Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study

  • Naomi Cano-IbáñezEmail author
  • Aurora Bueno-Cavanillas
  • Miguel Ángel Martínez-González
  • Jordi Salas-Salvadó
  • Dolores Corella
  • Gal-la Freixer
  • Dora Romaguera
  • Jesús Vioque
  • Ángel M. Alonso-Gómez
  • Julia Wärnberg
  • J. Alfredo Martínez
  • Lluis Serra-Majem
  • Ramón Estruch
  • Francisco J. Tinahones
  • José Lapetra
  • Xavier Pintó
  • Josep A. Tur
  • Antonio García-Ríos
  • Laura García-Molina
  • Miguel Delgado-Rodríguez
  • Pilar Matía-Martín
  • Lidia Daimiel
  • Vicente Martín-Sánchez
  • Josep Vidal
  • Clotilde Vázquez
  • Emilio Ros
  • Javier Bartolomé-Resano
  • Antoni Palau-Galindo
  • Olga Portoles
  • Laura Torres
  • Miquel-Fiol
  • María Teresa Cano Sánchez
  • Carolina Sorto-Sánchez
  • Noelia Moreno-Morales
  • Itziar Abete
  • Jacqueline Álvarez-Pérez
  • Emilio Sacanella
  • María Rosa Bernal-López
  • José Manuel Santos-Lozano
  • Marta Fanlo-Maresma
  • Cristina Bouzas
  • Cristina Razquin
  • Nerea Becerra-Tomás
  • Carolina Ortega-Azorin
  • Regina LLimona
  • Marga Morey
  • Josefa Román-Maciá
  • Leire Goicolea-Güemez
  • Zenaida Vázquez-Ruiz
  • Laura Barrubés
  • Montse Fitó
  • Alfredo Gea
Original Contribution



The prevalence of overweight/obesity and related manifestations such as metabolic syndrome (MetS) is increasing worldwide. High energy density diets, usually with low nutrient density, are among the main causes. Some high-quality dietary patterns like the Mediterranean diet (MedDiet) have been linked to the prevention and better control of MetS. However, it is needed to show that nutritional interventions promoting the MedDiet are able to improve nutrient intake.


To assess the effect of improving MedDiet adherence on nutrient density after 1 year of follow-up at the PREDIMED-Plus trial.


We assessed 5777 men (55–75 years) and women (60–75 years) with overweight or obesity and MetS at baseline from the PREDIMED-Plus trial. Dietary changes and MedDiet adherence were evaluated at baseline and after 1 year. The primary outcome was the change in nutrient density (measured as nutrient intake per 1000 kcal). Multivariable-adjusted linear regression models were fitted to analyse longitudinal changes in adherence to the MedDiet and concurrent changes in nutrient density.


During 1-year follow-up, participants showed improvements in nutrient density for all micronutrients assessed. The density of carbohydrates (− 9.0%), saturated fatty acids (− 10.4%) and total energy intake (− 6.3%) decreased. These changes were more pronounced in the subset of participants with higher improvements in MedDiet adherence.


The PREDIMED-Plus dietary intervention, based on MedDiet recommendations for older adults, maybe a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity.


Mediterranean diet Nutrient density Metabolic syndrome 



Analysis of variance


Body Mass Index


Confidence intervals


Cardiovascular disease


Food Frequency Questionnaire


Mediterranean diet


Metabolic syndrome


Monounsaturated fatty acids


Polyunsaturated fatty acids


Saturated fatty acids


Standard deviations


Waist circumference



The principal author (N.C-I), wish to express her gratitude to the Ministry of Education of Spain for the grant received (FPU14/3630). L.B. has also received a grant from the Ministry of Education of Spain (FPU16/00165). The authors especially thank the PREDIMED-Plus participants for their collaboration and the PREDIMED-Plus staff for their support and effort. CIBEROBN is an initiative of ISCIII, Spain.

Author contributions

NCI, ABC, MAMG, JSS, DC, MF, DR, JV, AMAG, JW, JAM, LSM, RE, FJT, JL, XP, JAT, AGR, MDR, PMM, LD, VMS, JV, CV, ER, and AG collected all the data from the PREDIMED-Plus trial. NCI, ABC and AG, designed the study; performed the analysis; and wrote the first draft of the manuscript. All authors contributed to the editing of the manuscript. All authors have read and approved the final version of the manuscript.


Ministry of Education of Spain (FPU14/3630) Grant Naomi Cano-Ibáñez. Ministry of Education of Spain (FPU16/00165) grant Laura Barrubés. The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research Grant 2013-2018; 340918) grant to Miguel Ángel Martínez-González, and by the official funding agency for biomedical research of the Spanish Government, ISCIII through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal), including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, The Especial Action Project entitled: “Implementación y Evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus” grant to Jordi Salas-Salvadó, the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, and CIBEROBN and FEDER funds (CB06/03), ISCIII. International Nut&Dried Fruit Council- FESNAD Nº201302: Miguel Ángel Martínez-González (PI). None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication. The corresponding author had full access to all the data in the study and had final responsibility to submit for publication.

Compliance with ethical standards

Conflict of interest

Jordi Salas-Salvadó reports serving on the board of and receiving grant support through his institution from International Nut and Dried Fruit Council; receiving consulting personal fees from Danone, Font Vella Lanjarón, Nuts for Life and Eroski; and receiving grant support through his institution from Nut and Dried Fruit Foundation and Eroski. Emilio Ros reports grants, non-financial support and other fees from California Walnut Commission and Alexion; personal fees from California Walnut Commission and Alexion; personal fees, non-financial support and other fees from Aegerion and Ferrer International; grants and personal fees from Sanofi Aventis; grants from Amgen and Pfizer and personal fees from Akcea and Amarin, outside of the submitted work. Xavier Pintó reports serving on the board and receiving consulting personal fees from Sanofi Aventis, Amgen and Abbott laboratories; receiving lecture personal fees from Esteve, Lacer and Rubio laboratories. Miguel Delgado-Rodríguez reports receiving grants from the Diputación Provincial de Jaén and the Caja Rural de Jaén. Lidia Daimiel reports grants from Fundación Cerveza y Salud. All other authors declare no competing interests.

Supplementary material

394_2019_2087_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
  2. 2.CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)MadridSpain
  3. 3.Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA)GranadaSpain
  4. 4.Department of Preventive Medicine and Public Health, Medical SchoolUniversity of NavarraPamplonaSpain
  5. 5.Navarra Institute for Health Research (IdisNa)PamplonaSpain
  6. 6.Department of NutritionHarvard T.H. Chan School of Public HealthBostonUSA
  7. 7.CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of HealthMadridSpain
  8. 8.Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPVUniversitat Rovira i VirgiliReusSpain
  9. 9.Institut d’Investigació Sanitària Pere Virgili (IISPV)ReusSpain
  10. 10.Nutrition UnitUniversity Hospital of Sant Joan de ReusReusSpain
  11. 11.Department of Preventive MedicineUniversity of ValenciaValenciaSpain
  12. 12.Unit of Cardiovascular Risk and NutritionHospital del Mar, Institut Municipal d’Investigació Médica (IMIM)BarcelonaSpain
  13. 13.Health Research Institute of the Balearic Islands (IdISBa)Palma de MallorcaSpain
  14. 14.Nutritional Epidemiology UnitMiguel Hernández University, ISABIAL-FISABIOAlicanteSpain
  15. 15.Department of Cardiology, OSI ARABA, University Hospital ArabaUniversity of the Basque Country UPV/EHUVitoria-GasteizSpain
  16. 16.Department of Nursing, School of Health SciencesUniversity of Malaga-Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
  17. 17.Department of Nutrition, Food Sciences and Physiology, Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
  18. 18.Nutritional Genomics and Epigenomics GroupIMDEA Food, CEI UAM + CSICMadridSpain
  19. 19.Institute for Biomedical ResearchUniversity of Las Palmas de Gran CanariaLas PalmasSpain
  20. 20.Department of Internal Medicine, Institut d’Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  21. 21.Department of Endocrinology, Virgen de la Victoria HospitalUniversity of MálagaMálagaSpain
  22. 22.Department of Family Medicine, Research UnitDistrito Sanitario Atención Primaria SevillaSevilleSpain
  23. 23.Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, IDIBELLHospitalet de LlobregatBarcelonaSpain
  24. 24.Research Group on Community Nutrition and Oxidative StressUniversity of Balearic IslandsPalma de MallorcaSpain
  25. 25.Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University HospitalUniversity of CórdobaCórdobaSpain
  26. 26.Department of Health SciencesUniversity of JaenJaenSpain
  27. 27.Department of Endocrinology and NutritionInstituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC)MadridSpain
  28. 28.Institute of Biomedicine (IBIOMED)University of LeónLeónSpain
  29. 29.Department of Endocrinology, IDIBAPS, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  30. 30.CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)MadridSpain
  31. 31.Department of EndocrinologyFundación Jiménez-DíazMadridSpain
  32. 32.Lipid Clinic Department of Endocrinology and NutritionIDIBAPS, Hospital ClinicBarcelonaSpain
  33. 33.Navarra Health Service-OsasunbideaPamplonaSpain
  34. 34.ABS Reus V. Centre d’Assistència Primària Marià Fortuny, SAGESSAReusSpain
  35. 35.Centro de Salud Santa PolaAlicanteSpain
  36. 36.Department of Physiotherapy, School of Health SciencesUniversity of Malaga-Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
  37. 37.Department of Internal Medicine, Regional University Hospital of MalagaInstituto de Investigación Biomédica de Malaga (IBIMA)MalagaSpain
  38. 38.Department of Medicine, Facultad de MedicinaUniversity of SevillaSevilleSpain

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