Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors

Ann Intern Med 4 July 2006, Volume 145 Issue 1, 1-11. © 2006 American Medical Association. All rights reserved. Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors - A Randomized Trial, Ramon Estruch, MD, PhD; Miguel Ángel Martínez-González, MD, PhD; Dolores Corella, PhD; Jordi Salas-Salvadó, MD, PhD; Valentina Ruiz-Gutiérrez, PhD; María Isabel Covas, PhD; Miguel Fiol, MD, PhD; Enrique Gómez-Gracia, MD, PhD; Mari Carmen López-Sabater, PhD; Ernest Vinyoles, MD, PhD; Fernando Arós, MD, PhD; Manuel Conde, MD, PhD; Carlos Lahoz, MD, PhD; José Lapetra, MD, PhD; Guillermo Sáez, MD, PhD; Emilio Ros, MD, PhD, for the PREDIMED Study Investigators. Correspondence to Ramon Estruch, MD, PhD

Background: The Mediterranean diet has been shown to have beneficial effects on cardiovascular risk factors.

Objective: To compare the short-term effects of 2 Mediterranean diets versus those of a low-fat diet on intermediate markers of cardiovascular risk.

Design: Substudy of a multicenter, randomized, primary prevention trial of cardiovascular disease (Prevención con Dieta Mediterránea [PREDIMED] Study).

Setting: Primary care centers affiliated with 10 teaching hospitals.

Participants: 772 asymptomatic persons 55 to 80 years of age at high cardiovascular risk who were recruited from October 2003 to March 2004.

Interventions: Participants were assigned to a low-fat diet (n = 257) or to 1 of 2 Mediterranean diets. Those allocated to Mediterranean diets received nutritional education and either free virgin olive oil, 1 liter per week (n = 257), or free nuts, 30 g/d (n = 258). The authors evaluated outcome changes at 3 months.

Measurements: Body weight, blood pressure, lipid profile, glucose levels, and inflammatory molecules.

Results: The completion rate was 99.6%. Compared with the low-fat diet, the 2 Mediterranean diets produced beneficial changes in most outcomes. Compared with the low-fat diet, the mean changes in the Mediterranean diet with olive oil group and the Mediterranean diet with nuts group were -0.39 mmol/L (95% CI, -0.70 to - 0.07 mmol/L) and - 0.30 mmol/L (CI, -0.58 to - 0.01 mmol/L), respectively, for plasma glucose levels; -5.9 mm Hg (CI, -8.7 to -3.1 mm Hg) and - 7.1 mm Hg (CI, -10.0 to -4.1 mm Hg), respectively, for systolic blood pressure; and -0.38 (CI, -0.55 to - 0.22) and - 0.26 (CI, -0.42 to -0.10), respectively, for the cholesterol-high-density lipoprotein cholesterol ratio. The Mediterranean diet with olive oil reduced C-reactive protein levels by 0.54 mg/L (CI, 1.04 to 0.03 mg/L) compared with the low-fat diet.

Limitations: This short-term study did not focus on clinical outcomes. Nutritional education about low-fat diet was less intense than education about Mediterranean diets.

Conclusion: Compared with a low-fat diet, Mediterranean diets supplemented with olive oil or nuts have beneficial effects on cardiovascular risk factors.

Pengaruh diet Mediterrania terhadap Faktor Risiko Kardiovaskuler

Telah diketahui bahwa diet Mediterrania dapat memperbaiki faktor risiko penyakit kardiovaskuler (PKV). Para ahli di Spanyol hendak membandingkan pengaruh diet Mediterrania (tinggi lemak golongan MUFA) dibanding diet rendah lemak terhadap faktor risiko PKV.

Penelitian berlangsung dari 2003 sampai 2004, diambil dari 10 sentra kesehatan dan dilakukan randomisasi, melibatkan 772 pasien asimptomatik risiko tinggi PKV, berusia 55-80 tahun. Pasien di-randomized menjadi kelompok diet rendah lemak (n=257) atau salah satu dari dua jenis diet Mediterrania, yaitu kelompok yang mendapat 1 liter perminggu virgin olive oil (n=257) atau 30g perhari kacang (n=258). Evaluasi dilakukan tiap 3 bulan terhadap berat badan, tekanan darah, profil lipid, kadar gula darah, dan penanda inflamasi.

Ternyata dibanding diet rendah lemak, kedua diet Mediterrania yang tinggi lemak MUFA lebih unggul dalam hal menurunkan kadar gula darah, menurunkan tekanan sistolik, menurunkan rasio kolesterol terhadap HDL. Diet Mediterrania dengan olive oil menurunkan kadar C-reactive protein (CRP adalah penanda inflamasi) dibanding diet rendah lemak.

Kesimpulan dari penelitian ini adalah diet Mediterrania yang tinggi lemak MUFA (sumber MUFA dari olive oil atau kacang) lebih unggul dalam memperbaiki faktor risiko PKV dibanding diet rendah lemak.

Adult Obesity and Number of Years Lived with and without Cardiovascular Disease

M. Carolina Pardo Silva*,, Chris De Laet*, Wilma J. Nusselder*, Abdulah A. Mamun and Anna Peeters*, * Department of Public Health and Department of Epidemiology and Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands; School of Population Health, University of Queensland, Queensland, Australia; and Department of Epidemiology and Public Health, Monash University, Victoria, Australia.

Abstract

Objective: To determine the differences in number of years lived free of cardiovascular disease (CVD) and number of years lived with CVD between men and women who were obese, pre-obese, or normal weight at 45 years of age. Research Methods and Procedures: We constructed multistate life tables for CVD, myocardial infarction, and stroke, using data from 2551 enrollees (1130 men) in the Framingham Heart Study who were 45 years of age. Results: Obesity and pre-obesity were associated with fewer number of years free of CVD, myocardial infarction, and stroke and an increase in the number of years lived with these diseases. Forty-five-year-old obese men with no CVD survived 6.0 years [95% confidence interval (CI), 4.1; 8.1] fewer than their normal weight counterparts, whereas, for women, the difference between obese and normal weight subjects was 8.4 years (95% CI: 6.2; 10.8). Obese men and women lived with CVD 2.7 (95% CI: 1.0; 4.4) and 1.4 years (95% CI: -0.3; 3.2) longer, respectively, than normal weight individuals. Discussion: In addition to reducing life expectancy, obesity before middle age is associated with a reduction in the number of years lived free of CVD and an increase in the number of years lived with CVD. Such information is paramount for preventive and therapeutic decision-making by individuals and practitioners alike.

Para peneliti dari Belanda dan Australia ingin mengetahui masa depan orang obesitas, pra-obesitas dan orang normal mulai usia 45 tahun, terhadap terjadinya penyakit kardiovaskuler (PKV), infark miokard (IM) dan strok. Data diambil dari Framingham Heart Study, jumlah sampel 2551 orang, 1130 laki2 dan sisanya wanita.

Ternyata keadaan obesitas dan pra-obesitas menyebabkan lebih sedikit tahun kehidupan tanpa PKV, IM dan strok. Dengan kata lain obesitas dan pra-obesitas menyebabkan seseorang lebih lama hidup mengidap ketiga penyakit tersebut. Laki2 usia 45 tahun dengan obesitas 6 tahun lebih awal terkena PKV dibanding laki2 normal usia yang sama. Untuk wanita perbedaan mencapai 8,4 tahun. Sedangkan laki2 dan wanita obesitas menderita PKV masing2 2,7 tahun dan 1,4 tahun lebih lama dibanding orang normal.

Kesimpulannya obesitas pada usia pertengahan akan memperpendek waktu hidup bebas PKV dan memperpanjang penderitaan PKV. Sehingga pencegahan dan terapi obesitas pada usia pertengahan adalah sangat penting.