Mediterranean Diet and Heart Health

This assignment delves into the relationship between the Mediterranean diet and cardiovascular health. It examines research studies and evidence supporting the positive effects of this dietary pattern on reducing the risk of heart disease. Students are expected to analyze various aspects of the Mediterranean diet, including its components, historical origins, and impact on factors like telomere length and blood lipid profiles. The assignment emphasizes understanding the scientific basis behind the diet's benefits and its potential role in promoting healthy aging.

Mediterranean Diet

Table of Contents
INTRODUCTION ...............................................................................................................................3
Mediterranean Diet......................................................................................................................3
NICE and JBS3 guidelines..........................................................................................................4
The role of nutrition in cardiovascular disease, both in causation and prevention.....................6
The role of the Mediterranean Diet in cardiovascular disease....................................................7
Mediterranean dietary components that are associated with the greatest reduction in CV events. .8
Can Mediterranean Diet be effectively adopted in the UK and what barriers have been presently
identified.....................................................................................................................................9
Strengths and weaknesses of the evidence................................................................................10
CONCLUSION..................................................................................................................................10
REFERENCES...................................................................................................................................11

INTRODUCTION
The Mediterranean diet is considered to be modern nutritional diet that is based on dietary
patterns adopted and inspired by Greece, southern Italy and Spain in late 19th Century (Stanley et
al., 2012). T he aspects of Mediterranean diet includes relatively higher consumption of food such
as olive oil leguminous plants, unrefined cereals, fruits, vegetables, high amount of fish products
lower consumption of red and white meat and moderate intake of milk products. There are many
benefits of Mediterranean diet and it has been reported to decrease the risk of cardiovascular disease
and early death (Gayet-Boyer et al., 2014). Other advantages of Mediterranean food include
increase in physical activity, decrease basal metabolic rate and cessation of smoking and drinking
habits.
The overall essay will be based different aspects of Mediterranean diet that is reported to
decrease the rate of cardiovascular disease. Further it will include dietary components that are
associated with reduction of cardiovascular events in individuals. Lastly the essay will evaluate
strength and weakness of evidence that support the essay topic.
Mediterranean Diet
Mediterranean diet varies with different countries and regions. More than 16 countries that
lie near the border of Mediterranean sea and has adopted the culture of Mediterranean food in their
own country (Boon et al., 2014). Due to the difference in culture, ethnic background, religion and
economic status the pattern of diet vary but the characteristics of Mediterranean diet remains
common for all the countries. The diet includes various food such as high consumption of fruits and
vegetables which are rich source of fibres and vitamins. Relatively higher consumption of olive oil
because it is mono-unsaturated fat source that is reported to burn the fat content of the body at a
faster rate. Dairy and poultry products are moderately consumed but fish is consumed at a much
higher rate as compared to red and white meat (Watson & Preedy, 2003). Eggs are not included in
diet on daily basis but it can be consumed twice or thrice in a week. Wine intake is also a part of
Mediterranean diet which is included in drinks. Although Mediterranean diet is considered very
close to various dietary recommendations but many individuals do not follow the same diet chart
which has contributed to increase rate of obese people in different parts of the world. Olive oil
which is a part of Mediterranean diet is rich in mono-unsaturated fat source which do not increase
the cholesterol content in the body (Starr and Bales, 2016). There are many other sources of oil
such as groundnut oil and sunflower oil which are different from olive oil. They tend to increase the
fat content in the body which is responsible for developing many cardiovascular diseases.
The overall concept of Mediterranean diet came into existence in early 1960s' from the
culture of Spain, Greece and Italy (Sahyoun & Sankavaram, 2016). As soon as it was developed it
could not gain much popularity but in late 1990s' the Mediterranean diet was presented and were

reported to lower down the levels of cardiovascular disease in individuals. Although people who
resides in Mediterranean countries tend to consume food which is high in fatty acids but, still they
have relatively lowered rate of encountering heart disease as compared to other countries. The
cuisine of Mediterranean diet originated from Northern part of Europe in which butter was replaced
with olive oil and beer was replaced with wine (Kopel et al.s, 2013). Mediterranean diet follows 4-5
times consumption of fruits in a day which also lowers down the rate of obesity in individuals who
follow them on regular basis.
As compared to United stated and United Kingdom, the people residing in Mediterranean
countries have lower risk of encountering any diseases especially cardiovascular diseases.
Although, diet is not only the factor that is responsible for decreasing the rate of diseases in a
person but it has also played a vital role in increasing the physical activity of a person (Martinez-
Gonzalez & Bes-Rastrollo, 2014). Different Mediterranean studies have revealed that it is very
beneficial to consume Mediterranean diet as it has high capacity of decreasing the formation and
accumulation of fatty acids and bad cholesterol in the body. 90% of the heart diseases that
originates is the result of unhealthy dietary habits. Hence, it is very necessary to maintain a proper
diet so that a person remains healthy throughout his/her life. If a person is consuming food which
is relatively higher in fat source then the fat accumulation will directly be noticed in liver and
adipose tissue. This increases the risk of encountering cardiovascular and obese conditions by 9%
as compared to individuals who do not consume it. Various research suggest that a person who daily
consumes Mediterranean diet is likely to live 7 more years as compared to individuals who do not
consume it on daily basis. Research also suggest that there are several benefits of Mediterranean
diet as compared to normal diet and almost all the physicians recommend diet so that rate of
developing several diseases is lowered in early or later stages of life (Widmer and et.al, 2015). The
Mediterranean eating pattern can control weight gain and weight loss by maintaining the fat ratio in
the body. It also maintains blood glucose levels in the body which is reported to decrease the risk of
people en encountering type 2 diabetes mellitus (Gayet-Boyer et al., 2014). Further, higher
consumption of olive oil and fish is associated with lowering down the levels of inflammation, heart
attacks, brain strokes and issues of memory loss.
NICE and JBS3 guidelines
NICE and JBS3 guidelines are formulated to provide a detailed overview of assessment of
risk factors associated with the different types of diseases especially cardiovascular disease in early
and later stages of life (de Lorgeril, 2013). According to NICE guidelines it stated that women who
are indulged in smoking and are planning to conceive a child should be immediately referred to help
so that they are able to quit smoking as soon as possible. Based on the guidelines there are eight
major types of recommendations that should be followed in order to reduce the risk of different

diseases that can be caused due to irregular eating and dietary habits. NHS professionals should be
given appropriate advice on identifying women who are involved in smoking. They should adopt
various strategies so that they can help them to attend NHS stop smoking services or other
campaigns which can prevent smoking (Casas et al., 2014). The guidelines also provides advice on
contacting all those women who have been referred to stop smoking services by NHS healthcare
professionals. How to educate them about quitting the habit of smoking so that they do not
encounter various diseases in their life. Generally it is noticed that a person who is involved in
smoking from a long period is not able to quit smoking so easily. So in that case the NICE
guidelines states that all those individuals who have been involved in smoking from a considerable
longer period should be provided with proper counselling so that they can easily quit smoking
(Lourida et al., 2013). Guidelines also provide information about when it is advisable to give them
nicotine replacement therapy and other pharmacological treatments so that they are able to quit
smoking. Professionals who are advised to handle smoking cases should be provided proper training
so that they are able to counsel the individual in effective manner. Apart from NICE guidelines
there are recommendations which are designed by Joint British societies so that they can prevent
the prevalence of cardiovascular disease caused mainly due to improper and poor eating patterns
(Ros et al., 2014). JBS3 has formulated different type of intervention based on lifestyle, diet,
physical activity, childhood and obesity.
Based on the JBS3 guidelines and recommendations it is stated that smoking cessations
should be encouraged for individuals who have been involved in smoking by supporting them
through stop smoking services (Sofi, Gensini & Casini, 2013). All the patients should be given
different types of training and counselling such as group therapy, pharma-cotherapy, behavioural
counselling sessions and combination of various treatments so that they are able to improve mental
and physical health of a person. Nicotine replacement therapy should also be incorporated in the
pharmacological treatment of a person who is planning to quit smoking till a particular date. People
who are living with cardiovascular disease should be aware of risk and adverse effects associated
with active and passive smoking of tobacco (Misirli et al., 2012). JBS3 has also recommended diet
interventions based on certain principles. It can help in lowering down the risk of cardiovascular
diseases in people at later stage of life. Intake of saturated fatty acids in diet should be minimum
with overall of less than 10%. Saturated fatty acids are produced more in lean meat and dairy
products. Saturated fat source should be replaced with polyunsaturated fat so that risk of deposition
of fat on liver and adipose tissue is reduced to minimal. Intake of fruits and vegetables should be
five portions in a day so that percentage of vitamins and fibre is increased in the body to greater
extent. Fish consumption should be increased and should be served twice in a week (Antonogeorgos
etal., 2012).

Whole grains and nuts should also be consumed regularly because they are rich in mono-
unsaturated fatty acids which are responsible for decreasing down the rate of cardiovascular
diseases. The consumption of salt should not be more than 6 g a day because excess of salt is
reported to increase the pressure of blood at a faster rate (Mediterranean Diet. 2016). The
guidelines also states that the limit of alcohol for men should be less than 21 units in a week and 14
units for women per week. It also advice to reduce the intake of processed and frozen meat because
they are rich in trans fat which increases the risk of heart attack and brain strokes. Further it also
states that food containing refined carbohydrates, sugar candies and high calorie snacks should be
avoided because they are rich in fatty acids but are nutritionally very poor (Estruch & Salas-
Salvadó, 2013).
The role of nutrition in cardiovascular disease, both in causation and prevention
Lifestyle factors and nutrition plays a vital role in causing and preventing cardiovascular
diseases to a higher extent. Dietary patterns, low fat diets low carbohydrate diets, intake of
Mediterranean food and regular physical activity are some factors that can help in reducing the rate
of cardiovascular disease (Doménech et al., 2014). But apart from these factors there are many other
reasons which have contributed towards increasing the heart diseases in recent times. According to
Stanley and et.al, 2012. It is very important to control the portion of diet a person is taking at a time.
It is very necessary to consume low fat food which is low in calorie but high in nutritional content.
This is one of the most effective strategies that can shape the heart well and can significantly cut
down the intake of calorie per day (Gayet-Boyer et al., 2014). Based on a survey it is reported that
fruits and vegetables contains high content of fibre, minerals and vitamins which can increase the
nutritional value there by decreasing the risk of heart attacks. Also, it is reported that green leafy
vegetables which are derived from plants are very helpful in preventing many cardiovascular
diseases and can increase life expectancy in many individuals. Apart from fruit and vegetable there
are much food which consistently increase the risk of cardiovascular disorders in a person (Boon et
al., 2014). Diet factors and cardiovascular disease have a bidirectional link. The role of nutrition
and diet is responsible for both developing and preventing cardiovascular diseases to a greater
extent. Starr and Bales, 2016 has stated that “abnormal intake of fat is highly responsible for
causing coronary heart diseases such as heart attacks, myocardial infraction and coronary death”.
Diet which is rich in saturated fatty acids considerably increase the risk of disease by 12%
(Ulbricht, (1991). Food such as cheese, dairy products, cakes cookies and fried foods are reported to
contain higher percentage of fats and lipids which are responsible for increasing the fat deposition
in liver. On contrary Sahyoun & Sankavaram, 2016 has stated that intake of food which is rich in
unsaturated fatty acids, polyunsaturated and mono-unsaturated is very good for health and reduce

down the risk of a person encountering cardiovascular disease in early or later stages of life.
Fish, nuts and seeds are rich in omega-3 and omega-6 which is not produced in the body
through normal metabolism. It is very necessary produce them in the body through dietary
supplements. Hence, it is beneficial to increase the intake of seeds, nuts and fish in the diet. But
Doménech et al., 2014 has stated that if a person is consuming fish nuts and seeds and if his daily
intake of fat exceeds more than 37% then the chances of a person encountering cardiovascular
disease increases by 6% (Kopel et al., 2013). The total intake of saturated fatty acid in the body
should not increase more than 10% of the total energy and should not increase to more than 7% in
patients who have the medical condition of diabetes type 2. One of the most common
cardiovascular disease is hypertension. A person who is on high intake of sodium gradually
increases the risk oh hypertension by 9% (Sofi, Gensini & Casini, 2013). According to survey and
other reports it is estimated that if a person is reducing down the intake of sodium to 1 g per day and
3 g per day of normal salt then the chance of developing various cardiovascular disorders is reduced
down by 52% (Martinez-Gonzalez & Bes-Rastrollo, 2014). The same decrease will also reduce
death due to heart strokes by 22%. Widmer and et.al, 2015 has stated that “high intake of fruits and
vegetables considerably lowers down the risk of cardiovascular disorders by 20%”. it is reported to
contain a component that is responsible for improving the physical activity and heart rate.
The role of the Mediterranean Diet in cardiovascular disease
Mediterranean diet basically includes fruits, vegetables, nuts, seeds, olive oil and low
intake of salt in diet. Food apart from Mediterranean diet can be anything which contains more
amount of cholesterol, fats, trans fats and high content of salt (de Lorgeril, 2013). Casas et al., 2014
has stated that People prefer Mediterranean diet because it is low in saturated fatty acid. Increase n
saturated fatty acids in diet can lead to heart failures and heart attacks hence, this should not be
incorporated in the diet. Red meat, cheese, butter and other dairy products are rich in cholesterol
content which is directly associated with increased risk of coronary heart diseases. High cholesterol
is a metabolic condition which is majorly influenced by dietary intake of a person (Schwingshackl
& Hoffmann, 2012). Large amount of fat is secreted by liver which accounts to more than 20-25%
of cholesterol in the body. Changing the diet patterns have significant effects on serum cholesterol
levels in the body. On contrary it was stated that a person should not completely stop consuming
dairy products and other oily food but controlling the level of consumption is always beneficial as it
helps in lowering down the risk of cardiovascular disease to a greater extent. Ros et al., 2014 trans
fat are found mainly in meat, poultry products hence, it should be completely eliminated from the
diet because it tends to increase the risk of cardiovascular diseases and increase in blood pressure
level.

According to Sofi, Gensini & Casini, 2013 Olive oil consumption has many advantages over
any other oils such as groundnut, peanut or sunflower oil. It reduces the percentage of bad
cholesterol which is the main reason of causing various heart diseases. It acts as a protective
covering to heart which helps in preventing the formation of fatty patches in blood, thereby
increasing the elimination of low density lipoproteins. Further olive oil is also linked to primary
prevention of cardiovascular diseases and also in secondary prevention where it prevents the relapse
of coronary heart disease (Misirli et al., 2012). Intake of nuts can reduce the risk of developing
blood clots which are primary cause of developing fatal heart diseases in early or later stages of life.
Seeds and nuts contain both mono-unsaturated and polyunsaturated fats that are effective in cutting
down the bad cholesterol levels to a higher extent.
Further, nuts and seeds also helps in reducing down the risk of obesity which is more or less
responsible for causing type 2 diabetes. Antonogeorgos et al., 2012 has stated that incorporating
healthy Mediterranean diet will automatically help in maintaining the body's blood pressure level
and this will further reduce the chances of developing cardiovascular diseases in the later stages of
life. The type of food a person eat and the amount of intake affects multiple factors such as body
weight, basal metabolic index and blood pressure (Scarmeas et al., 2014). According to American
Heart association a healthy Mediterranean plan includes consumption of food and vegetables 4-5
times a day, intake of fish at least twice a week, rich whole grain at least three times a day, intake of
sodium less than 1.5 g a day and consumption of calories no less than 450 calories in a week. To
prevent cardiovascular diseases it is very important to enjoy various types of nutritious and healthy
food which can also help in increasing the blood circulation in the body (Gayet-Boyer et al., 2014).
Mediterranean diet plays a very significant role in lowering down the risk of cardiovascular diseases
in all the individuals because Mediterranean diet is rich in proteins, vitamins and other nutritious
content. This is also known as low fat diet which reduces the fat deposition in liver.
Mediterranean dietary components that are associated with the greatest reduction in CV events
Olive oil is marked as one of the main Mediterranean food that is reported to reduce the fat
content of the body to considerable higher extent. The main components of olive oil is mixed
triglyceride esters that contains oleic acid and palmatic acid (Your Diet and Heart Disease. 2016).
The composition of olive changes based on the region, altitude, time of harvesting and process used
in extraction. The consumption of olive oil instead of any other oil is reported to maintain the shape
of heart thereby lowering down the risk of cardiovascular disease. Oily fishes such as mackerel,
tuna and salmon are considered to contain high content of omega-3 fatty acids which is directly
linked with the decrease in triglyceride content and increase in high density cholesterol in the body

(Doménech et al, 2014). Other than olive oil and fishes there are types of some vegetable oils that
are included in Mediterranean diet which contains more amount of omega-6 and omega 3 fatty
acids. Fats are mainly of three types which are present in food. Saturated, Mono-unsaturated and
polyunsaturated. Saturated fats tend to increase the level of blood cholesterol and it is generally
found in animal fats, poultry products pastries and biscuits. Hence, this should be avoided and the
intake should be limited (Schwingshackl & Hoffmann, 2012). Similarly, Mono-unsaturated fats
have comparatively less lowering effect on blood cholesterol and can be used in the place of
saturated fats. Polyunsaturated fats are a category of fats that tends to lower down the level of blood
cholesterol to a higher extent. Oils such as sunflower, soybean and nuts are rich in polyunsaturated
fats and these oils can be incorporated in daily diet.
Antioxidants present in fruit and vegetables are likely to protect heart from diseases such as
obesity, heart attacks, strokes and myocardial infraction (Schwingshackl & Hoffmann, 2012).
Consumption of tea is also reported to be one of the antioxidants that can help in preventing the
development of fatty acids in the body. Antioxidants present in fruit, vegetables and tea can form
anti clotting agent that is responsible for increased rate of blockage of arteries and veins. Deposition
of excess of fats on the liver leads to blockage of arteries and veins which can significantly decrease
the circulation of blood and oxygen within the body (Gayet-Boyer et al., 2014). Antioxidants plays
a vital role in formation of anti-blood clotting agents that can significantly allow the passage of
blood and oxygen freely.

Can Mediterranean Diet be effectively adopted in the UK and what barriers have been presently
identified
In the present scenario, the concept of Mediterranean Diet is getting more and more popular
along with the passage of time (Boon & et al., 2014). Furthermore, it can be defined as an effective
plan for health which includes consumption of food and recipes prepared in completely
Mediterranean style. This includes consumption of things such as red wine and olive oil for the
benefit of health and body. One of the most important benefit of consuming such type of diet is that
it is very cheap and easy. Further, it includes consumption of all those things and ingredients which
can provide the best and maximum benefits to individuals (Watson & Preedy, 2003). In the modern
era, people In UK have become more conscious about their health. Thus, they always seek for
consuming food which can be good for their health. Therefore, adopting Mediterranean diet can be
very suitable for individuals in the country. However, it can be argued that it is not easy for people
to adopt this diet and they are required to be very strict in terms of their schedule. Individuals needs
to lower down their consumption of fast food and red meat. On the other hand, they are also
required to consume olive oil instead of butter. They need to make sure that they are required to do
exercise for at least 5 days a week (Sahyoun & Sankavaram, 2016). Mediterranean Diet be

effectively adopted in the UK because of the benefits which people can have by its consumption. It
can be expressed that its consumption results in protecting individuals from different type of
diabetes. It also plays very important role in preventing people from different type of strokes and
heart disease. Mediterranean diet contains high amount of nutrients and therefore supports people in
keeping themselves agile.
One of the major barrier which has been presently identified is that people are not aware
about the benefits which they can have by consumption of Mediterranean diet. This means that the
diet is not popular among people (Oh, et.al, 2005). Other than this, there are various myths
associated with Mediterranean diet which has become another key barrier. For example people think
that if one glass of wine is good for health than consumption of three glasses will provide with three
times more benefits (Widmer et al., 2015). Heavy reliance on carbohydrate is another major
obstacles for people in country to effective adopted Mediterranean Diet. Furthermore, lots of
planning is required in order to prepare meals and this can results in consuming large amount of
time. People in UK prefer to use sunflower oil at the time of cooking and Mediterranean Diet lays
more emphasis on consumption of olive oil. Further, individuals needs to use more species and
herbs instead of salt in order to flavour their food. If, a person is allergic to consumption of
Mediterranean diet then it may leaf to severe hypersensitive reactions in the body. Hence it is
advisable for individuals to consult diet physicians before consuming Mediterranean diet. (Casas et
al., 2014). Thus, it can be stated that in order to make this diet more popular, effective marketing
needs to be carried out.
Strengths and weaknesses of the evidence
In a research paper the entire study was based on randomised controlled trials in which aim
of the study was to study the association between adherence of Mediterranean diet and
cardiovascular disease (Mozaffarian, Aro & Willett, 2009). Total of 7447 persons were enrolled in
the study in which 57% were women. Two Mediterranean diet groups revealed considerable
amount of adherence to the intervention whereas primary end point occurred in 288 participants.
Among the individuals who were at increased risk of cardiovascular disease, incorporation of
Mediterranean diet reduced the chances of cardiovascular diseases on them. In yet another study,
the research was based on systematic review and randomised controlled trials which yielded a total
of twenty-three independent experimental subject groups (Antonogeorgos et al., 2012). According
to the research it was stated that there was no relationship between daily intake of R-TFA and risk
of lowering down the levels of cardiovascular risk factors such as low density cholesterol,
triglyceride, saturated fatty acids and high density cholesterol content. Moreover, further studies
also revealed that multivariate regression in dietary variables confirmed that the intake of R-TFA is
clearly not linked to decreased level of lipid ratio (Martinez-Gonzalez & Bes-Rastrollo, 2014).

Findings in the study confirmed that there is no evidence that can prove a bidirectional link between
TFA and decreased levels of low density cholesterol. Further it was also stated that TFA derived
from natural sources have no adverse effects on healthy individuals (Boon and et.al, 2014).
Mediterranean diet studies
Mediterranean diet studies were considered because majority of the people are suffering
from various health issues such as cardiovascular diseases and myocardial infractions (Watson &
Preedy, 2003). Hence, it has become necessary to reduce the risk factors associated with these
diseases. In order to reduce down the factors several studies were undertaken which are as follows.
The PREDIMED Study
This was a parallel group multi-centre single blind randomised clinical trial which was
successfully conducted in seven communities of Spain between 16 research groups
This study grabbed headlines in the year 2013 because this study was responsible for reducing
down the rate of cardiovascular diseases to a much higher extent (Sahyoun & Sankavaram, 2016).
The participants who were selected in the study were basically randomised to three different diets.
The first diet was a Mediterranean diet which was mixed with extra virgin olive oil, the second
group was a Mediterranean diet with nuts and the third diet was low fat control diet. Based on the
results it was concluded that the risk of heart diseases and attacks were decreased to 30 % in
Mediterranean diet plus olive oil and 28% in Mediterranean diet plus nuts (Casas et al., 2014).
STALL Study
The use of Statins and almonds in diet to lower the lipoproteins level is also known as
STALL study. The dietary supplementation of almonds has noticed to decrease the level of low-
density lipoprotein's cholesterol (Mozaffarian, Aro & Willett, 2009). The consumption of almonds
helps in providing fibre and proteins which are also rich in mono-unsaturated and polyunsaturated
fatty acids.
CONCLUSION
The overall essay is based on Mediterranean diet which is based on reducing the risk of
cardiovascular diseases to a greater extent. The critical essay was based on general introduction of
Mediterranean diet and its origin which was followed by foods which are included in them. Further
it also included latest guidelines of NICE and JBS3 which were associated with lifestyle and diet
recommendations which can reduce down the risk of heart disease to maximum. The role of
Mediterranean diet in cardiovascular disease was also explored in the critical part of the essay. Food
which are responsible for causing and preventing heart disease were also included in the study.
Lastly strength and weaknesses of the supported evidence-were also discussed in the essay.

REFERENCES
Books and Journals
Antonogeorgos, G. et.al., (2012). Understanding the role of depression and anxiety on
cardiovascular disease risk, using structural equation modeling; the mediating effect of the
Mediterranean diet and physical activity: the ATTICA study. Annals of epidemiology, 22(9),
pp.630-637.
Boon, N. et.al., (2014). Joint British Societies’ consensus recommendations for the prevention of
cardiovascular disease (JBS3). Heart, 100(Suppl 2),ii1-ii67.
Casas, R. et.al., 2014. J, Fiol M, Arós F, Estruch R. The effects of the Mediterranean diet on
biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk
for cardiovascular disease. A randomized trial. PLoS One, 9, e100084.
de Lorgeril, M., 2013. Mediterranean diet and cardiovascular disease: historical perspective and
latest evidence. Current atherosclerosis reports,15(12), 1-5.
Doménech, M. and et.al., (2014). Mediterranean Diet Reduces 24-Hour Ambulatory Blood
Pressure, Blood Glucose, and Lipids One-Year Randomized, Clinical
Trial. Hypertension, 64(1), 69-76.
Estruch, R. Salas-Salvadó, J., (2013). Towards an even healthier Mediterranean diet. Nutrition,
Metabolism and cardiovascular diseases,23(12), 1163-1166.
Gayet-Boyer, C. et.al., (2014). Is there a linear relationship between the dose of ruminant trans-
fatty acids and cardiovascular risk markers in healthy subjects: results from a systematic
review and meta-regression of randomised clinical trials. British Journal of Nutrition, 112(12),
1914-1922.
Kopel, E. et.al., 2013. Mediterranean diet for primary prevention of cardiovascular disease. N Engl
J Med, 369, 672.
Lourida, I. et.al., (2013). Mediterranean diet, cognitive function, and dementia: a systematic
review. Epidemiology, 24(4), 479-489.
Martinez-Gonzalez, M.A. Bes-Rastrollo, & M., (2014). Dietary patterns, Mediterranean diet, and
cardiovascular disease. Current opinion in lipidology,25(1), 20-26.
Misirli, G. et.al., (2012). Relation of the traditional Mediterranean diet to cerebrovascular disease
in a Mediterranean population. American journal of epidemiology, 176(12), pp.1185-1192.
Mozaffarian, D., Aro, A., & Willett, W. C. (2009). Health effects of trans-fatty acids: experimental
and observational evidence. EurJ Clin Nutr, 63(S2), S5-S21
Oh, K. et.al., (2005). Dietary Fat Intake and Risk of Coronary Heart Disease in Women: 20 Years of
Follow-up of the Nurses' Health Study. American Journal of Epidemiology, 161(7), 672-679.
Ros, E. and et.al., (2014). Mediterranean diet and cardiovascular health: Teachings of the
PREDIMED study. Advances in Nutrition: An International Review Journal, 5(3), 30S-336S.
Sahyoun, N.R. & Sankavaram, K., (2016). Historical origins of the Mediterranean Diet, Regional
Dietary Profiles, and the Development of the Dietary Guidelines. In Mediterranean Diet .
Springer International Publishing.
Scarmeas, N. et.al., (2014). Mediterranean diet and leukocyte telomere length in a multi-ethnic
elderly population. Alzheimer's & Dementia: The Journal of the Alzheimer's
Association, 10(4), P755.
Schwingshackl, L., & Hoffmann, G. (2012). Monounsaturated fatty acids and risk of cardiovascular
disease: synopsis of the evidence available from systematic reviews and meta-analyses.
Nutrients, 4(12), 1989-2007
Sofi, F. et.al., (2013). Mediterranean diet and health. Biofactors, 39(4), pp.335-342.
Stanley, W.C. et.al., (2012). Dietary fat and heart failure: moving from lipotoxicity to
lipoprotection.Circulation research. 110(5). 764-776.
Starr, K.N.P. & Bales, C.W., (2016). The Value of the Mediterranean Diet for Older Adults:

Emphasis on Obesity Interventions. In Mediterranean Diet Springer International Publishing.
Ulbricht, T. L. V. S. D. A. T. (1991). Coronary heart disease: Seven dietary factors. Lancet,
338(8773), 985
Watson, R.R. and Preedy, V.R., 2003. Nutrition and heart disease: Causation and prevention. CRC
Press.
Widmer, R.J. et.al., (2015). The Mediterranean diet, its components, and cardiovascular
disease. The American journal of medicine, 128(3), 229-238.
Online
Your Diet and Heart Disease. 2016.[Online] Available through:
<https://health.clevelandclinic.org/2015/05/your-diet-and-heart-disease-rethinking-butter-
beef-and-bacon/>. [Accessed on 4th June 2016].
Cardiovascular diseases. 2016. [Online] Available through: <http://www.world-heart-
federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/>. [Accessed on
4th June 2016].
Mediterranean Diet. 2016. [Online] Available through:
<http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Mediterranean-
Diet_UCM_306004_Article.jsp#.V1KucaW1Gkp>. [Accessed on 4th June 2016].