title: Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review.
abstract: OBJECTIVE
  To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings.
  
  
  METHODS
  Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached.
  
  
  RESULTS
  Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups.
  
  
  CONCLUSIONS
  Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL. Electronic address: jmaderuelo@saludcastillayleon.es.
authors.forename: José A
authors.initials: JA
authors.lastname: Maderuelo-Fernandez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL. Electronic address: donrecio@gmail.com.
authors.forename: José I
authors.initials: JI
authors.lastname: Recio-Rodríguez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Statistics Department, University of Salamanca, Salamanca, Spain. Electronic address: carpatino@usal.es.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Patino-Alonso
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL. Electronic address: arechaederra@yahoo.es.
authors.forename: Diana
authors.initials: D
authors.lastname: Pérez-Arechaederra
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain. Electronic address: emiliano@usal.es.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Rodriguez-Sanchez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain. Electronic address: magomez@usal.es.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gomez-Marcos
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain. Electronic address: lgarciao@usal.es.
authors.forename: Luis
authors.initials: L
authors.lastname: García-Ortiz
mesh_terms: D000328:Adult; D000368:Aged; D038441:Diet, Mediterranean; D015444:Exercise; D005260:Female; D006266:Health Education / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D008875:Middle Aged; D044623:Nutrition Therapy; D010349:Patient Compliance; D011320:Primary Health Care
keywords: Diet; Diet, Mediterranean; Fruit; Health behavior; Health education counseling; Health promotion; Randomized controlled trials as topic; Review; Vegetables