Top

Published in:

01-09-2020 | Original Contribution

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

Authors: Naomi Cano-Ibáñez, 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

Published in: European Journal of Nutrition | Issue 6/2020

Abstract

Background

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.

Objective

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

Methods

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.

Results

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.

Conclusions

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.

Available only for authorised users

Peralta M, Ramos M, Lipert A, Martins J, Marques A (2018) Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand J Public Health 46(5):522–529. https://doi.org/10.1177/1403494818764810 CrossRefPubMed

Basterra-Gortari FJ, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Martinez-Gonzalez MÁ (2017) Prevalence of obesity and diabetes in Spanish adults 1987–2012. Med Clin 148(6):250–256. https://doi.org/10.1016/j.medcli.2016.11.022 CrossRef

Malik VS, Willett WC, Hu FB (2013) Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol 9(1):13–27. https://doi.org/10.1038/nrendo.2012.199 CrossRefPubMed

Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. PharmacoEconomics 33(7):673–689. https://doi.org/10.1007/s40273-014-0243-x CrossRefPubMedPubMedCentral

Darmon P, Kaiser MJ, Bauer JM, Sieber CC, Pichard C (2010) Restrictive diets in the elderly: never say never again? Clin Nutr 29(2):170–174. https://doi.org/10.1016/j.clnu.2009.11.002 CrossRefPubMed

Schröder H, Marrugat J, Vila J, Covas MI, Elosua R (2004) Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 134(12):3355–3361CrossRefPubMed

Salas-Salvadó J, Díaz-López A, Ruiz-Canela M, Basora J, Fitó M, Corella D, Serra-Majem L, Wärnberg J, Romaguera D, Estruch R, Vidal J, Alfredo M, Borau F, Vázquez C, Ros E, Vioque J, López-Miranda J, Bueno-Cavanillas A, Tur JA, Martínez-González M (2018) Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-plus trial. Diabetes Care. https://doi.org/10.2337/dc18-0836 CrossRefPubMedPubMedCentral

Martínez-González MA, Salas-Salvadó J, Estruch R, Corella D, Fitó M, Ros E (2015) Benefits of the Mediterranean diet: insights From the PREDIMED study. Prog Cardiovasc Dis 58(1):50–60. https://doi.org/10.1016/j.pcad.2015.04.003 CrossRefPubMed

Babio N, Toledo E, Estruch R, Ros E, Martínez-González MA, Castañer O, Bulló M, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Salas-Salvadó J (2014) Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ 186(17):E649–E657. https://doi.org/10.1503/cmaj.140764 CrossRefPubMedPubMedCentral

10.

Serra-Majem L, Bes-Rastrollo M, Román-Viñas B, Pfrimer K, Sánchez-Villegas A, Martínez-González MA (2009) Dietary patterns and nutritional adequacy in a Mediterranean country. Br J Nutr 101(S2):S21–S28. https://doi.org/10.1017/S0007114509990559 CrossRefPubMed

11.

Peng W, Berry EM, Goldsmith R (2019) Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents. J Hum Nutr Diet 32(1):41–52. https://doi.org/10.1111/jhn.12602 CrossRefPubMed

12.

Cano-Ibáñez N, Gea A, Ruiz-Canela M, Corella D, Salas-Salvadó J, Schröeder H, Navarrete-Muñoz EM, Romaguera D, Martínez JA, Barón-López FJ, López-Miranda J, Estruch R, Riquelme-Gallego B, Alonso-Gómez Á, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Gaforio JJ, Matía P, Ros E, Fernández-Carrión R, Díaz-López A, Zomeño MD, Candela I, Konieczna J, Abete I, Buil-Cosiales P, Basora J, Fitó M, Martínez-González MA, Bueno-Cavanillas A (2019) Diet quality and nutrient density in subjects with metabolic syndrome: influence of socioeconomic status and lifestyle factors A cross-sectional assessment in the PREDIMED-Plus study. Clin Nutr. https://doi.org/10.1016/j.clnu.2019.04.032 CrossRefPubMed

13.

Sanchez-Tainta A, Zazpe I, Bes-Rastrollo M, Salas-Salvado J, Bullo M, Vicente Sorli J, Corella D, Isabel Covas M, Aros F, Gutierrez-Bedmar M, Fiol M, Garcia de la Corte F, Serra-Majem L, Pinto X, Schroeeder H, Ros E, Carmen Lopez-Sabater M, Estruch R, Angel Martinez-Gonzalez M, Investigators PS (2016) Nutritional adequacy according to carbohydrates and fat quality. Eur J Nutr 55(1):93–106. https://doi.org/10.1007/s00394-014-0828-3 CrossRefPubMed

14.

Martínez-González MA, Buil-Cosiales P, Corella D, Bulló M, Fitó M, Vioque J, Romaguera D, Martínez JA, Wärnberg J, López-Miranda J, Estruch R, Bueno-Cavanillas A, Arós F, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Delgado-Rodríguez M, Matía P, Ros E, Fernández-Aranda F, Botella C, Portillo-Baquedano MP, Lamuela-Raventós RM, Marcos A, Sáez G, Gómez-Gracia E, Ruiz-Canela M, Toledo E, Alvarez-Alvarez I, Díez-Espino J, Sorlí JV, Basora J, Castañer O, Schröder H, Navarrete-Muñoz EM, Zulet MA, García-Rios A, Salas-Salvadó J, Investigators PR-P (2018) Cohort profile: design and methods of the PREDIMED-Plus randomized trial. Int J Epidemiol. https://doi.org/10.1093/ije/dyy225 CrossRefPubMedPubMedCentral

15.

Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WPT, Loria CM, Smith SC (2009) Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, lung, and blood institute; American heart association; World heart federation; International atherosclerosis society; And international association for the study of obesity. Circulation 120(16):1640–1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644 CrossRefPubMed

16.

Willet W (2013) Nutritional epidemiology, 3rd edn. Oxford University Press, New York

17.

Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó X, Ruiz-Gutierrez V, Covas MI (2011) A Short screener is valid for assessing Mediterranean diet adherence among older spanish men and women. J Nutr 141(6):1140–1145. https://doi.org/10.3945/jn.110.135566 CrossRefPubMed

18.

Martin-moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-rodriguez JC, Salvini S, Willett WC (1993) Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22(3):512–519. https://doi.org/10.1093/ije/22.3.512 CrossRefPubMed

19.

Moreiras OCA, Cabrera L, Cuadrado C (2003) Tablas de Composición de alimentos. (Spanish food composition tables), vol 7. Pirámide, Madrid

20.

Mataix Verdu J (2003) Tabla de composición de alimentos españoles. (Spanish food composition tables), Universidad de Granada, Granada

21.

Nicklas TA, Drewnowski A, O’Neil CE (2013) The nutrient density approach to healthy eating: challenges and opportunities. Public Health Nutrition 17(12):2626–2636. https://doi.org/10.1017/S136898001400158X CrossRef

22.

Schröder H, Vila J, Marrugat J, Covas MI (2008) Low energy density diets are associated with favorable nutrient intake profile and adequacy in free-living elderly men and women. J Nutr 138(8):1476–1481CrossRefPubMed

23.

Sánchez-Villegas A, Martínez JA, De Irala J, Martínez-González MA (2002) Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern. Eur J Nutr 41(6):249–257. https://doi.org/10.1007/s00394-002-0382-2 CrossRefPubMed

24.

Vitale M, Racca E, Izzo A, Giacco A, Parente E, Riccardi G, Giacco R (2019) Adherence to the traditional Mediterranean diet in a population of South of Italy: factors involved and proposal of an educational field-based survey tool. Int J Food Sci Nutr 70(2):195–201. https://doi.org/10.1080/09637486.2018.1481202 CrossRefPubMed

25.

Agnoli C, Sieri S, Ricceri F, Giraudo MT, Masala G, Assedi M, Panico S, Mattiello A, Tumino R, Giurdanella MC, Krogh V (2018) Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes. https://doi.org/10.1038/s41387-018-0023-3 CrossRefPubMedPubMedCentral

26.

Zazpe I, Estruch R, Toledo E, Sánchez-Taínta A, Corella D, Bulló M, Fiol M, Iglesias P, Gómez-Gracia E, Arós F, Ros E, Schröder H, Serra-Majem L, Pintó X, Lamuela-Raventós R, Ruiz-Gutiérrez V, Martínez-González MÁ (2010) Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial. Eur J Nutr 49(2):91–99. https://doi.org/10.1007/s00394-009-0053-7 CrossRefPubMed

27.

Drewnowski A (2018) Nutrient density: addressing the challenge of obesity. Br J Nutr 120(s1):S8–S14. https://doi.org/10.1017/S0007114517002240 CrossRefPubMed

28.

Roman Viñas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, De Groot LCPGM, Van’T Veer P, Matthys C, Serra Majem L (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59(2–4):84–95. https://doi.org/10.1159/000332762 CrossRefPubMed

29.

Ter Borg S, Verlaan S, Mijnarends DM, Schols JMGA, De Groot LCPGM, Luiking YC (2015) Macronutrient intake and inadequacies of community-dwelling older adults, a systematic review. Ann Nutr Metab 66(4):242–255. https://doi.org/10.1159/000435862 CrossRefPubMed

30.

Guasch-Ferré M, Salas-Salvadó J, Ros E, Estruch R, Corella D, Fitó M, Martínez-González MA, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Lamuela-Raventos RM, Tur J, Martinez JA, Serra-Majem L, Pintó X (2017) The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence? Nutr Metab Cardiovasc Dis 27(7):624–632. https://doi.org/10.1016/j.numecd.2017.05.004 CrossRefPubMed

31.

Salas-Salvadó J, Guasch-Ferré M, Lee CH, Estruch R, Clish CB, Ros E (2016) Protective effects of the mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr 146(4):920S–927S. https://doi.org/10.3945/jn.115.218487 CrossRefPubMedCentral

32.

Castro-Quezada I, Román-Viñas B, Serra-Majem L (2014) The Mediterranean diet and nutritional adequacy: a review. Nutrients 6(1):231–248. https://doi.org/10.3390/nu6010231 CrossRefPubMedPubMedCentral

33.

Gose M, Krems C, Heuer T, Hoffmann I (2016) Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT). Br J Nutr 115(8):1498–1507. https://doi.org/10.1017/S0007114516000544 CrossRefPubMed

34.

Casagrande SS, Cowie CC (2017) Trends in dietary intake among adults with type 2 diabetes: NHANES 1988–2012. J Hum Nutr Diet 30(4):479–489. https://doi.org/10.1111/jhn.12443 CrossRefPubMedPubMedCentral

35.

De La Fuente-Arrillaga C, Zazpe I, Santiago S, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Martinez-Gonzalez MA (2016) Beneficial changes in food consumption and nutrient intake after 10 years of follow-up in a Mediterranean cohort: the SUN project. BMC Public Health. https://doi.org/10.1186/s12889-016-2739-0 CrossRefPubMedPubMedCentral

36.

Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schröder H, Salas-Salvado J, Corella D, Fiol M, Gomez-Gracia E, Aros F, Ros E, Ruíz-Gutierrez V, Iglesias P, Conde-Herrera M, Martinez-Gonzalez MA (2008) A large randomized individual and group intervention conducted by registered dietitians increased adherence to mediterranean-type diets: the PREDIMED study. J Am Diet Assoc 108(7):1134–1144. https://doi.org/10.1016/j.jada.2008.04.011 CrossRefPubMed

37.

Nijjar SK, D’Amico MI, Wimalaweera NA, Cooper NAM, Zamora J, Khan KS (2017) Participation in clinical trials improves outcomes in women’s health: a systematic review and meta-analysis. BJOG 124(6):863–871. https://doi.org/10.1111/1471-0528.14528 CrossRefPubMed

38.

Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E, Perez-Bauer M, Martínez-González MA, Salas-Salvadó J, Martn-Moreno JM (2010) Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 103(12):1808–1816. https://doi.org/10.1017/S0007114509993837 CrossRefPubMed

39.

Ortiz-Andrellucchi A, Sánchez-Villegas A, Doreste-Alonso J, de Vries J, de Groot L, Serra-Majem L (2009) Dietary assessment methods for micronutrient intake in elderly people: a systematic review. Br J Nutr 102(Suppl 1):S118–S149. https://doi.org/10.1017/S0007114509993175 CrossRefPubMed

Title: Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study
Authors: Naomi Cano-Ibáñez
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
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nutrition / Issue 6/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-02087-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2020

Association of dietary lipid intake with low-density lipoprotein cholesterol levels: analysis of two independent population-based studies

Correction to: Low-phytate wholegrain bread instead of high-phytate wholegrain bread in a total diet context did not improve iron status of healthy Swedish females: a 12 week, randomized, parallel-design intervention study

EPA and DHA as markers of nutraceutical treatment response in major depressive disorder

Ergogenic effects of caffeine on peak aerobic cycling power during the menstrual cycle

Cardiovascular responses to a glucose drink in young male individuals with overweight/obesity and mild alterations in glucose metabolism, but without impaired glucose tolerance

Associations of sugar intake with anthropometrics in children from ages 2 until 8 years in the EU Childhood Obesity Project

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage