Abstract
BackgroundRandomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease.ObjectiveThis study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling.MethodsIn total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian—30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months.ResultsEnrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ≥9) increased significantly over time (P<.001)—from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups.ConclusionsBoth traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling.Trial RegistrationClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426
Highlights
MethodsCardiovascular disease (CVD) has been the leading cause of death every year since 1918 in the United States and currently accounts for 1 in every 3 deaths [1]
Neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling
The Mediterranean diet is typified by olive oil, nuts, vegetables, legumes, fish, white meat, and wine, and the Prevención con Dieta Mediterránea (PREDIMED) study showed a 30% reduction in major adverse cardiovascular events for patients at high risk of developing atherosclerotic disease when they received a Mediterranean diet enriched with olive oil and nut consumption [5]
Summary
MethodsCardiovascular disease (CVD) has been the leading cause of death every year since 1918 in the United States and currently accounts for 1 in every 3 deaths [1]. Diet is the most uncontrolled risk factor for cardiovascular health among US adults; per the 2015-2020 Dietary Guidelines for Americans, approximately 75% of the population follows an unhealthy eating pattern and less than 2% of Americans have an ideal diet [2]. These suboptimal dietary habits are the leading cause of mortality and disability-adjusted life years lost, greater than smoking, obesity, physical inactivity, high cholesterol, hypertension, or diabetes [3]. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease
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