Effect of improving dietary quality on carotid intima media thickness in subjects with type 1 and type 2 diabetes: A 12-mo randomized controlled trial

Background: People with diabetes are at a heightened risk of cardiovascular disease compared with the general population. To our knowledge, randomized controlled trials investigating the effect of improving dietary quality on carotid intima media thickness, a marker of subclinical atherosclerosis and predictor of cardiovascular disease, have not been conducted in populations with diabetes. Objective: We aimed to determine whether increasing fruit (+1 serving; 150 g/d), vegetable (+2 servings; 150 g/d), and dairy (+1 serving; 200-250 g/d) intakes slows 12-mo common carotid artery intima media thickness (CCA IMT) progression, compared with a control group continuing to consume their usual diet, in people with type 1 and type 2 diabetes. Design: A 12-mo randomized controlled trial was conducted. The primary outcome was mean CCA IMT, measured at baseline and 12 mo, with B-mode ultrasound. Participants in the intervention group received counseling from a dietitian at baseline and 1, 3, 6, and 9 mo, and compliance was measured with a food-frequency questionnaire at baseline, 3 mo, and 12 mo. The control group continued consuming their usual diet. Results: In total, 118 participants completed the study. Vegetable (46 g/d; 95% CI: 14, 77 g/d; P <0.001) and fruit (179 g/d; 95% CI: 119, 239 g/d; P <0.001) intakes were increased at 3 mo in the intervention group compared with the control group. This increase was not maintained at 12 mo, but intake increased overall in the cohort (fruit, 48 g/d; vegetables, 14 g/d). An increase in dairy consumption was not achieved, but yogurt intake was higher in the intervention group at 3 mo (38 g; 95% CI: 12, 65 g; P <0.001); this was not maintained at 12 mo. At 12 mo, CCA IMT regressed (mean 6 SD: 20.016 0.04 mm; P <0.001), with a greater effect in the treatment group (mean 6 SD: 20.02 6 0.04 mm compared with 20.004 6 0.04 mm; P = 0.009). Conclusion: Improving dietary quality in people with wellcontrolled type 1 and type 2 diabetes may slow CCA IMT progression. This trial was registered at https://www.anzctr.org.au as ACTRN12613000251729.