Empirically-derived food pattern and total ortality in the PREDIMED study

[Background]: There has been growing interest in the last years in assessing the relationship between diet and disease through the study of whole dietary patterris and not only focusing on single nutrients or foods. Though several studies have assessed the relationship between a posteriori dietary patterns and different health outcomes, there is little evidence on post hoc dietary patterns and all cause mortality in Southern European populations.[Objective]: To identify the association between a posteriori defined major dietary patterns and total mortality in the PREDIMED study. Methods We followed-up 7,340 participants (57.5 percent women, mean age: 67 years) during a median follow-up time of 4.8 years. To assess dietary exposures, a validated 137-item semi-quantitative food- frequency questionnaire was administered. Dietary patterns were ascertained through a factor analysis based on 30 predefined food groups. Participants were classified according to tertiles of adherence to dietary pattern scores at baseline. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for mortality. Deaths were confirmed by review of medical records and consultation of the National Death Index.[Results]: We identified two major dietary patterns: the “Western” dietary pattern and “Mediterranean” dietary pattern. During follow- up, 337 participants died. Among deceased participants, the median age of death was 70 (6.5). After controlling for potential confounders including the intervention group, higher baseline adherence to a “Mediterranean” dietary pattern was associated with lower risk of all- cause mortality (adjusted HR for third tertile vs. first textile: 0.68; 95 la CI: 0.49—0.95) (p for trend 0.028). [Conclusion]: Higher adherence to a Mediterranean-type diet may reduce the risk of all-cause mortality in elderly people at high cardiovascular risk

Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study

Background: Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet. Objective: We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention. Design: We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes. Results: In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption .210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death. Conclusion: Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639. © 2014 American Society for Nutrition.Peer Reviewe

Serum sterol responses to increasing plant sterol intake from natural foods in the Mediterranean diet

BACKGROUND: Phytosterols in natural foods are thought to inhibit cholesterol absorption. The Mediterranean diet is rich in phytosterol-containing plant foods. AIM OF THE STUDY: To assess whether increasing phytosterol intake from natural foods was associated with a cholesterol-lowering effect in a substudy of a randomized trial of nutritional intervention with Mediterranean diets for primary cardiovascular prevention (PREDIMED study). METHODS: One hundred and six high cardiovascular risk subjects assigned to two Mediterranean diets supplemented with virgin olive oil (VOO) or nuts, which are phytosterol-rich foods, or advice on a low-fat diet. Outcomes were 1-year changes in nutrient intake and serum levels of lipids and non-cholesterol sterols. RESULTS: Average phytosterol intake increased by 76, 158 and 15 mg/day in participants assigned VOO, nuts and low-fat diets, respectively. Compared to participants in the low-fat diet group, changes in outcome variables were observed only in those in the Mediterranean diet with nuts group, with increases in intake of fibre, polyunsaturated fatty acids and phytosterols (P < 0.020, all) and significant (P < 0.05) reductions of LDL-cholesterol (0.27 mmol/l or 8.3%) and the LDL/HDL-cholesterol ratio (0.29 mmol/l or 11.5%). Variations in saturated fat, cholesterol or fibre intake were unrelated to LDL-cholesterol changes. In the whole group, changes in serum sitosterol-to-cholesterol, which reflect those of dietary phytosterol intake and absorption, correlated inversely to LDL-cholesterol changes (r = -0.256; P = 0.008). In multivariate analyses, baseline LDL-cholesterol, increases in serum sitosterol ratios and statin use were independently associated with LDL-cholesterol reductions. CONCLUSIONS: Small amounts of phytosterols in natural foods appear to be bioactive in cholesterol lowering.The PREDIMED study is supported by grants from the Spanish Ministry of Health (FIS) RTIC G03/140, PI04/1828, PI04/1837, PI 04/2239, PI05/1839, PI06/0365, PI 07/240 and RTIC RD06/0045.Peer reviewe

Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3204 high-risk patients

Background The Mediterranean food pattern (MeDiet) has been suggested to have beneficial effects on cardiovascular risk factors. Scarcity of assessment of this effect on large samples of patients at high risk is, however, observed. Our objective was to estimate the association between adherence to MeDiet and the prevalence of risk factors in 3204 asymptomatic high-risk patients. Design Cross-sectional assessment of baseline characteristics of participants in a primary prevention trial. Methods Participants were assessed by their usual primary-care physicians to ascertain the prevalence of diet-related cardiovascular risk factors (diabetes, hypertension, dyslipidemia, or obesity) using standard diagnostic criteria. A dietitian interviewed each participant to obtain a 14-point score measuring the degree of adherence to MeDiet. Results Adherence to MeDiet was inversely associated with individual risk factors and, above all, with the clustering of them. The multivariate adjusted odds ratio to present simultaneously the four risk factors for those above the median value of the MeDiet score was 0.67 (95% confidence interval: 0.53–0.85). The multivariate odds ratios for successive categories of adherence to MeDiet were 1 (ref.), 1.03, 0.85, 0.70 and 0.54 (P for trend ≤0.001). Conclusion Following a MeDiet was inversely associated with the clustering of hypertension, diabetes, obesity, and hypercholesterolemia among high-risk patients.The authors acknowledge the Navarra Regional Government (G41/2005), Generalitat Valenciana (ACOMP06109) and Instituto de Salud Carlos III (ISCIII, Spanish Ministry of Health) [Grants FIS-PI040233; FIS-PI042241, FIS-PI050514, FIS-PI050976, FIS-PI052368, FIS-PI042234, FIS-PI041828, FIS-PI051839, FIS-PI070240, RD06/0045/0000, Red Temática PRE-DIMED and CIBEROBN ‘CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03)'] for supporting this study. CIBEROBN (CB06/03) is an initiative of ISCIII.Peer reviewe

Predictors of adherence to dietary treatment: The PREDIMED experience

Especial V Congreso de la Asociación Española de Dietistas-Nutricionistas. Investigación y práctica: claves de futuro en dietética y nutrición.Las enfermedades crónicas relacionadas con la alimentación (diabetes tipo 2, enfermedades cardiovasculares, obesidad y algunos tipos de cáncer) constituyen un serio problema de salud pública a nivel mundial. En las últimas dos décadas, muchos estudios han demostrado que la dieta mediterránea (DM) podría prevenir las enfermedades cardiovasculares y también proteger contra la diabetes y diversos cánceres. Sin embargo, en la práctica es difícil lograr cambios en los hábitos alimentarios, por lo que resulta de gran interés identificar qué factores predisponen a lograr cambios favorables en la dieta. Aunque algunos estudios han estudiado cuáles pueden ser estas variables, el estudio que se expone a continuación fue el primero evaluó de manera prospectiva que factores se asocian con un mayor éxito en el seguimiento de la DM en España.Peer Reviewe