地中海饮食轨迹与 20 年心血管疾病发病率：ATTICA 队列研究（2002-2022 年）。

Mediterranean diet trajectories and 20-year incidence of cardiovascular disease: The ATTICA cohort study (2002-2022).

机构信息

Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece.

First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece.

出版信息

Nutr Metab Cardiovasc Dis. 2024 Jan;34(1):153-166. doi: 10.1016/j.numecd.2023.09.019. Epub 2023 Sep 29.

DOI:10.1016/j.numecd.2023.09.019

PMID:38007352

Abstract

BACKGROUND AND AIMS

Only few studies have assessed longitudinal dietary trends in relation to cardiovascular disease (CVD) risk. We aimed to evaluate the association between adherence to the Mediterranean diet, both baseline and longitudinal, and 20-year CVD incidence.

METHODS AND RESULTS

This was a prospective study among 1988 Greek adults (50% men, age: 45 ± 14years). Adherence to the Mediterranean diet was evaluated at baseline and 10 years through the MedDietScore, based on which longitudinal Mediterranean diet trajectories were identified. CVD incidence was recorded at 20 years. Each one-unit increase in baseline MedDietScore was associated with an 8% reduction in 20-year CVD incidence. Compared to subjects in the lowest tertile of baseline MedDietScore, those in the highest exhibited a 44% lower 20-year CVD risk (relative risk: 0.56, 95% confidence interval: 0.32, 0.97) adjusted for age, sex, baseline body mass index, smoking, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, and family history of CVD; further adjustment for high-sensitivity C-reactive protein, uric acid and estimated glomerular filtration rate attenuated this association. Results were similar in models adjusted for longitudinal changes in body weight, physical activity and smoking, and 10-year medical status. Mediterranean diet trajectory analysis revealed that 24.7%, 8.6%, 45.8% and 20.9% of participants longitudinally sustained a low adherence, moved closer, moved away or sustained a high adherence, respectively; among those, the corresponding CVD incidence was 63.3%, 65.5%, 28.1% and 9.4% (p-value<0.001).

CONCLUSION

The Mediterranean diet offers long-term protection against CVD, part of which is mediated by inflammation, uricemia and renal function.

摘要

背景与目的

仅有少数研究评估了与心血管疾病（CVD）风险相关的纵向饮食趋势。我们旨在评估基线和纵向坚持地中海饮食与 20 年 CVD 发病率之间的关联。

方法和结果

这是一项针对 1988 名希腊成年人（50%为男性，年龄：45±14 岁）的前瞻性研究。基线和 10 年时通过 MedDietScore 评估地中海饮食的依从性，根据该评分确定纵向地中海饮食轨迹。20 年时记录 CVD 发病率。基线 MedDietScore 每增加一个单位，20 年 CVD 发病率降低 8%。与基线 MedDietScore 最低三分位的受试者相比，最高三分位的受试者 20 年 CVD 风险降低 44%（相对风险：0.56，95%置信区间：0.32，0.97），调整年龄、性别、基线 BMI、吸烟、体力活动、高胆固醇血症、高血压和糖尿病以及 CVD 家族史；进一步调整高敏 C 反应蛋白、尿酸和估计肾小球滤过率后，这种关联减弱。调整体重、体力活动和吸烟的纵向变化以及 10 年医疗状况的模型结果相似。地中海饮食轨迹分析显示，24.7%、8.6%、45.8%和 20.9%的参与者分别持续低依从性、更接近、远离或持续高依从性；其中，相应的 CVD 发病率分别为 63.3%、65.5%、28.1%和 9.4%（p 值<0.001）。