Summary: In a secondary analysis of 183 newly-diagnosed, treatment-naive type 2 diabetes (T2DM) patients with coronary heart disease from the CORDIOPREV trial (Spain), a lower baseline neutrophil count was associated with a higher likelihood of 5-year T2DM remission among those assigned to a Mediterranean diet but not a low-fat diet (lowest vs highest tertile, adjusted HR 4.23, 95% CI 1.53-11.69). This is an associational analysis of an immune marker, not a head-to-head test of one diet against the other for remission.
PICO Summary
| Element | Detail |
|---|---|
| Population | 183 newly-diagnosed T2DM patients with established coronary heart disease, not on glucose-lowering therapy; secondary analysis of the CORDIOPREV randomised trial, Spain. |
| Intervention | Lower baseline neutrophil count (lowest tertile), examined within the long-term Mediterranean diet arm over 5 years. |
| Comparison | Higher baseline neutrophil count (highest tertile); separate low-fat diet arm in which no such association was seen. |
| Outcome | T2DM remission over 5 years: 73 responders vs 110 non-responders. Lowest vs highest neutrophil tertile, Mediterranean diet only, adjusted HR 4.23 (95% CI 1.53-11.69); no association in the low-fat arm. Combined clinical-plus-neutrophil prediction model AUC 0.783 (95% CI 0.680-0.822). At 5 years, responders had lower neutrophil counts than non-responders (p=0.006) and a within-group decrease from baseline (p=0.001); Mediterranean-diet responders showed gains in insulin sensitivity (p=0.011) and disposition index (p=0.018). No absolute risk reduction or NNT reported. |
Expert Commentary
This secondary analysis of the CORDIOPREV trial is best read as hypothesis-generating rather than practice-changing. Within the Mediterranean-diet arm, a low baseline neutrophil count was associated with a roughly four-fold higher likelihood of diabetes remission, and remission was accompanied by improvements in insulin sensitivity and beta-cell function. The verdict, however, must stay cautious. The headline hazard ratio is an association observed in a subgroup defined after randomisation, so it describes which patients tended to respond, not proof that the Mediterranean diet causes remission or that it outperforms a low-fat diet for this outcome; the original post’s claim of a direct diet-versus-diet remission benefit, and its statement that no adverse effects occurred, are not supported by the abstract and have been removed. The principal limitation is imprecision and the risk of residual confounding: the confidence interval is wide (1.53 to 11.69), the responder group is modest, and an inflammatory marker such as the neutrophil count may simply track underlying metabolic and immune health rather than act as a lever clinicians can pull. Can I use this with my patients? Not yet as a decision tool. It is reasonable to keep recommending a Mediterranean dietary pattern to patients with coronary heart disease and early type 2 diabetes on its established merits, but a baseline neutrophil count should not be used to select who is offered dietary remission attempts until prospective validation exists. Larger, pre-specified studies are needed before neutrophil-guided dietary triage enters the clinic.
References
Boughanem H, Gutierrez-Mariscal FM, Arenas-de Larriva AP, et al. Effect of long-term Mediterranean versus low-fat diet on neutrophil count, and type 2 diabetes mellitus remission in patients with coronary heart disease: results from the CORDIOPREV study. Nutr Diabetes. 2025;15(1):11. doi:10.1038/s41387-025-00360-3
