Exploring the Facilitators and Barriers of Adherence to Mediterranean-Ketogenic
Dietary Interventions in Parkinson s Disease: A Qualitative Study
#MMPMID41341605
Tosefsky KN
; Wang YN
; Lam JS
; Cohen TR
; Appel-Cresswell S
Curr Dev Nutr
2025[Nov]; 9
(11
): 107591
PMID41341605
show ga
BACKGROUND: Emerging research suggests indications for both Mediterranean and
ketogenic diets in Parkinson's disease (PD), with hybrid Mediterranean-ketogenic
interventions potentially conferring maximal benefit. However, the acceptability
of these interventions in individuals with PD (PwPs) remains to be established.
OBJECTIVES: To explore and compare factors affecting PwPs' experiences with and
adherence to an 8-wk Mediterranean-ketogenic (MeDi-KD) versus an 8-wk
medium-chain triglyceride (MCT)-supplemented Mediterranean (MeDi-MCT) diet.
METHODS: Forty-eight PwPs took part in ?1 phase of the crossover trial.
Sixty-seven semistructured interviews were completed by 44 participants after
each intervention. Interview questions, structured using the Theory of Planned
Behavior (TPB), explored how participant attitudes, control beliefs,
environmental contexts, and social influences impacted study diet adherence.
Reflexive thematic analysis was applied to interview transcripts. RESULTS: Two
subthemes each emerged under of the overall themes of "Attitudes," "Perceived
behavioral control," and "Subjective norms" within the TPB framework. Attitudes
toward MeDi-KD and MeDi-MCT compositions were polarized, based on varying levels
of familiarity with similar dietary patterns, diverging taste preferences, and
wide-ranging expectations of effects on PD-specific and general health outcomes.
Capability and resources grouped together naturally under the "Perceived
behavioral control" theme. Within this domain, competing personal
responsibilities, attentional resources diverted to disease management tasks,
PD-related apathy, and motor deficits compromising cooking skills, all proved
especially problematic during the labor-intensive MeDi-KD phase. In the
"Subjective norms" domain, household and cultural acceptance of study diets
proved crucial for sustained adherence. Our study's registered dietitian played a
pivotal role in supporting adherence through the direct provision of
informational, instrumental, and social support, as well as by engaging care
partners to bolster social support within the home. CONCLUSIONS: Our qualitative
analysis illuminates behavioral and contextual determinants of adherence to
keto-adapted MeDis in PwPs, informing more sustainable dietary implementation
strategies relevant both to future trial design and dietetics clinical
practice.This trial was registered at clinicaltrials.gov as NCT05469997.
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