible towards developing Type
2 Diabetes Mellitus.
Brief of the Methodology Used
Rossi et al. (2013) conducted a cohort study in 23 research centers that are situated in
10 different countries in Europe in accordance to the Helsinki Declaration. The study used a
semi-quantitative questionnaire followed by statistical analysis in order to access the
frequency of consumption and portion size of the food and beverage intake among the focus
group. The nutrient and calorie intake was then subsequently calculated using a specific food
composition database that has been designed in accordance to the particularities if the Greek
diet.
A score (MDS) is given in order to access the conformity of the Mediterranean diet. 0
is assigned to minimal adherence of the diet while 9 is given for the maximum adherence.
The GL is calculated via estimating the carbohydrate content of the servings multiplied by the
average number of servings of that particular per day. This product is again multiplied with

EDITORIAL
the foods glycaemic index (GI) (derived from the Foster Powell Table). Furthermore, the
mode of cooking, food preservation are also taken into consideration to ascertain the GI.
Brief of the Findings
From the statistical analysis it showed that the Mediterranean diet lowers the diabetic risk and
the GL/GI diet is associated with high diabetes risk.
Conclusion of the Research
The study showed that the affect of Mediterranean diet on diabetes control is not
directly related with the weight control as in most of the Mediterranean people who follow
the Mediterranean diet are not freed from obesity. The affect of Mediterranean diet on
diabetes control is solely dependent on the dietary characteristics of the components included
in the Mediterranean diet such as olive oil and vegetables.
Strength of the Research Paper
The study showed that the use of the olive oil is beneficial of the health as it generates
the low risk of the Type Diabetes Mellitus. Olive oil, especially extra virgin olive oil is rich
in mono-unsaturated fatty acids. The replacing trans and mono or poly saturated fatty acids
with mono-unsaturated fatty acids has beneficial effect on the insulin sensitivity and hence
will possibly reduce the susceptibility towards the development of the Type 2 Diabetes
Mellitus (De Souza et al., 2015).
Another important strength of the study was, it was based on the general population.
Limitations of the Research Paper
This limitation of the research paper is, it did not include the diabetic people in the
survey and hence this particular research failed to elucidate the affect of the Mediterranean

EDITORIAL
diet on the people who are already suffering from the disease. Such that it did not throw light
on how the diet is decreasing the severity of the disease.
The research also failed to throw light on how olive oil, vegetables (principal
components of the Mediterranean diet) is helping to decrease to susceptibility of the Type 2
Diabetes Mellitus as Mediterranean diet has no direct relation with obesity (one of the most
important factors behind the development of the Type 2 Diabetes Mellitus (Martínez-
González et al., 2012). Moreover, the cohort study failed to follow-up the weight of the
participants while they are on Low GL and high Mediterranean diet and hence how weight is
getting affected by the diet cannot be ascertained.
Furthermore, it was unclear on which component of the Mediterranean diet has
contributed with the decrease in the susceptibility of the Type 2 Diabetes Mellitus was not
elucidated.
The study was conducted with a small sample size and hence biased results can be
generated (Bean, Stafford & Brashares, 2012).

EDITORIAL
Referencing List
Bean, W. T., Stafford, R., & Brashares, J. S. (2012). The effects of small sample size and
sample bias on threshold selection and accuracy assessment of species distribution
models. Ecography, 35(3), 250-258.
Chen, L., Magliano, D. J., & Zimmet, P. Z. (2012). The worldwide epidemiology of type 2
diabetes mellitus—present and future perspectives. Nature Reviews Endocrinology, 8(4),
228-236.
De Souza, R. J., Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., ... & Anand, S.
S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality,
cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of
observational studies. Bmj, 351, h3978.
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., ... & Lamuela-
Raventos, R. M. (2013). Primary prevention of cardiovascular disease with a Mediterranean
diet. New England Journal of Medicine, 368(14), 1279-1290.
Kaczmarczyk, M. M., Miller, M. J., & Freund, G. G. (2012). The health benefits of dietary
fiber: beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon
cancer. Metabolism, 61(8), 1058-1066.
Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle
intervention in type 2 diabetes. N engl J med, 2013(369), 145-154.
Martínez-González, M. A., García-Arellano, A., Toledo, E., Salas-Salvado, J., Buil-Cosiales,
P., Corella, D., ... & Fiol, M. (2012). A 14-item Mediterranean diet assessment tool and
obesity indexes among high-risk subjects: the PREDIMED trial. PloS one, 7(8), e43134.

EDITORIAL
Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka,
P., ... & Salminen, V. (2012). Prevention of type 2 diabetes mellitus by changes in lifestyle
among subjects with impaired glucose tolerance. New England Journal of Medicine, 344(18),
1343-1350.