Pamplona, Spain - People who eat a Mediterranean-style diet are less likely to develop new-onset diabetes, new research suggests [1]. Results from this analysis of the Seguimiento Universidad de Navarra (SUN) study—published online May 30, 2008 in BMJ—suggest that the benefits of a Mediterranean diet may be especially pronounced in people who are at higher risk of developing diabetes due to weight, family history, blood pressure, or other factors.
"Our prospective cohort study suggests that substantial protection against diabetes can be obtained with the traditional Mediterranean diet, rich in olive oil, vegetables, fruits, nuts, cereals, legumes, and fish but relatively low in meat and dairy products," Dr Miguel A Martínez-Gonzalez (University of Navarra, Pamlona, Spain) and colleagues write.
While earlier research has established a link between the Mediterranean diet and reduced risk of metabolic syndrome, only one other major study has found that adhering to such a diet may reduce the risk of developing diabetes. And this study, by Mozaffarian et al and previously reported by heartwire, looked specifically at survivors of recent AMI. In their study published today, Martínez-Gonzalez and colleagues looked specifically at university graduates who had no history of heart disease.
"This is the first time that such an assessment has been done in a large prospective cohort of initially healthy participants," Martínez-Gonzalez told heartwire.
High scores for Mediterranean diet
Among a total of 13 380 former and recent graduates enrolled between 1999 and 2007, 33 developed new-onset diabetes over 58 918 person-years of follow-up. When diabetes risk was considered in relation to adherence to Mediterranean diet, assessed by a comprehensive diet questionnaire, people who stuck closely to the diet were least likely to develop diabetes, followed by people who adhered "moderately" to the diet, as compared with people who had the lowest scores, representing low adherence. Strikingly, people with the highest scores for diet adherence were also more likely to have risk factors for diabetes, yet incidence of the disease was no higher in this group, "suggesting that the diet might have a substantial potential for prevention," the authors write.
Hazard ratios for developing diabetes, compared to low adherence to Mediterranean diet (score 0-2)
Adherence to Mediterranean diet (score)
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Multivariate adjusted hazard ratio
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95% CI
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Moderate (3-6)
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0.40
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0.18-0.90
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High (7-9)
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0.17
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0.04-0.72
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Martínez-Gonzalez and colleagues acknowledge that the low number of people diagnosed with diabetes in their analysis and the possibility that diabetes was underreported is a potential flaw of their study; further research is warranted to confirm their findings, they write. To heartwire, Martínez-Gonzalez also pointed out that while participants with the highest adherence to Mediterranean eating habits had an 83% relative reduction in the risk of developing diabetes during 4.4 years follow-up, the confidence intervals for this estimate were wide, ranging from 28% to 96%. Overall, he notes, a two-point increase in Mediterranean diet score was associated with a 35% relative reduction in the risk of diabetes, but here again the confidence intervals ranged from 5% to 56%.
Source
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Martínez-Gonzalez M, de la Fuente-Arrillaga, Nunez-Cordoba JM, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008; DOI:10.1136/bmj.39561.501007. Available at: http://www.bmj.com.
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Making a simple stress exam appointment a live changing experience
In our hospital cardiology department, I decided a few years ago that each and every patient contact will result in an opportunity for life style improvement. Whether it's smoking cessation, weight management, medical compliance issues, hypertension control or primary prevention, I take the time to do it each and every time. The most common piece of written material presented to our patients is the Mediterranean diet. I may never see that patient again. I don't get paid for that consultation because one has not been requested but I feel an obligation to let no one go out that door without some simple piece of advice that could change their lives forever. Besides, with the treadmill running and the patient tethered to ECG leads, they are a most captive audience!
This diet is simple. It doesn't seem to scare folks away. It can be easily implemented. Most of the foods are foods that we commonly eat, but the method of preparation needs some adjustment. (Fried chicken indeed!) It's savory and visually stimulating.
Just think of the number of patients whose lives we can change if we are diligent about presenting the very basic information about this method of food selection. I try to impress upon our patients that this is NOT a diet. It's a way of life. I truly think that approach works best.
I'd like to personally thank those wonderful Mediterranean chefs who gave us this great culinary gift and who can now allow the rest of world an opportunity to experience such joie de vivre!
So I urge each of you to make a file of information on the Mediterreanean diet available in your stress lab and make the only contact you may ever have with that patient last a life time. I think our patients really appreciate it.
Melissa |
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A "life" changing experience begins with benevolent but brutal honesty
In the hospital setting where things can be far more impersonal than the office setting, it's important to "touch" the patient. I'm not just talking about putting a stethoscope on their chest, I'm talking about shaking their hands, looking at them in the eye while they speak, listening. Then, after an introduction and an explanation of what they hope to gain from the exam (and in most cases, what they will NOT gain from the exam, like whether or not they have coronary artherosclerosis), I will say something like, "you know, if you have a little weight to lose, you may be as much as 300x higher than the usual risk of heart attack death as someone who stands at your height at a normal weight." That usually gets their attention very quickly. From there, we go into how easy it is to implement the Mediterranean diet. I explain the pyramid to them which as a concept is far less difficult than explaining the concept of servings, though portion control is important. I talk partcularly about how important "tree nuts" are for weight control because they are the secret to appetite supression.
By dumping in a half a palm full (one layer only) of almonds or walnuts with the morning meal, hunger is suppressed for hours. (And your palm only goes from your hypo thenar eminence to the base of your fingers, not your finger tips, that would a "handful" not a "palm full". I talk about how tree nuts blunt the insulin surge of a high carb breakfast, how they contain omega 3's that help our "heart artery linings" to stay clot free.....I try to say lots of things that a motivated person might latch on to, OR might catch the attention of that "demotivated" someone who's "heard it all before" and has been unimpressed with the old "you have to lose weight" speeches. I give them hope that "anyone can follow this food selection program" and how much more tasty this plan can be than a McDonals'd drive thru. I say things like "food is medication", we have to "take it a few times per day, but it has to be the right "dose" and the "right" drug.
With just a little encouragement and the right tools, we can change the course of our population one patient at a time, one pound at a time, one omega three fat gram at a time and give our patients or just those we will briefly encounter, hope and encouragment . The essence of these conversations should take patients and physicians back to why it is that we became physicians to begin with.....to improve quanity of life by improving quality of life. It's the practice of medicine in the truest sense of the word, except this "practice" doesn't require a pill but rather a broad sweeping prescription that will span a lifetime.
Melissa |
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BSA calculator---The Wheel of fortune and new packaging for our stents
I picked up the phone this morning (yes, it's Sunday morning and it was 6:40 am-my most creative time of the day) and called the cardiology department. Can't help it, I'm a morning person and I get a lot done between the hours of 5 am and 8 am). "Make certain that every single patient who presents for stress testing leaves there with an ideal body weight", a recommendation that should have been apparent when I asked for a simple set of scales to be brought into the department a few months ago.
A BSA wheel that will translate from meters squared to a more understandable "ideal body weight in good ole American pounds" could really get the attention of so many of our patients. Why is an explanation of ideal bodyweight important at the time of stress testing? I'll tell you why....we've become brainwashed. We don't even know anymore that we are fat.
If you sit in your car for 15 minutes and look at those of us who are exiting a local Walmart store, you soon realize that we've gone away from being capable of understanding that we ARE overweight to complete ignorance about the issue and in many cases have taken it a deadly step farther having embraced such idiotic notions as "fat is beautiful", an attitude often heralded by the proud display of a bare but obese middrift spilling over low riding jeans paired with a short wasted shirt. This "fashion don't" says it all about America and it's now defiant attitude that serves our addiction to carbs and our penchant for spending endless hours in front of the television or on the internet. It says "I'm beautiful no matter what" but we should follow that up by admitting that "I'm unhealthy no matter how great I think I look" or "I"m dying no matter how acceptable my body habitus may be" in today's culture.
So, a simple tool, like an ideal body weight calculator, or a BSA wheel can literally be a "wheel of fortune" for all of our patients. That simple tool that interjects a bit of objectivity into any conversation about obesity along with the Mediterranean diet plan, will save lives, money and the heart ache of badly fitting jeans and growing middrifts that spell an early death for much of our population. A BSA wheel is simple, cheap and accessible. Perhaps we should stick one onto our stethoscopes along with a copy of the Mediterranean diet and really roll up our sleeves to try and save the 400,000 of us who will die of complications of obesity in the next 12 months. Perhaps we should place it as an insert into our stent packaging as well.
Melissa |
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