The Relation between Mediterranean Diet Score and Coronary Artery Diseases: Dietary Patterns among Coronary Tunisian Patients

Case Report

Austin J Clin Case Rep. 2020; 7(3): 1171.

The Relation between Mediterranean Diet Score and Coronary Artery Diseases: Dietary Patterns among Coronary Tunisian Patients

Zidi W1,4, Hammami MB1, Zayani Y1, Zaroui A2, Fourty N1, Guizani I1, Aloui S1, El Ati J3, Sanhaji H1, Kaabachi N1, Mechmeche R2, Mourali MS2, Feki M1 and Allal-Elasmi M1*

1LR99ES11 Research Laboratory and Department of Biochemistry, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia

2Department of Cardiology, Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia

3National Institute of Nutrition, Tunis, Tunisia

4Faculty of Sciences of Bizerte, Carthage University, Tunis, Tunisia

*Corresponding author: Monia Allal-Elasmi, Biochemistry Department, Rabta Hospital, Tunisia

Received: September 01, 2020; Accepted: September 16, 2020; Published: September 23, 2020


Background: In this study, we not only assessed the association between the adherence to the Mediterranean diet (MD) and Coronary Artery Diseases (CAD), but also we tested how this association depends of gender in coronary Tunisian patients.

Methods: The study included 428 patients (292 with CAD and 136 without CAD) who underwent elective coronary angiography in the Cardiology Department. CAD severity was determined by Gensini score. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and the adherence to the MD was evaluated by the MD score (MDS).

Results: MDS was significantly lower in women with CAD. Women with CAD that present the highest quartile of MDS had a lower risk of CAD before and after adjustment for diabetes, hypertension and obesity. The risk of CAD decreased with a high intake of fruit and vegetables, fish, olive oil, and fruit only for women.

Conclusion: The adherence to vegetables, fish and olive oil’s diet pattern could favorably affect CAD’s risk because of their protective effect particularly in women. Also, MDS could be used to evaluate the nutritional status of patients and to assess other clinical and basic research.

Keywords: Mediterranean Diet Score; Coronary Artery Diseases; Cardiovascular Risk Factors 


MDS: Mediterranean Diet Score; CAD: Coronary Artery Disease; CVD: Cardiovascular Disease; FFQ: Food Frequency Questionnaire


Coronary Artery Disease (CAD) is a common chronic illnesses and one of the leading causes of death [1]. The prevalence of CAD varies considerably around the world with high rates found in the Middle East countries, Africa and the countries bordering the Mediterranean Sea [2]. An epidemiological transition is undergoing in Tunisia and this transition is may be due to ischemic heart disease’s risk which is increasing with global life expectancy [3].

The classic cardiovascular risk factor (hypertension, hyperlipidemia, diabetes, smoking and unhealthy lifestyles) are considered among the well-established risk factors for CAD. Otherwise, unhealthy dietary habits may influence the development and progression of CAD [4]. Identical eating habits are traditionally pursued in countries lining the Mediterranean Sea; we count 16 countries that are following similar diet called Mediterranean Diet (MD) [5]. The traditional Mediterranean dietary pattern is characterized by high plant-based dietary sources, based on a very important consumption of fruits and vegetables, cereals including bread, potatoes, beans, nuts and seeds. The MD includes also infrequent consumption of red meat and as regards to dairy products, fish, eggs and poultry the consumption was from low to moderate [6,7]. The traditional MD is well known for its cardio-protective effects [8,9] and has already been reported to be inversely associated to cardiovascular risk factors and precursors of Cardiovascular Disease (CVD). In fact, studies have shown that compliance with MD could prevent inflammation and this finding may explain its important role in atherosclerosis physiopathology and in cardiovascular disease [10,11]. In addition, it have been shown that elevated compliance with MD could, over time, decrease atherosclerosis in coronary arteries [12,13]. Furthermore, the existent difference of nutrition and eating habits between both sexes has been the interest of investigations for years. Research, in the nutrition field revealed that women diet and try weight loss practice more than men [14]. In this study, we assessed both the association between the MD and CAD and how it depends on gender.



We collected 428 patients who underwent elective coronary angiography in the Cardiology Department of “Rabta Hospital” (Tunis-Tunisia) by an experienced cardiologist. Those patients are divided into 2 groups (292 with CAD (CAD+) and 136 without CAD (CAD-). Patients with a history of neoplastic, hepatic, renal, cerebral, infections or autoimmune disease, valvular heart disease, peripheral atherosclerotic disease, dysfunction and myocardial infarction in less than 72 hours or any surgical procedure in the preceding six months, were excluded from this study [15].