Efeito dos padrões alimentares no tratamento e prevenção da hipertensão arterial: uma atualização / Effect of dietary patterns on the treatment and prevention of high blood pressure: an update

A hipertensão arterial (HA) é uma condição clínica caracterizada por elevação sustentada dos níveis pressóricos maior ou igual a 140 e/ou 90 mmHg. As diretrizes atuais têm apontado cada vez mais estudos que verificam a influência dos diferentes padrões alimentares e seus efeitos benéficos no controle da HA, como: Dietary Approach to Stop Hypertension (DASH) que preconiza o consumo de frutas, hortaliças, fibras, minerais e laticínios com baixos teores de gordura; DASH-Sodium a qual combina três níveis diferentes de ingestão de sódio; Dieta Mediterrânea (MedDiet) caracterizada pela ingestão reduzida de carne vermelha e processada, ovos, doces e bebidas açucaradas, somada ao consumo moderado de peixes, vinho tinto e laticínios com baixo teor de gordura e alta ingestão de azeite de oliva; Plant based cujo escopo é consumir principalmente proteínas de origem vegetal, com um padrão alimentar rico em fibras, que inclua cereais integrais, frutas, legumes, leguminosas e nozes, com uma ingestão regular de peixes e frutos do mar, laticínios com baixo teor de gordura. Todas essas intervenções mostraram benefícios nos níveis pressóricos, porém a DASH é o padrão alimentar mais frequentemente recomendado e com maior nível de evidência para a prevenção primária e o controle da HA (AU).

Arterial hypertension (AH) is a clinical condition characterized by a sustained increase in blood pressure levels higher than or equal to 140 and or 90 mmHg. Present guidelines have increasingly pointed to studies that show the influence of different dietary patterns and their beneficial effects on the control of AH, just as: Dietary Approach to Stop Hypertension (DASH), which advocates the consumption of fruits, vegetables, fiber, minerals and dairy products low in fat; DASH-Sodium which associate three different levels of sodium intake; Mediterranean Diet (MedDiet) characterized by reduced intake of red and processed meat, eggs, sweets, and sugary drinks, besides, moderate consumption of fish, red wine and low-fat dairy products and high intake of olive oil; Plant-based whose scope is to consume mainly plant-based proteins, with a dietary pattern rich in fiber, which includes whole grains, fruits, vegetables, legumes, and nuts, with a regular intake of fish and seafood, low-fat dairy products. All these interventions showed benefits in blood pressure levels, however DASH is the most frequently recommended dietary pattern with the highest level of evidence for primary prevention and AH control (AU).

Intervenciones nutricionales en la mejora de la cultura alimenticia y sostenibilidad en hondureños de primer año universitario / Nutritional interventions in the improvement of food culture and sustainability in Honduran first-year university students

RESUMEN Objetivo Evaluar el efecto de intervenciones educativas en la mejora de hábitos alimenticos y adherencia a una dieta saludable y sostenible (dieta mediterránea) en universitarios hondureños en época de COVID-19. La emancipación del hogar ocasiona que los estudiantes universitarios se enfrenten a un nuevo entorno para la planificación de su alimentación durante la transición a su vida universitaria. Métodos Se realizó un estudio observacional de cohorte descriptivo transversal entre febrero y junio 2020. Los datos presentados se derivan de encuestas de conductas alimenticias y adherencia a la dieta mediterránea (DM) antes y después de intervenciones educativas nutricionales. Resultados El grupo con intervenciones mejoró sus conductas alimenticias pasando de poco saludables (media: 14,4) a moderadamente saludables (media: 17,3); de igual forma sucedió en la adherencia a la DM, pasando de baja adherencia (media: 7,6) a adherencia media (media: 8,3). En el grupo control no cambió su adherencia, manteniéndose en baja adherencia; tampoco cambiaron sus hábitos alimenticios, manteniéndose en hábitos poco saludables (p=0,068). Conclusiones Existe evidencia de que el patrón dietético mediterráneo puede ser una opción para reducir los problemas de salud, especialmente, en la época de pandemia, por lo cual esta investigación expuso que un patrón alimenticio mediterráneo puede coexistir en un ambiente latinoamericano una vez que se conocen sus beneficios.

ABSTRACT Objective To evaluate the effect of educational interventions on improving eating habits and adherence to the Mediterranean diet in Honduran university students during the time of COVID-19. The emancipation of the home makes university students face a new environment for planning their diet during the transition to their university life. Methods An observational cross-sectional descriptive cohort study was conducted between February and June 2020. The data presented in this study are derived from surveys of eating behaviors and adherence to the Mediterranean diet (DM) before and after nutritional educational interventions in the COVID-19 pandemic. Results The group with interventions improved their eating behaviors going from unhealthy (median: 14,4) to moderately healthy (median: 17,3); in the same way, it happened in the adherence to DM, going from low adherence (median: 7,6) to medium adherence (median: 8,3). In the control group, their adherence did not change, maintaining low adherence, nor their eating habits, remaining in unhealthy habits. Conclusions There is evidence that the Mediterranean dietary pattern may be an option to reduce health problems, especially in times of pandemic, which is why this research showed that a foreign dietary pattern can coexist in a Latin-American environment once its benefits are known.

Intestinal Microbiota and Cardiovascular Diseases

Abstract Recently, gut microbiota has emerged as an important mediator of several diseases such as diabetes, atherosclerosis, arterial hypertension, obesity, cancers and neuropsychiatric diseases including Alzheimer, autism and depression. Intestinal microbiota is formed by bacteria, fungi and viruses and its main function is to facilitate the absorption and metabolism of foods (protein, fat and carbohydrate). One example of the multiple actions of the gut microbiota is the bidirectional relationship between the intestine and the brain, the so-called "gut/brain axis". Furthermore, metabolites produced by gut microbiota can induce effects locally or at distance, which suggests that the intestine is an endocrine organ. Given the participation of the gut microbiota in several diseases, there is great interest in strategies that may positively affect the gut flora and prevent or even treat diseases. Among these strategies, lifestyle change, but specially diet modulation has gained importance. In this article, we review the mechanisms through which intestinal microbiota participates in cardiovascular diseases and possible therapeutic interventions.

Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors / Associação entre adesão à dieta mediterrânea e prevalência de fatores de risco cardiovascular / Asociación entre la adherencia a la dieta mediterránea y la prevalencia de factores de riesgo cardiovascular

Objective: to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up. Method: a cross-sectional descriptive study was carried out on a cohort of 23,729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet. Results: 51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86). Conclusions: our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified.

Objetivo: determinar a prevalência de fatores de risco cardiovascular em uma coorte de trabalhadores e quantificar sua associação com o monitoramento da dieta mediterrânea. Método: estudo descritivo transversal, realizado em uma coorte de 23.729 trabalhadores. Dados clínicos dos exames médicos anuais e a Mediterranean Diet Adherence Screener foram usados para avaliar a adesão à dieta mediterrânea. Resultados: 51,3% dos participantes apresentaram boa adesão à dieta mediterrânea. A análise multivariada mostrou associação inversa e significativa entre o acompanhamento da dieta mediterrânea e a prevalência de obesidade abdominal (Odds Ratio = 0,64, IC 95% 0,56, 0,73), dislipidemia (Odds Ratio = 0,55, IC 95% 0,42, 0,73) e de síndrome metabólica (Odds Ratio = 0,76, IC 95% 0,67, 0,86). Conclusões: nossos resultados sugerem que a dieta mediterrânea é potencialmente eficaz na promoção da saúde cardiovascular. A implementação de intervenções que promovem a dieta mediterrânea na população trabalhadora parece justificada.

Objetivo: determinar la prevalencia de factores de riesgo cardiovascular en una cohorte de trabajadores y cuantificar su asociación con el seguimiento de la dieta mediterránea. Método: se llevó a cabo un estudio descriptivo transversal sobre una cohorte de 23.729 trabajadores. Se utilizaron los datos clínicos procedentes de los exámenes médicos anuales y el Mediterranean Diet Adherence Screener para evaluar la adherencia a la dieta mediterránea. Resultados: el 51,3% de los participantes presentó una buena adherencia a la dieta mediterránea. El análisis multivariante evidenció una asociación inversa y significativa entre el seguimiento de la dieta mediterránea y la prevalencia de obesidad abdominal (Odds Ratio = 0,64, IC 95% 0,56; 0,73), dislipidemia (Odds Ratio = 0,55, IC 95% 0,42; 0,73) y de síndrome metabólico (Odds Ratio = 0,76, IC 95% 0,67; 0,86). Conclusión: nuestros resultados sugieren que la dieta mediterránea es potencialmente eficaz en la promoción de la salud cardiovascular. Parece justificada la implementación de intervenciones que promuevan la dieta mediterránea en la población trabajadora.

Effects of Mediterranean diet on Alzheimer's disease / 中华老年医学杂志

Alzheimer's disease (AD)is most common in all dementia types in the elderly.Various researches have been done for studying its pathogenesis,but no single mechanism can explain all its pathological changes.AD is currently incurable and no effective treatment measures are available.So it is of prime importance to prevent the occurrence of AD.In the process of exploring the pathogenesis and treatment of AD,more and more attention is being paid to the role of diet and nutrition in the occurrence and development of AD.Mediterranean diet(MeDi)has been proved to have an unvarying role in the occurrence and development of Alzheimer's disease.This paper reviewed the relevant literatures and summarized the role of MeDi in AD,in order to provide the theoretical supports for dietary intervention and nutritional therapy in AD treatment.

Origen, componentes y posibles mecanismos de acción de la dieta mediterránea / Origin, components and mechanisms of action of the Mediterranean diet

The Mediterranean diet is currently considered a healthy dietary pattern. It includes a great variety of foods, which are eaten in moderation and within a positive social environment. The generic term “Mediterranean diet” was born after the “Seven Countries Study” led by Ancel Keys around 1960. This dietary pattern is characterized by a high intake of fruits and vegetables, whole grains, legumes, nuts, fish, white meats and olive oil. It also includes moderate consumption of fermented dairy products, low intake of red meat and drinking wine with moderation during meals. Nutritionally, this diet is low in saturated fats and animal protein, high in antioxidants, fiber and monounsaturated fats, and exhibits an adequate omega-6/omega-3 fatty acid balance. The main bioactive compounds, which explain the health benefits of this dietary pattern, are antioxidants, fiber, monounsaturated and omega-3 fatty acids, phytosterols and probiotics. This diet is not exclusively confined to the Mediterranean Basin. Central Chile has a Mediterranean climate and our agriculture and culinary traditions are similar to those found in Mediterranean countries. Therefore, it is fundamental to increase awareness about the richness of our natural produce as well as our culinary culture, which may bring many health benefits and improve the quality of life in our population.

Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile / Validation of self-applicable questionnaire for a Mediterranean dietary index in Chile

Background: Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of several chronic disease conditions. Aim: To adapt a self-applicable Mediterranean Dietary Index in Chile (Chilean-MDI). Material and Methods: The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, the index was applied in a sample of 53,366 Chilean adults in order to describe the diet quality of our population. Results: There was an adequate concordance between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and among people with higher educational levels. Conclusions: The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this dietary index describes overall food intake in Chilean adults, showing demographic trends that are comparable to those obtained with similar indexes applied in other populations.

Evidencia actual sobre los beneficios de la dieta mediterránea en salud / Current evidence on health benefits of the mediterranean diet

The Mediterranean diet is currently considered a functional diet with an increasing amount of scientific evidence that supports its beneficial effects in human health. Several observational cross-sectional and prospective cohort studies show an association between this diet and a lower prevalence and incidence of chronic diseases, such as cardiovascular disease, cancer, metabolic syndrome, diabetes, and neurodegenerative diseases as well as a reduced overall mortality. Additionally, clinical interventional studies, particularly the PREDIMED (Prevención con Dieta Mediterránea) initiative, have shown, with high quality scientific evidence, that a Mediterranean diet -supplemented either with olive oil or nuts- can lower by 30% the incidence of cardiovascular disease, reverse the metabolic syndrome, and prevent the development of diabetes and aging-related cognitive decline. Chile has one of the five Mediterranean ecosystems in the world, and therefore the implementation of this food pattern and lifestyle in our country may determine large benefits to the health status and quality of life in the Chilean population.

Diet quality assessment indexes / Índices de avaliação da qualidade da dieta

Various indices and scores based on admittedly healthy dietary patterns or food guides for the general population, or aiming at the prevention of diet-related diseases have been developed to assess diet quality. The four indices preferred by most studies are: the Diet Quality Index; the Healthy Eating Index; the Mediterranean Diet Score; and the Overall Nutritional Quality Index. Other instruments based on these indices have been developed and the words 'adapted', 'revised', or 'new version I, II or III' added to their names. Even validated indices usually find only modest associations between diet and risk of disease or death, raising questions about their limitations and the complexity associated with measuring the causal relationship between diet and health parameters. The objective of this review is to describe the main instruments used for assessing diet quality, and the applications and limitations related to their use and interpretation.

Para avaliação da qualidade da dieta, diferentes índices ou escores foram desenvolvidos, considerando padrões dietéticos reconhecidamente saudáveis ou baseando-se em guias alimentares para populações em geral ou para a prevenção de doenças. Dos vários índices, quatro deles servem de base para a maior parte dos estudos: Índice de Qualidade da Dieta, Índice de Alimentação Saudável, Escore da Dieta Mediterrânea e Índice Geral de Qualidade Nutricional. A partir desses modelos, alguns outros foram criados, com acréscimo do termo adaptado/revisado, ou em novas versões (I, II ou III) como referência do respectivo original. Esses índices, mesmo validados, apresentam associações geralmente modestas com o risco de mortalidade ou doenças, o que aponta suas limitações, bem como a complexidade de se medir a relação causal entre dieta e parâmetros de saúde. Esta revisão tem como objetivo descrever os principais instrumentos de avaliação da qualidade da dieta, assim como suas aplicações e limitações, relativas ao uso e interpretações.

La dieta meditrrránea: ¿es cardioprotectiva? / The mediterranean diet: is it cardioprotective?

La enfermedad coronaria es una de las principales causas de morbilidad y mortalidad en USA, la intervención de la dieta es una línea primaria en el tratamiento y prevención de la misma. El aumento de la evidencia científica muestra que la tradicional dieta mediterránea puede reducir los riesgos de una enfermedad cardiovascular, los beneficios cardiovasculares de esta dieta superan lo de las dietas de baja grasa prescriptas clásicamente, la carga de las enfermedades cardiovasculares es enorme, y los aportes nutricionales que puedan optimizar la salida cardiovascular son esenciales. Las evidencias clínicas apoyan el role de la dieta mediterránea en la salud cardiovascular, presentándose con mucho énfasis los efectos fisiológicos de los ácidos grasos omega -3. Se discuten las implicaciones en la práctica clínica y se enfocan futuras investigaciones.

Coronary heart disease is one of the main causes of morbidity and mortality in the United States. Dietary interventions are first-line therapy for coronary heart disease prevention and treatment. Increasing scientific evidence shows that the traditional Mediterranean diet may reduce the risk of a cardiovascular disease. The cardiovascular benefits of this whole-diet approach may outweigh those typically prescribed low-fat diets. The burden of coronary heart disease is enormous, and nutritional approaches that optimize cardiovascular health are essential. Clinical evidences support the role mention of the Mediterranean diet in the cardiovascular health is presented with an emphasis on the physiological effects of omega -3 fatty acids. Implications for clinical practice and future investigations are also discussed.