Title Determinants, trends and health outcomes associated with the Mediterranean diet in the population of Dalmatia, Croatia Title (croatian) Odrednice, trendovi i zdravstveni ishodi povezani s mediteranskom prehranom u populaciji Dalmacije, Hrvatska Author Ajka Pribisalić Mentor Ozren Polašek (mentor)Committee member Joško Božić (predsjednik povjerenstva)Committee member Tina Tičinović Kurir (član povjerenstva)Committee member Shelly Pranić (član povjerenstva)Granter University of Split Defense date and country 2022, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 614 - Public health and hygiene. Accident prevention Abstract One of the foremost public health challenges today and on the global level are noncommunicable
disease, arising mostly due to an unhealthy lifestyle. Especially high burden
represents an unhealthy diet. The Mediterranean diet is one of the most commonly investigated
nutritional pattern with a large body of evidence showing that adherence to it can sustain and
preserve human health, with numerous health benefits already being recorded. The most
prominent characteristics of the MD are the
... More use of olive oil as the primary fat source, an
abundance of vegetables, fruits, nuts, and whole grains daily, moderate red wine and legumes
consumption, while animal products are more of a relish, and the priority is given to fish and
white meat over red and processed meat.
The research aims of this thesis are to assess the compliance with the Mediterranean
dietary pattern and its constituting components, to estimate the temporal trend in adherence to
the Mediterranean diet and the contribution of several socio-economic factors in the changing
pattern of both the Mediterranean diet and body mass index in a follow-up study, and to
investigate the association between nut consumption and various cardiovascular risk factors in
the population of Dalmatia in Southern Croatia.
The results of this study revealed a rather unsatisfactory situation in Southern Croatia in
terms of Mediterranean diet consumption. A wide range of adherence to MDSS components
was present (from as low as 4.6% for nuts, and up to 91.7% adherence for cereals), with a rather
low prevalence of adherence to the Mediterranean diet in the entire sample (28.5%), especially
among younger individuals (14.0%). Better compliance with the overall Mediterranean diet, as
well as for the majority of the MDSS components was recorded among the oldest group of
subjects, especially women. We failed to find any association between subjective material
status and adherence to the Mediterranean diet, whereas objective material status presented as
the most prominent socio-economic indicator for the overall adherence to the Mediterranean
diet, but also several food groups.
Subjects included in the follow-up had higher adherence to the Mediterranean diet at
baseline (36.6%), with a borderline insignificant decline at the end of the follow-up period
(33.5%). The multivariate model revealed that female gender, older age at baseline, the highest
level of education, and a moderate level of physical activity were positively associated, while
the MDSS at baseline was negatively associated with the MDSS change during the follow-up.
On the other hand, BMI had increased on average by 6.5% in subjects available for follow-up.
BMI change during follow-up was positively associated with the female gender, and negatively with initial BMI, initial adherence to the MD, and change in adherence to the MD, as found in
the regression analysis.
Nut consumption in this study was associated with reduced odds for decreased HDL
cholesterol and reduced odds for increased fibrinogen, while total cholesterol and LDL
cholesterol did not reach the significance level (when overall P value was observed) and
triglycerides did not exhibit any association with nut intake within this study. The study also
revealed the association between nut consumption and indices of central obesity (defined by
the waist-to-height and waist-to-hip ratios), while at the same time there was no association
with direct measures, namely waist circumference or BMI. We found no such association
between nut intake and the presence of the diagnosis of hypertension, diabetes or gout, but we
did find some indication of the association between monthly nut intake and lower odds for
metabolic syndrome presence. Interestingly, we found that subjects who did not comply with
a Mediterranean diet had lower odds for the presence of diabetes and elevated HbA1c, but
higher odds for obesity.
Overall, the importance of a healthy lifestyle and healthy dietary habits came to the
frontline of attention due to the COVID-19 pandemic. The insights from these studies should
be used to inform the necessary and targeted public health interventions aimed at increasing
the MD uptake to ensure beneficial outcomes at the individual and the population level. This
is relevant from the perspective of population health and delivery of adequate health care, as
well as from the perspective of economic, social, and cultural development, and preservation
of cultural heritage for generations to come. Less Abstract (croatian) Jedan od najvećih javnozdravstvenih izazova danas na globalnoj razini su nezarazne
bolesti, koje uglavnom nastaju zbog nezdravog načina života. Posebno veliko opterećenje
predstavlja nezdrava prehrana. Mediteranska prehrana jedan je od najčešće istraživanih
prehrambenih obrazaca s velikim brojem dokaza koji pokazuju da njezino pridržavanje može
održati i očuvati ljudsko zdravlje, uz brojne zabilježene zdravstvene prednosti. Najistaknutije
karakteristike mediteranske prehrane su
... More korištenje maslinovog ulja kao primarnog izvora
masti, svakodnevno obilje povrća, voća, orašastih plodova i cjelovitih žitarica, umjerena
konzumacija crnog vina i mahunarki, dok su životinjski proizvodi više užitak a u odnosu na
crveno i prerađeno meso prednost ima riba i bijelo meso.
Ciljevi istraživanja ovog doktorskog rada su procijeniti usklađenost s mediteranskim
načinom prehrane i njegovim sastavnim komponentama, procijeniti vremenski trend
pridržavanja mediteranske prehrane i doprinos nekoliko socio-ekonomskih čimbenika u
promjeni obrasca mediteranske prehrane i indeksa tjelesne mase u ponovljenoj studiji, kao i
istražiti povezanost između konzumacije orašastih plodova i različitih kardiovaskularnih
čimbenika rizika u populaciji Dalmacije u južnoj Hrvatskoj.
Rezultati ovog istraživanja pokazali su prilično nezadovoljavajuću situaciju u južnoj
Hrvatskoj u pogledu pridržavanja mediteranskoj prehrani. Prisutan je širok raspon pridržavanja
pojedinim komponentama MDSS-a (od čak 4,6% za orašaste plodove, do 91,7% pridržavanja
za žitarice), s prilično niskom prevalencijom pridržavanja mediteranskoj prehrani u cijelom
uzorku (28,5%), osobito među mlađim osobama (14,0%). Bolja usklađenost s cjelokupnom
mediteranskom prehranom, kao i za većinu komponenti MDSS-a zabilježena je kod najstarije
skupine ispitanika, posebice žena. Nismo uspjeli pronaći povezanost između subjektivnog
materijalnog statusa i pridržavanja mediteranske prehrane, dok je objektivni materijalni status
predstavljen kao najistaknutiji socio-ekonomski pokazatelj za cjelokupno pridržavanje
mediteranske prehrane, ali i nekoliko skupina namirnica.
Ispitanici uključeni u praćenje imali su veću privrženost mediteranskoj prehrani na
početku (36,6%), s graničnim neznatnim padom na kraju razdoblja praćenja (33,5%).
Multivarijatni model je otkrio da su ženski spol, starija dob na početku, najviša razina
obrazovanja i umjerena razina tjelesne aktivnosti bili pozitivno povezani, dok je MDSS na
početku bio negativno povezan s promjenom MDSS-a tijekom praćenja. S druge strane, indeks
tjelesne mase se u prosjeku povećao za 6,5% kod ispitanika dostupnih za praćenje. Promjena
BMI tijekom praćenja bila je pozitivno povezana sa ženskim spolom, a negativno s početnim BMI-om, početnim pridržavanjem mediteranskoj prehrani i promjenom pridržavanja
mediteranskoj prehrani, kao što je pronađeno u regresijskoj analizi.
Konzumacija orašastih plodova u ovoj studiji bila je povezana sa smanjenim izgledima
za smanjenje HDL kolesterola i smanjenim izgledima za povećanje fibrinogena, dok ukupni
kolesterol i LDL kolesterol nisu dosegli razinu značajnosti (kada je promatrana ukupna P
vrijednost), a trigliceridi nisu pokazali nikakvu povezanost s unosom orašastih plodova unutar
ove studije. Studija je također otkrila povezanost između konzumacije orašastih plodova i
indeksa središnje pretilosti (definiranih omjerima struka prema visini, te struka i boka), dok u
isto vrijeme nije bilo povezanosti s izravnim mjerama, odnosno opsegom struka ili indeksom
tjelesne mase. Nismo pronašli takvu povezanost između unosa orašastih plodova i prisutnosti
dijagnoze hipertenzije, dijabetesa ili gihta, ali smo pronašli neke naznake povezanosti između
mjesečnog unosa orašastih plodova i nižih izgleda za prisutnost metaboličkog sindroma.
Zanimljiv je rezultat da ispitanici koji se nisu pridržavali mediteranske prehrane imaju manje
šanse za prisutnost dijabetesa i povišen HbA1c, ali veće šanse za pretilost.
Općenito, važnost zdravog načina života i zdravih prehrambenih navika došla je u prvi
plan pozornosti zbog pandemije COVID-19. Uvidi iz ovih studija trebali bi se koristiti za
informiranje o potrebnim i ciljanim javno-zdravstvenim intervencijama usmjerenim na
povećanje prihvaćanja mediteranske prehrane kako bi se osigurali korisni ishodi na razini
pojedinca i populacije. To je relevantno iz perspektive zdravlja stanovništva i pružanja
adekvatne zdravstvene skrbi, kao i iz perspektive gospodarskog, društvenog i kulturnog
razvoja, te očuvanja kulturne baštine za generacije koje dolaze. Less Keywords
Mediterranean diet
nuts
chronic diseases
diabetes
metabolic syndrome
BMI
socioeconomic status
Keywords (croatian)
mediteranska prehrana
orašasti plodovi
kronične bolesti
dijabetes
metabolički sindrom
BMI
socioekonomski status
Language english URN:NBN urn:nbn:hr:171:629360 Promotion 2022 Study programme Title: Translational Research in Biomedicine - TRIBE Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-09-07 11:17:17
