Long-term effect of a dietary intervention with two-healthy dietary approaches on food intake and nutrient density in coronary patients: results from the CORDIOPREV trial

Abstract

Background Cardiovascular disease (CVD) is the leading cause of disease burden in the world by non-communicable diseases. Nutritional interventions promoting high-quality dietary patterns with low caloric intake value and high nutrient density (ND) could be linked to a better control of CVD risk and recurrence of coronary disease. This study aims to assess the effects of a dietary intervention based on MedDiet or Low-Fat dietary intervention over changes in ND and food intake after 1 and 7 years of follow-up of the CORDIOPREV study. Methods We prospectively analyzed the results of the 802 coronary patients randomized to two healthy dietary patterns (MedDiet = 425, Low-Fat Diet = 377) who completed the 7 years of follow-up and had all the dietary data need. Dietary intake information obtained from a validated 137-item Food Frequency Questionnaire was used to calculate 1- and 7-year changes in dietary intake and ND (measured as nutrient intake per 1000 kcal). T test was used to ascertain differences in food intake and ND between groups across follow-up time. Within-subject (dietary allocation group) differences were analyzed with ANOVA repeated measures. Results From baseline to 7 years of follow-up, significant increases of vegetables, fruits, and whole cereals within groups (p < 0.001) was found. We found a higher increase in dietary intake of certain food groups with MedDiet in comparison with Low-Fat Diet for vegetables (46.1 g/day vs. 18.1 g/day, p < 00.1), fruits (121.3 g/day vs. 72.9 g/day), legumes (4.3 g/day vs. 0.16 g/day) and nuts (7.3 g/day vs. − 3.7 g/day). There was a decrease in energy intake over time in both groups, slightly higher in Low-Fat Diet compared to MedDiet group (− 427.6 kcal/day vs. − 279.8 kcal/day at 1st year, and − 544.6 kcal/day vs. − 215.3 kcal/day after 7 years of follow-up). ND of all the nutrients increased within group across follow-up time, except for Saturated Fatty Acids (SFA), cholesterol and sodium (p < 0.001). Conclusions A comprehensive dietary intervention improved quality of diet, reducing total energy intake and increasing the intake of healthy food groups and overall ND after 1 year and maintaining this trend after 7 years of follow-up. Our results reinforce the idea of the participation in trials, enhance nutrition literacy and produces better nutritional outcomes in adult patients with established CVD. Clinical trial registry The trial was registered in 2009 at ClinicalTrials.gov (number NCT00924937).

Association between Diet Quality and Risk of Type 2 Diabetes Mellitus in Patients with Coronary Heart Disease: Findings from the CORDIOPREV Study

“…An improvement in the NRF9.3 score was observed in the patients in our study, regardless of the dietary intervention group (Mediterranean diet or low-fat diet). These findings extend the results of a previous work, in which we demonstrated that a high-intensity dietary intervention with two healthy diets improved diet quality and that this improvement persisted during the 7 years of follow-up [14]. The inverse relationship between the NRF9.3 and the risk of developing T2DM found in the present study suggests that patients who changed their dietary habits early (within 1 year) towards a healthy, nutrient-dense diet (a Mediterranean diet or a low-fat diet) and did so more efficiently during the follow-up of the study, were less likely to develop T2DM in the following years.…”

“…The concept known as the nutrient density of a diet indicates the ratio between nutrients and total energy intake, and has been identified as a good indicator of diet quality [ 13 , 14 ]. Over the last few years, a few diet quality indices (DQIs) have been proposed.…”

Analysis of ancestry-specific polygenic risk score and diet composition in type 2 diabetes

“…Low carbohydrate and high protein diets may not be superior to other dietary patterns, such as the Mediterranean diet or the vegetarian diet for improvement in high blood glucose [ 57 , 59 ]. Diets that promote more satiety and less energy consumed, contribute to weight loss and better blood glucose control [ 60 ]. Conversely, other studies show concern with high protein diets as it relates to exacerbation of chronic kidney disease in patients with or without this pre-existing condition [ 61 ].…”

Telomere length as biomarker of nutritional therapy for prevention of type 2 diabetes mellitus development in patients with coronary heart disease: CORDIOPREV randomised controlled trial

“…In the context of our study, Cano-Ibáñez et al examined the nutritional disparities between both healthy diets (a Mediterranean and a low-fat diet), which were recommended in CORDIOPREV study. They specifically observed a lower nutritional density of mono and polyunsaturated fatty acids in the low-fat group, attributed to reduced consumption of nuts and olive oil [ 34 ]. The consumption of both fatty acids has been associated with TL in several studies, mainly [ 35 ], due to their crucial role in protecting against oxidative processes and their influence on lipid mediators that regulate inflammation, which is associated with DNA protection, including telomere integrity.…”