1.
Impacte de l’alimentació saludable i sostenible
en la prevenció de les malalties cròniques
Emili Ros
Investigador emèrit IDIBAPS.
Hospital Clínic.
Barcelona

2.
Conflict of Interest Disclosure
• I have received funds for research through my institution and fees
for research program supervision and lecture presentations from
the California Walnut Commission and I am a nonpaid member of
its Scientific Advisory Committee.
• I have received funds for travel and congress attendance from
the International Nuts and Dried Fruits Council.
• Advisory: Alexion

3.
GBD 2017 Diet Collaborators. Lancet 2019;393:1958–1972.
Impact of Suboptimal Diet on Non-Communicable Disease Mortality

4.
Principales factores dietéticos responsables de mortalidad
por cualquier causa a nivel global (el año 2017):
1. Ingesta excesiva de sal (3 millones)
2. Baja ingesta de cereales completos (3 m)
3. Baja ingesta de fruta (2,5 m)
4. Dieta baja en frutos secos y semillas (2 m)
5. Dieta baja en verduras (1,5 m)
6. Bajo consumo de pescado (1,5 m)

5.
Mortalidad estandarizada por edad
por 100.000 personas de la población
Lancet. 2019;393;1958-72.

6.
FAO & WHO. 2019

7.
Sustainable healthy diets:
2 …are based on a great variety of unprocessed or minimally processed
foods, balanced across food groups, while restricting highly processed
food and drink products.
3 … include wholegrains, legumes, nuts and an abundance and variety
of fruits and vegetables.
4 … can include moderate amounts of eggs, dairy, poultry and fish, and
small amounts of red meat.

8.
Sustainable healthy diets:
9 …maintain greenhouse gas emissions, water and land use, nitrogen
and phosphorus application and chemical pollution within set targets.
10 … preserve biodiversity, including that of crops, livestock, forest-
derived foods and aquatic genetic resources, and avoid overfishing
and overhunting.

9.
Sustainable healthy diets:
14 … are built on and respect local culture, culinary practices,
knowledge and consumption patterns, and values on the way food
is sourced, produced and consumed.
15 … are accessible and desirable.

10.
Sustainable healthy diets:
Help reduce the burden of
non-communicable diseases
(prevent chronic diseases)

11.
Traditional Mediterranean diet
Ancel Keys – 1950-60
Food pattern in Crete, Greece and Southern Italy
Climate & geography + underdevelopment:
wheat (bread, pasta), olive trees (oil), vines (wine)
seasonal vegetables and fruits
Small rural little red meat (1 pig / lamb per family/year)
properties dairy products as yoghurt and cheese
fish/seafood (fresh or pickled / salted)
little sugar
+ considerable physical activity, absence of obesity

12.
Characteristics of the Mediterranean diet
• Olive oil as main culinary fat
• Abundant vegetable products
cereals (bread, pasta and rice)
fresh vegetables and fruits
legumes
tree nuts
aromatic herbs and spices
• Frequent intake of fish and shellfish
• Moderate consumption of wine with meals
meat and animal products
• Low intake of milk and milk products
simple sugars

13.
Risk reduction associated with a 2-point increase
in a 9-point score of adherence to the MeDiet
Sofi F, et al. Am J Clin Nutr. 2010;92:1189-96.
End point Relative risk (95% CI)
CVD incidence & mortality 0.90 (0.87 – 0.93)
Total mortality 0.92 (0.90 – 0.94)
Cancer mortality or incidence 0.94 (0.92 – 0.96)
Neurodegenerative disease 0.87 (0.81 – 0.94)

14.
Risk of mortality from or incidence of CVD associated with a 2-
point increase in a 9-point score of adherence to the MedDiet
Martinez-González MA, et al. Curr Opin Lipidol 2014;25:20–26.

15.
Umbrella meta-analysis of prospective studies assessing
adherence to the Mediterranean diet and CVD outcomes
Grosso G, et al. Crit Rev Food Sci Nutr. 2017;57:3218–32.

16.
Forest plot of RRs for the association between MeDiet
score (high vs. low) and the risk of Alzheimer’s disease
Wu L, Sun D. Sci Rep. 2017;7:41317

17.
Mediterranean diet and cancer.
Summary of meta-analyses of observational studies
Guasch-Ferré M, Willett WC. J Intern Med. 2021;290:549–66.

18.
RCTs of dietary patterns with
outcomes of CVD events:
only with the Mediterranean diet

19.
de Lorgeril M, et al.
Final Report of the Lyon
Diet
Heart Study.
Circulation 1999;99:779-85.
The Lyon Diet Heart Study. A secondary CHD
prevention trial with a “peculiar” MedDiet

20.
PREDIMED Study – Main Outcome: CVD
Estruch R, et al. N Engl J Med. 2018;378:e34.

21.
HR: 0.73 (95% CI, 0.55 - 0.97)

22.
PREDIMED – Other benefits of the MedDiet
• Reduced incident diabetes
• Reduced incidence of atrial fibrillation
• Reduced incidence of peripheral artery disease
• Increased reversion of metabolic syndrome
• Decreased clinical diastolic BP
• Reduced breast cancer rates
• Reduced rates of incident depression
In sub-studies:
• Reduced 24-h BP
• Regression of carotid atheroma
• Improved cognition

23.
PREDIMED - 14-point MeDiet score (MEDAS)
1. Olive oil use as main culinary fat 8. Wine ≥7 glasses/wk
2. Olive oil ≥4 tbs/d 9. Legumes ≥3/wk
3. Vegetables ≥2/d 10. Fish & seafood ≥3/wk
4. Fruit ≥3/d 11. Cakes, sweets <3/wk
5. Red meat & meat products <1/d 12. Nuts ≥2/wk
6. Butter, cream, margarine <1/d 13. Poultry > red meats
7. Soda drinks <1/d 14. Sofrito sauce ≥2/wk
Schroeder H, et al. J Nutr. 2011;141:1140-5.

24.
Sofrito (salsa) – la receta de la abuela
La abuela Tomate, cebolla, perejil Aceite de oliva Triturar vegetales
Cocer a fuego lento
Muy sabroso, pero también:
• Aumenta la biodisponibilidad del beta-caroteno
(liposoluble – extraído por el aceite)
• Gran carga de polifenoles
• En platos de arroz o pasta refinados: reduce el
índice glicémico

25.
Efectos beneficiosos sobre enfermedades no transmisibles de
algunos componentes de la dieta mediterránea
Frutos secos
Frutas y
verduras
Cereales Legumbres
Aceite de oliva Pescado

26.
Frutas/verduras y Enfermedades Cardiovasculares.
Meta-análisis de 95 estudios prospectivos
Dosis-respuesta para ECV
Para frutas y verduras combinadas, la reducción de riesgo por cada 200 g/día fue:
• RR: 0.92 (IC 95%, 0.90–0.95) para ECV
• RR: 0.92 (IC 95%, 0.90–0.94) para ECC Datos similares para frutas y verduras aisladas
• RR: 0.84 (IC 95%, 0.76–0.92) para ictus
Aune D, et al. IJE 2017;46:1029-56.

27.
Frutas/verduras y mortalidad total.
Meta-análisis de 24 estudios prospectivos
Wang DD, et al. Circulation 2021;1143:1642-54.
Frutas y verduras Frutas Verduras

28.
Consumo de legumbres (alto frente a bajo) y riesgo de enf. cardiometabólicas.
Meta-análisis de 28 estudios prospectivos (de 6 meta-análisis).
Viguiliouk E, et al. Adv Nutr. 2019;10:S308–S319.

29.
Salvado*
Endospermo
Germen*
*Se pierden con el refinado
Grano de cereal

30.
Consumo de cereales integrales (por 90 g/día) y riesgo de ECV y ECC.
Meta-análisis de 45 estudios prospectivos
Aune D, et al. BMJ 2016;353:i2716. RR similares para ictus, mortalidad total y muertes por cáncer
ECV ECC

31.
Meta-analysis. Nut consumption (high vs- low)
and risk of CVD in prospective studies
CVD incidence
CVD mortality
CHD incidence
CHD mortality
Stroke incidence
Stroke mortality
Hemorrhagic stroke
Ischemic stroke
Atrial fibrillation
Heart failure
0.85 (0.80-0.91)
0.77 (0.72-0.82)
0.82 (0.69-0.96)
0.76 (0.67-0.86)
1.00 (0.92-1.09)
0.87 (0.76-1.00)
1.02 (0.77-1.34)
0.99 (0.89-1.10)
0.85 (0.73-0-99)
1.00 (0.86-1.16)
Becerra-Tomás N, et al. Nutr Rev. 2019;77: 691–709.

32.
Consumo de aceite de oliva/ácido oleico y ECV.
Meta-análisis de estudios prospectivos
Schwingshackl L, Hoffmann G. Lipids Health Dis. 2014;13:154.
Aceite de oliva
Ácido oleico

33.
For each 10-g/2000 Kcal increase in OO consumption, CHD risk
decreased by 3% for refined OO and 14% for virgin OO.

34.
Adv Nutr. 2020;11(5):1123-33.
Revisión de 34 meta-análisis de estudios observacionales
obtenidos de 298 estudios prospectivos en los que se
cuantificó la ingesta de pescado mediante encuestas
alimentarias (no suplementos de aceite de pescado). Cada
incremento de 100 g/día en el consumo de pescado se asoció
a una reducción del riesgo de:
• Mortalidad por ECV (RR: 0.75; IC 95%, 0.65-0.87)
• Infarto de miocardio (RR: 0.75; IC 95%, 0.65-0.93)
• Ictus (RR: 0.86; IC 95%, 0.75-0.99)
• Insuficiencia cardiaca (RR: 0.80; IC 95% 0.67-0.95)

35.
New Pyramid for a Sustainable Mediterranean diet
Serra-Majem L, et al. Int J Environ Res Public Health 2020;17:8758.

36.
Obesity
Metabolic syndrome
Diabetes
CHD
HF
AF
CKD
Stroke
Depression
Dementia - Parkinson
PAD
Cancer
COPD
Cataracts
Macular degeneration
Osteoporosis Frailty
Pathology of unhealthy aging

37.
Adherence to Mediterranean diet promotes healthy aging
Obesity
Diabetes
MetS
CHD
CKD
Stroke
Depression
Dementia
Parkinson
PAD
Cancer
COPD
Cataracts
Macular degeneration
AF
Osteoporosis
Frailty
HF

38.
Foeman KJ, et al. Lancet. 2018;392;2052-90.
Predicción de la esperanza de vida a nivel global en el año 2040

39.
Reto para el siglo XXI: El problema de alimentar 9.000
millones de personas dentro de 50 años
La eficiencia de la conversión de materia vegetal en animal es
~10%; está claro que la misma superficie de tierra de cultivo
puede alimentar a mucha más gente si siguen una dieta de
base vegetal, como la dieta mediterránea tradicional.

40.
A healthy diet from a sustainable food system promotes
both disease-free longevity and planetary health
The paradigm:
Mediterranean diet

41.
Recomendaciones para luchar contra el
cambio climático mediante la alimentación
1. Comer poca carne
2. Reducir el sobreconsumo de energía
(disminuir las tasas de obesidad)
¿Porqué no comer siempre en plato de postre?
(F. Grande Covián)

42.
Study Sponsors

43.
Gràcies per escoltar-me!