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

Authors: QUINTANA-NAVARRO, GRACIA - UNIVERSITY OF CORDOVA (UCO), SPAIN; ALCALA-DIAZ, JUAN - UNIVERSITY OF CORDOVA (UCO), SPAIN; LOPEZ-MORENO, JAVIER - UNIVERSITY OF CORDOVA (UCO), SPAIN; PEREZ-CORRAL, ISABEL - UNIVERSITY OF CORDOVA (UCO), SPAIN; LEON-ACUNA, ANA - UNIVERSITY OF CORDOVA (UCO), SPAIN; TORRES-PENA, JOSE - UNIVERSITY OF CORDOVA (UCO), SPAIN; RANGEL-ZUNIGA, ORIOL - UNIVERSITY OF CORDOVA (UCO), SPAIN; ARENAS DE LARRIVA, ANTONIO - UNIVERSITY OF CORDOVA (UCO), SPAIN; CORINA, ANDREEA - UNIVERSITY OF CORDOVA (UCO), SPAIN; CAMARGO, ANTONIO - UNIVERSITY OF CORDOVA (UCO), SPAIN; YUBERO-SERRANO, ELENA - UNIVERSITY OF CORDOVA (UCO), SPAIN; RODRIGUEZ-CANTALEJO, FERNANDO - UNIVERSITY HOSPITAL REINA SOFIA; GARCIA-RIOS, ANTONIO - UNIVERSITY OF CORDOVA (UCO), SPAIN; LUQUE, RAUL - UNIVERSITY OF CORDOVA (UCO), SPAIN; ORDOVAS, JOSE - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; PEREZ-MARTINEZ, PABLO - UNIVERSITY OF CORDOVA (UCO), SPAIN; LOPEZ-MIRANDA, JOSE - UNIVERSITY OF CORDOVA (UCO), SPAIN; DELGADO-LISTA, JAVIER - UNIVERSITY OF CORDOVA (UCO), SPAIN

Submitted to: European Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/15/2019
Publication Date: 7/24/2019
Citation: Quintana-Navarro, G.M., Alcala-Diaz, J.F., Lopez-Moreno, J., Perez-Corral, I., Leon-Acuna, A., Torres-Pena, J.D., Rangel-Zuniga, O.A., Arenas De Larriva, A.P., Corina, A., Camargo, A., Yubero-Serrano, E.M., Rodriguez-Cantalejo, F., Garcia-Rios, A., Luque, R.M., Ordovas, J.M., Perez-Martinez, P., Lopez-Miranda, J., Delgado-Lista, J. 2019. 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. European Journal of Nutrition. https://doi.org/10.1007/s00394-019-02059-5.
DOI: https://doi.org/10.1007/s00394-019-02059-5

Interpretive Summary: The most significant factor for long term success of any healthy dietary recommendation comes down to dietary adherence, and previous research has clearly shown a strong correlation between dietary adherence and reaching pre-determined health-related goals including cardiovascular disease prevention. Our objective was to evaluate 5-year changes in nutritional habits, adherence achieved, and maintenance in a cohort of coronary patients from the CORDIOPREV study. In this study, about 1,000 coronary patients were evenly randomized to a Mediterranean diet or a low-fat diet and received individual-group-telephone visits and personalized dietary advice. Several dietary instruments to evaluate adherence were used in the study. Dietary adherence was categorized into Low, Medium, and High Adherence. Between baseline and five years, significant increases were observed in overall dietary adherence and in the percentage of patients considered High Adherence for both intervention arms. When we evaluated the maintenance of adherence, patients considered Low and Medium Adherence at one year increased their adherence at five years with both diets. Conversely, patients regarded as High Adherence maintained their adherence with a Mediterranean diet but decreased their adherence with a low-fat diet. In summary, in a well-controlled dietary intervention, the overall long-term improvement and maintenance of dietary adherence were better for the Mediterranean than for the low-fat diet.

Technical 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.