Professional Documents
Culture Documents
Objectives of Seminar
1. Review of evidence of benefits of a Mediterranean diet in the dietary management of diabetes and cardiovascular disease;
2. The dietary recommendations for clients with diabetes and/or cardiovascular disease; 3. Three take home messages.
CHD mortality +ve association with SatF and -ve association with MonoFat
Cretan Cohort had lowest CHD Mortality linked to their diet (Med diet).
Source: Kromhout D., Keys A., Aravanis C. et al. Food Consumption patterns in the 1960s in seven countries. Am J Clin Nutr 1989;49:889-94.
The Healthy Greek Mediterranean Diet is a 1960s Post WWII Peasant Diet
Bioactive phytochemicals
Vit C Vit E Carotenoids Phytoestrogens Phenolics Allylthiosulfinates Flavonoids Selenium N3 fatty acids: ALA and EPA DHA
Ref: Simopoulos and Sidosis. What is so special about the Greek diet? World Rev Nutr Diet 2000
High Prevalence of CHD Risk Factors Obesity/ Hypertension/ Inactivity and Diabetes (Hodge et al, 2004; AIHW, 2006). Despite > 50 years since migration!
Published Evidence?
PubMed Search reveals 2142 published papers on Mediterranean diet (yrs:1961-2011)
Published papers
Med diets down-regulate inflammatory biomarkers (CRP, IL-6, endothelial adhesion molecules) in addition to lowering BP, IR and dyslipidaemia.
Ref: Estruch, R. Proceedings Nutr Soc 2010;69:333-340.
At 2 yrs 40/90 on Med diet still had MetabS whereas 78/90 on prudent diet still had MetabS
Esposito et al. JAMA 2004;292(12):1440-1446
Mediterranean diet: more sustainable weight loss and better for diabetes.
Lunch:
Baked fish with boiled potatoes and boiled leafy green vegetables (dandelion/ endive) Fresh fruit Red wine*
Dinner:
Thick bean and vegetable soup Slice wholegrain bread Greek salad: tomato/ cucumber/onion/ olive oil/ herbs + sm piece feta cheese Fresh fruit
Snacks:
Baklava* (*only once per week) Natural yoghurt Dried figs/ walnuts/ roasted chickpeas/ sultanas
Food Preparation
Foods prepared in using traditional methods; Food preparation was conducted and supervised by Greek women; All foods prepared using fresh ingredients.
Control Diet
6g
23g 65g
Cretan Diet
106g
162g
466g
149g
45g
P = 0.012
Clinically significant change in HbA1c (of the order found in many clinical drug trials) Change of - 0.3 HbA1c% = 10% reduction in CHD Mortality in T2 diabetes
Promotes Longevity?
Sofi et al, Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008:337:1344.
Is Genetics Important?
Greeks in Greece are becoming more Westernised and Heart Disease Risk factors are on the increase:
Kafatos et al. demonstrated significant changes in heart disease risk factors in the original Cretan Cohort at 30 years follow-up. AJCN 1997 Magkos et al investigated trends in cardiovascular risk factors among school-aged boys from Crete, Greece, 19822002 and found that boys were taller and heavier in 2002 and had a worse heart disease risk factors which may lead to early mortality. EJCN
2005
Greek migrants have maintained important components of the traditional Greek Mediterranean diet since migration (high intakes of vegetables, cereals, nuts, legumes, fresh fruit and olive oil) but increased meat and dairy food intake (Kosmidis et al,
1980; McMichael, 1983; Powles, 1990; Kouris-Blazos, 1996).
Food Habits In Later Life study found that intake of legumes associated with 8% reduction in mortality (Blackberry, Kouris-Blazos,
Wahlqvist et al, 2004).
Adherence to Med-style diet associated with lower risk of CVD mortality (Harriss et al, 2007). MCCS
Conclusions: Prevalence of Diabetic Retinopathy was lower in Greek-born vs Australian-born men with diabetes - not explained by established risk factors. Protective effect of ethnicity may be attributed to consumption of Mediterranean diet.
AGEs in Foods
Exogenous AGEs: Formed in foods by Maillard reaction e.g. browning of foods through toasting/ BBQ/ grilling at high temperatures/ dry heat. Effect of cooking:
Doughnut Duck skin pre 2,590 & post 60,820 AGE U/g PRO pre 2,350 & post 236,180 AGE U/ g PRO (Koschinsky et al, 1997)
Low in saturated fat Moderately low in protein Focus on slow and moist method of cooking Highly plant based (low substrate)
Renal Disease
AGEs
Accelerated Ageing
Myocardial dysfunction
Retinopathy
Nephropathy
Neuropathy
The Impact of Cooking Method on the AGE Content of a Healthy Greek Diet
Authors: Nor Fadhilla Shahril, Karen Walker, Allison Hodge, Laima Brazionis, Tania Thodis, Melinda Coghlan, Josephine Forbes, Kerin ODea, Catherine Itsiopoulos.
RCT 16 healthy M and F with 4 weeks on both arms and 4 weeks washout
Baseline Measurements
Week 4
Week 12
Beef casserole with peas, carrots, onions, potatoes and tomatoes Fish with potatoes 827 kU AGE/serve
Grilled/fried steak with potato chips Fried fish with potato chips 7897 kU AGE/serve Meatballs
Meatballs
Slow moist cooking (180oC in oven) without browning Raw Sliced Deli beef (no charring) or poached chicken
Red pepper Pita bread & cold cooked beef (or fresh cooked chicken)
Almonds
Eggs 182 kU AGE/serve
Raw
Boiled/poached/scra mbled
Almonds
Eggs 1287 kU AGE/serve
Roasted
Fried
Change in serum AGEs (as CML**) following low and high AGE diets
Serum AGE levels following Greek AGE diets
400.00
Serum AGE levels (ng/ml)
*
327
*
277
336 298
Before LAGE
Before HAGE
End of HAGE
PRELIMINARY DATA
Nor Fadhilla Shahril et al. (AMS Thesis)
Mighty Aphrodite
432 Greek and Australian-born people aged 44-83yrs +/- type 2 diabetes Investigations included diet, body composition, blood chemistry, clinical measures and lifestyle
PCA identified 3 CVD risk factor clusters: diabetes, vascular risk, metabolically healthy obesity
In multivariate analyses, the metabolically healthy obesity factor was positively associated with Greek ethnicity (p<0.001), negatively associated with prevalent CHD (p<0.002) and positively associated with adherence to a traditional Greek Mediterranean diet (p<0.01).
Pre-diabetes and Metabolic Syndrome Conference, Spain 6-9 April 2011
The following dietary principles were derived from our experience with this dietary study :
60mls/day (3 tblsp/d)
2. Eat vegetables with every meal: include leafy greens and tomatoes
100g tomatoes
(1 whole med.)
5. Eat Meat (beef, lamb, pork, chicken) less often (smaller portions)
Cheese in moderation
8.
small tastes
Small serve meat and Risoni pasta Red pepper salad Lettuce salad
Cauliflower salad
Acknowledgements
Dr Laima Brazionis (Uni Adelaide) Professor Kerin ODea (Uni SA) Theano Itsiopoulos my
mum
Paraskevi Koutsis my
mother in law
Dr Antigone Kouris (LaTrobe) Tania Thodis (LaTrobe) Dr Karen Walker (Monash Uni) Dr Allison Hodge (Cancer Council Victoria) Mary Kaimakamis (formerly @Cancer Council Victoria) Melissa Cameron (Cancer Council)