{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:53:51Z","timestamp":1793390031717,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,20]],"date-time":"2022-11-20T00:00:00Z","timestamp":1668902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Greek Governmental Institute of Scholarships"},{"name":"Harokopio University Department of Nutrition and Dietetics Graduate Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The ideal lifestyle intervention to battle both obesity and diabetes is currently unknown. The aim of this pilot uncontrolled intervention trial was to assess the effect of a modified Mediterranean diet (MedDiet) on weight loss and glucoregulation among overweight\/obese adults. Eleven men and women with overweight\/obesity, aged 37 \u00b1 12 years, participated in a free-living intervention until 10% weight loss was achieved. Participants followed an individualized MedDiet high in monounsaturated fat and protein with decreased carbohydrate and saturated fat contents. Physical activity and dietary intake were monitored with pedometers and food records, respectively. Upon weight loss achievement, anthropometric measurements, blood metabolic profiles and individual responses to oral glucose and mixed-meal tests were evaluated pre- and post-intervention. The results showed significant ameliorations in body fat, waist circumference and leptin levels (p &lt; 0.01), with concomitant increases in adiponectin\u2013leptin ratios (p &lt; 0.001). Glucoregulation was significantly improved according to glucose and insulin responses, homeostatic model assessment of insulin resistance indices and postprandial insulin sensitivity indices (p &lt; 0.05). In conclusion, the modified Mediterranean diet may induce significant improvements in body composition, adipocytokine profile and glucose metabolism in overweight\/obese individuals. Notably, ameliorated glycemia and increased insulin sensitivity may be retained even at postprandial level, irrespective of the meal consumed.<\/jats:p>","DOI":"10.3390\/ijerph192215347","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T03:05:11Z","timestamp":1668999911000},"page":"15347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["A Modified Mediterranean Diet Improves Fasting and Postprandial Glucoregulation in Adults with Overweight and Obesity: A Pilot Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4869-6815","authenticated-orcid":false,"given":"Aristea","family":"Gioxari","sequence":"first","affiliation":[{"name":"Department of Nutritional Science and Dietetics, School of Health Science, University of the Peloponnese, Antikalamos, GR24100 Kalamata, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-6595","authenticated-orcid":false,"given":"Maria G.","family":"Grammatikopoulou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Katsarou","sequence":"additional","affiliation":[{"name":"Laboratory of Nutrition & Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, 70th Eleftheriou Venizelou Str., GR17676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-153X","authenticated-orcid":false,"given":"Demosthenes B.","family":"Panagiotakos","sequence":"additional","affiliation":[{"name":"Laboratory of Nutrition & Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, 70th Eleftheriou Venizelou Str., GR17676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Toutouza","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Hippokration General Hospital, 2\u20134 Mesogeion Avenue, GR11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7485-8112","authenticated-orcid":false,"given":"Stavros A.","family":"Kavouras","sequence":"additional","affiliation":[{"name":"Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Labros S.","family":"Sidossis","sequence":"additional","affiliation":[{"name":"Laboratory of Nutrition & Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, 70th Eleftheriou Venizelou Str., GR17676 Athens, Greece"},{"name":"Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ 08854, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8229-1400","authenticated-orcid":false,"given":"Maria I.","family":"Maraki","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Sciences, Hellenic Mediterranean University, GR72300 Sitia, Greece"},{"name":"Section of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistaseos Str., GR17237 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dai, H., Alsalhe, T.A., Chalghaf, N., Ricc\u00f2, M., Bragazzi, N.L., and Wu, J. (2020). The global burden of disease attributable to high body mass index in 195 countries and territories, 1990\u20132017: An analysis of the Global Burden of Disease Study. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003198"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/oby.20562","article-title":"One day of overfeeding impairs nocturnal glucose but not fatty acid homeostasis in overweight men","volume":"22","author":"Magkos","year":"2014","journal-title":"Obesity"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jada.2008.11.041","article-title":"Position of the American Dietetic Association: Weight Management","volume":"109","author":"Seagle","year":"2009","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wiechert, M., and Holzapfel, C. (2021). Nutrition Concepts for the Treatment of Obesity in Adults. Nutrients, 14.","DOI":"10.3390\/nu14010169"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5687","DOI":"10.2174\/1381612822666160822125834","article-title":"Cardiovascular Prevention in Obese Patients","volume":"22","author":"Landecho","year":"2016","journal-title":"Curr. Pharm. Des."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1017\/S136898001600344X","article-title":"Association of BMI with risk of CVD mortality and all-cause mortality","volume":"20","author":"Kee","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.pcad.2018.06.004","article-title":"Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: An Update","volume":"61","author":"Poirier","year":"2018","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.2337\/dc08-S061","article-title":"Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association","volume":"31","author":"Bantle","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1111\/dme.13603","article-title":"Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes","volume":"35","author":"Dyson","year":"2018","journal-title":"Diabet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hwalla, N., and Jaafar, Z. (2020). Dietary Management of Obesity: A Review of the Evidence. Diagnostics, 11.","DOI":"10.3390\/diagnostics11010024"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e140065","DOI":"10.1172\/JCI140065","article-title":"Dietary interventions for obesity: Clinical and mechanistic findings","volume":"131","author":"Chao","year":"2021","journal-title":"J. Clin. Invest."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.3390\/nu6041406","article-title":"Mediterranean diet and diabetes: Prevention and treatment","volume":"6","author":"Georgoulis","year":"2014","journal-title":"Nutrients"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E440","DOI":"10.1152\/ajpendo.00245.2015","article-title":"Physiology in Medicine: Update on lifestyle determinants of postprandial triacylglycerolemia with emphasis on the Mediterranean lifestyle","volume":"309","author":"Maraki","year":"2015","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.amjmed.2015.11.028","article-title":"Systematic Review of the Mediterranean Diet for Long-Term Weight Loss","volume":"129","author":"Mancini","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/S2213-8587(19)30074-9","article-title":"Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: A prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial","volume":"7","author":"Estruch","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/09637486.2016.1228100","article-title":"Short-term benefits of an unrestricted-calorie traditional Mediterranean diet, modified with a reduced consumption of carbohydrates at evening, in overweight-obese patients","volume":"68","author":"Salvia","year":"2017","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1017\/S0007114512002589","article-title":"Dietary protein\u2014Its role in satiety, energetics, weight loss and health","volume":"108","author":"Lemmens","year":"2012","journal-title":"Br. J. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.numecd.2008.10.006","article-title":"High protein diets decrease total and abdominal fat and improve CVD risk profile in overweight and obese men and women with elevated triacylglycerol","volume":"19","author":"Clifton","year":"2009","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.3945\/ajcn.112.044321","article-title":"Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: A meta-analysis of randomized controlled trials","volume":"96","author":"Wycherley","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nut.2014.06.011","article-title":"Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base","volume":"31","author":"Feinman","year":"2015","journal-title":"Nutrition"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"200","DOI":"10.7326\/0003-4819-158-3-201302050-00583","article-title":"SPIRIT 2013 statement: Defining standard protocol items for clinical trials","volume":"158","author":"Chan","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1038\/oby.2010.218","article-title":"Lifestyle intervention leading to moderate weight loss normalizes postprandial triacylglycerolemia despite persisting obesity","volume":"19","author":"Maraki","year":"2011","journal-title":"Obesity"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/S0002-8223(03)00376-6","article-title":"Nutrient database for the 2003 exchange lists for meal planning","volume":"103","author":"Wheeler","year":"2003","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1038\/sj.ijo.0803086","article-title":"The effect of low carbohydrate on energy metabolism","volume":"29","author":"Mei","year":"2005","journal-title":"Int. J. Obes."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bellou, E., Maraki, M., Magkos, F., Botonaki, H., Panagiotakos, D.B., Kavouras, S.A., and Sidossis, L.S. (2013). Effect of acute negative and positive energy balance on basal very-low density lipoprotein triglyceride metabolism in women. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0060251"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.clnu.2009.10.007","article-title":"One day of moderate energy deficit reduces fasting and postprandial triacylglycerolemia in women: The role of calorie restriction and exercise","volume":"29","author":"Maraki","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.2337\/diacare.22.9.1462","article-title":"Insulin sensitivity indices obtained from oral glucose tolerance testing: Comparison with the euglycemic insulin clamp","volume":"22","author":"Matsuda","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.diabres.2008.11.017","article-title":"Classical and model-based estimates of beta-cell function during a mixed meal vs. an OGTT in a population-based cohort","volume":"83","author":"Rijkelijkhuizen","year":"2009","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge","volume":"18","author":"Friedewald","year":"1972","journal-title":"Clin. Chem."},{"key":"ref_32","first-page":"81.015B","article-title":"The impact of long-term changes in metabolic status on cardiovascular biomarkers and microvascular endothelial function in middle-aged men: A 25-year prospective study","volume":"7","author":"Kostka","year":"2015","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Papadaki, A., Nolen-Doerr, E., and Mantzoros, C.S. (2020). The effect of the mediterranean diet on metabolic health: A systematic review and meta-analysis of controlled trials in adults. Nutrients, 12.","DOI":"10.3390\/nu12113342"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1056\/NEJMc1809971","article-title":"Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts","volume":"379","author":"Correia","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2337\/dc10-1288","article-title":"Reduction in the incidence of type 2 diabetes with the Mediterranean diet: Results of the PREDIMED-Reus nutrition intervention randomized trial","volume":"34","author":"Babio","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Naude, C.E., Schoonees, A., Senekal, M., Young, T., Garner, P., and Volmink, J. (2014). Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: A systematic review and meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0100652"},{"key":"ref_37","first-page":"676","article-title":"Impact of different protein sources in the glycemic and insulinemic responses","volume":"26","author":"Alfenas","year":"2011","journal-title":"Nutr. Hosp."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"712","DOI":"10.3945\/an.115.009654","article-title":"Plant protein and animal proteins: Do they differentially affect cardiovascular disease risk?","volume":"6","author":"Richter","year":"2015","journal-title":"Adv. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1743-7075-11-53","article-title":"A high-protein diet for reducing body fat: Mechanisms and possible caveats","volume":"11","author":"Pesta","year":"2014","journal-title":"Nutr. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.2337\/dc14-2913","article-title":"Calorie Restriction and Matched Weight Loss from Exercise: Independent and Additive Effects on Glucoregulation and the Incretin System in Overweight Women and Men","volume":"38","author":"Weiss","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/gerona\/glx227","article-title":"Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms","volume":"73","author":"Tosti","year":"2018","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1152\/ajpendo.00165.2020","article-title":"Effects of carbohydrate restriction on postprandial glucose metabolism, b-cell function, gut hormone secretion, and satiety in patients with Type 2 diabetes","volume":"320","author":"Skytte","year":"2021","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"425","DOI":"10.2337\/diacare.25.3.425","article-title":"Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes","volume":"25","author":"Parker","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.2337\/dc12-0869","article-title":"The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: Results from the OmniHeart trial","volume":"36","author":"Gadgil","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.cca.2012.12.007","article-title":"Role of leptin and adiponectin in insulin resistance","volume":"417","author":"Yadav","year":"2013","journal-title":"Clin. Chim. Acta"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3945\/ajcn.115.109173","article-title":"Metabolic adaptation to caloric restriction and subsequent refeeding: The Minnesota Starvation Experiment revisited","volume":"102","author":"Enderle","year":"2015","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.metabol.2015.06.016","article-title":"Leptin and energy restriction induced adaptation in energy expenditure","volume":"64","author":"Camps","year":"2015","journal-title":"Metabolism"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"409679","DOI":"10.1155\/2013\/409679","article-title":"Metabolic risk susceptibility in men is partially related to adiponectin\/leptin ratio","volume":"2013","author":"Vega","year":"2013","journal-title":"J. Obes."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.cmet.2012.01.024","article-title":"Interplay between lipids and branched-chain amino acids in development of insulin resistance","volume":"15","author":"Newgard","year":"2012","journal-title":"Cell Metab."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/22\/15347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:22:29Z","timestamp":1760145749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/22\/15347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,20]]},"references-count":49,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192215347"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192215347","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,20]]}}}