Does the Mediterranean diet counteract the adverse effects of abdominal adiposity?
OBJECTIVE
We tested the hypothesis that an intervention with a Mediterranean diet (MeDiet) could mitigate the well-known harmful effects of abdominal obesity on cardiovascular health.


RESULTS
We assessed the relationship between baseline waist-to-height ratio (WHtR) and major cardiovascular events during a median follow-up of 4.8 years in the Prevention with Mediterranean Diet (PREDIMED) randomized primary prevention trial, which tested a MeDiet against a control diet (advice on a low-fat diet). We also examined whether the MeDiet intervention was able to counteract the detrimental cardiovascular effects of an increased WHtR. The trial included 7447 participants (55-80 years old, 57% women) at high cardiovascular risk but free of cardiovascular disease (CVD) at enrollment. An increased risk of CVD events (myocardial infarction, stroke, or cardiovascular death) was apparent for the highest versus the lowest quartile of WHtR (multivariable-adjusted hazard ratio: 1.98) (95% confidence interval: 1.10-3.57; linear trend: p = 0.019) only in the control-diet group, but not in the two groups allocated to intervention with MeDiet (p for interaction = 0.034). This apparent interaction suggesting that the intervention counterbalanced the detrimental cardiovascular effects of adiposity was also significant for body mass index (BMI) (p = 0.01) and waist circumference (p = 0.043).


CONCLUSIONS
The MeDiet may counteract the harmful effects of increased adiposity on the risk of CVD.
Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain.
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Eguaras
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain; PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain.
E
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Toledo
Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain; PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain.
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Buil-Cosiales
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Human Nutrition Department, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
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Salas-Salvadó
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain.
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Corella
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain.
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Gutierrez-Bedmar
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Family Medicine, San Pablo Health Center, Sevilla, Spain.
J M
JM
Santos-Lozano
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Cardiology, University Hospital of Alava, Vitoria, Spain.
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Arós
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Institute of Health Sciences (IUNICS), Palma de Mallorca, Spain.
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Fiol
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain.
M
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Fitó
Lipid Clinic, Hospital Clinic, Barcelona, Spain.
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Ros
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Clinical Sciences, University Las Palmas de Gran Canaria, Las Palmas, Spain.
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Serra-Majem
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Lipids and Vascular Risk Unit, Hospital Bellvitge, Barcelona, Spain.
X
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Pintó
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Nutrition, University of Navarra, Pamplona, Spain.
J A
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Martínez
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain.
J V
JV
Sorlí
Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain.
M A
MA
Muñoz
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Human Nutrition Department, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
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Basora
PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain; Department of Internal Medicine, Hospital Clinic, Barcelona, Spain.
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Estruch
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain; PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro Investigación Biomédica Red Obesidad-Nutrición (CIBERobn), Madrid, Spain. Electronic address: mamartinez@unav.es.
M Á
MÁ
Martínez-González
D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056128:Obesity, Abdominal / Q000175:diagnosis / Q000178:diet therapy* / Q000453:epidemiology; D011322:Primary Prevention / Q000379:methods*; D016016:Proportional Hazards Models; D065840:Protective Factors; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055105:Waist Circumference
Cardiovascular disease; Dietary intervention; Mediterranean diet; Waist-to-height ratio