The Mediterranean lifestyle (MEDLIFE) index and metabolic syndrome in a non-Mediterranean working population

Maria S Hershey; Mercedes Sotos-Prieto; Miguel Ruiz-Canela; Costas A Christophi; Steven Moffatt; Miguel Ángel Martínez-González; Stefanos N Kales

doi:10.1016/j.clnu.2021.03.026

The Mediterranean lifestyle (MEDLIFE) index and metabolic syndrome in a non-Mediterranean working population

Clin Nutr. 2021 May;40(5):2494-2503. doi: 10.1016/j.clnu.2021.03.026. Epub 2021 Mar 31.

Authors

Maria S Hershey¹, Mercedes Sotos-Prieto², Miguel Ruiz-Canela³, Costas A Christophi⁴, Steven Moffatt⁵, Miguel Ángel Martínez-González⁶, Stefanos N Kales⁷

Affiliations

¹ Department of Preventive Medicine and Public Health, Navarra Institute for Health Research (IdiSNA), University of Navarra, 31008, Pamplona, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. Electronic address: mhershey@alumni.unav.es.
² Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain. Electronic address: msotosp@hsph.harvard.edu.
³ Department of Preventive Medicine and Public Health, Navarra Institute for Health Research (IdiSNA), University of Navarra, 31008, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029, Madrid, Spain. Electronic address: mcanela@unav.es.
⁴ Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Cyprus University of Technology, School of Health Sciences, Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health, Limassol, Cyprus. Electronic address: costas.christophi@cut.ac.cy.
⁵ National Institute for Public Safety Health, Indianapolis, IN 324 E New York Street, Indianapolis, IN, 46204, USA. Electronic address: steven.moffatt@ascension.org.
⁶ Department of Preventive Medicine and Public Health, Navarra Institute for Health Research (IdiSNA), University of Navarra, 31008, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029, Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. Electronic address: mamartinez@unav.es.
⁷ Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Occupational Medicine, The Cambridge Health Alliance/Harvard Medical School, Boston, MA, 02139, USA. Electronic address: skales@hsph.harvard.edu.

PMID: 33932793
DOI: 10.1016/j.clnu.2021.03.026

Abstract

Background & aims: The Mediterranean lifestyle (MEDLIFE), as an overall lifestyle pattern, may be associated with a lower prevalence of metabolic syndrome. We assessed the association of a validated MEDLIFE index with metabolic syndrome and its components in a non-Mediterranean working population.

Methods: A cross-sectional analysis was conducted at baseline among 249 US career firefighters in Feeding America's Bravest 2016-2018. The MEDLIFE index consisted of 26 items on food consumption, dietary habits, physical activity, rest, and social interactions that scored 0 or 1 point. Thus, total scores could range from 0 to 26 points. Multivariable logistic regression models were used to determine the associations across tertiles of MEDLIFE adherence with metabolic syndrome and each of its individual components. Multivariable linear models further assessed each component as a continuous outcome.

Results: The prevalence of metabolic syndrome was 17.7%. Participants with higher MEDLIFE adherence (T3: 11-17 points) had 71% lower odds of having metabolic syndrome compared to those with lower MEDLIFE adherence (T1: 2-7 points) (OR = 0.29; 95%CI: 0.10 to 0.90, p for trend = 0.04). Furthermore, significant inverse associations were found for T3 versus T1 on abdominal obesity (OR = 0.42; 95%CI: 0.18 to 0.99, p for trend = 0.07) and hypertriglyceridemia (OR = 0.24; 95%CI: 0.09 to 0.63, p for trend = 0.002). Significant inverse associations for continuous outcomes included total-cholesterol (total-c), low-density lipoprotein (LDL) cholesterol, and total-c:high-density lipoprotein (HDL) cholesterol (p for trend <0.05).

Conclusion: Higher adherence to traditional Mediterranean lifestyle habits, as measured by a comprehensive MEDLIFE index, was associated with a lower prevalence of metabolic syndrome and a more favorable cardiometabolic profile in a non-Mediterranean working population. Future studies employing the MEDLIFE index in other populations are warranted to support this hypothesis.

Keywords: Cardiovascular disease; Lifestyle; Mediterranean diet; Metabolic syndrome; Type 2 diabetes mellitus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Diet, Mediterranean*
Exercise
Feeding Behavior
Female
Humans
Life Style*
Male
Metabolic Syndrome / prevention & control*
Middle Aged
Risk Factors
Sleep
Surveys and Questionnaires