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Background: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain. Higher adherence to the SEAD has been associated with lower levels of some cardiovascular risk factors and reduced risk for myocardial infarction, but whether this translates into lower all-cause mortality is uncertain. We hence examined the association between adherence to the SEAD and all-cause mortality in older adults., Methods: Data were taken from the Seniors-ENRICA-1 cohort, which included 3165 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Food consumption was assessed with a validated diet history, and adherence to the SEAD was measured with an index comprising 9 food components: fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Vital status was ascertained with the National Death Index of Spain. Statistical analyses were performed with Cox regression models and adjusted for the main confounders., Results: During a median follow-up of 10.9 years, 646 deaths occurred. Higher adherence to the SEAD was associated with lower all-cause mortality (fully adjusted hazard ratio [95% confidence interval] per 1-SD increment in the SEAD score 0.86 [0.79, 0.94]; p-trend < 0.001). Most food components of the SEAD showed some tendency to lower all-cause mortality, especially moderate wine consumption (hazard ratio [95% confidence interval] 0.71 [0.59, 0.86]). The results were robust in several sensitivity analyses. The protective association between SEAD and all-cause death was of similar magnitude to that found for the Mediterranean Diet Adherence Screener (hazard ratio [95% confidence interval] per 1-SD increment 0.89 [0.80, 0.98]) and the Alternate Healthy Eating Index (0.83 [0.76, 0.92])., Conclusions: Adherence to the SEAD is associated with a lower risk of all-cause death among older adults in Spain.

Objective: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and Galicia, a region in northwest Spain. The SEAD has been associated with a lower risk of non-fatal acute myocardial infarction, but the mechanisms of this association have not yet been investigated. Thus, we examined the association between the SEAD and numerous biomarkers of coronary risk, blood pressure and anthropometrics., Methods: Cross-sectional study conducted in 2008-2010 among 10,231 individuals representative of the population aged 18 years and older in Spain. Diet was assessed with a validated computerized diet history. SEAD adherence was measured with an index including 9 food components (fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine), which ranges from 0 (lowest adherence) to 9 (highest adherence). C-reactive protein, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose, glycated hemoglobin, insulin, leptin, fibrinogen, were determined in 12-h fasting blood samples, while creatinine and urine albumin were determined in urine., Results: Mean SEAD score was 2.9 points (inter-quartile range 2-4 points). Higher SEAD adherence was associated with a lower level of plasma C-reactive protein (adjusted difference in geometric means between the highest and lowest SEAD quartiles -0.2 mg/l; p for trend <0.001), plasma triglycerides (-3.4 mg/dl; p for trend 0.012), insulin (-0.5 mU/l; p for trend <0.001), HOMA-IR (-0.12; p for trend <0.001), urine albumin (-0.8 mg/l; p for trend <0.001), urine albumin-creatinine ratio (-0.3 mg/g creatinine; p for trend <0.034), and systolic blood pressure (-1.6 mm Hg; p for trend <0.001)., Conclusions: This study identifies possible mediators of the effect of SEAD on myocardial infarction, because SEAD is associated with a lower concentration of markers of inflammation and with reduced triglycerides, insulin, insulin resistance, and systolic blood pressure., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background and Aims: To assess, using principal component analysis, the independent associations of general, central and peripheral subcutaneous fat with high-sensitivity C-reactive protein (hs-CRP), in men and women from the general population., Methods and Results: We studied 833 women and 486 men, randomly selected from the non-institutionalized population of Porto, Portugal, with information on hs-CRP (≤10 mg/l) and anthropometrics (1999-2003). Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and a skinfold composite index to estimate the proportion of arm subcutaneous fat (PSFA), were ascertained by trained personnel. Beta regression coefficients were obtained from generalized linear models with adjustment for the main confounders. Direct associations were found between BMI, WC, WHR and hs-CRP. PSFA was inversely associated with hs-CRP in women (β=-0.080, p-trend=0.010). Since the anthropometric measures were strongly correlated, we used principal component analysis to identify new independent anthropometric factors. The first one, representing a generalized fat distribution (high BMI and WC), was directly associated with hs-CRP (β=0.226, p-trend<0.001 in women; β=0.138, p-trend=0.002 in men). The second factor, characterized by a high PSFA, showed an inverse association with hs-CRP in women (β=-0.071, p-trend=0.048). The third factor, representing a central pattern of fat distribution (low BMI, but high WC and high WHR), was directly associated with hs-CRP in men (β=0.090, p-trend=0.005)., Conclusion: A central pattern of fat distribution is directly associated with hs-CRP levels in men, while a high proportion of peripheral subcutaneous fat seems to be inversely associated with hs-CRP, but only in women., (Copyright © 2009 Elsevier B.V. All rights reserved.)

Background: The majority of the studies have focused on the effect of general and central fat on coronary risk, neglecting the potential role of peripheral body fat., Objective: To assess the effect of surrogate measures for general, central and peripheral body fat on the occurrence of non-fatal acute myocardial infarction (AMI)., Methods: Population-based case-control study; cases were patients aged >or=40 years consecutively hospitalized with an incident AMI (n=653), and controls were community participants without previous AMI, selected randomly from the hospitals' catchment area population (n=1713). Body mass index (BMI), waist circumference (WC), hip circumference and a skinfolds composite index to estimate the proportion of peripheral subcutaneous fat in the arms were ascertained. Associations were summarized with odds ratios (OR) and 95% confidence intervals (95% CI), obtained from unconditional logistic regression with adjustment for the main confounders., Results: WC, and in particular waist-to-hip ratio (WHR), had strong direct associations with AMI risk. Peripheral subcutaneous fat was inversely associated with AMI in women, but directly in men. Using principal component analysis, three uncorrelated factors were identified representing different patterns of fat distribution: (1) generalized fat, with high BMI and high WC; (2) central fat, with high WC and WHR; and (3) peripheral subcutaneous fat. The first factor showed no significant association with AMI, but the second factor increased AMI risk in each sex (upper vs lower fourth: OR 12.2, 95% CI 5.34-27.9 in women; OR 25.0, 95% CI 14.0-44.7 in men). In contrast, the third factor was inversely associated with AMI in women (upper vs lower fourth: OR 0.59, 95% CI 0.36-0.96) and directly associated in men (OR 2.45, 95% CI 1.69-3.55; P-value for sex interaction<0.001)., Conclusions: Central fat was associated with increased risk of AMI in women and men, while the peripheral subcutaneous fat index predicted a lower risk of AMI in women and a higher risk in men.