학술논문
Impact of COVID-19 pandemic on the PREDIMED-Plus randomized clinical trial: Effects on the interventions, participants follow-up, and adiposity
Document Type
article
Author
Indira Paz-Graniel; Montserrat Fitó; Emilio Ros; Pilar Buil-Cosiales; Dolores Corella; Nancy Babio; J. Alfredo Martínez; Ángel M. Alonso-Gómez; Julia Wärnberg; Jesús Vioque; Dora Romaguera; José López-Miranda; Ramon Estruch; Francisco J. Tinahones; José Lapetra; Lluis Serra-Majem; Aurora Bueno-Cavanillas; Josep A. Tur; Vicente Martín-Sánchez; Xavier Pintó; José Juan Gaforio; Pilar Matía-Martín; Josep Vidal; Clotilde Vázquez; Lidia Daimiel; Jesus F. García-Gavilán; Estefanía Toledo; Stephanie K. Nishi; Jose V. Sorlí; Olga Castañer; Antonio García-Ríos; Manoli García de la Hera; Francisco Javier Barón-López; Miguel Ruiz-Canela; Marga Morey; Rosa Casas; Eva María Garrido-Garrido; Lucas Tojal-Sierra; José C. Fernández-García; Zenaida Vázquez-Ruiz; Rebeca Fernández-Carrión; Albert Goday; Patricia J. Peña-Orihuela; Laura Compañ-Gabucio; Helmut Schröder; Miguel A. Martínez-Gonzalez; Jordi Salas-Salvadó
Source
Frontiers in Nutrition, Vol 9 (2023)
Subject
Language
English
ISSN
2296-861X
Abstract
BackgroundThe COVID-19 pandemic has affected the implementation of most ongoing clinical trials worldwide including the PREDIMED-Plus study. The PREDIMED-Plus is an ongoing, multicenter, controlled intervention trial, aimed at weight-loss and cardiovascular disease prevention, in which participants were randomized (1:1 ratio) to an intervention group (energy-reduced Mediterranean diet, promotion of physical activity, and behavioral support) or to a control group (Mediterranean diet with usual care advice). When the pandemic began, the trial was in the midst of the planned intervention. The objective of this report was to examine the effects of the pandemic on the delivery of the intervention and to describe the strategies established to mitigate the possible adverse effects of the pandemic lockdown on data collection and adiposity.MethodsWe assessed the integrity of the PREDIMED-Plus trial during 5 identified periods of the COVID-19 pandemic determined according to restrictions dictated by the Spanish government authorities. A standardized questionnaire was delivered to each of the 23 PREDIMED-Plus recruiting centers to collected data regarding the trial integrity. The effect of the restrictions on intervention components (diet, physical activity) was evaluated with data obtained in the three identified lockdown phases: pre lockdown, lockdown proper, and post lockdown.ResultsDuring the lockdown (March/2020-June/2021), 4,612 participants (48% women, mean age 65y) attended pre-specified yearly follow-up visits to receive lifestyle recommendations and obtain adiposity measures. The overall mean (SD) of the proportions reported by each center showed that 40.4% (25.4) participants had in-person visits, 39.8% (18.2) participants were contacted by telephone and 35% (26.3) by electronic means. Participants’ follow-up and data collection rates increased across lockdown periods (from ≈10% at onset to ≈80% at the end). Compared to pre-lockdown, waist circumference increased during (0.75 cm [95% CI: 0.60–0.91]) and after (0.72 cm [95% CI: 0.56–0.89]) lockdown. Body weight did not change during lockdown (0.01 kg [95% CI: –0.10 to 0.13) and decreased after lockdown (-0.17 kg [95% CI: –0.30 to –0.04]).ConclusionMitigating strategies to enforce the intervention and patient’s follow-up during lockdown have been successful in preserving the integrity of the trial and ensuring its continuation, with minor effects on adiposity.Clinical trial registrationhttps://doi.org/10.1186/ISRCTN89898870, identifier ISRCTN89898870.