diet is mediterranean diet indeed better
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Pekka Puska Dubai, 18.-21.4.2012TRANSCRIPT
Diet: Is Mediterranean diet indeed better?
WCC, Dubai 18-21.4.2012
Pekka Puska, professor, MD, PhD,MPolScPast President, World Heart Federation (WHF)Director General, National Institute for Health and Welfare (THL)Vice President, Int. Ass. of National Public Health Institutes (IANPHI)
Pekka Puska, Director General04/10/23
0 1000 2000 3000 4000 5000 6000 7000 8000
Occupational risk factors for injury
Unsafe health care injections
Vitamin A deficiency
Zinc deficiency
Urban air pollution
Iron deficiency
Indoor smoke from solid fuels
Unsafe water, sanitation, and hygiene
Alcohol
Physical inactivity
High Body Mass Index
Fruit and vegetable intake
Unsafe sex
Underweight
Cholesterol
Tobacco
Blood pressure
WORLDWORLDDeaths in 2000 Attributable to Selected Deaths in 2000 Attributable to Selected Leading Risk Leading Risk
FactorsFactors
Number of deaths (000s)
Source: WHR 2002
Pekka Puska, Director General04/10/23
Six of the Nine Top Determinants of Six of the Nine Top Determinants of Mortality in the World Relate to How Mortality in the World Relate to How We Eat, Drink and MoveWe Eat, Drink and Move
Diet and physical activity, together Diet and physical activity, together with tobacco and alcohol, are key with tobacco and alcohol, are key determinants of contemporary determinants of contemporary public healthpublic health
Pekka Puska, Director General04/10/23
Diet influences many biological risk factors
• Serum LDL cholesterol
• Other lipids
• Blood pressure
• Body weight
• Serum glucose
• Other (antioxidants etc.)
04/10/23 Pekka Puska, Director General
Mediterranean diet: Origins of the concept
• The Seven Countries Study
by: Ancel Keys & C. Aravanis,
H. Blackburn, R. Butzino, B. Djordjevic, A. Fontas, F. Fidanza, M. Karvonen,
N. Kimurc, A. Menolti etc.
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
Ancel Keys (1904-2004)
Ancel Keys and Italy
Pioppi, Italy: ” Home of the Medirerranean diet”
Ancel & Margaret Keys: ”Eat well and stay well” (1959)
Ancel & Margaret Keys: ”How to eat well and stay well the Mediterranean way” (1975)
04/10/23 Pekka Puska, Director General
What is the Mediterranean diet?
• Based on ”food patterns typical of Crete, much of the rest of Greece and Southern Italy in the early 1960’s”
• Emphasizes ”abundant plant foods, fresh fruit as the typical deily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry products consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts; in addition to physical activity
• Total fat: 25-35 %, saturated fats <8 %(Walter Willet)
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
Evidence of benefits of Mediterranean diet 1.
Nordman et al. Meta-analysis (Am J Med 2011): Compared to low fat diets; 2 years follow-up
• BMI: -2.2 kg
• Syst. Blood pressure: -1,7 mmHg
• Fasting plasma glucose: -3.3 mg/dL
• Total cholesterol: -7.4 mg/dL
”Mediterranean diets appea to be more effective than low fat diets”
The Mediterranean diet puts emphasis on the quality rather than quantity of dietary fat
04/10/23 Pekka Puska, Director General
Evidence of benefits of Mediterranean diet 2.
• Kastorini et al. (j. Am Coll Card, 2011): Meta-analysis of 50 studies
”Mediterranean diet is associated with lower blood pressure, blood sugar and triglycerides”
04/10/23 Pekka Puska, Director General
Evidence of benefits of Mediterranean diet 3.
Sofi et al. Meta-analysis (Am J. Clin Nutr. 2010) 2-point increase in adherence to Mediterranean diet
• Overall mortality: RR=0,92• Cardiovascular: incidence/mortality: RR=
0,90• Neurodegenerative diseases: RR=0,87 ”Significant and consistent protection of
provided by adherence to the Mediterranean diet”
04/10/23 Pekka Puska, Director General
The Mediterranean diet in secondary prevention of coronary heart disease: The Lyon Heart Study (Largevil & Salen, Clin Invest Med 2006)
50-70 % reduction of the risk of recurrence after four years of follow-up in CHD patients
04/10/23 Pekka Puska, Director General
What effect and what component importantEffects on
– Serum LDL cholesterol– Other lipids– Blood glucose– Other?
Components– Type of fat– Fruit and vegetables– Meat (fish & poultry vs red meet)?– Wine?– Other?
Also: Physical activity, portion sizes, pleasure in food, etc?
04/10/23 Pekka Puska, Director General
Lipids and diet
• Serum lipids, and especially LDL cholesterol, are major causal factors in the atherosclerotic process
• Important factor in the Mediterranean diet
• Numerous studies show how diet influences strongly serum LDL cholesterol and other lipids (Keys, Hegstedt, Mensink & Katan)
• Numerous expert recommendations
04/10/23 Pekka Puska, Director General
Iacono, Puska, Pietinen, Huttunen, Ehnholm et al.: Finland – Italy diet CHD risk study
04/10/23 Pekka Puska, Director General
The Finnish experience:The North Karelian Project
04/10/23 Pekka Puska, Director General
Serum Cholesterol in Men Aged 30–59 Serum Cholesterol in Men Aged 30–59 YearsYears
FINRISK Studies 1997 & 2002
mmol/l
5
5,5
6
6,5
7
7,5
1972 1977 1982 1987 1992 1997 2002 2007
North Karelia
Kuopio
Turku/Loimaa
Helsinki/Vantaa
Oulu
Lapland
Pekka Puska, Director General04/10/23
04/10/23 Pekka Puska, Director General
Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of Finland among males aged 35–64 years from 1969 to 2006.
Mortality per 100 000 populationAge-standadized to European population
start of the North Karelia Project
extension of the Project nationally
North Karelia
All Finland
- 85%
- 80%
Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men
-90
-80-70
-60
-50-40
-30
-20-10
0
1972 1977 1982 1987 1992 1997 2002 2007Year
%
ObservedPredictedCholesterolBlood pressureSmoking
Pekka Puska, Director General04/10/23
Estimates of S-Chol changes in Estimates of S-Chol changes in 19821982––2002*2002*
Men
-0,6
-0,5
-0,4
-0,3
-0,2
-0,1
0
0,1
1982 1992 2002
mm
ol/l
PUFA
DietarycholesterolSFA
Keys
SFA+trans
Keys (trans) **
MeasuredS-Chol
* Based on calculated intakes of dietary fatty acids and cholesterol. Standardized to the 2001 Finnish population. Users of cholesterol lowering medication excluded in -92 and -02. ** Trans fatty acids included as SFA
(Source: KTL/Valsta, Tapanainen, Laatikainen, Männistö, Vartiainen, in preparation )
Comment
Ancel Keys’ original message was (esp. In the USA) lost in ”fat-is-bad mantra – although the message was in the ”Mediterranean diet” of Ancel Keys was unsaturated fats over saturated.
Thus fats in esp. the USA were replaced with sugars, with obesity epidemic as result.
Mediterranean diet is a balanced diet, with quality of fat plus fruits and vegetables as key – with proper amount of calories with regular physical activity.
04/10/23 Pekka Puska, Director General
Mediterranean diet is one way to enjoy diet that complies with current evidence, expressed by the WHO/FAO recommendations and numerous other national and other expert recommendations.
You don’t need to eat Mediterranean diet to have heart healthy diet – you can base your diet on different cultural patterns, but following the expert recommendations.
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
WHO/FAO Expert ReportRecommendations• Limit saturated fat (<10 %) and replace by unsaturated
• Total fat intake: 15-30 %
• Limit salt (sodium) intake (<5 g)
• Limit sugar intake (<10 %)
• Increase fruit and vegetable intake (>400 g)
• Ensure physical activity: at least 30-60 min
• Ensure energy balance
RECOMMENDATIONS OF WHO/FAO EXPERT REPORT ON DIET, NUTRITION AND PREVENTION OF CHRONIC DISEASES (WHO/TRSNS. 16;2003)
04/10/23 Pekka Puska, Director General
General dietary recommendations for lipid control
• Reduce saturated fat and avoid trans fats
• Replace saturated fat with unsaturated (esp. polyunsaturated) fats
• Reduce dietary cholesterol
• Increase soluble fibers
• Maintain normal weight
04/10/23 Pekka Puska, Director General
04/10/23 Pekka Puska, Director General
National policies to promote healthy diet
WHO Global Strategy on Diet, Physical Activity and Health
04/10/23
Thanks
Pekka Puska, Director General