Prospective association between several dietary scores and risk of cardiovascular diseases: Is the Mediterranean diet equally associated to cardiovascular diseases compared to National Nutritional Scores?

Abstract

BACKGROUND\nMediterranean diet has been consistently negatively associated with cardiovascular diseases (CVD) but the superiority compared to official nutritional guidelines has not been tested yet. Our objective was to prospectively investigate the association between several nutritional scores and incidence of cardiovascular diseases.\n\n\nMETHODS AND FINDINGS\nA total of 94,113 participants from the NutriNet-Santé cohort were followed between 2009 and 2018. The participants have completed at least three 24 h dietary records during the first two-years of follow-up to compute nutritional scores reflecting adherence to the Mediterranean diet (MEDI-LITE), American dietary guidelines (AHEI-2010) and French dietary guidelines (mPNNS-GS). Sex-specific quartiles (Q) of scores were computed. Multivariable Cox proportional hazards models were used to estimate the associations between scores and incidence of CVD, documented using Hazard Ratio (HR) and 95% confidence intervals (95%CI). Thus, 1399 incident CVD events occurred during the follow-up (mean follow-up\u202f=\u202f5.4 years). Comparing Q4 versus Q1 quartile, HR for the MEDI-LITE and AHEI-2010 were 0.79 (95% CI: 0.67-0.93, P-trend\u202f=\u202f.004) and 0.75 (95% CI: 0.63-0.89, P-trend\u202f=\u202f.002) respectively. These associations remained similar when removing early cases of CVD, when analyses were restricted to participants with >6 dietary records and when considering transient ischemic attacks. In this last case, association between CVD risk and mPNNS-GS become significant.\n\n\nCONCLUSIONS\nA better nutritional quality of diet is overall associated with lower risk of CVD. The future version of the PNNS-GS, based on the updated version of the French dietary guidelines, should strengthen the CVD protective effect of French recommendations.