Vol.:(0123456789) 1 3 European Journal of Nutrition https://doi.org/10.1007/s00394-019-02087-1 ORIGINAL CONTRIBUTION Efect of changes in adherence to Mediterranean diet on nutrient density after 1‑year of follow‑up: results from the PREDIMED‑Plus Study Naomi Cano‑Ibáñez 1,2,3  · Aurora Bueno‑Cavanillas 1,2,3  · Miguel Ángel Martínez‑González 4,5,6,7  · Jordi Salas‑Salvadó 7,8,9,10  · Dolores Corella 7,11  · Gal‑la Freixer 12  · Dora Romaguera 7,13  · Jesús Vioque 2,14  · Ángel M. Alonso‑Gómez 7,15  · Julia Wärnberg 7,16  · J. Alfredo Martínez 7,17,18  · Lluis Serra‑Majem 7,19  · Ramón Estruch 7,20  · Francisco J. Tinahones 7,21  · José Lapetra 7,22  · Xavier Pintó 7,23  · Josep A. Tur 7,13,24  · Antonio García‑Ríos 7,25  · Laura García‑Molina 1,2  · Miguel Delgado‑Rodríguez 2,26  · Pilar Matía‑Martín 27  · Lidia Daimiel 18  · Vicente Martín‑Sánchez 2,28  · Josep Vidal 29,30  · Clotilde Vázquez 7,31  · Emilio Ros 7,32  · Javier Bartolomé‑Resano 4,33  · Antoni Palau‑Galindo 8,9,34  · Olga Portoles 7,11  · Laura Torres 12  · Miquel‑Fiol 7,13  · María Teresa Cano Sánchez 35  · Carolina Sorto‑Sánchez 7,15  · Noelia Moreno‑Morales 36  · Itziar Abete 5,17  · Jacqueline Álvarez‑Pérez 7,19  · Emilio Sacanella 7,20  · María Rosa Bernal‑López 7,37  · José Manuel Santos‑Lozano 7,22,38  · Marta Fanlo‑Maresma 23  · Cristina Bouzas 7,13,24  · Cristina Razquin 4,5,7  · Nerea Becerra‑Tomás 7,8,9  · Carolina Ortega‑Azorin 7,11  · Regina LLimona 12  · Marga Morey 7,13  · Josefa Román‑Maciá 35  · Leire Goicolea‑Güemez 7,15  · Zenaida Vázquez‑Ruiz 4,5,7  · Laura Barrubés 7,8,9  · Montse Fitó 7,12  · Alfredo Gea 4,5,7 Received: 23 May 2019 / Accepted: 30 August 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background The prevalence of overweight/obesity and related manifestations such as metabolic syndrome (MetS) is increas- ing worldwide. High energy density diets, usually with low nutrient density, are among the main causes. Some high-quality dietary patterns like the Mediterranean diet (MedDiet) have been linked to the prevention and better control of MetS. How- ever, it is needed to show that nutritional interventions promoting the MedDiet are able to improve nutrient intake. Objective To assess the efect of improving MedDiet adherence on nutrient density after 1 year of follow-up at the PRED- IMED-Plus trial. Methods We assessed 5777 men (55–75 years) and women (60–75 years) with overweight or obesity and MetS at baseline from the PREDIMED-Plus trial. Dietary changes and MedDiet adherence were evaluated at baseline and after 1 year. The primary outcome was the change in nutrient density (measured as nutrient intake per 1000 kcal). Multivariable-adjusted linear regression models were ftted to analyse longitudinal changes in adherence to the MedDiet and concurrent changes in nutrient density. Results During 1-year follow-up, participants showed improvements in nutrient density for all micronutrients assessed. The density of carbohydrates (− 9.0%), saturated fatty acids (− 10.4%) and total energy intake (− 6.3%) decreased. These changes were more pronounced in the subset of participants with higher improvements in MedDiet adherence. Conclusions The PREDIMED-Plus dietary intervention, based on MedDiet recommendations for older adults, maybe a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity. Keywords Mediterranean diet · Nutrient density · Metabolic syndrome Abbreviations ANOVA Analysis of variance BMI Body Mass Index CI Confdence intervals CVD Cardiovascular disease Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00394-019-02087-1) contains supplementary material, which is available to authorized users. Extended author information available on the last page of the article