jaime rozowski, ph.d. · fish and shellfish 3 ± 1 26 ± 9 17 ± 8 21 ± 2 0.001 legumes 13 ± 4 16...

Mediterranean Diet and HealthJaime Rozowski, Ph.D.

Characteristic eating pattern of theMediterranean Diet

Olive oil as the main fat

Abundance of vegetable foods

Fresh fruits and vegetables

Cereals and legumes

Nuts

Frequent consumption of fish

Wine

Low consumption of red meats, dairy products and simple sugars

Frequent use of spices (lemon, garlic, herbs)

Proximal composition of the MD

•Proteins : 18% of total calories (TC)

•Carbohidrates : 55% TC

•Total fat : 27% (25 a 40%)TC

•Polyunsaturated : 7% of fat calories

•Monounsaturated: 13% of fat cfalories

•Saturated : 7% of fat calories

•Cholesterol : 270 mg/day

•Fiber : 40 - 50 g/day

Mediterranean Diet in Chile

Chile is a Mediterranean country

Why?Why?

1. Climate

2. Agriculture

3. Health

4. Diet

Chile is a Mediterranean country

CLIMATE

1. Climate

• Dry summer and relatively humid winter

• 30° - 45° latitud

• Chile is one of the 5 regions in the world that have amediterranean climate:

– Mediterranean area in Europe and Africa– Central California in USA– Central Chile in South America– Area of Cape Town in South Africa– Southwest Australia

1. Mediterranean Climate

California Entorno delMediterráneo

Chile Sudáfrica Australia

Fuente: Presentación Inaugural Seminario “Chile Potencia Agroalimentaria”, Alberto Montanari, Octubre2004

2. MEDITERRANEAN

AGRICULTURE

2. MEDITERRANEAN

AGRICULTURE

• It is not specific of countries around theMediterranean Sea

• It is the result of geographic, climatic,demographic and cultural conditions

2. MEDITERRANEAN

AGRICULTURE

Fruits and vegetablesCerealsLegumes and nutsWineOlive oil

2. Mediterranean Agriculture

Countries where olives are grown

3. MEDITERRANEAN

HEALTH

3. Mediterranean Health

107

136,3

185,2 191,2

219,1

150,3

233,9

260,6275,3

0

50

100

150

200

250

300

Francia

España

Italia

Grecia

EEUU

Chile

Cuba

Argentina

Brasil

Adjusted Mortality Rate Due to Coronary Heart Disease (deaths/100.000)

4. DIET

Food Contributions to Caloric Intake

España Chile1993-1995

Source: FAO Balance Sheets

Foods Contributions to Caloric Intake

España Chile1993-19951961

Source: FAO Balance Sheets

Intervention Studies using Mediterraneandiet and Wine

-1998 Western Diet, Mediterranean diet in youngstudents

-1999Western MUFA or PUFA in young students

-2000 Mediterranean diet, 51-70 years old

-2008 Meditteranean diet by cafeteria modification

STUDY DESIGN

0 30 60 90

TIME (DAYS)

MEDITERRANEANn=21

HIGH FATn=21

Componentes de la Dieta Experimental

0 200 400 600 800 1000

1

2

3

4

5

6

7aceite (32 ml oliva/32 ml maravilla)

fibra (44/12)

papas (117/230)

pan, cereales y

legumbres (311/261)

carnes blancas (157/74)

carnes rojas (72/209)

frutas y verduras (675/246)

Gramos/día

OXIDATIVE DNA DAMAGEOXIDATIVE DNA DAMAGE8-

OH

8-

OH

dG

dG

High fat diet Mediterranean diet

PLASMATIC POLYPHENOLSµ

M R

uti

n e

qu

ival

ent

High fat dietHigh fat diet MediterraneanMediterranean dietdiet

Time (days)

00 3030 6060 9090 00 3030 6060 9090

MUFA n = 22MUFA n = 22

DISEÑO DEL ESTUDIODISEÑO DEL ESTUDIO

PUFA n = 20

TIEMPO (semanas)

0 74 10 13

CALORIC DISTRIBUTIONCALORIC DISTRIBUTION

MUFA DIETMUFA DIET PUFA DIETPUFA DIET

CHOCHOCHOCHO

PROTPROTPROTPROT

SFASFA SFASFA

MUFAMUFA MUFAMUFA

PUFAPUFAPUFAPUFA

OXYDATIVE DNA DAMAGEOXYDATIVE DNA DAMAGE8-

OH

8-

OH

dG

dG

a

*b

c

ed

A

*B

C

D

E

OBJETIVOSPrograma de Alimentación Laboral

Disminuir la incidencia de SíndromeMetabólico

Una familia, 1989

Fernando Botero

2. SÍNDROMEMETABÓLICO

ENCUESTA NACIONAL DE SALUD (ENS 2003)(Directora, Dra. Catterina Ferreccio, DSP, FM, UC)

• Workers

• Mediterranean Diet(on a freedom to choose basis)

• Metabolic Syndrome

Canteen intervention strategy:

PAL(Food at Work Program)

Center for Molecular Nutrition and Chronic DiseasesCatholic University of Chile

DESIGN OF THE INTERVENTION:

• All workers that use the industry canteen (lunch) are invited toparticipate

• The physical-architecture distribution of food stands at thecanteen is modified. Also the food offer is modified.

• Educational talks (4 per year) plus printed material and a bookspecifically designed for the workers

• Supported by a multidisciplinary team


Time 4 months

Oct 06Time 8 months

Mar 07

Time 12 months

Jul 07

MEASUREMENTS IN VOLUNTEERS: clinical and nutritional interview, bloodsamples

DIETARY INTERVENTION:

Food Mediterranization in MD canteen (free choice)Food Mediterranization in MD canteen (free choice)

Metabolic Syndrome risk factors:Metabolic Syndrome risk factors:- Abdominal Obesity

- HDL-Cholesterol Other measurements:Other measurements:- Blood Pressure - Nutrients in blood

- Triglycerides - Oxidation parameters

- Fasting Glucose - Inflammation, hemostasis, and others

Time 0

Jun 06

INTERVENTION STUDYINTERVENTION STUDY

in Maestranza Dieselin Maestranza Diesel


Junio 2006 Octubre 2006 Marzo 2007 Junio 2007

71% increase71% increase

VEGETABLES, excluding potatoesVEGETABLES, excluding potatoes(grams daily, per person, weekly averages,

consumption at the industry canteen)

June 2006 October 2006 March 2007 July 2007weeks


PAN BLANCO Y PAN INTEGRAL

-

20

40

60

80

100

Basal 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Co

nsu

mo

pro

med

io d

iari

o e

n c

asin

o

(g/d

ía/p

ers

on

a)

Pan blanco

Pan Integral

White bread

Whole bread

BREAD(grams daily, per person, weekly averages,

consumption at the industry canteen)

June 2006 October 2006 March 2007 July 2007weeks

Evolution of food composition at lunch time, average daily consumption per person at the cafeteria, along the twelve months diet mediterranization intervention period.

Food item at lunch(grams/person)

Basal Month 4 Month 8 Month 12 p value*

Vegetables (withoutpotatoes)

175 ± 27 280 ± 19 330 ± 63 264 ± 19 0.001

Potatoes 87 ± 36 83 ± 50 56 ± 32 83 ± 26 0.623

Fruits 47 ± 21 93 ± 30 149 ± 5 106 ± 13 0.000

White meat 53 ± 27 43 ± 28 56 ± 25 69 ± 16 0.535

Red meat 104 ± 19 38 ± 13 32 ± 4 38 ± 13 0.000

Fish and shellfish 3 ± 1 26 ± 9 17 ± 8 21 ± 2 0.001

Legumes 13 ± 4 16 ± 6 16 ± 2 14 ± 4 0.622

Dairy products 20 ± 8 7 ± 7 9 ± 6 11± 5 0.075

White bread 80 ± 9 31 ± 12 34 ± 5 34 ± 3 0.000

Whole grain bread 0 31 ± 6 24 ± 5 33 ± 2 0.000

Cereals 45 ± 8 57 ± 11 49 ± 3 62 ± 15 0.154

Vegetable fat 15 ± 9 0 13 ± 10 0 ± 1 0.011

Olive oil 0 7 ± 0 7 ± 1 6 ± 0 0.000

Canola oil 0 21 ± 0 9 ± 11 21 ± 3 0.000

Eggs 12 ± 6 6 ± 4 6 ± 2 4± 3 0.058

Sugar 16 ± 4 8 ± 4 14 ± 1 18 ± 3 0.005

MUFA/SFA 1.1 ± 0.0 3.7 ± 0.1 3.1 ± 1.1 3.2 ± 0.4 0.000

Omega-6/omega-3 39.3 ± 6.3 2.6 ± 0.2 15.4 ±11.9 2.7 ± 0.1 0.000

Data include all the workers that had lunch at the canteen, an average of 140, 145, 132, 155 workers per day at the basalmonth characterization period and at months 4, 8 and 12, respectively. * One way ANOVA of daily consumption values for

each food item.

Vegetables (without potatoes)Leguminous (plus nuts and dried fruits)Fruits (raw or cooked)Whole cereales (in pasta, rice, bread, others)Lean red meat - (beef, chicken, pork, 7 - 8% fat)Fish and seafoodRed meat (all fat-rich meats plus ham, viscera, sausages, from pork, bovine, and

ovine sources)Alcohol (moderate and regular, versus abstinence, excess, or binge)Dairy products, low-fat, fermentedDairy high fat non-fermented (cream, whole milk, butter)Vegetable oil (sunflower, soy, canola, vegetable margarines)Olive oilAvocadoSugar and sugar in food

Vegetables (without potatoes)Leguminous (plus nuts and dried fruits)Fruits (raw or cooked)Whole cereales (in pasta, rice, bread, others)Lean red meat - (beef, chicken, pork, 7 - 8% fat)Fish and seafoodRed meat (all fat-rich meats plus ham, viscera, sausages, from pork, bovine, and

ovine sources)Alcohol (moderate and regular, versus abstinence, excess, or binge)Dairy products, low-fat, fermentedDairy high fat non-fermented (cream, whole milk, butter)Vegetable oil (sunflower, soy, canola, vegetable margarines)Olive oilAvocadoSugar and sugar in food

MEDITERRANEAN DIET SCORE,in elaboration (PAM-Chile)



0

30

- 1 2 3 4 5 6 7 8 9 10 11 12 13 14

0

4

8

12

Mediterranean Diet ScoreMediterranean Diet Score

Mon

thM

onth

NN

Evolución del Índice de Alimentación Mediterránea(Hombres)

X = 4,85X = 4,85

X = 5,65X = 5,65

X = 6,74X = 6,74

X = 7,38X = 7,38




WHAT HAPPENED WITH

THE PREVALENCE OF

METABOLIC SYNDROME?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

JUNIO 2006 OCTUBRE 2006

ESTADO DE LA SALUDSíndrome Metabólico

24%

45%4455%%

32%19%

23%

56%5566%%

Distribución en Nº de factores de riesgo SM alterados

0 FR1 FR2 FR3 FR4 FR5 FR

19%

27%

29%

16%

29%

32%

7% 4%

16%18%

2% 1%

ESTADO DE LA SALUDSíndrome Metabólico

Factores de Riesgo de SM alterados

Junio 2006

1,68

Octubre 2006

1,35

20%20% de disminución

p < 0,000


Average number of Metabolic Syndrome RiskAverage number of Metabolic Syndrome RiskFactors per personFactors per person

(n = 90 , a cohort of men that completed all controls, without medical(n = 90 , a cohort of men that completed all controls, without medicaltreatment for these factors)treatment for these factors)

June 2006

1.611.61

July 2007

1.091.09

32% decrease32% decrease

p < 0,000

SM y DM en Maestranza Diesel (n = 90, hombres sin HTA)

23%19%

15% 12%

77%81%

85% 88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Basal 4 meses 8 meses 12 meses

% d

e v

olu

nta

rio

s

sin SM

SM

Metabolic Syndrome and Mediterranean Diet (n = 90)

without MS

with MS

Basal 4 months 8 months 12 months

N°

volu

ntee

rs

Casos de SM durante el estudio (sólo hombres)

21 1

4

32

15

13

10

8

3

0

3

6

9

12

15

18

21

Basal 4 meses 8 meses 12 meses

Nº

de

vo

lun

tari

os

3 FR

4 FR

5 FR

48%48%

decreasedecrease

Metabolic Syndrome and Mediterranean Diet (n = 90)

Basal 4 months 8 months 12 months

N°

volu

ntee

rs

CONCLUSIONS

1- Diet Mediterranization in adults is feasible. Nutritionand Gastronomy must act synergistically to promote the diet.

2- Clinical, Nutritional and Biochemical parametersallow monitoring the effect of this Functional Food Diet

3- Metabolic Syndrome is effectively controlled withMediterranean Diet. A suitable Score has been developed

4- Further efforts should center on functional foods,rich and enriched in:

- polyphenol antioxidants (gut & systemic)- sirtuin agonists- w3, w9 fatty acids- dietary fiber

PARTICIPANTS

PONTIFICIA UNIVERSIDAD CATOLICA DECHILE

Faculty of Biological Sciences

Faculty of Medicine

Faculty of Engineering

THANK YOU

jaime rozowski, ph.d. · fish and shellfish 3 ± 1 26 ± 9 17 ± 8 21 ± 2 0.001 legumes 13 ± 4 16...

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