title: Mediterranean diet score and left ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Data are limited on the relation between dietary patterns and left ventricular (LV) structure and function.
  
  
  OBJECTIVE
  We examined cross-sectional associations of a diet-score assessment of a Mediterranean dietary pattern with LV mass, volume, mass-to-volume ratio, stroke volume, and ejection fraction.
  
  
  METHODS
  We measured LV variables with the use of cardiac MRI in 4497 participants in the Multi-Ethnic Study of Atherosclerosis study who were aged 45-84 y and without clinical cardiovascular disease. We calculated a Mediterranean diet score from intakes of fruit, vegetables, nuts, legumes, whole grains, fish, red meat, the monounsaturated fat:saturated fat ratio, and alcohol that were self-reported with the use of a food-frequency questionnaire. We used linear regression with adjustment for body size, physical activity, and cardiovascular disease risk factors to model associations and assess the shape of these associations (linear or quadratic).
  
  
  RESULTS
  The Mediterranean diet score had a slight U-shaped association with LV mass (adjusted means: 146, 145, 146, and 147 g across quartiles of diet score, respectively; P-quadratic trend = 0.04). The score was linearly associated with LV volume, stroke volume, and ejection fraction: for each +1-U difference in score, LV volume was 0.4 mL higher (95% CI: 0.0, 0.8 mL higher), the stroke volume was 0.5 mL higher (95% CI: 0.2, 0.8 mL higher), and the ejection fraction was 0.2 percentage points higher (95% CI: 0.1, 0.3 percentage points higher). The score was not associated with the mass-to-volume ratio.
  
  
  CONCLUSIONS
  A higher Mediterranean diet score is cross-sectionally associated with a higher LV mass, which is balanced by a higher LV volume as well as a higher ejection fraction and stroke volume. Participants in this healthy, multiethnic sample whose dietary patterns most closely conformed to a Mediterranean-type pattern had a modestly better LV structure and function than did participants with less-Mediterranean-like dietary patterns. This trial was registered at clinicaltrials.gov as NCT00005487.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; elevitan@uab.edu.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: Center for Health and Aging, Washington DC VA Medical Center, Washington, DC;
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: College of Public Health, University of Kentucky, Lexington, KY;
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
authors.affiliation: Department of Radiology, Tufts University School of Medicine, Boston, MA;
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.affiliation: Departments of Internal Medicine (Cardiology) and Radiology, Wake Forest University School of Medicine, Winston-Salem, NC;
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
authors.affiliation: NIH Clinical Center, NIH, Bethesda, MD;
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA;
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; and.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center-Houston, Houston, TX.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Nettleton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D020257:Ventricular Remodeling
keywords: Mediterranean diet pattern; cardiovascular disease; epidemiology; left ventricular function; left ventricular structure; subclinical cardiovascular disease