Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

Karageorgou, Dimitra; Magriplis, Εmmanouella; Bakogianni, Ioanna; Mitsopoulou, Anastasia Vasiliki; Dimakopoulos, Ioannis; Micha, Renata; Michas, George; Ntouroupi, Triantafyllia; Tsaniklidou, S.‐M.; Argyri, Konstantina; Chourdakis, Michael; Panagiotakos, Demosthenes B.; Zampelas, Antonis; Fappa, Evangelia; Theodoraki, Eleni-Maria; Trichia, I.; Sialvera, Theodora-Eirini; Varytimiadi, Aggeliki; Spyrelli, Evgenia D.; Koutelidakis, Antonios E.; Karlis, George; Zacharia, Stauroula; Papageorgiou, Anna; Chrousos, George P.; Dedoussis, Georgios; Dimitriadis, George; Manios, Ioannis; Roma, Elefthería

doi:10.1016/j.numecd.2019.09.024

Cited by 8 publications

(8 citation statements)

References 59 publications

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“…In particular, the studies on dietary variety have reported heterogeneous associations with obesity [17,30,31] (in this study, no association between dietary variety and BMI was observed) and the measures of variety differed highly between studies [22,24,31,32]. Moreover, most previous data about dietary variety and health refer to associations with some cardiovascular risk factors [10,14,15,33] or frailty [12,34]. As far as we know, only one study evaluated the associations between dietary variety and CHD, and the results were not significant [35].…”

Section: Discussionmentioning

confidence: 58%

Overall dietary variety and adherence to the Mediterranean diet show additive protective effects against coronary heart disease

Amato

Bonomi

Laguzzi

et al. 2020

Nutrition, Metabolism and Cardiovascular Diseases

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Background and aim: Along with the increasing evidence of the cardioprotective effects of the Mediterranean Diet (MD), the scientific interest and advocacy of dietary variety as a potentially healthy eating habit gradually faded, until its complete oblivion in the latest European cardiovascular prevention guidelines. Our study aims to investigate whether dietary variety adds to the "Mediterranean-ness" of the diet in protecting against coronary heart disease (CHD). Methods and results: In this caseecontrol Italian study, data on eating habits were collected from 178 patients with CHD and 155 healthy controls, primarily males, frequency matched for age and gender, using the Food Frequency Questionnaire (FFQ) of the European Prospective Investigation into Cancer and Nutrition. Adherence to MD was estimated from FFQ by the Mediterranean Diet Score (MDS), an index developed by Trichopoulou (2003) ranging from 0 to 9, with higher scores indicating a stricter adherence. Overall dietary variety was computed from FFQ as a count of single food items consumed at least once a month. Associations between MDS or overall dietary variety and coronary status were evaluated by logistic regression models adjusted for BMI, physical activity, smoking, education, and caloric intake; the Odds Ratio (OR) for CHD for each 1.5-point increase in MDS was 0.76 [IC 95% 0.59; 0.98], whereas the OR for CHD for each 15-item increase in dietary variety was 0.62 [IC 95% 0.46; 0.84]. Remarkably, adherence to MD and overall dietary variety were independently associated with a significantly reduced chance of CHD. Conclusion: Dietary Mediterranean-ness and overall dietary variety exhibit additive cardioprotective effects.

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Section: Discussionmentioning

confidence: 58%

Overall dietary variety and adherence to the Mediterranean diet show additive protective effects against coronary heart disease

Amato

Bonomi

Laguzzi

et al. 2020

Nutrition, Metabolism and Cardiovascular Diseases

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“…4 Physical activity, based on MET values grouped in three categories: 1.0-1.5 METs defined as sedentary behaviour, 1.6-2.9 METs defined as light-intensity, and 3-5.9 METs defined as moderate-intensity [28]. 5 The Body Mass Index (BMI) was calculated as body weight (in kilograms) divided by the square of height (in meters). Based on their BMI values, participants were grouped in four categories: obese: BMI ≥ 30 kg/m 2 , overweight: 25 ≤ BMI ≤ 29.9 kg/m 2 , normal weight: 18.5 ≤ BMI ≤ 24.9 kg/m 2 , and underweight: BMI < 18.5 kg/m 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Health and nutrition surveys are internationally recognized as an important public health indicator for monitoring the nutritional status and health of populations. In Greece, since 2010, three nationally representative studies have been conducted, the HYDRIA (2013–2014) [ 3 , 4 ] survey, the PA.ME.D.Y (2013–2015) [ 5 , 6 , 7 ], and the EMENO (2013–2016) [ 8 , 9 ] study. PA.ME.DY investigated the association of dietary patterns with health and lifestyle characteristics of the adult Greek population [ 5 , 6 ], while EMENO investigated the morbidity and cardiovascular risk factors of the adult population [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Today’s Mediterranean Diet in Greece: Findings from the National Health and Nutrition Survey—HYDRIA (2013–2014)

et al. 2022

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Background: This study aimed to investigate the food and macronutrient intake of the population in Greece and evaluate its adherence to the Greek traditional Mediterranean diet. Methods: Adults over 18 years old (n = 4011) were included from the 2013–2014 National Health and Nutrition survey—HYDRIA. Dietary intake was collected using two 24-h recall interviews and a nonquantitative food frequency questionnaire. Macronutrient intakes were calculated using an updated version of the Greek FCT. Results: Only 28.3% of the adult population had high adherence to the Greek traditional Mediterranean diet, with a higher percentage (39.7%) observed for participants over 65 years compared to those under 65 years (25.5%). Differences in adherence to the MD were observed among the four geographical regions in Greece. Younger adults had a higher intake of meat, cereals, alcoholic and nonalcoholic beverages, and sugar products than older individuals who consumed more vegetables, fruits, legumes, dairy, fish, and lipids (mainly from olive oil). Adults do not meet the international dietary recommendations for the intake of several foods and macronutrients. Conclusions: The adult Greek population, especially younger people, has headed away from the Greek traditional Mediterranean diet. These observations indicate potential detrimental consequences in terms of morbidity and mortality.

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“…A range of scores were used to define MedDiet adherence, including: the 55-point Panagiotakos MedDietScore (n= 4) [43], 14-point MEDAS score (n=3) [44], an adapted 8-point Trichopoulou score (excluding olive oil; n=1) [45], the Modified 9point Trichopoulou Score (n=1) [46], a custom 30-point MedDiet score (n=1) [10], a 52-point Lebanese MedDiet score (n=1) [47], a 60-point MedTypeDietScore (n=1) [48], a modified 17point MedDiet score (n=1) [49], an 11-point Pyramid MedDiet score (n=1) [50], and the MED-LITE score (n=1) [12]. In addition, one study derived a MedDiet adherence score a posteriori via principal component analysis [51].…”

Section: Observational Studiesmentioning

confidence: 99%

“…Of the two prospective studies included in this review, one had a moderate quality score of 6 [11] and one had a high quality score of 7 [53] (Supplemental Digital Content 13). Twelve of the cross-sectional studies had moderate quality scores of 4-6 [10,12,13,47,48,50,51,[54][55][56][57] whilst two cross-sectional studies had low quality scores of 2 [52,58] (Supplemental Digital Content 14).…”

Section: Study Quality and Risk Of Biasmentioning

confidence: 99%

Effects of a Mediterranean diet on blood pressure: a systematic review and meta-analysis of randomized controlled trials and observational studies

Cowell

Mistry

Deighton

et al. 2020

Journal of Hypertension

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Objective: To conduct a systematic review and meta-analysis investigating effects of MedDiet on blood pressure in randomised controlled trials (RCTs) and associations of MedDiet with risk of hypertension in observational studies.Methods: PubMed, The Cochrane Library and EBSCOhost were searched from inception until January 2020 for studies that met the following criteria: 1) participants aged ≥18 years, 2) RCTs investigating effects of a MedDiet versus control on BP, 3) Observational studies exploring associations between MedDiet adherence and risk of hypertension. Random-effects metaanalyses were conducted. Meta-regression and subgroup analyses were performed for RCTs to identify potential effect moderators.Results: Nineteen RCTs reporting data on 4137 participants and 16 observational studies reporting data on 59,001 participants were included in the meta-analysis. MedDiet interventions reduced systolic and diastolic BP by a mean -1.4 mmHg (95% CI: -2.40 to -0.39 mmHg, p=0.007, I 2 =53.5%, Q=44.7, τ 2 =1.65, df=19) and -1.5 mmHg (95% CI: -2.74 to -0.32 mmHg, p=0.013, I 2 =71.5%, Q=51.6, τ 2 =4.72, df=19) versus control, respectively. Metaregression revealed that longer study duration and higher baseline systolic BP was associated with a greater decrease in BP, in response to a MedDiet (p<0.05). In observational studies, odds of developing hypertension were 13% lower with higher versus lower MedDiet adherence (95% CI: 0.78 to 0.98, p=0.017, I 2 =69.6%, Q=41.1, τ 2 =0.03, df=17).Conclusions: Data suggest that MedDiet is an effective dietary strategy to aid BP control, which may contribute towards the lower risk of CVD reported with this dietary pattern. This study was registered with PROSPERO: CRD42019125073.

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Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

Cited by 8 publications

References 59 publications

Overall dietary variety and adherence to the Mediterranean diet show additive protective effects against coronary heart disease

Overall dietary variety and adherence to the Mediterranean diet show additive protective effects against coronary heart disease

Today’s Mediterranean Diet in Greece: Findings from the National Health and Nutrition Survey—HYDRIA (2013–2014)

Effects of a Mediterranean diet on blood pressure: a systematic review and meta-analysis of randomized controlled trials and observational studies

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