Abstract
Adoption of a Mediterranean diet (MD) reduces cardiovascular disease (CVD) risk. However, interventions to achieve dietary behaviour change are typically resource intensive. Peer support offers a potentially low-cost approach to encourage dietary change. The primary objective of this randomised controlled trial is to explore the feasibility of peer support versus a previously tested dietetic-led intervention to encourage MD behaviour change, and to test recruitment strategies, retention and attrition in order to inform the design of a definitive trial. A total of 75 overweight adults at high CVD risk who do not follow a MD (Mediterranean Diet Score (MDS ≤ 3)) will be randomly assigned to either: a minimal intervention (written materials), a proven intervention (dietetic support, written materials and key MD foods), or a peer support intervention (group-based community programme delivered by lay peers) for 12 months. The primary end-point is change in MDS from baseline to 6 months (adoption of MD). Secondary end-points include: change in MDS from 6 to 12 months (maintenance of MD), effects on nutritional biomarkers and CVD risk factors, fidelity of implementation, acceptability and feasibility of the peer support intervention. This study will generate important data regarding the feasibility of peer support for ease of adoption of MD in an ‘at risk’ Northern European population. Data will be used to direct a larger scale trial, where the clinical efficacy and cost-effectiveness of peer support will be tested.
Highlights
This paper describes the protocol for the TEAM-MED study (Trial to Encourage Adoption and Maintenance of a MEiterranean Diet) that aims to explore the feasibility of peer support versus a previously tested dietitian-led intervention to encourage Mediterranean diet (MD) behaviour change [8], and to test recruitment strategies, retention and attrition, to inform the design of a definitive trial where the clinical and cost-effectiveness of the peer support intervention will be tested
Target behaviour change for the intervention is defined as a ≥ 3-point increase in Mediterranean Diet Score (MDS) from baseline to 6 months as this change is likely to be both achievable by the target population [15] and clinically important [40]
TEAM-MED will explore indicative effects of the intervention on cardiovascular disease (CVD) risk factors and markers of diabetes risk (blood glucose and glycated haemoglobin (HbA1c) levels) over the 12 months to inform the outcomes for a future definitive trial that will aim to assess clinical effectiveness of the peer support intervention for cardiometabolic health
Summary
The traditional Mediterranean diet (MD), rich in fruit, vegetables, wholegrains, nuts, fish and olive oil, and low in red meat and processed foods [1], is rated as the most likely dietary pattern to offer protection against cardiovascular disease (CVD) [2]. This is supported by robust evidence from epidemiologic studies [3,4,5], which have been subjected to meta-analysis [6]. Accessibility to foods and sociocultural influences on food choice differ between countries and populations [14] and it is not yet clear whether non-Mediterranean countries can adopt and maintain dietary behaviours consistent with a traditional MD
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