Patients’ dietary patterns are important triggers or modulators when it comes to cardiometabolic disease risk assessment. It has been stated that cardiovascular disease is the leading cause of death in the United States. Indeed, the United States population is commonly known for following the standard American diet (SAD) characterized by excess sodium, saturated fats, refined grains, and added sugars. Nowadays, clinical treatment guidelines recommend improving dietary patterns and habits to be the first line in preventing CVD and cardiometabolic disease.
The progression of chronic diseases is strongly influenced by the patient’s lifestyle and nutritional practices. Consequently, the SAD is playing a major role in creating a deleterious ecosystem. The combination of high sodium intake, excess sugar, refined grains, and saturated fat content leads to a proinflammatory ecosystem and promotes oxidative stress. This matter is the reason why clinical guidelines have recommended a low-fat diet intending to reduce CVD risk. However, observational studies show that a Mediterranean diet can have a better prevention potential than a low- fat diet. Let’s see why.
PREDIMED (Primary Prevention of Cardiovascular Disease with the Mediterranean diet) trial was research performed in the Spanish population on 7447 participants with high CVD risk enrolled. Furthermore, this study’s main focus was to change the nutritional recommendation from a low-fat diet to a Mediterranean diet supplemented with nuts or extra virgin olive oil (EVOO).
Moreover, the population was divided into three groups:
- Mediterranean diet + 1 liter per week of EVOO.
- Mediterranean diet + 30g of mixed nuts.
- low-fat diet + counseling (encourage fish and poultry low-fat dairy products, fruits, vegetables, and starches including bread, pasta, potatoes, and rice while minimizing the use of oils, nuts, fatty fish and meats, commercial baked goods, and fried foods
The evaluations were done every 1, 3, and 5 years. However, the study head to be terminated earlier due to the overwhelming difference between the groups’ starting cut-off points. Consequently, the study resulted in a 30% relative risk reduction of myocardial infarction, stroke, and overall death of CVD-related causes in the two Mediterranean diet groups when compared to the Low-fat group.
It is safe to mention that the primary factors influencing this prevention potential are protecting against oxidative stress.
- High unsaturated fat content.
- High polyphenol and micronutrient content.
- Macronutrient distribution.
Baseline oxidative stress:
In PREDIMED, a 527 patient cohort sample was compared to a healthy population (n=25). This comparison concluded that the PREDIMED cohort had an excess of oxidative stress markers, including damaged DNA. Furthermore, some of these markers were malondialdehyde (MDA), oxidized glutathione (GSSG), and GSSG/glutathione (GSH) ratio was increased, revealing a more negative oxidative stress profile in the individuals with high CVD risk. Besides, these patients showed lower levels of antioxidant enzymatic activity, such as catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx), leading to a decreased endogenous antioxidant activity.
Antioxidant systems and MedDiet:
Is it the EVOO?
The underlying mechanism of how the MedDIet can improve the endogenous antioxidant activity is not fully understood. However, observational studies have seen important improvements in SOD and CAT activity in those groups that intervene with MedDiet supplemented with EVOO or 30g of nuts. Another important fact is that pro-oxidant activity was decreased in these groups. When total antioxidant capacity (TAC) was measured in the three groups, the EVOO- supplemented group resulted in a higher TAC than the nuts-supplemented group.
Are the polyphenols responsible for MedDiet antioxidant protection?
The influence of vitamins and polyphenols against oxidative stress and systemic inflammation is well-established. Besides this, the protective effects of these factors against stroke, heart failure, and cancer are discussed elsewhere.
The primary sources of vitamins and polyphenols in the MedDiet are fruits, EVOO, whole grains, vegetables, nuts, and red wine. These compounds are believed to inhibit multiple inflammatory pathways, including NF-kB, e Nod-like receptor pyrin domain-containing protein (NLRP)3 inflammasome, and mitogen-activated protein kinase (MAPK). Ultimately, the interaction of vitamins and polyphenols reduce the synthesis of f proinflammatory cytokines such as interleukin(IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF-a), which have, in turn, been associated with adverse CV events.
|Betacarotene (vitamin A)|
|Polyphenols (secondary plant metabolites characterized by a large number of phenol groups.)|
Furthermore, a food frequency questionnaire (FFQ) gathered information about the primary sources of polyphenols consumed by the participants in PREDIMED. In this questionnaire, the primary source of polyphenols was coffee, followed by oranges, apples, olives, and EVOO, and lastly, red wine. When these groups were separated into quintiles to lowest polyphenol intake, those in the highest quintile presented a 37% relative mortality risk reduction.
Also, when looking for individual polyphenol protective effects, lignans were associated with a 49% relative risk reduction of CV events. Besides, in the PREDIMED cohort, EVOOO was the primary source of lignans. This reiterates EVOO’s potential to reduce inflammation, inhibit oxidative stress, and downregulate the expression of pro-atherosclerosis genes.
Now more than ever, we are invited to improve our health, not by traveling endless miles, working out complicated exercise routines, or buying expensive pills. The only thing that we need to do is improve our habits. Furthermore, the PREDIMED study provides us with a better insight into what to do and what amount to lower the risk of CVD. Today you can start improving your health by making a small change. How about some nuts? Or maybe add olive oil to that salad?
I said it before, and I will repeat it: it is refreshing to see a change towards the best finally. Instead of quitting the salt, we are going more profound, but it seems so much easier to follow a dietary pattern no longer based on limitation. Using the Mediterranean diet allows the patient to stop fearing the fats and introduce new flavors to their cuisine. The inclusion of fruits, vegetables, nuts, olive oil, olives, and wine is possible in our region, and the ingredients are easy to find and savory. – Ana Paola Rodríguez Arciniega, MS.
From the kitchen to your genes
Creamy coconut Tuscan salmon
Heat the olive oil in a pan and add the salmon fillet.
Remove the fillets when they are fully cooked.
Add the garlic, tomatoes, olives, and spinach to the pan.
Add the coconut milk and Italian spices to the mix
Serve the salmon fillets and top it with the mixture. Enjoy!
Billingsley, Hayley E., and Salvatore Carbone. “The antioxidant potential of the Mediterranean diet in patients at high cardiovascular risk: an in-depth review of the PREDIMED.” Nutrition & diabetes 8.1 (2018): 1-8.
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