11/07/2017
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Dieta Mediterránea,
Dietas Provegetarianas y
salud
MA Martínez-González
www.predimed.esDOG
11/07/2017
2
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
3
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
6
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
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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
11/07/2017
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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
19
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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Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
12
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
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
www.predimed.es 25
•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
26
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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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28
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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
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
17
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
Ros et al.
Adv Nutr.
2014;5:330S-6S
34
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3-yr attainments (%) for each of the 14 items
MeDiet + Virgin olive oil
MeDiet + mixed nuts
Control group
40
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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
43
Circulation. 2016;133:187-225.
44
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Prog Cardiovasc Dis.
2015;58:50-60.
45
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
46
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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
DOG
47
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
11/07/2017
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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
57
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
58
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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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Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
11/07/2017
31
Dieta provegetariana, Dieta mediterránea y salud,
• Enfermedades no transmisibles
• Enfermedad cardiovascular
• Dieta Mediterránea
• PREDIMED
• Dieta pro-vegetariana
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)
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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