| Abstract | Cilj istraživanja: Cilj istraživanja bio je ispitati povezanost između prehrambenih navika, posebice mediteranskog načina prehrane i elastičnosti arterijske stjenke, procijenjene pomoću brzine pulsnog vala u populaciji grada Splita i otoka Korčule i Visa te uz to utvrditi i povezanost drugih osobina s elastičnošću arterijske stjenke, posebice dobi, spola, antropometrijskih obilježja, obrazovanja, pušenja duhana, tjelesne aktivnosti, prisutnosti kroničnih nezaraznih bolesti i odabranih biokemijskih parametara.
Materijali i metode: Presječnim analitičkim istraživanjem obuhvaćeno je 2.894 odraslih ispitanika, a u analizu je uključeno njih 320 (13,8%) s otoka Visa, 1540 (66,5%) s otoka Korčule te 457 ispitanika (19,7%) iz grada Splita (577 ispitanika je isključeno iz analize zbog nepotpunih podatka). Uzorkovanje je provedeno u razdoblju od prosinca 2011. godine do ožujka 2014. Ispitanici su dali uzorak krvi na tašte za biokemijske pretrage. Mjerenje brzine pulsnog vala provedeno je u ležećem položaju, natašte, korištenjem metode aplanacijske tonometrije, pomoću uređaja SphygmoCor (SphygmoCor v8, AtCor, Sydney, Australia). Podaci o prehrambenim i drugim životnim navikama te socioekonomski podaci i podaci o zdravstvenom statusu prikupljeni su pomoću upitnika. Za procjenu načina prehrane koji se smatra tradicionalnom mediteranskom prehranom korišten je MDSS zbroj (engl. Mediterranean Diet Serving Score) (69). U analizi podataka korišten je χ2 test, Fisherov egzaktni test, annWhitney U test, Kruskal-Wallis test i multivarijatna logistička regresija. U modelu logističke regresije testirano je postoji li povezanost između mediteranskog načina prehrane i smanjene elastičnosti aortne stijenke (PWV≥10 m/s), pri čemu su u model uključene sljedeće varijable (čimbenici zabune): spol, dob, ITM, opseg trbuha, prisutnost kroničnih bolesti, sistolički i dijastolički tlak, koncentracija glukoze, kolesterola, HDL kolesterola, LDL kolesterola, triglicerida i fibrinogena, obrazovanje, pušenje i tjelesna aktivnost. Razina statističke značajnosti postavljena je na P<0,05.
Rezultati: Vrijednost indeksa mediteranske prehrane (MDSS) je bila najveća u ispitanika u dobnoj skupini ≥65 g. (medijan 12,0; interkvartilni raspon [IKR] 5), a najmanja u najmlađoj dobnoj skupini (18-35 g) (medijan 9,0; IKR 4) (P<0,001). Prosječna brzina pulsnog vala bila je najmanja u najmlađoj dobnoj skupini (medijan 6,4 m/s; IKR 1,1), dok su ispitanici u najstarijoj dobnoj skupini imali prosječnu vrijednost brzine pulsnog vala od 10,5 m/s (IKR 2,8; P<0,001). S obzirom na vrijednost brzine pulsnog vala zabilježena je statistički značajna razlika i prema spolu, pri čemu je 54,6 % žena i 45,4 % muškaraca imalo brzinu pulsnog vala ≥10 m/s. Ispitanici koju su imali brzinu pulsnog vala <10 m/s imali su statistički značajno niži indeks tjelesne mase, manji opseg struka te manji opseg kukova, kao i niže vrijednosti sistoličkog i dijastoličkog tlaka, koncentracije mokraćne kiseline, glukoze, HbA1c te niže vrijednosti fibrinogena, triglicerida i ukupnog kolesterola (sve P vrijednosti <0,05), a zabilježena je i razlika u obrazovanju, tjelesnoj aktivnosti i pušenju.
Kao rezultat logističke regresije ističe se povezanost mediteranske prehrane i arterijske elastičnosti, na način da su ispitanici koji su se hranili prema smjernicama mediteranske prehrane imali za 48% manju vjerojatnost za prisutnost smanjene arterijske elastičnosti (OR=0,516; 95% CI 0,302 - 0,881). Nadalje, ispitanici starije životne dobi imali su veću vjerojatnost za prisutnost smanjene elastičnosti velikih arterija (OR=1,141; 95% CI 1,113 - 1,171), muškarci su imali 2,27 puta veću vjerojatnost za smanjenu elastičnost velikih arterija u odnosu na žene (OR=2,271; 95% CI 1,458 - 3,536), dok su ispitanici koji su imali prisutne čak tri ili više kronične bolesti imali čak 2,9 puta veću vjerojatnost za prisutnost smanjene elastičnosti velikih arterija (OR=2,905; 95% CI 1,336 - 6,318). Veća vjerojatnost za prisutnost smanjene arterijske elastičnosti zabilježena je i za ispitanike s većim vrijednostima sistoličkog tlaka (OR=1,042; 95% CI 1,025 - 1,060), većim opsegom struka (OR=1,004; 95% CI 1,001 - 1,006), kao i većom koncentracijom fibrinogena OR= 1,354; 95% CI 1,105 - 1,660).
Zaključak: S obzirom da je utvrđena očekivana povezanost između mediteranskog načina prehrane i arterijske elastičnosti, kao i drugim istaknutim rizičnim čimbenicima, potrebno je uložiti dodatne napore u javno-zdravstvenu promociju mediteranske prehrane i općenito mediteranske stila života, posebice u mlađim generacijama, koje sve više pokazuju odstupanje od tradicionalnog mediteranskog načina života. |
| Abstract (english) | Objective: The aim of this study was to investigate the association between dietary habits, especially the Mediterranean diet and arterial stiffness assessed by puls wave velocity (PWV) in the population of the city of Split and of the islands of Korčula and Vis. Additionaly, we examined the association between arterial stiffness and other characteristics, namely age, gender, anthropometric characteristics, education, tobacco smoking, physical activity, presence of chronic diseases and selected biochemical parameters.
Materials and Methods: A cross–sectional analytical study included 2,894 adult participants, and the analyses included 320 participants (13,8%) from the island of Vis, 1540 (66,5%) from the island of Korčula and 457 (19,7%) participantsfrom the city of Split (577 participantswere excluded from the analysis because of the incomplete data). Sampling was conducted in the period from December 2011 to March 2014. The respondents gave a fasting blood sample for biochemical tests. PWV measurement was done lying down, after overnight fasting, using applanation tonometry technique (SphygmoCor v8, AtCor, Sydney, Australia). Data on dietary and other lifestyle factors, socio-economic data and information on health status were collected by questionnaire. Mediterranean Diet Serving Score was used to determine Mediterranean Diet adherence (69). Chi-square test, Fisher exact test, MannWhitney U test, Kruskal-Wallis's test and multivare logistic regression were used in statistical analysis. Logistic regression model was used to assess the association between poor Mediterranean Diet adherence and increased aortic PWV (PWV ≥10 m/s), and the model included following confounding factors: gender, age, BMI, abdominal circumference, presence of chronic disease, systolic and diastolic blood pressure, concentrations of glucose, cholesterol, HDL cholestreol, LDL cholesterol, triglyceride and fibrinogen, education attainament, smoking and physical acitivity. Significance level was set at P<0.05.
Results: Mediterranean Diet Serving Score (MDSS) was highest in responednts from the age group ≥65 years. (median 12.0; interquartile range [IQR] 5), and the lowest in the youngest age group (18-35 years) (median 9.0; IQR 4) (P <0.001). The average pulse PWV was lowest in the youngest age group (median 6.4 m/s; IQR 1.1), while respondents in the oldest age group had an average value of PWV of 10.5 m/s (IQR 2.8; P <0.001). Statistically significant difference in PWV was observed between gender groups, where 54.6% of women and 45.4% of men had a PWV≥10 m/s. Respondents with PWV<10 m/s had significantly lower body mass index, smaller both waist and hip circumference as well as lower systolic and diastolic blood pressure, serum uric acid, glucose, HbA1c and lower levels of fibrinogen, triglycerides and total cholesterol levels (all P values <0.05). There were also differences in education, physical activity and smoking.
Logistic regression result indicated that respondents who had good Mediterranean Diet adherence had a 48% lower probability for the presence of increased arterial stiffness (OR=0.516; 95% CI 0.302 - 0.881). Furthermore, older respondents had a greater probability for the presence of increased arterial stiffness (OR=1.141; 95% CI 1.113 - 1.171), men were 2.27 times more likely to have increased arterial stiffness compared to women (OR=2.271; 95% CI 1.458 - 3.536), while respondents who had three or more chronic diseases were 2.9 times more likely to have increased stiffness of aorta (OR=2.905; 95% CI 1.336 - 6.318). Greater probability for the presence of increased arterial stiffness was also observed for subjects with higher values of systolic blood pressure (OR=1.042; 95% CI 1.025 - 1.060), greater waist circumference (OR=1.004; 95% CI 1.001 - 1.006) and a higher concentration of fibrinogen (OR=1.354; 95% CI 1.105 - 1.660).
Conclusion: Since we confirmed the expected association between the Mediterranean diet and arterial stiffness, as well as other prominent risk factors, it is necessary to undertake additional efforts in public health promotion of the Mediterranean diet and Mediterranean lifstyle, especially in the younger generations, which increasingly demonstrate deviation from traditional Mediterranean lifestyle. |
