Evaluation of Coronary Artery Disease Patients’ Adherence to Mediterranean Diet

Öz

Aim: The Mediterranean diet is defined as an effective nutritional strategy to prevent and control non-communicable diseases, including cardiovascular diseases. The aim of this study is to investigate the adherence to the Mediterranean diet of patients with coronary artery disease.

Method: The study was included 116 participants with coronary artery disease and it was a descriptive and cross-sectional type. The Mediterranean Diet Scale was used to investigate patients' adherence to the Mediterranean Diet. Descriptive statistics and the Pearson chi-square test to determine the relationship between s and two categorical variables were used in statistical analyses. One-Way Anova test was used to determine the relationship between three or more variables, and Levene's test was used for homogeneity of variances. Post-hoc analysis was done with Tukey HSD test.

Results: The mean age of the participants was 60.64±11.21 years. The rate of those who are overweight or obese is 80.9%. It was determined that the majority of the participants did not consume cigarettes and alcohol. According to the Mediterranean Diet Scale classification, 11.2% of the participants scored high and 56.03% scored low. According to the Mediterranean Diet Scale classification of the participants, no significant difference was found between gender, age, body mass index, waist circumference and educational status, and scale scores.

Conclusion: In this study, it was determined that adherence to the Mediterranean diet was generally low, and at the same time, the majority of the participants were overweight and obese.

Anahtar Kelimeler

• Mediterranean diet
• nutrition
• nutrition in coronary artery disease

Koroner Arter Hastalarının Akdeniz Diyetine Bağlılık Durumunun Değerlendirilmesi

Öz

Amaç: Akdeniz diyeti, kardiyovasküler hastalıkları da kapsayan bulaşıcı olmayan hastalıkları önlemek ve kontrol etmek için etkili bir beslenme stratejisi olarak tanımlanmaktadır. Bu çalışmanın amacı, koroner arter hastalarının Akdeniz diyetine bağlılık durumlarının araştırılmasıdır.

Yöntem: Koroner arter hastalığı olan 116 katılımcı ile yapılan araştırma tanımlayıcı kesitsel tiptedir. Hastaların Akdeniz Diyeti’ne bağlılık durumlarını araştırmak için Akdeniz Diyeti Ölçeği kullanılmıştır. İstatistik analizlerde tanımlayıcı istatistik ve iki kategorik değişken arasında ilişki varlığını saptamak amacıyla Pearson ki kare testi kullanılmıştır. Üç veya daha fazla değişkenin arasındaki ilişkinin tespitinde One-Way Anova testi ve varyansların homojenliği için Levene testi kullanılmıştır. Post-hoc analizi ise Tukey HSD testi ile yapılmıştır.

Bulgular: Katılımcıları yaş ortalaması 60.64±11,21 yıldır. Fazla kilolu veya obez olanların oranı %80,9’dur. Katılımcıların çoğunluğunun sigara ve alkol tüketimi olmadığı belirlenmiştir. Akdeniz Diyeti Ölçeği sınıflamasına göre katılımcıların % 11,2’si yüksek ve % 56,03’ü düşük düzeyde puan almıştır. Katılımcıların Akdeniz Diyeti Ölçeği sınıflamasına göre cinsiyet, yaş, beden kütle indeksi, bel çevresi ve eğitim durumu ile ölçek puanları arasında anlamlı bir fark bulunmamıştır.

Sonuç: Bu çalışmada Akdeniz diyetine bağlılığın genel olarak düşük olduğu ve aynı zamanda katılımcıların çoğunluğunun fazla kilolu ve obez olduğu belirlenmiştir. 

Anahtar Kelimeler

• Akdeniz diyeti
• beslenme
• koroner arter hastalıkta beslenme

Kaynakça

1. World Health Organization. Cardiovascular diseases (CVDs). World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases. Güncellenme tarihi 11 Haziran 2021. Erişim tarihi: 12 Kasım 2021.
2. Heart Disease. Coronary Artery Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/coronary_ad.htm. Güncellenme tarihi 19 Temmuz 2021. Erişim tarihi 12 Kasım 2021.
3. Heart Disease. Know Your Risk for Heart Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/risk_factors.htm. Güncellenme tarihi 9 Aralık 2019. Erişim tarihi: 12 Kasım 2021.
4. Radd-Vagenas S, Kouris-Blazos A, Singh MF, Flood VM. Evolution of Mediterranean diets and cuisine: Concepts and definitions. Asia Pac J Clin Nutr. 2017;26(5):749-763. doi:10.6133/apjcn.082016.06.
5. Schwingshackl L, Morze J, Hoffmann G. Mediterranean diet and health status: active ingredients and pharmacological mechanisms. Br J Pharmacol. 2020;177(6):1241-1257. doi:10.1111%2Fbph.14778.
6. Food facts for healty choices. The Mediterranean diet. Food facts for healty choices. https://www.eufic.org/en/healthy-living/article/the-mediterranean-diet. Güncellenme tarihi 13 Ağustos 2018. Erişim tarihi 12 Kasım 2021.
7. Renzella J, Townsend N, Jewell J, et al. What national and subnational interventions and policies based on Mediterranean and Nordic diets are recommended or implemented in the WHO European Region, and is there evidence of effectiveness in reducing noncommunicable diseases? World Health Organisation Europe. https://www.euro.who.int/en/publications/abstracts/what-national-and-subnational-interventions-and-policies-based-on-mediterranean-and-nordic-diets-are-recommended-or-implemented-in-the-who-european-region,-and-is-there-evidence-of-effectiveness-in-reducing-noncommunicable-diseases-2018. Yayınlanma tarihi 2018. Erişim tarihi 12 Kasım 2021.
8. Martínez-González MA, García-Arellano A, Toledo E, et al. A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial. PLoS One. 2012;147(8):e43134. doi:10.1371/journal.pone.0043134.

9. World Health Organisation Europe. Body mass index - BMI. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Erişim tarihi 12 Kasım 2021.
10. Ebispro for Windows (computer program). Stuttgart, Germany; Turkish Version (BeBiS 8.2). Istanbul, Turkey: Pasifik Elektirik Elektronik Ltd. Şti; 2019. https://bebis.com.tr/anasayfa.
11. Murphy SP, Barr SI. Practice Paper of the American Dietetic Association: using the dietary reference intakes. J Am Diet Assoc. 2011;111(5):762–70. doi: 10.1016/j.jada.2011.03.022.
12. IBM SPSS Statistics for Windows (computer program). Version 20.0. Armonk, NY: IBM Corp; 2011.https://www.ibm.com/analytics/spss-statistics-software.
13. Sánchez-Sánchez ML, García-Vigara A, Hidalgo-Mora JJ, García-Pérez MÁ, Tarín J, Cano A. Mediterranean diet and health: a systematic review of epidemiological studies and intervention trials. Maturitas. 2020;136:25–37. doi:10.1016/j.maturitas.2020.03.008.
14. Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9(10):1–24. doi:10.3390/nu9101063.
15. Bloomfield HE, Koeller E, Greer N, MacDonald R, Kane R, Wilt TJ. Effects on health outcomes of a mediterranean diet with no restriction on fat intake: a systematic review and meta-analysis. Ann Intern Med. 2016;165(7):491–500. doi:10.7326/m16-0361.
16. Grosso G, Marventano S, Yang J, Micek A, et al. A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr. 2017;57(15):3218–3232. doi:10.1080/10408398.2015.1107021.
17. Becerra-Tomás N, Blanco Mejía S, Viguiliouk E, et al. Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr. 2020;60(7):1207–1227. doi:10.1080/10408398.2019.1565281.
18. Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, et al. Effects of the mediterranean diet on cardiovascular outcomes-a systematic review and meta-analysis. PLoS One. 2016;1011(8):e0159252. doi:10.1371/journal.pone.0159252.
19. Shannon OM, Mendes I, Köchl C, et al. Mediterranean diet increases endothelial function in adults: a systematic review and meta-analysis of randomized controlled trials. J Nutr. 2020;150(5):1151–1159. doi:10.1093/jn/nxaa002.
20. Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association between obesity and cardiovascular outcomes: updated evidence from meta-analysis studies. Curr Cardiol Rep. 2020;1222(4):25-43. doi:10.1007/s11886-020-1273-y.
21. Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and weight loss: Meta-analysis of randomized controlled trials. Metab Syndr Relat Disord. 2011;9(1):1–12. doi:10.1089/met.2010.0031.
22. Rees K, Takeda A, Martin N, et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2019;2019(3):CD009825. doi:10.1002/14651858.CD009825.pub3.
23. Malakou E, Linardakis M, Armstrong M, et al. The combined effect of promoting the mediterranean diet and physical activity on metabolic risk factors in adults: a systematic review and meta-analysis of randomised controlled trials. Nutrients. 2018;10(11):1577-95. doi:10.3390/nu10111577.
24. Ferrannini G, Manca ML, Magnoni M, Andreotti F, Andreini D, Latini R, et al. Coronary artery disease and type 2 diabetes: A proteomic study. Diabetes Care. 2020;43(4):843–851. doi: 10.2337/dc19-1902.
25. Merino J, Leong A, Posner DC, et al. Genetically driven hyperglycemia increases risk of coronary artery disease separately from type 2 diabetes. Diabetes Care. 2017;40(5):687–693. doi:10.2337/dc16-2625.
26. Carter P, Achana F, Troughton J, Gray LJ, Khunti K, Davies MJ. A Mediterranean diet improves HbA1c but not fasting blood glucose compared to alternative dietary strategies: a network meta-analysis. J Hum Nutr Diet. 2014;27(3):280–297. doi:10.1111/jhn.12138.
27. Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015;69(11):1200–1208.
28. Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: A systematic review with meta-analyses. BMJ Open. 2015;5(8):e008222. doi:10.1136/bmjopen-2015-008222.
29. Cheezum MK, Kim A, Bittencourt MS, et al. Association of tobacco use and cessation with coronary atherosclerosis. Atherosclerosis. 2017;257:201–207. doi:10.1016/j.atherosclerosis.2016.11.016.
30. Kondo T, Nakano Y, Adachi S, Murohara T. Effects of tobacco smoking on cardiovascular disease. Circ J. 2019;83(10):1980–1985. doi:10.1253/circj.cj-19-0323.
31. Piscopo S. The Mediterranean diet as a nutrition education, health promotion and disease prevention tool. Public Health Nutr. 2009;12(9A):1648–1655. doi:10.1017/s1368980009990504.
32. Razavi AC, Sapin A, Monlezun DJ, et al. Effect of culinary education curriculum on mediterranean diet adherence and food cost savings in families: a randomised controlled trial. Public Health Nutr. 2020;(7):1–7. doi:10.1017/S1368980020002256.