Amato, Manuela (2018) Studio di intervento randomizzato per valutare l'effetto della dieta mediterranea sul profilo degli acidi grassi ematici e sui fattori di rischio in pazienti con patologia coronarica. [Tesi di dottorato]

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Introduction: Observational studies highlight a possible role of the Mediterranean diet (MD) in the prevention of cardiovascular disease through mechanisms involving the reduction of inflammation. The blood fatty acids (FA) profile has also been associated with cardiovascular risk and its modification, induced by diet, could be a mediator of the positive effects of DM. Consequently, a change in dietary habits, induced by the adoption of a MD, could have positive effects on coronary patients in secondary prevention Purpose: To assess whether MD was able to modify classic metabolic risk factors, the marker of inflammation C-reactive protein and the blood FA profile in patients with coronary heart disease (CHD) on top of poly-therapy with drugs known to influence these factors. Methods: Randomized intervention study on Mediterranean Diet, open-label in parallel groups. Intervention: 130 patients (30-75 years) with a recent history of coronary revascularization were randomized 1:1 after clinical stabilization (>60 days) to intensive MD vs. conventional diet (CD) for 3 months. At the enrollment a validated food-frequency questionnaire (FFQ) was administered to all patients and from which was computed the Trichopoulou score (MDS) in order to evaluate the Mediterranean Diet adherence. At baseline and after 3 months of diet, anthropometric data, routine biochemical variables, lipid profile, high sensitivity C-reactive protein (hs-CRP), were determined. At baseline and after 3 months of treatment, adherence to MD was assessed in all patients by using the score derived from the Mediterranean Diet Adherence Screener (MeDAS), a 14-element tool developed and validated in the Spanish PREDIMED study. At the middle of the study a 7 days dietary recall was performed and the MD adherence was assessed by using both MDS and MeDAS. Results: 120 patients (58 MD, 62 CD) completed the study. In all patients, the change in MeDAS score after 3 months of treatment was negatively correlated with changes in hs-CRP (R=-0.22, p=.01), total cholesterol (R=-0.41, p<.0001), LDL cholesterol (R=-0.37, p<.0001), triglycerides (R=-0.26, p=.005), BMI (R=-0.34, p=.0001) and waist circumference (R=-0.25, p=.01). After 3 months of treatment many FA varied significantly and both diets significantly reduced the blood concentration of saturated FA (p<.0001). Putative favorable changes of blood n-3 (p=.026) and of the long chain n-3 (p=.039) were significantly larger with MD than with DC. In addition, 20:4 n-6 (arachidonic acid) increased more with MD than with DC (p=.049) but this change was not paralleled by an increase of hs-CRP. Notably, the results were not modified after adjustment for weight loss. The change of MeDAS score correlated with changes of many FA: inversely with 16:0 (R= -0.21, p=.02), and with 22:5 n-6 (R= -0.25 p=.007), and positively with total n-3 (R= 0.19, p=.03) and 20:5 n-3 (R=0.28, p=.002). Conclusions: In summary, an increased MD was associated with reduction of metabolic risk factors and hs-CRP even in patients on poly-therapy with drugs known to favorably modify these factors. Moreover, MD improves the blood FA profile, decreasing saturated FA and increasing n-3.

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