Dieta Mediterránea, Dietas Provegetarianas y salud · 11/07/2017 1 Dieta Mediterránea, Dietas...

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Dieta Mediterránea,

Dietas Provegetarianas y

salud

MA Martínez-González

www.predimed.esDOG

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Dieta provegetariana, Dieta mediterránea y salud,

• Enfermedades no transmisibles

• Enfermedad cardiovascular

• Dieta Mediterránea

• PREDIMED

• Dieta pro-vegetariana

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• PREDIMED


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• PREDIMED






• PREDIMED


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PLoS Med. 2006 Nov;3(11):e442. 13

Lancet 2016; 388:

1459–544

Leading causes of global YLLs for both sexes combined for 1990, 2005, and 2015

Lancet 2016; 388:1459–544

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JAMA. 2012;307:1273-83

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Albert Einstein:

• A clever person solves a problem

• A wise person avoids it

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Ideal CV Health METRICS (7)1.2.3.4.5.6.7.1. Never smo

Circulation. 2010;121:586-613

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Ideal CV Health

METRICS

1. Never smoking

2. BMI < 25 kg/m2

3. Phys. Act >149 min/wk

4. Healthy Eating >3/5

5. Total chol. <200 mg/dl

6. BP < 120/80 mmHg

7. Fasting glucose < 100

Ford et al, Circulation 2012;125:987

6/7

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• PREDIMED


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• PREDIMED


g/d USA The Netherlands Greece (Crete)

Fish/Seafood 3 12 18

Legumes 1 2 30

Bread 97 227 380

Fruit 233 82 464

Olive Oil 0 0 95

Meats 273 138 35

Butter 26 21 0

Margarine 4 56 0

MUFA/SFA RATIO

4,03,02,01,00,0

CH

D D

EA

TH

RA

TE

(15

yr)

/10

,00

0

1400

1200

1000

800

600

400

200

0

JAPJAPGRE

GRE

YUG

YUG

YUG

YUG

ITA

ITAITA

HOL

FIN

FIN

US

Keys et al

Am J Epidemiol 1986;124:903 24

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The heart of what we now consider the Mediterranean diet is mainly

vegetarian:

-pasta in many forms,

-leaves sprinkled with olive oil,-all kinds of vegetables in season,-and often cheese,

-all finished off with fruit,

-and frequently washed down with wine

Am J Clin Nutr 1995;61(suppl).1321S

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•1 point if >= sex-specific Median1. MUFA/SFA ratio

2. Fruits & nuts

3. Vegetables

4. Cereals

5. Legumes

6. Fish

•1 point if <= sex-specific Median7. Meat/meat products

8. Dairy

9. Alcohol: 1 point if•Men: between 10-50 g/d•Women: between 5-25 g/d

9-item

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For each + 2 points

When studies using only fatal cases

were removed, the heterogeneity disappearedand the risk

reduction for every

+2 points was 13%

Martinez-Gonzalez MA, Bes-Rastrollo M.

Curr Opin Lipidol 2014;25:20-6.

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www.unav.es/preventiva

Research designs

Source: Martínez JA, Martínez-González MA. Nutrition Research Methodology: the scientific method and nutritional research.

In: Gibney MJ, et al. Introduction to Human Nutrition. The Nutrition Society Textbook series. London: Blackwell Science, 2009.

Field Trial





• PREDIMED


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• PREDIMED


Ros et al.

Adv Nutr.

2014;5:330S-6S

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www.predimed.esDOG

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14-itemscreener

N Engl J Med 2013;368:1279-90

DOG

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www.unav.es/preventiva

PLos One 2012;7: e43134

www.predimed.es

www.predimed.es

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3-yr attainments (%) for each of the 14 items

MeDiet + Virgin olive oil

MeDiet + mixed nuts

Control group

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Stopped for early evidence of benefit

after 4.8-y median follow-up42

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PREDIMED RCT– Primary end-point (MI, stroke or CV death)

Estruch R, et al. N Engl J Med 2013

↓30%

↓30%

DOG

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Circulation. 2016;133:187-225.

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Prog Cardiovasc Dis.

2015;58:50-60.

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Hazard Ratios (95% CI)

EVOO: 0.32 (0.19-0.56)

Nuts: 0.51 (0.32-0.83)

N = 89 cases

Follow-up 4.8 y

Ruiz-Canela M, et al. JAMA 2014;311:415-7.

PREDIMED RCT– Peripheral Artery Disease

↓49%

↓68%

DOG

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253 cases

Follow-up 4.7 y

↓11%

↓38%

PREDIMED RCT – Atrial Fibrillation

Martínez-González MA, et al. Circulation 2014;130:18-26

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PREDIMED expanded F-U: 4.8 5.9 y

2003 2004 2005 2006 2007 2008 2009 2010 2011

June March

Recruitment

2003 2004 2005 2006 2007 2008 2009 2010 2011

June December

Longest F-U

2003 2004 2005 2006 2007 2008 2009 2010 2011

March December

Shortest F-U

May (Navarra)

2012

2012

June

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PREDIMED RCT - Incident diabetes

Salas-Salvadó J, et al. Ann Intern Med 2014;160:1-10.

Type-2 diabetes ↓18%↓40%

DOG

14 Sept 2015 (on line first)

DOG

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MedDiet+EVOO MedDiet+nuts Control

Baseline age 67.6 67.4 68.1

Current smoking (%) 7.6 7.3 7.0

BMI 30.4 30.2 30.7

Family history cancer (%) 54.7 52.9 51.0

Hormone use (%) 2.9 2.7 2.7

Menopause>55 (%) 6.9 4.8 5.6

LTPA (METS-min/d) 179 177 161

Baseline MeDiet (14p) 8.7 8.7 8.4

Alcohol 1-14 g/d (%) 43.7 50.0 41.3

Alcohol 15+ g/d (%) 4.5 3.8 4.0

DOG

ABSOLUTE rates of breast cancer per 1000 women-years(4.8 years median follow-up, only 35 cases: 8, 10, 17)

DOG

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METABOLC SYNDROMEPREDIMED – Breast cancer

Toledo E, et al. JAMA Intern Med 2015;175:1752-60.

38%

62%

DOG

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• Reduce la incidencia de ECV * *

• Reduce arteriopatía periférica (EVOO mejor)*

• Reduce la incidencia de diabetes (EVOO mejor)*

• Reduce retinopatía diabética (EVOO mejor)*

• Reduce cáncer de mama (EVOO mejor)*

• Reduce fibrilación auricular (EVOO mejor)*

• Reduce fracturas osteoporóticas (EVOO mejor)

• Reduce incidencia de demencia (FS mejor)*

PREDIMED – Hallazgos principales

• Reduce depresión (FS mejor, pero ns)

• Incrementa niveles de BDNF (FS mejor, ns)

• Regresión de la placa arteriosclerótica carotídea

• Revierte el síndrome metabólico*

• Reduce TA diastólica* y presión ambulatoria

• Reduce oxidación/inflamación

• Mejora la función cognitiva

PREDIMED – Hallazgos secundarios

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MeDiet: a high-quality diet

Maillot M, et al. Am J Clin Nutr 2011;94:1127-37.DOG

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We evaluated the intakes of• Zn• I• Se• Fe• Ca• K• P• Mg• Cr and vitamins • B1• B2• B3• B6• B12• C• A• D• E• folic acid.

Br J Nutr 2014;111:2000-9

DOG

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MeDiet: a high-quality diet

Quintiles of adherence to the Mediterranean diet(PREDIMED 14-item score)

Zn

iodine

Se

Fe

K

Ca

P

Mg

Chromium

Folic acid

B1

B2

B3

B6

B12

A

C

D

E

www.predimed.es

www.predimed.es

DOG

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• PREDIMED


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• PREDIMED


Am Clin Nutr 2014;100(suppl):320S–8S.

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Am Clin Nutr 2014;100(suppl):320S–8S.

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16,162 incident T2D cases during

4,102,369 person-years of follow-up.

uPDI: less healthy plant foods (fruit juices, sweetened beverages,

refined grains, potatoes, sweets/desserts)

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The SUN cohort’2017

•18 540 participants•9.5 year mean follow-up•176,916 person-years of follow-up

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Clin Nutr (in press)

>45 y

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Clin Nutr (in press)

For each additionalserving/d RR 95% CIRed 1.47 1.06–2.04

Total 1.23 1.05-1.45

Red+processed 1.32 1.05-1.65

<3 3-7 7 >7

servings/wk

>45 y

En resumen: Dieta Provegetariana y Dieta Mediterránea...

• una escala de 14 items es válida para– valorar adherencia Dieta Mediterránea– predecir incidencia futura de ECV– usarse para dar feedback inmediato

• No hay otro patrón alimentario con una evidencia tan fuerte de protección frente a ECV como MedDiet

• Dieta que priorice productos vegetales naturales

– Reducción de mortalidad y diabetes tipo 2

– Opción fácil: menos cárnicos y ser claro en el mensaje72

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Gracias

Dieta Mediterránea, Dietas Provegetarianas y salud · 11/07/2017 1 Dieta Mediterránea, Dietas...

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