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Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study.
Michaëlsson, Karl; Baron, John A; Byberg, Liisa; Höijer, Jonas; Larsson, Susanna C; Svennblad, Bodil; Melhus, Håkan; Wolk, Alicja; Warensjö Lemming, Eva.
Afiliação
  • Michaëlsson K; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Baron JA; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Byberg L; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America.
  • Höijer J; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
  • Larsson SC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
  • Svennblad B; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Melhus H; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Wolk A; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Warensjö Lemming E; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
PLoS Med ; 17(9): e1003331, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941436
ABSTRACT

BACKGROUND:

It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. METHODS AND

FINDINGS:

Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone.

CONCLUSIONS:

These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Dieta Mediterrânea Tipo de estudo: Estudo de etiologia / Estudo de incidência / Estudo observacional / Estudo prognóstico / Fatores de risco Limite: Idoso / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: Europa Idioma: Inglês Revista: PLoS Med Assunto da revista: Medicina Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Suécia

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Dieta Mediterrânea Tipo de estudo: Estudo de etiologia / Estudo de incidência / Estudo observacional / Estudo prognóstico / Fatores de risco Limite: Idoso / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: Europa Idioma: Inglês Revista: PLoS Med Assunto da revista: Medicina Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Suécia
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