epidemiologia nutrizionale - cnr · •to establish whether culturally different populations suffer...

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440

330430

340

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MORTALITA’ PER MALATTIE CARDIOVASCOLARI IN EUROPA (per 100.000 persone/anno)

Fonte: OMS, 1985

ISA, Epidemiologia e Genetica delle Popolazioni

The Seven Countries Study of Cardiovascular Diseases

The origins

• Created and coordinated by Prof Ancel Keys, Universityof Minnesota• Started in the late 1950’s, early 1960’s• 16 cohorts of men aged 40-59 enrolled in 7 countries (8nations) for a total of 12763 subjects in:• United States, Finland, the Netherlands, Italy, Croatia(former Yugoslavia), Serbia (former Yugoslavia), Greece,Japan


• To establish whether culturally different populationssuffer different amount of the disease (prevalence,incidence, mortality).

• To establish whether these differences, if true, areexplained by life-style, eating habits and othercharacteristics of the populations.

• To establish whether, within populations, somepersonal characteristics (risk factors) were predictiveof subsequent cardiovascular events.


Objectives


•Was run on sub-samples of each cohort.•In 13 cohorts the 7-day record method was used.•In 1 cohort (US) the 1-day record method was used.

•In 2 cohorts (Japan) the 4-day record method was used.


Dietary data collection


CHD mortality rates in 5 years in 8 nations ofthe Seven Countries Study.

0

5

10

15

20

25

30

US FIN NL IT HR SE GR JP

CH

D d

ea

th r

ate

s p

er

10

00

in

5 y

ea

rs


0

50

100

150

200

250

300

US FIN NL IT HR SE GR JPCH

D d

ea

th r

ate

s p

er

10

00

in

25

ye

ars

CHD mortality rates in 25 years in 8 nations ofthe Seven Countries Study.


0

20

40

60

80

100

120

140

0 5 10 15 20 25

dietary SAFA (% EN)

15-year

CHD d

eath

rate

s pe

r 1000

Correlation between dietary SAFAand 15-year CHD mortality in 16 cohorts

of the Seven Countries Study


128

130

132

134

136

138

Oliod’oliva

Burro

83

85

87

Oliod’oliva

Burro

PAS (mmHg) PAD (mmHg)

5,35

Oliod’oliva

Burro

Colesterolo (mmol/L)

5.45

5.55

4,55

Oliod’oliva

Burro

Glicemia (mmol/L)

4.75

4.95

Categorie di consumo: Basso Medio Elevato

M. Trevisan et al. JAMA, 1990

Fattori di rischio per cardiopatia ischemica in base alconsumo di grassi (The Italian Nine Communities Study)

CHANGING THE MEDITERRANEAN DIET...The POLLICA Study


CHANGING THE MEDITERRANEAN DIET...The POLLICA Study

SCOPO

• valutare gli effetti di modificazioni dei grassi alimentari suilipidi plasmatici e sulla pressione arteriosa

POPOLAZIONE

• 58 volontari sani abitanti nel comune di Pollica (ParcoNazionale del Cilento, Salerno)

DIETA SPERIMENTALE

• MENO cibi tradizionali di origine vegetale (in particolareolio d’oliva)

• PIU’ alimenti ricchi di grassi saturi di origine animale(burro, panna)


CHANGING THE MEDITERRANEAN DIET:EFFETTI SUI LIPIDI PLASMATICI

100

120

140

160

180

200

220

240

Dieta

tradizionale

Dieta

sperimentale

Dieta

tradizionale

Tot-CHOL (mg/dl) LDL-CHOL (mg/dl)

The Pollica Study

Ferro-Luzzi et al, Am J Clin Nutr, 1984

70

74

78

Traditional diet Experimental

diet

Traditional diet

CHANGING THE MEDITERRANEAN DIET: EFFETTI SULLA PRESSIONE The Pollica Study

108

112

116

120

Traditional diet Experimental

diet

Traditional diet

Strazzullo et al, J Hypertension, 1986

(mm Hg)

(mm Hg)

Pressione sistolica

Pressione diastolica

Variazioni nel consumo quotidiano di farmaci in pazientiipertesi in corso di 6 mesi di dieta ricca in olio extra-vergine

d’oliva o olio di girasole

-60

-40

-20

0

Vari

azio

ne (

%)

Olio d'oliva Olio di girasole

Olio d'oliva Olio di girasole

Ferrara et al. Arch Intern Med 2000; 160: 837-842

VARIAZIONI DEL CONTENUTO IN GRASSI NELLA DIETA DELL’ITALIAMERIDIONALE E INSULARE

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5

10

15

20

25

30

35

40

Olio d

'oliva

Oli veg

etali

Burro

Grassi

saturi

Grassi

vari

Grass

i total

i

1965

1985

%


95%

5%

SI

Pensate che un elevato contenutodi grassi animali nella dieta sia

pericoloso per la salute ?

0

2 5

5 0

7 5

1 0 0

NO

Non più di 2

3 o più

Sapete indicare uno o più alimentiricchi in grassi animali ?

INFORMAZIONE & SALUTE: indagine conoscitiva sul livello di conoscenza delruolo della nutrizione nella prevenzione delle malattie cardiovascolari condotta inaree urbane e rurali dell’Italia meridionale (Barba et al, Ital Heart J 2001; 2:546-552)

NO


Summary:

• Numerous comparisons between populations have shownthat there is a strong correlation between the intakeof saturated fatty acids (SFA) and CHD morbidity andmortality.

• A customary diet high in SFA is associated with highlevels of CHD. This is the case for the most Westernand Northern European countries.

• On the other hand, in the Mediterranean countries,where people consume their traditional diet in whichthe majority of fat calories is derived from olive oil,there is a low incidence of CHD.

LA DIETA MEDITERRANEA:

PATRIMONIO DELLA TRADIZIONE E RISORSA PER IL FUTURO


•Da un punto di vista scientifico, si definisce DIETA MEDITERRANEA la dietaabitualmente consumata in Italia Meridionale e Insulare e in Grecia durante glianni ‘50.

•La dieta mediterranea tradizionale è caratterizzata dall’abbondanza dialimenti vegetali come pane, pasta, verdure, insalate, legumi, frutta e fruttisecchi; olio di oliva come fonte primaria di grassi, un moderato consumo dipesce, di carne bianca, di latticini e uova, moderate quantita di carne rossae modesto consumo di vino durante i pasti.

•Questa dieta ha un basso contenuto di acidi grassi saturi, è ricca incarboidrati e fibra, e ha un alto contenuto di acidi grassi monoinsaturi chederivano principalmente dall´olio d´oliva.

Documento di Consenso Internazionale "Olio di oliva eDieta Mediterranea: implicazioni per la salute in Europa”.


16

18

20

22

Raro Moderato 1/die 2/die

Indi

ce d

i mas

sa c

orpo

rea

(Kg/

m2)

Frequenza di consumo di latte

Working hypotheses….

Calcium-linked mechanisms

•Low dietary Ca intake stimulates lipogenesis and fat accumulation•Calcitrophic hormones, such as parathyroid hormone and 1,25 dihydroxyvitamin D, mightinfluence lipid metabolism in the adipocyte, independently of dietary Ca• Supplemental dietary Ca has been shown to influence dietary fat absorption

Other plausible mechanisms:•Bioactive compounds in milk (ACE inhibitory peptides).They limit angiotensin II productionand thereby the angiotensin II stimulation of adipocyte lipogenesis.•Milk also promotes insulin-like growth factor production

Finally, milk consumption could be a marker of other factors either not measured (ormismeasured) in the present study or as yet unidentified.

Nuove frontiere dell’epidemiologia nutrizionale: la nutrigenomica

“Regardless of the type of diet-gene interaction, nutritive and non-nutritive components of food influence the abundance and function ofcellular proteins by governing gene expression at a variety of levels”

epidemiologia nutrizionale - cnr · •to establish whether culturally different populations suffer...

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