A modified Mediterranean diet, incorporating calorie reduction, increased physical activity, and professional weight loss support, reduced the risk of developing type 2 diabetes by 31%. This finding comes from the PREDIMED-Plus trial, a major Spanish clinical study involving 4,746 adults aged 55 to 75. Participants in the study had overweight or obesity and metabolic syndrome but no prior diabetes or cardiovascular disease.
The PREDIMED-Plus trial, the largest nutrition study conducted in Europe, followed participants for six years. One group adhered to a calorie-reduced Mediterranean diet, aiming for approximately 600 fewer calories daily, engaged in moderate physical activity such as brisk walking and strength training, and received professional guidance. A comparison group followed a traditional Mediterranean diet without calorie restrictions or exercise recommendations. The intervention group demonstrated a 31% lower likelihood of developing type 2 diabetes compared to the control group.
Study Outcomes and Funding
Participants in the intervention group also achieved greater weight loss and reduced abdominal fat more effectively. On average, this group lost 3.3 kg and decreased waist circumference by 3.6 cm, while the control group lost 0.6 kg and trimmed waist size by 0.3 cm. Researchers estimated that the program prevented approximately three cases of type 2 diabetes for every 100 participants.
PREDIMED-Plus commenced in 2013 with an Advanced Grant exceeding €2 million from the European Research Council (ERC) to the University of Navarra. Additional institutions joined between 2014 and 2016, increasing total funding to over €15 million. The Carlos III Health Institute (ISCIII) and the Center for Biomedical Research Network (CIBEROBN, CIBERESP, CIBERDEM) provided most of this support. The results were published inAnnals of Internal Medicine.
Public Health Implications
Type 2 diabetes is a rapidly growing chronic disease globally, affecting over 530 million people, according to the International Diabetes Federation.
Miguel Ángel Martínez-González, Professor of Preventive Medicine and Public Health at the University of Navarra and Adjunct Professor of Nutrition at Harvard University, stated, “Diabetes is the first solid clinical outcome for which we have shown — using the strongest available evidence — that the Mediterranean diet with calorie reduction, physical activity and weight loss is a highly effective preventive tool.” He added that applying these modest, sustained lifestyle changes at scale in at-risk populations could prevent thousands of new diagnoses annually.
Type 2 diabetes is a rapidly growing chronic disease globally, affecting over 530 million people, according to the International Diabetes Federation.
Factors contributing to this rise include urbanization, less healthy diets, sedentary lifestyles, reduced physical activity, population aging, and increasing rates of overweight and obesity. Spain alone has approximately 4.7 million adults with diabetes, predominantly type 2. Miguel Ruiz-Canela, Professor and Chair of Preventive Medicine and Public Health at the University of Navarra’s School of Medicine, noted that the Mediterranean diet improves insulin sensitivity and reduces inflammation, with calorie control and physical activity enhancing these benefits.
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