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And During This Time There Were Over 2,200 Documented Deaths. The Outcomes ...

and during this time there were over 2,200 documented deaths. The outcomes are extremely complex in both their analysis and presentation. In the terms of the dietary considerations of this essay we note that there was a positive correlation in all cause death rates with the average percentage of dietary energy derived from saturated fats and a negative correlation with that derived from monounsaturated fatty acids. There appeared to be no specific correlation to the energy intake derived from polyunsaturated fatty acids, proteins, carbohydrates, and alcohol. In addition to these considerations there were no nation specific differences in death rates related to mean relative body weight, degree of obesity, and physical activity. In all countries the overriding statistically significant finding was the negative relation of death rate to the ratio of monounsaturated to saturated fatty acids. This was allowing for the presence of independent variables such as age, blood pressure, serum cholesterol, and smoking habits.

As we have intimated earlier, the bulk of this difference was accounted for by the predominance of Oleic acid as the prime monounsaturate in the diet.

Despite the size of this study, it should be noted that these findings were not sufficiently specific to demonstrate a causal relationship between cardiovascular disease and diet and this has been left to later studies (which we shall discuss elsewhere) to evaluate further. The authors point to a number of confounding factors such as educational level which precluded attainment of statistical significance insofar as they noted that those with a higher educational level tended to have overall healthier lifestyles. (Keys A et al. 1986)

Possible mechanisms of action
In following the thrust of this essay we should now consider the mechanisms by which the Mediterranean Diet is thought to work. A brief overview of the literature on the subject shows that there is a wealth of publications on the subject (of variable quality) and we shall therefore present some of the most significant for further consideration. A recent landmark paper reports the findings of the Attica study. (Chrysohoou C et al. 2004)

The Attica Study was a large retrospective epidemiological study carried out near Athens with an enrolment intake of over 3,000 and we shall discuss their findings shortly. The rationale behind the study was that was (by 2004) a substantial evidence base to suggest that adherence to the Mediterranean Diet was associated with a reduction in the progress of cardiovascular disease. The (Trichopoulou (A et al.


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