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The journal of nutrition, health & aging
Published in: The journal of nutrition, health & aging 1/2018

01-01-2018

Aging and Adherence to the Mediterranean Diet: Relationship with Cardiometabolic Disorders and Polypharmacy

Authors: Roberto Vicinanza, G. Troisi, R. Cangemi, M. Ulderico de Martino, D. Pastori, S. Bernardini, F. Crisciotti, F. di Violante, A. Frizza, M. Cacciafesta, P. Pignatelli, V. Marigliano

Published in: The journal of nutrition, health & aging | Issue 1/2018

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Abstract

Objectives

To investigate the association between adherence to the Mediterranean Diet (Med-Diet), cardiometabolic disorders and polypharmacy.

Design

Cross-sectional study.

Setting

Geriatrics outpatient clinic, Policlinico Umberto I, Sapienza University of Rome.

Participants

508 patients (219 male, 289 female) aged 50 to 89 who were evaluated for cardiovascular and metabolic disorders.

Methods and Measurements

Patients underwent a comprehensive medical assessment including medical history and the use of medications. Adherence to Med-Diet was assessed using the validated Med-Diet 14-item questionnaire; for the analysis, patients were divided in high (≥8) and medium-low (<8) adherence. Polypharmacy was defined as taking ≥5 medications.

Results

476 patients completed the study. Mean age was 70.4 years; 58% female. Median Med-Diet score was 8 (6-9). Patients with medium-low adherence had higher body mass index (p=0.029) and higher prevalence of arterial hypertension (p<0.001), previous coronary (p=0.002) and cerebrovascular events (p=0.011), diabetes, (p<0.001) and dyslipidemia (p=0.001) compared to those at high adherence. Med-Diet score decreased with the number of cardiometabolic disorders (p<0.001). The prevalence of polypharmacy was 39%. Consumption of olive oil (p=0.005), vegetables, (p<0.001), wine (p=0.017), legumes (p=0.028), fish (p=0.046) and nuts (p=0.045) were all inversely associated with the overall number of medications. In a multivariable regression model, medium-low adherence to Med-Diet was independently associated to polypharmacy (O.R.:1.859; 95% CI 1.142 to 3.025; p=0.013), after adjusting for possible confounding factors.

Conclusion

Med-Diet was inversely associated with cardiometabolic disorders and with polypharmacy, suggesting that improved Med-Diet adherence might potentially delay the onset of age-related health deterioration and reduce the need of multiple medications.
Literature
1.
Lipsitz LA. Physiological complexity, aging, and the path to frailty. Sci Aging Knowledge Environ. 2004;pe16.
2.
Marengoni A, Rizzuto D, Wang HX et al. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009 Feb;57(2):225–30.CrossRefPubMed
3.
4.
Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002 Nov 11;162(20):2269–76.CrossRefPubMed
5.
Gijsen R, Hoeymans N, Schellevis FG et al. Causes and consequences of comorbidity: a review J Clin Epidemiol, 54 (7) (2001), pp. 661–674.CrossRefPubMed
6.
Buurman BM, Frenkel WJ, Abu-Hanna A et al. Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients. Eur J Intern Med. 2016 Jan;27:68–75.CrossRefPubMed
7.
Nobili A, Licata G, Salerno F et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011 May;67(5):507–19.CrossRefPubMed
8.
9.
Starfield B, Lemke KW, Bernhardt T et al. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med. 2003 May-Jun;1(1):8–14.CrossRefPubMedPubMedCentral
10.
Nagel G, Peter R, Braig S et al. The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health. 2008 Nov 11;8:384.CrossRefPubMedPubMedCentral
11.
Schram MT, Frijters D, van de Lisdonk EH et al. Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol. 2008 Nov;61(11):1104–12.CrossRefPubMed
12.
Marengoni A, Winblad B, Karp A et al. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health. 2008 Jul;98(7):1198–200.CrossRefPubMedPubMedCentral
13.
Marengoni A, Rizzuto D, Wang HX et al. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009 Feb;57(2):225–30.CrossRefPubMed
14.
Mercer SW, Smith SM, Wyke S et al. Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009 Apr;26(2):79–80.CrossRefPubMed
15.
Rozzini R, Sabatini T, Barbisoni P et al. How to measure comorbidity in elderly persons. J Clin Epidemiol. 2004 Mar;57(3):321–2.CrossRefPubMed
16.
de Groot V, Beckerman H, Lankhorst GJ et al. How to measure comorbidity. a critical review of available methods. J Clin Epidemiol. 2003 Mar;56(3):221–9.CrossRefPubMed
17.
Smith SM, O’Dowd T. Chronic diseases: what happens when they come in multiples? Br J Gen Pract. 2007 Apr;57(537):268–70.PubMedPubMedCentral
18.
Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005 Apr;17(4):123–32.CrossRefPubMed
19.
Frazier SC. Health outcomes and polypharmacy in elderly individuals: an integrated literature review. J Gerontol Nurs. 2005 Sep;31(9):4–11.CrossRefPubMed
20.
Bjerrum L, Rosholm JU, Hallas J et al. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol. 1997;53:7–11.CrossRefPubMed
21.
Stewart RB, Cooper JW. Polypharmacy in the aged. Practical solutions. Drugs Aging 1994;4(6):449–61.CrossRefPubMed
22.
Bikowski R, Ripsin C, Lorraine V. Physician-patient congruence regarding medication regimens. J Am Geriatr Soc 2001 Oct;49(10):1353–7.CrossRefPubMed
23.
Jörgensen T, Johansson S, Kennerfalk A et al. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother. 2001 Sep;35(9):1004–9.CrossRefPubMed
24.
Linjakumpu T, Hartkainen S, Klaukka T et al. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002Aug;55(8):809–17.CrossRefPubMed
25.
Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 2005 Apr;17(4):123–32.CrossRefPubMed
26.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009 Jan;85(1):86–8.CrossRefPubMed
27.
Steinman MA, Landefeld CS, Rosenthal GE et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006 Oct;54(10):1516–23.CrossRefPubMed
28.
Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag 2005 Mar;1(1):39–48.CrossRefPubMedPubMedCentral
29.
Lund BC, Camahan RM, Egge JA et al. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother 2010 Jun;44(6):957–63.CrossRefPubMed
30.
Bazzano LA, Serdula M, Liu S. Prevention of type 2 diabetes by diet and lifestyle modification. J Am Coll Nutr. 2005 Oct;24(5):310–9.CrossRefPubMed
31.
Li M, Fan Y, Zhang X et al. Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies. BMJ Open. 2014;4:e005497.
32.
Katcher HI, Hill AM, Lanford JL et al. Lifestyle approaches and dietary strategies to lower LDL-cholesterol and triglycerides and raise HDL-cholesterol. Endocrinol Metab Clin North Am. 2009 Mar;38(1):45–78.CrossRefPubMed
33.
Chomistek AK., Chiuve S, Eliassen AH et al. Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. J Am Coll Cardiol. 2015;65(1):43–51.CrossRefPubMedPubMedCentral
34.
Conlin PR. The Dietary Approaches to Stop Hypertension (Dash) Clinical Trial: Implications for Lifestyle Modifications in the Treatment of Hypertensive Patients. Cardiology Review. Cardiol Rev. 1999 Sep-Oct;7(5):284–8.CrossRef
35.
Labarthe DR, Dunbar SB. Global cardiovascular health promotion and disease prevention: 2011 and beyond. Circulation 2012 May 29;125(21):2667–76.CrossRefPubMed
36.
Mozaffarian D, Appel LJ, Van Horn L. Components of a cardioprotective diet: new insights. Circulation. 2011 Jun 21;123(24):2870–91.CrossRefPubMed
37.
Willett WC, Sacks F, Trichopoulou A et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1402S–1406S.CrossRefPubMed
38.
Estruch R, Ros E, Salas-Salvadó J et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279–90.CrossRefPubMed
39.
Salas-Salvadó J, Guasch-Ferré M, Lee CH et al. Protective Effects of the Mediterranean Diet on Type 2 Diabetes and Metabolic Syndrome. J Nutr. 2016 Mar 9. pii: jn218487.
40.
Roman B, Carta L, Martínez-González MA et al. Effectiveness of the Mediterranean diet in the elderly. Clin Interv Aging. 2008;3(1):97–109.PubMedPubMedCentral
41.
García-Calzón S, Martínez-González MA, Razquin C et al. Mediterranean diet and telomere length in high cardiovascular risk subjects from the PREDIMEDNAVARRA study. Clin Nutr. 2016 Dec;35(6):1399–1405.CrossRefPubMed
42.
García-Calzón S, Zalba G, Ruiz-Canela M et al. Dietary inflammatory index and telomere length in subjects with a high cardiovascular disease risk from the PREDIMED-NAVARRA study: cross-sectional and longitudinal analyses over 5 y. Am J Clin Nutr. 2015 Oct;102(4):897–904.CrossRefPubMedPubMedCentral
43.
44.
Pignatelli P, Pastori D, Farcomeni A et al. Mediterranean diet reduces thromboxane A2 production in atrial fibrillation patients. Clin Nutr. 2015 Oct;34(5):899–903.CrossRefPubMed
45.
Pastori D, Carnevale R, Bartimoccia S et al. Does Mediterranean Diet Reduce Cardiovascular Events and Oxidative Stress in Atrial Fibrillation? Antioxid Redox Signal. 2015 Sep 10;23(8):682–7.CrossRefPubMed
46.
Katz S, Ford AB, Moskowitz RW et al. (1963) Studies of illness in the aged: The index of ADL—A standardized measure of biological and psychosocial function. JAMA. 1963 Sep 21;185:914–9.CrossRefPubMed
47.
Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969 Autumn;9(3):179–86.CrossRefPubMed
48.
Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013 Jul;31(7):1281–357.CrossRefPubMed
49.
Genuth S, Alberti KG, Bennett P et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003 Nov;26(11):3160–7.CrossRefPubMed
50.
American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013 Jan; 36 Suppl 1:S11–66.CrossRef
51.
Jellinger PS, Smith DA, Mehta AE et al. American Association of Clinical Endocrinologists’ Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis. Endocr Pract. 2012 Mar-Apr;18 Suppl 1:1–78.CrossRefPubMed
52.
Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134.CrossRefPubMedPubMedCentral
53.
Mannucci PM, Nobili A, REPOSI Investigators. Multimorbidity and polypharmacy in the elderly: lessons from REPOSI. Intern Emerg Med. 2014 Oct;9(7):723–34.CrossRefPubMed
54.
Tinetti ME, Bogardus ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004 Dec 30;351(27):2870–4.CrossRefPubMed
55.
Tinetti ME, Studensky SA. Comparative effectiveness research and patients with multiple chronic conditions. N Engl J Med. 2011 Jun 30;364(26):2478–81.CrossRefPubMed
56.
Boyd CM, Darer J, Boult C et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005 Aug 10;294(6):716–24.CrossRefPubMed
57.
58.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001 Aug;23(8):1296–310.CrossRefPubMed
59.
Pitsavos C, Panagiotakos DB, Chrysohoou C et al. 2003. The adoption of Mediterranean diet attenuates the development of acute coronary syndromes in people with the metabolic syndrome. Nutr J. 2003 Mar 19;2:1.CrossRefPubMedPubMedCentral
60.
Panagiotakos DB, Arapi S, Pitsavos C et al. 2006. The relationship between adherence to the Mediterranean diet and the severity and short-term prognosis of acute coronary syndromes (ACS): the Greek Study of ACS (the GREECS). Nutrition. 2006 Jul-Aug;22(7–8):722–30.CrossRefPubMed
61.
Ciccarone E, Di Castelnuovo A, Salcuni M et al. A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes. J Thromb Haemost. 2003 Aug;1(8):1744–52.CrossRefPubMed
62.
Alvarez Leon E, Henriquez P, Serra Majem L. Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands. Public Health Nutr. 2006 Dec;9(8A):1089–98.CrossRefPubMed
63.
Kastorini CM, Milionis HJ, Esposito K et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011 Mar 15;57(11):1299–313.CrossRefPubMed
64.
Estruch R. Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc. 2010 Aug;69(3):333–40.CrossRefPubMed
65.
Alvarez-Leon E, Henrıquez P, Serra-Majem L. Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands. Public Health Nutr. 2006 Dec;9(8A):1089–98.CrossRefPubMed
66.
Buil-Cosiales P, Toledo E, Salas-Salvadó J et al. Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial. Br J Nutr. 2016 Aug;116(3):534–46.CrossRefPubMed
67.
Fuentes F, Lopez-Miranda J, Perez-Martınez P et al. Chronic effects of a high-fat diet enriched with virgin olive oil and a low-fat diet enriched with alpha-linolenic acid on postprandial endothelial function in healthy men. Br J Nutr. 2008 Jul;100(1):159–65.CrossRefPubMed
68.
Martınez-Gonzalez MA, Sanchez-Villegas A. The emerging role of Mediterranean diets in cardiovascular epidemiology: monounsaturated fats, olive oil, red wine or the whole pattern? Eur J Epidemiol. 2004;19(1):9–13.CrossRefPubMed
69.
Aparicio R, Roda L, Albi MS et al. Effect of various compounds on virgin olive oil stability measured by rancimat. J Agric Food Chem. 1999 Oct;47(10):4150–5.CrossRefPubMed
70.
Vessby B, Uusitupa M, Hermansen K et al. Substituting dietary satu-rated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia. 2001 Mar;44(3):312–9.CrossRefPubMed
71.
Rasmussen BM, Vessby B, Uusitupa M et al. Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr. 2006 Feb;83(2):221–6.CrossRefPubMed
72.
de Lorgeril M, Salen P. The Mediterranean diet in secondary prevention of coronary heart disease. Clin Invest Med. 2006 Jun;29(3):154–8.PubMed
73.
Song M, Fung TT, Hu FB et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2016 Oct 1;176(10):1453–1463CrossRefPubMedPubMedCentral
74.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan;13(1):57–65.CrossRefPubMed
75.
Heuberger RA, Caudell K. Polypharmacy and nutritional status in older adults. Drugs Aging. 2011 Apr 1;28(4):315–23CrossRefPubMed
76.
Jyrkkä J, Mursu J, Enlund H et al. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. 2012 Jan;15(1):1–6.CrossRefPubMed
Metadata
Title
Aging and Adherence to the Mediterranean Diet: Relationship with Cardiometabolic Disorders and Polypharmacy
Authors
Roberto Vicinanza
G. Troisi
R. Cangemi
M. Ulderico de Martino
D. Pastori
S. Bernardini
F. Crisciotti
F. di Violante
A. Frizza
M. Cacciafesta
P. Pignatelli
V. Marigliano
Publication date
01-01-2018
Publisher
Springer Paris
Published in
The journal of nutrition, health & aging / Issue 1/2018
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-017-0922-3

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