Long-Term Adherence to a Mediterranean Diet 1-Year after Completion of the MedLey Study

Abstract

Mediterranean populations enjoy the health benefits of a Mediterranean diet (MedDiet), but is it feasible to implement such a pattern beyond the Mediterranean region? The MedLey trial, a 6-month MedDiet intervention vs habitual diet in older Australians, demonstrated that the participants could maintain high adherence to a MedDiet for 6 months. The MedDiet resulted in improved systolic blood pressure (BP), endothelial dilatation, oxidative stress, and plasma triglycerides in comparison with the habitual diet. We sought to determine if 12 months after finishing the MedLey study, the participants maintained their adherence to the MedDiet principles and whether the reduction in the cardiovascular disease (CVD) risk factors that were seen in the trial were sustained. Participants completed a food frequency questionnaire, and a 15-point MedDiet adherence score (MDAS; greater score = greater adherence) was calculated. Home BP was measured over 6 days, BMI was assessed, and fasting plasma triglycerides were measured. The data were analysed using intention-to-treat linear mixed effects models with a group × time interaction term, comparing data at baseline, 2, 4, and 18 months (12 months post-trial). At 18 months (12 months after finishing the MedLey study), the MedDiet group had a MDAS of 7.9 ± 0.3, compared to 9.6 ± 0.2 at 4 months (p < 0.0001), and 6.7 ± 0.2 (p < 0.0001), at baseline. The MDAS in the HabDiet group remained unchanged over the 18-month period (18 months 6.9 ± 0.3, 4 months 6.9 ± 0.2, baseline 6.7 ± 0.2). In the MedDiet group, the consumption of olive oil, legumes, fish, and vegetables remained higher (p < 0.01, compared with baseline) and discretionary food consumption remained lower (p = 0.02) at 18 months. These data show that some MedDiet principles could be adhered to for 12 months after finishing the MedLey trial. However, improvements in cardiometabolic health markers, including BP and plasma triglycerides, were not sustained. The results indicate that further dietary support for behaviour change may be beneficial to maintaining high adherence and metabolic benefits of the MedDiet.

Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial

“…A slight reduction (-2.4 mmHg (CI -4.3 to -0.5)) in systolic blood pressure figures favorable to the IG has been observed. These results are similar to the findings of other recent studies, such as the MedLey study [ 43 ]. However, and despite including an adjustment for positive changes in physical activity and smoking cessation in the analysis model, we cannot firmly state that this reduction in systolic blood pressure is a consequence of the change in diet.…”

“…However, there are few studies focused on improving the adherence to this dietary pattern. The existing studies include very different populations and types of intervention [ 43 – 46 ]. In this sense, research has been focused on the study of populations at high cardiovascular risk, such as overweight or obese people [ 47 ] or people with type 2 diabetes mellitus [ 6 ], and thus very few interventions include general adult populations.…”

“…However, very few studies have found relevant differences. The MedLey study, whose intervention consisted of a dietitian-led intervention where all participants consulted the study dietitian fortnightly, received resources including recipes and meal plans, and those in the intervention arm collected study foods representing the MD, achieved an increase of 1.3 points in the adherence questionnaire [ 43 ]. While the reseach of Lugones-Sanchez et al [ 45 ] and Gonzalez-Ramirez et al [ 44 ], with interventions based on the use of smartphone applications, achieved very slight increases of 0.37 and 0.40 points, respectively, in the experimental group.…”

Improving Adherence to a Mediterranean Ketogenic Nutrition Program for High-Risk Older Adults: A Pilot Randomized Trial

“…However, as noted in a recent systematic review, studies examining integrated MI and behavior change techniques for lifestyle often lack an extended follow-up period to show improvements in long-term adherence [ 20 ]. Importantly, other nutrition programs have shown that more resource-intensive (e.g., requiring a dietician and individualized meal plans) and extended programs (e.g., 6-months) can produce sustained adherence to a Mediterranean diet [ 21 ]. Thus, to retain scalability, while enhancing long-term adherence, it may be important to extend the number of sessions or incorporate booster sessions beyond the current 6-week MKNA program.…”

Developing a Mediterranean Healthy Food Basket and an Updated Australian Healthy Food Basket Modelled on the Australian Guide to Healthy Eating

“…The Mediterranean Diet has increased in popularity due to its known health benefits, such that it was endorsed by the American Dietary Guidelines (2015–2020) [ 4 ]. Research suggests that Australian populations can adhere long-term to a Mediterranean style eating pattern and improve their health [ 5 , 6 , 7 , 8 ]; however, individuals may need guidance from nutrition professionals to modify the Mediterranean Diet to meet their needs and preferences in an Australian context and adhere long-term (>1 year) [ 7 ].…”