- About one in every nine adults around the world lives with diabetes, with 90% of them having type 2 diabetes.
- Past studies show that certain lifestyle factors can help lower a person’s risk for type 2 diabetes, such as exercising regularly and eating a healthy diet like the Mediterranean diet.
- A new study has found that a combination of following a calorie-restricted Mediterranean-style diet, plus moderate exercise and following a weight-loss program, is a more effective way to lower type 2 diabetes risk compared to only following the Mediterranean diet.
According to the International Diabetes Federation, about one in every nine adults around the world lives with diabetes, and 90% of these have type 2 diabetes — a chronic condition where your body is not able to manage healthy blood sugar levels on its own.
“Type 2 diabetes mellitus is a major public health problem worldwide,” Jordi Salas-Salvadó, MD, PhD, professor of nutrition at the University of Rovira i Virgili in Spain and general coordinator of the PREDIMED trial, told Medical News Today.
“The prevalence of type 2 diabetes is increasing in parallel to the obesity epidemics, and type 2 diabetes is a potent risk factor for cardiovascular disease, blindness, renal failure, and lower limb amputation, decreasing quality of life, and increasing the healthcare expenditures. Through such complications, diabetes kills 5 million people annually worldwide and most of them prematurely,” explained Salas-Salvadó.
Past studies show that certain lifestyle factors can help lower a person’s risk for type 2 diabetes, such as not smoking,
Salas-Salvadó is the corresponding and senior author of a new study recently published in the journal Annals of Internal Medicine, which adds to the evidence suggesting the Mediterranean diet may help lower type 2 diabetes risk.
In this study, researchers report that a combination of following a Mediterranean-style diet with fewer calories, plus moderate exercise and following a weight loss program, is a more effective way to lower type 2 diabetes risk compared to only following the Mediterranean diet.
This study is part of
Study participants were divided into two groups. The first group followed a calorie-reduced Mediterranean diet, a moderate exercise plan such as brisk walking and strength training, and were provided guidance through a professional weight loss program.
The control group only followed the Mediterranean diet without any calorie restriction, exercise advice, or weight loss plan.
Of the trial, Salas-Salvadó told us:
“Some years ago, in the context of the PREDIMED trial we have demonstrated that an ad libitum traditional MedDiet supplemented with either extra-virgin olive oil or mixed nuts — typically Mediterranean food rich in vegetable fat — reduced diabetes incidence by 30%, compared with a low-fat diet. However, this reduction occurred without parallel changes in body weight. Building on this finding, the PREDIMED-Plus trial was designed to test whether adding caloric restriction and physical activity to the MedDiet would provide additional benefit beyond the effect observed only with the MedDiet — the same recommendations that that we tested in the PREDIMED study a few years ago.”
At the study’s conclusion, researchers found that participants following the combination approach of a calorie-reduced Mediterranean-style diet, more moderate exercise, and professional support for weight loss, reduced their risk of developing type 2 diabetes by 31%, when compared to the control group.
“In adults aged 55 to 75 with overweight or obesity and other cardiometabolic risk factors, including prediabetes, even a relatively modest reduction in calorie intake combined with moderate physical activity further reduces the likelihood of developing type 2 diabetes,” Miguel Ruiz-Canela, MD, PhD, professor and chair of the Department of Preventive Medicine and Public Health at the University of Navarra in Spain and first author of this study, explained to MNT.
“Clinicians should consider recommending this multi-domain intervention approach for patients with overweight or obesity, particularly when conventional Mediterranean dietary advice alone has proven insufficient. We think that this multi-component lifestyle modification represents a practical and sustainable strategy that could be incorporated into routine clinical practice for diabetes prevention,” Ruiz-Canela told us.
In addition, scientists discovered that studyparticipants in the combination group lost an average of 3.3 kilograms (kg) and reduced their waist circumference by 3.6 centimeters (cm), compared to just 0.6 kg and 0.3 cm in the control group.
“A reduction of 3.3 kg in weight and 3.6 cm in waist circumference is clinically relevant, as even modest weight loss can significantly lower the risk of chronic conditions such as type 2 diabetes and cardiovascular disease,” Montse Fitó, MD, PHD, coordinator of the Cardiovascular Risk and Nutrition Research Group at the Hospital del Mar Research Institute and corresponding author on this study, told MNT.
“Additionally, maintaining these effects over the long term is crucial for ensuring the applicability and translation of these findings into practical recommendations. In this sense, the lifestyle intervention of the study has demonstrated a good adherence long-term,” said Fitó.
MNT had the opportunity to speak with Mir Ali, MD, a board-certified general surgeon, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, about this study.
“[The findings are] not surprising to me because there have been other studies that show any kind of calorie deficit is beneficial for patients who are trying to lose weight,” Ali, who was not involved in this research, commented. “And also the Mediterranean diet, and diets based on that, they’ve also been shown to help people lose weight and reduce symptoms for many conditions like diabetes, hypertension, and other issues.”
“Diabetes and obesity in general are on the rise in this country, and anything that can show improvement in that is going to be helpful,” he continued. “The problem [is that] no one thing works for every person. So as long as there’s research going on showing different options for people, better ways to improve their health, I think it’s going to be helpful.”
MNT also spoke to Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and owner of Nutrition-In-Sight, likewise not involved in the study, who commented she was not surprised by its results, as we already know the Mediterranean diet is associated with improved insulin sensitivity, reduced inflammation, and better metabolic outcomes.
“This study highlights the added power of pairing dietary quality with moderation in calories, movement, and support — a trifecta that’s realistic and sustainable for those willing to learn, explore and embrace change,” Richard told us.
“The study reinforces that lifestyle patterns — not one single food — has the ability to drive prevention of chronic disease. Our bodies are meant to move, by complementing that with quality nutrition and appropriate intake, the body thrives and works to prevent disease.”
– Monique Richard, MS, RDN, LDN
For those who may want to follow in the steps of this research by following a calorie-reduced Mediterranean dietary pattern, Richard offered these tips for doing it safely:
- mindful use of olive oil and nuts — they’re heart-healthy, but calorie-dense; portion guidance can help balance enjoyment with moderation, using measuring spoons, and/or preportioning snacks
- focus on meal structure and consistency — regular meals with balanced protein, complex carbohydrates, and healthy fats stabilize blood sugar and provide satiety in preventing overeating later
- swap sugar-sweetened drinks with water, sparkling water, or herbal teas
- add more calorie-light and nutrient-dense foods such as leafy greens (arugula, cabbage, kale, spinach) and nonstarchy vegetables (tomatoes, radishes, cucumbers, peppers, etc.)
- use an app or food diary to increase awareness of what you are actually consuming versus what your body needs
- practical tools — consider using smaller plates, mindful eating (no TV, screens, or phones), sitting at a table, conversing with loved ones, slowing down meals by chewing, observing the smell, taste, texture, and tuning into hunger/fullness cues as well as observing the environment around you.
“I would highly recommend individuals and families work with a registered dietitian nutritionist (RDN) for personalized support, to further understand calorie needs versus calorie intake and especially if there are existing health conditions or are taking medications,” Richard added. “It is also important to screen for those that calorie reduction would not be appropriate for.”
