Mediterranean Diet Score, Dietary Patterns, and Risk of Sudden Cardiac Death in the REGARDS Study

Background Sudden cardiac death (SCD) is a common cause of death in the United States. Few previous studies have investigated the associations of diet scores and dietary patterns with risk of SCD. We investigated the associations of the Mediterranean diet score and various dietary patterns with risk of SCD in participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study cohort. Methods and Results Diet was assessed with a food frequency questionnaire administered at baseline in REGARDS. The Mediterranean diet score was derived based on the consumption of specific food groups considered beneficial or detrimental components of that diet. Dietary patterns were derived previously using factor analysis, and adherence to each pattern was scored. SCD events were ascertained through regular contacts. Cox proportional hazards regression was used to examine the risk of SCD events associated with the Mediterranean diet score and adherence to each of the 5 dietary patterns overall and stratifying on history of coronary heart disease at baseline. The analytic sample included 21 069 participants with a mean 9.8±3.8 years of follow‐up. The Mediterranean diet score showed a trend toward an inverse association with risk of SCD after multivariable adjustment (hazard ratio [HR] comparing highest with lowest group, 0.74; 95% CI, 0.55–1.01; P trend =0.07). There was a trend toward a positive association of the Southern dietary pattern with risk of SCD (HR comparing highest with lowest quartile of adherence, 1.46; 95% CI, 1.02–2.10; P trend =0.06). Conclusions In REGARDS participants, we identified trends toward an inverse association of the Mediterranean diet score and a positive association of adherence to the Southern dietary pattern with risk of SCD.

Download Full-text

Abstract 13: Adherence to Various Dietary Patterns and Risk of Recurrent Coronary Heart Disease and Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.135.suppl_1.13 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

James M Shikany ◽

Monika M Safford ◽

Joanna Bryan ◽

PK Newby ◽

Joshua S Richman ◽

...

Keyword(s):

Racial Differences ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Mediterranean Diet Score ◽

The Mediterranean ◽

Diet Score

Background: We have shown that the Southern dietary pattern, characterized by added fats, fried foods, organ and processed meats, and sugar-sweetened beverages, is associated with a greater risk of incident CHD in REGARDS, a national, population-based, longitudinal cohort. We sought to determine if the Southern pattern, other dietary patterns, and the Mediterranean diet score were associated with CHD events and mortality in REGARDS participants who previously reported CHD. Methods: REGARDS enrolled white and black adults aged ≥45 years between 2003-2007. Data were analyzed from 3,562 participants with CHD at baseline. Participants completed an FFQ at baseline, from which 5 dietary patterns were derived through factor analysis (Table). The Mediterranean diet score was calculated for each participant. Expert-adjudicated CHD events included myocardial infarction and CHD death. Cox proportional hazards regression was used to model the association of the dietary patterns and score with CHD events and death, adjusting for sociodemographics, lifestyle factors, energy intake, anthropometrics, and medical conditions. Results: Over 7 years of follow-up, there were 581 recurrent CHD events and 1,098 deaths. In fully-adjusted analyses, the highest quartile of adherence to the alcohol/salads pattern and highest group of the Mediterranean diet score were associated with lower risk of recurrent CHD compared to the lowest quartile/group (HR: 0.76; 95% CI: 0.59 – 0.98, HR: 0.78; 95% CI: 0.62 – 0.98, respectively). The highest quartile of adherence to the Southern pattern was associated with higher mortality (HR: 1.57; 95% CI: 1.28 – 1.91), while the highest group of the Mediterranean diet score was associated with lower mortality (HR: 0.80; 95% CI: 0.68 – 0.95). Conclusions: While the Southern dietary pattern was not related to risk of recurrent CHD, it was associated with higher mortality in REGARDS participants with existing CHD. Greater adherence to a Mediterranean diet was associated with lower risk of recurrent CHD and mortality.

Download Full-text

Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000348 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Petra Jones ◽

Janet Cade ◽

Charlotte Evans ◽

Neil Hancock ◽

Darren Greenwood

Keyword(s):

Colorectal Cancer ◽

Cancer Risk ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

Colorectal Cancer Risk ◽

Mediterranean Diet Score ◽

Bland Altman Method ◽

The Mediterranean ◽

Diet Score

AbstractDietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.

Download Full-text

Abstract MP46: Dietary Pattern and Risk of Sudden Cardiac Death in Post-Menopausal Women

Circulation ◽

10.1161/circ.127.suppl_12.amp46 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Monica L Bertoia ◽

Elizabeth W Triche ◽

Dominique S Michaud ◽

Ana Baylin ◽

Joseph W Hogan ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Mediterranean Diet ◽

Dietary Pattern ◽

Cardiac Death ◽

Lower Risk ◽

Dash Diet ◽

Menopausal Women ◽

The Mediterranean ◽

Post Menopausal ◽

Diet Score

Background: The Mediterranean Diet and Dietary Approaches to Stop Hypertension (DASH) diet are characterized by higher intake of fruits, vegetables, whole grains, and unsaturated fatty acids. All of these foods/nutrients may affect cholesterol, inflammation, the development of atherosclerosis, and therefore risk of sudden cardiac death (SCD). Furthermore, the DASH diet is known to lower blood pressure and hypertension is a major risk factor for SCD. Objective: To examine the association between the Mediterranean and DASH dietary patterns and risk of SCD in women. Methods: Post-menopausal women enrolled in the Women’s Health Initiative observational study (n = 93,676) completed a food frequency questionnaire at enrollment and at year three. Women enrolled at 40 clinical sites across the U.S. between 1993 and 1998, and were followed for an average of 10.5 years. We scored their diets according to how closely reported diet resembled each dietary pattern. SCD was defined as death occurring within one hour of symptom onset. We estimated risk of SCD according to quintile of dietary pattern score using hazard models with time-varying exposures. Results: A higher Mediterranean diet score was associated with a lower risk of SCD: women in the highest quintile, or who came closest to following the Mediterranean dietary pattern, had a HR of 0.62 (95% CI 0.41-0.93) compared to women in the lowest quintile, after adjustment for age, total energy, race, income, smoking, and physical activity (Table). After adjusting for other traditional coronary heart disease risk factors which are potential mediators, the association remained statistically significant: HR 0.65 (95% CI 0.43-0.99). A higher DASH diet score was not associated with reduced risk of SCD. However, sodium intake, a crucial component of the DASH dietary pattern, was not well-characterized by the FFQ. Conclusions: The Mediterranean dietary pattern may be associated with a lower risk of SCD in post-menopausal women, however there was no indication of a dose-response relationship.

Download Full-text

Dietary Changes and Anxiety during the Coronavirus Pandemic: Differences between the Sexes

Nutrients ◽

10.3390/nu13124193 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4193

Author(s):

Mona Boaz ◽

Daniela Abigail Navarro ◽

Olga Raz ◽

Vered Kaufman-Shriqui

Keyword(s):

Mediterranean Diet ◽

Diet Quality ◽

Present Report ◽

Post Partum ◽

Inverse Association ◽

Mediterranean Diet Score ◽

Female Sex ◽

Baked Goods ◽

The Mediterranean ◽

Diet Score

The SARS-CoV-2 (COVID-19) pandemic has been associated with both increased anxiety, deterioration in diet and weight gain. These associations may differ by sex. The present report examines differences by sex in diet quality in order to determine whether associations between diet and psychological stress during the initial phase of the COVID-19 pandemic differed by sex. This online study is available internationally in seven languages. The Mediterranean Diet Score was used to measure diet quality, while the General Anxiety Disorder 7-point scale (GAD-7) was used to measure anxiety. Findings were compared by self-reported sex (male vs. female). A total of 3797 respondents provided informed consent and met eligibility criteria, of whom 526 women were omitted due to being pregnant or six months or less post-partum, or due to reproductive status not being reported. Thus, 3271 individuals are included in the present report, of whom 71.2% were women. The median age of women was 30 (interquartile range (IQR) = 16) years vs. 31 (IQR = 19) years, p = 0.079. The median diet quality score was 9 (IQ = 3) in both women and men (p = 0.75). Despite the overall similarity in diet score, several components of the score differed significantly by sex. Women reported consuming significantly more olive oil, daily servings of vegetables, and weekly servings of sweet baked goods. Men reported consuming significantly more sweetened/carbonated drinks, red meat, alcohol, legumes, and hummus/tahini. Women reported a GAD-7 score of 6 (IQR = 8), while men reported 3 (6), p < 0.001. An inverse association was detected between the Mediterranean diet score and the GAD-7 score in both women (rho = −0.166, p < 0.001) and men (rho = −0.154, p < 0.001), and the correlation coefficients did not differ by sex (p = 0.76). Mediterranean diet score and age both reduced the odds of elevated anxiety (GAD-7 ≥ 10), while female sex, deterioration of diet quality during the outbreak, unemployment, and completing the survey in English increased the odds of this outcome. During the COVID-19 lockdowns, overall diet quality did not differ by sex; however, some differences by sex in components of the total score were detected. Moderate to severe anxiety was positively associated with female sex and poorer diet quality even after controlling for age, employment status, and the language in which the survey was performed.

Download Full-text

The Mediterranean Diet Score and Mortality Are Inversely Associated in Adults Living in the Subarctic Region

Journal of Nutrition ◽

10.3945/jn.112.160499 ◽

2012 ◽

Vol 142 (8) ◽

pp. 1547-1553 ◽

Cited By ~ 52

Author(s):

Gianluca Tognon ◽

Lena Maria Nilsson ◽

Lauren Lissner ◽

Ingegerd Johansson ◽

Göran Hallmans ◽

...

Keyword(s):

Mediterranean Diet ◽

Subarctic Region ◽

Mediterranean Diet Score ◽

The Mediterranean ◽

Diet Score

Download Full-text

Abstract P515: Comparison of Dietary Measures Association With Incident Type 2 Diabetes: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽

10.1161/circ.141.suppl_1.p515 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Stephanie Tison ◽

April P Carson ◽

James M Shikany ◽

Keith Pearson ◽

George Howard ◽

...

Keyword(s):

Racial Differences ◽

Mediterranean Diet ◽

Dietary Patterns ◽

Dietary Pattern ◽

A Priori ◽

Incident Diabetes ◽

A Posteriori ◽

Regards Study ◽

Diet Score

Background: Previous studies have investigated the association of dietary patterns with risk of diabetes, but have not compared a priori and a posteriori dietary scores in the same diverse population. The objective of this study was to evaluate a priori and a posteriori dietary patterns associations with incident diabetes in the REGARDS study. Methods: This study included 8,875 Black and White adults with available dietary data, without diabetes (defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications) at baseline (2003-2007), and with follow-up (2013-2016) status of diabetes. Dietary patterns were examined by quintile and included a posteriori Plant-based and Southern, as well as a priori scores of Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) Diet Score, Dietary Inflammatory Index (DII) and Dietary Inflammation Score (DIS). Modified Poisson regression was used to obtain risk ratios for incident diabetes with models adjusted for total energy intake, demographics, and lifestyle factors. Results: The mean (SD) age at baseline was 63.2 (8.5) years, 27.1% were Black, 56.2% were female, and 11.7% had incident diabetes at follow-up. Adherence to the Southern dietary pattern was positively associated with incident diabetes for all models (figure). After adjustment for demographic factors, the highest quintiles of DII and DIS were associated with incident diabetes and the highest quintiles of DASH scores were protective of development of incident diabetes. Conclusion: The Southern dietary pattern derived in REGARDS showed the strongest association with incident diabetes of all the dietary scores and of the a priori scores the DIS showed the strongest association with incident diabetes. The lack of association in adjusted models with the Mediterranean Diet and Plant-based pattern show these scores to be less pertinent. The DIS demonstrates food based dietary inflammation as one of the potential pathways for incident diabetes.

Download Full-text

Mediterranean diet score and incidence of IHD: a global comparative study

Public Health Nutrition ◽

10.1017/s1368980018003877 ◽

2019 ◽

Vol 22 (8) ◽

pp. 1444-1450 ◽

Cited By ~ 1

Author(s):

Ayako Sezaki ◽

Tomoko Imai ◽

Keiko Miyamoto ◽

Fumiya Kawase ◽

Hiroshi Shimokata

Keyword(s):

Comparative Study ◽

Linear Model ◽

Mediterranean Diet ◽

General Linear Model ◽

General Linear ◽

Mediterranean Diet Score ◽

Per Capita ◽

The Mediterranean ◽

International Comparative ◽

Diet Score

AbstractObjectiveThe aim of the present study was to clarify the global relationship between Mediterranean diet score (MDS) and the incidence of IHD by country using international statistics.DesignThe incidence of IHD by country was derived from the Global Burden of Disease (GBD) database. Average supplies of food (g/d per capita) and energy (kcal/d per capita) by country, excluding loss between production and household, were obtained from the FAOSTAT database. MDS was evaluated based on the total score of nine food items that characterize the Mediterranean diet. The association between MDS and the incidence of IHD was examined in countries with a population of 1 million or greater using a general linear model controlled for socio-economic and lifestyle variables.SettingPopulation data from global international databases.ParticipantsOne hundred and thirty-two countries with a population of over 1 million.ResultsMDS was inversely correlated with obesity rate, ageing rate, years of education and IHD incidence; however, no associations were found with gross domestic product, life expectancy, smoking rate, energy supply or health expenditure. In the general linear model of IHD incidence by MDS controlled for socio-economic and lifestyle variables, the β of the MDS was –26·4 (se 8·6; P<0·01).ConclusionsThe results of this global international comparative study confirmed that the Mediterranean diet is inversely associated with the incidence of IHD.

Download Full-text