Skip to main content Accessibility help
×
Home

A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study

  • Lyn M. Steffen (a1), Linda Van Horn (a2), Martha L. Daviglus (a3), Xia Zhou (a1), Jared P. Reis (a4), Catherine M. Loria (a4), David R. Jacobs (a1) and Kiyah J. Duffey (a5)...

Abstract

The Mediterranean diet has been reported to be inversely associated with incident metabolic syndrome (MetSyn) among older adults; however, this association has not been studied in young African American and white adults. The objective of the present study was to evaluate the association of a modified Mediterranean diet (mMedDiet) score with the 25-year incidence of the MetSyn in 4713 African American and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. A diet history questionnaire was used to assess dietary intake at baseline, year 7 and year 20 and a mMedDiet score was created. Cardiovascular risk factors were measured at multiple examinations over 25 years. The MetSyn was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Cox proportional-hazards regression analysis was use to evaluate associations for incident MetSyn across the mMedDiet score categories adjusting for demographic characteristics, lifestyle factors and BMI. Higher mMedDiet scores represented adherence to a dietary pattern rich in fruit, vegetables, whole grains, nuts and fish, but poor in red and processed meat and snack foods. The incidence of MetSyn components (abdominal obesity, elevated TAG concentrations and low HDL-cholesterol concentrations) was lower in those with higher mMedDiet scores than in those with lower scores. Furthermore, the incidence of the MetSyn was lower across the five mMedDiet score categories; the hazard ratios and 95 % CI from category 1 to category 5 were 1·0; 0·94 (0·76, 1·15); 0·84 (0·68, 1·04); 0·73 (0·58, 0·92); and 0·72 (0·54, 0·96), respectively (P trend= 0·005). These findings suggest that the risk of developing the MetSyn is lower when consuming a diet rich in fruit, vegetables, whole grains, nuts and fish.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Dr L. M. Steffen, email steffen@umn.edu

References

Hide All
1 Estruch, R, Ros, E, Salas-Salvadó, J, et al. (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368, 12791290.
2 Martinez-Gonzalez, MA & Bes-Rastrollo, M (2014) Dietary patterns, Mediterranean diet, and cardiovascular disease. Curr Opin Lipidol 25, 2026.
3 Ministry of Health and Welfare (1999) Dietary guidelines for adults in Greece. Arch Hellen Med 16, 516524.
4 Trichopoulou, A, Costacou, T, Bamia, C, et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. New Engl J Med 348, 25992608.
5 Sofi, F, Cesari, F, Abbate, R, et al. (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337, a1344.
6 Martinez-Gonzalez, MA, Bes-Rastrollo, M, Serra-Majem, L, et al. (2009) Mediterranean food pattern and the primary prevention of chronic disease: recent developments. Nutr Rev 67, S111S116.
7 Kastorini, CM, Milionis, HJ, Esposito, K, et al. (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57, 12991313.
8 Tortosa, A, Bes-Rastrollo, M, Sanchez-Villegas, A, et al. (2007) Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 30, 29572959.
9 Rumawas, ME, Meigs, JB, Dwyer, JT, et al. (2009) Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort. Am J Clin Nutr 90, 16081614.
10 Kesse-Guyot, E, Ahluwalia, N, Lassale, C, et al. (2013) Adherence to Mediterranean diet reduces the risk of metabolic syndrome: a 6-year prospective study. Nutr Metab Cardiovasc Dis 23, 677683.
11 Friedman, GD, Cutter, GR, Donahue, RP, et al. (1988) CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol 41, 11051116.
12 Chamberlain, AM, Schreiner, PJ, Fornage, M, et al. (2009) Ala54Thr polymorphism of the fatty acid binding protein 2 gene and saturated fat intake in relation to lipid levels and insulin resistance: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Metabolism 58, 12221228.
13 Warnick, GR, Benderson, J & Albers, JJ (1982) Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density-lipoprotein cholesterol. Clin Chem 28, 13791388.
14 Warnick, GR (1986) Enzymatic methods for quantification of lipoprotein lipids. Methods Enzymol 129, 101123.
15 Folsom, AR, Jacobs, DR, Wagenknecht, LE, et al. (1996) Increase in fasting insulin and glucose over seven years with increasing weight and inactivity of young adults. The CARDIA Study. Am J Epidemiol 144, 235246.
16 Grundy, SM, Cleeman, JI, Daniels, SR, et al. (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 27352752.
17 McDonald, A, Van Horn, L, Slattery, M, et al. (1991) The CARDIA dietary history: development, implementation, and evaluation. J Am Diet Assoc 91, 11041112.
18 Liu, K, Slattery, M, Jacobs, DR, et al. (1994) A study of the reliability and comparative validity of the CARDIA dietary history. Ethn Dis 4, 1527.
19 Nutrition Coordinating Center & University of Minnesota (2005) Nutrition Data System for Research (NDSR), Food and Nutrient Database. http://www.ncc.umn.edu/products/databasefoodsnutrientsfoodgroups.html (accessed February 2014).
20 Scholer, M (2006) Coffee consumption. http://www.worldmapper.org/posters/worldmapper_1038_coffee_consumption_ver2.pdf (accessed February 2014).
21 Naska, A, Orfanos, P, Chloptsios, Y, et al. (2005) Dietary habits in Greece: The European Prospective Investigation into Cancer and nutrition (the EPIC project). Arch Hellen Med 22, 259269.
22 Fotiadou, E & Babajimopoulos, M (2006) Snack patterns of Greek adults 20–50 years of age. J Food Service 17, 197204.
23 Piernas, C & Popkin, B (2010) Snacking increased among U.S. adults between 1977 and 2006. J Nutr 140, 325332.
24 Jacobs, DR Jr, Ainsworth, BE, Hartman, TJ, et al. (1993) A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 25, 8191.
25 Hu, FB, Stampfer, MJ, Rimm, E, et al. (1999) Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 149, 531540.
26 Hosmer, DW, Lemeshow, S & May, S (2008) Applied Survival Analysis: Regression Modeling of Time to Event Data, 2nd ed. New York: John Wiley & Sons, Inc.
27 Center for Nutrition Policy and Promotion & U.S. Department of Agriculture (2011) ChooseMyPlate.gov. http://www.choosemyplate.gov (accessed accessed November 2013).
28 Kafatos, A, Verhagen, H, Moschandreas, J, et al. (2000) Mediterranean diet of Crete: foods and nutrient content. J Am Diet Assoc 100, 14871493.
29 Tzima, N, Pitsavos, C, Panagiotakos, DB, et al. (2007) Mediterranean diet and insulin sensitivity, lipid profile and blood pressure levels, in overweight and obese people; the Attica study. Lipids Health Dis 6, 22.
30 Psaltopoulou, T, Naska, A, Orfanos, P, et al. (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 80, 10121018.
31 Babio, N, Bullo, M & Salas-Salvado, J (2009) Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutr 12, 16071617.
32 Salas-Salvadó, J, Bullo, M, Babio, N, et al. (2011) Reduction in the incidence of type 2 diabetes with the Mediterranean Diet: results of the PREDIMED-Reus Nutrition Intervention Randomized trial. Diabetes Care 34, 1419.
33 McKeown, NM, Meigs, JB, Liu, S, et al. (2002) Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. Am J Clin Nutr 76, 390398.
34 de Silva Foster, ER, Harper, MM, Seidman, CE, et al. (2000) Alcohol consumption raises HDL-cholesterol levels by increasing the transport rate of apolipoproteins A-I and A-II. Circulation 102, 23472352.
35 Steffen, LM, Kroenke, CH, Yu, X, et al. (2005) Associations of plant foods, dairy products, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: The CARDIA Study. Am J Clin Nutr 82, 11691177.
36 Elliott, P, Stamler, J, Dyer, AR, et al. (2006) Association between protein intake and blood pressure: the INTERMAP Study. Arch Int Med 166, 7987.
37 Miura, K, Greenland, P, Stamler, J, et al. (2004) Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 159, 572580.
38 Wang, Y & Beydoun, MA (2009) Meat consumption is associated with obesity and central obesity among US adults. Int J Obes 33, 621628.
39 Aune, D, Ursin, G & Veierød, MB (2009) Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia 52, 22772287.
40 Baik, I, Abbott, RD, Curb, JD, et al. (2011) Intake of fish and n-3 fatty acids and future risk of metabolic syndrome. J Am Diet Assoc 110, 10181026.
41 Lara, JJ, Economou, M, Wallace, AM, et al. (2007) Benefits of salmon eating on traditional and novel vascular risk factors in young, non-obese healthy subjects. Atherosclerosis 193, 213221.
42 Singer, P, Berger, I, Lück, K, et al. (1986) Long-term effect of mackerel diet on blood pressure, serum lipids and thromboxane formation in patients with mild essential hypertension. Atherosclerosis 62, 259265.
43 Panagiotakos, DB, Zeimbekis, A, Boutziouka, V, et al. (2007) Long-term fish intake is associated with better lipid profile, arterial blood pressure, and blood glucose levels in elderly people from Mediterranean islands (MEDIS epidemiological study). Med Sci Monit 13, CR307CR312.
44 Covas, MI, Konstantinidou, V & Fito, M (2009) Olive oil and cardiovascular health. J Cardiovasc Pharmacol 54, 477482.
45 Neuhouser, ML, Tinker, L, Shaw, PA, et al. (2008) Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative. Am J Epidemiol 167, 12471259.

Keywords

A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study

  • Lyn M. Steffen (a1), Linda Van Horn (a2), Martha L. Daviglus (a3), Xia Zhou (a1), Jared P. Reis (a4), Catherine M. Loria (a4), David R. Jacobs (a1) and Kiyah J. Duffey (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed