A priori-defined Mediterranean-like dietary pattern predicts cardiovascular events better in north Europe than in Mediterranean countries

Abstract

BackgroundThe Mediterranean Diet (MD) is a model of healthy eating contributing to a favorable health status, but its clinical usefulness is still debated. The aim of this study was to relate the adherence to MD with the incidence of cardio/cerebro-vascular events (VEs) in north and south European participants of the IMPROVE study.MethodsIMPROVE is an observational, longitudinal, prospective cohort study involving 3703 individuals from five European countries (Finland, Sweden, Netherlands, France and Italy). The study end-point was the incidence of the first combined cardio/cerebro-vascular event occurring during 36-months follow-up. At baseline, a dietary questionnaire about the usual intake during the year preceding enrollment was administered. Based on 7 nutritional items, a MD Score was constructed in which minimal adherence was 0 and maximal adherence was 7.ResultsLatitude was the strongest determinant of MD score (p < 0.001). VEs occurred in 215 participants. The incidence of VEs was the highest in subjects with MD score 0–1, lower in those with score 2–3 and the lowest in those with score ≥ 4. MD score remained significantly associated with subsequent VEs after adjustment for confounders (hazard ratio for one-point increment of the score = 0.75, p < 0.001) and the association was stronger in northern than in southern countries (p = 0.04 for MD Score × latitude interaction).ConclusionsThe MD adherence score based on a simple dietary questionnaire detects changes of risk of VEs. According to our findings north Europeans appear to benefit most from VE-prevention when their diet is altered to the MD diet.

Data on the association between a simplified Mediterranean diet score and the incidence of combined, cardio and cerebro vascular events

“…The number of combined events was the highest in subjects with score 0–1 (9.2%), lower in those with score 2–3 (5.0%) and the lowest in those with score 4–7 (2.7%). Similar rates were obtained considering cardio- and cerebro-VEs separately [1].…”

Impact of the Level of Adherence to Mediterranean Diet on the Parameters of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Observational Studies

“…Not relevant to the topic examined studies, studies including population <18 years old, studies in which validated tool for assessment of MD were not used and in which the level of adherence was not clearly described were excluded. Overall, 58 studies were characterized as acceptable for the systematic review [ 39 , 40 , 43 , 44 , 45 , 46 , 47 , 49 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ,…”

“…Five studies were characterized as unsatisfactory due to their ratings (2–4 stars) [ 43 , 67 , 75 , 80 , 107 ], whereas for 17 studies the quality was only satisfactory (5–6 stars) [ 39 , 49 , 61 , 63 , 71 , 86 , 92 , 93 , 94 , 96 , 97 , 100 , 104 , 105 ]. The majority of the included studies ( n = 28) [ 40 , 44 , 45 , 47 , 58 , 59 , 60 , 62 , 65 , 68 , 69 , 70 , 72 , 74 , 76 , 77 , 79 , 81 , 82 , 83 , 84 , 85 , 87 , 88 , 95 , 101 , 103 , 106 ] were good quality studies (7–8 stars), and eight studies were at the top of quality studies scoring 9 stars [ 46 , 64 , 66 ...…”

“…Eligible studies for inclusion to systematic review were original observational studies that investigated the impact of MD adherence on three or more parameters of MetS (WC, HDL, TG, SBP and FBG), according to the revised criteria NCEP ATP III [ 11 ], in the adult population, using a validated tool or scoring algorithm. MDSs developed by Panagiotakos et al [ 31 ], Sofi et al [ 32 ] and Trichopoulou et al [ 21 ], as well as the PREDIMED MD Adherence Screener (MEDAS) score [ 33 ], the short MDS produced by Martinez Gonzalez et al [ 34 ] the serving MDS [ 35 ], the Mediterranean-Style Dietary Pattern Score (MSDPS) by Rumawas et al [ 36 ], the MD quality index [ 37 ], the relative MD system [ 38 ], and modified versions of MDSs [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], were used in our included studies. A summary of the diagnostic criteria of MetS can be found in Table 1 .…”

Intake of food rich in saturated fat in relation to subclinical atherosclerosis and potential modulating effects from single genetic variants

“…Micha et al 49 showed that the amount and sources of saturated fats may vary by geographical regions with Western European countries consuming less processed meat but more vegetables and whole grain than Northern American countries 49 . In light of our results, it is also noteworthy to consider that our study population has been shown to have a good compliance to a Mediterranean diet in general, although with a north–south gradient 50 , in which the fundamental components such as whole grain and alcohol have been shown to modify the increased risk of CVD associated with high intake of dietary saturated fat 51 .…”