A priori dietary patterns and blood pressure in the EPIC Florence cohort: a cross-sectional study
Several foods and nutrients have been independently associated with systolic (SBP) and diastolic (DBP) blood pressure values. This study aimed to evaluate the effects of combined dietary habits on SBP and DBP values in a large cohort of healthy adults, with a cross-sectional design. Adherence of participants to four a priori dietary patterns was considered: the Healthy Eating Index 2010 (HEI-2010); the Dietary Approaches to Stop Hypertension (DASH); the Greek Mediterranean Diet Score (MDS); and the Italian Mediterranean Index (IMI).
Overall, 13,597 volunteers (35–64 years) were enrolled in 1993–1998 in the EPIC-Florence cohort. Information on dietary habits, anthropometry, smoking status, education, physical activity habits, previous diagnosis of hypertension and SBP and DBP measurements were collected at baseline. Multivariate regression models were performed on 10,163 individuals (7551 women) after excluding subjects with prevalent hypertension.
IMI, DASH and HEI-2010 were significantly and inversely associated with SBP and DBP values in the total population. The strongest association emerged between IMI and SBP (β − 1.80 excellent adherence vs low adherence, 95% CI − 2.99; − 0.61, p trend 0.001) and DBP (β − 1.12, 95% CI − 1.869; − 0.39, p trend 0.001) values. In sub-group analyses, an inverse association also emerged between IMI and SBP and DBP values among females and between DASH and DBP among males. MDS was not associated with SBP or DBP.
Overall, this study, carried out in a large cohort of healthy adults from Tuscany (Central Italy), showed inverse significant associations between specific a priori dietary patterns, identifying general models of health-conscious diet, and blood pressure values.
KeywordsA priori dietary pattern Blood pressure Cross-sectional design Cohort study
The authors wish to acknowledge the cooperation of all study participants and staff members. The EPIC study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC), Milan, Italy.
Compliance with ethical standards
The EPIC study has been approved by the Ethical Review Board of the International Agency for Research on Cancer (IARC, Lyon) and by the local Florence Ethical Committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
At enrolment, all participants in the EPIC study signed an informed consent form and agreed to provide detailed information on their dietary and lifestyle habits and their health status.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.World Health Organization. Global status report on noncommunicable diseases (2014). WHO, Geneva. http://www.who.int/nmh/publications/ncd-status-report-2014/en/. Accessed 6 November 2017
- 2.ESH/ESC Task Force for the Management of Arterial Hypertension (2013) Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the management of arterial hypertension. J Hypertens 31(10):1925e38Google Scholar
- 3.Lafortune L, Martin S, Kelly S, Kuhn I, Remes O, Cowan A, Brayne C (2016) Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PLoS One 11(2):e0144405. https://doi.org/10.1371/journal.pone.0144405 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Rasmussen BM, Vessby B, Uusitupa M, Berglund L, Pedersen E, Riccardi G, Rivellese AA, Tapsell L, Hermansen K, KANWU Study Group (2006) Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr 83(2):221–226CrossRefPubMedCentralGoogle Scholar
- 7.Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336(16):1117–1124. https://doi.org/10.1056/NEJM199704173361601 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocké MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991. https://doi.org/10.1136/bmj.38415.644155.8F CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Agnoli C, Krogh V, Grioni S, Sieri S, Palli D, Masala G, Sacerdote C, Vineis P, Tumino R, Frasca G, Pala V, Berrino F, Chiodini P, Mattiello A, Panico S (2011) A priori-defined dietary patterns are associated with reduced risk of stroke in a large Italian cohort. J Nutr 141(8):1552–1558. https://doi.org/10.3945/jn.111.140061 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, Charrondière UR, Hémon B, Casagrande C, Vignat J, Overvad K, Tjønneland A, Clavel-Chapelon F, Thiébaut A, Wahrendorf J, Boeing H, Trichopoulos D, Trichopoulou A, Vineis P, Palli D, Bueno-De-Mesquita HB, Peeters PH, Lund E, Engeset D, González CA, Barricarte A, Berglund G, Hallmans G, Day NE, Key TJ, Kaaks R, Saracci R (2002) European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr 5(6B):1113–1124. https://doi.org/10.1079/PHN2002394 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Palli D, Berrino F, Vineis P, Tumino R, Panico S, Masala G, Saieva C, Salvini S, Ceroti M, Pala V, Sieri S, Frasca G, Giurdanella MC, Sacerdote C, Fiorini L, Celentano E, Galasso R, Decarli A, Krogh V, EPIC-Italy (2003) A molecular epidemiology project on diet and cancer: the EPIC-Italy Prospective Study. Design and baseline characteristics of participants. Tumori 89(6):586–593CrossRefPubMedCentralGoogle Scholar
- 13.Istituto Europeo di Oncologia (2017) Banca Dati di Composizione degli Alimenti per Studi Epidemiologici in Italia (BDA). http://www.bda-ieo.it/. Accessed 11 Aug 2017
- 15.InterAct Consortium, Peters T, Brage S, Westgate K, Franks PW, Gradmark A, Tormo Diaz MJ, Huerta JM, Bendinelli B, Vigl M, Boeing H, Wendel-Vos W, Spijkerman A, Benjaminsen-Borch K, Valanou E, de Lauzon Guillain B, Clavel-Chapelon F, Sharp S, Kerrison N, Langenberg C, Arriola L, Barricarte A, Gonzales C, Grioni S, Kaaks R, Key T, Khaw KT, May A, Nilsson P, Norat T, Overvad K, Palli D, Panico S, Ramón Quirós J, Ricceri F, Sanchez MJ, Slimani N, Tjonneland A, Tumino R, Feskins E, Riboli E, Ekelund U, Wareham N (2012) Validity of a short questionnaire to assess physical activity in 10 European countries. Eur J Epidemiol 27(1):15–25. https://doi.org/10.1007/s10654-011-9625 CrossRefGoogle Scholar
- 16.Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Lindholm LH, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Waeber B, Williams B, Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology (2007) 2007 Guidelines for the Management of Arterial Hypertension: the task force for the management of arterial hypertension of the european society of hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25(6):1105–1187. https://doi.org/10.1097/HJH.0b013e3281fc975a CrossRefPubMedGoogle Scholar
- 17.U.S. Department of Agriculture and U.S. and US Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th edn. U.S. Government Printing Office, Washington, DCGoogle Scholar
- 18.U.S. Department of Health and Human Services and U.S. Department of Agriculture (2005) Dietary Guidelines for Americans, 6th edn. U.S. Government Printing Office, Washington, DCGoogle Scholar
- 20.Masala G, Bendinelli B, Occhini D, Bruno RM, Caini S, Saieva C, Ungar A, Ghiadoni L, Palli D (2017) Physical activity and blood pressure in 10,000 Mediterranean adults: the EPIC-Florence cohort. Nutr Metab Cardiovasc Dis 27(8):670–678. https://doi.org/10.1016/j.numecd.2017.06.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Dauchet L, Kesse-Guyot E, Czernichow S, Bertrais S, Estaquio C, Péneau S, Vergnaud AC, Chat-Yung S, Castetbon K, Deschamps V, Brindel P, Hercberg S (2007) Dietary patterns and blood pressure change over 5-y follow-up in the SU.VI.MAX cohort. Am J Clin Nutr 85(6):1650–1656CrossRefPubMedCentralGoogle Scholar
- 24.Agnoli C, Grioni S, Sieri S, Palli D, Masala G, Sacerdote C, Vineis P, Tumino R, Giurdanella MC, Pala V, Berrino F, Mattiello A, Panico S, Krogh V (2013) Italian Mediterranean Index and risk of colorectal cancer in the Italian section of the EPIC cohort. Int J Cancer 132(6):1404–1411. https://doi.org/10.1002/ijc.27740 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Drouin-Chartier JP, Brassard D, Tessier-Grenier M, Côté JA, Labonté M, Desroches S, Couture P, Lamarche B (2016) Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Adv Nutr 7(6):1026–1040. https://doi.org/10.3945/an.115.01140 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Drouin-Chartier JP, Côté JA, Labonté M, Brassard D, Tessier-Grenier M, Desroches S, Couture P, Lamarche B (2016) Comprehensive review of the impact of dairy foods and dairy fat on cardiometabolic risk. Adv Nutr 7(6):1041–1051. https://doi.org/10.3945/an.115.011619 CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J (2017) The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2(2):e108–e120. https://doi.org/10.1016/S2468-2667(17)30003-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J (1990) Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335(8692):765–774CrossRefPubMedCentralGoogle Scholar
- 32.Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A (2010) Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 170(2):126–135. https://doi.org/10.1001/archinternmed.2009.470 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Appleby PN, Davey GK, Key TJ (2002) Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. 5(5):645–54. https://doi.org/10.1079/PHN2002332
- 35.Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 80(4):1012–1018CrossRefPubMedCentralGoogle Scholar