Diabetes Centre Hippokration Hospital Athens, Greece B. KARAMANOS 2007 Report of he MGSD Nutrition Study B. Karamanos MD Associate Professor of Medicine

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, Greece

Reportof he MGSD Nutrition Study

B. Karamanos MDAssociate Professor of Medicine

10th Meeting of the MGSD

27 April 2007Istambul

B. KARAMANOS 2007


15 year mortality %in the 7 Country Study

Area N All cause

CHDNon CHD

Non

Mediterranean

2701 21 6.6 14

Mediterranean 3506 16 2.8 13

Keys et al Am J Epidemiol 124:903, 1986

B. KARAMANOS 2007


Diet and 15 year mortality7 – country study

SAFA Positive PUFA Null

MUFA Negative Protein Null

MUFA/SAFA Negative CHO Null

Keys et al Am J Epidem 124:903, 1986

B. KARAMANOS 2007


B. KARAMANOS 2007


B. KARAMANOS 2007


Change in Mortality after a two point increment in the Mediterranean Diet Score

Mortality HR CI

Total 0.75 0.64 – 0.87

CVD 0.67 0.47 – 0.94

Cancer 0.76 0.59 – 0.98

NEJM 348:2599, 2003

B. KARAMANOS 2007


Fat intake g/day in Nicotera, Italy

1960 1996

Males 67 117

Females 51 119

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, Greece MGSD Nutrition Study PARTICIPATING CENTRES

Prof B. Karamanos (Co-ordinator), A. Thanopoulou, D. Roussi

Athens, GREECE

Prof F. Angelico, M. Del Ben, A. Barbato

Rome, ITALY

Prof S. Assaad-Khalil Alexandria, EGYPT

Prof P. Djordjevic, V. Dimitrijevic-Sreckovic, F. Canovic

Belgrade, SERBIA

Prof N. Katsilambros Athens, GREECE

Dr I. Migdalis Athens, GREECE

Dr M. Mrabet, S. Zarat, A. Bentousi

Oran, ALGERIA

Dr M. Petkova Sofia, BULGARIA

Prof M. T. Tenconi, C. Gallotti

Pavia, ITALY

B. KARAMANOS 2007


Comparison of the Dietary Questionnaire

with the 3-Day Diet Diary

Questionnaire p 3-Day Diet Diary

Energy Kcal/day

1897 NS 1791

CHO g/day 207 0.01 179

Prot g/day 83 NS 80

Fat g/day 79 NS 81

B. KARAMANOS 2007


Comparison of the Dietary Questionnaire

with the 3-Day Diet Diary

Questionnaire p 3-Day Diet Diary

Animal Fat 35 NS 35

Plant Fat 41 NS 43

Cholesterol 263 NS 263

Fibre g/day 21 0.01 16

B. KARAMANOS 2007


Subjects studied4254

Males Females Total

Normals 916 917 1833

Diabetics 913 984 1897

Total 1829 1901 3730

B. KARAMANOS 2007


Obesity % in males and females without and with Diabetes

Alg Egy I-Pav I-Rom Gr Bulg Serb

M 7.5% 3.7 15.2 21.6 30.4 19.2 ---

F 6.1% 14.7 16.7 29.9 35.5 17.1 ---

M 9 11 35 32 12 28 27

F 23 33 46 42 41 41 50

no

rm

D M

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, Greece Conclusions• The prevalence of obesity varies greatly

among Mediterranean countries• In diabetics does not reach the 80%

reported in the literature

B. KARAMANOS 2007


Energy intake and % contribution of each nutrient to it (normals)

Alg Egy I-Pav I-Rom Gr Bulg

Energy 2748 2422 3049 1824 2545 3322

Protein% 17.8 15.7 15.3 17.4 13.4 15.6

Fat% 33.9 26.5 29.4 28.3 36.5 37.2

CHO% 47.8 57.7 46.3 45.5 45.1 42.4

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, Greece Conclusions

• The prevalence of obesity varies greatly among Mediterranean countries

• In diabetics does not reach the 80% reported in the literature

• Diet composition varies greatly among countries

B. KARAMANOS 2007


MGSD

Normal Diabetic

Kcal/day 2654 * 1897

CHO % 47.9 * 44.0

Fat % 32.8 * 34.6

Prot % 16.0 * 19.3

Fiber g/d 22.2 NS 21.9

B. KARAMANOS 2007


Percentage of subjects who meet the Nutritional Recommendations of the DNSG. (normal & diabetic)

Alg Egy I-Pav I-Rom Gr Bulg Serb

Prot, CHO

and Fat

N 18 73 24 27 12 10

DM 4 24 12 10 2 2 20

All above

and Fibre N 3 42 5 2 6 4

DM 2 17 3 1 1 1 8

B. KARAMANOS 2007


Mediterranean DietComparison of data from the 7 – country and MGSD

studies. Greece

Bread Potato Veget Fruit Meat Cheese Milk

1961 380 190 191 464 35 13 235

1996 269 47 168 354 82 67 153

1. Kromhout D. Am J Clin Nutr 49:889, 1989

2. Karamanos B. Eur J Clin Nutr 56:983, 2002

B. KARAMANOS 2007


MediterraneanDiet Score

Plant /Animal Fat ratio Vegetables

Alcohol Consumption Meat

Legumes Dairy products

Cereals Fruits

Fish

Score 0-9 Good > 5BMJ 311:1457-60, 1995

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, Greece MGSD

g/d Normal Diabetic

Bread 219 * 170

Fish 32 34

Fruit 325 * 266

Meat 115 124

Vegetables 185 * 252

% Recomm 32 25

% MedDiet 58 36

B. KARAMANOS 2007




• Diet composition varies greatly among countries

• Nutritional recommendations and MD are followed by very few subjects, especially in diabetics

B. KARAMANOS 2007


Fat intake and DiabetesMGSD Study

Unknown DM Controls

Fat % 34.7 * 30.4

Animal Fat %

14.2 ** 10.6

Thanopulou A. Diabetes Care 26:302, 2003

13.0 %

34.0%

B. KARAMANOS 2007




• Diet composition varies greatly among countries• Nutritional recommendations and MD are followed by very

few subjects, especially in diabetics

• Fat intake is related with the incidence of diabetes

B. KARAMANOS 2007

Diabetes CentreHippokration HospitalAthens, GreecePrevalence of the Metabolic Syndrome

by country and in the population as a whole

27,2

81,7

0

10

20

30

40

50

60

70

80

90

100

Algeria Egypt Bulgaria Italy-Pavia Italy-Rome Greece Serbia Total

NormalsDiabetic

B. KARAMANOS 2007


Prevalence of the Metabolic Syndrome

by BMI category

2,37,5

27,5

59,9

0

10

20

30

40

50

60

%

<20 20-25 25-30 >30

p<0,001

B. KARAMANOS 2007


Prevalence of the Metabolic Syndrome

in the Mediterranean countries

Observed(499

subjects)

Expected (441 subjects)

27.223% p=0.03 24.036%

OR=1.18 (CI 1.01-1.37)

B. KARAMANOS 2007


Metabolic Syndrome (NCEP-ATP III)Presence 3 of the following risk factors

Expert Panel on Detection, Evaluation, and Treatment ofHigh Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497.

Risk factor LevelCentral ObesityWaist circumferenceMalesFemales

>102 cm > 88 cm

Triglycerides 150 mg%HDL-CMalesFemales

<40 mg/dL<50 mg/dL

Blood Pressure 130 / 85 mm HgFasting Glucose 110 mg%

B. KARAMANOS 2007


DM2 N OR p

W * HDL * BP 30.1% 14.2% 1.8<0.00

1

Tg * HDL* BP 27.9% 11.7% 2.3<0.001

W * Tg * BP 23.3% 7.2% 2.8<0.001

W * Tg * HDL 21.0% 7.2% 5.9<0.001

W * Tg * HDL * BP 17.6% 5.2% 3.9<0.001

B. KARAMANOS 2007




• Diet composition varies greatly among countries• Nutritional recommendations are followed by very few

subjects, especially in diabetics• Fat intake is related with the incidence of diabetes

• The components of MetS cluster more frequently than expected by chance

• Diabetes per se promotes the clustering of the other 4 components of MetS

B. KARAMANOS 2007


Documents

Diabetes Centre Hippokration Hospital Athens, Greece B. KARAMANOS 2007 Report of he MGSD Nutrition Study B. Karamanos MD Associate Professor of Medicine