Lyon Diet Heart Study is still considered as the ultimate evidence for the health benefits of Mediterranean diet. Unfortunately its' results have never been re-produced since then. However, PREDIMED trial may change this situation.
Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
Manual de orientação para a alimentação escolar na educação infantil, ensino ...Dr. Benevenuto
Introdução 11
1 Manual de Alimentação da Educação Infantil 13
1.1 Quais as principais características das crianças da educação infantil? 13
1.2 Como deve ser a alimentação do PNAE para a educação infantil? 14
1.2.1 O que oferecer? 14
1.2.2 O que restringir? 19
1.3 Como desenvolver a educação nutricional? 20
2 Manual de Alimentação do Escolar do Ensino Fundamental: 6 a 10 Anos 22
2.1 Quais as principais características dos escolares do ensino fundamental
com idade entre 6 e 10 anos? 22
2.2 Como deve ser a alimentação do PNAE no ensino fundamental? 23
2.2.1 O que oferecer? 23
2.2.2 O que controlar? 27
2.2.3 Educação alimentar e nutricional 28
3 Manual de Alimentação do Adolescente 31
3.1 Quais as principais características dos escolares na adolescência? 31
3.2 Como deve ser a alimentação do PNAE para os adolescentes? 33
3.2.1 O que oferecer? 33
3.2.2 O que controlar? 35
3.2.3 Educação alimentar e nutricional 36
4 Manual de Alimentação do Escolar na Fase Adulta 36
4.1 Principais características dos escolares na fase adulta 38
4.2 Como deve ser a alimentação do PNAE para o ensino de adultos? 39
4.2.1 O que oferecer? 40
4.2.2 O que controlar? 42
4.2.3 Educação alimentar e nutricional 43
Conclusões 45
Referências Bibliográficas 46
Obesidade
Classificação da obesidade através do IMC
Cirurgia da obesidade grau III
Indicação de cirurgia
Fatores importantes na reeducação alimentar
após a cirurgia
Dieta na cirurgia bariátrica
Fases das dietas no pós-operatório
Alimentos que devem ser evitados no
pós-operatório
Alimentos que devem ser estimulados no
pós-operatório
UFRGS - Hospital de Clínicas Porto Alegre - RS
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This study is the first one to show the effect of dietary intervention in the secondary prevention of CHD. It is meal pattern study even if very often labelled as sole fat modification study
Manual de orientação para a alimentação escolar na educação infantil, ensino ...Dr. Benevenuto
Introdução 11
1 Manual de Alimentação da Educação Infantil 13
1.1 Quais as principais características das crianças da educação infantil? 13
1.2 Como deve ser a alimentação do PNAE para a educação infantil? 14
1.2.1 O que oferecer? 14
1.2.2 O que restringir? 19
1.3 Como desenvolver a educação nutricional? 20
2 Manual de Alimentação do Escolar do Ensino Fundamental: 6 a 10 Anos 22
2.1 Quais as principais características dos escolares do ensino fundamental
com idade entre 6 e 10 anos? 22
2.2 Como deve ser a alimentação do PNAE no ensino fundamental? 23
2.2.1 O que oferecer? 23
2.2.2 O que controlar? 27
2.2.3 Educação alimentar e nutricional 28
3 Manual de Alimentação do Adolescente 31
3.1 Quais as principais características dos escolares na adolescência? 31
3.2 Como deve ser a alimentação do PNAE para os adolescentes? 33
3.2.1 O que oferecer? 33
3.2.2 O que controlar? 35
3.2.3 Educação alimentar e nutricional 36
4 Manual de Alimentação do Escolar na Fase Adulta 36
4.1 Principais características dos escolares na fase adulta 38
4.2 Como deve ser a alimentação do PNAE para o ensino de adultos? 39
4.2.1 O que oferecer? 40
4.2.2 O que controlar? 42
4.2.3 Educação alimentar e nutricional 43
Conclusões 45
Referências Bibliográficas 46
Obesidade
Classificação da obesidade através do IMC
Cirurgia da obesidade grau III
Indicação de cirurgia
Fatores importantes na reeducação alimentar
após a cirurgia
Dieta na cirurgia bariátrica
Fases das dietas no pós-operatório
Alimentos que devem ser evitados no
pós-operatório
Alimentos que devem ser estimulados no
pós-operatório
UFRGS - Hospital de Clínicas Porto Alegre - RS
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This study is the first one to show the effect of dietary intervention in the secondary prevention of CHD. It is meal pattern study even if very often labelled as sole fat modification study
The recovery and re-evaluation of the old data on Sydney Diet Heart Study uncovers unexpected outcomes. However, interpret with care because things have changed since 1970s.
Plant-based Eating: Enhancing Health Benefits, Minimizing Nutritional RisksRobin Allen
Learning Objectives
At the end of the session, the participants will be able to:
1. Know there is no single definition of a plant-based diet.
2. Discuss health aspects of vegetarian and vegan diets and quality of evidence supporting health claims.
3. Assess nutritional adequacy/status of vegetarians and/or vegans throughout the life cycle and provide strategies for meeting dietary recommendations for vitamin B12, DHA calcium, and zinc.
Kaurajuomien, -jogurttien-, kermojen vertailua ravitsemuksellisen arvon suhteen. Fokus rasvan laadussa, proteiinissa, kuidussa ja suojaravintoaineissa, kuten D-vitamiinisssa, kalsiumissa, B12-vitamiinissa ja jodissa.
Teen tässä diasrajassa vertailua, miten suomalaisten syöminen muuttuisi ravintoaineiden saannin ja toisaalta ruuan käytön näkökulmasta, jos siirtyisimme planetaariseen ruokavalioon.
Miten ruoka, laihdutus ja ravintolisät, kuten kurkuma, inkivääri ja omega-3 rasvahapot (kalaöljy) vaikuttavat tavallisten nivelsairauksien riskiin ja miten ne toimivat vaivojen hoidossa? Tutkimustietoon perustuvat diasarja.
Hullua menoa ravintotutkimuksessa ja -keskustelussaReijo Laatikainen
Tässä diasarjassa kerron näkemyksiäni siitä miksi ravintotutkimukset tuntuvat välillä niin hulluilta ja miksi keskustelu on välillä niin vaikeaa ja miksi solvaaminen on yleistä.
This presentation compares the effects of different animal proteins on cancer, diabetes, heart disease and stroke. Presentation covers fish, dairy, poultry, red meat, processed meat and eggs.
Fat intake US has remained rather stable during the past decades despite many claims. I present here the case based on USDA and NHANES data.
Claiming that fat intake has decreased in US is as silly as advising a dieter: “If you want to follow a low-fat diet just keep your fat intake at the current level and simply increase the consumption of carbs. Then you are on low-fat diet and you will reap all the benefits of the diet”
Suomalaisten energiaravintoaineiden ja ruokien kulutusReijo Laatikainen
Tämä diasarjaa kertoo miten suomalaisten ruuan käyttö on muuttunut. Luvut perustuvat FAO:n tilastoihin, jotka puolestaan perustuvat suomalaisiin Ravintotaseisiin.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. http://www.facebook.com/pronutritionist
Lyon Diet Heart Study
Mediterranean diet vs “traditional” western diet
Published as two separate papers:
de Lorgeril et al. Mediterranean diet, traditional risk factors, and the rate of
cardiovascular complications after myocardial infarction: final report of the
Lyon Diet Heart Study. Circulation. 1999; 99(6):779-85
de Lorgeril et al. Mediterranean alpha-linolenic acid-rich diet in
secondary prevention of coronary heart disease. Lancet 1994;
343(8911):1454-9
1 Original paper: 27 months of randomization
2 Follow up of 46 months’s
2. Page 2
Pronutritionist’s background
• In recent prospective cohorts based meta-analyses, saturated fat intake
was not linked to coronary heart disease (CHD) incidence (
Siri-Tarino et al. 2010, Skeaff & Miller J. 2009 and Mente et al. 2009)
• Another meta-analysis based on 48 randomized outcome trials,
demonstrated a lower incidence of CHD if saturated fat was replaced by
unsaturated fat or reduced (Hooper et al. 2011)
• However, a majority of the studiesare done during 1960s and 1970s,
used either soy, corn or safflower oil. All of these cooking oils have
been largely replaced by olive or canola (or turnip rapeseed) oil in
recent years, at least in many Nordic and Western European countries
• No hard outcome data exists for either canola or olive oil in clinical trials
scrutinizing the sole effect of displacement of saturated fat with canola
oil
• In Lyon Diet Heart Study (LDHS) canola oil was used as an integrative
part of Mediterranean diet model
• How do the results of LDHS stand the test of the time?
de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
3. Methods (schematic)
Page 3
Randomization
Experimental diet
Mediterranean diet including free canola oil based margarine
Control diet
normal French Diet
27 months
randomized
period
y. 1988
19 months open
follow up (delay in
stopping)
Premature
discontinuation (!)
de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
4. Methods (patients)
• Parallel randomized trial, Single blinded
• Secondary prevention of CHD among myocardial infarction (MI) survivors
• Primary outcomes: Reinfarctions and cardiac death
• Secondary outcomes: Coronary bypass surgery, angioplasty, and their
complications, stroke, angina, heart failure, pulmonary/venous embolism,
thrombophlebitis
• N=605, circa 90 % were males, median age 53,5 years
• Slightly more than 60 % of the patients received beta-blockers and ASA.
Statins were not prescribed
• Recruitment: during the hospitalization due to MI
• LDL cholesterol levels at baseline in both groups circa 4,5 mmol/L (175 mg/dl)
• Subjects were free living
• Length: 5 years per arm (!) but was discontinued prematurely at 27 months
due to excessive morbidity/mortality rate in control group (”Because of a
statistically significant result, the decision was made to stop the trial.” deLoergeril et al.
1999)
• Era: 1988 →
Page 4 de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
5. Methods (diet)
• Experimental Diet = Cretan style Mediterranean diet
• Patients in the experimental group were advised by the research cardiologist
and dietitian (a one-hour-long session)
• Mediterranean-type diet:
– more bread
– more root vegetables and green vegetables
– more fish, less meat (beef, lamb, and pork to be replaced with poultry)
– No day without fruit
– Butter and cream to be replaced with margarine supplied by the study. ”This margarine had a
composition comparable to olive oil with 15 % saturated fatty acids, 48% oleic acid but 5-4%
18:1 trans. However, it was slightly higher in linoleic (16-4 vs 8-6%) and more so in alpha-
linolenic acid (4-8 vs 0-6%)”
– The oils recommended for salads and food preparation were rapeseed and olive oils
exclusively.
– Moderate alcohol consumption in the form of wine was allowed at meals.
• At each subsequent visit of the experimental patients, a dietary survey and
further counselling were done by the research dietitian. Diet evaluations
comprised a 24-hour recall and frequency questionnaire.
Page 5 de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
6. Results 1/5 (27 months randomization)
• Totally 584 subjects were analyzed
• Drop out rate was low, ie. 7-8 % (patients who did not
attend two consecutive appointments)
• Dietary intake and biochemical parameters was analyzed
in 411 patients (70 % of all)
• There were no differences in baseline characteristics of
patients
• There was no difference in the degree of attention or care
given to the study groups (verified by separate survey)
• At the end of the study, number of smokers was higher in
Mediterranean group
• Study was discontinued prematurely due to excessive
morbidity/mortality rate in control group
Page de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
7. Results 2/5 (27 months randomization)
Page 7
Mediterranean diet Control French Diet Δ significance
Energy 1928 kcal 2140 kcal p< 0.001
SFA 8.3 E % 11.7 E % p< 0.001
Oleic acid 12.9 E % 10.3 E % p< 0.001
Linoleic acid 3.6 E % 5.3 E % p< 0.001
α –linolenic acid 0.81 E % 0.27 E % p< 0.001
Cholesterol 217 mg 318 mg p< 0.001
Carbohydrates* 52.3 E % 50.8 E % N/A
Protein 17.2 E % 16.5 E % P=0.12
Fat 30.5 E % 32.7 E % P=0.008
Fiber N/A N/A N/A
Trans fat** N/A N/A N/A
Dietary changes (at 1-4 years)
*) Not given, calculated **) Trans fat content of serum lipids did not differ between groups
de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
8. Results 3/5 (27 months randomization)
Page 8
Mediterranean
diet
Control
French Diet
Baseline value
(MedDiet/Ctrl)
Weight +1 kg +3 kg 74/73
Systolic blood pressure + 7 mmHg + 9 mmHg 120/119
Diastolic blood pressure + 4 mmHg + 5 mmHg 74/74
Triglycerides -0.15 mmol/L -0.23 mmol/L 2.0/2.15
LDL -0,36 mmol/L -0.43 mmol/L 4.52/4.54
HDL + 0.16 mmol/L + 0.11 mmol/L 1.16/1.17
Changes in cardiovascular risk factors vs baseline (at 104 weeks)
Note!
• There were no significant differences between groups
• Serum antioxidant levels were higher in Med Diet group
de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
9. Results 4/5 (27 months randomization)
Page 9
Deaths and cardiovascular end points (number of events)
P=0.02
Δ - 73 % (adjusted)
P=0.02
P=0.001
Δ - 76 % (adjusted)
Δ - 70 % (adjusted)
de Lorgeril et al.. Lancet 1994; 343(8911):1454-9
10. Results 5/5
(follow up results up 4 years)
Page 10 de Lorgeril et al.. Circulation 1999;
99(6):779-85
preceding plus minor events
requiring hospital admission,
including recurrent stable
angina, restenosis etc. -47 %
(CO 3)
Myocardial infarction
plus cardiovascular death plus major
secondary events -67 %
(CO 2).
Myocardfial infarction plus
cardiovascular death -72 %
(CO 1)
Note! Addtionally
reported in this paper:
- Fiber intake:
18,6 g/ 15,5 g/day
-Lipid Lowering Drugs
26,5 % vs 34 %
(Med Diet vs Controls)
11. Pronutritionist’s discussion (1/5)
• In my knowledge, LDHS delivered best-ever results in reducing
cardiovascular events in randomized dietary trial
• Remarkably, the results are not explained by any difference in LDL
cholesterol between the groups (4,2 vs 4.3 mmol/L)
• Authors interestingly point out that the high linoleic acid intake (such as in
classic outcome RCTs) is associated with platelet-induced aggregation
and lipid peroxidation.
• The magnitude of the displacement of SFA with margarine was circa 5 %
of daily energy intake (15 grams of butter was replaced with margarine)
and was associated with null difference in LDL cholesterol
• In a recent meta-analysis by Mozaffarian (2010), 5 E % replacement of
SFA with PUFA was 10 % reduction CHD events. However, in Lyon Heart
Study the outcomes were not driven by any changes in cholesterol, and
even more interestingly, the intake of PUFA was lower in Mediterranean
Diet group than in control group (4.6 E % vs 6.1 E %, p=0,0001, 4 year
results)
• Most striking dietary difference was α –linolenic acid intake (0.81 E % in
MedDiet vs 0.27 E % in controls)
Page 11 de Lorgeril et al. 1994; de Lorgeril et al. 1999
12. Pronutritionist’s discussion (2/5)
Strengths of Lyon Diet Heart Study
Page 12
• Randomized trial with free supplementation of margarine. Feeding of any
food item is likely to improve compliance to diet (which is notoriously poor
in long term trials)
• Diets were relatively well reported, even if fiber intake was reported only at
4 years (15.5 g/day in controla and 18.6g/day in Mediterranean group p=
0.004)
• Medical attention is likely to have been quite similar in between the groups
• Drop out is very low at 27 months (≤ 8 %)
• Well documented end points
• Well documented medications
de Lorgeril et al. 1994; de Lorgeril et al. 1999
13. Pronutritionist’s discussion (3/5)
Weaknesses of Lyon Diet Heart Study
Page 13
• Glucose levels of patients were neither monitored nor reported. It is not
known if incidence of diabetes or IGT was equally distributed among
groups
• A small difference in weight gain between the groups favoring active group
• The changes is dietary intakes were modest or even subtle, and underlining
the importance of free supplementation
• The mechanistic model behind the observed effects is vague (platelet-
induced aggregation and lipid peroxidation) and inadequately proven in
later trials. For example, latest meta-analyses on omega-3 fatty acid
supplementation have demonstrated modest or disappointing results (Chen
et al. 2011 )
• Currently, statins are routinely prescribed to MI survivors. It is not known if
Lyon Diet would yield good results on top of widely prescribed statin
treatment. In omega- 3 trials, the effect of omega-3 supplementation is only
seen among those who do not use statins and other modern MI drugs (
Chen et al. 2011 )
• The results have not been re-produced in any other long-term outcome trial
de Lorgeril et al. 1994; de Lorgeril et al. 1999
14. Pronutritionist’s discussion (4/5)
Contrasting Lyon and Oslo Diet Heart
Lyon Heart Study
ACTIVE TREATMENT
Oslo Diet Heart
ACTIVE TREATMENT
Linoleic acid intake (omega-6
FA intake)
↓ (rather low circa 4 E %) ↑ (very high, circa 15 E %)
α –linolenic acid ↑ ( circa 0,8 E %) ↑ ( circa 2,7 E %, Ramsden et al. 2010)
Trans fat ↑
(as margarine, circa 1 g/d)
↓
(Hard margarine was prohibited)
Marine omega-3 fatty acids ↑ (due to promotion of fish) ↑↑ (due to supplementation of sardines)
Fiber ↑ ↑ *
SFA ↓ ↓
Vitamin D No change ↑**
Total PUFA ↓ ↑
Antioxidants/(Polyphenols) ↑ ↑
Page 14 http://www.facebook.com/pron
utritionist
*) not reported but likely as brown bread, vegetables and fruit were promoted), **) free sardines in cod liver oil, intake of
vitamin estimated to be circa 15 mcg/day (Ramsden et al. 2010)
de Lorgeril et al. 1994; de Lorgeril et al. 1999
15. Pronutritionist’s discussion (5/5)
Conclusion
• LHS delivered robust results without any difference in LDL, HDL or
triglycerides
• LHS and Oslo Diet-Heart are very alike:
– Both were multi-factorial meal pattern trials where subjects were given
food items for free
– Both trials had emphasis on increasing omega-3 fatty acids, fish
instead of meat, fruit/vegetables, whole grains, and oils in cooking.
– But these trials also demonstrate that not one bad single dietary
change can dilute positive effects of comprehensive dietary
modification (very high linoleic acid intake in Oslo Diet-Heart, trans fat
intake in Lyon heart study)
• Background diet in LHS is much closer to current one than in any other
large fat displacement trials
• The LHS is still considered as the ultimate evidence for the health benefits
of Mediterranean diet. The results have not been reproduced since Lyon
Heart Study. PREDIMED trial will soon show if the effects of Mediterranean
diet can be re-produced
Page 15 http://www.facebook.com/pron
utritionist
de Lorgeril et al. 1994; de Lorgeril et al. 1999
16. Read also about
Oslo Diet-Heart Study
&
Predimes Study
www.pronutritionist.net16