The objective of the present study was to evaluate the effect of a nutritional intervention promoting the Mediterranean food pattern in free-living conditions on LDL electrophoretic characteristics in a group of seventy-one healthy women, aged between 30 and 65 years. The 12-week nutritional intervention consisted of two courses on nutrition and seven individual sessions with a dietitian. The first course provided information on the Mediterranean food pattern and the second was a cooking lesson. LDL peak particle diameter (LDL-PPD) and cholesterol levels in small (LDL-cholesterol<255 A) and large LDL fractions (LDL-cholesterol>260 A) were obtained by 2-16 % polyacrylamide gel electrophoresis of whole plasma. The sample was divided on the basis of baseline LDL-PPD using tertiles of the distribution (258.4 A and 260.0 A). Among the total sample of women, no significant change in LDL-PPD was observed in response to the nutritional intervention. However, subjects who at baseline were in the first tertile of the LDL-PPD distribution (<258.4 A) showed a significant increase in LDL-PPD and in the proportion of LDL %>260 A in response to the 12-week nutritional intervention (P<0.05). In contrast, LDL-PPD decreased significantly (P=0.007) among women with large LDL particles at baseline (LDL-PPD >260 A) while the proportion of LDL %<255 A and of LDL %>260 A remained unchanged. To conclude, changes in the food pattern, in response to a nutritional intervention promoting the Mediterranean food pattern, were accompanied by beneficial modifications in LDL electrophoretic characteristics in women who were characterised at baseline by smaller LDL particles.
CONTEXTO: El síndrome metabólico se ha identificado como un objetivo para las terapias dietéticas para reducir el riesgo de enfermedades cardiovasculares; sin embargo, el papel de la dieta en la etiología del síndrome metabólico es poco conocido.
OBJETIVO: Evaluar el efecto de una dieta de estilo mediterráneo en la función endotelial y los marcadores inflamatorios vasculares en pacientes con el síndrome metabólico.
Diseño, lugar y pacientes: ensayo aleatorizado, simple ciego realizado entre junio de 2001 enero de 2004 a un hospital universitario en Italia entre 180 pacientes (99 hombres y 81 mujeres) con el síndrome metabólico, según la definición del Adult Treatment Panel III.
Intervenciones: Los pacientes en el grupo de intervención (n = 90) fueron instruidos para seguir una dieta de estilo mediterráneo y recibieron asesoramiento detallado sobre cómo aumentar el consumo diario de cereales integrales, frutas, verduras, frutos secos y aceite de oliva; los pacientes en el grupo de control (n = 90) siguieron una dieta prudente (hidratos de carbono, 50% -60%; proteínas, 15% -20%; grasa total, <30%).
Principales medidas de resultado: la ingesta de nutrientes; puntuación de la función endotelial como una medida de la presión arterial y la respuesta de agregación de plaquetas a L-arginina; parámetros de lípidos y glucosa; sensibilidad a la insulina; y los niveles de alta sensibilidad proteína C-reactiva (PCR-as) y las interleucinas circulante 6 (IL-6), 7 (IL-7), y 18 (IL-18).
RESULTADOS: Después de 2 años, los pacientes que siguen la dieta de estilo mediterráneo se consume más alimentos ricos en grasas monoinsaturadas, poliinsaturadas y fibra y tenía una relación más baja de ácidos grasos omega-6 y ácidos grasos omega-3. Fruta Total, vegetal, y la ingesta de frutos secos (274 g / d), ingesta de granos integrales (103 g / d), y el consumo de aceite de oliva (8 g / d) fueron también significativamente mayor en el grupo de intervención (P <0,001). El nivel de actividad física aumentó en ambos grupos en aproximadamente un 60%, sin diferencia entre los grupos (P = 0,22). La media (SD) de peso corporal disminuyó más en los pacientes en el grupo de intervención (-4,0 [1,1] kg) que en los del grupo de control (-1,2 [0,6] kg) (p <0,001). En comparación con los pacientes que consumen la dieta de control, los pacientes que consumen la dieta de intervención habían reducido significativamente las concentraciones séricas de hs-CRP (P = 0,01), IL-6 (P = 0,04), IL-7 (P = 0,4), e IL -18 (P = 0.3), así como disminución de la resistencia a la insulina (P <0,001). Puntuación de la función endotelial mejorado en el grupo de intervención (cambio medio [DE], 1,9 [0,6]; p <0,001), pero se mantuvo estable en el grupo control (0,2 [0,2], p = 0,33). A los 2 años de seguimiento, 40 pacientes en el grupo de intervención todavía tenían las características del síndrome metabólico, en comparación con 78 pacientes en el grupo de control (P <0,001).
CONCLUSIÓN: Una dieta de estilo mediterráneo podría ser eficaz en la reducción de la prevalencia del síndrome metabólico y el riesgo cardiovascular asociado.
The type of diet consumed by individuals has been associated with the development of some chronic diseases, including cardiovascular disease (CVD), cancer, diabetes, and others. Populations that consume diets rich in fruits and vegetables and drink wine in moderation, as the Mediterranean, have a higher life expectancy and less chronic diseases than other occidental populations. We carried out an intervention study in humans to evaluate the effect of a Mediterranean diet (MD), an Occidental diet (OD) and their supplementation with red wine, on biochemical, physiological and clinical parameters related to atherosclerosis and other chronic diseases. For 3 months, two groups of 21 male volunteers each, received either a MD or an OD; during the second month, red wine was added isocalorically, 240 ml/day. At days 0, 30, 60 and 90, clinical, physiological and biochemical evaluations were made. In this article we report on the results obtained in plasma fatty acids profile that includes saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), omega-6 fatty acids, omega-3 fatty acids and omega-6/omega-3 ratio. Other results have been published previously. Plasma fatty acid percentages in the OD group, compared to the MD group, did not show differences in SFA, but the OD group showed lower levels of MUFA and omega-3 fatty acids, and higher levels of PUFA and omega-6 fatty acids, with a higher omega-6/omega-3 ratio than the MD group. Wine supplementation reduced MUFA and increased PUFA in both dietary groups, suggesting that wine could improve a diet with a good omega-6/omega-3 ratio. Volunteers on MD showed a better fatty acid profile than those on OD, suggesting a lower cardiovascular risk. Moderate consumption of wine improves this profile in the MD group.
OBJECTIVE: To report the rationale, recruitment, design, dietary intervention and baseline characteristics of participants in the Medi-RIVAGE study (Mediterranean Diet, Cardiovascular Risks and Gene Polymorphisms).
DESIGN: A randomised, parallel trial comparing a new nutritional programme with a conventional programme.
SETTING: Centre for Detection and Prevention of Arteriosclerosis, Timone University Hospital, Marseille, France, and collaborating teams.
SUBJECTS: Two hundred and twelve male and female volunteers with at least one cardiovascular risk factor.
INTERVENTION: A Mediterranean-type diet characterised mainly by the quality of fatty acids, amount of fish, vegetable foodstuffs and fibre was proposed and compared with a usually prescribed, low-fat/cholesterol diet. Body mass index, fasting lipids and lipoproteins, apolipoproteins, glucose, insulin and homocysteine were the main outcome measures. Gene polymorphisms of interest were determined.
RESULTS: Characteristics of men in the two arms were comparable with regard to sociodemographic variables, and clinical and biological cardiovascular risk factors. There were few differences between the groups of women (cholesterol-related parameters, P<0.05). There was no difference between arms in allelic distribution of the gene polymorphisms studied. Saturated fat and protein intakes were high while carbohydrate and fibre intakes were low, but with no difference between arms. Overall, the nutritional markers were comparable in both arms with few exceptions. Correlations between nutritional intakes and plasma nutrient levels ranged from 0.19 (beta-carotene) to 0.47 (folate).
CONCLUSIONS: The comparability of the two arms is notable and warrants a low risk of biases. Current diet departs from the traditional Mediterranean one. The assessment of nutritional intake is validated by correlations obtained between dietary intake and relevant biomarkers. This will be important to estimate participant compliance and to analyse intervention data.
BACKGROUND: Epidemiological studies suggest that nut intake decreases coronary artery disease (CAD) risk. Nuts have a cholesterol-lowering effect that partly explains this benefit. Endothelial dysfunction is associated with CAD and its risk factors and is reversed by antioxidants and marine n-3 fatty acids. Walnuts are a rich source of both antioxidants and alpha-linolenic acid, a plant n-3 fatty acid.
METHODS AND RESULTS: To test the hypothesis that walnut intake will reverse endothelial dysfunction, we randomized in a crossover design 21 hypercholesterolemic men and women to a cholesterol-lowering Mediterranean diet and a diet of similar energy and fat content in which walnuts replaced approximately 32% of the energy from monounsaturated fat. Participants followed each diet for 4 weeks. After each intervention, we obtained fasting blood and performed ultrasound measurements of brachial artery vasomotor function. Eighteen subjects completing the protocol had suitable ultrasound studies. Compared with the Mediterranean diet, the walnut diet improved endothelium-dependent vasodilation and reduced levels of vascular cell adhesion molecule-1 (P<0.05 for both). Endothelium-independent vasodilation and levels of intercellular adhesion molecule-1, C-reactive protein, homocysteine, and oxidation biomarkers were similar after each diet. The walnut diet significantly reduced total cholesterol (-4.4+/-7.4%) and LDL cholesterol (-6.4+/-10.0%) (P<0.05 for both). Cholesterol reductions correlated with increases of both dietary alpha-linolenic acid and LDL gamma-tocopherol content, and changes of endothelium-dependent vasodilation correlated with those of cholesterol-to-HDL ratios (P<0.05 for all).
CONCLUSIONS: Substituting walnuts for monounsaturated fat in a Mediterranean diet improves endothelium-dependent vasodilation in hypercholesterolemic subjects. This finding might explain the cardioprotective effect of nut intake beyond cholesterol lowering.
Mediterranean-inspired diets have been shown to decrease cholesterol levels in patients with hypercholesterolaemia, who frequently exhibit endothelial dysfunction. The aims of the present study are to improve endothelial function by dietary intervention in healthy subjects with lipid levels representative of a Western population. Twenty-two healthy subjects (mean total cholesterol, 5.6 mmol/l) were given a Mediterranean-inspired diet rich in omega-3 fatty acids and sterol esters, but low in saturated fat, or an ordinary Swedish diet, for 4 weeks in a randomized cross-over study. The composition of the diets were: in the Swedish diet, 2090 kcal (where 1 kcal=4.184 kJ; 48% of energy from carbohydrate, 15% from protein and 36% from fat) and 19 g of fibre; in the Mediterranean-inspired diet, 1869 kcal (48% of energy from carbohydrate, 16% from protein, 34% from fat) and 40 g of fibre. After each dietary period, fasting blood lipids, insulin and glucose levels, as well as apo B (apolipoprotein B) and LDL (low-density lipoprotein) particle size, were analysed. Endothelial-dependent and -independent vasodilation was measured invasively by venous occlusion plethysmography, and arterial distensibility was assessed by echocardiography tracking. Fibrinolytic capacity across the forearm, as well as oxidative stress measured through urinary F(2)-isoprostane, were evaluated. Total, LDL- and apo B-cholesterol and triacylglycerol (triglyceride) concentrations were decreased by 17%, 22%, 16% and 17% respectively, after the Mediterranean-inspired diet compared with the Swedish diet ( P <0.05 for all). However, no differences in plasma concentrations of insulin and glucose and LDL particle size, endothelial function, arterial distensibility, fibrinolytic capacity or oxidative stress were detected. Treatment for 4 weeks with a Mediterranean-inspired diet decreased blood lipids in healthy individuals with a low-risk profile for cardiovascular disease. This beneficial effect was not mirrored in vascular function or oxidative stress evaluation.
OBJETIVOS: comparar los efectos de una dieta alta en carbohidratos (CHO) y una dieta de ácidos grasos de alto monoinsaturado (MUFA) sobre la resistencia a la oxidación de LDL en individuos que viven en libertad con diabetes mellitus tipo 2.
Métodos: Veintidós hombres y mujeres pacientes ambulatorios con diabetes tipo 2, con una edad media de 61 años y en el control metabólico justo (HbA1c <8,0%), se inscribieron en una clínica de lípidos hospital universitario en un ensayo de alimentación cruzado aleatorio comparando dos dietas hipocalóricas durante 6 semanas cada una: CHO (grasa, 28% de la energía) y ácidos grasos monoinsaturados (grasa, 40% de energía) a base de aceite de oliva virgen. Mediciones de resultado fueron los cambios en la susceptibilidad a la oxidación de LDL, el peso corporal, el control glucémico, y los perfiles de lipoproteínas.
RESULTADOS: planeadas y las dietas observadas fueron bien adaptado. Los participantes prefirieron la dieta MUFA sobre la dieta CHO. El tiempo de retraso de la formación de dieno conjugado durante Cu2 + inducida por la oxidación LDL fue similar después de que las dietas CHO y MUFA (36,4 +/- 12,2 min y 36,0 +/- 13,7 min, respectivamente). El peso corporal, el control de la glucemia, triglicéridos totales, y total, los niveles de LDL y HDL-colesterol también fueron similares después de las dos dietas. En comparación con la dieta de CHO, la dieta MUFA rebajado VLDL-colesterol en un 35% (P = 0,023) y de triglicéridos VLDL por 16% (P = 0,016).
CONCLUSIONES: basada en alimentos naturales-alta y alta CHO-MUFA dietas tienen efectos similares sobre la resistencia a la oxidación de LDL y el control metabólico en pacientes con diabetes tipo 2. Una dieta MUFA es una buena alternativa a las dietas altas en CHO para el tratamiento nutricional de la diabetes, ya que también tiene un efecto beneficioso sobre el perfil lipídico y la aceptación del paciente superior.
BACKGROUND: Mediterranean and high carbohydrate diets play a dominant role in the prevention of atherosclerosis as a result of their lipid lowering effect. However, diets can also have a protective effect in other ways, such as modulating tissue factor expression in circulating monocytes.
METHODS AND RESULTS: Forty-one subjects participated in this randomised crossover study consisting of three dietary periods: a saturated fat enriched diet (SFA), a low fat and high carbohydrate diet (CHO), and a Mediterranean diet. Plasma levels of total cholesterol, triglycerides, low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) were determined at the end of each dietary period, as was the expression of tissue factor (TF) in circulating monocytes isolated from blood samples. Total cholesterol, LDL-C, HDL-C and TF expression were lower after the Mediterranean and high carbohydrate diets than after the SFA diet, and there was a positive correlation between LDL-C levels and monocyte TF expression.
CONCLUSIONS: High carbohydrate and Mediterranean diets reduce the expression of TF in circulating monocytes.
