The Diet Adherence in Cardiovascular Disease Risk Factors Patients in the North of Iran Based on the Mediterranean Diet Adherence

Background and objectives: Before any nutritional intervention, it is necessary to have the prospect of eating habits of people with cardiovascular risk factors. In this study, we assessed the adherence of healthy diet based on Mediterranean dietary pattern and related factors in adults in the north of Iran. Methods: This study was conducted on 550 men and women with cardiovascular risk factors that referred to Heshmat hospital in Rasht, northern Iran. Information was collected by interview and reading medical history and measuring anthropometric indexes. The Mediterranean Diet Adherence Screener was used for assessing dietary adherence, this screener was modified according to religious beliefs and culture of Iran. Results: The mean age of participants was 58±0.38 years. The mean of body mass index was 27±0.01 kg/m2, and the mean of waist circumference was 98±0.2 cm. The mean of dietary adherence was 5.76±0.07. 45% of participants had low adherence, and just 4% had suitable adherence. The mean of dietary adherence in men was significantly higher than women (p=0. 07). Participants in rural area and high educational participants insignificantly had an unsuitable dietary Adherence. There was no significant association between some cardiovascular disease risk factors and dietary adherence. Conclusion: Education to different group about dietary intake correction and using a Mediterranean dietary pattern that is similar to dietary intake in the north of Iran, for controlling cardiovascular disease is necessary.

[1] Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274-84.
[2] Panagiotakos DB, Pitsavos C, Stefanadis C. Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis. 2006 Dec;16(8):559-68.
[3] Schröder H, Fitó M, Estruch R, Martínez‐González MA, Corella D, Salas‐Salvadó J, 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):1140-5.
[4] Martínez-González MÁ, Sanchez-Villegas A. Review: The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine or the whole pattern? European journal of epidemiology. 2004;19(1):9-13.
[5] Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. The Journal of nutrition. 2004;134(12):3355-61.
[6] 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. Journal of the American College of Cardiology. 2004;44(1):152-8.
[7] Knoops KT, de Groot LC, Kromhout D, Perrin A-E, Moreiras-Varela O, Menotti A, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. Jama. 2004;292(12):1433-9.
[8] Robertson RM, Smaha L. Can a Mediterranean-style diet reduce heart disease? Circulation. 2001;103(13):1821-2
[9] Bilenko N, Fraser D, Vardi H, Shai I, Shahar DR. Mediterranean diet and cardiovascular diseases in an Israeli population. Preventive medicine. 2005;40(3):299-305.
[10] Martinez-Gonzalez M, Fernandez-Jarne E, Serrano-Martinez M, Wright M, Gomez-Gracia E. Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet. European Journal of Clinical Nutrition. 2004;58(11):1550-2.
[11] Hatmi Z, Tahvildari S, Motlag AG, Kashani AS. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovascular Disorders. 2007;7(1):32.
[12] di Giuseppe R, Bonanni A, Olivieri M, Di Castelnuovo A, Donati MB, de Gaetano G, et al. Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the ‘Alto Molise’region: the MOLI-SAL project. Nutrition, Metabolism and Cardiovascular Diseases. 2008;18(6):415-21.
[13] Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean depression: a meta‐analysis. Annals of neurology. 2013;74(4):580-91.
[14] Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. Journal of the American College of Cardiology. 2004;44(1):152-158.
[15] Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093-100
[16] Hu EA, Toledo E, Diez-Espino J, Estruch R, Corella D, Salas-Salva. 2013;8(4):e60166. Epub 2013/05/03.
[17] Viscogliosi G, Cipriani E, Liguori ML, Marigliano B, Saliola M, Ettorre E, et al. Mediterranean dietary pattern adherence: associations with prediabetes, metabolic syndrome, and related microinflammation. Metabolic syndrome and related disorders. 2013;11(3):210-6.
[18] Jafari A, Asal, Najafi, Mehdi, Saeed, et al. Diet quality in patients undergoing coronary artery bypass surgery based on quality Mediterranean diet. Journal of Diabetes and Metabolism. 2008;7(4):407-18.
[19] Dernini S, Berry EM. Mediterranean diet: From a healthy diet to a sustainable dietary pattern. Frontiers in nutrition. 2015;2:15.
[20] Campbell DJ, Ronksley PE, Manns BJ, Tonelli M, Sanmartin C, Weaver RG. The association of income with health behavior change and disease monitoring among patients with chronic disease. PloS one. 2014;9(4):e94.