Identification of change-points in the relationship between food groups in the mediterranean diet and overall mortality: an ‘a posteriori’ approach

European Journal of Nutrition volume 51, pages167–172(2012)Cite this article

Abstract

Background

Adherence to Mediterranean diet has been shown to be associated with a better health and greater survival. The aim of the present study was to identify change-points in the relationship between food groups composing Mediterranean diet and overall mortality.

Methods

The population of the Greek EPIC prospective cohort study (23,349 adult men and women in the Greek EPIC sample who had not previously been diagnosed as having cancer, coronary heart disease or diabetes mellitus at enrolment) was analysed. Segmented logistic regression analysis was conducted to examine the association between each of the food groups contributing to the Mediterranean diet score and overall mortality.

Results

This analysis allowed the determination of the following change-points: among men: 1 change-point for vegetables, legumes, cereals, fish and seafood and dairy products and 2 change-points for fruit and nuts, meat and meat products and ethanol; among women: 1 change-point for legumes and fish and seafood and 2 change-points for the remaining food groups. These cut-off points were used to construct an ‘a posteriori’ score that may be better in capturing the health-promoting potential of the traditional Mediterranean diet.

Conclusion

Identification of change-points in the relationship between components of the Mediterranean diet and mortality can be used to increase the discriminatory ability of a widely used Mediterranean diet score in relation to mortality.

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References

  1. 1.

    Martinez-Gonzalez MA, Bes-Rastrollo M, Serra-Majem L, Lairon D, Estruch R, Trichopoulou A (2009) Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev 67:S111–S116

    Article  Google Scholar 

  2. 2.

    Serra-Majem L, Roman B, Estruch R (2006) Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev 64:S27–S47

    Article  Google Scholar 

  3. 3.

    Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D (1995) Diet and overall survival in elderly people. BMJ 311:1457–1460

    Article  CAS  Google Scholar 

  4. 4.

    Trichopoulou A, Costacou T, Bamia C, Tricopoulou D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608

    Article  Google Scholar 

  5. 5.

    Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a344

    Google Scholar 

  6. 6.

    Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010 92:1189–1196

    Article  CAS  Google Scholar 

  7. 7.

    Bach A, Serra-Majem L, Carrasco JL, Roman B, Ngo J, Bertomeu I, Obrador B (2006) The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr 9:132–146

    Article  Google Scholar 

  8. 8.

    Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C (2007) Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med 44:335–340

    Article  Google Scholar 

  9. 9.

    Trichopoulou A, Bamia C, Trichopoulos D (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338:b2337

    Article  Google Scholar 

  10. 10.

    Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G (2006) Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 166:2437–2445

    Article  Google Scholar 

  11. 11.

    López-Miranda J, Pérez-Jiménez F, Ros E, De Caterina R, Badimón L, Covas MI, Escrich E, Ordovás JM, Soriguer F, Abiá R, de la Lastra CA, Battino M, Corella D, Chamorro-Quirós J, Delgado-Lista J, Giugliano D, Esposito K, Estruch R, Fernandez-Real JM, Gaforio JJ, La Vecchia C, Lairon D, López-Segura F, Mata P, Menéndez JA, Muriana FJ, Osada J, Panagiotakos DB, Paniagua JA, Pérez-Martinez P, Perona J, Peinado MA, Pineda-Priego M, Poulsen HE, Quiles JL, Ramírez-Tortosa MC, Ruano J, Serra-Majem L, Solá R, Solanas M, Solfrizzi V, de la Torre-Fornell R, Trichopoulou A, Uceda M, Villalba-Montoro JM, Villar-Ortiz JR, Visioli F, Yiannakouris N (2010) Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008. Nutr Metab Cardiovasc Dis 20:284–294

    Article  Google Scholar 

  12. 12.

    Pastor R, Guallar E (1998) Use of two-segmented logistic regression to estimate change-points in epidemiological studies. Am J Epidemiol 148:631–642

    Article  CAS  Google Scholar 

  13. 13.

    Muggeo VMR (2003) Estimating regression models with unknown break-points. Statist Med 22:3055–3071

    Article  Google Scholar 

  14. 14.

    Sofi F (2009) The Mediterranean diet revisited: evidence of its effectiveness grows. Curr Opin Cardiol 24:442–446

    Article  Google Scholar 

  15. 15.

    Bang H, Mazumdar M, Spence JD (2006) Tutorial in biostatistics: analyzing associations between total plasma homocysteine and B vitamins using optimal categorization and segmented regression. Neuroepidemiology 27:188–200

    Article  Google Scholar 

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Acknowledgments

We are indebted to Alessandro Sofi for his valuable statistical assistance and for the helpful comments in drafting the manuscript.

Conflict of interest

None.

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Affiliations

  1. Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Viale Morgagni, 85 50134, Florence, Italy

    Francesco Sofi, Rosanna Abbate & Gian Franco Gensini

  2. Agency of Nutrition, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Francesco Sofi & Alessandro Casini

  3. Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence, Italy

    Francesco Sofi & Gian Franco Gensini

  4. WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece

    Antonia Trichopoulou & Christina Bamia

Authors
  1. Francesco Sofi
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  2. Rosanna Abbate
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  3. Gian Franco Gensini
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  4. Alessandro Casini
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  5. Antonia Trichopoulou
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  6. Christina Bamia
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Corresponding author

Correspondence to Francesco Sofi.

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Sofi, F., Abbate, R., Gensini, G.F. et al. Identification of change-points in the relationship between food groups in the mediterranean diet and overall mortality: an ‘a posteriori’ approach. Eur J Nutr 51, 167–172 (2012). https://doi.org/10.1007/s00394-011-0202-7

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Keywords

  • Mediterranean diet
  • Adherence
  • Score
  • Food group