Inverse Association Between Mediterranean Diet and Cardiovascular Disease Interview with:
Dr Nita Forouhi, MRCP, PhD, FFPHM
Programme Leader
MRC Epidemiology Unit
University of Cambridge School of Clinical Medicine
Institute of Metabolic Science
Cambridge Biomedical Campus What is the background for this study? What are the main findings?

Response: The benefits of the Mediterranean diet for cardiovascular health are well documented in countries of the Mediterranean region and some other countries, but there is little such evidence in the UK general population. Our work fills this research gap.

In our study we followed up 23,902 initially healthy Britons living in Norfolk (Eastern England) for an average of 12 to 17 years, and determined the occurrence of new cases of cardiovascular diseases (CVD) and deaths due to CVD during that time period. Our results showed that those adults who adhered to a Mediterranean diet had 6% to 16% lower risk of developing CVD, compared to those who had dietary habits further away from the Mediterranean-type diet pattern. This was the case even when we accounted for several important risk factors and correlates of CVD, including as age, sex, body mass index, lifestyle habits such as smoking, alcohol intake and physical activity, and socio-economic factors.

We also modelled what would happen in the study population if all the participants increased their adherence to the Mediterranean-type diet. From this we estimated that nearly 4% of all new cardiovascular disease cases, or 12.5% of cardiovascular deaths in the population could potentially be avoided. This is novel information about the potential health benefit of a Mediterranean-type diet in a UK context. However, we should remember that our study was an observational study, not a clinical trial with a dietary intervention, and thus we cannot imply a cause and effect relationship between increasing adherence to the Mediterranean diet and reduction in cardiovascular disease.

We defined the Mediterranean diet using a 15 point score based on guideline recommendations from a Mediterranean dietary pyramid published by the Mediterranean Diet Foundation. The recommendations had not previously been specifically tested for their associations with health, so our findings, for the first time, show the utility of the Mediterranean dietary pyramid. What should readers take away from your report?

Response: Cardiovascular diseases like heart attack and stroke are serious medical conditions and our study provides research evidence that a healthy dietary pattern like greater adherence to the Mediterranean diet can play an important role in its prevention.

Our study highlights that greater adoption of a Mediterranean type diet can be a promising component of a wider strategy to help prevent cardiovascular disease, including other important factors such as not smoking, maintaining a healthy weight, blood cholesterol and blood pressure.

According to the British Heart Foundation, cardiovascular disease accounts for more than one quarter (27%) of all deaths, or around 155,000 deaths every year in the UK. If we assume that our study population is broadly representative of the overall UK population, a higher level of adherence to the Mediterranean diet could have a significant impact in lowering the cardiovascular burden in the UK.

Our findings suggest that despite potential cultural and regional differences between Mediterranean countries and non-Mediterranean ones, a Mediterranean-type diet could be considered as one option of a healthy diet in the UK. What recommendations do you have for future research as a result of this study?

Response: Our research demonstrated the potential utility of the Mediterranean dietary pyramid in defining adherence to the Mediterranean diet in the UK setting. Further research is needed to investigate its application to clinical practice and for public health promotion.

The effectiveness of a population-level recommendation and cost-effectiveness of the Mediterranean diet in the UK and other non-Mediterranean countries as a component of lifestyle recommendations should be studied in both the general population and in high risk (for CVD) populations.

Our findings should be replicated by other researchers to form a body of research evidence on the link between a Mediterranean-type diet and CVD in the UK and other non-Mediterranean settings. Is there anything else you would like to add?

Response: Our research shows an inverse association between Mediterranean diet and cardiovascular disease, but this does not automatically translate to people adopting such a diet. We need to recognise the social, economic and culturalchallenges to improving adherence to this dietary pattern in the UK population.

Our study makes a case for the potential benefit of a Mediterranean-type diet in the UK, but this should not be interpreted as being that the Mediterranean diet is the single best diet for the UK population, as that would require head-to-head comparison of different diet patterns.

Our findings are based on an observational study, not a clinical trial, and so a cause and effect relationship cannot be assumed. However, our analyses accounted for relevant lifestyle and other factors that could potentially distort the findings, and together with the consistency of results with other studies elsewhere these current findings provide robust evidence for a link. Thank you for your contribution to the community.


Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk Study

Tammy Y. N. Tong,Nicholas J. Wareham,Kay-Tee Khaw,Fumiaki Imamura and Nita G. Forouhi

BMC Medicine201614:135 DOI: 10.1186/s12916-016-0677-4

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on September 30, 2016 by Marie Benz MD FAAD