Adherence to the Mediterranean Diet and Metabolic Health in Older Adults: Insights from a Feasibility Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript under review is quite interesting. Although excellent work has been done, I do have to make some contributions:

• Title: (instead of “preliminary”) and in the rest of the manuscript that this is a pilot study (it does appear in the abstract).
• Abstract: too long; comply with the journal's guidelines.
• Methodology: the sample of 10 participants greatly limits the inference. The size must be explicitly justified as a pilot study. It is also necessary to add inclusion and exclusion criteria. Furthermore, the flow of participants is unclear (how many people refused or did not meet the criteria?). Include a STROBE flow diagram. The statement “Declaration of Helsinki Oviedo Convention” is poorly linked; I recommend separating it correctly and maintaining consistency with the final section on ethics (where the committee, code, and date are specified). It is necessary to clarify the date/fasting conditions, time of extraction, and waist measurement (anatomical position, technique, number of measurements). Among the statistical analyses used, Kruskal–Wallis is used with three categories of adherence. With such small group sizes, the interpretation is very limited. Consider grouping moderate/low or focusing on correlations (e.g., Spearman) with CI.
• Results: although the graphs and tables presented are well distributed, I believe that supplementary tables are missing with: distribution by PREDIMED items (14 questions), consumption of olive oil, nuts, fish, etc., and MetS criteria present per participant (anonymized). The text mentions “Supplementary 1” but does not specify.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

GENERAL COMMENTS:
This is an interesting community-based investigation. I have outlined comments and suggestions for improving the manuscript, detailed below.
ABSTRACT: Review each section in accordance with the recommendations mentioned below.
INTRODUCTION: The authors should comment on the Mediterranean dietary pattern relating to sociocultural aspects and community-based actions in the introduction and discussion, since these are the subjects of this investigation.
METHODS: 
- The sample type (convenience) must be described, and the short sample size commented on, with the reasons explained and the total number of participants in the community action where the subjects selected came from.
- Line 131–134 contains mixed text that requires editing.
- It is important to mention the method of data collection, either a self-administered questionnaire or an interview.
RESULTS AND DISCUSSION:
- Since the subjects came from Community Actions and the study analysed results from a small sample size, this needs to be presented in advance.
- It is vital that the discussion includes the insights gained from this preliminary study in a clearer way. The text will cover subjects such as small samples, community actions, the connection with participation in a physical activity programme and adherence to diet patterns, and the feasibility of implementing nutritional screening in exercise-based programmes for older adults.
- The aim of this pilot feasibility study was to examine the link between following the Mediterranean diet and metabolic risk factors in older people taking part in a community-based exercise programme. The advantages and disadvantages of this type of study must be included.
- Consider the following ideas when discussing the possible correlation between participation in a community action project and adherence to a Mediterranean diet;
- The data presented on line 261 suggests that participants with a greater number of chronic conditions tend to report lower adherence. This is an area that needs to be explained.
- The relation of age and comorbidity with fasting glucose should be discussed, as it was unexpectedly higher (line 300).
- The importance of integrating this dietary pattern and the social aspects of community action initiatives should also be discussed. What mean to develop research in a community action setting? What are the advantages and limitations?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

After making all the revisions suggested by some of the authors, the manuscript is ready for publication

Author Response

We are truly grateful for your thoughtful feedback. Your support, time, and valuable suggestions during the review process are sincerely appreciated. We are delighted to learn that, according to your evaluation, the paper is now deemed ready for publication. 

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have incorporated some of the proposed recommendations. However, the material does not currently meet all of the criteria for publication, particularly regarding the presentation of restricted data. To strengthen the submission, the research proposal could further focus on describing the study protocol rather than the analysis. Additionally, monitoring the measurements of community action participants might provide an interesting perspective. 

 

Author Response

see attached

Author Response File: Author Response.pdf