An Isoenergetic Multifactorial Diet Reduces Pancreatic Fat and Increases Postprandial Insulin Response in Patients With Type 2 Diabetes: A Randomized Controlled Trial

Abstract

OBJECTIVE To compare the effect of an isocaloric multifactorial diet with a diet rich in monounsaturated fatty acids (MUFA) and similar macronutrient composition on pancreatic fat (PF) and postprandial insulin response in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS According to a randomized controlled parallel-group design, 39 individuals with T2D, 35–75 years old, in satisfactory blood glucose control, were assigned to an 8 week isocaloric intervention with a multifactorial diet rich in MUFA, polyunsaturated fatty acids, fiber, polyphenols, and vitamins (n = 18) or a MUFA-rich diet (n = 21). Before/after the intervention, PF content was measured by the proton-density fat fraction using a three-dimensional mDIXON MRI sequence, and plasma insulin and glucose concentrations were measured over a 4 h test meal with a similar composition as the assigned diet. RESULTS After 8 weeks, PF significantly decreased after the multifactorial diet (from 15.7 ± 6.5% to 14.1 ± 6.3%; P = 0.024), while it did not change after the MUFA diet (from 17.1 ± 10.1% to 18.6 ± 10.6%; P = 0.139) with a significant difference between diets (P = 0.014). Postprandial glucose response was similar in the two groups. Early postprandial insulin response (incremental postprandial areas under the curve [iAUC0–120]) significantly increased with the multifactorial diet (from 36,340 ± 34,954 to 44,138 ± 31,878 pmol/L/min; P = 0.037), while it did not change significantly in the MUFA diet (from 31,754 ± 18,446 to 26,976 ± 12,265 pmol/L/min; P = 0.178), with a significant difference between diets (P = 0.023). Changes in PF inversely correlated with changes in early postprandial insulin response (r = −0.383; P = 0.023). CONCLUSIONS In patients with T2D, an isocaloric multifactorial diet, including several beneficial dietary components, markedly reduced PF. This reduction was associated with an improved postprandial insulin response.

Evidence for a causal link between intra-pancreatic fat deposition and pancreatic cancer: A prospective cohort and Mendelian randomization study

“… 32 Several randomized controlled trials have demonstrated that IPFD can be reduced through dietary interventions. 15 , 33 , 34 However, it is possible that a targeted approach to reducing IPFD through a healthy diet may require greater specificity than a general weight reduction diet. 15 , 33 , 34 For example, a reduction in IPFD was observed following a diet change to a Mediterranean diet with low carbohydrates or an isocaloric multifactorial diet, but not a diet change to a low-fat diet or a diet rich in monounsaturated fatty acids.…”

“… 15 , 33 , 34 However, it is possible that a targeted approach to reducing IPFD through a healthy diet may require greater specificity than a general weight reduction diet. 15 , 33 , 34 For example, a reduction in IPFD was observed following a diet change to a Mediterranean diet with low carbohydrates or an isocaloric multifactorial diet, but not a diet change to a low-fat diet or a diet rich in monounsaturated fatty acids. 33 , 34 Promisingly, emerging pharmacological therapies for weight loss have been shown to dramatically reduce fat mass 35 , 36 ; however, their potential to reduce IPFD has yet to be proven.…”

“… 15 , 33 , 34 For example, a reduction in IPFD was observed following a diet change to a Mediterranean diet with low carbohydrates or an isocaloric multifactorial diet, but not a diet change to a low-fat diet or a diet rich in monounsaturated fatty acids. 33 , 34 Promisingly, emerging pharmacological therapies for weight loss have been shown to dramatically reduce fat mass 35 , 36 ; however, their potential to reduce IPFD has yet to be proven. Further studies are needed to clarify if and to what extent a reduction of IPFD ultimately translates into decreased PDAC incidence.…”

Genetic Evidence Causally Linking Pancreas Fat to Pancreatic Cancer: A Mendelian Randomization Study

“…Our current findings can have major clinical implications as excess pancreas fat accumulation is a reversible condition 43 . A substantial weight loss through bariatric surgery or hypocaloric diet results in the reduction of pancreas fat 13 , and an innovative diet intervention also shows a specific effect on this fat compartment 44 . Promisingly, emerging pharmacological therapies for weight loss have been shown to significantly reduce fat mass 45,46 , suggesting that they may also have the potential to lower pancreas fat.…”

Differential Effects of Two Isocaloric Healthy Diets on Postprandial Lipid Responses in Individuals with Type 2 Diabetes

“…This study included a randomized, controlled, parallel-group trial, and participants were assigned to a MUFA or multifactorial diet for 8 weeks [21,22]. The two diets were isoenergetic, to avoid body weight changes over the course of the study, and provided the same content in total carbohydrates, fat, MUFA, and protein while differing for fiber, polyphenols, glycemic index, n-3 and n-6 PUFAs, and vitamins [20].…”