{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:02:10Z","timestamp":1789556530311,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,1]],"date-time":"2020-05-01T00:00:00Z","timestamp":1588291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The purpose of this study is to evaluate the effect of a Mediterranean diet supplemented with extra virgin olive oil and nuts on dry eye parameters. The participants in this study were randomized into one of the two interventional arms: (1) a standard intervention group, a Mediterranean diet supplemented with extra virgin olive oil and nuts; and (2) an intensive intervention group, based on a hypocaloric Mediterranean diet and an intensive lifestyle program with physical activity and weight-loss goals. In both groups, common dry eye tests were conducted at baseline and after six months: the Ocular Surface Disease Index (OSDI), the Dry Eye Scoring System (DESS), tear break-up time (TBUT), the Schirmer\u2019s test, and the Oxford staining grade. Sixty-seven eyes were examined. After six months, dry eye parameters improved in both groups; differences between groups were favorable for the intensive intervention group. The implementation of a Mediterranean diet pattern was beneficial for the selected patients with dry eye, and could be beneficial for patients with dry eye in general. Behavioral support for diet adherence and the promotion of healthy lifestyles (exercise) and weight loss (calorie restriction) have an added positive effect.<\/jats:p>","DOI":"10.3390\/nu12051289","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T03:29:39Z","timestamp":1588562979000},"page":"1289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Effectiveness of Mediterranean Diet Implementation in Dry Eye Parameters: A Study of PREDIMED-PLUS Trial"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4424-398X","authenticated-orcid":false,"given":"Ignacio","family":"Molina-Leyva","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hospital Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-2113","authenticated-orcid":false,"given":"Alejandro","family":"Molina-Leyva","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital Virgen de las Nieves, 18014 Granada, Spain"},{"name":"Department of Preventive Medicine and Public Health, Universidad de Granada, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3422-7310","authenticated-orcid":false,"given":"Blanca","family":"Riquelme-Gallego","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidad de Granada, 18016 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada IBS, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3640-5486","authenticated-orcid":false,"given":"Naomi","family":"Cano-Ib\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidad de Granada, 18016 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada IBS, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8703-0434","authenticated-orcid":false,"given":"Laura","family":"Garc\u00eda-Molina","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidad de Granada, 18016 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada IBS, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-3016","authenticated-orcid":false,"given":"Aurora","family":"Bueno-Cavanillas","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidad de Granada, 18016 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada IBS, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/00006324-199708000-00023","article-title":"A patient questionnaire approach to estimating the prevalence of dry eye symptoms in patients presenting to optometric practices across Canada","volume":"74","author":"Doughty","year":"1997","journal-title":"Optom. Vis. Sci. Off. Publ. Am. Acad. Optom."},{"key":"ref_2","first-page":"769","article-title":"Prevalencia de sintomas de enfermedad de la superficie ocular en pacientes que acuden a consulta oftalmologica","volume":"153","year":"2017","journal-title":"Gac. Med. Mex."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1007\/s11882-004-0077-2","article-title":"Dry eye: Diagnosis and current treatment strategies","volume":"4","author":"Collum","year":"2004","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Molina-Leyva, I., Molina-Leyva, A., and Bueno-Cavanillas, A. (2017). Efficacy of nutritional supplementation with omega-3 and omega-6 fatty acids in dry eye syndrome: A systematic review of randomized clinical trials. Acta Ophthalmol.","DOI":"10.1111\/aos.13428"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Seen, S., and Tong, L. (2017). Dry eye disease and oxidative stress. Acta Ophthalmol.","DOI":"10.1111\/aos.13526"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1080\/02713683.2017.1280511","article-title":"The Relationship between Metabolic Syndrome, Its Components, and Dry Eye: A Cross-Sectional Study","volume":"42","author":"Erdur","year":"2017","journal-title":"Curr. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1136\/bjophthalmol-2013-303953","article-title":"Decreased tear volume in patients with metabolic syndrome: The Osaka study","volume":"98","author":"Kawashima","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.2147\/OPTH.S95242","article-title":"Tear film osmolarity and dry eye disease: A review of the literature","volume":"9","author":"Potvin","year":"2015","journal-title":"Clin. Ophthalmol. (Auckl. N.Z.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.bbrc.2010.06.018","article-title":"Calorie restriction: A new therapeutic intervention for age-related dry eye disease in rats","volume":"397","author":"Kawashima","year":"2010","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1539\/joh.2017-0191-OA","article-title":"Impact of lifestyle intervention on dry eye disease in office workers: A randomized controlled trial","volume":"60","author":"Kawashima","year":"2018","journal-title":"J. Occup. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"943786","DOI":"10.1155\/2014\/943786","article-title":"The Association between Dry Eye Disease and Physical Activity as well as Sedentary Behavior: Results from the Osaka Study","volume":"2014","author":"Kawashima","year":"2014","journal-title":"J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Arpon, A., Milagro, F.I., Razquin, C., Corella, D., Estruch, R., Fito, M., Marti, A., Martinez-Gonzalez, M.A., Ros, E., and Salas-Salvado, J. (2017). Impact of Consuming Extra-Virgin Olive Oil or Nuts within a Mediterranean Diet on DNA Methylation in Peripheral White Blood Cells within the PREDIMED-Navarra Randomized Controlled Trial: A Role for Dietary Lipids. Nutrients, 10.","DOI":"10.3390\/nu10010015"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s13105-017-0552-6","article-title":"Adherence to Mediterranean diet is associated with methylation changes in inflammation-related genes in peripheral blood cells","volume":"73","author":"Arpon","year":"2016","journal-title":"J. Physiol. Biochem."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kojima, G., Avgerinou, C., Iliffe, S., and Walters, K. (2018). Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis. J. Am. Geriatr. Soc.","DOI":"10.1111\/jgs.15251"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ypmed.2006.12.009","article-title":"Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore","volume":"44","author":"Panagiotakos","year":"2007","journal-title":"Prev. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11745-010-3524-y","article-title":"Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors","volume":"46","author":"Gillingham","year":"2011","journal-title":"Lipids"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Sanches Machado d\u2019Almeida, K., Ronchi Spillere, S., Zuchinali, P., and Correa Souza, G. (2018). Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review. Nutrients, 10.","DOI":"10.3390\/nu10010058"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s11745-015-4113-x","article-title":"Current Evidence Supporting the Link Between Dietary Fatty Acids and Cardiovascular Disease","volume":"51","author":"Hammad","year":"2016","journal-title":"Lipids"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.2147\/OPTH.S22647","article-title":"Efficacy of a new prescription-only medical food supplement in alleviating signs and symptoms of dry eye, with or without concomitant cyclosporine A","volume":"5","author":"Jackson","year":"2011","journal-title":"Clin. Ophthalmol. (Auckl. N.Z.)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.preteyeres.2017.05.003","article-title":"The role of systemic and topical fatty acids for dry eye treatment","volume":"61","author":"Barabino","year":"2017","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ziemanski, J.F., Wolters, L.R., Jones-Jordan, L., Nichols, J.J., and Nichols, K.K. (2018). Relation between dietary essential fatty acid intake and dry eye disease and meibomian gland dysfunction in postmenopausal women. Am. J. Ophthalmol.","DOI":"10.1016\/j.ajo.2018.01.004"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.exer.2017.03.011","article-title":"The human meibomian gland epithelial cell line as a model to study meibomian gland dysfunction","volume":"163","author":"Hampel","year":"2017","journal-title":"Exp. Eye Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1097\/ICO.0000000000000874","article-title":"Influence of Omega 3 and 6 Fatty Acids on Human Meibomian Gland Epithelial Cells","volume":"35","author":"Liu","year":"2016","journal-title":"Cornea"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.nutres.2011.03.011","article-title":"Dietary polyunsaturated fatty acids reduce retinal stress induced by an elevation of intraocular pressure in rats","volume":"31","author":"Schnebelen","year":"2011","journal-title":"Nutr. Res. (N.Y.)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.exer.2013.12.014","article-title":"Alpha-lipoic acid restores tear production in an animal model of dry eye","volume":"120","author":"Andrade","year":"2014","journal-title":"Exp. Eye Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s00417-009-1080-z","article-title":"Efficacy of a 2-month dietary supplementation with polyunsaturated fatty acids in dry eye induced by scopolamine in a rat model","volume":"247","author":"Viau","year":"2009","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol. Albrecht Von Graefes Arch. Fur Klin. Und Exp. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.plefa.2017.10.006","article-title":"Abnormal lipoprotein oxylipins in metabolic syndrome and partial correction by omega-3 fatty acids","volume":"128","author":"Shearer","year":"2018","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.15537\/smj.2016.12.15623","article-title":"Dry eye disease in patients with metabolic syndrome","volume":"37","author":"Cakir","year":"2016","journal-title":"Saudi Med. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1185\/030079905X53333","article-title":"The prevalence of the metabolic syndrome using the National Cholesterol Educational Program and International Diabetes Federation definitions","volume":"21","author":"Athyros","year":"2005","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.3945\/ajcn.2008.26427","article-title":"Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: A randomized, controlled, investigator-blinded clinical trial","volume":"88","author":"Gisondi","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","unstructured":"WHO (2013). Country profiles on nutrition, physical activity and obesity in the 53 WHO European Region Member States. WHO Reg. Off. Eur. Cph. Den., 1, 10."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/5\/1289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:52:16Z","timestamp":1760363536000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/5\/1289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,1]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["nu12051289"],"URL":"https:\/\/doi.org\/10.3390\/nu12051289","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,1]]}}}