Mediterranean diet plus exercise burns fat, adds muscle

Rich in colorful fruits and vegetables, healthy fats and lean proteins, a Mediterranean style of eating consistently earns accolades for its long list of health benefits, including the prevention of heart disease and diabetes.

Now, new research from Spain shows this way of eating, when combined with regular exercise and fewer calories, can slash dangerous belly fat in older folks while helping to preserve their muscle mass.

Fat that accumulates around the midsection is known to cause inflammation and has been linked to heart disease, stroke, diabetes and some forms of cancer. Muscle mass is known to decline with advancing age, and this can lead to weakness, less mobility and a greater chance of falls.

The study, led by researcher Dora Romaguera, from the Health Research Institute of the Balearic Islands, included just over 1,500 middle-aged and older people who were overweight or obese and had metabolic syndrome, a cluster of disorders that signal a person's increased risk of diabetes, heart disease and stroke.

One group of people followed a Mediterranean diet while cutting their calories by 30% and increasing their physical activity. They were also told to limit their consumption of processed foods, meats, butter, added sugar and to eat more whole grains. But the advice did not stop with food: They were also encouraged to increase their physical activity progressively, with a goal of walking 45 minutes per day or more on six days per week, along with exercises to improve strength.

A second group of people followed a Mediterranean diet without calorie restrictions or changes in physical activity.

Folks who reduced their calories and got regular exercise while adhering to a Mediterranean diet showed decreases in the belly and total fat, and they kept much of it off for three years.

In contrast, people in the other group did not see any changes in belly fat.

Both groups did gain some lean muscle mass, but the folks in the exercise plus calorie restriction arm lost more fat than muscle.

The study, published Oct. 23 in the journal JAMA Network Open, presents the three-year results of an ongoing eight-year study designed to see if this style of eating can slash the risk for heart attack and stroke.

Two experts were not surprised the combination did the trick.

"This is an ambitious and elegant study," said Cewin Chao, director of clinical nutrition services at Montefiore Health System in New York City. "If you eat a high-quality diet, exercise and reduce calories, you will lose more body fat, especially the more dangerous deeper fat around the belly area surrounding your organs, and preserve more muscle. These investments do look like they will pay off at the three-year mark."

"If you reduce your calorie intake and increase your physical activity, you will lose weight. This works every time," said Marion Nestle, a retired professor of nutrition, food studies and public health at New York University in New York City.

"People following a Mediterranean diet… are able to maintain a reduced calorie intake and better calorie balance for the three years of the study," said Nestle. "This kind of diet is associated with all kinds of good health and is highly recommended."

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