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00925njm 22002777a 4500 dc Fernandez-Lazaro, Cesar I author Toledo, Estefanía author Buil-Cosiales, Pilar author Salas-Salvadó, Jordi author Corella, Dolores author Fitó, Montserrat author Martínez, J Alfredo author Alonso-Gómez, Ángel M author Wärnberg, Julia author Vioque, Jesús author Romaguera, Dora author López-Miranda, José author Estruch, Ramon author Tinahones, Francisco J author Lapetra, José author Serra-Majem, Luís author Bueno-Cavanillas, Aurora author Tur, Josep A author Martín Sánchez, Vicente author Pintó, Xavier author Delgado-Rodríguez, Miguel author Matía-Martín, Pilar author Vidal, Josep author Ros, Emilio author Vázquez, Clotilde author Daimiel, Lidia author SanJulián, Beatriz author García-Gavilán, Jesús F author Sorlí, Jose V author Castañer, Olga author Zulet, M Ángeles author Tojal-Sierra, Lucas author Pérez-Farinós, Napoleón author Oncina-Canovas, Alejandro author Moñino, Manuel author Garcia-Rios, Antonio author Sacanella, Emilio author Bernal-Lopez, Rosa M author Santos-Lozano, José Manuel author Vázquez-Ruiz, Zenaida author Muralidharan, Jananee author Ortega-Azorín, Carolina author Goday, Alberto author Razquin, Cristina author Goicolea-Güemez, Leire author Ruiz-Canela, Miguel author Becerra-Tomás, Nerea author Schröder, Helmut author Martínez González, Miguel A author PREDIMED-Plus investigators author 2021-11-30 Purpose: 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. Trial registration: ISRCTN registry 89898870, 24th July 2014 retrospectively registered http://www.isrctn.com/ISRCTN89898870 . Fernandez-Lazaro CI, Toledo E, Buil-Cosiales P, Salas-Salvado J, Corella D, Fito 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. 10.1007/s00394-021-02697-8 1436-6215 European journal of nutrition http://hdl.handle.net/10668/19875 https://hdl.handle.net/20.500.13003/19594 34846603 L2014330161 2-s2.0-85120331314 http://hdl.handle.net/20.500.12105/18511 724070900002 Dietary adherence Dietary change Factors Mediterranean diet PREDIMED-Plus Randomized controlled trials Factors associated with successful dietary changes in an energy-reduced Mediterranean diet intervention: a longitudinal analysis in the PREDIMED-Plus trial