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Effect of using repeated measurements of a Mediterranean style diet on the strength of the association with cardiovascular disease during 12 years: the Doetinchem Cohort Study

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Abstract

Background

In cohort studies, often only one baseline measurement of dietary intake is available. This may underestimate the strength of the association with cardiovascular diseases (CVD).

Objective

The main objective is to compare the strength of the association of a Mediterranean style diet with CVD using one baseline measurement of diet versus three repeated measurements over a 10-year period.

Design

We used dietary and lifestyle data of three rounds of the Doetinchem Cohort Study. At baseline, 7,769 persons aged 20–65 years were examined. Diet was assessed with a 178 item validated food-frequency questionnaire and operationalized with the Mediterranean Diet Score (MDS) ranging from 0 to 9. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CI). Analyses were adjusted for age, sex, and repeated measurements of smoking, sports, total energy intake, and educational level.

Results

Comparing an MDS of ≥5.5–9 to an MDS of 0–<3.5, baseline MDS was associated with a 23 % lower risk [HR 0.77 (95 % CI 0.53–1.11)] and the updated mean with a 35 % lower risk [HR 0.65 (0.43–0.97)] of a composite of fatal CVD, nonfatal myocardial infarction, and stroke (composite CVD). For fatal CVD, baseline MDS was associated with a 13 % lower risk [HR 0.87 (0.36–2.07)] and the updated mean with a 56 % lower risk [HR 0.44 (0.19–1.05)].

Conclusion

The strength of the association between a Mediterranean style diet and CVD is likely underestimated because most studies so far used only one baseline measurement.

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Acknowledgments

The authors would like to thank the field workers of the Municipal Health Services in Doetinchem for their contribution to the data collection for the present study. Project director is WMM Verschuren, PhD. Logistic management was provided by J Steenbrink and P Vissink. The data management was provided by A Blokstra, MSc, AWD van Kessel, MSc, and PE Steinberger. The project was funded by the National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

Conflict of interest

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Authors and Affiliations

  1. Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands

    Marieke P. Hoevenaar-Blom, Annemieke M. W. Spijkerman, Jolanda M. A. Boer & W. M. Monique Verschuren

  2. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    Marieke P. Hoevenaar-Blom, Hendriek C. Boshuizen & Daan Kromhout

  3. Department of Statistics, Mathematical Modeling and Data Logistics, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

    Hendriek C. Boshuizen

Authors
  1. Marieke P. Hoevenaar-Blom
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  2. Annemieke M. W. Spijkerman
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  3. Hendriek C. Boshuizen
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  4. Jolanda M. A. Boer
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  5. Daan Kromhout
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  6. W. M. Monique Verschuren
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Correspondence to Marieke P. Hoevenaar-Blom.

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Hoevenaar-Blom, M.P., Spijkerman, A.M.W., Boshuizen, H.C. et al. Effect of using repeated measurements of a Mediterranean style diet on the strength of the association with cardiovascular disease during 12 years: the Doetinchem Cohort Study. Eur J Nutr 53, 1209–1215 (2014). https://doi.org/10.1007/s00394-013-0621-8

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  • DOI: https://doi.org/10.1007/s00394-013-0621-8

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