Adherence to the Southern European Atlantic Diet and occurrence of nonfatal acute myocardial infarction

BACKGROUND: The Southern European Atlantic Diet (SEAD) is the traditional diet in northern Portugal and Galicia, a region in northwest Spain. OBJECTIVE: The objective was to examine the association between adherence to the SEAD and the occurrence of nonfatal acute myocardial infarction (AMI). DESIGN: This was a population-based case-control study in Porto, Portugal. Cases were patients aged 18 years or older who were hospitalized with an incident AMI (n = 820), and controls were individuals without AMI selected at random from the resident population of the participating hospitals' catchment area (n = 2196). A validated food-frequency questionnaire was administered in face-to-face interviews to assess dietary intake in the previous year. We developed an SEAD adherence index with 9 key components: fresh fish excluding cod, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. A score of 1 or 0 was assigned to each food consumed and reflected consumption that was higher or lower, respectively, than the sex-specific median in controls. RESULTS: After adjustment for the main confounders, a 1-point increment in the SEAD score was associated with a 10% reduced odds of AMI [odds ratio (OR): 0.90; 95% CI: 0.85, 0.96]. In comparison with individuals in the lower quartile of the SEAD index (lowest adherence), those in the upper quartile had a 33% lower likelihood of experiencing an AMI (OR: 0.67; 95% CI: 0.51, 0.88; P for trend = 0.003). An SEAD index calculated by reverse scoring for red meat and pork products and potatoes led to an even stronger inverse association between the SEAD and AMI (OR for the upper compared with the lower quartile of SEAD index: 0.40; 95% CI: 0.30, 0.52; P for trend < 0.001). CONCLUSIONS: Adherence to the SEAD was associated with lower odds of nonfatal AMI. However, some but not all food components of the SEAD may contribute to the very low coronary mortality in northern Portugal and Galicia.