Prospective association of the Mediterranean diet with the onset of cardiometabolic multimorbidity in a UK-based cohort: the EPIC-Norfolk study.
The Journal of nutrition 2024
Wang Q, Schmidt AF, Wannamethee SG
DOI : 10.1016/j.tjnut.2024.10.027
PubMed ID : 39424065
PMCID :
URL : https://linkinghub.elsevier.com/retrieve/pii/S0022316624011040
Abstract
Cardiometabolic multimorbidity (CMM), defined as the co-occurrence of two or more cardiometabolic diseases, including myocardial infarction (MI), stroke, and type 2 diabetes (T2D), is an increasing public health challenge. While poor diet is a known risk factor for a first cardiometabolic disease (FCMD), the relationship with subsequent occurrence of CMM is less studied.
This study aims to investigate the prospective association between baseline adherence to the Mediterranean diet and the onset of CMM across various follow-up durations.
We used data from the EPIC-Norfolk cohort study of 21,900 adults, aged 40-79 free of prevalent MI, stroke, and T2D at baseline (1993-1997). A median-based Mediterranean diet score (m-MDS) and a pyramid-based MDS (pyr-MDS) were used to measure baseline adherence to the Mediterranean diet. Multi-state modelling was employed to investigate associations with the FCMD and the subsequent CMM event.
Over the entire follow-up period of 21.4 years (median), we observed 5028 FCMD and 734 CMM events. Multi-state analysis indicated that the association between baseline Mediterranean diet and the risk of CMM may be stronger in shorter follow-up durations. Particularly, baseline pyr-MDS was significantly associated with the risk of subsequent CMM transitioning from FCMD when follow-up durations were limited to 10 and 15 years, with HR (95% CI) being 0.67 (0.53, 0.84) and 0.80 (0.70, 0.92) per SD increase in pyr-MDS, respectively. Additionally, we observed that the risk of CMM transitioning from FCMD was modified by social class across shorter to longer follow-ups, where the impact of baseline Mediterranean diet was only significant in non-manual workers.
Baseline adherence to the Mediterranean diet was potentially associated with a lower risk of CMM transitioning from FCMD, particularly during shorter follow-up periods.