Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden.
Preventive Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2018 Dec 7;1(8):e185708. doi: 10.1001/jamanetworkopen.2018.5708.
Higher Mediterranean diet (MED) intake has been associated with lower risk of cardiovascular disease (CVD), but limited data are available about the underlying molecular mechanisms of this inverse disease association in human populations.
To better characterize the relative contribution of traditional and novel factors to the MED-related risk reduction in CVD events in a US population.
DESIGN, SETTING, AND PARTICIPANTS: Using a prospective cohort design, baseline MED intake was assessed in 25 994 initially healthy US women in the Women's Health Study who were followed up to 12 years. Potential mediating effects of a panel of 40 biomarkers were evaluated, including lipids, lipoproteins, apolipoproteins, inflammation, glucose metabolism and insulin resistance, branched-chain amino acids, small-molecule metabolites, and clinical factors. Baseline study information and samples were collected between April 30, 1993, and January 24, 1996. Analyses were conducted between August 1, 2017, and October 30, 2018.
Intake of MED is a 9-category measure of adherence to a Mediterranean dietary pattern. Participants were categorized into 3 levels based on their adherence to the MED.
Incident CVD confirmed through medical records and the proportion of CVD risk reduction explained by mediators.
Among 25 994 women (mean [SD] age, 54.7 [7.1] years), those with low, middle, and upper MED intakes composed 39.0%, 36.2%, and 24.8% of the study population and experienced 428 (4.2%), 356 (3.8%), and 246 (3.8%) incident CVD events, respectively. Compared with the reference group who had low MED intake, CVD risk reductions were observed for the middle and upper groups, with respective HRs of 0.77 (95% CI, 0.67-0.90) and 0.72 (95% CI, 0.61-0.86) (P for trend < .001). The largest mediators of the CVD risk reduction of MED intake were biomarkers of inflammation (accounting for 29.2% of the MED-CVD association), glucose metabolism and insulin resistance (27.9%), and body mass index (27.3%), followed by blood pressure (26.6%), traditional lipids (26.0%), high-density lipoprotein measures (24.0%) or very low-density lipoprotein measures (20.8%), with lesser contributions from low-density lipoproteins (13.0%), branched-chain amino acids (13.6%), apolipoproteins (6.5%), or other small-molecule metabolites (5.8%).
In this study, higher MED intake was associated with approximately one-fourth relative risk reduction in CVD events, which could be explained in part by known risk factors, both traditional and novel.
更高的地中海饮食（MED）摄入量与心血管疾病（CVD）风险降低有关，但关于这种逆疾病关联在人类群体中的潜在分子机制的有限数据。
更好地描述传统和新型因素在美国家庭中与 MED 相关的 CVD 事件风险降低的相对贡献。
设计、地点和参与者：使用前瞻性队列设计，在参加妇女健康研究的 25994 名最初健康的美国女性中评估基线 MED 摄入量，随访时间长达 12 年。评估了 40 种生物标志物的潜在中介效应，包括脂质、脂蛋白、载脂蛋白、炎症、葡萄糖代谢和胰岛素抵抗、支链氨基酸、小分子代谢物和临床因素。基线研究信息和样本于 1993 年 4 月 30 日至 1996 年 1 月 24 日之间收集。分析于 2017 年 8 月 1 日至 2018 年 10 月 30 日之间进行。
MED 摄入量是一种 9 类适应地中海饮食模式的措施。根据他们对 MED 的依从性，参与者分为 3 个水平。
通过医疗记录确认的 CVD 事件以及中介物解释的 CVD 风险降低比例。
在 25994 名女性（平均[SD]年龄，54.7[7.1]岁）中，低、中、高 MED 摄入量组分别占研究人群的 39.0%、36.2%和 24.8%，分别经历了 428（4.2%）、356（3.8%）和 246（3.8%）例 CVD 事件。与低 MED 摄入量的参考组相比，中组和高组的 CVD 风险降低，相应的 HR 分别为 0.77（95%CI，0.67-0.90）和 0.72（95%CI，0.61-0.86）（P趋势<.001）。MED 摄入量与 CVD 风险降低相关的最大中介物是炎症生物标志物（占 MED-CVD 关联的 29.2%）、葡萄糖代谢和胰岛素抵抗（27.9%）和体重指数（27.3%），其次是血压（26.6%）、传统脂质（26.0%）、高密度脂蛋白测量值（24.0%）或极低密度脂蛋白测量值（20.8%），低密度脂蛋白（13.0%）、支链氨基酸（13.6%）、载脂蛋白（6.5%）或其他小分子代谢物（5.8%）的贡献较小。
在这项研究中，较高的 MED 摄入量与 CVD 事件风险降低约四分之一有关，这部分可以通过已知的风险因素来解释，包括传统和新型因素。
