Mediterranean Diet and Glycemic Load in Relation to Incidence of Type 2 Diabetes: Results From the Greek Cohort of the Population-Based European Prospective Investigation Into Cancer and Nutrition (EPIC)

Study Questions:

What is the association between adherence to the Mediterranean diet and glycemic load (GL) with diabetes occurrence?


The investigators analyzed data from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). From a total of 22,295 participants, actively followed for a median of 11.34 years, 2,330 cases of incident type 2 diabetes were recorded. All participants completed a validated, interviewer-administered semiquantitative food frequency questionnaire at enrollment. From this information, the authors calculated a 10-point Mediterranean diet score (MDS), reflecting adherence to the traditional Mediterranean diet, as well as the dietary GL. Investigators estimated hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of diabetes using Cox proportional hazards regression models adjusted for potential confounders.


A higher MDS was inversely associated with diabetes risk (HR, 0.88; 95% CI, 0.78-0.99 for MDS ≥6 vs. MDS ≤3). GL was positively associated with diabetes (HR, 1.21; 95% CI, 1.05-1.40 for the highest vs. the lowest GL quartile). A significant protection of approximately 20% was found for a diet with a high MDS and a low GL.


The authors concluded that a low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.


These data indicate that both the Mediterranean diet and a low glycemic diet were associated with a lower diabetes risk. The influence of the Mediterranean diet against diabetes risk was independent of GL levels, and individuals with a high MDS and a low GL tended to have the lowest diabetes risk. A low GL Mediterranean diet is easily doable, since olive oil and vegetables dominate this diet and do not contribute, or contribute only marginally, to the GL. In this study, the combined protection imparted by a diet with a high MDS and a low GL was approximately 20%. Clinicians should consider incorporating an optimal low glycemic Mediterranean diet for the management of patients with prediabetes or those at risk for diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Metabolic Syndrome X, Incidence, Prediabetic State, Blood Glucose, Vegetables, Plant Oils, Glycemic Index, Risk Factors, Nutritional Status, Diet, Diabetes Mellitus

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