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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEpidemiologic data have shown that a Mediterranean diet that is low in saturated fat and high in polyunsaturated fats reduces low-density lipoprotein cholesterol and lowers the risk of cardiovascular events. Yet, the clinical evidence of benefit with the components of these diets is mixed, and are reviewed in this article. Other topics include reshaping nutrition habits in clinical practice, as well as a review on epidemiological and clinical evidence of the negative impact of sugar-sweetened beverages on health.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAssessment\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAssessment\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEpidemiologic data have shown that a Mediterranean diet that is low in saturated fat and high in polyunsaturated fats reduces low-density lipoprotein cholesterol and lowers the risk of cardiovascular events. Yet, the clinical evidence of benefit with the components of these diets is mixed, and was reviewed by Peter Clifton, MBBS, University of South Australia, Adelaide, Australia.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Mediterranean diet recommends a low intake of saturated fats and high monounsaturated fats, with a low intake of meat and dairy, and high intake of fruits, vegetables, legumes, and nuts. Alcohol intake is modest.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf. Clifton discussed numerous studies that showed benefit of the Mediterranean diet and its components. Frequent nut consumption (\u0026gt;5 times\/week) was associated with a 35% reduction in the incidence of coronary heart disease (CHD) in 4 epidemiological studies [Kris Etherton et al. \u003Cem\u003EJ Nutr\u003C\/em\u003E 2008]. In addition, a Mediterranean diet supplemented with extra virgin olive oil or nuts was associated with lower risk of CV events in the Prevenci\u00f3n con Dieta Mediterr\u00e1nea (PREDIMED; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) study [Estruch R et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13630\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13630\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13630\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EPREDIMED\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the EPIC-NL cohort study of nearly 35,000 middle-aged persons without known CVD, a significant protective effect was found for each 2-point increment in the Mediterranean-style diet [Hoevenaar-Blom MP et al. \u003Cem\u003EPLoS One\u003C\/em\u003E 2012]. The Spanish EPIC study showed that each 10 gram increase in olive oil consumption was associated with a 7% reduction in CHD [Buckland G et al. \u003Cem\u003EBr J Nutr\u003C\/em\u003E 2012]. The Greek EPIC study found that each 2-unit increase in the Mediterranean diet score was associated with a 16% reduction in total mortality [Trichopoulou A et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EFruits and vegetables have been found to be associated with the same level of benefit in epidemiologic trials and are recommended as part of the DASH (Dietary Approaches to Stop Hypertension) diet for lowering blood pressure. However, there are no prospective clinical data showing that fruit and vegetable intake reduces CV events. Fish has been found to be associated with benefits in studies conducted in the United States, but this association has been less strong in Scandinavian studies. Recent intervention studies with fish oil have not found them to reduce CV events [The ORIGIN Trial Investigators. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012; de Caterina R et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. Meat and dairy products appear to be neutral or have mildly positive effects (dairy only). More data are required to identify the optimal level of salt intake. Some data have shown that limiting its intake is associated with a reduction in stroke and CV disease; however, increased salt intake can increase heart failure and may increase CV events in patients with diabetes.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERESHAPING NUTRITION HABITS IN CLINICAL PRACTICE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe public knows that a healthy diet is important for disease prevention, yet they are confused by the many different messages and changing research claims, said Beno\u00eet Lamarche, PhD, Universit\u00e9 Laval, Qu\u00e9bec City, Qu\u00e9bec, Canada. Restrictive diets are difficult to sustain long-term and usually are most effective when coupled with support, which is usually short-term.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe 2010 United States Department of Agriculture dietary recommendations were useful because they moved from nutrient-based recommendations to food-based recommendations. More effective than restricting foods is adding foods or nutritional components that may be beneficial. This approach was studied in the PREDIMED study which showed the primary composite endpoint of myocardial infarction (MI), stroke, and CV death was reduced with the Mediterranean diet supplemented with extra virgin olive oil (HR, 0.70; 95% CI, 0.53 to 0.91; p=0.009) and with nuts (HR, 0.70; 95% CI, 0.53 to 0.94; p=0.02) [Estruch R et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E, 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EA recent meta-analysis showed the Mediterranean diet is associated with positive effects (to different degrees) on metabolic syndrome and its components (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 2\u003C\/a\u003E) [Kastorini CM et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/16\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Mediterranean Diet on Metabolic Syndrome and Its Components in Meta-Analysis\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-740918605\u0022 data-figure-caption=\u0022Effect of Mediterranean Diet on Metabolic Syndrome and Its Components in Meta-Analysis\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/16\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/16\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/16\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13628\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EEffect of Mediterranean Diet on Metabolic Syndrome and Its Components in Meta-Analysis\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDBP=diastolic blood pressure; HDL-C=high-density lipoprotein cholesterol; HOMA-IR=homeostatic model assessment of insulin resistance; SBP=systolic blood pressure; TG=triglycerides.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Kastorini CM et al. The Effect of Mediterranean Diet on Metabolic Syndrome and its Components: A Meta-Analysis of 50 Studies and 534,906 Individuals. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011;57(11):1299\u20131313. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EA series of studies by Richard, Lamarche, and colleagues have shown that the Mediterranean diet has beneficial effects whether or not patients also lose weight. LDL-C was reduced by 9.9% along with a significant reduction in plasma PCSK9 (by 11.7%; p\u0026lt;0.01) and the phytosterol:cholesterol ratio (by 9.7%; p\u0026lt;0.01) versus control diet, with no additional benefit with weight loss [Richard C et al. \u003Cem\u003EBr J Nutr\u003C\/em\u003E 2012]. They also showed that adipokines were not reduced in patients who did not lose weight with the Mediterranean diet [Richard C et al. \u003Cem\u003EMetabolism\u003C\/em\u003E 2013]. Inflammation was also reduced with the Mediterranean diet regardless of weight loss, as measured by C-reactive protein (CRP), interleukins, and other measures, and greater reductions in waist circumference in men were associated with greater reductions in inflammatory markers [Richard C et al. \u003Cem\u003EObesity (Silver Spring)\u003C\/em\u003E 2013].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHEALTH CONSEQUENCES OF SUGAR-SWEETENED BEVERAGE CONSUMPTION\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EFrank B. Hu, MD, PhD, Harvard School of Public Health, Boston, Massachusetts, USA, reviewed epidemiological and clinical evidence of the negative impact of sugar-sweetened beverages (SSBs) on health. Although consumption of SSBs has plateaued in the United States over the last decade, consumption has skyrocketed globally, and SSB consumption patterns can make huge differences in weight gain, he said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003ESSBs contain 3.1 to 3.6 grams of sugar per ounce, or about 10 teaspoons per 12-ounce can. They are sweetened with high fructose corn syrup. SSB consumption patterns predicted weight gain in an epidemiological study of the effects of SSBs in a cohort of children [Ludwig DS et al. \u003Cem\u003ELancet\u003C\/em\u003E 2001].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe most rigorous trial of SSBs showed replacing high-caloric with noncaloric drinks reduced weight gain and fat accumulation in normal-weight children [de Ruyter JC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012]. A meta-analysis of 11 studies with nearly 311,000 participants showed that SSBs were associated with an increased risk of type 2 diabetes (RR, 1.26; 95% CI, 1.12 to 1.41) and increased risk of metabolic syndrome (RR, 1.20; 95% CI, 1.02 to 1.42) in the higher quartiles of SSB consumption compared with the lower quartiles [Malik VS et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EHigh consumption of SSBs is linked to several health risks, including increased body weight, diabetes, CVD, metabolic syndrome, and gout. Dr. Hu recommended more sugar-free or low-sugar alternatives be made available and that strategies learned from fighting tobacco abuse be used to reduce the consumption of SSBs. He proposed a multipronged approach that includes education, regulation, and taxation. The Obesity Prevention Source (\u003Ca href=\u0022http:\/\/www.obesitypreventionsource.org\u0022\u003Ewww.obesitypreventionsource.org\u003C\/a\u003E) provides information and materials to educate children.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/16\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznmdp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznmdp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznmdp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}