Academic literature on the topic 'Vegetarian Diet, Mediterranean Diet, Cardiovascular disease'

The gut microbiota (GM) is defined as the community of microorganisms (bacteria, archaea, fungi, viruses) colonizing the gastrointestinal tract. GM regulates various metabolic pathways in the host, including those involved in energy homeostasis, glucose and lipid metabolism, and bile acid metabolism. The relationship between alterations in intestinal microbiota and diseases associated with civilization is well documented. GM dysbiosis is involved in the pathogenesis of diverse diseases, such as metabolic syndrome, cardiovascular diseases, celiac disease, inflammatory bowel disease, and neurological disorders. Multiple factors modulate the composition of the microbiota and how it physically functions, but one of the major factors triggering GM establishment is diet. In this paper, we reviewed the current knowledge about the relationship between nutrition, gut microbiota, and host metabolic status. We described how macronutrients (proteins, carbohydrates, fat) and different dietary patterns (e.g., Western-style diet, vegetarian diet, Mediterranean diet) interact with the composition and activity of GM, and how gut bacterial dysbiosis has an influence on metabolic disorders, such as obesity, type 2 diabetes, and hyperlipidemia.

CVD are the main cause of death especially in high-income countries. Previously, research focused on single nutrients including saturated and MUFA, sodium and dietary fibre, or specific foods such as fish, fruit and vegetables, and olive oil, in the aetiology of CVD. In recent years, however, the effects of complete dietary patterns on the prevention of CVD have gained interest, to account for diet heterogeneity and food–nutrient interactions. Several dietary patterns have been investigated, such as the Paleolithic diet, the vegetarian and vegan diets, the Diet Approaches to Stop Hypertension (DASH), the Nordic and Mediterranean diets, with many contradictions remaining. The aim of this review is to give an overview of the effects of these dietary patterns on CVD risk, to discuss their overall nutrient adequacy and briefly discuss their environmental impact.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Platelet activation and aggregation play an integral role in hemostasis and thrombosis. Diets and nutrients play a potential role in modifying CVD progression, particularly in platelet function, and have the potential of altering platelet function tests. Diets such as Mediterranean diet, high in omega-3 polyunsaturated fatty acids (PUFA), and vegetarian diets have inverse relationships with CVD. Dark chocolate, foods with low glycemic index, garlic, ginger, omega-3 PUFA, onion, purple grape juice, tomato, and wine all reduce platelet aggregation. Dark chocolate and omega-3 PUFA also reduce P-selectin expression. In addition, dark chocolate reduces PAC-1 binding and platelet microparticle formation. Berries inhibit platelet function (PFA-100). Energy drinks have been shown to increase platelet aggregation and caffeine increases platelet microparticle formation. Therefore, repeat testing of platelet function may be required, not only after exclusion of known antiplatelet medications but also potentially after exclusion of dietary substances/nutrients that could have plausibly affected initial test data.

Cardiometabolic disease (CMD), such as type 2 diabetes mellitus and cardiovascular disease, contributes significantly to morbidity and mortality on a global scale. The gut microbiota has emerged as a potential target to beneficially modulate CMD risk, possibly via dietary interventions. Dietary interventions have been shown to considerably alter gut microbiota composition and function. Moreover, several diet-derived microbial metabolites are able to modulate human metabolism and thereby alter CMD risk. Dietary interventions that affect gut microbiota composition and function are therefore a promising, novel, and cost-efficient method to reduce CMD risk. Studies suggest that fermentable carbohydrates can beneficially alter gut microbiota composition and function, whereas high animal protein and high fat intake negatively impact gut microbiota function and composition. This review focuses on the role of macronutrients (i.e., carbohydrate, protein, and fat) and dietary patterns (e.g., vegetarian/vegan and Mediterranean diet) in gut microbiota composition and function in the context of CMD.

Convincing evidence supports the intake of specific food components, food groups, or whole dietary patterns to positively influence dyslipidemia and to lower risk of cardiovascular diseases (CVD). Specific macro- and micro-components of a predominantly plant-based dietary pattern are vegetable fats, dietary fibers, and phytonutrients such as phytosterols. This review summarizes the current knowledge regarding effects of these components on lowering blood lipids, i.e., low-density lipoprotein cholesterol (LDL-C) and on reducing CVD risk. The beneficial role of a plant-based diet on cardiovascular (CV) health has increasingly been recognized. Plant-based dietary patterns include a Mediterranean and Nordic diet pattern, the dietary approaches to stop hypertension (DASH), and Portfolio diet, as well as vegetarian- or vegan-type diet patterns. These diets have all been found to lower CVD-related risk factors like blood LDL-C, and observational study evidence supports their role in lowering CVD risk. These diet patterns are not only beneficial for dyslipidemia management and prevention of CVD but further contribute to reducing the impact of food choices on environmental degradation. Hence, the CV health benefits of a predominantly plant-based diet as a healthy and environmentally sustainable eating pattern are today recommended by many food-based dietary as well as clinical practice guidelines.

The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American’s poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on ‘healthy diets’ to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.

Nutrition is recognized as an essential component in the prevention of a number of chronic diseases, including periodontal disease. Based on these considerations, a better understanding is required regarding how the diet, and more particularly the intake of macronutrients and micronutrients, could impact the potential relationship between nutrition and periodontal diseases, periodontal diseases and chronic diseases, nutrition and chronic diseases. To overcome this complexity, an up-to-date literature review on the nutriments related to periodontal and chronic diseases was performed. High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake causes an increased risk of periodontal diseases. This pattern of nutrients is classically found in the Western diet, which is considered as an ‘unhealthy’ diet that causes cardiovascular diseases, diabetes and cancers. Conversely, low-sugar, high-fiber and high-omega-6-to-omega-3 fatty acid ratio intake reduces the risk of periodontal diseases. The Mediterranean, DASH, vegetarian and Okinawa diets that correspond to these nutritional intakes are considered as ‘healthy’ diets, reducing this risk of cardiovascular diseases, diabetes and cancers. The role of micronutrients, such as vitamin D, E, K and magnesium, remains unclear, while others, such as vitamin A, B, C, calcium, zinc and polyphenols have been shown to prevent PDs. Some evidence suggests that probiotics and prebiotics could promote periodontal health. Periodontal and chronic diseases share, with a time delay, nutrition as a risk factor. Thus, any change in periodontal health should be considered as a warning signal to control the dietary quality of patients and thus reduce the risk of developing chronic diseases later on.

Nutrition is recognized as an essential component in the prevention of a number of chronic diseases, including periodontal disease. Based on these considerations, a better understanding is required regarding how the diet, and more particularly the intake of macronutrients and micronutrients, could impact the potential relationship between nutrition and periodontal diseases, periodontal diseases and chronic diseases, nutrition and chronic diseases. To overcome this complexity, an up-to-date literature review on the nutriments related to periodontal and chronic diseases was performed. High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake causes an increased risk of periodontal diseases. This pattern of nutrients is classically found in the Western diet, which is considered as an ‘unhealthy’ diet that causes cardiovascular diseases, diabetes and cancers. Conversely, low-sugar, high-fiber and high-omega-6-to-omega-3 fatty acid ratio intake reduces the risk of periodontal diseases. The Mediterranean, DASH, vegetarian and Okinawa diets that correspond to these nutritional intakes are considered as ‘healthy’ diets, reducing this risk of cardiovascular diseases, diabetes and cancers. The role of micronutrients, such as vitamin D, E, K and magnesium, remains unclear, while others, such as vitamin A, B, C, calcium, zinc and polyphenols have been shown to prevent PDs. Some evidence suggests that probiotics and prebiotics could promote periodontal health. Periodontal and chronic diseases share, with a time delay, nutrition as a risk factor. Thus, any change in periodontal health should be considered as a warning signal to control the dietary quality of patients and thus reduce the risk of developing chronic diseases later on.

The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, Nordic, liquid meal replacement, and vegetarian dietary patterns. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. We summarized the evidence for disease incidence outcomes and risk factor outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. The Mediterranean diet showed a cardiovascular disease (CVD) incidence (RR: 0.62; 95%CI, 0.50, 0.78), and non-significant CVD mortality (RR: 0.67; 95%CI, 0.45, 1.00) benefit. The DASH dietary pattern improved cardiometabolic risk factors (P < 0.05) and was associated with the decreased incidence of CVD (RR, 0.80; 95%CI, 0.76, 0.85). Vegetarian dietary patterns were associated with improved cardiometabolic risk factors (P < 0.05) and the reduced incidence (0.72; 95%CI: 0.61, 0.85) and mortality (RR, 0.78; 95%CI, 0.69, 0.88) of coronary heart disease. The Portfolio dietary pattern improved cardiometabolic risk factors and reduced estimated 10-year coronary heart disease (CHD) risk by 13% (−1.34% (95%CI, −2.19 to −0.49)). The Nordic dietary pattern was correlated with decreased CVD (0.93 (95%CI, 0.88, 0.99)) and stroke incidence (0.87 (95%CI, 0.77, 0.97)) and, along with liquid meal replacements, improved cardiometabolic risk factors (P < 0.05). The evidence was assessed as low to moderate certainty for most dietary patterns and outcome pairs. Current evidence suggests that the Mediterranean, DASH, Portfolio, Nordic, liquid meal replacement and vegetarian dietary patterns have cardiometabolic advantages in populations inclusive of diabetes.

Unhealthy diet is a significant risk factor for cardiovascular diseases (CVD). Therefore, this umbrella review aims to comprehensively review the effects of dietary factors, including dietary patterns, food groups, and nutrients on CVD risks. Medline and Scopus databases were searched through March 2020. Systematic reviews with meta-analyses (SRMA) of randomized controlled trials (RCTs) or observational studies measuring the effects of dietary factors on CVD risks were eligible. Fifty-four SRMAs, including 35 SRMAs of observational studies, 10 SRMAs of RCTs, and 9 SRMAs of combined RCT and observational studies, were included for review. Findings from the SRMAs of RCTs suggest the significant benefit of Mediterranean and high-quality diets for lowering CVD risk, with pooled risk ratios (RRs) ranging from 0.55 (95%CI: 0.39–0.76) to 0.64 (95%CI: 0.53–0.79) and 0.70 (95%CI: 0.57–0.87), respectively. For food nutrients, two SRMAs of RCTs found that high intake of n-3 polyunsaturated fatty acid (PUFA) significantly reduced CVD risks, with pooled RRs ranging from 0.89 (95%CI: 0.82, 0.98) to 0.90 (95%CI: 0.85–0.96), while evidence of efficacy of n-6 PUFA and combined n-3 and n-6 PUFA were inconsistent. Moreover, results from the SRMAs of RCTs did not find a significant benefit of a low-salt diet and low total fat intake for CVD prevention. For food groups, results from the SRMAs of cohort studies suggest that high intakes of legumes, nuts, and chocolate, as well as a vegetarian diet significantly reduced the risk of coronary heart disease, with pooled RRs of 0.90 (95%CI: 0.84–0.97), 0.68 (95%CI: 0.59–0.78), 0.90 (95%CI: 0.82–0.97), and 0.71 (95%CI: 0.57–0.87), respectively. Healthy dietary patterns had a significant benefit for CVD prevention. With the substitutional and synergistic interactions between different food groups and nutrients, dietary recommendations for CVD prevention should be focused more on healthy dietary patterns than single food groups or nutrients.

Les malalties cardiovasculars (CV) són una de les primeres causes de morbimortalitat a tot el món. Aquestes malalties, en gran mesura, es podrien prevenir. La Dieta Mediterrània ha estat reconeguda com un dels patrons alimentaris més saludables. Fins el moment, existeix una forta evidència científica que demostra els beneficis de la dieta Mediterrània en la prevenció i el tractament de la malaltia cardiovascular. Aquesta tesi ha estat realitzada en el context de l’estudi PREDIMED, un estudi clínic paral•lel, multi cèntric i aleatoritzat que avaluava l’efecte de la dieta Mediterrània, en comparació a una dieta baixa en greix, en la prevenció primària de la malaltia cardiovascular. L’objectiu va ser determinar l’efecte dels fruits secs, l'oli d’oliva i les seves varietats, i el magnesi en el risc cardiovascular, mortalitat per causa específica i mortalitat per totes les causes en una població Mediterrània amb alt risc cardiovascular. Tots els aliments avaluats són components claus del patró de dieta Mediterrània i són consumits en altes quantitats en la nostra població. Els resultats del nostre treball demostren que consumir fruits secs amb més freqüència estava inversament relacionat amb la mortalitat cardiovascular, mortalitat per càncer i mortalitat total després de seguir als participants durant una mitja de 4.8 anys. L’oli d’oliva, concretament la varietat extra verge, s’associava a un risc reduït de malaltia cardiovascular i mortalitat cardiovascular després de 4.8 anys de mitja de seguiment. També vam observar que el magnesi dietètic s’associava inversament a la mort cardiovascular, per càncer i mortalitat total. En conclusió, els resultats d’aquesta tesi corroboren els efectes beneficiosos dels components de la dieta Mediterrània en la prevenció de malaltia cardiovascular i mort.
Las enfermedades cardiovasculares (CV) son una de las primeras causas de morbi-mortalidad en todo el mundo. Estas enfermedades, en gran medida, se podrían prevenir. La Dieta Mediterránea ha sido reconocida como uno de los patrones alimentarios más saludables. Hasta el momento, existe una fuerte evidencia científica que demuestra los beneficios de la dieta Mediterránea en la prevención y el tratamiento de la enfermedad cardiovascular. Esta tesis ha sido realizada en el contexto del estudio PREDIMED, un estudio clínico paralelo, multicéntrico y aleatorizado que evalúa el efecto de la dieta mediterránea, en comparación a una dieta baja en grasa, en la prevención primaria de la enfermedad cardiovascular. El objetivo fue determinar el efecto de los frutos secos, aceite de oliva y magnesio en el riesgo cardiovascular, mortalidad por causa específica y mortalidad por todas las causas en una población Mediterráneo con alto riesgo cardiovascular. Todos los alimentos evaluados son componentes claves del patrón de dieta Mediterránea y son consumidos en altas cantidades en nuestra población. Los resultados del presente trabajo demostraron que consumir frutos secos con más frecuencia estaba inversamente relacionado con la mortalidad cardiovascular, mortalidad por cáncer y mortalidad total tras seguir a los participantes durante una media de 4.8 años. Observamos también que el aceite de oliva, concretamente la variedad extra virgen, se asociaba a un riesgo reducido de enfermedad cardiovascular y mortalidad cardiovascular después de 4.8 años de media de seguimiento. También observamos que el magnesio dietético se asociaba inversamente a la muerte cardiovascular, por cáncer y mortalidad total. En conclusión, los resultados corroboran los efectos beneficiosos de los componentes de la dieta Mediterránea en la prevención de enfermedad cardiovascular y muerte.
Cardiovascular disease (CVD) is one of the main causes of disability and death worldwide. Importantly, in a large extent, CVD are preventable. The Mediterranean Diet (MedDiet) is recognized as one of the healthier dietary patterns. To date, strong evidence exists supporting the benefits of the MedDiet for the prevention and management of CVD. This thesis has been conducted in the framework of the PREDIMED Study, a parallel-group, multicenter randomized nutrition trial evaluating the efficacy of a MedDiet compared to a low-fat control diet on the primary prevention of CVD. We aimed to asses the associations between nuts, olive oil and its varieties, and magnesium on the risk of CVD, cause-specific and all-cause mortality on an elderly Mediterranean population at high cardiovascular risk. All of these foods are key components of the MedDiet pattern and are highly consumed in our population. The results of the present work demonstrate that the frequency of nut consumption was inversely related to cardiovascular, cancer and total mortality after 4.8 years of follow-up. We found that olive oil consumption, specifically the extra-virgin variety, was associated with reduced risk of cardiovascular disease and cardiovascular mortality after 4.8 years of follow-up. We have also observed that dietary magnesium intake was inversely associated with cardiovascular, cancer and total mortality risk after 4.8 years of follow-up. In conclusion, the findings of this thesis support the healthy benefits of the components of a MedDiet on the primary prevention of cardiovascular disease and mortality.

Background: The Mediterranean diet (MD) has significant benefits for cardiovascular health, yet clinicians and researchers lack reliable tools to measure patient knowledge. This thesis aims to develop a reliable MD nutrition knowledge tool. Methods: A 20-item tool (Med-NKQ) was developed to test knowledge of MD relevant to cardiovascular disease (CVD). Themes included CVD risk factors, cardioprotective nutrients, quantifying serve sizes, label reading and common MD foods and patterns. The tool underwent content validity via an expert Delphi survey and was tested for repeatability among people with self-reported CVD, using a test-retest protocol. Participants were recruited through social media and completed an online survey which was repeated two weeks later. A paired sample t test, Pearson’s correlation and Bland Altman plot were used to compare the two test periods. Results: Delphi Survey: Ten out of 25 invited experts responded to round one and six responded to round two. All items achieved expert consensus at the end of round two. Repeatability testing: 32 participants were recruited and 20 completed the survey twice. Participants were mostly male and 50 years or older. A paired sample t test showed no significant difference in the mean total scores of test one (28, SD 5.4) compared to test two (29.5, SD 5.5) (t= 1.41, p=0.174). Pearson’s correlation was significant between the two test scores (r= 0.59, p= 0.006). A Bland Altman plot indicated no bias between the two survey responses. Discussion: The Med-NKQ is a reliable tool for assessing MD nutrition knowledge relevant to CVD. It is short and easy to administer, making it practical in clinical and research settings. It can be administered online leading to potential use in remote education and e-health. The Med-NKQ will contribute to future clinical practice and research studies.

[eng] Introduction: The Mediterranean diet was proved to be beneficial in the prevention and prognosis of chronic diseases. Older adults are the age group with the highest incidence of chronic disease. The study was conducted in Spain and Lebanon. Research content: In Mallorca, the nutritional content of the food consumed by 211 older adults was researched using two non-consecutive recall diets. The mean daily intake of polyphenols was 332.7 mg/d. Polyphenol intake was highest among alcohol drinkers, high educational level, high income, and physically active people Flavonoids were the highest ingested polyphenols. Alcoholic beverages were the major contributors to the total polyphenol intake, mainly red wine. Mean daily intake of lipids was 68.6 g/day. Sex, age and educational level influenced fat intake. MUFA was the highest ingested fatty acid, and “oils & seeds” was the food group with highest contribution to lipid intake; both were in accordance with the Mediterranean diet pattern. However, the fatty acid intake did not abide by the recommendations in Mediterranean older adults. Calcium, copper, magnesium and iron were consumed in quantities lower than DRI. Female sex and an income ≥900euros were associated respectively with an increased and decreased probability of compliance with the DRI on a 5points scale. The intake of minerals should be adjusted to abide by the recommendations. Along with the nutritional content of food, the correlation between age, body composition and biomarker variables on one hand and the physical fitness variables on the other hand were researched. Many physical fitness measurement variables correlated negatively with predictors of cardiovascular disease. Physical fitness might be essential in healthy aging. Overall, 36.8%, 24.5% and 0.3% of participants had low maximum 8-f TUG score, low maximum HGS and sarcopenia, respectively. Prevalence of these low values varies according to sociodemographic and body composition variables. In Lebanon, adherence to Mediterranean diet was assessed in 525 university students and 125 older adults using MEDAS. Among university students, the mean Mediterranean score estimated was 7.96. Men had a slightly higher adherence to the Mediterranean diet than women. Nonsmokers had higher score than those who smoke. 59.05% of the sample had a score lower than adequate adherence but this did not affect their will to participate in research to ameliorate their health. 0.7% of the willingness to change diet depended on the score of adherence to Mediterranean diet and 28.58% of the participants were primarily worried about their health. Stratification of the questionnaire revealed a relatively high spread of olive oil usage in cooking (86.3%) although only 50.3% consume more than 4 teaspoons per day. The percentage of participants consuming food according to the Mediterranean diet standards was higher than 50% except for wine and fish. Positive correlations were found between the different components of MEDAS, in addition the percentage of participants who had an adequate score was higher in non-smokers. Among older adults, mean Mediterranean score estimated was 8.48. Men had a slightly higher adherence to the Mediterranean diet than women. Those who work had a higher adherence to Mediterranean diet than those who don’t. 52% of the sample had a higher score than adequate adherence and the highest percentage of participants who had adequate score were primarily worried about their health and were willing to engage in physical activity, diet and research for a better health. The percentage of participants consuming food according to the Mediterranean diet standards was higher than 50% except for wine and fish. Conclusion: More studies must be conducted to compare between Lebanon and Spain and develop strategies to increase adherence to Mediterranean diet in Lebanon for a better health.
[spa] Introducción: Se ha demostrado que la dieta mediterránea es beneficiosa para la prevención y el pronóstico de las enfermedades crónicas. Los adultos mayores son el grupo de edad con mayor incidencia de enfermedades crónicas. Este estudio se realizó en España y Líbano. Contenido de la investigación: En Mallorca, la composición nutricional de los alimentos consumidos por 211 adultos mayores se investigó utilizando dos recordatorios de 24h en días no consecutivos. La ingesta diaria media de polifenoles fué de 332.7 mg/d. La ingesta de polifenoles fué más alta entre los bebedores de alcohol, alto nivel educativo, altos ingresos y personas físicamente activas. Los flavonoides fueron los polifenoles que se ingirieron en más cantidad. Las bebidas alcohólicas fueron las principales contribuyentes a la ingesta total de polifenoles, principalmente el vino tinto. La ingesta diaria media de lípidos fué de 68.6 g/día. El sexo, la edad y el nivel educativo influyeron en la ingesta de grasas. MUFA fueron el tipo de ácido graso más altamente ingerido, y "aceites y semillas" fué el grupo de alimentos con mayor contribución a la ingesta de lípidos. La ingesta de ácidos grasos no cumplió con las recomendaciones en adultos mayores. El calcio, el cobre, el magnesio y el hierro se consumieron en cantidades inferiores a las IDR. La ingesta de minerales debe ajustarse para cumplir con las recomendaciones. Muchas variables de medición de la aptitud física se correlacionaron negativamente con los predictores de enfermedad cardiovascular. La aptitud física podría ser esencial para un envejecimiento saludable. Se evaluó la condición física y su asociación con los hábitos sociodemográficos, la composición corporal y el estilo de vida. 36.8%, el 24.5% y el 0.3% de los participantes tenían una puntuación TUG máxima inferior a 8-f, un HGS máximo bajo y sarcopenia, respectivamente. En Líbano, se evaluó la adherencia a la dieta mediterránea en 525 estudiantes universitarios y en 125 adultos mayores usando el MEDAS. Entre los estudiantes universitarios, la puntuación media estimada de adherencia a la dieta mediterránea fué 7.96. Los hombres tuvieron una adherencia ligeramente mayor a la dieta mediterránea que las mujeres. Los no fumadores tenían una puntuación más alta que aquellos que fuman. El 59,05% de la muestra tenía una puntuación inferior a la adecuada. El 0.7% de la voluntad de cambiar la dieta dependía del grado de adherencia a la dieta mediterránea y el 28.58% de los participantes estaban preocupados principalmente por su salud. La estratificación del cuestionario reveló una difusión relativamente alta del uso de aceite de oliva en la cocina, aunque solo el 50.3% consumía más de 4 cucharaditas por día. El porcentaje de participantes que consumían alimentos de acuerdo con los estándares de la dieta mediterránea era superior al 50% a excepción del vino y el pescado. Se encontraron correlaciones positivas entre los diferentes componentes de MEDAS. Entre los adultos mayores, la puntuación promedio estimada de adherencia a una dieta mediterránea fué de 8.48. Los hombres tenían una adherencia ligeramente mayor a la dieta mediterránea que las mujeres. El 52% de la muestra tenía una puntuación en adherencia superior a la adecuada y la mayor parte de participantes que tenían una puntuación adecuada estaban preocupados principalmente por su salud y estaban dispuestos a participar en intervención para mejorar la salud. El porcentaje de participantes que consumían alimentos de acuerdo con los estándares de la dieta mediterránea fué superior al 50% a excepción del vino y el pescado. Conclusión: Se deben realizar más estudios en el futuro para comparar Líbano y España, así como desarrollar estrategias para aumentar la adherencia a un patrón de dieta mediterránea en Líbano, con el fin de mejorar la salud de la población.
[cat] Introducció: S'ha demostrat que la dieta mediterrània és beneficiosa en la prevenció i prognòstic de malalties cròniques. Els adults majors són el grup d'edat amb major incidència de malalties cròniques. L'estudi s’ha portat a terme a Espanya i el Líban, dos països mediterranis. Continguts de recerca: A Mallorca, s’ha investigat la composició nutricional dels aliments consumits per 211 adults majors utilitzant dos recordatoris de 24h de dies no consecutius. La ingesta mitjana diària de polifenols va ser de 332.7 mg/d. La ingesta de polifenols va ser més elevada entre els bevedors d'alcohol, nivell educatiu elevat, ingressos elevats i persones físicament actives. Els flavonoides van ser els polifenols més ingerits. Les begudes alcohòliques van ser els principals contribuents a la ingesta total de polifenols, principalment el vi negre. La mitjana de consum diari de lípids va ser de 68.6 g/dia. El sexe, l'edat i el nivell educatiu van influir en la ingesta de lípids. MUFA van ser el tipus d’àcid gras més consumit, i "olis i llavors" va ser el grup alimentari amb major contribució a la ingesta de lípids. No obstant això, la ingesta d'àcids grassos no va complir amb les recomanacions per adults majors mediterranis. El calci, el coure, el magnesi i el ferro es van consumir en quantitats inferiors a les IDR. La ingesta de minerals s'hauria d'ajustar per complir amb les recomanacions. Moltes variables de mesura d'aptitud física es van correlacionar negativament amb els predictors de malaltia cardiovascular. L'aptitud física pot ser essencial en l'envelliment saludable. En total, el 36.8%, el 24.5% i el 0.3% dels participants tenien una puntuació màxima de TUG inferior a 8-f, HGS màxim baix i sarcopenia, respectivament. La prevalença d'aquests valors baixos varia segons les variables sociodemogràfiques i de composició corporal. Al Líban, l'adhesió a la dieta mediterrània es va avaluar en 525 estudiants universitaris i 125 adults majors utilitzant MEDAS. Entre els estudiants universitaris, la mitjana de la puntuació d’adherència a un patró de dieta mediterrània va ser de 7.96. Els homes tenien un grau d’adherència a la dieta mediterrània lleugerament superior a les dones. Els no fumadors tenien una puntuació més alta que els fumadors. El 59.05% de la mostra tenia una puntuació inferior a l'adherència adequada. El 0.7% de la voluntat de canviar de dieta depenia de la puntuació d'adhesió a la dieta mediterrània i el 28.58% dels participants es preocupaven principalment per la seva salut. L'estratificació del qüestionari va revelar una distribució relativament alta de l'ús de l'oli d'oliva en la cuina tot i que només el 50.3% consumia més de 4 culleradetes diàries. El percentatge de participants que consumien aliments d’acord amb un patró de dieta mediterrània era superior al 50%, excepte pel vi i el peix. Es van trobar correlacions positives entre els diferents components de MEDAS. A més, el percentatge de participants que tenien una puntuació adequada era major en els no fumadors. Entre els adults majors, la puntuació d’adhesió mitjana a un patró de dieta mediterrània va ser de 8.48. Els homes tenien una adherència lleugerament superior a la dieta mediterrània que les dones. Els que treballaven tenien una major adhesió a la dieta mediterrània que els que no treballaven. El 52% de la mostra tenia una puntuació per sobre de l'adherència adequada. El percentatge de participants que consumien aliments d’acord amb un patró de dieta mediterrània era superior al 50%, excepte pel vi i el peix. Conclusió: Cal fer més estudis en el futur per comparar el Líban amb Espanya i desenvolupar estratègies per augmentar l'adhesió a la dieta mediterrània al Líban per a una millor salut.

Introduzione e Obiettivi: Sebbene l'uso integrato di dati amministrativi in sanità pubblica e nella ricerca epidemiologica sia di crescente interesse, il loro utilizzo nel mettere in relazione dati provenienti da studi epidemiologici con quelli provenienti da fonti amministrative non è molto frequente. Ad oggi, pochi studi longitudinali hanno valutato gli effetti degli stili di vita, come la dieta, nella mezza età su esiti di salute a lungo termine e comunque i principali si sono focalizzati sulla mortalità. Gli obiettivi di questo progetto di tesi sono stati: i) ricostruire la storia di un gruppo di soggetti che furono visitati e intervistati tra il 1991 e il 1995, ii) stimare l'incidenza delle principali malattie che si sono verificate durante 20 anni di follow-up e la mortalità per tutte le cause, e iii) studiare la relazione tra abitudini alimentari e altri stili di vita raccolti nella mezza età e il rischio di sviluppare malattie cardiovascolari (CVD) e morte attraverso l’utilizzo di un follow-up passivo. Soggetti e Metodi: Per illustrare la possibile applicazione dell'uso di dati amministrativi in epidemiologia nutrizionale sono stati utilizzati dati provenienti dallo studio di 'Bollate Study Eye', condotto su un campione di popolazione di età compresa tra 40 e 74 anni residente nella Regione Lombardia. Al baseline, 1.693 soggetti furono visitati ed intervistati sull’utilizzo di farmaci, su malattie pregresse, e sugli stili di vita; ai soggetti fu inoltre somministrato un questionario alimentare per frequenza (FFQ) per stimare l'assunzione abituale di 158 alimenti durante l’anno precedente. Lo studio si è avvalso dell'applicazione di algoritmi sviluppati per identificare i soggetti della coorte nei database dei Servizi Sanitari Regionali (RHSD) dell'Azienda Sanitaria Locale (ASL) di Mi1, utilizzando il codice fiscale e regionale come codici identificativi personali. I due endpoints principali di questo lavoro sono stati l'incidenza delle malattie cardiovascolari (CVD) e il decesso per tutte le cause, che sono stati determinati per mezzo di record linkage deterministici (DRL) con i registri di dimissione ospedaliera e di mortalità. I dati originariamente raccolti al baseline sono stati integrati con quelli di follow-up in un unico dataset utilizzato per la conduzione delle analisi statistiche. Per valutare il ruolo della dieta, i dati nutrizionali raccolti al baseline sono stati elaborati ed analizzati mediante approcci differenti. In primo luogo è stata calcolata l’energia proveniente dal consumo dei macronutrienti e categorizzata in terzili, poi è stato calcolato un indice a priori al fine di valutare l'aderenza alla dieta mediterranea (MeDi) ed infine è stato applicato un approccio esplorativo a posteriori per caratterizzare i soggetti della coorte sulla base delle loro abitudini alimentari. Inoltre, è stato valutato l'effetto combinato dei diversi fattori legati agli stili di vita, calcolando un punteggio ‘salutare’. Lo studio della relazione tra le diverse esposizioni (dieta, attività fisica, abitudine al fumo e punteggio salutare) e l’insorgenza di CVD e la morte per tutte le cause è stata studiata utilizzando modelli di regressione di Cox, che permettono di stimare i rischi relativi (RRs) espressi come hazard ratios (HRs) con i relativi intervalli di confidenza al 95% (95% CI). Risultati e Conclusioni: Da un punto di vista metodologico, si sono presentate e sono conseguentemente state affrontate diverse problematiche relative alla ricostruzione della coorte e alla determinazione degli outcomes. Attraverso il record linkage, il 95% dei soggetti reclutati nel periodo 1991-1995 è stato recuperato dai registri regionali (n=1604). Escludendo i soggetti con precedenti di malattie croniche al baseline, 530 soggetti hanno sviluppato CVD e 194 persone sono morte durante il follow-up. I risultati confermano che mantenere un corretto stile di vita, consumare alimenti tipici della dieta mediterranea, come ad esempio l'olio d'oliva, non fumare e svolgere regolare attività fisica sono condizioni che riducono il rischio di CVD e garantiscono un prolungamento della vita, soprattutto considerando questi fattori in combinazione tra di loro. Inoltre, questa tesi ha mostrato una possibile applicazione dell'uso dei dati amministrativi, che in Italia vengono utilizzati raramente in combinazione con studi di epidemiologia. L’utilizzo di questa sorgente di informazioni può rivestire un ruolo promettente nella conduzione di studi di coorte osservazionali che dispongano di numerose informazioni al baseline, e risulterebbe molto vantaggioso sia per la riduzione dei tempi e dei costi rispetto agli studi tradizionali sia per il ridotto numero di persi al follow-up e, conseguentemente, per l’elevato numero di soggetti da poter analizzare.
Introduction and Aims: Although the integrated use of administrative data in public health and epidemiological research is of increasing interest, the practice of linking data from epidemiological studies to administrative data is not very common. As far as I know, only few longitudinal studies have been carried out combining historical cohort and administrative data for evaluating the effects of life-styles factors collected in mid-life on long term health outcome, and the main evidence are related to mortality. The aims of this thesis project were: i) to reconstruct the history of a cohort of subjects who were visited and interviewed during the period from 1991-1995, ii) to estimate the incidence of major diseases that occurred during 20-years follow-up and mortality for all causes, and iii) to study the relationship between dietary habits and other lifestyles factors in middle age, and risk of cardiovascular diseases (CVD) and death by means of passive follow-up. Subjects and Methods: The data used for illustrating the possible application of the use of administrative data in the nutritional epidemiology field come from the cross-sectional ‘Bollate Eye Study’, which was carried out in a population sample of people aged 40-74 resident in Lombardy Region. At baseline, the hospital visits were attended by 1693 subjects and included an interview concerning medical and family history, the past or current use of drugs, lifestyle habits, and a food frequency questionnaire (FFQ) for estimating the usual intake of 158 foods during the year preceding the assessment. The study involved the application of algorithms developed to retrieve subjects of the cohort in the Regional Health Services databases (RHSD) of the Local Health Authority (ASL) of Mi1 by using fiscal and regional code as personal identifiers codes. The main outcomes investigated in this work were the incidence of cardiovascular diseases (CVD) and all-causes death, that were determined by means of deterministic record linkage (DRL) with the Regional Hospital discharge forms and the Mortality registries by using an international coding system of diseases. Baseline data were thereafter aggregated into a single dataset to carry out all of the analyses. For evaluating the role of diet on the two endpoints, the dietary data collected at baseline were processed and analyzed with different approaches. First, energy derived from macronutrient intake was calculated and then categorized in tertiles, then an a priori index was computed in order to assess the adherence to Mediterranean Diet (MeDi) and finally an exploratory a posteriori approach was applied to characterize subjects on the basis of their dietary patterns. Furthermore, the combined effect of lifestyle factors was evaluated by calculating a healthy score. The relationship between exposures (diet, physical activity, smoking habits and the healthy score) and fatal and nonfatal CVD and all-causes death was investigated by means of Cox’s regression models that estimated relative risks (RRs) as hazard ratios (HRs) with their 95% confidence intervals (95%CI). Results and Conclusion: From a methodological point of view, several issues related to the reconstruction of the cohort and to the outcomes definition have been focused and then addressed. After the record linkage procedures, 95% of subjects recruited during the period 1991-1995 were retrieved in the registries (n=1604). Excluding subjects with previous chronic diseases at baseline, a total of 530 CVD occurred and 194 persons died for all causes during follow-up. Results support the evidence of a positive effect of a healthy lifestyle, as adherence to a Mediterranean dietary pattern, the intake of specific components of this pattern, such as olive oil, abstinence from smoking and engaging in regular physical activity on the risk of CVD and all-causes death, particularly when these modifiable risk factors were considered in a healthy score. Furthermore, this thesis showed a possible application of the use of administrative data rarely used for epidemiological analytical study in Italy, suggesting their promising role for carrying out observational cohort studies with a large amount of data collected at baseline, guaranteeing a reduction in times and costs compared to traditional studies, ensuring a minimal number of persons lost to follow-up and resulting in a high number of subjects to analyze.

Nutrition is able to alter the cardiovascular health of the general population. Actually, the optimal dietary strategy for cardiovascular prevention is yet far to be defined. Mediterranean and vegetarian diets are those reporting the greatest grade of evidence, but no experimental studies comparing these two dietary patterns are available. The aim of my PhD study was to implement a randomized, open, crossover clinical trial in a population of omnivorous individuals living in a low-risk European country for cardiovascular disease, in order to compare the effects of a 3-month period of vegetarian and Mediterranean diets on reducing body weight, fat mass and various cardiovascular risk parameters. We randomly assigned to overweight omnivores with a low-to-moderate cardiovascular risk profile a vegetarian diet compared to a Mediterranean diet. The outcomes were changes of body weight, body composition and risk parameters of cardiovascular disease from baseline. Anthropometric measurements and blood analyses were performed at both the beginning and end of each dietary intervention. One hundred-eighteen subjects (mean age: 51.1, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No significant difference between the vegetarian and Mediterranean diets was found, as both interventions produced equally effective results. In particular, a significant body weight reduction of 1.9 kg and 1.8 kg, with a significant BMI reduction of -0.6 kg/m2 and -0.7 kg/m2, and a significant fat mass reduction of 1.2 kg and 1.5 kg were reported in the vegetarian and Mediterranean diet groups, respectively. Significant differences between the two interventions were obtained for LDL-cholesterol and vitamin B12 levels, which significantly decreased by 5.44% and 5.06% only in the vegetarian diet group, and for triglyceride levels, which significantly decreased by 5.91% only in the Mediterranean diet group. Finally, there was no significant difference between dietary interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which improved only in the Mediterranean diet group. Overall, the vegetarian diet resulted in a reduction of 8 out of 13 cytokines with 6 that reached the statistical significance, whereas the Mediterranean diet determined a reduction of 11 out of 13 pro- and anti-inflammatory cytokines, with 7 that reached the statistical significance. Forty-six participants during the vegetarian diet period and 35 during the Mediterranean diet period reached the target values for at least one cardiovascular risk factor. In conclusion, both vegetarian and Mediterranean diets were effective in reducing body weight, BMI, and fat mass, with no significant differences between them. However, the vegetarian diet resulted more effective in reducing LDL-cholesterol levels, whereas the Mediterranean diet determined a significant reduction in triglyceride levels. These findings could be important for improving the awareness of the general population towards prevention-based interventions aimed at reducing cardiovascular disease.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
A dieta Mediterrânica (DM), proveniente dos países da bacia do Mediterrâneo, entre os quais Portugal, caracteriza-se por um modelo alimentar que tem vindo a ser considerado pela evidência atual como um dos mais saudáveis, traduzindo-se num mais baixo risco de incidência e mortalidade por certas patologias como doenças cardiovasculares (DCV), neoplasias e diabetes mellitus tipo 2.O presente estudo tem como principal objetivo explorar os hábitos alimentares de uma população de utentes inscritos em unidades de cuidados de saúde primários, nomeadamente, o seu nível de adesão a este tipo de dieta.O questionário PREDIMED (PREvención con DIeta MEDiterránea) foi adaptado e aplicado a uma amostra de conveniência constituída pela população de utentes maiores de 16 anos que recorreram a consulta médica durante dois dias consecutivos. Estes utentes foram ainda inquiridos sobre os seus hábitos tabágicos, alcoólicos e prática de exercício físico, assim como medidos os dados biométricos necessários para o cálculo do Índice de Massa Corporal (IMC), Relação Perímetro abdominal / Altura (RPaA) e Pressão Arterial Média (PAM).Dos 50 questionários entregues, foram recolhidos 29. Destes, 34,5% pertenciam ao sexo masculino e 65,5% ao sexo feminino, sendo a média de idades igual a 50 anos (17-80). Estes utentes sofriam em 13,8% concomitantemente de Hipertensão Arterial (HTA) e Diabetes Mellitus, 13,8% de Dislipidémia e HTA, 10,3% apenas de Dislipidémia e 17,2% de HTA. Esta última patologia existia em 44,8% e a Dislipidémia em 24,1% do total de respondentes. Um terço destes não apresentava qualquer tipo de patologia, enquanto 44,8% tinham história familiar de DCV. Relativamente ao IMC e RPaA, a média correspondia a 29,26 kg/m2 (20,06-46,25) e 0,61 (0,39-0,83), respetivamente. Constatou-se também que 34,4% dos utentes eram obesos e que 17,2% tinham IMC normal. O Score PREDIMED apresentava uma média alta, correspondendo a 9 (4-12) num máximo de 14. Os utentes não fumadores eram 58,6%, dos quais 48,3% eram ex-fumadores. Só 24,1% dos utentes afirmava praticar exercício físico regular. Não foi encontrada significância estatística nas várias correlações estudadas.No presente estudo, não se encontraram correlações estatisticamente significativas entre as variáveis estudadas, pelo que não foi possível tirar ilações acerca da relação entre a DM e os vários fatores de risco de DCV. No entanto, os autores acreditam que este estudo levanta uma questão pertinente: será que uma boa adesão à DM se traduz realmente numa diminuição do risco de DCV? Serão necessários mais estudos semelhantes, nomeadamente, com maior número de utentes, de modo a recolher uma amostra representativa da população dos Cuidados de Saúde Primários para se poder efetivamente aferir conclusões.
The Mediterranean diet, originated from the countries of the Mediterranean basin, including Portugal, is characterized by a nutritional model that has been considered by current evidence as one of the healthiest, translating into a lower risk of incidence and mortality from cardiovascular disease (CVD), cancer and diabetes mellitus type 2. The current study’s main goal is to explore the eating habits of a population of patients from Primary Care Unit’s, particularly regarding their level of adherence to this type of diet.The PREDIMED (PREvention with DIet MEDiterranean) questionnaire has been adapted and applied to a convenience sample consisting of a population of users over 16 years old, who resorted to scheduled medical consultations, for two consecutive days. These patients were also asked about their smoking habits, as well as alcohol and physical activity habits. In order to calculate their Body Mass Index (BMI), Waist Circumference Height Ratio (WCHR) and Mean Blood Pressure (MBP), the necessary biometric data was also measured on each patient.Thirty-five questionnaires were distributed, but only 29 were collected. Of these, 34.5% were male and 65.5% were female patients. The mean age value was 50 years old (17 - 80). Hypertension (HT) and Diabetes Mellitus were found concurrently on 13.8% of the patients. Dyslipidemia and HT were also found simultaneously on 13.8% of the patients. Dyslipidemia existed alone on 10.3% of the studied population while 17.2% suffered from just HT. This last condition existed in 44.8% of overall patients while Dyslipidemia existed in 24.1%. A third of the population did not have any kind of pathology and 44.8% had family history of CVD. For the BMI and WCHR, the mean value corresponded to 29.26 kg/m2 (20.06 - 46.25) and 0.61 (0.39 - 0.83), respectively. Also, of all the patients, 34.4% were obese and 17.2% had normal BMI. The PREDIMED Score had a high mean value, equal to 9 (4 - 12). Nonsmokers were 58.6% of the patients, of which 48.3% were former smokers. Only 24.1% of the patients claimed to practice exercise regularly. No statistical significance was found in the various correlations studied.We weren’t able to find statistically significant correlations between the studied variables in the present study. As such, we were unable to draw conclusions regarding the relation between the Mediterranean diet and the various risk factors for CVD. However, the authors believe that this study raises a pertinent question: will the adherence to the Mediterranean diet really reflect a decreased risk of CVD? Similar studies will be needed, focusing on a larger number of patients, in order to collect a representative sample of the population and effectively assess clearer conclusions.

Des méthodes d’évaluation de la consommation alimentaire permettant de vérifier l’efficacité de la diète méditerranéenne en prévention des maladies cardiovasculaires doivent être validées. Objectif: Évaluer la fiabilité et la validité d’un questionnaire de fréquence alimentaire (QF) semi-quantitatif permettant de mesurer l’alimentation dans le cadre d’études cliniques portant sur la diète méditerranéenne dans la population québécoise. Méthodologie: Cinquante-trois participants ont été recrutés. Le QF a été complété à deux reprises pour évaluer la fiabilité et comparé à un journal alimentaire (JA) de 12 jours pour évaluer la validité. Résultats: Pour la fiabilité, les coefficients de corrélation intra-classe (CCI) variaient de 0.38-0.91. Pour la validité, les coefficients de corrélation de Pearson (r) entre le JA et le QF pré-JA variaient de 0.26-0.84 et les CCI variaient de 0.25-0.84. Quant au JA et QF post-JA, les r variaient de 0.36-0.83 et les CCI de 0.36-0.83. Conclusion: Le QF présente une bonne fiabilité et validité pour l’énergie et la majorité des nutriments caractéristiques de la diète méditerranéenne.
Validated dietary assessment methods are needed to conduct clinical trials evaluating the efficacy of the Mediterranean diet in primary and secondary prevention of cardiovascular disease. Aim: To assess the reproducibility and the validity of a semi-quantitative food frequency questionnaire (FFQ) to be used in clinical trials on the Mediterranean diet within the population of Quebec. Methods: Fifty-three participants were recruited. The FFQ was administered twice to assess reproducibility and was compared to a 12-day dietary record (DR) to assess validity. Results: For reproducibility, intraclass correlation coefficients (ICCs) for energy and nutrients ranged from 0.38 to 0.91. For validity, Pearson’s correlation coefficients (r) between the DR and the FFQ pre-DR ranged from 0.26 to 0.84 and ICCs ranged from 0.25 to 0.84. As for the DR and the FFQ post-DR, r ranged from 0.36 to 0.83 and ICCs ranged from 0.36 to 0.83. Conclusion: The FFQ demonstrates good reproducibility and validity for energy and most key nutrients of the Mediterranean diet.

Vitamin B6 is required for the activity of a large number of enzymes with varied essential functions. Along with other B vitamins, it is involved in the metabolism of homocysteine to cysteine; if this reaction is disrupted, blood homocysteine levels rise, along with increased risks for cardiovascular disease, neuropsychiatric problems, and other adverse effects. Elevated homocysteine in pregnancy it is associated with anaemia, pre-eclampsia, preterm birth, and low birthweight. Vitamin B6 deficiency can also affect fetal brain development, as well as weight gain and linear growth in infancy. Although vitamin B6 is widely available in foods, mild to moderate deficiency is still common, even in developed countries. A #amp;#x2018;Mediterranean-style#amp;#x2019; diet is recommended to supply sufficient amounts of vitamin B6. In individuals with an adequate and balanced diet and healthy lifestyle, supplementation is generally unnecessary.

Cardiovascular diseases (CVDs) are still a major cause of mortality worldwide and are a serious health problem. Various factors that contribute toward CVDs include hypertension, tobacco use, physical inactivity, diabetes mellitus, obesity and overweight, alcohol, dietary factors and psychosocial aspects such as stress, anxiety and depression. Nutraceuticals and diet are very important for prevention of CVDs. The potential of nutraceuticals or functional food in mitigating risk of CVDs is discussed. Functional food with health related properties include fruit and vegetable, fish, legumes, nuts, soya protein, coffee, tea, chocolate, animal based functional food. In addition, some diet plans have shown the potential of reducing the incidence of CVDs. This includes the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Okinawan and vegetarian diets. This chapter examines the risk factors of CVDs, including hypertension, tobacco usage, physical inactivity, diabetes mellitus, overweight and obesity. The chapter also brings to the fore, functional foods with properties related to health and effect of dietary patterns in the treatment and prevention of CVDs.