Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

Abstract

Background: Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated.Aim of the study: To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk-factors and baseline dietary habits.Methods: 1048 asymptomatic subjects aged 55-80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants' characteristics were assessed at baseline among subjects. Dietary change were evaluated after 12 months. Main Outcome measures were: attained changes in 5 dietary goals: increases in 1) fruit consumption; 2) vegetable consumption, 3) monounsaturated fatty acid (MUFA)/ saturated fatty acid (SFA) ratio, and decreases in 4) sweets and pastries consumption, 5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet).Results: Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet.Conclusions/ applications: Some participant characteristics (marital status, and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.

Sex Differences in the Effects of Repeated Taste Exposure to the Mediterranean Diet: A 6-month Follow-up Study

“…men vs. women). In fact, it has been demonstrated that some strategies aimed at improving dietary habits may have different impacts in men and in women (25)(26)(27). Results from the present study are therefore relevant since they indicate for the first time that an intervention based mainly on exposure to the MedDiet may be effective for increasing adherence, irrespective of gender, as suggested by the increase in the MedScore in both men and women at the 6-month follow-up visit compared to baseline.…”

“…These differences may influence the quality of diet and the degree of adherence to healthy dietary recommendations (24). In the context of the MedDiet, previous studies found evidence that some nutritional strategies concerning adherence and dietary intakes have a different impact according to gender; some favoring men (25,26) whereas others impacting women more efficiently (27).…”

The Mediterranean Diet: Socio-cultural Relevance for Contemporary Health Promotion

“…The strategic cherry picking of the best elements of Mediterranean traditions has certainly created a useful 'whole diet model' that has had beneficial impact on populations in Northern Europe [44,45]. Numerous studies illustrate that the adoption of food choices typical of Mediterranean countries may be beneficial in metabolic and vascular diseases [46]. Ironically, although overall adherence to this 'model' of eating has decreased within the Mediterranean, in Northern Europe there has been growing acceptance of the diet pyramid [11,31,47].…”

Optimizing dietary fat in a weight-loss trial requires advice based on a structured “whole-of-diet” model

“…Previous trials have shown the usefulness of appreciating the macronutrient composition of foods for demonstrating adherence to nutrient targets [10] and subsequent health benefits [26]. For example, virgin olive oil (1L/week) and mixed nuts (30g/day) were used in the PREDIMED Study to enable participants to achieve the Mediterranean-style diet being tested [17]. However, the study design included the free provision of specific high fat foods and, therefore, did not provide evidence for free-living food choices in response to advice alone.…”

“…Studies demonstrating favourable modifications to the overall food pattern have relied on the free provision of foodstuffs to ensure achievement of dietary targets. For example, a Mediterraneanstyle diet was achieved in the PREDIMED study by providing participants with regular amounts of palatable key high fat foods [17], but its application may be difficult to replicate in free-living settings. In contrast, general approaches to advice, for example, choose low fat foods in ad libitum fashion do not appear to support significant changes to the macronutrient profile [18,19].…”