To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet.
A 12-month assessment of a randomized primary prevention trial.
One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or ≥3 cardiovascular risk factors.
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 (1 L/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.
Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted.
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.
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.
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I. Zazpe is a research fellow, Department of Preventive Medicine and Public Health and Department of Nutrition and Food Sciences, Physiology, and Toxicology, University of Navarra, Pamplona, Spain.
A. Sanchez-Tainta is a research fellow and M. A. Martinez-Gonzalez is professor & chair of Epidemiology, both with the Department of Preventive Medicine and Public Health, School of Medicine–Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
R. M. Lamuela-Raventos is associate professor of food sciences, Department of Nutrition and Food Science, University of Barcelona, Barcelona, Spain.
H. Schröder is a senior research scientist, Lipids and Cardiovascular Epidemiology Research Unit, Institut Municipal d'Investigació Mèdica, Hospital de Mar, Parc de Recerca Biomèdica de Barcelona, and CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
R. Estruch is associate professor of internal medicine, Department of Internal Medicine, Hospital Clinic, University of Barcelona, and CIBEROBN, ISCIII, Madrid, Spain.
J. Salas-Salvado is professor of nutrition, Human Nutrition Department, School of Medicine, University Rovira i Virgili, San Llorenc, Spain.
D. Corella is associate professor of epidemiology, Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain, and CIBEROBN, ISCIII, Madrid, Spain.
M. Fiol is attending physician of cardiology, Institut Universitàri de Ciències de la Salut, Universidad de les Illes Balears, Palma de Mallorca, Spain, and CIBEROBN, ISCIII, Madrid, Spain.
E. Gomez-Gracia is associate professor of epidemiology, Department of Epidemiology, School of Medicine, University of Malaga, Malaga, Spain.
F. Aros is attending physician of cardiology, Department of Cardiology, Hospital Txangorritxu, Alava, Spain.
E. Ros is associate professor of internal medicine, Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomediques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain, and CIBEROBN, ISCIII, Madrid, Spain.
V. Ruíz-Gutierrez is professor of biochemistry, Instituto de la Grasa, Consejo Superior de Investigaciones Científicas, Sevilla, Spain.
P. Iglesias is attending physician of community medicine, Department of Family Medicine, Primary Care Division of Sevilla, Sevilla, Spain, and CIBEROBN, ISCIII, Madrid, Spain.
M. Conde-Herrera is associate professor of epidemiology, Department of Epidemiology and Public Health, Hospital Virgen del Rocío, Sevilla, Spain.
Accepted: January 7, 2008
© 2008 American Dietetic Association. Published by Elsevier Inc. All rights reserved.