Analysis of contributing factors to a mediterranean style diet in eldery patients with cardiovascular disease history and implications for future preventive interventions

Purpose: Mediterranean diet (MD) is an established healthy-eating style that has demonstrated to have beneficial effects on patients with coronary artery diseases (CAD). Whether MD or its components are transferable to individuals living far from the Mediterranean area has not yet been clarified. Therefore, the aim of the present study was (1) to identify the level of adherence to a MD using a Mediterranean Diet Score (MDS), (2) to examine which components contribute to the MDS, and (3) to explore correlations between the MDS and individual factors (age, sex, education, partnership) as well as health characteristics (selfreported health, body mass index [BMI]). Methods: From a sample of 65 ambulatory patients (> 60 years) with a history of CAD and taking part in a study regarding ageing and health, we received 40 nutrition screening questionnaires (modified 14-item MD Screener from PREDIMED trial) and the MDS was calculated. Education level was defined as 'low' (without vocational training), 'middle' (vocational training) 'high' (higher vocational training), and 'very high' (university degree).. Self-reported health was rated on a 5-point Likert scale from '1= very bad ' to '5= very good '. To analyze which factors of a MD pattern are already prevalent we examined the frequency of positive answers to the respective items (FOI). Correlations were analyzed with Spearmans rank correlation using Stata 14.1.Results: The mean age of the patients was 74.7 years (SD= 8.43), 40% were female, and 55 % were living in a partnership. The proportion of the educational level attained were 12,5% low, 45 % middle, 25 % high and 17,5 % very high. The mean of self-rated health was 2.94 (SD= 0.77) and the mean BMI was 28.5 kg/ m2 (SD= 3.66). The mean MDS was 4.13 (SD= 1.74). The most prevalent food patterns in our sample were olive or canola oil use (FOI= 0.80), avoidance of commercial pastry (FOI= 0.70) and preference for chicken, turkey or rabbit (FOI= 0.68). The food patterns that were least prevalent were small quantity of consumed butter, margarine or cream (FOI= 0.03), high quantity of consumed olive oil (FOI= 0.03) and high quantity of consumed pulses (FOI= 0.05). No significant correlations were found between the MD-Score and individual as well as health characteristics. Conclusions: The mean value of the MDS in our population was significantly lower than in the Mediterranean population in the PREDIMED trial (8.6 [SD= 2]) as was expected in an elderly population in a non-mediterranean country. However, single Mediterranean food components are prevalent like olive oil use even if the quantity does not meet the recommendations. Dietary interventions enhancing the use of already preferred food groups may be able to further reduce unfavourable groups (e.g. oil instead of butter).