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Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial

  • Original Contribution
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Abstract

Purpose

Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort.

Methods

All PREDIMED-Plus participants (6874 men and women aged 55–75 years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF.

Results

Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90–0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89–0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90–0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87–0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS) in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures.

Conclusions

Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease

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Funding

This work is supported by the European Research Council [Advanced Research Grant 2014-2019; agreement #340918 granted to MAM-G], and the Spanish Government Official Agency for funding biomedical research-Instituto de Salud Carlos III (ISCIII) with competitive grants for the periods 2014-2016, 2015-2017, 2017-2019 and 2018-2020, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund [grants: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926]. Additional grants: Acciones Especiales from ISCIIII, Consejería-Salud, Junta de Andalucía [PI0458/2013, PS0358/2016], Recercaixa-grant 2013 [2013ACUP00194], a SEMERGEN grant, and Generalitat Valenciana PROMETEO [grant 17/2017] and International Nut & Dried Fruit Council-FESNAD [Nº 201302]. J.K. is awarded with a Juan de la Cierva-formación research grant (FJCI-2015-24058) of the Spanish Ministry of Economy, Industry and Competitiveness and European Social Funds, and the FOLIUM program within the FUTURMed project: Talent for the medicine within the future from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014-2020 of the Balearic Islands). Fundación Patrimonio Comunal Olivarero is providing the necessary amounts of olive oil. Nuts were initially and only partially provided by Pistachios Growers and Almond Board of California, but most of the nuts were purchased with funds from the official funding agency. None of these funding sources plays any role in the design, collection, analysis, or interpretation of the data or in the decision to submit manuscripts for publication.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, C/Irunlarrea 1, 31080, Pamplona, Navarra, Spain

    Ismael Alvarez-Alvarez, Estefanía Toledo, Oscar Lecea, Pilar Buil-Cosiales, Miguel Ruiz-Canela & Miguel Á. Martínez-González

  2. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Estefanía Toledo, Jordi Salas-Salvadó, Dolores Corella, Pilar Buil-Cosiales, J. Alfredo Martinez, Jadwiga Konieczna, José López-Miranda, Ramon Estruch, Ángel M. Alonso-Gómez, Josep A. Tur, Francisco J. Tinahones, Lluís Serra-Majem, Manuel Ortega-Calvo, Clotilde Vázquez, Xavier Pintó, José I. González, Andrés Díaz-López, Montse Fito, Emilio Ros, Miguel Ruiz-Canela & Miguel Á. Martínez-González

  3. Atención Primaria, Osasunbidea-Servicio Navarro de Salud, Pamplona, Spain

    Oscar Lecea & Pilar Buil-Cosiales

  4. Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana IISPV, Hospital Universitari Sant Joan de Reus, Rovira i Virgili University, Reus, Spain

    Jordi Salas-Salvadó, Andrés Díaz-López & Indira Paz-Graniel

  5. Department of Preventive Medicine, University of Valencia, Valencia, Spain

    Dolores Corella & José I. González

  6. Cardiovascular Risk and Nutrition, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain

    María Dolores Zomeño & Montse Fito

  7. Blanquerna School of Life Sciences, Universitat Ramon Llull, Barcelona, Spain

    María Dolores Zomeño

  8. CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Jesús Vioque, Aurora Bueno-Cavanillas, Vicente Martín & Miguel Delgado-Rodríguez

  9. Nutritional Epidemiology Unit, Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain

    Jesús Vioque & Salvador Pertusa-Martinez

  10. Department of Nutrition, Food Sciences and Physiology, University of Navarra, Pamplona, Spain

    J. Alfredo Martinez & Itziar Abete

  11. Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain

    J. Alfredo Martinez & Lidia Daimiel

  12. Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain

    Jadwiga Konieczna

  13. Department of Public Health, University of Malaga-IBIMA, Málaga, Spain

    Francisco J. Barón-López

  14. Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain

    José López-Miranda & Antonio García-Ríos

  15. Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Ramon Estruch

  16. Department of Preventive Medicine, University of Granada, Granada, Spain

    Aurora Bueno-Cavanillas

  17. Department of Cardiology Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain

    Ángel M. Alonso-Gómez

  18. University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain

    Ángel M. Alonso-Gómez

  19. Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain

    Josep A. Tur

  20. Department of Endocrinology, Hospital Virgen de la Victoria (IBIMA), University of Málaga, Málaga, Spain

    Francisco J. Tinahones

  21. Institute for Biomedical Research, University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Lluís Serra-Majem

  22. Institute of Biomedicine (IBIOMED), University of León, León, Spain

    Vicente Martín

  23. Department of Family Medicine, Healthcare centre Las Palmeritas, Distrito Sanitario Atención Primaria Sevilla, Seville, Spain

    Manuel Ortega-Calvo

  24. Department of Endocrinology, Fundación Jiménez-Díaz, Madrid, Spain

    Clotilde Vázquez

  25. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

    Xavier Pintó

  26. CIBER Diabetes y enfermedades metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Josep Vidal

  27. Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Josep Vidal

  28. Division of Preventive Medicine, University of Jaén, Jaén, Spain

    Miguel Delgado-Rodríguez

  29. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain

    Pilar Matía

  30. Gerencia territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain

    Miguel A. Muñoz

  31. Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain

    Miguel A. Muñoz

  32. Healthcare centre Cabo Huertas, Alicante, Spain

    Salvador Pertusa-Martinez

  33. Department of Endocrinology and Nutrition, Lipid Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    Emilio Ros

  34. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA

    Miguel Á. Martínez-González

Authors
  1. Ismael Alvarez-Alvarez
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  2. Estefanía Toledo
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  3. Oscar Lecea
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  4. Jordi Salas-Salvadó
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  5. Dolores Corella
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  6. Pilar Buil-Cosiales
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  7. María Dolores Zomeño
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  8. Jesús Vioque
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  9. J. Alfredo Martinez
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  10. Jadwiga Konieczna
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Corresponding author

Correspondence to Miguel Á. Martínez-González.

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Conflict of interest

E Ros is a consultant for the California Walnut Commission. J. Salas-Salvadó is a non-payed member of the Scientific Advisory Board of the International Nut and Dried Fruit Foundation and received research grants through his Institution of research. The other authors declare that they have no conflict of interests.

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Alvarez-Alvarez, I., Toledo, E., Lecea, O. et al. Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial. Eur J Nutr 59, 1219–1232 (2020). https://doi.org/10.1007/s00394-019-01982-x

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  • DOI: https://doi.org/10.1007/s00394-019-01982-x

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