Wang Qiaoye, Schmidt Amand Floriaan, Wannamethee S Goya
Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Nutr. 2024 Dec;154(12):3761-3769. doi: 10.1016/j.tjnut.2024.10.027. Epub 2024 Oct 17.
Cardiometabolic multimorbidity (CMM), defined as the co-occurrence of 2 or more cardiometabolic diseases, including myocardial infarction (MI), stroke, and type 2 diabetes (T2D), is an increasing public health challenge. Although poor diet is a known risk factor for a first cardiometabolic disease (FCMD), the relationship with subsequent occurrence of CMM is less studied.
This study aims to investigate the prospective association between baseline adherence to the Mediterranean diet and the onset of CMM across various follow-up durations.
We used data from the European Prospective Investigation into Cancer-Norfolk cohort study of 21,900 adults, aged 40-79 free of prevalent MI, stroke, and T2D at baseline (1993-1997). A median-based Mediterranean diet score and a pyramid-based MDS (pyr-MDS) were used to measure baseline adherence to the Mediterranean diet. Multistate modeling was employed to investigate associations with the FCMD and the subsequent CMM event.
Over the entire follow-up period of 21.4 y (median), we observed 5028 FCMD and 734 CMM events. Multistate analysis indicated that the association between baseline Mediterranean diet and the risk of CMM may be stronger in shorter follow-up durations. Particularly, baseline pyr-MDS was significantly associated with the risk of subsequent CMM transitioning from FCMD when follow-up durations were limited to 10 and 15 y, with hazard ratio (95% confidence interval) being 0.67 (0.53, 0.84) and 0.80 (0.70, 0.92) per SD increase in pyr-MDS, respectively. Additionally, we observed that the risk of CMM transitioning from FCMD was modified by social class across shorter to longer follow-ups, where the impact of baseline Mediterranean diet was only significant in nonmanual workers.
Baseline adherence to the Mediterranean diet was potentially associated with a lower risk of CMM transitioning from FCMD, particularly during shorter follow-up periods.
心脏代谢性多种疾病（CMM）定义为两种或更多种心脏代谢性疾病同时出现，包括心肌梗死（MI）、中风和2型糖尿病（T2D），这是一个日益严峻的公共卫生挑战。尽管不良饮食是已知的首发心脏代谢性疾病（FCMD）的危险因素，但与随后发生的CMM之间的关系研究较少。
本研究旨在调查基线时遵循地中海饮食与不同随访期间CMM发病之间的前瞻性关联。
我们使用了欧洲癌症前瞻性调查-诺福克队列研究中21900名40-79岁成年人的数据，这些人在基线时（1993-1997年）没有患MI、中风和T2D。基于中位数的地中海饮食评分和基于金字塔的地中海饮食评分（pyr-MDS）用于衡量基线时对地中海饮食的遵循情况。采用多状态建模来研究与FCMD和随后的CMM事件之间的关联。
在21.4年（中位数）的整个随访期内，我们观察到5028例FCMD和734例CMM事件。多状态分析表明，在较短的随访期内，基线地中海饮食与CMM风险之间的关联可能更强。特别是，当随访期限制在10年和15年时，基线pyr-MDS与随后从FCMD转变为CMM的风险显著相关，pyr-MDS每增加一个标准差，风险比（95%置信区间）分别为0.67（0.53，0.84）和0.80（0.70，0.92）。此外，我们观察到，在从较短到较长的随访期内，社会阶层会改变从FCMD转变为CMM的风险，其中基线地中海饮食的影响仅在非体力劳动者中显著。
基线时遵循地中海饮食可能与从FCMD转变为CMM的较低风险相关，特别是在较短的随访期内。
