4. Discussion
Anxiety, anxiety, breast cancer, multiple sclerosis, depression
MULTIPLE SCLEROSIS, BREAST CANCER
In the present 3month randomised controlled trial, we explored whether a personalised dietary regimen together with nutritional consultation supported by the CDSS, would be beneficial in improving MD adherence of healthy pregnant women. Our results indicate that the CDSS can assist clinicians to increase MD adherence during pregnancy and enhance nutritional status by increasing dietary intake of fiber. In fact, women following MD ameliorated body composition, blood lipid profile, and serum glucose at the study endpoint (3 months).It is well established that greater adherence to the MD during gestation is beneficial for the health of both the mother and the offspring [Regarding our primary outcome, we succeeded in proving our hypothesis that the use of CDSS increases adherence to the MD, as pregnant women in the CDSS group experienced an increase in the MedDietScore at the first trimester of their pregnancy, while women in the control group who received general lifestyle guidelines did not. Similarly, the same effect of CDSS application on MD adherence was observed in other studies of our group, which included breast cancer and multiple sclerosis patients [Our study also showed improved nutritional status in pregnant women who were supported with CDSS during the first semester of the pregnancy compared to those who only received lifestyle counseling. The CDSS group increased fibre intake, while the control group did not. Additionally, a slight increase in energy intake in the CDSS group and a respective decrease in the control group resulted in a significant difference between changes at follow-up. After follow-up, the percentage of fat intake in the intervention group increased, but that of the control group remained unchanged. The mean changes in percent fat intake of the two groups were significant at follow-up. Since olive oil is abundantly used in cooking and dressing, the MedDiet is not considered a high-unsaturated-fat food pattern.Regarding psychological status, pregnant women in the CDSS group presented a better anxiety level at the end of the trial, whereas the control group had a better depression level, although the depression category did not change in either group. Anxiety and depression during pregnancy have been associated with undesirable outcomes for both the mother and the offspring, such as shorter gestation, lower birth weight, and impaired foetal neurodevelopment [Potential limitations of the present study are the sample size, which is relatively small, and the use of self-reported tools such as food diaries. Therefore, results should be interpreted with caution. Nevertheless, we tried to address these limitations; we applied a computer-generated simple randomisation that was applied by a statistician who was not aware of the treatment allocation. Furthermore, all the appointed dieticians who supervised participants throughout the intervention were well experienced. They were able to identify possible disparities and seek clarifications from participants. Additionally, all tools used for nutritional and psychological status (FFQ, MedDietScore, and HADS) have been validated in the Greek population. Another potential limitation that occurs in nutritional interventions is treatment contamination in the control group. To overcome this, different dieticians were assigned for each study group. Finally, we recognise that subjects with limited computer skills would have difficulties using the CDSS in everyday life. Therefore, before the start of the intervention, all volunteers were trained to use the CDSS and were supported throughout the study.