1. The Southern European Atlantic Diet index – definition and effects on cardiovascular health
Andreia Oliveira
Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School
Institute of Public Health | University of Porto
Bristol | October 18, 2011

2. Methodological approaches to study Diet
Single nutrients/ foods
Dietary Patterns
defined a priori
defined a posteriori
Hypothesis-oriented approach
(a priori knowledge)
Exploratory approach
(data at hand)
Indexes and scores
Principal component analysis
Factor analysis
Cluster analysis
Mediterranean Diet Score (MDS)
Mediterranean Adequacy Index (MAI)
Mediterranean dietary pattern
Healthy Diet Indicator (HDI)
Healthy Food Index (HFI)
Europe
Adapted from: Schulze et al. Br J Nutr 2006; 95:

3. Adherence to a Mediterranean diet was poor in all Portuguese regions …
Portuguese Household’s Budget Surveys
1989/1990: n=12 403
1994/1995: n=10 554
2000/2001: n=10 020
Adherence to a Mediterranean diet was poor in all Portuguese regions …

4. Atlantic Diet
“Diet characteristic of regions with a straight link with the Atlantic Ocean sharing a specific high consumption of fish and other sea foods, red meats, vegetables and whole foods, and wine consumption during meals”
Atlantic Ocean
Mediterranean Sea
European Center of Atlantic Diet, Viana do Castelo, Portugal 2001
Varela G et al, Madrid 2004
Fundación Española de la Nutrición, Marid 2003, 2005

5. Objectives
 To define the Southern European Atlantic Diet (SEAD) index.
 To evaluate the association of this index with the occurrence of non-fatal acute myocardial infarction id adults from Porto, Portugal.

6. EPICardis study – a population-based case-control study
Cases
Patients admitted consecutively to the Cardiology Department of the four hospitals providing acute coronary care in Porto ( ), with a first diagnosis of acute myocardial infarction (AMI) (n=820).
Community participants aged ≥ 18 years
Baseline evaluation of the EPIPorto cohort ( )
- Who had no previous clinical or silent infarction (n=2196)
Controls

7. Data collection [by questionnaire and physical examination]
Mini-Mental State Examination test [in those ≥ 65 years; subjects excluded when scoring < 24 points]
Age | Education | Marital status | Occupational activity
Social and demographic characteristics
Dislipidemia | Diabetes | Hypertension | Personal history of cardiovascular diseases
Family history of acute myocardial infarction | Use of medication | Gynecological history
Personal and family medical history
Smoking status | Physical activity | Diet
Lifestyles

8. Food Frequency Questionnaire [previous 12 months](
Adapted software Food Processor Plus (ESHA Research, Salem-Oregon, 1997)
Lopes C, et al. J Am Diet Assoc 2007; 107: ; Lopes C. [PhD thesis in Portuguese]. University of Porto; 2000

9.  Possible range score: 0 to 9
Food components and scoring of the Southern European Atlantic Diet (SEAD) index
a Sex-specific medians in the controls were used as threshold for all food components, except wine.
b Each glass containing 125 ml of wine. W: women; M: men
 Possible range score: 0 to 9
 Food consumption adjusted for energy intake by the energy density model:
grams per 1000 kcal/day

10. ↓ 33% p-trend=0.003 OR=0.67 (0.51-0.88) Quartile 1 ≤ 3 points
[lower adherence]
Quartile 2
4 points
Quartile 3
5 points
Quartile 4
≥ 6 points
[higher adherence]
* Odds ratio adjusted for sex, age, education, total energy intake, fruits, refined cereals, white meat, smoking status, regular physical activity, family history of infarction, body mass index, and menopause and hormone replacement therapy in women.

11. Sensitivity analyses
a Sex-specific quartiles in the controls were used as threshold for all food components, except wine.
b Each glass containing 125 ml of wine. W: women; M: men
SEAD scoring based on: upper vs. 1st quartile p-trend
Sex-specific quartiles of food consumption OR=0.61 ( ) <0.001
Frequency of food consumption OR=0.58 ( ) <0.001

12. Additional analyses: reverse scoring for red meat and pork products + potatoes
a Sex-specific medians in the controls were used as threshold for all food components, except wine.
b Each glass containing 125 ml of wine. W: women; M: men
Reverse scoring for: upper vs. 1st quartile p-trend
Red meat and pork and potatoes OR=0.40 ( ) <0.001
Red meat and pork OR=0.45 ( ) <0.001

13. Conclusions
 A higher adherence to the Southern European Atlantic diet (SEAD index), culturally rooted in Northern Portugal and Galicia, was associated with a lower occurrence of non-fatal AMI events.
 The reduction in consumption of potatoes, and particularly of red meat and pork products, might increase the benefit of the SEAD on coronary heart disease.
 SEAD might contribute to the very low coronary mortality traditionally registered in northern Portugal and Galicia.

14. Research work developed at the Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School and the Public Health Institute, University of Porto
PhD grant from Fundação para a Ciência e a Tecnologia [SFRH/BD/31131/2006]