‘Effectiveness of a remote nutritional intervention to increase the adherence to the Mediterranean diet among recovered depression patients’

Figures & data

Figure 1. Flowchart of participant screening, recruitment, and randomization.

Table 1. Baseline characteristics of PREDIDEP participants (n = 157).

Characteristics	Control (n = 74)	Intervention (n = 83)	p-value*
Age, years, mean (SD)	50.89 (14.28)	51.39 (13.33)	0.8207
Sex, n (%)			0.452
Men	20 (27.03)	27 (32.53)
Women	54 (72.97)	56 (67.47)
Depressive episodes, n (%)			0.266
1	35 (47.30)	30 (36.14)
2	18 (24.32)	20 (24.10)
3 or more	21 (28.38)	33 (39.76)
Antidepressants use, n (%)	56 (75.68)	65 (78.31)	0.695
Civil status, n (%)			0.226
Single	27 (36.99)	28 (33.73)
Married	29 (39.73)	43 (51.81)
Others	17 (23.29)	12 (14.46)
Education, n (%)			0.299
Secondary or less	43 (58.90)	42 (50.60)
University	30 (41.10)	41 (49.40)
Working status, n (%)	33 (45.21)	37 (44.58)	0.997
Working	14 (19.18)	16 (19.28)
Retired	26 (35.62)	30 (36.14)
Others
BMI (kg/m^2)	25.90 (4.84)	26.57 (4.84)	0.391
Smoking status, n (%)	34 (46.58)	42 (50.60)	0.616
Illegal drugs, n (%)	6 (8.11)	7 (8.43)	0.941
Physical activity (MET -hours/week)	15.89 (19.23)	17.89 (24.73)	0.5771
MEDAS score (14 ítems)	6.90 (2.15)	7.20 (2.03)	0.3701
Energy intake (kcal/day)	2515.75 (811.52)	2715.32 (783.47)	0.1192
Carbohydrate intake (g/day)	288.32 (119.94)	314.11 (115.77)	0.1726
Protein intake (g/day)	98.40 (25.73)	110.89 (30.33)	0.0064
Fat intake (g/day)	104.33 (35.83)	108.16 (34.14)	0.4948

*p-value obtained by the Student’s t-test (quantitative variables) or the Chi-square (qualitative variables).

BMI: body mass index; MET: Metabolic equivalent; MEDAS: Mediterranean Diet Adherence Screener.

Figure 2. Adherence to the MD among participants in the intervention group.

Table 2. Baseline food groups consumption and changes by randomized treatment group at 12- and 24-month follow-up visits of PREDIDEP participants (n = 157).

Food groups	Control, mean (95% CI) (n = 74)	Intervention, mean (95% CI) (n = 83)	Between group difference^a, mean (95% CI)	p-value^b
Vegetables (g/day)
Baseline	312.54 (275.05–350.03)	337.53 (300.30–374.77)	N/A^c	N/A
1 year	282.61 (245.31–319.91)	327.88 (300.61–355.15)	N/A	N/A
1-year change	−29.93 (−75.09–15.23)	−9.65 (−45.94−26.63)	20.27 (−37.66−78.21)	0.493
2 years	224.92 (200.60−249.25)	285.34 (262.83−307.85)	N/A	N/A
2-years change	−87.61 (−127.62 to −47.61)	−52.19 (−92.97 to −11.41)	35.42 (−21.7−92.54)	0.224
Fruits (g/day)
Baseline	368.29 (309.63−426.95)	360.94 (314.40−407.47)	N/A	N/A
1 year	326.78 (277.96−375.60)	367.85 (327.80–407.90)	N/A	N/A
1-year change	−41.5 (−94.33–11.31)	6.9 (−45.34–59.15)	48.41 (−25.88–122.71)	0.202
2 years	292.69 (243.57–341.82)	377.65 (342.47–412.83)	N/A	N/A
2-years change	−75.59 (−135.69 to −15.50)	16.71 (−33.16–66.58)	92.3 (14.21–170.40)	0.021
Refined cereals (g/day)
Baseline	108.09 (84.73–131.45)	136.84 (112.56–161.12)	N/A	N/A
1 year	54.7 (43.61–65.78)	55.28 (44.69–65.86)	N/A	N/A
1-year change	−53.39 (−75.76 to −31.02)	−81.56 (−106.63 to −56.59)	−28.16 (−61.69–5.36)	0.100
2 years	46.31 (36.94–55.68)	38.74 (31–46.48)	N/A	N/A
2-years change	−61.78 (−83.43 to −40.12)	−98.09 (−123.08 to −73.10)	−36.31 (−69.37 to −3.24)	0.031
Whole cereals (g/day)
Baseline	52.22 (38.50–65.93)	41.42 (27.50–55.33)	N/A	N/A
1 year	33.82 (22.44–45.20)	32.63 (23.52–41.75)	N/A	N/A
1-year change	−18.39 (−33.16 a −3.63)	−8.78 (−23.81–6.24)	9.61 (−11.45–30.68)	0.371
2 years	23.78 (16.80–30.77)	30.86 (21.86–39.86)	N/A	N/A
2-years change	−28.43 (−41.39 to −15.47)	−10.56 (−26.28–5.16)	17.87 (−2.50–38.24)	0.086
Pulses (g/week)
Baseline	209.45 (171.06–247.83)	272.07 (228.28–315.86)	N/A	N/A
1 year	161.8 (128.47–195.14)	229 (192.71–265.28)	N/A	N/A
1-year change	−47.64 (−95.04 to −0.23)	−43.07 (−93.54–7.39)	4.56 (−64.67–73.81)	0.897
2 years	119.79 (99.89–139.68)	190.41 (166.47–214.34)	N/A	N/A
2-years change	−83.66 (−128.91 to −50.40)	−81.66 (−127.80 to −35.51)	7.99 (−52.58–68.58)	0.796
Nuts (g/week)
Baseline	117.18 (86.94–147.42)	153.43 (124.00–182.19)	N/A	N/A
1 year	112.37 (83.00–141.75)	207.02 (163.23–250.81)	N/A	N/A
1-year change	−4.8 (−44.02–34.40)	53.58 (8.10–99.06)	58.39 (−1.65–118.44)	0.057
2 years	84.44 (64.04–104.84)	188.25 (160.84–215.67)	N/A	N/A
2-years change	−32.74 (−62.23 to −3.25)	34.82 (−0.98–70.62)	67.56 (21.17–113.95)	0.004
White fish (g/week)
Baseline	348.08 (301.16–395.00)	440.61 (359.51–521.72)	N/A	N/A
1 year	325.89 (274.71–377.06)	526.58 (450.21–602.95)	N/A	N/A
1-year change	−22.18 (−70.76–26.38)	85.96 (−18.15–190.08)	108.15 (−6.73–223.04)	0.065
2 years	327.54 (281.45–373.64)	468.55 (421.39–515.71)	N/A	N/A
2-years change	−20.53 (−66.55–25.48)	27.93 (−54.13–110.00)	48.46 (−45.61–142.55)	0.313
Fatty fish (g/week)
Baseline	199.46 (166.51–232.24)	233.06 (194.18–271.96)	N/A	N/A
1 year	179.31 (148.03–210.58)	280.86 (238.65–323.08)	N/A	N/A
1-year change	−20.16 (−51.38–11.06)	47.79 (−2.54–98.14)	67.96 (8.71–127.19)	0.025
2 years	164.5 (128.58–200.42)	241.99 (204.16–279.83)	N/A	N/A
2-years change	−34.96 (−75.87–5.94)	8.92 (−37.18–55.03)	43.89 (−17.75–105.53)	0.163
White meat (g/week)
Baseline	440.24 (390.32–490.15)	452.39 (400.39–504.39)	N/A	N/A
1 year	412.05 (358.56–465.53)	478.02 (430.41–525.64)	N/A	N/A
1-year change	−28.18 (−89.65–33.27)	25.63 (−26.58–77.86)	53.82 (−26.83–134.47)	0.191
2 years	377.47 (332.88–422.06)	454.3 (400.96–507.64)	N/A	N/A
2-years change	−62.76 (−124.18 to −1.35)	1.91 (−65.92–69.75)	64.68 (−26.82–156.18)	0.166
Red and processed meat (g/week)
Baseline	521.23 (441.41–601.06)	537.94 (472.23–603.64)	N/A	N/A
1 year	431.03 (368.57–493.49)	447.65 (383.66–511.65)	N/A	N/A
1-year change	−90.2 (−175.92 to −4.48)	−90.28 (−153.77 to −26.79)	−0.08 (−106.75–106.59)	0.999
2 years	385.81 (327.62–443.99)	402.64 (346.17–459.12)	N/A	N/A
2-years change	−135.42 (−223.85 to −47.00)	−135.29 (−199.91 to −70.67)	0.13 (−109.38–109.65)	0.998
Olive oil (g/day)
Baseline	32.39 (28.95–35.83)	29.21 (26.35–32.07)	N/A	N/A
1 year	21.5 (17.72–25.28)	26.55 (22.10–31.00)	N/A	N/A
1-year change	−10.89 (−15.20 to −6.57)	−2.66 (−7.93–2.61)	8.23 (1.41–15.05)	0.018
2 years	25.77 (21.81–29.73)	37.66 (34.25–41.08)	N/A	N/A
2-years change	−6.62 (−10.81 a −2.43)	8.45 (3.99–12.91)	15.07 (8.96–21.19)	>0.001
Sweets (g/week)
Baseline	349.75 (268.35–431.14)	331.71 (263.33–400.09)	N/A	N/A
1 year	223.63 (175.41–271.86)	164.62 (122.28–206.97)	N/A	N/A
1-year change	−126.11 (−201.17 to −51.06)	−167.08 (−231.63 to −102.53)	−40.97 (−139.96–58.02)	0.417
2 years	245.56 (176.83–314.28)	140.81 (99.69–181.94)	N/A	N/A
2-years change	−104.18 (−189.99 to −18.38)	−190.89 (−265.62 to −116.16)	−86.7 (−200.49–27.08)	0.135
Red wine (g of alcohol/day)
Baseline	10.21 (4.22–16.19)	15.89 (3.90–27.88)	N/A	N/A
1 year	7.96 (3.72–12.21)	24.9 (11.63–38.17)	N/A	N/A
1-year change	−2.24 (−7.52–3.03)	9.01 (−7.75–25.77)	11.25 (−6.31–28.83)	0.209
2 years	13.17 (6.07–20.28)	30.99 (11.59–50.38)	N/A	N/A
2-years change	2.96 (−3.24–9.17)	15.09 (−7.78–37.98)	12.12 (−11.57–35.84)	0.316

^a Calculated using mixed-effect models with centre as random factor.

^b p-value between group intervention difference.

^c N/A: not applicable.

Table 3. Baseline nutrient intake and changes by randomized treatment group at 12- and 24-month follow-up visits of PREDIDEP participants (n = 157).

Energy or nutrient	Control, mean (95% CI) (n = 74)	Intervention, mean (95% CI) (n = 83)	Between group difference^a, mean (95% CI)	p-value^b
Energy (kcal/day)
Baseline	2527.67 (2367.26–2688.09)	2644.73 (2479.96–2809.50)	N/A^c	N/A
1 year	1983.53 (1853.76–2113.29)	2116.12 (2004.70–2227.55)	N/A	N/A
1-year change	−544.14 (−702.61 to −385.67)	−528.6 (−687.50 to −369.70)	15.53 (−208.87–239.94)	0.892
2 years	1871.46 (1761.28–1981.63)	2093.63 (1987.68–2199.58)	N/A	N/A
2-years change	−656.21 (−813.68 to −498.74)	−551.1 (−715.86 to −386.33)	105.11 (−122.80–333.03)	0.336
Fat (g/day)
Baseline	104.32 (97.33–111.31)	105.54 (98.69–112.39)	N/A	N/A
1 year	82.61 (76.44–88.77)	92.43 (85.87–98.98)	N/A	N/A
1-year change	−21.71 (−28.31 to −15.11)	−13.11 (−20.22 to −6.00)	8.59 (−1.10–18.29)	0.082
2 years	84.09 (77.49–90.68)	100.8 (94.98–106.62)	N/A	N/A
2-years change	−20.23 (−27.83 to −12.63)	−4.74 (−11.81–2.33)	15.49 (5.10–25.87)	0.003
MUFA (g/day)
Baseline	51.91 (48.14–55.68)	50.39 (46.90–53.87)	N/A	N/A
1 year	39.2 (35.75–42.64)	46.86 (42.66–51.06)	N/A	N/A
1-year change	−12.71 (−16.71 to −8.71)	−3.53 (−8.09–1.03)	9.18 (3.11–15.25)	0.003
2 years	40.94 (37.28–44.60)	52.96 (49.68–56.23)	N/A	N/A
2-years change	−10.97 (−15.13 to −6.80)	2.57 (−1.47–6.62)	13.54 (7.73–19.35)	<0.001
PUFA (g/day)
Baseline	18.15 (16.64–19.67)	20.23 (18.60–21.87)	N/A	N/A
1 year	15.15 (13.61–16.68)	17.86 (16.54–19.17)	N/A	N/A
1-year change	−3.00 (−4.79 to −1.21)	−2.37 (−4.06 to −0.69)	0.62 (−1.83–3.08)	0.618
2 years	14.17 (12.83–15.51)	18.40 (17.05–19.76)	N/A	N/A
2-years change	−3.98 (−5.80 to −2.16)	−1.82 (−3.59 to −0.06)	2.15 (−0.38–4.68)	0.096
SFA (g/day)
Baseline	28.26 (25.87–30.65)	28.86 (26.51–31.19)	N/A	N/A
1 year	22.86 (20.96–24.77)	22.82 (21.20–24.45)	N/A	N/A
1-year change	−5.39 (−7.39 to −3.38)	−6.02 (−7.99 to −4.06)	−0.63 (−3.44–2.16)	0.656
2 years	23.3 (21.17–25.44)	24.09 (22.39–25.79)	N/A	N/A
2-years change	−4.95 (−7.46 to −2.44)	−4.76 (−6.90 to −2.62)	0.19 (−3.10–3.48)	0.910
Trans fatty acids (g/day)
Baseline	0.68 (0.59–0.78)	0.67 (0.58–0.76)	N/A	N/A
1 year	0.54 (0.46–0.62)	0.44 (0.38–0.51)	N/A	N/A
1-year change	−0.14 (−0.21 to −0.07)	−0.22 (−0.30 to −0.14)	−0.08 (−0.19–0.02)	0.150
2 years	0.57 (0.47–0.66)	0.42 (0.36–0.49)	N/A	N/A
2-years change	−0.11 (−0.22 to −0.01)	−0.24 (−0.32 to −0.16)	−0.12 (−0.26–0.004)	0.058
Omega 3 (mg/day)
Baseline	0.73 (0.63–0.83)	0.86 (0.72–0.98)	N/A	N/A
1 year	0.63 (0.54–0.72)	0.98 (0.85–1.11)	N/A	N/A
1-year change	−0.09 (−0.18–0)	0.12 (−0.03–0.28)	0.22 (0.04–0.40)	0.017
2 years	0.57 (0.48–0.66)	0.86 (0.75–0.97)	N/A	N/A
2-years change	−0.16 (−0.26 to −0.06)	0.01 (−0.13–0.15)	0.16 (−0.01–0.34)	0.064
Magnesium (mg/day)
Baseline	452.19 (421.8–482.59)	477.69 (444.03–511.36)	N/A	N/A
1 year	378.09 (346.56–409.62)	436.28 (408.99–463.58)	N/A	N/A
1-year change	−74.1 (−107.26 to −40.96)	−41.4 (−76.67 to −6.14)	32.7 (−15.69–81.09)	0.185
2 years	329.33 (307.56–351.10)	406.42 (383.41–429.43)	N/A	N/A
2-years change	−122.86 (−153.29 to −92.42)	−71.27 (−106.89 to −35.65)	51.58 (4.73–98.44)	0.031
Vitamin B6 (mg /day)
Baseline	2.51 (2.36–2.66)	2.69 (2.52–2.87)	N/A	N/A
1 year	2.25 (2.08–2.41)	2.61 (2.46–2.75)	N/A	N/A
1-year change	−0.26 (−0.42 to −0.10)	−0.08 (−0.27–0.10)	0.18 (−0.18–0.42)	0.154
2 years	1.97 (1.84–2.11)	2.44 (2.31–2.56)	N/A	N/A
2-years change	−0.53 (−0.70 to −0.36)	−0.26 (−0.43 to −0.07)	0.27 (0.03–0.52)	0.028
Vitamin B12 (mcg/ day)
Baseline	8.08 (7.28–8.88)	8.85 (7.93–9.77)	N/A	N/A
1 year	7.91 (7.04–8.77)	8.85 (7.93–9.77)	N/A	N/A
1-year change	−0.16 (−0.86–0.53)	1.56 (0.09–3.02)	1.72 (0.10–3.34)	0.037
2 years	7.17 (6.21–8.14)	9.3 (8.42–10.17)	N/A	N/A
2-years change	−0.9 (−1.93–0.12)	0.44 (−0.54–1.44)	1.35 (−0.08–2.78)	0.065
Folic acid (mcg/day)
Baseline	399.42 (364.70–434.14)	416.2 (381.34–451.06)	N/A	N/A
1 year	332.11 (300.33–363.89)	388.14 (360.18–416.11)	N/A	N/A
1-year change	−67.3 (−104.64 to −29.97)	−28.06 (−64.52–8.39)	39.24 (−12.93–91.43)	0.14
2 years	270.73 (250.16–291.29)	344.38 (323.84–364.91)	N/A	N/A
2-years change	−128.69 (−162.28 to −95.09)	−71.82 (−106.70 to −36.94)	56.86 (8.43–105.29)	0.021

^a Calculated using mixed-effect models with centre as random factor.

^b p-value between group intervention difference.

^c N/A: not applicable.

MUFA: monounsaturated fatty acid; PUFA: polyunsaturated fatty acid; SFA: saturated fatty acid.

Table 4. Baseline dietary patterns adherence and changes by randomized treatment group at 12- and 24-month follow-up visits of PREDIDEP participants (n = 157).

Dietary patterns questionnaires	Control, mean (95% CI) (n = 74)	Intervention, mean (95% CI) (n = 83)	Between group difference^a, mean (95% CI)	p-value^b
MEDAS
Baseline	6.96 (6.54–7.39)	7 (6.63–7.39)	N/A^c	N/A
1 year	7.2 (6.82–7.58)	9.74 (9.3–10.18)	N/A	N/A
1-year change	0.23 (−0.19–0.65)	2.74 (2.28–3.19)	2.50 (1.88–3.12)	<0.001
2 years	7.06 (6.66–7.46)	9.68 (9.28–10.07)	N/A	N/A
2-years change	0.10 (−0.38–0.58)	2.67 (2.24–3.1)	2.57 (1.93–3.22)	<0.001
PDP
Baseline	36 (35.08–36.92)	35.9 (34.9–36.91)	N/A	N/A
1 year	35.65 (34.6–36.69)	36.19 (35.27–37.11)	N/A	N/A
1-year change	−0.35 (−1.61–0.9)	0.29 (−0.89–1.47)	0.64 (−1.08–2.36)	0.465
2 years	35 (34–36)	36.74 (35.67–37.81)	N/A	N/A
2-years change	−1.00 (−2.24–0.25)	0.83 (−5.51–2.18)	1.83 (−0.004–3.67)	0.050

^a Calculated using mixed-effect models with centre as random factor.

^b p-value between group intervention difference.

^c N/A: not applicable.

MEDAS: Mediterranean Diet Adherence Screener; PDP: Provegetarian Dietary Pattern.