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
RESEARCH
• Mediterranean diet
responsible?
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
Heart events over 5 years
Low fat diet
60
Med diet + nuts
50
% people 40
had heart
30
event
Med diet +
olive oil
20
10
0
0
1
2
3
Year
4
5
Estruch et al., 2013
PREDIMED Study
Cumulative survival from diabetes
Survival without diabetes over 5 years (non-diabetic individuals)
Med diet +
olive oil
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
Every main meal
Bach-Faig et al., 2011
• 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
MENU
Wholegrain bagel with olive
oil spread +fresh fruit
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)
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
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)
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
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.
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)
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
Encouraging adoption of a
Mediterranean diet
TEAM-MED Study
Time
0
(months)
75
people
at risk
of heart
disease
12
Written Mediterranean
diet advice (25)
Sessions with Dietitian
and provided olive oil
and nuts (25)
Peer support (25)
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?