Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: The SUN project

Background & aims: We prospectively assessed the association between adherence to several a priori defined healthy food patterns and risk of metabolic syndrome (MetS). Methods: We assessed 6851 participants of a Spanish dynamic prospective cohort of university graduates, initially free of any MetS-specific definition criteria, and followed-up for a median of 8.3 years. We calculated the adherence to thirteen different a priori defined food patterns or dietary indexes. MetS was classified according to the updated harmonizing criteria. We estimated multivariable-adjusted Incidence Rate Ratios (IRR) of metabolic syndrome and their 95% Confidence Intervals (95% CI), using Poisson regression models. Results: The cumulative incidence of MetS was 5.0%. Moderate adherence to the Pro-Vegetarian Diet (PVEG) was significantly associated with a lower risk for developing MetS (IRR=0.75, 95% CI=0.59-0.97). Among women, an inverse association with the PVEG was significant not only for a moderate adherence (IRR=0.54, 95% CI=0.36-0.82), but also for higher adherence (IRR=0.63, 95% CI=0.43-0.93). A higher adherence to the Dietary Approaches to Stop Hypertension (DASH) diet showed an inverse association with the MetS among participants, but only if they had low alcohol intake (RR=0.41, 95% CI=0.20-0.85). Conclusions: Our findings support the adoption of a PVEG dietary pattern for the reduction of MetS risk. The same statement can be applied in relation to the DASH diet, insofar a limited consumption of alcoholic beverages is also maintained.