Trichopoulou Olive Oil

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Trichopoulou Antonia, MD

WHO Collaborating Centre for Nutrition

Department of Epidemiology

Medical School, University of Athens

International Conference on Mediterranean Diet and HealthDecember 11-12, 2007New Delhi

Mediterranean Diet- A Gift of God


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The MD can be thought of as having 9 characteristics:

high olive oil consumption

high consumption of legumes

high consumption of cereals

high consumption of fruits

high consumption of vegetables

moderate consumption of dairy products, mostly as cheese and yogurt

moderate to high consumption of fish

low consumption of meat and meat products

moderate w ine consumption, if it is accepted by religion and social norms


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Ecological studies

Case-control studies

Prospective cohort studies

Randomized intervention studies

Mediterranean diet and Health:

Epidemiological Evidence


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Life expectancy / Disease Rates in U.S., Greeceand Japan, in 1960s

U.S. Greece JapanLife expectancy at

age 45 in years(M) 27 31 27

(F) 33 34 32

Coronary Heart

Disease (M) 18933

34

(F) 54 14 21

Cerebrovascular

Diseases(M) 30 26 102

(F) 24 23 57

Breast Cancer (F) 22 8 4

Stomach Cancer (M) 6 10 48

(F) 3 6 26

Colon, Rectal Cancer (M) 11 3 5

(F) 10 3 5

Total Cancer (M) 102 83 98

(F) 87 61 77Source:W. Willett, Science 1994


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EPIC participating countries


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European Prospective Investigation intoCancer and Nutrition (EPIC)

22 centres in 10 European Countries

Approximately 500.000 Europeans

participate in the EPIC project

Coordinating Center

International Agency for Research on Cancer (IARC)

Word Health Organization


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EPIC GREECE


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Many studies have evaluated theassociation between single foods, food

groups, or nutrients andchronic diseases

Last 10 years: focus on theidentification of a dietary pattern that

maximizes longevity


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Dietary patterns have the ability to:

integrate complex or subtle interactive effect

or many dietary exposures


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per2-unit increase in Mediterranean diet score

A higher degree of adherence to the Mediterranean diet was associated witha significant reduction in :

total mortality

adjusted mortality ratio0.75

coronary heart disease


cancer


Trichopoulou et al. NEJM 2003

Adherence to a editerranean diet and survival in a Greek population


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Rather than single foods or nutrients,a global health dietary pattern could

exert protective effect

The combination of different types offood with healthy characteristics

might be necessary to express theirprotective potential


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The role of diet on the longevity of elderly Europeans

QLK6-CT-2001-00241

100 000 elderly Europeans

> 60 years at enrolment

from 9 European countries, participants of EPIC


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Results

per2-unit increase in Mediterranean diet score

A higher degree of adherence to the Mediterranean diet was associated with

8% reduction in overall mortality:

But the reduction was considerably higher in Mediterranean countries like

Spain and Greece

Trichopoulou et al. BMJ 2005

Modified Mediterranean diet and survival: EPIC-Elderly cohort


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Knoops et al. JAMA, 2004

Mediterranean Diet, Lifestyle Factors, and 10-year mortality in ElderlyEuropen Men and Women

Among individuals aged 70 to 90 years,

adherence to a Mediterranean diet and

healthful lifestyle is associated with a more than

50% lower rate of all- cause and cause-specific

mortality


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Effect of a Mediterranean style diet on endothelial dysfunction and

markers of vascular inflammation in the metabolic Syndrome a

randomized trial markers

Esposito et al. JAMA 2004

A Mediterranean-style diet might be effective

in reducing

the prevalence of the metabolic syndrome

and its associated cardiovascular risk


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Results

a2-unit increase in Mediterranean diet score

was associated with

27 % reduction in overall mortality

among individuals diagnosed

as having coronary heart disease

Trichopoulou et al. Arch Intern Med 2005

Mediterranean diet and survival of coronary patients: EPIC-Greece cohort


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Results (continued)

The reduced mortality amounted to 31%

when only cardiac deaths were considered

as the relevant outcome


Mediterranean diet and survival of coronary patients: EPIC-Greece cohort


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Conclusion

Greater adherence to the traditional Mediterranean diet

is associated with a significant

reduction in mortality among individuals diagnosed ashaving coronary heart disease

Modified Mediterranean diet and survival: EPIC-Elderly cohort



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2671 EPIC participants

from nine countries

60 years or older

had prevalent myocardial infarction but no stroke

or cancer at enrollment

Trichopoulou A. et al. Eur J Epidem 2007

Modified Mediterranean diet and survival after myocardial

infarction: the EPIC-Elderly study


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Increased adherence to modified Mediterranean diet

by two units

was associated with

18% lower overall mortality rate

Trichopoulou A. et al. Eur J Epidem 2007

Modified Mediterranean diet and survival after myocardial

infarction: the EPIC-Elderly study


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Effects of a Mediterranean-style diet on cardiovascular risk factors:

a randomized trial

Estruch et al. Ann Intern Med, 2006

Compared with a low-fat diet

Mediterranean diets supplemented witholive oil or nuts have beneficial effects on

cardiovascular risk factors


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An increase of olive oil consumption

by one standard deviation was associated with

significant reduction

of both systolic and diastolic blood pressure

by almost 1mm Hg and 0.5 mm Hg

across 20 343 individuals

Olive oil, Mediterranean diet and arterial blood pressure: the Greek EPIC cohort

Psaltopoulou et al. 2004 AJCN


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Mediterranean diet in relation to body mass index and waist-to-hip

ratio: the Greek EPIC Study

Trichopoulou et al.Am J Clin Nutr 2005

There is no association

between

Mediterranean diet

and

BMI or W/H ratio


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The data indicated that

the traditional Mediterranean dietary pattern

may be inversely associated with BMI

Schroder, J Nutr 2004

Mediterranean diet and obesity in a Spanish population


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Olive oil and the Mediterranean diet: beyond the rhetoric

Serra-Mayem L. 2003 Eur J Clin Nutr

> 13,5 % of total calories from olive oil< 6,8 % of total calories from olive oil

Consumers of larger quantities of olive oil have

low saturated fat intake,

high consumption of vegetables and legumesand

more adequate vitamin intake


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Minor constituents of olive oil

Hydrocarbons

Non-glyceride esters

Tocopherols

Carotenoids

Aliphatic alcohols4-methyl sterols

Sterols

Hydroxy-and dihydroxy-terpenic alcoholsPhospholipids

Phenolic compounds (50-800 mg/Kg)

ChlorophylsGlycolipids

Aldehydes

Ketons

Esters


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The effect of polyphenols in olive oil on heart disease risk factors: a

randomized trial.

Olive oil is more than a monounsaturatedfat

Its phenolic content can also providebenefits for plasma lipid levels and

oxidative damage

Covas et al Ann Intern Med. 2006


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Ongoing research aims to elucidate

the role of dietary antioxidants in disease prevention

The main approach was based on the hypothesis

that the chronic disorders common in many societies

are relatedto cumulative oxidative damage to DNA, proteins and

lipids in body tissues

Oli il d d i i id l h l i hibi d h li l


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Olive oil and red wine antioxidant polyphenols inhibit endothelial

activation: antiatherogenic properties of Mediterranean diet

phytochemicals.

Carluccio et alArterioscler Thromb Vasc Biol. 2003

Antiatherogenic properties of Mediterranean diet

phytochemicals

Olive oil and red wine antioxidant polyphenols

inhibit endothelial activation

Eff t f t diti l M dit di t li t i id ti


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Effect of a traditional Mediterranean diet on lipoprotein oxidation:

A randomized, controlled trial

Fito et al.Arch Intern Med, 2007

Individuals at high cardiovascular risk

who improved their diet

toward a Traditional Mediterranean Diet

pattern

showed significant reductions in cellular

lipid levels and LDL oxidation


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The traditional Mediterranean diet isassociated with longer survival

This could be partly attributed to

Mediterranean traditional foods, which

this diet implies


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1

10

100

1000

10000

log(d

ailyintake,mg)

K Fe Na Ca Mg Zn Cu Mn

Inorganic constituents

Mediterranean menu

EC daily recommendations

1. Commission of the European Communities. Food-Science Techniques: Reports of the Scientific Committeefor Food (Thirty-first series), Office for Official Publications of the European Communities, Luxembourg,1993,pp 1-248

1


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The Netherlands

Tea beverages

Onions

Apples

Greece

Apples

Parsley

OnionsOlives

Spring onions

Red wine

Spinach

Contributors to the main flavonoids

categories intake for Greece & TheNetherlands

1

1. Hertog, Hollman, Katan, Kromhout Intake ofpotentially anticarcinogenic flavonoids and their

determinants in adults in The Netherlands, NutrCancer 1993;20(1):21-9

CO C S O S


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CONCLUSIONS

high flavonoid content- obtained from wide range of foods

The investigated traditional Mediterranean menu :

meets current dietary recommendations balanced diet

Trichopoulou et al. 2005 Diet diversification and health promotion. Forum Nutr.Basel, Karger,

Vasilopoulou et al. 2005Curr.Med.Chem-Immun, Endoc.& Metab.Agents,


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Med Diet Healthy alternative approach

Not sharply different from other recommended diets

Two elements distinguish it from other prudent diets

1. It stresses the pattern rather than individual components

and

2. Provides no restriction on lipid intake so long as they are notsaturated and are preferably in the form of olive oil


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Conclusion

Mediterranean diet corresponds so well

to the ideal diet, as currently understood

by the scientific community that can bethought of as a gift of the God to the

people of the Mediterranean basin.


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Conclusion

Results from large-scale observational

studies indicate that diets freely chosen

by the general population can approachthe Mediterranean-diet optimum

provided that the nutritional milieu and

the food culture are conducive to the

adoption of a Mediterranean diet


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"Let food be thy medicine

andmedicine be thy food"

Hippocrates


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