PREDIMED: Mediterranean Diet Costs More Than Standard Diet

Shelley Wood

April 22, 2013

ROME, ITALY — New data from the much ballyhooed PREDIMED diet study are confirming what many nutritionists and researchers have been warning for years: the Mediterranean diet may be best for the heart but may also be harder on the pocketbook.

Dr Maria Bes-Rastrollo , speaking here at the EuroPrevent 2013 meeting, reminded the audience that the recently published PREDIMED "showed that a Mediterranean diet rich in olive oil or nuts reduced the risk from CV causes by 30%.

"With these promising results . . . it seems reasonable to promote this healthy dietary pattern to prevent CV disease," she said. "But at this point, to implement prevention measures and promote this healthy dietary pattern, we should also ask ourselves about the cost."

Previous cost-efficacy studies have delivered mixed results, she noted, although most have suggested that healthier diets are costlier, deterring widespread adoption.

PREDIMED Main Results

As recently reported by heartwire , PREDIMED was a large primary-prevention trial that randomized 7447 patients at high cardiovascular risk (but no CVD) to either a control diet (including advice to reduce dietary fat) or to a Mediterranean diet supplemented with extra virgin olive oil or mixed nuts. After 4.8 years, risk of major CV events (MI, stroke, death from CV causes) was reduced by 30% in the Mediterranean groups combined, compared with the control diet.

To address costs, Bes-Rastrollo and colleagues first calculated daily food costs according to the diets participants were randomized to at baseline. In this preliminarily analysis, daily food costs per day were lowest for the control/low-fat diet at €5.85 per day, as opposed to €6.16 for the olive-oil supplemented diet and €6.33 for the nut-supplemented Mediterranean diet.

They also assessed patients as to how well they were adhering to a Mediterranean-style diet at the study outset, scoring them on the Mediterranean diet nine-point scale. Here again, those with the lowest scores, reflecting low adherence, had much lower costs per 1000 kcals than did subjects who scored very high for dietary adherence.

Next they tracked changes in food expenditures in the first year of the PREDIMED study. Strikingly, when people increased their adherence to the Mediterranean diet by a two-point increment, their daily food costs increased by at least 1.63%, compared with people who had made no change in adherence. By contrast, those who decreased their adherence to the Mediterranean dietary pattern saw their daily food costs dip by approximately half a percentage point.

The most expensive components of the Mediterranean diet appeared to be fish and other seafood.

"Our results support a population-level change to support cardiovascular health and specifically the promotion of a healthy dietary pattern such as the Mediterranean diet, but also making sure that the costs [are reasonable], taking into account the current economic crisis,"Bes-Rastrollo concluded. The time has come, she added, for governments "to make real on the promise that the healthiest choices should be the easiest ones."

Elaborating to heartwire , she said: "Other options or measures to increase the adherence to the traditional Mediterranean diet are needed--no taxes, for example, on healthier food choices."

Policies and the People

Drs Maria Bes-Rastrollo, Antonia Trichopoulou, and Marialaura Bonaccio

It's no small irony that the countries that gave the world the Mediterranean diet are, at least within Europe, those seeming least able to afford them. Speaking in the same EuroPrevent session, Dr Antonia Trichopoulou (University of Athens, Greece), one of the grandmothers of Mediterranean-diet research, also alluded to the economic crisis, most keenly felt in her own country, Greece.

But there is some hope on the horizon, Trichopoulou said.

"We have a situation very heavily affected by the crisis, but I think we can be optimistic because people are turning again to local products. Processed foods are relatively more expensive than going to the open markets, where the producers are bringing their fruit and vegetables into, say, downtown Athens in a cheap way. I think this is a good thing. On the other hand, the limitation of money available at the household level limits the food intake in general, but I think that they are pushing back to the more traditional foods."

Fifteen years ago, Greeks were "rejecting everything Greek," she said, reminiscing about a country wedding she'd attended where whiskey and beer were served instead of wine, and every table was switching to red meat and French cheeses.

"In the past 5 or 10 years we have started turning back to our roots," and this may have implications for health, she predicted, particularly in the face of the economic pressures.

Bes-Rastrollo, however, said that while a similar back-to-local phenomenon is enjoying a bit of a revival in Spain, there are other forces working against it. A big one, she noted, is the number of women now working full-time, rather than cooking traditional meals. "It's more usual these days that you just go out for a meal," she said.

A third speaker in the session, Dr Marialaura Bonaccio (Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy), reviewed a recently published analysis looking at the impact of socioeconomic factors and mass media on the Mediterranean lifestyle in the MOLI-SANI study.

Key findings in this analysis were that adherence to a Mediterranean diet among university graduates has been dropping annually since 2005. The finding held up even in older adults, who might be most likely to follow traditional diet patterns. In previous research, she and her colleagues have also demonstrated a link between income and adherence to a Mediterranean diet. "We might suppose that the economic constraints that are affecting the Italian population may be involved in this process," she said.

Bonaccio was less convinced that any kind of resurgence in traditional Italian values and culture as an offshoot of the economic downturn might turn the tide around. "In Italy, we will have to see, because the crisis here is still young." But lifestyles have changed in other ways, she pointed out. "We also have to consider the time spent shopping for and cooking the foods. These days, there is just not enough time."

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