Interrelationship between micronutrients and cardiovascular structure and function in type 2 diabetes

Abstract

Micronutrients are important for normal cardiovascular function. They may play a role in the increased risk of cardiovascular disease observed in people with type 2 diabetes (T2D) and T2D-related heart failure. The aims of this study were to (1) examine micronutrient status in people with T2D v. healthy controls; (2) assess any changes following a nutritionally complete meal replacement plan (MRP) compared with routine care; (3) determine if any changes were associated with changes in cardiovascular structure/function. This was a secondary analysis of data from a prospective, randomised, open-label, blinded end-point trial of people with T2D, with a nested case-control [NCT02590822]. Anthropometrics, cardiac resonance imaging and fasting blood samples (to quantify vitamins B₁, B₆, B₁₂, D and C; and iron and ferritin) were collected at baseline and 12 weeks following the MRP or routine care. Comparative data in healthy controls were collected at baseline. A total of eighty-three people with T2D and thirty-six healthy controls were compared at baseline; all had micronutrient status within reference ranges. Vitamin B₁ was higher (148⋅9 v. 131⋅7; P 0⋅01) and B₆ lower (37⋅3 v. 52⋅9; P 0⋅01) in T2D v. controls. All thirty participants randomised to routine care and twenty-four to the MRP completed the study. There was an increase in vitamins B₁, B₆, D and C following the MRP, which were not associated with changes in cardiovascular structure/function. In conclusion, changes in micronutrient status following the MRP were not independently associated with improvements in cardiovascular structure/function in people with T2D.

Keywords: BMI, body mass index; CMR; CMR, cardiac magnetic resonance imaging; CVD, cardiovascular disease; Cardiovascular function; EF, ejection fraction; HF, heart failure; LV, left ventricular; Low calorie; Low-energy meal replacement plan; MRP, meal replacement plan; Micronutrients; PLP, pyridoxal 5-phosphate; RCT, randomised control trial; T2D, type 2 diabetes; Type 2 diabetes.

Fig. 1.

CONSORT diagram. MRP, meal replacement plan; T2D, type 2 diabetes.

Fig. 2.

Comparison of between groups (MRP and routine care) change in micronutrients from baseline to 12 weeks. Data split according to the treatment group. Paired samples t tests or Wilcoxon test were used to determine if micronutrients were different from baseline to 12 weeks within the MRP and the routine care group. Independent samples t tests or Mann–Whitney tests were then used to determine if the change from baseline to 12 weeks was different between the MRP group and the routine care group. *Represents a significant change from baseline to 12 weeks. MRP, meal replacement plan.