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Mediterranean diet cuts heart death risk

26th February 2013

Researchers in Spain say that a Mediterranean diet rich in nuts, olive oil, fish and legumes can cut deaths from heart disease, as well as heart attacks and strokes, by around 30%.

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Researchers led by Ramon Estruch, a professor of medicine at the University of Barcelona carried out a five-year study of people already considered to be at high risk from such health problems.

The Mediterranean diet they used could also include wine with meals, as well as high levels of fruit and vegetables.
Writing in the online edition of the New England Journal of Medicine, they said they had ended the study early for ethical reasons, so as to offer the benefits of the diet to a control group which was on a regular diet that included red meat, commercial baked goods and fizzy drinks.
Most of those who followed the diet did not lose weight, and the majority were already taken prescription medication for blood pressure or diabetes.
Acccording to Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association, the study was meaningful because it looked at the incidence of heart attacks, strokes and death, rather than focusing on risk factors like cholesterol, hypertension or obesity.
Previous studies have focused on showing lower rates of heart disease among people in Mediterranean countries, but these were considered to be weaker than the current study because overall disease and mortality rates could be attributed to a number of factors, not just diet.
It was previously also considered unlikely that the effects of diet could even be isolated among people who were already on powerful medication aimed at reducing their risk of heart disease.
The high calorific content of oil and nuts has also meant that some nutrition experts have been reluctant to recommend the diet to people who were already overweigh or obese.
For the purposes of the study, a total of 7, 447 Spanish residents who had various risk factors for heart disease, including smoking, obesity and diabetes, were randomly assigned to a Mediterranean diet or a low-fat diet.
According to Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation, the size of the study made it highly authoritative.
The balanced nature of the diet also meant that people were able to enjoy life in spite of health problems, as well as lowering their risk of disease or death by 30%, he said.
The results are good news for people concerned about their health, but who find sticking to a low-fat diet too uninspiring.
Estruch's team took advice from around the world in planning their study, visiting Harvard cardiovascular disease prevention expert Frank Sacks on a number of occasions.
They assigned two groups to a Mediterranean diet with follow-up counselling and regular support, but soon realised the low-fat group needed support to stick to their plans.
Eventually, the low-fat group was treated as a regular diet group, because they had been unable to significantly lower their fat intake.
One of the Mediterranean groups was given extra olive oil - four tablespoons of extra-virgin oil daily - while the other was given extra nuts, comprising around an ounce a day of walnuts, almonds and hazelnuts.
Both Mediterranean groups ate at least three portions of fruit and two of vegetables daily, with fish and legumes (beans, peas and lentils) at least three times a week.
Both groups also ate only white meat, and were told to drink at least seven glasses of wine every week with meals.
Commercial baked goods, dairy produce and processed meats were strongly discouraged in these groups.
The research team then kept track of levels of hydroxytyrosol from olive oil and alpha-linolenic acid in the participants' urine.

Compliance rates were high among the two Mediterranean groups, while the low-fat group soon became a modern diet group instead, including commercial baked goods, red meat and fizzy drinks.

Overall, the researchers were surprised at how marked the effects of the Mediterranean diet were, and speculated that the benefits were not just the result of eating olive oil or nuts, but of the whole regime.

While more studies will be needed to discover whether people at low risk of heart disease will benefit equally from the diet, Estruch said he personally believed that people should begin such a diet in childhood, or as early as possible, and that anyone could benefit from it.

 

 

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