Skip to main content

Advertisement

Log in

Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Background

The prevalence of overweight/obesity and related manifestations such as metabolic syndrome (MetS) is increasing worldwide. High energy density diets, usually with low nutrient density, are among the main causes. Some high-quality dietary patterns like the Mediterranean diet (MedDiet) have been linked to the prevention and better control of MetS. However, it is needed to show that nutritional interventions promoting the MedDiet are able to improve nutrient intake.

Objective

To assess the effect of improving MedDiet adherence on nutrient density after 1 year of follow-up at the PREDIMED-Plus trial.

Methods

We assessed 5777 men (55–75 years) and women (60–75 years) with overweight or obesity and MetS at baseline from the PREDIMED-Plus trial. Dietary changes and MedDiet adherence were evaluated at baseline and after 1 year. The primary outcome was the change in nutrient density (measured as nutrient intake per 1000 kcal). Multivariable-adjusted linear regression models were fitted to analyse longitudinal changes in adherence to the MedDiet and concurrent changes in nutrient density.

Results

During 1-year follow-up, participants showed improvements in nutrient density for all micronutrients assessed. The density of carbohydrates (− 9.0%), saturated fatty acids (− 10.4%) and total energy intake (− 6.3%) decreased. These changes were more pronounced in the subset of participants with higher improvements in MedDiet adherence.

Conclusions

The PREDIMED-Plus dietary intervention, based on MedDiet recommendations for older adults, maybe a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ANOVA:

Analysis of variance

BMI:

Body Mass Index

CI:

Confidence intervals

CVD:

Cardiovascular disease

FFQ:

Food Frequency Questionnaire

MedDiet:

Mediterranean diet

MetS:

Metabolic syndrome

MUFAs:

Monounsaturated fatty acids

PUFAs:

Polyunsaturated fatty acids

SFAs:

Saturated fatty acids

SD:

Standard deviations

WC:

Waist circumference

References

  1. Peralta M, Ramos M, Lipert A, Martins J, Marques A (2018) Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand J Public Health 46(5):522–529. https://doi.org/10.1177/1403494818764810

    Article  PubMed  Google Scholar 

  2. Basterra-Gortari FJ, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Martinez-Gonzalez MÁ (2017) Prevalence of obesity and diabetes in Spanish adults 1987–2012. Med Clin 148(6):250–256. https://doi.org/10.1016/j.medcli.2016.11.022

    Article  Google Scholar 

  3. Malik VS, Willett WC, Hu FB (2013) Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol 9(1):13–27. https://doi.org/10.1038/nrendo.2012.199

    Article  PubMed  Google Scholar 

  4. Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. PharmacoEconomics 33(7):673–689. https://doi.org/10.1007/s40273-014-0243-x

    Article  PubMed  PubMed Central  Google Scholar 

  5. Darmon P, Kaiser MJ, Bauer JM, Sieber CC, Pichard C (2010) Restrictive diets in the elderly: never say never again? Clin Nutr 29(2):170–174. https://doi.org/10.1016/j.clnu.2009.11.002

    Article  PubMed  Google Scholar 

  6. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R (2004) Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 134(12):3355–3361

    Article  PubMed  Google Scholar 

  7. Salas-Salvadó J, Díaz-López A, Ruiz-Canela M, Basora J, Fitó M, Corella D, Serra-Majem L, Wärnberg J, Romaguera D, Estruch R, Vidal J, Alfredo M, Borau F, Vázquez C, Ros E, Vioque J, López-Miranda J, Bueno-Cavanillas A, Tur JA, Martínez-González M (2018) Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-plus trial. Diabetes Care. https://doi.org/10.2337/dc18-0836

    Article  PubMed  PubMed Central  Google Scholar 

  8. Martínez-González MA, Salas-Salvadó J, Estruch R, Corella D, Fitó M, Ros E (2015) Benefits of the Mediterranean diet: insights From the PREDIMED study. Prog Cardiovasc Dis 58(1):50–60. https://doi.org/10.1016/j.pcad.2015.04.003

    Article  PubMed  Google Scholar 

  9. Babio N, Toledo E, Estruch R, Ros E, Martínez-González MA, Castañer O, Bulló M, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Salas-Salvadó J (2014) Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ 186(17):E649–E657. https://doi.org/10.1503/cmaj.140764

    Article  PubMed  PubMed Central  Google Scholar 

  10. Serra-Majem L, Bes-Rastrollo M, Román-Viñas B, Pfrimer K, Sánchez-Villegas A, Martínez-González MA (2009) Dietary patterns and nutritional adequacy in a Mediterranean country. Br J Nutr 101(S2):S21–S28. https://doi.org/10.1017/S0007114509990559

    Article  CAS  PubMed  Google Scholar 

  11. Peng W, Berry EM, Goldsmith R (2019) Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents. J Hum Nutr Diet 32(1):41–52. https://doi.org/10.1111/jhn.12602

    Article  CAS  PubMed  Google Scholar 

  12. Cano-Ibáñez N, Gea A, Ruiz-Canela M, Corella D, Salas-Salvadó J, Schröeder H, Navarrete-Muñoz EM, Romaguera D, Martínez JA, Barón-López FJ, López-Miranda J, Estruch R, Riquelme-Gallego B, Alonso-Gómez Á, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Gaforio JJ, Matía P, Ros E, Fernández-Carrión R, Díaz-López A, Zomeño MD, Candela I, Konieczna J, Abete I, Buil-Cosiales P, Basora J, Fitó M, Martínez-González MA, Bueno-Cavanillas A (2019) Diet quality and nutrient density in subjects with metabolic syndrome: influence of socioeconomic status and lifestyle factors A cross-sectional assessment in the PREDIMED-Plus study. Clin Nutr. https://doi.org/10.1016/j.clnu.2019.04.032

    Article  PubMed  Google Scholar 

  13. Sanchez-Tainta A, Zazpe I, Bes-Rastrollo M, Salas-Salvado J, Bullo M, Vicente Sorli J, Corella D, Isabel Covas M, Aros F, Gutierrez-Bedmar M, Fiol M, Garcia de la Corte F, Serra-Majem L, Pinto X, Schroeeder H, Ros E, Carmen Lopez-Sabater M, Estruch R, Angel Martinez-Gonzalez M, Investigators PS (2016) Nutritional adequacy according to carbohydrates and fat quality. Eur J Nutr 55(1):93–106. https://doi.org/10.1007/s00394-014-0828-3

    Article  CAS  PubMed  Google Scholar 

  14. Martínez-González MA, Buil-Cosiales P, Corella D, Bulló M, Fitó M, Vioque J, Romaguera D, Martínez JA, Wärnberg J, López-Miranda J, Estruch R, Bueno-Cavanillas A, Arós F, Tur JA, Tinahones F, Serra-Majem L, Martín V, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Delgado-Rodríguez M, Matía P, Ros E, Fernández-Aranda F, Botella C, Portillo-Baquedano MP, Lamuela-Raventós RM, Marcos A, Sáez G, Gómez-Gracia E, Ruiz-Canela M, Toledo E, Alvarez-Alvarez I, Díez-Espino J, Sorlí JV, Basora J, Castañer O, Schröder H, Navarrete-Muñoz EM, Zulet MA, García-Rios A, Salas-Salvadó J, Investigators PR-P (2018) Cohort profile: design and methods of the PREDIMED-Plus randomized trial. Int J Epidemiol. https://doi.org/10.1093/ije/dyy225

    Article  PubMed  PubMed Central  Google Scholar 

  15. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WPT, Loria CM, Smith SC (2009) Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, lung, and blood institute; American heart association; World heart federation; International atherosclerosis society; And international association for the study of obesity. Circulation 120(16):1640–1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644

    Article  CAS  PubMed  Google Scholar 

  16. Willet W (2013) Nutritional epidemiology, 3rd edn. Oxford University Press, New York

    Google Scholar 

  17. Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó 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

    Article  CAS  PubMed  Google Scholar 

  18. 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. https://doi.org/10.1093/ije/22.3.512

    Article  CAS  PubMed  Google Scholar 

  19. Moreiras OCA, Cabrera L, Cuadrado C (2003) Tablas de Composición de alimentos. (Spanish food composition tables), vol 7. Pirámide, Madrid

    Google Scholar 

  20. Mataix Verdu J (2003) Tabla de composición de alimentos españoles. (Spanish food composition tables), Universidad de Granada, Granada

  21. Nicklas TA, Drewnowski A, O’Neil CE (2013) The nutrient density approach to healthy eating: challenges and opportunities. Public Health Nutrition 17(12):2626–2636. https://doi.org/10.1017/S136898001400158X

    Article  Google Scholar 

  22. Schröder H, Vila J, Marrugat J, Covas MI (2008) Low energy density diets are associated with favorable nutrient intake profile and adequacy in free-living elderly men and women. J Nutr 138(8):1476–1481

    Article  PubMed  Google Scholar 

  23. Sánchez-Villegas A, Martínez JA, De Irala J, Martínez-González MA (2002) Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern. Eur J Nutr 41(6):249–257. https://doi.org/10.1007/s00394-002-0382-2

    Article  PubMed  Google Scholar 

  24. Vitale M, Racca E, Izzo A, Giacco A, Parente E, Riccardi G, Giacco R (2019) Adherence to the traditional Mediterranean diet in a population of South of Italy: factors involved and proposal of an educational field-based survey tool. Int J Food Sci Nutr 70(2):195–201. https://doi.org/10.1080/09637486.2018.1481202

    Article  PubMed  Google Scholar 

  25. Agnoli C, Sieri S, Ricceri F, Giraudo MT, Masala G, Assedi M, Panico S, Mattiello A, Tumino R, Giurdanella MC, Krogh V (2018) Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes. https://doi.org/10.1038/s41387-018-0023-3

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zazpe I, Estruch R, Toledo E, Sánchez-Taínta A, Corella D, Bulló M, Fiol M, Iglesias P, Gómez-Gracia E, Arós F, Ros E, Schröder H, Serra-Majem L, Pintó X, Lamuela-Raventós R, Ruiz-Gutiérrez V, Martínez-González MÁ (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

    Article  CAS  PubMed  Google Scholar 

  27. Drewnowski A (2018) Nutrient density: addressing the challenge of obesity. Br J Nutr 120(s1):S8–S14. https://doi.org/10.1017/S0007114517002240

    Article  CAS  PubMed  Google Scholar 

  28. Roman Viñas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, De Groot LCPGM, Van’T Veer P, Matthys C, Serra Majem L (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59(2–4):84–95. https://doi.org/10.1159/000332762

    Article  CAS  PubMed  Google Scholar 

  29. Ter Borg S, Verlaan S, Mijnarends DM, Schols JMGA, De Groot LCPGM, Luiking YC (2015) Macronutrient intake and inadequacies of community-dwelling older adults, a systematic review. Ann Nutr Metab 66(4):242–255. https://doi.org/10.1159/000435862

    Article  CAS  PubMed  Google Scholar 

  30. Guasch-Ferré M, Salas-Salvadó J, Ros E, Estruch R, Corella D, Fitó M, Martínez-González MA, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Lamuela-Raventos RM, Tur J, Martinez JA, Serra-Majem L, Pintó X (2017) The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence? Nutr Metab Cardiovasc Dis 27(7):624–632. https://doi.org/10.1016/j.numecd.2017.05.004

    Article  PubMed  Google Scholar 

  31. Salas-Salvadó J, Guasch-Ferré M, Lee CH, Estruch R, Clish CB, Ros E (2016) Protective effects of the mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr 146(4):920S–927S. https://doi.org/10.3945/jn.115.218487

    Article  CAS  PubMed Central  Google Scholar 

  32. Castro-Quezada I, Román-Viñas B, Serra-Majem L (2014) The Mediterranean diet and nutritional adequacy: a review. Nutrients 6(1):231–248. https://doi.org/10.3390/nu6010231

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gose M, Krems C, Heuer T, Hoffmann I (2016) Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT). Br J Nutr 115(8):1498–1507. https://doi.org/10.1017/S0007114516000544

    Article  CAS  PubMed  Google Scholar 

  34. Casagrande SS, Cowie CC (2017) Trends in dietary intake among adults with type 2 diabetes: NHANES 1988–2012. J Hum Nutr Diet 30(4):479–489. https://doi.org/10.1111/jhn.12443

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. De La Fuente-Arrillaga C, Zazpe I, Santiago S, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Martinez-Gonzalez MA (2016) Beneficial changes in food consumption and nutrient intake after 10 years of follow-up in a Mediterranean cohort: the SUN project. BMC Public Health. https://doi.org/10.1186/s12889-016-2739-0

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schröder H, Salas-Salvado J, Corella D, Fiol M, Gomez-Gracia E, Aros F, Ros E, Ruíz-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

    Article  CAS  PubMed  Google Scholar 

  37. Nijjar SK, D’Amico MI, Wimalaweera NA, Cooper NAM, Zamora J, Khan KS (2017) Participation in clinical trials improves outcomes in women’s health: a systematic review and meta-analysis. BJOG 124(6):863–871. https://doi.org/10.1111/1471-0528.14528

    Article  CAS  PubMed  Google Scholar 

  38. Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E, Perez-Bauer M, Martínez-González MA, Salas-Salvadó J, Martn-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

    Article  CAS  PubMed  Google Scholar 

  39. Ortiz-Andrellucchi A, Sánchez-Villegas A, Doreste-Alonso J, de Vries J, de Groot L, Serra-Majem L (2009) Dietary assessment methods for micronutrient intake in elderly people: a systematic review. Br J Nutr 102(Suppl 1):S118–S149. https://doi.org/10.1017/S0007114509993175

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The principal author (N.C-I), wish to express her gratitude to the Ministry of Education of Spain for the grant received (FPU14/3630). L.B. has also received a grant from the Ministry of Education of Spain (FPU16/00165). The authors especially thank the PREDIMED-Plus participants for their collaboration and the PREDIMED-Plus staff for their support and effort. CIBEROBN is an initiative of ISCIII, Spain.

Funding

Ministry of Education of Spain (FPU14/3630) Grant Naomi Cano-Ibáñez. Ministry of Education of Spain (FPU16/00165) grant Laura Barrubés. The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research Grant 2013-2018; 340918) grant to Miguel Ángel Martínez-González, and by the official funding agency for biomedical research of the Spanish Government, ISCIII through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal), including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, The Especial Action Project entitled: “Implementación y Evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus” grant to Jordi Salas-Salvadó, the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, and CIBEROBN and FEDER funds (CB06/03), ISCIII. International Nut&Dried Fruit Council- FESNAD Nº201302: Miguel Ángel Martínez-González (PI). None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication. The corresponding author had full access to all the data in the study and had final responsibility to submit for publication.

Author information

Authors and Affiliations

Authors

Contributions

NCI, ABC, MAMG, JSS, DC, MF, DR, JV, AMAG, JW, JAM, LSM, RE, FJT, JL, XP, JAT, AGR, MDR, PMM, LD, VMS, JV, CV, ER, and AG collected all the data from the PREDIMED-Plus trial. NCI, ABC and AG, designed the study; performed the analysis; and wrote the first draft of the manuscript. All authors contributed to the editing of the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Naomi Cano-Ibáñez.

Ethics declarations

Conflict of interest

Jordi Salas-Salvadó reports serving on the board of and receiving grant support through his institution from International Nut and Dried Fruit Council; receiving consulting personal fees from Danone, Font Vella Lanjarón, Nuts for Life and Eroski; and receiving grant support through his institution from Nut and Dried Fruit Foundation and Eroski. Emilio Ros reports grants, non-financial support and other fees from California Walnut Commission and Alexion; personal fees from California Walnut Commission and Alexion; personal fees, non-financial support and other fees from Aegerion and Ferrer International; grants and personal fees from Sanofi Aventis; grants from Amgen and Pfizer and personal fees from Akcea and Amarin, outside of the submitted work. Xavier Pintó reports serving on the board and receiving consulting personal fees from Sanofi Aventis, Amgen and Abbott laboratories; receiving lecture personal fees from Esteve, Lacer and Rubio laboratories. Miguel Delgado-Rodríguez reports receiving grants from the Diputación Provincial de Jaén and the Caja Rural de Jaén. Lidia Daimiel reports grants from Fundación Cerveza y Salud. All other authors declare no competing interests.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cano-Ibáñez, N., Bueno-Cavanillas, A., Martínez-González, M.Á. et al. Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study. Eur J Nutr 59, 2395–2409 (2020). https://doi.org/10.1007/s00394-019-02087-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-019-02087-1

Keywords

Navigation