“Dieta Mediterránea y pérdida de peso” - SEEDO · 1.Conocerá los componentes de la Dieta...

“Dieta Mediterránea y pérdida de peso”

Miguel A. Martínez-González

Conflictos de interés

• Ninguno

ObjetivosAl final de esta presentación el participante:

1.Conocerá los componentes de la Dieta Mediterránea (MedDiet) y las razones científicas para recomendarla.

2. Podrá valorar críticamente la evidencia sobre la asociación MedDiet-cambio de peso (u obesidad / sobrepeso) obtenida a partir de grandes cohortes observacionales.

3. Estará al tanto de los resultados y limitaciones de los principales ensayos aleatorizados sobre el tema.

4. Sabrá aplicar un cuestionario de 14 items para valorar la adherencia a la MedDiet y proporcionar feedback inmediato a sus pacientes.

Obesidad

Dieta Mediterránea

Ensayos aleatorizados

Cohortes Observacionales

Interpretación

N Engl J Med 2013;369:954-64.

Wild SH, et al. BMJ 2006;333:1009-1011

Albert Einstein:

• A clever person solves a problem

• A wise person avoids it

Obesidad

Dieta Mediterránea



Interpretación

• Interaction Synergies Antagonisms

• Confounding Preempts confounding (by other dietary factors)

• Statistical power The isolated effect of a nutrient: too small Cumulative exposure = effect Avoids multicollinearity Avoids issues of multiple comparisons

• Public health a sociological reality per se

Dietary patterns: advantages

Satija A et al, Adv Nutr 2015;6:1‐14.

Three beneficial dietary patterns1.Healthy US-style pattern2.Healthy Mediterranean-style pattern3.Healthy Vegetarian pattern

Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC):

Evidence Basis and Key Recommendations (Feb 25, 2015)

The Committee`s examination of the association between dietary patterns and various health outcomes revealed remarkable consistency in the findings

The heart of what we now consider the Mediterranean diet is mainly vegetarian:

‐pasta in many forms,‐leaves sprinkled with olive oil,‐all kinds of vegetables in season,‐and often cheese,‐all finished off with fruit,‐and frequently washed down with wine

Am J Clin Nutr 1995;61(suppl).1321S

Fruta

Pescado

Verduras

Frutos secos

Aceite de oliva

Vino

Meta-análisis acumulado

de cohortes prospectivas

de Dieta Mediterránea (por

cada +2 puntos en escala

de 0 a 9) y riesgo de

enfermedad cardiovascular

(efectos aleatorios)

We evaluated the intakes of• Zn• I• Se• Fe• Ca• K• P• Mg• Cr and vitamins • B1• B2• B3• B6• B12• C• A• D• E• folic acid.

Br J Nutr 2014;111:2000‐9

DOG

www.proyectosun.es

MeDiet: a high‐quality diet

Quintiles of adherence to the Mediterranean diet(PREDIMED 14‐item score)

ZniodineSeFeKCaPMgChromiumFolic acidB1B2B3B6B12ACDE

www.predimed.es

www.predimed.es

DOG

Obesidad

Dieta Mediterránea



Interpretación

DOG

Cohortes prospectivas observacionales: MedDiet & weight loss

Am J Clin Nutr 2010;92:912–21.

Am J Clin Nutr 2010;92:1484-93

n F‐up Outcome Results Conclusion

EPIC‐PANACEA 373,803 5 y weight chgincidence OW/OB

–0.16 kg / 5 y(–0.24; –0.07)

a high adherence to MedDiet may reduce the likelihood of gaining

weight & OW/OB. Effect on weight change was rather weak

SUN 10,376 6 yweight chg,

relevant chg (5%)

–0.059 kg/y(–0.111; –0.008)

Mediterranean dietary pattern may have a beneficial effect in slowing down the weight gain usually

observed with age.

Am J Clin Nutr 2015;101:1216

16- to 24-y follow-up120,784 men and women free of chronic disease or obesity at baseline.

Mozzafarian D, et al. NEJM 2011

www.unav.es/preventiva

Research designs

Source: Martínez JA, Martínez-González MA. Nutrition Research Methodology: the scientific method and nutritional research.

In: Gibney MJ, et al. Introduction to Human Nutrition. The Nutrition Society Textbook series. London: Blackwell Science, 2009.

Field Trial

Obesidad

Dieta Mediterránea



Interpretación

DIRECT, n=322N Engl J Med 2008

Randomized Clinical Trial

Ros et al. Adv Nutr. 2014;5:330S-6S

www.predimed.es

PREDIMED, N Engl J Med2013;

Stopped for early evidence of benefitafter 4.8-y median

follow-up

www.predimed.es

www.predimed.es

Schröder H, et al. J Nutr 2011

DOG

www.predimed.es

www.unav.es/preventiva

PLos One 2012;7: e43134

www.predimed.es

www.predimed.es

Lancet Diab Endocrinol 2016 Aug;4(8):666-76.

Participants in all three groups reduced body weight.

Compared to the control group, adjusted differences in 5-yearchanges in body weight (kg):

• MeDiet + EVOO: –0.43 (95% CI, –0.86 to –0.01) kg• MeDiet +nuts: -0.08 (95% CI, -0.50 to +0.35) kg

Diff. in 5-y changes in waist circumference (cm):

• MeDiet + EVOO: –0.55 (95% CI, –1.16 to –0.06) cm• MeDiet +nuts: –0.94 (95% CI, –1.60 to –0.27) cm

DOG

www.predimed.es

Lancet Diab Endocrinol 2016;4:666-76.

DOG

www.predimed.es

Lo que NO se hizo en PREDIMED

• Si tiene sobrepeso, pierda peso

• Coma usted menos de todo

• Haga ejercicio físico

n = 5145 – all diabeticsBMI: >=25Max. follow-up: 13.5 yrrecruitment: 2001-2004

Interv. = 1.83 Control= 1.92 (events per 100 p-years)

HR = 0.95 (0.83 to 1.09) P=0.51

DOG

no difference in the number of cardiovascular events

was noted between the two groups

after (median F-U).

Nat Rev Cardiol. 2013;10:1846

DOG

Futility

• LOW-FAT DIETS– Long-term adherence & relapse

– vegetable oils vegetables

– Evidence of failure: Look ahead, WHI-DM

• LOW-CHO DIETS– BP, FPG & lipid improvements lost after 12-mo

– Rich in SFA LDL atherosclerosis

– Low in fibre, Ca, K, Mg

Nutritional quality

Fung TT, Pan A, Hou T, Chiuve SE, Tobias DK, Mozaffarian D, Willett WC, Hu FB. Long-Term Change in Diet Quality Is Associated with Body

Weight Change in Men and Women. J Nutr 2015;145:1850-6.

DOG

The Mediterranean diet has passed the tests of• long‐term sustainability, • effectiveness and • nutritional quality.

A low‐calorie Mediterranean diet might be the most sensible approach for weight loss and prevention of cardiovascular disease in patients with diabetes.

DOG

www.predimedplus.com

DOG

1ary end-point:AMI, non-fatal stroke or CV mortality

17-item screenernegociated goals for the intervention group

DOG

Pacientes aleatorizados 10 Nov, 2016(+ run in)

p<.001

n=1694

n=776n=776p<.001p<.001

n=1694

n=776n=776

p<.001

p<.001p<.001

n=776

n=776n=776

n=776

p<.001p<.001

n=776

n=776n=776

n=776

p=0.0015

n=1694

n=776n=776

p=0.015

p=0.0097p=0.0097

Obesidad

Dieta Mediterránea



Interpretación

Katan MB. N Engl J Med 2009;360:923-5

vv

DOG

Lancet Diabetes Endocrinol 2015 Dec;3:968-79.

Med Low‐fat Med Low‐fat

Shai, 2008 ‐4.7 –3.6 –4.4 –2.9

Esposito, 2009 –6.2 –4.2 –4.9 –3.7

Elhayany, 2010 –7.7 – – –

Tuttle, 2008 –2.0* –1.0* – –

McManus, 2001 –4.8 –5.0 –4.1 +2.9

24- months12- months

* BMI instead of weight

Conclusiones• MedDiet

– demostrada y consistente eficacia en prevención CV

– mejor mantenimiento y sostenibilidad a largo plazo

– herramienta de 14 items válida (valoración+feedback)

• Low-fat diets– Fracaso de los 2 ensayos sobre ECV: WHI & LookAHEAD

• No hay grandes ensayos de MedDiet+pérdida peso+activ. física que demuestren eficacia en ECV

• MedDiet+energy restriction: probablemente la opción ideal para combatir obesidad, DMT2 y ECV

Gracias

“Dieta Mediterránea y pérdida de peso” - SEEDO · 1.Conocerá los componentes de la Dieta...

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