Presentation on theme: "The Southern European Atlantic Diet index – definition and effects on cardiovascular health Andreia Oliveira Department of Clinical Epidemiology, Predictive."— Presentation transcript:
1 The Southern European Atlantic Diet index – definition and effects on cardiovascular health Andreia OliveiraDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, Medical SchoolInstitute of Public Health | University of PortoBristol | October 18, 2011
2 Methodological approaches to study Diet Single nutrients/ foodsDietary Patternsdefined a prioridefined a posterioriHypothesis-oriented approach(a priori knowledge)Exploratory approach(data at hand)Indexes and scoresPrincipal component analysisFactor analysisCluster analysisMediterranean Diet Score (MDS)Mediterranean Adequacy Index (MAI)Mediterranean dietary patternHealthy Diet Indicator (HDI)Healthy Food Index (HFI)EuropeAdapted from: Schulze et al. Br J Nutr 2006; 95:
3 Adherence to a Mediterranean diet was poor in all Portuguese regions … Portuguese Household’s Budget Surveys1989/1990: n=12 4031994/1995: n=10 5542000/2001: n=10 020Adherence to a Mediterranean diet was poor in all Portuguese regions …
4 Atlantic Diet“Diet characteristic of regions with a straight link with the Atlantic Ocean sharing a specific high consumption of fish and other sea foods, red meats, vegetables and whole foods, and wine consumption during meals”Atlantic OceanMediterranean SeaEuropean Center of Atlantic Diet, Viana do Castelo, Portugal 2001Varela G et al, Madrid 2004Fundación Española de la Nutrición, Marid 2003, 2005
5 Objectives To define the Southern European Atlantic Diet (SEAD) index. To evaluate the association of this index with the occurrence of non-fatal acute myocardial infarction id adults from Porto, Portugal.
6 EPICardis study – a population-based case-control study CasesPatients admitted consecutively to the Cardiology Department of the four hospitals providing acute coronary care in Porto ( ), with a first diagnosis of acute myocardial infarction (AMI) (n=820).Community participants aged ≥ 18 yearsBaseline evaluation of the EPIPorto cohort ( )- Who had no previous clinical or silent infarction (n=2196)Controls
7 Data collection [by questionnaire and physical examination] Mini-Mental State Examination test [in those ≥ 65 years; subjects excluded when scoring < 24 points]Age | Education | Marital status | Occupational activitySocial and demographic characteristicsDislipidemia | Diabetes | Hypertension | Personal history of cardiovascular diseasesFamily history of acute myocardial infarction | Use of medication | Gynecological historyPersonal and family medical historySmoking status | Physical activity | DietLifestyles
8 Food Frequency Questionnaire [previous 12 months] (http://higiene.med.up.pt/freq.php)Adapted software Food Processor Plus (ESHA Research, Salem-Oregon, 1997)Lopes C, et al. J Am Diet Assoc 2007; 107: ; Lopes C. [PhD thesis in Portuguese]. University of Porto; 2000
9 Possible range score: 0 to 9 Food components and scoring of the Southern European Atlantic Diet (SEAD) indexa Sex-specific medians in the controls were used as threshold for all food components, except wine.b Each glass containing 125 ml of wine. W: women; M: men Possible range score: 0 to 9 Food consumption adjusted for energy intake by the energy density model:grams per 1000 kcal/day
10 ↓ 33% p-trend=0.003 OR=0.67 (0.51-0.88) Quartile 1 ≤ 3 points [lower adherence]Quartile 24 pointsQuartile 35 pointsQuartile 4≥ 6 points[higher adherence]* Odds ratio adjusted for sex, age, education, total energy intake, fruits, refined cereals, white meat, smoking status, regular physical activity, family history of infarction, body mass index, and menopause and hormone replacement therapy in women.
11 Sensitivity analysesa Sex-specific quartiles in the controls were used as threshold for all food components, except wine.b Each glass containing 125 ml of wine. W: women; M: menSEAD scoring based on: upper vs. 1st quartile p-trendSex-specific quartiles of food consumption OR=0.61 ( ) <0.001Frequency of food consumption OR=0.58 ( ) <0.001
12 Additional analyses: reverse scoring for red meat and pork products + potatoes a Sex-specific medians in the controls were used as threshold for all food components, except wine.b Each glass containing 125 ml of wine. W: women; M: menReverse scoring for: upper vs. 1st quartile p-trendRed meat and pork and potatoes OR=0.40 ( ) <0.001Red meat and pork OR=0.45 ( ) <0.001
13 Conclusions A higher adherence to the Southern European Atlantic diet (SEAD index), culturally rooted in Northern Portugal and Galicia, was associated with a lower occurrence of non-fatal AMI events. The reduction in consumption of potatoes, and particularly of red meat and pork products, might increase the benefit of the SEAD on coronary heart disease. SEAD might contribute to the very low coronary mortality traditionally registered in northern Portugal and Galicia.
14 Research work developed at the Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School and the Public Health Institute, University of PortoPhD grant from Fundação para a Ciência e a Tecnologia [SFRH/BD/31131/2006]