IMIM - Institut Hospital del Mar d'Investigacions Mèdiques

Cardiovascular risk and nutrition Montse Fitó

This multidisciplinary team brings together specialists in clinical analysis, endocrinology, family medicine, biology, pharmacy, and nutrition. The group focuses on the study of nutrition and its relationship to the risk of chronic degenerative conditions, including cardiovascular diseases.

The study of the underlying mechanisms of the benefits of a healthy diet is centred on classic risk factors along with emerging biomarkers (inflammation and oxidation, lipid profile, HDL functions, atherogenicity of LDL, endothelial function, insulin resistance), and nutrients’ nutrigenomic effects and interactions with intestinal flora.

The group has three major lines of research, detailed below: nutrition intervention studies, epidemiology and the treatment of obesity and diabetes, and nutritional epidemiology and childhood obesity.

NUTRITION INTERVENTION STUDIES

The Mediterranean diet, our traditional eating pattern, has health benefits that protect against morbidity and mortality from cardiovascular diseases, and these have been well described and supported by scientific research. In this context, the objective of our nutrition intervention studies is to determine the specific beneficial effects of diet on cardiovascular risk factors and diseases, and to identify the cellular and molecular mechanisms responsible for these benefits. In addition to studies of bioavailability of nutrients, we would highlight several large-scale nutrition intervention studies, described below: PREDIMED, PREDIMED-plus and the multicentre European study, EUROLIVE.

  • PREDIMED: a multicentre, randomized, parallel study coordinated by Dr. Estruch, Hospital Clínic, Barcelona. The study randomized 7,447 individuals at high cardiovascular risk into three intervention groups: two Mediterranean diet groups, one diet enriched with virgin olive oil and the other with nuts, and a control group prescribed a low-fat diet. The effect of each diet on primary and secondary markers of cardiovascular diseases was evaluated. The PREDIMED Study has demonstrated that the Mediterranean diet is associated with a lower incidence of cardiovascular events (Estruch et al. NEJM, 2013).  
  • PREDIMED-plus: a multicentre study coordinated by Dr. Salas-Salvador, Universitat Rovira and Virgili, Reus. The study objective is to determine the merits of a low-calorie Mediterranean diet, along with behavioural support and lifestyle changes, in primary prevention of cardiovascular events in patients with metabolic syndrome.  
  • Interventions with olive oils and “functional” olive oils (enriched with biologically active compounds), various randomized crossover trials including the following highlights:
    • EUROLIVE, a multicentre European study coordinated by Dr. Covas, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona. This study recruited 200 healthy volunteers to a dietary intervention with three olive oils of different antioxidant phenolic compound content. The results were key to the November 2011 statement by the European Food Safety Authority (EFSA) on the dietary benefits of the phenolic compounds in olive oil in protecting against oxidation of LDL cholesterol.
    • VOHF, a randomized, double-blind, crossover, controlled trial, also coordinated by Dr. Covas. This study recruited 33 volunteers with dyslipidaemia to study the effects of 3 types of virgin olive oil: one enriched with phenolic compounds of olive oil, another also enriched with compounds from thyme, and a control olive oil (unenriched). The bioactivity of the phenolic compounds and derivatives, and of other compounds in the diet, is another research area being explored.

EPIDEMIOLOGY AND THE TREATMENT OF OBESITY AND DIABETES

This group initially focused on the epidemiology of diabetes and obesity with respect to the incidence of Type 1 diabetes, and more recently has studied the prevalence of Type 2 diabetes mellitus and obesity in Spain. The group is also involved in obesity treatment and follow-up in the primary health care setting. The Morbid Obesity Care Unit at Hospital del Mar has a multidisciplinary team of endocrinologists, surgeons and nutritionists treating obesity with an integrated clinical therapy and/or surgical approach. The goal is in-depth analysis of dietary habits associated with morbid obesity and the changes made after bariatric surgery, along with the study of the development of cardiovascular risk factors before and after surgery.

The Endocrinology Department, in collaboration with IMIM researchers, is participating in the PREDIMED-plus Study. The objective is to determine if a low-calorie Mediterranean diet and physical activity intervention, within the context of behavioural therapy, improves cardiovascular risk in patients with metabolic syndrome. .

NUTRITIONAL EPIDEMIOLOGY AND CHILDHOOD OBESITY

Our research centres on analysing the overall impact of dietary patterns on cardiovascular diseases and related comorbidities. The multifactorial nature of diet makes it difficult to study any one food or nutrient in isolation, unless data are available from randomized trials specifically designed for this purpose. In addition, we are interested in other lifestyle variables such as physical activity and alcohol consumption.

The epidemiology of obesity is currently one of the major challenges facing health policy. Indicators of general and abdominal adiposity have been associated with cardiometabolic risk in children, adolescents and adults. In addition to the study of the prevalence and incidence of overweight and obesity in the child and adult populations, we investigate the impact of adiposity of cardiovascular risk factors.

  • Diet and Cardiometabolic Risk: In recent years, improved treatment of cardiovascular diseases has reduced lethality and, given the stable incidence rate, the prevalence of these diseases has increased. In this context, it is evident that the best prevention strategy at the population scale is to try to reduce the number of cases by implementing primary prevention measures. Nonetheless, in contrast to assessments of tobacco and alcohol use, we do not have a standardized tool to quickly collect information about eating habits. Our group is working to develop and implement an instrument for dietary assessment in clinical practice. Within the framework of the REGICOR (Registre Gironí del Cor, coordinated by Jaume Marrugat) Study, data for the study of cardiometabolic risk are available on anthropometrics, physical activity, food intake, and follow-up of cardiovascular events in diverse cohorts of a general population.  
  • Overweight and Obesity in Children:  All around the world, overweight and obesity are having a serious effect on our young population. Our group, in collaboration with Professor Lluís Serra-Majem, head of the Nutrition Research Group at Universidad de Las Palmas, Gran Canaria (Canary Islands), is studying lifestyle variables that predict overweight. To establish indicators of cardiometabolic risk in the young population, we are participating in the EnKid Study follow-up; we have our own data from a cohort of 2140 children aged 8 to 10 years (Thao-Child Health Intervention Study). Finally, the effectiveness of the Thao-Child Health Intervention in preventing childhood obesity (POIBC Study) is being assessed in a community-based program, in an effort to reduce the high prevalence of overweight and obesity in boys and girls.
  • Healthy Aging: In older adults, factors such as a diet that is not balanced and healthy, low levels of physical activity, sedentary lifestyle, and excessive alcohol use increase the risk of chronic disease, functional limitations in daily living, and premature death. A means to quantify the impact of lifestyle factors over time could be very useful in understanding and managing obesity. Therefore, we are focused on measuring population distribution of obesity, nutritional status (muscle mass and adiposity) and functional status, along with changes over time and their association with individual variables.

Contact

Coordinator:
Montse Fitó

Tel:
93 316 07 24

Fax:
93 316 04 10

Dr. Aiguader, 88
08003 Barcelona

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