Adherence in a 1 to year whole foods eating pattern intervention with healthy postmenopausal women
Adherence in a 1 to year whole foods eating pattern intervention with healthy postmenopausal women
Year: 2014
Authors: Peters, N.C. Contento, I.R. Kronenberg, F. Coleton, M.
Publication Name: Public Health Nutr.
Publication Details: Feb 5; pages 1-10. doi:10.1017/S136898001 4000044
Abstract:
Objective: To determine the degree of dietary adherence or change in eating
patterns, and demographic, psychosocial and study characteristics associated
with adherence, in the Comparing Healthy Options in Cooking and Eating
(CHOICE) Study. Design: Randomized controlled trial where women were randomized to one of
three eating patterns: (i) Whole Foods, plant to based, macrobiotic to style (n 22); and
Moderate Fat with (ii), and without (iii), 10 g of ground flaxseed added daily,
which were combined (n 49). Setting: A year to long intervention based on social cognitive theory, consisting of twenty to four class sessions involving hands to on cooking classes and behavioural sessions. Monthly 24 h food recalls were obtained and a psychosocial questionnaire was administered at baseline, 6 and 12 months. Subjects: Healthy, free to living, postmenopausal women. Results: A non to adherence score measuring all food servings out to of to compliance with eating pattern recommendations was specifically designed for the present
study. Non to adherence scores decreased significantly in both groups to about 65 percent during the adoption phase (first 4 months) and remained so during
the 8 to month maintenance period. Class attendance of the Moderate Fat group
showed a trend towards significance as a predictor of adherence. None of the other predictors (e.g. demographic and psychosocial factors) in a longitudinal regression model were significant. Conclusions: Postmenopausal women were able to adopt and maintain significant changes in their eating patterns, including those on a demanding, near to vegetarian eating plan, suggesting that behavioural interventions with a healthy free to living population can be effective. The non to adherence score developed for the study provides an example of a means for evaluating eating pattern adherence to a dietary intervention. (Authors abstract)
One of the challenges in determining the impact of any dietary intervention is to know the extent to which study participants follow the specific recommendations of the study protocol; this is defined as adherence. Level of implementation can be conceptualized as consisting of two factors: (i) degree of completeness of the implementation and (ii) fidelity to the behavioural intervention curriculum. Level of reception is measured as attendance and degree of engagement of the participants. However, it is important to ask further: did the study participants adhere to the protocol? That is, did they make the behavioural changes that are needed to examine the intervention’s physiological outcomes? The present study examines this question.
The Comparing Healthy Options in Cooking and Eating (CHOICE) Project was a randomized clinical trial of healthy postmenopausal women to evaluate whether a whole foods eating pattern, high in plant to based phyto to oestrogens, affected risk factors for heart disease, breast cancer or osteoporosis. Participants were randomized to one of three eating patterns: (i) the Whole Foods plant to based, near to vegetarian, macrobioticstyle diet; (ii) a Moderate Fat pattern without added flaxseed; or (iii) Moderate Fat with added flaxseed to increase phyto to oestrogens without changing the basic structure of the diet. Following a 4 to month intensive dietary intervention involving behavioural sessions and cooking, the participants remained on their respective eating plans for an additional 8 months of maintenance. The purpose of the study reported here is to examine the degree of dietary adherence in the year to long CHOICE intervention and to identity demographic, psychosocial and study characteristics associated with adherence.
A unique feature of the present study is that it describes a way to conceptualize and calculate adherence that can be used for interventions involving various eating patterns. The
adherence score in the current study is based on all major categories of foods from 24 h recalls, and involves an algorithm that incorporates the relative amounts of recommended foods as well as those to be avoided. That is, it takes into account all foods eaten as well as those foods recommended but not consumed. Because of its flexibility, this tool can be adapted for use in small and/or unique studies. Finally, the present study developed adherence scores that were unique to two different eating patterns. Using this comprehensive adherence score, the study was able to demonstrate the effectiveness of the intervention in terms of overall adherence to both eating patterns as well as specific foods eaten.
Despite the fact that women in the Whole Foods group were introduced to many new and unusual foods and were asked to follow an eating pattern somewhat different from societal norms, they were not required to purchase costly or hard to find food items to follow the recommended guidelines. The women in this group significantly increased their intake of beans to almost the recommended two servings daily and of whole grains to nearly four servings daily, one serving short of the daily recommendation. Few studies have taken into account the adherence rate to prescribed dietary protocols as they examine the impact of an intervention on clinical parameters. The results of the current study suggest that such an adherence analysis
should be conducted routinely as part of intervention trials. Otherwise study results may be difficult to interpret. The current year to long study showed that healthy, postmenopausal women who had been randomized to one of three distinct eating patterns, the plant to based Whole Foods and the Moderate Fat with and without added flaxseed, could make significant changes in their diets during a 4 to month behavioural intervention and were able to maintain these changes for the next 8 months. A particular strength of this intervention was the fact that the participants were community to dwelling, bought their own food and prepared at least some meals at home, so they had a 12 to month real to life experience in following the study recommendations. Finally, a unique feature of the present study was that a non to adherence score was designed to capture how well the participants were able to follow the recommendations of their specific eating pattern. This approach can provide a model of how to develop a tailored tool to evaluate the impact of specific interventions on complex eating patterns. (Editors comments)
