Mediterranean Sea

Healthy Diet, Healthy Aging.

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Middle-aged women following a healthy Mediterranean-type diet — with an emphasis on fruits, vegetables, whole grains and fish, moderate amounts of alcohol, and little red meat — have much greater odds of healthy aging later on, a new study reports.

“In this study, women with healthier dietary patterns at midlife were 40% more likely to survive to age 70 or over free of major chronic diseases and with no impairment in physical function, cognition or mental health,” said lead study author, Cécilia Samieri, PhD, Institut pour la Santé Publique et le Developpement, Université Bordeaux, France.

This new study adds to growing research on the health benefits of the Mediterranean diet recently reported. Various studies have shown that this diet may contribute to reduced fasting glucose concentrations and lipid levels in those at risk for diabetes, may lower the risk for cardiovascular events and stroke, and improve cognition.

The new study was published in the November 5 issue of Annals of Internal Medicine.

The analysis included 10,670 participants in the Nurses’ Health Study, which began in 1976 when female nurses aged 30 to 55 years completed a mail-in survey. Since then, study participants have been closely followed on a regular basis.

In 1980, participants completed a food-frequency questionnaire (FFQ) that asked how often on average they consumed standard portions of various foods. This questionnaire was repeated in 1984 and 1986 and then every 4 years.

To assess dietary quality at midlife, researchers averaged information from the 1984 and 1986 FFQs. They calculated scores on 2 diet indexes:

  • Alternative Healthy Eating Index-2010 (AHEI-2010): This index considers greater intake of vegetables, fruits, whole grains, nuts, legumes, and polyunsaturated fatty acids (PUFAs); lower intake of sugar-sweetened beverages, red or processed meats, trans fats, and sodium; and moderate intake of alcoholic beverages. Total AHEI-2010 scores range from 0 (nonadherence) to 110 (perfect adherence).

  • Alternate Mediterranean diet (A-MeDi): Developed to assess adherence to the traditional Mediterranean diet, this index includes 9 components that are similar to those in the AHEI-2010. Total A-MeDi scores range from 0 (nonadherence) to 9 (perfect adherence).

In 1992, 1996, and 2000, participants completed the Medical Outcomes Short-Form 36 Health Survey, a questionnaire that evaluates 8 health concepts, including mental health and physical functioning. Scores from the Telephone Interview for Cognitive Status, an adaptation of the Mini-Mental State Examination, were used to evaluate cognitive health. From 1995 to 2001, a cognitive study was administered to participants aged 70 years or older.

Investigators separated “healthy” from “usual” aging on the basis of 4 health domains. Overall, 11.0% of the participants were considered healthy (and so were free of chronic diseases, such as cancers, myocardial infarction, and diabetes, and with no limitation in cognitive function, mental health, and physical function), and the remaining participants were considered usual agers.

Several health domains were typically impaired among the “usual” agers, said Dr. Samieri. “For example, 33% had both chronic diseases and limitations in cognitive, physical, or mental health; 64% had only limitations in cognitive, physical, or mental health; and 3.4% had only 1 or more chronic diseases.”

The analysis revealed that greater adherence at midlife to AHEI-2010 and A-MeDi was strongly associated with greater odds of healthy aging (P for trend < .001 for AHEI-2010; P for trend = .002 for A-Medi).

For example, compared with women in the worst quintile of diet scores, women in the highest quintile of the AHEI-2010 and A-MeDi scores had 34% (95% confidence interval [CI], 9% – 66%) and 46% (95% CI, 17% – 83%) greater odds of healthy aging, respectively.

Individual Components

When they analyzed individual dietary components, researchers found statistically significant associations of greater intake of fruits (odds ratio [OR] for upper versus lower quintiles, 1.46) and alcohol (OR, 1.28), and lower intakes of sweetened beverages (OR, 1.28) and PUFAs (OR, 1.38) with healthy aging (P for trend ≤ .04).

The authors noted that they could not exclude participants with impaired cognition, mental health, and physical function in midlife, and although probably few women had severe impairments at baseline, reverse causation in these participants may still be possible. Because they didn’t follow participants through to death or onset of a condition that would classify them as no longer healthy, researchers couldn’t prospectively estimate risks for transitioning from healthy to usual aging. As well, measurement errors may have occurred in the assessment of dietary patterns.

Other possible limitations were that the study was observational and, because it included mostly white women, its results may not be generalizable to other populations.

Middle age is probably the most relevant period of exposure for preventing chronic conditions of aging that develop over many years.

“It’s largely accepted that cumulative exposures to environmental risk factors over the lifespan are probably more important than late-life exposures to determine health in older ages,” said Dr. Samieri. “Several mechanisms of age-related chronic diseases, for example, atherosclerosis in cardiac diseases, brain lesions in dementia, start in midlife.”

Various researchers have reported on other newly documented health benefits of the Mediterranean diet, including the following:

Mediterranean Diets Beat Low-Fat for CVD Prevention.

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 A Mediterranean diet supplemented with either extra virgin olive oil or mixed nuts may cut the risk of cardiovascular events by as much as 30% in subjects at high risk of developing heart disease, as compared with people advised to eat a reduced-fat diet [1].

Those are the key findings from the randomized controlledPREDIMED primary-prevention trial presented here at theInternational Congress on Vegetarian Nutrition.

The Mediterranean diet already reigns supreme in secondary prevention of CV events. PREDIMED, which looked at diet effects on hard clinical end points, carves out an important role for this dietary eating pattern in primary prevention.

“These results support the benefits of the Mediterranean diet for CV risk reduction [and] are particularly relevant given the challenges of achieving and maintaining weight loss,” investigators write in a paper published in advance of the presentation in the New England Journal of Medicine. PREDIMED was led by Dr Ramón Estruch(Hospital Clinic, Barcelona, Spain) and Dr Miguel Angel Martínez-González (Clinical Universidad de Navaraa, Pamplona, Spain).

Commenting on the study for heartwire , Dr Marc Gillinov (Cleveland Clinic, OH), who was not involved in the study, pointed out that there are very few studies of any diets that are rigorously designed and that address hard clinical outcomes. “This randomized controlled trial is by far the best in class when it comes to dietary studies. We should take its results seriously: if you have risk factors for cardiovascular disease–and the majority of adult Americans do–your best bet is to follow a Mediterranean diet.”

PREDIMED: Oil and Nuts Over Fat Restriction

PREDIMED enrolled 7447 men and women ranging in age from 55 to 80 years, none of whom had established cardiovascular disease but who were at high CV risk. Subjects were randomized to one of two Mediterranean diet groups (one supplemented with olive oil, the other with nuts) or to a control diet wherein subjects were advised to try to reduce dietary fat.

Patients in the Mediterranean-diet groups were invited to regular dietary training sessions; by contrast, those in the control group were, for the first three years, sent leaflets explaining a low-fat diet. After a protocol amendment at the three-year mark, low-fat-diet patients were also invited to regular group sessions and offered personalized advice at the same level of intensity as the Mediterranean groups.

The study was stopped when an interim analysis at 4.8 years revealed a clear signal of benefit among subjects eating the Mediterranean diets. In the olive-oil and mixed-nut Mediterranean diet groups, the primary end point (MI, stroke, or CV death) was reduced by 30% and 28% respectively, as compared with the control group.

Study dropouts, meanwhile, were twice as common in the control diet group as in the Mediterranean diet group (11.3% vs 4.9%). “Favorable trends” were seen for both stroke and MI rates among subjects eating the Mediterranean diet, but numbers were too low to be relevant statistically. A total of 288 subjects experienced an event in the study: 96 events in the olive-oil group, 83 in the nut group, and 109 in the control group.

Of special note, subjects randomized to the Mediterranean diets were not told to reduce calories, a major barrier to success in many dietary interventions, particularly the long-supported “low-fat” approach.

Good Fat and Bad

In an email to heartwire , Estruch highlighted the importance of differentiating between different types of fat “Animal fat should be avoided,” he said, whereas “vegetal fats–extra virgin olive oil and nuts–should be recommended [within] a healthy food pattern such as the Mediterranean diet.”

Asked whether the findings would be applicable to other parts of the world where saturated fats are such a common component of everyday eating, Estruch stressed the importance of education.

“People should know that the Mediterranean diet is a diet healthier than others and should know the key components of this food pattern. The plan should be to increase the intake of the key foods (vegetables, fruit, nuts, fish, legumes, extra virgin olive oil, and red wine in moderation), also increase the intake of white meat, and decrease the intake of red and processed meat, soda drinks, whole dairy products, commercial bakery goods, and sweets and pastries.”

He continued: “To achieve a score of 14 in the 14-item adherence scale to traditional Mediterranean diet [laid out in a supplemental appendix in the paper] is more or less impossible, but to upgrade two to three points in this score is enough to reduce your cardiovascular risk by 30%.”

Gillinov, in turn, pointed out that there are no data of a similar quality supporting a low-fat diet, although these have long been promoted by physicians and professional medical groups. “The Mediterranean diet contains moderate quantities of fat, and it clearly wins in this trial of primary prevention,” he said.

Dr Steven Nissen , also of the Cleveland Clinic, was even more effusive, calling PREDIMED “a spectacular study that was extremely difficult to perform.”

“The findings are compelling and should alter the dietary advice we give patients. The currently popular ultralow-fat diets . . . are clearly not best for patients,” he told heartwire in an email. “The standard AHA-recommended diet should be modified to reflect these findings: fat is not the problem with the American diet, we just eat the wrong types of fats.”

Source: Medscape.com

 

Mediterranean Diet Reduces Stroke Risk Even in Those with High Genetic Risk.

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High risks for type 2 diabetes and cardiovascular complications conferred by variants in the TCF7L2 gene can be partially offset by strict adherence to a Mediterranean-style diet, according to a Diabetes Care study.

PREDIMED investigators followed some 7000 participants at very high risk for cardiovascular disease. Their genetic risks were determined by ascertaining the variant of the TCF7L2 gene they carried, with “TT” variants known to confer higher risk than “CT” or “CC” variants.

The subjects were randomized to Mediterranean or low-fat diets and followed for roughly 5 years. TT carriers who did not generally observe Mediterranean-style diets at baseline showed higher risks for cardiovascular events, although not significantly so. Furthermore, TT carriers randomized to and adhering to a Mediterranean diet had stroke rates similar to CT and CC carriers.

The authors conclude that their findings support the benefits of a Mediterranean diet, “especially for genetically susceptible individuals.”

Source: Diabetes Care