Predictive role of the Mediterranean diet on mortality in individuals at low cardiovascular risk: a 12-year follow-up population-based cohort study

Abstract

BackgroundAdherence to the Mediterranean diet reduces the risk of all-cause and cardiovascular (CV) mortality and the incidence of CV events. However, most previous studies were performed in high-risk individuals. Our objective was to assess whether the adherence to the Mediterranean diet, evaluated by the MED score, was associated with all-cause and CV mortality and incidence of CV events in individuals at low CV risk from a population-based cohort, after a 12-year mean follow-up.MethodsA cohort of 1658 individuals completed a validated food-frequency questionnaire in 2001–2003. The MED score was calculated by a 0–9 scale. Anthropometric, laboratory measurements, and the vital status were collected at baseline and during 2014. The baseline CV risk was estimated by the Framingham risk score. Participants were divided into two groups: individuals at low risk (CV < 10) and individuals with CV risk ≥10.ResultsDuring a 12-year mean follow-up, 220 deaths, 84 due to CV diseases, and 125 incident CV events occurred. The adherence to the Mediterranean diet was low in 768 (score 0–2), medium in 685 (score 4–5) and high in 205 (score >6) individuals. Values of BMI, waist circumference, fasting glucose and insulin significantly decreased from low to high diet adherence only in participants with CV risk ≥10. In a Cox-regression model, the hazard ratios (HRs) in low-risk individuals per unit of MED score were: HR = 0.83 (95 % CI 0.72–0.96) for all-cause mortality, HR = 0.75 (95 % CI 0.58–0.96) for CV mortality, and HR = 0.79 (95 % CI 0.65–0.97) for CV events, after multiple adjustments. In individuals with CV risk ≥10, the MED score predicted incident CV events (HR = 0.85; 95 % CI 0.72–0.99), while the associations with all-cause (HR = 1.02; 95 % CI 0.90–1.15) and CV mortality (0.94; 95 % CI 0.76–1.15) were not significant.ConclusionsGreater adherence to the Mediterranean diet was associated with reduced fatal and non fatal CV events, especially in individuals at low CV risk, thus suggesting the usefulness of promoting this nutritional pattern in particular in healthier individuals.

“Traditional” and “Healthy” Dietary Patterns Are Associated with Low Cardiometabolic Risk in Brazilian Subjects

“…In a model adjusted for confounding factors, the “Healthy” pattern was associated to low occurrence of abdominal obesity, dyslipidemia, diabetes, and hypertension. This pattern resembles other cardioprotective patterns described in the literature and associated with low disease risk [15, 51, 52] and low mortality [53–55]. Therefore, the protective effect of this pattern is well established.…”

Mediterranean diet and its components in relation to all-cause mortality: meta-analysis

“…Nevertheless, the summary RR for the nine MedDiet components are generally in agreement with the current literature. Several studies have reported the survival benefit (25) 2006 (30) 2007 (31) 2010 (32) 2012 (36) 2012 (37) 2015 (40,41) 2014 (39) 2017 (7) 2018 (47) 2015 (40,41) 2016 (6,42,43) 2018 (26) 1995 (27) 1999 (13) 2000 (28) 2004 (29) 2005 (25) 2006 (30) 2009 (4) 2010 (32) 2016 (20,42,43) 2017 (7,44,45,46) Time (year) Time (year) 2011 (33,34,35) 2011 (33,34,35) 2014 (22,23,38) Fig. 7.…”

“…The studies analysed by Sofi et al (4) were also included in the current meta-analysis, except for the study by Martínez-González et al (8) , as the most recent publication by Alvarez-Alvarez et al (29) used the same cohort and was more informative. Therefore, thirty articles were finally included in the meta-analyses of the MedDiet with all-cause mortality: fourteen published before (7,16,28,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and sixteen published after June 2013 (up to 31 December 2017) (9,10,23,25,26,29,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) . Detailed characteristics of these studies are shown in Table 1.…”

“…RR for all-cause mortality were reported: (a) only for continuous increments of MDS (e.g. one or two units) in nine studies (7,9,16,(30)(31)(32)40,42,50) , (b) only as a comparison of different categories of MDS in ten studies (23,25,26,29,34,39,41,(47)(48)(49) and (c) for both (a) and (b) in eleven studies (10,28,33,(35)(36)(37)(38)(43)(44)(45)(46) . Categories of MDS were defined arbitrarily or were based on percentiles.…”

An inverse association between the Mediterranean diet and bladder cancer risk: a pooled analysis of 13 cohort studies

“…The Mediterranean diet has been reported to be effective for preventing non-communicable diseases [12][13][14][15] and reducing overall mortality and the incidence of several cancers [16,17]. It is generally characterized by a high consumption of fruits, vegetables, legumes and cereals, moderate-to-high consumption of fish, moderate consumption of alcohol (mostly wine), low-to-moderate consumption of milk and dairy products, and low consumption of meat and meat products [18].…”