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.