Abstract
Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.
Highlights
Insulin resistance (IR) has been defined as a dysmetabolic condition in which the peptide hormone insulin produces a less-than-expected biological effect on peripheral target tissues, leading to hyperinsulinemia, the diagnostic hallmark of IR [1]
By way of illustration of their speculated pharmacological antidiabetic mechanisms, we propose the lead berries-extracted quercetin, which acts as the base for the formation of other flavonol skeletons [57]
Higher adherence to the Mediterranean diet (MedDiet) was negatively correlated to serum liver enzymes, fasting insulin, homeostatic model assessment (HOMA)-IR and non-alcoholic fatty liver disease (NAFLD) severity, and positively correlated to serum adiponectin levels
Summary
Insulin resistance (IR) has been defined as a dysmetabolic condition in which the peptide hormone insulin produces a less-than-expected biological effect on peripheral target tissues, leading to hyperinsulinemia, the diagnostic hallmark of IR [1]. The reduction in insulin levels and other measures of IR, i.e., the homeostatic model assessment (HOMA) index, triggered by this dietary approach, are precocious and sustainable over time [17,18]. These benefits should be ascribed to the caloric restriction state, which promotes weight loss and reduction of IR independent of the diet composition, and to the large amount of functional foods and nutraceuticals naturally present within the MedDiet. The “Mediterranean diet” term reflects food combinations typical of Mediterranean populations, such as Greeks, Southern
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