Dietetics and Nutrition in the Mediterranean By Dr. Ssa Fabiana Avallone
Hypertension Between 1991 and 2000, the prevalenceofhypertension in the US increased by 3,7%, and more than half of this increase was attributed to an increased prevalence of obesity. Hypertension continues to be a major risk factor for cardiovascular disease. As many as 58 million people in the United States have elevated blood pressure (systolic blood pressure > 140 mm Hg and/or diastolic blood pressure > 90 mm Hg) or are taking antihypertensive medications. Blood pressure level is predictive of mortality from stroke, heart disease and renal impairment.
Hypertension Based on a reviewof data from the third National Health and NutritionExaminationServeys (NHANES III), the southernregionof the UnitedStates, whichincludes the “strokebelt”, hasdietarypatternsthatmaycontributeto the high prevalenceofhypertension and cardiovasculardisease in thatregion. Comparedwithotherregionsof the US, residents in the southreported the highestsodiumconsumption, and the lowestconsumptionofpotassium, calcium and magnesium.
Hypertension and sodium A high sodiumchloride (NaCl) intakecontributestoelevatedarterialbloodpressure in populations; blood pressures increased progressively with progressive increases in dietary NaCl. The effect of NaCl on blood pressure increases with age, with the height of the blood pressure, and, in normotensive persons, with a family history of hypertension. Current estimates of NaCl intake in the United States are in range of 8 to 10 g/day. Specific guideline of the American Heart Association recommended that dietary NaCl be restricted to no more than 6 g/day, and more rigorous NaCl restriction (2-3 g/day) for hypertensive persons.
Hypertension and potassium Potassiumloadingprevents or amelioratesdevelopment of hypertension in severalanimalmodels of genetic and NaCl( sodiumcloraid)inducedHypertension. A low potassiumintakeresults in bloodpressureelevation and renalvascularremodeling, indicatingincreasedrenalvascularresistence. Reducedsodium (< 6 g/day) and increasedpotassiumintake (> 4 g day) loweredbloodpressure in men and women withmildto moderate hypertension.
Hypertension and calcium More than 80 studieshavereportedthatbloodpressureisloweredbyincreasingdietarycalcium; “isan inverse associationbetweendietarycalciumintake and bloodpressure, and low calciumintakeisassociatedwithanincreasedprevalenceofhypertension”. Diets with lessthan 600 mg of calcium/dayare mostclearlyassociated with hypertension. The National Academyfor Science recommendationsforcalciumconsumption are 1300 mg/dayforadolescents (9-18 years), 1000 mg/dayforadultslessthan 50 yearsofage, and 1200 mg/dayforthose more than 50 yearsold.
Hypertension and lipids Bothanimal and human data suggestthat omega-3 and omega-6 fattyacids play a role in bloodpressureregulation.In experimentalmodelsofhypertension, bothlinoleic acid (omega-6) and fish oil (omega-3) attenuate the developmentofhypertension. Epidemiologicevidencesuggests a directassociationbetweendiets high in saturatedfats and bloodpressure; conversely, diets high in omega-3 fattyacidsmaybeassociatedwithlowerbloodpressure.
Seafood is high in Omega-3
vegetables (at least 300-400 g a day)
fruit (at least 4 pieces or 400 g a day)
legumes and pulses
grains, pasta and/or bread (mostlywhole)
olive oil and nuts
water (more than 2 liters per day)
wine duringmeals ( maximum 2 glasses per day)
seafood (fish, shellfish, mollusc), 4-6 times a week
yoghurt, 2 - 4 times per week
cheese, 1 - 4 times per week
milk, 1 - 2 times per week
eggs, 1 - 4 eggs per week (maximun 1 per day)
poultry, 1 - 2 times per week
redmeat, 0 - 1 time a week
sweets, 0 - 1 time per week
Whatisceliacdisease? Celiac disease (from the greekKoil, cavity, stomach), also known as celiac disease or celiac sprue("sprue" identifies a chronic disease characterized by diarrhea and anemia leading to cachexia), is a permanent intolerance to gliadin. Gliadin is the alcohol-soluble component of gluten, a mixture of proteins contained in wheat, barley, rye, in 'oats in barley and kamut. Therefore, all foods derived from these cereals containing gluten should be considered toxic for patients suffering from this disease. Even ifthe disease has a Mendelian genetic transmission, it is characterized by a degree of familiarity, due to both major histocompatibility complex genes and other genes not yet identified. Gluten intolerance causes serious injury to the mucosa of the small intestine, which isresolved by eliminating gluten from the diet. The reversibility of the disease is closely related to non-recruitment by the subject of food containing gluten or celiac still contaminated by it. Celiac disease cannot be cured: the subject remains celiac during his/her life, the only cure is to adopt a strict gluten-free diet.
ETIOLOGYThe causes of celiac disease includes both genetic and environmental factors Environmental factors Environmental factors are represented by gluten, which is the protein component of wheat flour, barley, rye and oats. The wheat gluten is in turn composed of gliadins, proteins that are soluble in alcohol, and glutenins, alcohol-insoluble proteins Genetic factors The importance of genetic factors in the pathogenesis of celiac disease is confirmed by studies of families of celiac patients, which have shown a prevalence of celiac disease to 10% among first-degree relatives and 30% if brothers and sisters are HLA identical. A recent study showed the hypothesis that the initiation of celiac disease can occur on genetically susceptible (HLA DQ2/DQ8) subjects, following a common response to infection with rotavirus protein "VP7" rotavirus ( a common virus that causes enteritis in children, 90% of Italians in their lives have made contact)
CLINICAL Celiac disease may present a wide spectrum of clinical manifestations ranging from signs and symptoms of frank malabsorptionto more subtle symptoms.. There is talk of celiac disease begingincreased in the presence of symptoms typical of severe malabsorption, namely diarrhea, rasches, swelling of the steinand marked weight loss. There are cases of celiac disease in children and extraintestinal symptoms (anemia, osteoporosis, skin lesions typical, infertility, miscarriages, etc.). There are also cases of silent celiac disease for those patients diagnosed, usually between family members, who show no symptoms. In addition, there are many diseases associated with celiac disease.
DIAGNOSIS The diagnosis of celiac disease is based on gastroscopy with duodenal biopsy and detection of antibodies specific for celiac disease. The duodenal biopsy must show the histological features for celiac disease and that atrophy of intestinal villi, hypertrophy of crypts and increased number of intraepithelial lymphocytes. The development of these lesions, however, is a dynamic process that can occur in varying degrees, and then with injuries more or less marked, ranging from total atrophy of the mucosa (villi completely disappeared) to a normal intestinal architecture in which the only fault is measurable represented by an increase in intraepithelial lymphocytes.Diagnosis is necessary to demonstrate that the patient is also positive for antibodies specific for celiac disease, especially antiendomysialantitransglutaminasi and tissue. It is very important to keep in mind that both the intestinal lesions that antibodies specific for celiac disease is gluten-dependent and then disappear once the patient has removed the gluten from the diet. So when you think a patient is suffering from celiac disease, duodenal biopsy should be run and must seek specific antibodies when the patient is still eating gluten.
Treatment Currently, the gluten-free diet is the only therapy but specialists are investigating other therapeutic strategies. The gluten-free diet must be very strict because small amounts of gluten are enough to prevent the histological improvement and should be carefully followed inlife. Not only food containing wheat and dairy products need to be removed from the diet, but also those containing barley, rye and oats. Initially it may be difficult to stick to a strict diet aglutinata because gluten can be contained in various foods contained in the normal diet: wheat flour is one of the most common ingredients in several foods. Therefore, we need to properly inform the patient to prevent inadvertent violations and offer, with periodic checks, a continued service. In the early stages of the diet supportive therapy may also be necessary which is limited to the correction of specific deficits due to the presence of a mucosal that is stilldamaged. The dietary treatment is the only necessary therapy in more than 70% of celiacs. If the subject does not respond to a gluten-free dietanimmunosuppressive treatment is used.
DIET Celiac disease is fought with a gluten-free diet: rice, corn, buckwheat, millet, soy, amaranth, quinoa, in combination with fruits, vegetables, fish, meat, cheese, vegetables and others can however, be easily incorporated in the daily life of a celiac. It is worth emphasizing that a person with celiac disease, by keeping a proper diet, can lead a completely normal life. According to studies made the highest concentration of gluten a celiac can take in food is 20 ppm (parts per million), the threshold beyond which the gluten becomes toxic. It is important to understand that even the most minimal contact with those foods containing gluten, may contaminate the celiac using utensils or pats which have come into contact with food containing gluten is to be avoided.The ingestion of a small amount of gluten can override the diet, so it's important to make sure that the celiac does not ingest food that contain gluten in any form (eg wheat starch is often used as a thickener and in structuring many foods, for this reason, it is added to pharmaceutical preparations in tablet form, which people with celiac disease need to check the ingredients to make sure that the medicine does not contain gluten). We must also avoid beer (although there are some brands on the market and types of gluten-free) and pay attention to the espresso bar (because it can be contaminated with barley), spices, sugar, usually pre-cooked food, prepared food flavored (eg. yoghurt fruit) or flavored drinks.