The Mediterranean diet: is it cardioprotective?

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Background

Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain.

Methods

Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence).

Results

Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality.

Conclusions

The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.

Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: A cross-sectional assessment of a primary health care database

Objective

To determine the prevalence of metabolic syndrome (MS) in outpatients treated with antipsychotics included in a primary-health-care database.

Methods

A cross-sectional study was carried out assessing an administrative outpatients claim-database from 5 primary-health-centers. Subjects on antipsychotics for more than 3 months were included. The control group was formed by the outpatients included in the database without exposition to any antipsychotic drugs. MS was defined according to the modified NCEP-ATP III criteria, and required confirmation of at least 3 of the 5 following components: body mass index >28.8 kg/m2, triglycerides >150 mg/ml, HDL-cholesterol <40 mg/ml (men)/<50 mg/ml (women), blood pressure >130/85 mmHg, and fasting serum glucose >110 mg/dl.

Results

We identified 742 patients [51.5% women, aged 55.1 (20.7) years] treated with first- or second-generation antipsychotics during 27.6 (20.3) months. Controls were 85.286 outpatients [50.5% women, aged 45.5 (17.7) years]. MS prevalence was significantly higher in subjects on antipsychotics: 27.0% (95% CI, 23.8–30.1%) vs. 14.4% (14.1–14.6%); age- and sex-adjusted OR = 1.38 (1.16–1.65, P < 0.001). All MS components, except high blood pressure, were significantly more prevalent in the antipsychotic group, particularly body mass index >28.8 kg/m2: 33.0% (29.6–36.4%) vs. 17.8% (17.6–18.1%), adjusted OR = 1.63 (1.39–1.92, P < 0.001), and low HDL-cholesterol levels: 48.4% (44.8–52.0%) vs. 29.3% (29.0–29.6%); adjusted OR = 1.65 (1.42–1.93, P < 0.001). Compared with the reference population, subjects with schizophrenia or bipolar disorder (BD), but not dementia, showed a higher prevalence of MS.

Conclusions

Compared with the general outpatient population, the prevalence of MS was significantly higher in patients with schizophrenia or BD treated with antipsychotics.

An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta

OBJECTIVE

The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies.

DESIGN

We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990.

SETTING

Malta.

SUBJECTS

Whole population, with a focus on children.

RESULTS

Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored.

CONCLUSIONS

Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.

Association between C-reactive protein, anthropometric and lipid parameters among healthy normal weight and overweight postmenopausal women in Montenegro

OBJECTIVE

Although C-reactive protein (CRP) is among the best cardiovascular disease risk predictors, data regarding the association of CRP and menopause are controversial. In this study, we measured CRP by a high-sensitivity method (hsCRP), cholesterol, lipoproteins, and triglycerides in normal and overweight postmenopausal women.

METHODS

Body weight, height, waist circumference (WC), hsCRP, total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides, and lipoprotein (a) were measured in 30 normal weight and 60 overweight healthy postmenopausal women.

RESULTS

Significantly higher triglyceride and hsCRP levels (P = 0.005 and P < 0.001 respectively), together with lower HDL-c levels (P = 0.001) were found in overweight compared to normal weight women. In the overweight group, positive correlations of hsCRP were observed with age, body mass index and WC (P = 0.016, P = 0.001, and P < 0.001, respectively) and a negative correlation was observed with HDL-c (P = 0.007). In the normal weight group, positive correlations were found for hsCRP with age and WC (P = 0.023 and P = 0.014, respectively). WC was the best predictor of hsCRP level in both groups (P < 0.001).

CONCLUSION

Elevated hsCRP levels in conjunction with abnormal lipid profiles may be strongly associated with weight gain in postmenopausal women. Efforts to reduce obesity and inflammation in this group may help correct abnormal levels of hsCRP and lipids.

Is the Mediterranean lifestyle still a reality? Evaluation of food consumption and energy expenditure in Italian and Spanish university students

Objective

To evaluate the correspondence of diet and lifestyle to the Mediterranean model in two groups of Italian and Spanish university students.

Design

A cross-sectional nutritional survey to determine BMI, dietary habits (FFQ), energy daily expenditure and lifestyle (SenseWear® Armband; BodyMedia Inc.), and to define the Mediterranean diet quality index (MDQI) in the different student groups.

Setting

Bologna (Italy) and León (Spain).

Subjects

The survey was carried out on 210 (105 Italian; 105 Spanish) university students (mean age 27·0 (sd 3·8) years) of two different Mediterranean areas, Bologna (Italy) and León (Spain).

Results

The frequency of consumption of some food groups showed differences related to nationality and gender. Some classic Mediterranean foods such as cereals and vegetables were generally consumed more frequently by Italian students; others such as fish and pulses by Spanish students. Percentage of overweight was higher among Spanish students in spite of their higher physical activity level.

Conclusion

Young generations seem to give up the traditional Mediterranean dietary pattern, adopting new dietary trends. Overweight appears to be related not only to physical activity level, but also to the poor MDQI.

Incident solar radiation and coronary heart disease mortality rates in Europe

The reported low mortality rate from coronary heart disease in Portugal, Spain, Italy, Greece, and France, to a lesser extent, has been attributed in numerous nutritional studies to the consumption of a Mediterranean-type diet. There are still many unresolved issues about the direct causal effect of the Mediterranean dietary regime on low incidence of coronary heart disease. An analysis of coronary heart disease mortality rates in Europe from a latitudinal gradient perspective has shown to have a close correlation to incident solar radiation. It is surmised that the resulting increased in situ biosynthesis of Vitamin D(3) could be the critical missing confounder in the analysis of the beneficial health outcome of the Mediterranean diet.

Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a Health Management Organization database

OBJECTIVE

To estimate the prevalence of metabolic syndrome (MS) in patients with bipolar disorder (BD) included in a Health Management Organization (HMO) database.

METHODS

A cross-sectional analysis of the administrative claim database of Badalona Serveis Assistencials (BSA) was performed. All patients of either sex over 16 years of age and receiving treatment for BD for more than three weeks were included in the study group. The reference group comprised the rest of patients in the BSA database without BD. MS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria and required fulfillment of at least three of the following five components: body mass index (BMI) >or=28.8 kg/m(2), triglycerides >or=150 mg/dL, high-density lipoprotein (HDL) cholesterol <40 mg/dL (males)/<50 mg/dL (females), blood pressure >or=130/85 mmHg, and fasting glucose >or=110 mg/dL. Descriptive statistics, bivariate analysis, and logistic regression models were applied.

RESULTS

We identified 178 patients with BD out of 86,028 subjects (50.5% women; 45.5 +/- 17.8 years, mean +/- SD) included in the BSA database. MS prevalence was significantly higher in BD: 24.7% [95% confidence interval (CI): 18.6-31.7] versus 14.4% (CI: 14.2-14.7) with no statistically significant differences between genders; age-adjusted odds ratio (OR) = 1.65 (1.11-2.44, p = 0.013). All MS components were higher in the BD group, particularly BMI >28.8 kg/m(2) [33.1% (26.3-40.6) versus 17.9% (17.7-18.2), adjusted OR = 2.05 (1.46-2.87, p < 0.001)], high triglyceride levels [23.0% (17.1-29.9) versus 11.3% (11.1-11.5), adjusted OR = 2.09 (1.45-3.02, p < 0.001)], and low HDL cholesterol levels [54.5% (46.9-62.0) versus 29.4% (29.1-29.7), adjusted OR = 2.77 (2.02-3.80, p < 0.001)]. Furthermore, patients with BD showed a significantly higher frequency of obesity [41.4% (32.3-50.9) versus 27.1% (26.6-27.5); adjusted OR = 1.83 (1.24-2.68, p = 0.002)].

CONCLUSIONS

Compared with the general population managed by the BSA, the prevalence of MS was significantly higher in patients with BD, mainly due to a higher prevalence of obesity, high triglyceride levels, and low HDL cholesterol levels. These findings strongly support the development of health policies addressing this problem in BD patients.

Lipid-modifying therapy and attainment of cholesterol goals in Hungary: the return on expenditure achieved for lipid therapy (REALITY) study

BACKGROUND AND OBJECTIVE

Cardiovascular disease is a leading cause of death in Eastern Europe. Few studies on cholesterol goal achievement have been conducted in Hungarian clinical settings. This study set out to evaluate lipid-modifying therapy practices and their effects on total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) goal attainment in Hungarian patients with coronary heart disease (CHD), CHD risk equivalents, or >or=2 coronary risk factors.

METHODS

This multicentre observational study involved patients receiving lipid-modifying therapy who were under the care of general practitioners (n = 300) or specialists (n = 140). Physician questionnaires were used to collect data on baseline patient characteristics, including laboratory parameters. Using validated cardiovascular risk assessment measures, patients were stratified into high-risk (10-year absolute coronary risk >20%; n = 367) and lower risk groups (n = 73). Cholesterol goals were TC <4.5 mmol/L (<175 mg/dL) and LDL-C <2.5 mmol/L (<100 mg/dL) for the high-risk group and TC <5.0 mmol/L (<193 mg/dL) and LDL-C <3.0 mmol/L (<117 mg/dL) for those at lower risk.

RESULTS

Among 440 patients (n = 312 with CHD or CHD risk equivalents), 374 (85%) were initiated on HMG-CoA reductase inhibitors (statin monotherapy), 44 (10%) received fibric acid derivatives and 22 (5%) received combination regimens. Although >50% of patients needed >35% TC lowering to reach goal, <10% of patients received high or very high potency lipid-modifying regimens or combination regimens initially. A total of 116 (26.4%) patients achieved their TC goals after >/=1 year of treatment, including 27.9% of patients with CHD/risk equivalents and 22.7% of those with risk factors only. Sixty-six (15%) patients achieved goal on initial lipid-modifying regimens, while a further 50 (11.4%) achieved goal following treatment changes, including upward dosage adjustments.

CONCLUSION

Approximately 74% of Hungarian patients receiving lipid-modifying therapy in our study did not achieve cholesterol goals. The proportion of patients realising their TC goals was higher in those treated by specialists but still did not exceed one-third.

A Study of Dietary Patterns in the Mexican-American Population and Their Association with Obesity

OBJECTIVE

Data from the National Health and Nutrition Examination Survey 2001-2002 indicate that prevalence of overweight and obesity continues to rise among Mexican Americans. Little is know about the dietary factors associated with this trend. Ethnic groups have different dietary patterns based on their geographical locations and cultural influences. We examined the dietary patterns of Mexican Americans and their association with total and central obesity. We hypothesized that Mexican-American adults following a traditional diet would have a lower prevalence of obesity than those following a more typical American diet.

SUBJECTS

Data from the National Health and Nutrition Examination Survey 2001-2002 included 659 Mexican-American adults, ages 18 years and older.

EXPERIMENTAL DESIGN

Dietary patterns were defined by cluster analysis of food group variables, expressed as percentage contribution to total energy intake. Obesity was assessed by body mass index (calculated as kg/m2) and central obesity by waist circumference.

RESULTS

We defined four dietary patterns, each named for the food groups that were most predominant relative to the other clusters: poultry and alcohol, milk and baked products, traditional Mexican, and meat. Surprisingly, we did not identify a clear "healthy pattern" group in this population, as has been generally observed in other ethnic groups. Although the traditional Mexican diet contains relatively high intakes of legumes and dietary fiber, it also was high in cholesterol. Contrary to our hypothesis, those consuming the traditional Mexican diet pattern had high BMI and waist circumference values, which did not differ significantly from other groups.

CONCLUSION

In this representative population of Mexican-American adults, we identified distinct dietary patterns, but these were not significantly associated with obesity. Rather, obesity was prevalent in all diet groups. More details on possible changes within the traditional pattern, including use of fast food vs home-prepared Mexican foods, are needed to better understand how diet can be associated with obesity in this population.

Nutritional genomics: food industry applications from farm to fork

Nutritional genomics is a new and promising science area which can broadly be defined as the application of high throughput genomics (transcriptomics, proteomics, metabolomics/metabonomics) and functional genomic technologies to the study of nutritional sciences and food technology. First utilised in the food industry by plant biotechnologists to manipulate plant biosynthetic pathways, the use of genomic technologies has now spread within the agriculture sector, unleashing a host of new applications (e.g. approaches for producing novel, non-transgenic plant varietals; identification of genetic markers to guide plant and animal breeding programmes; exploration of diet-gene interactions for enhancing product quality and plant/animal health). Beyond agriculture, genomic technologies are also contributing to the improvement of food processing, food safety and quality assurance as well as the development of functional food products and the evolution of new health management concepts such as 'personalised nutrition', an emerging paradigm in which the diet of an individual is customised, based on their own genomic information, to optimise health and prevent disease. In this review the relevance of nutritional genomics to the food industry will be considered and examples given on how this science area is starting to be leveraged for economic benefits and to improve human nutrition and health.

The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study

BACKGROUND

Diet has long been associated with a risk of insulin resistance and poor glycemic control. We sought to investigate the association between food groups and indices of glycemic control in adults without type 2 diabetes and cardiovascular disease.

METHODS

During 2001 - 2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old) without evidence of cardiovascular disease from the Attica area of Greece. Of them, 118 men and 92 women were excluded from the present analysis due to a history of diabetes mellitus (type 2). Fasting blood glucose and insulin levels were measured, while dietary habits were evaluated through a semi-quantitative food frequency questionnaire.

RESULTS

Red meat consumption was positively associated with hyperglycemia (p = 0.04), hyperinsulinemia (p = 0.04), and HOMA levels (p = 0.03), even after adjusting for BMI and various other potential confounders. The intake of fruits, vegetables, legumes, yogurt and other dairy products was not associated with levels of glycemic control indices.

CONCLUSIONS

A higher consumption of red meat and its products may aggravate hyperinsulinemia and insulin resistance in non-diabetic people.

Cardiovascular risk factors in Croatia: struggling to provide the evidence for developing policy recommendations

Reliable epidemiological data on cardiovascular risk factors in Croatia have been lacking. This new study identifies targets for interventions