2.4. Intervention
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The dietary intervention was a step-by-step educational pathway, intended to encourage participants’ adherence to a Mediterranean diet pattern, provided by trained nutritionists in individual meetings. Accordingly, the latest version of the Mediterranean food pyramid was used to build up a model of intervention, to achieve the following goals:Daily vegetables and fruit intake (possibly seasonal and organic)Increase pulses intake up to 3/4 times a weekIncrease fish intake up to 3/4 times a week (particularly oily fish)Encourage nuts intake, up to 30 g a dayEncourage consumption of extra virgin olive oilEncourage consumption of whole grains and their productsLimit cheese consumption twice a week (milk, yoghurt and kefir were allowed every day)Limit meat intake to 3/4 times a week (2/3 times white meat, once a week red and processed meat)Limit alcohol consumption to a maximum of 2 alcohol units a dayLimit desserts and sweet snacks to once a weekAfter having collected the subject’s dietary habits using the EPIC questionnaire, the nutritionist proposed an individualized diet to each participant, based on some specific goals. The nutritionists developed a brief booklet, introducing the Mediterranean diet and describing its main food categories, as well as their suggested intakes. The booklet was provided to each subject of the intervention group during the first meeting. A regular and moderate physical activity of at least 150 min every week was also recommended if the participant did not play sports regularly.Various models have been proposed for counseling for behavior changes to prevent no adherence to recommended lifestyle changes, which is a frequent and difficult obstacle to achieve significant results [1st month: once a week2nd and 3rd months: every two weeks4th month: at the end of the month (final examination)To keep the participants motivated to achieve their individualized goals, they were asked to record their food intake in a diary during the last 30 days.The control group received only a leaflet reporting a graphic representation of the Mediterranean diet pyramid and generic recommendations for a correct diet by the Italian Council for Agricultural Research and Economics [