Nutrition and Dietetics Proposal-Discussion/Conclusion

Introduction

The main aim of this project was to assess the relationship of CVD risk factors and diet in Cuban Americans. More specifically, this project was aimed to see the association of omega 3 fatty acid with CVD biomarkers, homocysteine and CRP in Cuban Americans with and without type 2 diabetes. These aims were targeted with the views to providing information on cardiovascular disease risk factors and its association with diet and type 2 diabetes.The results suggested positive association between omega 3 fatty acid andhomocysteine quartiles, suggesting the significant role of omega 3 fatty acids in the regulation of homocysteine level. However, the association of omega 3 fatty acid was not found with CRP levels, which suggested the very little or no role of omega 3 fatty acid in lowering the level of CRP. Moreover, diabetic status was not found to be associated with either homocysteine quartiles or CRP levels. This finding concluded that homocysteine and CRP may not be involved in regulating the blood circulating blood sugar.

The result of the statistical t-test showed that waist circumference was directly associated with diabetes, which indicated obesity as a major indicator of diabetes. This finding supported several other previous findings that studied the association between obesity and type 2 diabetes (Daousi, et.al. 2006 and Yajnik and Ganpule, 2010).

Interestingly, another CVD risk factor, total blood cholesterol was found to be significantly higher in non-diabetics. However, whether HDL or LDL was higher non-diabetics was not measured, making it difficult to draw any conclusion from this finding. Other factors, such as BMI, systolic and diastolic blood pressure, were not found to be associated with diabetes. These results seemed slightly contradictory as previous studies have found the correlation between these parameters and diabetes (Bays, et.al. 2007 and Mancia, 2005)., Interestingly, linkage was found between diabetes and glycosylate haemoglobin and omega 3 fatty acids, which suggested the implication of thee tow factor in diabetes risk. These findings corroborate with similar other findings. Edelman, et.al (2013) reported that high level of HbA1c was associated with higher incidence of type 2 diabetes. Similarly, another study by Virtanen, et.al (2013) suggested that intake of long-chain omega-3 polyunsaturated fatty acid was associated with long-term lower risk of type 2 diabetes.

Furthermore, the results showed no association between CRP and diabetes, which contradicted the inflammatory pathogenesis of type 2 diabetes (Muqabo and Renier, 2010). Another important finding was that diabetic status was directly associated with the distribution of homocysteine quartiles, which supported the previous findings by Ndrepepa, et.al (2008) and Badiou, et.al (2012) as explained earlier.

Relationship between omega 3 fatty acid and homocysteine

This study showed positive association between omega 3 fatty acid and homocysteine level, suggesting the role of omega 3 fatty acids in regulating the level of homocysteine in the body. As discussed earlier, homocysteine is an important biomarker of CVD and control of which may reduce the risk of CVD. These findings support previous finding by Kulkarni, et.al (2011) who studied the association of omega 3 fatty acid with homocysteine concentrations. In the study they found that altered omega 3 fatty acids (mainly docosahexaenoic acid) may lead to increased homocysteine concentration. However, majority of studies have focused on the association between omega 3 fatty acids and other CVD markers such as LDL, blood sugar and clotting factors (Yeh, et.al. 2009; Etherton, et.al. 2002). Thus, further long term studies should be done to unravel the possible association between omega 3 fatty acid and homocysteine.

Limitations

Despite some interesting findings, the study had few limitations. The association of omega 3 fatty acids with homocysteine and CRP was only studied in diabetics and non-diabetics. The study would have given much clearer conclusion if the implication of omega 3 fatty acids and its biomarkers was also investigated in CVD patients. Moreover, although the study found the correlation between cholesterol and diabetes, it did not assess whether HDL or LDL had greater implication in diabetics.

Clinical implications of the findings and future research

Diabetes and CVD disease are two chronic conditions that are the major killers among all the diseases. Preventive measures and early diagnosis remains the key for proper management of the disease. This study suggests the beneficial role of omega 3 fatty acids in diabetes and cardiovascular disease. More so, the study also showed the association of omega 3 fatty acids with CVD markers such as homocysteine, cholesterol, as well as diabetes marker such as HbA1c. Thus, people who are at risk of developing CVD and diabetes can be encouraged to intake diet rich in omega 3 fatty acids. But , the association of omega 3 fatty acid with inflammatory maker, CRP remained inconclusive. Also, whether increased homocysteine in diabetics was associated with CVD was beyond the scope of this project and demands further studies. Future studied should be done to see the effects of omega 3 fatty acids in altering homocysteine level and CRP in CVD patients.

References

Bays, H.E., Chapman, R.H., Grandy, S. & SHIELD Investigators’ Group 2007, “The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys”, International journal of clinical practice, vol. 61, no. 5, pp. 737-747.

Daousi, C., Casson, I.F., Gill, G.V., MacFarlane, I.A., Wilding, J.P. & Pinkney, J.H. 2006, “Prevalence of obesity in type 2 diabetes in secondary care: association with cardiovascular risk factors”, Postgraduate medical journal, vol. 82, no. 966, pp. 280-284.

Edelman, D., Olsen, M.K., Dudley, T.K., Harris, A.C. &Oddone, E.Z. 2004, “Utility of hemoglobin A1c in predicting diabetes risk”, Journal of general internal medicine, vol. 19, no. 12, pp. 1175-1180.

Etherton, P.M.K., Harris, W.S andAppel, L.J, 2002. AHA Scientific Statement. “Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease”, vol. 106, pp. 2747-2757.

Kulkarni, A., Mehendale, S., Pisal, H., Kilari, A., Dangat, K., Salunkhe, S., Taralekar, V. & Joshi, S. 2011, “Association of omega-3 fatty acids and homocysteine concentrations in pre-eclampsia”, Clinical nutrition (Edinburgh, Scotland), vol. 30, no. 1, pp. 60-64.

Mancia, G. 2005, “The association of hypertension and diabetes: prevalence, cardiovascular risk and protection by blood pressure reduction”, ActaDiabetologica, vol. 42 Suppl 1, pp. S17-25.

Mugabo, Y., Li, L. &Renier, G. 2010, “The connection between C-reactive protein (CRP) and diabetic vasculopathy. Focus on preclinical findings”, Current diabetes reviews, vol. 6, no. 1, pp. 27-34.

Virtanen, J.K., Mursu, J., Voutilainen, S., Uusitupa, M. &Tuomainen, T.P. 2013, “Serum Omega-3 Polyunsaturated Fatty Acids and Risk of Incident Type 2 Diabetes in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study”, Diabetes care.

Yajnik, C.S. &Ganpule-Rao, A.V. 2010, “The obesity-diabetes association: what is different in indians?”, The international journal of lower extremity wounds, vol. 9, no. 3, pp. 113-115.

Yeh, E, Wood, R.D, Leeson, S and Squires, E.J, 2009.British poultry science. “Effect of dietary omega-3 and omega-6 fatty acids on clotting activities of Factor V, VII and X in fatty liver haemorrhagic syndrome-susceptible laying hens”, vol. 50, no.3, pp. 582-392.