Matala karanou'07.11

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  • The Meditarranean diet has been a success story of the nutritional epidemiology in the second half of the 20 th c.
  • Η SCS ήταν μια πολυεθνική προοπτική μελέτη που διερεύνησε τη σχέση ανάμεσα στη δίαιτα και την ολική και καδιαγγειακή θνησιμότητα σε υγιείς μεσήλικες άνδρες (45-60 ετών) σε οκτώ χώρες και 16 κοορτές (δηλ. Περιοχές).
  • Το 1970 , όταν προέκυψαν τα ευρήματα μετά την πρώτη πενταετία παρακολούθησης, ο Ancel Keys απέδωσε τις παρατηρούμενες διαφορές στα ποσοστά CHD στην M εσογειακή Δίαιτα Keys A., Circulation, 1970
  • Menotti and colleagues examined the association between the consumption of simple food-groups and the 25-year mortality from CHD. So the well known results from this study is the idea that dietary patterns are an important determinant of CHD risk, and propososed the Mediterranean diets’ cardioprotective effect.
  • Menotti and colleagues examined the association between the consumption of simple food-groups and the 25-year mortality from CHD. Diets rich in butter, dairy products and other animal products (usually rich in saturated fatty acids and cholesterol) were associated high rates of CHD while, food consumption patterns high in cereals, legumes, vegetable products, fish, oils and wine were associated with low or relatively low mortality rates from CHD. Greece –and primarily Crete- and Japan experienced the fewest death rates caused by CHD; USA, Finland, and The Netherlands, experienced the most. So the well known results from this study is the idea that dietary patterns are an important determinant of CHD risk, and propososed the Mediterranean diets’ cardioprotective effect.
  • After 2 5 years of follow up the study demonstrated that the mortality rate from coronary heart disease in southern Europe was 2- to 3- fold lower than in northern Europe or the United States.
  • Η πυραμίδα της Μεσογειακής Δίαιτας που προτάθηκε το 1995 και έχει υιοθετηθεί και από το ελληνικό Υπουργείο Υγείας ως ένα υπόδειγμα διατροφής για τη πρόληψη της χρόνιας νόσου, βασίσθηκε στα δεδομένα της της Μελέτης των Επτά Χωρών
  • Deuterogenis prolopsi Rafanidelaio rape seed oil oi thnisimotita logw emfragmatos ;htan sti omada xxx kata 70 % lig;oteri ap’oti stin omada legxou.
  • 8.5 years of follow u; 652 deaths, 12 694 participants followed (more women) Moderate alcohol consumption [10-50 /day men; 5-25 women] as opposed to either high or low consumption. Mean values 11 g men; 1.2 g women.
  • Katan M. Letter to the editor. American Journal of Clinical Nutrition, 2010-11??
  • H λιτή δίαιτα των κρητικών όπως καταγράφηκε το 1950 και το 1960, με τις περιορισμένες ποσότητες κρέατος και την εντατική αξιοποίηση της τοπικής χλωρίδας, της ελιάς και του κριθαριού ήταν ως ένα βαθμό , αποτέλεσμα ανάγκης σε μια κοινωνία που δεν είχε αναπτυχθεί οικονομικά. Οι κρητικοί έτρωγαν όσπρια αντί για κρέας, άγρια χόρτα με ελαιόλαδο αντί για πατάτες με βούτυρο, και φρούτα αντί για γλυκά και παγωτά. Μπορούν οι κάτοικοι των δυτικών κοινωνιών σήμερα να επωφεληθούν από την παραδοσιακή δίαιτα της Κρήτης? Οι προτάσεις που μέχρι τώρα η ιατρική επιστήμη δίνει για τον βιοχημικό ρόλο των μονοακόρεστων λιπών, των ω-3 λιπαρών οξέων και των αντιοξειδωτικών παρέχουν κάποιες απαντήσεις, αλλά δεν εξηγούν πλήρως τη μοναδικότητα της κρητικής δίαιτας.
  • Food sharing was embedded in the life of the rural communities of Crete; its manifestations are apparent in festivals and other occasions. Most of the agrarian festivals not only marked natural agricultural events, but also an attempt to redistribute food sources .
  • Σύμωνα με το αίτημα που έχει υποβληθεί στην ΟΥΝΕΣΚΟ προκειμένου να συμπεριληφθεί η Μεσογειακή δίαιτα στα μνημεία της Άυλης Παγκόσμιας Πολιτισμικής Κληρονομιάς, περιγράφεται ως το «σύνολο των πρακτικών, εκφράσεων, γνώσης και τεχνογνωσίας, χώρων και σχετικών αντικειμένων τα οποία οι λαοί γύρω από τη Μεσόγειο έχουν δημιουργήσει και αναπλάσει κατά τη διάρκεια της ιστορίας τους στα πλαίσια της αλληλεπίδρασής με τη φύση σε συνάρτηση με την τροφή» ( Reguant - Aleix et al . 2009). Το αιτήμα που έχουν από κοινού καταθέσει η Ισπανία, η Ελλάδα, η Ιταλία και το Μαρόκκο για την ανακύρηξη της Μεσογειακής δίαιτας ως αύλο μνημείο της Παγκόσμιας Κληρονομιάς κατοχυρώθηκε στην UNESCO στις 3 Απριλίου 2010 και αναμένεται να αξιολογηθεί οριστικά το Νοέμβριο του 2010. Spain, Greece, Italy and Morocco, jointly presented to the UNESCO, in Paris, the Nomination of the Mediterranean Diet for its inscription on the Representative List of Intangible Cultural Heritage of Humanity. The decision about the inscription, after the evaluation of the nomination by the Committee, will be made known on November 2010, during the meeting of the Intergovernmental Committee on Intangible Cultural Heritage.
  • Matala karanou'07.11

    1. 1. The Cretan diet on the edge of nutritional epidemiology since the 1950s. Are there more secrets to reveal? <ul><li>1st Symposium of Greek Gastronomy </li></ul><ul><li>Karano u 16 . 07 . 201 1 </li></ul>Antonia Matalas Ph.D Department of Nutrition and Dietetics Harokopion University, Athens Ε- mail: amatala@hua.gr
    2. 2. <ul><li>The cardioprotective properties of the Mediterranean diet have attracted western elites to convert partly to Cretan diet with consuming serious amounts of olive oil, green vegetables and wine </li></ul>
    3. 3. How it all begun: the Rockfeller Survey,1947-8 <ul><li>‘ Although Greece and the Mediterranean countries are usually considered to be areas of medium-high death rates (14.0-18.0 per 1000 inhabitants), death rates on the island of Crete have been below this level continuously since before 1930. </li></ul><ul><li>No other area in the Mediterranean basin has had as low a death rate as Crete, according to data compiled by the United Nations in their demographic yearbook for 1948. It was 11.3-13.7 per 1000 inhabitants before World War II and about 10.6 in 1946-1948. Cancer and heart disease caused almost three times as many deaths proportionally in the United States as in Crete.’ </li></ul>Allbaugh LG (1953). Crete: A case study of an underdeveloped area. Princeton, NJ: Princeton University Press.
    4. 4. Some of the observations in the Rockfeller Survey <ul><li>Because of fuel and cooking equipment scarcity, there was a tendency to cook one-dish meals </li></ul><ul><li>Cretans had a beneficial habit of dipping bread into the sauce of stewed or braised dishes; thus utilizing many nutrients that would otherwise had been lost </li></ul><ul><li>Hondros was prepared by three-fifths of all Cretan families </li></ul><ul><li>Menu options differed according to the numerous ways of eating bread: bread with olives, bread with tea, bread with wine, bread with tomatoes or fruits or bread with cheese. </li></ul>Allbaugh LG (1953). Crete: A case study of an underdeveloped area. Princeton, NJ: Princeton Univ. Press
    5. 5. The Seven Countries Study (SCS) an epidemiological survey among 12,763 middle-aged men The SCS was the first to reveal the relationship between diet and heart disease
    6. 6. 10-year heart disease rates in the SCS Keys A., Circulation, 1970 All-causes mortality was also the lowest in Crete (6 deaths/1,000)
    7. 7. Ancel Keys’ visit to Crete
    8. 8. In 1970, the term Mediterranean diet was coined in the medical literature <ul><li>Ancel Keys attributed the observed differences in CHD rates to the Mediterranean diet </li></ul><ul><li>«The strongest correlation was between coronary disease incidence and average saturated fatty acid intake». </li></ul><ul><ul><li>Ancel Keys 1975 «How to eat well and stay well the mediterranean way » </li></ul></ul>
    9. 9. Edible f ats’ consumption
    10. 12. 25-year Coronary Heart Disease mortality in the SCS 0 50 100 150 200 250 FIN NL USA SE IT CR GR JP CHD death rates per 1000 in 25 years Hertog et al. Archives of Internal Medicine 1995
    11. 13. Cretan diet and survival after 40 years ( 1961-2001) <ul><li>In 2001 the 40-year rate survival rate on Crete was 15% . </li></ul><ul><ul><li>When in most other cohorts, it was 0%. </li></ul></ul>
    12. 14. The Cretan diet of the 1960s became the basis of a dietary prototype, the Mediterranean diet Oldways Preservation and Exchange Fund, The Mediterranean Pyramid, 1995 Kromhout, Keys, Aravanis et al. 1989 18 100% alcohol 12 Sugar 18 Fish 3 5 Meat 13 & 235 Cheese and milk 95 Olive oil 464 Fruit 191 Vegetables 30 Legumes 190 Potato 30 Pasta & rice 380 Bread Average g/cap 1960-5, n=51 FOOD
    13. 15. In search of the beneficial component(s) <ul><li>Monounsaturated fatty acids (olive oil) </li></ul><ul><li>2. Omega -3 fatty acids ( greens, nuts, milk eggs & meat from free- range animals, snails ) </li></ul><ul><li>3. Large amounts of antioxidants (greens, fruits, wine , etc ) </li></ul><ul><li>4. Moderate alcohol consumption </li></ul><ul><li>5. Low Glycaemic Index foods/fiber (vegetables, greens legumes, whole grains) </li></ul><ul><li>6. Low intake of animal protein (reduced meat and milk) </li></ul><ul><li>Or, the dietary pattern as a whole ? </li></ul>
    14. 16. Therapeutic Lifestyle Changes based on the Mediterranean diet proposed by the European Heart Association * Lower trans fatty acids ** Emphasize complex sources Expert Panel , JAMA 2001 Balance energy intake and output to maintain expenditure healthy body weight/prevent weight gain Total calories (energy) Less than 200 mg/day Cholesterol Approximately 15% of total calories Protein 20–30 grams per day Fiber 50–60% of total calories Carbohydrate** 25–35% of total calories Total fat Up to 20% of total calories Monounsaturated fat Up to 10% of total calories Polyunsaturated fat Less than 7% of total calories Saturated fat*
    15. 17. Olive oil as the critical dietary component ‘ The generic term “Mediterranean diet” has come to be used, as referring to dietary patterns similar to those of Crete in the early 1960s and other regions of the Mediterranean where olive oil is the principal source of dietary fat .’ Willett et al., 1995 But no other epidemiological study has been able to demonstrate a direct relationship between mortality and the intake of olive oil or monunsaturated fat A question raised: Is olive oil beneficial by itself, or is it that it facilitates a high vegetable intake?
    16. 18. More questions raised …. Clinical studies using olive oil in high risk patients have failed to provide solid support for an inverse relation between olive oil and coronary heart disease Bertuzzi M, et al. Int J Epidemiol 2002; Fernández Jarne et al., Int J Epidemiol 2002
    17. 19. a-linolenic acid (an omega-3 fatty acid) as the critical component The Lyon Heart Study: a clinical evidence Clinical intervention in 605 patients with one non-fatal myocardial infraction Followed for 27 months Randomized into two diets: Modified Med diet (using margarine rich in a-linolenic) & Step I AHA diet Incidence of a 2nd myocardial infraction was reduced in MD by 70% De Lorgeril M. et al. Circulation 1999
    18. 20. Omega-3 fatty acids as the critical dietary component II <ul><li>‘ In traditional Cretan diet, omega-3 fatty acids are found throughout the food chain </li></ul><ul><li>Eggs of free - range chicken have a ratio of ω -6: ω -3 of 1:1 </li></ul><ul><li>Pasta made with eggs and milk that is rich in ω -3 fatty acids is enriched in ω -3’s’ </li></ul>Simopoulos and Kubinson, The Omega Diet, 2000
    19. 21. Mediterranean-inspired diets The Indo-Mediterranean Diet Heart Study A clinical trial in India to test the efficacy of a-linolenic to reverse the progression of heart disease Clinical intervention among 1000 patients with high risk for MI Followed for 2 years Randomized into two diets Indo- Mediterranean diet : whole grains, fruits, vegetables, soy oil, walnuts and almonds (573±127 g/day; 1.8g/day of a-linolenic), and Low fat diet (Step 1 prudent diet) : whole grains, fruits, vegetables, soy oil, walnuts and almonds 231 ± 19 g/day; 0.8 g/day of a-linolenic) Incidence of fatal myocardial infraction was almost three-fold lower in the Indo-Mediterranean diet (p<0.01) Singh et al. Lancet, 2002, retraction 2005
    20. 22. Moderate and daily use of alcohol as the critical component Among Greek adult men and women (n=12 694) of the EPIC prospective study: Moderate consumption of ethanol was found to be the only dietary factor that significantly contributes to decreased mortality when controlling for the other dietary factors Trichopoulou et al. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009
    21. 23. One of the SCS’s current investigators admits that we are still far from understanding <ul><li>‘ Our understanding of the Mediterranean diet is of meager and unsatisfactory kind, and recommendations to eat Mediterranean-type foods could lead to another dietary failure. We need to identify the responsible compounds first, however long it takes.’ </li></ul><ul><li>Katan M. American Journal of Clinical Nutrition, 2011 </li></ul>
    22. 24. The importance of the geographical and social dimensions of the Mediterranean diet I Olive oil consumption patterns, versus living in the ecosystem where the olive tree grows
    23. 25. The mythical Cretan diet is in part, the result of necessity ‘ Τ heir food consists chiefly of olives, beans, onions, bread, cheese and vegetables…’ Basil Stewart 1908 The importance of the geographical and social dimensions of the Mediterranean diet II
    24. 26. Is there more to learn on the role of the social norms? <ul><ul><li>Sharing food and redistribution of food sources </li></ul></ul><ul><ul><li>Social solidarity in food production </li></ul></ul><ul><ul><li>such as in: </li></ul></ul><ul><ul><li>agrarian festivities, weddings, religious festivals </li></ul></ul><ul><ul><li>manifestations of tolerated theft - the case of meat? </li></ul></ul>
    25. 27. Consumption of vegetable foods
    26. 29. 25-year CHD mortality in relation to serum cholesterol in the Seven Countries Study Verschuren, W.M. et al. (1995). Serum total cholesterol and long-term coronary heart disease mortality in different cultures: Twenty five-year follow-up of the seven countries study. JAMA, 274 (2).
    27. 30. The Nomination of the Mediterranean Diet was presented on April 3 2010 to the UNESCO for its recognition as Intangible Cultural Heritage of Humanity <ul><li>«Το σύνολο των πρακτικών, εκφράσεων, γνώσης και τεχνογνωσίας, χώρων και σχετικών αντικειμένων τα οποία οι λαοί γύρω από τη Μεσόγειο έχουν δημιουργήσει και αναπλάσει κατά τη διάρκεια της ιστορίας τους στα πλαίσια της αλληλεπίδρασής με τη φύση και σε συνάρτηση με την τροφή.» </li></ul><ul><li>Reguant - Aleix et al . 2009 </li></ul>
    28. 31. Meditarranean diet and the metabolic syndrome Kastorini, Milionis, Goudevenos, and Panagiotakos, EAS 2010

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