Miguel A Martínez-González1, Itziar Zazpe2, Cristina Razquin3, Ana Sánchez-Tainta4, Dolores Corella5, Jordi Salas-Salvadó6, Estefanía Toledo4, Emilio Ros7, Miguel Ángel Muñoz8, Javier Recondo9, Enrique Gómez-Gracia10, Miquel Fiol11, José Lapetra12, Pilar Buil-Cosiales13, Lluis Serra-Majem14, Xavier Pinto15, Helmut Schröder16, Josep A Tur17, José V Sorli5, Rosa M Lamuela-Raventós18, Ramón Estruch7. 1. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain. Electronic address: mamartinez@unav.es. 2. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain. 3. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain. 4. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain. 5. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain. 6. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain. 7. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain. 8. Unitat de Suport a la Recerca, División de Atención Primaria de Salud, Institut Català de la Salut e IDIAP-Jordi Gol, Barcelona, Spain; Departamento de Pediatría, Obstetricia, Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain. 9. Department of Cardiology, University Hospital of Alava, Vitoria, Spain. 10. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain. 11. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Son Espases, Palma de Mallorca, Spain. 12. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain. 13. Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain. 14. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain. 15. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. 16. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar-IMIM, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain. 17. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Fundamental Biology & Health Sciences, University of Balearic Islands, Spain. 18. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) and PREDIMED Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII) Spanish Government, Spain; Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. RESULTS: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a "Mediterranean-type" dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). CONCLUSIONS: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.
RCT Entities:
BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. RESULTS: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a "Mediterranean-type" dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). CONCLUSIONS: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.
Authors: Paulette D Chandler; Raji Balasubramanian; Nina Paynter; Franco Giulianini; Teresa Fung; Lesley F Tinker; Linda Snetselaar; Simin Liu; Charles Eaton; Deirdre K Tobias; Fred K Tabung; JoAnn E Manson; Edward L Giovannucci; Clary Clish; Kathryn M Rexrode Journal: Am J Clin Nutr Date: 2020-08-01 Impact factor: 7.045
Authors: Maria Del Mar Bibiloni; Alicia Julibert; Emma Argelich; Raquel Aparicio-Ugarriza; Gonzalo Palacios; Antoni Pons; Marcela Gonzalez-Gross; Josep A Tur Journal: Nutrients Date: 2017-07-06 Impact factor: 5.717
Authors: Laural K English; Jamy D Ard; Regan L Bailey; Marlana Bates; Lydia A Bazzano; Carol J Boushey; Clarissa Brown; Gisela Butera; Emily H Callahan; Janet de Jesus; Richard D Mattes; Elizabeth J Mayer-Davis; Rachel Novotny; Julie E Obbagy; Elizabeth B Rahavi; Joan Sabate; Linda G Snetselaar; Eve E Stoody; Linda V Van Horn; Sudha Venkatramanan; Steven B Heymsfield Journal: JAMA Netw Open Date: 2021-08-02