Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study
Despite convincing evidence in the Mediterranean region, the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear. The population attributable fraction (PAF) of adherence to this diet is al...
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| description | Despite convincing evidence in the Mediterranean region, the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear. The population attributable fraction (PAF) of adherence to this diet is also unknown.
In the UK-based EPIC-Norfolk prospective cohort, we evaluated habitual diets assessed at baseline (1993-1997) and during follow-up (1998-2000) using food-frequency questionnaires (n = 23,902). We estimated a Mediterranean diet score (MDS) using cut-points projected from the Mediterranean dietary pyramid, and also three other pre-existing MDSs. Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates, we examined prospective associations between each MDS with incident cardiovascular diseases (CVD) by 2009 and mortality by 2013, and estimated PAF for each outcome attributable to low MDS.
We observed 7606 incident CVD events (2818/100,000 person-years) and 1714 CVD deaths (448/100,000). The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes, with hazard ratios (95 % confidence intervals) of 0.95 (0.92-0.97) per one standard deviation for incident CVD and 0.91 (0.87-0.96) for CVD mortality. Associations were similar for composite incident ischaemic heart disease and all-cause mortality. Other pre-existing MDSs showed similar, but more modest associations. PAF due to low dietary pyramid based MDS ( |
| doi_str_mv | 10.1186/s12916-016-0677-4 |
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In the UK-based EPIC-Norfolk prospective cohort, we evaluated habitual diets assessed at baseline (1993-1997) and during follow-up (1998-2000) using food-frequency questionnaires (n = 23,902). We estimated a Mediterranean diet score (MDS) using cut-points projected from the Mediterranean dietary pyramid, and also three other pre-existing MDSs. Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates, we examined prospective associations between each MDS with incident cardiovascular diseases (CVD) by 2009 and mortality by 2013, and estimated PAF for each outcome attributable to low MDS.
We observed 7606 incident CVD events (2818/100,000 person-years) and 1714 CVD deaths (448/100,000). The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes, with hazard ratios (95 % confidence intervals) of 0.95 (0.92-0.97) per one standard deviation for incident CVD and 0.91 (0.87-0.96) for CVD mortality. Associations were similar for composite incident ischaemic heart disease and all-cause mortality. Other pre-existing MDSs showed similar, but more modest associations. PAF due to low dietary pyramid based MDS (<95th percentile) was 3.9 % (1.3-6.5 %) for total incident CVD and 12.5 % (4.5-20.6 %) for CVD mortality.
Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality in the UK. This diet has an important population health impact for the prevention of CVD.</description><identifier>ISSN: 1741-7015</identifier><identifier>EISSN: 1741-7015</identifier><identifier>DOI: 10.1186/s12916-016-0677-4</identifier><identifier>PMID: 27679997</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acute coronary syndromes ; Cancer ; Cardiovascular disease ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - mortality ; Cohort analysis ; Cohort Studies ; Consent ; Diabetes ; Diet ; Diet, Mediterranean ; Female ; Heart attacks ; Heart diseases ; Humans ; Incidence ; Male ; Medical prognosis ; Medical research ; Middle Aged ; Mortality ; Nutrition research ; Prevention ; Proportional Hazards Models ; Prospective Studies ; Public health ; Sensitivity analysis ; Systematic review</subject><ispartof>BMC medicine, 2016-09, Vol.14 (1), p.135-135, Article 135</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-eae50e688c70f2d98da453e9a43afaf2d9b5908d3bd288feca330363d2b22e133</citedby><cites>FETCH-LOGICAL-c525t-eae50e688c70f2d98da453e9a43afaf2d9b5908d3bd288feca330363d2b22e133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041408/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041408/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27679997$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tong, Tammy Y N</creatorcontrib><creatorcontrib>Wareham, Nicholas J</creatorcontrib><creatorcontrib>Khaw, Kay-Tee</creatorcontrib><creatorcontrib>Imamura, Fumiaki</creatorcontrib><creatorcontrib>Forouhi, Nita G</creatorcontrib><title>Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study</title><title>BMC medicine</title><addtitle>BMC Med</addtitle><description>Despite convincing evidence in the Mediterranean region, the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear. The population attributable fraction (PAF) of adherence to this diet is also unknown.
In the UK-based EPIC-Norfolk prospective cohort, we evaluated habitual diets assessed at baseline (1993-1997) and during follow-up (1998-2000) using food-frequency questionnaires (n = 23,902). We estimated a Mediterranean diet score (MDS) using cut-points projected from the Mediterranean dietary pyramid, and also three other pre-existing MDSs. Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates, we examined prospective associations between each MDS with incident cardiovascular diseases (CVD) by 2009 and mortality by 2013, and estimated PAF for each outcome attributable to low MDS.
We observed 7606 incident CVD events (2818/100,000 person-years) and 1714 CVD deaths (448/100,000). The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes, with hazard ratios (95 % confidence intervals) of 0.95 (0.92-0.97) per one standard deviation for incident CVD and 0.91 (0.87-0.96) for CVD mortality. Associations were similar for composite incident ischaemic heart disease and all-cause mortality. Other pre-existing MDSs showed similar, but more modest associations. PAF due to low dietary pyramid based MDS (<95th percentile) was 3.9 % (1.3-6.5 %) for total incident CVD and 12.5 % (4.5-20.6 %) for CVD mortality.
Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality in the UK. This diet has an important population health impact for the prevention of CVD.</description><subject>Acute coronary syndromes</subject><subject>Cancer</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Consent</subject><subject>Diabetes</subject><subject>Diet</subject><subject>Diet, Mediterranean</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nutrition research</subject><subject>Prevention</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Sensitivity analysis</subject><subject>Systematic review</subject><issn>1741-7015</issn><issn>1741-7015</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkltrFDEUxwdRbK1-AF8kIIgvU3OZzMUHoSxVC1X7oM_hbHKmmzqTrEmmsh_Nb2dmt9ZdkXDI7Xf-J5d_UTxn9JSxtn4TGe9YXdI56qYpqwfFMWsqVjaUyYd746PiSYw3lHLZNNXj4og3ddN1XXNc_LoKPq5RJ3uLBGL02kKy3hHfk7RC8gmNTRgCOARHjMVEftq0IhqCsf4Wop4GCHkjIkQk1mlr0Oms5QwZfUgw2LTZzmyKZO3Xmd8WsOMadMoZBIjzrjys9Bd8uz3H-dXFovzsQ--H7ySmyWyeFo96GCI-u-tPim_vz78uPpaXXz5cLM4uSy25TCUCSop12-qG9tx0rYFKCuygEtDDvLKUHW2NWBretj1qEIKKWhi-5ByZECfFu53uelqOaDS6FGBQ62BHCBvlwarDHWdX6trfKkkrVtE2C7y-Ewj-x4QxqdFGjcOQb-qnqFgrpOhqzquMvvwHvfFTcPl6meKSs_yDe9Q1DKis632uq2dRdVbVklIquzpTp_-hcjM4Wu0d9javHyS82ktYIQxpFf0wzZ8QD0G2A3X2TgzY3z8Go2o2ptoZU9E5sjHVfOYX-694n_HHieI3PNvh0w</recordid><startdate>20160929</startdate><enddate>20160929</enddate><creator>Tong, Tammy Y N</creator><creator>Wareham, Nicholas J</creator><creator>Khaw, Kay-Tee</creator><creator>Imamura, Fumiaki</creator><creator>Forouhi, Nita G</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160929</creationdate><title>Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study</title><author>Tong, Tammy Y N ; 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The population attributable fraction (PAF) of adherence to this diet is also unknown.
In the UK-based EPIC-Norfolk prospective cohort, we evaluated habitual diets assessed at baseline (1993-1997) and during follow-up (1998-2000) using food-frequency questionnaires (n = 23,902). We estimated a Mediterranean diet score (MDS) using cut-points projected from the Mediterranean dietary pyramid, and also three other pre-existing MDSs. Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates, we examined prospective associations between each MDS with incident cardiovascular diseases (CVD) by 2009 and mortality by 2013, and estimated PAF for each outcome attributable to low MDS.
We observed 7606 incident CVD events (2818/100,000 person-years) and 1714 CVD deaths (448/100,000). The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes, with hazard ratios (95 % confidence intervals) of 0.95 (0.92-0.97) per one standard deviation for incident CVD and 0.91 (0.87-0.96) for CVD mortality. Associations were similar for composite incident ischaemic heart disease and all-cause mortality. Other pre-existing MDSs showed similar, but more modest associations. PAF due to low dietary pyramid based MDS (<95th percentile) was 3.9 % (1.3-6.5 %) for total incident CVD and 12.5 % (4.5-20.6 %) for CVD mortality.
Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality in the UK. This diet has an important population health impact for the prevention of CVD.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27679997</pmid><doi>10.1186/s12916-016-0677-4</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute coronary syndromes Cancer Cardiovascular disease Cardiovascular Diseases - epidemiology Cardiovascular Diseases - mortality Cohort analysis Cohort Studies Consent Diabetes Diet Diet, Mediterranean Female Heart attacks Heart diseases Humans Incidence Male Medical prognosis Medical research Middle Aged Mortality Nutrition research Prevention Proportional Hazards Models Prospective Studies Public health Sensitivity analysis Systematic review |
| title | Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study |
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