Effects of the Mediterranean Diet on the reduction of risks of Cardiovascular disease
Student’s Name
University of Washington Tacoma
TNURS 350 A
Effects of the Mediterranean Diet on the reduction of risks of Cardiovascular disease
Introduction
Is there a relationship between high adherence to the Mediterranean Diet and vulnerability to Cardiovascular Disease? If so, do different socioeconomic groups have a different prevalence of Cardiovascular Diseases? Several observational studies have indicated a close association between the Mediterranean Diet and its impacts on various patients exposed to Cardiovascular Disease. Cardiovascular disease is taken to refer to several conditions, including high blood pressure, heart disease, heart attack, and atherosclerosis, among others. According to the World Health Organization, 17.9 million people die every year from CVDs, which is an projected 31% of all deaths worldwide. Of all these worldwide deaths, 75% occur in low- and middle-income countries. Heart attacks and strokes alone are responsible for 85% of the deaths.
A Mediterranean diet is a way in which people eat the traditional foods of the countries bordering the Mediterranean. The interest in Mediterranean Diets began in the 1960s when it was observed that countries along the Mediterranean recorded fewer deaths by coronary heart diseases. The World Health Organization has recognized the diet as a healthy and sustainable dietary pattern. Therefore, this study aims at identifying whether or not the Mediterranean Diet has any relationship with Cardiovascular heart diseases. To answer the arising issues, I am going to compare two research articles. The first article by Casas et al. (2014) supports the intervention of the Mediterranean Diet, as the writers believe that the diet can reduce morbidity and mortality occasioned by cardiovascular disease. The second article is Bonaccio et al. (2017), whose main contention is that the cardiovascular protection occasioned by the Mediterranean Diet can only be seen in higher socioeconomic groups as opposed to lower socioeconomic groups. To answer the issues arising from this research, I will identify and analyze the different arguments raised by the two articles using the steps in Asking the Right Questions as directed by Adler et. Al. (2018)
Differing positions in Casas et al. (2014) and Bonaccio et al. (2017)
Casas et al. (2014) sought to assess in 12 months, the effects of two enhanced Mediterranean Diets in comparison to a low-fat diet on inflammatory biomarkers that are related to atherosclerosis. To conduct this study, the researchers sought a randomized, multicenter, and a controlled 5-year clinical trial whose purpose was to assess the effects of MD on the prevention of cardiovascular disease. The participants were men aged 55-80 years and women aged 60-80 years. The eligibility to be a participant in the study was that one had to have type 2 diabetes, or had to have three or more major cardiovascular risk factors. The participants were divided into three groups in a ratio of 1:1:1. The division of the participants into three groups was done using a digitized computer.
Participants in 2 MD groups were recommended to increase vegetable intake while the control group had reduced fat amounts, with emphasis on eating lean meats and low-fat dairy products. At the end of the trial, the researchers noted that the two groups that were exposed to MD intervention that was supplemented with EVOO or nuts had significantly decreased inflammatory markers relating to atheroma plaque formation as well as plaque instability. This is because Mediterranean Diets protects against atherosclerosis by Modulating the inflammatory reaction Mediterranean Diets protects against atherosclerosis by Modulating the inflammatory reaction.
Taking a different approach from Casas et al. (2014), other authors like Bonaccio et al. (2017) believe that in as much as MD is associated with cardiovascular protection, the relationship can only be seen in higher and not in lower socioeconomic groups. Moved to determine whether cardiovascular benefits related to MD could differ across socioeconomic groups, the research sought 18991 men and women who were aged over 35 years from the inhabitants of the Molisani cohort in Italy. The Mediterranean Diet Score (MDS) was used to appraise the MD. The researchers further used household income as well as educational level as indicators of socioeconomic status. Over 4.3 years, a 2-point increase in MDS resulted in a reduction of 15% in CVD risk. This was seen in highly educated subjects as opposed to lower educated subjects. Similarly, there was a reduced CVD risk in households that had a high income. Bonaccio et al. (2017), therefore, concluded that MD could occasion lower CVD risk, but the relationship can only be seen in higher socioeconomic groups.
Ambiguous Words and Phrases
An ambiguous word or phrase is one that is not clear in its meaning, and that has the danger of bringing more than one meaning (Browne & Keeley, 2015). Casa et. Al. (2014) have used the phrase ‘cardiovascular diseases’ ambiguously, as it is not a single disease but a group of conditions associated with the heart.
Furthermore, Casas et al. (2014) have used ‘socioeconomic groups’ ambiguously as he has not explained how he classified his subjects.
Assumptions
Value Assumptions
According to Browne and Keeley (2015), a value assumption is a reference that is used implicitly for one over another. Bonaccio et al. assume that people at the lower socioeconomic groups do not eat healthy hence being vulnerable to cardiovascular diseases. Furthermore, the authors believe that eating healthy is good and thus implying that everyone wants to live long.
Descriptive Assumptions
According to Browne and Keeley (2015), a descriptive assumption is a belief that someone has of how the world should be or how things are. Bonaccio et al. (2017) assume that th participants reported their adherence to the Mediterranean Diets truthfully, that they can acquire MD.
Fallacies
A fallacy is a trick in reasoning that authors might use to fool the reader into accepting a particular conclusion (Browne & Keeley, 2015). In Bonaccio et al. (2017), there is a fallacy that a solution should be adopted because it has solved a part of the problem. They do not offer a solution to the lower socioeconomic groups.
In Casas et al. (2015), there is a fallacy that Cardiovascular disease will attack adults from the age of 55 years. This is a fallacy as they have confined the causes of CVD to solely matters the age.
Quality of the Evidence
Quality of evidence is the weight that a piece of evidence carries in proving the existence or inexistence of something. In Casas et. Al (20140 there is a low risk of bias hence strong evidence: the participants were divided randomly into three groups in a ratio of 1:1:1
There was ‘Intent to treat’ analysis as all the participants had at least stage 2 diabetes or three or more cardiovascular risk factors. There was a broad spectrum of persons who had the same expected condition, strengthening the evidence. Supporting evidence is based on the opinions of authors, expert panels, professional bodies, and the use of mixed-method research.
Bonucci et al. (2017) have also laid quality evidence in their research. They have a wide variety of participants; hence, the margin of error is very insignificant. They have also supported their evidence with the opinions of other authors and professional bodies.
Rival Causes
In Browne and Keeley (2015), a rival cause is a plausible alternative outcome that authors use the explain the result of something. In Bonaccio et al. (2017), there are other possible reasons for the outcome of the research, which may include stress levels among lower socioeconomic groups, differing food processing mechanisms, inaccurate reporting, difficulty in accessing MD, among other factors.
Deceptive Statistics
Deceptive statistics are numbers that authors can use to deceive readers on matters regarding research findings (Browne & Keeley, 2015). I did not note any case of deceptive statistics in both articles.
Omitted Information
According to the ARQ process, the next step is to identify critical information that might have been left out (Browne & Keeley, 2015). Omitted information is the small piece of a bigger story that has been left out. In Casas et al. (2015) and Bonaccio et al. (2017), the authors fail to tell us the Mediterranean foods that the participants were exposed to.
Other Reasonable Conclusions
Other reasonable conclusions are any other possible outcomes that might come from something. In Casas et al. (2015), it is fair to say that it is not only Mediterranean diets that can reduce CVD, but any of the foods that can supplement the MDs can reduce the risk of CVD.
Final Reasoned Point of View
While Casas et al. (2015) did an excellent job in identifying the dietary requirements in reducing the risk of CVC, he left a large part of the research. The authors missed a significant point in totally ignoring the lifestyles of their participants and merely focusing on their diet.
I stand with the conclusion provided by Bonaccio et al. (2017), who covered a broad spectrum of people. This is positive as it reduces the margin of error and focuses on the lifestyle of the participants. This is a research that was meant to determine whether socioeconomic groups have a relationship with adherence to MD to reduce the risk of CVD. Their findings were conclusive. Before the lower socioeconomic groups realize that a proper diet is the best way to reduce CVD, the prevalence of CVD will still be high.
Summary
In this paper, I compared two articles about the effects of Mediterranean foods on Cardiovascular diseases, and whether socioeconomic groups have a relationship with adherence to MD to reduce the risk of CVD. My conclusion on this issue was that Mediterranean foods are essential in reducing the risk of cardiovascular diseases. Access to MDs with the sufficient dietary requirements might be hard to come by, especially to people at the lower socioeconomic groups, hence CVD is still more prevalent in this group. This is important to nursing because the findings will help them to identify the kind of nutrients that the body needs or the people at risk of CVD need to fight the disease.
References
Browne, M. N., & Keeley, S. M. (2012). Asking the right questions: A guide to critical thinking (10th ed.). Upper Saddle River, NJ: Pearson.
Bonaccio M., Di Castalnuovo A., Pounis G., et al. (2017) High adherence to the Mediterranean Diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Molisani study, International Journal of Epidemiology, Vol 46(5)
Casas R, Sacanella E. Urpi Sarda M., Chiva Blanch G., Ros E., et al. (2014), The effects of the Mediterranean Diet on Biomarkers of Vascular Wall inflammation and Plaque Vulnerability in Subjects with high-risk CVD: A Randomized trial, plosone 9(6).
Appendix A: ARQ Worksheet
Comparison Table of Studies
| ARQ Step | Study #1/Supports intervention | Study #2/Does, not support intervention |
| Issue & Conclusion | Issue: Does the Mediterranean Diet have effects Biomarkers of vascular wall inflammation and Plaque Vulnerability in subjects that have a high risk for Cardiovascular Disease? Conclusion: Adherence to Mediterranean Diet plays a protective role against ischemic heart disease and significantly decreases inflammatory markers related to atheroma plaque formation as well as plaque instability. It also reduces Blood Pressure.
| Issue: With regards to Cardiovascular Protection, Does a high adherence of MD affects people in different socioeconomic groups differently? Conclusion: Although the Mediterranean Diet is associated with a lower risk of Cardiovascular Disease, this relationship is enjoyed by higher socioeconomic classes of people. |
| Reasons | Mediterranean Diets protects against atherosclerosis by Modulating the inflammatory reaction
| Lower socioeconomic groups have reported lower adherence to healthy dietary habits. Disparities in density levels of nutrients between socioeconomic classes. Access to organic foods and varying food purchasing behaviors. |
| Ambiguous words/phrases | Cardiovascular disease Socioeconomic group
| N/A |
| Assumptions | The participants were honest in filling the Food Frequency Questionnaire. The participants adhered to the shopping lists, cooking recipes, and weekly meal plans.
| That the Participants classified as Smokers, Non-smokers, and Ex-smokers were disciplined for the entire duration of the research. That the participants are trustworthy; they would not lie about their personal Authors have an assumption that the participants reported their adherence to the Mediterranean Diets truthfully, that they have the ability to acquire information. |
| Fallacies | Mistaking mediation for moderation: Relations between the adherence of MD and the reduction of CVD are not simple bivariate associations but are influenced by third party variables, i.e., weather conditions.
| Lower socioeconomic groups do not observe healthy dietary conditions. |
| Strength of evidence | Low risk of bias hence strong evidence: the participants were divided randomly into three groups in a ratio of 1:1:1 Intent to treat analysis: All participants had at least stage 2 diabetes or 3 or more cardiovascular risk factors. There was a broad spectrum of persons who had the same expected condition, strengthening the evidence. Supporting evidence is based on the opinions of authors, expert panels, professional bodies, and the use of mixed-method research.
| Strong evidence as the food intake was assessed by the validated Italian EPIC food frequency questionnaire. Supporting evidence is based on opinions of authors, expert panels and mixed-method research |
| Rival causes |
| Family history of high blood pressure, which may not be detected at the onset of the project.
|
| Deceptive stats | N/A
| N/A |
| Omitted information | The type of foods that the participants were given during the research, inclusive of the amounts of nutrients.
| The types of food that the participants were exposed to. |
| Alternative conclusion | Consumption of vegetables, and not only MDs, can reduce the risks of getting CVD.
| N/A |
Appendix B: Response to Doing the Assignment
Append a description of your reaction to doing this project, answering the following in a complete sentence & paragraph format:
- what was it like to do the analysis and write the paper?
The whole experience felt more than just schoolwork. Learning about the statistics behind Cardiovascular Disease was both sad and a reminder that we need more research like the ones we have handled to save people.
- What did you learn about analyzing, writing, etc.?
Writing and reading must be done very keenly. One can miss a lot of information if they do not carefully analyze the material they are reading.
3) in future classes, what you would do differently when you have a writing assignment
I will do in-depth research on the ARQ steps, and the process as a whole to analyze the differing opinions by authors, then analyze them using the ARQ process to come to a reasonable conclusion.