{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:08:52Z","timestamp":1791994132705,"version":"4.4.0"},"reference-count":117,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"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>Background: Insulin resistance (IR) is a hallmark of metabolic disorders including type 2 diabetes mellitus (T2DM), metabolic syndrome, metabolic dysfunction-associated steatotic liver disease (MASLD), obesity, polycystic ovary syndrome (PCOS), and cardiovascular diseases. It arises from impaired insulin signaling in muscle, liver, and adipose tissue, driven by ectopic lipid accumulation, chronic inflammation, oxidative stress, and gut microbiota dysbiosis. Methods: This narrative review synthesizes IR mechanisms and the evidence on specific dietary patterns. A structured search of PubMed\/MEDLINE and Embase (up to January 2026) prioritized RCTs, systematic reviews, meta-analyses, and clinical guidelines. Results: IR assessment relies on the hyperinsulinemic\u2013euglycemic clamp as gold standard, with HOMA-IR and QUICKI as validated clinical surrogates. The Mediterranean diet is the most evidence-supported strategy, with consistent HOMA-IR reductions, a 31% decrease in T2DM incidence (PREDIMED-Plus), and demonstrated efficacy across T2DM, MASLD, and PCOS. Low-GI and DASH diets improve postprandial insulin dynamics and are particularly effective in PCOS. Low-carbohydrate and ketogenic diets produce the largest short-term reductions in fasting glucose and insulin secretion, though long-term sustainability requires further study. Plant-based diets and intermittent fasting improve IR primarily via weight loss and gut microbiota modulation. Most studies rely on surrogate IR indices and are short-term (\u226426 weeks). Conclusions: Dietary pattern selection should be individualized according to metabolic phenotype, comorbidities, and adherence potential. Larger, longer, head-to-head trials measuring hard clinical outcomes are needed.<\/jats:p>","DOI":"10.3390\/nu18071119","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:23:17Z","timestamp":1774963397000},"page":"1119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Targeting Insulin Resistance Through Nutrition: Pathophysiological Insights and Dietary Interventions"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1153-6700","authenticated-orcid":false,"given":"Amelia","family":"Caretto","sequence":"first","affiliation":[{"name":"Diabetes Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Zanardini","sequence":"additional","affiliation":[{"name":"Diabetes Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6115-2476","authenticated-orcid":false,"given":"Giulio","family":"Frontino","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Pedone","sequence":"additional","affiliation":[{"name":"Diabetes Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhao, X., An, X., Yang, C., Sun, W., Ji, H., and Lian, F. (2023). The crucial role and mechanism of insulin resistance in metabolic disease. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1149239"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00125-002-1009-0","article-title":"The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 diabetes","volume":"46","author":"Kahn","year":"2003","journal-title":"Diabetologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1152\/physrev.00063.2017","article-title":"Mechanisms of Insulin Action and Insulin Resistance","volume":"98","author":"Petersen","year":"2018","journal-title":"Physiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Khalid, M., Alkaabi, J., Khan, M.A.B., and Adem, A. (2021). Insulin Signal Transduction Perturbations in Insulin Resistance. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22168590"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4093\/dmj.2021.0280","article-title":"Insulin Resistance: From Mechanisms to Therapeutic Strategies","volume":"46","author":"Lee","year":"2022","journal-title":"Diabetes Metab. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1017\/S1368980014001542","article-title":"Adherence to a Mediterranean diet and risk of diabetes: A systematic review and meta-analysis","volume":"18","author":"Schwingshackl","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s11906-018-0812-z","article-title":"The Global Epidemic of the Metabolic Syndrome","volume":"20","author":"Saklayen","year":"2018","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0300-2977(97)00012-0","article-title":"Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidaemia and atherosclerosis","volume":"50","author":"DeFronzo","year":"1997","journal-title":"Neth. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S2213-8587(21)00244-8","article-title":"COVID-19 and metabolic disease: Mechanisms and clinical management","volume":"9","author":"Steenblock","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.jhep.2019.06.021","article-title":"The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis","volume":"71","author":"Younossi","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Borai, A., Livingstone, C., Kaddam, I., and Ferns, G. (2011). Selection of the appropriate method for the assessment of insulin resistance. BMC Med. Res. Methodol., 11.","DOI":"10.1186\/1471-2288-11-158"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.diabet.2011.01.002","article-title":"How can we measure insulin sensitivity\/resistance?","volume":"37","author":"Disse","year":"2011","journal-title":"Diabetes Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1159\/000515462","article-title":"Measuring Insulin Resistance in Humans","volume":"93","author":"Sharma","year":"2020","journal-title":"Horm. Res. Paediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4103\/2230-8210.146874","article-title":"Assessment of insulin sensitivity\/resistance","volume":"19","author":"Gutch","year":"2015","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.metabol.2015.09.002","article-title":"Insulin resistance in type 1 diabetes mellitus","volume":"64","author":"Kaul","year":"2015","journal-title":"Metabolism"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27090","DOI":"10.1074\/jbc.M109.016675","article-title":"Insulin is a stronger inducer of insulin resistance than hyperglycemia in mice with type 1 diabetes mellitus (T1DM)","volume":"284","author":"Liu","year":"2009","journal-title":"J. Biol. Chem."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"989","DOI":"10.3945\/ajcn.112.036350","article-title":"Energy balance and its components: Implications for body weight regulation","volume":"95","author":"Hall","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"McArdle Maeve, A., Finucane, O.M., Connaughton, R.M., McMorrow, A.M., and Roche, H.M. (2013). Mechanisms of obesity-induced inflammation and insulin resistance: Insights into the emerging role of nutritional strategies. Front. Endocrin., 4.","DOI":"10.3389\/fendo.2013.00052"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1172\/JCI34260","article-title":"Insulin sensitivity: Modulation by nutrients and inflammation","volume":"118","author":"Schenk","year":"2008","journal-title":"J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1210\/jcem.87.7.8638","article-title":"Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men","volume":"87","author":"Vehkavaara","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4145","DOI":"10.1210\/jc.2005-0482","article-title":"The metabolically healthy but obese individual presents a favorable inflammation profile","volume":"90","author":"Karelis","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2174\/1570161115666171010115119","article-title":"Insulin Resistance the Link between T2DM and CVD: Basic Mechanisms and Clinical Implications","volume":"17","author":"Jayyousi","year":"2019","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/0026-0495(88)90133-3","article-title":"Hyperinsulinemia, upper body adiposity, and cardiovascular risk factors in non-diabetics","volume":"37","author":"Haffner","year":"1988","journal-title":"Metabolism"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00125-017-4390-4","article-title":"Diabetic cardiomyopathy: A hyperglycaemia- and insulin-resistance-induced heart disease","volume":"61","author":"Jia","year":"2018","journal-title":"Diabetologia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/0002-8703(88)90220-7","article-title":"The Prospective Cardiovascular M\u00fcnster (PROCAM) study: Prevalence of hyperlipidemia in persons with hypertension and\/or diabetes mellitus and the relationship to coronary heart disease","volume":"116","author":"Assmann","year":"1988","journal-title":"Am. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12933-021-01274-x","article-title":"Stronger association of triglyceride glucose index than the HOMA-IR with arterial stiffness in patients with type 2 diabetes: A real-world single-centre study","volume":"20","author":"Wang","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/1753-0407.12283","article-title":"Insulin resistance is associated with all chronic complications in type 1 diabetes","volume":"8","author":"Pop","year":"2016","journal-title":"J. Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5698","DOI":"10.1210\/jc.2005-0799","article-title":"The metabolic syndrome; insulin resistance; and cardiovascular risk in diabetic and nondiabetic patients","volume":"90","author":"Saely","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2002-0010","article-title":"Insulin resistance and chronic cardiovascular inflammatory syndrome","volume":"24","author":"Ricart","year":"2003","journal-title":"Endocr. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3887","DOI":"10.2337\/db13-0095","article-title":"Myocardial loss of IRS1 and IRS2 causes heart failure and is controlled by p38a MAPK during insulin resistance","volume":"62","author":"Qi","year":"2013","journal-title":"Diabetes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.ijcard.2016.07.087","article-title":"Impact of insulin resistance on cardiac and vascular function","volume":"221","author":"Novo","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E1716","DOI":"10.1210\/jc.2013-1166","article-title":"Sex differences in insulin resistance and cardiovascular disease risk","volume":"98","author":"Kim","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2977","DOI":"10.1113\/JP276747","article-title":"Cardiomyopathy in obesity, insulin resistance and diabetes","volume":"598","author":"Nakamura","year":"2020","journal-title":"J. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2337\/dc08-0854","article-title":"Relationship of insulin resistance and related metabolic variables to coronary artery disease: A mathematical analysis","volume":"32","author":"Eddy","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/joim.12719","article-title":"Causal relationship of hepatic fat with liver damage and insulin resistance in nonalcoholic fatty liver","volume":"283","author":"Dongiovanni","year":"2018","journal-title":"J. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jfma.2019.03.014","article-title":"Risk stratification of non-alcoholic fatty liver disease across body mass index in a community basis","volume":"119","author":"Huang","year":"2020","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2337\/dc17-1902","article-title":"Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: A meta-analysis","volume":"41","author":"Mantovani","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.diabres.2018.02.026","article-title":"Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis","volume":"139","author":"Sainsbury","year":"2018","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1210\/er.2011-1034","article-title":"Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications","volume":"33","author":"Dunaif","year":"2012","journal-title":"Endocr. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1210\/jcem-71-6-1653","article-title":"Androgen response to endogenous insulin secretion during the frequently sampled intravenous glucose tolerance test in normal and hyperandrogenic women","volume":"71","author":"Falcone","year":"1990","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1042\/CS20090399","article-title":"Insulin resistance and hyperinsulinaemia in the development and progression of cancer","volume":"118","author":"Godsland","year":"2009","journal-title":"Clin. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3638","DOI":"10.1002\/cncr.33002","article-title":"Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women\u2019s Health Initiative","volume":"126","author":"Pan","year":"2020","journal-title":"Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"789174","DOI":"10.1155\/2012\/789174","article-title":"Insulin resistance and cancer risk: An overview of the pathogenetic mechanisms","volume":"2012","author":"Arcidiacono","year":"2012","journal-title":"Exp. Diabetes Res."},{"key":"ref_44","first-page":"djw029","article-title":"The intestinal microbiome and estrogen receptor-positive female breast cancer","volume":"108","author":"Kwa","year":"2016","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1172\/JCI10583","article-title":"Cellular mechanisms of insulin resistance","volume":"106","author":"Shulman","year":"2000","journal-title":"J. Clin. Investig."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1007\/s00125-012-2644-8","article-title":"Regulation of insulin sensitivity by serine\/threonine phosphorylation of insulin receptor substrate proteins IRS1 and IRS2","volume":"55","author":"Copps","year":"2012","journal-title":"Diabetologia"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/nrm1837","article-title":"Critical nodes in signalling pathways: Insights into insulin action","volume":"7","author":"Taniguchi","year":"2006","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Lipke, K., Kubis-Kubiak, A., and Piwowar, A. (2022). Molecular Mechanism of Lipotoxicity as an Interesting Aspect in the Development of Pathological States-Current View of Knowledge. Cells, 11.","DOI":"10.3390\/cells11050844"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"38784","DOI":"10.1038\/s41598-025-22745-1","article-title":"Skeletal muscle insulin resistance in prediabetes: A lipidomic perspective on diacylglycerols, ceramides, and phospholipids","volume":"15","author":"Markova","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.7150\/thno.70588","article-title":"The relevance of organelle interactions in cellular senescence","volume":"12","author":"Huang","year":"2022","journal-title":"Theranostics"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.2337\/dc10-9990","article-title":"Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement","volume":"33","author":"Colberg","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"12385","DOI":"10.1002\/jcp.28066","article-title":"Molecular mechanisms by which aerobic exercise induces insulin sensitivity","volume":"234","author":"Yaribeygi","year":"2019","journal-title":"J. Cell Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"de Las Heras, N., Klett-Mingo, M., Ballesteros, S., Mart\u00edn-Fern\u00e1ndez, B., Escribano, \u00d3., Blanco-Rivero, J., Balfag\u00f3n, G., Hribal, M.L., Benito, M., and Lahera, V. (2018). Chronic Exercise Improves Mitochondrial Function and Insulin Sensitivity in Brown Adipose Tissue. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01122"},{"key":"ref_54","first-page":"641","article-title":"The Effect of Tai Chi on Cardiometabolic Risk Factors: Systematic Review and Meta-Analysis","volume":"31","author":"Wang","year":"2025","journal-title":"J. Integr. Complement. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1038\/ijo.2010.112","article-title":"Dietary intervention-induced weight loss decreases macrophage content in adipose tissue of obese women","volume":"35","author":"Sengenes","year":"2011","journal-title":"Int. J. Obes."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.2337\/diabetes.54.8.2404","article-title":"Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the diabetes prevention program: Effects of lifestyle intervention and metformin","volume":"54","author":"Kitabchi","year":"2005","journal-title":"Diabetes"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1007\/s001250100009","article-title":"A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons","volume":"44","author":"Pinillos","year":"2001","journal-title":"Diabetologia"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1743-7075-5-9","article-title":"Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: Time for a critical appraisal","volume":"5","author":"Accurso","year":"2008","journal-title":"Nutr. Metab."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Bolla, A.M., Caretto, A., Laurenzi, A., Scavini, M., and Piemonti, L. (2019). Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. Nutrients, 11.","DOI":"10.3390\/nu11050962"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1038\/nri2449","article-title":"Nutrient sensing and inflammation in metabolic diseases","volume":"8","author":"Hotamisligil","year":"2008","journal-title":"Nat. Rev. Immunol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.2337\/dc15-0761","article-title":"Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: A randomized clinical trial","volume":"38","author":"Jakubowicz","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.2337\/diacare.18.8.1104","article-title":"Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study","volume":"18","author":"Feskens","year":"1995","journal-title":"Diabetes Care"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.3945\/jn.114.193706","article-title":"Partly replacing meat protein with soy protein alters insulin resistance and blood lipids in postmenopausal women with abdominal obesity","volume":"144","author":"Feskens","year":"2014","journal-title":"J. Nutr."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/j.1365-2265.2012.04450.x","article-title":"What dietary modification best improves insulin sensitivity and why?","volume":"77","author":"Weickert","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"146S","DOI":"10.1080\/07315724.2002.10719212","article-title":"Regulation of adiposity and obesity risk by dietary calcium: Mechanisms and implications","volume":"21","author":"Zemel","year":"2002","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1210\/jc.2007-0298","article-title":"The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis","volume":"92","author":"Pittas","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1159\/000346553","article-title":"Mediterranean diet adherence in individuals with prediabetes and unknown diabetes: The Di@bet.es Study","volume":"62","author":"Ortega","year":"2013","journal-title":"Ann. Nutr. Metab."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Rossi, L., Gianfredi, V., Lezo, A., Maggi, S., Nucci, D., Onder, G., Silano, M., Troiano, E., Volpe, M., and Zanetti, M. (2025). Toward strong, transparent and science-based dietary guidance: Lessons learned from the Mediterranean Diet guideline development. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1708486"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Bakaloudi, D.R., Chrysoula, L., Kotzakioulafi, E., Theodoridis, X., and Chourdakis, M. (2021). Impact of the Level of Adherence to Mediterranean Diet on the Parameters of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 13.","DOI":"10.3390\/nu13051514"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Vetrani, C., Verde, L., Colao, A., Barrea, L., and Muscogiuri, G. (2023). The Mediterranean Diet: Effects on Insulin Resistance and Secretion in Individuals with Overweight or Obesity. Nutrients, 15.","DOI":"10.3390\/nu15214524"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Mirabelli, M., Chiefari, E., Arcidiacono, B., Corigliano, D.M., Brunetti, F.S., Maggisano, V., Russo, D., Foti, D.P., and Brunetti, A. (2020). Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients, 12.","DOI":"10.3390\/nu12041066"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.sleep.2023.07.004","article-title":"Changes in objectively measured sleep after a multidisciplinary lifestyle intervention in children with abdominal obesity: A randomized trial","volume":"109","year":"2023","journal-title":"Sleep Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s40618-023-02027-1","article-title":"The effect of Mediterranean diet on inflammatory biomarkers and components of metabolic syndrome in adolescent girls","volume":"46","author":"Asoudeh","year":"2023","journal-title":"J. Endocrinol. Investig."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"11170","DOI":"10.1038\/s41598-018-29495-3","article-title":"Weight loss and metabolic health effects from energy-restricted Mediterranean and Central-European diets in postmenopausal women: A randomized controlled trial","volume":"8","author":"Bajerska","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Blancas-S\u00e1nchez, I.M., Del Rosal Jurado, M., Aparicio-Mart\u00ednez, P., Quintana Navarro, G., Vaquero-Abellan, M., Castro Jim\u00e9nez, R.A., and Fonseca Pozo, F.J. (2022). A Mediterranean-Diet-Based Nutritional Intervention for Children with Prediabetes in a Rural Town: A Pilot Randomized Controlled Trial. Nutrients, 14.","DOI":"10.3390\/nu14173614"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts","volume":"378","author":"Estruch","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_77","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_78","doi-asserted-by":"crossref","first-page":"306","DOI":"10.7326\/0003-4819-151-5-200909010-00004","article-title":"A randomized trial of a Mediterranean diet for patients with type 2 diabetes","volume":"151","author":"Esposito","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.numecd.2014.03.003","article-title":"Mediterranean dietary pattern, inflammation and endothelial function: A systematic review and meta-analysis of intervention trials","volume":"24","author":"Schwingshackl","year":"2014","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Gonz\u00e1lez, M.A., Hershey, M.S., Zazpe, I., and Trichopoulou, A. (2017). Transferability of the Mediterranean diet to non-Mediterranean countries: What is and what is not the Mediterranean diet. Nutrients, 11.","DOI":"10.3390\/nu9111226"},{"key":"ref_81","first-page":"1","article-title":"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","volume":"178","author":"Corella","year":"2025","journal-title":"Ann Intern Med."},{"key":"ref_82","unstructured":"NIH National Heart, Lung and Blood Institute (2026, February 01). DASH Eating Plan, Available online: https:\/\/www.nhlbi.nih.gov\/education\/dash-eating-plan."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.17219\/acem\/109976","article-title":"Dietary support in insulin resistance: An overview of current scientific reports","volume":"28","year":"2019","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/cen.13333","article-title":"The effects of dietary approaches to stop hypertension diet on weight loss, anti-M\u00fcllerian hormone and metabolic profiles in women with polycystic ovary syndrome: A randomized clinical trial","volume":"87","author":"Foroozanfard","year":"2017","journal-title":"Clin. Endocrinol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1055\/s-0034-1376990","article-title":"DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: A randomized controlled clinical trial","volume":"47","author":"Asemi","year":"2015","journal-title":"Horm. Metab. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"661","DOI":"10.3945\/jn.116.245431","article-title":"The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults","volume":"147","author":"Mattei","year":"2017","journal-title":"J. Nutr."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/ajcn\/34.3.362","article-title":"Glycemic index of foods: A physiological basis for carbohydrate exchange","volume":"34","author":"Jenkins","year":"1981","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Yu, Y., Fu, J., Chen, X., Fang, Z., and Tsai, M.-H. (2025). Effect of dietary glycemic index on insulin resistance in adults without diabetes mellitus: A systematic review and meta-analysis. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1458353"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3945\/ajcn.2010.29771","article-title":"A low-glycemic index diet combined with exercise reduces insulin resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responses in obese, prediabetic humans","volume":"92","author":"Solomon","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Khorshidi, Y., Moslehi, N., Zolfaghari, F., Golzarand, M., and Asghari, G. (2026). Effects of carbohydrate-modified diets on insulin sensitivity in children and adolescents with overweight\/obesity: A systematic review and meta-analysis of randomized controlled trials. BMC Endocr. Disord., 26.","DOI":"10.1186\/s12902-026-02163-8"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1017\/S0007114509220836","article-title":"Cross-sectional association of dietary patterns with insulin-resistant phenotypes among adults without diabetes in the Framingham Offspring Study","volume":"102","author":"Liu","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Termannsen, A.-D., S\u00f8ndergaard, C.S., F\u00e6rch, K., Andersen, T.H., Raben, A., and Quist, J.S. (2024). Effects of Plant-Based Diets on Markers of Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients, 16.","DOI":"10.3390\/nu16132110"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Kahleova, H., Tura, A., Hill, M., Holubkov, R., and Barnard, N.D. (2018). A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial. Nutrients, 10.","DOI":"10.3390\/nu10020189"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e2025454","DOI":"10.1001\/jamanetworkopen.2020.25454","article-title":"Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial","volume":"3","author":"Kahleova","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s10654-018-0414-8","article-title":"Plant versus animal based diets and insulin resistance, prediabetes and type 2 diabetes: The Rotterdam Study","volume":"33","author":"Chen","year":"2018","journal-title":"Eur. J. Epidemiol."},{"key":"ref_96","first-page":"101","article-title":"Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets","volume":"77","author":"Paoli","year":"2023","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_97","unstructured":"Daley, S.F., Masood, W., Annamaraju, P., and Khan Suheb, M.Z. (2025). The Ketogenic Diet: Clinical Applications, Evidence-based Indications, and Implementation. StatPearls, StatPearls Publishing."},{"key":"ref_98","first-page":"282","article-title":"Effect of dietary carbohydrate intake on glycaemic control and insulin resistance in type 2 diabetes: A systematic review and meta-analysis","volume":"34","author":"Lan","year":"2025","journal-title":"Asia. Pac. J. Clin. Nutr."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1038\/s41387-020-00142-z","article-title":"Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: A systematic review and meta-analysis","volume":"10","author":"Yuan","year":"2020","journal-title":"Nutr. Diabetes"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1056\/NEJMoa022207","article-title":"A randomized trial of a low-carbohydrate diet for obesity","volume":"348","author":"Foster","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Al-Reshed, F., Sindhu, S., Al Madhoun, A., Bahman, F., AlSaeed, H., Akhter, N., Malik, M.Z., Alzaid, F., Al-Mulla, F., and Ahmad, R. (2023). Low carbohydrate intake correlates with trends of insulin resistance and metabolic acidosis in healthy lean individuals. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1115333"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"e004199","DOI":"10.1136\/bmjdrc-2024-004199","article-title":"Effect of weight-maintaining ketogenic diet on glycemic control and insulin sensitivity in obese T2D subjects","volume":"12","author":"Merovci","year":"2024","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1038\/ejcn.2013.90","article-title":"Ketosis and appetite-mediating nutrients and hormones after weight loss","volume":"67","author":"Sumithran","year":"2013","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Paoli, A., Bianco, A., Moro, T., Mota, J.F., and Coelho-Ravagnani, C.F. (2023). The Effects of Ketogenic Diet on Insulin Sensitivity and Weight Loss, Which Came First: The Chicken or the Egg?. Nutrients, 15.","DOI":"10.3390\/nu15143120"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1146\/annurev-nutr-071816-064634","article-title":"Metabolic effects of intermittent fasting","volume":"37","author":"Patterson","year":"2017","journal-title":"Annu. Rev. Nutr."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Vasim, I., Majeed, C.N., and DeBoer, M.D. (2022). Intermittent fasting and metabolic health. Nutrients, 14.","DOI":"10.3390\/nu14030631"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"4","DOI":"10.12701\/jyms.2022.00010","article-title":"Beneficial effects of intermittent fasting: A narrative review","volume":"40","author":"Song","year":"2023","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1002\/oby.22829","article-title":"Intermittent fasting and metabolic health: From religious fast to time-restricted feeding","volume":"28","author":"Hoddy","year":"2020","journal-title":"Obesity"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.7326\/M24-0859","article-title":"Time-Restricted Eating in Adults with Metabolic Syndrome: A Randomized Controlled Trial","volume":"177","author":"Manoogian","year":"2024","journal-title":"Ann. Intern. Med."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"102187","DOI":"10.1016\/j.ctim.2019.08.021","article-title":"Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial","volume":"47","author":"Parvaresh","year":"2019","journal-title":"Complement. Ther. Med."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Kunduraci, Y.E., and Ozbek, H. (2020). Does the energy restriction intermittent fasting diet alleviate metabolic syndrome biomarkers? A randomized controlled trial. Nutrients, 12.","DOI":"10.3390\/nu12103213"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1210\/clinem\/dgaa644","article-title":"Intermittent fasting improves cardiometabolic risk factors and alters gut microbiota in metabolic syndrome patients","volume":"106","author":"Guo","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Cramer, H., Hohmann, C., Lauche, R., Choi, K.A., Schneider, N., Steckhan, N., Rathjens, F., Anheyer, D., Paul, A., and von Scheidt, C. (2022). Effects of fasting and lifestyle modification in patients with metabolic syndrome: A randomized controlled trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164751"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"6999907","DOI":"10.1155\/2022\/6999907","article-title":"Effect of Intermittent Fasting Diet on Glucose and Lipid Metabolism and Insulin Resistance in Patients with Impaired Glucose and Lipid Metabolism: A Systematic Review and Meta-Analysis","volume":"2022","author":"Yuan","year":"2022","journal-title":"Int. J. Endocrinol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s12020-012-9863-0","article-title":"Improvement in insulin resistance and favourable changes in plasma inflammatory adipokines after weight loss associated with two months\u2019 consumption of a combination of bioactive food ingredients in overweight subjects","volume":"44","author":"Rondanelli","year":"2013","journal-title":"Endocrine"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"109648","DOI":"10.1016\/j.jnutbio.2024.109648","article-title":"EPA and DHA differentially improve insulin resistance by reducing adipose tissue inflammation-targeting GPR120\/PPAR\u03b3 pathway","volume":"130","author":"Yang","year":"2024","journal-title":"J. Nutr. Biochem."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"6947","DOI":"10.1080\/10408398.2021.1908223","article-title":"Nutritional guidelines for the management of insulin resistance","volume":"62","author":"Muscogiuri","year":"2022","journal-title":"Crit. Rev. Food Sci. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:38:13Z","timestamp":1774964293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":117,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nu18071119"],"URL":"https:\/\/doi.org\/10.3390\/nu18071119","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}