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Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RDD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ 2019. [PMID: 31142450 DOI: 10.n36/bmj.l1949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%. STUDY REGISTRATION ClinicalTrials.gov NCT02669602.
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Affiliation(s)
- Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ismael Alvarez-Alvarez
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Raquel de Deus Mendonça
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Department of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
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52
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Martinez-Lacoba R, Pardo-Garcia I, Amo-Saus E, Escribano-Sotos F. Mediterranean diet and health outcomes: a systematic meta-review. Eur J Public Health 2019; 28:955-961. [PMID: 29992229 DOI: 10.1093/eurpub/cky113] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The Mediterranean diet (MeDi) is considered a healthy dietary pattern, and greater adherence to this diet may improve health status. It also may reduce the social and economic costs of diet-related illnesses. This meta-review aims to summarize, synthesize and organize the effects of MeDi pattern on different health outcomes. Methods This meta-review was performed following the PRISMA guidelines. A systematic search was conducted in the electronic databases PubMed, Web of Science and Scopus. Two researchers screened all the records to eliminate any duplicate, and they selected the articles to be fully reviewed. A third researcher was consulted to resolve discrepancies and so reach a consensus agreement. Results Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs. Conclusion MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.
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Affiliation(s)
- Roberto Martinez-Lacoba
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Isabel Pardo-Garcia
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Elisa Amo-Saus
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Francisco Escribano-Sotos
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
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53
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Cassambai S, Salzano A, Yazaki Y, Bernieh D, Wong M, Israr MZ, Heaney LM, Suzuki T. Impact of acute choline loading on circulating trimethylamine N-oxide levels. Eur J Prev Cardiol 2019; 26:1899-1902. [DOI: 10.1177/2047487319831372] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shabana Cassambai
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Andrea Salzano
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Yoshiyuki Yazaki
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Max Wong
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - M Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Liam M Heaney
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
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Silveira BKS, de Novaes JF, Reis NDA, Lourenço LP, Capobiango AHM, Vieira SA, Hermsdorff HHM. "Traditional" and "Healthy" Dietary Patterns Are Associated with Low Cardiometabolic Risk in Brazilian Subjects. Cardiol Res Pract 2018; 2018:4585412. [PMID: 30581607 PMCID: PMC6276399 DOI: 10.1155/2018/4585412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/28/2018] [Accepted: 10/23/2018] [Indexed: 12/18/2022] Open
Abstract
This study aimed at determining the dietary patterns and investigating their association with cardiometabolic risk markers in a brazilian population at risk. This transversal study was carried out with data of 265 patients (n = 123 M/172 W, age 42 ± 16 years) of the Cardiovascular Health Care Program-PROCARDIO-UFV, Brazil-who had their first appointment between 2012 and 2017. A 24-hour recall was applied. The dietary patterns were determined by Principal Component Analysis. Anthropometric, clinical-metabolic, sociodemographic, and lifestyle data were collected through medical record analysis. Five patterns were identified: "Traditional", "Caloric", "Unhealthy", "Healthy," and "Healthy Snacks". In bivariate analysis, the "Healthy" pattern was negatively associated with WC (waist circunference), BMI (body mass index), WHR (waist-to-hip ratio), SBP (systolic blood pressure), fasting glucose, TG/HDL, LDL/HDL, and TG/HDL values and positively to HDL. The "Traditional" pattern was positively associated with adiposity indicators (WC, BMI, and WHR) and negatively associated with body fat, TyG (triglyceride-glucose index), HDL, and LDL (P < 0.05). However, in adjusted models of Poisson regression, individuals with positive factor score (higher adherence) in the "Traditional" and "Healthy" patterns had less occurrence of abdominal obesity (PR 0.85; 95% CI 0.74-0.99/PR 0.88; 95% CI 0.02-0.76), as well as dyslipidemia (PR 0.06; 95% CI 0.02-0.51/PR 0.03; 95% CI 0.01-0.27), diabetes (PR 0.05; 95% CI 0.01-0.45/PR 0.02; 95% CI 0.01-021), and hypertension (PR 0.06; 95% CI 0.02-0.50/PR 0.02; 95% CI 0.01-0.21). A greater adherence to the "Healthy" pattern was associated with lower values to cardiometabolic risk markers and less occurrence of chronic diseases, while the "Traditional" pattern presented contradictory results.
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Affiliation(s)
| | - Juliana Farias de Novaes
- PhD, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Nínive de Almeida Reis
- MSc, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Larissa Pereira Lourenço
- Undergraduate Student, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Ana Helena Moretto Capobiango
- Undergraduate Student, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Sarah Aparecida Vieira
- PhD, Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
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55
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Malakou E, Linardakis M, Armstrong MEG, Zannidi D, Foster C, Johnson L, Papadaki A. The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2018; 10:nu10111577. [PMID: 30366431 PMCID: PMC6267322 DOI: 10.3390/nu10111577] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m2, 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.
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Affiliation(s)
- Evangelia Malakou
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion 71003, Crete, Greece.
| | - Miranda Elaine Glynis Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Dimitra Zannidi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Kallithea 176 76, Athens, Greece.
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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Sans S. Mediterranean diet, active lifestyle and cardiovascular disease: A recipe for immortality? Eur J Prev Cardiol 2018; 25:1182-1185. [DOI: 10.1177/2047487318785745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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57
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Alvarez-Alvarez I, de Rojas JP, Fernandez-Montero A, Zazpe I, Ruiz-Canela M, Hidalgo-Santamaría M, Bes-Rastrollo M, Martínez-González MÁ. Strong inverse associations of Mediterranean diet, physical activity and their combination with cardiovascular disease: The Seguimiento Universidad de Navarra (SUN) cohort. Eur J Prev Cardiol 2018; 25:1186-1197. [PMID: 29944010 DOI: 10.1177/2047487318783263] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Inverse associations of the Mediterranean diet (MedDiet) and physical activity with cardiovascular disease have been previously reported. We investigated the individual and combined contributions of both to this inverse association in a Mediterranean cohort. Design We used data from 19,536 participants from a prospective cohort of Spanish university graduates, the 'Seguimiento Universidad de Navarra' (SUN) cohort, followed up between December 1999 and December 2016. Methods Adherence to the MedDiet was obtained from a 136-item validated food-frequency questionnaire and categorized in tertiles using four previously reported dietary scores. A validated questionnaire assessed the physical activity levels according to volume, intensity and frequency. Results Participants were followed up during a median time of 10.4 years. Compared with the lowest category of adherence to the MedDiet (≤3 in the Mediterranean Diet Score), higher adherence (6-9 points) was strongly inversely associated with cardiovascular disease (multivariable adjusted hazard ratio = 0.33; 95% confidence interval (CI) 0.20-0.55). Also, engaging in an active lifestyle (6-8 points in an eight-item score) compared with low activity (<2 points) was associated with a reduced risk of incident cardiovascular disease (hazard ratio = 0.43; 95% CI 0.20-0.90). Greater adherence to the MedDiet and engaging in high levels of active lifestyle showed a 75% relatively reduced risk of cardiovascular disease (hazard ratio = 0.25; 95% CI 0.13-0.48). Conclusions The combined effect of adherence to the MedDiet and adopting an active lifestyle showed a synergistic inverse association with cardiovascular disease risk.
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Affiliation(s)
- Ismael Alvarez-Alvarez
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - Javier Pérez de Rojas
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - Alejandro Fernandez-Montero
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,2 Department of Occupational Medicine, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | - Itziar Zazpe
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,3 Department of Nutrition and Food Sciences and Physiology, School of Pharmacy, University of Navarra, Pamplona, Spain.,4 Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Miguel Ruiz-Canela
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,4 Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - María Hidalgo-Santamaría
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,5 Department of Internal Medicine, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | - Maira Bes-Rastrollo
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,4 Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Miguel Á Martínez-González
- 1 Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain.,4 Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,6 Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
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Mediterranean Diet and Health Outcomes in the SUN Cohort. Nutrients 2018; 10:nu10040439. [PMID: 29614726 PMCID: PMC5946224 DOI: 10.3390/nu10040439] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022] Open
Abstract
The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018. Data on diet, lifestyle and clinical diagnosis are collected at baseline and every two years. After reviewing 21 publications from the SUN cohort on the effects of the MedDiet, we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality, fatal and non-fatal major cardiovascular disease (CVD), type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis. An inverse dose-response relationship was found for many of these associations. The MedDiet was also associated with lower average heart rate, a mitigation of the harmful effects of overweight/obesity on the risk of CVD, and an attenuation of the effects of obesity on type 2 diabetes. A suggestion that the MedDiet may enhance fertility was also found.
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