A Target Trial Emulation of the PREDIMED Trial Protocol in Two US Cohorts

Objectives: The PREDIMED trial concluded that a Mediterranean diet (MedDiet) supplemented with olive oil or nuts reduced type 2 diabetes (T2D) incidence compared to a low-fat diet among high-risk older adults in Spain. To emulate the PREDIMED trial protocol for prevention of T2D in the Nurses Health Study and the Health Professionals' follow-up Study. However, is it unclear if these results are generalizable to US populations with differences in risk factors or cultural food ways. We set out to estimate the 4-year risk of incident type 2 diabetes (T2D) had all participants been told to follow a Mediterranean diet versus a low-fat pattern.