Scientific Aspects That Justify the Benefits of the Mediterranean Diet
Mild-to-Moderate Versus Heavy Drinking
Corresponding Author
M. I. COVAS
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Address for correspondence: Dr. M.I. Covas, Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), Carrer Dr. Aiguader, 80, 08003 Barcelona, Spain. Voice: 34-932211009; fax: 34-932213237; [email protected].Search for more papers by this authorJ. MARRUGAT
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorM. FITÓ
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorR. ELOSUA
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorC. DE LA TORRE-BORONAT
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorCorresponding Author
M. I. COVAS
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Address for correspondence: Dr. M.I. Covas, Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), Carrer Dr. Aiguader, 80, 08003 Barcelona, Spain. Voice: 34-932211009; fax: 34-932213237; [email protected].Search for more papers by this authorJ. MARRUGAT
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorM. FITÓ
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorR. ELOSUA
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorC. DE LA TORRE-BORONAT
Lipids and Cardiovascular Research Unit, Municipal Institute for Medical Research (IMIM), 08003 Barcelona, Spain
Search for more papers by this authorAbstract
Abstract: The Mediterranean diet is now recognized as being both limited in toxicity and abundant in nutrient and non-nutrient protective factors. A large body of basic, clinical and epidemiological studies have been developed in recent years to provide evidence of the benefits of the Mediterranean diet or its components on health. Evidence-based medicine ranks randomized controlled clinical trials as providing the highest level of evidence and expert opinions the lowest. On the basis of these criteria, the current state of knowledge about Mediterranean diet in primary and secondary prevention of disease and mortality and morbidity as functions of the amount of alcoholic beverage consumption, is reviewed. Efficacy versus effectiveness, the role of basic and animal research, and bioavailability studies providing evidence is also discussed.
REFERENCES
- 1 Keys, A., A. Menotti & M.I. Karovene. 1986. The diet and 15-years death rate in the Seven Countries Study. Am. J. Epidemiol. 124: 903–915.
- 2 Ducimetiere, P., L. Richard, F. Cambien, et al. 1980. Coronary heart disease in middle-aged Frenchmen. Comparisons between Paris Prospective Study, Seven Countries and Pooling Project. Lancet 1: 1346–1350.
- 3 Gjonca, A. & M. Bobak. 1998. Albanian paradox, another example of protective effect of Mediterranean lifestyle Lancet 351: 835–836.
- 4 Pérez, G., A. Pena, J. Sala, et al. 1998. Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. REGICOR Investigators. Int. J. Epidemiol. 27: 599–604.
- 5 Masiá, R., A. Pena, J. Marrugat, et al. 1998. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infraction incidence. REGICOR Investigators. J. Epidemiol. Comm. Health 52: 707–715.
- 6 Tunstall-Pedoe, H., K. Kuulasmaa, M. Mahonen, et al. 1999. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10 year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353: 1547–1557.
- 7 McGovern, P.G., J.S. Pankow, E. Shahar, et al. 1996. Recent trends in acute coronary heart disease-mortality, morbidity, medical care, and risk factors: The Minnesota Heart Survey Investigators. N. Engl. J. Med. 334: 884–890.
- 8 Trichopoulou, A. & P. Lagiou. 1997. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutr. Rev. 55: 383–389.
- 9 Jovell, A.J. & M.D. Navarro-Rubio. 1995. Evaluation of scientific evidence. Med. Clin. (Barc.) 105: 740–743.
- 10 Sackett, D.L. & W.M. Rosenberg. 1995. On the need for evidence-based medicine. J. Public Health Med. 17: 330–334.
- 11 Wolff, S.M, R.N. Battista, G.M. Anderson, et al. 1990. Assessing the clinical effectiveness of preventive manoeuvres: analytic principals and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian Task Force on the Periodic Health Examination. J. Clin. Epidemiol. 43: 891–905.
- 12 U.S. Preventive Task Force. 1989. Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions. Williams and Wilkins. Baltimore.
- 13 Goodman, C. 1993. Literature Searching and evidence interpretation for assessing health care practices. The Swedish Council of Technology Assessment in Health Care. Stockholm. Sweden.
- 14
De Lorgeril, M., P. Salen, J.L. Martin,
et al.
1999. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction.
Final report of the Lyon Diet Heart Study. Circulation
99: 779–785.
10.1161/01.CIR.99.6.779 Google Scholar
- 15 De Lorgeril, M., P. Salen, J.L. Martin, et al. 1998. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch. Intern. Med. 158: 1181–1187.
- 16 Kouris-Blazos, A., C. Gnardellis, M.L. Wahlqvist, et al. 1999. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br. J. Nutr. 82: 57–61.
- 17 Trichopoulou, A., A. Kouris-Blazos, M.L. Wahlqvist, et al. 1995. Diet and overall survival in elderly people. Br. Med. J. 311: 1457–1460.
- 18 Lasheras, C., S. Fernandez, A.M. Patterson, et al. 2000. Mediterranean diet and age with respect to overall survival in institutionalised, non-smoking elderly people. Am. J. Clin. Nutr. 71: 987–992.
- 19 Hu, F.B., E.B. Rimm, M.J. Stampfer, et al. 2000. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am. J. Clin. Nutr. 72: 912–921.
- 20 Lairon, D. 1998. Mediterranean diet, fats and cardiovascular disease risk: what news? Br. J. Nutr. 82: 5–6.
- 21 Kris-Etherton, P.M & the Nutrition Committee. 1999. AHA Science Advisory. Monounsaturated fatty acids and risk of cardiovascular disease. Circulation 100: 1253–1258.
- 22 Hu, F.B, M.J. Stampfer, J.E. Manson, et al. 1997. Dietary fat intake and the risk of coronary heart disease in women. N. Engl. J. Med. 337: 1491–1499.
- 23 Pietinen, P., A. Ascherio, P. Korhonen, et al. 1997. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men: the Alpha Tocopherol, Beta-carotene Cancer Preventive Study. Am. J. Epidemiol. 145: 876–887.
- 24 Kromhout, D. & C.D.L. Coulander. 1984. Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men: the Zuphten Study. Am. J. Epidemiol. 119: 733–741.
- 25 Kromhout, D., A. Menotti, B. Bloemberg, et al. 1995. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev. Med. 24: 308–315.
- 26 Holmes, M.D., D.J. Hunter, G.A. Colditz, et al. 1999. Association of dietary intake of fat and fatty acids with risk of breast cancer. JAMA 281: 914–920.
- 27 Bartsch, H., J. Nair & R.W. Owen. 1999. Dietary polyunsaturated fatty acids and cancers of breast and colorectum: emerging evidence for their role as risk modifiers. Carcinogenesis 20: 2209–2218.
- 28 Tavani, A. & C. La Vecchia. 1999. Beta-carotene and risk of coronary heart disease. A review of observational and intervention studies. Biomed. Pharmacother. 3: 409–416.
- 29 Omenn, G.S., G.E. Goodman, M.D. Thornquist, et al. 1996. Effects of beta-carotene and vitamin on lung cancer and cardiovascular disease. N. Engl. J. Med. 334: 1150–1155.
- 30 Visioli, F. 2000. Antioxidants in Mediterranean Diets. In Mediterranean Diets. A.P. Simopoulos & F. Visioli, Eds. World Rev. Nutr. Diet. Karger. Basel 87: 43–55.
- 31 Rimm, E.B. & M.J. Stampfer. 2000. Antioxidants for cardiovascular disease. Med. Clin. North Am. 84: 239–249.
- 32 Pryor, W.A. 2000. Vitamin E and heart disease. Basic Science to clinical intervention trials. Free Radical Biol. Med. 28: 141–164.
- 33 Hill, A.B. 1953. Observation and experiment. N. Engl. J. Med. 248: 995–1001.
- 34 Miró, E., M. Farré, M.I. Covas, et al. 2001. Tyrosol bioavailability in humans after virgin olive oil ingestion. Clin. Chem. 47: 341–343.
- 35 Visioli, F., C. Galli, F. Bornet, et al. 2000. Olive oil phenolics are dose-dependently absorbed in humans. FEBS Lett. 468: 159–160.
- 36 De La Torre-Boronat, M.C. 1999. Scientific basis for the health benefits of the Mediterranean diet. Drugs Exp. Clin. Res. XIX: 1551–1561.
- 37 Martín, S., R. Elosua, M.I. Covas, et al. 1999. Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease. Am. J. Public Health 89: 383–385.
- 38 Corrao, G., V. Bagnardi, A. Zambon, et al. 1999. Exploring the dose-relationship between alcohol consumption and the risk of several alcohol-related conditions, a meta-analysis. Addiction 94: 1551–1573.
- 39 Cleophas, T.J. 1999. Wine, beer and spirits and the risk of myocardial infarction: a systematic review. Biomed. Pharmacother. 53: 417–423.
- 40 Holman, C.D., D.R. English, E. Milne, et al. 1996. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations. Med. J. Aust. 164: 141–145.
- 41 Leino, E.V., A. Romelsjo, C. Shoemaker, et al. 1998. Alcohol consumption and mortality. II. Studies of male populations. Addiction 93: 205–218.
- 42 Tseng, M., C.R. Weinberg, D.M. Umbach, et al. 1999. Calculation of population attributable risk for alcohol and breast cancer (United States). Cancer Causes Control 10: 119–123.
- 43 Beilin, L.J., B. PuddeI & V. Burke. 1996. Alcohol and hypertension, kill or cure? J. Hum. Hypertens. 10(Suppl. 2): 51–55.
- 44 Rimm, E.B., P. Williams, K. Fosher, et al. 1999. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ 319: 1523–1528.
- 45 Prescott, E., M. Gronbaek, U. Becker, et al. 1999. Alcohol intake and the risk of lung cancer: influence of type of alcoholic beverage. Am. J. Epidemiol. 149: 463–470.
- 46 Gronbaek, M., A. Deis, T.I.A. Sorensen, et al. 1995. Mortality associated with moderate intakes of wine, beer, or spirits. BMJ 310: 1165–1169.
- 47 Leighton, F., A. Cuevas, V. Guasch, et al. 1999. Plasma polyphenols and antioxidants, oxidative DNA damage and endothelial function in a diet and wine intervention study in humans. Drugs Exp. Clin. Res. 25: 133–141.
- 48 Duthie, G.G., M.W. Pedersen, P.T. Gardner, et al. 1998. The effect of whisky and wine consumption on total phenol content and antioxidant capacity of plasma from healthy volunteers. Eur. J. Clin. Nutr. 52: 733–736.
- 49 Van der Gaag, M.S., R. van den Berg, H. van den Berg, et al. 2000. Moderate consumption of beer, red wine and spirits has counteracting effects on plasma antioxidants in middle-aged men. Eur. J. Clin. Nutr. 54: 586–591.
- 50 Agewall, S., S. Wright, R.N. Doughty, et al. 2000. Does a glass of red wine improve endothelial function? Eur. Heart. J. 21: 74–78.
- 51 Chopra, M., P.E. Fitzsimons, J.J. Strain, et al. 2000. Non-alcoholic red wine extract and quercetin inhibit LDL oxidation without affecting plasma antioxidant vitamin and carotenoid concentrations. Clin. Chem. 46: 1162–1170.
- 52 Stein, J.H., J.G. Keevil, D.A. Wiebe, et al. 1999. Purple grape juice improves endothelial function and reduces the susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 100: 1050–1055.
- 53 Kris-Etherton, P., R.H. Eckel, B.V. Howard, et al. 2001. Lyon Diet Heart Study. Benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation 103: 1823–1825.