Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

Nutr Metab Cardiovasc Dis. 2020 Feb 10;30(2):201-213. doi: 10.1016/j.numecd.2019.09.024. Epub 2019 Sep 30.


Background and aims: Empirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults.

Methods and results: Adult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30-0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02-2.26). No association was found between the Prudent pattern and CVD outcomes.

Conclusion: The variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.

Keywords: Cardiovascular disease; Diet; Intake; Mediterranean diet; National survey; Pattern; Risk factor.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cross-Sectional Studies
  • Diet, Healthy*
  • Diet, Mediterranean*
  • Diet, Western* / adverse effects
  • Dyslipidemias / epidemiology
  • Dyslipidemias / prevention & control
  • Energy Intake
  • Feeding Behavior*
  • Female
  • Greece / epidemiology
  • Humans
  • Hypertension / epidemiology
  • Hypertension / prevention & control
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Nutritive Value
  • Prevalence
  • Protective Factors
  • Recommended Dietary Allowances
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior*
  • Young Adult