Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial

Jordi Salas-Salvadó, Monica Bulló, Nancy Babio, Miguel Ángel Martínez-González, Núria Ibarrola-Jurado, Josep Basora, Ramon Estruch, Maria Isabel Covas, Dolores Corella, Fernando Arós, Valentina Ruiz-Gutiérrez, Emilio Ros, PREDIMED Study Investigators, Jordi Salas-Salvadó, Monica Bulló, Nancy Babio, Miguel Ángel Martínez-González, Núria Ibarrola-Jurado, Josep Basora, Ramon Estruch, Maria Isabel Covas, Dolores Corella, Fernando Arós, Valentina Ruiz-Gutiérrez, Emilio Ros, PREDIMED Study Investigators

Abstract

Objective: To test the effects of two Mediterranean diet (MedDiet) interventions versus a low-fat diet on incidence of diabetes.

Research design and methods: This was a three-arm randomized trial in 418 nondiabetic subjects aged 55-80 years recruited in one center (PREDIMED-Reus, northeastern Spain) of the Prevención con Dieta Mediterránea [PREDIMED] study, a large nutrition intervention trial for primary cardiovascular prevention in individuals at high cardiovascular risk. Participants were randomly assigned to education on a low-fat diet (control group) or to one of two MedDiets, supplemented with either free virgin olive oil (1 liter/week) or nuts (30 g/day). Diets were ad libitum, and no advice on physical activity was given. The main outcome was diabetes incidence diagnosed by the 2009 American Diabetes Association criteria.

Results: After a median follow-up of 4.0 years, diabetes incidence was 10.1% (95% CI 5.1-15.1), 11.0% (5.9-16.1), and 17.9% (11.4-24.4) in the MedDiet with olive oil group, the MedDiet with nuts group, and the control group, respectively. Multivariable adjusted hazard ratios of diabetes were 0.49 (0.25-0.97) and 0.48 (0.24-0.96) in the MedDiet supplemented with olive oil and nuts groups, respectively, compared with the control group. When the two MedDiet groups were pooled and compared with the control group, diabetes incidence was reduced by 52% (27-86). In all study arms, increased adherence to the MedDiet was inversely associated with diabetes incidence. Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity.

Conclusions: MedDiets without calorie restriction seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk.

Figures

Figure 1
Figure 1
Cumulative diabetes free-survival by group of intervention. Cox regression models with outcome of diabetes onset and exposure to MedDiet intervention group vs. control diet group, adjusted by sex, age, baseline energy intake, BMI, waist circumference, physical activity, smoking status, fasting serum glucose, use of lipid-lowering drugs, Mediterranean diet score, and weight change during the study. a, MedDiet and virgin olive oil group; b, MedDiet and nuts group; c, control diet group.

References

    1. American Diabetes Association, Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML: Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31:S61–S78
    1. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537–544
    1. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa MFinnish Diabetes Prevention Study Group Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–1350
    1. Kosaka K, Noda M, Kuzuya T: Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract 2005;67:152–162
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DMDiabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403
    1. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay VIndian Diabetes Prevention Programme (IDPP) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49:289–297
    1. Kastorini CM, Panagiotakos DB: Dietary patterns and prevention of type 2 diabetes; from research to clinical practice; a systematic review. Curr Diabetes Rev 2009;5:221–227
    1. Martínez-González MA, Bes-Rastrollo M, Serra-Majem L, Lairon D, Estruch R, Trichopoulou A: Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev 2009;67(Suppl. 1):S111–S116
    1. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, Benito S, Tortosa A, Bes-Rastrollo M: Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008;336:1348–1351
    1. Mozaffarian D, Marfisi R, Levantesi G, Silletta MG, Tavazzi L, Tognoni G, Valagussa F, Marchioli R: Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors. Lancet 2007;370:667–675
    1. Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, Petrizzo M, Saccomanno F, Beneduce F, Ceriello A, Giugliano D: Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 2009;151:306–314
    1. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, Fiol M, Gómez-Gracia E, López-Sabater MC, Vinyoles E, Arós F, Conde M, Lahoz C, Lapetra J, Sáez G, Ros EPREDIMED Study Investigators Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1–11
    1. Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E, Perez-Bauer M, Martínez-González MA, Salas-Salvadó J, Martín-Moreno JM: Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 2010;103:1808–1816
    1. Elosua R, Marrugat J, Molina L, Pons S, Pujol E: Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish men. The MARATHOM Investigators. Am J Epidemiol 1994;139:1197–1209
    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;31(Suppl. 1):S55–S60
    1. Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, Corella D, Fiol M, Gómez-Gracia E, Arós F, Flores G, Lapetra J, Lamuela-Raventós R, Ruiz-Gutiérrez V, Bulló M, Basora J, Covas MIPREDIMED Study Investigators Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med 2008;168:2449–2458
    1. Riserus U, Willett WC, Hu FB: Dietary fats and prevention of type 2 diabetes. Progr Lipid Res 2009;48:44–51
    1. Covas MI, Konstantinidou V, Fitó M: Olive oil and cardiovascular health. J Cardiovasc Pharmacol 2009;54:477–482
    1. Ros E: Nuts and novel biomarkers of cardiovascular disease. Am J Clin Nutr 2009;89:1649S–1656S
    1. Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB: Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA 2002;288:2554–2560
    1. Kochar J, Gaziano JM, Djoussé L: Nut consumption and risk of type II diabetes in the Physicians' Health Study. Eur J Clin Nutr 2010;64:75–79
    1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A: Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;11:337:a1344.
    1. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto JFinnish Diabetes Prevention Study Group Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006;368:1673–1679
    1. Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, Li H, Li H, Jiang Y, An Y, Shuai Y, Zhang B, Zhang J, Thompson TJ, Gerzoff RB, Roglic G, Hu Y, Bennett PH: The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008;371:1783–1789
    1. Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374:1677–1686

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