Diet quality and carotid atherosclerosis in intermediate cardiovascular risk individuals

Recio-Rodriguez et al. Nutrition Journal (2017) 16:40 DOI 10.1186/s12937-017-0266-1 RESEARCH Open Access Diet quality and carotid atherosclerosis in intermediate cardiovascular risk individuals Jose I. Recio-Rodriguez1,8*, Irene A. Garcia-Yu2, Rosario Alonso-Dominguez3, José A. Maderuelo-Fernandez3, Maria C. Patino-Alonso4, Cristina Agudo-Conde3, Natalia Sanchez-Aguadero3, Rafel Ramos5, Ruth Marti5, Emiliano Rodriguez-Sanchez3, Manuel A. Gómez-Marcos6 and Luis Garcia-Ortiz7 Abstract Background: Diet quality indices address the diet’s complexity and are calculated by a combination of foods and/ or nutrients which together represent a dietary pattern. The current study analysed the relationship between the common carotid artery intima media thickness (cIMT), the presence of plaque and the carotid target organ damage (cTOD) with the diet quality assessed through the Diet Quality Index (DQI) questionnaire in a Spanish adult population. Methods: A cross-sectional study. The target population comprised of 500 individuals aged between 35 to 74 years who had intermediate cardiovascular risk. The diet was evaluated by DQI which included beneficial and detrimental foods scored 3, 2 or 1. The total possible score ranges from 18 (the lowest quality) to 54 (the highest quality). Carotid ultrasound was used to assess the cIMT, the presence of plaque and the cTOD. Results: Among the 500 participants (mean age 60.3 ± 8.4 years), 54.4% were male. DQI mean was 40.08 ± 2.79, with no differences between men and women. The cIMT was lower in women (p = 0.002) and 16.6% of the participants presented plaque. No significant association was found between DQI and cIMT after adjusting by age and sex, and other confounders (p = 0.690). The logistic regression analysis showed no association of DQI with thickened cIMT (p = 0.890), the presence of plaques (p = 0.799) or cTOD (p = 0.942). Conclusions: The diet quality index was not associated with subclinical atherosclerosis in this Spanish population at intermediate risk of cardiovascular disease. Trial registration: ClinicalTrials.gov; Identifier: NCT01428934. Keywords: Carotid artery diseases, Food habits, Diet, Mediterranean Background The measurement of common carotid artery intimamedia thickness (cIMT) allows the detection of thickening of the artery wall during the initial phases of atherosclerosis, as well as to predict the risk of its clinical complications (coronary artery disease (CAD) or cardiovascular events) [1]. Increased cIMT and/or atheromatous plaque may increase the risk of cardiovascular disease by up to * Correspondence: 1 Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (redIAPP), Department of Nursing and Physiotherapy (University of Salamanca), Salamanca, Spain 8 Primary Care Research Unit. Alamedilla Health Center, 37003 Salamanca, Spain Full list of author information is available at the end of the article four-fold in comparison with individuals who do not suffer from carotid target organ damage (cTOD) [2–5]. To be more specific, with every increase of 0.1 mm of the cIMT, the risk of coronary heart disease is increased by 15% and the risk of cerebrovascular disease by 18% [2, 6–9]. The cIMT has been related to several components of the Mediterranean diet (MD) in isolation (fruits, whole grain cereals, fibre, walnuts and olive oil) [10, 11]. Nevertheless, its relationship with the adherence to the MD as a whole is uncertain. Thus, some studies suggest the MD may slow down the progress of the cIMT [12, 13], whereas others do not show this association, or just show it in individuals with a basal cIMT up to 0.9 mm [14, 15]. Diet quality indices address the diet’s complexity and are calculated by a © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Recio-Rodriguez et al. Nutrition Journal (2017) 16:40 combination of foods and/or nutrients which together represent a dietary pattern [16]. The best values in these indices have been associated with positive changes in weight [17]. They have also indicated an inverse relationship with several inflammatory response markers [18]. On the other hand, the diet quality has been related with vascular health assessed by arterial stiffness and endothelial dysfunction [19]. However, there is little evidence of the association between the diet quality indices and the surrogate markers of atherosclerosis as the cIMT. For all these reasons and taking into account that the cIMT shows a greater predictive value of cardiovascular disease [20], the current study analysed the relationship between the cIMT and the diet quality. It is assessed through the Diet Quality Index (DQI) questionnaire in adults. Methods Design The findings shown here are a sub-analysis of the MARK study [21]. The MARK study is a cross-sectional study whose purpose was to evaluate if ankle-brachial index (ABI), measures of arterial stiffness by the Cardio ankle vascular index (CAVI), postprandial glucose, glycosylated haemoglobin, self-measured blood pressure and the presence of comorbidities are independently associated with the incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate risk population. The second step will be 5- and 10-year follow up to evaluate cardiovascular morbidity and mortality. Study population The MARK study included 2384 participants but only in 500 of these was carotid ultrasound performed. This was the only reason to exclude the rest (1884 participants) from the analysis of this work. The population comprised individuals aged between 35 and 74 years who had intermediate cardiovascular risk, which was defined as coronary risk between 5 and 15% at 10 years according to the Framingham-adapted risk equation (REGICOR) [22], cardiovascular mortality risk between 1 and 5% at 10 years according to the SCORE equation [23] or moderate risk according to the 2007 European Society of Hypertension guidelines for the management of arterial hypertension [24]. The exclusion criteria were terminal illness, institutionalization at the appointment time, or a personal history of atherosclerotic disease (Acute myocardial infarction, angina pectoris or stroke), registered in his/her electronic clinical history. Sample selection wa (...truncated)