Introduction: Data are limited if Western populations can adhere to the Predimed Diet (PD), the Mediterranean Diet supplemented with olive oil or nuts. 

Objectives: To determine if patients in a healthy heart program can adhere to the PD.  To identify factors that improves or worsen dietary adherence to the PD in a Western population.

Methods: A 6 month qualitative study was conducted in self-selected adults (n=30) using a validated 14 point Mediterranean Diet Questionnaire (MDQ) score where ≥9 points indicated adherence to the PD as well as 3 day food record analyses.  Factors affecting adherence were identified using a 10 question semi-structured interview.

Results: The MDQ average score was 5.6 ± 2.2 at baseline and 9.2 ± 2.4 (p<0.001) with 63% adherence of participants at completion.  Adherence was high for consuming olive oil as the main culinary fat (97% of the participants); the recommended amount of nuts (93%) and low for consuming fish (53%) and wine (27%).  Monounsaturated fat intake increased from 10 ± 4.6 to14 ± 6.0 percent of total energy (p<0.001).  Participants scoring ≥9 felt this diet was not more expensive and food was readily available. However, participants scoring ≤9 stated that the volume of vegetables was too large, they missed consuming red meat as often and they were not accustomed to using the recommended amount of legumes.  

Conclusions: Sixty-three percent of our participants could adhere to the PD in this Western population.  Overall most participants were satisfied with the diet, would continue to follow this diet and recommend it to friends and family. 

Significance to dietetics:  These results identified most of the components of the PD are easy to follow however, consuming supplemental olive oil, legumes, vegetables, fish and wine are difficult.  Additional nutrition counseling may be required to improve adherence to these components of the PD.

Determining the feasibility of following the Mediterranean/Predimed diet in a North American setting of patients attending a healthy heart program