A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study

Zazpe, Itziar; Sanchez-Tainta, Ana; Estruch, Ramon; Lamuela-Raventos, Rosa María; Schröder, Helmut; Salas-Salvado, Jordi; Corella, Dolores; Fiol, Miquel; Gomez-Gracia, Enrique; Aros, Fernando; Ros, Emilio; Ruíz-Gutierrez, Valentina; Iglesias, Pablo; Conde-Herrera, Manuel; Martinez-Gonzalez, Miguel Angel

doi:10.1016/j.jada.2008.04.011

Cited by 193Nutritional Studies and DietNutrition, Genetics, and DiseaseNuts composition and effects

A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study

Zazpe, Itziar, Sanchez-Tainta, Ana, Estruch, Ramon, Lamuela-Raventos, Rosa María, Schröder, Helmut, Salas-Salvado, Jordi, Corella, Dolores, Fiol, Miquel +7 more·2008·Journal of the American Dietetic Association

DOI 10.1016/j.jada.2008.04.011

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Abstract

Objective To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet.Design A 12-month assessment of a randomized primary prevention trial.Subjects/settings One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or > or =3 cardiovascular risk factors.Intervention Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines.Main outcome measures Changes in food and nutrient intake after 12 months.Statistical analyses Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted.Results Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups.Conclusions A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.

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In PREDIMED, the MD-based intervention group increased olive oil, nuts, vegetables, legumes, and fruit intake and reduced meat, pastries, cakes, and sweets, improving overall dietary patterns.
“Participants exposed to the MD-based intervention increased consumption of olive oil, nuts, vegetables, legumes and fruit and reduced consumption of meat and pastries, cakes and sweets, thus improving overall dietary patterns and supporting the use of PN in facilitating change towards a Mediterranean-style diet.”
From Effect of an Internet-based, personalized nutrition randomized trial on dietary changes associated with the Mediterranean diet: the Food4Me Study (2016) · cites this paper as [45]

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“Dietary changes achieved after an intervention for 12 months were similar to those observed at 3 months, which led to substantial improvements in various surrogate markers of cardiovascular risk in the Mediterranean diet groups compared with the control group in the pilot study of the PREDIMED trial ( 39 ).”
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Martínez‐González, M. Á., Toledo, E., Arós, F., Fiol, M., Corella, D., Salas‐Salvadó, J., Ros, E., Covas, M. I., Navajas, J. F.-C., Lapetra, J., et al. (2014) · Circulation · doi:10.1161/circulationaha.113.006921 · Cited by 217 · see citing works
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Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity
Rallidis, L. S., Lekakis, J. P., Kolomvotsou, A., Zampelas, A., Vamvakou, G. D., Efstathiou, S. P., Dimitriadis, G., Raptis, S., & Kremastinos, D. T. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.27290 · Cited by 201 · see citing works
One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes
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A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial
Davis, C. R., Hodgson, J. M., Woodman, R., Bryan, J., Wilson, C., & Murphy, K. J. (2017) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.146803 · Cited by 191 · see citing works
Effects of dietary fibre intake on risk factors for cardiovascular disease in subjects at high risk
Estruch, R., Martínez‐González, M. Á., Corella, D., Basora, J., Ruíz-Gutiérrez, V., Covas, M., Fiol, M., Gómez‐Gracia, E., López‐Sabater, M. C., Escoda, R., et al. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2008.082214 · Cited by 175 · see citing works
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A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain
Razquín, C., Martínez, J. A., Martínez‐González, M. Á., Mitjavila, M. T., Estruch, R., & Martí, A. (2009) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2009.106 · Cited by 172 · see citing works
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Can the Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomized cross-over study
Itsiopoulos, C., Brazionis, L., Kaimakamis, M., Cameron, M., Best, J. D., O’Dea, K., & Rowley, K. (2011) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2010.03.005 · Cited by 171 · see citing works
Validation of the English Version of the 14-Item Mediterranean Diet Adherence Screener of the PREDIMED Study, in People at High Cardiovascular Risk in the UK
Papadaki, A., Johnson, L., Toumpakari, Z., England, C. Y., Rai, M., Toms, S., Penfold, C. M., Zazpe, I., Martínez‐González, M. Á., & Feder, G. S. (2018) · Nutrients · doi:10.3390/nu10020138 · Cited by 168 · see citing works
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The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: The PREDIMED-NAVARRA randomized trial
Sánchez‐Villegas, A., Galbete, C., Martínez‐González, M. Á., Martínez, J. A., Razquín, C., Salas‐Salvadó, J., Estruch, R., Buil‐Cosiales, P., & Martí, A. (2011) · Nutritional Neuroscience · doi:10.1179/1476830511y.0000000011 · Cited by 163 · see citing works
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Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake: A Systematic Review and Meta-analysis
Bloomfield, H. E., Koeller, E., Greer, N., MacDonald, R., Kane, R., & Wilt, T. J. (2016) · Annals of Internal Medicine · doi:10.7326/m16-0361 · Cited by 159 · see citing works
Effect of Mediterranean diet on the expression of pro-atherogenic genes in a population at high cardiovascular risk
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Effects of total fat intake on body weight
Hooper, L., Abdelhamid, A. S., Bunn, D. K., Brown, T. J., Summerbell, C. D., & Skeaff, C. M. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011834 · Cited by 159 · see citing works
The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence?
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Dietary inflammatory index and telomere length in subjects with a high cardiovascular disease risk from the PREDIMED-NAVARRA study: cross-sectional and longitudinal analyses over 5 y
García-Calzón, S., Zalba, G., Ruiz‐Canela, M., Shivappa, N., Hébert, J. R., Martínez, J. A., Fitó, M., Gómez‐Gracia, E., Martínez‐González, M. Á., & Martí, A. (2015) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.116863 · Cited by 135 · see citing works
A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial
Opie, R. S., O'Neil, A., Jacka, F. N., Pizzinga, J., & Itsiopoulos, C. (2018) · Nutritional Neuroscience · doi:10.1080/1028415x.2017.1312841 · Cited by 130 · see citing works
Nut consumption, weight gain and obesity: Epidemiological evidence
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Reduced or modified dietary fat for preventing cardiovascular disease
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Influence of a Mediterranean Dietary Pattern on Body Fat Distribution: Results of the PREDIMED–Canarias Intervention Randomized Trial
Álvarez-Pérez, J., Sánchez-Villegas, A., Díaz-Benítez, E. M., Ruano-Rodríguez, C., Corella, D., Martínez-González, M. Á., Estruch, R., Salas-Salvadó, J., Serra-Majem, L., & for the PREDIMED Study Investigators (2016) · Journal of the American College of Nutrition · doi:10.1080/07315724.2015.1102102 · Cited by 116 · see citing works
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Effect of an Internet-based, personalized nutrition randomized trial on dietary changes associated with the Mediterranean diet: the Food4Me Study
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The Mediterranean Diet Pattern and Its Main Components Are Associated with Lower Plasma Concentrations of Tumor Necrosis Factor Receptor 60 in Patients at High Risk for Cardiovascular Disease
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A 3-year intervention with a Mediterranean diet modified the association between the rs9939609 gene variant in FTO and body weight changes
Razquin, C., Martinez, J. A., Martinez-Gonzalez, M. A., Bes-Rastrollo, M., Fernández-Crehuet, J., & Marti, A. (2010) · International Journal of Obesity · doi:10.1038/ijo.2009.233 · Cited by 109 · see citing works
Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults
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Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials
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Association of Tryptophan Metabolites with Incident Type 2 Diabetes in the PREDIMED Trial: A Case–Cohort Study
Yu, E., Papandreou, C., Ruiz‐Canela, M., Guasch‐Ferré, M., Clish, C. B., Dennis, C., Liang, L., Corella, D., Fitó, M., Razquín, C., et al. (2018) · Clinical Chemistry · doi:10.1373/clinchem.2018.288720 · Cited by 97 · see citing works
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Olive oil in the primary prevention of cardiovascular disease
Ruiz‐Canela, M., & Martínez‐González, M. Á. (2011) · Maturitas · doi:10.1016/j.maturitas.2010.12.002 · Cited by 91 · see citing works
Carotid intima-media thickness changes with Mediterranean diet: A randomized trial (PREDIMED-Navarra)
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A Mediterranean Diet Enriched with Olive Oil Is Associated with Higher Serum Total Osteocalcin Levels in Elderly Men at High Cardiovascular Risk
Fernández‐Real, J. M., Bulló, M., Moreno‐Navarrete, J. M., Ricart, W., Ros, E., Estruch, R., & Salas‐Salvadó, J. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-2221 · Cited by 90 · see citing works
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Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study)
Alonso‐Domínguez, R., García‐Ortiz, L., Patino-Alonso, M. C., Sánchez‐Aguadero, N., Gómez-Marcos, M. Á., & Recio-Rodriguez, J. I. (2019) · Nutrients · doi:10.3390/nu11010162 · Cited by 90 · see citing works
Factors Associated with Adherence to the Mediterranean Diet in the Adult Population
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A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: Design of the NU-AGE dietary intervention study
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Total polyphenol excretion and blood pressure in subjects at high cardiovascular risk
Medina-Remón, A., Zamora-Ros, R., Rotchés-Ribalta, M., Andres-Lacueva, C., Martínez-González, M. A., Covas, M. I., Corella, D., Salas-Salvadó, J., Gómez-Gracia, E., Ruiz-Gutiérrez, V., et al. (2011) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2009.10.019 · Cited by 80 · see citing works
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Predictors of short- and long-term adherence with a Mediterranean-type diet intervention: the PREDIMED randomized trial
Downer, M. K., Gea, A., Stampfer, M. J., Sánchez‐Tainta, A., Corella, D., Salas‐Salvadó, J., Ros, E., Estruch, R., Fitó, M., Gómez‐Gracia, E., et al. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0394-6 · Cited by 81 · see citing works
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An Italian Survey on Dietary Habits and Changes during the COVID-19 Lockdown
Izzo, L., Santonastaso, A., Cotticelli, G., Federico, A., Pacifico, S., Castaldo, L., Colao, A., & Ritieni, A. (2021) · Nutrients · doi:10.3390/nu13041197 · Cited by 76 · see citing works
Mediterranean diets supplemented with virgin olive oil and nuts enhance plasmatic antioxidant capabilities and decrease xanthine oxidase activity in people with metabolic syndrome: The PREDIMED study
Sureda, A., Bibiloni, M. D. M., Martorell, M., Buil‐Cosiales, P., Martí, A., Pons, A., Tur, J. A., Martínez‐González, M. Á., & PREDIMED Study Investigators (2016) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201600450 · Cited by 69 · see citing works
Genotype patterns at CLU, CR1, PICALM and APOE, cognition and Mediterranean diet: the PREDIMED-NAVARRA trial
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Effect of Mediterranean dietversusprudent diet combined with physical activity on OSAS: a randomised trial
Papandreou, C., Schiza, S. E., Bouloukaki, I., Hatzis, C., Kafatos, A. G., Siafakas, N. M., & Tzanakis, Ν. (2011) · European Respiratory Journal · doi:10.1183/09031936.00103411 · Cited by 64 · see citing works
Changes in Dietary Intake and Adherence to the NU-AGE Diet Following a One-Year Dietary Intervention among European Older Adults—Results of the NU-AGE Randomized Trial
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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
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Intermittent fasting, Paleolithic, or Mediterranean diets in the real world: exploratory secondary analyses of a weight-loss trial that included choice of diet and exercise
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Effect of interdisciplinary care on weight loss: a randomised controlled trial
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Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review
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Nutritional adequacy according to carbohydrates and fat quality
For the PREDIMED study investigators, Sánchez‐Tainta, A., Zazpe, I., Bes‐Rastrollo, M., Salas‐Salvadó, J., Bulló, M., Sorlí, J. V., Corella, D., Covas, M. I., Arós, F., et al. (2015) · European Journal of Nutrition · doi:10.1007/s00394-014-0828-3 · Cited by 61 · see citing works
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Effect of a Mediterranean Diet Intervention on Dietary Glycemic Load and Dietary Glycemic Index: The PREDIMED Study
Rodríguez‐Rejón, A. I., Castro‐Quezada, I., Ruano-Rodríguez, C., Ruiz‐López, M. D., Sánchez‐Villegas, A., Toledo, E., Artacho, R., Estruch, R., Salas‐Salvadó, J., Covas, M. I., et al. (2014) · Journal of Nutrition and Metabolism · doi:10.1155/2014/985373 · Cited by 61 · see citing works
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Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial
Basterra-Gortari, F. J., Ruiz‐Canela, M., Martínez‐González, M. Á., Babió, N., Sorlí, J. V., Fitó, M., Ros, E., Gómez‐Gracia, E., Fiol, M., Lapetra, J., et al. (2019) · Diabetes Care · doi:10.2337/dc18-2475 · Cited by 58 · see citing works
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Validation of the 14-item mediterranean diet adherence screener
Bekar, C., & Göktaş, Z. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.12.026 · Cited by 58 · see citing works
Effects of total fat intake on body fatness in adults
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A Mediterranean diet rich in virgin olive oil may reverse the effects of the ‐174G/C IL6 gene variant on 3‐year body weight change
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The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies
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Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme
Connolly, S. B., Kotseva, K., Jennings, C. S., Atrey, A., Jones, J. L., Brown, A., Bassett, P., & Wood, D. A. (2017) · Heart · doi:10.1136/heartjnl-2016-310477 · Cited by 53 · see citing works
Eating Competence of Elderly Spanish Adults Is Associated with a Healthy Diet and a Favorable Cardiovascular Disease Risk Profile
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Adherence to Mediterranean diet and close dietetic supervision increase total dietary antioxidant intake and plasma antioxidant capacity in subjects with abdominal obesity
Kolomvotsou, A., Rallidis, L. S., Mountzouris, K. C., Lekakis, J. P., Koutelidakis, A. Ε., Efstathiou, S. P., ANASTASIOU‐NANA, M. I., & Zampelas, A. (2012) · European Journal of Nutrition · doi:10.1007/s00394-011-0283-3 · Cited by 50 · see citing works
Dietary fibre intake is inversely associated with carotid intima-media thickness: a cross-sectional assessment in the PREDIMED study
Buil‐Cosiales, P., Irimia, P., Ros, E., Riverol, M., Gilabert, R., Martínez‐Vila, E., Núñez, I., Díez‐Espino, J., Martínez‐González, M. Á., & Serrano-Martínez, M. (2009) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2009.45 · Cited by 49 · see citing works
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Impact of Dietary Fiber on Inflammation in Humans
Kabisch, S., Hajir, J., Sukhobaevskaia, V., Weickert, M. O., & Pfeiffer, A. F. H. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26052000 · Cited by 50 · see citing works
Reprint of: A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: Design of the NU-AGE dietary intervention study
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Methods for the Selection of Covariates in Nutritional Epidemiology Studies: A Meta-Epidemiological Review
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Herbals Used for Diabetes, Obesity, and Metabolic Syndrome
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A Community Program of Integrated Care for Frail Older Adults: +AGIL Barcelona
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Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index
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The Mediterranean diet protects against waist circumference enlargement in 12Ala carriers for the PPARγ gene: 2 years' follow-up of 774 subjects at high cardiovascular risk
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Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study
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Older Australians Can Achieve High Adherence to the Mediterranean Diet during a 6 Month Randomised Intervention; Results from the Medley Study
Davis, C., Hodgson, J., Bryan, J., Garg, M., Woodman, R., & Murphy, K. (2017) · Nutrients · doi:10.3390/nu9060534 · Cited by 38 · see citing works
A quantitative characterisation of meals and their contexts in a sample of 25 to 49-year-old Spanish people
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A systematic review of longer-term dietary interventions on human cognitive function: Emerging patterns and future directions
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Foods and food components in the Mediterranean diet: supporting overall effects
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Reduction in systemic and VLDL triacylglycerol concentration after a 3-month Mediterranean-style diet in high-cardiovascular-risk subjects
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Does the Mediterranean diet counteract the adverse effects of abdominal adiposity?
Eguaras, S., Toledo, E., Buil-Cosiales, P., Salas-Salvadó, J., Corella, D., Gutierrez-Bedmar, M., Santos-Lozano, J. M., Arós, F., Fiol, M., Fitó, M., et al. (2015) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2015.03.001 · Cited by 32 · see citing works
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Yearly attained adherence to Mediterranean diet and incidence of diabetes in a large randomized trial
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A large randomized individual and grupal intervention conducted by dietitians increased the adherence to Mediterranean-type diets: The PREDIMED study
Zazpe, I., Sánchez‐Tainta, A., Martínez-González, Lamuela-Raventós, R. M., Schröder, H., Estruch, R., Salas‐Salvadó, J., Corella, D., Fiol, M., Gómez‐Gracia, E., et al. (2008) · Deposito Adademico Digital Universidad De Navarra (University of Navarra)
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ORIGINAL CONTRIBUTION Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial
Miquel, Æ., Pablo, F. Æ., Enrique, I. Æ., Fern, G.-G. Æ., Æ, O. A., Miguel, Æ., Zazpe, I., Estruch, R., Estruch, R., Corella, D., et al. (2009)
Self-citation

Authors: Zazpe, I., Sanchez-Tainta, A., Estruch, R., Lamuela-Raventos, R. M., Schröder, H., Salas-Salvado, J., Corella, D., Fiol, M., Gomez-Gracia, E., Aros, F., Ros, E., Ruíz-Gutierrez, V., Iglesias, P., Conde-Herrera, M., & Martinez-Gonzalez, M. A.
ORCID: Schröder, Helmut
Corella, Dolores
Fiol, Miquel
Ros, Emilio
Venue: Journal of the American Dietetic Association
Publisher: Elsevier BV
Published: 2008-07
Volume: 108
Issue: 7
Pages: 1134-1144
ISSN: 0002-8223 (ISSN-L)
DOI: 10.1016/j.jada.2008.04.011
OpenAlex: W2171300544
Cited by: 193
References: 43
Citations by year: 2026: 4 · 2025: 7 · 2024: 3 · 2023: 7 · 2022: 14 · 2021: 10 · 2020: 9 · 2019: 12 · 2018: 11 · 2017: 15 · 2016: 10 · 2015: 13 · 2014: 15 · 2013: 10 · 2012: 12
FWCI: 13.58
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of the American Dietetic Association (publishedVersion)
PubMed (publishedVersion)
DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
Funders: Generalitat Valenciana (ACOMP06109)
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición
Instituto de Salud Carlos III (RTIC RD06/0045, PI41/2005)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
Health Sciences › Nursing › Nutrition and Dietetics › Nuts composition and effects
Keywords: Mediterranean diet, dietary adherence, motivational interviewing, virgin olive oil, mixed nuts, registered dietitians, primary prevention, cardiovascular risk factors, diabetes mellitus, older adults, dietary intake, dietary fiber, monounsaturated fatty acids, polyunsaturated fatty acids
MeSH terms: Olive Oil, Aged, Aged, 80 and over, Cardiovascular Diseases, Dietetics, Feeding Behavior, Female, Fruit, Health Promotion, Humans, Fabaceae, Male, Middle Aged, Nuts, Patient Compliance, Plant Oils, Risk Factors, United States, Vegetables, Biomarkers, Prevalence, Diet, Mediterranean

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A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study

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