| Summary: | Background & aims: Short telomeres have been observed in chronic disease patients. Identifying envi-
ronmental and lifestyle factors that could reduce telomere attrition is crucial for disease prevention. The
aim of this work was to determine whether weight-loss induced by an energy-reduced Mediterranean
diet (erMedDiet) and physical activity (PA) could modify telomere length (TL).
Methods: In 317 randomized non-smoker participants (mean age, 65.8 ± 4.98 years) with metabolic
syndrome from two “Prevenci on con Dieta Mediterr anea-Plus” (PREDIMED-Plus) trial centers, we
evaluated MedDiet adherence, PA, anthropometric variables and TL at baseline and after a 3-year
intervention using an intensive lifestyle program (IG) with an erMedDiet and PA or an unrestricted
MedDiet without PA promotion (CG).
Results: Participants in the IG displayed greater 3-year weight reductions ( 3.7 ± 4 kg, P < 0.001)
compared to those in the CG. No differences in TL changes between groups were observed in the cohort
as a whole. However, an interaction was observed between the intervention group and sex for TL changes
(pinteraction ¼ 0.039). Women in the IG showed an increase in TL after 3-y (þ0.25 ± 0.9, relative units)
compared to women in the CG ( 0.07 ± 1.0) (p ANCOVA ¼ 0.036), whereas no differences between groups
were observed in men. Women in the IG had a lower risk of telomere shortening after the intervention
(OR ¼ 0.17, 95%CI: 0.05e0.64, p ¼ 0.008) compared to women in the CG.
Conclusions: A 3-year lifestyle intervention based on an erMedDiet and PA slowed telomere shortening
in women but not in men.
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