Patrones de alimentación saludables

Las primeras observaciones sobre las diferencias en la longevidad y la incidencia de las principales enfermedades no transmisibles, mediante variaciones geográficas, han llevado al estudio de los patrones específicos de la dieta en la promoción de la salud81.

La dieta mediterránea (Mediet) es la mejor dieta estudiada y las pruebas cada vez más sólidas que apoyan su efecto preventivo sobre muchas condiciones médicas en la mitad de la vida82. Mediet es más una filosofía de estilo de vida que una mera combinación de nutrientes, que consiste en frecuentes comidas comunales, ejercicio diario moderado y el consumo moderado de vino tinto con las comidas83. Vegetales de temporada cocidos o crudos, frijoles y legumbres, así como moderadas cantidades de queso, yogur y pescado son la base de la Meddiet.

El consumo de aceite de oliva caracteriza los hábitos de alimentación mediterránea. La carne se consume rara vez y la grasa saturada es generalmente menos del 7% de las calorías totales diarias82. La adhesión a Mediet entre las poblaciones del Mediterráneo ha mostrado consistentemente una menor mortalidad total, menor incidencia de enfermedades cardiovasculares y el cáncer, posiblemente inferior incidencia de enfermedades neurodegenerativas84-87.

Las dietas vegetarianas han ganado popularidad como una forma saludable de estilo de vida. En los vegetarianos se ha demostrado que tienen una menor mortalidad por cualquier causa y menor incidencia de enfermedad coronaria del corazón, diabetes e hipertensión arterial, un efecto mediado en parte por el menor índice de masa corporal88. Los datos sobre la incidencia y mortalidad por cáncer siguen siendo concluyentes88,91. La dificultad para establecer asociaciones radica principalmente en el hecho de que el término «vegetariano» incluye muchos patrones de la dieta, es decir, los lacto-ovo-vegetarianos que consumen productos animales; pesco-vegetarianos que consumen pescado y los vegetarianos estrictos que no consumen productos de carne, aves, pescado o animal. La última categoría está sujeta a las deficiencias de vitamina D, calcio, vitamina B12, hierro y zinc88,91.

Conclusión

Una dieta sana es esencial para la prevención de todas las enfermedades crónicas principales no transmisibles en la mediana edad y más allá, tanto de forma directa, a través del efecto de macro y micronutrientes individuales e indirectamente, a través del control del peso corporal. El consumo adecuado de proteínas se debe garantizar principalmente en el consumo de pescado, aves de corral, productos lácteos bajos en grasa o legumbres. Los carbohidratos deben ser derivados de cereales integrales, frutas y verduras, los alimentos ricos en fibra, mientras que el consumo de productos azucarados o refinados debe ser desalentado.

La grasa saturada contenida en las carnes rojas y los productos lácteos con grasa total debe limitarse a < 7% de la ingesta calórica  total. La energía derivada de la grasa debe provenir de aceites vegetales, en particular aceite de oliva, que es rico en ácidos grasos mono insaturados. El consumo moderado de alcohol puede conferir algún beneficio con respecto a la prevención de la enfermedad cardiovascular.

Sin embargo, las personas que no consumen alcohol no deben animarse a hacerlo únicamente sobre la base de estos hallazgos.

Más allá de suplementos de calcio y vitamina D para la prevención de fracturas, actualmente no hay evidencia suficiente para apoyar la el uso de suplementos para la prevención de las enfermedades crónicas de mediana edad.

Resumen de las recomendaciones

• La dieta puede modificar la epidemiología de las enfermedades más importantes de la mediana edad, a saber: diabetes, enfermedades cardiovasculares, cáncer, osteoporosis y demencia.
• La obesidad sarcopénica en los ancianos puede ser enmascarada por el índice de masa corporal «normal» y debe ser manejado con la ingesta adecuada de proteínas y ejercicio físico adaptado.
• Diabetes mellitus tipo 2 se puede prevenir o ser manejada por la restricción de la cantidad total de carbohidratos en la dieta y derivando energía a partir de carbohidratos de cereales integrales, frutas y verduras.
• La sustitución de los ácidos grasos saturados y trans por grasas mono insaturadas y ácidos grasos, omega-3, es la más importante intervención dietética para la prevención de la enfermedad cardiovascular.
• La obesidad es un factor de riesgo para una variedad de cánceres. El consumo de carne roja o procesada está asociado con un aumento de cáncer colorrectal.
• Adecuada ingesta de proteínas, calcio y vitamina D debe ser garantizada para la prevención de las fracturas osteoporóticas. Es necesario control periódico con el fin de evitar posible deficiencia de vitamina D en poblaciones de alto riesgo.
• Una dieta rica en vitamina E, ácido fólico, B12 y ácidos grasos, omega-3 pueden tener un efecto protector contra el deterioro cognitivo.
• Más allá de calcio y vitamina D, la suplementación de rutina de vitaminas, antioxidantes o micronutrientes no se justifica en la actualidad para la prevención de enfermedades crónicas.
• La dieta mediterránea, ha demostrado que posiblemente protege contra la enfermedad cardiovascular, el cáncer y el declive cognitivo.
• Las dietas vegetarianas se asocian con una menor incidencia de diabetes, hipertensión y enfermedad cardiovascular.

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