Mediterranean diet andheart health

Dr Claire McEvoy and Sarah Moore

Overview

• Does a Mediterranean diet reduce risk of heart disease and diabetes?

• What is the Mediterranean diet?

• TEAM-MED research study

Heart disease • In NI, over 75,000 people with heart disease

and 1 in 4 people die each year due to heart disease

• Diabetes is a major risk factor for heart disease

• Most deaths could be prevented by making lifestyle changes such as eating a healthy diet…

BHF, 2013 & NHS, 2012

• Seven Countries Study (1968)

• Disease rates and dietary patterns differed across countries

• Mediterranean diet responsible?

Mediterranean Diet and Heart Disease

RESEARCH

Keys et al., 1986

Does a Mediterranean diet reduce risk of heart disease and diabetes?

• People: 7447 adults at risk of heart disease

• Groups: Med diet and olive oil Med diet and nuts Low fat diet

• Outcome: Heart related death, heart attack, stroke or diabetes

• Duration: 5 years

Predimed Study

PREDIMED Study

Year 0 1 2 3 4 5

60

40

30

20

10

0

50

Low fat diet

Med diet + nuts

Med diet + olive oil

% people had heart event

Estruch et al., 2013

Heart events over 5 years

PREDIMED Study

Med diet + olive oil

Low fat diet

Salas-Salvadó et al., 2011

Med diet + nuts

Survival without diabetes over 5 years (non-diabetic individuals)

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30% reduction in risk of heart disease 52% reduction in risk of diabetes

PREDIMED Results

(Taylor et al, 2013; (Knowler et al, 2002)

27% reduction in risk of heart disease with statin treatment

30% reduction in risk of diabetes with metformin treatment

Greater adherence to a Mediterranean diet is more effective than current drug treatments to reduce the risk of heart disease and diabetes.

What these results tell us…

Mediterranean Diet: How it reduces risk

Blood pressure

Cholesterol

Blood glucose

Weight gain

Other health benefits of a Mediterranean diet

Following a Mediterranean diet can:

• reduce the risk of Alzheimer's and Parkinson's disease

• reduce the risk of death from or occurrence of Cancer

Sofi F et al., 2010

Summary

• Heart disease remains a major cause of death

• Good evidence that following a Mediterranean diet can reduce risk of heart disease and diabetes

• Further research needed on how to support people to change their diet

What is the Mediterranean diet?

The Mediterranean diet

• High in fruits, vegetables, wholegrain bread, rice and pasta, potatoes, beans, nuts, and seeds

• Olive oil as an important fat source and dairy products, fish, and poultry (consumed low- moderate amounts)

• Eggs (moderate amounts), and red meat (low amounts)

• Wine is consumed in low to moderate amounts.

• Dietary pattern based on food patterns of many Mediterranean regions in 1960s

Kris-Etherton, 2001

Mediterranean Diet Pyramid

Mediterranean Diet guidelinesEvery main meal• 1-2 portions fruits, 2+ portions vegetables• 1-2 servings wholegrain bread/ rice/ pasta• Use olive oil as main cooking fat or as a dressingEvery day• 2 servings dairy• 1-2 servings nuts Weekly • 2 servings poultry, 2+ servings oily fish, 2+ servings legumes • Less than 2 servings red meat, 1 or less serving processed meat• 0-4 servings Eggs• Less than 2 servings sweet foods • Optional: 1 glass wine/day(women), 2 glasses/day(men) most days

Bach-Faig et al., 2011

Eat more fruit & vegetables

Include oily fish (e.g. salmon, herring, sardines) 2-3 times/ week Eat wholegrain bread and cereals instead of white/ low fibre

Use olive or rapeseed oils & spreads

Add more natural nuts into your diet (e.g. walnuts, almonds or hazelnuts)

Reduce red meat intake and eat poultry more often

Alcohol in moderation (optional)

Guidelines: key foods & advice

BreakfastFruit or small glass of unsweetened fruit juiceWholegrain breakfast cereal/ porridge/ muesliWholemeal bread/ toast with olive oil spread Lunch Soup and wholemeal breadSmall portion of chicken/ fish/ egg/ cheeseSaladWholemeal breadFruit and yoghurt Evening mealSmall portion meat/ chicken/ fish/ eggPlenty of salad/ vegetablesPotatoes, rice, pasta, other grains or wholemeal breadFruit for dessertGlass of wine (optional)

Mediterranean diet meal plan

MENU

Wholegrain bagel with olive oil spread +fresh fruit

Lentil soup + wholegrain bread

Mediterranean-style marinated fish or chicken

Snacks: Fruit/ nuts

2 tbsp olive oil 1 clove garlic, thinly sliced1 carrot, diced1 large onion, sliced1 celery stick, sliced 1 medium potato, diced1-2 slices of turnip, diced 100g (4oz) red lentils 1L (1 ¾ pt) chicken or vegetable stock (serves 4)

Heat the olive oil in a saucepan and add the onion and garlic.

Sauté gently for 5 minutes until softening Add the rest of the vegetables and cook for a further 4-5 minutes. Add the lentils and stock and bring to the boil. Simmer for 15-20 minutes. Season with pepper, blend until smooth. Pour the mixture back into the pan, reheat gently.

Serve with wholemeal bread

  

 

Mediterranean diet recipes

LENTIL SOUP

2 (100g/4oz) fish fillets (or chicken breasts)2 tbsp olive oil 2 tsp red wine vinegar½ tsp ground black pepper½ dried basil or thyme ¼ tsp garlic granules2 bay leaves(serves 2)

In a bowl, mix olive oil, vinegar, pepper, basil, thyme and garlic. Coat both sides of the fish/ chicken fillets. Break the bay leaves into 3-4 pieces, press onto both sides of fillets. Cover and refrigerate for at least an hour. Remove the bay leaves. Cook in a non-stick pan over a medium-high heat.

Serve with potatoes, pasta, rice or another ‘grain’ such as couscous and vegetables  

 

Mediterranean diet recipes

MED-STYLE MARINATED FISH (or chicken)

Encouraging adoption of a Mediterranean diet

75 peopleat risk

of heart disease

Peer support (25)

Time 0 12 (months)

Written Mediterranean diet advice (25)

Sessions with Dietitian and provided olive oil

and nuts (25)

TEAM-MED Study

LOOKING FOR VOLUNTEERS!

Nutrition and Metabolism GroupCentre for Public Health, QUB

Thank you for your attention

Any questions?