Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-25-00388. https://doi.org/10.7326/ANNALS-25-00388 Dr. Miguel Ruiz-Canela et al.
Points
- An intensive lifestyle intervention combined a calorie-reduced Mediterranean diet with increased physical activity and behavioral support for weight loss in adults aged 55 to 75 with metabolic syndrome.
- This intervention group was compared against a control group that received advice for an ad libitum Mediterranean diet without specific guidance on exercise or weight loss strategies.
- After a six-year follow-up, the intervention group experienced a 31% lower incidence of type 2 diabetes compared to the control group, with a significant reduction in risk.
- Participants in the intensive intervention group achieved greater average reductions in both body weight, losing 3.3 kilograms, and waist circumference, which decreased by 3.6 centimeters.
- The study concluded that adding caloric reduction and physical activity to the MedDiet more effectively prevents diabetes in overweight individuals with metabolic syndrome than the diet alone.
Summary
This prespecified secondary outcome analysis of the PREDIMED-Plus randomized controlled trial evaluated whether an energy-reduced Mediterranean diet (erMedDiet) combined with physical activity could lower the incidence of type 2 diabetes compared to a standard Mediterranean diet (MedDiet). The trial enrolled 4,746 adults aged 55 to 75 with metabolic syndrome and overweight or obesity but without prior diabetes. Participants were assigned 1:1 to an intensive intervention group (erMedDiet with a planned 600 kcal/day reduction, physical activity, and behavioral support) or a control group receiving ad libitum MedDiet advice. The study was a single-blinded trial conducted at 23 centers in Spain.
Over a median follow-up of six years, 280 cases of diabetes were recorded in the intervention group compared to 349 in the control group. The 6-year absolute risk was 9.5% (95% CI, 9.4% to 9.6%) for the intervention group and 12.0% (95% CI, 11.9% to 12.1%) for the control group. This corresponded to a 31% relatively lower incidence of diabetes in the intervention group (CI, 18% to 41%), with an absolute risk reduction of –2.6 cases per 1000 person-years (CI, –2.7 to –2.4). The intervention group also achieved greater reductions in body weight (3.3 kg vs. 0.6 kg) and waist circumference (3.6 cm vs. 0.3 cm).
The study concluded that an intensive, multi-component lifestyle intervention featuring a calorie-restricted Mediterranean diet, increased physical activity, and modest weight loss is more effective in reducing diabetes incidence than an ad libitum Mediterranean diet alone in this high-risk population. Key limitations included the secondary nature of the outcome, the single-blinded design, and reliance on self-reported dietary adherence.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00388
References Ruiz-Canela, M., Corella, D., Martínez-González, M. Á., Babio, N., Martínez, J. A., Forga, L., Alonso-Gómez, Á. M., Wärnberg, J., Vioque, J., Romaguera, D., López-Miranda, J., Estruch, R., Santos-Lozano, J. M., Serra-Majem, L., Bueno-Cavanillas, A., Tur, J. A., Martín-Sánchez, V., Riera-Mestre, A., Delgado-Rodríguez, M., … Salas-Salvadó, J. (2025). Comparison of an energy-reduced mediterranean diet and physical activity versus an ad libitum mediterranean diet in the prevention of type 2 diabetes: A secondary analysis of a randomized controlled trial. Annals of Internal Medicine, ANNALS-25-00388. https://doi.org/10.7326/ANNALS-25-00388
