Dietary Quality Indices and Its Cardiovascular Diseases Risk Factors: A Survey from the Kavar Cohort Study

  • Mohammad Jafar Dehzad Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran https://orcid.org/0000-0002-1596-5791
  • Ali Reza Safarpour Colorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Laparoscopy Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
  • Najmeh Hejazi Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
  • Zahra Moghdani Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Keywords: Cardiovascular Diseases, DASH, Mediterranean Diet, Visceral Adiposity Index, Dietary Inflammatory Index

Abstract

Background: Atherosclerosis is known to be a significant reason for cardiovascular diseases (CVDs). Hypertension, dyslipidemia, diabetes, obesity, smoking, physical inactivity, and unhealthy diet are the most important causes of atherosclerosis. This study aimed to determine the relationship between DASH Diet Index, Dietary Inflammatory Index (DII), Mediterranean Diet (MEDI-LITE) Index, and CVDs risk factors. Materials and Methods: Out of 4997 patients, all eligible patients with CVDs (n=264) were chosen as the patient group, and 264 healthy individuals were included in the healthy group. Dietary intake and anthropometric measures were evaluated, including height, weight, hip and waist circumference, blood pressure, and lipid profile. Results: Among the three dietary indices, the DASH diet score was significantly higher in the healthy group than in the patient group (P=0.02). An inverse relationship was found between the DASH Diet Index and waist-to-hip ratio (r=-0.33, P=0.042), Visceral Adiposity Index (VAI; r=-0.16, P=0.044), systolic blood pressure (r=-0.13, P=0.035), triglycerides (r=-0.36, P=0.046), total cholesterol (r=-0.47, P=0.02), and low-density lipoprotein-C (LDL-C) levels (r=-0.09, P=0.03) in the patient group. Additionally, the MEDI-LITE Index was inversely associated with body mass index (BMI; r=-0.12, P=0.04), waist circumference (r=-0.065, P=0.05), triglyceride (r=-0.25, P=0.015), total cholesterol (r=-0.4, P=0.02), LDL-C levels (r=-0.2, P=0.006), and systolic blood pressure (r=-0.122, P=0.005) in the patient group. Also, a significant positive relationship was observed between the DII and BMI in both patients and healthy individuals (r=0.76, P=0.006 vs. r=0.24, P=0.01, respectively) and hip circumference (r=0.638, P=0.035) in the patients group. However, no significant relationship was observed between DII and CVDs risk factors. Conclusion: Patients with higher DASH diet scores had lower waist-to-hip ratio, VAI, total cholesterol, LDL-C, triglycerides, and lower blood pressure. In addition, patients with higher MEDI-LITE scores had lower BMI, waist circumference, triglycerides, total cholesterol, LDL-C, and lower blood pressure, but no correlation was found the healthy group.

Author Biographies

Mohammad Jafar Dehzad, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Clinical Nutrition, School of Nutrition and food sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Ali Reza Safarpour, Colorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Laparoscopy Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Colorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Najmeh Hejazi, Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Clinical Nutrition, School of Nutrition and food sciences, Shiraz University of Medical Sciences, Shiraz, Iran

References

Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Medicine. 2013;11:117.

https://doi.org/10.1186/1741-7015-11-117

PMid:23635324 PMCid:PMC3658954

Pourshahidi LK, Caballero E, Osses A, Hyland BW, Ternan NG, Gill CIR. Modest improvement in CVD risk markers in older adults following quinoa (Chenopodium quinoa Willd.) consumption: a randomized-controlled crossover study with a novel food product. Eur J Nutr. 2020;59(7):3313-23.

https://doi.org/10.1007/s00394-019-02169-0 PMid:31919583

Hajar R. Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views. 2017;18(3):109-14.

https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_106_17

PMid:29184622 PMCid:PMC5686931

Ruiz-Canela M, Zazpe I, Shivappa N, Hebert JR, Sanchez-Tainta A, Corella D, et al. Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvencion con DIeta MEDiterranea) trial. Br J Nutr. 2015;113(6):984-95.

https://doi.org/10.1017/S0007114514004401

PMid:25720588 PMCid:PMC4870040

Calder PC, Ahluwalia N, Brouns F, Buetler T, Clement K, Cunningham K, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. 2011;106 Suppl 3:S5-78.

https://doi.org/10.1017/S0007114511005460

PMid:22133051

Ramallal R, Toledo E, Martinez-Gonzalez MA, Hernandez-Hernandez A, Garcia-Arellano A, Shivappa N, et al. Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the SUN Cohort. PLoS One. 2015;10(9):e0135221.

https://doi.org/10.1371/journal.pone.0135221

PMid:26340022 PMCid:PMC4560420

Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689-96.

https://doi.org/10.1017/S1368980013002115

PMid:23941862 PMCid:PMC3925198

Shivappa N, Hebert JR, Rietzschel ER, De Buyzere ML, Langlois M, Debruyne E, et al. Associations between dietary inflammatory index and inflammatory markers in the Asklepios Study. Br J Nutr. 2015;113(4):665-71.

https://doi.org/10.1017/S000711451400395X

PMid:25639781 PMCid:PMC4355619

Finicelli M, Squillaro T, Di Cristo F, Di Salle A, Melone MAB, Galderisi U, et al. Metabolic syndrome, Mediterranean diet, and polyphenols: Evidence and perspectives. J Cell Physiol. 2019;234(5):5807-26.

https://doi.org/10.1002/jcp.27506

PMid:30317573

Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093-100.

https://doi.org/10.1161/CIRCULATIONAHA.108.816736

PMid:19221219 PMCid:PMC2724471

Chiuve SE, Fung TT, Rexrode KM, Spiegelman D, Manson JE, Stampfer MJ, et al. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA. 2011;306(1):62-9.

https://doi.org/10.1001/jama.2011.907

PMid:21730242 PMCid:PMC3210472

Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9):841-51.e2.

https://doi.org/10.1016/j.amjmed.2011.04.024

PMid:21854893

NIH. National Heart, Lung, and Blood Institute Your guide to lowering your blood pressure with DASH [Internet]. 2016 [Accessed 2016 August 27]. Available from: www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index.

NIH. National Heart, Lung, and Blood Institute Description of the DASH eating plan [Internet]. 2016 [Accessed 2016 August 27]. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/dash.

Eghtesad S, Mohammadi Z, Shayanrad A, Faramarzi E, Joukar F, Hamzeh B, et al. The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform. Arch Iran Med. 2017;20(11):691-5.

WHO. International statistical classification of diseases and related health problems (11th ed.). 2019. Available from: https://icd.who.int/.

Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design. Am J Epidemiol. 2018;187(4):647-55. https://doi.org/10.1093/aje/kwx314 PMid:29145581 PMCid:PMC6279089

Sofi F, Dinu M, Pagliai G, Marcucci R, Casini A. Validation of a literature-based adherence score to Mediterranean diet: the MEDI-LITE score. Int J Food Sci Nutr. 2017;68(6):757-62.

https://doi.org/10.1080/09637486.2017.1287884

PMid:28276908

Mellen PB, Gao SK, Vitolins MZ, Goff DC, Jr. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med. 2008;168(3):308-14.

https://doi.org/10.1001/archinternmed.2007.119

PMid:18268173

Fitzgerald KC, Chiuve SE, Buring JE, Ridker PM, Glynn RJ. Comparison of associations of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with risks of cardiovascular disease and venous thromboembolism. J Thromb Haemost. 2012;10(2):189-98.

https://doi.org/10.1111/j.1538-7836.2011.04588.x

PMid:22151600 PMCid:PMC3272095

Panbehkar-Jouybari M, Mollahosseini M, Salehi-Abargouei A, Fallahzadeh H, Mirzaei M, Hosseinzadeh M. The Mediterranean diet and dietary approach to stop hypertension (DASH)-style diet are differently associated with lipid profile in a large sample of Iranian adults: a cross-sectional study of Shahedieh cohort. BMC Endocr Disord. 2021;21(1):192.

https://doi.org/10.1186/s12902-021-00856-w

PMid:34548048 PMCid:PMC8456584

Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr. 2011;141(6):1083-8.

https://doi.org/10.3945/jn.110.136739

PMid:21525259 PMCid:PMC3137257

Navarro-Prado S, Schmidt-RioValle J, Montero-Alonso MA, Fernández-Aparicio Á, González-Jiménez E. Stricter Adherence to Dietary Approaches to Stop Hypertension (DASH) and its Association with Lower Blood Pressure, Visceral Fat, and Waist Circumference in University Students. Nutrients. 2020;12(3):740.

https://doi.org/10.3390/nu12030740

PMid:32168861 PMCid:PMC7146277

Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr. 2015;113(1):1-15.

https://doi.org/10.1017/S0007114514003341

PMid:25430608

Oraii A, Shafiee A, Jalali A, Alaeddini F, Saadat S, Sadeghian S, et al. Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study. Glob Heart. 2022;17(1):31.

https://doi.org/10.5334/gh.1120

PMid:35586741 PMCid:PMC9104493

Alì S, Davinelli S, Accardi G, Aiello A, Caruso C, Duro G, et al. Healthy ageing and Mediterranean diet: A focus on hormetic phytochemicals. Mech Ageing Dev. 2021;200:111592.

https://doi.org/10.1016/j.mad.2021.111592

PMid:34710375

Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M, et al. 'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013(8):Cd009825.

https://doi.org/10.1002/14651858.CD009825.pub2

Akhlaghi M, Ghasemi-Nasab M, Riasatian M. Mediterranean diet for patients with non-alcoholic fatty liver disease, a systematic review and meta-analysis of observational and clinical investigations. J Diabetes Metab Disord. 2020;19(1):575-84.

https://doi.org/10.1007/s40200-019-00475-2

PMid:32550210 PMCid:PMC7271299

Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, et al. Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol. 2015;25(6):398-405.

https://doi.org/10.1016/j.annepidem.2015.03.009

PMid:25900255 PMCid:PMC4433562

Shivappa N, Hebert JR, Marcos A, Diaz LE, Gomez S, Nova E, et al. Association between dietary inflammatory index and inflammatory markers in the HELENA study. Mol Nutr Food Res. 2017;61(6):1600707.

https://doi.org/10.1002/mnfr.201600707

PMid:27981781 PMCid:PMC5517083

Ariya M, Shahraki HR, Farjam M, Ehrampoush E, Bahramali E, Homayounfar R, et al. Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study). Sci Rep. 2020;10(1):16762.

https://doi.org/10.1038/s41598-020-73844-0

PMid:33028906 PMCid:PMC7542151

Lam BC, Koh GC, Chen C, Wong MT, Fallows SJ. Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One. 2015;10(4):e0122985.

https://doi.org/10.1371/journal.pone.0122985

PMid:25880905 PMCid:PMC4400161

Li C, Engstrom G, Hedblad B, Calling S, Berglund G, Janzon L. Sex differences in the relationships between BMI, WHR and incidence of cardiovascular disease: a population-based cohort study. Int J Obes (Lond). 2006;30(12):1775-81.

https://doi.org/10.1038/sj.ijo.0803339

PMid:16607382

Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism. 2019;92:98-107.

https://doi.org/10.1016/j.metabol.2018.10.011

PMid:30399375

Lustig RH, Collier D, Kassotis C, Roepke TA, Ji Kim M, Blanc E, et al. Obesity I: Overview and molecular and biochemical mechanisms. Biochem Pharmacol. 2022;199:115012.

https://doi.org/10.1016/j.bcp.2022.115012 PMid:35393120

Khanna D, Khanna S, Khanna P, Kahar P, Patel BM. Obesity: A Chronic Low-Grade Inflammation and Its Markers. Cureus. 2022;14(2):e22711. https://doi.org/10.7759/cureus.22711

Jakubiak GK, Osadnik K, Lejawa M, Osadnik T, Goławski M, Lewandowski P, et al. "Obesity and Insulin Resistance" Is the Component of the Metabolic Syndrome Most Strongly Associated with Oxidative Stress. Antioxidants (Basel). 2021;11(1):79.

https://doi.org/10.3390/antiox11010079

PMid:35052583 PMCid:PMC8773170

Kouli GM, Panagiotakos DB, Kyrou I, Georgousopoulou EN, Chrysohoou C, Tsigos C, et al. Visceral adiposity index and 10-year cardiovascular disease incidence: The ATTICA study. Nutr Metab Cardiovasc Dis. 2017;27(10):881-9.

https://doi.org/10.1016/j.numecd.2017.06.015

PMid:28851556

Kosmas CE, Martinez I, Sourlas A, Bouza KV, Campos FN, Torres V, et al. High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs Context. 2018;7:212525.

https://doi.org/10.7573/dic.212525

PMid:29623098 PMCid:PMC5877920

Nicholls SJ, Nelson AJ. HDL and cardiovascular disease. Pathology. 2019;51(2):142-7.

https://doi.org/10.1016/j.pathol.2018.10.017

PMid:30612759

Tan J, Zhang X, Wang W, Yin P, Guo X, Zhou M. Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up. Int J Environ Res Public Health. 2018;15(5):1026.

https://doi.org/10.3390/ijerph15051026

PMid:29783678 PMCid:PMC5982065

Published
2022-12-30
How to Cite
Dehzad, M. J., Safarpour, A. R., Hejazi, N., & Moghdani, Z. (2022). Dietary Quality Indices and Its Cardiovascular Diseases Risk Factors: A Survey from the Kavar Cohort Study. Galen Medical Journal, 11, e2236. https://doi.org/10.31661/gmj.v11i.2236
Section
Short Communication