Mediterranean diet and non-fatal acute myocardial infarction: a case-control study from Italy

Objective To add epidemiological data on the association of adherence to the Mediterranean diet with non-fatal acute myocardial infarction (AMI) in a Southern European population. Design Hospital-based case-control study. Conformity to the traditional Mediterranean diet was assessed through a score (i.e. the Mediterranean diet score, MDS) based on nine dietary components (high consumption of vegetables, legumes, fruit and nuts, cereals, and fish and seafood; high ratio of monounsaturated to saturated lipids; low consumption of dairy and meat; and moderate alcohol consumption). The score ranged between 0 (lowest adherence) and 9 (highest adherence). The association of the MDS, or its components, with the risk of AMI was evaluated through multiple logistic regression models, controlling for potential confounding variables. Setting The study was conducted in the greater Milan area (Italy) between 1995 and 2003. Subjects Seven hundred and sixty patients with a first episode of non-fatal AMI and 682 controls. Results High consumption of vegetables and legumes were inversely associated with non-fatal AMI risk. As compared with MDS<4, the OR of non-fatal AMI were 0·85 (95 % CI 0·65, 1·12) for MDS of 4-5 and 0·55 (95 % CI 0·40, 0·75) for MDS≥6, with a trend in risk (P<0·01). Results were consistent in strata of selected risk factors and an apparently stronger association emerged for individuals with a lower BMI. Conclusions The Mediterranean diet is inversely associated with the risk of non-fatal AMI in this Southern European population.