Fernández Lázaro, César I.Fitó Colomer, MontserratCastañer, OlgaGoday Arno, AlbertoSchröder, Helmut, 1958-Martínez-González, Miguel Ángel, 1957-PREDIMED-Plus investigators2022-07-262022-07-262022Fernández-Lázaro CI, Toledo E, Buil-Cosiales P, Salas-Salvadó J, Corella D, Fitó M, et al. Factors associated with successful dietary changes in an energy-reduced mediterranean diet intervention: a longitudinal analysis in the PREDIMED-Plus trial. Eur J Nutr. 2022 Apr; 61(3):1457-75. DOI: 10.1007/s00394-021-02697-81436-6207http://hdl.handle.net/10230/53809Purpose: long-term nutrition trials may fail to respond to their original hypotheses if participants do not comply with the intended dietary intervention. We aimed to identify baseline factors associated with successful dietary changes towards an energy-reduced Mediterranean diet (MedDiet) in the PREDIMED-Plus randomized trial. Methods: longitudinal analysis of 2985 participants (Spanish overweight/obese older adults with metabolic syndrome) randomized to the active intervention arm of the PREDIMED-Plus trial. Dietary changes were assessed with a 17-item energy-reduced MedDiet questionnaire after 6 and 12 months of follow-up. Successful compliance was defined as dietary changes from baseline of ≥ 5 points for participants with baseline scores < 13 points or any increase if baseline score was ≥ 13 points. We conducted crude and adjusted multivariable logistic regression models to identify baseline factors related to compliance. Results: consistent factors independently associated with successful dietary change at both 6 and 12 months were high baseline perceived self-efficacy in modifying diet (OR6-month: 1.51, 95% CI 1.25-1.83; OR12-month: 1.66, 95% CI 1.37-2.01), higher baseline fiber intake (OR6-month: 1.62, 95% CI 1.07-2.46; OR12-month: 1.62, 95% CI 1.07-2.45), having > 3 chronic conditions (OR6-month: 0.65, 95% CI 0.53-0.79; OR12-month: 0.76, 95% CI 0.62-0.93), and suffering depression (OR6-month: 0.80, 95% CI 0.64-0.99; OR12-month: 0.71, 95% CI 0.57-0.88). Conclusion: our results suggested that recruitment of individuals with high perceived self-efficacy to dietary change, and those who initially follow diets relatively richer in fiber may lead to greater changes in nutritional recommendations. Participants with multiple chronic conditions, specifically depression, should receive specific tailored interventions.application/pdfengCopyright © Fernández-Lázaro CI, Toledo E, Buil-Cosiales P, Salas-Salvadó J, Corella D, Fitó M, 2021. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1007/s00394-021-02697-8Dietary adherenceDietary changeFactorsMediterranean dietPREDIMED-PlusRandomized controlled trialsinfo:eu-repo/semantics/openAccess