Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study

Table 2 Prospective association between adherence to the Mediterranean diet and incident cardiovascular diseases in EPIC-Norfolk (n = 23,902, 7606 cases, 269,935 person-years)

Mediterranean diet score^a	Hazard ratios (95 % confidence intervals)
Mediterranean diet score^a	Adjusted for age and sex	Further adjusted for potential confounders^b	Further adjusted for potential mediators^b
PyrMDS, based on dietary pyramid (0–15)
Low (3.2–8.0)	Reference	Reference	Reference
Medium (8.0–9.1)	0.95 (0.90–1.00)	0.96 (0.91–1.02)	0.97 (0.92–1.02)
High (9.1–13.1)	0.85 (0.80–0.90)	0.89 (0.84–0.94)	0.91 (0.85–0.96)
P trend	<0.001	<0.001	0.001
Per SD difference	0.93 (0.91–0.95)	0.95 (0.92–0.97)	0.95 (0.93–0.97)
LitMDS, based on literature (0–18)
Low (0–8)	Reference	Reference	Reference
Medium (9–10)	0.96 (0.90–1.01)	0.95 (0.90–1.01)	0.95 (0.90–1.01)
High (11–18)	0.91 (0.86–0.97)	0.92 (0.87–0.97)	0.92 (0.87–0.98)
P trend	0.002	0.005	0.005
Per SD difference	0.96 (0.93–0.98)	0.96 (0.94–0.99)	0.96 (0.94–0.98)
mMDS, based on medians (0–9)
Low (0–3)	Reference	Reference	Reference
Medium (4–5)	0.94 (0.89–0.99)	0.96 (0.91–1.01)	0.95 (0.90–1.00)
High (6–9)	0.95 (0.89–1.00)	0.97 (0.92–1.03)	0.97 (0.91–1.03)
P trend	0.053	0.295	0.21
Per SD difference	0.97 (0.95–1.00)	0.98 (0.96–1.01)	0.98 (0.96–1.00)
tMDS, based on tertiles (0–18)
Low (0–7)	Reference	Reference	Reference
Medium (8–9)	0.97 (0.92–1.03)	0.98 (0.93–1.04)	0.97 (0.92–1.03)
High (10–18)	0.93 (0.88–0.98)	0.94 (0.89–0.99)	0.93 (0.88–0.98)
P trend	0.008	0.024	0.011
Per SD difference	0.96 (0.94–0.98)	0.97 (0.94–0.99)	0.96 (0.94–0.99)

^aFor each Mediterranean diet score, three groups (low, medium and high adherence) were assigned to ensure approximately equal numbers of observations per group. Ordinal scores were assigned to participants, according to four different pre-specified algorithms (see methods, Additional file 1: Table S1 and S2 for details)
^bSee methods for list of confounders and mediators

ISSN: 1741-7015