Dietary patterns and cardiomethabolic health

Abstract

Las enfermedades cardiometabólicas son la primera causa de muerte a nivel mundial. La prevención primaria de dichas enfermedades es el pilar fundamental para una salud óptima de los adultos, debiendo empezar desde la infancia. La dieta y el ejercicio físico se han reconocido como las estrategias de prevención primaria más efectivas. El estudio de patrones dietéticos permite realizar un análisis detallado y adaptado de los hábitos alimenticios de una población concreta, así como su relación con los factores de riesgo de las enfermedades cardiometabólicas. Existen diferentes tipos de clasificaciones para el análisis de patrones dietéticos: a priori y a posterori. La presente tesis pretende analizar la asociación de patrones alimentarios a posteriori con la aparición de enfermedad cardiovascular y síndrome metabólico. Para ello se han realizado dos revisiones sistemáticas y meta-análisis, así como un tercer estudio donde se han analizado los patrones dietéticos de una cohorte de adultos españoles con elevado riesgo de diabetes. Los resultados de las revisiones sistemáticas y meta-análisis indican que la adherencia a un patrón dietético prudente/saludable disminuye el riesgo de enfermedad cardiovascular y síndrome metabólico. En el caso de la adherencia a un patrón considerado no prudente o no saludable, en relación a la enfermedad cardiovascular, los resultados, a pesar de mostrar una tendencia de riesgo, no fueron estadísticamente significativos. En el caso del síndrome metabólico, los resultados mostraron una asociación directa, pudiendo establecer que un patrón no saludable aumenta el riesgo de desarrollar síndrome metabólico. En el tercer estudio se pudo observar un distanciamiento en la adherencia del patrón mediterráneo típico de otras cohortes estudiadas en áreas geográficas similares. Además, no se pudo observar ninguna asociación entre la adherencia a los patrones de la población de estudio y la diabetes o el síndrome metabólico. En conclusión, el estudio de los patrones dietéticos permite caracterizar los hábitos alimentarios de una población concreta y su relación con patologías prevalentes.

Cardiometabolic diseases are the leading cause of mortality and morbidity worldwide. The primary prevention of these diseases is the fundamental basis for achieving an optimum adult health, starting from childhood. Diet and physical activity have been recognized as the most effective primary prevention strategies. The study of dietary patterns allows a detailed and adapted analysis of the dietary habits of a specific population, as well as its relation with the risk factors of developing cardiometabolic diseases. There are different approaches for the analysis of dietary patterns: a priori and a posteriori. The present thesis aims to analyze the association of a posteriori dietary patterns with the onset of cardiovascular disease and metabolic syndrome. Therefore, two systematic reviews and meta-analyses have been carried out, as well as a third study where the dietary patterns of a cohort of Spanish adults with high diabetes risk have been analyzed. The first study provides evidence that following a prudent/healthy dietary pattern is protective against all clinical cardiovascular endpoints, except for stroke. In the case of a Western/unhealthy dietary pattern, no direct associations with any of the cardiovascular outcomes were seen. Findings from the second study demonstrate that a prudent/healthy dietary pattern is associated with a lower prevalence of MetS in cross-sectional studies, and an unhealthy pattern is linked to an increased risk of developing the syndrome. The pooled estimates from the three included prospective cohort studies generally agree with the findings from the cross-sectional studies; however, the protective role of the prudent/healthy dietary pattern was not supported by the 95% confidence interval. Evidence from the third study shows that the dietary patterns of a Mediterranean population at high risk of diabetes can be analyzed in order to tailor interventions and achieve better health outcomes. Despite their participation in a lifestyle intervention aiming to improve the dietary habits of individuals at high diabetic risk, subjects in the third study showed a high degree of adherence to the three non-Mediterranean dietary patterns throughout the four-year follow-up. This is illustrative of the difficulty individuals commonly encounter when attempting to change any habit, and begs the need for alternative strategies to aid the switch to a healthier dietary pattern. However, none of the dietary patterns identified in the present study appeared to be significantly associated with the development of MetS or T2DM.

In conclusion, the study of dietary patterns in this thesis allows to a better characterization of the eating habits of a specific population and its relation with prevalent pathologies.