Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 16, 2020
Date Accepted: Oct 28, 2020
Effect of a remote nutritional intervention (using web and telephone contacts) on changes in dietary habits among patients undergoing ablation of atrial fibrillation: The PREDIMAR randomized trial
ABSTRACT
Background:
The PREDIMED trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease.. However, the effect of a remote intervention to follow the Mediterranean diet (MedDiet) has been less explored.
Objective:
To assess the effectiveness of a remotely provided MedDiet nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of AF.
Methods:
The Prevention of recurrent arrhythmias with Mediterranean Diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the MedDiet enriched with EVOO on the prevention of atrial tachyarrhythmia recurrences after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (MedDiet enriched with EVOO) or control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with online provision of dietary recommendations, and participants had access to a webpage, a mobile app and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, MedDiet classroom, and Your personal experience. At baseline, at 1 year and 2 years of follow-up the 14-item MedDiet Adherence Screener (MEDAS) questionnaire and a semi-quantitative food frequency questionnaire were collected by a dietitian by phone.
Results:
A total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to May 2020, 560 subjects completed the first year (560 out of 574, retention rate 95.6%) and 304 the second year of the intervention (304 of 322, retention rate 94.4%). After 24 months of follow-up, increased adherence to the MedDiet was observed in both groups, but the improvement was significantly higher in the intervention than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire [95% CI 1.4 to 2.2] p<0.001). Compared with the control group, the MedDiet intervention group showed a significant increase in the consumption of fruits, olive oil, whole grain cereals, pulses, nuts, white fish, fatty fish, and white meat; and a significant reduction in refined cereals, red and processed meat, and sweets (all p values <0.005) at 2 years of the intervention. In terms of nutrients, the intervention group increased significantly the intake of omega-3 and fiber; and decreased the intake of carbohydrates and saturated fatty acids, compared to the control group (all p values <0.005).
Conclusions:
The remotely nutritional intervention, using a website and phone calls, is effective in increasing the adherence to the MedDiet pattern among AF patients treated with catheter ablation.
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