title: Quality, but not cost, of diet is associated with 5-year incidence of CVD: the ATTICA study.
abstract: OBJECTIVE
  The aim of the present work was to calculate the current cost of the Mediterranean diet in Greece and to evaluate the role of diet cost in the development of cardiovascular events after a 5-year follow-up.
  
  
  METHODS
  Cross-sectional. Cost of diet was measured in €/week based on common Greek dietary choices, while baseline dietary habits were assessed through a semi-quantitative FFQ (Greek-EPIC). The Mediterranean Diet Score (MedDietScore) was applied to assess overall adherence to this pattern using scores of eleven food variables and alcohol, according to the principles of the Mediterranean diet.
  
  
  METHODS
  Five-year follow-up of the ATTICA study, a nutrition and health survey of a representative, free-living sample of the Greek population resident in the province of Attica, where Athens is a major metropolis.
  
  
  METHODS
  From 2001 to 2002, 1514 men and 1528 women (aged >18 years) without known CVD were enrolled. In 2006, the 5-year follow-up was performed.
  
  
  RESULTS
  The weekly cost of participants' diets varied from 5·35 to 83·57 €/week in men (mean 25·45 (sd 6·80) €/week) and from 10·89 to 55·49 €/week in women (mean 25·63 (sd 6·30) €/week). Diet cost was correlated marginally to MedDietScore (r = 0·060, P = 0·05) as well as being associated with history of hypercholesterolaemia (mean (sd), yes v. no: 24·90 (5·73) v. 25·82 (6·95) €/week, P = 0·027), physical activity (mean (sd), yes v. no: 26·42 (6·90) v. 24·82 (6·20) €/week, P < 0·001) and current smoking (mean (sd), yes v. no: 24·99 (6·40) v. 25·98 (6·70) €/week, P = 0·017). No significant association was found between diet cost and 5-year incidence of CVD (hazard ratio = 1·021, 95 % CI 0·965, 1·081). However, adherence to the traditional Mediterranean diet was inversely associated with the development of CVD (relative risk per 1-unit increase in MedDietScore = 0·92, 95 % CI 0·89, 0·94) after adjustment for various potential confounders including diet cost.
  
  
  CONCLUSIONS
  Quality but not cost of the diet is associated with the development of CVD.
authors.affiliation: Department of Nutrition Science - Dietetics, Harokopio University, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vlismas
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.forename: Yannis
authors.initials: Y
authors.lastname: Skoumas
authors.forename: Marietta
authors.initials: M
authors.lastname: Sitara
authors.forename: John
authors.initials: J
authors.lastname: Yfantopoulos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Stavrinos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004032:Diet / Q000191:economics*; D038441:Diet, Mediterranean / Q000191:economics*; D005247:Feeding Behavior; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009753:Nutritive Value; D012307:Risk Factors; D012959:Socioeconomic Factors