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A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study

Zazpe, I.A. Sanchez-Tainta, R. Estruch, R.M. Lamuela-Raventos, H. Schröder, J. Salas-Salvado, D. Corella, M. Fiol, E. Gomez-Gracia, F. Aros, E. Ros, V. Ruíz-Gutierrez, P. Iglesias, M. Conde-Herrera, M.A. Martinez-Gonzalez, 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 1134-1143.

Objective: To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet. Design: A 12-month assessment of a randomized primary prevention trial. Subjects/settings: One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or ≥3 cardiovascular risk factors. Intervention: 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 (1L/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. Main outcome measures: Changes in food and nutrient intake after 12 months. Statistical analyses: Paired tests (for within-group changes) and analysis of variance (for between-group changes) were conducted. Results: 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. Conclusions: 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.