Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: The EPIC-Spain cohort study

Guallar-Castillón, Pilar; Rodríguez‐Artalejo, Fernando; Tormo, María José; Sánchez, María‐José; Rodríguez, Laudina; Quiŕos, J. Ramón; Navarro, Carmen; Molina, Esther; Martínez, Carmen; Marin, Pilar; López-Garcı́a, Esther; Larrañaga, Nerea; Huerta, José María; Dorronsoro, Miren; Chirlaque, María Dolores; Buckland, Genevieve; Barricarte, Aurelio; Banegas, José R.; Arriola, Larraitz; Ardanaz, Eva; González, Carlos A.; Moreno-Iribas, Concepción

doi:10.1016/j.numecd.2010.06.004

Cited by 72 publications

(77 citation statements)

References 26 publications

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“…However, the MDP was the second pattern identified. These data are in agreement with previous studies in Spain and in other Mediterranean countries bordering the Mediterranean Sea (22,(38)(39)(40)(41). A possible explanation could be that highly educated people are more likely to work in activities which very often may also condition their dietary pattern (38).…”

Section: Discussionsupporting

confidence: 92%

“…Finally, it is noteworthy that, except for the study conducted in Italy (23) and a previous study in the Spanish EPIC-cohort which assessed coronary heart disease as the outcome, but not total mortality (22), most studies using this approach have been conducted outside the Mediterranean setting.…”

Section: Discussionmentioning

confidence: 99%

“…However, to our knowledge, there is still limited evidence on the association between the adherence to empirically-derived dietary patterns and all-cause mortality (8,(18)(19)(20)(21) in Mediterranean populations (22).…”

Section: Introductionmentioning

confidence: 99%

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Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

Zazpe¹,

Sánchez‐Tainta²,

Toledo³

et al. 2014

Journal of the Academy of Nutrition and Dietetics

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Background: Different dietary patterns have been associated with several health outcomes, including morbidity and mortality. There is little evidence on the association between empirically-derived dietary patterns and all cause mortality in Southern European populations.Objective: the aim of this study was to prospectively evaluate the association between an empirically-derived dietary pattern and all-cause mortality.Design: The SUN Project is an ongoing, multipurpose, prospective and dynamic Spanish cohort.Participants/setting: a prospective cohort of 16,008 middle-aged Spanish adults. All of them were former university graduates (alumni) (59.6 percent women, mean age: 38 years). Usual diet was assessed at baseline with a validated semiquantitative foodfrequency questionnaire.Main outcome measures: Deaths were confirmed by review of medical records and of the National Death Index.Statistical analyses performed: Dietary patterns were ascertained through a factor (principal component) analysis based on 30 predefined food groups. Participants were classified according to tertiles of adherence to the three main dietary patterns identified with factor analysis. Cox regression models were fitted to estimate multivariableadjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality.Results: Three major dietary patterns were identified: they were labelled Western dietary pattern (WDP) (rich in red and processed meat, potatoes and fast food), Mediterranean dietary pattern (MDP) (rich in vegetables, fish and seafood, fruits, and olive oil) and Alcoholic beverages dietary pattern (ABDP). During follow-up, 148 deaths were reported (mean age at death: 54.5 years). After adjustment for potential confounders, the lowest risk of all-cause mortality was found in the tertile of highest adherence to the MDP (adjusted HR for third vs. first tertile: 0.53; 95% CI: 0.34-0.84) (p for trend <0.01). The WDP and ABDP showed no significant association with mortality.Conclusions: Greater adherence to an empirically-derived dietary pattern approaching the traditional Mediterranean diet was associated with a reduction in the risk of allcause mortality among middle-aged Mediterranean adults.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

Zazpe¹,

Sánchez‐Tainta²,

Toledo³

et al. 2014

Journal of the Academy of Nutrition and Dietetics

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“…For example, a 'prudent diet' characterised by high intake of vegetables, fruit, legumes, whole grains, fish and poultry, has been associated with almost 30% decrease in the risk of CVD among men and women in the USA, Germany, Spain and the Netherlands (18)(19)(20)(21)24,34) . In contrast, a 'Western' dietary pattern characterised by high intake of red meat, processed meat, refined grains and sweets was associated with increased risk of CHD in the USA and Sweden (18)(19)(20)35) , but this relationship was not observed in Spain (24) . An Italian study found that a dietary pattern featuring high consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and low consumption of milk, sugar, fruit and alcoholic beverages was associated with a reduced risk of CHD (23) , whereas in Chinese adults, a pattern characterised by refined cereals, salted vegetables and potatoes was associated with an increased risk of stroke (36) .…”

Section: Cardiometabolic Disordersmentioning

confidence: 99%

Nutrition and healthy ageing: the key ingredients

2014

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Healthy longevity is a tangible possibility for many individuals and populations, with nutritional and other lifestyle factors playing a key role in modulating the likelihood of healthy ageing. Nevertheless, studies of effects of nutrients or single foods on ageing often show inconsistent results and ignore the overall framework of dietary habits. Therefore, the use of dietary patterns (e.g. a Mediterranean dietary pattern) and the specific dietary recommendations (e.g. dietary approaches to stop hypertension, Polymeal and the American Healthy Eating Index) are becoming more widespread in promoting lifelong health. A posteriori defined dietary patterns are described frequently in relation to age-related diseases but their generalisability is often a challenge since these are developed specifically for the population under study. Conversely, the dietary guidelines are often developed based on prevention of disease or nutrient deficiency, but often less attention is paid to how well these dietary guidelines promote health outcomes. In the present paper, we provide an overview of the state of the art of dietary patterns and dietary recommendations in relation to life expectancy and the risk of age-related disorders (with emphasis on cardiometabolic diseases and cognitive outcomes). According to both a posteriori and a priori dietary patterns, some key 'ingredients' can be identified that are associated consistently with longevity and better cardiometabolic and cognitive health. These include high intake of fruit, vegetables, fish, (whole) grains and legumes/pulses and potatoes, whereas dietary patterns rich in red meat and sugar-rich foods have been associated with an increased risk of mortality and cardiometabolic outcomes.

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“…Factor analysis, a data‐driven exploratory method, assesses eating patterns in specified groups without preconceived judgments about which foods commonly are consumed together and has been used in previous studies to derive dietary patterns that subsequently were related to CHD risk 8, 9, 10, 11, 12, 13, 14, 15, 16. In a previous analysis, we derived dietary patterns with factor analysis within the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, a national, population‐based, longitudinal cohort 17.…”

Section: Introductionmentioning

confidence: 99%

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

Shikany

Safford

Bryan

et al. 2018

JAHA

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BackgroundPreviously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all‐cause mortality in REGARDS participants with existing CHD.Methods and ResultsWe included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events—definite or probable MI or acute CHD death—and all‐cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant‐based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow‐up, there were 581 recurrent CHD events and 1098 deaths. In multivariable‐adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62–0.98; PT rend=0.036). The Southern dietary pattern was adversely associated with the hazard of all‐cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28–1.91; P Trend<0.001). The Mediterranean diet score was inversely associated with the hazard of all‐cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67–0.95; PT rend=0.014).ConclusionsThe Southern dietary pattern was associated with a greater hazard of all‐cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all‐cause mortality.

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Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: The EPIC-Spain cohort study

Cited by 72 publications

References 26 publications

Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

Dietary Patterns and Total Mortality in a Mediterranean Cohort: The SUN Project

Nutrition and healthy ageing: the key ingredients

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

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