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The Impact of the Dietary Guidelines and Benefits of a Mediterranean Diet: 

The Impact of the Dietary Guidelines and Benefits of a Mediterranean Diet Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University

Outline: 

Outline Dietary Recommendations to Achieve Nutrient Adequacy and Decrease Risk of Chronic Disease Dietary Patterns for Health and Decreased Risk of Chronic Diseases USDA Food Guide MyPyramid.gov DASH Diet Health Benefits of Moderate Fat Diets (~30% of calories) Lyon Diet Heart Study Mediterranean Style Diet Pattern Health Benefits of Low Fat Diets (<20% of calories) Lifestyle Heart Program DPPT Women’s Health Initiative

Slide3: 

National Academies, 2002

PRIMARY FAT RECOMMENDATION: 

PRIMARY FAT RECOMMENDATION Minimize Saturated and Trans Fatty Acid and Cholesterol Consumption while Consuming a Nutritionally Adequate Diet National Academies, 2002 200-01

Dietary Guidelines for Americans, 2005: 

Dietary Guidelines for Americans, 2005

Nine Focus Areas: 

Nine Focus Areas Adequate Nutrients Within Calorie Needs Weight Management Physical Activity Food Groups To Encourage Fats Carbohydrates Sodium and Potassium Alcoholic Beverages Food Safety

Key Scientific Recommendations: 

Key Scientific Recommendations Consume a variety of foods within and among the basic food groups while staying within energy needs Control calorie intake to manage body weight Be physically active every day Increase daily intake of fruits and vegetables, whole grains, and reduced-fat milk and milk products Choose fats wisely for good health Choose carbohydrates wisely for good health Choose and prepare foods with little salt If you drink alcoholic beverages, do so in moderation Keep food safe to eat

Dietary Guidelines for Americans – 2005Total Fat and Fatty Acids: 

Dietary Guidelines for Americans – 2005 Total Fat and Fatty Acids

USDA Food Guide - Food Group Recommendations: 

USDA Food Guide - Food Group Recommendations

Slide10: 

Percent Increase or Decrease from Current Consumption (zero line) to Recommended Intakes

Slide11: 

Percent Increase or Decrease from Current Consumption (zero line) to Recommended Intakes

Physical Activity: 

Physical Activity Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a health body weight Achieve physical fitness by including cardiovascular conditioning, stretching, and resistance exercises. Children and adolescents – At least 60 minutes on most, preferably all, days of the week.

New for 2005: 

New for 2005 Specificity of recommendations At least 30 minutes to reduce risk of chronic disease Up to 60 minutes of moderate to vigorous physical activity may be needed to prevent gradual weight gain that occurs over time 60 to 90 minutes of moderate-intensity physical activity to sustain weight loss

Print materials: Mini Poster: 

Print materials: Mini Poster

Macronutrient Profile of a Mypyramid.gov Recommended 2000 kcal diet: 

Macronutrient Profile of a Mypyramid.gov Recommended 2000 kcal diet

Slide16: 

DASH PYRAMID

A “Prudent Dietary Pattern” Decreases Risk of Coronary Heart Disease: 

A “Prudent Dietary Pattern” Decreases Risk of Coronary Heart Disease Prudent Pattern Higher intake of Vegetables Fruit Legumes Whole grains Fish Poultry RR for highest quintile: 0.70 Western Pattern Higher Intake of Red meat Processed meat Refined grains Sweets and desserts French fries High-fat dairy products RR for highest quintile: 1.64 Hu et al, 2000

Slide22: 

Mediterranean-style Diet Pattern

Slide23: 

Decreased Death Rate Related to Mediterranean Diet Score Trichopoulou, NEJM, 2003

Slide24: 

Increased Vegetable Consumption Related to Better Mediterranean Diet Score Trichopoulou, NEJM, 2003

Slide25: 

Trichopoulou, NEJM, 2003 Increased Olive Oil Consumption Related to Better Mediterranean Diet Score

Lyon Diet Heart StudyPurpose: To assess whether a Mediterranean Diet would reduce rate of recurrence after a first MIPatients with a MI were randomly assigned to a treatment or control groupFollow-up was 46 mos De Lorgeril et al, Circulation, 1999: 

Lyon Diet Heart Study Purpose: To assess whether a Mediterranean Diet would reduce rate of recurrence after a first MI Patients with a MI were randomly assigned to a treatment or control group Follow-up was 46 mos De Lorgeril et al, Circulation, 1999

Mediterranean-style Dietary Pattern used in Lyon Diet Heart Study: 

Mediterranean-style Dietary Pattern used in Lyon Diet Heart Study More whole grains - bread More root and green vegetables More fish Fruit daily Less red meat – more poultry Margarine supplied to replace butter and cream (high in linoleic and -linolenic fatty acids) Recommendation to use canola and olive oil for salad dressing and food preparation

Slide28: 

N u t r i e n t ( % c a l o r i e s ) C o n t r o l ( n = 8 3 ) E x p e r i m e n t a l ( n = 1 4 4 ) P T o t a l l i p i d s S a t u r a t e d f a t s 1 8 : 1 (  - 9 ) , o l e i c 1 8 : 2 (  - 6 ) , l i n o l e i c 1 8 : 3 (  - 3 ) , l i n o l e n i c A l c o h o l C h o l e s t e r o l , m g 3 3 . 6 1 1 . 7 1 0 . 8 5 . 3 0 . 3 6 . 0 3 1 2 3 0 . 4 8 . 0 1 2 . 9 3 . 6 0 . 8 5 . 8 2 0 3 0 . 0 0 2 0 . 0 0 0 1 0 . 0 0 0 1 0 . 0 0 0 1 0 . 0 0 0 1 0 . 8 0 . 0 0 0 1 Lyon Diet-Heart Study Nutrient Intake at Final Visit (Mean Follow-up = 46 Months) de Lorgeril et al., 1998

Slide29: 

Cumulative Survival Without Nonfatal Infarction, Without Major Secondary End Points, and Without Minor Secondary End Points deLorgeril, 1999

Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome: 

Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome Esposito K, et al. JAMA 2004;292:1440-1446

Objective: 

Objective To assess the effect of a Mediterranean-style diet on endothelial function and vascular inflammation in patients with the metabolic syndrome

Slide32: 

Esposito K, et al. JAMA 2004;292:1440-1446

Results: 

Esposito K, et al. JAMA 2004;292:1440-1446 Results Patients following the Mediterranean-style diet consumed more foods rich in: MUFA PUFA Fiber Fruits Vegetables Nuts Whole Grains Olive Oil

Results: Changes in Anthropometrics: 

Esposito K, et al. JAMA 2004;292:1440-1446 Results: Changes in Anthropometrics Weight (kg) BMI (kg/m2) Waist Circumference (cm) Change from Baseline

Prevalence of the Metabolic Syndrome: 

Esposito K, et al. JAMA 2004;292:1440-1446 Prevalence of the Metabolic Syndrome Baseline 2-Year Follow-Up Control Diet Intervention Diet 90 90 78 40

Effects of High-Saturated Fat, NCEP-1 and Mediterranean Diets on Lipids, Endothelial Function and Inflammation: 

Effects of High-Saturated Fat, NCEP-1 and Mediterranean Diets on Lipids, Endothelial Function and Inflammation mmole/L Fuentes et al., Ann Intern Med 2001 (28 days)

Slide37: 

Increased Adherence to the Mediterranean Diet is Associated by Tertiles with Reduction in Risk for Alzheimer’s Disease Scarmeas, Annals of Neurology, 2005

Practical Suggestions for Following a Mediterranean Diet: 

Practical Suggestions for Following a Mediterranean Diet Category Consume Curtis & O’Keefe, 2002

Program for Reversing Heart Disease: The Reversal Diet: 

Program for Reversing Heart Disease: The Reversal Diet Eat More, Weigh Less

Main Concepts“Intensive Lifestyle Changes”: 

Main Concepts “Intensive Lifestyle Changes” Diet Eating fat makes you fat and causes CVD Limit type not amount of food you eat Low-fat vegetarian diet Emphasize complex carbohydrates Reduce consumption of: sugar, stimulants (caffeine), salt, alcohol Stop smoking Stress management - 1 hr/d (stretching, breathing techniques, meditation, imagery) (Group) social support meetings 2x/wk Exercise - minimum 3 hr/wk; 30 min/session at target heart rate

The Lifestyle Heart Trial: 

The Lifestyle Heart Trial Randomized controlled trial: 1 year intervention, 5 year follow-up 48 subjects with documented CAD Intervention: “intensive lifestyle changes” Control: follow the advice of their personal physicians JAMA 1998;280(23):2001-2007, Lancet 1990;336:129-33

Slide44: 

Mean Percentage Diameter Stenosis in Treatment and Control Groups at Baseline, 1 year, and 5 years 20 of 28 patients maintained intensive lifestyle changes 15 of 20 control subjects made more moderate changes * p=.02 † p = .001 Ornish et al., 1998 RESULTS

Diabetes Prevention Program:Lifestyle Intervention: 

Diabetes Prevention Program:Lifestyle Intervention An intensive program with the following specific goals: > 7% loss of body weight and maintenance of weight loss Dietary fat goal -- <25% of calories from fat Calorie intake goal -- 1200-1800 kcal/day > 150 minutes per week of physical activity

Slide46: 

Metformin- 850 mg per day escalating after 4 weeks to 850 mg twice per day Placebo- Metformin placebo adjusted in parallel with active drugs Diabetes Prevention Program: Medication Intervention

Slide47: 

The Development of the Metabolic Syndrome in High Risk Subjects in the Diabetes Prevention Program, 4 yr. Follow-up Placebo (n-490) Metformin (n=503) Lifestyle (n=530) Orchard et.al, Ann Intern Med 2005

Low-Fat Dietary Pattern and Risk of CVDResults from the WHI Randomized Controlled Dietary Modification Trial: 

Low-Fat Dietary Pattern and Risk of CVD Results from the WHI Randomized Controlled Dietary Modification Trial Intervention: Postmenopausal women (19,5541) were assigned to a low-fat (20% of energy) dietary intervention for 8 years Results: Diet Total fat decreased by 8.2% of energy SFA decreased by 2.9% of energy Fruits and vegetables increased by 1.1 serv/day Whole grains increased by 0.5 serv/day Endpoints LDL-C decreased by 3.55 mg/dL No significant effects on incidence of CHD, stroke, CVD Howard et al., JAMA 295; 655,2006

Additional Analysis of the WHI Dietary Modification Trial:Reported CHD Benefits in Some Women who Reached Diet Targets: 

Additional Analysis of the WHI Dietary Modification Trial: Reported CHD Benefits in Some Women who Reached Diet Targets A trend was observed toward reduction of CHD risk among those in the intervention group who: Reached the lowest levels of saturated fat intake (adjusted HR, 0.82, p=0.051) Reached the lowest levels of trans fat intake (adjusted HR, 0.84, p=0.101) Reached the highest intake of vegetables and fruits (adjusted HR, 0.89, p=0.11) Howard et al., JAMA 295; 655,2006

Slide50: 

Okinawa Japan U.S. Prevalence (%) Age Group

Slide51: 

“Super seniors” in three very different regions (Sardinia, Italy,Okinawa, Japan and Loma Linda, CA share a number of key habits: Don’t smoke Put family first Be active every day Keep socially engaged Eat fruits, vegetables and whole grains

Summary: 

Summary

Macronutrient Profile of the Okinawan and Greek Diet: 

Macronutrient Profile of the Okinawan and Greek Diet