Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου

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1 ΠΡΟΓΡΑΜΜΑ ΜΕΤΑΠΤΥΧΙΑΚΩΝ ΣΠΟΥΔΩΝ «Η ΔΙΑΤΡΟΦΗ ΣΤΗΝ ΥΓΕΙΑ ΚΑΙ ΣΤΗ ΝΟΣΟ» Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου Γεώργιος Ντάιος Παθολογική Κλινική Πανεπιστημίου Θεσσαλίας

2 Stroke Statistics Stroke is the third leading cause of death ranking behind diseases of the heart and cancers Killed 150,147 people in 2014; females accounted for 60.9 percent of stroke deaths. About 5,700,000 stroke survivors are alive today. 2,400,000 are males and 3,300,000 are females. 700,000 people suffer a new or recurrent stroke each year.

3 Stroke Prevalence

4 Stroke Incidence

5 Stroke 1yr mortality

6 Stroke 5yr mortality

7 Stroke 5yr recurrence rate

8 Stroke risk factors Non-Modifiable Age Gender Genetic factors Modifiable Hypertension Exposure to cigarette smoke Diabetes Atrial fibrillation and other cardiac conditions Dislipidemia (ischemic stroke) Post-menopausal hormone therapy Poor diet Obesity/body fat distribution Inactivity

9 Stroke risk factors

10 American diet Mediterranean diet

11 WHAT IS THE MEDITERRANEAN DIET? Olive oil as the main added lipid Unrestricted Total Fat Poly-unsaturated fatty acids Low consumption of meat / meat products What it is NOT the MeDiet Margarine, soybean oil, mustard oil. European Journal Epidemiology. 2004;19:9-13.

12 Poly-unsaturated fatty acids: - are less oxidized and contribute to reduced insulin resistance. - reduce blood cholesterol levels and atherosclerosis October 7, 2010 in Diabetes Care

13 DIABETES CARE "Also, some of the components of the Mediterranean diet are very rich in antioxidant compounds, with important anti-inflammatory effects. It is now well recognized that a chronic low-grade inflammation and a pro-oxidation status are pathogenic factors in diabetes." Time, Health: The Fires Within. Feb. 2004

14 MEDITERRANEAN DIET SCORE CRITERIA Food Group Criteria for Earning 1 Point [ ] Vegetables 3-5+ servings/day [ ] Legumes 4+ servings/week [ ] Fruit 3 + servings per day [ ] Nuts 4-5+ servings per week [ ] Whole grains 2-3+ servings per day [ ] Fish 2+ servings per week Score 0-9 possible. High score is linked to lower risk of death from cancer, heart disease, and stroke, and a significant decrease in all causes of mortality. [ ] Healthy fats (plant oils) Mostly plant oils, 1.5 to 1 ratio, plant to animal fats [ ] Red and processed meats None, or limited to no more than 1-2 servings/week [ ] Red wine intake Limited, women no more than 2-7 drinks/week Men, no more than 4-7 drinks per week Harvard Study: 6-7 years of follow-up: 6,137 men; 11,278 women American Journal Clinical Nutrition. 2014;99:

15 MEDITERRANEAN DIET SCORE AND MORTALITY 1,00,900,800,700, Risk of Disease Lowered Risks of Disease,85,85,81, of the 14 Points Diet Getting 7 to 9 points of the Predimed diet means lowered risk of disease. Compare those with 7-9 points to those with fewer than 7 points. More points means decreased risk of these diseases: 15% risk of cancer 15% risk of cardiovascular disease 21% risk of death from other causes 19% risk of death from all causes Harvard Study: 6-7 years of follow-up: 6,137 men; 11,278 women American Journal Clinical Nutrition. 2014;99:

16 Adherence to MedDiet and Stroke Kontogiani M, Panagiotakos D. Maturitas 2014

17 Post-prandial levels Fasting levels of lipids alone do not reflect the general lipid content of a person s diet and there is good evidence that postprandial levels of fats and oxidative stress are as important as fasting lipid levels. The Mediterranean diet (the Cretan diet in particular) resulted in similar levels of fasting lipids to those of people on other diets but also in significantly lower post-prandial lipid levels.

18 Fruits, Vegetables & Stroke

19 Fruits, Vegetables & Stroke

20 Sodium & Stroke

21 Magnesium & Stroke

22 Multivitamins β carotene, vita & vit E

23 Multivitamins vitamin E

24 Homocysteine and CVD risk

25 Homocysteine and B vitamins

26 B-vitamins for stroke prevention

27 B-vitamins for stroke prevention

28 B-vitamins for stroke prevention

29 Vitamin D

30 Vitamin D & Stroke

31 Vitamin D & Stroke

32 Vitamin D & Stroke

33 Rice & Stroke

34 Fish & Stroke

35 Fish & Stroke

36 Red meat & Stroke

37 Red meat & Stroke

38 Alcohol & Stroke

39 Wine & Stroke

40 Alcohol & Stroke

41 Beer & Stroke

42 Coffee & Stroke

43 Coffee & Stroke

44 Tea & Stroke

45 Tea & Stroke

46 Chocolate & Stroke

47 Chocolate & Stroke

48 AHA/ASA Guidelines - limit saturated fatty acids to a minimum, avoid fried foods, fatty meats, butter and margarine and creamed or whole-milk products (instead they should choose lean meats, poultry and fish or substitute legumes and soy products for meats) choose tub margarines containing plant stanol or sterol esters, which help to lower cholesterol, and minimise their use of highly processed, canned and frozen prepared foods; limit salt to 2300 mg per day and substitute other seasonings and flavourings limit alcohol to two drinks per day for most men and one drink per day for women and low-weight people choose low-fat or fat-free dairy products in place of higher-fat versions read food labels carefully and select foods for which whole grain appears as one of the first ingredients, and substitute whole-grain breads, pastas and flours for their traditional white versions eat a variety of nuts (if their swallowing is normal).

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