Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study

Sanchez-Aguadero et al. Health and Quality of Life Outcomes (2016) 14:169 DOI 10.1186/s12955-016-0572-x RESEARCH Open Access Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study Natalia Sanchez-Aguadero1*, Rosario Alonso-Dominguez1, Luis Garcia-Ortiz1,2, Cristina Agudo-Conde1, Carmela Rodriguez-Martin1, Angela de Cabo-Laso1, Benigna Sanchez-Salgado1, Rafel Ramos3, Jose A. Maderuelo-Fernandez1, Manuel A. Gomez-Marcos1,4, Jose I. Recio-Rodriguez1,5 and MARK Group Abstract Background: To analyze the interplay between diet, physical activity and health-related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk. Methods: This study analyzed 314 subjects, aged 35–74 years (50.6% women), from the MARK study, conducted in Spain. Health related quality of life was measured by the SF-12 questionnaire. The assessment of the lifestyles included the diet quality index, the adherence to the Mediterranean diet and the leisure time physical activity practice. Results: The highest values of health related quality of life were obtained in the area of vitality (51.05 ± 11.13), while the lowest were found in the general health (39.89 ± 8.85). In the multiple linear regression analysis, after adjustment for age, gender and other confounders, for each point of increase in the Mediterranean diet adherence score, there was an increase of 1.177 points in the mental component value (p < 0.01). Similarly, for each point of increase in the Diet Quality Index Score, there was an increase in the mental component of 0.553 (p < 0.05). Likewise, the physical activity was positively associated with the physical function and vitality (β = 0.090 and 0.087, (p < 0.01 and p < 0.05), respectively). Conclusions: In people with intermediate cardiovascular risk, better food habits and greater adherence to the Mediterranean diet are associated with higher scores on the mental component of quality of life. Likewise, increased physical activity is related with positive scores on the physical function. Keywords: Health-related quality of life, Life style, Food habits, Exercise Background Self-reporting of health outcomes have increasing relevance to research, clinical practice and health planning [1, 2]. Analysis of quality of life provides complementary information to traditional health indicators based on morbidity and mortality [3] and it is a valid measurement for self-perceived mental and physical health * 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), 37003 Salamanca, Spain Full list of author information is available at the end of the article status that is closely associated with cardiovascular disease and all-cause mortality [4, 5]. One of the most used instruments worldwide to measure the health related quality of life (HRQL) is the SF-36 questionnaire or its shorter version SF-12 that reduces the administration workload [3, 4]. Self-perceived health status has been previously associated with diet. Poor diet quality, characterized by low consumption of particular healthy foods or nutrients has been associated with low mental and physical health [5–9]. Furthermore, evidence from dietary intervention studies indicates an improvement of quality of life through healthy diets [10, 11]. It has been argued that the social © The Author(s). 2016 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. Sanchez-Aguadero et al. Health and Quality of Life Outcomes (2016) 14:169 and cultural aspects related to the Mediterranean diet may provide additional health benefits [12]. The PREDIMED study showed in a follow-up period of 4.8 years, that an energy-unrestricted Mediterranean diet which includes consumption of extra-virgin olive oil or nuts resulted in an absolute risk reduction of approximately 3 major cardiovascular events per 1000 person-year, for a relative risk reduction of approximately 30%. These results support the benefits of the Mediterranean diet for cardiovascular risk reduction [13]. Currently, physical inactivity is a major public health problem [14]. Exercise reduces mortality and lowers the risk of developing physical and mental chronic diseases [15]. Studies in the general population [16–19] have found a positive association between physical activity, vitality and mental health. This improves the overall quality of life [20, 21]. Similar results were found in special populations such as the elderly or the obese [22, 23]. The subgroup of patients with intermediate cardiovascular risk is the group in which the highest number of cardiovascular events occur [24], and it is known the association of these with a worse HRQL [25]. The European Guidelines on cardiovascular disease prevention in clinical practice highlights the importance in those subjects of promoting healthy lifestyle behaviour by tackling unhealthy lifestyles (e.g. poor-quality diet, physical inactivity, smoking) and by optimising risk factors [26, 27]. Some studies have analyzed the relationship between quality of life, exercise and Mediterranean diet in healthy subjects and individuals with various pathologies but few have focused their research on individuals with intermediate cardiovascular risk. Therefore, the purpose of this study is to analyze the interplay between diet, physical activity and health related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk. Methods Design The MARK study [28] is a longitudinal study to evaluate if ankle-brachial index (ABI), measures of arterial stiffness (CAVI), postprandial glucose, glycosylated hemoglobin, 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 current study refers to the baseline visit. The second step will be 5- and 10-years follow up to evaluate cardiovascular morbidity and mortality. Study population The study population comprised 500 subjects recruited (...truncated)