23 Sep 2004 09:52:07 -0700 in article
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(Tony Lew) said:Matti Narkia <[email hidden]> wrote in message news:<[email hidden]>...
Quoted message said:22 Sep 2004 16:01:54 -0700 in article
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(Tony Lew) said:[email hidden] (Roman Bystrianyk) wrote in message news:<[email hidden]>...
> http://www.healthsentinel.com/news.php?event=news_print_list_item&id=264
>
> Liz Szabo,, "We should all eat like a Mediterranean", USA Today,
> September 22, 2004,
> Link: http://www.usatoday.com/news/health/2004-09-21-mediterranean-usat_x.htm
>
> Two new studies confirm the health benefits of eating the
> Mediterranean way.
>
> In a study in today's Journal of the American Medical Association,
> mortality rates were 65% lower among elderly people who combined a
> so-called Mediterranean diet with 30 minutes of daily exercise,
> moderate drinking and no tobacco use.
>
> Although experts say there is no single Mediterranean diet, doctors
> say cuisines from these regions favor olive oil rather than butter and
> include lots of legumes, nuts, seeds, grains, fish, vegetables and
> potatoes but little meat and dairy.
Little dairy? Really? Then what do the mediterraneans do with all
the cheese they make? Export it? Feed it to the dogs?
The best example of Mediterranean diet is the traditional Cretan diet, which
contains relatively low amount of dairy products. Only fermented dairy
products, feta cheese and yoghurt made of goat or sheep milk are used. And
yes, Mediterranean countries do export cheese.\
Then why is it called the "Mediterranean" diet when most Mediterraneans
don't eat like that?
As I understand it, the name originates from _traditional_ Mediterranean
diets. During last decades the diets may have deteriorated also in the
Mediterranean area. _Traditional_ Mediterranean diets have common features
which distinguishes the Mediterranean diet pattern for example from
American, English, German, Northern European, or Japanese diet pattern. Best
features of Mediterranean diets have been analyzed and many studies have
used a scoring system for measuring the adherence to the best common
features of traditional Mediterranean diets. In these scoring systems
generally above median consumption of beneficial components and below median
consumption of detrimental components increase the adherence score.
Generally, beneficial components are vegetables, legumes, fruits and nuts,
cereal, and fish, and detrimental components are meat, poultry, and dairy
products. Therefore, if a person uses for example a lot of meat and dairy
products, his/her adherence score will be lower.
The scoring system used in the subject study
Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in
Elderly European Men and Women.
The HALE Project.
Kim T. B. Knoops, MSc; Lisette C. P. G. M. de Groot, PhD; Daan
Kromhout, PhD; Anne-Elisabeth Perrin, MD, MSc; Olga Moreiras-
Varela, PhD; Alessandro Menotti, MD, PhD; Wija A. van Staveren,
PhD
JAMA, September 22/29, 2004; 292:1433-1439.
<URL:http://jama.ama-assn.org/cgi/content/full/292/12/1433>
is described there as follows:
"To assess the association of diet and the lifestyle factors
with mortality, a low-risk group was defined for diet and
lifestyle factors. For dietary intake, the low-risk group
was defined as those who had a score of at least 4 on a
modified version of the Mediterranean diet score proposed by
Trichopoulou et al.4
The modified Mediterranean diet score comprised 8
components: ratio of monounsaturated to saturated fat;
legumes, nuts, and seeds; grains; fruit; vegetables and
potatoes; meat and meat products; dairy products; and fish.
Intake of each component was adjusted to daily intakes of
2500 kcal (10.5 MJ) for men and 2000 kcal (8.5 MJ) for
women. The sex-specific median intake values were taken as
cutoff points. The diet score varied from 0 (low-quality
diet) to 8 (high-quality diet). For the components
monounsaturated fatty acids to saturated fatty acids (MUFA
to SAFA) ratio; fruits and fruit products; vegetables and
potatoes; legumes, nuts, and seeds; fish; and grains, a
value of 1 was assigned to persons whose consumption was at
least as high as the sex-specific median value, and 0 to the
others. The vegetables group of the original Mediterranean
diet score was replaced by the vegetables and potatoes group
because the European classification system (EUROCODE) was
used when the 2 food groups were assessed together.16 For
meat and meat products and dairy products, a value of 1 was
assigned to persons whose consumption was less than the sex-
specific median and 0 to the others.
The low-risk group for alcohol was defined as those who
consumed more than 0 g of alcohol per day. Alcohol
consumption was initially divided into 3 groups: 0 g, 1 to
29 g, and 30 g or more of alcohol per day. However, the
Kaplan-Meier survival curves of the 3 alcohol groups showed
no difference in survival between participants who consumed
between 1 g to 29 g of alcohol per day and those who
consumed 30 g or more alcohol per day.
For smoking, individuals were considered to be at low risk
if they had never smoked or had stopped smoking more than 15
years ago.17-19
Individuals with a score in the intermediate and the highest
tertile on the Voorrips or Morris questionnaire were
considered the low-risk group for physical activity.14-15
A lifestyle score was calculated by adding the individual
scores for diet, physical activity level, smoking status,
and alcohol intake. Individuals scored 1 point if they
belonged to the low-risk group for diet or a particular
lifestyle factor and 0 if they belonged to the high-risk
group. In total, an individual could obtain 4 points: 1
point for a Mediterranean diet and 3 points for the
healthful lifestyle factors."
This scoring system left out alcohol from Mediterranean diet score, because
it was included as a separate factor. Other scoring systems have included
alcohol. The above cited "the Mediterranean diet score proposed by
Trichopoulou et al.4" is described in the study
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D.
Adherence to a Mediterranean diet and survival in a Greek population.
N Engl J Med. 2003 Jun 26;348(26):2599-608.
PMID: 12826634 [PubMed - indexed for MEDLINE]
<URL:http://content.nejm.org/cgi/content/full/348/26/2599?ijkey=954de3729cd4bf6a762b30acdf92d99b1f97f246>
as follows:
"A scale indicating the degree of adherence to the
traditional Mediterranean diet was constructed by
Trichopoulou et al.6 and revised to include fish intake.35 A
value of 0 or 1 was assigned to each of nine indicated
components with the use of the sex- specific median as the
cutoff. For beneficial components (vegetables, legumes,
fruits and nuts, cereal, and fish), persons whose
consumption was below the median were assigned a value of 0,
and persons whose consumption was at or above the median
were assigned a value of 1. For components presumed to be
detrimental (meat, poultry, and dairy products, which are
rarely nonfat or low-fat in Greece), persons whose
consumption was below the median were assigned a value of 1,
and persons whose consumption was at or above the median
were assigned a value of 0. For ethanol, a value of 1 was
assigned to men who consumed between 10 and 50 g per day and
to women who consumed between 5 and 25 g per day. Finally,
for fat intake, we used the ratio of monounsaturated lipids
to saturated lipids, rather than the ratio of
polyunsaturated to saturated lipids, because in Greece,
monounsaturated lipids are used in much higher quantities
than polyunsaturated lipids. Thus, the total Mediterranean-
diet score ranged from 0 (minimal adherence to the
traditional Mediterranean diet) to 9 (maximal adherence)."
"A scale indicating the degree of adherence to the traditional Mediterranean
diet was constructed by Trichopoulou et al.6" in the above excerpt refers to
the study
Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C,
Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L,
Trichopoulos D.
Diet and overall survival in elderly people.
BMJ. 1995 Dec 2;311(7018):1457-60.
PMID: 8520331 [PubMed - indexed for MEDLINE]
<URL:http://bmj.bmjjournals.com/cgi/content/full/311/7018/1457>
An excerpt from there:
"For analysis the frequency of consumption of different food
items was quantified approximately in terms of the number of
times a month the food was consumed, as done by Graham et
al4 and Katsouyanni et al.5 Thus, daily consumption was
multiplied by 30 and weekly consumption by 4, a value of 0
was assigned to food items rarely or never consumed. Food
items were considered in groups as recommended by Davidson
and Passmore6 and used by Graham et al,4 Dales et al,7 and
Trichopoulou et al.8 Food frequencies were translated into
food quantities in grams per day on the basis of standard
portion size estimations, and they were further adjusted to
daily intakes of 2500 kcal for men and 2000 kcal for women.
Nutrient intakes for individual people were estimated by
multiplying the nutrient contents of a selected typical
portion for each specified food item by the frequency that
the food item was eaten a month and adding these estimates
for all food items. Data on the nutrient composition of
Greek foods and recipes were based on a nutrient database
developed in Greece by the department of nutrition and
biochemistry, National School of Public Health.9 The
estimation of portion size was based on the results from
previous validation studies.3 10 11
Composite scores are often used to describe total diet;
these scores are necessary for the evaluation of
epidemiological associations,11 12 although they require
some operational definitions. We used the food groups
recommended by Davidson and Passmore6 in devising a score
except that we combined starchy roots with cereals and did
not consider sugars and syrups for which no systemic health
implications have been documented over and beyond their
contribution to net energy intake. The traditional
Mediterranean diet is also defined in terms of these food
groups with the addition of moderate intake of ethanol13 14
and therefore can be reasonably scored in terms of eight
component characteristics: high monounsaturated:saturated
fat ratio; moderate ethanol consumption (there were no men
who drank more than seven glasses of wine a day and no women
who drank more than two glasses of wine a day so that no
study subject could be considered a heavy drinker); high
consumption of legumes; high consumption of cereals
(including bread and potatoes); high consumption of fruits;
high consumption of vegetables; low consumption of meat and
meat products; and low consumption of milk and dairy
products. We used as a cut off point for all characteristics
the corresponding median values specific for each sex. We a
priori hypothesised that a diet with more of these
components has beneficial health effects whereas a diet with
fewer of these components would be less healthy. These
considerations are based on the collective epidemiological
and biological evidence as summarised in the report of the
National Academy of Science1 and a recent critical
overview.15 In our study sample only 34 subjects (or 19% of
the total) were found to have two or fewer of the eight
desirable dietary components, whereas 104 subjects (57%)
were found to have four or more of the eight desirable
components, a reasonable pattern given the attachment of
elderly rural Greeks to their traditional diet.
The statistical analysis was undertaken by modelling the
data through Cox's proportional hazards regression.16 This
approach takes into account not only the event of death but
also the time until its occurrence. An assumption in the
model is that the rate ratio is constant over follow up
time. Initially, eight Cox's models were developed; these
controlled for age at enrolment (in three month intervals),
sex (0=female, 1=male), and current smoking status (0=non-
smoker, 1=smoker) and evaluated alternatively the eight
individual components of the diet score adjusted for energy.
An additional Cox's model was developed that controlled for
age at enrolment, sex, and current smoking status and
evaluated the total diet score as a predictor of the hazard
of death. Survival curves were plotted by using the Kaplan-
Meier method."
--
Matti Narkia
