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Effect of a PROtein-enriched MEDiterranean diet and EXercise (PROMED-EX) on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline: the PROMED-EX randomized controlled trial
Nicola Ann Ward, Rachel Reid-McCann, Danielle Logan, Dominic N Farsi, Lorraine Brennan, Chris R. Cardwell, C.P.G.M. de Groot, Stefania Maggi et al.. American Journal of Clinical Nutrition, 2026-08-14
Topic: Brain proteins, microglia and lab models
At baseline, the mean MNA score was 22.5 ± 2.3. After 6 mo, nutritional status improved significantly in both intervention groups compared with CON: mean differences in MNA were 2.7 [95% confidence interval (CI): 1.3, 4.2] for PROMED and 2.9 (95% CI: 1.5, 4.3) for PROMED-EX (both P < 0.001). Cognitive function also improved, with NTB z-score differences of 0.3 (95% CI: 0.1, 0.5; P = 0.01) in PROMED and 0.2 (95% CI: 0.0, 0.4; P = 0.02) in PROMED-EX compared with CON. Diet quality scores significantly increased with mean differences of 4.0 (95% CI: 2.9, 5.0) for PROMED and 3.9 (95% CI: 2.8, 4.9) for PROMED-EX compared with CON (both P < 0.001). Despite low adherence to exercise, additional benefits were observed for physical performance and quality of life. Dietary intervention improved nutritional status in community-dwelling older adults at risk of undernutrition. Correcting undernutrition could help to slow cognitive decline and promote physical health and quality of life during aging. This study was registered at clinicaltrials.gov as NCT05166564.
Key findings
- At baseline, the mean MNA score was 22.5 ± 2.3.
- After 6 mo, nutritional status improved significantly in both intervention groups compared with CON: mean differences in MNA were 2.7 [95% confidence interval (CI): 1.3, 4.2] for PROMED and 2.9 (95% CI: 1.5, 4.3) for PROMED-EX (both P < 0.001).
- Cognitive function also improved, with NTB z-score differences of 0.3 (95% CI: 0.1, 0.5; P = 0.01) in PROMED and 0.2 (95% CI: 0.0, 0.4; P = 0.02) in PROMED-EX compared with CON.
- Diet quality scores significantly increased with mean differences of 4.0 (95% CI: 2.9, 5.0) for PROMED and 3.9 (95% CI: 2.8, 4.9) for PROMED-EX compared with CON (both P < 0.001).
- Despite low adherence to exercise, additional benefits were observed for physical performance and quality of life.
Why it matters
In this 6-month trial, older adults at risk of undernutrition and cognitive decline who received a protein-enriched Mediterranean diet, with or without exercise, showed improved nutritional status and cognitive function compared with the control group. Correcting undernutrition could help slow cognitive decline and promote physical health during aging.
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Study details
- Participants105
- Evidence strengthHigh
How this study scored 49/100
Published in a peer-reviewed journal. Scored zero for study design and effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (American Journal of Clinical Nutrition) |
| Journal's citation record | 3 / 4 | American Journal of Clinical Nutrition: journal h-index 499 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 105 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.5 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 3 / 6 | Cited 4.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Claire T. McEvoy: h-index 24 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Wageningen University & Research: institution h-index 990 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 9 institution(s) in 5 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42680255) |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1016/j.ajcnut.2026.101383
- PubMed: 42680255
- Original source →
- Free full text: American Journal of Clinical Nutrition →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Ward, N. A., Reid-McCann, R., Logan, D., Farsi, D. N., Brennan, L., Cardwell, C. R., et al. (2026). Effect of a PROtein-enriched MEDiterranean diet and EXercise (PROMED-EX) on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline: the PROMED-EX randomized controlled trial. American Journal of Clinical Nutrition. https://doi.org/10.1016/j.ajcnut.2026.101383
Vancouver
Ward NA, Reid-McCann R, Logan D, Farsi DN, Brennan L, Cardwell CR, et al. Effect of a PROtein-enriched MEDiterranean diet and EXercise (PROMED-EX) on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline: the PROMED-EX randomized controlled trial. American Journal of Clinical Nutrition. 2026. doi:10.1016/j.ajcnut.2026.101383. PMID: 42680255.
BibTeX
@article{ward2026-42680255,
author = {Ward, Nicola Ann and Reid-McCann, Rachel and Logan, Danielle and Farsi, Dominic N and Brennan, Lorraine and Cardwell, Chris R. and de Groot, C.P.G.M. and Maggi, Stefania and others},
title = {{Effect of a PROtein-enriched MEDiterranean diet and EXercise (PROMED-EX) on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline: the PROMED-EX randomized controlled trial}},
journal = {American Journal of Clinical Nutrition},
year = {2026},
doi = {10.1016/j.ajcnut.2026.101383},
pmid = {42680255},
url = {https://doi.org/10.1016/j.ajcnut.2026.101383}
}
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