Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status One-Year Results of the PREDIMED Randomized Trial

Human Nutrition Unit, School of Medicine, University of Rovira i Virgili, Reus, Spain.
Archives of internal medicine (Impact Factor: 17.33). 01/2009; 168(22):2449-58. DOI: 10.1001/archinte.168.22.2449
Source: PubMed


Epidemiological studies suggest that the Mediterranean diet (MedDiet) may reduce the risk of developing the metabolic syndrome (MetS). We compared the 1-year effect of 2 behavioral interventions to implement the MedDiet vs advice on a low-fat diet on MetS status.
A total of 1224 participants were recruited from the PREDIMED (Prevención con Dieta Mediterránea) Study, a multicenter, 3-arm, randomized clinical trial to determine the efficacy of the MedDiet on the primary prevention of cardiovascular disease. Participants were older subjects at high risk for cardiovascular disease. Interventions were quarterly education about the MedDiet plus provision of either 1 L/wk of virgin olive oil (MedDiet + VOO) or 30 g/d of mixed nuts (MedDiet + nuts), and advice on a low-fat diet (control diet). All diets were ad libitum, and there was no increase in physical activity for any of the interventions. Lifestyle variables and MetS features as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria were assessed.
At baseline, 61.4% of participants met criteria for the MetS. One-year prevalence was reduced by 6.7%, 13.7%, and 2.0% in the MedDiet + VOO, MedDiet + nuts, and control diet groups, respectively (MedDiet + nuts vs control groups, P = .01; MedDiet + VOO vs control group, P = .18). Incident rates of the MetS were not significantly different among groups (22.9%, 17.9%, and 23.4%, respectively). After adjustment for sex, age, baseline obesity status, and weight changes, the odds ratios for reversion of MetS were 1.3 (95% confidence interval, 0.8-2.1) for the MedDiet + VOO group and 1.7 (1.1-2.6) for the MedDiet + nuts group compared with the control diet group.
A traditional MedDiet enriched with nuts could be a useful tool in the management of the MetS.

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Available from: Jordi Salas-Salvadó
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    • "Moreover, a MeDiet supplemented with nuts during 1 year was associated with a 14% reduction in prevalence of MetS [47]. A cross-sectional study in the Canary Islands showed that fruit intake had a protective effect on the triglyceride criteria of MetS and that cereal intake protected from insulin resistance [48]. "
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    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.
    Full-text · Article · Sep 2014 · Journal of nutrition and metabolism
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    • "The PREDIMED study [22] was designed to determine whether the Mediterranean diet supplemented with virgin olive oil or nuts prevents the development of major cardiovascular complications in high vascular risk individuals, compared with a low-fat diet. In its initial phase, this study recorded an average increase of 1.8 points on the 14-point scale assessing adherence to the Mediterranean diet, versus an increase of 0.3 points in the control group [28]. During the first year, this implied a decrease in the prevalence of metabolic syndrome and its components and in the incidence of diabetes mellitus [28,29]. "
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    ABSTRACT: New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging.Methods/design: A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health.Trial registration: Clinical Identifier: NCT02016014.
    Full-text · Article · Mar 2014 · BMC Public Health
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    • "The frequency of nut consumption was also related to lower rates of sudden cardiac death in a large cohort of men [7]. Furthermore, epidemiologic studies and clinical trials have shown that frequent nut consumption is associated with a reduced load of cardiovascular disease risk factors, such as dyslipidemia, type 2 diabetes, and metabolic syndrome [4,6,8,9]. In addition, reports from the Iowa Women’s Health study [10], a large Dutch cohort [11], and the US Nurses’ Health Study [12], which assessed populations with relatively low overall nut intake, suggested that frequent nut consumption related inversely to total mortality, albeit the protective effect was weak, with adjusted risk reductions ranging from 5% to 15% [10]–[12]. "
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    ABSTRACT: Background: Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person. Methods: We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED ('PREvencion con DIeta MEDiterranea') study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality. Results: During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend < 0.05, all). Compared to non-consumers, subjects consuming nuts > 3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts > 3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66). Conclusions: Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk.
    Full-text · Article · Jun 2013 · BMC Medicine
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