title: Metabolic syndrome, adherence to the Mediterranean diet and 10-year cardiovascular disease incidence: The ATTICA study.
abstract: OBJECTIVE
  To better understand the metabolic syndrome (MS) spectrum through principal components analysis and further evaluate the role of the Mediterranean diet on MS presence.
  
  
  METHODS
  During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III) definition. Adherence to the Mediterranean diet was assessed using the MedDietScore (range 0-55).
  
  
  RESULTS
  Five principal components were derived, explaining 73.8% of the total variation, characterized by the: a) body weight and lipid profile, b) blood pressure, c) lipid profile, d) glucose profile, e) inflammatory factors. All components were associated with higher likelihood of CVD incidence. After adjusting for various potential confounding factors, adherence to the Mediterranean dietary pattern for each 10% increase in the MedDietScore, was associated with 15% lower odds of CVD incidence (95%CI: 0.71-1.06). For the participants with low adherence to the Mediterranean diet all five components were significantly associated with increased likelihood of CVD incidence. However, for the ones following closely the Mediterranean pattern positive, yet not significant associations were observed.
  
  
  CONCLUSIONS
  Results of the present work propose a wider MS definition, while highlighting the beneficial role of the Mediterranean dietary pattern.
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Christina-Maria
authors.initials: CM
authors.lastname: Kastorini
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. Electronic address: d.b.panagiotakos@usa.net.
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Ekavi
authors.initials: E
authors.lastname: Georgousopoulou
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Pitaraki
authors.affiliation: Laboratory of Biotechnologies Applied to Cardiovascular Medicine, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatrical Sciences, University of Rome, Sapienza, Italy.
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Puddu
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000178:diet therapy* / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D025341:Principal Component Analysis; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D015430:Weight Gain; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D018836:Inflammation Mediators; D008055:Lipids
keywords: Cardiovascular disease; Incidence; Mediterranean diet; Metabolic syndrome