Relationship between Mediterranean Diet Score and atherothrombotic risk: findings from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.

BACKGROUND

Mediterranean diet has been promoted as the preferred dietary model for cardiovascular disease prevention in the United States.

OBJECTIVE

We sought to evaluate the degree to which the Mediterranean diet is associated with reduced levels of atherothrombotic biomarkers in a population-based sample in the U.S.

DESIGN

Data from 13,197 adults between the ages of 18 and 90 were collected and atherothrombotic risk factors assessed as part of the NHANES III, 1988-1994. Adherence to the Mediterranean diet was evaluated using food frequency questionnaires, supplemented by the 24-h dietary recall data, to develop Mediterranean Diet Scores (MedDietScore) that were analyzed in tertiles. The cross-sectional relationship of MedDietScore to atherothrombotic factors were analyzed using multiple variable regression analysis adjusted for complex sampling design using SUDAAN.

RESULTS

The components of the Mediterranean diet and the dietary pattern's associations with atherothrombotic risk factors differed by age and gender. For men <45 years of age as MedDietScore increased: total cholesterol/HDL cholesterol (TC/HDL) ratio (p=0.0390), serum insulin (p=0.0414), and white blood cell (WBC) (p=0.0246) decreased. For men>or=45 years as MedDietScore increased: TC/HDL ratio (p=0.0008), Hemoglobin A1c (HgbA1c) (p=0.0001), HOMA index (p=0.0486), C-reactive protein (p=0.0034), fibrinogen (p=0.0028) decreased and HDL cholesterol (HDL-c) levels (p<0.0001) increased. For pre-menopausal women, as MedDietScore increased: TC/HDL ratio (p<0.0001), non-HDL cholesterol (p=0.0012), apolipoprotein B (p=0.0112), HgbA1c (p=0.0001), decreased and HDL-c levels (p<0.0001) increased. For post-menopausal women, as MedDietScore increased: TC/HDL ratio (p=0.0005), Triglycerides (p<0.0001), serum insulin (p=0.0062), HOMA index (p=0.0063) and Homocysteine (Hcy) (0.0046) levels decreased and HDL-c levels (p=0.0005) increased.

CONCLUSIONS

Mediterranean diet appears to be associated with selective measures of cardioprotective lipid profiles, glucose metabolism, and inflammation and coagulation levels.