Utvrđivanje povezanosti mediteranskog načina ishrane i faktora rizika za nastanak akutnog koronarnog sindroma upotrebom „MedDiet” skora

Abstract

Uvod: Kardiovaskularne bolesti predstavljaju vodeći uzrok obolevanja i umiranja savremenog čoveka i vodeći su javno-zdravstveni problem u svetu i kod nas. Brojna istraživanja sugerišu da se mediteranski način ishrane povezuje sa smanjenjem rizika za nastanak i razvoj kardiovaskularnih bolesti i drugih masovnih nezaraznih bolesti kao i smanjenjem stope ukupnog mortaliteta. Cilj istraživanja: Utvrditi stepen pridržavanja mediteranskom načinu ishrane kod obolelih od akutnog koronarnog sindroma i kod osoba sa utvrđenim rizikom za nastanak kardiovaskularnih bolesti, upotrebom validovanog skora mediteranske ishrane – MedDiet skora. Takođe, cilj istraživanja je bio da se utvrdi da li postoji značajna razlika u vrednostima biohemijskih i kliničkih faktora rizika za razvoj kardiovaskularnih bolesti između dve posmatrane grupe ispitanika, kao i da se odredi granična vrednost MedDiet skora između poželjnog i rizičnog načina ishrane za nastanak akutnog koronarnog sindroma. Metod: Istraživanje je sprovedeno kao analitička studija preseka na uzorku od 294 ispitanika (146 žena i 148 muškaraca), starosti od 30 do 82 godine. Istraživanje je sprovedeno u vremenskom periodu od 07.02.2016. godine do 16.03.2017. godine. Prvu grupu činili su ispitanici kod kojih je dijagnostikovan akutni koronarni sindrom, koji su hospitalizovani u Institutu za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici, dok su drugu grupu činili ispitanici kod kojih je utvrđeno prisustvo najmanje jednog faktora rizika za nastanak kardiovaskularnih bolesti, bez klinički manifestne koronarne bolesti, koji su se javili na pregled u Savetovalište za pravilnu ishranu, Instituta za javno zdravlje Vojvodine u Novom Sadu. Kod svih učesnika u studiji izvršena su: antropometrijska merenja, merenje arterijskog krvnog pritiska, odgovarajuće biohemijske analize, EKG i anketiranje upotrebom posebno pripremljenog upitnika, u čijem sastavu se nalazio i MedDiet skor – validovan skor system za procenu stepena zastupljenosti mediteranskog načina ishrane kod pojedinca. Rezultati istraživanja: Srednja vrednost MedDiet skora ispitanika bez akutnog koronarnog sindroma bila je 27,48±6,59, dok je srednja vrednost MedDiet skora ispitanika sa akutnim koronarnim sindromom bila 20,53±4,01. Razlika srednjih vrednosti MedDiet skora između dve grupe ispitanika bila je statistički značajna (p=0,029). Ispitivanjem prediktivnih vrednosti pojedinih varijabli utvrđeno je da su MedDiet skor i glikemija našte odlični markeri za akutni koronarni sindrom (AUROC=0,815, p<0,0005 i AUROC=0,829, p<0,0005, respektivno). Rezultati istraživanja su pokazali da konzumiranje pojedinih namirnica iz kategorija definisanih MedDiet skorom (voće, povrće, živinsko meso i maslinovo ulje) može doprineti smanjenju rizika za nastanak akutnog koronarnog sindroma. Konzumiranje crvenog mesa i mesnih prerađevina povećava rizik od pojave akutnog koronarnog sindroma. Utvrđena granična vrednost MedDiet skora iznosila je 22,5. Vrednosti MedDiet skora ≤22,5 predstavljaju faktor rizika za nastanak akutnog koronarnog sindroma, dok vrednosti MedDiet skora >22,5 ukazuju na smanjen rizik za nastanak akutnog koronarnog sindroma. Multivarijantnom regresionom analizom pokazano je da na pojavu akutnog koronarnog sindroma utiču sledeći faktori rizika: godine starosti 1,063 (1,270-1,819), muški pol 4,071 (1,901-8,719), pušenje 3,067 (1,322-7,114), indeks telesne mase 0,902 (0,839-0,970), sistolni pritisak 1,020 (1,003-1,037), glikemija našte 1,520 (1,025-1,101) i MedDiet skor 0,783 (0,722-0,849). Zaključak: Akutni koronarni sindrom predstavlja značajan javno-zdravstveni problem odraslog stanovništva u Republici Srbiji na šta ukazuju visoke prevalencije u populaciji. Rezultati sprovedenog istraživanja pokazuju da je i diskretnim povećanjem unosa namirnica koje predstavljaju osnovu mediteranskog načina ishrane moguće postići značajne zdravstvene koristi. Ovi rezultati mogu predstavljati okvir za razvoj lokalnog skoring sistema ishrane prikladnog za nemediteransko područje, kao i modela za procenu rizika za nastanak akutnog koronarnog sindroma u našoj populaciji.

Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality of a modern society and are major public health problem in our country and also worldwide. Numerous studies suggest that the Mediterranean diet is associated with a reduction in the risk of developing cardiovascular diseases and other non-communicable diseases, as well as reduction in the overall mortality rate. Aim: To determine the degree of Mediterranean diet complience in subjects with acute coronary syndrome and subjects with an established risk for developing cardiovascular diseases, using validated Mediterranean diet score - MedDiet. Also, the aim of the study was to determine whether there is a significant difference in the values of the biochemical and clinical risk factors for the development of cardiovascular diseases between the two observed groups of subjects, and to determine the cut-off value of the MedDiet score between the favorable and unfavorable dietaty pattern for the development of acute coronary syndrome. Method: The study was conducted as an analytical cross-sectional study with enrollment of 294 subjects (146 women and 148 men), 30 to 82 years of age. The research was conducted during the period from 02/07/2016 until 03/16/2017. The first group of subjects consisted of patients diagnosed with acute coronary syndrome who were hospitalized at the Institute for Cardiovascular Diseases Vojvodina in Sremska Kamenica. The second group was comprised of subjects with established at least one major risk factor for the development of cardiovascular diseases but without clinically manifest coronary artery disease, who came to the medical examination of the Counseling Center for Proper Nutrition, Institute of Public Health of Vojvodina in Novi Sad. Among all participants in the study the following examinations were conducted: anthropometric measurements, arterial blood pressure measurements, appropriate biochemical analysis, ECG and surveys using a specially prepared questionnaire, which included MedDiet score - validated score system for assessing the degree of compliance with Mediterranean dietary pattern among subjects. Results of the study: The average value of the MedDiet score among subjects without acute coronary syndrome was 27.48 ± 6.59, while the average value of MedDiet score among subjects with acute coronary syndrome was 20.53 ± 4.01. The difference in MedDiet average values between the two groups of subjects was statistically significant (p = 0.029). By examining the predictive values of individual variables, it was shown that MedDiet score and fasting blood sugar were excellent markers for acute coronary syndrome (AUROC = 0.815, p<0.0005 and AUROC = 0.829, p <0.0005, respectively). The results of the study showed that the consumption of certain foods in the categories defined by MedDiet score (fruits, vegetables, poultry, and olive oil) can contribute to reduction of the risk for developing acute coronary syndrome. On the other hand, consuming red meat and meat products increased the risk of acute coronary syndrome. The established cut-off value for MedDiet score was 22.5. MedDiet score ≤22.5 practicaly indicated greater risk for the development of acute coronary syndrome, while MedDiet score> 22.5 indicated reduced risk for the development of acute coronary syndrome. Multivariate regression analysis showed that acute coronary syndrome is affected by the following risk factors: age 1,063 (1,270-1,819), male gender 4,071 (1,901-8,719), smoking 3,067 (1,322-7,114), body mass index 0,902 (0.839-0.970 ), systolic blood pressure 1.020 (1.003-1.037), fasting blood sugar 1.520 (1.025-1.101) and MedDiet score 0.783 (0.722- 0.849). Conclusion: Acute coronary syndrome is a major public health problem in the adult population of the Republic of Serbia, as indicated by its high prevalence. The results of the conducted research show that discrete increase in food intakes of foods which represent the basis of the Mediterranean diet, can lead to significant health benefits. These results can represent a framework for the development of a local scoring system for a non-mediterranean area, and also for creation of risk assessment model for acute coronary syndrome in our population.