NUTRI-BITES Webinar Series Mediterranean Diet Pattern and Health will begin at the top of the hour Audio for today s presentation is being broadcast over your computer speakers, so be sure they are turned on and the volume is up Today s presentation in handout form can be downloaded from: http://bit.ly/handout-06-29-17 (type in your browser) NUTRI-BITES Webinar Series Mediterranean Diet Pattern and Health June 29, 2017 Presenter: Regan Lucas Bailey, PhD, RD, MPH, CPH Associate Professor of Nutrition Science Faculty Associate, Center of Aging and the Life Course Purdue University Moderator: Amy Continelli Director of Marketing & Client Services Rippe Health Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics. 1
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Webinar logistics CEUs a link to obtain your Continuing Education Credit certificate will be available on this webinar s page at www.conagranutrition.com and emailed to you within 2 days. A recording of today s webinar and slides as a PDF will be available to download within 2 days at: www.conagranutrition.com The presenter will answer questions at the end of this webinar. Please submit questions by using the Chat dialogue box on your computer screen. Today s Faculty Regan Lucas Bailey, PhD, RD, MPH, CPH Associate Professor of Nutrition Science Faculty Associate, Center of Aging and the Life Course Purdue University Moderator: Amy Continelli Director of Marketing & Client Services Rippe Health 3
Mediterranean Diet Pattern and Health NUTRI-BITES Webinar Series Learning Objectives Identify dietary recommendations to help your clients incorporate key principles of the Mediterranean Diet into their diets Understand how dietary patterns are derived and characterized for use in research Describe the history of the Mediterranean Diet both in its native context and how it is applied in the U.S. population Provide a summary of key research relating the Mediterranean Diet to health outcomes The Mediterranean Diet Regan Bailey, PhD, MPH, RD 4
Definition : Dietary patterns The quantities, proportions, variety or combination of different foods, drinks, and nutrients in diet, and the frequency with which they are habitually consumed* * Nutrition Evidence Library, Technical Expert Collaborative on Study of Dietary Patterns Why are patterns important? Diet is complicated Patterns may help to reflect whole foods and/or combinations of consumption temporal distribution of intake habitual patterns (e.g. snacking and food preparation methods) collinearity of foods and nutrients Positive interventions Policy Implications 5
Dietary Pattern Methods and Health Outcomes Health Outcome Independent Dependent Index and Scores Cluster Analysis Factor Analysis Selective Diets Reduced Rank Regression Classification and Regression Tree (CART) Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793. Health Outcome Independent Factor Analysis Groups foods Scores Cluster Analysis Groups people Exclusivity Strategies for data reduction Both use input variables to group and classify foods and beverages together Treatment of inputs Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793. 6
Indexes and Scores Diet is compared to a priori criteria Healthy Eating Index DASH Diet Index How close is a group to meeting a set of criteria Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793. Indexes and Scores Allows researchers to compare across groups using a common metric Not subjective but scoring may be Y/N vs Range Gleason PM, Boushey CJ, Harris JE ZoellnerJ. 2015; JAND 1072-1082. 7
Outcome Independent A Priori Criteria Indexes Scores Special or Selective Diets Elimination of certain components E.g., Vegetarian Based on culture or geography Krebs-Smith SM, Subar AF, Reedy J. 2015; Circulation 790-793. Mediterranean Diet and Heart Disease Seven Countries Study Disease rates and dietary patterns differed across countries Keys et al., 1986 Mediterranean diet responsible? 8
Mediterranean Diet http://www.eastmeetswestnutrition.com/2010/04/03/mediterranean-diet-or-mediterranean-style-diet/ What is the Mediterranean Diet? Based on traditional foods of countries bordering the Mediterranean Sea Higher in monounsaturated fats More fresh food less processed 9
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Mediterranean Diet Emphasis on Fruits and vegetables Whole grains Fresh herbs/spices instead of salt Nuts, seeds, legumes Fish and poultry at least twice/week Red wine in moderation Mediterranean Diet Avoidance or limit Processed foods Margarine Most oils other than EVOO 11
Also Eat Daily in Small Amounts Olive oil and olives Cheese and yogurt Use sparingly Weekly Fish Skinless poultry Eggs Sweets Monthly Red meat 12
PREDIMED: RCT Men: 55-80 y Women: 60-80 y 1 0 prevention but high risk (3+) Smoking Hypertension LDL-C HDL-C Overweight / obesity Family history of early-onset CHD 13
The 3 groups of the study The EVOO Group One third of the volunteers were told to adopt a Mediterraneanstyle diet and were given one liter a week of Extra Virgin Olive Oil. The Low Fat Group The third group was told to adopt a low fat diet. The Mixed Nut Group The second group was also told to adopt a Mediterranean style diet, and they were given about an ounce a day of mixed nuts (walnuts, hazelnuts, and almonds). PREDIMED Study Main Outcome: CVD Estruch R, et al. N Engl J Med 2013;368:1279-90. 14
PREDIMED Study Survival without diabetes over 5 years (non diabetic individuals) Cumulative survival from diabetes Med diet + olive oil Med diet + nuts Low fat diet Salas Salvadó et al., 2011 PREDIMED: Diabetes Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity. MedDiets without calorie restriction seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk. Salas Salvado et al. Diabetes Care; 2011 34 (1): 14 19. 15
Metabolic Syndrome (MS) Metabolic Syndrome (MS) Large waistline High triglycerides Low HDL cholesterol High blood pressure High fasting blood sugar Reduction in MS MeDiet + nuts 13.7% MeDiet + EVOO 6.7% Control 2.0% Estruch R, et al. N Engl J Med 2013;368:1279-90. 16
14 Points of the Med Diet Score (MDS) 2 points Olive oil: use abundantly in cooking and dressings 1 point Vegetables: at least 2 3 servings daily 1 point Fruits: at least 2 3 servings daily 1 point Beans: 3 or more servings weekly 1 point Fish or seafood: 3 or more servings weekly 1 point Nuts or seeds: at least 1 serving weekly 1 point If you eat meat, choose lean, skinless, e.g. poultry 1 point Sofrito: 2 or more servings weekly 1 point If you drink alcohol, drink moderately 4 points Limit or eliminate: Cream, butter, margarine, red meat, sugared beverages, premade desserts and baked goods, french fries, potato chips, cured or fatty cheeses Schroder H et al. J Nutr 2011; 141: 1140-1145. What is sofrito? https://www.northshore.org/globalassets/healthy you/blog/2015/mediterranean sofritos recipe.jpg 17
Secondary Prevention Lyon Diet Heart Study 605 patients following a MI randomized to a Mediterranean* or Western** diet for 4 years A Mediterranean diet reduces cardiovascular events *High in polyunsaturated fat and fiber, **High in saturated fat and low in fiber De Lorgeril M et al. Circulation 1999;99:779 785 18
What about Prospective Cohorts? What about Prospective Cohorts? 19
What about Prospective Cohorts? What about Prospective Cohorts? 20
What about the American diet? Alternative Mediterranean Diet Score Food Criteria Group [ ] Vegetables 3 5+ servings/day [ ] Legumes 4+ servings/week [ ] Fruit 3 + servings per day [ ] Nuts 4 5+ servings per week [ ] Whole grains 2 3+ servings per day [ ] Fish 2+ servings per week [ ] Healthy fats (plant oils) [ ] Red and processed meats Criteria for Earning 1 Point Mostly plant oils, 1.5 to 1 ratio, plant to animal fats None, or limited to no more than 1 2 servings/week Score 0 9 possible. High score is linked to lower risk of death from cancer, heart disease, and stroke, and a significant decrease in mortality. [ ] Red wine intake Limited, women no more than 2 7 drinks/week Men, no more than 4 7 drinks per week Harvard Study: 6 7 years of follow up: 6,137 men; 11,278 women American Journal Clinical Nutrition. 2014;99:172 180. 21
1.0 0.9 0.8 0.7 0.6 amds and Mortality Lowered Risks of Disease 1.00 Risk of Disease 0.85 0.85 0.81 0.79 Getting 7 to 9 points of ameds diet means lowered risk of disease. Compare those with 7 9 points to those with fewer than 7 points. 15% risk of cancer 15% risk of cardiovascular disease 21% risk of death from other causes 19% risk of death from all causes Harvard Study: 6 7 years of follow up: 6,137 men; 11,278 women American Journal Clinical Nutrition. 2014;99:172 180. amds and Sudden Cardiac Death Sudden Cardiac Death (RR) 1.2 1.0 0.8 0.6 0.4 0.2 0.0 1.00 Low score 0.67 High score Mediterranean Diet Score The Women s Health Initiative study included 93,122 women and 10.5 years of follow up. Women with a high score (7 to 9 points) had a 33% decrease in sudden cardiac death, compared to women with a low score (less than 7 points). Women s Health Initiative Study. American Journal of Clinical Nutrition. 2014;99:344 51. 22
Dietary Guidelines Advisory Committee Report 2015 What is the relationship between dietary patterns and risk of CVD? DGAC#1: CVD using an index or score : NEL I Strong Number of studies 55 Assessment FFQ 45 24 hour recall 2 Records or History 8 Study design RCT 3 Prospective Cohort Studies 52 Outcome CVD 29 CHD 16 Stroke 13 Myocardial Infarction 5 Heart Failure 3 Intermediate Outcomes: Hypertension, Blood 6 Pressure, and Blood Lipids USDA/CNPP. Nutrition Evidence Library: Series of Systematic Reviews on the Relationship Between Dietary Patterns and Health Outcomes. March 2014. 23
Strategies for increasing the MDS score Eat More: Fruits Vegetables Nuts Legumes and beans Whole grains Fish in place of red meat Olive oil and other healthy fats If you choose to drink red wine, do so moderately (3 7 drinks/week) Strategies for increasing the MDS score Eat less: Red/processed meats Sugar and baked goods High fat dairy Sweets and soft drinks 24
American Heart Association Guidelines for a Healthy Diet Eat an overall healthy dietary pattern that emphasizes: a variety of fruits and vegetables, whole grains, low fat dairy products, skinless poultry and fish nuts and legumes non tropical vegetable oils Limit saturated fat, trans fat, sodium, red meat, sweets and sugar sweetened beverages. Updated Guidelines: March 27, 2017 Summary Good evidence that following a Mediterranean diet can reduce risk of heart disease and diabetes RCTs Moderate evidence that Mediterranean diet is associated with lower risk of many chronic diseases Prospective cohorts 25
Summary Further research needed on how to support people to change their diet Understanding the context of the diet is also an important area of research Many healthy dietary exist! Additional Resources 26
Additional Resources The National Heart, Lung, and Blood Institute Workshop: "Toward testing the effects of a Mediterranean dietary pattern on cardiovascular and other diseases in the United States" Full summary available at: https://www.nhlbi.nih.gov/research/reports /national heart lung and blood instituteworkshop toward testing effectsmediterranean dietary Questions? 27
Mediterranean Diet Pattern and Health NUTRI-BITES Webinar Series Based on this webinar the participant should be able to: Identify dietary recommendations to help your clients incorporate key principles of the Mediterranean Diet into their diets Understand how dietary patterns are derived and characterized for use in research Describe the history of the Mediterranean Diet both in its native context and how it is applied in the U.S. population Provide a summary of key research relating the Mediterranean Diet to health outcomes Conagra Nutrition Nutri-Bites Webinar details A link to obtain your Continuing Education Credit certificate will be will be available on our website and emailed within 2 days Today s webinar will be available to download within 2 days at: www.conagranutrition.com For CPE information: acontinelli@rippelifestyle.com Recent CEU webinars archived at the Conagra Nutrition website: An Update from FDA on the Revised Nutrition Facts Panel Diet, Microbiome and Health: Past, Present and Future. Using Technology to Enhance Your Weight Loss Practice 28
Next Conagra Nutrition Nutri-Bites Webinar The Academy of Nutrition and Dietetics Evidence Analysis Library Alison Steiber, PhD, RDN Chief Science Officer of the Academy of Nutrition and Dietetics September 2017 Day and Time TBD www.conagranutrition.com How are we doing? Stay on the line for a brief survey about today s Conagra Nutrition Nutri-Bites webinar: Mediterranean Diet Pattern and Health Thank you! 29