Longitudinal changes in adherence to the Portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study cohort.

Andrea Glenn, Author, Nutritional Sciences, University of Toronto, Toronto, ON, M5S 1A8Presenting Author

Andrea J. Glenn, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, M4Y2H7

Pablo Hernández-Alonso, Coauthor, Human Nutrition Department, Universitat Rovira i Virgili, Reus, Spain,

Cyril W.C. Kendall, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario,

Miguel Ángel Martínez-González, Coauthor, Department of Preventative Medicine and Public Health, University of Navarra, Pamplona, Spain,

David J.A. Jenkins, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario,

Dolores Corella, Coauthor, Department of Preventative Medicine, University of Valencia, Valencia, Spain,

Montserrat Fitó, Coauthor, Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Research Institute, Barcelona, Spain,

Dora Romaguera, Coauthor, Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology, Health Research Institute of the Balearic Islands, University Hospital Son Espases, Palma de Mallorca, Spain,

Jesús Vioque, Coauthor, ISABIAL-FISABIO, Miguel Hernandez University, Alicante, Spain,

Ángel M. Alonso-Gómez, Coauthor, Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain,

Julia Wärnberg, Coauthor, Department of Nursing, School of Health Sciences, University of Málaga, Institute of Biomedical Research in Malaga (IBIMA)-IBIMA, Málaga, Spain,

J. Alfredo Martínez, Coauthor, Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain,

Luís Serra-Majem, Coauthor, Research Institute of Biomedical and Health Sciences (IUIBS), Preventive Medicine Service, University of Las Palmas de Gran Canaria, Las Palmas, Spain,

Ramon Estruch, Coauthor, Department of Internal Medicine, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),, University of Barcelona, Barcelona, Spain,

Francisco J. Tinahones, Coauthor, Virgen de la Victoria Hospital, Department of Endocrinology. Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain,

José Lapetra, Coauthor, Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain,

Xavier Pintó, Coauthor, Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain,

Josep A. Tur, Coauthor, Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology. Health Research Institute of the Balearic Islands, University Hospital Son Espases, Palma de Mallorca, Spain,

Patricia J. Peña-Orihuela, Coauthor, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain,

Aurora Bueno-Cavanillas, Coauthor, Department of Preventive Medicine, University of Granada, Granada, Spain,

Miguel Delgado-Rodríguez, Coauthor, Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain,

Pilar Matía-Martín, Coauthor, Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain,

Lidia Daimiel, Coauthor, Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain,

Vicente Martín Sánchez, Coauthor, Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain,

Josep Vidal, Coauthor, Departament of Endocrinology, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain,

Clotilde Vázquez, Coauthor, Department of Endocrinology, Fundación Jiménez-Díaz, Madrid, Spain,

Emilio Ros, Coauthor, Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, IDIBAPS, Barcelona, Spain,

John L. Sievenpiper, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario,

Jordi Salas-Salvadó, Coauthor, Human Nutrition Department, Universitat Rovira i Virgili, Reus, Spain,

The Portfolio and Dietary Approaches to Stop Hypertension (DASH) diets have been shown to lower cardiometabolic risk factors in randomized controlled trials (RCTs). However, the Portfolio diet has only been assessed in RCTs of hyperlipidemic patients. We therefore conducted a longitudinal analysis of one-year data from PREDIMED-Plus, an ongoing clinical trial (Trial registration: ISRCTN89898) in Spain that includes 6,636 older participants (mean age 65y, 48% women) with overweight/obesity fulfilling at least 3 criteria for metabolic syndrome. Data for this analysis were collected at baseline, 6 months and 1 year. Adherence to the Portfolio and DASH diet indices were derived from repeated validated 143-item food frequency questionnaires. We used linear mixed models to examine the associations of changes in dietary indices with concomitant changes in cardiometabolic risk factors. Models were adjusted for cardiovascular risk factors, lifestyle factors, and other potential confounders. At 1 year, greater adherence to the Portfolio diet was significantly associated with lower HbA1c (β [95% CI]: -0.004 [-0.006, -0.002]), glucose (-0.11 [-0.20, -0.01]), triglycerides (-0.32 [-0.57, -0.08]), waist circumference (WC) (-0.12 [-0.14, -0.10]), and body mass index (BMI) (-0.04 [-0.05, -0.03]), while greater adherence to the DASH diet was significantly associated with lower HbA1c (-0.005 [-0.007, -0.003]), glucose (-0.17 [-0.24, -0.10]), triglycerides (-0.69 [-0.89, -0.48]), non-HDL-cholesterol (-0.10 [-0.19, -0.01]), WC (-0.14 [-0.16, -0.12]), BMI (-0.05 [-0.06, -0.04]), systolic blood pressure (-0.11 [-0,16, -0.06]), and diastolic blood pressure (-0.03 [-0.06, -0.01]), and with higher HDL-cholesterol (0.04 [0.02, 0.07]). Similar associations were seen when both diet scores were assessed as quartiles, comparing high to low adherence. In conclusion, among older adults at high cardiovascular risk, greater adherence to the Portfolio and DASH diets showed significant favourable associations with many cardiometabolic risk factors. Both diets may therefore be beneficial for cardiovascular/diabetes risk reduction. (Supported by Banting & Best Diabetes Centre and CIHR. This trial was supported by ISCIII, through the Fondo de Investigación para la Salud, (PI13/00462, PI16/00501) and Recercaixa-grant (2013ACUP00194), granted to JS-S; the European Research Council (Advanced Research Grant 2014-2019; 340918) granted to MAM-G; and FEDER funds (CB06/03). Consortium CIBER, M.P., CIBEROBN is an initiative of ISCIII, Spain).