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      Mediterranean Diet and Cardiovascular Disease: A Critical Evaluation of A Priori Dietary Indexes

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          Abstract

          The aim of this paper is to analyze the a priori dietary indexes used in the studies that have evaluated the role of the Mediterranean Diet in influencing the risk of developing cardiovascular disease. All the studies show that this dietary pattern protects against cardiovascular disease, but studies show quite different effects on specific conditions such as coronary heart disease or cerebrovascular disease. A priori dietary indexes used to measure dietary exposure imply quantitative and/or qualitative divergences from the traditional Mediterranean Diet of the early 1960s, and, therefore, it is very difficult to compare the results of different studies. Based on real cultural heritage and traditions, we believe that the a priori indexes used to evaluate adherence to the Mediterranean Diet should consider classifying whole grains and refined grains, olive oil and monounsaturated fats, and wine and alcohol differently.

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          Diet and overall survival in elderly people.

          Nicholas A. Kouris, L Lipworth, T Vassilakou … (1995)
          To assess the influence of a specific dietary pattern on overall survival. Cohort study. Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life. 182 elderly residents of the three villages. Overall mortality. Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%). A diet meeting currently understood health criteria does predict survival among people.
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            Plant-based foods and prevention of cardiovascular disease: an overview.

            Frank Hu (2003)
            Evidence from prospective cohort studies indicates that a high consumption of plant-based foods such as fruit and vegetables, nuts, and whole grains is associated with a significantly lower risk of coronary artery disease and stroke. The protective effects of these foods are probably mediated through multiple beneficial nutrients contained in these foods, including mono- and polyunsaturated fatty acids, n-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In dietary practice, healthy plant-based diets do not necessarily have to be low in fat. Instead, these diets should include unsaturated fats as the predominant form of dietary fat (eg, fats from natural liquid vegetable oils and nuts), whole grains as the main form of carbohydrate, an abundance of fruit and vegetables, and adequate n-3 fatty acids. Such diets, which also have many other health benefits, deserve more emphasis in dietary recommendations to prevent chronic diseases.
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              Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study.

              Anne Thiébaut, Andrew Flood, Jill Reedy … (2007)
              The Mediterranean diet has been suggested to play a beneficial role for health and longevity. However, to our knowledge, no prospective US study has investigated the Mediterranean dietary pattern in relation to mortality. Study participants included 214,284 men and 166,012 women in the National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study. During follow-up for all-cause mortality (1995-2005), 27,799 deaths were documented. In the first 5 years of follow-up, 5,985 cancer deaths and 3,451 cardiovascular disease (CVD) deaths were reported. We used a 9-point score to assess conformity with the Mediterranean dietary pattern (components included vegetables, legumes, fruits, nuts, whole grains, fish, monounsaturated fat-saturated fat ratio, alcohol, and meat). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using age- and multivariate-adjusted Cox models. The Mediterranean diet was associated with reduced all-cause and cause-specific mortality. In men, the multivariate HRs comparing high to low conformity for all-cause, CVD, and cancer mortality were 0.79 (95% CI, 0.76-0.83), 0.78 (95% CI, 0.69-0.87), and 0.83 (95% CI, 0.76-0.91), respectively. In women, an inverse association was seen with high conformity with this pattern: decreased risks that ranged from 12% for cancer mortality to 20% for all-cause mortality (P = .04 and P < .001, respectively, for the trend). When we restricted our analyses to never smokers, associations were virtually unchanged. 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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nutrients
                Journal ID (iso-abbrev): Nutrients
                Journal ID (publisher-id): nutrients
                Title: Nutrients
                Publisher: MDPI
                ISSN (Electronic): 2072-6643
                Publication date (Electronic): 16 September 2015
                Publication date Collection: September 2015
                Volume: 7
                Issue: 9
                Pages: 7863-7888
                Affiliations
                [1 ]Endocrinologist, General Practitioner, General Medicine ASL BA/4 D.S.S. 8, viale Japigia 38/G, Bari 70126, Italy
                [2 ]Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Oncology, School of Medicine, Policlinico, Piazza Giulio Cesare 11, University of Bari “Aldo Moro”, Bari 70124, Italy; E-Mail: gdepergola@ 123456libero.it
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: a.dalessandro2011@ 123456libero.it ; Tel.: +39-080-2021905.
                Article
                Publisher ID: nutrients-07-05367
                DOI: 10.3390/nu7095367
                PMC ID: 4586562
                PubMed ID: 26389950
                SO-VID: ccd71c45-23da-46b6-b5a7-5e5b28550dc7
                Copyright © © 2015 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 11 July 2015
                Date accepted : 01 September 2015
                Categories
                Subject: Review

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: mediterranean diet,cardiovascular disease,coronary heart disease,cerebrovascular disease,a priori dietary indexes
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: mediterranean diet, cardiovascular disease, coronary heart disease, cerebrovascular disease, a priori dietary indexes

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