Abstract
PurposeMediterranean-type dietary pattern has been associated with lower risk of cardiovascular (CVD) and other chronic diseases, primarily in Southern European populations. We examined whether Mediterranean diet score (MDS) is associated with total, CVD, coronary heart disease (CHD) and stroke mortality in a prospective cohort study in three Eastern European populations.MethodsA total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study in the Czech Republic, Poland and the Russian Federation were included in the analysis. Diet was assessed by food frequency questionnaire, and MDS was derived from consumption of nine groups of food using absolute cut-offs. Mortality was ascertained by linkage with death registers.ResultsOver the median follow-up time of 7 years, 1314 participants died. The proportion of participants with high adherence to Mediterranean diet was low (25 %). One standard deviation (SD) increase in the MDS (equivalent to 2.2 point increase in the score) was found to be inversely associated with death from all causes (HR, 95 % CI 0.93, 0.88–0.98) and CVD (0.90, 0.81–0.99) even after multivariable adjustment. Inverse but statistically not significant link was found for CHD (0.90, 0.78–1.03) and stroke (0.87, 0.71–1.07). The MDS effects were similar in each country cohort.ConclusionHigher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban populations. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean populations.
Highlights
Mediterranean diet is the traditional eating pattern of populations around the Mediterranean Sea in Southern Europe [1]
Using a Mediterranean diet score (MDS) with absolute cut-off values for component scores, we found that high adherence to Mediterranean diet, an indicator of healthy eating habits, in this Eastern European sample was rare
The findings of this study are consistent with previous evidence which suggests that Mediterranean diet reduces the risk of cardiovascular disease (CVD) and total mortality [2, 5, 26]
Summary
Mediterranean diet is the traditional eating pattern of populations around the Mediterranean Sea in Southern Europe [1]. It is usually characterized by high consumption of fruits, vegetables, legumes, cereals, fish and olive oil, low consumption of milk and meat and moderate intake of alcohol [2, 3]. Mediterranean diet score (MDS), the indicator of adherence to the Mediterranean diet, based on consumption of selected foods, was first introduced by Trichopoulou. The associations between MDS and mortality outcomes have been investigated primarily in Southern European countries and less frequently in non-Mediterranean populations.
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