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



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.

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Fig. 1
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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


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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.


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.

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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.

Corresponding author

Correspondence to Naomi Cano-Ibáñez.

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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.

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Cano-Ibáñez, N., Bueno-Cavanillas, A., Martínez-González, M.Á. et al. Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study. Eur J Nutr 59, 2395–2409 (2020). https://doi.org/10.1007/s00394-019-02087-1

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  • Mediterranean diet
  • Nutrient density
  • Metabolic syndrome