{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:16:09Z","timestamp":1779376569946,"version":"3.53.1"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2018,3,20]],"date-time":"2018-03-20T00:00:00Z","timestamp":1521504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>This three-arm, randomized, controlled study aimed to determine the differences in the effects of general advice (GA) on lifestyle change, intensive lifestyle modification programme (ILMP) and GA + metformin (GA + Met) in reducing the prevalence of full metabolic syndrome (MetS) in subjects with prediabetes; 294 Saudis with prediabetes (fasting glucose 5.6\u20136.9 mmol\/L) were initially randomized, 263 completed 6 months and 237 completed 12 months. They were allocated into three groups: GA group which received a standard lifestyle change education; ILMP which followed a rigorous lifestyle modification support on diet and physical activity; and a GA + Met group. Anthropometric and biochemical estimations were measured. Full MetS (primary endpoint) and its components (secondary endpoint) were screened at baseline, 6 and 12 months. Full MetS in the ILMP group decreased by 26% (p &lt; 0.001); in GA + Met group by 22.4% (p = 0.01) and in GA group by 8.2% (p = 0.28). The number of MetS components decreased significantly in the ILMP and GA + Met groups (mean change 0.81, p &lt; 0.001 and 0.35, p = 0.05, respectively). Between-group comparison revealed a clinically significant decrease in MetS components in favor of the ILMP group (\u22120.58 (\u22120.88\u20130.28), p &lt; 0.001). This study highlights the clinical potency of ILMP versus other diabetes prevention options in reducing MetS in Saudi adults with elevated fasting glucose.<\/jats:p>","DOI":"10.3390\/nu10030383","type":"journal-article","created":{"date-parts":[[2018,3,20]],"date-time":"2018-03-20T06:57:11Z","timestamp":1521529031000},"page":"383","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Effects of Different Dietary and Lifestyle Modification Therapies on Metabolic Syndrome in Prediabetic Arab Patients: A 12-Month Longitudinal Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4794-1778","authenticated-orcid":false,"given":"Hanan","family":"Alfawaz","sequence":"first","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Department of Food Science and Nutrition, College of Food Science &amp; Agriculture, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-6516","authenticated-orcid":false,"given":"Kaiser","family":"Wani","sequence":"additional","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alnaami","sequence":"additional","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef","family":"Al-Saleh","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11461, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naji","family":"Aljohani","sequence":"additional","affiliation":[{"name":"Specialized Diabetes and Endocrine Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Al-Attas","sequence":"additional","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majed","family":"Alokail","sequence":"additional","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Metabolic and Vascular Health, Clinical Sciences Research Institute, University Hospitals Coventry and Warwickshire Trust, Walsgrave, Coventry CV2 2DX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5472-1725","authenticated-orcid":false,"given":"Nasser","family":"Al-Daghri","sequence":"additional","affiliation":[{"name":"Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"},{"name":"Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37, S81\u2013S90.","DOI":"10.2337\/dc14-S081"},{"key":"ref_2","unstructured":"(2012). Prediabetes and the Potential to Prevent Diabetes. Lancet, 379, Available online: http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736%2812%2960960-X\/fulltext."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Bray","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"537","DOI":"10.2337\/diacare.20.4.537","article-title":"Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and Diabetes Study","volume":"20","author":"Pan","year":"1997","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00125-005-0097-z","article-title":"The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)","volume":"49","author":"Ramachandran","year":"2006","journal-title":"Diabetologia"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cardona-Morrell, M., Rychetnik, L., Morrell, S.L., Espinel, P.T., and Bauman, A. (2010). Reduction of diabetes risk in routine clinical practice: Are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-653"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/dme.12018","article-title":"Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence","volume":"30","author":"Johnson","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Expert Panel on Detection, Evaluation (2001). Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 285, 2486\u20132497.","DOI":"10.1001\/jama.285.19.2486"},{"key":"ref_9","first-page":"1360","article-title":"Prevalence of metabolic syndrome in Saudi adult soldiers","volume":"26","author":"Imtiaz","year":"2005","journal-title":"Saudi Med. J."},{"key":"ref_10","first-page":"1918","article-title":"Metabolic syndrome in Saudi Arabia","volume":"26","author":"Arafah","year":"2005","journal-title":"Saudi Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3066","DOI":"10.1161\/CIRCULATIONAHA.105.539528","article-title":"Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus","volume":"112","author":"Wilson","year":"2005","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3120","DOI":"10.2337\/diabetes.51.10.3120","article-title":"Components of the \u201cmetabolic syndrome\u201d and incidence of type 2 diabetes","volume":"51","author":"Hanson","year":"2002","journal-title":"Diabetes"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Al-Daghri, N.M., Al-Attas, O.S., Alokail, M.S., Alkharfy, K.M., Yousef, M., Sabico, S.L., and Chrousos, G.P. (2011). Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): A decade of an epidemic. BMC Med., 9.","DOI":"10.1186\/1741-7015-9-76"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"170","DOI":"10.4103\/2230-8229.142971","article-title":"Metabolic syndrome: Risk factors among adults in Kingdom of Saudi Arabia","volume":"21","author":"Aljohani","year":"2014","journal-title":"J. Fam. Community Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1242\/dmm.001180","article-title":"A comprehensive definition for metabolic syndrome","volume":"2","author":"Huang","year":"2009","journal-title":"Dis. Models Mech."},{"key":"ref_16","unstructured":"American Diabetes Association (2017). Standards of Medical Care in Diabetes. Diabetes Care, 40, Available online: http:\/\/care.diabetesjournals.org\/content\/diacare\/suppl\/2016\/12\/15\/40.Supplement_1.DC1\/DC_40_S1_final.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1056\/NEJM200105033441801","article-title":"Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance","volume":"344","author":"Tuomilehto","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.diabres.2004.06.010","article-title":"Prevention of type 2 diabetes by lifestyle intervention: A Japanese trial in IGT males","volume":"67","author":"Kosaka","year":"2005","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/1476-511X-13-87","article-title":"A 6-month \u201cself-monitoring\u201d lifestyle modification with increased sunlight exposure modestly improves vitamin D status, lipid profile and glycemic status in overweight and obese Saudi adults with varying glycemic levels","volume":"13","author":"Alfawaz","year":"2014","journal-title":"Lipids Health Dis."},{"key":"ref_20","first-page":"19850","article-title":"Age-specific improvements in impaired fasting glucose and vitamin D status using a lifestyle intervention programme in overweight and obese Saudi subjects","volume":"9","author":"Alfawaz","year":"2016","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"611","DOI":"10.7326\/0003-4819-142-8-200504190-00009","article-title":"The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The Diabetes Prevention Program randomized trial","volume":"142","author":"Orchard","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1001\/archinte.163.16.1889","article-title":"Effects of exercise and weight loss on cardiac risk factors associated with syndrome X","volume":"163","author":"Watkins","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1001\/jama.292.12.1440","article-title":"Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial","volume":"292","author":"Esposito","year":"2004","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.2337\/diacare.28.12.2823","article-title":"Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome","volume":"28","author":"Azadbakht","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.2337\/diacare.26.8.2261","article-title":"Low\u2013glycemic index diets in the management of diabetes","volume":"26","author":"Hayne","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1007\/s00125-017-4342-z","article-title":"The mechanisms of action of metformin","volume":"60","author":"Rena","year":"2017","journal-title":"Diabetologia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/MED.0000000000000095","article-title":"Effects of metformin on weight loss: Potential mechanisms","volume":"21","author":"Malin","year":"2014","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yamaoka, K., and Tango, T. (2012). Effects of lifestyle modification on metabolic syndrome: A systematic review and meta-analysis. BMC Med., 10.","DOI":"10.1186\/1741-7015-10-138"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2005). Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care, 28, 888\u2013894.","DOI":"10.2337\/diacare.28.4.888"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2796.2004.01328.x","article-title":"The effect of metformin on blood pressure, plasma cholesterol and triglycerides in type 2 diabetes mellitus: A systematic review","volume":"256","author":"Kooy","year":"2004","journal-title":"J. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/HJH.0000000000001119","article-title":"Effects of metformin on blood pressure in nondiabetic patients: A meta-analysis of randomized controlled trials","volume":"35","author":"Zhou","year":"2017","journal-title":"J. Hypertens."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1161\/HYPERTENSIONAHA.116.07353","article-title":"Metformin reverses development of pulmonary hypertension via aromatase inhibition","volume":"68","author":"Dean","year":"2016","journal-title":"Hypertension"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1038\/sj.jhh.1002118","article-title":"Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects","volume":"21","author":"Kagan","year":"2007","journal-title":"J. Hum. Hypertens."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1038\/nri3041","article-title":"The anti-inflammatory effects of exercise: Mechanisms and implications for the prevention and treatment of disease","volume":"11","author":"Gleeson","year":"2011","journal-title":"Nat. Rev. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1001\/jama.2013.277669","article-title":"Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial","volume":"310","author":"Messier","year":"2013","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0140-6736(06)69075-2","article-title":"Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study)","volume":"368","author":"Andersen","year":"2006","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/S0895-4356(00)00315-2","article-title":"Stability of indicators of the metabolic syndrome from childhood and adolescence to young adulthood: The Quebec Family Study","volume":"54","author":"Katzmarzyk","year":"2001","journal-title":"J. Clin. Epidemiol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/3\/383\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:57:46Z","timestamp":1760194666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/3\/383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,20]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,3]]}},"alternative-id":["nu10030383"],"URL":"https:\/\/doi.org\/10.3390\/nu10030383","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,20]]}}}