Mediterranean Diet Pattern and Health - Conagra Nutrition€¦ · The Mediterranean Diet can be considered a selective diet. The MD is not new. Ancel Keys and colleagues were central
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June 29, 2017 Presenter: Regan Lucas Bailey, PhD, RD, MPH, CPH Associate Professor of Nutrition Science Faculty Associate, Center of Aging and the Life Course Purdue University Moderator: Amy Continelli – Director of Marketing & Client Services Rippe Health Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics. NUTRI-BITES ® Webinar Series Mediterranean Diet Pattern and Health
Regan Lucas Bailey, PhD, RD, MPH, CPHAssociate Professor of Nutrition Science
Faculty Associate, Center of Aging and the Life Course
Purdue University
Moderator:Amy ContinelliDirector of Marketing & Client ServicesRippe Health
Learning Objectives Identify dietary recommendations to help your clients
incorporate key principles of the Mediterranean Diet into their diets
Understand how dietary patterns are derived and characterized for use in research
Describe the history of the Mediterranean Diet both in its native context and how it is applied in the U.S. population
Provide a summary of key research relating the Mediterranean Diet to health outcomes
NUTRI-BITES®
Webinar SeriesMediterranean Diet Pattern and Health
The Mediterranean DietRegan Bailey, PhD, MPH, RD
Definition : Dietary patterns
• The quantities, proportions, variety or combination of different foods, drinks, and nutrients in diet, and the frequency with which they are habitually consumed*
* Nutrition Evidence Library, Technical Expert Collaborative on Study of Dietary Patterns
Why are patterns important?
• Diet is complicated
• Patterns may help to reflect • whole foods and/or combinations of consumption
• temporal distribution of intake
• habitual patterns (e.g. snacking and food preparation methods)
• collinearity of foods and nutrients
• Positive interventions
• Policy Implications
Presenter
Presentation Notes
Patterns help to capture the complexity of the overall diet and its constituent parts so that researchers can relate the patterns to outcomes of interest. In doing so, we can essentially deal with the known collinearity among foods and nutrients. DASH and PREDIMED are two examples of successful dietary pattern interventions. Finally, understanding patterns is critical to inform policy and our most recent iteration of the Dietary Guidelines has taken a decidedly important focus on understanding patterns. The dietary pattern approach has advanced nutrition research by capturing overall food consumption behaviors and its quality in relationship to health.
Dietary Pattern Methods and Health Outcomes
• Index and Scores• Cluster Analysis• Factor Analysis• Selective Diets
Independent
• Reduced Rank Regression• Classification and
Regression Tree (CART)DependentHea
lth O
utco
me
Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793.
Presenter
Presentation Notes
Dietary patterns methods can broadly be classified in to health outcome independent and dependent groupings. Health outcome independent methods are the most commonly used in the field of nutrition at this point in time. What the term independent means is that in deriving the diet pattern there is no consideration used for an outcome – essentially it is a two step process. First the patterns are formed, and next the patterns are tested against a health outcome. Whereas in the outcome dependent methods, the end point or a surrogate end point is used in the creation of the patterns – this is a newer approach; but, one that will certainly gain traction in our field.
Health Outcome Independent
• Cluster Analysis– Groups people– Exclusivity
• Factor Analysis– Groups foods– Scores
Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793.
• Strategies for data reduction• Both use “input” variables to group and
classify foods and beverages together• Treatment of inputs
Presenter
Presentation Notes
Common methodology for assessing dietary patterns is through data reduction techniques, such as factor or cluster analysis (8). Factor analysis creates food groupings based upon correlations of dietary intake; this is beneficial in determining frequency of food types consumed (9). Cluster analysis creates latent variables of people with similar mean dietary intakes (1). Cluster analysis is useful in nutrition as it can be used to create groups of people with homogenous dietary patterns. These clusters can then be treated as independent variables for further analysis of associations between dietary patterns and markers of disease risk or health outcomes. The input variables can be foods (i.e. pizza) or foods broken down in to their component parts (cheese, tomato sauce). The metric for the input variable is also a subjective decision, is it the number of servings, gram weight, or the percentage of energy that is contributed by the foods.
Indexes and Scores
• Diet is compared to a priori criteria Healthy Eating Index DASH Diet Index
• How close is a group to meeting a set of criteria
Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793.
Presenter
Presentation Notes
Diet is compared to a priori criteria so in a sense this is taking self reported diet and comparing it to a specified rubric
Indexes and Scores• Allows researchers to compare across
groups using a common metric
• Not subjective but scoring may be – Y/N vs Range
Gleason PM, Boushey CJ, Harris JE ZoellnerJ. 2015; JAND 1072-1082.
Presenter
Presentation Notes
Indexes and scores provide a systematic way to evaluate diets and compare diet across different research studies or cohorts. Thus, there is not much subjective decision making in the process other than how the scores are determined. Scoring can truly impact results.
Outcome Independent• A Priori Criteria
– Indexes–Scores
• Special or Selective Diets–Elimination of certain components
• E.g., Vegetarian–Based on culture or geography
Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793.
Presenter
Presentation Notes
The next outcome independent method that can be used to examine dietary patterns is whether or not individuals in a group chose selective diets often because a food group or component is eliminated from the diet. The most common dietary pattern examined this way is vegetarianism, while this is a pattern of eating it is not necessarily consistent all vegetarians.
• Seven Countries Study
• Disease rates and dietary patterns differed across countries
• Mediterranean diet responsible?
Mediterranean Diet and Heart Disease
Keys et al., 1986
Presenter
Presentation Notes
The Mediterranean Diet can be considered a selective diet. The MD is not new. Ancel Keys and colleagues were central to the modern recognition, definition, and promotion of the eating pattern they found in Italy and Greece in the 1950s and ’60s. Ancel Keys was the first researcher who associated the traditional Mediterranean diet with a low risk of heart disease. 1958 Ancel Keys organized 7 countries study: Finland, USA, Netherlands, Yugoslavia, Greece , Italy, Japan. It showed: A lower prevalence of hypercholesterolemia and heart disease in populations of Greece and Italy especially the Greek Island of Crete, which he attributed to diet.
Many of these foods are commonly eaten in the countries surrounding the Mediterranean Sea like olive oil, thus this dietary pattern has been named the Mediterranean Diet. However, the TRUE Mediterranean diet does not exist. The Mediterranean Sea borders 18 countries that differ not only in the foods consumed but in geography, economic status, health, and lifestyle practices.
What is the Mediterranean Diet?
• Based on traditional foods of countries bordering the Mediterranean Sea
• Higher in monounsaturated fats• More fresh food – less processed
Presenter
Presentation Notes
The Mediterranean Diet is the meal plan based on the traditional foods and beverages consumed in the countries around the Mediterranean Sea. This diet may be higher in fat than some other healthy diets. However it uses more olive oil and oils from nuts while using less animal fat. Therefore it is lower in saturated fat, but higher in monounsaturated fat, which may be healthier for our hearts. It also relies on more fresh produce, whole grains and less meat.
Presenter
Presentation Notes
Just taking a moment to focus on lifestyle and the way foods are presented and enjoyed in MD countries
Mediterranean DietEmphasis on
• Fruits and vegetables
• Whole grains
• Fresh herbs/spices instead of salt
• Nuts, seeds, legumes
• Fish and poultry at least twice/week
• Red wine in moderation
Presenter
Presentation Notes
The Mediterranean diet emphasizes: Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts Replacing butter with healthy fats, such as olive oil Using herbs and spices instead of salt to flavor foods Limiting red meat to no more than a few times a month Eating fish and poultry at least twice a week Drinking red wine in moderation (optional) The ratio of unsaturated to saturated is very favorable in this diet
Mediterranean DietAvoidance or limit
• Processed foods
• Margarine
• Most oils other than EVOO
Presenter
Presentation Notes
However, several methodological issues deserve further consideration. First, the very definition of MeDiet is important. Some authors, including our group, have questioned certain so-called “Mediterranean Diets” that used major sources of fat other than olive oil, such as margarines or seed oils which are not typical of Mediterranean countries. In this MeDiet, olive oil was the main added lipid, or source of fat. They did not restrict total fat. In fact, they GAVE everybody a liter of olive oil, every week. It was high in mono-unsaturated fatty acids. They recommended a low consumption of meat or any meat products. And a Mediterranean Diet does NOT include margarine, soybean oil, mustard oil, or any other kind of oil. This was just a diet. They didn't look at exercise. They factored out whatever potential benefit might be from exercise. Or decreased benefit from smoking. They eliminated those risk factors.
Also Eat Daily in Small Amounts
• Olive oil and olives• Cheese and yogurt
Presenter
Presentation Notes
Olive oil, olives, yogurt and cheese are also to be used in moderate amounts on a daily basis.
Use sparingly
• Weekly– Fish– Skinless poultry– Eggs – Sweets
• Monthly– Red meat
Presenter
Presentation Notes
Other animal products are to be used sparingly, mainly as flavoring for the grain, vegetable and fruit dishes. Red meat in particular is to be used only once a month or less. If possible, the poultry, fish and meat should be fresh or minimally processed.
PREDIMED: RCT• Men: 55-80 y
• Women: 60-80 y
• 10 prevention but high risk (3+)
– Smoking
– Hypertension
– ↑ LDL-C
– ↓ HDL-C
– Overweight / obesity
– Family history of early-onset CHD
Presenter
Presentation Notes
The PREDIMED (Prevencion con Dieta Mediterranea) study was designed to assess the long-term effects of the Mediterranean diet (MeDiet) without any energy restriction on incident cardiovascular disease (CVD) as a multicenter, randomized, primary prevention trial in individuals at high risk participatings over the age of 55. All participants were over age 55. None had been diagnosed with heart disease — though all were at high risk for developing it.
The 3 groups of the study
The EVOO Group
• One third of the volunteers were told to adopt a Mediterranean-style diet and were given one liter a week of Extra Virgin Olive Oil.
The Mixed Nut Group• The second group was
also told to adopt a Mediterranean-style diet, and they were given about an ounce a day of mixed nuts (walnuts, hazelnuts, and almonds).
The Low-Fat GroupThe third group was
told to adopt a low-fat diet.
Presenter
Presentation Notes
One-third of the volunteers were counseled to take a Mediterranean Diet and were given one liter of Extra Virgin Olive Oil a week. The other group was given the same diet and given nuts to eat. 3 whole walnuts (15 g) + 8 hazelnuts (7.5 g) + 6 almonds (7.5 g) The third group was counseled to adopt a low-fat diet. about 20-25 percent fat diet. The trial was stopped early, after just under five years of follow-up, when a review of the results determined that there had been significantly fewer heart attacks, strokes, and deaths from cardiovascular disease in the Mediterranean groups than in the low-fat diet group. 1) MeDiet supplemented with extra-virgin olive oil (EVOO); 2) MeDiet supplemented with nuts; and 3) control diet (advice on a low-fat diet).
PREDIMED Study – Main Outcome: CVD
Estruch R, et al. N Engl J Med 2013;368:1279-90.
Presenter
Presentation Notes
After 4.8 y, 288 major CVD events occurred in 7447 participants; crude hazard ratios were 0.70 (95% CI: 0.53, 0.91) for the MeDiet + EVOO and 0.70 (95% CI: 0.53, 0.94) for the MeDiet + nuts compared with the control group. After 1-y follow-up, participants in the MeDiet + nuts group showed a significant 13.7% reduction in prevalence of metabolic syndrome compared with reductions of 6.7% and 2.0% in the MeDiet + EVOO and control groups, respectively.
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)
Cum
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Presenter
Presentation Notes
Respective hazard ratios for incident diabetes (273 cases) among 3541 participants without diabetes were 0.60 (95% CI: 0.43, 0.85) and 0.82 (95% CI: 0.61, 1.10) compared with the control group.
PREDIMED: Diabetes
• “Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity.”
• “MedDiets without calorie restriction seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk.”
Salas-Salvado et al. Diabetes Care; 2011 34 (1): 14-19.
Presenter
Presentation Notes
In Predimed Study, diabetes risk reduction occurred in the absence of any changes in body weight. In the Predimed Study, people did not have to lose lots of weight. These people had to eat lots of food.
Metabolic Syndrome (MS)
Metabolic Syndrome (MS)• Large waistline
• High triglycerides
• Low HDL cholesterol
• High blood pressure
• High fasting blood sugar
• Reduction in MS– MeDiet + nuts 13.7% – MeDiet + EVOO 6.7% – Control 2.0%
Estruch R, et al. N Engl J Med 2013;368:1279-90.
14 Points of the Med Diet Score (MDS)• 2 points Olive oil: use abundantly in cooking and dressings
• 1 point Vegetables: at least 2-3 servings daily
• 1 point Fruits: at least 2-3 servings daily
• 1 point Beans: 3 or more servings weekly
• 1 point Fish or seafood: 3 or more servings weekly
• 1 point Nuts or seeds: at least 1 serving weekly
• 1 point If you eat meat, choose lean, skinless, e.g. poultry
• 1 point Sofrito: 2 or more servings weekly
• 1 point If you drink alcohol, drink moderately
• 4 points Limit or eliminate: Cream, butter, margarine, red meat, sugared beverages, premade desserts and baked goods, french fries, potato chips, cured or fatty cheeses
Schroder H et al. J Nutr 2011; 141: 1140-1145.
Presenter
Presentation Notes
So here are the 14 Points of the Mediterranean Diet. Olive Oil: Use it as your primary fat. And use it abundantly Vegetables: Eat at least 2-3 servings daily. Fruit: Eat at least 2-3 servings daily Beans: 3 or more servings WEEKLY Fish: 3 or more serving weekly, if you eat fish Nuts and seeds: 3 servings a week Meat: Choose poultry instead of processed or red meat, if you eat meat Sofrito: Cook at least twice a week with tomato, garlic, and onion simmered in olive oil Moderate alcohol: If you drink alcohol, drink moderately. They focused on wine. Moderate alcohol: If you drink alcohol. They focused on wine. Eat as desired some of these other foods. Notice they say only DARK chocolate. And Limit or eliminate: Cream, butter, margarine, sugar beverages and pre-made sweets.
Sofrito is a sauce that can be used in many different ways and there are many different variations on it but generally includes Fresh tomatoes, garlic, onion, EVOO and fresh herbs
Lyon Diet Heart Study
De Lorgeril M et al. Circulation 1999;99:779-785
*High in polyunsaturated fat and fiber, **High in saturated fat and low in fiber
Secondary Prevention605 patients following a MI randomized to a Mediterranean* or
Western** diet for 4 years
A Mediterranean diet reduces cardiovascular events
Presenter
Presentation Notes
The Lyon Diet Heart Study sought to determine whether a Mediterranean diet could reduce the risk of cardiovascular events following a myocardial infarction. The study randomized 605 patients to a Mediterranean diet high in polyunsaturated fat and fiber or a Western diet high in saturated fat and low in fiber. Three composite outcomes were studied: (a) cardiac death and nonfatal myocardial infarction, (b) cardiac death, nonfatal MI, and major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism, and (c) cardiac death, nonfatal MI, major secondary end points, and minor events requiring hospital admission. All three composite outcomes were significantly reduced in the Mediterranean diet group. This slide shows cumulative survival without MI among control and experimental (Mediterranean group) subjects.
What about Prospective Cohorts?
What about Prospective Cohorts?
What about Prospective Cohorts?
What about Prospective Cohorts?
What about the American diet?
Alternative Mediterranean Diet Score CriteriaFood Group Criteria for Earning 1 Point
[ ] Vegetables 3-5+ servings/day[ ] Legumes 4+ servings/week[ ] Fruit 3 + servings per day[ ] Nuts 4-5+ servings per week[ ] Whole grains 2-3+ servings per day[ ] Fish 2+ servings per week[ ] Healthy fats (plant oils)
Mostly plant oils, 1.5 to 1 ratio, plant to animal fats
[ ] Red and processed meats
None, or limited to no more than 1-2 servings/week
[ ] Red wine intake Limited, women no more than 2-7 drinks/weekMen, no more than 4-7 drinks per week
Score 0-9 possible. High score is linked to lower risk of death from cancer, heart disease, and stroke, and a significant decrease in mortality.
Harvard Study: 6-7 years of follow-up: 6,137 men; 11,278 womenAmerican Journal Clinical Nutrition. 2014;99:172-180.
Presenter
Presentation Notes
If you are a non-drinker, substitute a small glass of red grape juice 3-4 times per week. Other research shows red grape juice is also good for the heart and healthy circulation, but it doesn’t carry the increased risk of cancer and mental/social problems that alcoholic beverages do.
aMDS and Mortality• Getting 7 to 9 points of aMedS
diet means lowered risk of disease.
• Compare those with 7-9 points to those with fewer than 7 points. 15% ↓ risk of cancer
– 15% ↓ risk of cardiovascular disease
– 21% ↓ risk of death from other causes
– 19% ↓ risk of death from all causes
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Harvard Study: 6-7 years of follow-up: 6,137 men; 11,278 womenAmerican Journal Clinical Nutrition. 2014;99:172-180.
Ris
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Lowered Risks of Disease
Presenter
Presentation Notes
Scores of 7-9 were considered high, in the top quintile. Am J Clin Nutr. 2014 Jan;99(1):172-80. doi: 10.3945/ajcn.113.068106. Epub 2013 Oct 30. The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. Lopez-Garcia E1, Rodriguez-Artalejo F, Li TY, Fung TT, Li S, Willett WC, Rimm EB, Hu FB. Author information Abstract BACKGROUND: The role of the Mediterranean diet among individuals with previous cardiovascular disease (CVD) is uncertain. OBJECTIVE: The aim of this study was to assess the association between the Alternate Mediterranean Diet (aMED) score and all-cause, cardiovascular, and cancer mortality in men and women with CVD from the Health Professionals Follow-Up Study and the Nurses' Health Study. DESIGN: This study included 6137 men and 11,278 women with myocardial infarction, stroke, angina pectoris, coronary bypass, and coronary angioplasty. Diet was first assessed in 1986 for men and in 1980 for women with a food-frequency questionnaire (FFQ) and then repeatedly every 2-4 y. Cumulative consumption was calculated with all available FFQs from the diagnosis of CVD to the end of the follow-up in 2008. RESULTS: During a median follow-up of 7.7 y (IQR: 4.2-11.8) for men and 5.8 y (IQR: 3.8-8.0) for women, we documented 1982 deaths (1142 from CVD and 344 from cancer) among men and 1468 deaths (666 from CVD and 197 from cancer) among women. In multivariable Cox regression models, the pooled RR of all-cause mortality from a comparison of the top with the bottom quintiles of the aMED score was 0.81 (95% CI: 0.72, 0.91; P-trend < 0.001). The corresponding pooled RR for CVD mortality was 0.85 (95% CI: 0.67, 1.09; P-trend = 0.30), for cancer mortality was 0.85 (95% CI: 0.65, 1.11; P-trend = 0.10), and for other causes was 0.79 (95% CI: 0.65, 0.97; P-trend = 0.01). A 2-point increase in adherence to the aMED score was associated with a 7% (95% CI: 3%, 11%) reduction in the risk of total mortality. CONCLUSION: Adherence to a Mediterranean-style dietary pattern was associated with lower all-cause mortality in individuals with CVD.
aMDS and Sudden Cardiac Death
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Low score High score
• The Women’s Health Initiative study included 93,122 women and 10.5 years of follow-up.
• Women with a high score (7 to 9 points) had a 33% decrease in sudden cardiac death, compared to women with a low score (less than 7 points).
Women’s Health Initiative Study. American Journal of Clinical Nutrition. 2014;99:344-51.
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Mediterranean Diet Score
Presenter
Presentation Notes
High scores, top quintile, were 25-40. People received a score from 0-4 for each quintile they were in. Scores were reversed for red meat, poultry, and high fat dairy. These results were adjusted for age, BMI, exercise, race, education, smoking, heart disease, diabetes, and hypertension. BACKGROUND: The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets are characterized by higher intake of fruit, vegetables, whole grains, and unsaturated fatty acids. All of these foods and nutrients may affect cholesterol, inflammation, the development of atherosclerosis, and, therefore, risk of cardiac death. OBJECTIVE: Our objective was to examine the association between the Mediterranean and DASH dietary patterns and risk of sudden cardiac death (SCD) in women. DESIGN: We used a prospective cohort of 93,122 postmenopausal women enrolled in the Women's Health Initiative study between 1993 and 1998 and followed for an average of 10.5 y. Women completed a food-frequency questionnaire (FFQ) twice during follow-up. We scored their diets according to how closely the reported diet resembled each dietary pattern. SCD was defined as death that occurred within 1 h of symptom onset. RESULTS: A higher Mediterranean diet score was associated with lower risk of SCD (HR: 0.64; 95% CI: 0.43, 0.94) when women in the highest quintile were compared with women in the lowest quintile after adjustment for age, total energy, race, income, smoking, and physical activity. After adjustment for potential mediators, the association was similar (HR: 0.67; 95% CI: 0.46, 0.99). A higher DASH diet score was not associated with risk of SCD. However, sodium intake, which is a crucial component of the DASH dietary pattern, was not well characterized by the FFQ. CONCLUSION: The Mediterranean dietary pattern may be associated with lower risk of SCD in women.
• What is the relationship between dietary patterns and risk of CVD?
DGAC#1: CVD-using an index or score : NEL I- StrongNumber of studies 55
Assessment FFQ 45
24 hour recall 2
Records or History 8
Study design RCT 3
Prospective Cohort Studies 52
Outcome
CVD 29
CHD 16
Stroke 13
Myocardial Infarction 5
Heart Failure 3
Intermediate Outcomes: Hypertension, Blood Pressure, and Blood Lipids
6
USDA/CNPP. Nutrition Evidence Library: Series of Systematic Reviews on the Relationship Between Dietary Patterns and Health Outcomes. March 2014.
Presenter
Presentation Notes
Three major categories of dietary pattern scores were identified related to cardiovascular disease (CVD) risk: dietary exposure based on adherence to (1) a Mediterranean dietary pattern, (2) dietary guidelines recommendations, or (3) a DASH diet. • The preponderance of the evidence from studies carried out in large, well-characterized prospective cohorts from the United States, Europe, Japan, and Australia showed that, in healthy adults, an increase in a Mediterranean diet score or dietary guidelines-related score was associated with decreased risk of fatal and nonfatal CVD, defined as coronary heart disease (CHD) and stroke, as well as decreased risk of CHD and stroke as individual clinical outcomes. Fewer studies assessed the association between adherence to a DASH diet and CVD, CHD, or stroke outcomes, using an index or score, and their findings were inconsistent. •
Strategies for increasing the MDS score
Eat More:– Fruits
– Vegetables
– Nuts
– Legumes and beans
– Whole grains
– Fish in place of red meat
– Olive oil and other healthy fats
– If you choose to drink red wine, do so moderately (3-7 drinks/week)
Strategies for increasing the MDS score
Eat less:– Red/processed meats
– Sugar and baked goods
– High fat dairy
– Sweets and soft drinks
American Heart AssociationGuidelines for a Healthy Diet
• Eat an overall healthy dietary pattern that emphasizes:– a variety of fruits and vegetables,– whole grains,– low-fat dairy products,– skinless poultry and fish– nuts and legumes– non-tropical vegetable oils
• Limit saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages.
Updated Guidelines: March 27, 2017
Presenter
Presentation Notes
As we look at these guidelines from the AHA, do they look very similar to the Dietary Guidelines? The highlighted ones are what we will look at a bit more today as we focus on fat intake.
Summary• Good evidence that following a
Mediterranean diet can reduce risk of heart disease and diabetes– RCTs
• Moderate evidence that Mediterranean diet is associated with lower risk of many chronic diseases– Prospective cohorts
Summary• Further research needed on how to support
people to change their diet
• Understanding the context of the diet is also an important area of research
• Many healthy dietary exist!
Additional Resources
Additional Resources
• The National Heart, Lung, and Blood Institute Workshop: "Toward testing the effects of a Mediterranean dietary pattern on cardiovascular and other diseases in the United States"
• Full summary available at: https://www.nhlbi.nih.gov/research/reports/national-heart-lung-and-blood-institute-workshop-toward-testing-effects-mediterranean-dietary
Presenter
Presentation Notes
The National Heart, Lung, and Blood Institute, in partnership with the National Cancer Institute and Office of Disease Prevention, convened a Working Group in Bethesda, Maryland, to discuss the feasibility of and provide recommendations for testing the effects of a Mediterranean dietary pattern on cardiovascular and other disease morbidity and mortality in adults in the United States in a large lower-cost trial.
Questions?
Identify dietary recommendations to help your clients incorporate key principles of the Mediterranean Diet into their diets
Understand how dietary patterns are derived and characterized for use in research
Describe the history of the Mediterranean Diet both in its native context and how it is applied in the U.S. population
Provide a summary of key research relating the Mediterranean Diet to health outcomes
NUTRI-BITES®
Webinar SeriesMediterranean Diet Pattern and Health
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