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1985). We Also Should Note That This Effect Is Not Just Present In The ...

1985).

We also should note that this effect is not just present in the Northern Hemisphere and appears to increase in impact the further one moves away from the equator. If one considers conditions such as fatal neural tube defects and Type 1 diabetes not only is there a geographical component but there is also a seasonal one (Van Horn R N 1980). It is postulated that this seasonal effect is due to the time of conception with lower quality oocytes being released away from the optimal time of ovulation and that this effect also increases with greater distance from the equator (Roenneberg T et al. 1990)

This essay does not seek to suggest that these negative or confounding factors are necessarily proved, but simply present them for a balanced consideration of the overall issue.

Conclusions and discussion
It is often suggested by experienced healthcare professionals that it is easier to prescribe drugs than to change the long term dietary habits of a patient. It is to be noted that the trials that we have considered here do appear to have achieved a good degree of compliance. This may represent the fact that they have recruited a highly motivated group of subjects (as most trials have an entry criteria of a first cardiovascular event). It may equally reflect the fact that in a trial, the empowerment and education of the patients is considerably greater than would be the case at a routine cardiac clinic in the NHS (Simopoulos, A. P et al. 2001(D)). In terms of the original research the diets were clearly normal in the areas studied, but the thrust of the research suggests that such diets should be more widely adopted to try to reduce the burden of cardiovascular disease morbidity in other geographical areas and this may cause problems as a new diet must be financially and gastronomically acceptable to the patient as well as easily obtainable. In these days of widespread supermarket shopping, the majority of ingredients are easily and cheaply available in most areas (de Lorgeril, M et al. 2004). It should also be noted that the adoption of the Mediterranean Diet does not preclude nor negate the ability nor the necessity to take medication. Indeed most of the trials that we have reported here have had concurrent medication prescribed and continued throughout the trial. Some of the trials have had sufficient statistical power to be able to show that dietary intervention and pharmacological treatment (viz the taking of aspirin) are independent beneficial variables.

In conclusion we note that the World Health Organisation currently recognises three major components in the prevention of cardiovascular disease namely smoking, physical inactivity and an unhealthy diet as these are three factors that can be changed. The evidence base presented here appears to go a long way to suggest that the adoption of a Mediterranean style Diet is of benefit to those patients who are at risk of developing cardiovascular disease.


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