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

Abstract

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.

Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters

“…The PREDIMED study also found similar results for the Mediterranean diet arms of the intervention, where a reduction of carbohydrates and the increase of monounsaturated dietary fatty acids (MUFA) resulted in lower cholesterol levels and increased HDL cholesterol levels [46]. Similar results were reported from another recent randomized control trial from Italy [47]. In summary, the present study is consistent with past research demonstrating that the Mediterranean diet has cardioprotective effects by improving HDL-cholesterol levels and the total cholesterol/HDL ratio [19,23,48].…”

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

“…Regarding the MED participant countries, analogous results with scores in the midrange of the scale were previously reported in SP [ 15 , 16 , 28 , 30 , 37 , 42 , 43 ], PT [ 22 , 44 , 45 ], IT [ 17 , 18 , 46 , 47 , 48 , 49 ], GR [ 50 , 51 ], and CY [ 52 ]. Other Southern European as well as some non-European MED countries [ 23 , 27 , 53 ] have also been attributed a moderate value of MD adherence.…”

Nutritional Properties of Rice Varieties Commonly Consumed in Italy and Applicability in Gluten Free Diet

“…Rice is an important staple food for more than half of the world's population [72], representing one of the main sources of carbohydrate with an important role in a healthy diet [68]. However, it should be considered as part of a balanced and varied diet [12,13]. Indeed, cereals, including rice, should be present at each meal together with healthy proteins, plant-based fat, vegetables, and fruits [34].…”

“…Mediterranean diet (MD) has been widely described to positively impact health status [11]. According to the MD dietary guidelines, it is necessary to consume different food categories every day to guarantee nutrient balance in the diet [12,13]. Cereals are one of the pillars of the Mediterranean diet and they should be part of every daily meal [14,15].…”