**3. Results**

#### *3.1. Characteristics of the Population and Adherence to an MD*

The general characteristics of the study population at baseline are shown in Table 1. The median age was 55 (IQR 45–64) and the 106 patients were equally male and female. Most of them (*n* = 98, 92.5%) were natives of Liguria, a region in the North-West of Italy, while six patients were born in South America (5.7%) and one subject came from each of UK and Romania. Most of the enrolled patients (except two subjects) did not practice moderate physical activity for more than 15 min every day. The comedications used by patients are reported in Supplementary Table S2.


**Table 1.** Characteristics of all 106 dyslipidemic patients.

Abbreviations: M = male, F = female, BMI = body mass index, SBP = systolic blood pressure, DBP = diastolic blood pressure, IQR= Interquartile range, TC = total cholesterol, HDL-C = high-density lipoprotein cholesterol,LDL-C = low-density lipoprotein cholesterol, TG = triglycerides.

The mean MEDI-LITE score for the patients was 10 ± 3 (median 10, IQR 8–12) points. A regression analysis of the lipid profile adjusted for sex, age, BMI, and smoking habits showed that the presence of a higher MEDI-LITE score was independently correlated with higher levels of HDL-C levels (*β* ± SE 1.099 ± 0.413, r = 0.253, *p* = 0.009) and TC (*β* ± SE 1.353 ± 0.449, r = 0.283, *p* = 0.003) and lower levels of TG (*β* ± SE 3.712 ± 2.272, r = 159, *p* = 0.105). LDL-C levels did not correlate with the MEDI-LITE score.

#### *3.2. Cross-Sectional Analysis: Relationship between Lipid Profile and Different Food Categories*

Table 2 shows the number of patients based on the MEDI-LITE scores obtained for specific food categories. Lipid levels normalized by sex, age, BMI, and smoking habits were divided according to food categories and the score assigned (Table 2). Independent sample comparison tests were preliminarily performed. Patients with fruit intake >300 g/day had significantly higher levels of TC and HDL-C than those who ate <150 g/day or between 150 and 300 g/day. The levels of TC and HDL-C were significantly lower in subjects who ate fewer vegetables (<150 g/day) than in moderate and higher consumers of vegetables (150–300 and >300 g/day, respectively). No statistically significant differences were observed in the serum levels of LDL-C. Patients who consumed more meat and meat products (>120 g/day) had significantly lower levels of TC and HDL-C than moderate (80–120 g/day) and low (<80 g/day) meat consumers, while levels of TG were significantly higher in the latter (<80 g/day) than subjects who ate >120 g/day. LDL-C levels did

not vary significantly. Patients who consumed the most (270 g/day) dairy products had significantly higher levels of TC, HDL-C, and LDL-C and lower levels of TG than patients with the lowest intake of dairy products (<180 g/day). No alcohol consumption was significantly associated with higher levels of TC and HDL-C and significantly lower levels of TG than alcohol consumption by patients. None differences in LDL-C levels have been observed in different alcohol consumer groups.


**Table 2.** Lipid profile and patient distribution according to food categories and the score assigned.


**Table 2.** *Cont.*

Abbreviations: AU = Alcoholic Unit; NS = Non-statistically significant. † Independent samples Kruskal–Wallis tests. Significance values have been adjusted by the Bonferroni correction for multiple tests. Unadjusted *p*-values have been also reported.

> Finally, the relationships among the lipid profile (TC, HDL-C, LDL-C, and TG adjusted for sex, age, BMI, and smoking habits) and all food categories considered in the baseline analysis was investigated through a cross-sectional multivariate analysis (details of the statistical analysis are reported in Table 3. Higher consumption of dairy products correlated independently with higher levels of TC, HDL-C, and LDL-C and with a lower level of TG. Instead, lower levels of HDL-C and TG and higher levels of TC were independently associated with higher consumption of meat and meat products. Finally, a lower level of TC also correlated independently with the frequent use of olive oil. No other statistically significant differences were observed in LDL-C levels.

**Table 3.** Multivariate analysis on baseline lipid profile in all 106 patients.



**Table 3.** *Cont.*

Abbreviations: TC = total cholesterol, HDL-C = high-density lipoprotein cholesterol, LDL-C = low-density lipoprotein cholesterol, TG = triglycerides. Dependent variable were TC, HDL-C, LDL-C and TG (bold text) and were adjusted for sex, age, BMI and smoking habits. Predictors were fruit intake (<150 g/day = 0, 150–300 g/day = 1 and >300 g/day = 2), vegetables intake (<100 g/day = 0, 100–250 g/day =1 and >250 g/day = 2), legumes intake (<70 g/week = 0, 70–140 g/week = 1 and >140 g/week = 2), cereals intake (<130 g/day = 0, 130–200 g/day = 1 and >200 g/day = 2), fish intake (<100 g/week = 0, 100–250 g/week = 1 and >250 g/week = 2), meat products intake (>120 g/day = 0, 80–120 g/day = 1 and <80 g/day = 2), dairy products intake (>270 g/day = 0, 180–270 g/day = 1 and <180 g/day = 2), alcohol consume (>2 AU/day = 0, 1–2 AU/day = 1 and <1 AU/day = 2) and olive oil use (Occasional = 0, Frequent = 1 and Regular = 2). Abbreviation: *β* = angular coefficient, SE = standard error, r2 = square correlation coefficient, F = F-value, *p*-values for predictors, † *p*-value for model fitting significance.

## *3.3. Follow-Up Analysis*

Thirty-four patients (32.1%) did not attend the follow-up visit, and therefore were excluded from the follow-up analysis. Thus, demographical and clinical characteristics of the remaining 72 patients are reported in Table 4. The median follow-up period was 12 weeks (10–13 weeks).

Adherence to an MD significantly improved after the follow-up period, from a mean value of 10 ± 3 (median 10, IQR 8–12) to 13 ± 2 (median 14, IQR 12–15) with *p* < 0.0001 (Table 4). Overall, the number of patients with higher scores in the specific food categories considered in the MEDI-LITE score increased significantly, with the exception of olive oil and cereal consumption which did not statistically differ from baseline (Supplementary Table S3).

Nutritional counseling was effective for improving weight, BMI, and lipid profile excluding HDL-C levels. The addition of a nutraceutical or lipid-lowering drug was further effective in reducing TC, LDL-C, and TG levels (Table 5).


**Table 4.** Characteristics of the 72 dyslipidemic patients included in follow-up analysis.

Abbreviations: M = male, F = female, IQR = Interquartile range, SBP = systolic blood pressure, DBP = diastolic blood pressure.

**Table 5.** Variation in anthropometric measures, MEDI-LITE score, and lipid profile after the nutritional counseling.


Abbreviations: BMI = body mass index, IQR= Interquartile range. † *p*-values for dependent samples nonparametric Wilcoxon Signed Ranks Test between baseline and follow-up values.
