1. Mediterranean diet and
heart health
Dr Claire McEvoy and Sarah Moore

2. Overview
Does a Mediterranean diet reduce risk of heart disease and diabetes?
What is the Mediterranean diet?
TEAM-MED research study

3. 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

4. Mediterranean Diet and Heart Disease
Seven Countries Study (1968)
Disease rates and dietary patterns differed across countries
Mediterranean diet responsible?
RESEARCH
Keys et al., 1986

5. Does a Mediterranean diet reduce risk of heart disease and diabetes?

6. 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

7. PREDIMED Study Year Heart events over 5 years Low fat diet60
Med diet + nuts 50
% people had heart event 40 30
Med diet + olive oil 20 10
Year
Estruch et al., 2013

8. Survival without diabetes over 5 years (non-diabetic individuals)
PREDIMED Study
Survival without diabetes over 5 years (non-diabetic individuals)
Med diet + olive oil
Cumulative survival from diabetes
Med diet + nuts
Low fat diet
Salas-Salvadó et al., 2011

9. 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)

10. 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.

11. Mediterranean Diet: How it reduces risk
Blood pressure Cholesterol Blood glucose Weight gain

12. 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

13. 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

14. What is the Mediterranean diet?

15. 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

16. Mediterranean Diet Pyramid

17. Mediterranean Diet guidelines
Bach-Faig et al., 2011
Every main meal
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

18. 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)

19. 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
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)
MENU
Wholegrain bagel with olive oil spread +fresh fruit
Lentil soup + wholegrain bread
Mediterranean-style marinated fish or chicken
Snacks: Fruit/ nuts

20. 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
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 minutes.
Season with pepper, blend until smooth.
Pour the mixture back into the pan, reheat gently.
Serve with wholemeal bread
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)

21. 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.
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
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)

22. Encouraging adoption of a Mediterranean diet

23. TEAM-MED Study Time 0 12 (months)
75 people
at risk of heart disease
Peer support (25)
Time
(months)
Written Mediterranean diet advice (25)
Sessions with Dietitian and provided olive oil and nuts (25)
We are currently working on the TEAM-MED study. The aim of this study is to examine different ways of supporting people, at risk of heart disease to change their diet towards a MD.
We will recruit 75 individuals that are at risk of heart disease but who have no history of heart disease or diabetes. Individuals will be asked to follow a MD for 12 months and will be given different levels of support; 1 group will receive written advice, one group will receive sessions with a dietitian and olive oil and nuts and one group will receive peer support- which is a form of support provided by individuals that have experience of successfully making dietary changes to lower their risk of heart disease.

24. 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 (tel: ) or
Sarah Moore: (tel: )

25. Nutrition and Metabolism Group Centre for Public Health, QUB
Thank you for your attention
Any questions?