Nutrition, Mediterranean Diet, and Management of Cardiovascular Diseases (with community educational support)

The programme “Nutrition, Mediterranean Diet, and Management of Cardiovascular Diseases” falls into the broader field of clinical nutrition and is addressed to health professionals (medical doctors, nutritionists, dietician’s assistants, nurses, trainers) as well as to the general public.

A High School diploma is considered to be the minimum qualification for the participation in the programme.

The direction of the programme is dual, as it regards both the prevention of cardiovascular diseases through proper nutrition and the changes that should be made in the diet on the ground of cardiovascular problems and risk factors for them (e.g. hypertension, elevated blood lipids, blood sugar etc.).

Directional axle of the programme is the practical application of the latest dietary recommendations concerning the prevention of cardiovascular diseases. Therefore, in the context of the program are presented the basic principles of nutrition science (i.e. the importance of vitamins, minerals and water, the factors which determine the energy needs), recommendations for a balanced diet, the characteristics of the Mediterranean diet, indicative diets according to coexistent health problems and possible interactions between drugs and nutrition. Alongside, the process of developing atherosclerosis is shown and the role of nutrition in it is clarified. 

Particular emphasis is given to the presentation of the sections with a variety of examples, audiovisual material and practical advices concerning the choice of food and the way of cooking. We believe that aftereffect of the attendance of the program will be the embodiment of the principle of Ancel Keys, one of the pioneers of the designation of the relationship between nutrition and cardiovascular diseases, “eat well, and stay well”.

MODULE 1
INTRODUCTORY CONCEPTS IN NUTRITIONAL SCIENCES

Lesson 1 The object of the nutritional sciences

The purpose of this section is to present some introductory information about the science of nutrition. More specifically, some fundamental concepts of nutrition science are defined (e.g. food, nutrients). Additionally, an overview of nutrient metabolism will be the concept of caloric intake will be explained. In other words, the student will understand how many calories each class of nutrients attributes. In summary the student will acquire a first image of basic concepts relating to the science of nutrition.

Lesson  2 Energy needs

The purpose of this module is to present the factors that determine energy needs, i.e. all the calories you need per day to ingest. We will analyze the three main parameters affecting energy needs (basal metabolism, thermogenesis and exercise thermogenesis) and will also provide practical ways for their assessment in adults. We will also clarify the meaning of "energy balance" and make clear how disturbances in this balance can lead to changes in weight.

Lesson 3 Digestion - food absorption

The purpose of this module is to present the basic processes carried out to effect food digestion and absorption. More specifically, we will describe the organs that participate in digestion, the enzymes secreted and the reactions catalyzed. Additionally, we will analyze the movements of the gastrointestinal system, which assist the digestive process (e.g. peristaltic bowel movements). Finally, students will understand the ways of absorption of nutrients by the small intestine (e.g. passive, facilitated, active transport), the role of water and electrolyte absorption from the large intestine and the transport of nutrients to the tissues.

Lesson 4 Carbohydrates

This section will present the types of carbohydrates (monosaccharides, oligosaccharides and polysaccharides), their main sources from the diet and some key elements of their digestion and metabolism. Focus will be given on hormones that regulate blood sugar (such as insulin, glucagon and epinephrine) and their changes during exercise, stress or the presence of diabetes. Furthermore, the importance of carbohydrate intake from the diet will be discussed and the consequences of their reduced intake. Particular emphasis will be given to fiber as a showcase for their beneficial effects on health and the content of different food in them. Upon completion of the module the examinee will know the sources of carbohydrates and their effects on health.

Lesson 5 Lipids

In this section we will present the various classes of lipids and components for digestion and metabolism. Furthermore, we will present the hormones responsible for lipolysis and lipogenesis and their changes in various conditions. Emphasis will be given to sources of fat from our diet, the quality of oils and their effects on health. Upon completion of the module the examinee will know the sources of omega-3 fatty acids, saturated and trans- fatty acids and their effects on health.

Lesson 6 Proteins

This section will present the concepts of amino acids, peptides and proteins. The basic principles will be presented for protein digestion and metabolism and protein functions in the human body (e.g. formation of antibodies, hormones etc.). Moreover, we will present the hormones that regulate protein metabolism, the changes that occur in starvation and the daily recommended intake. Additionally, data will be presented on the immunomodulatory amino acids, such as glutamine and arginine, and their effects on the immune system. Upon completion of the module the examinee will know the sources of proteins and their effects on health.

Lesson 7 Vitamins

This section will provide a brief overview of all fat-soluble (A, D, E, K) and water-soluble vitamins (B vitamins, vitamin C). Specifically, it analyzes the role of vitamins, foods that are rich in each vitamin and symptoms in cases of hypo- and hyper-consumption. In addition, data will be presented on vitamins absorption and several therapeutic actions. Finally, the recommended daily intake (Recommended dietary allowance, RDA) and the maximum tolerable intake (Upper level, UL) of each vitamin will be given. Upon completion of the module the examinee will know the sources of vitamins and their effects on health.

Lesson 8 Minerals, trace elements, electrolytes

In this section we will present the various metals and minerals (e.g. iron, calcium, zinc, selenium, etc.). Specifically, the foods that are rich in each component will be presented as well as the symptoms in case of deficiencies (eg iron deficiency anemia) or toxicity. Moreover, the competition for the absorption of several nutrients will be discussed (eg calcium- iron competition) and their actions in various pathophysiological conditions. We will provide information on the recommended daily intake (Recommended dietary allowance, RDA) and the maximum tolerable intake (Upper level, UL) of these nutrients. Upon completion of the module the examinee will know the sources of minerals, trace elements and electrolytes and their effects on health.

Lesson 9 Water

In this section we will present in detail the role of water in the body, the daily water needs and how they are formed according to absorption, excretion and environmental conditions (eg increased temperature, exercise). Moreover, we will explain the term "water-retention" and how it is involved in various diseases and weight loss. Finally, reference will be made to the sources of water from the diet (e.g. drinking water, fruits, vegetables, beverages based on water) and the types of water (natural or bottled). Upon completion of the module the examinee will know water sources and their effects on health.

Lesson 10 Phytochemicals

The phytochemicals are a new category of ingredients with many promising actions. In this section the examinee will understand what is meant by the term "phytochemicals" and how they are categorized. Their role in the human body will be analyzed (e.g. antioxidant, anti-inflammatory, antihypertensive action). Moreover, data on their metabolism, possible adverse effects as well as their interactions with metals will be presented. Upon completion of the module the examinee will know the sources of phytochemicals and their effects on health.

Lesson 11 Nutrition assessment

In this section fundamental principles of dietary intake assessment will be presented. We will analyze the concept of dietary reference intakes (DRI) and present several indicators for evaluating diet quality (e g. MedDietScore,  Healthy Eating Index, etc.). Moreover, the techniques of anthropometric and body fat measurements will be presented (e.g., weight measurement, waist circumference, body fat measurement). Upon completion of the module the examinee will know the fundamental principles of nutritional assessment and how these can be used as a tool for assessing health in daily practice.

Lesson 12 Basic principles of a healthy diet

In this section the basic principles for a proper diet will be presented, such as moderation and variety, which are associated with good health and disease prevention. In addition, various popular diets will be commented such as vegetarian diet, the Atkins diet, the blood type diet and others focusing on their possible harmful effects. The concept of "detoxification" will be also explained as part of a slimming diet and the reasons for it is contraindicated. Upon completion of the module the examinee will know the basic principles of a proper diet and its effects on health.

Lesson 13 The relationship between diet and disease

This brings up the interactive relationship between diet and disease in historical examples from ancient Greece to the Native Americans. In addition, the diet and disease link and the vicious cycle of malnutrition with disease will be discussed (i.e. malnourished people get sick more easily and the disease can worsen their nutritional status). Furthermore, the concept of societies that are "nutritional transition" will be presented (the change from traditional to westernized dishes in parallel with bad quality food and increased quantity) and how this change is linked to the occurrence of diseases. Upon completion of the module the examinee will know the reciprocal relationship between diet and the disease and its effects on health.

MODULE 2

CARDIOVASCULAR DISEASES

Lesson 14 Development of atherosclerosis

This section presents the concept of atherosclerosis emphasizing the stages of development the mechanisms implicated and its relationship with cardiovascular disease. Reference will be made to the various theories that exist for the manifestation of atherosclerosis and the latest scientific opinion concerning the PAF (Platelet activating factor), a lipid that appears to be strongly involved in this pathology. After completing this section the trainee will know the causes and mechanisms for atherosclerosis development.

Lesson 15 Calculation of cardiovascular risk

In this section, the risk factors for cardiovascular disease will be presented (eg gender, age, smoking, poor eating habits, etc.) and the possible mechanisms through which they exert their action will be presented. Moreover, the available tools for cardiovascular risk calculation will be discussed (European and US algorithms). After the end of this section the trainee will know how to calculate (approximately) the 10 year cardiovascular risk of somebody by knowing basic characteristics of the person (such as age, smoking etc) and several biochemical measurements, such as cholesterol.

Lesson 16 Evaluation of basic laboratory tests

In this section we will present basic laboratory tests, such as cholesterol, triglycerides, glucose, insulin, liver enzymes, thyroid hormones and markers of renal function. After completing this module the trainee will know the normal and pathological values of these indicators (such as diagnosis of diabetes based on fasting glucose values) and how to interpret them.

Lesson 17 Hypertension

This section includes epidemiological data on hypertension, analysis of its causative mechanisms and hypertension diagnosis based on blood pressure measurement. Additionally, the notions of hypertension and prehypertension are distinguished and the types of drugs used to regulate blood pressure are mentioned. After completing this section the trainee will know the causes and medical management of hypertension.

Lesson 18 Hypercholesterolemia- Hypertriglyceridemia

In this section we will present epidemiological data on hypercholesterolemia- hypertriglyceridemia. The different types of lipoproteins (such as HDL and LDL lipoproteins) and their metabolism are presented. Moreover, the diagnostic criteria of hypercholesterolemia will be presented as well as the drug types used to regulate cholesterol and triglycerides levels. After completing this section the trainee will know the causes and pharmacological treatment of hyperlipidemia.

Lesson 19 Hyperuricemia (increased uric acid)

In this section we will present epidemiological evidence for the presence of elevated levels of uric acid in the blood. The causes and symptoms of hyperuricemiand will be presented. Furthermore drugs used for regulating elevated levels of uric acid are presented. After completing this section the trainee will know the causes and medical management of hyperuricemia.

Lesson 20 Hyperglycemia - Diabetes

In this section we will present epidemiological data on the occurrence of diabetes. Furthermore, the different types of diabetes will be described (type 1, type 2 diabetes and gestational diabetes). We will additionally analyze the diagnostic criteria for type 2 diabetes and "prediabetes", diabetes symptoms, complications, and medical treatment. After completing this section the trainee will know the causes and medical management of diabetes.

Lesson 21 Abdominal obesity

This section will provide epidemiological data on obesity and in particular abdominal obesity, analyze its causes and its effects on health and daily life. The criteria of obesity and abdominal obesity will be presented based on weight, height and waist circumference measurements. Finally, certain drugs against obesity will be presented as well as data on obesity surgery. After completing this section the trainee will know the causes and medical management of obesity.

Lesson 22 Metabolic syndrome

In this section we will realize the definition of metabolic syndrome, its causes and its clinical spectrum. Moreover, the importance of the postprandial state in this pathogenesis will be stressed. Finally, its medical treatment will be briefly presented.

Lesson 23 Heart failure

This section will analyze data on both the epidemiology and the pathogenesis of heart failure. We will describe the symptoms of heart failure, the hormonal changes that take place and its diagnostic criteria. Finally, we will provide information on medicines used to treat heart failure.

MODULE 3

NUTRITIONAL MANAGEMENT OF CARDIOVASCULAR DISEASES

Lesson 24 Mediterranean diet

This section will present the basic principles of the Mediterranean diet enriched with examples of diets that were followed by Cretans in the 1960s. The recommended food intake for each food group will be presented (eg meat consumption, vegetables, dairy, etc.) and the model of the Mediterranean diet in the form of a pyramid will be described (pyramid of the Mediterranean diet). We will analyze the beneficial effects of the Mediterranean diet and identify the bioactive components of the Mediterranean diet and the possible atheroprotecive mechanisms of their action. Particular emphasis will be given to food ingredients that inhibit PAF (Platelet activating factor) actions, a molecule involved in atherosclerosis.

Lesson 25 Diet and myocardial infarction

In this section we will first present the dietary recommendations for the first days after an episode of myocardial infarction. Moreover, we will provide recommendations for the diet that should be followed subsequently, physical activity and weight loss. Examples of a diet plan will be given for patients after myocardial infarction.

Lesson 26 Diet and hypertension

In this section we will present the nutrition guidelines for treating hypertension. In this context, the importance of salt restriction (salt added to cooking and hidden salt in various processed foods). We will provide practical advice to reduce salt in everyday life and choose foods with less added salt. We will analyze the DASH diet (Dietary Approaches to Stop Hypertension), the proposed consumption from each food group and the role of micronutrients such as potassium. An example of a diet plan for the treatment of hypertension will be given.

Lesson 27 Diet and hyperlipidemia

This section will analyze how diet may be used to treat hyperlipidemia. The new European and US guidelines for hyperlipidemia will be presented. Additionally, we will answer the question whether cholesterol from foods affects blood cholesterol. An example of a diet plan for the treatment of

Hyperlipidemia will be given.

Lesson 28 Diet and hyperuricemia

In this section we analyze the relationship between diet uric acid levels. Specifically, we present the foods that are rich in purines, which may affect uric acid. Moreover, we will discuss the role of fructose, alcohol and weight in uric acid levels. Finally, we will emphasize the importance of losing weight for the regulation of uric acid levels in the blood. After completing this module the trainee will know what foods increase uric acid. An example of a diet plan for the treatment of hyperuricemia will be given.

Lesson 29 Diet and Diabetes

In this section, the European and US recommendations will be presented for the dietary treatment of diabetes. Specifically, we will described the role of carbohydrate intake in the regulation of diabetes, the importance of fiber and whether artificial sweeteners are useful in diabetic patients. Additionally, the role of lipids, proteins and micronutrients that regulate diabetes will be discsussed. Finally we will analyze that diet therapy may change depending on the followed therapy (eg insulin, hypoglycemic tablets). After completing the module the trainee will know what is the right diet for diabetes. An example of a diet plan for the treatment of diabetes will be given.

Lesson 30 Diet and heart failure

This section will present the type of diet that should be followed by people suffering from heart failure. More specifically, guidelines for sodium intake will be presented. Furthermore, the importance of other components of the diet, will be stressed, such as omega-3 fatty acids, as well as the overall quality of the diet.

Lesson 31 Diet- Drug Interactions

This section analyzes the various drug-nutrient interactions. More specifically, it describes how various drugs affect vitamins bioavailability. In addition, it presents how food influences the absorption or the availability of certain drugs (eg the interaction of vitamin K and certain anticoagulants). Furthermore, the role of certain herbs in the cardiovascular system is described. The analysis of drug-nutrient interactions will be enriched with numerous examples.

Lesson 32 Practical tips for eating out of home and in special occasions

This section will provide practical advice on heart-friendly dietary choices outside home. For example, will be present ideas for meal options when one is away from home for many hours, or when one is invited to social events etc. Additionally, advice on nutrition in special periods such as summer, Christmas, Easter and religious fasts will be given. After attending this module the learner will know heart-friendly choices for several occasions.

MODULE 4 FOOD MARKET AND COOKING

Lesson  33 Food Labeling

This section presents what a consumer needs to know the on food labels. Specifically, we will present the definition of food additives (E): flavoring agents, coloring agents, preservatives and ingredients that affect food texture or other product features. Moreover, we will focus on other information found on food labels such as containing allergens, sugar, saturated fats, sodium, allegations of "light" foods, expiration date etc. After completing this module the student will be a more conscious consumer and will know which foods are more “friendly” for the cardiovascular system.

Lesson 34 Genetically modified foods

The concept of biotechnology includes the development of new and improved plants and animals (genetically modified or simply modified organisms) which have manipulated of genetic material. This section will analyze the meanings of GMO, with examples of foods produced in this way and their properties. We will present the advantages and disadvantages of GM foods and discuss the ethical considerations that arise from their widespread use.

Lesson 35 Heart friendly cooking

This section will analyze the processes that occur during cooking (eg color change, odor, loss of vitamins etc.). We will give additional practical tips for reducing fat and salt when cooking. Finally, we will discuss various ways of cooking such as frying and microwave while presenting the changes occurring in the antioxidant capacity of foods depending on the way of cooking. After completing this module the trainee will know healthy and delicious ways of cooking.

Lesson 36 Functional foods and cardiovascular disease

In this section we analyze the concept of "functional foods", appearing with increasing frequency in public. The mechanism of cholesterol-reducing foods enriched with sterols and stanols will be discussed. We will also refer to products, which are enriched with probiotics and prebiotics and discuss how they could benefit the consumer.

Each programme consists of modules and each module is divided into lessons. In each module, learners submit the corresponding tests, within the deadline given by their instructors. The final mark fluctuates from 0 to 100%. The overall grade in each module is calculated based on the student's marks on assessment exercises that follow each lesson while their instructor might also assign them a final assessment at the end of the lesson. Finally, if the total score on one or more lessons of the programme does not exceed 50%, students can ask for reassessment.

Online and distance training learning at National and Kapodistrian University of Athens offers a new way of combining innovative learning and training techniques with interaction with your tutor and fellow trainees from around the world.

The e-learning course is implemented via a user-friendly educational platform adjusted to the Distance Learning Principles. Courses are structured as weekly online meetings; interaction with the course tutor and other trainees takes place in a digital learning environment. The courses are designed to fit around your schedule; you access the course whenever it is convenient for you, however within the given deadlines.

The whole world becomes your classroom as e-learning can be done on laptops, tablets and phones as a very mobile method. Learning can be done on the train, on a plane or even during your trip to Greece!

The educational platform is a portal that offers access to electronic educational material based on modern distance learning technologies. The computer based nature of training means new technology is being introduced all the time to help trainees engage and learn in a tailored way that will meet their needs. E-learners have access to the educational platform with their personal code number in order to browse all relevant training material and interact with their instructors.

Moreover, an online communication system through own personal e-mail account is available in order to make the process easier and more interactive. Trainees can contact directly their tutors or the administration office of the course and share any concerns or anxieties related to the course in order to make the most of their experience.

Every week e-learners are provided with the relevant material, delivered either in the form of video-lectures, text notes and relevant presentations or as a combination of them. The educational material of the course is uploaded gradually, per educational unit. During the course, important info for the smooth conduct of the educational process, such as timetables for the submission of the exercises are announced on the Announcement section of the platform.

For successful completion of the course the e-learner should have fulfill her/his academic obligations, meaning should have submitted all corresponding assessment exercises and have achieved at least an average of 50% grade in the corresponding tests for each module. The score scale ranges from 0 to 100%. Finally, if the total score on one or more lessons of the course does not exceed 50%, trainees can ask for reassessment.

During the course trainees will be attending a training experience designed by academics and lecturers from the National University of Athens as well as from other Universities, Research Institutes and Cultural organizations around Greece.

Interactivity, flexibility and our long tradition guarantee that learning with us offers a successful and rewarding experience. Finally, access to a large variety of material and online resources available in each unit aims to excite your curiosity and guide you in exploring further your favourite topic. Part of the online material can be downloaded providing the chance to quickly refresh your memory after the completion of the course.

When will I receive the Certificate?

The Certificate will be sent to you electronically 30 working days upon completion, if you have no remaining academic or financial obligations. The Certificate will be also sent to you through traditional post services. Upon request the Certificate can be sent with the use of courier services. In this case, the relative cost should be covered by your side.