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A priori dietary patterns and blood pressure in the EPIC Florence cohort: a cross-sectional study

A Correction to this article was published on 10 October 2018

This article has been updated



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.

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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.

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Correspondence to G. Masala.

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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.

Informed consent

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.

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Bendinelli, B., Masala, G., Bruno, R.M. et al. A priori dietary patterns and blood pressure in the EPIC Florence cohort: a cross-sectional study. Eur J Nutr 58, 455–466 (2019).

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  • A priori dietary pattern
  • Blood pressure
  • Cross-sectional design
  • Cohort study