Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain; University Hospital of Sant Joan de Reus, Nutrition Unit, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Clin Nutr. 2021 May;40(5):2825-2836. doi: 10.1016/j.clnu.2021.03.016. Epub 2021 Mar 18.
BACKGROUND & AIMS: The Portfolio and Dietary Approaches to Stop Hypertension (DASH) diets have been shown to lower cardiometabolic risk factors in randomized controlled trials (RCTs). However, the Portfolio diet has only been assessed in RCTs of hyperlipidemic patients. Therefore, to assess the Portfolio diet in a population with metabolic syndrome (MetS), we conducted a longitudinal analysis of one-year data of changes in the Portfolio and DASH diet scores and their association with cardiometabolic risk factors in Prevención con Dieta Mediterránea (PREDIMED)-Plus trial.
PREDIMED-Plus is an ongoing clinical trial (Trial registration: ISRCTN89898) conducted in Spain that includes 6874 older participants (mean age 65 y, 48% women) with overweight/obesity fulfilling at least three criteria for MetS. Data for this analysis were collected at baseline, six months and one year. Adherence to the Portfolio and DASH diet scores were derived from a validated 143-item food frequency questionnaire. We used linear mixed models to examine the associations of 1-SD increase and quartile changes in the diet scores with concomitant changes in cardiometabolic risk factors.
After adjusting for several potential confounders, a 1-SD increase in the Portfolio diet score was significantly associated with lower HbA1c (β [95% CI]: -0.02% [-0.02, -0.01], P < 0.001), fasting glucose (-0.47 mg/dL [-0.83, -0.11], P = 0.01), triglycerides (-1.29 mg/dL [-2.31, -0.28], P = 0.01), waist circumference (WC) (-0.51 cm [-0.59, -0.43], P < 0.001), and body mass index (BMI) (-0.17 kg/m [-0.19, -0.15], P < 0.001). A 1-SD increase in the DASH diet score was significantly associated with lower HbA1c (-0.03% [-0.04, -0.02], P < 0.001), glucose (-0.84 mg/dL [-1.18, -0.51], P < 0.001), triglycerides (-3.38 mg/dL [-4.37, -2.38], P < 0.001), non-HDL-cholesterol (-0.47 mg/dL [-0.91, -0.04], P = 0.03), WC (-0.69 cm [-0.76, -0.60 cm], P < 0.001), BMI (-0.25 kg/m [-0.28, -0.26 kg/m], P < 0.001), systolic blood pressure (-0.57 mmHg [-0.81, -0.32 mmHg], P < 0.001), diastolic blood pressure (-0.15 mmHg [-0.29, -0.01 mmHg], P = 0.03), and with higher HDL-cholesterol (0.21 mg/dL [0.09, 0.34 mg/dL, P = 0.001]). Similar associations were seen when both diet scores were assessed as quartiles, comparing extreme categories of adherence.
Among older adults at high cardiovascular risk with MetS, greater adherence to the Portfolio and DASH diets showed significant favourable prospective associations with several clinically relevant cardiometabolic risk factors. Both diets are likely beneficial for cardiometabolic risk reduction.
Portfolio 饮食和 DASH 饮食已被证明可以降低随机对照试验（RCT）中的心血管代谢风险因素。然而，Portfolio 饮食仅在高脂血症患者的 RCT 中进行了评估。因此，为了在代谢综合征（MetS）人群中评估 Portfolio 饮食，我们对 Prevención con Dieta Mediterránea（PREDIMED）-Plus 试验的一年数据进行了纵向分析，以评估 Portfolio 和 DASH 饮食评分的变化及其与心血管代谢风险因素的相关性。
PREDIMED-Plus 是一项正在进行的临床试验（注册号：ISRCTN89898），在西班牙进行，纳入了 6874 名超重/肥胖且符合至少三项 MetS 标准的老年参与者（平均年龄 65 岁，48%为女性）。本分析的数据采集于基线、6 个月和 1 年。通过验证过的 143 项食物频率问卷来计算 Portfolio 和 DASH 饮食评分的依从性。我们使用线性混合模型来检验饮食评分每增加 1 个标准差和四分位变化与同期心血管代谢风险因素变化的关系。
在调整了几个潜在的混杂因素后，Portfolio 饮食评分每增加 1 个标准差与糖化血红蛋白（HbA1c）降低（β[95%CI]：-0.02%[-0.02，-0.01]，P<0.001）、空腹血糖（-0.47mg/dL[-0.83，-0.11]，P=0.01）、三酰甘油（-1.29mg/dL[-2.31，-0.28]，P=0.01）、腰围（WC）（-0.51cm[-0.59，-0.43]，P<0.001）和体重指数（BMI）（-0.17kg/m[-0.19，-0.15]，P<0.001）显著相关。DASH 饮食评分每增加 1 个标准差与 HbA1c 降低（-0.03%[-0.04，-0.02]，P<0.001）、血糖（-0.84mg/dL[-1.18，-0.51]，P<0.001）、三酰甘油（-3.38mg/dL[-4.37，-2.38]，P<0.001）、非高密度脂蛋白胆固醇（-0.47mg/dL[-0.91，-0.04]，P=0.03）、WC（-0.69cm[-0.76，-0.60cm]，P<0.001）、BMI（-0.25kg/m[-0.28，-0.26kg/m]，P<0.001）、收缩压（-0.57mmHg[-0.81，-0.32mmHg]，P<0.001）、舒张压（-0.15mmHg[-0.29，-0.01mmHg]，P=0.03）和高密度脂蛋白胆固醇升高（0.21mg/dL[0.09，0.34mg/dL]，P=0.001）显著相关。当将两个饮食评分都评估为四分位数并比较依从性的极端类别时，也观察到了类似的相关性。
在心血管风险较高的患有 MetS 的老年人群中，较高的 Portfolio 和 DASH 饮食依从性与多个具有临床意义的心血管代谢风险因素呈显著有利的前瞻性相关性。两种饮食可能都有益于降低心血管代谢风险。
