Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study

Identifier:  imarina:1968269

Handle: https://hdl.handle.net/20.500.11797/imarina1968269

Authors:  Martinez-Gonzalez, Miguel A; Zazpe, Itziar; Razquin, Cristina; Sanchez-Tainta, Ana; Corella, Dolores; Salas-Salvado, Jordi; Toledo, Estefania; Ros, Emilio; Angel Munoz, Miguel; Recondo, Javier; Gomez-Gracia, Enrique; Fiol, Miguel; Lapetra, Jose; Buil-Cosiales, Pilar; Serra-Majem, Lluis; Pinto, Xavier; Schroeder, Helmut; Tur, Josep A; Sorli, Jose V; Lamuela-Raventos, Rosa M; Estruch, Ramon

Abstract:
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).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.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).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.Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.