Objective: To assess the barriers and facilitators of dietary adherence among people with Parkinson’s disease (PD) following an 8-week Mediterranean-ketogenic and 8-week MCT-supplemented Mediterranean diet.

Background: Emerging research suggests beneficial effects of both Mediterranean and ketogenic diets in PD, with hybrid Mediterranean-ketogenic interventions potentially conferring maximal benefit. However, the acceptability of these interventions in individuals living with PD has yet to be established.

Method: All participants (n=48) in a phase II crossover study (NCT05469997) comparing an 8-week Mediterranean-ketogenic with an 8-week MCT-supplemented Mediterranean diet were invited to complete post-intervention semi-structured interviews. The trial was run out of a tertiary Movement Disorders clinic in Vancouver, BC, Canada. Sixty-seven semi-structured interviews were conducted with a total of 44 trial participants. Interview questions were formulated based on the Theory of Planned Behaviour (TPB). Thematic analysis of interview transcripts was performed using a combination of inductive and deductive techniques. Individual codes were aggregated into 2-6 subthemes for each TPB construct.

Results: Dietitian and care partner support were consistently identified as key facilitators of adherence, while attitudes towards the perceived health benefits and palatability of each dietary intervention varied among participants. Major adherence barriers included social pressures, conflicting cultural dietary preferences, high costs of specialty food items and time-intensive meal preparation. PD-related adherence challenges included loss of fine motor skills, gastrointestinal dysfunction, apathy, sensory disturbances, cognitive slowing and overwhelm with the combined burden of diet and medication management.

Conclusion: Dietary interventions in PD should consider multiple bidirectional relationships between eating behaviour and health-related quality of life, while harnessing available social supports to best enable behaviour change.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/barriers-and-facilitators-of-adherence-to-mediterranean-ketogenic-and-mct-supplemented-mediterranean-diets-in-parkinsons-disease-a-qualitative-secondary-analysis-from-a-random-order-crossove/