ΠαραδοσιακήΕλληνικήΜεσογειακήΔιατροφή, άλλοτεκαιτώρα: Η έρευνα ΕΠΙΚ στην Ελλάδα Antonia Trichopoulou WHO Collaborating Center for Nutrition Department of Hygiene, Epidemiology and Medical Statistics University of Athens Hellenic Health Foundation ΕΦΕΤ Επιστηµονικές προκλήσεις και κατευθύνσεις στη χάραξη διατροφικής πολιτικής Αθήνα, 22 Οκτωβρίου, 2010
I.A.R.C. LYON PARIS FLORENCE MILAN RAGUSA TURIN NAPLES BARCELONA OVIEDO GRANADA MURCIA PAMPLON A SAN SEBASTIAN CAMBRIDGE OXFORD BILTHOVEN UTRECHT ATHENS HEIDELBERG POTSDA M MALMO UMEA AARHUS COPENHAGEN TROMSO UK: OXFORD CAMBRIDGE NETHERLANDS: UTRECHT RIVM GERMANY: POTSDAM HEIDELBERG FRANCE: PARIS ITALY: TURIN MILAN FLORENCE NAPLES RAGUSA SPAIN OVIEDO SAN SEBASTIAN PAMPLONA MURCIA GRANADA GREECE ATHENS SWEDEN: UMEA MALMO DENMARK: AARHUS COPENHAGEN NORWAY: TROMSO EPIC collaborating centres
EPIC Greece
EPIC data on diet Two dietary measurements: Dietary questionnaire One day actual diet from a 7% sample of subjects
EPIC data related to lifestyle and personal history
EPIC Blood Collection and Storage plasma (red straws) serum (yellow straws) buffy coat (blue straws) red blood cells (green straws)
EPIC- Greece Biorepository: plastic straws used for storage of plasma, serum, serum,red blood cells,and buffy coat
EPIC-Greece Biorepository: Tubes and goblets used to hold plastic strows
EPIC Study - Timetable 1992-1998 Subject recruitment 1998- Start of follow-up
The MD can be thought of as having 9 characteristics: 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 norms 10
Mediterranean diet score Cut off point: energy adjusted gender-specific median intake Range: 0-9 Beneficial components Non-beneficial components Vegetables Meat Legumes Dairies (whole fat) Fruit Unprocessed cereals Fish M/S ratio Moderate ethanol intake 1:mean daily consumption (g) 0: mean daily consumption (g) at/above cut-off, 0: otherwise at/above cut-off, 1: otherwise Ethanol: 1: for males/females with consumption [10-50]/[5-25] g/day, 0: otherwise Trichopoulou et al. NEJM 2003 12
Mediterranean diet and mortality 13
Diet and overall survival in elderly people Trichopoulou et al. BMJ 1995
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
Rather than single foods or nutrients, a global health dietary pattern could exert protective effect The combination of different types of food with healthy characteristics might be necessary to express their protective potential
Adherence to MD and overall mortality Study Weight (%) RR (95% CI) Trichopoulou et al. 1995 Kouris-Blazos et al. 1999 Lasheras et al. 2000 Trichopoulou et al. 2003 Knoops et al. 2004 Trichopoulou et al. 2005 9.68 0.69 (0.48 0.99) 6.22 0.79 (0.50 1.25) 2.81 0.48 (0.22 1.02) 16.81 0.75 (0.64 0.87) 11.19 0.88 (0.82 0.94) 8.22 0.93 (0.89 0.97) Lagiou et al. 2006 12.61 0.93 (0.83 1.04) Mitrou et al. 2007 (males) Mitrou et al. 2007 (females) -9% 15.71 16.46 0.92 (0.91 0.94) 0.93 (0.91 0.95) Total (95% CI) 100 0.91 (0.89-0.94) 0.1 0.2 0.5 1 2 Decreased risk Increased risk 17 Sofi et al., BMJ 2008
Mediterranean diet and coronary heart disease 18
Mediterranean Diet and Survival Among Patients with Coronary Heart Disease in Greece The EPIC-GREECE cohort Recruitment : 1994-1997 28 572 volunteers 20 to 86 years old 1302 persons with diagnosed coronary heart disease at enrollment followed up 3.78 y Trichopoulou, et al Arch InternMed.2005
Mediterranean Diet and Survival Among Patients with Coronary Heart Disease in Greece The EPIC-GREECE cohort The fatality rate is reduced by 31% for every 2 units of increased adherence Trichopoulou, et al Arch InternMed.2005
Mediterranean diet and cancer 22
Conformity to a traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort Benetou et al. British Journal of Cancer 2008
??????? Which is the relative importance of the individual components of the Mediterranean diet in generating the inverse association of increased adherence to this diet and overall mortality 24
The dominant components of the Mediterranean diet score as a predictor of lower mortality moderate consumption of alcohol low consumption of meat and meat products high consumption of vegetables, fruits and nuts, olive oil, and legumes BMJ 2009 Trichopoulou et al. 25
What this study adds The contribution of the nine components to the apparent protective effect of the score assessing adherence to traditional Mediterranean diet is approximately additive BMJ 2009 Trichopoulou et al. 26
The contemporary Mediterranean Diet in the Greek population is a rich source of a variety of antioxidants Dilis & Trichopoulou J Nutr. 2010
The traditional Mediterranean diet is associated with longer survival. This could be partly attributed to Mediterranean traditional foods, which this diet implies. 28
STUDY OF TRADITIONAL FOODS (1992 - present) Antonia Trichopoulou AIMS To provide scientific evidence on the effects of traditional foods on health To contribute to the preservation of our cultural inheritance 29
Study of Traditional Foods in Greece In this context, more than 100 Greek traditional foods and recipes have been studied
Traditional Food" definition EuroFIR Traditional means conforming to established practice or specifications prior to the Second World War. Traditional food is a food of a specific feature or features, which distinguish it clearly from other similar products of the same category, in terms of the use of traditional ingredients (raw materials or primary products) or traditional composition or traditional type of production and/or processing method. Trichopoulou et al. 2006Trends in Food Science&Technology, 31
Indicative results The flavonoid content (flavones + flavonols + flavan3ols) of traditional fava of Santorini 1: Fava of Santorini, plain m g / serving 35 30 25 20 15 10 2: Fava of Santorini with cured caper, onions and extra virgin olive oil 5 0 1 2 3 Recipe 3: Fava of Santorini with caper in casserole sauce International Symposium on Ethnic Food and Longevity October the 8 th, Sunchang Gun County Hall, Sunchang Gun, ChonBuk, Korea
The flavonol, flavone and flavan-3-ol content of a typical traditional serving of fava complemented with "caper in casserole" sauce 40 35 mg / serving 30 25 20 15 Capers Caper in casserole Fava of Santorini 10 5 Fava 0 1 Source: Stuy of Traditional Greek foods: 33
Flavonoid content of green pies (mg/100g)and selected beverages (mg/100ml) 12 10 8 6 4 2 0 Quercetin Kaempferol Myricetin Apigenin Luteolin Green pie Red wine Black tea A pple juice Trichopoulou et al. Food Chemistry 2000 34
Identification of Greek traditional foods potentially rich in Vit C for the elderly population group (% coverage of Dietary Reference Intakes per 100g of food) % E. Vasilopoulou and A. Trichopoulou. Mediterr J Nutr Metab. 2009
Identification of Greek traditional foods potentially rich in Vit E for the infants population group (% coverage of Dietary Reference Intakes per 100g of food) Vasilopoulou & Trichopoulou Mediterr J Nutr Metab (2009)
10000 Inorganic constituents log(daily intake, mg) 1000 100 10 Mediterranean menu EC daily recommendations 1 1 K Fe Na Ca Mg Zn Cu Mn 1. Commission of the European Communities. Food-Science Techniques: Reports of the Scientific Committee for Food (Thirty-first series), Office for Official Publications of the European Communities, Luxembourg,1993,pp 1-248 37
Percentage of supplements Users the previous day in the EPIC calibration study WOMEN Country % of users Greece 7 Spain 14 Italy 12 France 31 Germany 30 The Netherlands 32 UK General population 47 UK Health-conscious 50 Denmark 64 Sweden 41 Norway 62 Source: Modified Skeie Eur J Clin Nutr. 2009 38
A wise statement (not by me) In order to avoid dietary disorders associated with uncontrolled consumption of functional foods and dietary supplements, it seems only prudent not to exceed the amounts historically ingested in human diets.
Thank you four your attention