11 beneficios de la dieta mediterránea que debes conocer
11 beneficios de la dieta mediterránea · 1. Combate el llamado colesterol malo · 2. Es beneficiosa para el corazón · 3. Previene los ACV · 4. Evita problemas ...
enfermedades cardiovasculares
La dieta mediterránea ayuda a disminuir los riesgos de padecer <anchor>enfermedades cardiovasculares</anchor>, debido a que reduce la hipertensión arterial gracias a la presencia de ácidos grasos insaturados combinados con los nitratos y nitritos de los vegetales. Asimismo, su variedad de nutrientes permiten aumentar el número de plaquetas naturalmente.
Mediterranean Diet and reduced cardiovascular disease | European Heart Journal | Oxford Academic
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# The Mediterranean Diet and reduced cardiovascular disease

Marialaura Bonaccio, PhD,

Marialaura Bonaccio, PhD

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Licia Iacoviello, MD PhD,

Licia Iacoviello, MD PhD

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Giovanni de Gaetano, MD PhD

Giovanni de Gaetano, MD PhD

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Published:

28 February 2017

### Cite

Marialaura Bonaccio, Licia Iacoviello, Giovanni de Gaetano, The Mediterranean Diet and reduced cardiovascular disease, European Heart Journal, Volume 38, Issue 8, 21 February 2017, Pages 535–536, https://doi.org/10.1093/eurheartj/ehx052

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The Mediterranean diet (MD) may reduce cardiovascular disease (CVD) and mortality, but who actually benefits from its benefits?

Some cardiovascular advantages deriving from the MD were first proposed in the early 1960s by the pioneering studies of the American scientist Ancel Keys who first established an association between dietary behaviours and risk of coronary heart disease.1,2

This eating pattern was typically consumed at that time among the populations bordering the Mediterranean Sea and was primarily characterized by a large intake of vegetables, legumes, fruits, nuts, and cereals, a low-to-moderate intake of dairy products, low consumption of meat and poultry, a moderately high intake of fish, olive oil as a main source of fat and moderate alcohol (mainly wine) drinking during meals.3,4

To date, a persuasive body of observational studies has documented the association of Mediterranean-like dietary patterns with a reduced incidence of CVD and mortality5,6 along with lower rates of cancer,7 neurodegenerative diseases and all-cause mortality.4,8 Benefits of a MD were documented both in a general population and in high-risk groups, such as people with diabetes, whose risk of dying from CVD causes was reportedly reduced by 30% for each 2-point increment in adherence to the MD score.9 In a sub-group of elderly subjects ( n = 5162, aged ≥ 65 years) recruited within the Moli-sani project, a prospective cohort study on 25 000 citizens of Molise, a Southern Italian area, higher adherence to the traditional MD was associated with reduced risk of coronary heart disease, stroke, and mortality from all causes ( Figure 1).

Risk of fatal and non-fatal cardiovascular disease (coronary heart disease/stroke) and all-cause mortality associated with different categories of adherence to the Mediterranean diet in the elderly (age ≥ 65 years) sample of the Moli-sani study (n = 5162).

Figure 1

Risk of fatal and non-fatal cardiovascular disease (coronary heart disease/stroke) and all-cause mortality associated with different categories of adherence to the Mediterranean diet in the elderly (age ≥ 65 years) sample of the Moli-sani study ( n = 5162).

Stronger evidence on cardiovascular protection from a MD was provided by interventional studies showing reduced risk of CVD by MD-like patterns both in primary10 and secondary cardiovascular prevention.11 The landmark PREDIMED trial demonstrated a reduction of about 30% in the risk of CVD (including a composite end-point of myocardial infarction, stroke, and death from cardiovascular causes) for those allocated to a MD supplemented with either olive oil or nuts.10

The majority of studies on the cardiovascular benefits of a MD have been conducted in Southern European populations, but lately, some convincing evidence has also been produced in other epidemiological settings. Recent findings from the HAPIEE study showed that higher adherence to the MD was associated with 10% reduced risk of CVD deaths in three large Eastern European urban populations.12 Similar results were obtained in a US cohort of about 400 000 men and women for whom higher adherence to MD was found to be associated with a 22% reduction in CVD death risk.13 A study on elderly Swedish men also reported a substantial reduction to the risk of CVD mortality associated with increasing adherence to MD (1 SD increase in the score) compared with a carbohydrate-restricted diet or the healthy diet indicator scoring.14

Several hypotheses have been proposed to explain the mechanisms through which MD exerts its beneficial effects on cardiovascular health. The most accredited ones are the favourable modulation of both traditional (lipids, body weight, visceral adiposity, and blood pressure) and emerging CVD risk factors such as inflammation, oxidative stress and vascular reactivity.15,16 However, none of these pathways completely explains the benefits of the Mediterranean eating on health; thus, it is likely that this diet acts favourably on multiple rather than on a single pathway.17

For such reasons, the most appropriate approach to investigate the diet-heart hypothesis should include hard clinical endpoints.17 Similarly, a holistic approach to dietary patterns accounting for potential inter-correlations and interactions between nutrients and food groups may be more predictive of disease risk than individual foods or nutrients.18

After 60 years of research, we can reasonably conclude that MD is able to confer a remarkable advantage for CVD health, in different epidemiological settings or latitude levels.

Therefore, has the research on MD reasonably reached an end?

Ancel Keys and colleagues mainly conducted their studies on groups of countrymen of rural Italian villages, when the MD was basically the diet of the poorest strata of the society. More recently, however, the scenario has been turned upside down and a number of studies have been showing that adherence to this pattern has become a distinguishing feature of the most advantaged individuals rather than of their deprived counterparts.19 Moreover, adherence to the MD has dramatically decreased over the last few decades, a decline more evident in the Mediterranean than in other regions.20 Recent findings from the Moli-sani study21 revealed a substantial shifting from the MD around the years 2007–08, possibly linked to the current economic crisis, the withdrawal being more evident for those of low socioeconomic status ( Figure 2).

Prevalence of high adherence to the Mediterranean diet over time across different wealth groups in the Moli-sani cohort (based on data published in reference 21).

Figure 2

Prevalence of high adherence to the Mediterranean diet over time across different wealth groups in the Moli-sani cohort (based on data published in reference 21).

Given such a scenario, the main question on health and MD research presently appears to be on the population group that actually adhere to a MD style and receives its benefits, considering the documented higher costs generally associated with healthy diets.22,23

Possible additional socioeconomic-related disparities in food access may still hold beyond intake. Indeed, people reporting a similar adherence to the MD—usually measured by scores derived from food-frequency questionnaires—may still eat quite differently. As an example, increased dietary variety, largely encouraged within a healthy Mediterranean lifestyle, is clearly socioeconomically patterned, as well as safe and nutritious foods, which may vary even across groups reporting a similar adherence to MD.24

As epidemiologists, we should ask ourselves whether we are provided with appropriate tools to categorise the actual dietary behaviours of people. We should ask whether the bundle of foods of the traditional MD have remained unchanged in their nutritional value over time. Most likely the nutritional value and/or the antioxidant content of fruits, vegetables, and extra-virgin olive oil—just to mention some of the most representative food groups of MD—depends on how such foods were grown and the animals were fed, and how the grocery was transported, stored, and delivered. We should seriously consider the opportunity of introducing such additional information as a fundamental part of our epidemiological approach with the purpose of understanding whether access to MD and its consequent health benefits are actually equal for all.

In conclusion, the declining adherence to MD recorded during the last decades poses important threats to its preservation and transmission to future generations,25 while its rising socioeconomic patterning jeopardizes the general commitment to ensure equal access to the health advantages delivered by MD.

No matter how beneficial MD is against CVD and mortality risk, if the weakest population groups continue losing the most important protective factor that to date had provided them with a desirable cardiovascular health benefit.

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## References

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

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