Healthy-eating attitudes and the incidence of cardiovascular disease: the SUN cohort

Abstract

There is an emerging use of brief dietary questionnaires to investigate diet-health relation. We prospectively assess the association between eating attitudes (yes/no) and incident cardiovascular disease (CVD) in 19,138 participants of the Seguimiento Universidad de Navarra (SUN) Cohort. We calculated a baseline healthy-eating attitudes score (in quartiles), positively weighting answers on more fruit, vegetables, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. We observed 139 incident cases of CVD. A higher score was associated with a lower risk of CVD [3-5 points Hazard Ratio (HR): 0.38 (95% confidence interval: 0.18-0.81); 6-8 points: 0.57 (0.29-1.12); 9-10 points: 0.31 (0.15-0.67), compared to 0-2 points]. Key contributors were the attitude to increase fruit [HR: 0.59 (0.40-0.87)], vegetables [HR: 0.57 (0.29-1.12)] and fiber intake [HR: 0.69 (0.48-0.98)]. Brief questionnaire on attitudes towards healthy-eating may be a useful tool for the primary prevention of CVD.

Keywords:

• Eating attitudes
• diet
• follow-up studies
• cardiovascular disease

Acknowledgements

We thank other members of the SUN Group: Alonso A, Álvarez I, Balaguer A, Barrientos I, Barrio-López MT, Basterra-Gortari FJ, Bazal P, Benito S, Bes-Rastrollo M, Beulen Y, Beunza JJ, Buil-Cosiales P, Canales M, Carlos S, Carmona L, Cervantes S, Cristobo C, de Irala J, de la Fuente-Arrillaga C, Delgado-Rodríguez M, Díaz-Gutiérrez J, Díez Espino J, Domínguez L, Donat-Vargas C, Donazar M, Eguaras S, Fernández-Montero A, Fresán U, Galbete C, García-Arellano A, García López M, Gardeazábal I, Gutiérrez-Bedmar M, Gómez-Gracia E, Goñi E, Guillén F, Henríquez P, Hernández A, Hu E, Lahortiga F, Leone A, Llorca J, López del Burgo C, Marí A, Marques I, Martí A, Martín Calvo N, Martínez JA, Mendonça R, Molendijk M, Molero P, Murphy K, Núñez-Córdoba JM, Papadaki A, Parletta N, Pérez de Ciriza P, Pérez Cornago A, Pimenta AM, Pons J, Ramallal R, Razquin C, Rico A, Ruano C, Ruiz Zambrana A, Salgado E, San Julián B, Sánchez D, Sánchez-Tainta A, Sánchez-Villegas A, Sayón-Orea C, Toledo E, Toledo J, Vázquez Z, Zarnowiecki D.

Ethics approval and consent to participate

The SUN cohort was conducted according to the guidelines laid down in the Declaration of Helsinki, and the Institutional Review Board of the University of Navarra approved the study protocol. Voluntary completion of the first self-administrated questionnaire was considered to imply informed consent.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

The Seguimiento Universidad de Navarra Project was supported by the Spanish Ministry of Health and European Regional Development Fund (FEDER) [Grants PI10/02993, PI10/02658, PI13/00615, PI14/01668, PI14/01798, PI14/01764, RD06/0045, G03/140], the Navarra Regional Government [45/2011, 122/2014], and the University of Navarra. AG is supported by an FPU scholarship from the Spanish Government.