Incremental monounsaturated to saturated fat ratio and fibre consumption is associated with a reduction in a composite score of modifiable cardiovascular risk factors: Prospective results from the Moli-sani study

Abstract

Background/objectives: Unsaturated fats, fibre-rich foods and polyphenols are distinctive features of a traditional Mediterranean diet and have pleiotropic properties possibly contributing to reduce the long-term risk of non-communicable diseases and mortality associated with this diet. We aimed to evaluate whether changes over time in dietary fats, fibre and polyphenols consumption are associated with modifications in cardiovascular disease (CVD) risk factors.

Methods: The analytic sample consists of a sub-cohort of 2023 men and women enrolled in the Moli-sani Study (n = 24,325). Dietary and health data were obtained both at baseline (2005-2010) and at re-examination (2017-2020). The exposures were changes in dietary fats, fibre and polyphenols consumption measured after 12.7 years (median), and the outcome was change in a composite score including 13 modifiable CVD risk factors (e.g., blood lipids, C-reactive protein), measured both at enrolment and after the 12.7 years period.

Results: In multivariable-adjusted analysis including lifestyles, sociodemographic and clinical factors, an incremental intake of the ratio of monounsaturated to saturated fats or of fibre was associated with a reduction in the composite score of CVD risk factors (β = -0.086; 95%CI -0.150, -0.021 and β = -0.051; 95%CI -0.091, -0.012, respectively). Change in polyphenol intake was not associated with a substantial variation in the CVD risk score (p = 0.15).

Conclusions: An incremental consumption over time of monounsaturated versus saturated fats and of fibre was associated with an improvement in modifiable CVD risk factors as reflected by a composite score.

Fig. 1. Changes over time in the intake of fats, fibre and polyphenols (tertiles of) associated with 1-SD change of the composite score of cardiovascular disease risk factors over 12.7 years in the Moli-sani cohort (n = 2023).

Regression coefficient β with 95% confidence interval (95%CI) obtained from the linear regression analysis adjusted for age, sex, duration of follow-up, baseline marital status, educational level, housing, occupational class, baseline energy intake and changes in energy intake, history of CVD (at baseline and follow-up), history of cancer (at baseline and follow-up), diabetes (at baseline and follow-up), hypertension (at baseline and follow-up), dyslipidaemia (at baseline and follow-up), baseline physical activity and changes in physical activity, smoking status (at baseline and follow-up), baseline levels of each the dietary exposure and initial levels of the score of cardiovascular disease risk factors, changes in alcohol intake (g/d), energy from carbohydrates and protein, and included all the listed dietary variables simultaneously.