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Randomized Controlled Trial
. 2024 Sep 9;16(17):3044.
doi: 10.3390/nu16173044.

The Effect of Individual Attitude toward Healthy Nutrition on Adherence to a High-UFA and High-Protein Diet: Results of a Randomized Controlled Trial

Thu Huong Nguyen  1   2   3 , Laura Pletsch-Borba  1   2   4 , Peter H Feindt  3   5 , Caroline S Stokes  3   6   7 , Anne Pohrt  8 , Nina M T Meyer  1   2 , Charlotte Wernicke  1   2 , Miriam Sommer-Ballarini  1   2 , Konstantina Apostolopoulou  1 , Silke Hornemann  9 , Tilman Grune  2   7   10   11 , Tilman Brück  3   5   12   13 , Andreas F H Pfeiffer  1   2   9 , Joachim Spranger  1   2   9   10 , Knut Mai  1   2   3   9   10   11
Affiliations
Randomized Controlled Trial

The Effect of Individual Attitude toward Healthy Nutrition on Adherence to a High-UFA and High-Protein Diet: Results of a Randomized Controlled Trial

Thu Huong Nguyen et al. Nutrients. .

Abstract

Despite beneficial cardiovascular effects, substantial long-term modulation of food pattern could only be achieved in a limited number of participants. The impact of attitude towards healthy nutrition (ATHN) on successful modulation of dietary behavior is unclear, especially in the elderly. We aimed to analyze whether the personal ATHN influences 12-month adherence to two different dietary intervention regimes within a 36-month randomized controlled trial.

Methods: 502 subjects were randomized to an intervention group (IG; dietary pattern focused on high intake of unsaturated fatty acids (UFA), plant protein and fiber) or control group (CG; dietary recommendation in accordance with the German Society of Nutrition) within a 36-month dietary intervention trial. Sum scores for effectiveness, appreciation and practice of healthy nutrition were assessed using ATHN questionnaire during the trial (n = 344). Linear regression models were used to investigate associations between ATHN and dietary patterns at baseline and at month 12.

Results: Retirement, higher education level, age and lower body mass index (BMI) were associated with higher ATHN sum scores. ATHN was similar in CG and IG. Higher baseline intake of polyunsaturated fatty acids (PUFA) and fiber as well as lower intake in saturated fatty acids (SFA) were associated with higher scores in practice in both groups. The intervention resulted in a stronger increase of UFA, protein and fiber in the IG after 12 months, while intake of SFA declined (p < 0.01). Higher scores in appreciation were significantly associated with higher intake of fiber and lower intake of SFA in the CG at month 12, whereas no associations between ATHN and macronutrient intake were observed in the IG after 12 months.

Conclusions: While ATHN appeared to play a role in general dietary behavior, ATHN did not affect the success of the specific dietary intervention in the IG at month 12. Thus, the dietary intervention achieved a substantial modification of dietary pattern in the IG and was effective to override the impact of the individual ATHN on dietary behavior.

Keywords: attitude; healthy aging; healthy nutrition.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cross-sectional associations between ATHN and baseline macronutrient pattern. Protein in %E (A), Fiber in g/d (B), MUFA in %E (C), PUFA in %E (D), SFA in %E (E), Carbohydrate in %E (F). Linear regression estimates (circles) and 95% confidence intervals (bars) of multivariate linear models showing associations of ATHN dimensions and macronutrient pattern at month 0 in both groups (n = 344); models were adjusted for age and sex. ** indicates significance level of p < 0.01, * indicates significance level of p < 0.05.
Figure 2
Figure 2
Association of the ATHN dimensions with macronutrient intake at month 12 in the IG. Protein in %E (A), Fiber in g/d (B), MUFA in %E (C), PUFA in %E (D), SFA in %E (E), Carbohydrate in %E (F). Linear regression estimates (circles) and 95% confidence intervals (bars) of multivariate linear models showing associations of ATHN dimensions and each macronutrient at month 12 in the IG (n = 170); models were adjusted for age, sex, BMI, nutritional counseling sessions and baseline intake of the respective macronutrient. *** indicates significance level of p < 0.001, ** indicates significance level of p < 0.01, * indicates significance level of p < 0.05.
Figure 3
Figure 3
Association of the ATHN dimensions with macronutrient intake at month 12 in the CG. Protein in %E (A), Fiber in g/d (B), MUFA in %E (C), PUFA in %E (D), SFA in %E (E), Carbohydrate in %E (F). Linear regression estimates (circles) and 95% confidence intervals (bars) of multivariate linear models showing cross-sectional associations of ATHN dimensions and each macronutrient at month 12 in the CG (n = 173); models were adjusted for age, sex, BMI, nutritional counseling sessions and baseline intake of the respective macronutrient. *** indicates significance level of p < 0.001, ** indicates significance level of p < 0.01, * indicates significance level of p < 0.05.
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