title: Lifestyles and risk factors associated with adherence to the Mediterranean diet: a baseline assessment of the PREDIMED trial.
abstract: BACKGROUND
  The traditional Mediterranean dietary pattern (MedDiet) is associated with longevity and low rates of cardiovascular disease (CVD). However, there is little information on who is more likely to follow this food pattern.
  
  
  OBJECTIVE
  To evaluate how different factors are associated with lower MedDiet adherence in older Spanish subjects.
  
  
  METHODS
  We included 7305 participants (men aged 55-80 y, women 60-80 y) at high-risk of CVD recruited into the PREDIMED trial (ISRCTN35739639). Socioeconomic, anthropometric, lifestyle characteristics and CVD risk factors were recorded. A validated 14-item questionnaire was used to evaluate MedDiet adherence at baseline. Multivariate models were used to estimate odds ratios (OR) and 95% confidence intervals for lower adherence to the MedDiet (<9 points out of 14) and ascertain factors independently associated with it.
  
  
  RESULTS
  Former smoking (OR = 0.87; 95% CI, 0.78-0.98), physical activity (OR for the 3(rd) vs. the 1(st)tertile: 0.69; 0.62-0.78), and higher educational level (OR for university vs. less than primary school: 0.54; 0.38-0.77) were associated with higher MedDiet adherence. Conversely, having a larger waist-to-height ratio (OR for 0.1 units, 1.35; 1.22-1.49), being diabetic (OR = 1.13; 1.03-1.24), being single (OR = 1.27; 1.01-1.61) or divorced or separated (OR = 1.44; 1.09-1.89), and current smoking (OR = 1.28; 1.11-1.47) were associated with lower adherence.
  
  
  CONCLUSIONS
  Participants with little education, a larger waist-to-height ratio, or diabetes and those who were less physically active, single, divorced or separated, or smokers were less likely to adhere to the MedDiet, an ideal model for food choices. Stronger efforts of health promotion are needed in these groups to foster adoption of the MedDiet.
authors: Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
authors: Emily A
authors: EA
authors: Hu
authors: Estefania
authors: E
authors: Toledo
authors: Javier
authors: J
authors: Diez-Espino
authors: Ramon
authors: R
authors: Estruch
authors: Dolores
authors: D
authors: Corella
authors: Jordi
authors: J
authors: Salas-Salvado
authors: Ernest
authors: E
authors: Vinyoles
authors: Enrique
authors: E
authors: Gomez-Gracia
authors: Fernando
authors: F
authors: Aros
authors: Miquel
authors: M
authors: Fiol
authors: Jose
authors: J
authors: Lapetra
authors: Lluis
authors: L
authors: Serra-Majem
authors: Xavier
authors: X
authors: Pintó
authors: Maria Puy
authors: MP
authors: Portillo
authors: Rosa M
authors: RM
authors: Lamuela-Raventos
authors: Emilio
authors: E
authors: Ros
authors: Jose V
authors: JV
authors: Sorli
authors: Miguel A
authors: MA
authors: Martinez-Gonzalez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors
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