A Large Randomized Individual and Group Intervention Conducted by Registered Dietitians Increased Adherence to Mediterranean-Type Diets: The PREDIMED Study

Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
Journal of the American Dietetic Association (Impact Factor: 3.92). 07/2008; 108(7):1134-44; discussion 1145. DOI: 10.1016/j.jada.2008.04.011
Source: PubMed


To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet.
A 12-month assessment of a randomized primary prevention trial.
One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or > or =3 cardiovascular risk factors.
Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines.
Changes in food and nutrient intake after 12 months.
Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted.
Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups.
A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.

Download full-text


Available from: Ramon Estruch, Oct 09, 2015
19 Reads
  • Source
    • "A 14-item dietary screener was used to assess adherence to the MeDiet at baseline and every three months [21, 22]. This tool was useful in evaluating the compliance with MeDiet, allowing personalized dietary advice to be provided to subjects allocated in MeDiet groups by adapting it to the participant's clinical condition, preferences, and beliefs [23]. This questionnaire consists of 14 dichotomous questions on food consumption frequency. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To compare the one year effect of two dietary interventions with MeDiet on GL and GI in the PREDIMED trial. Methods. Participants were older subjects at high risk for cardiovascular disease. This analysis included 2866 nondiabetic subjects. Diet was assessed with a validated 137-item food frequency questionnaire (FFQ). The GI of each FFQ item was assigned by a 5-step methodology using the International Tables of GI and GL Values. Generalized linear models were fitted to assess the relationship between the intervention group and dietary GL and GI at one year of follow-up, using control group as reference. Results. Multivariate-adjusted models showed an inverse association between GL and MeDiet + extra virgin olive oil (EVOO) group: 𝛽 = −8.52 (95% CI: −10.83 to −6.20) and MeDiet + Nuts group: 𝛽 = −10.34 (95% CI: −12.69 to −8.00), when comparing with control group. Regarding GI, 𝛽 = −0.93 (95% CI: −1.38 to −0.49) for MeDiet + EVOO, 𝛽 = −1.06 (95% CI: −1.51 to −0.62) for MeDiet + Nuts when comparing with control group. Conclusion. Dietary intervention with MeDiet supplemented with EVOO or nuts lowers dietary GL and GI.
    Journal of nutrition and metabolism 09/2014; 2014(Article ID 985373,):10. DOI:10.1155/2014/985373
  • Source
    • "There are other nuances to consider. Total polyphenol intake had a stronger inverse association with mortality risk in women who did not drink alcohol [15], and those beginning with the worst dietary habits more frequently made changes toward better compliance to the diet [16], a phenomenon that has been shown elsewhere [17]. The re-analysis of the PREDIMED trial data reported in BMC Medicine[13] found no apparent modification of the polyphenol effect between diet groups, but then the trial was not designed to test the effects of polyphenol intakes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The recent publication of the PREDIMED trial provided definitive evidence that a Mediterranean diet provides protection against cardiovascular disease. Two articles published in BMC Medicine provide further understanding of why this may be the case, by considering contributory effects of olive oil, a core food in the diet, and polyphenols, a class of identifiable protective compounds. Using a number of statistical models, analyses were conducted to show around a 35% cardiovascular disease risk reduction in the highest consumers of olive oil and a similar degree of risk reduction for all-cause mortality comparing highest to lowest quintiles of polyphenol intake. The effects were an advance on cohort studies not related to trials. This suggests that it may be necessary to have better control of the background diet to enable exposure of the value of individual foods and nutrients in a dietary pattern, bearing in mind that, by nature, it is difficult to separate out effects of foods, nutrients and whole diets. Please see related articles: and
    BMC Medicine 06/2014; 12(1):100. DOI:10.1186/1741-7015-12-100 · 7.25 Impact Factor
  • Source
    • "Moreover, in intervention trials, the degree of change in the dietary habits of participants is always suboptimal, because of the lack of compliance with the intended intervention of some participants [19]. In fact, the control group in the PREDIMED trial was assigned a healthy dietary pattern recommended by the American Heart Association to prevent CVD [18], and also they tended at baseline to be on a dietary pattern that was similar to the Mediterranean diet. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A few observational studies have found an inverse association between adherence to a Mediterranean diet and the risk of depression. Randomized trials with an intervention based on this dietary pattern could provide the most definitive answer to the findings reported by observational studies. The aim of this study was to compare in a randomized trial the effects of two Mediterranean diets versus a low-fat diet on depression risk after at least 3 years of intervention. This was a multicenter, randomized, primary prevention field trial of cardiovascular disease (Prevención con Dieta Mediterránea (PREDIMED Study)) based on community-dwelling men aged 55 to 80 years and women aged 60 to 80 years at high risk of cardiovascular disease (51% of them had type 2 diabetes; DM2) attending primary care centers affiliated with 11 Spanish teaching hospitals. Primary analyses were performed on an intention-to-treat basis. Cox regression models were used to assess the relationship between the nutritional intervention groups and the incidence of depression. We identified 224 new cases of depression during follow-up. There was an inverse association with depression for participants assigned to a Mediterranean diet supplemented with nuts (multivariate hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.55 to 1.10) compared with participants assigned to the control group, although this was not significant. However, when the analysis was restricted to participants with DM2, the magnitude of the effect of the intervention with the Mediterranean diet supplemented with nuts did reach statistical significance (multivariate HR = 0.59; 95% CI 0.36 to 0.98). The result suggest that a Mediterranean diet supplemented with nuts could exert a beneficial effect on the risk of depression in patients with DM2. This trial has been registered in the Current Controlled Trials with the number ISRCTN 35739639.
    BMC Medicine 09/2013; 11(1):208. DOI:10.1186/1741-7015-11-208 · 7.25 Impact Factor
Show more

Similar Publications