epidemiologia nutrizionale - cnr · •to establish whether culturally different populations suffer...
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530
520
440
330430
340
190
150
160
170
MORTALITA’ PER MALATTIE CARDIOVASCOLARI IN EUROPA (per 100.000 persone/anno)
Fonte: OMS, 1985
ISA, Epidemiologia e Genetica delle Popolazioni
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The Seven Countries Study of Cardiovascular Diseases
The origins
• Created and coordinated by Prof Ancel Keys, Universityof Minnesota• Started in the late 1950’s, early 1960’s• 16 cohorts of men aged 40-59 enrolled in 7 countries (8nations) for a total of 12763 subjects in:• United States, Finland, the Netherlands, Italy, Croatia(former Yugoslavia), Serbia (former Yugoslavia), Greece,Japan
ISA, Epidemiologia e Genetica delle Popolazioni
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• To establish whether culturally different populationssuffer different amount of the disease (prevalence,incidence, mortality).
• To establish whether these differences, if true, areexplained by life-style, eating habits and othercharacteristics of the populations.
• To establish whether, within populations, somepersonal characteristics (risk factors) were predictiveof subsequent cardiovascular events.
The Seven Countries Study of Cardiovascular Diseases
Objectives
ISA, Epidemiologia e Genetica delle Popolazioni
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•Was run on sub-samples of each cohort.•In 13 cohorts the 7-day record method was used.•In 1 cohort (US) the 1-day record method was used.
•In 2 cohorts (Japan) the 4-day record method was used.
The Seven Countries Study of Cardiovascular Diseases
Dietary data collection
ISA, Epidemiologia e Genetica delle Popolazioni
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CHD mortality rates in 5 years in 8 nations ofthe Seven Countries Study.
0
5
10
15
20
25
30
US FIN NL IT HR SE GR JP
CH
D d
ea
th r
ate
s p
er
10
00
in
5 y
ea
rs
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0
50
100
150
200
250
300
US FIN NL IT HR SE GR JPCH
D d
ea
th r
ate
s p
er
10
00
in
25
ye
ars
CHD mortality rates in 25 years in 8 nations ofthe Seven Countries Study.
ISA, Epidemiologia e Genetica delle Popolazioni
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0
20
40
60
80
100
120
140
0 5 10 15 20 25
dietary SAFA (% EN)
15-year
CHD d
eath
rate
s pe
r 1000
Correlation between dietary SAFAand 15-year CHD mortality in 16 cohorts
of the Seven Countries Study
ISA, Epidemiologia e Genetica delle Popolazioni
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128
130
132
134
136
138
Oliod’oliva
Burro
83
85
87
Oliod’oliva
Burro
PAS (mmHg) PAD (mmHg)
5,35
Oliod’oliva
Burro
Colesterolo (mmol/L)
5.45
5.55
4,55
Oliod’oliva
Burro
Glicemia (mmol/L)
4.75
4.95
Categorie di consumo: Basso Medio Elevato
M. Trevisan et al. JAMA, 1990
Fattori di rischio per cardiopatia ischemica in base alconsumo di grassi (The Italian Nine Communities Study)
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CHANGING THE MEDITERRANEAN DIET...The POLLICA Study
ISA, Epidemiologia e Genetica delle Popolazioni
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CHANGING THE MEDITERRANEAN DIET...The POLLICA Study
SCOPO
• valutare gli effetti di modificazioni dei grassi alimentari suilipidi plasmatici e sulla pressione arteriosa
POPOLAZIONE
• 58 volontari sani abitanti nel comune di Pollica (ParcoNazionale del Cilento, Salerno)
DIETA SPERIMENTALE
• MENO cibi tradizionali di origine vegetale (in particolareolio d’oliva)
• PIU’ alimenti ricchi di grassi saturi di origine animale(burro, panna)
ISA, Epidemiologia e Genetica delle Popolazioni
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CHANGING THE MEDITERRANEAN DIET:EFFETTI SUI LIPIDI PLASMATICI
100
120
140
160
180
200
220
240
Dieta
tradizionale
Dieta
sperimentale
Dieta
tradizionale
Tot-CHOL (mg/dl) LDL-CHOL (mg/dl)
The Pollica Study
Ferro-Luzzi et al, Am J Clin Nutr, 1984
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70
74
78
Traditional diet Experimental
diet
Traditional diet
CHANGING THE MEDITERRANEAN DIET: EFFETTI SULLA PRESSIONE The Pollica Study
108
112
116
120
Traditional diet Experimental
diet
Traditional diet
Strazzullo et al, J Hypertension, 1986
(mm Hg)
(mm Hg)
Pressione sistolica
Pressione diastolica
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Variazioni nel consumo quotidiano di farmaci in pazientiipertesi in corso di 6 mesi di dieta ricca in olio extra-vergine
d’oliva o olio di girasole
-60
-40
-20
0
Vari
azio
ne (
%)
Olio d'oliva Olio di girasole
Olio d'oliva Olio di girasole
Ferrara et al. Arch Intern Med 2000; 160: 837-842
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VARIAZIONI DEL CONTENUTO IN GRASSI NELLA DIETA DELL’ITALIAMERIDIONALE E INSULARE
0
5
10
15
20
25
30
35
40
Olio d
'oliva
Oli veg
etali
Burro
Grassi
saturi
Grassi
vari
Grass
i total
i
1965
1985
%
ISA, Epidemiologia e Genetica delle Popolazioni
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95%
5%
SI
Pensate che un elevato contenutodi grassi animali nella dieta sia
pericoloso per la salute ?
0
2 5
5 0
7 5
1 0 0
NO
Non più di 2
3 o più
Sapete indicare uno o più alimentiricchi in grassi animali ?
INFORMAZIONE & SALUTE: indagine conoscitiva sul livello di conoscenza delruolo della nutrizione nella prevenzione delle malattie cardiovascolari condotta inaree urbane e rurali dell’Italia meridionale (Barba et al, Ital Heart J 2001; 2:546-552)
NO
ISA, Epidemiologia e Genetica delle Popolazioni
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Summary:
• Numerous comparisons between populations have shownthat there is a strong correlation between the intakeof saturated fatty acids (SFA) and CHD morbidity andmortality.
• A customary diet high in SFA is associated with highlevels of CHD. This is the case for the most Westernand Northern European countries.
• On the other hand, in the Mediterranean countries,where people consume their traditional diet in whichthe majority of fat calories is derived from olive oil,there is a low incidence of CHD.
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LA DIETA MEDITERRANEA:
PATRIMONIO DELLA TRADIZIONE E RISORSA PER IL FUTURO
ISA, Epidemiologia e Genetica delle Popolazioni
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•Da un punto di vista scientifico, si definisce DIETA MEDITERRANEA la dietaabitualmente consumata in Italia Meridionale e Insulare e in Grecia durante glianni ‘50.
•La dieta mediterranea tradizionale è caratterizzata dall’abbondanza dialimenti vegetali come pane, pasta, verdure, insalate, legumi, frutta e fruttisecchi; olio di oliva come fonte primaria di grassi, un moderato consumo dipesce, di carne bianca, di latticini e uova, moderate quantita di carne rossae modesto consumo di vino durante i pasti.
•Questa dieta ha un basso contenuto di acidi grassi saturi, è ricca incarboidrati e fibra, e ha un alto contenuto di acidi grassi monoinsaturi chederivano principalmente dall´olio d´oliva.
Documento di Consenso Internazionale "Olio di oliva eDieta Mediterranea: implicazioni per la salute in Europa”.
ISA, Epidemiologia e Genetica delle Popolazioni
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16
18
20
22
Raro Moderato 1/die 2/die
Indi
ce d
i mas
sa c
orpo
rea
(Kg/
m2)
Frequenza di consumo di latte
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Working hypotheses….
Calcium-linked mechanisms
•Low dietary Ca intake stimulates lipogenesis and fat accumulation•Calcitrophic hormones, such as parathyroid hormone and 1,25 dihydroxyvitamin D, mightinfluence lipid metabolism in the adipocyte, independently of dietary Ca• Supplemental dietary Ca has been shown to influence dietary fat absorption
Other plausible mechanisms:•Bioactive compounds in milk (ACE inhibitory peptides).They limit angiotensin II productionand thereby the angiotensin II stimulation of adipocyte lipogenesis.•Milk also promotes insulin-like growth factor production
Finally, milk consumption could be a marker of other factors either not measured (ormismeasured) in the present study or as yet unidentified.
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Nuove frontiere dell’epidemiologia nutrizionale: la nutrigenomica
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“Regardless of the type of diet-gene interaction, nutritive and non-nutritive components of food influence the abundance and function ofcellular proteins by governing gene expression at a variety of levels”
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