Emilio Ros

Dr. Emilio Ros served as the creator and leader of the Lipid Unit, Endocrinology and Nutrition Service at Hospital Clínic, Barcelona until 2016. Currently, he holds the position of Emeritus Researcher at the Institut de Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona. Additionally, he is a former Principal Investigator and a current member of the CIBEROBN Group at Instituto de Salud Carlos III, Madrid.

During his postgraduate training from 1970 to 1976 in the United States (New York and Boston), Dr. Ros obtained the American Board of Internal Medicine and the American Board of Gastroenterology. He played a pivotal role as a founding member of the Spanish Society of Arteriosclerosis (SEA) and was the founder and editor of its official journal, Clínica e Investigación en Arteriosclerosis. He is an esteemed member of the European Atherosclerosis Society (EAS), International Atherosclerosis Society (IAS), American Society of Nutrition, and American College of Cardiology. From 2000 to 2005, he served as the president of the Ibero-Latin American Atherosclerosis Society (SILAT).

Dr. Emilio Ros’s outstanding contributions to the fields of nutrition, lipidology, and atherosclerosis have garnered global recognition, as he has been acknowledged as one of the top 1% most cited and influential scientists worldwide by Clarivate Analytics from 2018 to 2021. His extensive research portfolio includes 530 original articles, 95 reviews, and 30 editorials published in renowned journals. Additionally, he has contributed 90 book chapters, showcasing his breadth of knowledge and expertise. Notably, his Google Scholar index stands at 113, and he possesses an ORCID identifier (0000-0002-2573-1294). To honor his remarkable scientific career, Dr. Emilio Ros has received several prestigious awards, including the Best Scientific Career in Nutrition from the Danone Foundation in 2013, the SEA (Spanish Society of Arteriosclerosis) in 2014, and the Catalan Nutrition Centre in 2015. One of his notable accomplishments was leading the nutritional intervention in the groundbreaking clinical study PREDIMED, which focused on the Mediterranean diet for primary cardiovascular prevention.

Evidence-Based Nutrition – How Can It Be Improved: Insights from the PREDIMED trials

Emilio Ros, IDIBAPS, University of Barcelona, Barcelona, Spain.

Evidence from randomized controlled trials (RCTs) and prospective cohort studies examining associations between exposure to foods, nutrients or dietary patterns and health outcomes is the basis to issue dietary recommendations for individuals and populations. Cohort studies are the most common sources of evidence in nutrition research but, compared to RCTs, they are considered to provide less reliable data, being prone to bias from confounding, misreporting and measurement errors. In contrast, well-conducted RCTs are the gold standard to assess benefits and harms of interventions and for drawing causal inferences. However, RCTs are challenging and unfeasible or unethical for many nutrition research questions. Interestingly, meta-epidemiological studies have examined the agreement of effect estimates from RCTs and observational studies in nutrition research and reported a high degree of concordance. This is particularly befitting in the case of the Mediterranean diet (MeDiet) and incidence of cardiovascular disease (CVD) events, as there are many cohort studies assessing these outcomes and two landmark RCTs, the primary prevention PREDIMED and the secondary prevention CORDIOPREV. Both RCTs provided a similar degree of CVD risk reduction for MeDiets supplemented with extra-virgin olive oil (30% and 28%, respectively). Of note, recent meta-analyses of cohort studies of exposure to the MeDiet for CVD outcomes also provide risk reduction estimates between 20% and 30% comparing the highest versus the lowest categories of adherence, while supporting the consistency of findings, as almost all individual studies disclose beneficial associations. Indeed, the evidence derived from the two types of studies (cohort and RCTs) is complementary, and that obtained from scientifically-sound cohort studies with long follow-up, periodically updated measures of dietary exposure, and a large set of confounders can inform dietary guidelines when evidence from RCTs is scarce. Still, evidence-based nutrition should be improved with further well-designed RCTs, such as the ongoing PREDIMED-Plus trial, and the exploitation of large existing cohorts or the design of new well-powered prospective studies.