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Paz-Graniel I, Fitó M, Ros E, Buil-Cosiales P, Corella D, Babio N, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Serra-Majem L, Bueno-Cavanillas A, Tur JA, Martín-Sánchez V, Pintó X, Gaforio JJ, Matía-Martín P, Vidal J, Vázquez C, Daimiel L, García-Gavilán JF, Toledo E, Nishi SK, Sorlí JV, Castañer O, García-Ríos A, García de la Hera M, Barón-López FJ, Ruiz-Canela M, Morey M, Casas R, Garrido-Garrido EM, Tojal-Sierra L, Fernández-García JC, Vázquez-Ruiz Z, Fernández-Carrión R, Goday A, Peña-Orihuela PJ, Compañ-Gabucio L, Schröder H, Martínez-Gonzalez MA, Salas-Salvadó J. Impact of COVID-19 pandemic on the PREDIMED-Plus randomized clinical trial: Effects on the interventions, participants follow-up, and adiposity. Front Nutr 2023; 9:1098269. [PMID: 36712515 PMCID: PMC9878159 DOI: 10.3389/fnut.2022.1098269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background The 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. Methods We 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. Results During 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]). Conclusion Mitigating 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 registration https://doi.org/10.1186/ISRCTN89898870, identifier ISRCTN89898870.
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Affiliation(s)
- Indira Paz-Graniel
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain,Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Montserrat Fitó
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d‘Investigació Médica (IMIM), Barcelona, Spain
| | - Emilio Ros
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Pilar Buil-Cosiales
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Primary Health Care, IdiSNA, Servicio Navarro de Salud, Pamplona, Spain
| | - Dolores Corella
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,School of Medicine, Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain
| | - Nancy Babio
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain,Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - J. Alfredo Martínez
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain,Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Ángel M. Alonso-Gómez
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Jesús Vioque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - Dora Romaguera
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José López-Miranda
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Ramon Estruch
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco J. Tinahones
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, Málaga, Spain
| | - José Lapetra
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Research Unit, Department of Family Medicine, Distrito Sanitario Atención Primaria Seville, Seville, Spain
| | - Lluis Serra-Majem
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain
| | - Aurora Bueno-Cavanillas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Josep A. Tur
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Vicente Martín-Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Xavier Pintó
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-Idibell, Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, Spain
| | - José Juan Gaforio
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Departamento de Ciencias de la Salud, Instituto Universitario de Investigación en Olivar y Aceites de Oliva, Universidad de Jaén, Jaén, Spain
| | - Pilar Matía-Martín
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Josep Vidal
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Endocrinology, Institut d’Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Clotilde Vázquez
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Endocrinology and Nutrition, Hospital Fundación Jimenez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, Madrid, Spain
| | - Lidia Daimiel
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Jesus F. García-Gavilán
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain,Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Estefanía Toledo
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain
| | - Stephanie K. Nishi
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain,Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada,Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Unity Health Toronto, ON, Canada
| | - Jose V. Sorlí
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,School of Medicine, Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain
| | - Olga Castañer
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d‘Investigació Médica (IMIM), Barcelona, Spain
| | - Antonio García-Ríos
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Manoli García de la Hera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - Francisco Javier Barón-López
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Miguel Ruiz-Canela
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain
| | - Marga Morey
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Rosa Casas
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Lucas Tojal-Sierra
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - José C. Fernández-García
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, Málaga, Spain
| | - Zenaida Vázquez-Ruiz
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain
| | - Rebeca Fernández-Carrión
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,School of Medicine, Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain
| | - Albert Goday
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d‘Investigació Médica (IMIM), Barcelona, Spain
| | - Patricia J. Peña-Orihuela
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Laura Compañ-Gabucio
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España,Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - Helmut Schröder
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d‘Investigació Médica (IMIM), Barcelona, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Miguel A. Martínez-Gonzalez
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States,Miguel A. Martínez-Gonzalez,
| | - Jordi Salas-Salvadó
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Institute of Health Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain,Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,*Correspondence: Jordi Salas-Salvadó,
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Pekmezi D, Fontaine K, Rogers LQ, Pisu M, Martin MY, Schoenberger-Godwin YM, Oster RA, Kenzik K, Ivankova NV, Demark-Wahnefried W. Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) cancer survivor health: program project protocols for remote lifestyle intervention and assessment in 3 inter-related randomized controlled trials among survivors of obesity-related cancers. BMC Cancer 2022; 22:471. [PMID: 35488238 PMCID: PMC9051494 DOI: 10.1186/s12885-022-09519-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project. METHODS Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis. DISCUSSION Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov , NCT04000880 . Registered 27 June 2019.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA.
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yu-Mei Schoenberger-Godwin
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Kelly Kenzik
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | | | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
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