Benefits of the Mediterranean Diet: Insights From the PREDIMED Study.
The PREDIMED (PREvención con DIeta MEDiterránea) multicenter, randomized, primary prevention trial assessed the long-term effects of the Mediterranean diet (MeDiet) on clinical events of cardiovascular disease (CVD). We randomized 7447 men and women at high CVD risk into three diets: MeDiet supplemented with extra-virgin olive oil (EVOO), MeDiet supplemented with nuts, and control diet (advice on a low-fat diet). No energy restriction and no special intervention on physical activity were applied. We observed 288 CVD events (a composite of myocardial infarction, stroke or CVD death) during a median time of 4.8years; hazard ratios were 0.70 (95% CI, 0.53-0.91) for the MeDiet+EVOO and 0.70 (CI, 0.53-0.94) for the MeDiet+nuts compared to the control group. Respective hazard ratios for incident diabetes (273 cases) among 3541 non-diabetic participants were 0.60 (0.43-0.85) and 0.82 (0.61-1.10) for MeDiet+EVOO and MeDiet+nuts, respectively versus control. Significant improvements in classical and emerging CVD risk factors also supported a favorable effect of both MeDiets on blood pressure, insulin sensitivity, lipid profiles, lipoprotein particles, inflammation, oxidative stress, and carotid atherosclerosis. In nutrigenomic studies beneficial effects of the intervention with MedDiets showed interactions with several genetic variants (TCF7L2, APOA2, MLXIPL, LPL, FTO, M4CR, COX-2, GCKR and SERPINE1) with respect to intermediate and final phenotypes. Thus, the PREDIMED trial provided strong evidence that a vegetable-based MeDiet rich in unsaturated fat and polyphenols can be a sustainable and ideal model for CVD prevention.
Department of Preventive Medicine and Public Health, University of Navarra, IDISNA (Navarra Health Research Institute), Pamplona, Spain; The PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: mamartinez@unav.es.
Miguel A
MA
Martínez-González
The PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
Jordi
J
Salas-Salvadó
The PREDIMED Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Ramón
R
Estruch
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain.
Dolores
D
Corella
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain.
Montse
M
Fitó
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Emilio
E
Ros
D002318:Cardiovascular Diseases / Q000235:genetics / Q000401:mortality / Q000517:prevention & control*; D038441:Diet, Mediterranean; D019317:Evidence-Based Medicine; D059647:Gene-Environment Interaction; D020022:Genetic Predisposition to Disease; D006304:Health Status; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D010641:Phenotype; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D065840:Protective Factors; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors
Atrial fibrillation; Dietary intervention; Mediterranean diet; Peripheral artery disease; Primary prevention; Randomized trials; Stroke; Type-2 diabetes