A score appraising paleolithic diet and the risk of cardiovascular disease in a Mediterranean prospective cohort

Purpose To assess the association between a score appraising adherence to the PaleoDiet and the risk of cardiovascular disease (CVD) in a Mediterranean cohort. Methods We included 18,210 participants from the Seguimiento Universidad de Navarra (SUN) cohort study. The PaleoDiet score comprised six food groups promoted within this diet (fruit, nuts, vegetables, eggs, meat and fsh) and fve food groups whose consumption is discouraged (cereals and grains, dairy products, legumes, culinary ingredients, and processed/ultraprocessed foods). CVD was defned as acute myocardial infarction with or without ST elevation, non-fatal stroke and cardiovascular death. Cox proportional hazards models adjusted for potential confounders were ftted to assess the association between the PaleoDiet score and CVD risk, and the PaleoDiet and MedDiet indices to explore diferences between both diets. Results During 12.2 years of follow-up, 165 incident CVD cases were confrmed. A signifcant inverse association was found between the PaleoDiet score and CVD (HR Q5 vs. Q1: 0.45, 95% CI 0.27–0.76, P for trend=0.007). A weaker association that became non-signifcant was observed when the item for low consumption of ultra-processed foods was removed from the score. Joint analysis of PaleoDiet and MedDiet Trichopoulou scores suggested that the inverse association between PaleoDiet and CVD was mainly present when adherence to the MedDiet was also high (HR for high adherence vs low adherence to both diet scores: 0.22, 95% CI 0.08–0.64). Conclusions Our fndings suggest that the PaleoDiet may have cardiovascular benefts in participants from a Mediterranean country. Avoidance of ultra-processed foods seems to play a key role in this inverse association