Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care

Abstract

Background: Diet can help preserve lung function in smokers, as well as aid individuals who avoid smoking. This study aimed to evaluate the effectiveness of a nutritional intervention, using the Social Networks 2.0 tool, to increase adherence to the Mediterranean diet (MD) and improve lung function in smokers without prior respiratory disease.

Methods: A randomized controlled parallel design was used. The participants were assigned to either the intervention or control group. Data from representative smokers without respiratory disease (n = 77) aged 18-70 years were analyzed. The participants completed a validated semi-quantitative food-frequency questionnaire, and their adherence to the diet was evaluated by using the questionnaire called the Mediterranean Diet Adherence Score (MEDAS, with 14 items), which considers ≥9 points to indicate high adherence. The lung function was assessed by spirometry. Associations among variables were determined by logistic regression.

Results: A comparison of the variables at the end of the study between the control and intervention groups showed that the intervention significantly increased adherence to the MD based on the MEDAS questionnaire (0.69 (2.1) vs. 2.05 (2.03); p = 0.009). Specifically, the consumption of fruits was increased after two years in both groups; however, a more significant increase was detected in the intervention group (121 (178) vs. 12.7 (167) in the control group; p-value = 0.008). In the unadjusted analysis, the intervention only showed a statistical significant increase in the score of adherence to the MD (β: 1.36; 95% CI 0.35; 2.3; p = 0.009), and this increase was maintained after adjusting for age and sex (β: 1.15; 95% CI 0.05; 2.2; p = 0.040) and after adjusting for various sociodemographic, lifestyle and anthropometric variables (β: 1.17; 95% CI 0.02; 2.31; p = 0.046). The pulmonary function parameters improved more in the intervention group; however, no significant differences were observed between the two groups.

Conclusions: A nutritional intervention based on a dietetic-nutritional education program resulted in a significant increase in adherence to the MD. However, some evidence suggests that an MD dietary intervention can improve lung function, but in our study, we were not able to demonstrate this. Further research is needed to obtain more robust data and confirm a possible benefit of the program before it can be extended to general practice.

Keywords: Mediterranean diet; lung disease; nutritional intervention; primary care centers.

Figure 1

Flow diagram of the project: participant selection, randomization and follow-up.

Figure 2

Participants with positive answer (%) to each of the 14 Items of MEDAS. MEDAS refers to the 14-point test of adherence to the Mediterranean diet validated by the PREDIMED study [34]: (Q1) use olive oil as main culinary fat, (Q2) olive oil > 4 tablespoons, (Q3) vegetables ≥ 2 servings/day, (Q4) fruits ≥ 3 servings/day, (Q5) red or processed meats < 1/day, (Q6) butter/cream/margarine < 1/day, (Q7) soda drinks < 1/day, (Q8) Wine glasses ≥ 7/week, (Q9) legumes ≥ 3/week, (Q10) fish or seafood ≥ 3/week, (Q11) commercial bakery ≤ 2/week, (Q12) nuts ≥ 3/week, (Q13) poultry more than red meats and (Q14) use of sofrito sauce ≥ 2/week. Data are presented with the number of answer participants’ (n). Negative values show the difference in the number of participants responding affirmatively to the questionnaire question at the final visit compared to the baseline visit. The McNemar test was used for analysis (test for paired qualitative variable). ^a p-value <0.05 when comparing data between baseline and final visit. ^b p-value <0.01 when comparing data between baseline and final visit.