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Quality of ingredients that you eat in a Mediterranean Diet is key to protecting yourself from heart disease

Mediterranean diet

It seems it's not only what you eat that is important, but the quality of the ingredients you put into your body that is the vital part of the picture. 

A recent study showed that "High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups". The investigators concluded that:

"Mediterranean Diet (MD) is associated with lower Cardiovascular Disease (CVD  = strokes and heart attacks) risk but this relationship is confined to higher socioeconomic groups. In groups sharing similar scores of adherence to MD, diet-related disparities across socioeconomic groups persisted. These nutritional gaps may reasonably explain at least in part the socioeconomic pattern of CVD protection from the MD."

A Mediterranean diet incorporates the traditional healthy living habits of people from countries bordering the Mediterranean Sea, including Italy, France, Greece and Spain. For these people it helps overcome many behaviours which are considered unhealthy, particularly high rates of smoking. Most people in these countries consume daily alcohol, normally wine, with their meals and this has been summed up in the "French Paradox" where diet/daily red wine drinking by the French has given unusually long life spans.

What is the Mediterranean Diet?

The traditional Mediterranean diet consists largely of unprocessed plant foods. A daily menu on the Mediterranean diet includes regular combinations of:

  • Fruits, vegetables, and whole grains
  • Legumes, nuts, and seeds
  • Olives, olive oil, wine, and spices

The diet allows for occasional servings of seafood, yogurt, cheese, poultry, and eggs, and rare servings of sugar, sweet desserts, salt, and meat.

The Mediterranean diet has been associated with good health, including a healthier heart. Observational studies have shown the link between the diet with reduced cardiovascular disease (CVD) incidence and mortality (death), ,along with lower rates of cancer, neurodegenerative diseases e.g. Parkinson's Disease and all-cause mortality. More recently, evidence on cardiovascular protection from an MD was provided by studies where participants changed their habit from a normal to MD diet showing reduced risk of CVD. The benefits of MD are clear cut

You can make your diet more Mediterranean-style by: eating plenty of starchy foods, such as bread and pasta, eating plenty of fruit and vegetables, eating some fish, eating less meat, choosing products made from vegetable and plant oils, such as olive oil

Conclusions

But...... a diet made up of vegetables, olive oil, fish etc. may indeed be stop you getting heart diseases and improve your life span but one bottle of olive oil may have a different effect to another. Lower economic groups tend to buy cheap oils, eat poorer quality meats and fish. So buy the best you can to protect your heart e.g. organic extra-virgin olive oil from a good producer. Of course, keep up that daily red wine, the higher quality the better, minimising nasties like sulfites and pesticides i.e. biodynamic or organic (with good taste of course).

Further information

Design of the study

The Moli-sani study is a prospective cohort study of 24 325 men and women (aged ≥ 35) randomly recruited from the general population of a Southern Italian region from March 2005 to April 2010.15 For the purpose of this study, individuals with a history of CVD (7.1%), diabetes (10.6%), those reporting implausible energy intakes (<800 kcal/day in men and <500 kcal/day in women or >4000 kcal/day in men and >3500 kcal/day in women; 3.2%), subjects with missing information on educational level (0.2%), unreliable medical or dietary questionnaires (1% and 3.9%, respectively), subjects lost to follow-up (0.2%) or with incomplete personal data (1.7%) were excluded from the analyses. The final sample consisted of 18 991 individuals.

Dietary assessment and indices of diet quality

Food intake was assessed by the validated Italian EPIC food frequency questionnaire.Adherence to the MD was defined according to the Mediterranean Diet Score.

Food antioxidant content (FAC) was appraised by a score determining the content in antioxidant vitamins and phytochemicals of each food group and ranged from −99 to 99, with higher values indicating increased consumption of foods rich in antioxidants. The polyphenol content of diet was measured by a polyphenol antioxidant content (PAC)-score and Total antioxidant capacity of diet (TAC).

Variety of fruit and/or vegetable intake was assessed by four (fruit, vegetables, vegetables subgroups and fruit/vegetable combined) different diet diversity scores. Diversity was the total number of individual vegetable/fruit products eaten at least once in 2 weeks. Data on cooking procedures were collected for vegetables, meat and fish. A score was constructed to discriminate healthy (boiling, stewing) and hazardous (frying, roasting, grilling) cooking methods; the healthier the procedure, the higher the score. Organic food intake was limited to organic vegetables and categorised as yes/no. Whole-grain products consumption was restricted to whole-grain bread intake (yes/no).

High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Moli-sani study 

Marialaura Bonaccio, Augusto Di Castelnuovo, George Pounis et. al

on behalf of the Moli-sani Study Investigators

Int J Epidemiol dyx145. Published: 01 August 2017

Abstract

Background: It is uncertain whether the cardiovascular benefits associated with Mediterranean diet (MD) may differ across socioeconomic groups.

Methods: Prospective analysis on 18,991 men and women aged ≥35 years from the general population of the Moli-sani cohort (Italy). Adherence to MD was appraised by the Mediterranean diet score (MDS). Household income (euros/year) and educational level were used as indicators of socioeconomic status. Hazard ratios (HR) were calculated by multivariable Cox proportional hazard models.

Results: Over 4.3 years of follow-up, 252 cardiovascular disease (CVD) events occurred. Overall, a two-point increase in MDS was associated with 15% reduced CVD risk (95% confidence interval: 1% to 27%). Such association was evident in highly (HR = 0.43; 0.25–0.72) but not in less (HR = 0.94; 0.78–1.14) educated subjects (P for interaction = 0.042). Similarly, CVD advantages associated with the MD were confined to the high household income group (HR = 0.39; 0.23–0.66, and HR = 1.01; 0.79–1.29 for high- and low-income groups, respectively; P for interaction = 0.0098). In a subgroup of individuals of different socioeconomic status but sharing similar MDS, diet-related disparities were found as different intakes of antioxidants and polyphenols, fatty acids, micronutrients, dietary antioxidant capacity, dietary diversity, organic vegetables and whole grain bread consumption.

Conclusions: MD is associated with lower CVD risk but this relationship is confined to higher socioeconomic groups. In groups sharing similar scores of adherence to MD, diet-related disparities across socioeconomic groups persisted. These nutritional gaps may reasonably explain at least in part the socioeconomic pattern of CVD protection from the MD.