Factors associated with adherence to the Mediterranean diet in patients with coronary artery disease: a prospective cohort study

Cirelli, Melissa Alves; Lopes, Juliana de Lima; Marcadenti, Aline; Santos, Vinícius Batista; Cavalcante, Agueda Maria Ruiz Zimmer; Barros, Alba Lucia Bottura Leite de

doi:10.1590/0034-7167-2025-0248

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 79 • 2026 • https://doi.org/10.1590/0034-7167-2025-0248 linkcopy

Factors associated with adherence to the Mediterranean diet in patients with coronary artery disease: a prospective cohort study

Factores asociados al cumplimiento de la dieta mediterránea en pacientes con enfermedad arterial coronaria: estudio prospectivo de cohorte

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives: to verify the association between adherence to the Mediterranean diet (MedDiet), sociodemographic, clinical, and biochemical factors, and hospital readmission in patients with coronary artery disease.

Methods: prospective cohort study in a tertiary hospital. MedDiet adherence was analyzed at admission and at three and six months after discharge using the Mediterranean Diet Adherence Screener. C-reactive protein, total cholesterol, LDL cholesterol, and triglycerides were analyzed at admission and six months after discharge; readmission was assessed at three and six months. Associations were verified using the generalized estimating equation model, with p-values ≤0.05 considered significant.

Results: a total of 146 patients participated, mostly men, with a mean age of 66 years. MedDiet adherence increased from 3% to 41% and 47% during follow-up and was associated with age, female gender, complete higher education, economic activity, and previous myocardial revascularization.

Conclusions: MedDiet adherence was associated with sociodemographic and clinical factors.

Descriptors:
Diet; Mediterranean; Coronary Artery Disease; Sociodemographic Factors; Nursing; Cohort Studies.

Variable	N = 146*	RR†	IC95%	p value
Length of stay (days)
Mean (SD)	6.70 (11.56)	0.992	0.976-1.008	0.321
Age
Mean (SD)	66.27 (12.09)	0.984	0.969-0.999	0.042
Sexo
Male	117 (80.14%)	0.566	0.350-0.917	0.021
Female	29 (19.86%)	Reference
Education
Higher education	126 (86.30%)	Reference
High school	16 (10.96%)	0.939	0.484-1.825	0.854
Elementary School	4 (2.74%)	0.410	0.183-0.917	0.030
Marital status
Lives with partner	131 (89.73%)
Without a partner	15 (10.27%)	0.835	0.398-1.753	0.634
Race
White	143 (97.95%)
Not white	3 (2.05%)
Occupation classification
Economically active	123 (84.25%)	Reference
Not economically active	23 (15.75%)	0.377	0.149-0.953	0.039
Medical diagnosis
Chronic DAC	93 (63.70%)	1.236	0.810-1.888	0.326
Acute DAC	53 (36.30%)
Personal background
Sedentarism	111 (76.03%)	Reference
Hypercholesterolemia	110 (75.34%)	1.037	0.637-1.689	0.883
Systemic arterial hypertension	102 (69.86%)	1.754	1.155-2.662	0.008
Treatment performed
Angioplasty	115 (78.77%)	Reference
Clinical	18 (12.33%)	0.935	0.507-1.727	0.831
Surgical	13 (8.90%)	1.614	1.018-2.558	0.042
BMI
Mean (SD)	27.51 (3.97)	0.985	0.942-1.031	0.517
Maximum/Minimum	17.48. 42.39
BMI classification
Overweight	81 (55.48%)
Regular	33 (22.60%)
Obese	31 (21.23%)
Low weight	1 (0.68%)
CRP
Mean (SD)	0.65 (1.18)
Maximum/Minimum	0.03. 7.67
Absence of results	13
Cardiovascular Risk Indicator according to the CRP
High (above 0.3mg /dL)	52 (39.10%)
Low (below 0.1 mg/dL)	35 (26.32%)
Intermediate (0.1mg/dL to 0.3mg/dL)	46 (34.59%)
Absence of results	13
Total cholesterol
Mean (SD)	167.09 (51.94)
Desirable cholesterol <190
Yes	72 (71.29%)
LDL
Mean (SD)	96.36 (42.80)
Desirable LDL<100
Yes	64 (63.37%)
Triglycerides
Mean (SD)	152.87 (106.01)
Desirable triglycerides < 150
Yes	68 (67.33%)
Prescription drugs
Antiplatelet agents	113 (77.40%)	1.053	0.685-1.618	0.814
Lipid-lowering agents	103 (70.55%)
Beta-blockers	56 (38.36%)	1.077	0.698-1.660	0.738

Variable	Hospital readmission (T0)			p value^§
Variable	Total N = 146‡	No n = 143‡	Yes n = 3‡	p value^§
Adherence to the MEDAS T0				0.101
No	141 (96.55%)	139 (97.18%)	2 (66.67%)
Yes	5 (3.45%)	4 (2.82%)	1 (33.33%)
	Hospital readmission (T6)
	Total N = 144‡	No n = 135‡	Yes n = 9‡
Adherence to the MEDAS T3				0.145
No	76 (60.32%)	69 (58.47%)	7 (87.50%)
Yes	50 (39.68%)	49 (41.53%)	1 (12.50%)
Absence of results	18	17	1

Covariate	Generalized Linear Mixed Model (GLMM)
	Total cholesterol			Triglycerides			LDL cholesterol			CRP
	Beta	IC 95%	p value	Beta	IC 95%	p value	Beta	IC 95%	p value	Beta	IC 95%	p value
Tempo
T0	-	-	-	-	-	-	-	-	-	-	-	-
T6	-32.49	-46.5 -18.3	<0.001	0.812	0.69 - 0.95	0.012	0.76	0.64 - 0.89	<0.001	0.75	-0.09 - 1.60	0.082
Adesão ao MEDAS
Não	-	-	-	-	-	-	-	-	-	-	-	-
Sim	-1.86	-21.3 - 1.02	0.841	0.850	0.67 - 1.06	0.162	0.95	0.75 - 1.20	0.701	0.49	-0.69 - 1.68	0.413
Hipolipomiante
Não	-	-	-	-	-	-	-	-	-	-	-	-
Sim	4.32	-34.07 -25.38	0.776	0.901	0.62 - 1.30	0.578	0.896	0.62 - 1.29	0.558	0.34	-0.93 - 1.63	0.594

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[1] IRR† - Incidence of Relative Risk;

[TFN1] ^*
N (%); SD - Standard Deviation; IC - Interval of Confidence; BMI - Body Mass Index; CAD - Coronary Artery Disease; CRP - C-reactive Protein; SAH - Systemic Arterial Hypertension; DM - Diabetes Mellitus.