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The Southern European Atlantic Diet index – definition and effects on cardiovascular health Andreia Oliveira Department of Clinical Epidemiology, Predictive.

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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 Oliveira Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School Institute of Public Health | University of Porto Bristol | October 18, 2011

2 Methodological approaches to study Diet Adapted from: Schulze et al. Br J Nutr 2006; 95: Hypothesis-oriented approach (a priori knowledge) Indexes and scores defined a priori Principal component analysis Factor analysis Cluster analysis Exploratory approach (data at hand) defined a posteriori Single nutrients/ foodsDietary Patterns Mediterranean Diet Score (MDS) Mediterranean Adequacy Index (MAI) Mediterranean dietary pattern Healthy Diet Indicator (HDI) Healthy Food Index (HFI) Europe

3 Portuguese Households Budget Surveys 1989/1990: n= /1995: n= /2001: n= Adherence 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 Ocean Mediterranean Sea European Center of Atlantic Diet, Viana do Castelo, Portugal 2001 Varela G et al, Madrid 2004 Fundación 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 Cases Patients 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). - Who had no previous clinical or silent infarction (n=2196) Controls Community participants aged 18 years Baseline evaluation of the EPIPorto cohort ( ) EPICardis study – a population-based case-control study

7 Age | Education | Marital status | Occupational activity Social and demographic characteristics Dislipidemia | Diabetes | Hypertension | Personal history of cardiovascular diseases Family history of acute myocardial infarction | Use of medication | Gynecological history Dislipidemia | Diabetes | Hypertension | Personal history of cardiovascular diseases Family history of acute myocardial infarction | Use of medication | Gynecological history Personal and family medical history Data collection [by questionnaire and physical examination] Mini-Mental State Examination test [in those 65 years; subjects excluded when scoring < 24 points] Smoking status | Physical activity | Diet Smoking status | Physical activity | Diet Lifestyles

8 (http://higiene.med.up.pt/freq.php) Food Frequency Questionnaire [previous 12 months] 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 Food components and scoring of the Southern European Atlantic Diet (SEAD) index 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: men Possible range score: 0 to 9 Food consumption adjusted for energy intake by the energy density model: grams per 1000 kcal/day

10 OR=0.67 ( ) Quartile 1 3 points [lower adherence] Quartile 3 5 points Quartile 4 6 points [higher adherence] Quartile 2 4 points p-trend= % * 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 analyses SEAD scoring based on: upper vs. 1 st quartile p-trend Sex-specific quartiles of food consumption OR=0.61 ( ) <0.001 Frequency of food consumption OR=0.58 ( ) <0.001 a 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: men

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: men Reverse scoring for: upper vs. 1 st quartile p-trend Red meat and pork and potatoes OR=0.40 ( ) <0.001 Red meat and porkOR=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 PhD grant from Fundação para a Ciência e a Tecnologia [SFRH/BD/31131/2006] 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 Porto


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