Yearly attained adherence to Mediterranean diet and incidence of diabetes in a large randomized trial
Author
Martínez-González, Miguel Ángel, 1957-
Montero, Pedro
Toledo, Estefanía
Estruch Riba, Ramon
Gómez-Gracia, Enrique
Li, Jun
Ros Rahola, Emilio
Arós, Fernando
Hernáez, Álvaro
Corella Piquer, Dolores
Fiol, Miquel
Lapetra, José
Serra Majem, Lluís
Pintó Sala, Xavier
Cofán Pujol, Montserrat
Sorlí, José V.
Babio, Nancy
Márquez-Sandoval, Yolanda F.
Castañer, Olga
Salas Salvadó, Jordi
Other authors
Universitat Ramon Llull. Facultat de Ciències de la Salut Blanquerna
Publication date
2023-09Abstract
Background
Several large observational prospective studies have reported a protection by the traditional Mediterranean diet against type 2 diabetes, but none of them used yearly repeated measures of dietary intake. Repeated measurements of dietary intake are able to improve subject classification and to increase the quality of the assessed relationships in nutritional epidemiology. Beyond observational studies, randomized trials provide stronger causal evidence. In the context of a randomized trial of primary cardiovascular prevention, we assessed type 2 diabetes incidence according to yearly repeated measures of compliance with a nutritional intervention based on the traditional Mediterranean diet.
Methods
PREDIMED (‘‘PREvención con DIeta MEDiterránea’’) was a Spanish trial including 7447 men and women at high cardiovascular risk. We assessed 3541 participants initially free of diabetes and originally randomized to 1 of 3 diets: low-fat diet (n = 1147, control group), Mediterranean diet supplemented with extra virgin olive (n = 1154) or Mediterranean diet supplemented with mixed nuts (n = 1240). As exposure we used actual adherence to Mediterranean diet (cumulative average), yearly assessed with the Mediterranean Diet Adherence Screener (scoring 0 to 14 points), and repeated up to 8 times (baseline and 7 consecutive follow-up years). This score was categorized into four groups: < 8, 8–< 10, 10– < 12, and 12–14 points. The outcome was new-onset type 2 diabetes.
Results
Multivariable-adjusted hazard ratios from time-varying Cox models were 0.80 (95% confidence interval, 0.70–0.92) per + 2 points in Mediterranean Diet Adherence Screener (linear trend p = .001), and 0.46 (0.25–0.83) for the highest (12–14 points) versus the lowest (< 8) adherence. This inverse association was maintained after additionally adjusting for the randomized arm. Age- and sex-adjusted analysis of a validated plasma metabolomic signature of the Mediterranean Diet Adherence Screener (constituted of 67 metabolites) in a subset of 889 participants also supported these results.
Conclusions
Dietary intervention trials should quantify actual dietary adherence throughout the trial period to enhance the benefits and to assist results interpretation. A rapid dietary assessment tool, yearly repeated as a screener, was able to capture a strong inverse linear relationship between Mediterranean diet and type 2 diabetes.
Document Type
Article
Document version
Published version
Language
English
Keywords
Diabetis
Alimentació -- Proves
Epidemiologia nutricional
Oli d'oliva
Olis i greixos comestibles
Greixos monoinsaturats
Dietètica -- Avaluació
Pages
11 p.
Publisher
BioMed Central
Is part of
Cardiovascular Diabetology, 2023, 22: 262
Grant agreement number
info:eu-repo/grantAgreement/MINECO/ISCIII/RTIC G03/140
info:eu-repo/grantAgreement/MINECO/ISCIII/RTIC RD 06/0045
info:eu-repo/grantAgreement/MINECO/ISCIII i CNIC/CNIC 06/2007
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI04- 2239
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI 05/2584
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/CP06/00100
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI07/0240
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI07/1138
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI07/0954
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI 07/0473
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI10/01407
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI10/02658
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI11/01647
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/P11/02505
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/PI13/00462
info:eu-repo/grantAgreement/MINECO/ISCIII i FEDER/JR17/00022
info:eu-repo/grantAgreement/MICINN/PN I+D+i/AGL-2009–13906-C02
info:eu-repo/grantAgreement/MICINN/PN I+D+i/AGL2010- 22319- C03
info:eu-repo/grantAgreement/MICINN/PN I+D+i/AGL2011-23430
info:eu-repo/grantAgreement/MICINN/PN I+D+i/SAF2016–80532-R
info:eu-repo/grantAgreement/DS/PROMETEO/PROMETEO 17/2017
info:eu-repo/grantAgreement/DS/PROMETEO/PROMETEO 21/2021
info:eu-repo/grantAgreement/Fundació la Marató de TV3/grant 294/C/2015
info:eu-repo/grantAgreement/Fundació la Marató de TV3/grant 538/U/2016
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Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by/4.0/