International Task Force for Prevention of Coronary Heart Disease

1. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement "Dietary Fat, the Mediterranean Diet, and Lifelong Good Health"- London, January 2000 -

2. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Characteristics of theTraditional Mediterranean Diet • Abundance of plant foods • fruit, vegetables, legumes, bread, cereals, potatoes, nuts • minimally processed, seasonally fresh, and locally grown food • Olive oil as the principle source of fat • Dairy products, principally joghurt and cheese, consumed daily in low to moderate amounts • Fish and poultry in low to moderate amounts • Red meat in low amounts • Wine in moderation and with meals

3. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Heart Disease (1) Important dietary factors for preventing atherosclerosis: • Substantial reduction of saturated fat. • Substitution of saturated fats by unsaturated fats, preferably monounsaturated fats and oils. • Consumption of fish. • Increased consumption of vegetables, fruits and whole grains.

4. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Heart Disease (2) Possible protective mechanisms of dietary factors: • Inprovement in theblood lipid profile (LDL-cholesterol  and triglycerides , HDL-cholesterol  or ) • Decrease inoxidation of lipids • Decreased risk inatherothrombosis • Improvement inendothelial function • Decrease inventricular irritability(lowering the risk of sudden death) • Decrease ininflammation • Reduction inplasma homocysteine concentrations

5. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Antioxidants A. In general Mediterranean diet contains an important amount of antioxidants: • Vitamins E, C and carotenoids; • various polyphenolic compounds • Source: vegetables, fruits, nuts, whole grains, legumes, virgin olive oil, and wine. B. Effect: Antioxidants - absorbed at least to some extent - could play an important role in the prevention of cardiovascular disease, cancer and ageing.

6. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Diabetes A. Principal message: Control weight, increase physical activity, and reduce sedentary behavior. B. Improvement of blood glucose and lipid profile with: eitherhigh carbohydrate diets based on minimally-processed cereal grains, vegetables, and fruits that are also high in fiber or alternatively  a diet, that emphasizes vegetables oils, predominantly monounsatured, along with the foods listed above.

7. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Obesity (1) General information about obesity: A. Primarily a disorder of energy balance B. Increases the risk of many diseases including diabetes, heart disease, hypertension, dyslipidemia and certain cancers. C. A common and increasing public health problem in both developed and developing countries. D. Likely no strong association between dietary fat and body fatness (although limited data in population studies)

8. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Obesity (2) Prevention and control of obesity by: balancing energy intake and energy expenditure through a healthy diet and regular physical activity Role of Mediterranean diet: Though not a low fat diet, it may contribute to the prevention and treatment of obesity, because of its variety and palatability, provided it is controlled in calories.

9. International Task Force for Prevention of Coronary Heart Disease General agreement: There is substantial und consistent evidence that diets rich in vegetables, fruits, and whole grains reduce risk of cancer. A. Colon cancer: • Total fat is probably unrelated. • Saturated fat may increase risk. • Olive oil and marine oils may decrease risk. • Antioxidants and phytosterols may decrease risk. • Disagreement on the strength of the association of red meat with increased risk. 2000 Consensus Statement - London Cancer (1)

10. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Cancer (2) B. Breast cancer: • Total fat intakes in the range of 20 - 40 % of energy are not related. • Monounsatureted fatsand olive oil may decrease risk. C. Prostate cancer: Some evidence of an association between intake of saturated fat and risk of prostate cancer.

11. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Alcohol A. Well established: Light-to-moderate intake of wine and other alcoholic beverages: • reduced risk of coronary heart disease and ischemic stroke of 30 % or more • associated with a reduction in all-cause mortality B. Open question: Is wine advantageous over other types of alcoholic beverages in the prevention of coronary heart disease? CONTRA: additional positive lifestyle habits of wine drinkers as possible confounders PRO: Phenolics and other non-alcoholic substances in wine powerful antioxidants and potential important health effects

12. International Task Force for Prevention of Coronary Heart Disease 2000 Consensus Statement - London Gene/Environment Interaction A. Significant genetic predisposition in common chronic and degenerative diseases such as: • coronary heart disease, diabetes, cancer, hypertension, and obesity. B. Environmental factors, mainly dietary habits can modulate a higher genetic risk. C. Further knowledge of these genetic factors and their interaction with environment, such as diet, has the potential to provide the tools for a more precise and personalized approach to prevent and treat chronic disease.