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Title:	Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study
Author:	Martínez-González, Miguel Ángel, 1957-; Zazpe, Itziar; Razquin, Cristina; Sánchez Tainta, Ana; Corella Piquer, Dolores; Salas Salvadó, Jordi; Toledo Atucha, Estefanía; Ros Rahola, Emilio; Muñoz, M. A.; Recondo, J.; Gómez Gracia, Enrique; Fiol Sala, Miguel; Lapetra, José; Buil Cosiales, Pilar; Serra Majem, Lluís; Pintó Sala, Xavier; Schröder, Helmut, 1958-; Tur, Josep Antoni; Sorlí, José V.; Lamuela Raventós, Rosa Ma.; Estruch Riba, Ramon
Notes:	BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. RESULTS: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a 'Mediterranean-type' dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). CONCLUSIONS: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.
Subject(s):	-Malalties cardiovasculars -Mortalitat -Dieta -Cuina mediterrània -Cardiovascular diseases -Mortality -Diet -Mediterranean cooking
Rights:	cc-by-nc-nd (c) Elsevier Ltd and European Society for Clinical Nutrition and Metabolism, 2015 http://creativecommons.org/licenses/by-nc-nd/3.0/es
Document type:	Article Article - Accepted version
Published by:	Elsevier
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