Predimed study is one of the few truly long term randomized trials with disease and mortality outcomes. It is unique in many ways and will have a strong and lasting impact
Protein doesn't just mean steak! Nuts, beans/legumes, soy, and other plant based proteins can adequately meet a person's protein needs while reducing one's carbon footprint and improving health. In this workshop, discover how to incorporate more plant proteins into your diet with recipes using ingredients like lentils, chickpeas, almonds, and seitan.
The Footprint Forum in association with Partners In Purchasing tackled the role of food in staff performance and wellbeing. And while the idea of mood food is far from mainstream, more and more big businesses are looking at the concept
Protein doesn't just mean steak! Nuts, beans/legumes, soy, and other plant based proteins can adequately meet a person's protein needs while reducing one's carbon footprint and improving health. In this workshop, discover how to incorporate more plant proteins into your diet with recipes using ingredients like lentils, chickpeas, almonds, and seitan.
The Footprint Forum in association with Partners In Purchasing tackled the role of food in staff performance and wellbeing. And while the idea of mood food is far from mainstream, more and more big businesses are looking at the concept
05.12.09(a): Energy Balance and ObesityOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M1 Human Growth and Development sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1GrowthDevelopment
Esiste una dieta per la fertilità?
La provocazione
E’ preferibile non avere idee
piuttosto che averne di sbagliate,
per cui è meglio
non avere un’opinione sulle diete,
rispetto ad averne una sbagliata.
Felicity Luckey
HEALTHY EATING What can I eat?
Diabetes education classes can assist people with diabetes in gaining knowledge about the effect of food on blood glucose, sources of carbohydrates and fat, appropriate meal planning and resources to assist in making food choices. Skills taught include reading labels, planning and preparing meals, measuring foods for portion control, fat control and carbohydrate counting. Barriers, such as environmental triggers and emotional, financial, and cultural factors, are also addressed.
As a biochemist, I was floored by this presentation by Dr. Lustig of UCSF on high-fructose corn syrup. I watched him on the UC channel on cable and downloaded a copy of the presentation to share.
Discover why diet so important for diabetes prevention.
-- Plus Download our 2 FREE Ebooks - Diabetes Natural Cures & Diet and Exercise for Type 2 Diabetes --
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.
Development of Nutraceuticals & functional foodsEkta Belwal
“Nutraceuticals” & “Health food” shops has grown enormously, fostered by wide media coverage of their benefits. There has been a boom in their sales as patients rush to self-medicate, either in the hope that these products will be effective in treating diseases unsatisfactorily treated with pharmaceuticals, or that the adverse effects of some pharmaceuticals may be avoided.
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.
Maidon, voin ja punaisen lihan vaikutus terveyteen Reijo Laatikainen
Tämä kuvasaraja tiivistää etenevien väestötutkimuksien tuloksien valossa lihan, maitotaloustuotteiden ja kanan vaikutuksia syöpiin, sydän- ja verisuonisairauksiin ja aikuistyypin diabetekseen.
05.12.09(a): Energy Balance and ObesityOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M1 Human Growth and Development sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1GrowthDevelopment
Esiste una dieta per la fertilità?
La provocazione
E’ preferibile non avere idee
piuttosto che averne di sbagliate,
per cui è meglio
non avere un’opinione sulle diete,
rispetto ad averne una sbagliata.
Felicity Luckey
HEALTHY EATING What can I eat?
Diabetes education classes can assist people with diabetes in gaining knowledge about the effect of food on blood glucose, sources of carbohydrates and fat, appropriate meal planning and resources to assist in making food choices. Skills taught include reading labels, planning and preparing meals, measuring foods for portion control, fat control and carbohydrate counting. Barriers, such as environmental triggers and emotional, financial, and cultural factors, are also addressed.
As a biochemist, I was floored by this presentation by Dr. Lustig of UCSF on high-fructose corn syrup. I watched him on the UC channel on cable and downloaded a copy of the presentation to share.
Discover why diet so important for diabetes prevention.
-- Plus Download our 2 FREE Ebooks - Diabetes Natural Cures & Diet and Exercise for Type 2 Diabetes --
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.
Development of Nutraceuticals & functional foodsEkta Belwal
“Nutraceuticals” & “Health food” shops has grown enormously, fostered by wide media coverage of their benefits. There has been a boom in their sales as patients rush to self-medicate, either in the hope that these products will be effective in treating diseases unsatisfactorily treated with pharmaceuticals, or that the adverse effects of some pharmaceuticals may be avoided.
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.
Maidon, voin ja punaisen lihan vaikutus terveyteen Reijo Laatikainen
Tämä kuvasaraja tiivistää etenevien väestötutkimuksien tuloksien valossa lihan, maitotaloustuotteiden ja kanan vaikutuksia syöpiin, sydän- ja verisuonisairauksiin ja aikuistyypin diabetekseen.
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.
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.
Naturopathic Treatmentfor the Prevention ofCardiovascular Disease: A Randomized Pragmatic TrialCCNM – Journal Club Sept 30th, 2010Dugald Seely, ND, MScDirector; Research & Clinical EpidemiologyThe Canadian College of Naturopathic Medicine
Discuss the epidemiological burden of diabetes and rising food intakes, recognize insulin-glucose pathway effects by intramyocellular lipids, familiarize with clinical evidence and utilize guidelines by ACE/AACE, implement rapid assessment and practical application of plant-based nutrition and apply CPT billing codes for this intervention
What constitutes "Women's Health" issues? All too often this category is hijacked with conversations related exclusively to sex and breast care. In this revealing conversation we review other topics related to women's health and the relationship to "plant based nutrition" and general preventive strategies
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
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.
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.
In this slide deck I demonstrate the effects of carbohydrate restriction on different lipoproteins such as HDL, LDL, non-HDL-cholesterol and apolipoprotein B (apoB). The effect of butter and saturated fat as such are compared to unsaturated fat and especially to canola oil. Meta-analysis by Mensink et al. 2003 is the primary reference for the analysis.
Dietary guidelines are accused to be the key reason for obesity and diabetes epidemic. This slide deck shows why they are not. Junk food diet is the key reason.
Ruokavalio ja sydän- ja verisuonisairaudet SuomessaReijo Laatikainen
Tässä diasarjassa esittelen sydänsairauksien ja ravinnon välisiä yhteyksiä erityisesti suomalaisten perspektiivistä. Esittelen pääasiassa meta-analyysien ja systemoitujen katsauksien tuloksia koska ne ovat luotettavampia kuin yksittäiset tutkimukset.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Predimed study
Primary Prevention of Cardiovascular
Disease with a Mediterranean Diet
Estruch J et al. NEJM February 25, 2013 DOI:
10.1056/NEJMoa1200303
Page 1
2. Introduction
• Systematic reviews of prospective cohort studies suggest that
Mediterranean Diet pattern (Med Diet) is linked to better
cardiovascular (Mente et al. 2009), cognitive (Daviglus et al.
2011), weight management outcomes (Esposito et al. 2011) &
cancer outcomes (Sofi et al 2010)
• Lyon Diet Heart Study is so far the only randomized trial with
morbidity and mortality outcomes on Med Diet. The study
delivered robust results favouring Med Diet vs usual French Diet
(de Lorgeril et al 1994).
• It may be argued that Oslo Diet Heart (1966) study was also Med
Diet study. It also delivered clear benefits in favor of Med Diet
• The effects of Med Diet as primary prevention strategy are not
known
2 www.pronutritionistblog.com
3. Methods 1/4
Note! Processed and red meat was restricted in both
groups and fish encouraged in both groups.
Estruch J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. NEJM February 25, 2013 DOI:
10.1056/NEJMoa1200303
Page 3
4. Methods 2/4
• High risk patients in primary care setting (Spain)
– A) Type 2 Diabetes OR
– B) Minimum 3 out of the following: Smoking, LDL>4,1 (or statin in
use), low HDL, hypertension, BMI>25 and CHD heritage
– Exclusion criteria: Not ready to the dietary change (Prochaska &
DiClemente Scale), MI, peripheral artery disease & allergy to nuts
• N=7447
• Diets
– A) American Heart Association diet (version from year 2000) without
any free delivery of food items
– B) Mediterranean Diet (Med Diet) with free extra virgin olive oil
(minimum use per day is 4 teaspoons)
– C) Mediterranean Diet with free nut mix , 30 g/day (walnuts 15 g,
almonds 7,5 g & hazelnuts 7.5 g)
– Diet were constructed and patients informed by study dietitians
– Adherence to diets is evaluated by Med Diet scores and AHA scores
Page 4 Marttinez-González et al. Cohort Profile: design and methods of the PREDIMED
study. International Journal of Epidemiology 2010;1–9
5. Methods 3/4
• Primary endpoints
– Composite endpoint of myocardial infarction, strokes and
cardiovascular deaths
• Secondary endpoints
– Deaths (any reason)
– Myocardial infarctions
– Strokes
– Dementia and other neurodegenerative diseases
– Cancers
– Surrogate markers like LDL, HDL, inflammation markers, glucose,
insulin …
Page 5 Marttinez-González et al. Cohort Profile: design and methods of the PREDIMED
study. International Journal of Epidemiology 2010;1–9
6. Methods 4/4
Randomization of patients
(High risk patients in primary
care, Spanish n = 7447)
A) Mediterranean diet including
free extra virgin olive oil daily
B) Mediterranean diet including
free nut mix daily
Year 2003 → Year 2012
C) Low fat diet (AHA diet early 2000), no
free delivery of any food items
Mean follow up ∼ 4,8 years
Drop out rates were very low. 11,4 % of participants were lost in
control group and 5,4 % in Med Diet groups
Page 6
7. Results /primary end point
Risk of composite cardiovascular end point was reduced by 30
% in both Med Diet groups vs controls.
Estruch J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. NEJM February 25, 2013 DOI:
10.1056/NEJMoa1200303
8. Results /myocardial infarctions
Incidence of myocardial infarctions was not significantly different
between groups (trend favouring Med Diet)
Estruch J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. NEJM February 25, 2013 DOI:
10.1056/NEJMoa1200303 (SUPPLEMENT MATERIAL)
9. Results /strokes
Strokes were reduced by nut enriched Med Diet by 49 % and by
extra virgin olive oil based 36 %
Estruch J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. NEJM February 25, 2013 DOI:
10.1056/NEJMoa1200303 (SUPPLEMENT MATERIAL)
10. Results / mortality end points
•Incidence of fatal cardiovascular events was not significantly
different between groups
•Total mortality was not significantly different between groups
11. Results / Diets
• There was no difference is the use of red and prosessed meat
bwetween the groups (disencouraged also in the control group)
• Control group used also a diet high in fish, fruits and vegetables
– More than 60 % of participants in control group used
veggies and fruits at least five servings per day
– 66 % of participants in control group used lean fish at least
three servings per week
– Intake of fiber was at the same level in between the groups
• Intake of saturated fat did not differ between the groups. Intake
of ALA (plant based PUFA) was higher in nut enriched Med Diet
group
• It seems that the biggest changes in diet happened in nut, olive
oil, sofrito and wine intake
11
12. Similarities & differences vs other Med
Diet trials
Predimed Lyon Heart Study Oslo Diet Heart
• Outcomes on dementia, cancer, strokes and myocardial
ACTIVE GROUPS ACTIVE GROUP ACTIVE GROUP
infarctions and deaths will N=584 (at end) soon
N=7447 (at start) be published N=412 (at start)
Fat used (provides for Extra virgin olive (Active Canola spread, canola Soy oil
free in all 3 trials) Group A only) oil & olive oil
Nuts Provided for free (Active Encouraged Encouraged
Group B only)
Fish (oily) Encouraged Encouraged Canned sardines in oil for free
Red & Processed To be restricted To be restricted To be restricted
meat
Whole grains Not stated (neutral) Encouraged Encouraged
Fruit/berries Encouraged Encouraged Encouraged
Vegetables Encouraged Encouraged Encouraged
Butter & milk fat Butter resticted, dairy To be restricted To be restricted
neutral
Alcohol Wine encouraged Wine encouraged Alcohol “allowed”
13. My discussion
• Thisis the largest randomized study ever on Mediterranean diet. Thus,
the results will have strong and lasting impact
• Done in modern era (vs fat replacement RCT during 1960’s)
• The results are in line with surrogate marker trials (short RCTs),
prospective cohort studies and ecological correlations. Thus,
mediterranean diet pattern has the most robust evidence supporting its
effect on cardiovascular health
• This is the first randomized trial on diet demonstrating a clear benefit in
terms of strokes
• Mechanism of action is not clear as the data on lipid ,inflammation,
blood pressure, sugar and other parameters was not disclosed at his
stage
13
14. Please read the whole paper
Estruch J et al. NEJM February 25, 2013
DOI: 10.1056/NEJMoa1200303
Page 14
15. Follow me
http://twitter.com/pronutritionist
http://www.facebook.com/pronutritionist
http://www.pronutritionistblog.com (English)
http://wwwpronutritionist.net (Finnish)
Reijo Laatikainen, M Sc, MBA,
Registered Dietitian
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