October 15, 2019
2 min read

Intervention improves adherence to Mediterranean diet

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An intervention promoting an energy-reduced Mediterranean diet and physical activity was linked with better adherence to the Mediterranean diet at 1 year compared with the traditional Mediterranean diet in individuals with metabolic syndrome, according to interim results from the PREDIMED-Plus study.

Participants assigned the intervention were advised to follow an energy-reduced Mediterranean diet, which had more restrictive limits on red and processed meats, butter, margarine, cream and sweetened beverages than the traditional Mediterranean diet. They were also counseled on physical activity and given behavioral support once per month for 1 year. Participants assigned to the control group attended two educational sessions per year on the Mediterranean diet and were given general lifestyle recommendations. All participants were given free olive oil and nuts.

The primary outcome for the present analysis was change in adherence based on the energy-reduced Mediterranean diet score, which ranged from 0 for no adherence to 17 for perfect adherence, at 1 year. The trial is expected to last 6 to 8 years.

At baseline, the groups were similar in energy-reduced Mediterranean diet score (intervention, 8.5; control, 8.6), but at 1 year, the score was 13.2 in the intervention group (increase, 4.7; 95% CI, 4.6-4.8) and 11.1 in the control group (increase, 2.5; 95% CI, 2.3-2.6; between-group difference, 2.2; P < .001)

Between-group differences in three other dietary pattern scores were also significant at 1 year, according to the researchers.

“Improvements in diet quality, energy intake and cardiovascular risk factors also were observed in the energy-reduced Mediterranean diet group,” Carmen Sayón-Orea, MD, from the University of Navarra Medical School, Spain, and colleagues wrote. “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 analysis included 6,874 participants who completed 1-year follow-up (mean age, 65 years; 52% men). All had BMI 27 kg/m2 to 40 kg/m2 and met at least three criteria for metabolic syndrome but had no history of CVD at baseline.

In a related Editor’s Note, Philip Greenland, MD, Harry W. Dingman Professor of Cardiology, professor of preventive medicine and director of Institute for Public Health and Medicine’s Center for Population Health Sciences at Northwestern University Feinberg School of Medicine, and senior editor of JAMA, wrote: “The greater diet adherence in the intervention group provides reassurance that the intervention is having a measurable effect on diet and body weight. The authors have demonstrated in this study and previous research that large-scale dietary intervention studies are practical if carefully conducted.” – by Erik Swain

Disclosures: Sayón-Orea and Greenland report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.