Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis

Alejandro Oncina-Cánovas^{1

2

3}, Jesús Vioque^{4

5

6

7}, Sandra González-Palacios^{1

2

3}, Miguel Ángel Martínez-González^{8

9

10}, Jordi Salas-Salvadó^{8

11

12

13}, Dolores Corella^{8

14}, Dolores Zomeño^{8

15}, J Alfredo Martínez^{8

16

17}, Ángel M Alonso-Gómez^{8

18}, Julia Wärnberg^{8

19}, Dora Romaguera^{8

20}, José López-Miranda^{8

21}, Ramon Estruch^{8

22}, Rosa M Bernal-Lopez^{8

23}, José Lapetra^{8

24}, J Luís Serra-Majem^{8

25}, Aurora Bueno-Cavanillas^{1

26}, Josep A Tur^{8

27}, Vicente Martín-Sánchez^{14

28}, Xavier Pintó^{8

29}, Miguel Delgado-Rodríguez^{14

30}, Pilar Matía-Martín³¹, Josep Vidal^{32

33}, Clotilde Vázquez^{8

34}, Lidia Daimiel³⁵, Emili Ros^{8

36}, Estefanía Toledo^{8

9}, Nancy Babio^{8

11

12

13}, Jose V Sorli^{8

14}, Helmut Schröder^{1

15}, María Angeles Zulet^{8

16}, Carolina Sorto-Sánchez^{8

18}, Francisco Javier Barón-López^{8

19}, Laura Compañ-Gabucio^{1

2

3}, Marga Morey^{8

20}, Antonio García-Ríos^{8

21}, Rosa Casas^{8

22}, Ana María Gómez-Pérez^{8

23}, José Manuel Santos-Lozano^{8

24}, Zenaida Vázquez-Ruiz^{8

9}, Stephanie K Nishi^{8

11

12

13}, Eva M Asensio^{8

14}, Núria Soldevila^{1

15}, Itziar Abete^{8

16}, Leire Goicolea-Güemez^{8

18}, Pilar Buil-Cosiales^{8

9}, Jesús F García-Gavilán^{8

11

12

13}, Erik Canals^{1

15}, Laura Torres-Collado^{1

2

3}, Manuela García-de-la-Hera^{1

2

3}

Affiliations

¹ CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
² Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain.
³ Nutritional Epidemiology Unit, University Miguel Hernandez, Alicante, Spain.
⁴ CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. vioque@umh.es.
⁵ Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain. vioque@umh.es.
⁶ Nutritional Epidemiology Unit, University Miguel Hernandez, Alicante, Spain. vioque@umh.es.
⁷ Dpto. Salud Pública, Facultad de Medicina, Hª de La Ciencia y Ginecología, Avda. Ramón y Cajal s/n, Sant Joan d'Alacant, 03550, Alicante, Spain. vioque@umh.es.
⁸ Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
⁹ Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain.
¹⁰ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹¹ Departament de Bioquímica I Biotecnologia, Universitat Rovira I Virgili, Unitat de Nutrició, Reus, Spain.
¹² Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain.
¹³ Institut D'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
¹⁴ Department of Preventive Medicine, University of Valencia, Valencia, Spain.
¹⁵ Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal D'Investigació Médica (IMIM), Barcelona, Spain.
¹⁶ Department of Nutrition, Food Sciences, and Physiology, University of Navarra, Pamplona, Spain.
¹⁷ Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain.
¹⁸ Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
¹⁹ EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29010, Málaga, Spain.
²⁰ Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain.
²¹ Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
²² Department of Internal Medicine, Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain.
²³ Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de La Victoria Hospital, University of Málaga, Málaga, Spain.
²⁴ Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
²⁵ Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas de Gran Canaria, Spain.
²⁶ Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
²⁷ Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain.
²⁸ Institute of Biomedicine (IBIOMED), University of León, León, Spain.
²⁹ Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
³⁰ Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain.
³¹ Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
³² CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
³³ Department of Endocrinology, Institut D'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain.
³⁴ Department of Endocrinology and Nutrition, Hospital Fundación Jimenez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, Madrid, Spain.
³⁵ Nutritional Control of the Epigenome Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain.
³⁶ Lipid Clinic, Department of Endocrinology and Nutrition, Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain.

PMID: 34368892
PMCID: PMC8783853
DOI: 10.1007/s00394-021-02647-4

Randomized Controlled Trial

Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis

Alejandro Oncina-Cánovas et al. Eur J Nutr. 2022 Feb.

. 2022 Feb;61(1):357-372.

doi: 10.1007/s00394-021-02647-4. Epub 2021 Aug 9.

Authors

Affiliations

¹ CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
² Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain.
³ Nutritional Epidemiology Unit, University Miguel Hernandez, Alicante, Spain.
⁴ CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. vioque@umh.es.
⁵ Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain. vioque@umh.es.
⁶ Nutritional Epidemiology Unit, University Miguel Hernandez, Alicante, Spain. vioque@umh.es.
⁷ Dpto. Salud Pública, Facultad de Medicina, Hª de La Ciencia y Ginecología, Avda. Ramón y Cajal s/n, Sant Joan d'Alacant, 03550, Alicante, Spain. vioque@umh.es.
⁸ Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
⁹ Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, Pamplona, Spain.
¹⁰ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹¹ Departament de Bioquímica I Biotecnologia, Universitat Rovira I Virgili, Unitat de Nutrició, Reus, Spain.
¹² Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain.
¹³ Institut D'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
¹⁴ Department of Preventive Medicine, University of Valencia, Valencia, Spain.
¹⁵ Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal D'Investigació Médica (IMIM), Barcelona, Spain.
¹⁶ Department of Nutrition, Food Sciences, and Physiology, University of Navarra, Pamplona, Spain.
¹⁷ Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain.
¹⁸ Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
¹⁹ EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29010, Málaga, Spain.
²⁰ Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain.
²¹ Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
²² Department of Internal Medicine, Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain.
²³ Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de La Victoria Hospital, University of Málaga, Málaga, Spain.
²⁴ Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
²⁵ Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas de Gran Canaria, Spain.
²⁶ Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
²⁷ Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain.
²⁸ Institute of Biomedicine (IBIOMED), University of León, León, Spain.
²⁹ Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
³⁰ Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain.
³¹ Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
³² CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
³³ Department of Endocrinology, Institut D'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain.
³⁴ Department of Endocrinology and Nutrition, Hospital Fundación Jimenez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, Madrid, Spain.
³⁵ Nutritional Control of the Epigenome Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain.
³⁶ Lipid Clinic, Department of Endocrinology and Nutrition, Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain.

PMID: 34368892
PMCID: PMC8783853
DOI: 10.1007/s00394-021-02647-4

Abstract

Purpose: We explored the cross-sectional association between the adherence to three different provegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), and the cardiometabolic risk in adults with metabolic syndrome (MetS) of the PREDIMED-Plus randomized intervention study.

Methods: We performed a cross-sectional analysis of baseline data from 6439 participants of the PREDIMED-Plus randomized intervention study. The gPVG food pattern was built by positively scoring plant foods (vegetables/fruits/legumes/grains/potatoes/nuts/olive oil) and negatively scoring, animal foods (meat and meat products/animal fats/eggs/fish and seafood/dairy products). The hPVG and uPVG were generated from the gPVG by adding four new food groups (tea and coffee/fruit juices/sugar-sweetened beverages/sweets and desserts), splitting grains and potatoes and scoring them differently. Multivariable-adjusted robust linear regression using MM-type estimator was used to assess the association between PVG food patterns and the standardized Metabolic Syndrome score (MetS z-score), a composed index that has been previously used to ascertain the cardiometabolic risk, adjusting for potential confounders.

Results: A higher adherence to the gPVG and hPVG was associated with lower cardiometabolic risk in multivariable models. The regression coefficients for 5th vs. 1st quintile were - 0.16 (95% CI: - 0.33 to 0.01) for gPVG (p trend: 0.015), and - 0.23 (95% CI: - 0.41 to - 0.05) for hPVG (p trend: 0.016). In contrast, a higher adherence to the uPVG was associated with higher cardiometabolic risk, 0.21 (95% CI: 0.04 to 0.38) (p trend: 0.019).

Conclusion: Higher adherence to gPVG and hPVG food patterns was generally associated with lower cardiovascular risk, whereas higher adherence to uPVG was associated to higher cardiovascular risk.

Keywords: Cardiometabolic risk; Dietary food patterns; Metabolic syndrome; Pro-vegetarian.

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Conflict of interest statement

J.S.-S. reported receiving research support from the Instituto de Salud Carlos III, Ministerio de Educación y Ciencia, Departament de Salut Pública de la Generalitat de Catalunya, the European Commission, the USA National Institutes of Health; receiving consulting fees or travel expenses from Danone, California Walnut Commission, Eroski Foundation, Instituto Danone, Nestle, and Abbott Laboratories, receiving nonfinancial support from Hojiblanca, Patrimonio Comunal Olivarero, the California Walnut Commission, Almond Board of California, La Morella Nuts, Pistachio Growers and Borges S.A; serving on the board of and receiving grant support through his institution from the International Nut and Dried Foundation and the Eroski Foundation; and grants and personal fees from Instituto Danone; Serving in the Board of Danone Institute International. D.C. reported receiving grants from Instituto de Salud Carlos III. R.E. reported receiving grants from Instituto de Salud Carlos III, Fundación Dieta Meditarránea and Cerveza y Salud and olive oil for the trial from Fundación Patrimonio Comunal Olivarero and personal fees from Brewers of Europe, Fundación Cerveza y Salud, Interprofesional del Aceite de Oliva, Instituto Cervantes in Albuquerque, Milano and Tokyo, Pernod Ricard, Fundación Dieta Mediterránea (Spain), Wine and Culinary International Forum and Lilly Laboratories; non-financial support from Sociedad Española de Nutrición and Fundación Bosch y Gimpera; and grants from Uriach Laboratories. E.R. reports grants, personal fees, non-financial support and other from California Walnut Commission, during the conduct of the study; grants, personal fees, non-financial support and other from Alexion; grants from Amgen and Pfizer; grants, personal fees and other from Sanofi Aventis; personal fees, non-financial support and other from Ferrer International, Danone and Merck Sharp & Dohme, personal fees and other from Amarin, outside the submitted work. S.K.N. received research support from a Canadian Institutes of Heath Research and is a volunteer member of the non-for-profit group Plant Based Canada. The rest of the authors have declared that no competing interests exist. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

**Fig. 1**
Flowchart of participants included in the present analysis from the PREDIMED-Plus Study

See this image and copyright information in PMC

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Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis

Affiliations

Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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MeSH terms

LinkOut - more resources

Medical