The Effect of Adherence to Mediterranean Diet on Quality of Life in Patients with Coronary Artery Disease

Abstract

Objective: The aim of this study was to evaluate the effect of Mediterranean diet adherence on quality of life in individuals with a history of coronary artery disease. Materials and Methods: This cross-sectional study was conducted with the participation of 378 patients diagnosed with coronary artery disease between the ages of 18 and 65. Data were collected through face-to-face interviews using a questionnaire including questions on demographic characteristics, dietary habits, the Mediterranean Diet Adherence Scale (MEDAS), and the Cardiac Quality of Life Scale (HeartQoL). The IBM SPSS Statistics 26.0 program was used in the analysis of data. Results: The mean HeartQoL score of the patients was 25.33±10.42, and the mean MEDAS score was 6.13±1.69. Diet quality was low in 62% of the participants. No significant effect of the level of adherence to the Mediterranean diet on blood pressure and lipid profile was detected (p>0.05). MEDAS score (B=3.04; 95% CI: 2.52–3.57; p<0.001) and hemoglobin A1c (HbA1c) level (B=–1.04; 95% CI: –1.68– –0.40; p=0.002) were found to be associated with HeartQoL score. Education level (B=0.23; 95% CI: 0.05–0.41; p=0.013) and waist circumference (B=–0.49; 95% CI: –0.08– –0.02; p=0.002) were found to be associated with MEDAS score. Conclusion: Diet quality is generally low in coronary artery disease patients. High diet quality positively affects emotional and physical quality of life. On the other hand, high HbA1c levels negatively affect quality of life. Therefore, patients should be made aware of healthy nutrition, and the treatment process should include strategies to ensure glycemic control.

Keywords

• Coronary artery disease
• Mediterranean diet
• Quality of life
• Lifestyle
• Glycemic control

References

1. Komilovich EBZ. Coronary Artery Disease. Eur J Mod Med Pract. 2023;3(12), 81-87.
2. Miller CLA. review of symptoms of coronary artery disease in women. J Adv Nurs. 2002;39(1):17-23. doi:10.1046/j.1365-2648.2002.02237.x
3. Khawaja IS, Westermeyer JJ, Gajwani P, Feinstein RE. Depression and coronary artery disease: the association, mechanisms, and therapeutic implications. Psychiatry (Edgmont). 2009 Jan;6(1):38-51.
4. Tenenbaum A, Motro M, Fisman EZ, et al. Functional capacity impairment in patients with coronary artery disease: Prevalence, risk factors and prognosis. Cardiology. 2003;100(4):207-215. doi:10.1159/000074814
5. Yang YL, Leu HB, Yin WH, et al. Adherence to healthy lifestyle improved clinical outcomes in coronary artery disease patients after coronary intervention. J Chin Med Assoc. 2021 Jun 1;84(6):596-605. doi:10.1097/JCMA.0000000000000536
6. Gantenbein KV, Kanaka-Gantenbein C. Mediterranean diet as an antioxidant: The impact on metabolic health and overall wellbeing. Nutrients. 2021;13(6):1951. doi:10.3390/nu13061951
7. Kushkestani M, Moghadassi M, Sidossis L. Mediterranean lifestyle: More than a diet, A way of living (and thriving). Endocrine, Metabolic & Immune Disorders-Drug Targets. 2024;24(15):1785-1793. doi:10.2174/0118715303279769240215105510
8. Tuttolomondo A, Simonetta I, Daidone M, Mogavero A, Ortello A, Pinto A. Metabolic and vascular effect of the Mediterranean diet. International Journal of Molecular Sciences, 2019;20(19):4716. doi:10.3390/ijms20194716.

9. Cai T, Verze P, Bjerklund Johansen TE. The quality of life definition: Where are we going? Uro. 2021;1(1):14-22. doi:10.3390/uro1010003
10. Unsar S, Sut N, Durna Z. Health-related quality of life in patients with coronary artery disease. Journal of Cardiovascular Nursing. 2007;22(6):501-507. doi:10.1097/01.JCN.0000297382.91131.8d
11. Sajobi TT, Wang M, Awosoga O, et al. APPROACH Investigators. Trajectories of health-related quality of life in coronary artery disease. Circ Cardiovasc Qual Outcomes. 2018 Mar;11(3):e003661. doi:10.1161/CIRCOUTCOMES.117.003661
12. Trichopoulou A, Bamia C, Trichopoulos D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Archives of Internal Medicine. 2005;165(8):929-935. doi:10.1001/archinte.165.8.929
13. Widmer, R. J., Flammer, A. J., Lerman, L. O., Lerman, A. The Mediterranean diet, its components, and cardiovascular disease. The American Journal of Medicine. 2015;128(3):229-238. doi:10.1016/j.amjmed.2014.10.014
14. Pekcan AG. Beslenme durumunun saptanması. In: Baysal A, Aksoy M, Besler HT, Bozkurt N, Keçecioğlu S, Mercanlıgil SM, ve ark., editörler. Diyet El Kitabı. 7. baskı. Ankara, Türkiye: Hatiboğlu Yayınevi; 2013:67-142.
15. Schröder H, Fitó M, Estruch R, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. The Journal of Nutrition. 2011;141(6):1140-1145. doi:10.3945/jn.110.135566
16. Pehlivanoğlu EFÖ, Balcıoğlu H, Ünlüoğlu İ. Akdeniz diyeti bağlılık ölçeği’nin Türkçe’ye uyarlanması geçerlilik ve güvenilirliği. Osmangazi Tıp Dergisi. 2020;42(2):160-164. doi:10.20515/otd.504188
17. Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H, HeartQoL Project Investigators). The HeartQoL: Part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. European Journal of Preventive Cardiology. 2014;21(1):98-106. doi:10.1177/20474873124505
18. Duğan Ö, Bektaş H. Koroner arter hastalarında kalp yaşam kalitesi ölçeği’nin Türkçeye uyarlama çalışması. Turk J Cardiovasc Nurs. 2020;11(25):71-81. doi:10.5543/khd.2020.38278
19. Albadrani AM, Al-Ajlan SS, Alharbi ASE, Alharbi AS, Alharbi SMR. Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: A cross-sectional study. International Journal of Medicine in Developing Countries, 2020;4(3):593. doi:10.24911/IJMDC.51-1572217065
20. Jia S, Liu Y, Yuan J. Evidence in guidelines for treatment of coronary artery disease. Coronary Artery Disease: Therapeutics and Drug Discovery. 2020:37-73. doi:10.1007/978-981-15-2517-9_2
21. Ozturk U, Ozturk O, Toksoz P. Dietary quality after diagnosis of coronary heart disease. Int Cardiovasc Res J. 2016;10(2):72. doi:10.17795/icrj-10(2)72
22. Ma Y, Li W, Olendzki BC, et al. Dietary quality 1 year after diagnosis of coronary heart disease. J Am Diet Assoc. 2008 Feb;108(2):240-246; discussion 246-247. doi:10.1016/j.jada.2007.10.047
23. Oikonomou E, Psaltopoulou T, Georgiopoulos G, et al. Western dietary pattern is associated with severe coronary artery disease. Angiology. 2018 Apr;69(4):339-346. doi:10.1177/0003319717721603
24. Mayr HL, Tierney AC, Kucianski T, Thomas CJ, Itsiopoulos C. Australian patients with coronary heart disease achieve high adherence to 6-month Mediterranean diet intervention: Preliminary results of the AUSMED Heart Trial. Nutrition. 2019;61:21-31. doi:10.1016/j.nut.2018.10.027
25. Henríquez Sánchez P, Ruano C, De Irala J, Ruiz-Canela M, Martínez-González MA, Sánchez-Villegas A. Adherence to the Mediterranean diet and quality of life in the SUN Project. European Journal of Clinical Nutrition. 2012;66(3):360-368.
26. Galilea-Zabalza I, Buil-Cosiales P, Salas-Salvadó J, Toledo E, Ortega-Azorín C, Díez-Espino J. PREDIMED-PLUS Study Investigators. Mediterranean diet and quality of life: Baseline cross-sectional analysis of the PREDIMED-PLUS trial. PloS One. 2018;13(6):e0198974. doi:10.1371/journal.pone.0198974
27. Bonaccio M, Di Castelnuovo A, Bonanni A, et al. Adherence to a Mediterranean diet is associated with a better health-related quality of life: A possible role of high dietary antioxidant content. BMJ Open. 2013;3(8):e003003. doi:10.1136/bmjopen-2013-003003
28. Godos J, Guglielmetti M, Ferraris C, et al. Mediterranean diet and quality of life in adults: A systematic review. Nutrients. 2025 Feb5;17(3):577. doi:10.3390/nu17030577
29. Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean diet as a tool to combat inflammation and chronic diseases. An overview. Biomedicines. 2020;8(7):201. doi:10.3390/biomedicines8070201
30. Abd El-Rahman YH. Hemoglobin A1c in non-diabetic NSTEMI patients as a predictor of severity of coronary artery disease. Benha Med J. 2024. doi:10.21608/bmfj.2024.327152.2225
31. Cunningham AT, Crittendon DR, White N, Mills GD, Diaz V, LaNoue MD. The effect of diabetes self-management education on HbA1c and quality of life in African Americans: A systematic review and meta-analysis. BMC Health Services Research. 2018;18:113. doi:10.1186/s12913-018-3186-7
32. Holzer R, BlochW, Brinkmann C. Continuous glucose monitoring in healthy adults possible applications in health care, wellness, and sports. Sensors. 2022;22(5):2030. doi:10.3390/s22052030
33. De Pergola G, D’Alessandro A. Influence of Mediterranean diet on blood pressure. Nutrients. 2018;10(11):1700. doi:10.3390/nu10111700
34. Peñalvo JL, Oliva B, Sotos-Prieto M, et al. Greater adherence to a Mediterranean dietary pattern is associated with improved plasma lipid profile: The Aragon Health Workers Study cohort. Rev Esp Cardiol (Engl Ed). 2015;68(4):290-297. doi:10.1016/j.rec.2014.09.019
35. Handayani DR, Septiadi E, Inayati I, et al. The duration of Mediterranean diet affects the levels of the lipid profile in dyslipidemia patients. ACTA Medical Health Sciences. 2022;1(2):64-70. doi:10.35990/amhs.v1n2.p64-70
36. Hong SJ, Lee YJ, Lee SJ. Hong BK, et al. Treat-to-target or high-intensity statin in patients with coronary artery disease: A randomized clinical trial. Jama. 2023;329(13):1078-1087. doi:10.1001/jama.2023.2487
37. Mesías M, Seiquer I, Muñoz-Hoyos A, Galdó G, Navarro MP. The beneficial effect of Mediterranean dietary patterns on dietary iron utilization in male adolescents aged 11–14 years. International Journal of Food Sciences and Nutrition. 2009;60(sup7):355-368. doi:10.1080/09637480903170641
38. Banerjee A, Dey T, Majumder R, et al. Oleic acid prevents erythrocyte death by preserving haemoglobin and erythrocyte membrane proteins. Free Radical Biology and Medicine. 2023;202:17-33. doi:10.1016/j.freeradbiomed.2023.03.019
39. Xu T, Zhang X, Liu Y, et al. Effects of dietary polyphenol supplementation on iron status and erythropoiesis: A systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2021 Aug 2;114(2):780-793. doi:10.1093/ajcn/nqab068
40. Lane DJ, Richardson DR. The active role of vitamin C in mammalian iron metabolism: Much more than just enhanced iron absorption! Free Radical Biology and Medicine. 2014;75:69-83. doi:10.1016/j.freeradbiomed.2014.07.007