Page last updated: Thursday, January 31, 2008
Review of recent presentations on the mediterranean diet by R. Curtis Ellison, MD Institute on Lifestyle & Health Boston University School of Medicine
Cottin Y. Evaluation of alcohol consumption based on the Mediterranean diet adherence score after myocardial infarction in patients with coronary artery disease. Data from the Observatoire des Infarctus du myocarde de Côte d’Or (RICO), The RICO Survey, CHU Dijon, France.

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Cottin described the level of a Mediterranean diet adherence score (MDS-1), proposed by Trichopoulos in Greece, when applied to French patients having had a myocardial infarction. In the adherence score, alcohol consumption is given 5 points for a consumption of up to 300 ml of an alcoholic beverage per day (the equivalent of up to about 3 drinks/day). Four points to 1 point are given for greater amounts of alcohol (between 300 and 700 ml), and 0 points for a consumption of more than 700 ml per day or total abstinence from alcohol. (Thus, maximum points are given for moderate drinking but no points if abstaining or drinking greater amounts of alcohol.)

In an earlier study from Greece, the mean score was 24 out of 55. In RICO, the mean score of the French subjects was higher, 27.5. Subjects with dyslipidemia had higher scores than those with normal lipids, and there were lower scores among smokers and higher scores among patients over 60 years of age. A total of 48% of subjects in the RICO study consumed between 1 and 3 drinks/day, which contributed 5 points to their scores. The author states that the better adherence among their patients with dyslipidemia suggests that such patients are more sensitive to the relationship between eating habits and cardiovascular disease. He suggests that this adherence score is easily implemented and serves as a useful evaluation tool to assess the dietary status of patients with coronary artery disease in both clinical and research situations.

Comment: This paper describes the application of an adherence score for judging how closely someone is following a Mediterranean-type diet (which is increasingly being shown to lower the risks of heart disease and most other diseases of ageing). In this study of people who had had a myocardial infarction, those with abnormal lipids and older subjects appeared to be better at following such a diet.

Another way of estimating overall lifestyle can be based on the 5-component definition of a “healthy lifestyle” from the epidemiologists at Harvard: (1) not smoking, (2) eating a Mediterranean-type diet, (3) not being obese, (4) getting regular moderate exercise, and (5) consuming 1/2 to 2 drinks/day (unless alcohol is contraindicated). With each approach, moderate drinking makes a significant contribution to the score.

Goñi I, Perez-Jimenez J, Saura-Calixto F*. Contribution of wine to the total antioxidant capacity of the Mediterranean diet. Unidad de Nutrición y Salud Gastrointestinal (CSIC-UCM) Instituto del Frio-Facultad de Farmacia, 28040 Madrid, Spain.

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In a paper by Goñi and colleagues, it was stated that dietary antioxidants may be a critical mediator of the beneficial effects of the Mediterranean diet (MD), and a greater adherence to the MD is associated with a high antioxidant capacity levels in serum. The objective of this work was to estimate the contribution of wine consumption in Southern France to total intake of antioxidants using a measurement termed the total dietary antioxidant capacity (TDAC). In their earlier studies in Spain, wine consumption (90 mL/person/day) represented 19% of the TDAC (with a greater percentage of antioxidants coming from coffee.)

The MONICA epidemiological study found the lowest coronary heart disease mortality in the region of Toulouse, France, where a daily intake of 383 ml of wine was reported. The authors stated that if they assume that the antioxidant capacity of the Toulouse wine is comparable to that of Spanish red wine, the antioxidant capacity solely from wine intake in Toulouse is equivalent to the TDAC of the whole Spanish diet. Adding the reported intake of 238 g of fruit and 306 g of vegetables to wine consumption, the estimated antioxidant intake in Toulouse is very high and could be a key factor in the low coronary heart disease mortality in this region.

Comment: The TDAC is a measure of the intake of phenolics, and may be a reasonable index of anti-oxidant capacity. The dramatic percentage of the TDAC from wine among subjects in Toulouse suggests that wine may be an important factor in the demonstrated very low rates of coronary heart disease in that area of France.

Leighton F*, Urquiaga I. Mediterranean diets and oxidative stress in the metabolic syndrome. Molecular Nutrition and Chronic Diseases Center, Universidad Católica de Chile, Casilla 114-D, Santiago, Chile.

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Striking results from an intervention study were reported by Leighton and Urquiaga. It was stated that Mediterranean Diets are associated with reduced incidence of the metabolic syndrome (MS), which adversely affects endothelial function, haemostatic parameters, inflammatory markers and antioxidants. In a 12-month intervention study in an industrial plant, the authors studied approximately 150 workers, of whom 24% had MS at baseline. As part of the intervention, the authors conducted educational lectures with workers, modified the arrangement of foods at the plant cafeteria, and presented additional fresh vegetables in a salad bar.

At the end of the intervention, there was a 71% increase in vegetable consumption and a 71% decrease in red meat consumption. There was a significant decrease in triglycerides, and a striking lowering of blood pressure. The number of subjects meeting criteria for MS decreased by 48%.

Comment: Using interventions at the work place has been tried for several decades, with mixed results in terms of lowering blood pressure or blood cholesterol. The dramatic benefits in this study (reducing metabolic syndrome by 48%) suggests that Dr. Leighton and his colleagues were very effective in increasing the consumption of a Mediterranean diet. This study demonstrates that a combination of education and modification of food presentation (including re-arranging the plant’s cafeteria to make healthier foods more available and making the workers search to find foods such as bread, hi-fat and hi-sugar foods, and red meat) markedly reduced the prevalence of MS, and could be especially important in reducing the risk of cardiovascular disease.

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