PMID- 35745097
OWN - NLM
STAT- MEDLINE
DCOM- 20220627
LR  - 20220716
IS  - 2072-6643 (Electronic)
IS  - 2072-6643 (Linking)
VI  - 14
IP  - 12
DP  - 2022 Jun 7
TI  - Exploring the Path of Mediterranean Diet, Non-Alcoholic Fatty Liver Disease 
      (NAFLD) and Inflammation towards 10-Year Cardiovascular Disease (CVD) Risk: The 
      ATTICA Study 10-Year Follow-Up (2002-2012).
LID - 10.3390/nu14122367 [doi]
LID - 2367
AB  - BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of 
      liver disease, affecting ~30% of the population and increasing CVD. This study 
      aimed to explore the direct, indirect and combined effects of Mediterranean diet, 
      NAFLD and inflammation on the 10-year CVD risk in a healthy adult population. 
      METHODS: Using baseline and 10-year follow-up data from the ATTICA study, 
      adherence to Mediterranean diet was measured using MedDietScore, and presence of 
      NAFLD at baseline was assessed using the fatty liver index (FLI). Participants' 
      10-year CVD outcomes were recorded and C-reactive protein (CRP) was used as a 
      surrogate marker for inflammation. The direct and indirect roles of these factors 
      were explored using logistic regression models and the pathways between them were 
      analysed using a structural equation model (SEM). RESULTS: NAFLD prevalence was 
      22.9% and its presence was 17% less likely for every unit increase in 
      MedDietScore. NAFLD presence at baseline was associated with increased 10-year 
      CVD incidence (39.4% vs. 14.5%, p = 0.002), but when adjusted for MedDietScore, 
      NAFLD was not an independent predictor of 10-year CVD risk. MedDietScore was an 
      independent protective factor of 10-year CVD risk (OR = 0.989, 95% CI: 0.847, 
      0.935), when adjusted for NAFLD at baseline, age, gender, sedentary lifestyle and 
      other confounders. Further exploration using SEM showed that MedDietScore was 
      associated with CVD risk directly even when inflammation as CRP was introduced as 
      a potential mediator. CONCLUSION: FLI as a proxy measure of NAFLD is a strong 
      predictor of 10-year CVD risk, and this prognostic relationship seems to be 
      moderated by the level of adherence to Mediterranean diet. Adherence to 
      Mediterranean diet remained an independent and direct CVD risk factor 
      irrespective of NAFLD status and CRP.
FAU - George, Elena S
AU  - George ES
AUID- ORCID: 0000-0002-1385-2371
AD  - Institute for Physical Activity and Nutrition, School of Exercise and Nutrition 
      Sciences, Deakin University, Geelong, VIC 2600, Australia.
FAU - Georgousopoulou, Ekavi N
AU  - Georgousopoulou EN
AUID- ORCID: 0000-0002-0592-3838
AD  - Medical School, Australian National University, Canberra, ACT 2601, Australia.
AD  - School of Medicine, University of Notre Dame Australia, Darlinghurst, SYD 2010, 
      Australia.
AD  - Centre for Health and Medical Research, ACT Health Directorate, Canberra, ACT 
      2601, Australia.
FAU - Mellor, Duane D
AU  - Mellor DD
AUID- ORCID: 0000-0002-1369-3868
AD  - Aston Medical School, Aston University, Birmingham B4 7ET, UK.
FAU - Chrysohoou, Christina
AU  - Chrysohoou C
AUID- ORCID: 0000-0002-6340-3996
AD  - First Cardiology Clinic, Athens Medical School, National Kapodistrian University 
      of Athens, 10679 Athens, Greece.
FAU - Pitsavos, Christos
AU  - Pitsavos C
AD  - First Cardiology Clinic, Athens Medical School, National Kapodistrian University 
      of Athens, 10679 Athens, Greece.
FAU - Panagiotakos, Demosthenes B
AU  - Panagiotakos DB
AUID- ORCID: 0000-0001-8583-153X
AD  - Department of Nutrition and Dietetics, School of Health and Education, Harokopio 
      University, 46 Paleon Polemiston St., Glyfada, Attica, 16674 Athens, Greece.
LA  - eng
GR  - AS2003/AS/Autism Speaks/United States
GR  - n/a/Hellenic Atherosclerosis Society/
GR  - n/a/Hellenic Cardiological Society/
PT  - Journal Article
DEP - 20220607
PL  - Switzerland
TA  - Nutrients
JT  - Nutrients
JID - 101521595
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Adult
MH  - C-Reactive Protein
MH  - *Cardiovascular Diseases/epidemiology/etiology
MH  - *Diet, Mediterranean
MH  - Follow-Up Studies
MH  - Humans
MH  - Inflammation/complications/epidemiology
MH  - *Non-alcoholic Fatty Liver Disease/complications/epidemiology
MH  - Risk Factors
PMC - PMC9229573
OTO - NOTNLM
OT  - Mediterranean diet
OT  - cardiovascular disease
OT  - cardiovascular risk
OT  - fatty liver index
OT  - inflammation
OT  - non-alcoholic fatty liver disease
COIS- The authors have no conflict of interest to declare.
EDAT- 2022/06/25 06:00
MHDA- 2022/06/28 06:00
PMCR- 2022/06/07
CRDT- 2022/06/24 01:34
PHST- 2022/04/21 00:00 [received]
PHST- 2022/06/03 00:00 [revised]
PHST- 2022/06/05 00:00 [accepted]
PHST- 2022/06/24 01:34 [entrez]
PHST- 2022/06/25 06:00 [pubmed]
PHST- 2022/06/28 06:00 [medline]
PHST- 2022/06/07 00:00 [pmc-release]
AID - nu14122367 [pii]
AID - nutrients-14-02367 [pii]
AID - 10.3390/nu14122367 [doi]
PST - epublish
SO  - Nutrients. 2022 Jun 7;14(12):2367. doi: 10.3390/nu14122367.