Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial
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Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated.
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.
A total of 1,048 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 changes were evaluated after 12 months. Main outcome measures were: attained changes in five 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).
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.
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.
KeywordsDietary predictors Dietary adherence Mediterranean diet Cardiovascular risk PREDIMED study
The authors thank the participants for their enthusiastic collaboration, the PREDIMED personnel for excellent assistance and the personnel of all primary care centers affiliated, especially to Beatriz San Julian, Pilar Buil Cosiales, Javier Díez Espino, Ana García-Arellano, Julia Wärnberg, Jordi Salas- Salvadó, José Lapetra, Maria Isabel Covas, Manolo Serrano and Jackeline Alvarez. We gratefully acknowledge the Instituto de Salud Carlos III (ISCIII) and other funding sources (see below).
Conflict of interest statement
Spanish Government (Instituto de Salud Carlos III, RTIC RD06/0045, Fondo de Investigaciones Sanitarias, FIS PI04/0233, PI04/2239, PI05/2368, PI05/1839, PI081943, PI07/0312, PI04/2241, PI05/0976, PI07/0240, and PE 087/0819), CIBEROBN, “CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) is an initiative of ISCIII”), the Navarra Government (PI41/2005), Generalitat Valenciana (ACOMP06109). Fundación Patrimonio Comunal Olivarero and Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain) and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit this manuscript.
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