Title: Adherence to Mediterranean diet has a mediating effect inflammation as regards cardiovascular disease risk: The 10-year (2002-12) follow-up of ATTICA study
Abstract: Introduction: Mediterranean diet has been associated with lower all-cause and cardiovascular disease (CVD) morbidity and mortality, but the clinical and pathway has not been well understood and appreciated. Aim: The aim of this work was to explore the path between adherence to a Mediterranean-type diet, lifestyle behaviors, clinical status and 10-year incidence of CVD. Materials and methods: the ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to Mediterranean diet was assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the Attica study (15% lost-to-follow-up). Results: Adherence to Mediterranean diet decreased CVD risk (Relative Risk (RR) per 1/55 unit =0.96, 95%, CI: 0.93-1.00), independently of various socio-demographic, lifestyle and clinical factors. Path analysis revealed that adherence to Mediterranean diet decreases C-reactive protein’s levels and interleukin-6 levels, but also has an independent protective role on CVD risk per se (total effect of the MedDietScore on CVD=-0.003, 95%CI: -0.005-0.000). Conclusions: adherence to Mediterranean diet confers a considerable reduction on CVD risk, independently of various factors. Therefore, even subjects with unhealthy lifestyle behaviors may benefit from adherence to this diet, suggesting another dimension on prevention strategies.