Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample
2.2. Baseline Evaluation
2.2.1. Sociodemographic, Clinical and Biochemical Parameters
2.2.2. Anthropometric Indices and Lifestyle Habits
2.2.3. Depression and Anxiety Symptoms
2.3. Follow-Up Evaluation
2.4. Mediterranean Diet Trajectories
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Mediterranean Diet Trajectories | p-Value * | ||||
---|---|---|---|---|---|
Low–Low (n = 687) | Low–High (n = 233) | High–Low (n = 1179) | High–High (n = 484) | ||
Age, years | 55.5 ± 13.5 a | 54.7 ± 10.7 a | 43.2 ± 12.0 b | 35.2 ± 10.0 c | <0.001 |
Age group, n (%) | |||||
<35 years 35–65 years >65 years | 49 (7.1) a 442 (64.3) a 196 (28.5) a | 4 (1.7) b 187 (80.3) b 42 (18.0) b | 284 (24.1) c 842 (71.4) c 53 (4.5) c | 240 (49.6) d 243 (50.2) d 1 (0.2) d | <0.001 |
Males, n (%) | 500 (72.8) a | 190 (81.5) b | 524 (44.4) c | 76 (15.7) d | <0.001 |
Marital status, n (%) | |||||
never married married divorced widowed | 64 (9.3) a 560 (81.6) a 25 (3.6) 38 (5.5) a | 13 (5.6) a 208 (89.3) a 4 (1.7) 8 (3.4) a,b | 257 (21.8) b 839 (71.2) b 47 (4.9) 36 (3.1) b | 206 (42.6) c 260 (53.7) c 14 (2.9) 4 (0.8) c | <0.001 |
Education, years | 11.0 ± 4.0 a | 11.6 ± 3.9 a | 12.3 ± 3.6 b | 13.3 ± 3.0 c | <0.001 |
Educational level, n (%) | |||||
low medium high | 202 (29.4) a 301 (43.8) 184 (26.8) a | 58 (24.9) a 103 (44.2) 72 (30.9) a,b | 190 (16.1) b 572 (48.5) 417 (35.4) b | 32 (6.6) c 229 (47.4) 223 (46.0) c | <0.001 |
Financial status, n (%) | |||||
low medium high very high | 113 (16.4) a 226 (32.9) 281 (40.9) a 67 (9.8) a | 17 (7.6) b 67 (28.7) 104 (44.6) a 45 (19.1) b | 258 (21.9) a,c 380 (32.2) 403 (34.2) a,b 138 (11.7) a,b | 136 (28.1) c 184 (38.0) 125 (25.8) b 39 (8.1) a | <0.001 |
SES, n (%) | |||||
low medium high | 165 (24.0) a 345 (50.2) 177 (25.8) a | 44 (19.1) a,b 113 (48.4) 76 (32.5) a,b | 157 (13.3) b 641 (54.4) 381 (32.3) a,b | 28 (5.8) c 266 (54.9) 190 (39.3) b | <0.001 |
Mediterranean Diet Trajectories | p-Value * | ||||
---|---|---|---|---|---|
Low–Low (n = 687) | Low–High (n = 233) | High–Low (n = 1179) | High–High (n = 484) | ||
Anthropometric indices | |||||
BMI, kg/m2 | 29.5 ± 4.2 a | 29.9 ± 4.2 a | 25.6 ± 3.3 b | 22.4 ± 2.5 c | <0.001 |
BMI status, n (%) | |||||
underweight normal-weight overweight obese | 1 (0.1) a 69 (10.0) a 354 (51.5) a 263 (38.4) a | 0 (0.0) a 22 (9.4) a 108 (46.4) a 103 (44.2) a | 13 (1.1) a 488 (41.4) b 581 (49.3) a 97 (8.2) b | 21 (4.3) b 396 (81.8) c 64 (13.3) b 3 (0.6) c | <0.001 |
WC, cm | |||||
males females | 102.8 ± 11.7 a 97.0 ± 14.5 a | 103.8 ± 11.2 a 99.4 ± 12.4 a | 93.3 ± 11.2 b 83.2 ± 11.8 b | 83.9 ± 9.2 c 76.3 ± 9.8 c | <0.001 <0.001 |
Increased WC, n (%) | 460 (67.0) a | 169 (72.5) a | 545 (46.3) b | 109 (22.6) c | <0.001 |
WHtR | 0.60 ± 0.07 a | 0.60 ± 0.07 a | 0.52 ± 0.07 b | 0.46 ± 0.06 c | <0.001 |
Central obesity, n (%) | 513 (74.7) a | 191 (82.0) a | 656 (62.1) b | 94 (19.4) c | <0.001 |
Lifestyle habits | |||||
Current smokers, n (%) | 250 (36.4) a | 91 (39.1) a,b | 520 (44.1) b | 223 (46.2) b | 0.002 |
Ever smokers, n (%) | 373 (54.3) | 145 (62.2) | 644 (54.7) | 259 (53.6) | 0.140 |
Pack-years | 540 (223, 900) a | 600 (300, 1020) a | 320 (143, 600) b | 180 (60, 375) c | <0.001 |
Energy intake, kcal/d | 2499 ± 975 a | 2385 ± 883 a,b | 2424 ± 951 a | 2109 ± 879 b | 0.001 |
MET-min/week | 231 (149, 1519) a | 231 (149, 1377) a | 198 (149, 735) a | 330 (149, 1406) b | 0.050 |
Physical activity status, n (%) | |||||
minimally active moderately active highly active | 415 (60.4) 107 (15.6) a 165 (24.0) | 137 (58.8) 48 (20.6) a,b 48 (20.6) | 726 (61.6) 210 (17.8) a,b 243 (20.6) | 278 (57.5) 113 (23.3) b 93 (19.2) | 0.022 |
Depression and anxiety symptoms | |||||
ZDRS (20–80) | 34.5 ± 7.2 a,b | 33.1 ± 5.5 a | 35.6 ± 7.8 b | 36.2 ± 7.5 b | 0.028 |
STAI (20–80) | 40.6 ± 11.6 | 38.8 ± 11.4 | 41.2 ± 11.4 | 40.6 ± 12.5 | 0.524 |
Mediterranean Diet Trajectories | p-Value * | ||||
---|---|---|---|---|---|
Low–Low (n = 687) | Low–High (n = 233) | High–Low (n = 1179) | High–High (n = 484) | ||
Cardiometabolic indices | |||||
Glucose, mg/dL | 93 (85, 106) a | 97 (87, 108) a | 89 (80, 97) b | 86 (78, 94) c | <0.001 |
Insulin, μU/ml | 13.6 (12.6, 14.9) a | 14.1 (12.9, 15.3) a | 12.4 (11.5, 13.6) b | 11.5 (10.8, 12.3) c | <0.001 |
HOMA-IR | 3.12 (2.6, 3.9) a | 3.33 (2.77, 4.09) a | 2.72 (2.31, 3.20) b | 2.44 (2.10, 2.87) c | <0.001 |
TC, mg/dL | 201 (176, 230) a | 198 (177, 225) a | 190 (163, 219) b | 174 (153, 202) c | <0.001 |
LDL-C, mg/dL | 129 (107, 153) a | 126 (110, 150) a | 119 (97, 146) b | 106 (85, 131) c | <0.001 |
HDL-C, mg/dL | 43 (37, 51) a | 42 (35, 48) a | 48 (40, 57) b | 52 (44, 61) c | <0.001 |
TG, mg/dL | 123 (91, 172) a | 124 (93, 182) a | 96 (67, 140) b | 73 (54, 100) c | <0.001 |
hs-CRP, mg/L | 1.43 (0.66, 3.08) a | 1.51 (0.67, 2.95) a | 1.05 (0.47, 2.25) b | 0.60 (0.28, 1.33) c | <0.001 |
SBP, mm Hg | 132 ± 19 a | 131 ± 17 a | 122 ± 17 b | 112 ± 14 c | <0.001 |
DBP, mm Hg | 83 ± 11 a | 84 ± 11 a | 79 ± 11 b | 72 ± 10 c | <0.001 |
Medical status | |||||
Family history of HCL, n (%) | 208 (66.9) a,b | 77 (58.3) a | 479 (72.6) b | 225 (76.5) b | <0.001 |
HCL, n (%)-baseline | 342 (49.8) a | 114 (48.9) a,b | 469 (39.8) b | 125 (25.9) c | <0.001 |
HCL, n (%)-10 years | 410 (59.7) a | 134 (57.5) a,b | 553 (46.9) b | 155 (32.0) c | <0.001 |
Family history of HTN, n (%) | 86 (12.5) | 36 (15.5) | 181 (15.4) | 82 (16.9) | 0.174 |
HTN, n (%)-baseline | 314 (45.7) a | 103 (46.8) a | 297 (27.1) b | 41 (8.5) c | <0.001 |
HTN, n (%)-10 years | 397 (57.8) a | 128 (54.9) a | 392 (33.2) b | 62 (12.8) c | <0.001 |
MetS, n (%)-baseline | 238 (34.6) a | 97 (41.6) a | 181 (15.4) b | 14 (2.9) c | <0.001 |
MetS, n (%)-10 years | 486 (70.7) a | 172 (73.8) a | 622 (52.8) b | 163 (33.7) c | <0.001 |
Family history of T2DM, n (%) | 169 (24.6) | 78 (33.5) | 304 (25.8) | 128 (26.4) | 0.775 |
T2DM, n (%)-baseline | 104 (15.1) a | 34 (14.6) a | 56 (4.7) b | 3 (0.6) c | <0.001 |
T2DM, n (%)-10 years | 173 (25.2) a | 71 (30.5) a | 128 (10.9) b | 16 (3.3) c | <0.001 |
Family history of CVD, n (%) | 156 (22.7) | 60 (25.8) | 317 (26.9) | 127 (26.2) | 0.534 |
10-year incidence of cardiometabolic diseases | |||||
HCL 10-year incidence, n (%) | 114 (45.4) a | 37 (40.2) a,b | 155 (32.8) b | 46 (20.2) c | <0.001 |
HTN 10-year incidence, n (%) | 121 (48.0) a | 31 (33.7) a,b | 139 (25.4) b | 29 (11.0) c | <0.001 |
MetS 10-year incidence, n (%) | 248 (55.2) a | 75 (55.1) a | 442 (44.4) b | 149 (31.7) c | <0.001 |
T2DM 10-year incidence, n (%) | 69 (19.2) a | 37 (25.5) a | 72 (10.4) b | 13 (4.6) c | <0.001 |
CVD 10-year incidence, n (%) | 153 (30.1) a | 56 (32.6) a | 93 (10.0) b | 15 (3.7) c | <0.001 |
Total Sample (n = 2583) | OR | 95% CI | p-Value |
---|---|---|---|
Age (per 1 year increase) | 0.942 | 0.927–0.956 | <0.001 |
Sex (males vs. females) | 0.163 | 0.110–0.241 | <0.001 |
SES (medium vs. low) (high vs. low) | 1.121 1.404 | 0.601–2.093 0.744–2.649 | 0.719 0.295 |
Smoking (current smokers vs. non-smokers) | 0.914 | 0.657–1.272 | 0.595 |
BMI (per 1 kg/m2 increase) | 0.756 | 0.715–0.799 | <0.001 |
Physical activity (per 100 MET-min/week increase) | 1.000 | 0.999–1.020 | 0.067 |
<40 years (n = 1304) | OR | 95% CI | p-Value |
Sex (males vs. females) | 0.192 | 0.128–0.288 | <0.001 |
SES (medium vs. low) (high vs. low) | 0.686 0.729 | 0.304–1.550 0.320–1.663 | 0.365 0.453 |
Smoking (current smokers vs. non-smokers) | 0.954 | 0.669–1.361 | 0.797 |
BMI (per 1 kg/m2 increase) | 0.777 | 0.734–0.822 | <0.001 |
Physical activity (per 100 MET-min/week increase) | 1.014 | 1.000–1.025 | 0.012 |
≥40 years (n = 1279) | OR | 95% CI | p-Value |
Sex (males vs. females) | 0.853 | 0.547–1.392 | 0.991 |
SES (medium vs. low) (high vs. low) | 5.070 5.389 | 1.491–17.24 1.379–21.05 | 0.025 0.009 |
Smoking (current smokers vs. non-smokers) | 0.674 | 0.289–1.576 | 0.363 |
BMI (per 1 kg/m2 increase) | 0.521 | 0.430–0.631 | <0.001 |
Physical activity (per 100 MET-min/week increase) | 1.000 | 0.999–1.039 | 0.650 |
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Georgoulis, M.; Georgousopoulou, E.N.; Chrysohoou, C.; Pitsavos, C.; Panagiotakos, D.B. Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults. Foods 2022, 11, 2389. https://doi.org/10.3390/foods11162389
Georgoulis M, Georgousopoulou EN, Chrysohoou C, Pitsavos C, Panagiotakos DB. Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults. Foods. 2022; 11(16):2389. https://doi.org/10.3390/foods11162389
Chicago/Turabian StyleGeorgoulis, Michael, Ekavi N. Georgousopoulou, Christina Chrysohoou, Christos Pitsavos, and Demosthenes B. Panagiotakos. 2022. "Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults" Foods 11, no. 16: 2389. https://doi.org/10.3390/foods11162389
APA StyleGeorgoulis, M., Georgousopoulou, E. N., Chrysohoou, C., Pitsavos, C., & Panagiotakos, D. B. (2022). Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults. Foods, 11(16), 2389. https://doi.org/10.3390/foods11162389