Advertisement

Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial

  • Ismael Alvarez-Alvarez
  • Estefanía Toledo
  • Oscar Lecea
  • Jordi Salas-Salvadó
  • Dolores Corella
  • Pilar Buil-Cosiales
  • María Dolores Zomeño
  • Jesús Vioque
  • J. Alfredo Martinez
  • Jadwiga Konieczna
  • Francisco J. Barón-López
  • José López-Miranda
  • Ramon Estruch
  • Aurora Bueno-Cavanillas
  • Ángel M. Alonso-Gómez
  • Josep A. Tur
  • Francisco J. Tinahones
  • Lluís Serra-Majem
  • Vicente Martín
  • Manuel Ortega-Calvo
  • Clotilde Vázquez
  • Xavier Pintó
  • Josep Vidal
  • Lidia Daimiel
  • Miguel Delgado-Rodríguez
  • Pilar Matía
  • José I. González
  • Andrés Díaz-López
  • Indira Paz-Graniel
  • Miguel A. Muñoz
  • Montse Fito
  • Salvador Pertusa-Martinez
  • Itziar Abete
  • Antonio García-Ríos
  • Emilio Ros
  • Miguel Ruiz-Canela
  • Miguel Á. Martínez-GonzálezEmail author
Original Contribution

Abstract

Purpose

Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort.

Methods

All PREDIMED-Plus participants (6874 men and women aged 55–75 years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF.

Results

Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90–0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89–0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90–0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87–0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS) in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures.

Conclusions

Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease

Keywords

Hypertension Obesity Type 2 diabetes Dyslipidemias Dietary pattern Mediterranean diet 

Notes

Funding

This work is supported by the European Research Council [Advanced Research Grant 2014-2019; agreement #340918 granted to MAM-G], and the Spanish Government Official Agency for funding biomedical research-Instituto de Salud Carlos III (ISCIII) with competitive grants for the periods 2014-2016, 2015-2017, 2017-2019 and 2018-2020, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund [grants: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926]. Additional grants: Acciones Especiales from ISCIIII, Consejería-Salud, Junta de Andalucía [PI0458/2013, PS0358/2016], Recercaixa-grant 2013 [2013ACUP00194], a SEMERGEN grant, and Generalitat Valenciana PROMETEO [grant 17/2017] and International Nut & Dried Fruit Council-FESNAD [Nº 201302]. J.K. is awarded with a Juan de la Cierva-formación research grant (FJCI-2015-24058) of the Spanish Ministry of Economy, Industry and Competitiveness and European Social Funds, and the FOLIUM program within the FUTURMed project: Talent for the medicine within the future from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014-2020 of the Balearic Islands). Fundación Patrimonio Comunal Olivarero is providing the necessary amounts of olive oil. Nuts were initially and only partially provided by Pistachios Growers and Almond Board of California, but most of the nuts were purchased with funds from the official funding agency. None of these funding sources plays any role in the design, collection, analysis, or interpretation of the data or in the decision to submit manuscripts for publication.

Compliance with ethical standards

Conflict of interest

E Ros is a consultant for the California Walnut Commission. J. Salas-Salvadó is a non-payed member of the Scientific Advisory Board of the International Nut and Dried Fruit Foundation and received research grants through his Institution of research. The other authors declare that they have no conflict of interests.

Supplementary material

394_2019_1982_MOESM1_ESM.pdf (113 kb)
Supplementary material 1 (PDF 112 kb)
394_2019_1982_MOESM2_ESM.pdf (185 kb)
Supplementary material 2 (PDF 184 kb)
394_2019_1982_MOESM3_ESM.pdf (190 kb)
Supplementary material 3 (PDF 189 kb)
394_2019_1982_MOESM4_ESM.pdf (176 kb)
Supplementary material 4 (PDF 175 kb)
394_2019_1982_MOESM5_ESM.pdf (107 kb)
Supplementary material 5 (PDF 107 kb)
394_2019_1982_MOESM6_ESM.pdf (107 kb)
Supplementary material 6 (PDF 107 kb)
394_2019_1982_MOESM7_ESM.pdf (108 kb)
Supplementary material 7 (PDF 107 kb)
394_2019_1982_MOESM8_ESM.pdf (107 kb)
Supplementary material 8 (PDF 107 kb)
394_2019_1982_MOESM9_ESM.pdf (108 kb)
Supplementary material 9 (PDF 107 kb)
394_2019_1982_MOESM10_ESM.pdf (108 kb)
Supplementary material 10 (PDF 107 kb)
394_2019_1982_MOESM11_ESM.pdf (180 kb)
Supplementary material 11 (PDF 180 kb)
394_2019_1982_MOESM12_ESM.pdf (182 kb)
Supplementary material 12 (PDF 181 kb)
394_2019_1982_MOESM13_ESM.pdf (114 kb)
Supplementary material 13 (PDF 114 kb)
394_2019_1982_MOESM14_ESM.pdf (112 kb)
Supplementary material 14 (PDF 112 kb)

References

  1. 1.
    Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G et al (2013) Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 70:1–25CrossRefGoogle Scholar
  2. 2.
    Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB et al (2003) Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 290:891–897CrossRefGoogle Scholar
  3. 3.
    Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952CrossRefGoogle Scholar
  4. 4.
    Rigotti NA, Clair C (2013) Managing tobacco use: the neglected cardiovascular disease risk factor. Eur Heart J 34:3259–3267CrossRefGoogle Scholar
  5. 5.
    Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PW et al (2006) Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 113:791–798CrossRefGoogle Scholar
  6. 6.
    Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A et al (2012) Lifetime risks of cardiovascular disease. N Eng J Med 366:321–329CrossRefGoogle Scholar
  7. 7.
    Banegas JR, Graciani A, Guallar-Castillón P, León-Muñoz LM, Gutiérrez-Fisac JL, López-García E, et al (2011) Estudio de Nutrición y Riesgo Cardiovascular en España (ENRICA). Universidad Autónoma de Madrid. http://www.isfie.org/documentos/estudio_enrica.pdf. Accessed 12 Mar 2019
  8. 8.
    Guallar-Castillón P, Pérez RF, López García E, León-Muñoz LM, Aguilera MT, Graciani A et al (2014) Magnitude and management of metabolic syndrome in Spain in 2008–2010: the ENRICA study. Rev Esp Cardiol 67:367–373CrossRefGoogle Scholar
  9. 9.
    Jacobs DR Jr, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78(3 Suppl):508S–513SCrossRefGoogle Scholar
  10. 10.
    Schulze MB, Hoffmann K (2006) Methodological approaches to study dietary patterns in relation to risk of coronary heart disease and stroke. Br J Nutr 95:860–869CrossRefGoogle Scholar
  11. 11.
    Willett WC, McCullough ML (2008) Dietary pattern analysis for the evaluation of dietary guidelines. Asia Pac J Clin Nutr 17:75–78Google Scholar
  12. 12.
    Trichopoulos D, Lagiou P (2004) Mediterranean diet and cardiovascular epidemiology. Eur J Epidemiol 19:7–8Google Scholar
  13. 13.
    Pimenta AM, Toledo E, Rodriguez-Diez MC, Gea A, Lopez-Iracheta R, Shivappa N et al (2015) Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: the SUN project. Clin Nutr 34:508–514CrossRefGoogle Scholar
  14. 14.
    George SM, Ballard-Barbash R, Manson JE, Reedy J, Shikany JM, Subar AF et al (2014) Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women’s Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol 180:616–625CrossRefGoogle Scholar
  15. 15.
    Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR et al (2015) Associations of key diet-quality indexes with mortality in the multiethnic cohort: the dietary patterns methods project. Am J Clin Nutr 101:587–597CrossRefGoogle Scholar
  16. 16.
    Liese AD, Krebs-Smith SM, Subar AF, George SM, Harmon BE, Neuhouser ML et al (2015) The dietary patterns methods project: synthesis of findings across cohorts and relevance to dietary guidance. J Nutr 145:393–402CrossRefGoogle Scholar
  17. 17.
    Jacobs S, Boushey CJ, Franke AA, Shvetsov YB, Monroe KR, Haiman CA et al (2017) A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort. Br J Nutr 118:312–320CrossRefGoogle Scholar
  18. 18.
    Martínez-González MA, Buil-Cosiales P, Corella D, Bulló M, Fitó M, Vioque J et al (2018) Cohort profile: design and methods of the PREDIMED-Plus randomized trial. Int J Epidemiol.  https://doi.org/10.1093/ije/dyy225 Google Scholar
  19. 19.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645CrossRefGoogle Scholar
  20. 20.
    Willett W (2013) Nutritional epidemiology, 3rd edn. Oxford University Press, New York, p 306Google Scholar
  21. 21.
    Martin-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-Rodriguez JC, Salvini S et al (1993) Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22:512–519CrossRefGoogle Scholar
  22. 22.
    Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E et al (2010) Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 103:1808–1816CrossRefGoogle Scholar
  23. 23.
    de la Fuente-Arrillaga C, Ruiz ZV, Bes-Rastrollo M, Sampson L, Martinez-González MA (2010) Reproducibility of an FFQ validated in Spain. Public Health Nutr 13:1364–1372CrossRefGoogle Scholar
  24. 24.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Eng J Med 348:2599–2608CrossRefGoogle Scholar
  25. 25.
    Benítez-Arciniega AA, Mendez MA, Baena-Díez JM, Rovira Martori MA, Soler C, Marrugat J et al (2011) Concurrent and construct validity of Mediterranean diet scores as assessed by an FFQ. Public Health Nutr 14:2015–2021CrossRefGoogle Scholar
  26. 26.
    Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J et al (2011) A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 141:1140–1145CrossRefGoogle Scholar
  27. 27.
    Martínez-González MA, Sánchez-Tainta A, Corella D, Salas-Salvadó J, Ros E, Arós F et al (2014) A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am J Clin Nutr 100(Suppl 1):320S–328SCrossRefGoogle Scholar
  28. 28.
    Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M et al (2012) Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 142:1009–1018CrossRefGoogle Scholar
  29. 29.
    Zazpe I, Santiago S, Gea A, Ruiz-Canela M, Carlos S, Bes-Rastrollo M et al (2016) Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project. Nutr Metab Cardiovasc Dis 26:1048–1056CrossRefGoogle Scholar
  30. 30.
    Fung TT, Isanaka S, Hu FB, Willett WC (2018) International food group-based diet quality and risk of coronary heart disease in men and women. Am J Clin Nutr 107:120–129CrossRefGoogle Scholar
  31. 31.
    Molina L, Sarmiento M, Peñafiel J, Donaire D, Garcia-Aymerich J, Gomez M et al (2017) Validation of the Regicor Short Physical Activity Questionnaire for the adult population. PLoS One 12:e0168148CrossRefGoogle Scholar
  32. 32.
    American Diabetes Association (2017) Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes—2017. Diabetes Care 40:S11–S40CrossRefGoogle Scholar
  33. 33.
    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 106:3143–3421CrossRefGoogle Scholar
  34. 34.
    Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691CrossRefGoogle Scholar
  35. 35.
    Newson RB (2010) Frequentist q-values for multiple-test procedures. Stata J 10:568–584CrossRefGoogle Scholar
  36. 36.
    Chong S, Ding D, Byun R, Comino E, Bauman A, Jalaludin B (2017) Lifestyle changes after a diagnosis of type 2 diabetes. Diabetes Spectr 30:43–50CrossRefGoogle Scholar
  37. 37.
    Castro-Sánchez AE, Ávila-Ortíz MN (2013) Changing dietary habits in persons living with type 2 diabetes. J Nutr Educ Behav 45:761–766CrossRefGoogle Scholar
  38. 38.
    Ball L, Davmor R, Leveritt M, Desbrow B, Ehrlich C, Chaboyer W (2016) Understanding the nutrition care needs of patients newly diagnosed with type 2 diabetes: a need for open communication and patient-focussed consultations. Aust J Prim Health 22:416–422CrossRefGoogle Scholar
  39. 39.
    Burch E, Ball L, Somerville M, Williams LT (2018) Dietary intake by food group of individuals with type 2 diabetes mellitus: a systematic review. Diabetes Res Clin Pract 137:160–172CrossRefGoogle Scholar
  40. 40.
    Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvadó J et al (2013) Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med 11:207CrossRefGoogle Scholar
  41. 41.
    Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, Batterham MJ (2016) Dietary patterns and blood pressure in adults: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr 7:76–89CrossRefGoogle Scholar
  42. 42.
    Davis CR, Hodgson JM, Woodman R, Bryan J, Wilson C, Murphy KJ (2017) A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial. Am J Clin Nutr 105:1305–1313Google Scholar
  43. 43.
    Medina-Remón A, Tresserra-Rimbau A, Pons A, Tur JA, Martorell M, Ros E et al (2015) Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial. Nutr Metab Cardiovasc Dis 25:60–67CrossRefGoogle Scholar
  44. 44.
    Storniolo CE, Casillas R, Bulló M, Castañer O, Ros E, Sáez GT et al (2017) A Mediterranean diet supplemented with extra virgin olive oil or nuts improves endothelial markers involved in blood pressure control in hypertensive women. Eur J Nutr 56:89–97CrossRefGoogle Scholar
  45. 45.
    Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D et al (2012) A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 7:e43134CrossRefGoogle Scholar
  46. 46.
    Agnoli C, Sieri S, Ricceri F, Giraudo MT, Masala G, Assedi M et al (2018) Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes 8:22CrossRefGoogle Scholar
  47. 47.
    Asghari G, Mirmiran P, Yuzbashian E, Azizi F (2017) A systematic review of diet quality indices in relation to obesity. Br J Nutr 117:1055–1065CrossRefGoogle Scholar
  48. 48.
    Razquin C, Sanchez-Tainta A, Salas-Salvadó J, Buil-Cosiales P, Corella D, Fito M et al (2017) Dietary energy density and body weight changes after 3 years in the PREDIMED study. Int J Food Sci Nutr 68:865–872CrossRefGoogle Scholar
  49. 49.
    Howarth NC, Saltzman E, Roberts SB (2001) Dietary fiber and weight regulation. Nutr Rev 59:129–139CrossRefGoogle Scholar
  50. 50.
    Peñalvo JL, Oliva B, Sotos-Prieto M, Uzhova I, Moreno-Franco B, León-Latre M et al (2015) Greater adherence to a Mediterranean dietary pattern is associated with improved plasma lipid profile: the Aragon Health Workers Study cohort. Rev Esp Cardiol (Engl Ed) 68:290–297CrossRefGoogle Scholar
  51. 51.
    Solá R, Fitó M, Estruch R, Salas-Salvadó J, Corella D, de La Torre R et al (2011) Effect of a traditional Mediterranean diet on apolipoproteins B, A-I, and their ratio: a randomized, controlled trial. Atherosclerosis 218:174–180CrossRefGoogle Scholar
  52. 52.
    Damasceno NR, Sala-Vila A, Cofán M, Pérez-Heras AM, Fitó M, Ruiz-Gutiérrez V et al (2013) Mediterranean diet supplemented with nuts reduces waist circumference and shifts lipoprotein subfractions to a less atherogenic pattern in subjects at high cardiovascular risk. Atherosclerosis 230:347–353CrossRefGoogle Scholar
  53. 53.
    Esposito K, Chiodini P, Maiorino MI, Bellastella G, Panagiotakos D, Giugliano D (2014) Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine 47:107–116CrossRefGoogle Scholar
  54. 54.
    Ley SH, Hamdy O, Mohan V, Hu FB (2014) Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 383:1999–2007CrossRefGoogle Scholar
  55. 55.
    Salas-Salvadó J, Guasch-Ferré M, Lee CH, Estruch R, Clish CB, Ros E (2016) Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr 146:920S–927SCrossRefGoogle Scholar
  56. 56.
    Hébert JR (2016) Social desirability trait: biaser or driver of self-reported dietary intake? J Acad Nutr Diet 116:1895–1898CrossRefGoogle Scholar
  57. 57.
    Sánchez-Taínta A, Estruch R, Bulló M, Corella D, Gómez-Gracia E, Fiol M et al (2008) Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil 15:589–593CrossRefGoogle Scholar
  58. 58.
    Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57:1299–1313CrossRefGoogle Scholar
  59. 59.
    Hosseini Z, Whiting SJ, Vatanparast H (2016) Current evidence on the association of the metabolic syndrome and dietary patterns in a global perspective. Nutr Res Rev 29:152–162CrossRefGoogle Scholar
  60. 60.
    Rodríguez-Monforte M, Sánchez E, Barrio F, Costa B, Flores-Mateo G (2017) Metabolic syndrome and dietary patterns: a systematic review and meta-analysis of observational studies. Eur J Nutr 56:925–947CrossRefGoogle Scholar
  61. 61.
    Andriantsitohaina R, Auger C, Chataigneau T, Étienne-Selloum N, Li H, Martínez MC et al (2012) Molecular mechanisms of the cardiovascular protective effects of polyphenols. Br J Nutr 108:1532–1549CrossRefGoogle Scholar
  62. 62.
    Sabaté J, Wien M (2015) A perspective on vegetarian dietary patterns and risk of metabolic syndrome. Br J Nutr 113:S136–S143CrossRefGoogle Scholar
  63. 63.
    Babio N, Balanza R, Basulto J, Bulló M, Salas-Salvadó J (2010) Dietary fibre: influence on body weight, glycemic control and plasma cholesterol profile. Nutr Hosp 25:327–340Google Scholar
  64. 64.
    Babio N, Bulló M, Salas-Salvadó J (2009) Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutr 12:1607–1617CrossRefGoogle Scholar
  65. 65.
    Milà-Villarroel R, Bach-Faig A, Puig J, Puchal A, Farran A, Serra-Majem L et al (2011) Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet. Public Health Nutr 14:2338–2345CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ismael Alvarez-Alvarez
    • 1
  • Estefanía Toledo
    • 1
    • 2
  • Oscar Lecea
    • 1
    • 3
  • Jordi Salas-Salvadó
    • 2
    • 4
  • Dolores Corella
    • 2
    • 5
  • Pilar Buil-Cosiales
    • 1
    • 2
    • 3
  • María Dolores Zomeño
    • 6
    • 7
  • Jesús Vioque
    • 8
    • 9
  • J. Alfredo Martinez
    • 2
    • 10
    • 11
  • Jadwiga Konieczna
    • 2
    • 12
  • Francisco J. Barón-López
    • 13
  • José López-Miranda
    • 2
    • 14
  • Ramon Estruch
    • 2
    • 15
  • Aurora Bueno-Cavanillas
    • 8
    • 16
  • Ángel M. Alonso-Gómez
    • 2
    • 17
    • 18
  • Josep A. Tur
    • 2
    • 19
  • Francisco J. Tinahones
    • 2
    • 20
  • Lluís Serra-Majem
    • 2
    • 21
  • Vicente Martín
    • 8
    • 22
  • Manuel Ortega-Calvo
    • 2
    • 23
  • Clotilde Vázquez
    • 2
    • 24
  • Xavier Pintó
    • 2
    • 25
  • Josep Vidal
    • 26
    • 27
  • Lidia Daimiel
    • 11
  • Miguel Delgado-Rodríguez
    • 8
    • 28
  • Pilar Matía
    • 29
  • José I. González
    • 2
    • 5
  • Andrés Díaz-López
    • 2
    • 4
  • Indira Paz-Graniel
    • 4
  • Miguel A. Muñoz
    • 30
    • 31
  • Montse Fito
    • 2
    • 6
  • Salvador Pertusa-Martinez
    • 9
    • 32
  • Itziar Abete
    • 10
  • Antonio García-Ríos
    • 14
  • Emilio Ros
    • 2
    • 33
  • Miguel Ruiz-Canela
    • 1
    • 2
  • Miguel Á. Martínez-González
    • 1
    • 2
    • 34
    Email author
  1. 1.Department of Preventive Medicine and Public HealthUniversity of Navarra-IdiSNAPamplonaSpain
  2. 2.CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII)MadridSpain
  3. 3.Atención Primaria, Osasunbidea-Servicio Navarro de SaludPamplonaSpain
  4. 4.Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana IISPVHospital Universitari Sant Joan de Reus, Rovira i Virgili UniversityReusSpain
  5. 5.Department of Preventive MedicineUniversity of ValenciaValenciaSpain
  6. 6.Cardiovascular Risk and NutritionIMIM-Hospital del Mar Medical Research InstituteBarcelonaSpain
  7. 7.Blanquerna School of Life SciencesUniversitat Ramon LlullBarcelonaSpain
  8. 8.CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)MadridSpain
  9. 9.Nutritional Epidemiology UnitMiguel Hernandez University, ISABIAL-FISABIOAlicanteSpain
  10. 10.Department of Nutrition, Food Sciences and PhysiologyUniversity of NavarraPamplonaSpain
  11. 11.Nutritional Genomics and Epigenomics GroupIMDEA FoodMadridSpain
  12. 12.Health Research Institute of the Balearic Islands (IdISBa)University Hospital Son EspasesPalmaSpain
  13. 13.Department of Public HealthUniversity of Malaga-IBIMAMálagaSpain
  14. 14.Lipids and Atherosclerosis Unit, Department of Internal MedicineMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of CórdobaCórdobaSpain
  15. 15.Department of Internal Medicine, IDIBAPS, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  16. 16.Department of Preventive MedicineUniversity of GranadaGranadaSpain
  17. 17.Department of Cardiology Organización Sanitaria Integrada (OSI) ARABAUniversity Hospital ArabaVitoria-GasteizSpain
  18. 18.University of the Basque Country, UPV/EHUVitoria-GasteizSpain
  19. 19.Research Group on Community Nutrition & Oxidative StressUniversity of Balearic IslandsPalma de MallorcaSpain
  20. 20.Department of EndocrinologyHospital Virgen de la Victoria (IBIMA), University of MálagaMálagaSpain
  21. 21.Institute for Biomedical Research, University of Las Palmas de Gran CanariaLas PalmasSpain
  22. 22.Institute of Biomedicine (IBIOMED), University of LeónLeónSpain
  23. 23.Department of Family MedicineHealthcare centre Las Palmeritas, Distrito Sanitario Atención Primaria SevillaSevilleSpain
  24. 24.Department of EndocrinologyFundación Jiménez-DíazMadridSpain
  25. 25.Lipids and Vascular Risk Unit, Internal MedicineHospital Universitario de Bellvitge, Hospitalet de LlobregatBarcelonaSpain
  26. 26.CIBER Diabetes y enfermedades metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)MadridSpain
  27. 27.Department of Endocrinology, IDIBAPS, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  28. 28.Division of Preventive MedicineUniversity of JaénJaénSpain
  29. 29.Instituto de Investigación Sanitaria del Hospital Clínico San CarlosMadridSpain
  30. 30.Gerencia territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
  31. 31.Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
  32. 32.Healthcare centre Cabo HuertasAlicanteSpain
  33. 33.Department of Endocrinology and Nutrition, Lipid ClinicInstitut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital ClínicBarcelonaSpain
  34. 34.Department of NutritionHarvard T. H. Chan School of Public HealthBostonUSA

Personalised recommendations