Mediterranean diet and heart health Dr Claire McEvoy and Sarah Moore

Overview Does a Mediterranean diet reduce risk of heart disease and diabetes? What is the Mediterranean diet? TEAM-MED research study

Heart disease In NI, over 75,000 people with heart disease and 1 in 4 people die each year due to heart disease Diabetes is a major risk factor for heart disease Most deaths could be prevented by making lifestyle changes such as eating a healthy diet… BHF, 2013 & NHS, 2012

Mediterranean Diet and Heart Disease Seven Countries Study (1968) Disease rates and dietary patterns differed across countries Mediterranean diet responsible? RESEARCH Keys et al., 1986

Does a Mediterranean diet reduce risk of heart disease and diabetes?

Predimed Study People: 7447 adults at risk of heart disease Groups: Med diet and olive oil Med diet and nuts Low fat diet Outcome: Heart related death, heart attack, stroke or diabetes Duration: 5 years

PREDIMED Study Year Heart events over 5 years Low fat diet 60 Med diet + nuts 50 % people had heart event 40 30 Med diet + olive oil 20 10 0 1 2 3 4 5 Year Estruch et al., 2013

Survival without diabetes over 5 years (non-diabetic individuals) PREDIMED Study Survival without diabetes over 5 years (non-diabetic individuals) Med diet + olive oil Cumulative survival from diabetes Med diet + nuts Low fat diet Salas-Salvadó et al., 2011

PREDIMED Results 30% reduction in risk of heart disease 52% reduction in risk of diabetes 27% reduction in risk of heart disease with statin treatment 30% reduction in risk of diabetes with metformin treatment (Taylor et al, 2013; (Knowler et al, 2002)

What these results tell us… Greater adherence to a Mediterranean diet is more effective than current drug treatments to reduce the risk of heart disease and diabetes.

Mediterranean Diet: How it reduces risk Blood pressure Cholesterol Blood glucose Weight gain

Other health benefits of a Mediterranean diet Following a Mediterranean diet can: reduce the risk of Alzheimer's and Parkinson's disease reduce the risk of death from or occurrence of Cancer Sofi F et al., 2010

Summary Heart disease remains a major cause of death Good evidence that following a Mediterranean diet can reduce risk of heart disease and diabetes Further research needed on how to support people to change their diet

What is the Mediterranean diet?

The Mediterranean diet High in fruits, vegetables, wholegrain bread, rice and pasta, potatoes, beans, nuts, and seeds Olive oil as an important fat source and dairy products, fish, and poultry (consumed low- moderate amounts) Eggs (moderate amounts), and red meat (low amounts) Wine is consumed in low to moderate amounts. Dietary pattern based on food patterns of many Mediterranean regions in 1960s Kris-Etherton, 2001

Mediterranean Diet Pyramid

Mediterranean Diet guidelines Bach-Faig et al., 2011 Every main meal 1-2 portions fruits, 2+ portions vegetables 1-2 servings wholegrain bread/ rice/ pasta Use olive oil as main cooking fat or as a dressing Every day 2 servings dairy 1-2 servings nuts Weekly 2 servings poultry, 2+ servings oily fish, 2+ servings legumes Less than 2 servings red meat, 1 or less serving processed meat 0-4 servings Eggs Less than 2 servings sweet foods Optional: 1 glass wine/day(women), 2 glasses/day(men) most days

Guidelines: key foods & advice Eat more fruit & vegetables Include oily fish (e.g. salmon, herring, sardines) 2-3 times/ week Eat wholegrain bread and cereals instead of white/ low fibre Use olive or rapeseed oils & spreads Add more natural nuts into your diet (e.g. walnuts, almonds or hazelnuts)  Reduce red meat intake and eat poultry more often  Alcohol in moderation (optional)

Mediterranean diet meal plan Breakfast Fruit or small glass of unsweetened fruit juice Wholegrain breakfast cereal/ porridge/ muesli Wholemeal bread/ toast with olive oil spread   Lunch Soup and wholemeal bread Small portion of chicken/ fish/ egg/ cheese Salad Wholemeal bread Fruit and yoghurt Evening meal Small portion meat/ chicken/ fish/ egg Plenty of salad/ vegetables Potatoes, rice, pasta, other grains or wholemeal bread Fruit for dessert Glass of wine (optional) MENU Wholegrain bagel with olive oil spread +fresh fruit Lentil soup + wholegrain bread Mediterranean-style marinated fish or chicken Snacks: Fruit/ nuts

Mediterranean diet recipes LENTIL SOUP Heat the olive oil in a saucepan and add the onion and garlic. Sauté gently for 5 minutes until softening   Add the rest of the vegetables and cook for a further 4-5 minutes. Add the lentils and stock and bring to the boil. Simmer for 15-20 minutes. Season with pepper, blend until smooth. Pour the mixture back into the pan, reheat gently. Serve with wholemeal bread 2 tbsp olive oil 1 clove garlic, thinly sliced 1 carrot, diced 1 large onion, sliced 1 celery stick, sliced 1 medium potato, diced 1-2 slices of turnip, diced 100g (4oz) red lentils 1L (1 ¾ pt) chicken or vegetable stock (serves 4)

Mediterranean diet recipes MED-STYLE MARINATED FISH (or chicken) In a bowl, mix olive oil, vinegar, pepper, basil, thyme and garlic.   Coat both sides of the fish/ chicken fillets. Break the bay leaves into 3-4 pieces, press onto both sides of fillets. Cover and refrigerate for at least an hour. Remove the bay leaves. Cook in a non-stick pan over a medium-high heat. Serve with potatoes, pasta, rice or another ‘grain’ such as couscous and vegetables 2 (100g/4oz) fish fillets (or chicken breasts) 2 tbsp olive oil 2 tsp red wine vinegar ½ tsp ground black pepper ½ dried basil or thyme ¼ tsp garlic granules 2 bay leaves (serves 2)

Encouraging adoption of a Mediterranean diet

TEAM-MED Study Time 0 12 (months) 75 people at risk of heart disease Peer support (25) Time 0 12 (months) Written Mediterranean diet advice (25) Sessions with Dietitian and provided olive oil and nuts (25) We are currently working on the TEAM-MED study. The aim of this study is to examine different ways of supporting people, at risk of heart disease to change their diet towards a MD. We will recruit 75 individuals that are at risk of heart disease but who have no history of heart disease or diabetes. Individuals will be asked to follow a MD for 12 months and will be given different levels of support; 1 group will receive written advice, one group will receive sessions with a dietitian and olive oil and nuts and one group will receive peer support- which is a form of support provided by individuals that have experience of successfully making dietary changes to lower their risk of heart disease.

TEAM-MED Study TEAM-MED is seeking to recruit suitable people to take part in the study.    If you are over 40 years, overweight and with no previous history of heart disease, stroke or diabetes you may be eligible to take part in TEAM-MED. For more details contact: Claire McEvoy: c.mcevoy@qub.ac.uk (tel: 02890 632764) or Sarah Moore: smoore550@qub.ac.uk (tel: 02890 635020)

Nutrition and Metabolism Group Centre for Public Health, QUB Thank you for your attention Any questions?