Antonia Trichopoulou, MD Dr. Trichopoulou is a Medical Doctor with State Certification in Biopathology (Laboratory Medicine) and has a Master in

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1 Antonia Trichopoulou, MD Dr. Trichopoulou is a Medical Doctor with State Certification in Biopathology (Laboratory Medicine) and has a Master in Public Health and a PhD in Nutrition and Biochemistry. She is currently Director of the World Health Organization Collaborating Center for Nutrition at the Department of Hygiene and Epidemiology, School of Medicine, University of Athens. was President of the Federation of the European Nutrition Societies. She has received numerous honors and awards, including the Corato award (2001) and the IV Grande Covian Award (2002) for her studies concerning the health effects of Mediterranean diet. In 2003 she was decorated by the President of the Greek Republic with the Golden Cross of Honor. Dr. Trichopoulou s research focuses on various aspects of nutrition and particularly issues concerning the Mediterranean diet.

2 New Scientific Evidence: Healthfulness of the Mediterranean Diet Trichopoulou Antonia, MD WHO Collaborating Centre for Nutrition Department of Epidemiology Medical School, University of Athens WORLD PASTA DAY October 25, 2006, Rome INTERNATIONAL SCIENTIFIC COLLOQUIUM

3 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

4 BACKGROUND Many studies have evaluated the association between single foods, food groups, or nutrients and chronic diseases Last 10 years: focus on the identification of a dietary pattern that maximizes longevity

5 Dietary patterns have the ability to integrate complex or subtle interactive effects of many dietary exposures

6 The MD can be thought of as having 9 components: high olive oil consumption high consumption of legumes high consumption of cereals high consumption of fruits high consumption of vegetables moderate consumption of dairy products, mostly as cheese and yogurt moderate to high consumption of fish low consumption of meat and meat products moderate wine consumption, if it is accepted by religion and social ground

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8 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

9 Aim To evaluate the association between either: degree of adherence to the traditional, Greek-Mediterranean diet, or individual food groups and total mortality during 2-8 years of follow-up

10 Adherence to a Μediterranean diet and survival in a Greek population Results per 2-unit increase in Mediterranean diet score A higher degree of adherence to the Mediterranean diet was associated with a significant reduction in : total mortality adjusted mortality ratio 0.75 coronary heart disease adjusted mortality ratio 0.67 Trichopoulou et al. NEJM 2003 cancer adjusted mortality ratio 0.76

11 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

12 Modified Mediterranean diet and survival: EPIC-Elderly cohort Results per 2-unit increase in Mediterranean diet score A higher degree of adherence to the Mediterranean diet was associated with 8% reduction in overall mortality: But the reduction was considerably higher in Mediterranean countries like Spain and Greece Trichopoulou et al. BMJ 2005

13 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

14 Olive oil, Mediterranean diet and arterial blood pressure: the Greek EPIC cohort Results An increase of olive oil consumption by one standard deviation was associated with significant reduction of both systolic and diastolic blood pressure across the individuals Psaltopoulou et al AJCN

15 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

16 Mediterranean diet and survival of coronary patients: EPIC-Greece cohort Results a 2-unit increase in Mediterranean diet score was associated with 27 % reduction in overall mortality among individuals diagnosed as having coronary heart disease Trichopoulou et al. Arch Intern Med 2005

17 Modified Mediterranean diet and survival: EPIC-Elderly cohort Conclusion Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in mortality among individuals diagnosed as having coronary heart disease Trichopoulou et al. Arch Intern Med 2005

18 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

19 Mediterranean diet and obesity Conclusion There was no important association Between Mediterranean diet score and BMI and W/H ratio Am J Clin Nutr, 2005

20 What is the Mediterranean Diet? Mediterranean Diet and longevity: the Greek EPIC cohort. N Engl J Med, 2003 Modified Mediterranean Diet and survival: the EPIC-Elderly study. BMJ, 2005 Olive oil, Mediterranean Diet and arterial blood pressure: the Greek EPIC cohort. Am J Clin Nutr, 2004 Mediterranean Diet and survival of coronary patients: the Greek EPIC cohort. Arch Intern Med, 2005 Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Cohort Am J Clin Nutr, 2005 Diet and physical activity in relation to overall mortality among adult diabetics in a general population cohort Journal of Internal Medicine, 2006

21 Objective To evaluate the effect on overall and cardiovascular mortality of diet and physical activity among diabetics

22 Results Monounsaturated lipids appear, in comparison with other lipids, preferable for the management of diabetes, as they are the only ones which are unrelated to mortality

23 Results Two nutritional variables were significantly associated with diabetic mortality, with hazard ratios for increases of daily intake by one standard deviation 1.31 for eggs (95% CI, 1.07 to 1.60] and 1.82 for saturated lipids (95% CI, 1.14 to 2.90) These two associations were considerably stronger for cardiovascular mortality

24 Results Striking positive association between egg intake and diabetic mortality implying that increased daily intake by one egg (40 g) increases the risk of death overall threefold and the risk of coronary death more than fivefold

25 Amongst confirmed diabetic persons, increased physical activity is associated with significant reduction of mortality whereas increased consumption of eggs and saturated fats is associated with significant increase of mortality Monounsaturated lipids are preferable for diabetic persons

26 Ann Intern Med. 2006;145: , September 5, 2006 The Effect of Polyphenols in Olive Oil on Heart Disease Risk Factors: Covas et al A Randomized Trial Conclusions: Olive oil is more than a monounsaturated fat. Its phenolic content can also provide benefits for plasma lipid levels and oxidative damage.

27 Arch Neurol. 2006; October 9 [Epub ahead of print] Links Mediterranean Diet, Alzheimer Disease, and Vascular Mediation Scarmeas et al Conclusions: Higher adherence to the MeDi is associated with a reduced risk for AD. The association does not seem to be mediated by vascular comorbidity. This could be the result of either other biological mechanisms (oxidative or inflammatory) being implicated or measurement error of the vascular variables.

28 Med Diet Healthy alternative approach Not sharply different from other recommended diets Two elements distinguish it from other prudent diets 1. It stresses the pattern rather than individual components and 2. Provides no restriction on lipid intake so long as they are not saturated and are preferably in the form of olive oil

29 THANK YOU FOR YOUR ATTENTION