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Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study

Autores: Martínez González, Miguel Ángel; Zazpe García, Itzíar; Razquin Burillo, Cristina; Sánchez Tainta, Ana; Corella, D.; Salas-Salvadó, J.; Toledo Atucha, Estefanía; Ros, E.; Muñoz, M. A.; Recondo, J.; Gómez-Gracia, E.; Fiol, M.; Lapetra, J.; Buil-Cosiales, P.; Serra-Majem, L. l.; Pinto, X.; Schröeder, H.; Tur, J. A.; Sorli, J. M.; Lamuela-Raventós, R. M.; Estruch, R.; PREDIMED Group
Título de la revista: CLINICAL NUTRITION
ISSN: 0261-5614
Volumen: 34
Número: 5
Páginas: 859 - 867
Fecha de publicación: 2014
Background& Aims: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). Design: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. Results: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a "Mediterranean-type" dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). Conclusions: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.