The Mediterranean diet, its components, and cardiovascular disease: Miguel Martinez-Gonzalez, Pamplona, Spain
The rise of cardiometabolic disease as global health threat: towards the UN 2030 goals
Miguel Martinez-Gonzalez is a chronic disease epidemiologist and the leader of several cohorts and trials conducted in Spain. His major research interests include the effects of the Mediterranean food pattern on health; nutritional epidemiology of cardiovascular disease, type 2 diabetes, obesity, metabolic syndrome and major depression; metabolomic profiling of type 2 diabetes mellitus and cardiovascular disease; and trials investigating the effect of lifestyle/diet intervention for the prevention of cardiovascular disease. He is the Principal Investigator of the SUN project, with >22,500 participants and mean follow-up of >9 years, as well as the PREDIMED trial at the University of Navarra (the vanguard centre of PREDIMED), and coordinator of the PREDIMED Research Network funded by the Spanish Government (Instituto de Salud Carlos III, RD 06/0045). In addition, Dr. Martinez-Gonzalez is Principal Investigator of the PREDIMED-PLUS trial, an on-going cardiovascular primary prevention trial with >6,800 randomized subjects, which aims to assess the cardiovascular effects of an energy-restricted Mediterranean diet with physical activity and weight loss.
Diet is one of the fundamental cornerstones of cardiovascular disease prevention. The Mediterranean diet, characterised by high intake of olive oil and plant foods (fruits, vegetables, legumes, nuts and non-refined cereals), low-to-moderate intake of dairy products, fish and poultry, moderate intake of alcohol, and low intake of red meat and sweets, represents an effective and robust nutritional strategy against cardiovascular disease. The PREDIMED (PREvención con DIeta MEDiterránea) trial demonstrated that this dietary pattern, supplemented with either extra virgin olive oil or nuts, is useful in the primary prevention of cardiovascular disease in individuals at high cardiovascular risk. There was also benefit in preventing diabetes and managing metabolic syndrome in this cohort.
Given the complexity of the Mediterranean diet, encompassing a multitude of nutrients and phytochemicals, subsequent research aims to identify key dietary components associated with cardiovascular benefit. Insights from the PREDIMED study showed that extra-virgin olive oil and nuts influenced the methylation status of peripheral white blood cells, with favourable impact on metabolism, diabetes and inflammation. Monounsaturated fatty acids, antioxidant vitamins and phytochemicals have also been implicated in the cardiovascular benefit, although further work is needed to elucidate the underlying mechanisms. The impact of dietary components on epigenetic modulation, as well as the microbiome, also merits further study.
The latest findings from the PREDIMED trial identified a metabolic signature of the Mediterranean diet that is predictive of cardiovascular risk, offering new potential for personalized nutrition to prevent cardiovascular disease.
Fernandez-Lazaro CI, Zazpe I, Santiago S, Toledo E, Barbería-Latasa M, Martínez-González MÁ. Association of carbohydrate quality and all-cause mortality in the SUN Project: A prospective cohort study. Clin Nutr 2020:S0261-5614(20)30572-0.
Bouzas C, Bibiloni MDM, Garcia S, Mateos D, Martínez-González MÁ, Salas-Salvadó J, et al. Dietary quality changes according to the preceding maximum weight: a longitudinal analysis in the PREDIMED-Plus randomized trial. Nutrients 2020;12:3023.
Godos J, Micek A, Brzostek T, Toledo E, Iacoviello L, Astrup A, Franco OH, Galvano F, Martinez-Gonzalez MA, Grosso G. Egg consumption and cardiovascular risk: a dose-response meta-analysis of prospective cohort studies. Eur J Nutr 2020 Aug 31. doi: 10.1007/s00394-020-02345-7.