Dietetics and Nutrition in the Mediterranean

By Dr. Ssa Fabiana Avallone

Hypertension Between 1991 and 2000, the prevalence of hypertension in the US increased by 3,7%, and more than half of this increase was attributed to an increased prevalence of obesity. Hypertension continues to be a major risk factor for cardiovascular disease. As many 58 million people in the United States have elevated blood pressure (systolic blood pressure > 140 mm Hg and/or diastolic blood pressure > 90 mm Hg) or are taking antihypertensive medications. Blood pressure level is predictive of mortality from stroke, heart disease and renal impairment.

Hypertension Based on a review of data from the third National Health and Nutrition Examination Serveys (NHANES III), the southern region of the United States, which includes the “stroke belt”, has dietary patterns that may contribute to the high prevalence of hypertension and cardiovascular disease in that region. Compared with other regions of the US, residents in the south reported the highest sodium consumption, and the lowest consumption of potassium, calcium and magnesium.

Hypertension and sodium A high sodium chloride (NaCl) intake contributes to elevated arterial blood pressure in populations; blood pressures increased progressively with progressive increases in dietary NaCl. The effect of NaCl on blood pressure increases with age, with the height of the blood pressure, and, in normotensive persons, with a family history of hypertension. Current estimates of NaCl intake in the United States are in range of 8 to 10 g/day. Specific guideline of the American Heart Association recommended that dietary NaCl be restricted to no more than 6 g/day, and more rigorous NaCl restriction (2-3 g/day) for hypertensive persons.

Sodium rich food mg/100gProsciutto crudo di Parma 2578

Prosciutto crudo 2238Caviar 2200

Smoking Salmon 1880Salami 1827

Pecorino1800Bresaola 1597

Speck 1557Feta cheese 1440

Tomato ketchup 1120Cornflakes 1100

Marinated Herring 1030Wurstel (hot dog) 930

Taleggio 873Provolone 860Margarine 800

Pizza 767Grana 700

Gorgonzola 600Parmigiano 600

Hypertension and potassium Potassium loading prevents or ameliorates development of hypertension in several animal models of genetic and NaCl induced Hypertension.A low potassium intake results in blood pressure elevation and renal vascular remodeling, indicating increased renal vascular resistence. Reduced sodium (< 6 g/day) and increased potassium intake (> 4 g day) lowered blood pressure in men and women with mild to moderate hypertension.

Potassium rich food mg/100g 1. Soy beans 17402. Borlotti beans 14783. Cannellini beans 14114. Dried apricots 12605. Dried figs 10106. Peas 9907. Lentils 9808. Pistachios 9729. Chickpeas 88110. Sultans 86411. Chestnut flour 84712. Dried plums 824

Potassium rich food mg/100g 13.Dried dates 75014.Tinned oil sardines 70015.Peanuts 68016.Fresh borlotti beans 65017.Sardines, anchovies 63018.Potatoes 57019.Spinach 53020.Whole wheat 49421.Arugula 46822. Hezelnuts 46623. Brussels sprouts 45024. Black olives 433

Top 10 fruits for potassium content/100g1. kiwi 4002. bananas 3503. melon 3334. apricots 3205. pomegranate 2906. watermelon 2807. figs 2708. peches, blackberries 2609. ananas, medlar, 25010. grapefruit 23011. cherries 229

12. raspberries 22013. clementines21014. oranges 20015. grape 19216. plums, susine 19017. kaki 17018. strawberries, blueberries

16019. pear 12720. apple 125

Hypertension and calcium More than 80 studies have reported that blood pressure is lowered by increasing dietary calcium; “is an inverse association between dietary calcium intake and blood pressure, and low calcium intake is associated with an increased prevalence of hypertension”. Diets with less than 600 mg calcium/day are most clearly associated with hypertension. The National Academy for Science recommendations for calcium consumption are 1300 mg/day for adolescents (9-18 years), 1000 mg/day for adults less than 50 years of age, and 1200 mg/day for those more than 50 years old.

Foods richest in Calcium content mg/100g 1. Pecorino 11602. Parmigiano 11593. Arugula 3094. Ricotta 2955. Almonds 2406. Dried figs 1867. Oyster 1868. Green beet 1609. Mozzarella 16010. Hazelnuts 15211. Cicory 15012. Anchovies 14813. Octopus 14414. Squid 14315. Chickpeas 14216. Cannellini 13217. Walnuts 131

18. Agretti 131 19. Pistachios 130 20. Yogurt 12521. Milk 11922. Radicchio 11523. Shrimp 11024. Buckwheat 11025. Borlotti 10226. Broccoli 9727. Cardoons 9628. Endive 9329. Fava beans 9030. Mussels 8831. Artichoke 8632. Dried apricot 8533. Spinach 7834. Raisin 78

35. Dates 6936. Chard 6737. Jhon Dory 6538. Hare 6439. Olive 6340. Kale 6241. Cauliflower 60

Hypertension and lipids Both animal and human data suggest that omega-3 and omega-6 fatty acids play a role in blood pressure regulation.In experimental models of hypertension, both linoleic acid (omega-6) and fish oil (omega-3) attenuate the development of hypertension. Epidemiologic evidence suggests a direct association between diets high in saturated fats and blood pressure; conversely, diets high in omega-3 fatty acids may be associated with lower blood pressure.

Seafood is high in Omega-3

SpeciesOil (%)

Omega-3(mg/100g)

DHA(mg/100g)

Shark 0,9 300 250Swordfish 7,7 1350 550Spanish mackerel 1,2 400 275Atlantic salmon 2,7 650 425Tiger prawn 0,8 180 75Blue mussel 1,7 330 170Oyster 1,0 300 150Anchovies 1478Eel 653Trout 1175Fresh tuna 1298

Mediterranean Diet Rules• vegetables (at least 300-400 g a day) • fruit (at least 4 pieces or 400 g a day)• legumes and pulses• grains, pasta and/or bread (mostly whole) • olive oil and nuts• water (more than 2 liters per day)• wine during meals ( maximum 2 glasses per day )• seafood (fish, shellfish, mollusc), 4-6 times a week• yoghurt, 2 - 4 times per week• cheese, 1 - 4 times per week• milk, 1 - 2 times per week• eggs, 1 - 4 eggs per week (maximun 1 per day)• poultry, 1 - 2 times per week• red meat, 0 - 1 time a week • sweets, 0 - 1 time per week

What is celiac disease?• Celiac disease (from the greek Koil, cavity, stomach), also known as celiac

disease or celiac sprue (for "sprue" identifies a chronic disease characterized by diarrhea and anemia leading to cachexia) is a permanent intolerance to gliadin. Gliadin is the alcohol-soluble component of gluten, a mixture of proteins contained in wheat, barley, rye, in 'oats in barley, kamut in. Therefore, all foods derived from these cereals containing gluten or after contamination should be considered toxic for patients suffering from this disease. Although the disease has a Mendelian genetic transmission, it is characterized by a degree of familiarity, due to both major histocompatibility complex genes and other genes not yet identified. Gluten intolerance causes serious injury to the mucosa of the small intestine, which were resolved by eliminating gluten from the diet. The reversibility of the disease is closely related to non-recruitment by the subject of food containing gluten or celiac still contaminated by it. Celiac disease does not heal: the subject celiac remain so throughout his life, the only cure is to adopt a strict gluten-free diet.

ETIOLOGYThe causes of celiac disease includes both genetic and environmental factors

Environmental factors• Environmental factors are

represented by gluten, which is the protein component of wheat flour, barley, rye and oats. The wheat gluten is in turn composed of gliadins, proteins that are soluble in alcohol, and glutenins, alcohol-insoluble proteins

Genetic factors• The importance of genetic factors in

the pathogenesis of celiac disease is confirmed by studies of families of celiac patients have shown a prevalence of celiac disease to 10% among first-degree relatives and 30% if brothers and sisters HLA identical. A recent study showed the hypothesis that the initiation of celiac disease can occur on genetically susceptible (HLA DQ2/DQ8), following a common response to infection with rotavirus protein "VP7" rotavirus ( a common virus that causes enteritis in children, 90% of Italians in their lives they have made contact)

CLINICAL

• Celiac disease may present with a wide spectrum of clinical manifestations ranging from signs and symptoms of frank malabsorption checked more subtle and nuanced. There is talk of celiac disease increased in the presence of symptoms typical of severe malabsorption, namely diarrhea, steatorrhea and marked weight loss. It speaks of celiac disease in case of minor children and extraintestinal symptoms (anemia, osteoporosis, skin lesions typical, infertility, miscarriages, etc.). It speaks of silent celiac disease for those patients diagnosed, usually between family members, who show no symptoms. In addition, there are many diseases associated with celiac disease.

DIAGNOSIS• The diagnosis of celiac disease is based on gastroscopy with duodenal biopsy and

detection of antibodies specific for celiac disease. The duodenal biopsy must show the histological features for celiac disease and that atrophy of intestinal villi, hypertrophy of crypts and increased number of intraepithelial lymphocytes. The development of these lesions, however, is a dynamic process that can occur in varying degrees, and then with injuries more or less marked, ranging from total atrophy of the mucosa (villi completely disappeared) to a normal intestinal architecture in which the only fault is measurable represented by an increase in intraepithelial lymphocytes.Diagnosis is necessary to demonstrate that the patient is also positive for antibodies specific for celiac disease, especially antiendomysial antitransglutaminasi and tissue. It is very important to keep in mind that both the intestinal lesions that antibodies specific for celiac disease is gluten-dependent and then disappear once the patient has removed the gluten from the diet. So when you think a patient is suffering from celiac disease, duodenal biopsy should be run and must seek specific antibodies when the patient is still eating gluten.

Treatment• Currently, the gluten-free diet is the only therapy but are investigating other

therapeutic strategies. The gluten-free diet must be very strict because small amounts of gluten are enough to prevent the histological improvement and should be carefully followed throughout life. Need to be removed from the diet not only food containing wheat and dairy products, but also those containing barley, rye and oats. Initially it may be difficult to stick to a strict diet aglutinata because gluten can be contained in various foods contained in the normal diet: wheat flour is one of the most common ingredients in several foods. Therefore, we need properly inform the patient to prevent inadvertent violations and offer, with periodic checks, a service continued. In the early stages of the diet may also be necessary supportive therapy that is limited to the correction of specific deficits due to the presence of a mucosal still damaged. The dietary treatment is the only necessary in more than 70% of celiacs. In ways that do not respond to a gluten-free diet, is used to immunosuppressive treatment.

DIET• Celiac disease is fought so with a gluten-free diet: rice, corn, buckwheat, millet, soy,

amaranth, quinoa, in combination with fruits, vegetables, fish, meat, cheese, vegetables and other can however, be easily incorporated in the daily of celiac. It is worth emphasizing that a person with celiac disease, by keeping a proper diet, can lead a completely normal life. According to studies made the highest concentration of gluten a celiac can take in food is 20 ppm (parts per million), the threshold beyond which the gluten becomes toxic. It is important to understand minimal contact with those of foods containing gluten for celiac may contaminate them, for example using the same utensils to stir the pasta is cooked in different pots to be avoided. The ingestion of a small amount of gluten can override the diet, so it's important to make sure that celiac can not ingest food that contain gluten in any form (eg wheat starch. Is often used as a thickener and in structuring many foods, for the same reason it is added to pharmaceutical preparations in tablet form, which people with celiac disease need to check the ingredients under the heading of the ingredients). We must also avoid beer (although there are some brands on the market and types of gluten-free) and pay attention to the espresso bar (because it can be contaminated with barley), spices, sugar, usually pre-cooked food, prepared food flavored (eg. yoghurt fruit) or flavored drinks.