Relationship between Mediterranean Diet Score and atherothrombotic risk: Findings from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994

Background: Mediterranean diet has been promoted as the preferred dietary model for cardiovascular disease prevention in the United States. Objective: We sought to evaluate the degree to which the Mediterranean diet is associated with reduced levels of atherothrombotic biomarkers in a population-based sample in the U.S. Design: Data from 13,197 adults between the ages of 18 and 90 were collected and atherothrombotic risk factors assessed as part of the NHANES III, 1988-1994. Adherence to the Mediterranean diet was evaluated using food frequency questionnaires, supplemented by the 24-h dietary recall data, to develop Mediterranean Diet Scores (MedDietScore) that were analyzed in tertiles. The cross-sectional relationship of MedDietScore to atherothrombotic factors were analyzed using multiple variable regression analysis adjusted for complex sampling design using SUDAAN. Results: The components of the Mediterranean diet and the dietary pattern's associations with atherothrombotic risk factors differed by age and gender. For men < 45 years of age as MedDietScore increased: total cholesterol/HDL cholesterol (TC/HDL) ratio (p = 0.0390), serum insulin (p = 0.0414), and white blood cell (WBC) (p = 0.0246) decreased. For men = 45 years as MedDietScore increased: TC/HDL ratio (p = 0.0008), Hemoglobin A1c (HgbA1c) (p = 0.0001), HOMA index (p = 0.0486), C-reactive protein (p = 0.0034), fibrinogen (p = 0.0028) decreased and HDL cholesterol (HDL-c) levels (p < 0.0001) increased. For pre-menopausal women, as MedDietScore increased: TC/HDL ratio (p < 0.0001), non-HDL cholesterol (p = 0.0012), apolipoprotein B (p = 0.0112), HgbA1c (p = 0.0001), decreased and HDL-c levels (p < 0.0001) increased. For post-menopausal women, as MedDietScore increased: TC/HDL ratio (p = 0.0005), Triglycerides (p < 0.0001), serum insulin (p = 0.0062), HOMA index (p = 0.0063) and Homocysteine (Hcy) (0.0046) levels decreased and HDL-c levels (p = 0.0005) increased. Conclusions: Mediterranean diet appears to be associated with selective measures of cardioprotective lipid profiles, glucose metabolism, and inflammation and coagulation levels. (c) 2010 Elsevier Ireland Ltd. All rights reserved.