Effect of a Nutritional and Behavioral Intervention on Energy-Reduced Mediterranean Diet Adherence Among Patients With Metabolic Syndrome

Abstract

IMPORTANCE High-quality dietary patterns may help prevent chronic disease, but limited data exist from randomized trials about the effects of nutritional and behavioral interventions on dietary changes. OBJECTIVE To assess the effect of a nutritional and physical activity education program on dietary quality. DESIGN, SETTING, AND PARTICIPANTS Preliminary exploratory interim analysis of an ongoing randomized trial. In 23 research centers in Spain, 6874 men and women aged 55 to 75 years with metabolic syndrome and no cardiovascular disease were enrolled in the trial between September 2013 and December 2016, with final data collection in March 2019. INTERVENTIONS Participants were randomized to an intervention group that encouraged an energy-reduced Mediterranean diet, promoted physical activity, and provided behavioral support (n = 3406) or to a control group that encouraged an energy-unrestricted Mediterranean diet (n = 3468). All participants received allotments of extra-virgin olive oil (1 L/mo) and nuts (125 g/mo) for free. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in adherence based on the energy-reduced Mediterranean diet (er-MedDiet) score (range, 0-17; higher scores indicate greater adherence; minimal clinically important difference, 1 point). RESULTS Among 6874 randomized participants (mean [SD] age, 65.0 [4.9] years; 3406 [52%] men), 6583 (96%) completed the 12-month follow-up and were included in the main analysis. The mean (SD) er-MedDiet score was 8.5 (2.6) at baseline and 13.2 (2.7) at 12 months in the intervention group (increase, 4.7 [95% CI, 4.6-4.8]) and 8.6 (2.7) at baseline and 11.1 (2.8) at 12 months in the control group (increase, 2.5 [95% CI, 2.3-2.6]) (between-group difference, 2.2 [95% CI, 2.1-2.4]; P < .001). CONCLUSIONS AND RELEVANCE In this preliminary analysis of an ongoing trial, an intervention that encouraged an energy-reduced Mediterranean diet and physical activity, compared with advice to follow an energy-unrestricted Mediterranean diet, resulted in a significantly greater increase in diet adherence after 12 months. Further evaluation of long-term cardiovascular effects is needed.

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

“…Regarding the prevention of MetS, Godos et al also conducted a meta-analysis to demonstrate the preventive role of the promotion of healthy dietary patterns to reduce the prevalence of MetS [ 15 ]. Furthermore, some sub-studies from the PREDIMED-Plus cohort showed associations between some dietary components of the traditional Mediterranean Diet (MedDiet) and improvement in MetS components [ 16 , 17 , 18 , 19 , 20 ]. The aim of the present review was to analyze the potential benefits of different dietary approaches on MetS status and their use as efficient strategies to prevent and treat MetS and its comorbidities.…”

Relationship of visceral adipose tissue with surrogate insulin resistance and liver markers in individuals with metabolic syndrome chronic complications

“…Detailed methods and protocols of the study have been published previously. 21 , 22 In brief, 6874 individuals were recruited in 23 Spanish centres. Eligible participants were men (55–75 years) and women (60–75 years) with a BMI ⩾27 kg/m 2 and <40 kg/m 2 and fulfilling at least three criteria for the MetS: waist circumference (WC) in White people ⩾102 cm for men and ⩾88 cm for women, elevated triglycerides levels ⩾150 mg/dl or drug treatment for hyperlipidemia; reduced high-density lipoprotein cholesterol (HDL-c) <40 mg/dl in men and <50 mg/dl in women or drug treatment; elevated blood pressure systolic ⩾130 mmHg and/or diastolic ⩾85 mmHg or current use of antihypertensive medication; elevated fasting glucose ⩾100 mg/dl or drug treatment, according to guidelines from the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (2009).…”

Urinary Resveratrol Metabolites Output: Differential Associations with Cardiometabolic Markers and Liver Enzymes in House-Dwelling Subjects Featuring Metabolic Syndrome

“…A validated 143-item semi-quantitative food frequency questionnaire was administered in a face to face interviews by a trained nutritionist to explore dietary intake over the previous 12 months [ 63 ]. Furthermore, adherence to MedDiet was assessed by a 17-point score questionnaire, which is a version of the 14-point score performed in the PREDIMED study [ 56 , 64 , 65 ]. The 17-point score questionnaire includes additional questions to the 14-point score and more restrictive cut-offs for some caloric-dense foods [ 56 , 65 ].…”