The  Effect  of  a  Mediterranean  Diet  on  Cardiovascular  

Disease  

The  Burden  of  Cardiovascular  Disease  

• Number  one  cause  of  death  worldwide  (WHO  2014)  

• In  the  UK  alone  responsible  for  one  third  of  all  deaths.  

• Financial  implicaCons  (BHF  2016)  

• Aging  populaCon  

Risk  Factors  

•  Some  risk  factors  cannot  be  changed  e.g  sex,  geneCcs  and  age.    

•  However  many  risk  factors  are  modifiable.  

•  An  improvement  in  modifiable  risk  factors  would  result  in  a  large  majority  of  cardiovascular  events  being  prevented.  Such  modifiable  risk  factors  include  tobacco  smoking,  physical  inacCvity  and  an  unhealthy  diet  and  are  said  by  WHO  (2014)  to  aPribute  to  the  majority  of  CVD-­‐related  deaths.    

Diet  as  a  Risk  Factor  •     

•  The  role  of  an  unhealthy  diet  in  CVD  risk  is  well  documented,  with  a  high  saturated  fat,  salt  and  alcohol  intake  and  low  fruit,  vegetable,  oily  fish  and  fibre  intake  each  being  established  as  individual  risk  factors  for  CVD.  ParCcular  macro-­‐  and  micronutrients  which  have  been  found  to  play  a  key  role  in  the  protecCon  against  cardiovascular  disease  include  omega-­‐3  faPy  acids,  monounsaturated  faPy  acids  and  a  diet  that  is  rich  in  vitamins  and  minerals  (SIGN,  2007).  

•  According  to  the  WHF  (World  Heart  FederaCon)  comparisons  between  groups  of  people  following  a  diet  low  in  sat  fat  and  with  plenty  of  fresh  fruit  and  veg  and  those  following  a  typical  western  diet  showed  that  the  former  was  associated  with  a  73%  reducCon  in  risk  of  cardiovascular  event.  

A  Brief  Review  of  current  Literature  

•  Death  rates  from  CVD  are  lower  in  the  Mediterranean  countries  of  Southern  Europe  than  in  North  West  Europe.  This  is  generally  assumed  to  be  as  a  result  of  different  dietary  paPerns  in  Mediterranean  countries  compared  to  the  Western  diet.  Hence  North  Western  European  countries  have  been  advised  to  adopt  a  Mediterranean-­‐style  diet  (more  fruit,  vegetables  and  fish  and  replace  foods  high  in  saturated  fat  with  products  based  on  vegetable  and  plant  oils)  (NICE  2007)  

•  Other  well  known  studies  have  also  found  correlaCons  between  a  Mediterranean  style  diet  and  lower  risk  of  CVD  include;  The  Nurses’  Health  Study,  Framington  Heart  Study,  Seven  Countries  study.  

•  MigraCon-­‐  it  is  suggested  that  individuals  who  have  migrated  to  North  Western  European  countries  tend  to  take  their  dietary  paPerns  with  them.  However,  there  is  evidence  that  cardiovascular  risk  increases  amongst  these  populaCon.  Although  outwith  the  scope  of  this  presentaCon  the  concept  of  vitamin  D  deficiency  has  also  been  explored  Hyppönen  and  Power  (1996)    

             Possible  Mechanisms    •  Since  atherosclerosis  is  by  far  the  most  important  underlying  pathological  process  for  CVD,  ergo  how  does  adherence  to  a    Mediterranean  diet  influence  it’s  development.  

•  Obesity-­‐  Maintaining  a  healthy  weight  through  a  healthy  balanced  diet  is  important.    Obesity  increases  cardiovascular  risk  through  inflammaCon  mediated  pathways.  

•  Improved  Blood  lipid  profile-­‐  The  Mediterranean  diet  was  associated  with  low  levels  of  LDL    and  high  levels  of  LDL.    In  some  studies  even  if  no  weight  loss  is  achieved.  

•  ReducCon  in  systolic  blood  pressure  

•  Total  cholesterol,  HDL  cholesterol  along  with  blood  pressure  is  established  as  a  classical  Framingham  risk  factors  which  esCmate  the  10  year  risk  of  suffering  myocardial  infarcCon.  

                 Possible  Mechanisms  

•  High  content  of  fruit,  vegetables,  cereals  and  olive  oil  guarantee  a  high  intake  of  beta  carotene,  vitamins  C  and  E,  polyphenols  and  various  important  minerals.  These  elements  are  said  to  explain  the  beneficial  effect  the  diet  has  on  human  health.  

•  It  is  also  suggested  that  the  diet  includes  a  number  if  protecCve  substances  such  as  selenium,  glutathione  a  balanced  raCo  of  (n-­‐6):  (n-­‐3)  essenCal  faPy  acids,  high  fiber,  anCoxidants    (especially  resveratrol  from  wine  and  polyphenols  from  olive  oil.  

•  Some  studies  are  currently  examining  the  effects  of  individual  components  of  the  diet  e.g  Red  wine.  

Recommendations                  •  In  light  of  the  extensive  evidence  the  following  dietary  recommendaCons  have  been  suggested:  

•  eaCng  plenty  of  starchy  foods,  such  as  bread  and  pasta  •  eaCng  plenty  of  fruit  and  vegetables  •  eaCng  some  fish  •  eaCng  less  meat  •  choosing  products  made  from  vegetable  and  plant  oils,  such  as  olive  oil  

•  Moderate  alcohol  intake  •  Adding  nuts,  beans  and  pulses  to  the  diet  

           

Future  Considerations  

•  Influence  of  individual  components  of  the  diet    

•  EducaCon  of  the  public  

•  The  influence  of  vitamin  D  

                                       Dieticians  

•  It  should  be  acknowledged  that  other  health  professionals  besides  doctors  play  a  role  in  advising  paCents  on  diet.  

•  Registered  DieCCans  (RDs)  are  the  only  qualified  health  professionals  that  assess,  diagnose  and  treat  dietary  and  nutriConal  problems  at  an  individual  and  wider  public  health  level.    

•  They  advise  and  help  to  maintain  nutriConal  status  when  individuals  want  to  trial  dietary  intervenCons  such  as  exclusion  diets,  nutriConal  supplementaCon  or  dietary  intervenCons  in  areas  such  as  auCsm  for  which  evidence  is  sCll  emerging.    

•  PaCents  at  parCcularly  high  risk  can  be  referred  on  the  a  dieCcian  for  individual  dietary  advice  

References  •  hPps://www.bda.uk.com/publicaCons/dieCCan_nutriConist.pdf  

•  hPp://www.sign.ac.uk  

•  hPp://www.who.int/en/  

•  hPps://www.nice.org.uk/guidance  

•  Hyppönen  ,  E.  and  Power,  C.  2007.  Hypovitaminosis  D  in  BriCsh  adults  at  age  45  y:naConwide  cohort  study  of  dietary  and  lifestyle  predictors.  American  Journal  of  Clinical  Nutri2on.  85  (9)  Feb,  pp.  860–868.  

•  hPps://www.framinghamheartstudy.org  

•  hPps://en.wikipedia.org/wiki/Nurses%27_Health_Study  

•  hPps://en.wikipedia.org/wiki/Seven_Countries_Study  

•  hPp://onlinelibrary.wiley.com/doi/10.1111/j.1524-­‐6175.2005.04079.x/full  

•  hPp://www.ncbi.nlm.nih.gov/pmc/arCcles/PMC4222885/  

•  hPp://www.bmj.com/content/349/bmj.g6674  

•  hPp://www.world-­‐heart-­‐federaCon.org/cardiovascular-­‐health/cardiovascular-­‐disease-­‐risk-­‐factors/diet/