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Mediterranean diet and CHD: the Greek European Prospective Investigation into Cancer and Nutrition cohort

  • Vardis Dilis (a1) (a2), Michail Katsoulis (a1) (a2), Pagona Lagiou (a1) (a3) (a4), Dimitrios Trichopoulos (a3) (a4), Androniki Naska (a1) (a2) and Antonia Trichopoulou (a1) (a2)...

Abstract

Adherence to the Mediterranean diet (MD) has been reported to improve CHD prognosis and to be inversely associated with CHD mortality. The aim of the present study was to investigate the association of adherence to the MD with CHD incidence and mortality in the Greek European Prospective Investigation into Cancer and Nutrition cohort, a population with traditional Mediterranean roots. In a general population sample of 23 929 adult men and women with no CVD or cancer at enrolment, a validated FFQ was interviewer-administered, sociodemographic, physical activity and other characteristics were recorded, and arterial blood pressure and anthropometric characteristics were measured. In a median period of 10 years, 636 incident CHD cases and 240 CHD deaths were recorded. Associations of adherence to the MD, operationalised through a nine-component score (0, poor; 9, excellent), with CHD incidence and mortality were evaluated through Cox regression controlling for potentially confounding variables. A two-point increase in the MD score was associated with lower CHD mortality by 25 % (95 % CI 0·57, 0·98) among women and 19 % (95 % CI 0·67, 0·99) among men. The association of adherence to the MD with CHD incidence was again inverse, but weaker (hazard ratios 0·85 (95 % CI 0·71, 1·02) among women and 0·98 (95 % CI 0·87, 1·10) among men). With respect to score components, only meat among men (positively) and fruits and nuts among women (inversely) were associated with both the incidence of and mortality from CHD. The MD, as an integral entity, is inversely associated with CHD incidence and, particularly, mortality.

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Corresponding author

*Corresponding author: Dr A. Trichopoulou, fax +30 210 746 2079, email antonia@nut.uoa.gr

References

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1Keys, A (1980) Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge: Harvard University Press.
2Helsing, E & Trichopoulou, A (1989) The Mediterranean diet and food culture – a symposium. Eur J Clin Nutr 43, Suppl. 2, 192.
3Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, M, et al. (1995) Diet and overall survival in elderly people. BMJ 311, 14571460.
4Trichopoulou, A, Costacou, T, Bamia, C, et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.
5Fung, TT, McCullough, ML, Newby, PK, et al. (2005) Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 82, 163173.
6Trichopoulou, A, Orfanos, P, Norat, T, et al. (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991.
7Mitrou, PN, Kipnis, V, Thiébaut, AC, et al. (2007) Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Results from the NIH-AARP Diet and Health Study. Arch Intern Med 167, 24612468.
8Lagiou, P, Trichopoulos, D, Sandin, S, et al. (2006) Mediterranean dietary pattern and mortality among young women: a cohort study in Sweden. Br J Nutr 96, 384392.
9Sofi, F, Abbate, R, Gensini, GF, et al. (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92, 11891196.
10Fung, TT, Rexrode, KM, Mantzoros, CS, et al. (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119, 10931100.
11Benetou, V, Trichopoulou, A, Orfanos, P, et al. (2008) Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer 99, 191195.
12Fung, TT, Hu, FB, McCullough, ML, et al. (2006) Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr 136, 466472.
13Reedy, J, Mitrou, PN, Krebs-Smith, SM, et al. (2008) Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol 168, 3848.
14Buckland, G, Agudo, A, Luján, L, et al. (2010) Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr 91, 381390.
15Trichopoulou, A, Bamia, C, Lagiou, P, et al. (2010) Conformity to traditional Mediterranean diet and breast cancer risk in the Greek EPIC (European Prospective Investigation into Cancer and Nutrition) cohort. Am J Clin Nutr 92, 620625.
16Willett, W (1998) Nutritional Epidemiology, 2nd ed., pp. 414466. New York: Oxford University Press.
17Knoops, KT, de Groot, LC, Kromhout, D, et al. (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292, 14331439.
18De Lorgeril, M, Salen, P, Martin, J-L, et al. (1998) Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med 158, 11811187.
19Trichopoulou, A, Bamia, C & Trichopoulos, D (2005) Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165, 929935.
20Trichopoulou, A, Bamia, C, Norat, T, et al. (2007) Modified Mediterranean diet and survival after myocardial infarction: the EPIC-elderly study. Eur J Epidemiol 22, 871881.
21Buckland, G, González, CA, Agudo, A, et al. (2009) Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol 170, 15181529.
22Martínez-González, MA, García-López, M, Bes-Rastrollo, M, et al. (2011) Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. Nutr Metab Cardiovasc Dis 21, 237244.
23Riboli, E, Hunt, KJ, Slimani, N, et al. (2002) European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr 5, 11131124.
24Gnardellis, C, Trichopoulou, A, Katsouyianni, K, et al. (1995) Reproducibility and validity of an extensive semi-quantitative food frequency questionnaire among Greek school teachers. Epidemiology 6, 7477.
25Katsouyianni, K, Rimm, EB, Gnardellis, C, et al. (1997) Reproducibility and relative validity of an extensive semi-quantitative Food Frequency Questionnaire using dietary records and chemical markers among Greek school teachers. Int J Epidemiol 26, Suppl. 1, S118SS27.
26Trichopoulou, A & Georga, K (2004) Composition Tables of Foods and Greek Dishes, 3rd ed.Athens: Parisianou Publications.
27Ainsworth, BE, Haskell, WL, Leon, AS, et al. (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25, 7180.
28Trichopoulou, A, Gnardellis, C, Lagiou, A, et al. (2000) Body mass index in relation to energy intake and expenditure among adults in Greece. Epidemiology 11, 333336.
29Psaltopoulou, T, Orfanos, P, Naska, A, et al. (2004) Prevalence, awareness, treatment and control of hypertension in a general population sample of 26,913 adults in the Greek EPIC study. Int J Epidemiol 33, 13451352.
30World Health Organisation (2006) International Statistical Classification of Diseases and Related Health Problems, 10th rev.Geneva: World Health Organization.
31Misirli, G, Bamia, C, Dilis, V, et al. (2012) Validation of self-reported incident cardiovascular disease events in the Greek EPIC cohort study. EBPH, (In the Press).
32Romaguera, D, Norat, T, Vergnaud, AC, et al. (2010) Mediterranean dietary patterns and prospective weight change in participants of the EPIC-PANACEA project. Am J Clin Nutr 92, 912921.
33Esposito, K, Kastorini, CM, Panagiotakos, DB, et al. (2011) Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 9, 112.
34Salas-Salvadó, J, Fernández-Ballart, J & Ros, E (2008) Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med 168, 24492458.
35Mente, A, de Koning, L, Shannon, HS, et al. (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169, 659669.
36Keys, A, Aravanis, E & Sdrin, H (1966) The diets of middle-aged men in two rural areas of Greece. Voeding 27, 575586.
37Kromhout, D, Keys, A, Aravanis, C, et al. (1989) Food consumption patterns in the 1960s in seven countries. Am J Clin Nutr 49, 889894.
38Jacques, PF & Tucker, KL (2001) Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 73, 12.
39Trichopoulou, A, Bamia, C & Trichopoulos, D (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338, b2337.

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