Mediterranean Diet for Cardiovascular Disease | Report

Running head: THE MEDITERRANEAN DIET AND CARDIOVASCULAR DISEASE
THE MEDITERRANEAN DIET AND CARDIOVASCULAR DISEASE
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THE MEDITERRANEAN DIET AND CARDIOVASCULAR DISEASE1
Introduction
The following paper will provide a detailed, comprehensive and critical insight into the
current validity, strengths and limitations of dietary and biochemical assessments underlying the
estimation of an individual’s compliance with the Mediterranean Diet and his or her risk of
acquiring cardiovascular diseases, using evidenced based literature. Additionally, this paper will
also discuss the relevant strengths and limitations of each of these assessment methods for the
purpose of recommending improved assessment methodologies which may be considered for
future implementation of more robust, valid comprehensive research.
Discussion
Mediterranean Diet for Cardiovascular Disease
Cardiovascular disease (CVD) is a collective term used to describe a range of chronic
conditions impacting the blood vessels, heart and surrounding cardiac muscles due to pathologies
associated with the endothelial deposition of fatty streaks and resultant emergence of
thromboembolic symptoms which may hinder blood circulation (Rosenson et al., 2016). Indeed,
the CVDs have been reported by the World Health Organization (WHO, 2017) to be the leading
contributor of mortality across global populations and has been estimated to cause approximately
31% of deaths internationally. Additionally, CVDs like stroke have been evidenced to contribute
to life-long hindrances to the quality of life in the form of impairments in mobility, engagement
in activities of daily living, social engagement as well as negative psychological outcomes like
depression (American Diabetes Association, 2016). Dietary risk factors which have been
evidenced to be associated with an increased risk of CVD, include: an excessive consumption of
packaged, processed and junk foods rich in saturated fats, added sodium and added sugars, as

THE MEDITERRANEAN DIET AND CARDIOVASCULAR DISEASE2
well as the inclusion of foods in the diet which are directly associated with increased
cardiovascular mortality, such as red meats, refined grains and sugars (Estruch et al., 2018).
Thus, the high global prevalence and associated long term debilitating outcomes of CVD
coupled with its direct association with consumption of a nutritionally imbalanced diet forms the
rationale underlying the selection of individuals with CVD as the key target population.
Additionally, CVDs have been evidenced to impact both economically privileged as well as
underprivileged groups with significant severity, with a greater concern towards populations
belonging to socially disadvantaged groups (Wei et al., 2017). The increased consumption of fast
foods and packaged, processed items have been linked to both economically privileged as well as
underprivileged populations – with the former engaging in their intake due to improvements in
urbanization, commercialization and living standards and the latter engaging in their intake due
to their relatively inexpensive nature and easy availability. This implies that the CVDs and
associated dietary risk factors are a cause for concern for individuals irrespective to their
economic backgrounds, which in turn, forms an additional rationale for research in this paper
(Frayn, 2018).
The Mediterranean Diet (MD), has been evidenced to yield beneficial effects in the
prevention and improved mitigation of CVDs across individual. This is due to the abundant
availability plant based foods with minimal processing and inclusion of foods groups like
vegetable oils, nuts, seeds and seafood which are rich in monounsaturated fatty acids (MUFA) –
a key type of fat with evidenced protective effects on the cardiovascular system (Martínez-
González, Gea & Ruiz-Canela, 2019). Such dietary components have been evidenced to regulate
the deposition of lipids in blood vessels and further limit the key inflammatory pathologies
responsible for CVD progression. The MD further considers avoidance of alcohol, added sugar

THE MEDITERRANEAN DIET AND CARDIOVASCULAR DISEASE3
and red meat and inclusion of cereals and whole fruits, which in turn, has been associated as key
contributors to improved cardiovascular functioning and disease protection (Rees et al., 2019).
The MD is one of the most heavily researched diets and has been traditionally preferred by both
healthcare professionals alike due to its balanced inclusion of a wide range of food groups which
in turn, demonstrates a range of additional benefits such as improved satiety and weight
regulation, improved mental health outcomes and reduced risk of cancer and diabetes. Thus, the
evidenced based benefits of the MD in associated with CVD and additional metabolic conditions
forms the rationale underlying its research in this descriptive study (Wang et al., 2017).
The compliance with MD and associated estimation on one’s risk of CVD have been
traditionally performed via implementation of dietary assessment methods such as the
Mediterranean Diet Score (MDS) and the Mediterranean Diet and Culinary Index (MediCul).
However, the validity and reliability of only dietary assessments for screening of dietary based
CVD risk have been questioned in current evidence based literature. Additionally, there has been
an increasing emphasis towards the need to combine dietary assessment scores with other
assessment components such as screening of biochemical markers of CVD (Ghisi et al., 2019).
Research Objectives
Thus, with respect to the above, the aim of this paper is: ‘to critically review and
explore the strengths and limitations of dietary and biochemical or clinical assessments as
valid predictors of MD intake association and CVD risk across individuals with CVD.’
Thus, the objectives of this research are as follows:
1. To explore the validity and reliability of prevalently used dietary assessment scores as
valid predictors of MD intake association and CVD risk across individuals.