The effect of the combination of Mediterranean diet and leisure time physical activity on the risk of developing acute coronary syndromes, in hypertensive subjects.
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The World Health Organization reports that the number of hypertensives, worldwide, is estimated to be 600 million people. In addition a considerable proportion of hypertensive subjects remains untreated or uncontrolled. In this work we investigated the combined effect of physical activity and Mediterranean diet on coronary risk, in hypertensives. Thus we randomly selected, from all Greek regions, 848 hospitalised patients (695 males, 58 +/- 10 years old and 153 females, 65 +/- 9 years old) with a first event of coronary heart disease (CHD) and 1078 paired, by sex, age, region controls, without any suspicions for CHD. Physically active were those who reported non-occupational physical activity more than once per week. Subjects 'closer' to the Mediterranean diet were assessed through a special nutrient questionnaire. A total of 418 (49%) of the patients and 303 (28%) of the controls were hypertensive. Of these, 115 (27%) patients and 70 (23%) controls were untreated, 148 (35%)-111 (36%) were uncontrolled and 155 (38%)-122 (41%) were controlled (P-value <0.01). One hundred and sixty-two (19%) of the patients and 265 (25%) of the controls (P < 0.01) were 'closer' to the combination of Mediterranean type of diet and physical activity. The analysis showed that the previous combination is related to a 25% reduction of the coronary risk in controlled hypertensive subjects (OR = 0.75, P < 0.01), a 11% reduction in untreated (OR = 0.89, P < 0.05) and 17% reduction (OR = 0.83, P < 0.05) in uncontrolled, after adjusting for age, sex, educational and financial level and the conventional cardiovascular risk factors. Consequently, the adoption of Mediterranean diet by physically active subjects seems to reduce significantly the coronary risk and prevent, approximately, the one-third of acute CHD, in controlled hypertensive subjects. (+info)
The high-fat Greek diet: a recipe for all?
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OBJECTIVE: To examine critically the published results of dietary surveys on the fat content of the Greek diet, and to assess its evolution and its relationship to the health of the Greeks. To consider the implications of these findings for current views on the nature and health implications of the traditional Mediterranean diet and how best to define it for use in modern policy making. DESIGN: A systematic review of the literature on food consumption in Greece. SETTING: Greece. RESULTS: The first fully published data on the fat content of the Greek diet-the Seven Countries Survey-relates only to a small number of adult males in Crete and Corfu; the legitimacy of extrapolating these results to the rest of Greece is questioned. Earlier studies and chemical validation of intakes point to a lower fat content of the traditional diet than that inferred for Crete. Nearly all later surveys relate only to urban groups in Athens (mostly case-control hospital-based samples) and a variety of non-representative Cretan groups. Only two studies are larger and more representative, but one uses FAO food balance-sheets to reflect the national diet, and the other surveyed school-age children in three out of the 52 Greek counties. Unfortunately recent dietary studies have proved unreliable, given the continuing lack of national food composition tables with survey methods which proved inaccurate for dietary fat content. A progressive upward trend in total and saturated fat intake appears to have occurred with all health indicators in relation to fat indicating remarkable increases in adult and childhood obesity with attendant progressive deterioration in cardiovascular mortality and its risk factors, ie hypertension and diabetes. These data emphasise the need to alter current nutritional advice in Greece, particularly when it focuses on the promotion of olive oil and a high-fat diet. CONCLUSIONS: The findings reaffirm low-moderate fat policies for optimum health, within which olive oil can be an important component of the diet. (+info)
Effects of a 'healthy' diet and of acute and long-term vitamin C on vascular function in healthy older subjects.
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OBJECTIVE: Aging is associated with endothelial dysfunction. We studied the acute and longer-term effects of vitamin C compared to a 'Mediterranean-type' diet on endothelial function in healthy older subjects. METHODS: Bilateral venous occlusion plethysmography was used to measure forearm blood flow in subjects aged 57-80 years. Responses to cumulative intra-arterial doses of the endothelium-dependent dilator bradykinin (BK; n=56; 20, 40, 80 pmol/min) and the nitric oxide donor glyceryl trinitrate (GTN; n=54; 4, 8, 16 nmol/min), were determined alone and in the presence of vitamin C (25 mg/min). We then randomised 54 subjects to a 'healthy' diet (n=18), vitamin C (1 g/day; n=18) or placebo for 6 weeks and reassessed endothelial and smooth muscle function. RESULTS: Acute intra-arterial vitamin C did not alter dilatation to BK or GTN. Similar increases in plasma vitamin C occurred on oral vitamin C (83+/-4 to 135+/-8 micromol/l) and 'healthy' diet (84+/-5 to 135+/-27 micromol/l; P<0.01 for both), with no change seen on placebo. Treatment with a 'healthy' diet but not oral vitamin C improved endothelium-dependent (P=0.043) and endothelium-independent dilatation (P=0.011). CONCLUSIONS: A 'Mediterranean-type' diet rich in vitamin C improves vascular function. Neither acute intra-arterial nor sustained administration of oral vitamin C improves vascular function in healthy older subjects. (+info)
Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD).
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OBJECTIVE: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. DESIGN: Cross-sectional study. SETTINGS: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. SUBJECTS: Randomly selected non-diabetic subjects from the general population, of age 35-60, not on diet for at least 3 months before the study. INTERVENTIONS: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. RESULTS: All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy-Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy-Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy-Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123-377 vs 464 g/day of the Mediterranean diet, meat, 72-193 vs 35 g/day, cheese, 15-79 vs 13 g/day, bread, 126-367 vs 380 g/day. CONCLUSIONS: (a) Dietary habits of the 'normal' population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits. (+info)
The nutrition transition in Spain: a European Mediterranean country.
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BACKGROUND: Mediterranean diets are felt to be healthful diets linked with reduced mortality from diet-related noncommunicable diseases. OBJECTIVE: To examine trends in diet, activity, obesity and diet-related noncommunicable diseases for Spain and compare these with other European countries, particularly those from the Mediterranean area. DESIGN: A combination of large-scale primary and secondary nationally representative data analysis are used. DATA: Nationally representative data on household food consumption, physical activity, adult obesity, and cause of death are combined with regionally representative adolescent obesity data, obtained in the last four decades. Comparative diet and obesity data come from nationally representative comparable data, obtained during the same period. RESULTS: The Spanish diet has shifted toward a very high level of fat intake, high fruit and dairy intake and moderate vegetable intake. Dairy and fruit intakes were the highest in Europe, as was the proportion of energy from fat, when we compared with the available data. Adult overweight and obesity trends show a marked increase in the past decade to levels as high as Italy and far above France. Overweight for children aged 6-7 is above that of even the USA, while adolescent overweight levels are among the highest in the world. Cardiovascular disease mortality is low, as with Italy and France, and the cancer mortality rate is lower than Italy and France. CONCLUSIONS: We have observed that, in Spain, relatively high obesity prevalences and dairy intake levels are related to much lower levels of cardiovascular disease and cancer mortality than are found in other European countries. This unique Spanish dietary and obesity pattern should be further explored in order to clarify the causal links. SUPPORT: The National Institutes of Health (NIH; R01-HD30880 and R01-HD38700). (+info)
Identification and quantitation of major carotenoids in selected components of the Mediterranean diet: green leafy vegetables, figs and olive oil.
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OBJECTIVE: To characterize the carotenoid content of selected components of the Mediterranean diet commonly eaten by Greek migrants to Melbourne, a population group maintaining a traditional dietary regimen, and who exhibit relatively high circulating carotenoid concentrations and low cardiovascular disease mortality. DESIGN AND SPECIMENS: Opportunistic sampling of wild (sow thistle, amaranth, purslane and dandelion, collected from roadsides and home gardens) and commercially available (chicory, endive) green leafy vegetables and figs in season. Foods were selected on the basis that they are commonly eaten by Greek migrants but not by Anglo-Celtic persons, and had not previously been well-characterized with respect to their carotenoid contents. Extra virgin, cold-pressed olive oil and 'extra light' olive oil were obtained from commercial sources. Specimens were extracted with tetrahydrofuran (or chloroform:methanol for olive oil) and carotenoid contents were quantified using HPLC with UV detection. Two to six specimens of greens and figs were analysed. Dietary intake was assessed by food frequency questionnaire. RESULTS: Wild green vegetables contained high concentrations of lutein (sow thistle>amaranth>purslane>dandelion) and beta-carotene (sow thistle>amaranth>purslane=dandelion). Sow thistle and amaranth contained lutein (15 and 13 mg/100 g, respectively) and beta-carotene (3.3 and 4.0 mg/100 g, respectively) at concentrations greater than that seen in the commercially available species of chicory and endive. Figs contained all major carotenoids appearing in plasma, albeit at low concentrations. Extra virgin cold-pressed olive oil contained substantial quantities of lutein and beta-carotene, but the more-refined 'extra light' olive oil did not. CONCLUSIONS: These components of the traditional Mediterranean diet contribute to the higher circulating concentrations of carotenoids in Greek migrants compared to Anglo-Celtic Australians. SPONSORSHIP: This study largely funded by the National Health and Medical Research Council of Australia (grant no. 974098). Extra virgin olive oil donated by Picuba Foods, Marrickville, NSW, Australia. (+info)
An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis.
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OBJECTIVE: To investigate the efficacy of a Mediterranean diet (MD) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis (RA). METHODS: Patients with well controlled, although active RA of at least two years' duration, who were receiving stable pharmacological treatment, were invited to participate. All patients were randomly allocated to the MD or the control diet (CD). To achieve good compliance with prescribed diets all patients were for the first three weeks served the MD or the CD, respectively, for lunch and dinner at the outpatient clinic's canteen. Clinical examinations were performed at baseline, and again in the 3rd, 6th, and 12th week. A composite disease activity index (DAS28), a physical function index (Health Assessment Questionnaire (HAQ)), a health survey of quality of life (Short Form-36 (SF-36)), and the daily consumption of non-steroidal anti-inflammatory drugs were used as primary efficacy variables. RESULTS: From baseline to the end of the study the patients in the MD group (n=26) showed a decrease in DAS28 of 0.56 (p<0.001), in HAQ of 0.15 (p=0.020), and in two dimensions of the SF-36 Health Survey: an increase in "vitality" of 11.3 (p=0.018) and a decrease in "compared with one year earlier" of 0.6 (p=0.016). For the control patients (n=25) no significant change was seen at the end of the study. This difference between the two treatment groups was notable only in the second half of the trial. CONCLUSION: The results indicate that patients with RA, by adjusting to a Mediterranean diet, did obtain a reduction in inflammatory activity, an increase in physical function, and improved vitality. (+info)
Commodities consumed in Italy, Greece and other Mediterranean countries compared with Australia in 1960s and 1990s.
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Consumption figures for 15 major commodities (cereals, wheat, rice, maize, potato, pulses, olive oil, other vegetable oils, vegetables, fruits, wine, meats, animal fats, milk + products, and fish + seafood) were collected from FAO Food Balance Sheets during the 1960s (1961-1969) and late 1990s (1995-1999). For some nutritionists the "model Mediterranean diet" is the Italian or Greek diet of the 1960s, for others the concept of Mediterranean countries is more general. Analysis shows: (1) In the 1960s, Australia consumed more meat, milk, animal fat than Italy or Greece and less cereals, wheat, pulses, olive oil, vegetables, fruits and wine. (2) In the 1960s, Australia's olive oil, vegetables, fruits and wine consumption were within the range for all 18 Mediterranean countries (i.e. Spain, France, Italy, Malta, Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Israel, Egypt, Libya, Tunisia, Algeria and Morocco). (3) In the 1990s, food consumptions have evolved; Australia's wine and milk consumption is now similar to Italy and Greece; consumption of wheat, olive oil, vegetables, fruits and fish are lower; consumption of potato, pulses, other vegetable oils and meat are higher than Italy or Greece. (4) Australia's consumption of the 15 commodities is within the range of all Mediterranean countries in the late 1990s, except wheat consumption was lower. (+info)