Razquin C, Ruiz-Canela M, Clish CB, et al. - Researchers sought to determine the relationships of lysine, 2-aminoadipic acid (2-AAA) or pipecolic acid with the risk of T2D or cardiovascular disease (CVD) in the PREDIMED trial. Further, they assessed how the dietary intervention affects 1-year changes in these metabolites, and whether the effects of these metabolites on CVD or T2D risk could be modified via the Mediterranean diet (MedDiet) interventions. They employed two unstratified case-cohort studies nested within the PREDIMED trial. For CVD analyses, 696 non-cases and 221 incident CVD cases were selected; for T2D, 610 non-cases and 243 type 2 diabetes incident cases were assessed. Outcomes support the association of 2-AAA with future risk of T2D. Lysine was observed to be associated with subsequent CVD risk in this work, which is apparently diabetes-dependent. MedDiet intervention seemed to have no effects on lysine, 2-AAA or pipecolic acid changes.