Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial
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.
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.
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.
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
KeywordsHypertension Obesity Type 2 diabetes Dyslipidemias Dietary pattern Mediterranean diet
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.
- 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
- 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.Trichopoulos D, Lagiou P (2004) Mediterranean diet and cardiovascular epidemiology. Eur J Epidemiol 19:7–8Google Scholar
- 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
- 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.Willett W (2013) Nutritional epidemiology, 3rd edn. Oxford University Press, New York, p 306Google Scholar
- 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
- 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
- 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
- 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