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Observational Study
. 2024 Jan 10;22(1):44.
doi: 10.1186/s12967-023-04814-z.

Sex-differences in Mediterranean diet: a key piece to explain sex-related cardiovascular risk in obesity? A cross-sectional study

Luigi Barrea #  1   2 , Ludovica Verde #  3   4 , Rosario Suárez  5 , Evelyn Frias-Toral  6 , Celina Andrade Vásquez  5 , Annamaria Colao  3   7   8 , Silvia Savastano  3   7 , Giovanna Muscogiuri  9   10   11
Affiliations
Observational Study

Sex-differences in Mediterranean diet: a key piece to explain sex-related cardiovascular risk in obesity? A cross-sectional study

Luigi Barrea et al. J Transl Med. .

Abstract

Background: Mediterranean Diet (MD) has many health benefits, particularly in reducing cardiovascular risk (CVR). However, it is still little known if there are any sex differences in following this nutritional pattern and, thus, the potential sex-related repercussions on CVR in obesity. The study aimed to characterize sex-related adherence to MD and its association with CVR factors in subjects with obesity.

Methods: A total of 968 females (33.81 ± 11.06 years; BMI 34.14 ± 7.43 kg/m2) and 680 males (aged 34.77 ± 11.31years; BMI 33.77 ± 8.13 kg/m2) were included in a cross-sectional observational study. Lifestyle habits, anthropometric parameters, high sensitivity C-reactive protein (hs-CRP), and adherence to MD were evaluated.

Results: Females had significantly higher adherence to MD and lower hs-CRP levels than males (p < 0.001). Additionally, females consumed significantly more vegetables, fruits, legumes, fish/seafood, nuts, and sofrito sauce and less quantity of olive oil, butter, cream, margarine, red/processed meats, soda drinks (p = 0.001), red wine, and commercial sweets and confectionery than their counterparts. A PREDIMED score of ≤ 6 was associated with a significantly increased CVR in both sexes.

Conclusions: Females had higher adherence to MD, lower CVR, and different food preferences than males. Although the same PREDIMED threshold has been identified as a spy of CVR, the sex-related preference of individual foods included in the MD could explain the different impact of this nutritional pattern on CVR in both sexes.

Keywords: Cardiovascular risk; Diet; Gender; High sensitivity C reactive protein; Mediterranean diet; Nutrition; Obesity; Sex differences.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study participants
Fig. 2
Fig. 2
Sex differences in adherence to MD and hs-CRP levels. A p-value in bold type denotes a significant difference (p < 0.05). PREDIMED, PREvención con DIetaMEDiterránea; hs-CRP, High Sensitivity C Reactive Protein. Median values (minimum—maximum): PREDIMED score: 7 (1 – 14) vs 7 (1–14) females and males, respectively; hs-CRP levels: 1.80 (0.02–19.22 mg/L) vs 2.33 (0.90–17.70 mg/L) females and males, respectively
Fig. 3
Fig. 3
Cardiovascular risk categories assessed according to hs-CRP levels by sex. The % CVR was calculated based on sex. A p-value in bold type denotes a significant difference (p < 0.05). CVR, cardiovascular risk
Fig. 4
Fig. 4
Adherence to MD according to sex. The % adherence to MD was calculated based on sex. A p-value in bold type denotes a significant difference (p < 0.05). MD Mediterranean Diet
Fig. 5
Fig. 5
ROC for predictive values of PREDIMED score in detecting the high cardiovascular risk (hs-CRP ≥ 3.0 mg/L). A p-value in bold type denotes a significant difference (p < 0.05). PREDIMED PREvención con DIetaMEDiterránea
See this image and copyright information in PMC

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