Dietary Patterns and Cardiovascular Risk: Are the Mediterranean Diet, the Heart-Healthy Diet, and Phytochemicals Associated with Lower Cardiovascular Risks?
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Abstract
Background: Dietary pattern may be one of the determinants of cardiovascular health. This study aimed to examine the relationship between a heart-healthy diet, the phytochemical content of a diet, and Mediterranean diet and cardiovascular disease (CVD) risks.
Methods: This study was conducted with healthy volunteers (n=1446) from Turkey between August 2022 and September 2022. As risk assessment systems to determine CVD risks, SCORE (Systematic Coronary Risk Evaluation) and ASCVD (Atherosclerotic Cardiovascular Disease) were used. We utilized MEDFICTS (Meats, Eggs, Dairy, Fried foods, Fat in Baked Goods, Convenience Foods, Fats Added at the Table, and Snacks) to establish the suitability of the current diet for heart health, and MEDAS (Mediterranean Diet Adherence Screener) to examine the Mediterranean diet characteristics of the current diet. The phytochemical content of the diet was determined using the Phytochemical Index method developed by McCarty.
Results: The lifetime and 10-year risk scores of SCORE and ASCVD were positively correlated with the MEDFICTS score (r=0.12, P<0.001; r=0.06, P=0.020; r=0.10, P=0.001, respectively). Mediterranean diet characteristics were correlated with lower CVD risk as per the SCORE categories (r=-0.07, P=0.009). A one-unit increase in MEDFICTS scores increased high-to-very high CVD risk and 10-year moderate-to-high CVD risk by 1.01 times, while a one-unit increase in the Mediterranean diet score decreased high-to-very high CVD risk and 10-year moderate-to-high CVD risk by 0.91 times and 0.95 times, respectively. In addition, high values of body weight, body mass index, waist circumference, waist-height ratio, and neck circumference were associated with higher CVD risk (P<0.001).
Conclusion: Adopting a Mediterranean diet and a heart-healthy diet may be a good strategy to reduce CVD risks.
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2. Denova-Gutiérrez E, Huitrón-Bravo G, Ta-lavera JO, et al (2010). Dietary glycemic index, dietary glycemic load, blood li-pids, and coronary heart disease. J Nutr Metab, 2010:170680.
3. World Health Organization. “-Fact Sheets-Cardiovascular diseases”, 2021. http://www.who.int/mediacentre/factsheets/fs317/en/ [accessed: 20 Apr 2022].
4. Lakka TA, Bouchard C (2005). Physical ac-tivity, obesity and cardiovascular diseas-es. Handb Exp Pharmacol, (170):137-63.
5. Milte CM, Thorpe MG, Crawford D, et al (2015). Associations of diet quality with health-related quality of life in older Australian men and women. Exp Geron-tol, 64:8-16.
6. Edwards MK, Crush E, Loprinzi PD (2018). Dietary behavior and predicted 10-year risk for a first atherosclerotic cardiovas-cular disease event using the pooled co-hort risk equations among US adults. Am J Health Promot, 32(6):1447-51.
7. Jenkins DJA, Dehghan M, Mente A, et al (2021). Glycemic index, glycemic load, and cardiovascular disease and mortali-ty. N Engl J Med, 384(14):1312-22.
8. Yu E, Malik VS, Hu FB (2018). Cardiovascu-lar disease prevention by diet modifica-tion: JACC Health Promotion Series. J Am Coll Cardiol, 72(8):914-26.
9. Bernstein AM, Sun Q, Hu FB, et al (2010). Major dietary protein sources and risk of coronary heart disease in women. Circulation, 122(9):876-83.
10. George SM, Ballard-Barbash R, Manson JE, et al (2014). Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observation-al Study: evidence to inform national dietary guidance. Am J Epidemiol, 180(6):616-25.
11. Göktaş Z, Dikmen D, Rakıcıoğlu N (2022). Validation of MEDFICTS dietary as-sessment questionnaire in Turkish popu-lation. Public Health Nutr, 25(1):13-17.
12. Kris-Etherton P, Eissenstat B, Jaax S, et al (2001). Validation for MEDFICTS, a die-tary assessment instrument for evaluat-ing adherence to total and saturated fat recommendations of the National Cho-lesterol Education Program Step 1 and Step 2 diets. J Am Diet Assoc, 101(1): 81-6.
13. Wong ND, Budoff MJ, Ferdinand K, et al (2022). Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clini-cal practice statement. Am J Prev Cardiol, 10:100335.
14. Ural D (2012). A perspective to lipid lower-ing therapy after ESC/EAS guidelines for the management of dyslipidaemias and the European guidelines on cardio-vascular disease prevention in clinical practice. Turk Kardiyol Dern Ars, 40(4):293-7.
15. Arnett DK, Blumenthal RS, Albert MA, et al (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American Col-lege of Cardiology/American Heart As-sociation Task Force on Clinical Prac-tice Guidelines. Circulation, 140(11):e596-e646.
16. Marshall AL, Smith BJ, Bauman AE, Kaur S (2005). Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med, 39(5):294-7.
17. World Health Organization (WHO) Global Database for Body Mass Index. The in-ternational classification of adult un-derweight, overweight and obesity ac-cording to BMI. Web: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html [accessed: 06.06.2022].
18. World Health Organization. Waist circum-ference and waist-hip ratio. Report of a WHO Expert Consultation. Geneva, https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/. [ac-cessed: 14.06.2022].
19. Ben‐Noun LL, Sohar E, Laor A (2001). Neck circumference as a simple screen-ing measure for identifying overweight and obese patients. Obes Res, 9(8):470-7.
20. Ashwell M, Gibson S (2016). Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’based on BMI and waist circumference. BMJ Open, 6(3): e010159.
21. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002). Third Re-port of the National Cholesterol Educa-tion Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circu-lation, 106(25):3143-421.
22. Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V (2005). Dietitian ser-vices are associated with improved pa-tient outcomes and the MEDFICTS die-tary assessment questionnaire is a suita-ble outcome measure in cardiac rehabil-itation. J Am Diet Assoc, 105(10):1533-40.
23. McCarty MF (2004). Proposal for a dietary “phytochemical index. Med Hypotheses, 63(5):813-817.
24. Martínez-González MA, García-Arellano A, Toledo E, et al (2012). A 14-item Medi-terranean diet assessment tool and obe-sity indexes among high-risk subjects: the PREDIMED trial. PLoS One, 7(8):e43134.
25. Özkan Pehlivanoğlu EF, Balcıoğlu H, Ünlüoğlu İ (2020). Turkish validation and reliability of Mediterranean Diet Adherence Screener. Osmangazi Journal of Medicine, 42(2):160-4.
26. Wang DD, Hu FB (2017). Dietary fat and risk of cardiovascular disease: recent controversies and advances. Annu Rev Nutr, 37:423-46.
27. Astrup A, Magkos F, Bier DM, , et al (2020). Saturated fats and health: a reassessment and proposal for food-based recom-mendations: JACC state-of-the-art re-view. J Am Coll Cardiol, 76(7):844-57.
28. Zhang Y, Lu C, Li X, et al (2022). Healthy Eating Index-2015 and predicted 10-year cardiovascular disease risk, as well as heart age. Front Nutr, 9:888966.
29. Shan Z, Li Y, Baden MY, et al (2020). Asso-ciation between healthy eating patterns and risk of cardiovascular disease. JA-MA Intern Med, 180(8):1090-1100.
30. Hu EA, Steffen LM, Coresh J, et al (2020). Adherence to the Healthy Eating Index-2015 and other dietary patterns may re-duce risk of cardiovascular disease, car-diovascular mortality, and all-cause mor-tality. J Nutr, 150(2):312-321.
31. Li J, Guasch-Ferré M, Chung W, et al (2020). The Mediterranean diet, plasma metab-olome, and cardiovascular disease risk. Eur Heart J, 41(28):2645-56.
32. Tang C, Wang X, Qin LQ, Dong JY (2021). Mediterranean diet and mortality in people with cardiovascular disease: A meta-analysis of prospective cohort studies. Nutrients, 13(8):2623.
33. Rosato V, Temple NJ, La Vecchia C, et al (2019). Mediterranean diet and cardio-vascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr, 58(1):173-91.
34. Wang DD, Toledo E, Hruby A, et al (2019). Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED Trial (Prevención con Dieta Mediterránea) Circulation, 140(16):e726.
35. Widmer RJ, Flammer AJ, Lerman LO, Lerman A (2015). The Mediterranean di-et, its components, and cardiovascular disease. Am J Med, 128(3):229-38.
36. Zhang YJ, Gan RY, Li S, Zhou Y, et al (2015). Antioxidant phytochemicals for the prevention and treatment of chronic diseases. Molecules, 20(12):21138-56.
37. Costa A, Garcia-Diaz DF, Jimenez P, Silva PI (2013). Bioactive compounds and health benefits of exotic tropical red-black berries. J Funct Food, 5(2):539-49.
38. Hutchins-Wolfbrandt A, Mistry AM (2011). Dietary turmeric potentially reduces the risk of cancer. Asian Pac J Cancer Prev, 12(12):3169-73.
39. Xie CH, Kang J, Chen JR, et al (2011). Phe-nolic acids are in vivo atheroprotective compounds appearing in the serum of rats after blueberry consumption. J Agric Food Chem, 59(18):10381-7.
40. Ismaeel A, Greathouse KL, Newton N, Mi-serlis D, et al (2021). Phytochemicals as therapeutic interventions in peripheral artery disease. Nutrients, 13(7):2143.
2. Denova-Gutiérrez E, Huitrón-Bravo G, Ta-lavera JO, et al (2010). Dietary glycemic index, dietary glycemic load, blood li-pids, and coronary heart disease. J Nutr Metab, 2010:170680.
3. World Health Organization. “-Fact Sheets-Cardiovascular diseases”, 2021. http://www.who.int/mediacentre/factsheets/fs317/en/ [accessed: 20 Apr 2022].
4. Lakka TA, Bouchard C (2005). Physical ac-tivity, obesity and cardiovascular diseas-es. Handb Exp Pharmacol, (170):137-63.
5. Milte CM, Thorpe MG, Crawford D, et al (2015). Associations of diet quality with health-related quality of life in older Australian men and women. Exp Geron-tol, 64:8-16.
6. Edwards MK, Crush E, Loprinzi PD (2018). Dietary behavior and predicted 10-year risk for a first atherosclerotic cardiovas-cular disease event using the pooled co-hort risk equations among US adults. Am J Health Promot, 32(6):1447-51.
7. Jenkins DJA, Dehghan M, Mente A, et al (2021). Glycemic index, glycemic load, and cardiovascular disease and mortali-ty. N Engl J Med, 384(14):1312-22.
8. Yu E, Malik VS, Hu FB (2018). Cardiovascu-lar disease prevention by diet modifica-tion: JACC Health Promotion Series. J Am Coll Cardiol, 72(8):914-26.
9. Bernstein AM, Sun Q, Hu FB, et al (2010). Major dietary protein sources and risk of coronary heart disease in women. Circulation, 122(9):876-83.
10. George SM, Ballard-Barbash R, Manson JE, et al (2014). Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observation-al Study: evidence to inform national dietary guidance. Am J Epidemiol, 180(6):616-25.
11. Göktaş Z, Dikmen D, Rakıcıoğlu N (2022). Validation of MEDFICTS dietary as-sessment questionnaire in Turkish popu-lation. Public Health Nutr, 25(1):13-17.
12. Kris-Etherton P, Eissenstat B, Jaax S, et al (2001). Validation for MEDFICTS, a die-tary assessment instrument for evaluat-ing adherence to total and saturated fat recommendations of the National Cho-lesterol Education Program Step 1 and Step 2 diets. J Am Diet Assoc, 101(1): 81-6.
13. Wong ND, Budoff MJ, Ferdinand K, et al (2022). Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clini-cal practice statement. Am J Prev Cardiol, 10:100335.
14. Ural D (2012). A perspective to lipid lower-ing therapy after ESC/EAS guidelines for the management of dyslipidaemias and the European guidelines on cardio-vascular disease prevention in clinical practice. Turk Kardiyol Dern Ars, 40(4):293-7.
15. Arnett DK, Blumenthal RS, Albert MA, et al (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American Col-lege of Cardiology/American Heart As-sociation Task Force on Clinical Prac-tice Guidelines. Circulation, 140(11):e596-e646.
16. Marshall AL, Smith BJ, Bauman AE, Kaur S (2005). Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med, 39(5):294-7.
17. World Health Organization (WHO) Global Database for Body Mass Index. The in-ternational classification of adult un-derweight, overweight and obesity ac-cording to BMI. Web: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html [accessed: 06.06.2022].
18. World Health Organization. Waist circum-ference and waist-hip ratio. Report of a WHO Expert Consultation. Geneva, https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/. [ac-cessed: 14.06.2022].
19. Ben‐Noun LL, Sohar E, Laor A (2001). Neck circumference as a simple screen-ing measure for identifying overweight and obese patients. Obes Res, 9(8):470-7.
20. Ashwell M, Gibson S (2016). Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’based on BMI and waist circumference. BMJ Open, 6(3): e010159.
21. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002). Third Re-port of the National Cholesterol Educa-tion Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circu-lation, 106(25):3143-421.
22. Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V (2005). Dietitian ser-vices are associated with improved pa-tient outcomes and the MEDFICTS die-tary assessment questionnaire is a suita-ble outcome measure in cardiac rehabil-itation. J Am Diet Assoc, 105(10):1533-40.
23. McCarty MF (2004). Proposal for a dietary “phytochemical index. Med Hypotheses, 63(5):813-817.
24. Martínez-González MA, García-Arellano A, Toledo E, et al (2012). A 14-item Medi-terranean diet assessment tool and obe-sity indexes among high-risk subjects: the PREDIMED trial. PLoS One, 7(8):e43134.
25. Özkan Pehlivanoğlu EF, Balcıoğlu H, Ünlüoğlu İ (2020). Turkish validation and reliability of Mediterranean Diet Adherence Screener. Osmangazi Journal of Medicine, 42(2):160-4.
26. Wang DD, Hu FB (2017). Dietary fat and risk of cardiovascular disease: recent controversies and advances. Annu Rev Nutr, 37:423-46.
27. Astrup A, Magkos F, Bier DM, , et al (2020). Saturated fats and health: a reassessment and proposal for food-based recom-mendations: JACC state-of-the-art re-view. J Am Coll Cardiol, 76(7):844-57.
28. Zhang Y, Lu C, Li X, et al (2022). Healthy Eating Index-2015 and predicted 10-year cardiovascular disease risk, as well as heart age. Front Nutr, 9:888966.
29. Shan Z, Li Y, Baden MY, et al (2020). Asso-ciation between healthy eating patterns and risk of cardiovascular disease. JA-MA Intern Med, 180(8):1090-1100.
30. Hu EA, Steffen LM, Coresh J, et al (2020). Adherence to the Healthy Eating Index-2015 and other dietary patterns may re-duce risk of cardiovascular disease, car-diovascular mortality, and all-cause mor-tality. J Nutr, 150(2):312-321.
31. Li J, Guasch-Ferré M, Chung W, et al (2020). The Mediterranean diet, plasma metab-olome, and cardiovascular disease risk. Eur Heart J, 41(28):2645-56.
32. Tang C, Wang X, Qin LQ, Dong JY (2021). Mediterranean diet and mortality in people with cardiovascular disease: A meta-analysis of prospective cohort studies. Nutrients, 13(8):2623.
33. Rosato V, Temple NJ, La Vecchia C, et al (2019). Mediterranean diet and cardio-vascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr, 58(1):173-91.
34. Wang DD, Toledo E, Hruby A, et al (2019). Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED Trial (Prevención con Dieta Mediterránea) Circulation, 140(16):e726.
35. Widmer RJ, Flammer AJ, Lerman LO, Lerman A (2015). The Mediterranean di-et, its components, and cardiovascular disease. Am J Med, 128(3):229-38.
36. Zhang YJ, Gan RY, Li S, Zhou Y, et al (2015). Antioxidant phytochemicals for the prevention and treatment of chronic diseases. Molecules, 20(12):21138-56.
37. Costa A, Garcia-Diaz DF, Jimenez P, Silva PI (2013). Bioactive compounds and health benefits of exotic tropical red-black berries. J Funct Food, 5(2):539-49.
38. Hutchins-Wolfbrandt A, Mistry AM (2011). Dietary turmeric potentially reduces the risk of cancer. Asian Pac J Cancer Prev, 12(12):3169-73.
39. Xie CH, Kang J, Chen JR, et al (2011). Phe-nolic acids are in vivo atheroprotective compounds appearing in the serum of rats after blueberry consumption. J Agric Food Chem, 59(18):10381-7.
40. Ismaeel A, Greathouse KL, Newton N, Mi-serlis D, et al (2021). Phytochemicals as therapeutic interventions in peripheral artery disease. Nutrients, 13(7):2143.
| Files | ||
| Issue | Vol 52 No 12 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i12.14322 | |
| Keywords | ||
| Dietary patterns Cardiovascular risk Mediterranean diet Phytochemicals | ||
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How to Cite
1.
Bakırhan H, İncedal Irgat S. Dietary Patterns and Cardiovascular Risk: Are the Mediterranean Diet, the Heart-Healthy Diet, and Phytochemicals Associated with Lower Cardiovascular Risks?. Iran J Public Health. 2023;52(12):2611-2620.
