{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T11:20:20Z","timestamp":1775474420530,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Programa Operacional Competitividade e Internacionaliza\u00e7\u00e3o \u2013 COMPETE2020","award":["POCI-01-0145-ERDF-007746"],"award-info":[{"award-number":["POCI-01-0145-ERDF-007746"]}]},{"DOI":"10.13039\/501100017014","name":"Centro de Investiga\u00e7\u00e3o em Tecnologias e Servi\u00e7os de Sa\u00fade","doi-asserted-by":"publisher","award":["POCI-01-0145-ERDF-007746"],"award-info":[{"award-number":["POCI-01-0145-ERDF-007746"]}],"id":[{"id":"10.13039\/501100017014","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Comprehensive Health Research Center (CHRC)","award":["POCI-01-0145-ERDF-007746"],"award-info":[{"award-number":["POCI-01-0145-ERDF-007746"]}]},{"name":"Portuguese Society of Diabetology","award":["Pr\u00e9mio Em\u00edlio Peres 2018 e 2019"],"award-info":[{"award-number":["Pr\u00e9mio Em\u00edlio Peres 2018 e 2019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The Mediterranean diet (MD) has been recommended for type 2 diabetes (T2D) treatment. The impact of diet in shaping the gut microbiota is well known, particularly for MD. However, the link between MD and diabetes outcome improvement is not completely clear. This study aims to evaluate the role of microbiota modulation by a nonpharmacological intervention in patients with T2D. In this 12-week single-arm pilot study, nine participants received individual nutritional counseling sessions promoting MD. Gut microbiota, biochemical parameters, body composition, and blood pressure were assessed at baseline, 4 weeks, and 12 weeks after the intervention. Adherence to MD [assessed by Mediterranean Diet Adherence Screener (MEDAS) score] increased after the intervention. Bacterial richness increased after 4 weeks of intervention and was negatively correlated with fasting glucose levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Prevotella to Bacteroides ratio also increased after 4 weeks. In contrast, glycated haemoglobin (HbA1c) and HOMA-IR were only decreased at the end of study. Alkaline phosphatase activity was assessed in fecal samples and was negatively correlated with HbA1c and positively correlated with bacterial diversity. The results of this study reinforce that MD adherence results in a better glycemic control in subjects with T2D. Changes in gut bacterial richness caused by MD adherence may be relevant in mediating the metabolic impact of this dietary intervention.<\/jats:p>","DOI":"10.3390\/nu13041228","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T21:27:44Z","timestamp":1617917264000},"page":"1228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["A Pilot Study on the Metabolic Impact of Mediterranean Diet in Type 2 Diabetes: Is Gut Microbiota the Key?"],"prefix":"10.3390","volume":"13","author":[{"given":"Sh\u00e1mila","family":"Ismael","sequence":"first","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9327-2897","authenticated-orcid":false,"given":"Marta P.","family":"Silvestre","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"Unidade Universit\u00e1ria Lifestyle Medicine Jos\u00e9 de Mello Sa\u00fade by NOVA Medical School, 1169-056 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6112-8951","authenticated-orcid":false,"given":"Miguel","family":"Vasques","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"Endocrinology Department, Centro Hospitalar e Universit\u00e1rio Lisboa Central, 1069-166 Lisboa, Portugal"}]},{"given":"Jo\u00e3o R.","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"given":"Juliana","family":"Morais","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CHRC\u2014Comprehensive Health Research Center, CEDOC\u2014Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"given":"Maria In\u00eas","family":"Duarte","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"given":"Diogo","family":"Pestana","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"given":"Ana","family":"Faria","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CHRC\u2014Comprehensive Health Research Center, CEDOC\u2014Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"given":"Jos\u00e9 B.","family":"Pereira-Leal","sequence":"additional","affiliation":[{"name":"Ophiomics-Precision Medicine, 1600-513 Lisboa, Portugal"}]},{"given":"Joana","family":"Vaz","sequence":"additional","affiliation":[{"name":"Ophiomics-Precision Medicine, 1600-513 Lisboa, Portugal"}]},{"given":"Pedro","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center Germano de Sousa, 1600-513 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2162-1450","authenticated-orcid":false,"given":"Diana","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ci\u00eancias, Universidade NOVA de 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