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Trichopoulou Antonia, MD
WHO Collaborating Centre for Nutrition
Department of Epidemiology
Medical School, University of Athens
International Conference on Mediterranean Diet and HealthDecember 11-12, 2007New Delhi
Mediterranean Diet- A Gift of God
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The MD can be thought of as having 9 characteristics:
high olive oil consumption
high consumption of legumes
high consumption of cereals
high consumption of fruits
high consumption of vegetables
moderate consumption of dairy products, mostly as cheese and yogurt
moderate to high consumption of fish
low consumption of meat and meat products
moderate w ine consumption, if it is accepted by religion and social norms
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Ecological studies
Case-control studies
Prospective cohort studies
Randomized intervention studies
Mediterranean diet and Health:
Epidemiological Evidence
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Life expectancy / Disease Rates in U.S., Greeceand Japan, in 1960s
U.S. Greece JapanLife expectancy at
age 45 in years(M) 27 31 27
(F) 33 34 32
Coronary Heart
Disease (M) 18933
34
(F) 54 14 21
Cerebrovascular
Diseases(M) 30 26 102
(F) 24 23 57
Breast Cancer (F) 22 8 4
Stomach Cancer (M) 6 10 48
(F) 3 6 26
Colon, Rectal Cancer (M) 11 3 5
(F) 10 3 5
Total Cancer (M) 102 83 98
(F) 87 61 77Source:W. Willett, Science 1994
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EPIC participating countries
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European Prospective Investigation intoCancer and Nutrition (EPIC)
22 centres in 10 European Countries
Approximately 500.000 Europeans
participate in the EPIC project
Coordinating Center
International Agency for Research on Cancer (IARC)
Word Health Organization
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EPIC GREECE
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Many studies have evaluated theassociation between single foods, food
groups, or nutrients andchronic diseases
Last 10 years: focus on theidentification of a dietary pattern that
maximizes longevity
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Dietary patterns have the ability to:
integrate complex or subtle interactive effect
or many dietary exposures
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per2-unit increase in Mediterranean diet score
A higher degree of adherence to the Mediterranean diet was associated witha significant reduction in :
total mortality
adjusted mortality ratio0.75
coronary heart disease
adjusted mortality ratio0.67
cancer
adjusted mortality ratio0.76
Trichopoulou et al. NEJM 2003
Adherence to a editerranean diet and survival in a Greek population
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Rather than single foods or nutrients,a global health dietary pattern could
exert protective effect
The combination of different types offood with healthy characteristics
might be necessary to express theirprotective potential
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The role of diet on the longevity of elderly Europeans
QLK6-CT-2001-00241
100 000 elderly Europeans
> 60 years at enrolment
from 9 European countries, participants of EPIC
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Results
per2-unit increase in Mediterranean diet score
A higher degree of adherence to the Mediterranean diet was associated with
8% reduction in overall mortality:
But the reduction was considerably higher in Mediterranean countries like
Spain and Greece
Trichopoulou et al. BMJ 2005
Modified Mediterranean diet and survival: EPIC-Elderly cohort
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Knoops et al. JAMA, 2004
Mediterranean Diet, Lifestyle Factors, and 10-year mortality in ElderlyEuropen Men and Women
Among individuals aged 70 to 90 years,
adherence to a Mediterranean diet and
healthful lifestyle is associated with a more than
50% lower rate of all- cause and cause-specific
mortality
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Effect of a Mediterranean style diet on endothelial dysfunction and
markers of vascular inflammation in the metabolic Syndrome a
randomized trial markers
Esposito et al. JAMA 2004
A Mediterranean-style diet might be effective
in reducing
the prevalence of the metabolic syndrome
and its associated cardiovascular risk
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Results
a2-unit increase in Mediterranean diet score
was associated with
27 % reduction in overall mortality
among individuals diagnosed
as having coronary heart disease
Trichopoulou et al. Arch Intern Med 2005
Mediterranean diet and survival of coronary patients: EPIC-Greece cohort
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Results (continued)
The reduced mortality amounted to 31%
when only cardiac deaths were considered
as the relevant outcome
Trichopoulou et al. Arch Intern Med 2005
Mediterranean diet and survival of coronary patients: EPIC-Greece cohort
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Conclusion
Greater adherence to the traditional Mediterranean diet
is associated with a significant
reduction in mortality among individuals diagnosed ashaving coronary heart disease
Modified Mediterranean diet and survival: EPIC-Elderly cohort
Trichopoulou et al. Arch Intern Med 2005
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2671 EPIC participants
from nine countries
60 years or older
had prevalent myocardial infarction but no stroke
or cancer at enrollment
Trichopoulou A. et al. Eur J Epidem 2007
Modified Mediterranean diet and survival after myocardial
infarction: the EPIC-Elderly study
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Increased adherence to modified Mediterranean diet
by two units
was associated with
18% lower overall mortality rate
Trichopoulou A. et al. Eur J Epidem 2007
Modified Mediterranean diet and survival after myocardial
infarction: the EPIC-Elderly study
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Effects of a Mediterranean-style diet on cardiovascular risk factors:
a randomized trial
Estruch et al. Ann Intern Med, 2006
Compared with a low-fat diet
Mediterranean diets supplemented witholive oil or nuts have beneficial effects on
cardiovascular risk factors
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An increase of olive oil consumption
by one standard deviation was associated with
significant reduction
of both systolic and diastolic blood pressure
by almost 1mm Hg and 0.5 mm Hg
across 20 343 individuals
Olive oil, Mediterranean diet and arterial blood pressure: the Greek EPIC cohort
Psaltopoulou et al. 2004 AJCN
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Mediterranean diet in relation to body mass index and waist-to-hip
ratio: the Greek EPIC Study
Trichopoulou et al.Am J Clin Nutr 2005
There is no association
between
Mediterranean diet
and
BMI or W/H ratio
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The data indicated that
the traditional Mediterranean dietary pattern
may be inversely associated with BMI
Schroder, J Nutr 2004
Mediterranean diet and obesity in a Spanish population
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Olive oil and the Mediterranean diet: beyond the rhetoric
Serra-Mayem L. 2003 Eur J Clin Nutr
> 13,5 % of total calories from olive oil< 6,8 % of total calories from olive oil
Consumers of larger quantities of olive oil have
low saturated fat intake,
high consumption of vegetables and legumesand
more adequate vitamin intake
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Minor constituents of olive oil
Hydrocarbons
Non-glyceride esters
Tocopherols
Carotenoids
Aliphatic alcohols4-methyl sterols
Sterols
Hydroxy-and dihydroxy-terpenic alcoholsPhospholipids
Phenolic compounds (50-800 mg/Kg)
ChlorophylsGlycolipids
Aldehydes
Ketons
Esters
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The effect of polyphenols in olive oil on heart disease risk factors: a
randomized trial.
Olive oil is more than a monounsaturatedfat
Its phenolic content can also providebenefits for plasma lipid levels and
oxidative damage
Covas et al Ann Intern Med. 2006
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Ongoing research aims to elucidate
the role of dietary antioxidants in disease prevention
The main approach was based on the hypothesis
that the chronic disorders common in many societies
are relatedto cumulative oxidative damage to DNA, proteins and
lipids in body tissues
Oli il d d i i id l h l i hibi d h li l
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Olive oil and red wine antioxidant polyphenols inhibit endothelial
activation: antiatherogenic properties of Mediterranean diet
phytochemicals.
Carluccio et alArterioscler Thromb Vasc Biol. 2003
Antiatherogenic properties of Mediterranean diet
phytochemicals
Olive oil and red wine antioxidant polyphenols
inhibit endothelial activation
Eff t f t diti l M dit di t li t i id ti
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Effect of a traditional Mediterranean diet on lipoprotein oxidation:
A randomized, controlled trial
Fito et al.Arch Intern Med, 2007
Individuals at high cardiovascular risk
who improved their diet
toward a Traditional Mediterranean Diet
pattern
showed significant reductions in cellular
lipid levels and LDL oxidation
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The traditional Mediterranean diet isassociated with longer survival
This could be partly attributed to
Mediterranean traditional foods, which
this diet implies
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1
10
100
1000
10000
log(d
ailyintake,mg)
K Fe Na Ca Mg Zn Cu Mn
Inorganic constituents
Mediterranean menu
EC daily recommendations
1. Commission of the European Communities. Food-Science Techniques: Reports of the Scientific Committeefor Food (Thirty-first series), Office for Official Publications of the European Communities, Luxembourg,1993,pp 1-248
1
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The Netherlands
Tea beverages
Onions
Apples
Greece
Apples
Parsley
OnionsOlives
Spring onions
Red wine
Spinach
Contributors to the main flavonoids
categories intake for Greece & TheNetherlands
1
1. Hertog, Hollman, Katan, Kromhout Intake ofpotentially anticarcinogenic flavonoids and their
determinants in adults in The Netherlands, NutrCancer 1993;20(1):21-9
CO C S O S
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CONCLUSIONS
high flavonoid content- obtained from wide range of foods
The investigated traditional Mediterranean menu :
meets current dietary recommendations balanced diet
Trichopoulou et al. 2005 Diet diversification and health promotion. Forum Nutr.Basel, Karger,
Vasilopoulou et al. 2005Curr.Med.Chem-Immun, Endoc.& Metab.Agents,
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Med Diet Healthy alternative approach
Not sharply different from other recommended diets
Two elements distinguish it from other prudent diets
1. It stresses the pattern rather than individual components
and
2. Provides no restriction on lipid intake so long as they are notsaturated and are preferably in the form of olive oil
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Conclusion
Mediterranean diet corresponds so well
to the ideal diet, as currently understood
by the scientific community that can bethought of as a gift of the God to the
people of the Mediterranean basin.
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Conclusion
Results from large-scale observational
studies indicate that diets freely chosen
by the general population can approachthe Mediterranean-diet optimum
provided that the nutritional milieu and
the food culture are conducive to the
adoption of a Mediterranean diet
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"Let food be thy medicine
andmedicine be thy food"
Hippocrates
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THANK YOU FOR YOUR ATTENTION