Transcript Mediterranean Diet

Sandy Arner, RD, LDN, Clinical Dietitian
James H. Quillen VA Medical Center
March 29, 2011
Conflict of Interest Disclosures
Unapproved/Investigative Use
I, Sandra Arner,
DO NOT anticipate discussing
the unapproved/investigative
use of a commercial
product/device during this
activity or presentation.
Financial Interest
I, Sandra Arner,
DO NOT have a financial
interest/arrangement or
affiliation with one or more
organizations that could be
perceived as a real or
apparent conflict of interest in
the context of the subject of
this presentation.
Learning Objectives
 Describe key characteristics of the Mediterranean
diet pattern
 List some foods that make up the Mediterranean
dietary pattern
 Give examples of some potential health benefits of
the Mediterranean dietary pattern
 Relate two tips on using the Mediterranean dietary
pattern that you could give to patients
Mediterranean
Mediterranean Region
Some Myths About the
Mediterranean Diet
 It’s just another fad diet.
 It’s a relatively new way of eating.
 It’s hard to follow.
 It requires buying hard-to-get “foreign” foods.
 Meats and sweets are not allowed.
 I can eat how much ever I want on this diet.
History
 Mediterranean region, especially Greece
and Italy
 Ancel Keys’ influence
 The modern Mediterranean Diet/Lifestyle in
America
History
 Mediterranean region, especially Greece
and Italy
Ancel Keys’ Influence
Mediterranean Region of the Diet
 The Mediterranean diet/lifestyle is a modern
nutritional recommendation inspired by the
traditional dietary patterns of some coastal
regions of southern Italy, as well as Crete and
other parts of Greece in the 1960s.
Old Pyramid
2000 Oldways Preservation Trust
Old Pyramid
2000 Oldways Preservation Trust
New Pyramid
2009 Oldways Preservation Trust
2010 Oldways Mediterranean Food Alliance
Pyramid Comparison
“Old”
“New”
MyPyramid (US Food Pyramid)
Comparison Mediterranean
US Food Pyramid
Foods & Flavors
2009 Oldways Preservation & Exchange Trust www.oldwayspt.org
Foods & Flavors (Cont’d)
2009 Oldways Preservation & Exchange Trust www.oldwayspt.org
Eating Pattern
 An abundance of food from plant sources, including
fruits and vegetables, potatoes, breads and grains,
beans, nuts, and seeds.
 Emphasis on a variety of minimally processed and,
wherever possible, seasonally fresh and locally grown
foods (which often maximizes the health-promoting
micronutrient and antioxidant content of these
foods).
 Olive oil as the principal fat, replacing other fats and
oils (including butter and margarine).
Today’s Dietitian, February 2010, volume 12, no. 4, p 48
Eating Pattern (Cont’d)
 Total fat ranging from less than 25 percent to over 35
percent of energy, with saturated fat no more than 7
to 8 percent of energy (calories).
 Daily consumption of low to moderate amounts of
cheese and yogurt (low-fat and non-fat versions may
be preferable).
 Twice-weekly consumption of low to moderate
amounts of fish and poultry (recent research suggests
that fish be somewhat favored over poultry); up to 7
eggs per week (including those used in cooking and
baking).
Today’s Dietitian, February 2010, volume 12, no. 4, p 48
Eating Pattern (Cont’d)
 Fresh fruit as the typical daily dessert; sweets with a
significant amount of sugar (often as honey) and
saturated fat consumed not more than a few times per
week.
 Red meat a few times per month (recent research
suggests that if red meat is eaten, its consumption
should be limited to a maximum of 12 to 16 ounces
[340 to 450 grams] per month; where the flavor is
acceptable, lean versions may be preferable).
 Regular physical activity at a level which promotes a
healthy weight, fitness and well-being.
Today’s Dietitian, February 2010, volume 12, no. 4, p 48
Eating Pattern (Cont’d)
 Moderate consumption of wine, normally with meals;
about one to two glasses per day for men and one
glass per day for women. From a contemporary public
health perspective, wine should be considered
optional and avoided when consumption would put
the individual or others at risk.
Today’s Dietitian, February 2010, volume 12, no. 4, p 48
Olive Oil Healthy Morsels
 Backbone of Mediterranean diet
 Olives oil—in the plant group of the
Mediterranean diet pyramid
 Considered a monunsaturated fat (75%)
 Rich in polyphenols
The Complete Idiot’s Guide to The Mediterranean Diet, 2010
Benefits of Mediterranean Diet
2010 US Dietary Guidelines
 Patterns of eating that have been shown to be
healthful include Mediterranean-style dietary
patterns
 Reduced risk for coronary heart disease with
the “traditional Mediterranean diet”
 Of Crete in the 1960s
Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines
for Americans, 2010
Important Nutrients
 Potassium
 Omega 3 fatty acids
 Monounsaturated fats
 Phytonutrients
 Complex carbohydrates
 B vitamins
Why Should We Consider?
What Does the Research Say?
Old Ways Mediterranean Foods Alliance, 2010
Lengthen Your Life
 * Greater adherence to a Mediterranean diet is associated with a
significant improvement in health status, as seen by a significant reduction
in overall mortality (9%), mortality from cardiovascular diseases (9%),
incidence of or mortality from cancer (6%), and incidence of Parkinson’s
disease and Alzheimer’s disease (13%). These results seem to be clinically
relevant for public health, in particular for encouraging a Mediterraneanlike dietary pattern for primary prevention of major chronic diseases.
 Sofi F, Cesari F, Abbate R, et al. Adherence to Mediterranean diet and
health status: meta-analysis. British Medical Journal. 2008;337:a1344-50.
 * These results provide strong evidence for a beneficial effect of higher
conformity with the Mediterranean dietary pattern on risk of death from
all causes, including deaths due to CVD and cancer, in a US population.
 Mitrou PN, Kipnis V, Thiébaut ACM, et al. Mediterranean Dietary Pattern
and Prediction of All-Cause Mortality in a US Population: Results From the
NIH-AARP Diet and Health Study. Archives of Internal Medicine.
2007;167(22):2461-8.
Lengthen Your Life
 * The findings of the present study in a northern European
population of young women indicate that closer adherence to a
Mediterranean dietary pattern reduces mortality even among young
persons.
 Lagiou P, Trichopoulos D, Sandin S, et al. Mediterranean dietary pattern
and mortality among young women: a cohort study in Sweden. British
Journal of Nutrition. 2006;96(2):384-92.
 * In this large, population-based cohort study, we found that a
higher degree of adherence to the traditional Mediterranean diet
was associated with a reduction in total mortality (17%) ... with
respect to both deaths due to coronary heart disease and deaths
due to cancer.
 Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a
Mediterranean diet and Survival in a Greek Population. The New
England Journal of Medicine. 2003;348:2599-2608.
Lengthen Your Life
 * Trichopoulou et al. report the results of a population-based study
involving 22,043 apparently healthy adults in Greece, in which adherence
to a traditional Mediterranean diet was associated with significantly lower
total mortality, mortality from coronary heart disease, and mortality from
cancer.
 Hu FB. The Mediterranean Diet and Mortality – Olive Oil and Beyond. New
England Journal of Medicine. 2003;348(26):2595-96.
 * Adherence to the principles of the traditional Mediterranean diet is likely
to be associated with lower overall mortality. Moreover, key features of
this diet appear to be transplantable to other dietary cultures and cuisines,
and may have a substantial beneficial impact on the general mortality of
elderly people who have the Westernized dietary habits. We conclude that
a diet that adheres to thee principles of the traditional Mediterranean diet
is associated with longer survival.
 Kouris-Blazos A. Are the Advantages of the Mediterranean Diet Transferable
to Other Populations? A Cohort Study in Melbourne, Australia. British
Journal of Nutrition. 1999;82:57-61.
Decreased Overall Chronic Disease Risk
Decreased Mortality
Cardioprotective
Protection Against Alzheimer’s and
Cognitive Decline
Diabetes Management
Weight Management
Cancer Reduction
Depression
Rheumatoid Arthritis
Improved Respiratory Function
Improved Pregnancy Outcomes
American Diabetic Association
 2011 Clinical Practice Guidelines
 2010 Clinical Practice Guidelines
 2009 Clinical Practice Guidelines
 2008 Clinical Practice Guidelines
What Does This Mean in Primary Care?
 Refer to your friendly Registered Dietitian
 Include more LEAN meat
 Consume more fish
 Include more whole grains
 Include more fruits and vegetables
 Use olive oil as the oil of choice, when fat added
(in moderation)
 Reduce red meat
 Reduce eggs
 IF one has alcohol, consume only in moderation
Achieving the Mediterranean
Lifestyle
 Focus on healthy eating habits and nutritious
foods
 Adjust schedules , personal habits, customs
 Change slowly, progress gradually
 Enjoy activity
 Enjoy family meals
Characteristics of the Cuisine
 Wide use of olive oil and citrus juice in cooking
 Majority of diet is based on fresh, seasonal, local,
and organic produce
 Abundance of freshly caught seafood
 Small portion of lean meat and poultry are
enjoyed
 Mealtime is honored as an important ritual in
daily life
 Beans, nuts, and legumes are important and
frequently used staples
The Mediterranean Diabetes Cookbook, Amy Riol0, American
Diabetes Association, 2010
Characteristics of the Cuisine
 Desserts are limited to special occasions
 Fresh, homemade food is considered a necessity
 Unique herb and spice blends are used to
enhance flavors
 Walking and other forms of physical activity are
practiced
 Main meals are eaten in the afternoon; smaller,
lighter meals are enjoyed in the evening
The Mediterranean Diabetes Cookbook, Amy Riol0, American
Diabetes Association, 2010
Thanks
Mediterranean Mark