Prevented fractions of cardiovascular disease cases, by long-term adherence to the Mediterranean diet; the ATTICA study (2002-2022).

Background and aims: Cardiovascular disease (CVD) and its related co-morbidities, i.e., type 2 diabetes mellitus (T2DM), hypertension and hypercholesterolemia, have an enormous burden on population health and healthcare systems. Mediterranean diet can reduce this burden; quantifying this reduction via the calculation of the Prevented Fraction for the Population (PFP) could offer positive-framed messages to encourage adherence to this healthful dietary pattern. Hence, the aim of this study was to calculate PFP of CVD, T2DM, hypertension, and hypercholesterolemia by long-term adherence to the Mediterranean type of diet, during a 20-year period, in a Mediterranean population.

Methods and results: The sample consisted of adult participants, initially free-of-CVD, from the ATTICA prospective cohort study (2002-2022). At all evaluations (2002, 2006, 2012, 2022), CVD, T2DM, hypertension, and hypercholesterolemia were assessed according to WHO-ICD-10, and Mediterranean diet adherence was assessed via MedDietScore. PFP by Mediterranean diet was computed for each outcome in different population groups. It was found that approximately 30 % of CVD, T2DM, hypertension and hypercholesterolemia cases were prevented due to the high long-term adherence to the Mediterranean diet. Concerning different population groups, it was observed that due to their decreased adherence and PFPs, male participants, older participants and participants with comorbidities might benefit more from following the Mediterranean diet during a long-term period.

Conclusion: The study findings suggest that future public health strategies should aim to make the Mediterranean diet a long-term lifestyle change rather than a short-term diet intervention, while shedding light on which population groups should be targeted first.