Flaminio Fidanza

Mediterranean Adequacy Index: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study

BACKGROUND AND AIM The Mediterranean Adequacy Index (MAI) is an overall indicator characterising a diet in comparison with a Reference Mediterranean Diet. We computed the MAI of random samples of men surveyed for their eating habits in the 16 cohorts of the Seven Countries Study, and found that it inversely correlated with the 25-year death rates from coronary heart disease in the 16 cohorts (R = -0.72; p = 0.001). The correlation coefficient was -0.84 (p < 0.001) when the MAI was converted into natural logarithms. CONCLUSIONS These findings once again support the association between typical Mediterranean eating habits and protection against coronary heart disease.

Factor analysis in the identification of dietary patterns and their predictive role in morbid and fatal events

OBJECTIVE The purpose was to examine the role of dietary patterns derived from factor analysis and their association with health and disease. DESIGN Longitudinal population study, with measurement of diet (dietary history method), cardiovascular risk factors and a follow-up of 20 years for CHD incidence and 40 years for mortality. SETTING Two population samples in rural villages in northern and central Italy. SUBJECTS Men (n 1221) aged 45-64 years were examined and followed up. RESULTS One of the factors identified with factor analysis, run on seventeen food groups, was converted into a factor score (Factor 2 score) and used as a possible predictor of morbid and fatal events. High values of Factor 2 score were characterized by higher consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and by lower consumption of milk, sugar, fruit and alcoholic beverages. In multivariate analysis, Factor 2 score (mean 0·0061; sd 1·3750) was inversely and significantly associated (hazard ratio for a 1 sd increase; 95% CI) with 20-year CHD incidence (0·88; 0·73, 0·96) and 40-year mortality from CHD (0·79; 0·66, 0·95), CVD (0·87; 0·78, 0·96), cancer (0·84; 0·74, 0·96) and all causes (0·89; 0·83, 0·96), after adjustment for five other risk factors. Men in quintile 5 of Factor 2 score had a 4·1 years longer life expectancy compared with men in quintile 1. CONCLUSIONS A dietary pattern derived from factor analysis, and resembling the characteristics of the Mediterranean diet, was protective for the occurrence of various morbid and fatal events during 40 years of follow-up.

The Mediterranean Adequacy Index: further confirming results of validity.

BACKGROUND AND AIMS Since dietary patterns can influence levels of major risk factors for chronic disease, various indexes or scores of overall diet quality have been proposed and related to risk factors for disease. The Mediterranean Adequacy Index (MAI) was developed to simply assess how close a diet is to the Healthy Reference National Mediterranean Diet (HRNMD), a healthful diet in which Mediterranean food patterns are inversely correlated with prevalence of risk factors for chronic disease. This report describes further evidence of MAI values for diets of population groups from different countries. METHODS AND RESULTS MAI is obtained by dividing the food group intakes typical of a healthy reference Mediterranean diet, expressed in g/day, by the food group intakes not characteristic of a healthy Mediterranean diet. In this paper, the MAI was computed based on the diets of 23 population groups from Italy, Greece, U.S.A., Costa Rica, Chile, Spain, and Germany. High MAI values were recorded among working class men from southern Italy, and Seven Countries Study (SCS) men from the Greek islands, and the lowest among U.S.A. men and a control group of German women; surprisingly low values were recorded among Madrid men and women and participants from Spanish-speaking Latin American countries. The inversely significant correlation between the 16 SCS cohort diet MAI values and the 25-year coronary heart disease death rate previously observed was stable when an appropriate statistical analysis was used. Furthermore, MAI values of diets in elderly participants from 10 European countries followed for 10 years were inversely associated with total mortality. CONCLUSIONS The above results further confirm the validity of MAI, indicating that it is as good as the most utilised indexes or scores proposed for adults in Europe.

The association of the Mediterranean Adequacy Index with fatal coronary events in an Italian middle-aged male population followed for 40 years

BACKGROUND AND AIMS The dietary habits defined as the Mediterranean diet have shown to be protective for coronary heart disease (CHD) and other morbid conditions. The present analysis aims to test the Mediterranean Adequacy Index (MAI), a dietary index derived from the Mediterranean habits, versus the occurrence of fatal CHD events in an Italian male population followed for 40 years. METHODS AND RESULTS In 1965, at the time of the 5-year follow-up examination of the Italian Rural Areas of the Seven Countries Study, the diet was assessed by the dietary-history method in 1139 men aged 45-64 years, free from previous coronary events, in the rural communities of Crevalcore (Northern Italy) and Montegiorgio (Central Italy). MAI has been computed and its natural log (lnMAI) used for the analysis. Mortality data were collected and coded for the subsequent 40 years. The lnMAI was inversely associated with CHD mortality at 20 and 40 years when entered alone in the Cox proportional hazards model and when adjusted for age, cigarette smoking, systolic blood pressure, serum cholesterol, physical activity and body mass index. The hazard ratio for 1 unit of lnMAI (roughly corresponding to 2.7 units of MAI) was associated with a CHD mortality reduction of 26% in 20 years and 21% in 40 years of follow-up, when adjusted for the covariates. CONCLUSIONS In an Italian middle-aged male population, MAI showed the protective effect of a healthy Mediterranean Diet pattern versus the occurrence of fatal CHD events at 20 and 40 years.

Cardiovascular risk factors predict survival in middle-aged men during 50 years.

OBJECTIVES We aimed at studying the expectancy of life in middle-aged men as a function of several personal characteristics and risk factors. MATERIAL AND METHODS A sample of 1712 Italian men aged 40-59, first examined in 1960, was followed-up for mortality for 50 years. The length of survival was estimated as a function of 48 personal characteristics and risk factors using the multiple linear regression. RESULTS In 50 years 1672 men died (97.7%) and 40 survived (2.3%). Twenty risk factors, most of which were never measured in previous studies of such duration, proved to be significant, for the estimation of survival with an overall adjusted R(2) of 0.3236. They were: age, 4 anthropometric measurements (body mass index, and its squared term, laterality-linearity index, shoulder/pelvis shape), mean blood pressure, father and mother history of premature (<65-year) death, marital status, arm circumference, 2 respiratory measurements (vital capacity and forced expiratory volume), serum cholesterol, corneal arcus, xantelasma, cancer, cardiovascular diseases, diabetes and chronic bronchitis. Coefficients of 5 suitable risk factors became definitely larger after adjustment for regression dilution bias with 5 year data. All 40 cases of survival were located in the higher 5 deciles of estimated survival and 25 (62.5%) were in the upper decile. CONCLUSION A small number of risk factors and personal characteristics, mainly known as cardiovascular risk factors and measured once in middle-aged men, are strongly associated with the length of survival in a 50-year follow-up.

Food and nutrient consumption of two rural population groups of Italy followed for ten years.

Two groups of men, 40 through 59 years old, from two rural areas of Italy (one in the north and one in the centre) were subjects of dietary surveys on three occasions over 10 years, using the individual weighing technique. Over the 10 years, changes in the consumption of some foods were observed; these were most striking in respect to cereals and legumes, which decreased, and to animal protein and fats, which increased. The decrease of energy was much greater than expected (partly explained by the current mechanization in agriculture in Italy). In one area a low intake of riboflavin was observed, but otherwise the diets could be considered to be nutritionally good. There was no correlation between some dietary variables and anthropometric and blood lipid data, as observed previously. This was probably because the population groups examined were practically homogeneous in regard to habits.

Healthy Italian Mediterranean Diet Temple Food Guide

The definition of the Healthy Mediterranean Diet, the meaning of the Reference Mediterranean Diet, and the criteria for the selection of a specific reference population are described. The Healthy Mediterranean Temple Food Guide is a simple, clear, and nonprescriptive graphic message for the Italian