Category Archive for: ‘Dietary patterns’
A healthful diet and lifestyle is related to low CVD risk
A Mediterranean style diet, a high level of physical activity, not smoking and moderate alcohol consumption were all associated with low 10-year risk of CHD and CVD in the European HALE project. A very low risk of these diseases was observed in elderly men who had four compared to those who had none or one healthful diet and lifestyle factor. We estimate that among elderly men who did not adhere to a low-risk lifestyle pattern, 64% of deaths due to CHD and 61% due to CVD might have been prevented based on the observed risk differences.
Among elderly men, the more healthful factors of diet and lifestyle the lower the CVD mortality observed. More than 60% of CVD mortality was associated with lack of adherence to the low-risk pattern. This finding implies that even at advanced ages those who follow a Mediterranean style diet and maintain a healthful lifestyle are less likely to die from CVD.
Low alcohol intake associated with low all-cause mortality and better survival
Among regular consumers of alcoholic beverages in the Zutphen Study, average alcohol intake increased from 8 g/d in 1960 to 18 g/d in 1985 and then decreased to 13 g/d in 2000. All-cause mortality during 40 years of follow-up was 25% lower in men who drank less than 20 g alcohol per day and on average 6 g/d compared to non-drinkers. Men average aged 50 with a long-term regular alcohol intake of 20 g/d or less, had a 2.3 years longer life expectancy than those who did not use alcohol.
Wine drinkers had the best life expectancy
The life expectancy of wine drinkers (average age 50, average alcohol intake 2 g/d) was 4.7 years longer compared to those who did not use alcohol. For those who consumed on average 8 g/d alcohol as beer or spirits the difference in life expectancy from non-alcohol drinkers was 2.2 years.
Healthy diet associated with low all-cause mortality
A Healthy Diet Indicator (HDI) score was calculated based on the 1990 Guidelines of WHO on prevention of chronic diseases for men aged 50-70 from Finland, The Netherlands and Italy. The 20-year all-cause mortality was 13% lower in the group with the highest compared to the lowest HDI.
Mediterranean diet related to low all-cause mortality
In the HALE project the Mediterranean Diet Score (MDS) was associated with a 18% lower and the Mediterranean Adequacy Index (MAI) with a 17% lower 10-year all-cause mortality. The MDS and the MAI were both based on foods characteristic of the traditional Mediterranean diet in the 1960s. Within these dietary patterns, grains, fruit and fish were most strongly and inversely related to all-cause mortality.
All three scores indicated that a healthy dietary pattern is associated with a lower all-cause mortality.
A Mediterranean style diet was consistently associated with lower cardiovascular risk
Adhering to a Mediterranean style diet was associated with a 39% lower coronary mortality risk and a 29% lower cardiovascular mortality risk in middle-aged and elderly European men and women in the HALE project. The Mediterranean diet score we used was based on eight basic food groups: bread, legumes, vegetables, fruit, fish, fats, dairy products and meats. A high intake of bread, legumes, vegetables, fruit and fats rich in unsaturated fatty acids, a moderate intake of fish and a low intake of dairy and meat was characteristic of a Mediterranean diet.
Measuring habitual diets
The HALE project dealt with European elderly men and women participating in the FINE and the SENECA Studies. They were 70-90 years old at baseline and were followed for 10 years. In both studies the dietary history was recorded as the measure of habitual food consumption.
CVD Main topics
A high intake of animal foods is related to higher long-term CHD mortality
The Seven Countries Study showed that animal food groups, with the exception of fish, were strongly positively related to 25-year CHD mortality and that plant foods, with the exception of potatoes, were inversely related. Of the individual foods, butter, hard margarines and meat were most strongly related to CHD mortality rates. The summary factor score was positive for animal foods and negative for plant foods. The population factor scores were strongly positively correlated with CHD mortality rates. The plant food-based Mediterranean Adequacy Index was inversely related to 25-year CHD mortality rates.
Western, Mediterranean and Japanese dietary patterns
In the 1960s dietary patterns high in animal foods and rich in saturated fat (Western diets) were characterized by a high meat intake in the US, a high dairy (whole fat milk and butter) intake in Finland, a high margarine (hardened fish oils) intake in the Netherlands and a high intake of lard in Slavonia (Croatia). Mediterranean patterns, with olive oil as the main source of fat, were characterized by a high intake of plant foods. The Japanese patterns were high in fish and soy products and had a very low saturated fat intake.
- Menotti et al. Eur J Epidemiol 1999;15:507-15
- Fidanza et al. Nutr Metab Cardiovasc Dis 2004;14:254-8
- Kromhout et al. Am J Clin Nutr 1989;49:889-94
Many Mediterranean diets
Ancel Keys and his Italian colleague Flaminio Fidanza and their SCS colleagues were central to the modern recognition, definition, and promotion of the eating pattern they found in Italy and Greece in the 1950s and ’60s, now popularly called “The Mediterranean Diet”. Ancel Keys was the first researcher who associated the traditional Mediterranean diet with a low risk of CHD. However, the Mediterranean diet does not exist. The Mediterranean Sea borders 18 countries that differ markedly in geography, economic status, health, lifestyle and diet.
Traditional Mediterranean diets had olive oil as their principal component of fat, were high in cereal products, legumes, fruit and vegetables, moderate in fish and low in dairy and meat products. Moderate amounts of wine were taken with meals. The traditional Mediterranean diets were nutritionally adequate with a varying amounts of total fat, low in saturated fat and very low in trans fat, rich in fiber and in antioxidant vitamins or flavonoids.
Mediterranean diets in the the Seven Countries Study in the 1960s
The Seven Countries Study included four Mediterranean cohorts: Crete and Corfu in Greece, Dalmatia in Croatia and Montegiorgio in Italy. In the 1960s the Greek diet had the highest content of olive oil and was high in fruit, the Dalmatian diet was highest in fish and the Italian diet was high in vegetables. In line with their diet, these cohorts were characterized by low mortality rates from CHD.
- Keys, Ancel and Margaret. Eat well and stay well. Doubleday, 1959.
- Kromhout et al. Am J Clin Nutr 1989;49:889-94
- Fidanza Proc Nutr Soc 1991;50:519-26
CVD Main topics