1. Introduction
Obesity, ADRD, anxiety, ’, inflammation, dementia, chronic diseases, MCI, Alzheimer’s disease, MKN
OBESITY, INFLAMMATION, OXIDATIVE STRESS, CHRONIC DISEASES
(1) Background: Mediterranean ketogenic nutrition (MKN) may directly target multiple neurobiological mechanisms associated with dementia risk in older adults. Despite its promise, this type of nutrition can be challenging to learn and adhere to in a healthy manner. Our team used the National Institutes of Health Obesity Related Behavioral Intervention Trials (NIH ORBIT) model to develop and pilot a program to help older adults with memory concerns use MKN. (2) Methods: Using a two-arm, randomized design, we evaluated an MKN Adherence (MKNA) program compared to an MKN education (MKNE) program (Research shows that modifiable factors account for up to 40% of Alzheimer’s disease and related dementia (ADRD) risk [Multiple mechanisms between these diets and ADRD have been proposed. For the Mediterranean diet, there is evidence that benefits may be derived through increased fruit and vegetable intake in addition to high intake of monounsaturated fats, which may reduce inflammation and oxidative stress, in addition to cardiovascular risks for ADRD [Despite promising evidence of the effectiveness of these diets, there are multiple societal and individual-level factors affecting the integration of this information into daily practice. First, nutrition recommendations are frequently changing, and specialized ways of eating are often viewed as “fad diets.” Recently, these problems have been exacerbated by highly processed, expensive products labeling themselves as “keto” or “heart healthy,” without evidence to support claimed health benefits. Thus, misinformation about the health benefits of different foods is highly prevalent, and many individuals do not have the information needed to make choices that will promote brain health. Another challenge, common to many lifestyle interventions and diets, is the issue of long-term adherence. Mediterranean and ketogenic diets may be particularly challenging due to the greater divergence from a traditional Western diet, as well as perceived costs of these “healthier” foods. Further, adherence is influenced by a range of personal characteristics, such as enjoyment from eating unhealthy foods, feeling deprived, and eating due to stress or anxiety [The success of MKN in addressing ADRD risk rests on the ability to develop behavioral interventions that provide individuals with the education, support, and skills needed for making this lifestyle change in a way that can be easily disseminated to the larger population. The National Institute of Health-funded Obesity Related Behavioral Intervention Trials (ORBIT) model provides a framework for developing and testing behavioral interventions for chronic diseases [To address these challenges, our team developed a nutrition program designed for older adults with cognitive concerns and possible MCI. This 6-week group program provides participants with in-depth information about using MKN, framing this shift as a change in nutrition versus short-term dieting. Participants are provided with basic nutrition education for broadly understanding and evaluating the food they eat and purchase, while providing a supportive environment and additional skills training for overcoming personal challenges. Specifically, we incorporated principles of MI and BCTs to help participants identify their own values and reasons for making a lifestyle change, while providing structured skills practice for overcoming long-term obstacles. BCTs are often considered the ‘active ingredient’ in behavioral interventions that influence mechanisms of action [Using the ORBIT framework, the current study was a feasibility pilot (Phase 2b) designed to evaluate the MKNA program in a larger sample with a goal of assessing whether the MI-BCT components are effective in improving adherence or require additional refinement. Further, the study aimed to confirm the feasibility and acceptability of the program, as well as evaluate important clinical outcomes, such as cognition and cardiometabolic markers. A two-arm, pilot clinical trial was completed with a total of 58 participants who were randomized to an MKNA arm or an MKN education (MKNE)-only arm.