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Title: Predictors of short- and long-term adherence with a Mediterranean-type diet intervention: the PREDIMED randomized trial
Authors: Downer, Mary Kathryn
Gea, Alfredo
Stampfer, Meir
Sánchez-Tainta, Ana
Corella, Dolores
Salas-Salvadó, Jordi
Ros, Emilio 
Estruch, Ramón 
Fitó, Montserrat
Gómez-Gracia, Enrique
Arós, Fernando
Fiol, Miquel
García De-la-Corte, Francisco Jose
Serra-Majem, Lluís 
Pinto, Xavier
Basora, Josep
Sorlí, José V.
Vinyoles, Ernest
Zazpe, Itziar
Martínez-González, Miguel-Ángel
UNESCO Clasification: 3206 Ciencias de la nutrición
Keywords: Dietary adherence
Dietary intervention
Dietary predictors
Long-term dietary adherence
Mediterranean Diet, et al
Issue Date: 2016
Journal: International Journal of Behavioral Nutrition and Physical Activity 
Abstract: Background: Dietary intervention success requires strong participant adherence, but very few studies have examined factors related to both short-term and long-term adherence. A better understanding of predictors of adherence is necessary to improve the design and execution of dietary intervention trials. This study was designed to identify participant characteristics at baseline and study features that predict short-term and long-term adherence with interventions promoting the Mediterranean-type diet (MedDiet) in the PREvención con DIeta MEDiterránea (PREDIMED) randomized trial. Methods: Analyses included men and women living in Spain aged 55-80 at high risk for cardiovascular disease. Participants were randomized to the MedDiet supplemented with either complementary extra-virgin olive oil (EVOO) or tree nuts. The control group and participants with insufficient information on adherence were excluded. PREDIMED began in 2003 and ended in 2010. Investigators assessed covariates at baseline and dietary information was updated yearly throughout follow-up. Adherence was measured with a validated 14-point Mediterranean-type diet adherence score. Logistic regression was used to examine associations between baseline characteristics and adherence at one and four years of follow-up. Results: Participants were randomized to the MedDiet supplemented with EVOO (n = 2,543; 1,962 after exclusions) or tree nuts (n = 2,454; 2,236 after exclusions). A higher number of cardiovascular risk factors, larger waist circumference, lower physical activity levels, lower total energy intake, poorer baseline adherence to the 14-point adherence score, and allocation to MedDiet + EVOO each independently predicted poorer adherence. Participants from PREDIMED recruiting centers with a higher total workload (measured as total number of persons-years of follow-up) achieved better adherence. No adverse events or side effects were reported. Conclusions: To maximize dietary adherence in dietary interventions, additional efforts to promote adherence should be used for participants with lower baseline adherence to the intended diet and poorer health status. The design of multicenter nutrition trials should prioritize few large centers with more participants in each, rather than many small centers. Trial registration: This study was registered at (http://www.controlled-trials. com/ISRCTN35739639). International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005. Trial design: parallel randomized trial.
ISSN: 1479-5868
DOI: 10.1186/s12966-016-0394-6
Source: International Journal of Behavioral Nutrition and Physical Activity [EISSN 1479-5868],v. 13 (1), article number 67, (Junio 2016)
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