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Background <p>While adherence to the Mediterranean diet has been associated with reduced cardiovascular disease risk, its relationship with coronary artery disease (CAD) severity remains underexplored in non-Western populations. The present study investigated the relationship between adherence to the Mediterranean diet and the severity of CAD among Iranian patients referred for coronary angiography.</p> Methods <p>This cross-sectional analysis enrolled 945 adult patients undergoing elective coronary angiography. Adherence to the Mediterranean diet was evaluated using the validated 13-item Mediterranean Diet Adherence Screener (MEDAS). The severity of CAD was assessed using the Gensini scoring system, with scores ≥ 60 indicating severe disease and scores &lt; 60 indicating non-severe disease. Participants were categorized according to BMI into normal-weight (&lt; 25&#xa0;kg/m²) and overweight or obese (25–40&#xa0;kg/m²) groups. Multivariable logistic regression models were applied to examine the association between quintiles of MEDAS score and the likelihood of severe CAD.</p> Results <p>Among participants with overweight or obesity, higher adherence to the Mediterranean diet was independently associated with a reduced probability of severe coronary artery disease. Compared with the lowest quintile, adjusted odds ratios were 0.58 (95%CI 0.35, 0.94) for the fourth quintile and 0.58 (95%CI 0.35, 0.95) for the highest quintile, with a significant trend (P for trend = 0.005). No statistically significant associations were observed in individuals with normal body weight. However, the formal test of interaction between MEDAS score and BMI category did not reach statistical significance (P for interaction = 0.128).</p> Conclusion <p>In this cross-sectional analysis of an Iranian population, higher adherence to the Mediterranean diet was associated with lower odds of severe CAD in stratified analyses of overweight/obese patients, whereas no significant association was observed in normal-weight individuals. However, the non-significant effect modification by BMI status according to the formal interaction testing suggests that these stratified findings should be interpreted cautiously. While dietary quality may play a role in modulating CAD severity in metabolically high-risk groups, this observation requires confirmation in larger studies.</p>

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Mediterranean diet adherence and coronary artery disease severity in an Iranian population: a cross-sectional study

  • 期刊论文

  • 发表日期：

    2026年5月23日

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  • Marjan Mahdavi-Roshan,
  • Shiva Parvaneh,
  • Morvarid Noormohammadi,
  • Zeinab Ghorbani,
  • Amir Aris

摘要

Background

While adherence to the Mediterranean diet has been associated with reduced cardiovascular disease risk, its relationship with coronary artery disease (CAD) severity remains underexplored in non-Western populations. The present study investigated the relationship between adherence to the Mediterranean diet and the severity of CAD among Iranian patients referred for coronary angiography.

Methods

This cross-sectional analysis enrolled 945 adult patients undergoing elective coronary angiography. Adherence to the Mediterranean diet was evaluated using the validated 13-item Mediterranean Diet Adherence Screener (MEDAS). The severity of CAD was assessed using the Gensini scoring system, with scores ≥ 60 indicating severe disease and scores < 60 indicating non-severe disease. Participants were categorized according to BMI into normal-weight (< 25 kg/m²) and overweight or obese (25–40 kg/m²) groups. Multivariable logistic regression models were applied to examine the association between quintiles of MEDAS score and the likelihood of severe CAD.

Results

Among participants with overweight or obesity, higher adherence to the Mediterranean diet was independently associated with a reduced probability of severe coronary artery disease. Compared with the lowest quintile, adjusted odds ratios were 0.58 (95%CI 0.35, 0.94) for the fourth quintile and 0.58 (95%CI 0.35, 0.95) for the highest quintile, with a significant trend (P for trend = 0.005). No statistically significant associations were observed in individuals with normal body weight. However, the formal test of interaction between MEDAS score and BMI category did not reach statistical significance (P for interaction = 0.128).

Conclusion

In this cross-sectional analysis of an Iranian population, higher adherence to the Mediterranean diet was associated with lower odds of severe CAD in stratified analyses of overweight/obese patients, whereas no significant association was observed in normal-weight individuals. However, the non-significant effect modification by BMI status according to the formal interaction testing suggests that these stratified findings should be interpreted cautiously. While dietary quality may play a role in modulating CAD severity in metabolically high-risk groups, this observation requires confirmation in larger studies.