Evaluation of adherence to the Mediterranean diet after a nutritional dietary intervention from primary care.

Introduction: currently there are changes in lifestyle that have been modifying the nutritional culture, moving away from the Mediterranean diet (DMed) and acquiring a more sedentary lifestyle, a fact that has contributed to a significant increase in risk factors. (CVRF) such as obesity and type 2 diabetes mellitus (DM2), and consequently to a global increase in metabolic syndrome (MS) and cardiovascular diseases (CVD), which in the 21st century reinforces being the first cause of morbidity and mortality To reduce this pandemic, a multidisciplinary approach is required focused on the application of primary and secondary prevention strategies for modifiable CVRFs, focused on nutritional promotion and education through the promotion of a healthier lifestyle and diet from childhood, as the one that encompasses the MedD. This dietary pattern, together with physical exercise, has been shown to contribute to the primary and secondary prevention of DM2 and coexisting CVRF.

Objective: to determine the initial adherence to the DMed in patients with poorly controlled type 2 diabetes and to analyze the effects of a nutritional educational intervention from Primary Care on glycemic control and the degree of adherence to the Mediterranean diet post-intervention and their relationship.

Material And Methods: descriptive observational study and quasi-experimental analytical study (before-after) in 93 patients diagnosed with type 2 diabetes mellitus with poor glycemic control (A1c ≥ 7 %), carried out in various health centers in Albacete and Cuenca between 2018 and 2019, in which the relationship between adherence to MedDM and CVRF is evaluated, before and after an educational intervention on MedDM. They are administered a data collection sheet that includes a MedD adherence survey (MEDAS-14) at baseline and at 6 months, after completing an education on MedD in Primary Care (PC) medical and nursing consultations). The pre- and post-intervention variables were analyzed: age groups, sex, years of evolution of DM2, body mass index (BMI), as well as basal glycemia (GB) and glycosylated hemoglobin (A1c). The main variable "MEDAS-14" is related to the rest of the variables.

Results: both poor glycemic control and having a high BMI are related to low adherence to the Mediterranean diet. Pre-intervention the score of the survey of adherence to the Mediterranean diet was relatively low (7.44 ± 0.22 points), being in women (7.66 points) than in men (7.1 points). Despite the high consumption of olive oil, a large number of processed products are consumed (sweetened beverages, butter, commercial confectionery), with a low consumption of fruit, fish and nuts. The high levels of basal glycemia are also related to the low adherence to the Mediterranean diet (p < 0.04), as well as the increase in glycosylated hemoglobin (p < 0.06). Post-intervention, adherence to the DMED increased by 1.09 ± 2.56 points (8.55 points). Men being those who present 0.4 points more (8.7 points) than women (8.4 points). The biggest changes have been in relation to the increase in the consumption of white meat, olive oil, nuts, vegetables and stir-fry, and a decrease in the consumption of processed foods.

Conclusions: in diabetic patients with poor control, a nutritional educational intervention that promotes MedDM from PC improves adherence to said diet, increasing the consumption of healthy foods and decreasing harmful ones, thus optimizing metabolic control. Keywords Mediterranean diet, type 2 diabetes, obesity, MEDAS-14, cardiovascular risk factors, nutritional education.