This Is AuburnElectronic Theses and Dissertations

The Evaluation of a Pilot Theory-Based Nutrition Intervention Promoting a Mediterranean diet for the Reduction of Cardiovascular Disease Risk Factors in a High-Risk Population of the Southeastern United States: The Healthy Hearts Program




Willis, Amy

Type of Degree

PhD Dissertation


Nutrition, Dietetics and Hospitality Management


In the United States, Cardiovascular disease (CVD) is responsible for 25% of deaths among adults with morbidity rates highest in the southeastern region of the country. Despite studies showing adherence to a Mediterranean-style Diet (MD) can decrease CVD risk, no clinical MD studies have been conducted in the southeastern United States and few studies worldwide have documented theory-based nutrition education usage in such studies. The primary aim of the study was to develop a 12-week, theory-based, nutrition education intervention that promotes MD dietary patterns with the supplementation of EVOO and mixed nuts for the reduction of CVD risk in a high-risk population of the southeastern US. The framework and implementation of the nutrition education component of the intervention was based on the constructs of the social cognitive and the self-determination theory. Thirty participants were randomized into either the American Heart Association group or the MD group. Each group received a 12-week, web-based nutrition education program including 7 nutrition education sessions; weekly access to a registered dietitian; and discussion boards; handouts, recipes, and grocery lists. At baseline and 6 weeks the MD group also received extra-virgin olive oil (EVOO) and mixed nuts. Blood samples; urine; blood pressure; height; waist, and hip circumference; and body weight and composition were measured at baseline, 6- and 12-weeks. Participants also completed a Mediterranean diet screener (MDS), and the International Physical Activity Questionnaire. At 12-weeks both groups had increased nutrition knowledge and MD adherence; however, changes were greater in the MD group. Percent education completion significantly impacted MD adherence scores. Nutrition knowledge and adherence impacted blood glucose, total cholesterol, and non-HDLc. Nutrition knowledge also significantly influenced total cholesterol to HDLc ratio. The AHA group also saw negative shifts for both HDLc (decreased values), LDLc (upward trends) and increased total cholesterol to HDLc ratio. Nut consumption and the interaction of nut and EVOO consumption was correlated with positive changes in HDLc. Percent EVOO consumption was shown to decrease LDLc. Therefore, this pilot study was successful in increasing nutrition knowledge and MD adherence and reducing CVD risk factors in a high-risk population in the Southeastern US.