Mediterranean Diet and Cardiovascular Prevention: Why Analytical Observational Designs Do Support Causality and Not Only Associations

Miguel Ángel Martínez-González, Nerea Martín-Calvo (), Telmo Bretos-Azcona, Silvia Carlos and Miguel Delgado-Rodríguez
Additional contact information
Miguel Ángel Martínez-González: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain
Nerea Martín-Calvo: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain
Telmo Bretos-Azcona: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain
Silvia Carlos: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain
Miguel Delgado-Rodríguez: Department of Health Sciences, University of Jaén, Área de Medicina Preventiva y Ciencias de la Salud, 23071 Jaén, Spain

IJERPH, 2022, vol. 19, issue 20, 1-18

Abstract: Causal reductions in cardiovascular disease (CVD) with the Mediterranean diet (MedDiet) are supported by randomized trials, but the ability of nonrandomized studies to provide causal inferences in nutritional epidemiology is questioned. The “Seguimiento Universidad de Navarra” (SUN) project, conducted during 1999–2019 with 18,419 participants, was used to try to refute non-causal explanations for the inverse association found between adherence to the MedDiet and reduced CVD risk. A framework of different analytical strategies is proposed: alternative definitions of the exposure, exploration of residual confounding, resampling methods, depiction of absolute risks across the follow-up period, trial emulation, and negative controls. Additionally, we calculated the rate advancement period (RAP). We found that one standard deviation increase in the most frequently used MedDiet score was associated with a 29% relative reduction in CVD risk (95% Confidence Interval [CI] 14–41%), which is almost identical to that found in 2 randomized trials. The RAP of CVD would be postponed by an average of 7.9 years (95% CI: 1.6 to 14.2 years) by switching from low (MDS = 0 to2) to high (MDS = 7 to 9) adherence to the MedDiet in the fully adjusted model. Sensitivity analyses, graphical representations of absolute risks, trial emulation, and negative controls also supported causality. In conclusion, a framework of analytical approaches supported the causal effect of the MedDiet on CVD prevention using observational data. Similar methodology could be applied for causal inferences regarding other hypotheses.

Keywords: causal inference; Mediterranean diet; observational studies; risk assessment; statistical modeling of disease risk (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/19/20/13653/pdf (application/pdf)
https://www.mdpi.com/1660-4601/19/20/13653/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:20:p:13653-:d:949089

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().