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; Christoper Cardwell; Lisette C.P.G.M. de Groot; Stefania Maggi; Noel McCaffrey; Bernadette McGuinness; Michelle C. McKinley; Marianna Noale; Federica Prinelli; Giuseppe Sergi; Emma J. Stevenson; Caterina Trevisan; Dorothee Volkert; Jayne V. Woodside; Claire T McEvoy

doi:10.1016/j.ajcnut.2026.101383

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
, Christoper Cardwell
, Lisette C.P.G.M. de Groot
, Stefania Maggi
, Noel McCaffrey
, Bernadette McGuinness
, Michelle C. McKinley
, Marianna Noale
, Federica Prinelli
, Giuseppe Sergi
, Emma J. Stevenson
, Caterina Trevisan
, Dorothee Volkert
, Jayne V. Woodside
, Claire T McEvoy

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background
Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited.
Objectives
The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in “at risk” community-dwelling older adults.
Methods
A total of 105 participants (69% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0–30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0–14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. Results
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.
Conclusions
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.

Original language	English
Article number	101383
Journal	The American journal of clinical nutrition
Volume	124
Issue number	3
DOIs	https://doi.org/10.1016/j.ajcnut.2026.101383
Publication status	Published - Sept 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger

Access to Document

10.1016/j.ajcnut.2026.101383Licence: CC BY

https://edepot.wur.nl/722925Licence: CC BY

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this

Ward, N. A., Reid-McCann, R., Logan, D., Farsi, D. N., Brennan, L., Cardwell, C., de Groot, L. C. P. G. M., Maggi, S., McCaffrey, N., McGuinness, B., McKinley, M. C., Noale, M., Prinelli, F., Sergi, G., Stevenson, E. J., Trevisan, C., Volkert, D., Woodside, J. V., & McEvoy, C. T. (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. The American journal of clinical nutrition, 124(3), Article 101383. https://doi.org/10.1016/j.ajcnut.2026.101383

@article{b4a698013e9c455493d38c6105d5b7eb,

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",

abstract = "Background Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. Objectives The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in “at risk” community-dwelling older adults. Methods A total of 105 participants (69\% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0–30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0–14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. Results 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. Conclusions 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.",

author = "Ward, \{Nicola Ann\} and Rachel Reid-McCann and Danielle Logan and Farsi, \{Dominic N.\} and Lorraine Brennan and Christoper Cardwell and \{de Groot\}, \{Lisette C.P.G.M.\} and Stefania Maggi and Noel McCaffrey and Bernadette McGuinness and McKinley, \{Michelle C.\} and Marianna Noale and Federica Prinelli and Giuseppe Sergi and Stevenson, \{Emma J.\} and Caterina Trevisan and Dorothee Volkert and Woodside, \{Jayne V.\} and McEvoy, \{Claire T\}",

year = "2026",

month = sep,

doi = "10.1016/j.ajcnut.2026.101383",

language = "English",

volume = "124",

journal = "The American journal of clinical nutrition",

issn = "0002-9165",

publisher = "American Society for Nutrition",

number = "3",

}

Ward, NA, Reid-McCann, R, Logan, D, Farsi, DN, Brennan, L, Cardwell, C, de Groot, LCPGM, Maggi, S, McCaffrey, N, McGuinness, B, McKinley, MC, Noale, M, Prinelli, F, Sergi, G, Stevenson, EJ, Trevisan, C, Volkert, D, Woodside, JV & McEvoy, CT 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', The American journal of clinical nutrition, vol. 124, no. 3, 101383. https://doi.org/10.1016/j.ajcnut.2026.101383

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. / Ward, Nicola Ann; Reid-McCann, Rachel; Logan, Danielle et al.
In: The American journal of clinical nutrition, Vol. 124, No. 3, 101383, 09.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - 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

AU - Ward, Nicola Ann

AU - Reid-McCann, Rachel

AU - Logan, Danielle

AU - Farsi, Dominic N.

AU - Brennan, Lorraine

AU - Cardwell, Christoper

AU - de Groot, Lisette C.P.G.M.

AU - Maggi, Stefania

AU - McCaffrey, Noel

AU - McGuinness, Bernadette

AU - McKinley, Michelle C.

AU - Noale, Marianna

AU - Prinelli, Federica

AU - Sergi, Giuseppe

AU - Stevenson, Emma J.

AU - Trevisan, Caterina

AU - Volkert, Dorothee

AU - Woodside, Jayne V.

AU - McEvoy, Claire T

PY - 2026/9

Y1 - 2026/9

N2 - Background Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. Objectives The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in “at risk” community-dwelling older adults. Methods A total of 105 participants (69% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0–30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0–14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. Results 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. Conclusions 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.

AB - Background Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. Objectives The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in “at risk” community-dwelling older adults. Methods A total of 105 participants (69% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0–30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0–14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. Results 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. Conclusions 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.

U2 - 10.1016/j.ajcnut.2026.101383

DO - 10.1016/j.ajcnut.2026.101383

M3 - Article

SN - 0002-9165

VL - 124

JO - The American journal of clinical nutrition

JF - The American journal of clinical nutrition

IS - 3

M1 - 101383

ER -

Ward NA, Reid-McCann R, Logan D, Farsi DN, Brennan L, Cardwell C 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. The American journal of clinical nutrition. 2026 Sept;124(3):101383. doi: 10.1016/j.ajcnut.2026.101383