Mediterranean diet score and left ventricular structure and function: The multi-ethnic study of atherosclerosis

Emily B. Levitan, Ali Ahmed, Donna K. Arnett, Joseph F. Polak, W. Gregory Hundley, David A. Bluemke, Susan R. Heckbert, David R. Jacobs, Jennifer A. Nettleton

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Data are limited on the relation between dietary patterns and left ventricular (LV) structure and function. Objective: We examined cross-sectional associations of a dietscore assessment of a Mediterranean dietary pattern with LV mass, volume, mass- To-volume ratio, stroke volume, and ejection fraction. Design: We measured LV variables with the use of cardiac MRI in 4497 participants in the Multi-Ethnic Study of Atherosclerosis study who were aged 45-84 y and without clinical cardiovascular disease. We calculated a Mediterranean diet score from intakes of fruit, vegetables, nuts, legumes, whole grains, fish, red meat, the monounsaturated fat:saturated fat ratio, and alcohol that were selfreported with the use of a food-frequency questionnaire. We used linear regression with adjustment for body size, physical activity, and cardiovascular disease risk factors to model associations and assess the shape of these associations (linear or quadratic). Results: The Mediterranean diet score had a slight U-shaped association with LV mass (adjusted means: 146, 145, 146, and 147 g across quartiles of diet score, respectively; P-quadratic trend = 0.04). The score was linearly associated with LV volume, stroke volume, and ejection fraction: for each +1-U difference in score, LV volume was 0.4 mL higher (95% CI: 0.0, 0.8 mL higher), the stroke volume was 0.5 mL higher (95% CI: 0.2, 0.8 mL higher), and the ejection fraction was 0.2 percentage points higher (95% CI: 0.1, 0.3 percentage points higher). The score was not associated with the mass- To-volume ratio. Conclusions: A higher Mediterranean diet score is cross-sectionally associated with a higher LV mass, which is balanced by a higher LV volume as well as a higher ejection fraction and stroke volume. Participants in this healthy, multiethnic sample whose dietary patterns most closely conformed to a Mediterranean- Type pattern had a modestly better LV structure and function than did participants with less-Mediterranean-like dietary patterns. This trial was registered at as NCT00005487. Am J Clin Nutr 2016;104:595-602.

Original languageEnglish
Pages (from-to)595-602
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Issue number3
StatePublished - Sep 1 2016

Bibliographical note

Publisher Copyright:
© 2016 American Society for Nutrition.


  • Cardiovascular disease
  • Epidemiology
  • Left ventricular function
  • Left ventricular structure
  • Mediterranean diet pattern
  • Subclinical cardiovascular disease

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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