TITLE: Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

Background: Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated. Aim of the study: To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk-factors and baseline dietary habits. Methods: 1048 asymptomatic subjects aged 55-80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants’ characteristics were assessed at baseline among subjects. Dietary change were evaluated after 12 months. Main Outcome measures were: attained changes in 5 dietary goals: increases in 1) fruit consumption; 2) vegetable consumption, 3) monounsaturated fatty acid (MUFA)/ saturated fatty acid (SFA) ratio, and decreases in 4) sweets and pastries consumption, 5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet). Results: Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet. Conclusions/ applications: Some participant characteristics (marital status, and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.