Greater adherence to Mediterranean diet reduces CVD burden

Even a slight increase in the level of adherence to the Mediterranean diet on a population basis results in significant decreases in new cardiovascular disease (CVD) cases and in better prognosis of patients with established CVD, according to two epidemiological studies.

“This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10 percent), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part,” the researchers said.

The microsimulation for individuals was developed based on ATTICA (2002‒2012; n=3,042 participants free of CVD) and GREECS (2004‒2014; n=2,172 patients with acute coronary syndrome) studies.

The researchers then compared eight scenarios on the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one- to 10-point increases in MedDietScore) in terms of relative change in CVD incidence and mortality, as well as the number of preventable CVD events and deaths.

Improving adherence to the Mediterranean diet in at least 10 percent of the population could significantly reduce 10-year CVD onset, recurrence, and deaths. In particular, at least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be stopped or delayed. [Eur J Clin Nutr 2022;76:434-441]

Mediterranean diet clustering also showed that achieving higher scores in fruits, vegetables, whole wheat products, and legumes was more important than scoring higher in low consumption of mean and full-fat dairy products against CVD.

Studies have shown that the Mediterranean diet correlated with a lower CVD morbidity and mortality risk through direct or indirect paths. Recently, the large-scale primary prevention PREDIMED trial in individuals with metabolic syndrome found that adherence to this diet significantly reduced CVD risk. [Eur J Public Health 2018;28:955-961; Prog Cardiovasc Dis 2015;58:50-60]

“An additional finding here is related to the clustering of Mediterranean diet components within a population,” the researchers said.

“Although sodium, sugars, fat, and red meat have been the main focus of diet policy debate within the past two decades, our assessment shows that increasing the consumption of plant-based products should be the leading target to achieve better cardiometabolic health and preventing CVD deaths,” they added. [http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf]

Population-based strategies

Policies based on populations complement individual-based efforts and may have broad and sustained impact, but many challenges remain. [Circulation 2012;126:1514-1563; Curr Cardiol Rep 2015;17:98; Annu Rev Nutr 2013;33:373-393]

For instance, many dietary interventions are subpar in terms of the level required to achieve optimal dietary habits in a significant fraction of a population. Most dietary interventions are also lacking in meeting a holistic approach, with much focus directed towards specific food groups and nutrients, such as sugars, salt, and beverages, as well as saturated fats and trans fatty acids.

“Therefore, in view of the magnitude of the disease burden attributable to diet and the limitations of the existing interventions, the development of novel food system interventions is urgently needed,” the researchers said.