Mediterranean Vs Carbohydrate Restricted Vs Healthy Who Diet

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  • 1. www.pronutritionist.net Mediterranean and carbohydrate- restricted diets and mortality among elderly men: a cohort study in Sweden Sjögren P et al. Am J Clin Nutr 2010; Sept 8 E-pub ahead of print Page 1 Sjögren P et al. Am J Clin Nutr 2010; Sept 8 e-pub ahead of print
  • 2. Page 2 Background • Low-carbohydrate diets have proved to be effective for weight loss. However, the long-term safety of low-carbohydrate diets remains controversial – adverse long-term health effects have been described in some studies (Lagiou et al. 2007, Trichopoulou et al. 2007) – but some studies have not found any adverse health effects (Halton et al. 2006) • There is also evidence on the beneficial effects of a Mediterranean-like dietary pattern (Sofi et al. 2008, Lagiou et al. 2006) • Head to head randomized trials on dietary patterns and long-term mortality and morbidity are sparse. However, Shai et al. 2009 and Esposito et al. 2009 have shown that Mediterranean diet is associated with improvement of some metabolic parameters vs low fat diet. • Elhayany et al 2010 showed that low carbohydrate-Mediterranean diet improved metabolic parameters more than traditional Mediterranean diet or low fat diet plus induced better weight loss Sjögren P et al. Am J Clin Nutr 2010; Sept 8 e-pub ahead of print www.pronutritionist.net
  • 3. Methods • A prospective cohort study • n = 924 men – mean age 71 years • Follow-up 10 years • Dietary habits were determined by 7-d dietary records – a subpopulation of adequate reporters was created (n = 511) • Study assessed the adherence to – the World Health Organization (WHO) dietary guidelines (The Healthy Diet Indicator, HDI) – a Mediterranean-like diet (The Mediterranean Diet Score, MDS) – carbohydrate restricted diet (CR) • Extreme deciles of patterns were the basis of comparison Page 3 Sjögren P et al. Am J Clin Nutr 2010; Sept 8 e-pub ahead of print www.pronutritionist.net
  • 4. Results (1/2) • No significant relation was found between mortality and WHO’s HDI score • Mean carbohydrate intake in the CR diet was 43 % of energy in the high-adherent group of adequate reporters • A moderately CR diet was associated with – a nonsignificant 20 % increased risk in total mortality – a significant 50 % increased risk in CVD mortality for each SD increment in the score Page 4 Sjögren P et al. Am J Clin Nutr 2010; Sept 8 e-pub ahead of print www.pronutritionist.net
  • 5. Results (2/2) Effect of each SD increment in the Mediterranen Diet Score (in adequate reporters,n=511) Total mortality risk CVD mortality risk www.pronutritionist.netSjögren P et al. Am J Clin Nutr 2010; Sept 8: e- pub ahead of print 5 -29 % -37 %
  • 6. Pronutrionist’s discussion (1/2) • Adherence to a Mediterranean-like dietary (MDS) pattern may reduce mortality, whereas adherence to carbohydrate restricted dietary pattern may increase mortality in elderly men • Harmful effects of slightly restricted carbohydrate diet may be a result of possibly unfavorable fat composition, high amount of energy-dense foods and/or low intake of fruits and vegetables. • In this study, restricted carbohydrate diet was characterized also by high protein consumption which may influence results and which is not always typical to low carbohydrate diets • Contemporary low carbohydrate diets contain a lot vegetables and berries unlike in this elderly population 6 Sjögren P et al. Am J Clin Nutr 2010; Sept 8 e-pub ahead of print www.pronutritionist.net
  • 7. Pronutritionist’s discussion (2/2) • The study population was relatively small to be prospective cohort study. This may introduce bias • There was no relationship between Healthy Diet Indicator and mortality in this study – this is may be caused by a low number of individuals in this study identified as highly adherent to HDI • Alternative explanation is that WHO’s HDI does not contain crucial elements of healthy diet (alcohol, meat and milk products are lacking t vs MDS) • These results may not be applicable younger populations www.pronutritionist.netSjögren P et al. Am J Clin Nutr 2010; Sept 8 e- pub ahead of print 7