People who eat a Mediterranean-style diet rich in fruit, vegetables, whole grains, olive oil and fish have at least a 25 percent reduced risk of dying from heart disease and cancer, researchers reported in a study being published today.
For decades, scientists have had inklings that a diet that derives about 40 percent of its calories from healthy fat and about half from complex carbohydrates such as whole grains, fruit and vegetables, combined with daily exercise, could promote health and reduce premature death.
But this is the first large trial of healthy men and women to demonstrate a significant reduction in death rates for heart disease, cancer and all other causes of mortality for those who follow a Mediterranean diet and are physically active.
'In the past, when we talked about the Mediterranean diet, we usually talked about cardiovascular benefits,' Frank Hu, associate professor of nutrition and epidemiology at the Harvard School of Public Health, said yesterday. 'This is talking about primary prevention. The better the Mediterranean diet, the lower the cardiovascular disease and cancer mortality. . . . That is very intriguing.'
The results suggest a middle course between the often confusing diet extremes, from the very low-carbohydrate, high-fat Atkins approach to the higher carbohydrate, low-fat U.S. dietary guidelines.
The findings also point to 'diet as being very important in more ways than we had anticipated,' said Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, who advocates boosting 'healthy fat' in the American diet as well as adding more grains, fruit, vegetables and fish. (So-called healthy fats are found in such foods as olive oil, avocados, nuts, and fish.)
The U.S government's recommendation of consuming only 30 percent total fat may 'not be optimal for many people,' Willett said. But the study also 'emphasizes that for overall good health, eating porterhouse steak, butter and lard is not the way to go.'
What the results also underscore is the importance of the overall Mediterranean diet approach, rather than any one food type. In an article that accompanies the results, which are published in today's New England Journal of Medicine, Hu suggests that this could be explained in two ways: either the effects of any one nutrient are too small to detect, or there may be synergistic effects of the Mediterranean diet that are important.
'That's interesting,' Willett said, 'because any one piece of the Mediterranean diet on its own was not so impressive. It's the whole package -- the fruit and vegetables, the nuts . . . all those things that seem to contribute.'
The study involved 22,043 adults, ages 20 to 86, who live in Greece; people with diabetes and known heart disease were excluded.
Upon entering the study, participants were interviewed in depth about their daily diets and exercise habits. The researchers assigned points for each component of diet and lifestyle.
For example, eating vegetables, legumes and beans, fruit, nuts, whole grains (in cereal, bread and pasta) and fish raised the scores. So did consuming more monounsaturated fats, such as olive oil, rather than saturated fats, such as butter or cream.
Participants also received a point for drinking moderate amounts of alcohol -- about a glass of wine a day for women; two glasses for men -- but got a zero if they imbibed more or less than that.
Regularly eating meat, poultry, sweets and dairy products, which in Greece are generally high in saturated fat, added no points and resulted in a lower overall diet score.
The research team, which was led by Antonia Trichopoulou of the University of Athens Medical School and Dimitrios Trichopoulos of the Harvard School of Public Health, then tracked participants for an average of nearly four years.
They also took into account age, sex, years of education, smoking status, body mass index (to gauge overweight and obesity) and waist-to-hip ratios, which help determine risk for heart disease and diabetes.
The study found that the higher the healthy diet score, the lower the risk of death. For every two-point rise -- achieved, for example, by eating a lot of vegetables and consuming beans and nuts daily -- the risk of death dropped by 25 percent, the study found.
'This says you can get tremendous benefit from simply moving away from unhealthy foods, and there are multiple ways that you can achieve this,' Hu said.
Daily physical activity also played a critical role in reducing mortality from heart disease and cancer, the study found. People who engaged in at least an hour a day of very vigorous activity, either on the job or at leisure, had a 28 percent reduced risk of mortality compared with their more sedentary counterparts.
The effects of physical activity 'cannot be overemphasized,' Hu said.
The findings echo the results of smaller studies, including the Lyon Diet Heart Study in France, that have hinted at health benefits of the Mediterranean lifestyle.
In the Lyon trial, researchers randomly assigned 605 people diagnosed with heart disease to either follow a Mediterranean-style diet or the American Heart Association diet, which has about 30 percent of calories from fat, including 10 or less from saturated fat.
In this study, people assigned to the Mediterranean group were encouraged to eat more fruit, vegetables and fish, to cut back on red meat and to use olive oil instead of butter and cream.
The study found that the Mediterranean diet group suffered 73 percent fewer heart attacks or other heart-related problems and had 70 percent fewer deaths than those on the heart association diet.
For decades, scientists have had inklings that a diet that derives about 40 percent of its calories from healthy fat and about half from complex carbohydrates such as whole grains, fruit and vegetables, combined with daily exercise, could promote health and reduce premature death.
But this is the first large trial of healthy men and women to demonstrate a significant reduction in death rates for heart disease, cancer and all other causes of mortality for those who follow a Mediterranean diet and are physically active.
'In the past, when we talked about the Mediterranean diet, we usually talked about cardiovascular benefits,' Frank Hu, associate professor of nutrition and epidemiology at the Harvard School of Public Health, said yesterday. 'This is talking about primary prevention. The better the Mediterranean diet, the lower the cardiovascular disease and cancer mortality. . . . That is very intriguing.'
The results suggest a middle course between the often confusing diet extremes, from the very low-carbohydrate, high-fat Atkins approach to the higher carbohydrate, low-fat U.S. dietary guidelines.
The findings also point to 'diet as being very important in more ways than we had anticipated,' said Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, who advocates boosting 'healthy fat' in the American diet as well as adding more grains, fruit, vegetables and fish. (So-called healthy fats are found in such foods as olive oil, avocados, nuts, and fish.)
The U.S government's recommendation of consuming only 30 percent total fat may 'not be optimal for many people,' Willett said. But the study also 'emphasizes that for overall good health, eating porterhouse steak, butter and lard is not the way to go.'
What the results also underscore is the importance of the overall Mediterranean diet approach, rather than any one food type. In an article that accompanies the results, which are published in today's New England Journal of Medicine, Hu suggests that this could be explained in two ways: either the effects of any one nutrient are too small to detect, or there may be synergistic effects of the Mediterranean diet that are important.
'That's interesting,' Willett said, 'because any one piece of the Mediterranean diet on its own was not so impressive. It's the whole package -- the fruit and vegetables, the nuts . . . all those things that seem to contribute.'
The study involved 22,043 adults, ages 20 to 86, who live in Greece; people with diabetes and known heart disease were excluded.
Upon entering the study, participants were interviewed in depth about their daily diets and exercise habits. The researchers assigned points for each component of diet and lifestyle.
For example, eating vegetables, legumes and beans, fruit, nuts, whole grains (in cereal, bread and pasta) and fish raised the scores. So did consuming more monounsaturated fats, such as olive oil, rather than saturated fats, such as butter or cream.
Participants also received a point for drinking moderate amounts of alcohol -- about a glass of wine a day for women; two glasses for men -- but got a zero if they imbibed more or less than that.
Regularly eating meat, poultry, sweets and dairy products, which in Greece are generally high in saturated fat, added no points and resulted in a lower overall diet score.
The research team, which was led by Antonia Trichopoulou of the University of Athens Medical School and Dimitrios Trichopoulos of the Harvard School of Public Health, then tracked participants for an average of nearly four years.
They also took into account age, sex, years of education, smoking status, body mass index (to gauge overweight and obesity) and waist-to-hip ratios, which help determine risk for heart disease and diabetes.
The study found that the higher the healthy diet score, the lower the risk of death. For every two-point rise -- achieved, for example, by eating a lot of vegetables and consuming beans and nuts daily -- the risk of death dropped by 25 percent, the study found.
'This says you can get tremendous benefit from simply moving away from unhealthy foods, and there are multiple ways that you can achieve this,' Hu said.
Daily physical activity also played a critical role in reducing mortality from heart disease and cancer, the study found. People who engaged in at least an hour a day of very vigorous activity, either on the job or at leisure, had a 28 percent reduced risk of mortality compared with their more sedentary counterparts.
The effects of physical activity 'cannot be overemphasized,' Hu said.
The findings echo the results of smaller studies, including the Lyon Diet Heart Study in France, that have hinted at health benefits of the Mediterranean lifestyle.
In the Lyon trial, researchers randomly assigned 605 people diagnosed with heart disease to either follow a Mediterranean-style diet or the American Heart Association diet, which has about 30 percent of calories from fat, including 10 or less from saturated fat.
In this study, people assigned to the Mediterranean group were encouraged to eat more fruit, vegetables and fish, to cut back on red meat and to use olive oil instead of butter and cream.
The study found that the Mediterranean diet group suffered 73 percent fewer heart attacks or other heart-related problems and had 70 percent fewer deaths than those on the heart association diet.
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