November 12, 2018
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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.

Publicated to:Diabetes Care. 42 (5): 777-788 - 2019-05-01 42(5), DOI: 10.2337/dc18-0836

Authors: Salas-Salvado, Jordi; Diaz-Lopez, Andres; Ruiz-Canela, Miguel; Basora, Josep; Fito, Montse; Corella, Dolores; Serra-Majem, Luis; Waernberg, Julia; Romaguera, Dora; Estruch, Ramon; Vidal, Josep; Alfredo Martinez, J; Alfredo Martinez, J; Aros, Fernando; Vazquez, Clotilde; Ros, Emilio; Vioque, Jesus; Lopez-Miranda, Jose; Bueno-Cavanillas, Aurora; Tur, Josep A; Tur, Josep A; Tinahones, Francisco J; Tinahones, Francisco J; Martin, Vicente; Lapetra, Jose; Pinto, Xavier; Daimiel, Lidia; Delgado-Rodriguez, Miguel; Matia, Pilar; Gomez-Gracia, Enrique; Diez-Espino, Javier; Babio, Nancy; Castaner, Olga; Sorli, Jose V; Sorli, Jose V; Fiol, Miquel; Angeles Zulet, Maria; Bullo, Monica; Goday, Albert; Martinez-Gonzalez, Miguel A; Martinez-Gonzalez, Miguel A

Affiliations

Distrito Sanitario Atenc Primaria Sevilla, Res Unit, Dept Family Med, Seville, Spain - Author
Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA - Author
Hosp Clin Univ, Endocrinol & Nutr Dept, Barcelona, Spain - Author
Hosp Mar Med Res Inst IMIM, Cardiovasc Risk & Nutr Res Grp, Barcelona, Spain - Author
Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Dept Internal Med, Lipid Unit, Barcelona, Spain - Author
Inst Invest & Recerca Atencio Promaria IDIAP, Catalan Inst Hlth, Primary Care Div, Barcelona, Spain - Author
Inst Invest Biomed August Pi Sunyer IDIBAPS, Barcelona, Spain - Author
Inst Salud Carlos III, Ctr Invest Biomed Red Diabet Enfermedades Metab A, Madrid, Spain - Author
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain - Author
Inst Salud Carlos III, Ctr Invest Biomed Red Fisiopatol Obesidad & Nutr, Madrid, Spain - Author
Madrid Inst Adv Studies IMDEA, Food Inst, Madrid, Spain - Author
Rovira & Virgili Univ, Univ Hosp St Joan de Reus, Pere Virgili Inst Hlth Res IISPV, Dept Biochem & Biotechnol,Human Nutr Unit, Reus, Spain - Author
Serv Navarro Salud Osasunbidea, Atenc Primaria, Pamplona, Spain - Author
Traslational Medicine. Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program. Cardiovascular Diseases - Author
UAM, CSIC, Nutr Genom & Epigen Grp, Madrid Inst Adv Studies IMDEA,Food Inst, Madrid, Spain - Author
Univ Balear Isl, Res Grp Community Nutr & Oxidat Stress, Palma De Mallorca, Spain - Author
Univ Barcelona, Dep Med, Barcelona, Spain - Author
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi Sunyer IDIBAPS, Lipid Clin Endocrinol & Nutr Serv, Barcelona, Spain - Author
Univ Barcelona, Inst Invest Biomed August Pi Sunyer IDIBAPS, Hosp Clin, Dept Internal Med, Barcelona, Spain - Author
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdiSSC, Fac Med, Endocrinol & Nutr Dept, Madrid, Spain - Author
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Lipids & Atherosclerosis Unit, Cordoba, Spain - Author
Univ Granada, Dept Prevent Med & Publ Hlth, Granada, Spain - Author
Univ Hosp Araba, Dept Cardiol, Vitoria, Spain - Author
Univ Hosp Fdn Jimenez Diaz, Dept Endocrinol & Nutr, Madrid, Spain - Author
Univ Hosp Son Espases, Inst Invest Sanitaria Illes Balears IdISBa, Palma De Mallorca, Spain - Author
Univ Jaen, Dept Hlth Sci, Jaen, Spain - Author
Univ Leon, Biomed Inst IBIOMED, Leon, Spain - Author
Univ Leon, Res Grp Gene Environm Interact & Hlth, Leon, Spain - Author
Univ Malaga, Dept Prevent Med & Publ Hlth, Malaga, Spain - Author
Univ Malaga, Inst Biomed Res Malaga IBIMA, Sch Hlth Sci, Dept Nursing, Malaga, Spain - Author
Univ Malaga, Inst Biomed Res Malaga IBIMA, Virgen Victoria Hosp, Dept Endocrinol & Nutr, Malaga, Spain - Author
Univ Miguel Hernandez, Nutr Epidemiol Unit, Alicante, Spain - Author
Univ Navarra, Ctr Nutr Res, Dept Nutr Food Sci & Physiol, Pamplona, Spain - Author
Univ Navarra, Navarra Inst Hlth Res IdiSNA, Dept Prevent Med & Publ Hlth, Pamplona, Spain - Author
Univ Palmas Gran Canaria, Res Inst Biomed & Hlth Sci, Las Palmas Gran Canaria, Spain - Author
Univ Valencia, Dept Prevent Med, Valencia, Spain - Author
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Abstract

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 PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight-loss lifestyle intervention on primary cardiovascular prevention.Overweight/obese adults with metabolic syndrome aged 55-75 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.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 < 0.001), a mean difference of -2.5 kg (95% CI -3.1 to -1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL-cholesterol, significantly improved in IG participants (P < 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 < 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.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.© 2018 by the American Diabetes Association.

Keywords

AgedBehavior therapyBlood glucoseCaloric restrictionCardiovascular diseasesDiet, mediterraneanExerciseExercise therapyFemaleFollow-up studiesHumansLife styleMaleMetabolic syndromeMiddle agedObesityOverweightPrediabetic stateRisk factorsWeight loss

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Diabetes Care due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2019, it was in position 4/143, thus managing to position itself as a Q1 (Primer Cuartil), in the category Endocrinology & Metabolism. Notably, the journal is positioned above the 90th percentile.

This publication has been distinguished as a “Highly Cited Paper” by the agencies WoS (ESI, Clarivate) and ESI (Clarivate), meaning that it ranks within the top 1% of the most cited articles in its thematic field during the year of its publication. In terms of the observed impact of the contribution, this work is considered one of the most influential worldwide, as it is recognized as highly cited. (source consulted: ESI Nov 14, 2024)

And this is evidenced by the extremely high normalized impacts through some of the main indicators of this type, which, although dynamic over time and dependent on the set of average global citations at the time of calculation, already indicate that they are well above the average in different agencies:

  • Normalization of citations relative to the expected citation rate (ESI) by the Clarivate agency: 10.36 (source consulted: ESI Nov 14, 2024)
  • Weighted Average of Normalized Impact by the Scopus agency: 11.62 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 66.94 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-16, the following number of citations:

  • WoS: 274
  • Scopus: 294
  • Europe PMC: 110
  • Google Scholar: 330

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-16:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 849.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 906 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 214.15.
  • The number of mentions on the social network Facebook: 2 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 165 (Altmetric).
  • The number of mentions in news outlets: 12 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Granada; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Salas Salvadó, Jorge) .

the authors responsible for correspondence tasks have been Salas Salvadó, Jorge and Martinez-Gonzalez MA.