The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults

Abstract

Background: Multiple diet quality scores have been used to evaluate adherence to specific dietary recommendations or to consumption of healthful foods and nutrients. It remains unknown which score can more strongly predict longitudinal changes in cardiometabolic risk factors.Objective: We aimed to determine associations of 5 diet quality scores [AHA diet score (AHA-DS), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI)-2005, Mediterranean diet score (MeDS), and Alternative Healthy Eating Index (AHEI)] with 2-y changes in cardiometabolic risk factors in adults 45-75 y old.Methods: Data from the Boston Puerto Rican Health Study were analyzed (n = 1194). Diet quality scores were calculated from a baseline-validated food-frequency questionnaire. Multivariable-adjusted, repeated-subjects, mixed-effects models, adjusted for baseline measures, estimated associations between each z score and 14 individual cardiometabolic factors measured at 2 y.Results: MeDS was significantly associated with lower 2-y waist circumference (β coefficient ± SE: -0.52 ± 0.26, P = 0.048); body mass index (BMI; -0.23 ± 0.08, P = 0.005); log-insulin (-0.06 ± 0.02, P = 0.005); log-homeostasis model assessment of insulin resistance (HOMA-IR; -0.05 ± 0.02, P = 0.030), and log-C-reactive protein (-0.13 ± 0.03, P = 0.0002). Similar but weaker associations were observed for the AHEI with BMI, insulin, and HOMA-IR. The AHA-DS was inversely associated with BMI (-0.17 ± 0.08, P = 0.033). Neither the HEI-2005 nor DASH was significantly associated with any variable. Traditional Puerto Rican foods consumed by individuals with high MeDSs included vegetables and meats in homemade soups, orange juice, oatmeal, beans and legumes, fish, whole milk, corn oil, and beer.Conclusions: The MeDS comprises food components and scores associated with a favorable cardiometabolic profile over 2 y in Puerto Rican adults. An overall healthy diet may be particularly beneficial for maintaining a lower BMI. These results can help identify suitable measures of diet quality in epidemiologic studies and craft meaningful nutritional messages and dietary recommendations for the intended population. This study was registered at clinicaltrials.gov as NCT01231958.

Keywords: Hispanics/Latinos; Mediterranean diet; Puerto Ricans; cardiometabolic risk factors; diet quality; diet quality comparison; diet quality indexes; diet quality scores; longitudinal studies; traditional foods.

Conflict of interest statement

Author disclosures: J Mattei, M Sotos-Prieto, SJ Bigornia, SE Noel, and KL Tucker, no conflicts of interest.

© 2017 American Society for Nutrition.

Figures

FIGURE 1

Changes over 2 y in cardiometabolic risk factor per each healthy dietary component of the Mediterranean diet score followed by Puerto Rican adults. Values are means or back-transformed geometric means for the log-TGs, log-glucose, log-insulin, log–HOMA-IR, log-CRP with corresponding 95% CIs; n = 1194. The following were calculated with multivariable-adjusted, repeated-subjects, mixed-effects models adjusted for baseline covariates: age, sex, smoking (packs per year), physical activity score, ratio of income to poverty, educational attainment, marital status, frequency of foods away from home, acculturation, cardiovascular disease, diabetes (except for glucose metabolism parameters, which were adjusted for diabetes medication only), hypertension (except for BP, which was adjusted for hypertension medication only), baseline measurements, and time. Lipid outcomes were additionally adjusted for baseline lipid-lowering medication. CRP was additionally adjusted for anti-inflammatory medications at baseline and white blood cell count at 2 y. BP, blood pressure; CRP, C-reactive protein; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol. *P < 0.05.