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Does the Mediterranean Diet Prevent Diabetes? FREE

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The full report is titled “Prevention of Diabetes With Mediterranean Diets. A Subgroup Analysis of a Randomized Trial.” It is in the 7 January 2014 issue of Annals of Internal Medicine (volume 160, pages 1-10). The authors are J. Salas-Salvadó, M. Bulló, R. Estruch, E. Ros, M.I. Covas, N. Ibarrola-Jurado, D. Corella, F. Arós, E. Gómez-Gracia, V. Ruiz-Gutiérrez, D. Romaguera, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pintó, J. Basora, M.A. Muñoz, J.V. Sorlí, and M.A. Martínez-González.

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Ann Intern Med. 2014;160(1):I-24. doi:10.7326/P14-9001
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What is the problem and what is known about it so far?

Type 2 diabetes mellitus is a chronic disease that causes high levels of sugar (glucose) in the blood and increases the risk for heart disease, blindness, kidney failure, lower limb amputation, and death. Studies have shown that weight loss from a low-calorie diet plus exercise can prevent type 2 diabetes. There is little information on whether changes in the overall diet that do not lead to weight loss and do not include calorie restriction or increased physical activity can also prevent it.

Why did the researchers do this particular study?

To find out whether a Mediterranean diet without calorie restrictions prevented diabetes.

Who was studied?

3541 men and women without diabetes (aged 55 to 80 years) at high risk for heart disease, a subgroup from the Prevención con Dieta Mediterránea cardiovascular prevention trial in Spain.

How was the study done?

Participants were randomly assigned to 1 of 3 diets: 1154 to a Mediterranean diet plus approximately 50 mL of extra-virgin olive oil (EVOO) daily; 1147 to a Mediterranean diet plus roughly 30 g of mixed nuts daily; and 1240 to a control diet, which consisted of advice on following a low-fat diet. Dietitians provided participants in the Mediterranean diet groups with guidance on following the diet, including increased consumption of beans, fish, fruits, and vegetables and avoidance of red or processed meat, butter, and sweets. No participants were told to restrict calories or increase physical activity.

What did the researchers find?

After approximately 4 years, 273 participants had developed diabetes. More of these participants were in the control group (101 participants) than in the Mediterranean diet groups supplemented with EVOO (80 participants) or nuts (92 participants). Changes in body weight, waist circumference, and physical activity were minor and did not differ by group. On the basis of answers to questionnaires, participants in the Mediterranean diet groups were more likely to stick to their assigned diets than those in the low-fat control group.

What were the limitations of the study?

The participants were all older and white, and it is unclear whether the findings apply to other age groups or ethnicities. The control group had a greater withdrawal rate during follow-up (120 participants) than the Mediterranean diet groups supplemented with EVOO (47 participants) and nuts (85 participants), which could have affected the findings.

What are the implications of the study?

A Mediterranean diet without calorie restrictions that is supplemented with EVOO or nuts may reduce the risk for type 2 diabetes.





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