TOPLINE:
Among adults with overweight or obesity and metabolic syndrome, adding caloric restriction and physical activity to a Mediterranean diet reduced the risk of developing type 2 diabetes (T2D) by 31% compared with following a Mediterranean diet alone.
METHODOLOGY:After the PREDIMED trial showed that an ad libitum Mediterranean diet resulted in only minimal weight loss despite reducing diabetes incidence, the PREDIMED-Plus trial was launched to test whether an energy-reduced Mediterranean diet combined with physical activity and dietitian-led behavioral support could reduce body weight and prevent cardiovascular events.Researchers conducted a secondary analysis of the PREDIMED-Plus trial to check if the energy-reduced Mediterranean diet could also reduce the risk for T2D, analyzing data of 4746 adults (mean age, 64.9 years; 50% women) with metabolic syndrome and overweight or obesity who were free of T2D at baseline.Participants were randomly assigned to an intervention group (n = 2342) receiving an energy-reduced Mediterranean diet (600 kcal/d reduction) with physical activity recommendations and behavioral support or to a control group (n = 2404) receiving educational sessions on the traditional Mediterranean diet with ad libitum caloric intake.All the participants received 1 L of extra-virgin olive oil monthly to support adherence.T2D incidence was assessed annually over 7 years (6 years of intervention plus 1 observation year) using American Diabetes Association criteria to identify new cases.TAKEAWAY:After a median follow-up duration of 6.6 years, diabetes was diagnosed in 629 participants. Incidence rates were 18.7 vs 23.2 cases per 1000 person-years in the intervention vs control group.Over 6 years, participants in the intervention group had a 31% lower relative risk for incident diabetes than those in the control group, with an adjusted absolute risk reduction of 2.4% (95% CI, -3.1% to -1.8%); the risk reduction was more prominent in men than women.The intervention group also achieved better adherence to the energy-reduced Mediterranean diet, higher physical activity levels, and greater reductions in body weight and waist circumference than the control group.IN PRACTICE:
“Although there is no ‘one-size-fits-all’ dietary strategy plan for diabetes prevention, the MedDiet’s higher palatability and cultural acceptance could make it a highly sustainable, long-term, weight-loss option when combined with moderately reduced energy intake,” the authors wrote. “Clinicians should consider recommending this approach for patients with overweight or obesity, particularly when conventional Mediterranean dietary advice alone has proven insufficient,” they added.
SOURCE:
This study was led by Miguel Ruiz-Canela, PhD, and Dolores Corella, PhD, Instituto de Salud Carlos III, Madrid, Spain. It was published online on August 25, 2025, in Annals of Internal Medicine.
LIMITATIONS:
Diabetes was a secondary outcome in this study. Dietary adherence was self-reported. Additionally, the findings may have limited generalizability beyond adults aged 55-75 years with metabolic syndrome in a European Mediterranean country.
DISCLOSURES:
This study was primarily funded by the Instituto de Salud Carlos III and supported by the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición and other sources. Some authors reported serving as consultant, receiving grants/contracts, and having other ties with various institutes and foundations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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