3 years ago

Adherence to an Energy-restricted Mediterranean Diet Score and Prevalence of Cardiovascular Risk Factors in the PREDIMED-Plus: A Cross-sectional Study

Ismael Álvarez-álvarez, Miguel Á. Martínez-gonzález, Ana Sánchez-tainta, Dolores Corella, Andrés Díaz-lópez, Montserrat Fitó, Jesús Vioque, Dora Romaguera, J. Alfredo Martínez, Julia Wärnberg, José López-miranda, Ramón Estruch, Aurora Bueno-cavanillas, Fernando Arós, Josep A. Tur, Francisco J. Tinahones, Lluís Serra-majem, Vicente Martín, José Lapetra, Sebastián Más Fontao

Publication date: Available online 2 October 2018

Source: Revista Española de Cardiología (English Edition)

Author(s): Ismael Álvarez-Álvarez, Miguel Á. Martínez-González, Ana Sánchez-Tainta, Dolores Corella, Andrés Díaz-López, Montserrat Fitó, Jesús Vioque, Dora Romaguera, J. Alfredo Martínez, Julia Wärnberg, José López-Miranda, Ramón Estruch, Aurora Bueno-Cavanillas, Fernando Arós, Josep A. Tur, Francisco J. Tinahones, Lluís Serra-Majem, Vicente Martín, José Lapetra, Sebastián Más Fontao

Introduction and objectives

The cardiovascular benefits of the Mediterranean diet have usually been assessed under assumptions of ad libitum total energy intake (ie, no energy restriction). In the recently launched PREDIMED-Plus, we conducted exploratory analyses to study the baseline associations between adherence to an energy-restricted Mediterranean diet (MedDiet) and the prevalence of cardiovascular risk factors (CVRF).


Cross-sectional assessment of all PREDIMED-Plus participants (6874 older adults with overweight/obesity and metabolic syndrome) at baseline. The participants were assessed by their usual primary care physicians to ascertain the prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidemia). A 17-point PREDIMED-Plus score was used to measure adherence to the MedDiet. Multivariable models were fitted to estimate differences in means and prevalence ratios for individual and clustered CVRF.


Better adherence to a MedDiet pattern was significantly associated with lower average triglyceride levels, body mass index, and waist circumference. Compared with low adherence (≤ 7 points in the 17-point score), better adherence to the MedDiet (11-17 points) showed inverse associations with hypertension (prevalence ratio = 0.97; 95%CI, 0.94-1.00) and obesity (prevalence ratio = 0.96; 95%CI, 0.92-1.00), but positive associations with diabetes (prevalence ratio = 1.19; 95%CI, 1.07-1.32). Compared with the lowest third of adherence, women in the upper third showed a significantly lower prevalence of the clustering of 3 or more CVRF (prevalence ratio = 0.91; 95%CI, 0.83-0.98).


Among participants at high cardiovascular risk, better adherence to a MedDiet showed significant inverse associations with CVRF among women, and improved lipid profiles and adiposity measures.

This trial was registered in 2014 at the International Standard Randomized Controlled Trial Registry (ISRCTN89898870).

Introducción y objetivos

Los beneficios cardiovasculares de la dieta mediterránea se han evaluado bajo supuestos de ingesta total de energía ad libitum (sin restricción de energía). En el presente trabajo se estudia basalmente la cohorte de un gran ensayo en marcha denominado PREDIMED-Plus y la asociación entre la adherencia a la dieta mediterránea hipocalórica según la escala de 17 puntos (MedDiet) de este ensayo con la prevalencia inicial de factores de riesgo cardiovascular (FRCV).


Evaluación transversal de los participantes de PREDIMED-Plus (6.874 adultos mayores con sobrepeso/obesidad y síndrome metabólico). Se evaluó a los participantes para determinar la prevalencia de 4 FRCV (hipertensión, obesidad, diabetes, dislipemia). Se estimaron diferencias de medias y razones de prevalencia para FRCV individuales y agrupados con modelos multivariables.


Una mejor adhesión al patrón MedDiet se asoció significativamente con niveles más bajos de triglicéridos, índice de masa corporal y perímetro abdominal. Comparado con una baja adhesión (≤ 7 puntos en el score de 17 puntos), una mejor adhesión a la MedDiet (11-17 puntos) mostró asociaciones inversas con hipertensión (razón de prevalencia = 0,97; IC95%, 0,94-1,00) y obesidad (razón de prevalencia = 0,96; IC95% 0,92-1,00), pero se observaron asociaciones positivas con diabetes (razón de prevalencia = 1,19; IC95% 1,07-1,32). Comparado con el tercil más bajo de adhesión, las mujeres en el tercil superior mostraron un riesgo menor para la agrupación de 3 o más FRCV (razón de prevalencia = 0,91; IC95% 0,83-0,98).


Entre participantes con alto riesgo cardiovascular, la mejor adhesión a MedDiet se asoció a mejores perfiles lipídicos y medidas de adiposidad, y entre las mujeres mostró asociaciones inversas significativas con la agregación de FRCV.

Este ensayo se registró en 2014 en el International Standard Randomized Controlled Trial Registry (ISRCTN89898870).

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