Adherence To A Diet — What Does It Mean?

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Hard on the heels of studies showing that following the Mediterranean diet (MD) or MIND diet can have significant effects on the likelihood of dementia as one ages, comes a very large-scale study showing that the fine-grain details of following the MD can significantly affect the cardiovascular outcomes for an individual as he/she ages, and so, presumably, also the brain health outcomes. At the simplest, “MD is associated with lower CVD [cardiovascular disease] risk but this relationship is confined to higher socioeconomic groups.” Since the MIND diet is quite similar to the the MD diet, presumably these results will also apply to it.

It has been informally obvious for some time that healthy eating focusing on quality vegetables is seriously sensitive to the price of those vegetables: Just perform a search on “health effects of the cost of fresh vegetables” and browse the results. However, the study in question, High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups… set out to scientifically study the issue and quantify the relationship.

The Background statement for the study is:

It is uncertain whether the cardiovascular benefits associated with Mediterranean diet (MD) may differ across socioeconomic groups.

The study, conducted in Italy, enrolled 18,991 men and women aged 35 years and older from the Molise region and ran for 4.3 years. The degree of adherence to the Mediterranean Diet was was determined by the (self-reported) Mediterranean diet score (9-question version; see also 14-question version). Socioeconomic status (group) was determined by the household income (euros/year) combined with educational level. The individual cardiovascular hazard ratios (risk of heart attack) were calculated by standard statistical techniques).

This study reconfirmed earlier work that the Mediterranean diet (MD) is associated with lower cardiovascular disease (CVD) risk. However, it showed that amount of protection provided is sensitive to the socioeconomic status (group) of an individual. Specifically, for higher socioeconomic groups, an increase in the MD score was associated with an increase in protection from CVD risk, but that association was notably weaker for lower socioeconomic groups. Examination of the details of the study inputs showed that for each given MD score group, the socioeconomic subgroups of that score group showed many diet-related disparities such as dietary diversity and different intakes of antioxidants and polyphenols, organic vegetables and whole grain bread consumption.

To a certain extent, this shows that the Mediterranean diet score (MD score) is a blunt instrument. People attaining the same MD score can have such different dietary details that the associated CVD risk protection is significantly different. Since this effect appears independently for education and for income, it is not totally a matter of money, but also education and point of view.

This Moli-sani Project study focused on the MD and protection from CVD. However, the accumulation of findings culminating in Mediterranean/MIND Diet Seriously Fights Alzheimer’s/Dementia showed that the MD diet can provide protections against dementia. It would seem likely that the finds of the present study would also apply to dementia. Hopefully, the Moli-sani Project will have data available to explore this question too.

Several media articles about the study are given below. Unfortunately, they have taken a sensationalistic approach to their headlines, which imply that the MD won’t/cannot benefit someone who isn’t upper class. Clearly someone who is not upper class, but who devotes the same level of attention to diet (and a greater proportion of income) will statistically see similar benefits.

Here are two of the media article links together with a link to the study:

The Mediterranean diet doesn’t benefit everyone, study says

Health benefits of the Mediterranean diet are confirmed, but just for the upper class

Published research:
High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups…

All the links have been added to Health > Diet.

Category: Announcements