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Peng Y, Zhong Z, Huang C, Wang W. The effects of popular diets on bone health in the past decade: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1287140. [PMID: 38665424 PMCID: PMC11044027 DOI: 10.3389/fendo.2023.1287140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/14/2023] [Indexed: 04/28/2024] Open
Abstract
Bone health encompasses not only bone mineral density but also bone architecture and mechanical properties that can impact bone strength. While specific dietary interventions have been proposed to treat various diseases such as obesity and diabetes, their effects on bone health remain unclear. The aim of this review is to examine literature published in the past decade, summarize the effects of currently popular diets on bone health, elucidate underlying mechanisms, and provide solutions to neutralize the side effects. The diets discussed in this review include a ketogenic diet (KD), a Mediterranean diet (MD), caloric restriction (CR), a high-protein diet (HP), and intermittent fasting (IF). Although detrimental effects on bone health have been noticed in the KD and CR diets, it is still controversial, while the MD and HP diets have shown protective effects, and the effects of IF diets are still uncertain. The mechanism of these effects and the attenuation methods have gained attention and have been discussed in recent years: the KD diet interrupts energy balance and calcium metabolism, which reduces bone quality. Ginsenoside-Rb2, metformin, and simvastatin have been shown to attenuate bone loss during KD. The CR diet influences energy imbalance, glucocorticoid levels, and adipose tissue, causing bone loss. Adequate vitamin D and calcium supplementation and exercise training can attenuate these effects. The olive oil in the MD may be an effective component that protects bone health. HP diets also have components that protect bone health, but their mechanism requires further investigation. In IF, animal studies have shown detrimental effects on bone health, while human studies have not. Therefore, the effects of diets on bone health vary accordingly.
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Affiliation(s)
- Yue Peng
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zikang Zhong
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
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Andreo-López MC, Zarco-Martín MT, Contreras-Bolívar V, Fernández-Soto ML. Prevalence of Sarcopenia and Dynapenia and Related Clinical Outcomes in Patients with Type 1 Diabetes Mellitus. Nutrients 2023; 15:4914. [PMID: 38068772 PMCID: PMC10708144 DOI: 10.3390/nu15234914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sarcopenia has recently been recognized as a complication of diabetes. However, there are few results about the prevalence of sarcopenia and dynapenia and the related clinical outcomes in type 1 diabetes mellitus (T1DM). Our objectives were to evaluate the prevalence of sarcopenia and dynapenia and to determine whether there are any associations with disease-related factors in people with T1DM. METHODS A cross-sectional study was conducted in people with T1DM. We assessed appendicular skeletal mass index (ASMI) using bioimpedance 50 Hz (Nutrilab Akern). Muscle function was assessed through handgrip strength (HGS) using a Jamar dynamometer. Sarcopenia was defined as a low HGS with low ASMI, whereas dynapenia was defined as low HGS with a normal ASMI. We used HGS data from the Spanish population percentile table and a cut-off point at p5 as dynapenia. The association of clinical, metabolic, and lifestyle variables with sarcopenia and dynapenia was studied. RESULTS This study included 62 T1DM patients (66% females, mean age of 38 ± 14 years, body mass index (BMI) of 24.9 ± 4.7 kg/m2). The prevalence of sarcopenia and dynapenia was 8% and 23%, respectively. In our sample, there were more men in the sarcopenic and dynapenic groups. The sarcopenic group showed a significantly higher mean HbA1c value. Lower diabetes duration, PREDIMED score, BMI, and muscle mass measures (fat-free mass index (FFMI), ASMI, and body cell mass index (BCMI)) were significantly associated with sarcopenia. Decreased diabetes duration, PREDIMED score, phase angle (PhA), and HGS values showed a significant association with dynapenia. CONCLUSIONS The prevalence of sarcopenia and dynapenia was high in people with T1DM in our study. Specifically, the proportion of dynapenia was quite high. HGS and ASMI are practical tools for the assessment of muscle health status in T1DM, and low values are associated with poor glycemic control, underweight, and low adherence to the Mediterranean diet. Thus, dynapenia may predict accelerated muscle aging in T1DM.
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Affiliation(s)
- María Carmen Andreo-López
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain; (M.C.A.-L.); (V.C.-B.); (M.L.F.-S.)
| | - María Teresa Zarco-Martín
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain; (M.C.A.-L.); (V.C.-B.); (M.L.F.-S.)
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18012 Granada, Spain
| | - Victoria Contreras-Bolívar
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain; (M.C.A.-L.); (V.C.-B.); (M.L.F.-S.)
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18012 Granada, Spain
- CIBER on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 18012 Granada, Spain
| | - María Luisa Fernández-Soto
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain; (M.C.A.-L.); (V.C.-B.); (M.L.F.-S.)
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18012 Granada, Spain
- Department of Medicine, University of Granada, 18016 Granada, Spain
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Andreo-López MC, Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. The Influence of the Mediterranean Dietary Pattern on Osteoporosis and Sarcopenia. Nutrients 2023; 15:3224. [PMID: 37513646 PMCID: PMC10385532 DOI: 10.3390/nu15143224] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Diet is a modifiable factor in bone and muscle health. The Mediterranean diet (MedDiet) is rich in nutrients and contains key bioactive components with probable protective effects on muscle and bone deterioration. Osteoporosis (OP) and sarcopenia are diseases that increase frailty and susceptibility to fracture, morbidity and mortality. Therefore, it is necessary to combat them in the population. In this regard, MedDiet adherence has proven to be beneficial to bone mineral density (BMD), muscle mass, physical function, OP and sarcopenia. Hence, this diet is proposed as a therapeutic tool that could slow the onset of osteoporosis and sarcopenia. However, there is doubt about the interaction between the MedDiet, strength and fracture risk. Perhaps the amount of EVOO (extra virgin olive oil), fruits, vegetables and fish rich in anti-inflammatory and antioxidant nutrients ingested has an influence, though the results remain controversial.
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Affiliation(s)
| | - Victoria Contreras-Bolívar
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18014 Granada, Spain
- CIBER on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 18012 Granada, Spain
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18014 Granada, Spain
- CIBER on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 18012 Granada, Spain
- Department of Cell Biology, University of Granada, 18016 Granada, Spain
| | - Cristina García-Fontana
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18014 Granada, Spain
- CIBER on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 18012 Granada, Spain
| | - Manuel Muñoz-Torres
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18014 Granada, Spain
- CIBER on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 18012 Granada, Spain
- Department of Medicine, University of Granada, 18016 Granada, Spain
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Guiné RPF, Florença SG, Aparício MG, Cardoso AP, Ferreira M. Food Knowledge for Better Nutrition and Health: A Study among University Students in Portugal. Healthcare (Basel) 2023; 11:healthcare11111597. [PMID: 37297738 DOI: 10.3390/healthcare11111597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
When students enter university, they suffer adaptations, including, usually, greater autonomy and responsibility for the choices they make. Therefore, it is crucial that they are well informed so as to make healthier food choices. The aim of this study was to determine whether sociodemographic characteristics, academic performance and lifestyle (tobacco and alcohol consumption) interfere with food literacy in university students. A quantitative, analytical, descriptive, transversal and correlational study was carried out, using quantitative data obtained through a questionnaire survey applied to a sample of 924 university students in Portugal. Food literacy was assessed through a scale of 27 items, distributed in three dimensions: D1-Literacy about food nutritional value and composition, D2-Literacy about labelling and food choice and D3-Literacy about healthy eating practices. Results showed no differences in food literacy according to sex or age. However, food literacy varied significantly with nationality, either globally (p = 0.006) or in the different dimensions evaluated (p-values of 0.005, 0.027 and 0.012 for D1, D2 and D3, respectively). In terms of academic achievement, the results showed no significant differences according to self-reported academic performance or even to the average classification obtained in the course. Regarding lifestyle variables, it was observed that alcohol consumption or smoking are not associated with food literacy, that is, food literacy does not vary significantly with these two lifestyle variables. In conclusion, food literacy in general and the dimensions evaluated are essentially constant among university students in Portugal, only varying for students from abroad. These results help to better perceive the food literacy levels for the population under study, university students, and that can be a valuable tool to better increase food literacy at these institutions as a way to better prepare for a healthier life and proper food habits that can enhance health in the long term.
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Affiliation(s)
- Raquel P F Guiné
- CERNAS Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Sofia G Florença
- CERNAS Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Maria Graça Aparício
- UICISA:E Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Ana Paula Cardoso
- CIDEI Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Manuela Ferreira
- UICISA:E Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
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Mediterranean Diet and Sarcopenia Features in Apparently Healthy Adults over 65 Years: A Systematic Review. Nutrients 2023; 15:nu15051104. [PMID: 36904104 PMCID: PMC10005300 DOI: 10.3390/nu15051104] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Low muscle mass combined with changes in physical function and muscle quality is defined as sarcopenia. In people > 60 years, sarcopenia reaches 10% and tends to increase with age. Individual nutrients, such as protein, may have a protective role against sarcopenia, but recent evidence suggests that protein alone has been ineffective in increasing muscle strength. Dietary patterns, instead, with a high "anti-inflammatory" potential, such as the Mediterranean dietary pattern, have been considered as an emerging dietary remedy against sarcopenia. The aim of this systematic review was to summarize the evidence of the role of Mediterranean diet in sarcopenia prevention and/or improvement, including recent data, in healthy elders. We searched published studies about sarcopenia and the Mediterranean diet until December 2022 in Pubmed, Cochrane, Scopus search engine and grey literature. In total, ten articles were identified as relevant: four cross-sectional studies and six prospective. No clinical trial was identified. Only three studies assessed sarcopenia presence and four measured muscle mass, which is an essential criterion in sarcopenia diagnosis. Mediterranean diet adherence had, in general, a positive role in muscle mass and muscle function, while the results were less clear with regard to muscle strength. Additionally, there was no evidence of a positive effect of the Mediterranean diet on sarcopenia. There is a need for conduction of clinical trials in order to reach cause-effects conclusions regarding the importance of the Mediterranean diet in sarcopenia prevention and management in Mediterranean and non-Mediterranean populations.
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Food Literacy Scale: Validation through Exploratory and Confirmatory Factor Analysis in a Sample of Portuguese University Students. Nutrients 2022; 15:nu15010166. [PMID: 36615823 PMCID: PMC9823542 DOI: 10.3390/nu15010166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Eating behaviors and healthy food choices are associated with food literacy, and they have a huge impact on one's health status. For that reason, to increase food literacy is a way to effectively help individuals make appropriate choices that help maintain health and diminish the incidence of non-communicable diseases. The objective of this work was to test and validate a scale to assess food literacy. The validation was conducted on a sample of 924 Portuguese university students. The scale was composed of 50 items, which were submitted to exploratory and confirmatory factors analysis. The final validated scale corresponded to a second-order model with a global factor called "Food literacy", which retained 26 items distributed by three factors: F1-literacy about the nutritional composition of foods (10 items), F2-literacy about labelling and food choices (7 items), and F3-literacy about healthy eating practices (9 items). The internal consistency of the scale is very high, with an alpha higher than 0.9, and the Pierson correlations between the three factors and the global are also higher than 0.9. In conclusion, the present scale has been validated and can therefore be utilized to measure food literacy.
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Park JW, Kakuta S, Sakai R, Hamasaki T, Ansai T. Effects of Both Japanese-Style Dietary Patterns and Nutrition on Falling Incidents among Community-Dwelling Elderly Individuals: A Cross-Sectional Study. Nutrients 2022; 14:nu14214663. [PMID: 36364924 PMCID: PMC9656056 DOI: 10.3390/nu14214663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in the elderly is largely unknown. We investigated falling incidents and nutritional status, including a Japanese-style diet in a community-dwelling cohort. Using a cross-sectional design, 186 subjects (median age 83.0 years, males/females 67/119) were analyzed. Oral and systemic health conditions were assessed. A brief-type self-administered diet history questionnaire (BDHQ) was given for nutritional status. Analysis of covariance (adjusted for gender, age, BMI, articular disease/osteoporosis history, present tooth number, educational level) and the Japanese-Mediterranean diet (jMD) score adapted for Japan were used. The jMD score and falling incidents were significantly associated, with point increases related to a significantly decreased falling risk of 28% (OR: 0.72; 95%CI: 0.57−0.91). Of the 13 jMD food components, fish, eggs, and potatoes had a significant relationship with reduced falling, while significant associations of intake of animal protein, potassium, magnesium, zinc, and cholesterol (p < 0.05) were also observed. The results suggest that the jMD dietary pattern is an important factor for the prevention of falling incidents in elderly individuals.
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Affiliation(s)
- Ji-Woo Park
- Division of Community Oral Health Development, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
| | - Satoko Kakuta
- Division of Community Oral Health Development, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
- Correspondence: (S.K.); (T.A.); Tel.: +81-93-285-3089 (T.A.); Fax: +81-93-591-7736 (T.A.)
| | - Rie Sakai
- Division of Medical Nutrition Faculty of Healthcare, Tokyo Healthcare University, 3-11-3 Setagaya, Setagaya-ku, Tokyo 154-8568, Japan
| | - Tomoko Hamasaki
- Department of Nutrition, Faculty of Home Economics, Kyushu Women’s University, 1-1 Jiyugaoka, Yahatanishi-ku, Kitakyushu 807-8586, Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
- Correspondence: (S.K.); (T.A.); Tel.: +81-93-285-3089 (T.A.); Fax: +81-93-591-7736 (T.A.)
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Bizzozero-Peroni B, Brazo-Sayavera J, Martínez-Vizcaíno V, Fernández-Rodríguez R, López-Gil JF, Díaz-Goñi V, Cavero-Redondo I, Mesas AE. High Adherence to the Mediterranean Diet is Associated with Higher Physical Fitness in Adults: a Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:2195-2206. [PMID: 36166848 PMCID: PMC9776663 DOI: 10.1093/advances/nmac104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 01/29/2023] Open
Abstract
Although prior research has synthesized the relationships between the Mediterranean diet (MD) and components of physical fitness (PF) in adults, they are limited and inconclusive. This study aimed to synthesize the associations between high (compared with low) MD adherence and PF levels with each of its components (cardiorespiratory, motor, and musculoskeletal) in adulthood. We conducted a systematic search in 5 databases from inception to January 2022. Observational studies and randomized controlled trials were included. Pooled odds ratios (ORs) and effect sizes (Cohen d index) with their 95% CIs were calculated via a random effects model. A total of 30 studies were included (19 cross-sectional in young, middle-aged, and older adults; 10 prospective cohort in older adults; and 1 randomized controlled trial in young adults) involving 36,807 individuals (mean age range: 20.9-86.3 y). Pooled effect sizes showed a significant cross-sectional association between higher MD adherence scores (as a continuous variable) and overall PF (d = 0.45; 95% CI: 0.14, 0.75; I2 = 91.0%, n = 6). The pooled ORs from cross-sectional data showed that high adherence to MD was associated with higher cardiorespiratory fitness (OR: 2.26; 95% CI: 2.06, 2.47; I2 = 0%, n = 4), musculoskeletal fitness (OR: 1.26; 95% CI: 1.05, 1.47; I2 = 61.4%, n = 13), and overall PF (OR: 1.44; 95% CI: 1.20, 1.68; I2 = 83.2%, n = 17) than low adherence to MD (reference category: 1). Pooled ORs from prospective cohort studies (3- to 12-y follow-up) showed that high adherence to MD was associated with higher musculoskeletal fitness (OR: 1.20; 95% CI: 1.01, 1.38; I2 = 0%, n = 4) and overall PF (OR: 1.14; 95% CI: 1.02, 1.26; I2 = 9.7%, n = 7) than low adherence to MD (reference category: 1). Conversely, no significant association was observed between MD and motor fitness. High adherence to MD was associated with higher PF levels, a crucial marker of health status throughout adulthood. This trial was registered at PROSPERO as CRD42022308259.
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Affiliation(s)
- Bruno Bizzozero-Peroni
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain,Instituto Superior de Educación Física, Universidad de la República, Rivera, Uruguay,Grupo de Investigación en Análisis del Rendimiento Humano, Universidad de la República, Rivera, Uruguay
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | | | - José F López-Gil
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Valentina Díaz-Goñi
- Grupo de Investigación en Análisis del Rendimiento Humano, Universidad de la República, Rivera, Uruguay,Instituto Superior de Educación Física, Universidad de la República, Maldonado, Uruguay
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Arthur E Mesas
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain,Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
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Long-Term Adherence to a Mediterranean Diet 1-Year after Completion of the MedLey Study. Nutrients 2022; 14:nu14153098. [PMID: 35956274 PMCID: PMC9370195 DOI: 10.3390/nu14153098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
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.
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