Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Components of the mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease

Abstract

Objective:

To evaluate associations between components of the Mediterranean diet and circulating markers of inflammation in a large cohort of asymptomatic subjects at high risk for cardiovascular disease.

Subjects/Methods:

A total of 339 men and 433 women aged between 55 and 80 years at high cardiovascular risk because of presence of diabetes or at least three classical cardiovascular risk factors, food consumption was determined by a semi-quantitative food frequency questionnaire. Serum concentrations of high-sensitivity C-reactive protein (CRP) were measured by immunonephelometry and those of interleukin-6 (IL-6), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) by enzyme-linked immunosorbent assay.

Results:

After adjusting for age, gender, body mass index, diabetes, smoking, use of statins, non-steroidal antiinflammatory drugs and aspirin, a higher consumption of fruits and cereals was associated with lower concentrations of IL-6 (P for trend 0.005;both). Subjects with the highest consumption of nuts and virgin olive oil showed the lowest concentrations of VCAM-1, ICAM-1, IL-6 and CRP; albeit only for ICAM-1 was this difference statistically significant in the case of nuts (for trend 0.003) and for VCAM-1 in the case of virgin olive oil (P for trend 0.02). Participants with higher adherence to the Mediterranean-type diet did not show significantly lower concentrations of inflammatory markers (P<0.1 for VCAM-1 and ICAM-1).

Conclusions:

The consumption of some typical Mediterranean foods (fruits, cereals, virgin olive oil and nuts) was associated with lower serum concentrations of inflammatory markers especially those related to endothelial function, in subjects with high cardiovascular risk living in a Mediterranean country.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  • Ajani U, Ford E, Mokdad A (2004). Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. J Nutr 134, 1181–1185.

    CAS  Article  Google Scholar 

  • Alonso A, Beunza JJ, Delgado-Rodriguez M, Martinez JA, Martinez-Gonzalez MA (2005). Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr 82, 972–979.

    CAS  Article  Google Scholar 

  • Bingham S, Luben R, Welch A, Wareham N, Khaw KT, Day N (2003). Are imprecise methods obscuring a relation between fat and breast cancer? Lancet 362, 212–214.

    Article  Google Scholar 

  • Blomhoff R, Carlsen MH, Andersen LF, Jacobs Jr DR (2006). Health benefits of nuts: potential role of antioxidants. Br J Nutr 96 (Suppl 2), S52–S60.

    CAS  Article  Google Scholar 

  • Carluccio M, Siculella L, Ancora M, Massaro M, Scoditti E, Storelli C et al. (2003). Olive oil and red wine antioxidant polyphenols inhibit endothelial activation. Arterioscler Thromb Vasc Biol 23, 622–629.

    CAS  Article  Google Scholar 

  • Choi H, Willet W, Stampfer M, Rimm E, Hu F (2005). Dairy consumption and risk of type 2 diabetes mellitus in men. Arch Intern Med 165, 997–1003.

    Article  Google Scholar 

  • Chrysohoou C, Panagiotakos D, Pitsavos C, Das U, Stefanadis C (2004). Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults. J Am Coll Cardiol 44, 152–158.

    Article  Google Scholar 

  • Cooke JP, Tsao P, Singer A, Wang BY, Kosek J, Drexler H (1993). Anti-atherogenic effect of nuts: is the answer NO? Arch Intern Med 153, 896–902.

    CAS  Article  Google Scholar 

  • Danesh J, Wheeler J, Hirschfield G, Eda S, Eiriksdottir G, Rumley A et al. (2004). C-Reactive Protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med 350, 1387–1397.

    CAS  Article  Google Scholar 

  • Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P et al. (2000). Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. B M J 321, 199–204.

    CAS  Article  Google Scholar 

  • De Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I et al. (1994). Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 343, 1454–1459.

    CAS  Article  Google Scholar 

  • Devaraj S, Jialal I (2000). Antioxidants and vitamins to reduce cardiovascular disease. Curr Atheroscler Rep 2, 342–351.

    CAS  Article  Google Scholar 

  • Esposito K, Marfella R, Ciotola M, Di-Palo C, Giugliano F, Giugliano G et al. (2004). Effect of Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA 292, 1440–1446.

    CAS  Article  Google Scholar 

  • Estruch R, Martínez-González M, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas M et al. (2006). Effects of a Mediterranean-style diet on cardiovascular risk factors: randomized trial. Ann Int Med 145, 1–11.

    Article  Google Scholar 

  • Estruch R, Sacanella E, Badia E, Antúnez E, Nicolás J, Fernández-Sola J et al. (2004). Different effects of red wine and gin consumption on inflammatory biomarkers of atherosclerosis: a prospective randomized crossover trial effects of wine on inflammatory markers. Atherosclerosis 175, 117–123.

    CAS  Article  Google Scholar 

  • Fernández-Jarne E, Martínez-Losa E, Prado Santamaría M, Brugarolas. Brufau C, Serrano-Martínez M, Martínez-González MA (2002). Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case–control study in Spain. Int J Epidemiol 31, 474–480.

    Article  Google Scholar 

  • Fitó M, Cladellas M, Torre R, Martí J, Alcántara M, Pujadas-Bastardes M et al. (2005). Antioxidant effect of virgin olive oil in patients with stable coronary heart disease: a randomized, crossover, controlled, clinical trial. Atherosclerosis 181, 149–158.

    Article  Google Scholar 

  • Fitzpatrick DF, Hirschfield SL, Ricci T, Jantzen P, Coffey RG (1999). Endothelium-dependent vasorelaxation caused by various plant extracts. J Cardiovasc Pharmacol 26, 90–95.

    Article  Google Scholar 

  • Fowke JH, Chung FL, Jin F, Qi D, Cai Q, Conaway C et al. (2003). Urinary isothiocyanate levels, brassica, and human breast cancer. Cancer Res 63, 3980–3986.

    CAS  PubMed  Google Scholar 

  • Fung T, McCullough M, Newby PK, Manson J, Meigs J, Rifai N et al. (2005). Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 82, 163–173.

    CAS  Article  Google Scholar 

  • Haffner S (2006). The metabolic syndrome: inflammation, diabetes mellitus and cardiovascular disease. Am J Cardiol 97, 3A–11A.

    CAS  Article  Google Scholar 

  • Harris T, Ferrucci L, Tracy R, Corti M, Wacholder S, Ettinger W et al. (1999). Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med 106, 506–512.

    CAS  Article  Google Scholar 

  • Jensen M, Koh-Banerjee P, Franz M, Sampson L, Gronbaek M, Rimm E (2006). Whole grains, bran, and germ in relation to homocysteine and markers of glycemic control, lipids and inflammation. Am J Clin Nutr 83, 275–283.

    CAS  Article  Google Scholar 

  • Jiang R, Jacobs D, Mayer-Davis E, Szklo M, Herington D, Jenny N et al. (2006). Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. Am J Epidemiol 163, 222–231.

    Article  Google Scholar 

  • Koh KK, Han S, Quon M (2005). Inflammatory markers and the metabolic syndrome: insights from therapeutic interventions. J Am Coll Cardiol 46, 1978–1985.

    CAS  Article  Google Scholar 

  • Knoops K, Groot L, Dromhout D, Perrin A, Moreiras O, Menotti A et al. (2003). Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women. JAMA 292, 1433–1439.

    Article  Google Scholar 

  • Kris-Etherton P, Yu-Poth S, Sabaté J, Ratcliffe H, Zhao R, Etherton T (1999). Nuts and their bioactive constituents: effects on serum lipids and other factors that affect disease risk. Am J Clin Nutr 70, 504S–511S.

    CAS  Article  Google Scholar 

  • Kristal AR, Peters U, Potter JD (2005). Is it time to abandon the food frequency questionnaire? Cancer Epidemiol Biomarkers Prev 14, 2826–2828.

    Article  Google Scholar 

  • Libby P, Ridker P, Maseri A (2002). Inflammation and atherosclerosis. Circulation 105, 1135–1143.

    CAS  Article  Google Scholar 

  • López-García E, Schulze M, Fung T, Meigs J, Rifai N, Manson J et al. (2004). Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 80, 1029–1035.

    Article  Google Scholar 

  • Ma Y, Griffith J, Chasan-Taber G, Olendzki B, Jackson E, Stanek E et al. 2006. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr 83, 760–766.

    CAS  Article  Google Scholar 

  • Malik I, Danesh J, Whincup P, Bhatía V, Papacosta O, Walker M et al. (2001). Soluble adhesion molecules and prediction of coronary heart disease: a prospective study and meta-analysis. Lancet 358, 971–975.

    CAS  Article  Google Scholar 

  • Martinez-Dominguez E, de la Puerta R, Ruiz-Gutierrez V (2001). Protective effects upon experimental inflammation models of a polyphenol-supplemented virgin olive oil diet. Inflamm Res 50, 102–106.

    CAS  Article  Google Scholar 

  • Martín-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernández-Rodríguez JC, Salvini S et al. (1993). Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22, 512–519.

    Article  Google Scholar 

  • Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Wright M, Gómez-Gracia E (2004). Development of a short dietary questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet. Eur J Clin Nutr 58, 1550–1552.

    Article  Google Scholar 

  • Mataix J, Mañás M, Llopis J, Martínez E, Sánchez J, Borregón A (2003). Tablas de composición de alimentos españoles [Spanish food composition tables], 4th edn. Monografica University of Granada: Granada, Spain.

    Google Scholar 

  • Michalsen A, Lehmann N, Pithan C, Knoblauch NT, Moebus S, Kannenberg F et al. (2006). Mediterranean diet has no effect on markers of inflammation and metabolic risk factors in patients with coronary artery disease. Eur J Clin Nutr 60, 478–485.

    CAS  Article  Google Scholar 

  • Michels KB (2001). A renaissance for measurement error. Int J Epidemiol 30, 421–422.

    CAS  Article  Google Scholar 

  • Miles E, Zoubouli P, Calder P (2005). Differential anti-inflammatory effects of phenolic compounds from extra virgin olive oil identified in human whole blood culture. Nutrition 21, 389–394.

    CAS  Article  Google Scholar 

  • Mori T, Woodman R, Burke V, Puddey I, Croft K, Beilin L (2003). Effect of eicosapentaenoic acid and docosahexaenoic acid on oxidative stress and inflammatory markers in treated-hypertensive type 2 diabetic subjects. Free Rad Biol Med 35, 772–781.

    CAS  Article  Google Scholar 

  • Nash SD, Westpfal M (2005). Cardiovascular benefits of nuts. Am J Cardiol 95, 963–965.

    Article  Google Scholar 

  • Paschos G, Rallidis L, Liakos G, Panagiotakos D, Anastasiadis G, Votteas V et al. (2004). Background diet influences the anti-inflammatory effect of á-linolenic acid in dyslipedaemic subjects. Br J Nutr 92, 649–655.

    CAS  Article  Google Scholar 

  • Pereira M, Jacobs Jr DR, Horn L, Slattery M, Kartashov A, Ludwig D (2002). Dairy consumption, obesity, and the insulin resistance syndrome in young adults. JAMA 287, 2081–2089.

    Article  Google Scholar 

  • Pérez-Jiménez F, Alvarez de Cienfuegos G, Badimon L, Barja G, Battino M, Blanco A, Bonanome A et al. (2005). International conference on the healthy effect of virgin olive oil. Eur J Clin Invest 35, 421–424.

    Article  Google Scholar 

  • Pradham AD, Ridker PM (2002). Do atherosclerosis and type 2 diabetes share a common inflammatory basis? Eur Heart J 23, 831–834.

    Article  Google Scholar 

  • Redon J, Coca A (2003). Guidelines for the diagnosis, evaluation and treatment of hypertension: the point of view of the Spanish Society of Hypertension. Med Clin (Barc) 121, 739–740.

    Article  Google Scholar 

  • Ridker PM (2004). High-sensitivity C-reactive protein, inflammation, and cardiovascular risk: from concept to clinical practice to clinical benefit. Am Heart J 148, S19–S26.

    CAS  Article  Google Scholar 

  • Ros E, Mataix J (2006). Fatty acid composition of nuts – implications for cardiovascular health. Br J Nutr 96 (Suppl 2), S29–S35.

    CAS  Article  Google Scholar 

  • Ros E, Nuñez I, Pérez-Heras A, Serra M, Gilabert R, Casals E et al. (2004). A walnut diet improves endothelial function in hypercholesterolemic subjects: a randomized crossover trial. Circulation 109, 1609–1614.

    CAS  Article  Google Scholar 

  • Ross R (1999). Atherosclerosis: an inflammatory disease. N Engl J Med 340, 115–126.

    CAS  Article  Google Scholar 

  • Salas-Salvadó J, Bullo M, Perez-Heras A, Ros E. (2006). Dietary fibre, nuts and cardiovascular diseases. Br J Nutr 96 (Suppl 2), S45–S51.

    Article  Google Scholar 

  • Schulze M, Hoffmann K, Manson J, Willet W, Meigs J, Weikert C et al. (2005). Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr 82, 675–684.

    CAS  Article  Google Scholar 

  • Serrano-Martínez M, Palacios M, Martínez-Losa E, Lezaun R, Maravi C, Prado M et al. (2005). Mediterranean dietary style influences TNF-alpha and VCAM-1 coronary blood levels in unstable angina patients. Eur J Nutr 44, 348–354.

    Article  Google Scholar 

  • Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L et al. (2005). Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 82, 1169–1177.

    CAS  Article  Google Scholar 

  • Trichopoulou A, Bamia C, Trichopoulou D (2005). Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165, 929–935.

    Article  Google Scholar 

  • Trichopoulou A, Costaucou T, Bamia C, Trichopoulos D (2003). Adherence to a Mediterranean diet and survival in Greek population. N Engl J Med 348, 2599–2608.

    Article  Google Scholar 

  • Trichopoulou A, Lagiou P (1997). Healthy traditional Mediterranean diet: an expression of culture, history and lifestyle. Nutr Rev 55, 383–389.

    CAS  Article  Google Scholar 

  • Vissers MN, Zock PL, Katan MB (2004). Bioavailability and antioxidant effects of olive phenols in humans: a review. Eur J Clin Nutr 58, 955–965.

    CAS  Article  Google Scholar 

  • Wannamethee SG, Lowe GD, Rumley A, Bruckdorfer KR, Whincup PH (2006). Associations of vitamin C status, fruit and vegetable intakes, and markers of inflammation and hemostasis. Am J Clin Nutr 83, 567–574.

    CAS  Article  Google Scholar 

  • Watzl B, Kulling SE, Moseneder J, Barth SW, Bub A (2005). A 4-wk intervention with high intake of carotenoid-rich vegetables and fruit reduces plasma C-reactive protein in healthy, nonsmoking men. Am J Clin Nutr 82, 1052–1058.

    CAS  Article  Google Scholar 

  • Wells B, Mainous A, Everett C (2005). Association between dietary arginine and C-reactive protein. Nutrition 21, 125–130.

    CAS  Article  Google Scholar 

  • Zemel MB (1998). Nutritional and endocrine modulation of intracellular calcium: implications in obesity, insulin resistance and hypertension. Mol Cell Biochem 188, 129–136.

    CAS  Article  Google Scholar 

  • Zhao G, Etherton T, Martin K, West S, Gillies P, Kris-Etherton P (2004). Dietary á-linolenic acid reduces inflammatory and lipid cardiovascular risk factors in hepercholesterolemic men and women. J Nutr 134, 2991–2997.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

This study was funded, in part, by the Instituto de Salud Carlos III (Thematic Network G03/140 and RD06/0045, CIBER 06/03, and PI051839), Spain.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to J Salas-Salvadó.

Additional information

Guarantor: J Salas-Salvadó. Contributors: JS-S, MAM-G and RE had primary responsibility for the data analysis and manuscript preparation. RE is the overall coordinator of the PREDIMED study. AGA and MAM-G were responsible for the statistical analysis. JS-S, RE, DC, MF, EG-G, EV, FA, CH, CL, JL and MAM-G were the principal investigators of the centres participating in the data collection. All the coauthors participated in the design and execution of the study and contributed to the critical revision of the manuscript for important intellectual content.

Appendix

Appendix

Investigators not listed as authors and institutions participating in the PREDIMED Study:

University Rovira i Virgili, Reus (Tarragona): M Bulló, J Basora, J Fernandez-Ballart, P Casas

University of Navarra: P Buil

Hospital Clinic–IDIBAPS: E Sacanella, M Serra

University of Valencia: JV Sorlí

University Institute for Health Sciences Investigation, Palma de Mallorca: G Frontera, F Rigo

University of Málaga: V Velasco-García

Primary Health Care Division, Barcelona: C Cabezas

Hospital Txangorritxu, Vitoria: J San Vicente, J Alcorta

Hospital Virgen del Rocío, Sevilla: A Nieto

Hospital Carlos III, Madrid: JM Mostaza

San Pablo Health Center, Sevilla: P Iglesias, JM Santos

Instituto de la Grasa, CSIC, Sevilla: V Ruíz-Gutiérrez

Municipal Institut for Medical Research (IMIM), Barcelona: M Fitó

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Salas-Salvadó, J., Garcia-Arellano, A., Estruch, R. et al. Components of the mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. Eur J Clin Nutr 62, 651–659 (2008). https://doi.org/10.1038/sj.ejcn.1602762

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602762

Keywords

  • mediterranean diet
  • virgin olive oil
  • nuts
  • fruit
  • inflammation
  • PREDIMED study

This article is cited by

Search

Quick links