Search

Purpose: There is no evidence of a dietary index that measures not only the quantity but also the quality of protein. The aim is to investigate the association between a new dietary protein quality index (PQI) and micronutrient intake adequacy in a Mediterranean cohort. Design: We assessed 17,535 participants' diet at baseline using a semi-quantitative FFQ. The PQI was calculated according to the ratio of protein (g/d) sources: [fish, seafood, lean meat, pulses, eggs, nuts, low-fat dairy, and whole grains]/[red and ultra-processed meats, whole-fat or semi-skimmed dairy, potatoes and refined grains]. Participants were classified into quintiles of PQI. We evaluated the intakes of Fe, Cr, I, K, Mg, Ca, P, Na, Se, Zn and vitamins A, B1, B2, B3, B6, B12, C, E and folic acid. Micronutrient adequacy was evaluated using DRIs. Logistic regression analysis was used to assess the micronutrient adequacy according to quintiles of PQI. Results: In this cross-sectional analysis, a total of 24.2% and 4.3% participants did not to meet DRIs in ≥ 4 and ≥ 8 micronutrients, respectively. The odds of failing to meet ≥ 4 and ≥ 8 DRI were lower in participants in the highest quintile of protein quality (OR = 0.22; IC 95% = 0.18, 0.26; P-trend < 0.001; and OR = 0.08; IC 95% = 0.05, 0.14; P-trend < 0.001, respectively) as compared to participants in the lowest quintile. Conclusion: Higher PQI was found to be strongly associated with better micronutrient intake adequacy in this Mediterranean cohort. The promotion of high-quality protein intake may be helpful for a more adequate intake of micronutrients. The odds of failing to meet certain numbers of DRIs were lower rather than saying lower risk. [ABSTRACT FROM AUTHOR]

The Mediterranean diet (MedD) is a flexible dietary pattern which has such variability that has led to inconsistencies in definitions and assessment. The purpose of this narrative review is to evaluate scoring systems in a cultural and geographic context, from Mediterranean and non-Mediterranean countries, for comparison and application. The early MedD scoring systems (i.e. Trichopoulou's MedD Scale (T-MDS) and alternative MedD Scale (aMed)) are widely applied throughout the world but use population-specific median cut-offs which limit interpretation and cross-study comparisons. The T-MDS and aMed also do not account for non-traditional MedD foods which are consumed in greater quantities than when the scoring systems were developed. Scoring systems developed after the MedD pyramid publication in 2011 have generally used these recommendations as a basis for food group intake cut-offs, incorporating more foods/food groups as negative components, and some have included dietary and lifestyle behaviours. The different approaches to MedD assessment have created much variability in the foods/food group components included in scoring systems. Assessments that include dietary and lifestyle behaviours may reflect the nutrition transition occurring in Mediterranean countries and better guide clinical intervention approaches. While the new scoring systems are theorised to better capture MedD adherence and behaviours, comparisons are sparse in the literature and none exists outside of Europe. Consensus on food and dietary behaviours to include as well as the methodology for assigning points in MedD scoring systems is needed to advance our understanding of MedD and health relationships to promote public health messaging and clinical application. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between three different a priori dietary patterns adherence (17-item energy reduced-Mediterranean Diet (MedDiet), Trichopoulou-MedDiet and Dietary Approach to Stop Hypertension (DASH)), as well as the Protein Diet Score and kidney function decline after one year of follow-up in elderly individuals with overweight/obesity and metabolic syndrome (MetS). Methods: We prospectively analyzed 5675 participants (55–75 years) from the PREDIMED-Plus study. At baseline and at one year, we evaluated the creatinine-based estimated glomerular filtration rate (eGFR) and food-frequency questionnaires-derived dietary scores. Associations between four categories (decrease/maintenance and tertiles of increase) of each dietary pattern and changes in eGFR (ml/min/1.73m2) or ≥ 10% eGFR decline were assessed by fitting multivariable linear or logistic regression models, as appropriate. Results: Participants in the highest tertile of increase in 17-item erMedDiet Score showed higher upward changes in eGFR (β: 1.87 ml/min/1.73m2; 95% CI: 1.00–2.73) and had lower odds of ≥ 10% eGFR decline (OR: 0.62; 95% CI: 0.47–0.82) compared to individuals in the decrease/maintenance category, while Trichopoulou-MedDiet and DASH Scores were not associated with any renal outcomes. Those in the highest tertile of increase in Protein Diet Score had greater downward changes in eGFR (β: − 0.87 ml/min/1.73m2; 95% CI: − 1.73 to − 0.01) and 32% higher odds of eGFR decline (OR: 1.32; 95% CI: 1.00–1.75). Conclusions: Among elderly individuals with overweight/obesity and MetS, only higher upward change in the 17-item erMedDiet score adherence was associated with better kidney function after one year. However, increasing Protein Diet Score appeared to have an adverse impact on kidney health. Trial Registration Number: ISRCTN89898870 (Data of registration: 2014). [ABSTRACT FROM AUTHOR]

Purpose: Inflammation could play a key role in tissue damage and bone metabolism. The modified dietary inflammatory score (M-DIS) is a validated tool to estimate the inflammatory potential of the diet. In the present study, we evaluate the associations between the M-DIS and bone mineral density (BMD) in a senior Mediterranean population with overweight/obesity and metabolic syndrome. Methods: Baseline cross-sectional association between the M-DIS and bone mineral density was assessed in 1134 participants of the multicenter PREDIMED-Plus trial (aged 55–75 with overweight/obesity and metabolic syndrome). BMD was measured using Dual-energy X-ray Absorptiometry scans and participants answered a food frequency questionnaire to determine the M-DIS. BMD was categorized as low BMD when T score was equal or lower than -1 and normal BMD in another case. Associations between BMD and M-DIS were evaluated by using linear and logistic regressions adjusted by other co-variates. Results: Participants in the top tertile of the M-DIS had a lower BMD at total femur [β (95% CI) − 0.02 (− 0.04, − 0.01)], trochanter areas [β (95% CI) − 0.03 (− 0.05, − 0.01)] and lumbar spine area [β (95% CI) − 0.03 (− 0.07, 0.01)] (but in the last case, measures were less precise and hence not statistically significant) compared to those in the lower M-DIS tertile. Multiple logistic regression analyses showed that the odds of the total femur and femoral trochanter osteopenia/osteoporosis were higher in participants in the top tertile compared to those in the lowest tertile of M-DIS [OR (95% CI) 1.71 (1.12, 2.64), P for trend 0.015; 2.02 (1.29, 3.21), P for trend 0.002, respectively]. Conclusion: A high pro-inflammatory diet, measured by the M-DIS, is associated with lower BMD in a senior Mediterranean population with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Introduction: The effects of protein consumption on overall human health and longevity remain one of the most controversial issues in nutrition science to date. Aim: To evaluate the association between dietary protein intake and psychological distress, in people aged >65 years of age, living in insular Greece. Methodology: Data from older people living in 20 Greek islands, from the MEDiterranean Islands Study (MEDIS) (n=2,221) population-based cross-sectional study were used. Anthropometric, clinical and socio-demographic and lifestyle characteristics, and protein consumption (total, animal, plant) consumed based on validated FFQ, were derived through standard procedures and questionnaires. Psychological distress was assessed as a combined variable representing symptoms of depression and anxiety. Results: Animal protein, but not plant protein intake, was associated with higher PDS following adjustment for age, sex, education level, Mediterranean diet adherence and physical activity (b±SE: 0.403 ± 0.090, p=0.003). Following analysis by Mediterranean diet adherence level, among low adherers, animal protein intake was positively associated with Psychological Distress (b±SE: 1.119 ± 0.174, p=0.008); no associations were observed in moderate or high adherence groups or as regards plant protein intake and Psychological Distress. Conclusions: The present study suggests that plant protein sources form an important part of the overall dietary pattern and that low to moderate red meat intake within a Mediterranean diet pattern may be associated with lower Psychological Distress. [ABSTRACT FROM AUTHOR]

The Mediterranean diet, which was born in the Mediterranean basin, was initially quite poor and simple, essentially based on the products that grew almost spontaneously along the shores of the Mediterranean, i.e., olives, grapes, and wheat, which were long cultivated in the Mediterranean region. The invasions of the Roman Empire by barbarian populations, between 400 and 800 AD, made the diet enriched with products from wild uncultivated areas, meat from game and pigs, and vegetables. With the arrival of the Arabs in southern Italy in the ninth century, the focus of the diet shifted to carbohydrates, particularly to dried pasta and to other new ingredients. The Arabs primarily brought a new imaginative spirit to the kitchen by introducing and using an infinity of condiments and seasonings. The discovery of the Americas and the arrival of new ingredients from the New World brought the final adjustments to the Mediterranean diet: new meat (turkey), new vegetables (potatoes, broad beans, corn, tomatoes,) new fruits (strawberries, pineapples, coconuts, peanuts), chocolate, coffee and sugar completed the list of components of the Mediterranean diet as we know it today., (© 2024. The Author(s).)

Abstract The present research intends to contribute to the literature on sustainable food consumption by investigating the present-day dietary patterns of Italian households to assess the degree of adherence to the Mediterranean diet together with the level of organic and local food consumption. The analysis is based on data from the Italian National Institute of Statistics survey "Aspects of Daily Life" for the year 2014; this is a Multipurpose Survey conducted in Italy with 44,984 individuals across 18,864 households. A Heckman two-step probit model was implemented to estimate equations to assess the impact of Italian household composition and adherence to the Mediterranean diet upon organic and local food consumption. The study's findings show that both those households with children and those with a higher degree of adherence to the Mediterranean diet have higher probabilities of buying both organic and local products, while increasing household size reduces the likelihood of buying local products. Furthermore, good economic status and a higher level of education increase the probability of consuming organic food. Some of the differences highlighted are of low amplitude; however, these results offer novel and original insights for Italy and support the need to for both policy makers and marketers to implement a wide range of initiatives aimed at educating consumers about, and facilitating access to sustainable food products. [ABSTRACT FROM AUTHOR]

Dietary polyphenols, including flavonoids, are abundantly present in a healthy and balanced diet. Evidence for their role in preventing non-communicable diseases is emerging. We examined the association between estimated habitual intake of dietary flavonoid and obesity in a cohort study. After adjusting for potential confounding factors, inverse association between total flavonoid intake and excess weight (BMI ≥25) was found (OR = 0.66, 95% CI: 0.45, 0.99); among individual classes of flavonoids, only flavanones were inversely associated with excess body weight (OR = 0.68, 95% CI: 0.48, 0.97). However, when considering adjustment for dietary factors (adherence to the Mediterranean diet), the associations were no more significant. When considering obesity as the outcome (BMI ≥30), individuals with high intake of total flavonoids and flavonols resulted less likely to be obese (OR = 0.38, 95% CI: 0.21, 0.66 and OR = 0.63, 95% CI: 0.39, 0.99, respectively), even after adjustment for confounding factors. The results of the present study add to the current literature further evidence of the association between higher flavonoid intake and decreased body weight. Further studies are needed to confirm retrieved association. [ABSTRACT FROM AUTHOR]

Purpose To the best of our knowledge, the studies on determining adherence to the Mediterranean dietary pattern (MDP) in Iran as a non-Mediterranean country are scarce. Thus, the aim of the study is to determine the adherence to the MDP in a sample of female adolescents who are residents of Tehran, Iran.Design/methodology/approach In this cross-sectional study, 263 female adolescents aged 15-18 years were studied. Information on socio-demographic, lifestyle and anthropometric variables were obtained using a structured questionnaire. Also, dietary intakes were determined using a validated 168-item food frequency questionnaire. Adherence to MDP was characterized using Mediterranean-style dietary pattern score (MSDPS).Findings Typically, the mean ± SD MSDPS was low in the present study (15.9 ± 5.6). The mean ± SD age and body mass index of the study population was 16.2 ± 0.9 years and 22.2 ± 4.1 kg/m2, respectively. In this study, the maximum MSDPS was 34.3, which was only one-third of maximum possible score (100). Multiple linear regression analyses showed that higher MSDPS scores were positively associated with age (standardized β = 0.1; p = 0.006), higher energy intake (standardized β = 0.2; p < 0.001) and marginally higher physical activity (standardized β = 0.1; p = 0.079).Originality/value Understanding low adherence to MDP in Tehranian female adolescents can provide basic knowledge to launch systematic programmes for gravitation toward MDP. [ABSTRACT FROM AUTHOR]

Current evidence suggests a beneficial effect of the Mediterranean diet (MD) on human health. This has led to a rise in studies investigating the role of the MD in cardiovascular disease (CVD) prevention outside the region of its origin. We aimed to outline the evolving understanding of the MD and to provide an overview of adherence to MD in non-Mediterranean countries and the modulatory effects of MD on CVD biomarkers. Evidence suggest that MD may exert a protective effect on CVD via ameliorating blood lipid profile and blood pressure. A protective effect of MD was found with regard to left ventricular mass but data on carotid intima media thickness and pulse wave velocity are lacking. The paucity of data does not give a clear picture of the health effects of the MD in non-Mediterranean countries, thus larger and well-designed studies on MD outside the Mediterranean countries are warranted. [ABSTRACT FROM AUTHOR]

Objective: The consumption of potatoes is increasing worldwide, but few studies have assessed the association between potato consumption and mortality, particularly in Mediterranean countries. We therefore investigated whether potato consumption is associated with higher risk of death in a large cohort of people living in South Italy.Design: Longitudinal.Setting: Community-dwelling.Measurements: 2,442 participants coming from MICOL and NUTRIHEP studies aged more than 50 years at baseline were followed-up for 11 years. Dietary intake was assessed by means of a Food Frequency Questionnaire. Potato consumption was categorized in quintiles according to their daily consumption (< 3.95, 3.96-8.55, 8.56-15.67, 15.68-22.0, and > 22.0 g/day). Mortality was ascertained through validated cases of death. The association between potato consumption and mortality was assessed through Cox’s regression models, adjusted for potential confounders, and reporting the data as hazard ratios (HRs) with 95% confidence intervals (CIs).Results: The 2,442 eligible participants were prevalently males (54.6%) and aged a mean of 64.3±9.3 years. During the 11-year follow-up, 396 (=16.2%) participants died. After adjusting for 12 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not have an increased overall mortality risk (HR=0.75; 95%CI: 0.53-1.07). Modelling the potato consumption as continuous (i.e. as increase in 10 g/day) did not substantially change our findings (fully-adjusted HR=0.93; 95%CI: 0.84-1.02).Conclusion: Overall potato consumption was not associated with higher risk of death in older people living in a Mediterranean area. Future studies are warranted to elucidate the role of potato consumption on all-cause and cause-specific mortality. [ABSTRACT FROM AUTHOR]

Background Recent trends in the food science industry and consumers’ preferences for diversified diets suggest the consumption of wild greens not only as diet complements but also as healthy and functional foods for targeted conditions, rendering its commercial cultivation of major importance in order to avoid irrational gathering and genetic erosion threats. The Mediterranean basin abounds in wild edible species which have been used for food and medicinal purposes by human throughout the centuries. Many of these species can be found near coastal areas and usually grow under saline conditions, while others can adapt in various harsh conditions including high salinity. Scope and approach The aim of this review focuses on listing and describing the most important halophyte species that traditionally have been gathered by rural communities of the Mediterranean basin, while special interest will be given on their chemical composition and health promoting components. Cases of commercially cultivated halophytes will be also presented to highlight their potential as alternative cash crops, while results from in vitro and in vivo health effects will be presented. Key findings and conclusions The recent literature has provided useful information regarding the potential of wild halophytes as promising ingredients in functional food products and/or as sources of bioactive compounds. However, further research is needed regarding the chemical characterization of these species under commercial cultivation practices, while further clinical and model trials have to be conducted to assess their long term bioactivity and elucidate potential toxic effects and regulations of safe consumption. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between the adherence to empirically derived dietary patterns and gestational diabetes mellitus (GDM) risk and of healthy lifestyles with the prevention of GDM defining an overall healthy score. The Seguimiento Universidad de Navarra project is a Mediterranean cohort of university graduates started in 1999. We included 3455 pregnant women. During a mean follow-up of 10·3 (SD 3·3) years, we identified 173 incident GDM cases. Two major dietary patterns were identified using principal component analysis: the Western dietary pattern (WDP) (characterised by a high consumption of meat-based products and processed foods) and the Mediterranean dietary pattern (MDP) (characterised by a high consumption of vegetables, fruits, fish and non-processed foods). A low-risk score for GDM was defined taking into account important risk factors (age, BMI and unhealthy dietary pattern) for GDM. Positive association was found in the multivariable model between the highest quartile of adherence to WDP and GDM incidence compared with the lowest quartile (OR 1·56; 95% CI 1·00, 2·43). No association was found between adherence to the MDP and GDM incidence (OR 1·08; 95% CI 0·68, 1·70 for the highest quartile compared with the lowest). Women who adhered to all three low-risk factors had a 76% lower risk of GDM (OR 0·24; 95% CI 0·10, 0·55) compared with women who did not adhere to any factor before pregnancy. In conclusion, our results reinforce the importance of dietary recommendations and other two factors (low BMI and young age at pregnancy) in pre-gravid women. [ABSTRACT FROM AUTHOR]

A large body of research data suggests that traditional dietary habits and lifestyle unique to the Mediterranean region (Mediterranean diet, MD) lower the incidence of chronic diseases and improve longevity. These data contrast with troubling statistics in the United States and other high income countries pointing to an increase in the incidence of chronic diseases and the projected explosion in cost of medical care associated with an aging population. In 2013, the MD was inscribed by UNESCO in the "Representative List of the Intangible Cultural Heritage of Humanity." The 2015-2020 Dietary Guidelines for Americans included the MD as a healthy dietary pattern. Therefore, specific objectives of this article are to provide an overview of the nutritional basis of this healthful diet, its metabolic benefits, and its role in multiple aspects of disease prevention and healthy aging. Whereas recommendations about the MD often focus on specific foods or bioactive compounds, we suggest that the eating pattern as a whole likely contributes to the health promoting effects of the MD. [ABSTRACT FROM AUTHOR]

Securing food for growing populations while minimizing environmental externalities is becoming a key topic in the current sustainability debate. This is particularly true in the Mediterranean region, which is characterized by scarce natural resources and increasing climate-related impacts. This paper focuses on the pressure Mediterranean people place on the Earth ecosystems because of their food consumption and sourcing patterns and then explores ways in which such pressure can be reduced. To do so, it uses an Ecological-Footprint-Extended Multi-Regional Input-Output (EF-MRIO) approach applied to 15 Mediterranean countries. Results indicate that food consumption is a substantial driver of the region's ecological deficit, whereby demand for renewable resources and ecosystems services outpaces the capacity of its ecosystems to provide them. Portugal, Malta and Greece are found to have the highest per capita food Footprints (1.50, 1.25 and 1.22 global hectares (gha), respectively), while Slovenia, Egypt and Israel have the lowest (0.63, 0.64 and 0.79 gha, respectively). With the exception of France, all Mediterranean countries rely on the biocapacity of foreign countries to satisfy their residents' demand for food. By analyzing the effect of shifting to a calorie-adequate diet or changing dietary patterns, we finally point out that the region's Ecological Footprint – and therefore its ecological deficit – could be reduced by 8% to 10%. [ABSTRACT FROM AUTHOR]

The metabolic syndrome (MetS) is a key indicator of two main causes of death worldwide: CVD and diabetes. The present paper aimed to perform a review of the population-based research on the association of dietary patterns and the MetS in terms of methodology and findings. For the purpose of the present study, a scoping literature review was conducted using MEDLINE and EMBASE databases and hand searching in Google Scholar. Thirty-nine population-based studies were selected. Most of these studies used the factor analysis method and the a priori dietary approach, which had been initially extracted via a posteriori methods such as using the Mediterranean dietary pattern. The main finding was that following the Mediterranean or similar ‘healthy’ pattern reduced risk of the MetS, while following a ‘Western’ pattern increased risk of the MetS. The methodological approach in determining the dietary pattern of a population, whether a priori or a posteriori, should be chosen based on the purpose of the research. Overall, evidence suggests a diet based on the components of the Mediterranean diet and the avoidance of the ‘Western’ diet can aid in preventing the MetS. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Mixtures of wild food plants, part of the Mediterranean diet, have potential benefits for their content in bioactive compounds, minerals and fibers. In Italy, wild plants are still consumed in various ways, for their taste, effects on health and nutritional value. In this paper, we provide a list of wild plants used in vegetable mixtures, indicating their phytochemical and nutritional profile, highlighting those not yet studied. Aim of the study We provide a first complete review of traditional uses of wild food plants used as vegetables and their preparations (e.g., salads, soups, rustic pies). We also highlight their phytochemical constituents. Materials and methods We carried out an extensive literature review of ethnobotanical publications from 1894 to date for finding plants used in traditional vegetable mixtures. We also performed an online search for scientific papers providing the phytochemical profile of plants that were cited at least twice in recipes found in the literature. Results We list a total of 276 wild taxa used in traditional vegetable mixtures, belonging to 40 families. Among these, the most represented are Asteraceae (88), Brassicaceae (33), Apiaceae (21), Amaranthaceae (12). Many plants are cited in many recipes across several Italian regions. Among the most cited plant we note: Reichardia picroides (L.) Roth , Sanguisorba minor Scop. , Taraxacum campylodes G. E. Haglund, Urtica dioica L. Tuscany is the region with the highest number of food recipes that incorporate wild plants used as vegetables. We also list the phytochemical constituents and some pharmacological activities of the plants cited at least twice. Finally, we discuss topics such as the taste of plants used in the recipes. Conclusions Nineteen edible wild plants, such as Asparagus albus L. , Campanula trachelium L., Hypochaeris laevigata (L.) Benth. & Hook f. , Phyteuma spicatum L. , Scolymus grandiflorus Desf., are not yet studied as regards their phytochemical and nutritional profile. Some plants should be avoided due to the presence of toxic compounds such as Adenostyles alliariae (Gouan) A. Kern or Ranunculus repens L. [ABSTRACT FROM AUTHOR]

Background/objectives: The objective of this study is to extract and assess data on the dietary intake of flavonoids and lignans in a healthy free-living Mediterranean population, using newly updated harmonized European Union food composition data. This work also aimed at analyzing in a holistic way the total content of the diet in major classes of polyphenols.Subjects/methods: Six thousand nine hundred and eighty-one men and 7048 women (aged ⩾ 35 years) of the Moli-sani cohort, randomly recruited from the general population, were analyzed. The European Prospective Investigation into Cancer (EPIC) and Nutrition-Food Frequency Questionnaire was used for dietary assessment. The polyphenol content of each food group was evaluated using Eurofir BioActive Substances in Food Information System and the United States Department of Agriculture food composition tables (FCTs), when data were missing. Flavonol, flavone, flavanone, flavanol, anthocyanin, isoflavone and lignan intakes were calculated and polyphenol antioxidant content (PAC) score (-28, 28) constructed, to assess the total content of the diet in these nutrients.Results: Seasonal and citrus fruits, leafy, grain, pod and root vegetables, and onions and garlic accounted for different proportions (11-70%) of the total intake of different polyphenols. Within the Moli-sani population, men or older, or no/former smokers, or physically active or obese/overweight individuals presented higher consumption of flavonoids, lignans and PAC score (P for all <0.01). Multiple regression analysis showed that PAC score and its seven components were positively associated with Mediterranean diet (MeD) adherence in both genders (β-coefficient >0, P<0.001). In addition, 1 unit increase in PAC score was associated with 7.1-7.8% increase in the likelihood of high MeD adherence (P<0.001).Conclusions: The intake of flavonoids and lignans in an European Union population was calculated using harmonized European Union FCT data. In addition, a holistic approach in dietary analysis of polyphenol intake was proposed. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease, the most prevalent liver disease in developed countries, remains difficult to manage with no proven safe and effective pharmacotherapy available. While weight reduction is the most commonly practiced treatment strategy, this is difficult to both achieve and/or maintain in the majority. Furthermore evidence-based dietary recommendations to guide the nutritional management of these patients are lacking. Using a randomised controlled trial design, this study compares the effectiveness of the Mediterranean diet to a standard low fat diet in terms of differences in insulin sensitivity, hepatic steatosis and metabolic outcomes in participants with non-alcoholic fatty liver disease.Methods: Ninety four eligible patients who have non-alcoholic fatty liver disease and who are insulin resistant, will be randomised into either a Mediterranean or low fat diet group for a 3 month intervention period. Insulin sensitivity will be measured on peripheral blood using Homeostatic Model Assessment and liver fat content quantified using Magnetic Resonance Spectroscopy. Both arms will consist of three face to face and three telephone call follow up consultations delivered by an Accredited Practicing Dietitian. The intervention arm focuses on recommendations from the traditional Mediterranean diet which have been tailored for use in the Australian population The standard arm uses the Australian Guide to Healthy Eating and the Australian National Heart Foundation dietary guidelines. Study recruitment will take place at four major metropolitan hospitals in Melbourne, Australia. Data collection will occur at all face to face reviews including baseline, 6, and 12 weeks. A follow up assessment to measure sustainability will take place at 6 and 12 months. The primary end point is improved insulin sensitivity scores at the 12 week time point.Discussion: This trial aims to demonstrate in a large cohort of participants with NALFD that a Mediterranean diet independent of weight loss can result in significant benefits in liver fat and insulin sensitivity and that these changes are sustained at 12 months. These metabolic changes would potentially lead to reductions in the risk of chronic liver disease, heart disease, type 2 diabetes and liver cancer.Trial Registration: Australia and New Zealand Clinical Trials RegisterActrn: ACTRN12615001010583 . [ABSTRACT FROM AUTHOR]

Study Question: Are there any associations of dietary patterns with semen quality, reproductive hormone levels, and testicular volume, as markers of testicular function?Summary Answer: These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential.What Is Known Already: The Mediterranean diet has been related to lower risk of multiple chronic diseases, but its effects on reproduction potential are unclear.Study Design, Size, Duration: Cross-sectional sample of 215 male university students recruited from October 2010 to November 2011 in Murcia Region (Spain).Participants/materials, Setting, Methods: Two hundred and nine healthy men aged 18-23 years were finally included in this analysis. Diet was assessed using a validated food frequency questionnaire, and dietary patterns were identified by factor analysis. Linear regression was used to analyze the relation between diet patterns with semen quality parameters, reproductive hormone levels and testicular volume adjusting for potential confounders.Main Results and the Role Of Chance: We identified two dietary patterns: a Mediterranean (characterized by high intakes of vegetables, fruits and seafood) and a Western pattern (characterized by high intakes of processed meats, French fries and snacks). The Mediterranean pattern was positively associated with total sperm count (P, trend = 0.04). The Western pattern was positively related to the percentage of morphologically normal sperm (P, trend = 0.008). We found an inverse association between adherence to the Western pattern and sperm concentration among overweight or obese men (P, trend = 0.04).Limitations, Reasons For Caution: As with all cross-sectional studies, causal inference is limited. However, participants were blinded to the study outcomes thus reducing the potential influenced their report of diet. Although we adjusted for a large number of known and suspected confounders, we cannot exclude the possibility of residual confounding or chance findings.Wider Implications Of the Findings: This study was carried out on healthy and young men, so it is difficult to predict whether and how the observed differences in semen quality translate into reproductive success for men in couples trying to conceive. These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential. [ABSTRACT FROM AUTHOR]

Objective: The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. Method: During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. Results: After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = −0.21[−0.37, −0.05], as well as positive energy balance, b-coefficient [95% CI] = −0.21 [−0.37, −0.05], were inversely associated with successful aging. Conclusion: A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging. [ABSTRACT FROM AUTHOR]

Virgin olive oil (VOO) is the pillar fat of Mediterranean diet. It is made from olive fruits and obtained by squeezing olives without any solvent extraction. Respect to the seed oils, an unique polar polyphenol-rich fraction gives VOO a bitter and pungent taste. The recent substantiation by European Food Safety Authority (EFSA) of a health claim for VOO polyphenols may represent an efficient stimulus to get the maximum health benefit from one of the most valuable traditional product of Mediterranean countries educating consumers to the relationship between the VOO bitterness and its health effect. Agronomical practices and new processing technology to avoid phenolic oxidation and hydrolysis and to enhance the aromatic components of the VOO have been developed and they can be used to modulate taste and flavor to diversify the products on the market. VOOs having high concentration of phenol compounds are bitter and pungent therefore many people do not consume them, thus loosing the health benefits related to their intake. In this paper, the chemist's and nutritionist's point of view has been considered to address possible strategies to overcome the existing gap between the quality perceived by consumer and that established by expert tasters. Educational campaigns emphasizing the bitter-health link for olive oils should be developed. [ABSTRACT FROM AUTHOR]

A prospective nested case–control study within the PREvention with MEDiterranean Diet (PREDIMED) was conducted to evaluate the relationship between excess body Fe (measured as serum ferritin (SF), soluble transferrin receptor (sTfR) and sTfR:ferritin ratio) and the risk of type 2 diabetes mellitus (T2DM) in a Mediterranean population at a high risk of CVD, without T2DM at the start of the study. The study contained 459 subjects, 153 with incident T2DM (cases) and 306 without incident T2DM (controls). The follow-up period was for 6·0 (interquartile range 3·9–6·5) years. For each incident diabetic subject, two subjects were selected as controls who were matched broadly for age as well as for sex, intervention group and BMI. We observed a relationship between SF values >257 μg/l in males and >139 μg/l in females and the risk of T2DM, following adjustment in the conditional logistic regression model for high-sensitivity C-reactive protein, fasting glucose and other components of the metabolic syndrome (OR 3·62, 95 % CI 1·32, 19·95; P= 0·022). We also found an association between low sTfR:ferritin ratio levels and the incidence of T2DM (OR 3·02, 95 % CI 1·09, 8·39; P= 0·042), but no association with sTfR (OR 1·29, 95 % CI 0·51, 3·23; P= 0·722). Oxidative stress has been hypothesised to contribute to the development of insulin resistance and β-cell dysfunction, the two key events in the clinical development of T2DM. Following adjustment for other risk factors for T2DM, excess body Fe (measured as SF and sTfR:ferritin ratio) was associated with an increased risk of developing T2DM in a Mediterranean population at a high risk of CVD. [ABSTRACT FROM PUBLISHER]

Background: Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in general population and typically used only a single assessment of diet. Objective: We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention. Design: We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes. Results: In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with first fifth: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death. Conclusion: Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the association between nut consumption and all-cause mortality after 5-y follow-up in a Spanish cohort. Methods: The SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) project is a prospective cohort study, formed by Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. In all, 17 184 participants were followed for up to 5 y. Baseline nut consumption was collected by self-reported data, using a validated 136-item semi-quantitative food frequency questionnaire. Information on mortality was collected by permanent contact with the SUN participants and their families, postal authorities, and the National Death Index. The association between baseline nut consumption and all-cause mortality was assessed using Cox proportional hazards models to adjust for potential confounding. Baseline nut consumption was categorized in two ways. In a first analysis energy-adjusted quintiles of nut consumption (measured in g/d) were used. To adjust for total energy intake the residuals method was used. In a second analysis, participants were categorized into four groups according to pre-established categories of nut consumption (servings/d or servings/wk). Both analyses were adjusted for potential confounding factors. Results: Participants who consumed nuts ≥2/wk had a 56% lower risk for all-cause mortality than those who never or almost never consumed nuts (adjusted hazard ratio, 0.44; 95% confidence intervals, 0.23-0.86). Conclusion: Nut consumption was significantly associated with a reduced risk for all-cause mortality after the first 5 y of follow-up in the SUN project. [ABSTRACT FROM AUTHOR]

Abstract: To examine the association between dietary habits, cognitive functioning and brain volumes in older individuals, data from 194 cognitively healthy individuals who participated in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort were used. At age 70, participants kept diaries of their food intake for 1week. These records were used to calculate a Mediterranean diet (MeDi) score (comprising dietary habits traditionally found in Mediterranean countries, e.g. high intake of fruits and low intake of meat), with higher scores indicating more pronounced MeDi-like dietary habits. Five years later, participants' cognitive capabilities were examined by the seven minute screening (7MS) (a cognitive test battery used by clinicians to screen for dementia), and their brain volumes were measured by volumetric magnetic resonance imaging. Multivariate linear regression analyses were constructed to examine the association between the total MeDi score and cognitive functioning and brain volumes. In addition, possible associations between MeDi's eight dietary features and cognitive functioning and brain volumes were investigated. From the eight dietary features included in the MeDi score, pertaining to a low consumption of meat and meat products was linked to a better performance on the 7MS test (P=0.001) and greater total brain volume (i.e. the sum of white and gray matter, P=0.03) when controlling for potential confounders (e.g. BMI) in the analysis. Integrating all dietary features into the total MeDi score explained less variance in cognitive functioning and brain volumes than its single dietary component meat intake. These observational findings suggest that keeping to a low meat intake could prove to be an impact-driven public health policy to support healthy cognitive aging, when confirmed by longitudinal studies. Further, they suggest that the MeDi score is a construct that may mask possible associations of single MeDi features with brain health domains in elderly populations. [Copyright &y& Elsevier]

Background/Aims: An important public health issue is monitoring folate inadequacy in women of childbearing potential. The aim of the present study was to investigate associations between folate intake, red blood cell (RBC) folate, total homocysteine (tHcy) and the MTHFR 677T allele. Methods: A total of 204 women were enrolled in a cross-sectional study. Folate intake was assessed by a food frequency questionnaire, and RBC folate, tHcy and MTHFR C677T genotype were determined. Results: About half of the women had a decreased RBC folate level (<305 nmol/l) and all were <906 nmol/l, even though 51% of the subjects reported use of supplements. Overall 91.5% had a high Hcy concentration. Notably, younger women, and those with a low level of education, were shown to be at higher risk of inadequate RBC folate levels. Additionally, younger women were also at higher risk of carrying the TT genotype, particularly unfavorable in the setting of a low folate status. Conclusions: Our study revealed significant folate deficiency in our Mediterranean population and higher than ideal Hcy concentrations, thus emphasizing that in these groups an improvement in the folate status is needed via a food-based approach or supplement. Consequently, public health policy strategies aiming at improved supplementation are required. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This review outlines the limitations of current techniques for evaluating the Mediterranean diet in Mediterranean versus non- Mediterranean populations. Differences between the two populations with regard to the foods that are available, food processing and preparation techniques, and eating and lifestyle habits may influence the implementation and effects of a Mediterranean diet in non- Mediterranean regions. For example, the composition of food groups may vary significantly, due to differences in the specific foods within a food group and to differences in aspects of food production and preparation. Notable differences between the diets of Mediterranean versus non- Mediterranean populations include the source of monounsaturated fatty acids (olive oil versus meat), the amount of vegetables consumed and their manner of preparation, the source of alcohol (wine versus other) and the pattern of intake, and the types of meat and dairy products consumed. Lifestyle factors such as meal patterns and exposure to sunlight may also act as confounding factors when the overall benefits of a Mediterranean diet are assessed. Improving the calculation of Mediterranean diet scores and measuring plasma nutrient levels may help mitigate the effects of confounders. These considerations could have important health implications when a Mediterranean diet is implemented by non- Mediterranean populations. [ABSTRACT FROM AUTHOR]

Objective: To identify dietary patterns among participants in a representative nutritional survey in the Valencia Community, and to analyze the association with socio-demographic characteristics and lifestyles. Methods: Data for this study were from 1803 participants (973 women) in the Nutrition and Health Survey conducted in 1994 on a representative sample of adult population of Valencia Community. Diet was assessed by a validated food frequency questionnaire. Foods intakes were adjusted for 1,000 calories and grouped in 26 groups. Cluster analysis was used to identify dietary patterns using standardized values of the variables (zscores). Results: Three dietary patterns were identified and labeled as follows: the Prudent pattern (57.2%), characterized by a low-medium intake of most food of groups; the Mediterranean pattern (29.1%) characterized by high intake of fruits, vegetables, fish, poultry, cheese, and legumes; and the Western pattern (13.7%) characterized by high intake of meat and processed meats, high fat content foods, sweets and sugar, beverages, and alcoholic beverages. The Mediterranean pattern obtained higher scores for known diet quality index defined a priori. Using the Mediterranean pattern as reference, Western pattern included significantly more young people, higher number of men and smokers, and the Prudent pattern higher number of men, lower physical activity and lower alcohol consumption. Conclusion: Three dietary patterns were identified among participants in the Nutrition Survey of Valencia conducted in the mid-1990S: Prudent, Mediterranean and Western. The Prudent pattern was the most prevalent; the Mediterranean pattern was associated with healthier lifestyles and behaviors; and the Western pattern, the less prevalent although more frequently followed by youth, men and smokers. Further Nutrition Surveys should be carried out to make nutritional surveillance and analyze health effects of these observed patterns. [ABSTRACT FROM AUTHOR]

The first studies reporting on the health effects of Mediterranean diet are recalled. Then the results brought about by a priori and a posteriori dietary patterns are reported. The first method has been the most frequently used and when applied to non-Mediterranean populations, the results were somehow different from those obtained in Mediterranean countries. Explanations are proposed emphasising other factors than food in the Mediterranean diet and lifestyle. A posteriori dietary patterns suggested that olive oil could be a must in the Mediterranean diet. Finally intervention trials, mainly the PREDIMED study provided the definite evidence for the effect of Mediterranean diet on over all and cardiovascular mortality. Evidence is less stringent for cancers, and insufficient for cognitive function and dementia. But Mediterranean diet is actually a lifestyle well-suited for coping with health and environmental issues of our society. [ABSTRACT FROM AUTHOR]

Abstract: There is a substantial body of evidence linking Mediterranean Diet to cardiovascular risk reduction and prevention of the major chronic diseases. Nevertheless Mediterranean societies are rapidly withdrawing from this eating pattern orienting their food choices toward products typical of the Western diet pattern, which is rich in refined grains, animal fats, sugars, processed meat but are quite poor in legumes, cereals, fruits and vegetables. The reasons people keep on shifting from healthy to unhealthy dietary habits remain open to several interpretations. Social changes appear to have consistently contributed to radical reversal in dietary habits in European Mediterranean societies even though developing Countries are somewhat turning into westernized diets as well. Among possible causes, increasing prices of some of the major food items of Mediterranean pyramid seem to have led people to give up this eating pattern in favor of less expensive products which allow to save money but are definitively unhealthy. Many studies suggest that diet quality follows a socio-economic gradient highlighting how disadvantaged people present higher rates of obesity, diabetes, cardiovascular disease and some types of cancer. Recent studies have shown a linear relationship between food cost and adherence to eating patterns and obesity. In addition to financial crisis, during the last decades the Mediterranean Diet has been put on the spot because of its alcohol –in- moderation component. Does it make any sense to blame a whole philosophy, which turned out to have beneficial effects on human health, just because, in some Countries, there is a misuse of alcoholic beverages? [Copyright &y& Elsevier]

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII) definition being the most effective in the identification of glucose intolerance and cardiovascular risk. Except for these, MetS is associated with fatty liver disease, some forms of cancer, hypogonadism, and vascular dementia. The Mediterranean diet seems to be an ideal diet in patients with MetS, being rich in fibre, monounsaturated and polyunsaturated fats, and low in animal protein; and decreases the prevalence of MetS and cardiovascular disease risk. Except for weight loss, multifactorial intervention including insulin resistance reduction and normoglycemia, management of dyslipidemia, optimizing blood pressure and administration of low-dose aspirin for patients at high or moderately high cardiovascular disease (CVD) risk are additional targets. The present review provides current understanding about MetS in the Mediterranean region, focusing on its prevalence, clinical significance, and therapeutic strategy. [ABSTRACT FROM AUTHOR]

Background: High saturated fat consumption, mostly from red meat and sausage meat has been associated with an increase in cardiovascular risk (CVR) in contrast to the effect of high fish consumption. Objective: To get to know the frequency of meat and fish consumption in an elderly high Mediterranean population, their correlations with adherence to the Mediterranean diet (MD) and their association with intermediate CVR phenotypes. Methods: A cross-sectional study was carried out on 945 people (67.4 ± 6.2 years old) with high CVR recruited in primary care centres of Valencia, and participating in the PREDIMED study. The frequency of meat and fish consumption was determined through a validated questionnaire. We analyzed clinical, biochemical and anthropometric variables using standard methods. Results: Mean red meat consumption was high (7.4 ± 4.7 times/week), being higher in men than in women (P = 0.031) and was associated with greater weight (P = 0.001) and prevalence of obesity (P = 0.025). Fish consumption was also high (4.5 ± 2.6 time/week) and was associated with lower concentrations of fasting plasma glucose (P = 0.016) as well as with lower prevalence of diabetes (P = 0.017). Conclusion: Red meat consumption in this high CVR population is very high and far from the recommendations of MD, needing, therefore, to be reduced. Fish consumption is closer to the recommendations and should be maintained. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of metabolic syndrome (MetS) has highlighted the need for effective dietary interventions to combat this growing problem. Objective: To assess the impact of a Mediterranean-style low-glycemic-load diet (control arm, n = 44) or the same diet plus a medical food containing phytosterols, soy protein, and extracts from hops and acacia (intervention arm, n = 45) on cardiometabolic risk variables in women with MetS. Methods: In this 12-week, 2-arm randomized trial, baseline, week 8 and 12, fasting blood samples were drawn to measure plasma lipids, apolipoproteins, and homocysteine. Dietary records were also collected and analyzed. Results: There were decreases in fat and sugar intake (P < .001 for both) and increases in docosahexaenoic acid and eicosapentaenoic acid intake (P < .001 for both) over time, consistent with the prescribed diet. Regarding MetS variables, there were decreases in waist circumference, systolic and diastolic blood pressure, and plasma triglycerides in all subjects (P < .001 for all) with no differences between arms. Plasma low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein (apo) B, and apo B/apo A1 were reduced over time but to a greater extent in the intervention arm (P < .05 for all), indicating the medical food had a greater effect in altering lipoprotein metabolism. Further, medical food intake was associated with reduced plasma homocysteine (P < .01) compared to the control arm. Conclusion: A Mediterranean-style low-glycemic-load diet effectively reduces the variables of MetS. Addition of the medical food results in a less atherogenic lipoprotein profile and lower plasma homocysteine. [ABSTRACT FROM AUTHOR]

Background: Although several studies have investigated the association of the Mediterranean diet with overall mortality or risk of specific cancers, data on overall cancer risk are sparse.Methods: We examined the association between adherence to Mediterranean dietary pattern and overall cancer risk using data from the European Prospective Investigation Into Cancer and nutrition, a multi-centre prospective cohort study including 142,605 men and 335,873. Adherence to Mediterranean diet was examined using a score (range: 0-9) considering the combined intake of fruits and nuts, vegetables, legumes, cereals, lipids, fish, dairy products, meat products, and alcohol. Association with cancer incidence was assessed through Cox regression modelling, controlling for potential confounders.Results: In all, 9669 incident cancers in men and 21,062 in women were identified. A lower overall cancer risk was found among individuals with greater adherence to Mediterranean diet (hazard ratio=0.96, 95% CI 0.95-0.98) for a two-point increment of the Mediterranean diet score. The apparent inverse association was stronger for smoking-related cancers than for cancers not known to be related to tobacco (P (heterogeneity)=0.008). In all, 4.7% of cancers among men and 2.4% in women would be avoided in this population if study subjects had a greater adherence to Mediterranean dietary pattern.Conclusion: Greater adherence to a Mediterranean dietary pattern could reduce overall cancer risk. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of the present study was to analyse the evolution of the Spanish population’s global and regional adherence to the Mediterranean diet (MD) since 1987.DesignA cross-sectional study was conducted analysing food consumption from the Spanish Household Consumption Surveys administered by the Spanish Ministry of Agriculture, Fisheries and Food.SettingThe Mediterranean Adequacy Index (MAI) was applied to measure the adherence to the MD. The significance of the MAI trend was evaluated using a regression model.SubjectsThe sample comprises a household consumption data set, which consisted of 2500 households in 1987 and increased to 6200 in 2005.ResultsThere was a significant decrease in the MAI (P = 0·001) during the past two decades in Spanish households. From 1987 to 1997, MD adherence significantly decreased, but since 1998 it appears to have stabilised. In recent years, the daily household availability of several of the food components of the MD has increased. The MAI was observed to be significantly higher during the entire period in some Mediterranean regions, such as Andalusia, and significantly lower in more inland regions, such as Castile-Leon.ConclusionsDuring the past two decades, Spain has experienced a significant downward trend in adherence to the predominant dietary pattern, likely as a result of numerous socio-economic changes. However, a stabilisation and a recent slight recovery have been observed during the past decade. [ABSTRACT FROM PUBLISHER]

Abstract: The aim of the present study was to describe the dietary pattern of a representative sample of 516 adult participants (203 men and 313 women) from Catalonia, a Spanish Mediterranean region, to assess their current dietary and plasma levels of trans C18:1, the major trans-fatty acid (TFA), and cis-9, trans-11 CLA, and trans-10, cis-12 CLA, the two major conjugated linoleic acid (CLA) isomers, and to evaluate their correlation with several cardiovascular disease risk factors. The population was a random sample derived from the Catalan Nutrition Survey. Plasma levels of the CLA isomers were determined in a subsample of 100 volunteers. The Catalan diet seemed to maintain some traits of the ‘traditional’ Mediterranean diet, although other components were lost. The dietary intakes of saturated fatty acids (SFA), TFA, cis-9, trans-11 CLA, and trans-10, cis-12 CLA were 12.3%, 0.84% (2.0g/d), 0.030% (71.5mg/d), and 0.0015% (3.4mg/d) of the energy intake, respectively. Trans C18:1 accounted for 0.19% of the total plasma fatty acids, while the sum of cis-9, trans-11and trans-10, cis-12 CLA isomers represented about 0.09% of the plasma fatty acids. Trans C18:1 isomers correlated significantly with the intake of French fries and pastries, while cis-9, trans-11 CLA significantly correlated with the intake of dairy products and ruminant meat. None of the cardiovascular disease risk factors were found to be associated with the plasma levels of TFA or CLA. The results of this study suggest that monounsaturated fatty acids (MUFA) are the main dietary fat source in the Catalan population, due to their regular olive oil consumption. Moreover, plasma levels of the main TFA and CLA suggest that the Catalan diet is not at present strongly influenced by the occidental dietary patterns. However, a reduction of the intake of SFA in the Catalan population should be recommended. [Copyright &y& Elsevier]

Obesity is a serious global health problem and is associated with a variety of chronic diseases. Increasing evidence suggests that obesity increases the risk of Alzheimer's disease. Several studies have shown that a Mediterranean diet is effective in reducing weight and epidemiological data suggest that such a diet is associated with lower risk of neurodegenerative disorders, including Alzheimer's disease. Therefore, we examined the relationship between obesity and neurodegeneration and the possible effects of Mediterranean diet on both in adult obese rats. Obese rats showed significant dyslipidaemia, insulin resistance, down-regulation of adiponectin mRNA expression in adipose tissue, up-regulation of brain amyloid precursor protein, apolipoprotein E and caspase-3 mRNA expression and a marked increase in brain oxidative stress. Treatment with Mediterranean diet induced significant weight loss and improvement in these various markers. The present study suggests that Mediterranean diet is a viable nutritional intervention in obesity and, more importantly, in the prevention and treatment of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Abstract: We conducted a systematic review of the available studies that assessed the effect of a Mediterranean diet in type 2 diabetes. We searched publications up to 30 November 2009. Seventeen studies were included. Two large prospective studies report a substantially lower risk (83% and 35%, respectively) of type 2 diabetes in healthy people or in post-infarct patients with the highest adherence to a Mediterranean diet. Five randomized controlled trials have evaluated the effects of a Mediterranean diet, as compared with other commonly used diets, on indices of glycaemic control in subjects with type 2 diabetes. Improvement of fasting glucose and HbA1c levels was greater with a Mediterranean diet and ranged from 7 to 40mg/dl for fasting glucose, and from 0.1 to 0.6% for HbA1c. No trial reported worsening of glycaemic control with a Mediterranean diet. Two controlled trials in a secondary prevention setting demonstrated that post-infarct patients, including diabetic patients, had cardiovascular benefits from a Mediterranean diet. The evidence so far accumulated suggests that adopting a Mediterranean diet may help prevent type 2 diabetes, and also improve glycaemic control and cardiovascular risk in persons with established diabetes. [Copyright &y& Elsevier]

Mutations in the HFE gene result in iron overload and can produce hereditary hemochromatosis (HH), a disorder of iron metabolism characterized by increased intestinal iron absorption. Dietary quality, alcoholism and other life-style factors can increase the risk of iron overload, especially among genetically at risk populations. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were measured together with serum ferritin (SF), transferrin saturation (TS) and hemoglobin, to measure iron status, in randomly-selected healthy subjects living in the Spanish Mediterranean coast (n = 815; 425 females, 390 males), 18 to 75 years of age. The intake of dietary components that affect iron absorption was calculated from 3-day dietary records. The presence of C282Y/H63D compound heterozygote that had a prevalence of 2.8% in males and 1.2% in females was associated with an elevated TS and SF. No subject was homozygous for C282Y or S65C. The C282Y heterozygote, H63D heterozygote and homozygote and H63D/S65C compound heterozygote genotypes were associated with increased TS relative to the wild type in the general population. These genotypes together with the alcohol and iron intake increase the indicators of iron status, while calcium intake decreases them. We did not observe any affect of the S65C heterozygote genotype on these levels. All the HFE genotypes except for the S65C heterozygote together with the alcohol, iron and calcium intake affect the indicators of iron status. The C282Y/H63D compound heterozygote genotype has the higher phenotypic expression in our Spanish Mediterranean population. [ABSTRACT FROM AUTHOR]

Olive from Olea europaea is native to the Mediterranean region and, both the oil and the fruit are some of the main components of the Mediterranean diet. The main active constituents of olive oil include oleic acid, phenolic constituents, and squalene. The main phenolic compounds, hydroxytyrosol and oleuropein, give extra-virgin olive oil its bitter, pungent taste. The present review focuses on recent works that have analyzed the relationship between the major phenolic compound oleuropein and its pharmacological activities including antioxidant, anti-inflammatory, anti-atherogenic, anti-cancer activities, antimicrobial activity, antiviral activity, hypolipidemic and hypoglycemic effect. [ABSTRACT FROM AUTHOR]

Abstract: Background: The proportion of elderly worlwide is increasing. This increase in life expectancy, is staggering posing tremendous challenges in disease burden, especially, in chronic diseases such as obesity, diabetes, hypertension, hypercholesterolemia, cancer and cardiovascular disease (CVD). Limited studies investigate the effect of Mediterranean diet on cardiovascular risk and cancer in older populations. In this review, findings from observational studies are summarized to evaluate the effect of Mediterranean diet on cancer and cardiovascular disease risk in elderly people. Methods: Published results from observational studies that assessed food habits on cancer and cardiovascular disease risk in elderly were retreived and summarized. Results: In all studies diet had an effect on cardiovascular disease risk. The Mediterranean diet, a high-qulaity diet and increased fruit and vegetable consumption were all found to be cardioprotective. Conclusion: The systematically reviewed studies reveal that a high adherence to a Mediterranean type of diet or “prudent diet” is associated with reduced risk of CVD and some types of cancer, even in the elderly. Also dietary intervention strategies can prevent morbidity, premature mortality and improve quality of life in older persons worldwide. [Copyright &y& Elsevier]

As consumers, we are constantly inundated with dietary advice on what and what not to eat. From news outlets, health care professionals, food organizations, family and friends, the issue of diet is front and center. Who can forget the catchy saying, “You are what you eat, so you better eat right”? With the battle for health care reform a hot topic from Wall Street to Main Street, nutrition and diet have become important components, and adopting the Mediterranean diet can be a viable option. Information sources freely available on the Internet will be provided for an introductory exploration into this dietary option. [ABSTRACT FROM AUTHOR]

Abstract: Objective: There is some evidence regarding the association between adherence to the Mediterranean diet (MD) and obesity among adults; to our knowledge, however, no relevant data exist for children. We investigated the association between adherence to the MD and obesity status in children. Methods: A national cross-sectional study among 1140 children (mean age 10.7±0.98 y) was carried out in Cyprus using stratified multistage sampling design. Body mass index was calculated according to International Obesity Task Force criteria, from parental reference. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for children and adolescents (KIDMED diet score). To test the research hypothesis, a logistic regression analysis was applied with two dependent variable categories of obesity status, normal weight (NW) versus overweight/obese (OW/OB), and the three categories of the KIDMED score independently, after controlling for several potential confounders. Results: Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (95% confidence interval 0.041–0.976), adjusted for age, gender, parental obesity status, parental educational level, and dietary beliefs and behaviors (model 2). When physical activity was taken into account, however, the aforementioned relation was not significant (model 3; odds ratio 0.20, 95% confidence interval 0.021–1.86). Furthermore, male gender, maternal obesity, and dietary beliefs and behaviors emerged as more significant in predicting obesity in children compared with their KIDMED score. Conclusion: Adherence to the MD is inversely associated with obesity in this sample of 9- to 13-y-old children; however, other behaviors, and in particular physical activity, maternal obesity, dietary beliefs and behaviors, seem to be more significant. [Copyright &y& Elsevier]

Objectives: Obesity is the consequence of an imbalance between energy intake and expenditure, food intake being affected by multiple factors—psychological, social, work-related, etc. This revision discusses the role of diet in the behavioural treatment (BT) of obesity, which faces multiple approaches and focuses on patients' behaviour rather than their mere energy intake. Setting: Recent literature has been revised that deals with the health benefits of Mediterranean diet in order to assess its suitability for obesity treatment based on BT. Results: BT helps patients to develop skills and techniques in order to adopt proper habits and attain their healthiest weight. Patients learn to establish realistic goals, both as regards weight and behaviour, and to evaluate their progress in modifying eating and exercising habits. The application of the Mediterranean diet in obesity treatment presents various advantages which are based on the principles of this diet—wide variety of food, high carbohydrate content, or high satiating capacity, which prevents specific hunger and ketogenesis—, and has been demonstrated to be effective in reducing body weight. Conclusions: BT based on the Mediterranean diet is a useful tool for obesity treatment. The Mediterranean diet provides the patients with a diet established on widely recognised nutritional benefits, suitable to their social and daily life, and that can be easily followed in the long term, according to the objectives of BT. For these reasons, Mediterranean diet-based BT helps to prolong both the treatment and maintenance periods and therefore contributes to a more stable weight loss. [ABSTRACT FROM AUTHOR]

Background: The aim of the present work was to evaluate the relationships between sociodemographic, clinical, lifestyle and psychological characteristics and the presence of obesity, among elderly individuals without known cardiovascular disease. Methods: During 2005-2007, 553 elderly men and 637 elderly women (mean age 74±7 years) from eight Mediterranean Islands in Greece and Cyprus were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. The MedDietScore assessed adherence to the Mediterranean dietary pattern. Results: The prevalence of obesity was 27% in males and 41% in females (P <0.001), while 48% of males and 39% of females were overweight. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese elderly than in the overweight or normal (P <0.001). After adjusting for various confounders, one unit increase in the MedDietScore was associated with 88% (P =0.07) lower likelihood of being obese; similarly, physical activity was associated with 81% lower likelihood of obesity (P <0.001). Conclusions: Roughly seven out of 10 of our elderly were overweight or obese, while the majority of them presented other co-morbidities, too. Greater adherence to the Mediterranean diet may reduce the burden of obesity among elderly individuals. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To delineate the influences of the Mediterranean diet (MD) on human mortality and age-related morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders. Method: Citations were selected from a PubMed search according to their clinical and experimental relevance. Results and conclusions: Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10–20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and pro-apoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimer''s disease, Parkinson''s disease). [Copyright &y& Elsevier]

Objective: To evaluate the feasibility of diet mediterranisation, in a food-at-work context, and its consequence on metabolic syndrome in a mid-age unselected healthy male population group. Design: One-year longitudinal intervention study. Physical exercise was not modified. Setting: All workers of the Santiago division of 'Maestranza Diesel', a metal-mechanic company servicing the mining industry, were invited to participate. Subjects: Initially, 145 workers of a total of 171, of average age 39 years, accepted to participate (sixteen women and 129 men). A subgroup of ninety-six men fully completed the controls programmed for the intervention study. Losses from the original group correspond to missing one control (sixteen), leaving the company (eleven) or blood sampling discomfort (six). The women and sixteen male workers, hired post study initiation, did participate but were excluded from this 12-month analysis. Results: Diet mediterranisation was successful, reflected in the daily food consumption at the canteen and the evolution of the Mediterranean diet score (MDS) from 4.8±1.4 to 7.4±1.5 (limits 0-14). Some metabolic syndrome components showed statistically significant improvement and also statistically significant correlation with the MDS: waist circumference, HDL-cholesterol, systolic and diastolic blood pressure. After 12 months, the reversion rate for metabolic syndrome was 48% (12/23) with an incidence rate of 4?1% for new cases (3/73). In total, metabolic syndrome decreased from 24.0% to 15.6% (23/96 to 15/96) (P=0.029). Conclusions: Diet mediterranisation is feasible in a food-at-work intervention, affecting lunch consumption at the workers canteen and overall consumption evaluated with MDS, together with a significant reduction in metabolic syndrome. [ABSTRACT FROM AUTHOR]