2,508 research outputs found
A traditional mediterranean diet effectively reduces inflammation and improves cardiovascular health
Chrysohoou et al. fifteen years ago, showed in an elegant analysis nested within the ATTICA
study [1] that a dietary score reflecting adherence to the traditional Mediterranean diet (MedDiet) was
inversely associated with plasma biomarkers of low-grade inflammation. Specifically, participants
in the highest tertile of adherence to the MedDiet presented 20% lower levels of highly-sensitive
C reactive protein (hs-CRP), 17% lower levels of interleukin-6 (IL-6), and 14% lower white blood
cell counts. This was an observational study that could be affected by residual confounding and
other potential imperfections. However, another similar study, this time nested within the Nurses
Cohort in the USA [2], assessed hs-CRP, IL-6, E-selectin, soluble intercellular cell adhesion molecule 1,
and soluble vascular cell adhesion molecule 1 and found that better adherence to the MedDiet was also
associated with a reduction in inflammatory biomarker concentrations, with relative reductions of 24%
in hs-CRP, 16% in IL-6, and 13% in E-selectin concentrations [2]. These well conducted observational
studies were subsequently confirmed by a randomized clinical trial (the pilot study of the PREDIMED
(PREvención con DIeta MEDiterránea) trial) where we were able to show that an intervention with 2
MedDiets maintained during 3 months was able to reduce hs-CRP, IL-6 (in both cases) and adhesion
molecules compared to a low-fat diet [3]. However, hs-CRP was reduced only when the MedDiet was
supplemented with polyphenol-rich extra-virgin olive oil, but not with nuts
Mediterranean diet as the ideal model for preventing non-alcoholic fatty liver disease (NAFLD)
The prevalence of nonalcoholic fatty liver disease (NAFLD)
has dramatically increased in the 2–3 last decades and it
represents the most frequent global cause of liver disease,
affecting 25% to 45% of adults in most studies (1). The
worldwide elevation in the population rates of NAFLD has
come in parallel with rising unprecedented pandemics of
obesity and diabetes. There is no specific medication for
NAFLD and dietary/lifestyle modifications are the main
foundations for the treatment of NAFLD. They are also
very likely to be effective for its primary prevention. In this
context, a dietary pattern that meets most requirements to
become the ideal model for the prevention of NAFLD is
the traditional Mediterranean diet (2). In addition to the
potential for preventing NAFLD, the Mediterranean diet
has sufficiently demonstrated its great ability to improve
cardiovascular health. The accrual of prospective and
well conducted studies showing cardiovascular benefits
associated with better adherence to a high-quality food
pattern is superior for the traditional Mediterranean food
pattern than for any other dietary pattern (3)
Interaction between genes and lifestyle factors on obesity.
Obesity originates from a failure of the body-weight control systems, which may be affected by changing environmental influences. Basically, the obesity risk depends on two important mutually-interacting factors: (1) genetic variants (single-nucleotide polymorphisms, haplotypes); (2) exposure to environmental risks (diet, physical activity etc.). Common single-nucleotide polymorphisms at candidate genes for obesity may act as effect modifiers for environmental factors. More than 127 candidate genes for obesity have been reported and there is evidence to support the role of twenty-two genes in at least five different populations. Gene-environment interactions imply that the synergy between genotype and environment deviates from either the additive or multiplicative effect (the underlying model needs to be specified to appraise the nature of the interaction). Unravelling the details of these interactions is a complex task. Emphasis should be placed on the accuracy of the assessment methods for both genotype and lifestyle factors. Appropriate study design (sample size) is crucial in avoiding false positives and ensuring that studies have enough power to detect significant interactions, the ideal design being a nested case-control study within a cohort. A growing number of studies are examining the influence of gene-environmental interactions on obesity in either epidemiological observational or intervention studies. Positive evidence has been obtained for genes involved in adiposity, lipid metabolism or energy regulation such as PPARgamma2 (Pro12Ala), beta-adrenoceptor 2 (Gln27Glu) or uncoupling proteins 1, 2 and 3. Variants on other genes relating to appetite regulation such as melanocortin and leptin receptors have also been investigated. Examples of some recently-identified interactions are discussed
Prevención cardiovascular y de la osteoporosis con terapia hormonal sustitutiva
Se recomienda actualmente que todo
médico -sea cual sea su especialidad- aproveche la oportunidad que supone la atención clínica a cualquier mujer postmenopáusica o que se halle en torno a la
menopausia para aconsejarle acerca de los beneficios y riesgos que supone la terapia hormonal sustitutiva (THS) con estrógenos y progesterona. Una vez que sea adecuadamente informada de estos beneficios y riesgos, debe ser la propia mujer quien decida
si va a iniciar o no esta terapia, teniendo en cuenta no sólo su propio perfil de riesgo sino también sus preferencias. Los beneficios más claros se refieren a
la reducción del riesgo de osteoporosis y de fracturas, así como al control y prevención de algunos síntomas frecuentes en la menopausia. Para prevenir la osteoporosis se requiere un uso continuado de IaTHS.
También existen cada vez más argumentos que sugieren una reducción del riesgo de un primer episodio coronario. No obstante, no hay pruebas de que laTHS sea útil en la prevención secundaria de la cardiopatía
isquémica o aporte alguna protección frente a los accidentes cerebrovasculares. Las desventajas más importantes de la THS se refieren a un mayor riesgo de hiperplasia de endometrio y de cáncer endometrial cuando se usan estrógenos solos, sin combinarlos con
progestágenos. También existe un pequeño incremento del riesgo de cáncer de mama cuando se prolonga la THS, también cuando se asocian progestágenos
Benefits of the Mediterranean diet beyond the Mediterranean Sea and beyond food patterns
Abundant and growing evidence has accrued to demonstrate that the traditional Mediterranean diet is likely to be the
ideal dietary pattern for the prevention of cardiovascular disease. A landmark randomized trial (PREDIMED) together
with many well-conducted long-term observational prospective cohort studies support this causal effect.
A new, large British cohort study by Tong et al. assessing the association between adherence to the Mediterranean diet
and cardiovascular disease was recently published in BMC Medicine. Using a superb methodology, they followed-up
23,902 participants for 12.2 years on average and observed several thousand incident cases.
The results of this cohort study showed a significant beneficial effect of the Mediterranean diet on cardiovascular
events. These findings support the transferability of this dietary pattern beyond the shores of the Mediterranean Sea.
The authors provided measures of population impact in cardiovascular prevention and estimated that 19,375 cases of
cardiovascular death would be prevented each year in the UK by promoting the Mediterranean Diet
The SUN cohort study (Seguimiento University of Navarra)
Objective: Cohort study (the SUN project) to identify dietary determinants of
hypertension, diabetes, obesity and coronary heart disease (CHD), among other conditions.
Design: The SUN project is a Mediterranean dynamic prospective follow-up (cohort)
study assessing participants every 2 years. The recruitment started in 2000 and it is
permanently open (this is a dynamic cohort). A preliminary case–control study of
myocardial infarction was also conducted, selecting incident cases of myocardial
infarction and matched hospital controls.
Setting: The SUN study is conducted in Spain with university graduates, most of them
being former students of the University of Navarra. The case–control study was conducted in three tertiary hospitals in the city of Pamplona (Spain).
Subjects: The case–control study included 171 cases and 171 controls. We have
currently enrolled more than 17 500 participants in the SUN cohort. Approximately
7500 of them were enrolled less than 2 years ago, and have not received yet the
invitation to complete the 2-year follow-up assessment. The follow-up rate for the first
10 000 participants approaches 90%.
Results: The case–control study found inverse associations between olive oil (or
adherence to a Mediterranean food pattern) and myocardial infarction. In the SUN
cohort, after 28.5 months of follow-up a higher adherence to a Mediterranean food
pattern rich in olive oil was associated with a reduced risk of hypertension, though
the results were statistically significant only among men.
Conclusions: The SUN study and the accompanying case–control study support the
benefits of a Mediterranean diet and olive oil against CHD and hypertension
Incidence of Hypertension in a Cohort of Spanish University Graduates:The SUN Study
Hypertension is a major public health problem. However,
no estimates of age- and sex-specific incidences are available
for the Spanish population. Our objective was to estimate
the incidence of hypertension in a cohort of university
graduates in Spain. We followed up 5648 individuals aged
25-65 years who were initially free of hypertension, diabetes,
and cardiovascular disease for a median of 30 months. New
diagnoses of hypertension were identified using mailed
questionnaires. We validated the self-reported diagnosis of
hypertension. In 18 250 person-years of follow-up, we
identified 248 new cases of hypertension. The unadjusted
incidences of hypertension in women and men were 8.2 per
1000 person-years (95% CI, 6.7-10.1) and 21.8 per 1000
person-years (95% CI, 18.6-25.4), respectively. The
cumulative probability of receiving a medical diagnosis of
hypertension by the age of 65 years was 50% among women
and 72% among men. In conclusion, we have provided new
evidence confirming that hypertension is one of the most
important public health problems in Spain
Determinants of the adherence to an "a priori" defined Mediterranean dietary pattern
Background: A prospective cohort study with university level participants was initiated to study the effect of Mediterranean diet on health. Aims: The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern (MDP). Method: This analysis includes 1587 males and 2260 females. MDP was defined “a priori” by summing the standardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable. Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females. Results: Women were more compliant than men with the MDP (Coefficient regression (b) = 4.1; Confidence Interval (CI) 95 % = 3.2 to 4.9). The compliance with the MDP was significantly poorer among younger participants both in men and women (p < 0.001 in men and in women). Participants who were more physically active were more likely to fulfill the traditional MDP (p = 0.01 in men and p < 0.001 in women). Conclusions: Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area. A more active life-style is associated with a better compliance with the MDP
Dieta mediterránea y enfermedad cardiovascular: resultados del estudio piloto del proyecto SUN
Fundamento: La dieta mediterránea ha sido propuesta como modelo de patrón dietético para la prevención de la cardiopatía isquémica. El proyecto SUN (“Seguimiento Universidad de Navarra”) es un estudio
epidemiológico prospectivo de cohortes, que se inició en el año 2000 y que va dirigido a identificar determinantes dietéticos y no dietéticos implicados en estas enfermedades. La viabilidad del proyecto, se
comprobó con un estudio piloto en dos fases.
Métodos: La primera fase del estudio piloto contó con la participación de voluntarios en los que se valoraron las exposiciones dietéticas y no dietéticas mediante un cuestionario autoadministrado y por
entrevista personal. Para la segunda fase, se seleccionó una muestra aleatoria de 600 graduados y se les envió el cuestionario por correo. Para estimar la variabilidad inter-sujetos se calcularon los percentiles
10, 25, 50, 75 y 90 de consumo para los principales alimentos y nutrientes considerados.
Resultados: Los participantes entendieron y respondieron adecuadamente los cuestionarios. El tiempo medio empleado en contestar el cuestionario fue de 55,0 minutos (IC 95%=50,7-59,3). Se encontró
una amplia variabilidad inter-sujetos entre los percentiles 10 y 90 en el consumo de los principales alimentos que pueden considerarse
indicadores de la dieta mediterránea, como son el aceite de oliva, las frutas, las verduras y el vino.
Conclusiones: La submuestra presentó una participación relativamente aceptable. Se halló un patrón de dieta mediterránea con una
variabilidad inter-sujetos suficientemente amplia como para poder encontrar asociaciones entre el consumo de alimentos y la incidencia de las principales enfermedades cardiovasculares
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