Introduction
muscle mass, cardiovascular disease, obesity-associated chronic diseases, overweight or obesity, metabolic syndrome, weight loss
METABOLIC SYNDROME, TYPE 2 DIABETES, CARDIOVASCULAR DISEASE
Specific body composition components seem to be the key in the development of obesity-associated chronic diseases. In particular, excess visceral fat and loss of muscle mass, which occurs with increasing age, have been associated with a higher risk for a broad spectrum of health outcomes including cardiovascular disease and type 2 diabetes (T2D).The Mediterranean diet (MedDiet), and particularly an energy-reduced MedDiet, is emerging as an effective strategy for weight loss and its long-term maintenance.The PREDIMED-Plus randomized clinical trial (RCT) provides a unique opportunity to assess the effects on body composition of multifactorial intervention with an energy-reduced MedDiet, PA promotion, and behavioral support for weight-loss goals in middle-aged and older adults with metabolic syndrome initially with overweight or obesity. In this study we aimed to determine the long-term effects of the lifestyle intervention on changes in age-related overall and regional body composition after the first 3 years of the PREDIMED-Plus trial.