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      The EVIDENT diet quality index is associated with cardiovascular risk and arterial stiffness in adults

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          Abstract

          Background

          We aimed to simplify information from food frequency questionnaires (FFQs) in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV).

          Methods

          The sample from the EVIDENT study, consisting of 1553 subjects (aged 20–80 years) with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0–100) was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD). Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured.

          Results

          Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score) had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity). In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR), blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively ( p < 0.05, all).

          Conclusions

          The diet quality index developed is associated to CVR and its components, and also with arterial stiffness, as measured with PWV. This index is also a good predictor of adherence to MD.

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          Most cited references18

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          General cardiovascular risk profile for use in primary care: the Framingham Heart Study.

          Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions ("general CVD" algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P<0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non-laboratory-based predictors. A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care.
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            Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement.

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              Dietary patterns and CVD: a systematic review and meta-analysis of observational studies.

              Epidemiological studies show that diet is linked to the risk of developing CVD. The objective of this meta-analysis was to estimate the association between empirically derived dietary patterns and CVD. PubMed was searched for observational studies of data-driven dietary patterns that reported outcomes of cardiovascular events. The association between dietary patterns and CVD was estimated using a random-effects meta-analysis with 95 % CI. Totally, twenty-two observational studies met the inclusion criteria. The pooled relative risk (RR) for CVD, CHD and stroke in a comparison of the highest to the lowest category of prudent/healthy dietary patterns in cohort studies was 0·69 (95% CI 0·60, 0·78; I 2=0%), 0·83 (95% CI 0·75, 0·92; I 2=44·6%) and 0·86 (95% CI 0·74, 1·01; I 2=59·5%), respectively. The pooled RR of CHD in a case-control comparison of the highest to the lowest category of prudent/healthy dietary patterns was 0·71 (95% CI 0·63, 0·80; I 2=0%). The pooled RR for CVD, CHD and stroke in a comparison of the highest to the lowest category of western dietary patterns in cohort studies was 1·14 (95% CI 0·92, 1·42; I 2=56·9%), 1·03 (95% CI 0·90, 1·17; I 2=59·4%) and 1·05 (95% CI 0·91, 1·22; I 2=27·6%), respectively; in case-control studies, there was evidence of increased CHD risk. Our results support the evidence of the prudent/healthy pattern as a protective factor for CVD.
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                Author and article information

                Contributors
                carmelarroma@hotmail.com
                rosa90alonso@hotmail.com
                carpatino@usal.es
                magomez@usal.es
                jmaderuelo@saludcastillayleon.es
                Carlos.Martin@uab.es
                lgarciao@usal.es
                0034650330694 , donrecio@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                8 April 2017
                8 April 2017
                2017
                : 17
                : 305
                Affiliations
                [1 ]GRID grid.11762.33, , Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), ; Salamanca, Spain
                [2 ]GRID grid.11762.33, , Department of statistics, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), ; Salamanca, Spain
                [3 ]GRID grid.11762.33, , Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Department of medicine, University of Salamanca, Spanish Network for Preventive Activities and Health Promotion (redIAPP), ; Salamanca, Spain
                [4 ]Passeig de Sant Joan Health Center, Catalan Health Service, Spanish Network for Preventive Activities and Health Promotion (redIAPP), Barcelona, Spain
                [5 ]GRID grid.11762.33, , Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Department of biomedical and diagnostic sciences, University of Salamanca, Spanish Network for Preventive Activities and Health Promotion (redIAPP), ; Salamanca, Spain
                [6 ]GRID grid.11762.33, Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Department of Nursing and Physiotherapy, , University of Salamanca, ; Avda. Comuneros N° 27, 37003 Salamanca, Spain
                Article
                4194
                10.1186/s12889-017-4194-y
                5385012
                28390406
                f6016363-0bf2-41e0-bb9f-948f705d27d4
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 September 2016
                : 21 March 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Award ID: PS09/00233, PS09/01057, PS09/01972, PS09/01376, PS09/0164, PS09/01458, RETICS RD12/0005
                Funded by: Regional Health Management of Castilla y Leon
                Award ID: SAN/1778/2009
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                food habits,risk factors,vascular stiffness,diet, mediterranean
                Public health
                food habits, risk factors, vascular stiffness, diet, mediterranean

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