Diet is mediterranean diet indeed better

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Pekka Puska
Dubai, 18.-21.4.2012

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Diet is mediterranean diet indeed better

  1. 1. Pekka Puska, professor, MD,PhD,MPolScPast President, World Heart Federation(WHF)Director General, National Institute forHealth and Welfare (THL)Vice President, Int. Ass. of National PublicHealth Institutes (IANPHI) Diet: Is Mediterranean diet indeed better? WCC, Dubai 18-21.4.2012
  2. 2. 12/04/12 Pekka Puska, Director General
  3. 3. WORLD Deaths in 2000 Attributable to Selected Leading Risk Factors Blood pressure Tobacco Cholesterol Underweight Unsafe sex Fruit and vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health care injections Occupational risk factors for injury Number of deaths (000s) 0 1000 2000 3000 4000 5000 6000 7000 8000 Source: WHR 200212/04/12 Pekka Puska, Director General
  4. 4. Six of the Nine Top Determinants ofMortality in the World Relate to HowWe Eat, Drink and Move Diet and physical activity, together with tobacco and alcohol, are key determinants of contemporary public health12/04/12 Pekka Puska, Director General
  5. 5. Diet influences many biologicalrisk factors• Serum LDL cholesterol• Other lipids• Blood pressure• Body weight• Serum glucose• Other (antioxidants etc.)12/04/12 Pekka Puska, Director General
  6. 6. Mediterranean diet: Origins of the concept• The Seven Countries Study by: Ancel Keys & C. Aravanis, H. Blackburn, R. Butzino, B. Djordjevic, A. Fontas, F. Fidanza, M. Karvonen, N. Kimurc, A. Menolti etc. 12/04/12 Pekka Puska, Director General
  7. 7. 12/04/12 Pekka Puska, Director General
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  9. 9. 12/04/12 Pekka Puska, Director General
  10. 10. 12/04/12 Pekka Puska, Director General
  11. 11. Ancel Keys(1904-2004)12/04/12 Pekka Puska, Director General
  12. 12. Ancel Keys and ItalyPioppi, Italy: ” Home of the Medirerranean diet”Ancel & Margaret Keys: ”Eat well and stay well” (1959)Ancel & Margaret Keys: ”How to eat well and stay well the Mediterranean way” (1975)12/04/12 Pekka Puska, Director General
  13. 13. What is the Mediterranean diet?• Based on ”food patterns typical of Crete, much of the rest of Greece and Southern Italy in the early 1960’s”• Emphasizes ”abundant plant foods, fresh fruit as the typical deily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry products consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts; in addition to physical activity• Total fat: 25-35 %, saturated fats <8 % (Walter Willet)12/04/12 Pekka Puska, Director General
  14. 14. 12/04/12 Pekka Puska, Director General
  15. 15. Evidence of benefits ofMediterranean diet 1. Nordman et al. Meta-analysis (Am J Med 2011): Compared to low fat diets; 2 years follow-up• BMI: -2.2 kg• Syst. Blood pressure: -1,7 mmHg• Fasting plasma glucose: -3.3 mg/dL• Total cholesterol: -7.4 mg/dL ”Mediterranean diets appea to be more effective than low fat diets” The Mediterranean diet puts emphasis on the quality rather than quantity of dietary fat12/04/12 Pekka Puska, Director General
  16. 16. Evidence of benefits of Mediterraneandiet 2.• Kastorini et al. (j. Am Coll Card, 2011): Meta-analysis of 50 studies ”Mediterranean diet is associated with lower blood pressure, blood sugar and triglycerides”12/04/12 Pekka Puska, Director General
  17. 17. Evidence of benefits of Mediterraneandiet 3. Sofi et al. Meta-analysis (Am J. Clin Nutr. 2010) 2-point increase in adherence to Mediterranean diet • Overall mortality: RR=0,92 • Cardiovascular: incidence/mortality: RR= 0,90 • Neurodegenerative diseases: RR=0,87 ”Significant and consistent protection of provided by adherence to the Mediterranean diet”12/04/12 Pekka Puska, Director General
  18. 18. The Mediterranean diet in secondary prevention of coronary heart disease: The Lyon Heart Study (Largevil & Salen, Clin Invest Med 2006) 50-70 % reduction of the risk of recurrence after four years of follow-up in CHD patients12/04/12 Pekka Puska, Director General
  19. 19. What effect and what componentimportantEffects on – Serum LDL cholesterol – Other lipids – Blood glucose – Other?Components – Type of fat – Fruit and vegetables – Meat (fish & poultry vs red meet)? – Wine? – Other?Also: Physical activity, portion sizes, pleasure in food, etc?12/04/12 Pekka Puska, Director General
  20. 20. Lipids and diet• Serum lipids, and especially LDL cholesterol, are major causal factors in the atherosclerotic process• Important factor in the Mediterranean diet• Numerous studies show how diet influences strongly serum LDL cholesterol and other lipids (Keys, Hegstedt, Mensink & Katan)• Numerous expert recommendations12/04/12 Pekka Puska, Director General
  21. 21. Iacono, Puska, Pietinen, Huttunen, Ehnholm etal.: Finland – Italy diet CHD risk study12/04/12 Pekka Puska, Director General
  22. 22. The Finnish experience: The North Karelian Project12/04/12 Pekka Puska, Director General
  23. 23. Serum Cholesterol in Men Aged 30–59 Years mmol/l 7,5 7 North Karelia Kuopio 6,5 Turku/Loimaa Helsinki/Vantaa 6 Oulu Lapland 5,5 5 1972 1977 1982 1987 1992 1997 2002 2007FINRISK Studies 1997 & 2002 12/04/12 Pekka Puska, Director General
  24. 24. Age-adjusted mortality rates of coronary heart disease in NorthKareliaand the whole of Finland amongmales aged35–64 years start of the North Karelia Projectfrom 1969to 2006. extension of the Project nationally North Karelia Mortality per - 85% 100 000 All Finland population - 80% Age-standadized to European population 12/04/12 Pekka Puska, Director General
  25. 25. Observed and Predicted Declines inCoronary Mortality in Eastern Finland,Men % 0-10 Observed-20 Predicted-30 Cholesterol-40 Blood pressure Smoking-50-60-70-80-90 1972 1977 1982 1987 1992 1997 2002 2007 Year 12/04/12 Pekka Puska, Director General
  26. 26. Estimates of S-Chol changes in 1982–2002* Men 0,1 PUFA 0 Dietary cholesterol -0,1 SFA -0,2 mmol/l Keys -0,3 SFA+trans -0,4 Keys (trans) ** -0,5 Measured S-Chol -0,6 1982 1992 2002* Based on calculated intakes of dietary fatty acids and cholesterol. Standardized to the 2001 Finnish population. Users of cholesterol lowering medication excluded in -92 and -02.** Trans fatty acids included as SFA (Source: KTL/Valsta, Tapanainen, Laatikainen, Männistö, Vartiainen, in preparation )
  27. 27. CommentAncel Keys’ original message was (esp. In the USA) lost in ”fat-is-bad mantra – although the message was in the ”Mediterranean diet” of Ancel Keys was unsaturated fats over saturated.Thus fats in esp. the USA were replaced with sugars, with obesity epidemic as result.Mediterranean diet is a balanced diet, with quality of fat plus fruits and vegetables as key – with proper amount of calories with regular physical activity.12/04/12 Pekka Puska, Director General
  28. 28. Mediterranean diet is one way to enjoydiet that complies with currentevidence, expressed by the WHO/FAOrecommendations and numerous othernational and other expertrecommendations.You don’t need to eat Mediterraneandiet to have heart healthy diet – youcan base your diet on different culturalpatterns, but following the expertrecommendations. 12/04/12 Pekka Puska, Director General
  29. 29. 12/04/12 Pekka Puska, Director General
  30. 30. WHO/FAO Expert ReportRecommendations• Limit saturated fat (<10 %) and replace by unsaturated• Total fat intake: 15-30 %• Limit salt (sodium) intake (<5 g)• Limit sugar intake (<10 %)• Increase fruit and vegetable intake (>400 g)• Ensure physical activity: at least 30-60 min• Ensure energy balance RECOMMENDATIONS OF WHO/FAO EXPERT REPORT ON DIET, NUTRITION AND PREVENTION OF CHRONIC DISEASES (WHO/TRSNS. 16;2003)12/04/12 Pekka Puska, Director General
  31. 31. General dietary recommendationsfor lipid control• Reduce saturated fat and avoid trans fats• Replace saturated fat with unsaturated (esp. polyunsaturated) fats• Reduce dietary cholesterol• Increase soluble fibers• Maintain normal weight12/04/12 Pekka Puska, Director General
  32. 32. WHO GlobalNational policies Strategy onto promote Diet, Physicalhealthy diet Activity and Health12/04/12 Pekka Puska, Director General
  33. 33. Thanks12/04/12 Pekka Puska, Director General

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