Effectiveness of a community-based nutritional intervention on Mediterranean Diet adherence in rural older adults: A quasi-experimental study

Objective To evaluate the effectiveness of a community intervention on lifestyle in adherence to the Mediterranean Diet and the metabolic health of a highly vulnerable rural population. Design 12-Month prospective quasi-experimental study. Setting Sparsely populated rural primary care areas in the south of Spain. Participants 187 adults aged ≥ 65 years, allocated to a Control Group (CG: n = 96) and an Intervention Group (IG: n = 91). 91.4% reported low socioeconomic status and 85% possessed only primary education or were illiterate. Interventions The IG received personalized nutritional counseling and educational workshops led by community pharmacists, designed to complement standard primary care. The CG received standard care. Main measurements The primary outcome was Mediterranean Diet adherence (MEDAS-14 test). Secondary outcomes included physical activity levels, body mass index, waist circumference, and lipid profiles (total cholesterol, triglycerides, LDL, HDL). Results Following the 12-month intervention, the IG exhibited a profound behavioral shift: the proportion of participants with high Mediterranean Diet adherence skyrocketed from 51.6% to 92.3%, and those engaging in high physical activity increased almost sixfold (6.6–38.5%). The CG showed no lifestyle improvements. The IG achieved progressive, statistically significant reductions in waist circumference, triglycerides, and LDL-cholesterol (Rosenthal's r ≈ 0.50). Conclusions A pharmacist-led intervention effectively overcomes severe health literacy barriers. This task-shifting model induces massive lifestyle changes and mitigates cardiometabolic risk, relieving overburdened rural primary care teams.