In the Journals

Mediterranean diet with behavioral support improves meal plan adherence, CV risk factors

Adults with metabolic syndrome assigned to a reduced-calorie Mediterranean diet plan with physical activity and behavioral support were more likely to stick with the program, report better diet quality and reduce their cardiovascular risk factors at 12 months compared with adults assigned to an unrestricted Mediterranean eating plan, according to an interim analysis of the PREDIMED-Plus trial published in JAMA.

Miguel A. Martinez-Gonzalez

“This randomized clinical trial found that a nutritional and behavioral intervention encouraging an energy-reduced Mediterranean diet and physical activity led to a significant improvement in diet adherence at 12 months,” Miguel A. Martinez-Gonzalez, MD, PhD, MPH, professor and chair of preventive medicine and public health at the University of Navarra, Spain, told Endocrine Today. “The main clinical implication of our preliminary findings should be to underline that changes after 1 year in the 17-item MedDiet score, which measured adherence to an energy-reduced Mediterranean diet, were paralleled by successful changes in most classic risk factors.”

In an exploratory, interim analysis, Martinez-Gonzalez and colleagues analyzed data from 6,874 adults aged 55 to 75 years with metabolic syndrome but without CVD, recruited from 23 centers in Spain between September 2013 and December 2016 (mean age, 65 years; 52% men). Researchers randomly assigned participants to an intervention group that encouraged an energy-reduced Mediterranean diet, promoted physical activity and provided behavioral support (n = 3,406) or to a control group that encouraged an energy-unrestricted Mediterranean diet (n = 3,468). All participants received allotments of extra-virgin olive oil (1 L per month) and nuts (125 g per month). Primary outcome was 12-month change in adherence based on the energy-reduced Mediterranean diet score (range, 0-17, with higher scores indicating greater adherence). Final data collection took place in March 2019.

Mediterranean Diet 
Adults with metabolic syndrome assigned to a reduced-calorie Mediterranean diet plan with physical activity and behavioral support were more likely to stick with the program, report better diet quality and reduce their cardiovascular risk factors at 12 months compared with adults assigned to an unrestricted Mediterranean eating plan.
Source: Shutterstock

Among participants in the intervention group, the mean energy-reduced Mediterranean diet score was 8.5 at baseline and increased to 13.2 at 12 months, for an increase of 4.7 (95% CI, 4.6-4.8). Among participants in the control group, diet score increased from a mean of 8.6 at baseline to 11.1 at 12 months, for an increase of 2.5 (95% CI, 2.3-2.6) and a between-group difference of 2.2 (95% CI, 2.1-2.4).

The researchers also observed reductions in the consumption of specific foods or food groups at 12 months for both groups. Consumption of refined grains fell by a mean of 535 g per week for the intervention group and 226 g per week for controls, for a between-group difference of –309 g per week (P < .001). Researchers noted the greatest increases were observed for vegetables, with mean increases of 347 g per week and 137 g per week for intervention and control participants, respectively, for a between-group difference of 210 g per week (P < .001).

Researchers also observed favorable changes for the intervention vs. control group in body weight, waist circumference, BMI, HDL cholesterol, non-HDL cholesterol, total cholesterol to HDL cholesterol ratio, triglycerides, and systolic and diastolic blood pressure at 12 months.

“The effectiveness of the intervention, reflected by significant changes in dietary habits and reduced cardiovascular risk factors, support that nutritional interventions and behavioral therapies in patients at high cardiovascular risk, including patients with diabetes and metabolic syndrome, are likely to facilitate modifications of targeted dietary habits, reductions in body weight and improvements in risk factors,” the researchers wrote.

The researchers noted that the dietary intervention was multifaceted and it is not possible to determine which aspects of the intervention may be influencing the outcomes.

“An energy-reduced Mediterranean diet may represent an optimal model for subjects with overweight or obesity to be evaluated in other long-term randomized controlled trials,” Martinez-Gonzalez said. “In fact, randomized controlled trials should be based on realistic interventions, because the main challenge for feasibility of large nutritional interventions using a whole dietary pattern is the expected compliance with the intended goals. Furthermore, the evaluation of long-term cardiovascular outcomes is needed.” – by Regina Schaffer

For moreinformation :

Miguel A. Martinez-Gonzalez, MD, PhD, MPH, can be reached at the Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea, 1,31080 Pamplona, Navarra, Spain; email: mmartinez@unav.es.

Disclosures: Martinez-Gonzalez reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Adults with metabolic syndrome assigned to a reduced-calorie Mediterranean diet plan with physical activity and behavioral support were more likely to stick with the program, report better diet quality and reduce their cardiovascular risk factors at 12 months compared with adults assigned to an unrestricted Mediterranean eating plan, according to an interim analysis of the PREDIMED-Plus trial published in JAMA.

Miguel A. Martinez-Gonzalez

“This randomized clinical trial found that a nutritional and behavioral intervention encouraging an energy-reduced Mediterranean diet and physical activity led to a significant improvement in diet adherence at 12 months,” Miguel A. Martinez-Gonzalez, MD, PhD, MPH, professor and chair of preventive medicine and public health at the University of Navarra, Spain, told Endocrine Today. “The main clinical implication of our preliminary findings should be to underline that changes after 1 year in the 17-item MedDiet score, which measured adherence to an energy-reduced Mediterranean diet, were paralleled by successful changes in most classic risk factors.”

In an exploratory, interim analysis, Martinez-Gonzalez and colleagues analyzed data from 6,874 adults aged 55 to 75 years with metabolic syndrome but without CVD, recruited from 23 centers in Spain between September 2013 and December 2016 (mean age, 65 years; 52% men). Researchers randomly assigned participants to an intervention group that encouraged an energy-reduced Mediterranean diet, promoted physical activity and provided behavioral support (n = 3,406) or to a control group that encouraged an energy-unrestricted Mediterranean diet (n = 3,468). All participants received allotments of extra-virgin olive oil (1 L per month) and nuts (125 g per month). Primary outcome was 12-month change in adherence based on the energy-reduced Mediterranean diet score (range, 0-17, with higher scores indicating greater adherence). Final data collection took place in March 2019.

Mediterranean Diet 
Adults with metabolic syndrome assigned to a reduced-calorie Mediterranean diet plan with physical activity and behavioral support were more likely to stick with the program, report better diet quality and reduce their cardiovascular risk factors at 12 months compared with adults assigned to an unrestricted Mediterranean eating plan.
Source: Shutterstock

Among participants in the intervention group, the mean energy-reduced Mediterranean diet score was 8.5 at baseline and increased to 13.2 at 12 months, for an increase of 4.7 (95% CI, 4.6-4.8). Among participants in the control group, diet score increased from a mean of 8.6 at baseline to 11.1 at 12 months, for an increase of 2.5 (95% CI, 2.3-2.6) and a between-group difference of 2.2 (95% CI, 2.1-2.4).

The researchers also observed reductions in the consumption of specific foods or food groups at 12 months for both groups. Consumption of refined grains fell by a mean of 535 g per week for the intervention group and 226 g per week for controls, for a between-group difference of –309 g per week (P < .001). Researchers noted the greatest increases were observed for vegetables, with mean increases of 347 g per week and 137 g per week for intervention and control participants, respectively, for a between-group difference of 210 g per week (P < .001).

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Researchers also observed favorable changes for the intervention vs. control group in body weight, waist circumference, BMI, HDL cholesterol, non-HDL cholesterol, total cholesterol to HDL cholesterol ratio, triglycerides, and systolic and diastolic blood pressure at 12 months.

“The effectiveness of the intervention, reflected by significant changes in dietary habits and reduced cardiovascular risk factors, support that nutritional interventions and behavioral therapies in patients at high cardiovascular risk, including patients with diabetes and metabolic syndrome, are likely to facilitate modifications of targeted dietary habits, reductions in body weight and improvements in risk factors,” the researchers wrote.

The researchers noted that the dietary intervention was multifaceted and it is not possible to determine which aspects of the intervention may be influencing the outcomes.

“An energy-reduced Mediterranean diet may represent an optimal model for subjects with overweight or obesity to be evaluated in other long-term randomized controlled trials,” Martinez-Gonzalez said. “In fact, randomized controlled trials should be based on realistic interventions, because the main challenge for feasibility of large nutritional interventions using a whole dietary pattern is the expected compliance with the intended goals. Furthermore, the evaluation of long-term cardiovascular outcomes is needed.” – by Regina Schaffer

For moreinformation :

Miguel A. Martinez-Gonzalez, MD, PhD, MPH, can be reached at the Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea, 1,31080 Pamplona, Navarra, Spain; email: mmartinez@unav.es.

Disclosures: Martinez-Gonzalez reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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