Dr Claire McEvoy and Sarah Moore. Overview Does a Mediterranean diet reduce risk of heart disease and diabetes? What is the Mediterranean diet? TEAM-MED.

Mediterranean diet andheart health

Dr Claire McEvoy and Sarah Moore

Overview

• Does a Mediterranean diet reduce risk of heart disease and diabetes?

• What is the Mediterranean diet?

• TEAM-MED research study

Heart disease

• In NI, over 75,000 people with heart disease and 1 in 4 people die each year due to heart disease

• Diabetes is a major risk factor for heart disease

• Most deaths could be prevented by making lifestyle changes such as eating a healthy diet…

BHF, 2013 & NHS, 2012

• Seven Countries Study (1968)

• Disease rates and dietary patterns differed across countries

• Mediterranean diet responsible?

Mediterranean Diet and Heart Disease

RESEARCH

Keys et al., 1986

Does a Mediterranean diet reduce risk of heart disease and diabetes?

• People: 7447 adults at risk of heart disease

• Groups: Med diet and olive oil Med diet and nuts Low fat diet

• Outcome: Heart related death, heart attack, stroke or diabetes

• Duration: 5 years

Predimed Study

PREDIMED Study

Year

0 1 2 3 4 5

60

40

30

20

10

0

50

Low fat diet

Med diet + nuts

Med diet + olive oil

% people had heart event

Estruch et al., 2013

Heart events over 5 years

PREDIMED Study

Med diet + olive oil

Low fat diet

Salas-Salvadó et al., 2011

Med diet + nuts

Survival without diabetes over 5 years (non-diabetic individuals)

Cum

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30% reduction in risk of heart disease 52% reduction in risk of diabetes

PREDIMED Results

(Taylor et al, 2013; (Knowler et al, 2002)

27% reduction in risk of heart disease with statin treatment

30% reduction in risk of diabetes with metformin treatment

Greater adherence to a Mediterranean diet is more effective than current drug treatments to reduce the risk of heart disease and diabetes.

What these results tell us…

Mediterranean Diet: How it reduces risk

Blood pressure

Cholesterol

Blood glucose

Weight gain

Other health benefits of a Mediterranean diet

Following a Mediterranean diet can:

• reduce the risk of Alzheimer's and Parkinson's disease

• reduce the risk of death from or occurrence of Cancer

Sofi F et al., 2010

Summary

• Heart disease remains a major cause of death

• Good evidence that following a Mediterranean diet can reduce risk of heart disease and diabetes

• Further research needed on how to support people to change their diet

What is the Mediterranean diet?

The Mediterranean diet

• High in fruits, vegetables, wholegrain bread, rice and pasta, potatoes, beans, nuts, and seeds

• Olive oil as an important fat source and dairy products, fish, and poultry (consumed low- moderate amounts)

• Eggs (moderate amounts), and red meat (low amounts)

• Wine is consumed in low to moderate amounts.

• Dietary pattern based on food patterns of many Mediterranean regions in 1960s

Kris-Etherton, 2001

Mediterranean Diet Pyramid

Mediterranean Diet guidelinesEvery main meal• 1-2 portions fruits, 2+ portions vegetables• 1-2 servings wholegrain bread/ rice/ pasta• Use olive oil as main cooking fat or as a dressingEvery day• 2 servings dairy• 1-2 servings nuts Weekly • 2 servings poultry, 2+ servings oily fish, 2+ servings legumes • Less than 2 servings red meat, 1 or less serving processed meat• 0-4 servings Eggs• Less than 2 servings sweet foods • Optional: 1 glass wine/day(women), 2 glasses/day(men) most days

Bach-Faig et al., 2011

Eat more fruit & vegetables

Include oily fish (e.g. salmon, herring, sardines) 2-3 times/ week Eat wholegrain bread and cereals instead of white/ low fibre

Use olive or rapeseed oils & spreads

Add more natural nuts into your diet (e.g. walnuts, almonds or hazelnuts)

Reduce red meat intake and eat poultry more often

Alcohol in moderation (optional)

Guidelines: key foods & advice

BreakfastFruit or small glass of unsweetened fruit juiceWholegrain breakfast cereal/ porridge/ muesliWholemeal bread/ toast with olive oil spread Lunch Soup and wholemeal breadSmall portion of chicken/ fish/ egg/ cheeseSaladWholemeal breadFruit and yoghurt Evening mealSmall portion meat/ chicken/ fish/ eggPlenty of salad/ vegetablesPotatoes, rice, pasta, other grains or wholemeal breadFruit for dessertGlass of wine (optional)

Mediterranean diet meal plan

MENU

Wholegrain bagel with olive oil spread +fresh fruit

Lentil soup + wholegrain bread

Mediterranean-style marinated fish or chicken

Snacks: Fruit/ nuts

2 tbsp olive oil 1 clove garlic, thinly sliced1 carrot, diced1 large onion, sliced1 celery stick, sliced 1 medium potato, diced1-2 slices of turnip, diced 100g (4oz) red lentils 1L (1 ¾ pt) chicken or vegetable stock (serves 4)

Heat the olive oil in a saucepan and add the onion and garlic.

Sauté gently for 5 minutes until softening Add the rest of the vegetables and cook for a further 4-5 minutes. Add the lentils and stock and bring to the boil. Simmer for 15-20 minutes. Season with pepper, blend until smooth. Pour the mixture back into the pan, reheat gently.

Serve with wholemeal bread

Mediterranean diet recipes

LENTIL SOUP

2 (100g/4oz) fish fillets (or chicken breasts)2 tbsp olive oil 2 tsp red wine vinegar½ tsp ground black pepper½ dried basil or thyme ¼ tsp garlic granules2 bay leaves(serves 2)

In a bowl, mix olive oil, vinegar, pepper, basil, thyme and garlic. Coat both sides of the fish/ chicken fillets. Break the bay leaves into 3-4 pieces, press onto both sides of fillets. Cover and refrigerate for at least an hour. Remove the bay leaves. Cook in a non-stick pan over a medium-high heat.

Serve with potatoes, pasta, rice or another ‘grain’ such as couscous and vegetables  

Mediterranean diet recipes

MED-STYLE MARINATED FISH (or chicken)

Encouraging adoption of a Mediterranean diet

75 peopleat risk

of heart disease

Peer support (25)

Time 0 12 (months)

Written Mediterranean diet advice (25)

Sessions with Dietitian and provided olive oil

and nuts (25)

TEAM-MED Study

TEAM-MED Study

TEAM-MED is seeking to recruit suitable people to take part in the study. If you are over 40 years, overweight and with no previous history of heart disease, stroke or diabetes you may be eligible to take part in TEAM-MED.

For more details contact:Claire McEvoy: [email protected] (tel: 02890 632764) or Sarah Moore: [email protected] (tel: 02890 635020)

Nutrition and Metabolism GroupCentre for Public Health, QUB

Thank you for your attention

Any questions?