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Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

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Abstract

Background

Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated.

Aim

To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk factors, and baseline dietary habits.

Methods

A total of 1,048 asymptomatic subjects aged 55–80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants’ characteristics were assessed at baseline among subjects. Dietary changes were evaluated after 12 months. Main outcome measures were: attained changes in five dietary goals: increases in (1) fruit consumption, (2) vegetable consumption, (3) monounsaturated fatty acid (MUFA)/saturated fatty acid (SFA) ratio, and decreases in (4) sweets and pastries consumption, (5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet).

Results

Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet.

Conclusions

Some participant characteristics (marital status and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet, and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.

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Acknowledgments

The authors thank the participants for their enthusiastic collaboration, the PREDIMED personnel for excellent assistance and the personnel of all primary care centers affiliated, especially to Beatriz San Julian, Pilar Buil Cosiales, Javier Díez Espino, Ana García-Arellano, Julia Wärnberg, Jordi Salas- Salvadó, José Lapetra, Maria Isabel Covas, Manolo Serrano and Jackeline Alvarez. We gratefully acknowledge the Instituto de Salud Carlos III (ISCIII) and other funding sources (see below).

Conflict of interest statement

Spanish Government (Instituto de Salud Carlos III, RTIC RD06/0045, Fondo de Investigaciones Sanitarias, FIS PI04/0233, PI04/2239, PI05/2368, PI05/1839, PI081943, PI07/0312, PI04/2241, PI05/0976, PI07/0240, and PE 087/0819), CIBEROBN, “CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) is an initiative of ISCIII”), the Navarra Government (PI41/2005), Generalitat Valenciana (ACOMP06109). Fundación Patrimonio Comunal Olivarero and Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain) and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit this manuscript.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain

    Itziar Zazpe, Ana Sánchez-Taínta & Miguel Ángel Martínez-González

  2. Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain

    Itziar Zazpe

  3. Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Ramón Estruch

  4. CIBER CB06/03 Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain

    Ramón Estruch, Dolores Corella, Miquel Fiol, Emilio Ros & Helmut Schröder

  5. Department of Preventive Medicine and Quality Management, Hospital Virgen del Camino, Pamplona, Spain

    Estefanía Toledo

  6. Department of Preventive Medicine, University of Valencia, Valencia, Spain

    Dolores Corella

  7. Human Nutrition Department, University Rovira i Virgili, Reus, Spain

    Mónica Bulló

  8. Institut Universitàri de Ciències de la Salut (IUNICS), Universidad de les Illes Balears, Palma de Mallorca, Spain

    Miquel Fiol

  9. Department of Family Medicine, Primary Care Division of Sevilla, Bellavista Health Center, Sevilla, Spain

    Pablo Iglesias

  10. Department of Preventive Medicine, University of Malaga, Malaga, Spain

    Enrique Gómez-Gracia

  11. Department of Cardiology, Hospital Universitario Txagorritxu, Vitoria, Spain

    Fernando Arós

  12. Unitat de Lípids, Servei d’Endocrinologia i Nutrició, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    Emilio Ros

  13. Lipids and Cardiovascular Epidemiology Research Unit, Institut Municipal d’Investigació Mèdica, IMIM- Hospital del Mar, Barcelona, Spain

    Helmut Schröder

  14. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Lluis Serra-Majem

  15. Lipids and Vascular Risk Unit, Internal Medicine Service Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

    Xavier Pintó

  16. Department of Nutrition and Food Science, University of Barcelona, Barcelona, Spain

    Rosa Lamuela-Raventós

  17. Instituto de la grasa, Consejo Superior de Investigaciones Científicas, Sevilla, Spain

    Valentina Ruiz-Gutiérrez

  18. School of Medicine, Clinica Universitaria de Navarra, Irunlarrea 1, 31080, Pamplona, Navarra, Spain

    Itziar Zazpe

Authors
  1. Itziar Zazpe
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  2. Ramón Estruch
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  3. Estefanía Toledo
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  4. Ana Sánchez-Taínta
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  5. Dolores Corella
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  6. Mónica Bulló
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  7. Miquel Fiol
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  8. Pablo Iglesias
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  9. Enrique Gómez-Gracia
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  10. Fernando Arós
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  11. Emilio Ros
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  12. Helmut Schröder
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  13. Lluis Serra-Majem
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  14. Xavier Pintó
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  15. Rosa Lamuela-Raventós
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  16. Valentina Ruiz-Gutiérrez
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  17. Miguel Ángel Martínez-González
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Corresponding author

Correspondence to Itziar Zazpe.

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Zazpe, I., Estruch, R., Toledo, E. et al. Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial. Eur J Nutr 49, 91–99 (2010). https://doi.org/10.1007/s00394-009-0053-7

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  • DOI: https://doi.org/10.1007/s00394-009-0053-7

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