The Relationship of Adherence to the Mediterranean Diet, Dietary Inflammatory Index and Nutrient Intake in University Students: A Cross-Sectional Study

Abstract

Objective: Investigating the relationships between dietary inflammatory index (DII), nutrient intake, and adherence to the Mediterranean diet (MD) of university students was aimed in the present study. Material and Method: A questionnaire consisting of socio-demographic characteristics, the Mediterranean Diet Adherence Screener (MEDAS), the 24-hour food record, and the DII scoring was completed by undergraduate students in Uskudar University. Results: A total of 750 students (52.3% male, mean age= 21.6±2.2 years, mean body mass index= 23.97±2.63 kg/m2) were included in the study. Half (50.7%) of the students had low adherence to the MD. A 19.4% decrease was detected in the MEDAS scores as the body mass index of the students increased. The MEDAS score was positively associated with macronutrient (carbohydrates) intake. It was determined that as the MEDAS score increased; Vitamin A, Vitamin E, Vitamin C, Vitamin B6, biotin, folate, potassium, magnesium, phosphorus, chlorine, and iodine intake increased, and the DII decreased by 6.8% (p<0.001). Conclusion: The dietary inflammatory potential was found not affected by the MEDAS score since the relationship disappeared in the regression analysis. Adherence to the MD was related to the intake of macro- and micro-nutrients, however, no statistically significant association was found on dietary inflammatory potential.

Keywords

• Mediterranean diet
• dietary inflammatory index
• nutrition

Üniversite Öğrencilerinde Akdeniz Diyetine Uyumun Diyet İnflamatuvar İndeksi ve Besin Alımı ile İlişkisi: Kesitsel Bir Çalışma

Abstract

Amaç: Bu çalışmada üniversite öğrencilerinin diyet inflamatuvar indeksi (DII), besin alımı ve Akdeniz diyetine (AD) uyumu arasındaki ilişkilerin incelenmesi amaçlandı. Gereç ve Yöntem: Üsküdar Üniversitesinde lisans eğitimi alan öğrenciler sosyodemografik özellikler, Akdeniz diyetine uyum ölçeği (MEDAS), 24-saatlik besin tüketim kaydı ve DII skorlamasını içeren bir anketi tamamladılar. Bulgular: Çalışmaya toplamda 750 öğrenci (%52,3 erkek, ortalama yaş= 21,6±2,2 yıl, ortalama beden kütle indeksi= 23,97±2,63 kg/m2) dahil edildi. Öğrencilerin yarısının (%50,7) AD uyumu düşüktü. Öğrencilerin beden kütle indeksi değerleri arttıkça Akdeniz diyetine uyum (MEDAS) puanlarında %19,4’lük azalma saptandı. MEDAS puanı makrobesin (karbonhidrat) alımı ile pozitif ilişkiliydi. MEDAS puanı arttıkça A vitamini, E vitamini, C vitamini, B6 vitamini, biyotin, folat, potasyum, magnezyum, fosfor, klor ve iyot alımının arttığı ve DII %6,8 oranında azaldığı saptandı (p<0.001). Sonuç: Regresyon analizinde ilişkinin ortadan kalkması nedeniyle diyetin inflamatuvar potansiyelinin MEDAS skorundan etkilenmediği görülmüştür. AD'ye bağlılık makro ve mikro besinlerin alımıyla ilişkiliydi, ancak diyetin inflamatuar potansiyeli üzerinde istatistiksel olarak anlamlı bir ilişki bulunmadı.

Keywords

• Akdeniz diyeti
• diyet inflamatuvar indeksi
• beslenme

References

1. Dernini S, Berry E. Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutr. 2015;2.
2. Guasch‐Ferré M, Willett W. The Mediterranean diet and health: a comprehensive overview. J. Intern. Med. 2021;290(3):549-566.
3. Tosti V, Bertozzi B, Fontana L. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. J Gerontol A Biol Sci Med Sci. 2017;73(3):318-326.
4. Shin D, Lee K, Brann L, Shivappa N, Hébert J. Dietary inflammatory index is positively associated with serum high-sensitivity C-reactive protein in a Korean adult population. Nutr. 2019;63-64:155-161.
5. Tolkien K, Bradburn S, Murgatroyd C. An anti-inflammatory diet as a potential intervention for depressive disorders: a systematic review and meta-analysis. Clin Nutr. 2019;38(5):2045-2052.
6. Hébert J, Shivappa N, Wirth M, Hussey J, Hurley T. Perspective: the dietary inflammatory index (DII)-lessons learned, improvements made, and future directions. Adv Nutr. 2019;10(2):185-195.
7. 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):1689-1696.
8. Liu F, Liu C, Gong T, Gao S, Sun H, Jiang Y, et al. Dietary inflammatory index and health outcomes: an umbrella review of systematic review and meta-analyses of observational studies. Front Nutr. 2021;8:647122.

9. Phillips C, Chen L, Heude B, Bernard J, Harvey N, Duijts L, et al. Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutr. 2019;11(8):1873.
10. Casas R, Urpi-Sardà M, Sacanella E, Arranz S, Corella D, Castañer O, et al. Anti-inflammatory effects of the Mediterranean diet in the early and late stages of atheroma plaque development. Mediators Inflamm. 2017;2017:1-12.
11. Mena M, Sacanella E, Vazquez-Agell M, Morales M, Fitó M, Escoda R, et al. Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr. 2008;89(1):248-256.
12. Nordmann A, Suter-Zimmermann K, Bucher H, Shai I, Tuttle K, Estruch R, et al. Meta-analysis comparing Mediterranean to lowfat diets for modification of cardiovascular risk factors. Am. J. Med. 2011;124(9):841-851.e2.
13. Schwingshackl L, Hoffmann G. Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis. 2014;24(9):929-939.
14. Mayr H, Thomas C, Tierney A, Kucianski T, George E, Ruiz-Canela M, et al. Randomization to 6-month Mediterranean diet compared with a low-fat diet leads to improvement in dietary inflammatory index scores in patients with coronary heart disease: the AUSMED Heart Trial. Nutr Res. 2018;55:94-107.
15. Hodge A, Bassett J, Shivappa N, Hébert J, English D, Giles G, et al. Dietary inflammatory index, Mediterranean diet score, and lung cancer: a prospective study. Cancer Causes Control. 2016;27(7):907-917.
16. Ricceri F, Giraudo M, Fasanelli F, Milanese D, Sciannameo V, Fiorini L, et al. Diet and endometrial cancer: a focus on the role of fruit and vegetable intake, Mediterranean diet and dietary inflammatory index in the endometrial cancer risk. BMC Cancer. 2017;17(1).
17. Büyüköztürk S. Sosyal bilimler için veri analizi el kitabı. 29th ed. Ankara: Pegem Akademi; 2021.
18. Weir CB, Jan A. BMI classification percentile and cut off points, 2019.
19. Martinez-Gonzalez M, Corella D, Salas-Salvado J, Ros E, Covas M, Fiol M, et al. Cohort profile: design and methods of the PREDIMED study. Int J Epidemiol. 2010;41(2):377-385.
20. Özkan Pehlivanoğlu EF, Balcıoğlu H, Ünlüoğlu İ. Akdeniz Diyeti Bağlılık Ölçeği’nin Türkçe’ye uyarlanması geçerlilik ve güvenilirliği. Osmangazi Tıp Dergisi. 2020;42(2):160-164.
21. Choi J, Peters M, Mueller RO. Correlational analysis of ordinal data: from Pearson’s r to bayesian polychoric correlation. Asia Pacific Educ. Rev. 2010;11(4):459–466.
22. Sönmez T. Üniversite öğrencilerinin Akdeniz diyetine uyumu ve beslenme durumunun belirlenmesi. SYBD. 2021;3(1):85-90.
23. Hadjimbei E, Botsaris G, Gekas V, Panayiotou AG. Adherence to the Mediterranean diet and lifestyle characteristics of university students in Cyprus: a cross-sectional survey. J Nutr Metab. 2016;2016:2742841.
24. Leblanc V, Bégin C, Corneau L, Dodin S, Lemieux S. Gender differences in dietary intakes: what is the contribution of motivational variables?. J Hum Nutr Diet. 2015;28(1):37-46.
25. Garriguet D. Diet quality in Canada. Health Rep. 2009;20(3):41-52.
26. Leblanc V, Bégin C, Hudon AM, Royer MM, Carneau SD, Lemieux S. Gender differences in the long-term effects of a nutritional intervention program promoting the Mediterranean diet: changes in dietary intakes, eating behaviors, anthropometric and metabolic variables. Nutr J. 2014;13:107.
27. Bemelmans WJ, Broer J, de Vries JH, Hulshof KF, May JF, Meyboom- De Jong B. Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease. Public Health Nutr. 2000;3(3):273-283.
28. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599-2608.
29. Shatwan IM, Alhinai EA, Alawadhi B, Surendran S, Aljefree NM, Almoraie NM. High adherence to the Mediterranean diet is associated with a reduced risk of obesity among adults in gulf countries. Nutrients. 2021;13(3):995.
30. Lotfi K, Saneei P, Hajhashemy Z, Esmaillzadeh A. Adherence to the Mediterranean diet, five-year weight change, and risk of overweight and obesity: a systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr. 2022;13(1):152-166.
31. Pereira EV, Costa JDA, Alfenas RDC. Effect of glycemic index on obesity control. Arch Endocrinol Metab. 2015;59(3):245-251.
32. Castro-Barquero S, Lamuela-Raventós RM, Doménech M, Estruch R. Relationship between Mediterranean dietary polyphenol intake and obesity. Nutrients. 2018;10(10):1523.
33. Peng W, Berry EM, Goldsmith R. Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents. J Hum Nutr Diet. 2019;32(1):41-52.
34. Bayındır Gümüş A, Yardımcı H. Üniversite öğrencilerinin günlük besin ögesi alımlarının Akdeniz diyeti kalite indeksi (KIDMED) ile ilişkisi. ADYÜ Sağlık Bilimleri Derg. 2020; 6(2): 167-173.
35. Moreno LA, Sarría A, Popkin BM. The nutrition transition in Spain: a European Mediterranean country. Eur J Clin Nutr. 2002;56(10):992-1003.
36. Bawaked RA, Schröder H, Ribas-Barba L, Izquierdo-Pulido M, Pérez-Rodrigo C, Fíto M, et al. Association of diet quality with dietary inflammatory potential in youth. Food Nutr Res. 2017;61(1):1328961.
37. Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14(4):245-254.
38. Amato M, Bonomi A, Laguzzi F, Veglia F, Tremoli E, Werba JP, et al. Overall dietary variety and adherence to the Mediterranean diet show additive protective effects against coronary heart disease. Nutr Metab Cardiovasc Dis. 2020;30(8):1315-1321.
39. Billingsley HE, Carbone S. The antioxidant potential of the Mediterranean diet in patients at high cardiovascular risk: an in-depth review of the PREDIMED. Nutr Diabetes. 2018;8(1):13.
40. Temple NJ, Guercio V, Tavani A. The Mediterranean diet and cardiovascular disease: gaps in the evidence and research challenges. Cardiol Rev. 2019;27(3):127-130.
41. Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant. 2018;33(5):725-735.
42. Ruiz-Canela M, Zazpe I, Shivappa N, Hébert JR, Sánchez-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 (PREvención con DIeta MEDiterránea) trial. Br J Nutr. 2015;113(6):984-995.
43. Meinilä J, Perälä MM, Kautiainen H, Männistö S, Kanevra N, Shivappa N, et al. Healthy diets and telomere length and attrition during a 10-year follow-up. Eur J Clin Nutr. 2019;73(10):1352-1360.
44. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA study. J Am Coll Cardiol. 2004;44(1):152-158.
45. Sureda A, Bibiloni MDM, Julibert A, Bouzas C, Argelich E, Llompart I, et al. Adherence to the Mediterranean diet and inflammatory markers. Nutrients. 2018;10(1):62.