2457). Two features from this study that stand out when compared to the previous study (as read about earlier) was that this study sought to keep the participants weight relatively stable and that the participants were not obese and old, but were young and healthy. The goal of this study was measurably the same as the pervious study, but was set in entirely different circumstances. This is important to individuals seeking entry to the nursing field because it provides ammunition for lifestyle interventions even before the patient may think it is necessary.

The study's primary interest was to ascertain "the contrasts between the carbohydrate and protein diets and between the carbohydrate and unsaturated fat diets" (pg. 2459). What the study found was that for each diet (when compared to baseline) "systolic and diastolic blood pressure and levels of LDL, total, and HDL cholesterol were lower on each diet" (pg. 2459). However, the diet that showed the most effect on blood pressure and lipids was the protein diet. "Compared with the carbohydrate diet, both the protein and unsaturated fat diets significantly lowered systolic and diastolic blood pressure in all participants and in those who were hypertensive" (pg. 2459).

The protein diet was effective for lowering blood pressure and for lowering lipids. The study determined "the protein diet but not the unsaturated fat diet significantly lowered LDL cholesterol levels compared to the carbohydrate diet…the protein diet significantly reduced HDL cholesterol levels compared with the carbohydrate and the unsaturated fat diets" (pg. 2459).

This data and the study's findings can be invaluable when questioned by a patient seeking information that may help them live longer and healthier lives. A nurse must be knowledgeable in all aspects of health, even when approached by a seemingly healthy, young or vibrant individual. Knowing that a high protein diet has shown more infinity (at least by this study) to lowering blood pressure and cholesterol levels may come in handy as interactions with patients oftentimes takes place.

Especially helpful would be the study's estimated cardiovascular risk component that states, "compared with baseline, the 10-year risk of CHD was lower on each study diet by 16.1 to 21% as estimated from the Framingham risk equation" (pg. 2461). Espousing such data could surely be a risk worth taking.

A final study that might be of interest to the nursing industry was a study that took place between 1994 and 1997 and had over 28,572 volunteers. The participants were all recruited from various regions of Greece and overall enjoyed the Mediterranean diet as their normal food consumption. This is an interesting study due to the large numbers and the fact that it looked to ascertain the effects of a local culture on the local citizenry.

"The Mediterranean diet was first considered…as a diet low in saturated lipids that conveyed protection against coronary heart disease by lowering plasma cholesterol levels" (Trichopoulou, Bamia, Trichopoulos, 2005, pg. 929).

This study is in sharp contrast to the other two studies presented above. The first study was on obese, older adults, many of whom had already experienced some form of high blood pressure, hypertension and other cardiovascular maladies. The second study focused on healthy, young individuals who wished to have relatively small changes to their lifestyles. That study showed how protein, monounsaturated fat, and carbohydrate diets lowered the risk factors of early hypertension and other cardio health symptoms. The Trichopoulou study sought to determine whether an entire culture could be effectively combating cardiovascular disease based on the diet that was consumed.

The researchers state, "we have been able to evaluate the effects of the traditional Mediterranean diet on survival among individuals previously diagnosed as having coronary heart disease" (Trichopoulou, pg. 929). Results from the study show that "in an analysis of a fairly large sample of individuals participating...

932).
In this case significant may be understated, since a "2-unit increment in the 10-unit Mediterranean diet score was associated with a 27% lower overall mortality and a 31% lower cardiac mortality" Trichopoulou, pg. 932).

Whether switching to an entire Mediterranean style diet makes good sense for every patient is entirely up to the individual involved, but it is certainly information that can be extrapolated into certain areas of concern.

This was not the first study to take into account the Mediterranean diet, and it probably will not be the last. Earlier studies have shown even greater benefits to many individuals with one particular study showing a reduction in the mortality rate "of 70% and of cardiac mortality by 81% in the prevention group" (Trichopoulou, pg. 933). Such studies bear reporting and at least a more than passing glance by the medical community. The advantages of both the studies are the large samples from which they had to draw on. The Trichopoulou study had more than 1300 active participants who completed the study.

Of course, there are also disadvantages to this study (and other randomized population-based studies) in that the "lack of medical documentation and the self-reported coronary heart disease" (pg. 234) could be grossly overstated. Many, if not all, population-based volunteer studies will have these same type of issues and the researchers acknowledged in their report these disadvantages.

The study addresses the issue of why the Mediterranean diet seems to be so effective.

It did so by offering the following information; "the apparent, although not statistically significant beneficial effect of vegetables and olive oil, both of which contain a-linolenic acid, indicate that this compound may play an important role in the beneficial effect of the Mediterranean diet on the prognosis of heart disease" (pg. 934).

Nurses can recommend the Mediterranean diet, a diet high in protein, a carbohydrate diet such as the DASH diet, or even a monounsaturated fat diet to the patient, but must always remember that the information given to the patient(s) must be complemented with an admonishment that a healthy lifestyle is one that includes a healthy diet coupled with exercise and moderation. Studies such as the ones quoted in this paper can be used to further a nurse's growth, but making wise decisions in recommending different actions to patients must be done a continual, consistent and constant basis. These studies, and studies like them, can provide the data necessary to make recommendations, but overall it is the nurses relationship with the patient that means the most in promoting good health. The goal of this paper was to provide data to assist those nurses who wish to be knowledgeable regarding different avenues of diet and exercise in order to promote the good health and quality of life that patients always seem to be searching for.