El 13 de abril de 2015, el doctor Ramón Struch, del Hospital Clinic de Barcelona, acudió a la Fundación Ramón Areces para hablar sobre 'Patrones de alimentación saludables en las personas mayores: la dieta mediterránea'. Dentro del III ciclo de conferencias que organizamos en colaboración con el Centro de Estudios del Envejecimiento. "La dieta mediterránea debe de mantenerse a cualquier edad", comentó.
Dr. Ramón Estruch - Patrones de alimentación saludables en las personas mayores: la dieta mediterránea
1. Patrones de Alimentación
Saludable en
Personas Mayores:
La Dieta Mediterránea
Ramon Estruch
S. Medicina Interna – Hospital Clínic
Universitat de Barcelona,
CIBER obn – ISCIII, Madrid
2. Centro de Investigación Biomédica En Red
Fisiopatología de la Obesidad y Nutrición
Centro de Investigación Biomédica En Red
Fisiopatología de la Obesidad y Nutrición
LA DONACIÓN POR PARTE DE LAS EMPRESAS ALIMENTARIAS DEL ACEITE DE OLIVA VIRGEN EXTRA Y LOS
FRUTOS SECOS ES UNA CONTRIBUCIÓN SUSTANCIAL AL ESTUDIO. NINGUNA DE ESTAS COMPAÑÍAS HA
DESEMPEÑADO NINGÚN PAPEL EN EL DISEÑO, RECOGIDA, ANÁLISIS NI INTERPRETACIÓN DE LOS DATOS.
Agradecimientos
5. Factores genéticos – ApoE-e4
Estilo de vida:
• Alimentación: Semivegetarismo
• Actividad física constante
• Familia y entorno social
• Actitud positiva
• No hábitos tóxicos: Tabaco
Características Comunes
de las “Blue Zones”
6. McNaughton SA, et al. J Nutr 2012;142:320–5.
MORTALIDAD EN ADULTOS ≥ 65 AÑOS EN FUNCIÓN
DE LA CALIDAD DE LA DIETA
7. RESTRICCIÓN CALÓRICA Y ENVEJECIMIENTO
Willcox BJ, et al. Ann N Y Acad Sci 2007;1114:434–55.
8. Restricción calórica y Mortalidad
Willcox BJ, et al. Ann N Y Acad Sci 2007;1114:434–55.
Ok 83.8 – 104.9 y
Jp 82.3 – 101.1 y
US 78.9 – 101.3 y
16. Revisiones sistemáticas - Meta-análisisRevisiones sistemáticas - Meta-análisis
Grandes Ensayos Clínicos MulticéntricosGrandes Ensayos Clínicos Multicéntricos
Revisiones sistemáticas - Meta-análisisRevisiones sistemáticas - Meta-análisis
Grandes Ensayos Clínicos MulticéntricosGrandes Ensayos Clínicos Multicéntricos
Ensayos Clínicos AleatorizadosEnsayos Clínicos AleatorizadosEnsayos Clínicos AleatorizadosEnsayos Clínicos Aleatorizados
Ensayos Controlados no-AleatorizadosEnsayos Controlados no-AleatorizadosEnsayos Controlados no-AleatorizadosEnsayos Controlados no-Aleatorizados
Estudios de CohortesEstudios de CohortesEstudios de CohortesEstudios de Cohortes
Estudios Caso – ControlEstudios Caso – ControlEstudios Caso – ControlEstudios Caso – Control
Series de CasosSeries de CasosSeries de CasosSeries de Casos
Alta
Baja
CalidaddelaEvidencia
Jerarquía de la Medicina basada
en la Evidencia
Jerarquía de la Medicina basada
en la Evidencia
17. 1) Prevalencia de enfermedad coronaria:
- Estados Unidos: 4.6%
- Finlandia: 3.4%
- Italia: 1.1%
- Grecia: 0.5%
2) Mortalidad a 10 años por enfermedad coronaria:
- Finlandia 45.5 / 10,000
- Estados Unidos 42.4
- Holanda 31.7
- Italia 20.3
- Grecia 6.6
ESTUDIO DE LOS SIETE PAISES
21. Revisiones sistemáticas - Meta-análisisRevisiones sistemáticas - Meta-análisis
Grandes Ensayos Clínicos MulticéntricosGrandes Ensayos Clínicos Multicéntricos
Revisiones sistemáticas - Meta-análisisRevisiones sistemáticas - Meta-análisis
Grandes Ensayos Clínicos MulticéntricosGrandes Ensayos Clínicos Multicéntricos
Ensayos Clínicos AleatorizadosEnsayos Clínicos AleatorizadosEnsayos Clínicos AleatorizadosEnsayos Clínicos Aleatorizados
Ensayos Controlados no-AleatorizadosEnsayos Controlados no-AleatorizadosEnsayos Controlados no-AleatorizadosEnsayos Controlados no-Aleatorizados
Estudios de CohortesEstudios de CohortesEstudios de CohortesEstudios de Cohortes
Estudios Caso – ControlEstudios Caso – ControlEstudios Caso – ControlEstudios Caso – Control
Series de CasosSeries de CasosSeries de CasosSeries de Casos
Alta
Baja
CalidaddelaEvidencia
Jerarquía de la Medicina basada
en la Evidencia
Jerarquía de la Medicina basada
en la Evidencia
22. Efectos de la Dieta Mediterránea
en la Prevención Primaria de la
Enfermedad Cardiovascular
(PREDIMED)
23. • Valorar los efectos de una Dieta Mediterránea suplementada
con aceite de oliva virgen extra sobre la incidencia
de complicaciones cardiovasculares mayores (muerte
cardiovascular, infarto de miocardio y accidente vascular
cerebral).
• Valorar los efectos de una Dieta Mediterránea suplementada
con frutos secos (nueces, avellanas y almendras) sobre la
incidencia de complicaciones cardiovasculares mayores.
• Valorar el efecto de la ingesta moderada de vino y cerveza
sobre la incidencia de complicaciones cardiovasculares.
Objetivos
24. Varones: 55-80 aVarones: 55-80 a
Mujeres: 60-80 aMujeres: 60-80 a
Alto riesgo CV sin ECVAlto riesgo CV sin ECV
Diabtéticos tipo 2Diabtéticos tipo 2
3+ factores de riesgo3+ factores de riesgo
ESTUDIO PREDIMED: DISEÑOESTUDIO PREDIMED: DISEÑO
AzarAzar
1.1. TabaquismoTabaquismo
2.2. HipertensiónHipertensión
3.3. ↑↑ LDLLDL
4.4. ↓↓ HDLHDL
5.5. Sobrepeso/obesidadSobrepeso/obesidad
6.6. Historia FamiliarHistoria Familiar
25. Tamaño de Muestra y Aleatorización
7,447 participantes
Dieta Mediterránea
Aceite de Oliva Virgen Extra
(1L/semana)
Dieta Mediterránea
Frutos secos
(30g/día)
Dieta Baja en Grasa
“American Heart
Association guidelines”
n=2.450n=2.543 n=2.454
27. Intervención
Introducir cambios en el patrón alimentario global
Dieta Baja
en grasa
Control
Reducir todo tipo de grasa
Aumento de CHO
NO limitación de energía
Dieta
Mediterránea
2 grupos
Grasa total: ad libitum
Alto en:
MUFA (aceite de oliva virgen)
Pescado
Frutas, verduras, legumbres
Bajo en:
Carnes
Productos lácteos
Alcohol permitido: vino y cerveza
tocoferoles
polifenoles
flavonoides
fitosteroles
Tocoferoles
Polifenoles
Fitosteroles
28. 30g/día
Estrategias para el cambio
Listas de la compra por estación
Menús y recetas
ESTRATEGIAS ADICIONALES
SÓLO en los 2 grupos de Dieta Mediterránea
Provisión de alimentos clave
1L/semana
29. VARIABLES FINALES PRINCIPALES
• Muerte Cardiovascular
• Infarto de Miocardio No-fatal
• Accidente Vascular Cerebral No-fatal
VARIABLES FINALES SECUNDARIAS
• Muerte por cualquier causa
• Angina que requiere técnicas de revascularización
• Insuficiencia cardiaca
• Diabetes
• Cáncer
31. Fitó for the PREDIMED group. Arch Inter Med 2007;167:1195-1203.
n = 372n = 372
Mediet+VOO=123 Mediet+nuts=128Mediet+VOO=123 Mediet+nuts=128 control=121control=121
32. Olive oil Nuts Low-fat diet
-1.25
-1.00
-0.75
-0.50
-0.25
0.00
0.25
0.50
0.75
1.00
1.25
**
ChangesinC-ReactiveProtein(mg/L)
Olive oil Nuts Low-fat diet
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
**
*
ChangesinInterleukin-6(pg/mL)
Olive oil Nuts Low-fat diet
-100
-75
-50
-25
0
25
50
75
**
**
*
ChangesinICAM-1(ng/mL)
Olive oil Nuts Low-fat diet
-250
-200
-150
-100
-50
0
50
100
150
200
**
**
*
ChangesinVCAM-1(ng/mL)
*p<0.05
**p<0.01
EFECTOS A LOS 3 MESES SOBREEFECTOS A LOS 3 MESES SOBRE
BIOMARCADORES DE INFLAMACIÓNBIOMARCADORES DE INFLAMACIÓN
33. Δ FOODS AND NUTRIENTS TERTILES
a a
b
a
ab
b
a a
a
ab
a
b
Urpi-Sarda et al. J Nutr 2012; 1019–1025.
14 points
score
35. ESTUDIO PREDIMED: Cambios 3 meses
p=0.039
p=0.017
p<0.001
p<0.001
p<0.001
p<0.001
Ann Intern Med 2006;145:1-11
36. Diabetes Care 2011Diabetes Care 2011
INCIDENCIA DE DIABETES – 4,5 AÑOS DE SEGUIMIENTOINCIDENCIA DE DIABETES – 4,5 AÑOS DE SEGUIMIENTO
Incidencia acumulada de diabetes
37. MedDiet + VOO
MedDiet + Nuts
Control group
1.00
0.98
0.96
0.94
0.92
0.90
0.88
0 1 2 3 4 5
Years
Cumulativediabetesfree-survival
a
b
c
Pa vs c= 0.047
Pb vs c= 0.053
INCIDENCIA ACUMULADA DE DIABETES TRAS 4,5 AÑOS DE
SEGUIMIENTO
ESTUDIO PREDIMEDESTUDIO PREDIMED
Reducción en un 52 %
en la Incidencia
No cambios en el
peso corporal
Diabetes Care 2011Diabetes Care 2011
38. PREVENCIÓN DE DIABETES CON DIETA MEDITERRÁNEA:PREVENCIÓN DE DIABETES CON DIETA MEDITERRÁNEA:
ESTUDIO ALEATORIZADO, CONTROLADOESTUDIO ALEATORIZADO, CONTROLADO
MedDiet+EVOO
(n=1154)
MedDiet+nuts
(n=1240)
Control group
(n=1147)
Person-years, No. 4990 4876 4271
New cases of diabetes, No. 80 92 101
Rate per 1000 person-years (95% CI) 16.0 (12.7-19.9) 18.7 (15.1-22.9) 23.6 (19.3-28.7)
Cumulative incidence (95% CI) 6.93 (5.53-8.55) 7.42 (6.02-9.02) 8.81 (7.23-10.60)
Incidencia de diabetes por grupo de intervención durante el seguimiento
Ann Int Med 2014
39. Incidencia acumulada de diabetes por grupo de intervención
PREVENCION DE DIABETES CON DIETA MEDITERRANEAPREVENCION DE DIABETES CON DIETA MEDITERRANEA
Ann Int Med 2014
40. MedDiet+EVOO versus
control diet
MedDiet+nuts versus
control diet
Both MedDiet versus
control diet
Crude model 0.69 (0.51-0.93) 0.81 (0.61-1.08) 0.75 (0.59-0.96)
Age- and sex-adjusted model
0.68 (0.51-0.92) 0.80 (0.60-1.06) 0.74 (0.58-0.95)
Multivariate adjusted model (a)
0.68 (0.51-0.92) 0.82 (0.61-1.09) 0.75 (0.58-0.96)
Multivariate adjusted model (b)
0.60 (0.43-0.85) 0.82 (0.61-1.10) 0.70 (0.54-0.92)
Cox regression models to assess the relative risk of diabetes by allocation group, estimating the hazard ratios and their 95% CIs were performed.
(a) Adjusted for age, sex and BMI (kg/m2).
(b) Additionally adjusted for smoking (never, current or former smoker), fasting glucose at baseline, prevalence of dyslipidemia (yes/no) and
hypertension (yes/no), total energy intake (kcal/d) and adherence to Mediterranean diet (14-point score) at baseline, physical activity at baseline (MET-
min/d), education level (Illiterate/primary education, secondary education and academic/graduate) and alcohol intake at baseline (continuous (g/d),
adding a quadratic term). All models were stratified by recruitment center and robust standard errors were used.
Hazard ratios (Intervalos de confianza del 95%) de diabetes por grupo de
intervention con dieta mediterránea comparado con el grupo control
Ann Int Med 2014
PREVENCIÓN DE DIABETES CON DIETA MEDITERRÁNEA:PREVENCIÓN DE DIABETES CON DIETA MEDITERRÁNEA:
ESTUDIO ALEATORIZADO, CONTROLADOESTUDIO ALEATORIZADO, CONTROLADO
52. Psaltopoulou T, et al. Ann Neurol 2013;74:580-91.
Adherencia a la DMed y riesgo de deterioro cognitivo / AD
53. Mejor puntuación en tests neurosicológicos
con aumento del consumo de:
• Vino
• Aceite de oliva total y virgen extra
• Café
• Nueces
54. 0
P for lineal trend = 0.018
0
P for lineal trend = 0.003
Puntuaciones de los tests de memoria de RAVLT según quintiles
de excreción urinaria de polifenoles
Recuerdo inmediato Recuerdo diferido
Valls-Pedret C, et al. J Alzheimers Dis 2012;29:773–82.
PREDIMED – DMed y Cognición
55. Estudio longitudinal de 447 participantes en el
PREDIMED
Estudio basal y tras una media de 4 años de intervención:
• Batería de tests neuropsicológicos
• Consumo de alimentos y cuestionario de 14 puntos
Cambios de tests cognitivos estandarizados a puntuaciones z y
derivación de 3 evaluaciones compuestas (memoria, función
ejecutiva y cognición global) para cada participante, con ajuste por
factores de confusión.
Subestudio PREDIMED – Dieta y Cognición (II)
56. Changes of mean z scores (final minus baseline)
PREDIMED – Diet & Cognition (II). Results
Valls-Pedret C, et al. JAMA Intern Med 2015; en prensa.
57. La dieta mediterránea
suplementada con aceite de oliva
virgen extra o frutos secos,
alimentos ricos en polifenoles,
retrasa el deterioro cognitivo
relacionado con la edad.
PREDIMED – Dieta y Cognición
72. • MUFA (ácido oleico)
• Tocoferoles
• Polifenoles
• Fitoesteroles
Aceite de Oliva Virgen Extra
73. 0,5
1
1,5
1,94
0,98
1,22
2,7 mg 64 mg
Randomized trial with 25 ml of olive oil with different
concentration of phenol compounds (Ann Intern Med 2006).
Changes in HDL-c (mg/dL) from
basal levels
200 healthy male
3 weeks intervention
trial
366 mg
Phenols mg/Kg
74. Camargo A. et al. BMC Genomics. 2010 Apr 20;11(1):253
El análisis de microarrays identificó a 98 genes con
cambios en la expresión (79 infraexpresados y 19
sobrexpresados) cuando se comparó la ingesta de un
aceite de oliva rico en polifenoles vs. otro pobre en
polifenoles.
Las genes involucrados incluían aquellos relacionados
con la respuesta inflamatoria mediada por
mecanismos relacionados con el NF-κB, MAPKs o el
ácido araquidónico.
El análisis de microarrays identificó a 98 genes con
cambios en la expresión (79 infraexpresados y 19
sobrexpresados) cuando se comparó la ingesta de un
aceite de oliva rico en polifenoles vs. otro pobre en
polifenoles.
Las genes involucrados incluían aquellos relacionados
con la respuesta inflamatoria mediada por
mecanismos relacionados con el NF-κB, MAPKs o el
ácido araquidónico.
La ingesta de aceite de oliva virgen rico en compuestos fenólicos es capaz
de suprimir in vivo la expresión de genes proinflamatorios y, con ello,
cambiar hacia un perfil menos deletéreo.
La ingesta de aceite de oliva virgen rico en compuestos fenólicos es capaz
de suprimir in vivo la expresión de genes proinflamatorios y, con ello,
cambiar hacia un perfil menos deletéreo.
77. Aumentar el consumo
de Cereales Integrales
Consumo de Fibra Dietética
Aumentar el consumo de frutas
y verduras
Aumentar el
consumo de pescado
azul
Disminuir el cosumo de
cereales refinados
79. J. Nutr 2012;142: 1304–13
RR for cardiovascular disease random
effects
80. White bread, trend p = 0.003
Brown bread, trend p = 0.74
Br J Nutr 2013;110:337-46
change in consumptionchange in consumption
change in consumptionchange in consumption
81. White bread, trend p <0.001
Brown bread, trend p = 0.85
Br J Nutr 2013;110:337-46
82. J Epidemiol Commun
Health 2009;63:582
N=772 with data at baseline and after intervention for 3 months
–5.7 versus +8.3 g/d
84. Consumo de
FRUTA – Riesgo
Relativo de varios
tipos de Cáncer en
Italia, 1992-2012
84
85. Tomar 5 raciones entre frutas y
hortalizas frescas al día es
fundamental para tener una
alimentación equilibrada y
mantenerse sano.
Cada ración pesa entre
140 y 150 gr. y es muy
importante la variedad.
CAMPAÑA 5 AL DÍA
86. Fomentar el consumo de productos
frescos, locales y ligados a la
estacionalidad (circuitos de
distribución cortos).
La capacidad
antioxidante de los
productos del campo
abierto es mayor que la
de productos cultivados
en invernaderos.
(Pincemail et al. 2012)
Las condiciones de cultivo y
de almacenaje
(temperatura) pueden
determinar cambios
sustanciales en la calidad
del producto.
(Cordenunsi et al. 2005)
(Gündüz et al. 2014)
Las técnicas de cocción y la
estructura de la matriz
alimentaria determinan las
concentraciones de los
compuestos bioactivos del
producto final
(Palermo et al. 2014)
87. Consumo moderado
de vino con las
comidas,
preferententemente
por la noche
Aumentar el consumo
de frutos secos
Reducir la ingesta
de sal
88. HACIA UN DIETA MEDITERRÁNEA
TODAVÍA MÁS SANA
• CAMBIAR EL ACEITE DE OLIVA COMÚN POR ACEITE DE
OLIVA VIRGEN EXTRA.
• AUMENTAR EL CONSUMO DE FRUTOS SECOS Y
PESCADO AZUL.
• SUSTITUIR LOS CEREALES REFINADOS POR
INTEGRALES; AUMENTO DEL CONSUMO DE FIBRA
DIETÉTICA.
• REDUCIR LA INGESTA DE SAL (SODIO).
• MANTENER EL CONSUMO MODERADO DE VINO.
• REDUCIR EL CONSUMO DE CARNE ROJA Y
PRODUCTOS PROCESADOS DE LA CARNE.
• EVITAR EL CONSUMO DE BEBIDAS REFRESCANTES
AZUCARADAS, BOLLERIA, DULCES Y PASTELES.
When we analyze the possible factors that may explain the low cardiovascular risk in countries from the South of Europe, first of all we may consider genetic factors. Although this seems improbable because of the long history of migrations in Europe, their possible role can not be excluded. Actually, the lower risk may more easily be explained by the different lifestyle habits between countries from the North and those of the South of Europe.
Figure 2. Daily energy balance and BMI in Okinawans and Americans (kcal/day). (A) Caloric expenditure for various levels of activity is based on reported occupation and activity levels from NHANES I (U.S. National Center for Health Statistics 1978), the Office of the Civil Administrator of the Ryukyu Islands (1949), the U.S. Department of the Office of the Civil Administrator of the Ryukyu Islands (1949), and the National Nutrition Survey, Japan Ministry of Health, Labor and Welfare (1972). BMR = basal metabolic rate (based on sex, height, body weight at age 50, Harris–Benedict equation).29 Energy balance shifted from negative to positive in Okinawa from 1949 to 1972, supporting an early-life CR phenotype for older Okinawans. By the 1970s, population data from the U.S. and Okinawa standardized to 50 year olds show that both Americans and Okinawans were in positive energy balance. (B) Population data from the U.S. and Okinawa show that Okinawans were in negative energy balance of approximately −218 kcal/day in 1949. Both Okinawans and Americans were in positive energy balance in the 1970s. Americans had a positive energy balance of approximately 239 kcal/day in the 1970s, while Okinawans were in positive energy balance of approximately 212 kcal/day. This supports an energy balance shift of approximately 400 kcal/day for Okinawans during these years.
FIGURE 4 displays survival curves for Okinawan, Japanese, and
U.S. populations for the year 1995. These data show increases in both average
and maximum life span in the Okinawan population compared to Japanese
and American populations, consistent with caloric restriction (CR). Average life span and maximum
life span in the Okinawan, Japanese, and U.S. populations was 83.8
and 104.9 years, 82.3 and 101.1 years, and 78.9 and 101.3 years, respectively.
However, as you probably know, it was an American researcher, Ancel Keys, who first started to investigate on the possible benefits of the Mediterranean diet. After a sabbatical year in Italy, he designed the Seven Countrys study and compared the prevalence of coronary heart disease in seven different countries. He observed that the USA had the highest prevalence of coronary heart disease (4.6%) and Greece (and specially the Isle of Crete) had the lowest prevalence (0.5%). Later they performed a second study and analyzed the 10-year mortality due to coronary heart disease and the results were similar. In this case, Finland had the highest mortality (45.5 per 10,000 inhabitants), followed by the United States. Again, Greece exhibited the lowest mortality.
Good afternoon.
It is a pleasure and an honor for me to be here today in the Friday Forum in Cardiovascular Epidemiology and I want to thank Prof. Eric Rimm and Ken Mukamal for inviting me to present the latest results of the PREDIMED trial, and I also want to thank Frank Hu for his work on the Drug and Safety Monitoring Board of the PREDIMED trial. I know that last year another good friend, Dr. Miguel Angel Martinez-González from Spain explained the objectives, design and first results of this trial in the Monday Nutrition Seminar of this institution. Today I will go further and give an update of the latest results of this trial.
The trial has 3 ARMS and we have recruited men (aged: 55 to 80 years) and women (aged: 60 to 80 years) with either diabetes or three or more major cardiovascular risk factors out the six factors shown in this slide.
All participants were free of cardiovascular disease at baseline.
They were randomly allocated into three equally-sized groups. Two intervention groups were assigned to a traditional Mediterranean Diet. In one of these two groups we supplemented the diet with VOO (1 liter/week) and the other with 30 g/day of mixed nuts (walnuts, hazelnuts, and almonds). The third arm of randomization is the control group, in which participants receive education on how to follow a low-fat diet according to the guidelines of the American Heart Association.
As explained before, the primary end-point we want to assess is a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke. Up to now, we have detected 235 primary end-points, but we have to wait until the end of the study to report the results. Secondary end-points are total mortality, angina leading to a revascularization procedure, heart failure, new diagnosis of diabetes and major cancers.
Now I will discuss the mechanisms of the effects of the MedDiet
In a study published in the Archives of Internal Medicine in 2007 we analyzed the effects of a Mediterranean diet on lipoprotein oxidation and we found a significant protective effect on the circulating levels of oxidized LDL in plasma, but not on Serum glutathione peroxidase activity with the intervention with both Mediterranean diets at 3 months.
An this was associated with a decrease in several markers of peripheral inflammation in those individuals randomized to both MedDiet interventions supplemented with VOO or Nuts.
These pilot study results encourage us to continue the trial because we were able to find clear differences between interventions in several traditional cardiovascular risk markers.
An important key of the intervention studies is the assessment of compliance. In the PREDIMED study we use a 14-point scale and biochemical markers related to the intake of virgin olive oil and walnuts.
This slide show the changes in plasma glucose and insulin concentration and in the HOMA index. As you can see the participants in both Mediterranean Diet groups showed a significant decrease in glucose concentration, in insulin concentration and consequently in the HOMA index.
This graphic shows the cumulative incidence of diabetes in the three intervention groups. As you can see the cumulative incidence was significantly lower in both MedDiet groups compared to controls.
An important key of the intervention studies is the assessment of compliance. In the PREDIMED study we use a 14-point scale and biochemical markers related to the intake of virgin olive oil and walnuts.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Ambulatory 24 h blood pressure monitoring measures blood pressure every 20 minutes throughout the day and provides a mean value of around 200 blood pressure measurements. We assessed the changes at one year in 107 PREDIMED participants. The mean age was 67 years, the mean BMI was 29.4 Kg/m2 and 52 % were women .
This slide shows the changes observed in the mean systolic and diastolic blood pressures in the three groups. As you can see there was a significant reduction in both systolic and diastolic blood pressure in the two Mediterranean diet groups. Please note that the reduction was somewhat higher in the MedDiet plus nuts group.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Another way to measure atherosclerotic burden is using imaging techniques. In a on-going study, we are evaluating the effects of Mediterranean dIet on atherosclerosis by imaging techniques.
Comparing the analyses of tomatoes from conventional and organic production systems demonstrated statistically higher levels (P &lt; 0.05) of phenolic compounds in organic tomatoes.
Data obtained revealed that light gazpachos displayed a higher significant phytochemical content than conventionally produced alternatives.
Serie integrata di studi caso-controllo condotti in Italia negli anni ’80 e ’90 su vari neoplasie.
Rischi relativi tra 0.30 e 0.70 per tumori del tratto digerente per coloro che hanno un elevato consumo di verdura rispetto a coloro che hanno un basso consumo
-Recent studies have focused on the nutrient and phytochemical contents of the F&V and on factors affecting the composition of these. These studies have included genotype, harvest time, influence of the degree of maturity, climatic factors, post-harvest storage, plant materials such as (berries, fruits, vegetables, herbs, cereals, tree material, plant sprouts, and seeds), geographic origin, environmental factors such as light exposure, cultural system and storage temperature, cultivated and wild form, genotype, cultural system (covered with black polyethylene mulch and without mulch) and integrated pest management and organic farming (Aaby et al., 2012, Capocasa et al., 2008, Crespo et al., 2010, Diamanti et al., 2012, Fernandes et al., 2012, Giampieri et al., 2012, Jin et al., 2011, Pincemail et al., 2012 and Tulipani et al., 2011).
Polyphenolics can vary greatly amongst cultivars (Aaby et al., 2012 and Tulipani et al., 2008), and geographic origin (Hakkinen & Torronen, 2000), environmental factors such as light exposure (Ordidge et al., 2010), cultural system, storage temperature (Jin et al., 2011) amongst others.
Temperatures around 0 °C are considered the best for strawberry storage because they cause few changes in quality. However, the commercialization and post-market storage usually occur at higher temperatures. These higher temperatures can affect, not only the strawberry shelf-life, but also its nutritional value, in terms of soluble sugars, vitamin C and antioxidant compounds.
Changes in phytochemicals upon cooking may result from two opposite phenomena: (1) thermal degradation, which reduces their concentration, and (2) a matrix softening effect, which increases the extractability of phytochemicals, resulting in a higher concentration with respect to the raw material. The final effect of cooking on phytochemical concentration depends on the processing parameters (por ejemplo mejor la cocción al vapor que freír o hervir), and the structure of food matrix (la adición de aceite de oliva virgen extra en los sofritos, aumenta la biodisponibilidad de los compuestos fitoquímicos).