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
An erratum to this article was published (Ann Intern Med, Mar 2026 ↗)
Authors' conclusion
An intensive intervention with the MedDiet adding caloric reduction, physical activity, and modest weight loss was more effective than only an ad libitum MedDiet in reducing diabetes incidence in overweight/obese persons with metabolic syndrome.
Study context
- Population
- Adults aged 55 to 75 years with metabolic syndrome and overweight or obesity, without prior CVD or diabetes; 23 centers in Spainrandomized 1:1
- Participants
- 4,746 adults
- Comparison
- Energy-reduced Mediterranean diet (MedDiet) plus physical activity vs ad libitum MedDiet
- Primary endpoint
- Diabetes incidence (American Diabetes Association criteria)
- Follow-up
- median 6-year follow-up
Methodological detailsprespecified secondary outcome analysis, single-blinded, controlled, multicentre (23 centers, Spain), Limitations: secondary outcome, single-blinded design, self-reported dietary adherence
- Prespecified secondary outcome analysis
- Single-blinded
- Controlled
- Multicentre (23 centers, Spain)
- Limitations: secondary outcome, single-blinded design, self-reported dietary adherence
Primary result
As reported in the abstract
Diabetes incidence · 6 years
Intervention vs ControlAbsolute risk reduction, cases per 1000 person-years (CI)
Diabetes incidence
−2.6(−2.7 to −2.4)
- Lower with Intervention
- relative reduction 31% (CI 18%–41%)
Secondary outcomes
- Intervention attained better adherence to the energy-reduced MedDiet (erMedDiet), higher physical activity levels, and greater reductions in body weight and waist circumference
Original publication
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. Ann Intern Med. Published 26 August 2025. doi:10.
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