Abstract
Purpose
Adherence to a healthy dietary pattern positively influences clinical outcomes in cardiovascular prevention, but long-term adherence is difficult to maintain. We evaluated 5-year changes in dietary habits, adherence achieved, and its maintenance in a cohort of coronary patients from the CORDIOPREV study.
Methods
1002 coronary patients were randomized to a Mediterranean diet (n = 502) or a low-fat diet (n = 500) and received individual-group-telephone visits and personalized dietary advice. A validated food-frequency questionnaire, a 14-point Mediterranean diet adherence screener, and a 9-point low-fat diet adherence score were used. Dietary adherence was categorized into Low, Medium, and High Adherence. Changes in nutrient intake, food consumption, and adherence were analyzed on a yearly basis. The maintenance of long-term dietary adherence was evaluated using data after the first year and fifth year.
Results
From baseline to 5 years, significant increases were observed in overall dietary adherence (Mediterranean diet from 8.9 to 11.4; low-fat diet from 3.9 to 7.1) and in the percentage of patients considered High Adherence (Mediterranean diet from 41 to 89%; low-fat diet from 4 to 67%). When we evaluated the maintenance of adherence, patients considered Low and Medium Adherence at 1 year increased their adherence at the 5 years with both diets and patients considered High Adherence maintained their adherence with a Mediterranean diet, but decreased their adherence with a low-fat diet.
Conclusions
A comprehensive dietary intervention results in an overall long-term improvement and maintenance of adherence to the Mediterranean and low-fat diets. In our population, the Mediterranean diet group achieved a high level of adherence in the short term which was maintained in the long term.
Similar content being viewed by others
References
World Health Organization (Website). Press center. Accessed Dec 18
Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Basora J, Munoz MA, Sorli JV, Martinez JA, Martinez-Gonzalez MA (2018) Retraction and republication: primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–90. N Engl J Med 378(25):2441–2442. https://doi.org/10.1056/nejmc1806491
Delgado-Lista J, Perez-Martinez P, Garcia-Rios A, Alcala-Diaz JF, Perez-Caballero AI, Gomez-Delgado F, Fuentes F, Quintana-Navarro G, Lopez-Segura F, Ortiz-Morales AM, Delgado-Casado N, Yubero-Serrano EM, Camargo A, Marin C, Rodriguez-Cantalejo F, Gomez-Luna P, Ordovas JM, Lopez-Miranda J, Perez-Jimenez F (2016) CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (the CORDIOPREV study): rationale, methods, and baseline characteristics: a clinical trial comparing the efficacy of a Mediterranean diet rich in olive oil versus a low-fat diet on cardiovascular disease in coronary patients. Am Heart J 177:42–50. https://doi.org/10.1016/j.ahj.2016.04.011
National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A (2002) Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106(25):3143–3421
Barzi F, Woodward M, Marfisi RM, Tavazzi L, Valagussa F, Marchioli R, Investigators GI-P (2003) Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr 57(4):604–611. https://doi.org/10.1038/sj.ejcn.1601575
Trichopoulou A, Bamia C, Trichopoulos D (2005) Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165(8):929–935. https://doi.org/10.1001/archinte.165.8.929
Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196. https://doi.org/10.3945/ajcn.2010.29673
Sofi F, Macchi C, Abbate R, Gensini GF, Casini A (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17(12):2769–2782. https://doi.org/10.1017/S1368980013003169
Grosso G, Marventano S, Yang J, Micek A, Pajak A, Scalfi L, Galvano F, Kales SN (2017) A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr 57(15):3218–3232. https://doi.org/10.1080/10408398.2015.1107021
Crichton GE, Howe PR, Buckley JD, Coates AM, Murphy KJ, Bryan J (2012) Long-term dietary intervention trials: critical issues and challenges. Trials 13:111. https://doi.org/10.1186/1745-6215-13-111
Desroches S, Lapointe A, Ratte S, Gravel K, Legare F, Turcotte S (2013) Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2:CD008722. https://doi.org/10.1002/14651858.cd008722.pub2
De Geest S, Sabate E (2003) Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs 2(4):323. https://doi.org/10.1016/S1474-5151(03)00091-4
Women’s Health Initiative Study G (2004) Dietary adherence in the Women’s Health Initiative Dietary Modification Trial. J Am Diet Assoc 104(4):654–658. https://doi.org/10.1016/j.jada.2004.01.014
Downer MK, Gea A, Stampfer M, Sanchez-Tainta A, Corella D, Salas-Salvado J, Ros E, Estruch R, Fito M, Gomez-Gracia E, Aros F, Fiol M, De-la-Corte FJ, Serra-Majem L, Pinto X, Basora J, Sorli JV, Vinyoles E, Zazpe I, Martinez-Gonzalez MA (2016) Predictors of short- and long-term adherence with a Mediterranean-type diet intervention: the PREDIMED randomized trial. Int J Behav Nutr Phys Act 13:67. https://doi.org/10.1186/s12966-016-0394-6
Vilaro MJ, Staub D, Xu C, Mathews AE (2016) Theory-based interventions for long-term adherence to improvements in diet quality: an in-depth review. Am J Lifestyle Med 10(6):369–376. https://doi.org/10.1177/1559827616661690
Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J (2016) Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adher 10:1547–1559. https://doi.org/10.2147/PPA.S103649
Lara J, Evans EH, O’Brien N, Moynihan PJ, Meyer TD, Adamson AJ, Errington L, Sniehotta FF, White M, Mathers JC (2014) Association of behaviour change techniques with effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomised controlled trials. BMC Med 12:177. https://doi.org/10.1186/s12916-014-0177-3
Wibisono C, Probst Y, Neale E, Tapsell L (2016) Impact of food supplementation on weight loss in randomised-controlled dietary intervention trials: a systematic review and meta-analysis. Br J Nutr 115(8):1406–1414. https://doi.org/10.1017/S0007114516000337
Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schroder H, Salas-Salvado J, Corella D, Fiol M, Gomez-Gracia E, Aros F, Ros E, Ruiz-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
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
Fernandez-Ballart JD, Pinol JL, Zazpe I, Corella D, Carrasco P, Toledo E, Perez-Bauer M, Martinez-Gonzalez MA, Salas-Salvado J, Martin-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
Moreiras O, Carbajal A, Cabrera L, Cuadrado C (2013) Tablas de composición de alimentos y guía de prácticas, 16ª edn. Ediciones Pirámide (Grupo Anaya, SA), Madrid
Mataix Verdu J, Garcia Diz L, Mañas Almendros M, Martinez de Vitoria E, Llopis Gonzalez J (2009) Tabla de composición de alimentos españoles, 5ª edn. Editorial Universidad de Granada, Granada
Schroder H, Fito M, Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Lamuela-Raventos R, Ros E, Salaverria I, Fiol M, Lapetra J, Vinyoles E, Gomez-Gracia E, Lahoz C, Serra-Majem L, Pinto 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
Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, Covas MI, Schroder H, Aros F, Gomez-Gracia E, Fiol M, Ruiz-Gutierrez V, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Munoz MA, Warnberg J, Ros E, Estruch R, Investigators PS (2012) A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 7(8):e43134. https://doi.org/10.1371/journal.pone.0043134
Elosua R, Marrugat J, Molina L, Pons S, Pujol E (1994) Validation of the Minnesota leisure time physical activity questionnaire in Spanish men. The MARATHOM Investigators. Am J Epidemiol 139(12):1197–1209. https://doi.org/10.1093/oxfordjournals.aje.a116966
Elosua R, Garcia M, Aguilar A, Molina L, Covas MI, Marrugat J (2000) Validation of the Minnesota Leisure Time Physical Activity Questionnaire In Spanish Women. Investigators of the MARATDON Group. Med Sci Sports Exerc 32(8):1431–1437
Willett W (1998) Nutritional epidemiology, 2nd edn. Oxford University Press, New York
Rosato V, Temple NJ, La Vecchia C, Castellan G, Tavani A, Guercio V (2017) Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr. https://doi.org/10.1007/s00394-017-1582-0
Lara J, Hobbs N, Moynihan PJ, Meyer TD, Adamson AJ, Errington L, Rochester L, Sniehotta FF, White M, Mathers JC (2014) Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Med 12:60. https://doi.org/10.1186/1741-7015-12-60
Zazpe I, Estruch R, Toledo E, Sanchez-Tainta A, Corella D, Bullo M, Fiol M, Iglesias P, Gomez-Gracia E, Aros F, Ros E, Schroder H, Serra-Majem L, Pinto X, Lamuela-Raventos R, Ruiz-Gutierrez V, Martinez-Gonzalez MA (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
Satija A, Yu E, Willett WC, Hu FB (2015) Understanding nutritional epidemiology and its role in policy. Adv Nutr 6(1):5–18. https://doi.org/10.3945/an.114.007492
Acknowledgements
We would like to thank the team at the EASP (Escuela Andaluza de Salud Publica), Granada, Spain, who performed the randomization process for this study, and also the volunteers who participated in the study.
Funding
The CORDIOPREV study is supported by the Fundacion Patrimonio Comunal Olivarero. We also received additional funding from Centro Tecnologico del Olivar y del Aceite (CITOLIVA), Centro de Excelencia en Investigacion sobre Aceite de Oliva y Salud (CEAS), Junta de Andalucia (Consejeria de Salud, Consejeria de Agricultura y Pesca, Consejeria de Innovacion, Ciencia y Empresa), Diputaciones de Jaen y Cordoba and Ministerio de Medio Ambiente, Medio Rural y Marino, Spanish Government. It was also partly supported by research grants from the Ministerio de Ciencia e Innovacion (FIS PI13/00185 to PP-M, FIS PI13/00023 to J D-L); Ministerio de Economia, Industria y Competitividad (AGL2012/39615 to J Lopez-Miranda and AGL2015-67896-P to J Lopez-Miranda); Instituto de Salud Carlos III (PIE14/00005, PIE14/00031); Proyecto de Excelencia, Consejería de Economía, Innovación, Ciencia y Empleo (CVI-7450 to J Lopez-Miranda); and by a Research Grant from the European Community (NUTRITECH European Integrated Project-289511) and Fondo Europeo de Desarrollo Regional (FEDER). Ana Leon-Acuña is supported by an Instituto de Salud Carlos III research contract (Programa Rio-Hortega). Antonio Camargo is supported by an Instituto de Salud Carlos III research contract (Programa Miguel-Servet CP14/00114). This material is partially based on work supported by the U.S. Department of Agriculture-Agricultural Research Service (ARS), under Agreement No. 58-1950-4-003. The Centro de Investigacion Biomedica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) is an initiative of the Instituto de Salud Carlos III, Madrid, Spain. The sponsors had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Author information
Authors and Affiliations
Contributions
J Lopez-Miranda, PP-M, and JD-L conceived and designed the research. JFA-D, J Lopez-Moreno, AL-A, JDT-P, APAL, AG-R, PP-M, J Lopez-Miranda, and JD-L participated in the recruitment and carried out the clinical control of the volunteers. GMQ-N, IP-C, and A Corina carried out the nutritional control of the volunteers and GMQ-N drafted the nutritional approach for this paper. OAR-Z, A Camargo, EMY-S, and FR-C performed the lab tests. GMQ-N, JFA-D, and JD-L analyzed and interpreted the data. GMQ-N drafted the manuscript. RML, JMO, PP-M, J Lopez-Miranda, and JD-L provided critical revision of the paper for important intellectual content and edited the content of the draft. PP-M, J Lopez-Miranda, and JD-L had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All the authors revised the manuscript, and read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has any conflict of interest that could affect the performance of the work or the interpretation of the data.
Ethical approval
The study protocol was approved by the Human Investigation Review Committee of the Reina Sofia University Hospital, according to institutional and Good Clinical Practice guidelines.
Informed consent
All participants provided written informed consent.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Quintana-Navarro, G.M., Alcala-Diaz, J.F., Lopez-Moreno, J. et al. Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial. Eur J Nutr 59, 2099–2110 (2020). https://doi.org/10.1007/s00394-019-02059-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00394-019-02059-5