西班牙网络生物医学研究中心（CIBER）Miguel A. Martínez-González课题组在研究中取得进展。他们提出了营养和行为干预对代谢综合征患者能量减少的地中海饮食依从性的影响。相关论文发表在2019年10月15日出版的《美国医学会杂志》上。

2013年9月至2016年12月，研究组在西班牙的23个研究中心招募了6874名年龄在55-75岁、患有代谢综合征且无心血管疾病的成年人。将参与者随机分组，其中3406名为干预组，接受鼓励能量减少的地中海饮食、促进体力活动并提供行为支持，3468名为对照组，接受鼓励能量不受限制的地中海饮食。所有参与者均可免费获得特级初榨橄榄油和坚果。根据能量减少地中海饮食评分（er-MedDiet）对依从性进行评估，0-17分，评分越高依从性越强。

最终有6583名（96%）参与者完成了12个月的随访。干预组和对照组的基线er-MedDiet评分分别为8.5分和8.6分，12个月后则分别为13.2分和11.1分，组间差异显著。

总之，与遵循能量不受限制的地中海饮食建议相比，鼓励能量减少的地中海饮食和体力活动的干预措施可显著增加12个月后的饮食依从性，但仍需进一步评价参与者的长期心血管效应。

据悉，高质量的饮食模式有助于预防慢性疾病，但关于营养和行为干预对饮食变化影响的数据依然很有限。

附：英文原文

Title: Effect of a Nutritional and Behavioral Intervention on Energy-Reduced Mediterranean Diet Adherence Among Patients With Metabolic Syndrome: Interim Analysis of the PREDIMED-Plus Randomized Clinical Trial

Author: Carmen Sayón-Orea, Cristina Razquin, Mónica Bulló, Dolores Corella, Montserrat Fitó, Dora Romaguera, Jesús Vioque, ángel M. Alonso-Gómez, Julia Wrnberg, J. Alfredo Martínez, Luís Serra-Majem, Ramón Estruch, Francisco J. Tinahones, José Lapetra, Xavier Pintó, Josep A. Tur, José López-Miranda, Aurora Bueno-Cavanillas, Miguel Delgado-Rodríguez, Pilar Matía-Martín, Lidia Daimiel, Vicente Martín Sánchez, Josep Vidal, Clotilde Vázquez, Emilio Ros, Miguel Ruiz-Canela, José V. Sorlí, Olga Castaer, Miquel Fiol, Eva M. Navarrete-Muoz, Fernando Arós, Enrique Gómez-Gracia, M. Angeles Zulet, Almudena Sánchez-Villegas, Rosa Casas, Rosa Bernal-López, José M. Santos-Lozano, Emili Corbella, Cristina Bouzas, Ana García-Arellano, Josep Basora, Eva M. Asensio, Helmut Schrder, Manuel Moino, Manoli García de la Hera, Lucas Tojal-Sierra, Estefanía Toledo, Andrés Díaz-López, Albert Goday, Jordi Salas-Salvadó, Miguel A. Martínez-González

Issue&Volume: 2019/10/15

Abstract: 

Importance  High-quality dietary patterns may help prevent chronic disease, but limited data exist from randomized trials about the effects of nutritional and behavioral interventions on dietary changes.

Objective  To assess the effect of a nutritional and physical activity education program on dietary quality.

Design, Setting, and Participants  Preliminary exploratory interim analysis of an ongoing randomized trial. In 23 research centers in Spain, 6874 men and women aged 55 to 75 years with metabolic syndrome and no cardiovascular disease were enrolled in the trial between September 2013 and December 2016, with final data collection in March 2019.

Interventions  Participants were randomized to an intervention group that encouraged an energy-reduced Mediterranean diet, promoted physical activity, and provided behavioral support (n = 3406) or to a control group that encouraged an energy-unrestricted Mediterranean diet (n = 3468). All participants received allotments of extra-virgin olive oil (1 L/mo) and nuts (125 g/mo) for free.

Main Outcomes and Measures  The primary outcome was 12-month change in adherence based on the energy-reduced Mediterranean diet (er-MedDiet) score (range, 0-17; higher scores indicate greater adherence; minimal clinically important difference, 1 point).

Results  Among 6874 randomized participants (mean [SD] age, 65.0 [4.9] years; 3406 [52%] men), 6583 (96%) completed the 12-month follow-up and were included in the main analysis. The mean (SD) er-MedDiet score was 8.5 (2.6) at baseline and 13.2 (2.7) at 12 months in the intervention group (increase, 4.7 [95% CI, 4.6-4.8]) and 8.6 (2.7) at baseline and 11.1 (2.8) at 12 months in the control group (increase, 2.5 [95% CI, 2.3-2.6]) (between-group difference, 2.2 [95% CI, 2.1-2.4]; P < .001).

Conclusions and Relevance  In this preliminary analysis of an ongoing trial, an intervention that encouraged an energy-reduced Mediterranean diet and physical activity, compared with advice to follow an energy-unrestricted Mediterranean diet, resulted in a significantly greater increase in diet adherence after 12 months. Further evaluation of long-term cardiovascular effects is needed.

DOI: 10.1001/jama.2019.14630

Source: https://jamanetwork.com/journals/jama/article-abstract/2752925