Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults

Abstract

Despite the well-established health benefits of the Mediterranean diet, there are signs that Mediterranean populations are deviating from this traditional pattern. We aimed to evaluate longitudinal changes in adherence to the Mediterranean diet, its determinants and health effects in a representative sample of the adult Greek population. This was a secondary analysis of the ATTICA epidemiological cohort study conducted in 2001/2002 and 2011/2012. The study sample consisted of 3042 men and women free of cardiovascular diseases living in Attica, Greece; of them, 2583 were followed-up for 10 years. Participants were evaluated in terms of sociodemographic, lifestyle and clinical parameters at baseline, and incidence of cardiometabolic diseases was recorded at follow-up. Dietary habits were assessed both at baseline and 10 years through a validated food frequency questionnaire and adherence to the Mediterranean diet was evaluated through the MedDietScore, based on which four trajectories were identified, i.e., low–low, low–high, high–low and high–high. During the study period, 45.6% of participants moved away from the Mediterranean diet (high–low), 9.0% moved closer (low–high), while 18.7% sustained a high adherence (high–high). Participants in the high–high trajectory were younger, mostly women, more physically active, had a higher socioeconomic status, and a more favorable body composition and cardiometabolic profile at baseline, and exhibited lower 10-year incidence rates of hyperlipidemia, hypertension, diabetes mellitus and cardiovascular disease compared to other trajectories (all p-values < 0.050). Adherence to the Mediterranean diet is declining among Greek adults. Staying close to the Mediterranean diet is associated with significant health benefits and should be a major target of public health strategies.

Food Compass Score predicts incident cardiovascular disease: The ATTICA cohort study (2002–2022)

“…Moreover, the FCS value in the ATTICA study participants was higher than the value found in Greek University students (median 47.6/100), who were assessed in 2018 13 . It appears that the level of diet quality is low, and this could be attributed to the nutrition transition phenomenon observed in various countries, including Greece, in the past decades, 47 which led to a decline in diet quality and adherence to MTD 48–50 …”

“…13 It appears that the level of diet quality is low, and this could be attributed to the nutrition transition phenomenon observed in various countries, including Greece, in the past decades, 47 which led to a decline in diet quality and adherence to MTD. [48][49][50] Regarding the association of FCS with CVDs, FCS has already been positively associated with optimal cardiometabolic markers, and inversely associated with the prevalence of CVD, metabolic syndrome, cancer and lung disease, as well as all-cause and cause-specific mortality, in a US population. 12 Moreover, increased diet quality, measured by other NPS tools, has also been associated with reduced 12-year 51 and 20-year CVD mortality 52 in the US population.…”

“…This finding can be explained by the fact that a lower adherence to MTD means a lower quality of diet, and thus lower FCS values and a shorter range, which appears to be inadequate with respect to offering a significant cardio-protection. Unfortunately, presently, accumulating evidence support a decline in adherence to the MTD or other healthy dietary patterns, 47,50 a fact that should be urgently taken into consideration by public health policy makers.…”

Comparative performance of equations to estimate low‐density lipoprotein cholesterol levels and cardiovascular disease incidence: The ATTICA study (2002–2022)

“…Participants were evaluated through face‐to‐face interviews in terms of medical status (including a detailed medical history of cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes mellitus, as well as the use of relevant medications), sociodemographic characteristics (age, sex, and years of education) and lifestyle habits (i.e., smoking habits, physical activity, adherence to a Mediterranean type diet) using validated questionnaires, as described in detail in previously published papers (Georgoulis, Chrysohoou, et al, 2022; Georgoulis, Georgousopoulou, et al, 2022; Nomikos et al, 2015; Pitsavos et al, 2003).…”

“…During the physical examination, participants were evaluated in terms of clinical status, body weight, and height, as well as systolic and diastolic blood pressure according to standard procedures (Georgoulis, Chrysohoou, et al, 2022; Georgoulis, Georgousopoulou, et al, 2022; Nomikos et al, 2015; Pitsavos et al, 2003). The body mass index (BMI) was calculated as weight/height 2 ; participants were classified as obese if their BMI was ≥30 kg/m 2 .…”