Published Online
on December 17, 2007

A more recent version of this article appeared on January 15, 2008

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Submitted on April 23, 2007
Accepted on October 26, 2007

Adherence to the Mediterranean Diet Is Inversely Associated With Circulating Interleukin-6 Among Middle-Aged Men. A Twin Study

Jun Dai MD, MSc, Andrew H. Miller MD, J. Douglas Bremner MD, Jack Goldberg PhD, Linda Jones BS, Lucy Shallenberger MPH, Rocky Buckham BS, Nancy V. Murrah RN, BSN, Emir Veledar PhD, Peter W. Wilson MD, and Viola Vaccarino MD, PhD^*

From the Nutrition and Health Sciences Program (J.D., V.V.) and Department of Epidemiology, Rollins School of Public Health (P.W.W., V.V.), Emory University, Atlanta, Ga; Department of Medicine, Division of Cardiology (J.D., L.J., L.S., R.B., N.V.M., E.V., P.W.W., V.V.) and Department of Psychiatry and Behavioral Sciences (A.H.M., J.D.B.), Emory University School of Medicine, Atlanta, Ga; Vietnam Era Twin Registry, Seattle VA Epidemiologic Research and Information Center and the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle (J.G.); and Center of Epidemiology and Genomic Medicine, Atlanta VA Medical Center, Atlanta, Ga (P.W.W.).

^* To whom correspondence should be addressed. E-mail: viola.vaccarino{at}emory.edu.

Background—The Mediterranean diet is protective against cardiovascular disease; a proposed mechanism is through a reduction in systemic inflammation. It is unknown to what extent the association between the Mediterranean diet and inflammation is due to genetic or other familial factors.

Methods and Results—We administered the Willett food frequency questionnaire to 345 middle-aged male twins and assessed adherence to the Mediterranean diet using a published adherence score. Fasting plasma levels of interleukin-6, C-reactive protein, and known cardiovascular risk factors were measured. Mixed-effect regression analyses were used to examine the relationship between diet score and inflammatory biomarkers after accounting for known cardiovascular risk factors. Adherence to the Mediterranean diet was associated with reduced levels of interleukin-6 (P<0.001) but not C-reactive protein (P=0.10) after adjustment for total energy intake, other nutritional factors, known cardiovascular risk factors, and use of supplements and medications. When the overall association of adherence to the diet with interleukin-6 levels was partitioned into between- and within-pair effects, the between-pair effect was not significant (P=0.9) and the within-pair effect was highly significant (P<0.0001). A 1-unit within-pair absolute difference in the diet score was associated with a 9% (95% CI, 4.5 to 13.6) lower interleukin-6 level.

Conclusions—Shared environmental and genetic factors are unlikely to play a major role in the association between adherence to the Mediterranean diet and systemic inflammation. These results support the hypothesis that reduced inflammation is an important mechanism linking Mediterranean diet to reduced cardiovascular risk.

Key words: diet, Mediterranean • inflammation • twins, dizygotic • twins, monozygotic

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