title: Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population.
abstract: The authors aimed to evaluate the association of the traditional Mediterranean diet and major food groups with incidence of and mortality from cerebrovascular disease (CBVD) in a Mediterranean population. The study population was a cohort of 23,601 participants from the Greek segment of the EPIC Study (European Prospective Investigation into Cancer and Nutrition) who were free of cardiovascular diseases and cancer at baseline (1994-1999). Diet was assessed by means of a validated food frequency questionnaire. A 10-point scale integrating key Mediterranean diet characteristics was used to assess the participants' degree of adherence to this diet. During a median follow-up period of 10.6 years (1994-2009), 395 confirmed incident cases and 196 deaths from CBVD were recorded. Using Cox proportional hazards regression and adjusting for potential confounders, increased adherence to the Mediterranean diet, as measured by 2-point increments in score, was inversely associated with CBVD incidence (adjusted hazard ratio = 0.85, 95% confidence interval: 0.74, 0.96) and mortality (adjusted hazard ratio = 0.88, 95% CI: 0.73, 1.06). These inverse trends were mostly evident among women and with respect to ischemic rather than hemorrhagic CBVD and were largely driven by consumption of vegetables, legumes, and olive oil. These data provide support for an inverse association of adherence to the Mediterranean diet with CBVD incidence and mortality.
authors.affiliation: Hellenic Health Foundation, Tetrapoleos 10-12, 11527 Athens, Greece. m.misirli@nut.uoa.gr
authors.forename: Gesthimani
authors.initials: G
authors.lastname: Misirli
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Benetou
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
mesh_terms: D017677:Age Distribution; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D000069463:Olive Oil; D010938:Plant Oils; D016016:Proportional Hazards Models; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000401:mortality
chemical_list: D000069463:Olive Oil; D010938:Plant Oils