1. Introduction
AMD
DISEASES, CARDIOVASCULAR DISEASES
There is an urgent need to implement intervention programs to promote adherence to the Mediterranean diet (AMD) in university students to prevent non-communicable diseases. A powerful tool for this is smartphone apps. Furthermore, it is necessary to determine the subgroups that are most likely to benefit from these technologies. The objective is to evaluate the effectiveness of an app (e-12HR) at improving AMD in a sample of Spanish university students and different strata. The study method was a controlled and randomized clinical trial over a four-week follow-up period and involving 385 participants (76.9% women). The participants were in two parallel groups: the control group (CG) and the intervention group (IG), with only the IG receiving feedback to improve their AMD. There were significant statistical improvements (with higher values in the IG) at week four, after no significant statistical differences at baseline (Week One): in the whole sample: +25.7% AMD index and +74.5% percentage with moderate/high AMD index. In the subgroups, seven of eight subgroups, ranging in AMD index from +17.8% (≥20 years) to +33.0% (<20 years); and for males, in weeks two (+27.9%) and three (+23.9%), but not at week four. In conclusion, e-12HR could improve AMD among university students (in the total sample and all subgroups, except ≥25 kg/mUniversity students are particularly vulnerable to nutritional alterations mainly due to the fact that many are faced for the first time with the opportunity to make their own dietary choices [Numerous epidemiological and nutritional studies have shown that a healthy diet, such as the Mediterranean diet (MD), improves the quality of life and helps prevent several non-communicable diseases (NCDs) such as cardiovascular diseases [Although there is no single MD, common aspects of this healthy dietary pattern include a high intake of fruits, vegetables, legumes, and cereals; olive oil as the main fat; moderate amounts of dairy products and fish; and low amounts of meat and meat products [The degree of adherence to MD (AMD) of Spanish university students has been the subject of several studies, which have shown that more than half of these students had poor AMD [Several studies have analyzed the AMD in different population strata of university students (by age, gender, field of study and body mass index (BMI)). According to age group, gender, and BMI, the results were inconsistent. With respect to age group, various studies have shown that AMD increased as age did [University students are an important target audience for public health actions, as this is a stage where they can consolidate previously learned patterns or learn new ones to replace old ones, ultimately establishing their nutritional habits for the future [A powerful tool to promote and improve AMD among university students is the utilization of smartphone apps. Previously, the research team developed and validated a mobile app for measuring AMD called e-12HR [As a continuation of the research team’s previous studies, the main hypothesis of this work was that the previously mentioned factors influencing AMD [