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      Adherence to the “Mediterranean Diet” in Spain and Its Relationship with Cardiovascular Risk (DIMERICA Study)

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          Abstract

          Background: Nutritional studies focus on traditional cultural models and lifestyles in different countries. The aim of this study was to examine the adherence to the Mediterranean diet, life habits, and risk factors associated with cardiovascular diseases among people living in different geographical regions in Spain. Methods: A descriptive cross-sectional study was conducted in each region. The sampling scheme consisted of a random three-stage stratified sampling program according to geographic region, age, and gender. A total of 1732 subjects were asked to complete a questionnaire designed to assess their nutrient intake, dietary habits, and exercise. A diet score that assesses the adherence of participants to the Mediterranean diet (range 0–10) was also applied. Results: Southeastern Spain had the lowest score for adherence to the Mediterranean diet because of the low consumption of fish and plant products. A lower adherence score to the Mediterranean diet was strongly associated with the prevalence of hypertension ( p = 0.018). Conclusions: A low level of adherence to the Mediterranean diet is accompanied by a high prevalence of hypertension and, therefore, a raised cardiovascular risk in the country. The adherence score could help identify individuals at greater cardiovascular risk.

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          Most cited references28

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          Cardiovascular disease in Europe 2014: epidemiological update.

          This paper provides an update for 2014 on the burden of cardiovascular disease (CVD), and in particular coronary heart disease (CHD) and stroke, across the countries of Europe. Cardiovascular disease causes more deaths among Europeans than any other condition, and in many countries still causes more than twice as many deaths as cancer. There is clear evidence in most countries with available data that mortality and case-fatality rates from CHD and stroke have decreased substantially over the last 5-10 years but at differing rates. The differing recent trends have therefore led to increasing inequalities in the burden of CVD between countries. For some Eastern European countries, including Russia and Ukraine, the mortality rate for CHD for 55-60 year olds is greater than the equivalent rate in France for people 20 years older.
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            Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.

            To assess the relation between adherence to a Mediterranean diet and the incidence of diabetes among initially healthy participants. Prospective cohort study with estimates of relative risk adjusted for sex, age, years of university education, total energy intake, body mass index, physical activity, sedentary habits, smoking, family history of diabetes, and personal history of hypertension. Spanish university department. 13 380 Spanish university graduates without diabetes at baseline followed up for a median of 4.4 years. Dietary habits assessed at baseline with a validated 136 item food frequency questionnaire and scored on a nine point index. New cases of diabetes confirmed through medical reports and an additional detailed questionnaire posted to those who self reported a new diagnosis of diabetes by a doctor during follow-up. Confirmed cases of type 2 diabetes. Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes. The incidence rate ratios adjusted for sex and age were 0.41 (95% confidence interval 0.19 to 0.87) for those with moderate adherence (score 3-6) and 0.17 (0.04 to 0.75) for those with the highest adherence (score 7-9) compared with those with low adherence (score <3). In the fully adjusted analyses the results were similar. A two point increase in the score was associated with a 35% relative reduction in the risk of diabetes (incidence rate ratio 0.65, 0.44 to 0.95), with a significant inverse linear trend (P=0.04) in the multivariate analysis. Adherence to a Mediterranean diet is associated with a reduced risk of diabetes.
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              Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study.

              No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                28 October 2016
                November 2016
                : 8
                : 11
                : 680
                Affiliations
                [1 ]Departamento de Nutrición y Cátedra de Riesgo Cardiovascular, Facultad de Ciencias de la Salud, UCAM Universidad Católica San Antonio de Murcia, Campus de los Jerónimos, s/n, Guadalupe 30107, Murcia, Spain; jabellan@ 123456ucam.edu (J.A.A.); mpzafrilla@ 123456ucam.edu (M.P.Z.R.); jmulero@ 123456ucam.edu (J.M.); aperez@ 123456ucam.edu (A.P.G.); arboleja@ 123456yahoo.es (M.L.)
                [2 ]Grupo EHRICA (Enfermería de Hipertensión y Riesgo Cardiovascular) Hospital 12 de Octubre, Madrid 28041, Spain; lucia.guerrero@ 123456ehrica.org (L.G.); elena-rq@ 123456telefonica.net (E.R.)
                [3 ]Instituto de Investigación y Unidad de Hipertensión, Hospital 12 de Octubre, Madrid 28041, Spain; ruilope@ 123456ad-hocbox.com
                Author notes
                [* ]Correspondence: smontoro@ 123456ucam.edu ; Tel.: +34-968-278-638
                Article
                nutrients-08-00680
                10.3390/nu8110680
                5133068
                27801819
                9a2d2722-cc30-4070-b0f5-239aa1336214
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 July 2016
                : 20 October 2016
                Categories
                Article

                Nutrition & Dietetics
                adherence,cardiovascular risk factors,mediterranean diet,spain,score
                Nutrition & Dietetics
                adherence, cardiovascular risk factors, mediterranean diet, spain, score

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