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Dietary folate intake and metabolic syndrome in participants of PREDIMED-Plus study: a cross-sectional study

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Abstract

Purpose

We examined the association between dietary folate intake and a score of MetS (metabolic syndrome) and its components among older adults at higher cardiometabolic risk participating in the PREDIMED-Plus trial.

Methods

A cross-sectional analysis with 6633 with overweight/obesity participants with MetS was conducted. Folate intake (per 100 mcg/day and in quintiles) was estimated using a validated food frequency questionnaire. We calculated a MetS score using the standardized values as shown in the formula: [(body mass index + waist-to-height ratio)/2] + [(systolic blood pressure + diastolic blood pressure)/2] + plasma fasting glucose–HDL cholesterol + plasma triglycerides. The MetS score as continuous variable and its seven components were the outcome variables. Multiple robust linear regression using MM-type estimator was performed to evaluate the association adjusting for potential confounders.

Results

We observed that an increase in energy-adjusted folate intake was associated with a reduction of MetS score (β for 100 mcg/day = − 0.12; 95% CI: − 0.19 to − 0.05), and plasma fasting glucose (β = − 0.03; 95% CI: − 0.05 to − 0.02) independently of the adherence to Mediterranean diet and other potential confounders. We also found a positive association with HDL-cholesterol (β = 0.07; 95% CI: 0.04–0.10). These associations were also observed when quintiles of energy-adjusted folate intake were used instead.

Conclusion

This study suggests that a higher folate intake may be associated with a lower MetS score in older adults, a lower plasma fasting glucose, and a greater HDL cholesterol in high-risk cardio-metabolic subjects.

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Acknowledgements

We thank all PREDIMED-Plus participants and researchers. CIBEROBN, CIBERESP, and CIBERDEM are initiatives of the Instituto de Salud Carlos III (ISCIII), Madrid, Spain. The Hojiblanca (Lucena, Spain) and Patrimonio Comunal Olivarero (Madrid, Spain) food companies donated extra-virgin olive oil. The Almond Board of California (Modesto, CA), American Pistachio Growers (Fresno, CA), and Paramount Farms (Wonderful Company, LLC, Los Angeles, CA) donated nuts. Jordi Salas-Salvadó gratefully acknowledges the financial support by ICREA from the ICREA Academia programme. Thanks to Desirée Valera-Gran for her help with the first draft English-language version. We like to acknowledge Emily Felt for providing assistance with the English revision of the paper; she received compensation.

Funding

The PREDIMED-Plus trial was supported by grants from the Instituto de Salud Carlos III, co-financed by the Fondo Europeo de Desarrollo Regional-FEDER including the following projects: 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, and PI17/00926; the Cohorte PREDIMED-Plus grant; the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the Recercaixa grant to J.S.-S. (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03 and CB12/03), The International Nut & Dried Fruit Council—FESNAD (Long-term effects of an energy-restricted Mediterranean diet on mortality and cardiovascular disease 2014–2015, No. 201302) [M.A.M.-G.]; the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 [D.R.], EU-COST Action CA16112, Grant of support to research groups no. 35/2011 from the Balearic Islands Government, Grants from Balearic Islands Health Research Institute (IDISBA). This work is partially supported by ICREA under the ICREA Academia programme. None of the funding sources took part in the design, collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication.

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Authors

Contributions

ENM-M and JV conducted the statistical analyses and drafted the article. All authors contributed substantially to the acquisition of data or analysis and interpretation of data. All authors revised the article critically for important intellectual content. All authors approved the final version to be published.

Corresponding author

Correspondence to Jesus Vioque.

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Conflict of interest

J.S.-S. reports serving on the board of the International Nut and Dried Fruit Council from which he has also received grant support through his institution, receiving consulting fees from Danone, Font Vella Lanjaron, Nuts for Life, and Eroski, and being given grant support through his institution from Eroski. J.S.-S is a member of the executive committee of the Instituto Danone Spain and a member of the scientific committee of the Institute Danone International. L.D. reports receiving a grant from the Fundación Cerveza y Salud. N-B. declares that she received payments from Danone S.A. for the purposes of scientific and technical consulting but not for preparing this study and grant support through his institution from Font Vella Lanjaron. No other potential conflicts of interest relevant to this article were reported.

Ethical approval

All participants provided written informed consent, and the study protocol and procedures were approved according to the ethical standards of the Declaration of Helsinki.

Additional information

The original online version of this article was revised: José M Gámez was not listed among the authors.

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Navarrete-Muñoz, EM., Vioque, J., Toledo, E. et al. Dietary folate intake and metabolic syndrome in participants of PREDIMED-Plus study: a cross-sectional study. Eur J Nutr 60, 1125–1136 (2021). https://doi.org/10.1007/s00394-020-02364-4

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Keywords

  • Folate
  • Cardiometabolic risk
  • Metabolic syndrome score
  • Diabetes
  • Cholesterol