Abstract
We aimed at comparing 2 a-priori -Mediterranean Adequacy Index (MAI), the Median Score (MED) - versus 2 a-posteriori, -Factor Analysis (FA2) and Principal Components analysis (PC2)- dietary scores in 1214 CHD-free men aged 45–64 belonging to the Italian Rural Areas of the Seven Countries Study examined in 1965 and followed-up for mortality during 40 years. CHD death was the end-point. Collection of dietary history allowed to define 17 main food groups expressed in gr/day and to compare dietary scores, each divided into 3 classes. Kaplan-Meier curves showed higher survival for classes 2 and 3 (healthy) versus class 1 (unhealthy), but the log-rank test was not significant for the 2 a-priori scores. Cox proportional hazards models showed similar significant findings comparing class 3 with class 1 in the a-posteriori scores FA2 and PC2, with hazards ratios of 0.48 and 0.43, that became 0.65 and 0.53 respectively after adjusting for six specific risk factors for CHD (age, cigarette smoking, systolic blood pressure, serum cholesterol, body mass index and physical activity). Food intake of class 3 in all 4 scores matched rather well the characteristics of the Mediterranean Diet. The poor performance of a-priori dietary scores was partly explained by the unexpected and direct relationship of fruit intake with CHD deaths. The superiority of a-posteriori dietary patterns could be in turn due to the specificity of the study population. External validations and comparisons of a-priori versus a-posteriori dietary patterns in larger cohorts, using the same 17 food groups explored here, are urgently needed.
Highlights
The most recent studies tended to concentrate on scores derived from the combination of many food groups alone or with selected nutrients
Dietary habits were summarized in 17 food groups, that is using the same employed for the construction of the Mediterranean Adequacy Index (MAI) dietary score[5], as follows: bread, cereals, potatoes, legumes, vegetables, fruit, meat, fish, eggs, milk, cheese, hard fats, vegetable oils, sugar, pastry, sugar beverages, alcohol, all expressed in gr/day
The relationships of the 3 classes of each dietary score with coronary heart diseases (CHD) deaths are depicted in Figs 1–4 that report Kaplan-Meier survival curves
Summary
The most recent studies tended to concentrate on scores derived from the combination of many food groups alone or with selected nutrients. Systematic comparisons of the two approaches on the same data-base are rare[8,9] and this prompted the interest to explore and compare the role of 4 dietary scores, 2 a-priori and 2 a-posteriori, in a sample of middle aged men followed-up during 40 years for CHD mortality. These approaches are rather different and a basic question is whether they produce similar or different results when using the same database. The selection of these score types was done based on the information at hand in the datafile we had
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