Healthy diet indicator and metabolic syndrome in the Czech Republic, Russia and Poland: cross-sectional findings from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study

Abstract

In Eastern Europe, cardiovascular disease (CVD) mortality is high, but the causes of this remain poorly understood. Metabolic syndrome (MetS) is a risk factor for CVD and is thought to be partly determined by diet. However, few studies have examined the prevalence of MetS and the associations between dietary quality and MetS in Eastern European populations. This cross-sectional study used data from the baseline wave of HAPIEE study—21519 randomly selected adults aged 45-69 years. MetS was defined using the ATP III definition. Healthy Diet Indicator (HDI) was derived using WHO 2003 recommendations: each component was scored from 0 (worst) to 10 (best adherence) and the total score ranged from 0 (worst) to 70 (best dietary quality). Anthropometric data and blood samples were collected during clinic visits. Prevalence of MetS was high in the Czech Republic (men: 37.1%, women: 35.7%), Russia (20.8%, 36.3%), and Poland (27.9%, 28.6%). In logistic regression, adherence to total HDI score was not associated with risk of MetS (P>0.05), but higher HDI was associated with lower risk of having raised blood pressure in the pooled sample (OR per 10 unit increase in HDI=0.82, 95% CI: 0.72-0.94). A better adherence to recommended protein intake was consistently associated with lower risk of having high blood glucose in three countries (Czech Republic: OR per 1 unit increase in protein score=0.87, 95% CI: 0.80-0.94; Russia: 0.93, 0.88-0.99; Poland: 0.82, 0.75-0.89), and also associated with lower risk of MetS (0.92, 0.86-0.98) and central obesity (0.90, 0.84-0.96) in Poland. Findings showed that MetS prevalence was high and diet quality was moderate to poor. Findings also provide some support for the beneficial role of diet quality (especially moderate protein intake) in lowering MetS prevalence. Future longitudinal studies should examine whether higher adherence to HDI reduces the risk of MetS and CVD