Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Abstract

Background Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain. Methods Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence). Results Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality. Conclusions The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.

The Effects of Dietary Pattern on Metabolic Syndrome in Jiangsu Province of China: Based on a Nutrition and Diet Investigation Project in Jiangsu Province

“…However, adherence to a "meat/Western" pattern (which is characterized by a high loading of red meat, processed meat, animal fat, eggs, and sweets) increased the risk of metabolic syndrome in stratified analyses based on either geographical region (Asia, Europe, America) or study design [14]. A previous study found that a Mediterranean diet, which is characterized as rich in vegetables, fruit, whole grains, cereal, fish, and seafood products, was associated with a lower frequency of metabolic syndrome and reduced all-cause mortality [15,16].…”

Mediterranean diet in the treatment of metabolic syndrome: nutritional therapy and life perspective

“…Accordingly, Noel et al [18] found that a traditional dietary pattern rich in rice, beans, and fat, and sweets rich in sugar, sugary drinks, and dairy desserts was associated with a higher probability of having MS and low concentrations of HDL-cholesterol. In this context, the Mediterranean diet has been presented as the main element in the treatment of MS [2][3][4][5][6][7].…”

“…Thus, lifestyle changes are undoubtedly necessary to minimize this problem and they necessarily go through an increase in the practice of physical exercise and the consequent reduction in sedentary activities (watching television, playing computer, playing with cell phones, etc.). Changes in diet, especially in this age group, are essential, since energy-dense foods are often used, which end up providing a lot of calories; other measures must be taken, such as the use of drugs or other more specific treatments, when the goals are not achieved at all with the lifestyle changes mentioned above [4][5][6][7].…”

“…It has been proven that even minor reductions in body weight greatly improve the components of MS and, as almost all individuals who suffer from it are overweight or even obese, perhaps start a diet suited to their health and lifestyle problems, is a good starting point [6,7].…”

“…In this sense, the search for weight loss is one of the constants that affect the population in order to solve a problem that is obesity [2][3][4]. Excessive weight gain generates comorbidities that many of them are characterized as metabolic syndrome, in which the individual, to be diagnosed, must have three or more metabolic or anthropometric changes such as increased waist circumference, systemic arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduction in serum HDL levels [5][6][7].…”