Published in:
01-08-2014 | Original Contribution
Effect of using repeated measurements of a Mediterranean style diet on the strength of the association with cardiovascular disease during 12 years: the Doetinchem Cohort Study
Published in: European Journal of Nutrition | Issue 5/2014
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Background
In cohort studies, often only one baseline measurement of dietary intake is available. This may underestimate the strength of the association with cardiovascular diseases (CVD).
Objective
The main objective is to compare the strength of the association of a Mediterranean style diet with CVD using one baseline measurement of diet versus three repeated measurements over a 10-year period.
Design
We used dietary and lifestyle data of three rounds of the Doetinchem Cohort Study. At baseline, 7,769 persons aged 20–65 years were examined. Diet was assessed with a 178 item validated food-frequency questionnaire and operationalized with the Mediterranean Diet Score (MDS) ranging from 0 to 9. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CI). Analyses were adjusted for age, sex, and repeated measurements of smoking, sports, total energy intake, and educational level.
Results
Comparing an MDS of ≥5.5–9 to an MDS of 0–<3.5, baseline MDS was associated with a 23 % lower risk [HR 0.77 (95 % CI 0.53–1.11)] and the updated mean with a 35 % lower risk [HR 0.65 (0.43–0.97)] of a composite of fatal CVD, nonfatal myocardial infarction, and stroke (composite CVD). For fatal CVD, baseline MDS was associated with a 13 % lower risk [HR 0.87 (0.36–2.07)] and the updated mean with a 56 % lower risk [HR 0.44 (0.19–1.05)].
Conclusion
The strength of the association between a Mediterranean style diet and CVD is likely underestimated because most studies so far used only one baseline measurement.