Abstract
Introduction:Undernutrition, caused by inadequate food or nutrient intake, is common in older adults and linked to increased dementia risk. Unintentional weight loss can precede dementia by over a decade, offering a window for early intervention. The PROMED-EX trial investigated whether a protein-optimised Mediterranean diet, with or without exercise, could improve nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline.
Methods:
105 participants aged 60 years and over at risk of undernutrition and with subjective cognitive decline were recruited for a 6-month, single-blind, parallel-group RCT. Participants were randomised to receive either a diet and exercise intervention (PROMED-EX), a diet-only intervention (PROMED), or standard care. The primary outcome was nutritional status (Mini Nutritional Assessment). Secondary outcomes included cognitive and physical function, muscle strength, appetite, diet quality, and adherence.
Results:
The PROMED-EX Trial successfully recruited its target (n=105) over 18 months. At the outset, many participants had low intakes of key nutrients, including energy, protein, fibre, vitamin D and selenium. Furthermore, 63% reported poor appetite. Both interventions significantly improved MNA scores after 6 months (+4.5; +4.5; +0.9 in the PROMED-EX, PROMED and Control; P<0.001). There were significant improvements in the intake of several nutrients and micronutrients; however, exercise compliance was poor, with no significant changes in PAEE score in the PROMED-EX group.
Discussion:
The PROMED-EX RCT demonstrated that a personalised, nutrient-dense diet improved nutritional status and diet quality among older adults at increased risk of undernutrition and cognitive decline, and that older adults can improve diet behaviour with the right level of support. This food-based approach had beneficial effects on important health outcomes, including cognitive function, even though the ability to detect this was underpowered. These results support the value of early dietary intervention and justify a larger, longer-term study.
Thesis is embargoed until 31 July 2026.
| Date of Award | Jul 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Sponsors | European Joint Programming Initiative , EC-Horizon Europe & Northern Ireland Department for the Economy |
| Supervisor | Claire McEvoy (Supervisor) & Jayne Woodside (Supervisor) |
Keywords
- Undernutrition
- older adults
- mediterranean diet
- protein
- exercise
- community intervention
- subjective cognitive decline
- dementia
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