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Andaluc\u00eda","award":["PS0358\/2016"],"award-info":[{"award-number":["PS0358\/2016"]}]},{"DOI":"10.13039\/501100003359","name":"Generalitat Valenciana","doi-asserted-by":"crossref","award":["PROMETEO\/2017\/017"],"award-info":[{"award-number":["PROMETEO\/2017\/017"]}],"id":[{"id":"10.13039\/501100003359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"crossref","award":["CB06\/03"],"award-info":[{"award-number":["CB06\/03"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004587","name":"ISCIII","doi-asserted-by":"publisher","award":["JR17\/00022"],"award-info":[{"award-number":["JR17\/00022"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvenci\u00f3n con DIeta MEDiterr\u00e1nea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention.<\/jats:p>\n <\/jats:sec>\n \n RESEARCH DESIGN AND METHODS<\/jats:title>\n Overweight\/obese adults with metabolic syndrome aged 55\u201375 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P &lt; 0.001), a mean difference of \u22122.5 kg (95% CI \u22123.1 to \u22121.9). Weight loss \u22655% occurred in 33.7% of IG participants compared with 11.9% in the CG (P &lt; 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P &lt; 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P &lt; 0.05). IG participants with prediabetes\/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight\/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2337\/dc18-0836","type":"journal-article","created":{"date-parts":[[2018,11,2]],"date-time":"2018-11-02T15:35:16Z","timestamp":1541172916000},"page":"777-788","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":354,"title":["Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial"],"prefix":"10.2337","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-7459","authenticated-orcid":false,"given":"Jordi","family":"Salas-Salvad\u00f3","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Biotechnology, Human Nutrition Unit, Pere Virgili Institute for Health Research (IISPV), University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"D\u00edaz-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biotechnology, Human Nutrition Unit, Pere Virgili Institute for Health Research (IISPV), University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7684-2787","authenticated-orcid":false,"given":"Miguel","family":"Ruiz-Canela","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Preventive Medicine and Public Health, University of Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Basora","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biotechnology, Human Nutrition Unit, Pere Virgili Institute for Health Research (IISPV), University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Primary Care Division, Catalan Institute of Health, Institut d\u2019Investigaci\u00f3 i Recerca en Atenci\u00f3 Prim\u00e0ria (IDIAP)-Jordi Gol, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montse","family":"Fit\u00f3","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Corella","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Preventive Medicine, University of Valencia, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Serra-Majem","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"W\u00e4rnberg","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Nursing, School of Health Sciences, University of Malaga-Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora","family":"Romaguera","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Illes Balears (IdISBa), University Hospital of Son Espases, Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Estruch","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Internal Medicine, Hospital Cl\u00ednic, Institut d\u2019Investigacions Biom\u00e8diques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Vidal","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Hospital Clinic Universitari, Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi Sunyer (IDIBAPS), Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alfredo","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain"},{"name":"Madrid Institute for Advanced Studies (IMDEA) Food Institute, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Ar\u00f3s","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Cardiology, University Hospital Araba, Vitoria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clotilde","family":"V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Endocrinology and Nutrition, University Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Ros","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Lipid Clinic, Endocrinology and Nutrition Service, Institut d\u2019Investigacions Biom\u00e8diques August Pi Sunyer (IDIBAPS), Hospital Cl\u00ednic, University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Vioque","sequence":"additional","affiliation":[{"name":"Nutritional Epidemiology Unit, University of Miguel Hern\u00e1ndez, Isabial-Fisabio, Alicante, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"L\u00f3pez-Miranda","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, 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de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, University of Malaga-Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Mart\u00edn","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Research Group on Gene-Environment Interactions and Health, University of Le\u00f3n, Le\u00f3n, Spain"},{"name":"Biomedicine Institute (IBIOMED), University of Le\u00f3n, Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Lapetra","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Family Medicine, Research Unit, Distrito Sanitario Atenci\u00f3n Primaria Sevilla, Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Pint\u00f3","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Lipid Unit, Department of Internal Medicine, Bellvitge Biomedical Research Institute (IDIBELL)-Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Daimiel","sequence":"additional","affiliation":[{"name":"Nutritional Genomics and Epigenomics Group, Madrid Institute for Advanced Studies (IMDEA) Food Institute, Campus of International Excellence UAM+CSIC, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Delgado-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Health Sciences, University of Ja\u00e9n, Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Mat\u00eda","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Facultad de Medicina, Hospital Cl\u00ednico San Carlos-Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"G\u00f3mez-Gracia","sequence":"additional","affiliation":[{"name":"Centro de 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