Ann Intern Med

Calorie-reduced Mediterranean diet and exercise linked to superior diabetes prevention than ad lib diet alone

August 28, 2025

Study details: This prespecified secondary analysis of the PREDIMED-Plus randomized trial included 4,746 adults aged 55 to 75 years with metabolic syndrome and overweight/obesity, but no prior diabetes or CV disease. Participants were randomized to either an energy-reduced Mediterranean diet (erMedDiet) with physical activity and behavioral support, or a control group following an ad libitum Mediterranean diet. Diabetes incidence was assessed over a median 6-year follow-up using ADA criteria.

Results: The intervention group had a 31% relative reduction in diabetes incidence compared with controls (9.5% vs. 12.0% absolute risk). This translated to an absolute risk reduction of 2.6 cases per 1,000 person-years. Participants in the intervention group also achieved greater weight loss, waist circumference reduction, and adherence to diet and activity goals.

Clinical impact: For patients with metabolic syndrome, a structured lifestyle program combining caloric restriction, Mediterranean diet, and physical activity is more effective than diet alone in preventing diabetes. These findings support intensive lifestyle interventions as a cornerstone of diabetes prevention in high-risk populations.

Source:

Ruiz-Canela M, et al. (2025, August 26). Ann Intern Med. 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. https://pubmed.ncbi.nlm.nih.gov/40854218/