Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study

Do Diet and Dietary Supplements Mitigate Clinical Outcomes in COVID-19?

The coronavirus disease 2019 (COVID-19) has caused a pandemic and upheaval that health authorities and citizens around the globe are still grappling with to this day. While public health measures, vaccine development, and new therapeutics have made great strides in understanding and managing the pandemic, there has been an increasing focus on the potential roles of diet and supplementation in disease prevention and adjuvant treatment. In the literature, the impact of nutrition on other respiratory illnesses, including the common cold, pneumonia, and influenza, has been widely demonstrated in both animal and human models. However, there is much less research on the impact related to COVID-19. The present study discusses the potential uses of diets, vitamins, and supplements, including the Mediterranean diet, glutathione, zinc, and traditional Chinese medicine, in the prevention of infection and severe illness. The evidence demonstrating the efficacy of diet supplementation on infection risk, disease duration, severity, and recovery is mixed and inconsistent. More clinical trials are necessary in order to clearly demonstrate the contribution of nutrition and to guide potential therapeutic protocols.

The Role of Diet and Gut Microbiota in Regulating Gastrointestinal and Inflammatory Disease

Diet is an important lifestyle factor that is known to contribute in the development of human disease. It is well established that poor diet plays an active role in exacerbating metabolic diseases, such as obesity, diabetes and hypertension. Our understanding of how the immune system drives chronic inflammation and disease pathogenesis has evolved in recent years. However, the contribution of dietary factors to inflammatory conditions such as inflammatory bowel disease, multiple sclerosis and arthritis remain poorly defined. A western diet has been associated as pro-inflammatory, in contrast to traditional dietary patterns that are associated as being anti-inflammatory. This may be due to direct effects of nutrients on immune cell function. Diet may also affect the composition and function of gut microbiota, which consequently affects immunity. In animal models of inflammatory disease, diet may modulate inflammation in the gastrointestinal tract and in other peripheral sites. Despite limitations of animal models, there is now emerging evidence to show that anti-inflammatory effects of diet may translate to human gastrointestinal and inflammatory diseases. However, appropriately designed, larger clinical studies must be conducted to confirm the therapeutic benefit of dietary therapy.

Higher scores of dietary and lifestyle inflammatory indices are associated with increased risk of insulin-related disorders in Iranian adults

BACKGROUND/OBJECTIVES

The roles of potential inflammation of diet and lifestyle in the risk of insulin-related disorders are unclear. In the current study, we aimed to assess the relationship between dietary inflammation scores (DIS), lifestyle inflammation scores (LIS), and dietary and lifestyle inflammation score (DLIS) and the risk of insulin resistance (IR) and hyperinsulinemia in Tehranian adults.

SUBJECTS/METHODS

A total of 1,244 participants, aged ≥20 years, who were free of insulin-related disorders at baseline (2006-08), were followed for 3.2 years (2009-11) to ascertain the incidence of hyperinsulinemia and IR. A food frequency questionnaire was used to determine the score of DIS, LIS, and DLIS at baseline. Logistic regression models were used to determine the odds ratio (ORs) of insulin-related disorders across tertiles of DIS, LIS, and DLIS.

RESULTS

Mean ± SD age of participants (42.7% men) was 43.0 ± 13.0 years. During the 3.2 years follow-up, the incidence of IR and hyperinsulinemia was 30.0% and 20.0%, respectively. In the multivariable model, there was a direct association between the higher score of DLIS (OR = 2.10; 95% CI: 1.17-3.74) and DIS (OR = 1.84; 95% CI: 1.09-3.11) with the risk of IR incident (P for trend <0.05). Also, the higher score of LIS was related to increased risk of IR (OR = 2.28; 95% CI: 1.19-4.37) and hyperinsulinemia (OR = 1.69; 95% CI: 1.02-2.85) (P for trend <0.05). However, no significant association was observed between the higher score of DLIS and DIS with risk of hyperinsulinemia CONCLUSION: The higher inflammatory potential of diet and lifestyle, determined by DLIS, DIS, and LIS scores, were associated with a higher risk of IR. Also, individuals with a higher score of LIS are more prone to hyperinsulinemia risk.

Adherence to mediterranean diet, physical activity level and severity of periodontitis. Results from a University-based cross-sectional study

AIM

to evaluate the association between adherence to Mediterranean Diet (MD) and Physical Activity (PA) level with the periodontal status of a University-based cohort of individuals.

MATERIALS AND METHODS

235 individuals were included in the study. MD adherence and PA level were registered through validated questionnaires, together with a full periodontal examination. Crude and adjusted Odds ratios (ORs) [95% Confidence Interval] were calculated to evaluate the association between MD adherence, PA level and periodontitis severity. A final logistic multivariate regression model was built to evaluate the impact of the combination between low MD adherence and low PA level on the prevalence of stage III/IV periodontitis.

RESULTS

The adjusted ORs for stage III/IV periodontitis were 1.65[0.84-3.28;p = .42] for low PA and 5.63[3.21-9.84;p = .00] for low MD adherence. The final logistic multivariate regression model resulted in OR = 10.23[4.01,26.09;p = .00] of having stage III/IV periodontitis in individuals with low MD adherence and low PA.

CONCLUSIONS

Individuals conducing a lifestyle characterized by the combination of low MD adherence and lack of regular exercise had 10 times the odds to have severe forms of periodontitis. This article is protected by copyright. All rights reserved.

The Impact of Diet on Bone and Fracture Risk in Diabetes

PURPOSE OF REVIEW

The purpose of this review is to summarize the recently published scientific evidence on the effects of diet on diabetes and skeletal health.

RECENT FINDINGS

The impact of diet on overall health has been a growing topic of interest among researchers. An inappropriate eating habit is a relatively modified risk factor for diabetes in adults. Parallel with the significant increase in the incidence of diabetes mellitus worldwide, many studies have shown the benefits of lifestyle modifications, including diet and exercise for people with, or at risk of developing, diabetes. In the last years, accumulating evidence suggests that diabetes is a risk factor for bone fragility. As lifestyle intervention represents an effective option for diabetes management and treatment, there is potential for an effect on bone health. Healthy lifestyle is critical to prevent bone fragility. However, more studies are needed to fully understand the impact of diet and weight loss on fracture risk in diabetics.

The Mediterranean Diet Protects Renal Function in Older Adults: A Prospective Cohort Study

Background: Chronic kidney disease entails a high disease burden that is progressively increasing due to population aging. However, evidence on the effect of the Mediterranean diet on renal function is limited, in particular among older adults in Mediterranean countries. Methods: Prospective cohort study with 975 community-dwelling adults aged ≥ 60 recruited during 2008–2010 in Spain and followed up to 2015. At baseline, food consumption was obtained using a validated dietary history. Two Mediterranean dietary patterns were used: (i) An a priori-defined pattern, the Mediterranean Diet Adherence Screener (MEDAS score: low adherence: 0–5 points; moderate: 6–8 points; high: 9–14 points); (ii) An a posteriori Mediterranean-like dietary pattern, based on 36 food groups, which was generated using factor analysis. Renal function decline was calculated as an estimated glomerular filtration rate (eGFR) decrease ≥1 mL/min/1.73 m2 per year of follow-up. Results: A total of 104 cases of renal function decline occurred. Compared with participants with a low MEDAS adherence, the multivariable-adjusted odds ratios (95% confident interval) for renal function decline risk were 0.63 (0.38–1.03) for moderate adherence, and 0.52 (0.29–0.95) for high adherence (p-trend: 0.015). Multivariable-adjusted odds ratios (95% confidence interval) for renal function decline risk according to increasing quartiles of the adherence to the a posteriori Mediterranean-like dietary pattern were 1.00, 0.67 (0.38–1.20), 0.65 (0.35–1.19), and 0.47 (0.23–0.96) (p-trend: 0.042). Conclusion: A higher adherence to a Mediterranean diet was associated with a lower risk of renal function decline in older adults, suggesting benefits to health of this dietary pattern in Mediterranean countries.

Adherence to Mediterranean Diet and Its Association with Metabolic Health Status in Overweight and Obese Adolescents

BACKGROUND

Obesity is becoming more prevalent around the world and greatly contributes to chronic disease progression. Previous studies have investigated individual food groups in relation to metabolic health status of adolescents, mainly in Western countries. Limited data are available on the association between dietary patterns and metabolic health in Middle East nations, where childhood overweight/obesity is increasing drastically. Therefore, we investigated the relationship between the Mediterranean diet and metabolic health status among Iranian adolescents.

METHODS

This cross-sectional study was conducted on 203 overweight/obese adolescents. Dietary intakes were evaluated by a validated food frequency questionnaire. Anthropometric parameters and blood pressure were measured. Fasting blood samples were obtained to determine circulating insulin, glucose, and lipid profile. Two different methods were applied to classify participants as metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) criteria and IDF along with insulin resistance (HOMA-IR) criteria.

RESULTS

A total of 79 (38.9%) and 67 (33.0%) adolescents were, respectively, categorized as MUO, based on IDF and IDF/HOMA definitions. Considering IDF criteria, higher adherence to the Mediterranean diet was related to lower odds of being MUO, both in the crude (OR: 0.17; 95%CI: 0.08-0.37) and fully adjusted model (OR: 0.33; 95% CI: 0.13-0.84). Excluding each component from the score made the association insignificant, except for two components of meat and dairy products. Based on the IDF/HOMA-IR criteria, there was no significant association between Mediterranean diet score and MUO, after considering all potential confounders (OR: 0.47; 95% CI: 0.17-1.30).

CONCLUSIONS

We found an inverse association between the Mediterranean diet and odds of MUO among Iranian adolescents, based on IDF criteria. No significant relation was found when MUO was defined based on HOMA-IR/IDF criteria. Further prospective cohort studies are needed to confirm these findings.

Dietary factors and the risk of lumbar spinal stenosis: A case-control analysis from the PREFACE study

BACKGROUND AND AIMS

There is a lack of knowledge on the association of dietary factors and Lumbar Spinal Stenosis (LSS). We evaluated the association of a Mediterranean diet (MD), its major food components and ultra-processed food (UPF) with the risk of LSS.

METHODS AND RESULTS

Participants were recruited from the Neurosurgery Department of the IRCCS Neuromed, Italy. The study sample consisted of 156 cases of LSS, and 312 controls matched 1:2 for sex, age (±6 months) and physical activity, without a history or clinical evidence of LSS who were identified from the general population. Adherence to MD was assessed by the Mediterranean Diet Score based on 9 food groups. UPF was defined according to NOVA classification and calculated as the ratio (%) of UPF (g/d) on total food consumed (g/d). In multivariable-adjusted analysis, a 2-point increase in the MD score was not associated with LSS risk (OR: 1.02, 95% CI: 0.72-1.46). An increment of 10 g/d of fruits and nuts, cereals or fish led to lower odds of LSS (OR: 0.97, 95% CI: 0.95-0.99; OR: 0.88, 95% CI: 0.82-0.94; OR: 0.87, 95% CI: 0.76-0.99, respectively). Additionally, 1% increment in the consumption of UPF in the diet was independently associated with higher LSS risk (OR: 1.09, 95% CI: 1.04-1.14).

CONCLUSION

A diet rich in fruits, cereals, fish is associated with lower risk of LSS while a large dietary share of UPF increases the risk of this disease. Further studies with a prospective design and larger sample sizes are warranted.

Molecular Responses of Lactobacilli to Plant Phenolic Compounds: A Comparative Review of the Mechanisms Involved

Lactobacilli are well-studied bacteria that can undergo oxidative selective pressures by plant phenolic compounds (PPCs) in plants, during some food fermentations or in the gastrointestinal tract of animals via dietary inputs. Lactobacilli are known to be more tolerant to PPCs than other bacterial groups and, therefore, must have mechanisms to cope with the effects of these metabolites. In this review, we intend to present what is currently known about the basics beyond the responses of Lactobacillus spp. to individual PPCs. We review the molecular mechanisms that are engaged in the PPC-modulated responses studied to date in these bacteria that have been mainly characterized by system-based strategies, and we discuss their differences and similarities. A wide variety of mechanisms are induced to increase the oxidative stress response highlighting the antimicrobial nature of PPCs. However other uncovered mechanisms that are involved in the response to these compounds are reviewed, including the capacity of PPCs to modulate the expression of molecular functions used by lactobacilli to adapt to host environments. This shows that these phytochemicals can act as more than just antimicrobial agents in the dual interaction with lactobacilli.

Mediterranean diet and depression: a population-based cohort study

Background

Depression imposes immense public health burden, demonstrating an urgent need of the identification of modifiable risk factors. Only a few cohort studies have analyzed the association between Mediterranean dietary pattern (MDP) and depression but with mixed results. We examined the impact of MDP on clinically ascertained depression in a large population-based dataset.

Methods

In 1991/92, detailed information on diet, using a food frequency questionnaire, and potential confounding factors (body weight, height, educational attainment, smoking, previous diabetes and hypertension, and physical activity) was collected, in a random sample of 49,261 Swedish women aged 29-49. Adherence to MDP was calculated. Clinical depression was extracted from the National Patient Register. Study participants were followed up through 2012.

Results

During an average follow-up of 20.4 years, 1677 incident cases of depression were diagnosed. We observed a lower risk of depression for medium (score 4-5) and high (6-9) adherence to MDP, compared with low (0-3) adherence (Medium: hazard ratio (HR) = 0.90, 95% confidence interval (CI) = 0.81-1.00; High: HR = 0.82, 95%CI = 0.71-0.94). Per unit increase of adherence, the risk of depression was reduced by 5% (HR = 0.95, 95%CI = 0.92-0.98). The association became stronger when restricting to severe form of depression (HR = 0.51, 95%CI = 0.33-0.76). The HRs were higher from age 50 onward both over the first and the second 10-year follow-up period, compared with before age 50, indicating stronger association with increasing age. Results remained after extensive sensitivity analyses.

Conclusion

Higher adherence to a Mediterranean diet at middle age was associated with a lower risk of depression later in life among Swedish women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01227-3.

Distribution of Urolithins Metabotypes in Healthy Chinese Youth: Difference in Gut Microbiota and Predicted Metabolic Pathways

This is the first study to report the distribution of urolithin metabotypes (UMs) in Asian people, specifically in the Chinese. As was reported for Europeans and Latin Americans, three UMs were observed, UM-A (54.3%), UM-B (31.4%), and UM-0 (14.3%), in 35 healthy Chinese youth. The richness and diversity of gut microbiota were lower in UM-0 than in UM-A and UM-B at the genus level. Gordonibacter in UM-A and UM-B was significantly higher than that in UM-0. The Akkermansia was not found in UM-0. The correlation analysis between the type and content of urolithins and the gut microbiota at the genus level showed that 27 genera were significantly positively correlated with urolithin A and 20 genera were significantly positively associated with isourolithin A and urolithin B. In addition, different KEGG pathways such as TCA cycle, energy metabolism, and some disease were found between the gut microbiome of the three UMs. Further research is needed to explore the mechanisms of metabotypes and the differential health benefits or illness predisposition of the three UMs.

Fine-grained investigation of the relationship between human nutrition and global DNA methylation patterns

PURPOSE

Nutrition is an important, modifiable, environmental factor affecting human health by modulating epigenetic processes, including DNA methylation (5mC). Numerous studies investigated the association of nutrition with global and gene-specific DNA methylation and evidences on animal models highlighted a role in DNA hydroxymethylation (5hmC) regulation. However, a more comprehensive analysis of different layers of nutrition in association with global levels of 5mC and 5hmC is lacking. We investigated the association between global levels of 5mC and 5hmC and human nutrition, through the stratification and analysis of dietary patterns into different nutritional layers: adherence to Mediterranean diet (MD), main food groups, macronutrients and micronutrients intake.

METHODS

ELISA technique was used to measure global 5mC and 5hmC levels in 1080 subjects from the Moli-sani cohort. Food intake during the 12 months before enrolment was assessed using the semi-quantitative EPIC food frequency questionnaire. Complementary approaches involving both classical statistics and supervised machine learning analyses were used to investigate the associations between global 5mC and 5hmC levels and adherence to Mediterranean diet, main food groups, macronutrients and micronutrients intake.

RESULTS

We found that global DNA methylation, but not hydroxymethylation, was associated with daily intake of zinc and vitamin B3. Random Forests algorithms predicting 5mC and 5hmC through intakes of food groups, macronutrients and micronutrients revealed a significant contribution of zinc, while vitamin B3 was reported among the most influential features.

CONCLUSION

We found that nutrition may affect global DNA methylation, suggesting a contribution of micronutrients previously implicated as cofactors in methylation pathways.

A Cross-sectional Study of Plasma Trace Elements and Vitamins Content in Androgenetic Alopecia in Men

Androgenetic alopecia (AGA) is the most common variant of male pattern baldness in which occurrence and development of multiple genetic, hormonal, and metabolic factors are involved. We aimed to estimate plasma element content (Mg, Ca, Zn, Cu, Se, Fe), vitamin status (B12, D, E, and folic acid) in patients with AGA using direct colorimetric tests or atomic absorption spectrometry, and the influence of these parameters in the formation of various hair loss patterns. The study included 50 patients with I-IV stages of AGA divided into two groups with normal and high levels of dihydrotestosterone compared with 25 healthy individuals. The presence of two patterns of pathological hair loss in the androgen-dependent (parietal) and androgen-independent (occipital) areas of the scalp was confirmed. It was shown that all patients with AGA have a deficiency of elements (Zn, Cu, Mg, Se) and vitamins (B12, E, D, folic acid). However, the hair loss rate was not due to their content. А positive interrelation between quantitative trichogram parameters in the occipital region and iron metabolism in pairs "hair density vs Fe" and "hair diameter vs ferritin" was shown. In turn, in the parietal region, an inverse correlation of hair diameter with plasma Cu level was found, the most pronouncing in patients with high levels of dihydrotestosterone. The obtained results indicate the importance of multiple micronutrient deficiencies in the AGA occurrence accompanied by the existence of two different hair loss patterns, differently related to the content of certain trace elements and androgens in the blood.

Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices

The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child’s diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the “Planetary Health Diet” approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods.

A Review Study of a Green Diet and Healthy Ageing

Nowadays people are living longer, and there has been a substantial growth in the global elderly population in the past decades. While life expectancy is increasing, there are growing concerns towards the heavy financial and social burdens related to chronic diseases among the elderly. These have been critical health care issues, and healthy ageing is considered a top priority in public health. Diet and eating habits are crucial factors contributing to healthy ageing. These important aspects have attracted much attention in health research, particularly in consideration of the causes and management of chronic conditions which affect most elder adults in the world. Recently, a growing number of investigations have reported significant findings on the association of reduction in the risks of chronic non-communicable diseases with plant-based diets. Meanwhile, there have been worldwide initiatives and programmes implemented for reduction of salt intake. A green diet, which emphasises the consumption of a diet rich in plant foods with minimal portions of red or processed meat and reduced salt intake, is advocated with due consideration to the importance of sustainable environment and healthy ageing. This paper highlights a brief review of the recent advance of knowledge in diet and health, its effects on the elderly and the significance of a green diet on healthy ageing. Implications for a green diet and recommendations for future research are also discussed.

The 3-Year Effect of the Mediterranean Diet Intervention on Inflammatory Biomarkers Related to Cardiovascular Disease

The intervention with the Mediterranean diet (MD) pattern has evidenced short-term anti-inflammatory effects, but little is known about its long-term anti-inflammatory properties at molecular level. This study aims to investigate the 3-year effect of MD interventions compared to low-fat diet (LFD) on changes on inflammatory biomarkers related to atherosclerosis in a free-living population with a high-risk of cardiovascular disease (CD). Participants (n = 285) in the PREDIMED trial were randomly assigned into three intervention groups: MD with extra-virgin olive oil (EVOO) or MD-Nuts, and a LFD. Fourteen plasma inflammatory biomarkers were determined by Luminex assays. An additional pilot study of gene expression (GE) was determined by RT-PCR in 35 participants. After 3 years, both MDs showed a significant reduction in the plasma levels of IL-1β, IL-6, IL-8, TNF-α, IFN-γ, hs-CRP, MCP-1, MIP-1β, RANTES, and ENA78 (p < 0.05; all). The decreased levels of IL-1β, IL-6, IL-8, and TNF-α after MD significantly differed from those in the LFD (p < 0.05). No significant changes were observed at the gene level after MD interventions, however, the GE of CXCR2 and CXCR3 tended to increase in the control LFD group (p = 0.09). This study supports the implementation of MD as a healthy long-term dietary pattern in the prevention of CD in populations at high cardiovascular risk.

Targeting Inflammation by Anthocyanins as the Novel Therapeutic Potential for Chronic Diseases: An Update

Low-grade chronic inflammation (LGCI) and oxidative stress act as cooperative and synergistic partners in the pathogenesis of a wide variety of diseases. Polyphenols, including anthocyanins, are involved in regulating the inflammatory state and activating the endogenous antioxidant defenses. Anthocyanins' effects on inflammatory markers are promising and may have the potential to exert an anti-inflammatory effect in vitro and in vivo. Therefore, translating these research findings into clinical practice would effectively contribute to the prevention and treatment of chronic disease. The present narrative review summarizes the results of clinical studies from the last 5 years in the context of the anti-inflammatory and anti-oxidative role of anthocyanins in both health and disease. There is evidence to indicate that anthocyanins supplementation in the regulation of pro-inflammatory markers among the healthy and chronic disease population. Although the inconsistencies between the result of randomized control trials (RCTs) and meta-analyses were also observed. Regarding anthocyanins' effects on inflammatory markers, there is a need for long-term clinical trials allowing for the quantifiable progression of inflammation. The present review can help clinicians and other health care professionals understand the importance of anthocyanins use in patients with chronic diseases.

Use of Polyphenols as Modulators of Food Allergies. From Chemistry to Biological Implications

The multifactorial process of aging predisposes humans to infections and inflammatory disorders, thus affecting their quality of life and longevity. Given this reality, the need to increase the consumption of bioactive compounds, like dietary polyphenols emerges in our daily basis mostly due to their health related effects in slowing-down the incidence of chronic and degenerative diseases and even food allergy, which has been growing rapidly in prevalence currently affecting 5% of adults and 8% of children. Polyphenols embrace a large family of secondary metabolites from plant-derived foods and food wastes and are considerable of interest since they have attracted special attention over the years because of their reported anti-inflammatory and antimicrobial properties along with their high antioxidant capacity. These compounds are claimed as nutraceuticals with protective effect in offsetting oxidant species over-genesis in normal cells, and with the potential ability to stop or reverse oxidative stress-related diseases. Plant-derived foods represent a substantive portion of human diet containing a significant amount of structurally diverse polyphenols. There is a need to understand the polyphenolic composition of plant-derived foods mainly because of its chemistry, which discloses the bioactivity of a plant extract. However, the lack of standardized methods for analysis and other difficulties associated to the nature and distribution of plant polyphenols leads to a high variability of available data. Furthermore, there is still a gap in the understanding of polyphenols bioavailability and pharmacokinetics, which clearly difficult the settlement of the intake needed to observe health outcomes. Many efforts have been made to provide highly sensitive and selective analytical methods for the extraction (liquid-liquid; solid-liquid; supercritical-fluid), separation (spectrophotometric methods) and structural identification (chromatographic techniques, NMR spectroscopy, MS spectrometry) of phenolic and polyphenolic compounds present in these extracts. Liquid chromatography coupled to mass spectrometry (LC-MS) has been a fundamental technique in this area of research, not only for the determination of this family of compounds in food matrices, but also for the characterization and identification of new polyphenols classified with nutraceutical interest. This review summarizes the nature, distribution and main sources of polyphenols, analytical methods from extraction to characterization to further evaluate the health effects toward immune reactions to food.

Association Between Dietary Inflammatory Index and Heart Failure: Results From NHANES (1999-2018)

Objective: To explore the relationship between dietary inflammatory index (DII) and heart failure (HF) in participants with cardiovascular and cerebrovascular diseases.

Methods: NHANES (1998–2018) data were collected and used to assess the association of HF with DII. Twenty-four-hour dietary consumptions were used to calculate the scores of DII. Demographic characteristics and physical and laboratory examinations were collected for the comparison between HF and non-HF groups. Logistic regression analysis and random forest analysis were performed to calculate the odds rate and determine the potential beneficial dietary components in HF.

Results: A total of 19,067 cardiac-cerebral vascular disease participants were categorized as HF (n = 1,382; 7.25%) and non-HF (n = 17,685; 92.75%) groups. Heart failure participants had higher levels of DII score compared with those in the non-HF group (0.239 ± 1.702 vs. −0.145 ± 1.704, p < 0.001). Compared with individuals with T1 (DII: −3.884 to −0.570) of DII, those in T3 (DII: 1.019 to 4.598) had a higher level of total cholesterol (4.49 ± 1.16 vs. 4.75 ± 1.28 mmol/L, p < 0.01), globulin (29.92 ± 5.37 vs. 31.29 ± 5.84 g/L, p < 0.001), and pulse rate (69.90 ± 12.22 vs. 72.22 ± 12.77, p < 0.001) and lower levels of albumin (40.76 ± 3.52 vs. 39.86 ± 3.83 g/L, p < 0.001), hemoglobin (13.76 ± 1.65 vs. 13.46 ± 1.77 g/dl, p < 0.05), and hematocrit (40.83 ± 4.69 vs. 40.17 ± 5.01%, p < 0.05). The odds rates of HF for DII from the logistic regression were 1.140, 1.158, and 1.110 in models 1, 2, and 3, respectively. In addition, from the results of random forest analysis, dietary magnesium, fiber, and beta carotene may be essential in HF.

Conclusion: Dietary inflammatory index was positively associated with HF in US adults, and dietary intervention might be a promising method in the therapy of HF.

Inflammatory Potential of the Diet and Incidence of Crohn's Disease and Ulcerative Colitis in the EPIC-Spain Cohort

Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29–69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05–2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66–1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings.

Dietary patterns and risk of developing knee osteoarthritis: data from the osteoarthritis initiative

OBJECTIVE

Some studies have examined the association between dietary factors and risk of knee osteoarthritis (OA). We aimed to examine the prospective association of major dietary patterns with the risk of developing knee OA.

METHOD

We followed 2,842 participants in Osteoarthritis Initiative (OAI) aged 45-79 years and with at least one knee free from radiographic knee OA at baseline for up to 72 months. We defined knee OA incidence as Kellgren and Lawrence grade ≥2 during follow-up visits. Using principal component analysis, Western and prudent dietary patterns were derived. Cox proportional hazards models were used to assess the association between dietary patterns and incident knee OA.

RESULTS

Among study participants, 385 (418 knees) developed knee OA within 72 months. Following a Western dietary pattern was associated with an increased risk of knee OA (HR _{quartile 4 vs 1} = 1.69, 95% CI: 1.13 to 2.52, p trend: 0.03), while adherence to the prudent pattern was associated with a reduced risk of knee OA (HR _{quartile 4 vs 1} = 0.70, 95% CI: 0.50 to 0.98, p trend: 0.05). The observed associations attenuated after additionally adjusting for body mass index (BMI). The observed associations were mediated through BMI by approximately 30%.

CONCLUSION

Following a Western diet was associated with increased risk of knee OA, whereas following a prudent pattern was associated with a reduced risk of knee OA. The associations were partially mediated through BMI.

Mediterranean Diet and Neurodegenerative Diseases: The Neglected Role of Nutrition in the Modulation of the Endocannabinoid System

Neurodegenerative disorders are a widespread cause of morbidity and mortality worldwide, characterized by neuroinflammation, oxidative stress and neuronal depletion. The broad-spectrum neuroprotective activity of the Mediterranean diet is widely documented, but it is not yet known whether its nutritional and caloric balance can induce a modulation of the endocannabinoid system. In recent decades, many studies have shown how endocannabinoid tone enhancement may be a promising new therapeutic strategy to counteract the main hallmarks of neurodegeneration. From a phylogenetic point of view, the human co-evolution between the endocannabinoid system and dietary habits could play a key role in the pro-homeostatic activity of the Mediterranean lifestyle: this adaptive balance among our ancestors has been compromised by the modern Western diet, resulting in a “clinical endocannabinoid deficiency syndrome”. This review aims to evaluate the evidence accumulated in the literature on the neuroprotective, immunomodulatory and antioxidant properties of the Mediterranean diet related to the modulation of the endocannabinoid system, suggesting new prospects for research and clinical interventions against neurodegenerative diseases in light of a nutraceutical paradigm.

Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients

Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.

Changes in the consumption of foods characterising the Mediterranean dietary pattern and major correlates during the COVID-19 confinement in Italy: results from two cohort studies

We investigated the effect of confinement during the COVID-19 pandemic on the consumption of foods characterising the Mediterranean dietary pattern (MDP) and its major correlates in two Italian population-based cohorts comprising 3161 subjects (mean age 57.7 ± 15.4 y). At population level, 38.8% of participants reported an improvement of diet quality during the first nationwide lockdown. Healthful dietary changes were associated with older age (β = 0.41; 95% confidence interval [CI] 0.08, 0.73 for 56-65 vs. 18-39 y), greater wealth (β = 0.45; 0.01, 0.89 for >40,000 ≤ 60,000 vs. ≤ 10,000 EUR/y), increased physical activity (β = 0.52; 0.22, 0.81) and reduced body weight (β = 0.36; 0.11, 0.62). Switching to healthy eating was also related to increased consumption of organic (β = 1.24; 0.88, 1.60) and locally-grown food (β = 0.74; 0.51, 0.96). The first Italian lockdown led, in a substantial part of the population, to higher intake of foods characterising a MDP; this was also accompanied by healthier lifestyle and more sustainable food choices.

Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults

BACKGROUND

In the current study, we aimed to investigate the association of dietary inflammation scores (DIS) and lifestyle inflammation scores (LIS) with the risk of metabolic syndrome (MetS) in a prospective population-based study.

METHODS

A total of 1625 participants without MetS were recruited from among participants of the Tehran Lipid and Glucose Study(2006-2008) and followed a mean of 6.1 years. Dietary data of subjects were collected using a food frequency questionnaire at baseline to determine LIS and DIS. Multivariable logistic regression models, were used to calculate the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across tertiles of DIS and LIS.

RESULTS

Mean ± SD age of individuals (45.8 % men) was 37.5 ± 13.4 years. Median (25-75 interquartile range) DIS and LIS for all participants was 0.80 (- 2.94, 3.64) and 0.48 (- 0.18, - 0.89), respectively. During the study follow-up, 291 (17.9 %) new cases of MetS were identified. Based on the age and sex-adjusted model, a positive association was found between LIS (OR = 7.56; 95% CI 5.10-11.22, P for trend < 0.001) and risk of MetS, however, the association of DIS and risk of MetS development was not statistically significant (OR = 1.30;95% CI 0.93-1.80, P for trend = 0.127). In the multivariable model, after adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, and energy intake, the risk of MetS is increased across tertiles of DIS (OR = 1.59; 95% CI 1.09-2.33, P for trend = 0.015) and LIS(OR = 8.38; 95% CI 5.51-12.7, P for trend < 0.001).

CONCLUSIONS

The findings of the current study showed that greater adherence to LIS and DIS, determined to indicate the inflammatory potential of diet and lifestyle, are associated with increased the risk of MetS.

Anthropometric variables as mediators of the association of changes in diet and physical activity with inflammatory profile

BACKGROUND

Mechanisms underlying the associations of high levels of physical activity (PA) and adherence to the Mediterranean Diet (MedDiet) with a better inflammatory profile remain unclear. Our objective was to assess the mediating role of changes in body mass index (BMI) and waist circumference (WC), as markers of body fat in the association of changes in PA and adherence to the MedDiet, with changes in the inflammatory profile.

METHODS

This study included 489 adults, aged 55 to 75 years, from the PREDIMED-Plus multi-centre lifestyle intervention trial. An inflammatory score was calculated, based on 8 blood biomarkers: high-sensitivity C-reactive protein, interleukin 6, interleukin 8, interleukin 18, monocyte chemo-attractant protein-1, C-peptide, leptin, and regulated on activation, normal T-cell expressed and secreted chemokine (RANTES). Biomarkers, levels of PA, score of MedDiet adherence, BMI and WC were measured at baseline and at one-year follow-up. Linear regression models were fitted according to the Baron and Kenny framework for mediation analysis.

RESULTS

Changes in BMI and WC mediated the association of both changes in PA and changes in the MedDiet adherence with the inflammatory score. BMI mediated 26% of the association of changes in total PA with the inflammatory profile, and 27% of the association of changes in the MedDiet, while WC mediated 13% and 12% of these associations, respectively.

CONCLUSION

In older adults at high cardiovascular risk, increasing PA levels and adherence to a MedDiet during 1 year were associated with a lower inflammatory score, which was partly mediated by a reduction in body fat.

Negative Association Between Mediterranean Diet Adherence and COVID-19 Cases and Related Deaths in Spain and 23 OECD Countries: An Ecological Study

In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) emerged in Wuhan, China, sparking the Coronavirus disease 2019 (COVID-19) pandemic. The high prevalence of nutrition-related COVID-19 risk factors including obesity, type 2 diabetes, and hypertension, suggests that healthy dietary approaches may mitigate COVID-19 related outcomes and possibly SARS-CoV-2 infection. Based on the fundamental role of nutrition in immune function and the well-documented association between Mediterranean diet consumption and risk reduction for chronic diseases that are comorbidities in COVID-19 patients, we hypothesized that there would be a relationship between Mediterranean diet adherence and COVID-19 cases and related deaths. In this perspective, we examined the association between regional adherence to a Mediterranean diet and COVID-19 cases and deaths using an ecological study design. We observed that Mediterranean diet adherence was negatively associated with both COVID-19 cases and related deaths across 17 regions in Spain and that the relationship remained when adjusted for factors of well-being. We also observed a negative association between Mediterranean diet adherence and COVID-19 related deaths across 23 countries when adjusted for factors of well-being and physical inactivity. The anti-inflammatory properties of the Mediterranean diet - likely due to the polyphenol content of the diet - may be a biological basis to explain our findings. However, there are confounding factors unrelated to dietary factors driving COVID-19 cases and related deaths across the regions in Spain and the 23 countries examined in our analysis. Our findings will need to be confirmed and further explored in cohort studies.

Association between dietary inflammatory index and gestational diabetes mellitus risk in a prospective birth cohort study

OBJECTIVE

Information is limited regarding the possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM). This study investigated the association between the inflammatory potential of the diet, measured by the dietary inflammatory index (DII), and GDM risk in pregnant Chinese women.

METHODS

This study included 2639 eligible women from the Tongji Maternal and Child Health Cohort. Dietary intake was assessed by a validated semiquantitative food frequency questionnaire and was used to calculate the DII score. The DII was then validated using C-reactive protein measurements in a subsample of 133 pregnant women. GDM diagnoses were collected from medical records based on the results of a 75 g oral glucose tolerance test at 24 to 28 wk gestation. Multivariable-adjusted logistic regression models were performed to estimate the odds ratios (ORs) for GDM risk by DII score, modeled continuously and in tertiles.

RESULTS

Of the 2639 participants, 13.1% were diagnosed with GDM. DII scores ranged from -4.45 to 3.15 and were positively associated with C-reactive protein (adjusted β : 1.28, 95% confidence interval [CI]: 0.16, 2.40; P trend = 0.023) when comparing DII tertile 3 (most pro-inflammatory) to tertile 1 (most anti-inflammatory). A significant and positive association was observed between DII scores and GDM risk (adjusted OR: 1.43; 95% CI: 1.05, 1.95; P trend = 0.022) comparing the highest versus lowest tertiles. The stratified analysis showed that this association was stronger in pregnant women who were overweight or obese before pregnancy (adjusted OR: 2.20; 95% CI: 1.03, 4.69).

CONCLUSIONS

These findings suggest that a higher DII score, corresponding to a more proinflammatory diet, is associated with a higher risk of GDM, particularly in pregnant women who were overweight or obese before pregnancy.

Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions

Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.

The effects of canola and olive oils consumption compared to sunflower oil, on lipid profile and hepatic steatosis in women with polycystic ovarian syndrome: a randomized controlled trial

BACKGROUND

Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrinopathies and metabolic disorders in women during their reproductive years. It is often associated with dyslipidemia and other risk factors of cardiovascular diseases (CVD). This study was aimed to evaluate dietary intervention effects with canola and olive oils compared to sunflower oil on lipid profile and fatty liver severity among women with PCOS.

METHOD

This study was a 10-week intervention including 72 women with PCOS. Patients were randomly assigned to three groups for receiving 25 g/day canola, olive, or sunflower oils for 10 weeks. The primary and secondary outcomes were to assess changes in lipid profile and in fatty liver severity, respectively.

RESULT

At the end of the study, 72 patients with a mean age of 29.31 were analysed. Canola oil consumption resulted in a significant reduction in serum levels of TG (P = 0.002) and TC/HDL (P = 0.021), LDL/HDL (P = 0.047), and TG/HDL (P = 0.001) ratios, however, there was no significant reduction in lipid profile following olive oil consumption. Canola (P < 0.001) and olive oils (P = 0.005) could significantly reduce the fatty liver grade. Moreover, HOMA-IR in both canola (P < 0.001) and olive (P = 0.004) groups was significantly decreased.

CONCLUSION

In total, compared to olive and sunflower oils, significant improvements in lipid profile, liver function, and HOMA-IR were observed following canola oil consumption in women with PCOS.

TRIAL REGISTRATION

IR.MUI.

RESEARCH

REC.1397.315. Registered 30 JUNE 2019 - Retrospectively registered, https://www.irct.ir/trial/38684.

Extractable and Non-Extractable Antioxidants Composition in the eBASIS Database: A Key Tool for Dietary Assessment in Human Health and Disease Research

The antioxidant properties of foods are crucial in nutrition, food chemistry, and medicine studies but are often underestimated, with significant amounts of bioactive compounds containing physiological and biochemical properties remaining in the residue from extraction as non-extractable antioxidants. Over the last decade, extractable and non-extractable compounds have become key in the evaluation/determination of the antioxidant properties of food matrices because of their relevance in human health. This has led to the need to include extractable and non-extractable antioxidants in comprehensive and harmonized food composition databases for a wide range of applications within research, food, pharmaceutical, nutraceutical, and cosmeceutical areas. Additionally, the databases are invaluable as part of the health claims application process. eBASIS, (Bioactive Substances in Food Information System) a comprehensive database containing quality-evaluated scientific data, covering the composition of bioactive compounds present in foods, has flexible structures, allowing it to be extended to include newly emerging data on extractable and non-extractable compounds. Search criteria were developed and defined for compiling suitable peer-reviewed literature. Data quality assessment methods were established for the addition of composition data and antioxidant activity, with a focus on various parameters including: the extraction procedure, the antioxidant measurements, the expression of results. A total of 437 quality-evaluated datapoints on the composition of extractable and/or non-extractable compounds were entered into the database. This database update represents one of the first examples of building a database dedicated to antioxidant properties. This expansion of eBASIS provides a novel and unique tool for nutritionists, dietitians, researchers to use for a wide range of applications, such as dietary assessment, exposure studies and epidemiological studies, and may contribute to an increase in high-bioactive food consumption by consumers.

Mediterranean Dietary Pattern at Middle Age and Risk of Parkinson's Disease: A Swedish Cohort Study

Background

The Mediterranean diet has been proposed to protect against neurodegeneration.

Objectives

The aim of this study was to assess the association of adherence to Mediterranean dietary pattern (MDP) at middle age with risk for Parkinson's disease (PD) later in life.

Method

In a population‐based cohort of >47,000 Swedish women, information on diet was collected through a food frequency questionnaire during 1991–1992, from which adherence to MDP was calculated. We also collected detailed information on potential confounders. Clinical diagnosis of PD was ascertained from the Swedish National Patient Register through 2012.

Results

We observed an inverse association between adherence to MDP and PD, multivariable hazard ratio of 0.54 (95% confidence interval: 0.30–0.98), comparing high with low adherence. The association was noted primarily from age 65 years onward. One unit increase in the adherence score was associated with a 29% lower risk for PD at age ≥ 65 years (95% confidence interval: 0.57–0.89).

Conclusion

Higher adherence to a Mediterranean diet at middle age was associated with lower risk for PD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?

BACKGROUND

The EU-supported ATHENA project stems from a previous study suggesting that moderate wine consumption reduced the side-effects of radiotherapy (RT) in breast cancer patients, an effect possibly due to non-alcoholic anthocyanin fractions of wine.

OBJECTIVE

To evaluate the role of anthocyanins on RT skin side effects in breast cancer patients.

METHODS

Randomized, controlled, double-blind clinical trial. Patients were assigned to an intensity modulated radiation therapy (IMRT) either for three or five weeks, then randomized to receive three times a day a water-soluble anthocyanin (125 mg)-rich extract of corn cob or a placebo. Supplementation started one week before till the end of RT. Skin characteristics were detected by a standardized, non-invasive Cutometer® dual-MPA580, providing quantitative indices of skin maximal distensibility (R0), elasticity (R2, R5, R7) and viscoelasticity (R6); a Mexameter® MX18 probe evaluated the skin erythema (Er) and melanin (M). Measures were performed before (T0), at the end of RT and of supplementation (T1), and 1, 6 and 12 months after RT (T2-T4). Acute and late skin toxicity were scored according to the RTOG/EORTG scale. Selected biomarkers were measured at T0 and T1.

RESULTS

193 patients previously assigned to 3- or 5-week RT schedules were randomized to either anthocyanin (97) or placebo (96) supplementation. RT induced changes in skin parameters: R0, R2, R5 and R7 decreased, while R6 increased; the changes in R0 and R6 continued in the same direction up to one year, while the others recovered towards basal values; Er and M peaked at T1 and T2, respectively, and returned to basal values at T4. Comparable skin changes were apparent in anthocyanin and placebo groups. A moderate RT-induced increase in total and HDL cholesterol and triglycerides was prevented by anthocyanins.

CONCLUSIONS

Anthocyanin supplementation did not prevent RT-induced local skin toxicity. The supplementation was well tolerated and safe.

The Inflammatory Potential of Diet is Associated with Breast Cancer Risk in Urban Argentina: A Multilevel Analysis

Dietary patterns have been associated with breast cancer (BC) in Argentina. However, little evidence exists relating the inflammatory potential of diet and BC in Latin American countries and how this may relate to rurality.The aim of the present study was to evaluate the association between the Dietary Inflammatory Index (DII^®) and BC considering urbanization contexts in Córdoba, Argentina.A frequency-matched case-control study (317 BC cases, 526 controls) was conducted from 2008 through 2016. DII scores were computed based on dietary intake assessed by a validated food frequency questionnaire. Multi-level logistic regression models were fit to evaluate the association between DII and BC, following adjustment for age, body mass index, age at menarche, number of children, smoking habits, socio-economic status and family history of BC as first-level covariates and urbanization level as the contextual variable.Increasing DII score showed significant positive associations with BC risk (OR_{tertile3vs.tertile1} 1.34; 95%CI 1.05, 1.70). The association was stronger in overweight and obese women (OR_{tertile3vs.tertile1} 1.98; 95%CI 1.86, 2.10). The DII effect on BC was higher with increased urbanization.A pro-inflammatory diet, reflected by higher DII scores, was positively associated with BC, especially in overweight women and with increased urbanization.

Nutrition and immune system: from the Mediterranean diet to dietary supplementary through the microbiota

The interaction between nutrition and the immune system is very complex. In particular, at every stage of the immune response, specific micronutrients, including vitamins and minerals play a key role and often synergistic, and the deficiency of only one essential nutrient may impair immunity. An individual's overall nutrition status and pattern of dietary intake (comprised of nutrients and non-nutritive bioactive compounds and food) and any supplementation with nutraceuticals including vitamins and minerals, can influence positively or negatively the function of the immune system. This influence can occur at various levels from the innate immune system and adaptive immune system to the microbiome. Although there are conflicting evidence, the current results point out that dietary supplementation with some nutrients such as vitamin D and zinc may modulate immune function. An update on the complex relationship between nutrition, diet, and the immune system through gut microbiota is the aim of this current review. Indeed, we will provide the overview of the link among immune function, nutrition and gut microbiota, paying particular attention at the effect of the Mediterranean diet on the immune system, and finally we will speculate the possible role of the main one functional supplements on immune function.

A randomized controlled trial investigating the effects of a mediterranean-like diet in patients with multiple sclerosis-associated cognitive impairments and fatigue

Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory dietary approaches. Therefore, this study aimed to explore the effects of a modified Mediterranean-like diet on cognitive changes and fatigue levels in comparison with a conventional standard diet over a 1-year follow-up. Methods: In the current single-blind randomized controlled trial, 34 MS patients in the Mediterranean- like diet group and 38 patients in the standard healthy diet group were studied for 1 year. The dietary interventions were modified each month by an expert nutritionist. MS-associated fatigue level was evaluated using the Modified Fatigue Impact Scale (MFIS). Cognitive assessment was also performed using Minimal Assessment of Cognitive Function in MS (MACFIMS). Results: Intergroup ‎comparisons demonstrated that after considering confounding variables in ANCOVA, fatigue scores appeared significantly lower in patients who were treated with the Mediterranean-like diet than those in the standard healthy diet group [Mean 95% confidence interval (CI)}: 33.93 (32.97-34.89) and 37.98 (36.99-38.97), respectively; P < 0.001]. However, the intergroup ‎analysis of cognitive status only showed a difference in the mean score of Brief Visuospatial Memory Test-Revised (BVMT-R) subtest of the MACFIMS. The BVMT-R‎ was higher among standard healthy diet patients compared to the Mediterranean-like diet group after the intervention following adjustment for covariates [Mean (95% CI): 23.73 (21.88-25.57) and 20.56 (18.60-22.51), respectively; P = 0.020]. Conclusion: In conclusion, the results of this study highlighted the higher protective effects of the Mediterranean-like diet against MS-related fatigue than the standard healthy diet. However, no significant improvement was observed in the cognitive status of MS patients after a 1-year treatment with the Mediterranean-like diet. More randomized clinical trials with larger sample sizes are needed to elucidate the effects of dietary modifications on MS-associated symptoms and complications.

Anticancer Effects of Nutraceuticals in the Mediterranean Diet: An Epigenetic Diet Model

Epidemiological and clinical studies support the association between nutrition and development or progression of different malignancies such as colon, breast, and prostate cancer, defining these tumors as diet-associated cancer. The Mediterranean diet shows inverse associations with metabolic diseases, cardiovascular pathologies and various types of cancer. Many bioactive nutrients of the Mediterranean diet have been identified as factors protective against these types of pathologies. The epigenome has been identified as the primary goal of modulations in gene expression related to these molecular nutrients. In fact, they can modify the epigenome and can be incorporated into the 'epigenetic diet', which translates into a diet regimen that can be used therapeutically for health or preventative purposes. Most epigenetic changes are influenced by lifestyle and nutrition. Epigenetic therapy is a new area for the development of nutraceuticals whose absence of toxicity can represent a valid asset in cancer prevention strategies. Recent advances in understanding the mechanisms of nutrigenomics, nutrigenetics and nutraceuticals have led to the identification of superfoods capable of favorably conditioning gene expression. In this review, we highlight the importance of nutraceuticals present in the Mediterranean diet as epigenetic modifiers both in the mechanisms of tumor onset and as protective agents.

Polyphenols as Caloric Restriction Mimetics Regulating Mitochondrial Biogenesis and Mitophagy

The tight coordination between mitochondrial biogenesis and mitophagy can be dysregulated during aging, critically influencing whole-body metabolism, health, and lifespan. To date, caloric restriction (CR) appears to be the most effective intervention strategy to improve mitochondrial turnover in aging organisms. The development of pharmacological mimetics of CR has gained attention as an attractive and potentially feasible approach to mimic the CR phenotype. Polyphenols, ubiquitously present in fruits and vegetables, have emerged as well-tolerated CR mimetics that target mitochondrial turnover. Here, we discuss the molecular mechanisms that orchestrate mitochondrial biogenesis and mitophagy, and we summarize the current knowledge of how CR promotes mitochondrial maintenance and to what extent different polyphenols may mimic CR and coordinate mitochondrial biogenesis and clearance.

Periodontitis, Low-Grade Inflammation and Systemic Health: A Scoping Review

Background and objectives: Periodontitis is a multifactorial chronic inflammatory infectious disease in which an infection is necessary, but not sufficient, for development of the condition. Individual susceptibility strictly linked to the immune and inflammatory response of the organism must also be present. Low-grade inflammation (LGI) is a systemic status of chronic sub-clinical production of inflammatory factors. This condition represents a risk factor for many chronic diseases including diabetes, cardiovascular disease, cerebrovascular disease, neurodegenerative disease and cancer. This scoping review aims to clarify, summarize and disseminate current knowledge on the possible link between periodontitis, LGI and systemic health. Materials and Methods: PRISMA Extension for Scoping Reviews guidelines were followed. An ad-hoc created keyword string was used to search the electronic databases of PubMed/Medline, Embase, The Cochrane Library and ClinicalTrials.gov. A hand search of specialized journals and their reference lists was also performed. Results: 14 studies that respected eligibility criteria were selected and analyzed. There is emerging evidence of strong links between periodontitis, LGI and systemic health. On the one hand, periodontitis influences the systemic status of LGI and on the other hand, the systemic production of inflammatory factors affects periodontitis with a bidirectional connection. Conclusions: LGI and the subsequent onset of a systemic inflammatory phenotype can be considered the common substrate of many chronic inflammatory diseases including periodontitis, with multiple mutual connections between them. Understanding of the biological principles and mechanisms underlying such a complex interrelationship could lead to significant improvements in the field of personalized diagnostics and therapeutic protocols.

Association of a traditional Mediterranean diet and non-Mediterranean dietary scores with all-cause and cause-specific mortality: prospective findings from the Moli-sani Study

PURPOSE

To evaluate in an Italian general population, the association with mortality of a traditional Mediterranean diet (MD) and non-Mediterranean dietary (non-MD) patterns, and their combined effect, and to test some biomarkers of cardiovascular (CVD) risk as potential mediators of such associations.

METHODS

Longitudinal analysis on 22,849 men and women aged ≥ 35 years, recruited in the Moli-sani Study (2005-2010), followed up for 8.2 years (median). The MD was assessed by the Mediterranean diet score (MDS). The Dietary  Approaches to Stop Hypertension (DASH), the Palaeolithic diet, and the Nordic diet were chosen as reportedly healthy non-MD patterns. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression.

RESULTS

Participants reaching higher MDS or DASH diet score experienced lower risk of both all-cause (HR 0.77; 95% CI 0.66-0.90 and 0.81; 0.69-0.96, respectively, highest vs lowest quartile) and CVD (0.77; 0.59-1.00 and 0.81; 0.69-0.96, respectively) death risk; risk reduction associated with the Palaeolithic diet was limited to total and other cause death, whereas the Nordic diet did not alter risk of mortality. Increasing adherence to MD was associated with higher survival in each stratum of non-MD diets. Biomarkers of glucose metabolism accounted for 7% and 21.6% of the association between either MDS or DASH diet, respectively, with total mortality risk.

CONCLUSIONS

Both the traditional MD and DASH diet may reduce risk of all-cause mortality among Italians, as well as risk of dying from cardiovascular causes. The Palaeolithic diet did not appear to reduce cardiovascular risk, while the Nordic eating pattern was unlikely to be associated with any substantial health advantage.

COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation

The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has engulfed the world, affecting more than 180 countries. As a result, there has been considerable economic distress globally and a significant loss of life. Sadly, the vulnerable and immunocompromised in our societies seem to be more susceptible to severe COVID-19 complications. Global public health bodies and governments have ignited strategies and issued advisories on various handwashing and hygiene guidelines, social distancing strategies, and, in the most extreme cases, some countries have adopted "stay in place" or lockdown protocols to prevent COVID-19 spread. Notably, there are several significant risk factors for severe COVID-19 infection. These include the presence of poor nutritional status and pre-existing noncommunicable diseases (NCDs) such as diabetes mellitus, chronic lung diseases, cardiovascular diseases (CVD), obesity, and various other diseases that render the patient immunocompromised. These diseases are characterized by systemic inflammation, which may be a common feature of these NCDs, affecting patient outcomes against COVID-19. In this review, we discuss some of the anti-inflammatory therapies that are currently under investigation intended to dampen the cytokine storm of severe COVID-19 infections. Furthermore, nutritional status and the role of diet and lifestyle is considered, as it is known to affect patient outcomes in other severe infections and may play a role in COVID-19 infection. This review speculates the importance of nutrition as a mitigation strategy to support immune function amid the COVID-19 pandemic, identifying food groups and key nutrients of importance that may affect the outcomes of respiratory infections.

The Functional Medicine Approach to COVID-19: Nutrition and Lifestyle Practices for Strengthening Host Defense

The developing symptoms of COVID-19, as well as the progression of illness and fatality, are a clearly a function of the overall health status of the individual. Complex, chronic diseases such as obesity, hypertension, and diabetes are directly correlated with risk of disease severity and mortality. We explore lifestyle interventions that have specifically been demonstrated to strengthen host defense, reduce the probability and mitigate the severity of viral infection. Lifestyle interventions, from a Functional Medicine perspective, include nutrition, sleep, exercise, stress reduction, and connection. These factors, when in balance, provide a foundation for optimal health and immune function.

Mediterranean Diet and Osteoarticular Diseases

Background:

Besides the well-known positive effect on the reduction of the risk of cardiovascular diseases, in the latest decades growing evidence has accumulated on the beneficial effects of MD on various aspects of health outcomes. Nevertheless, data concerning the existence of a direct positive effect of MD, irrespective of its beneficial effect on body weight, in osteo-articular diseases, are still controversial. In osteo-articular diseases, a pro-inflammatory environment is highlighted, with an increased systemic levels of pro-inflammatory cytokines.

Objective:

Our objective is to investigate the effects of adherence to the Mediterranean diet and osteo-articular diseases.

Conclusion:

Many foods included in MD, have anti-inflammatory properties, due to the presence of nutrients, such as polyunsaturated (PUFA) and monounsaturated (MUFA) fats. The two types of polyunsaturated fatty acids, omega-3 and omega-6, have opposing effects on the inflammatory process. Omega-6 stimulates the production of pro-inflammatory cytokines, while omega-3 fatty acids exert anti-inflammatory effects, including significant reductions in the release of pro-inflammatory cytokines. Some studies have shown that the dietary pattern of MD consumption has an important role in the prevention and development of inflammatory arthritis. Nevertheless, the possible influence of MD on chronic osteo-articular diseases is very limited, this review updates the main experimental and clinical evidences concerning the potential beneficial effects of the Mediterranean Diet on the most diffuse osteo-articular chronic and degenerative joint disease.

Association between adherence to the Mediterranean Diet and circulating Vitamin D levels

Vitamin D improves bone density and latest studies show adherence to Med-Diet as protective on osteoporosis. This observational study aimed at investigating the relationship between 25(OH)D levels and adherence to Med-Diet. Body weight, BMI, WC, glucose, insulin, 25(OH)D, total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, uric acid, and creatinine serum levels and insulin resistance were determined in 284 overweight/obese subjects not taking medications or supplements. Adherence to Med-Diet was evaluated by using PREDIMED score. High-level of adherence stood out. 25(OH)D was inversely related to BMI, WC, HOMA-IR, serum insulin and triglycerides, while directly to PREDIMED score. Two different regression models confirmed this positive correlation independently of gender and other parameters showing univariate relationship with 25(OH)D. This study argues that a closer adherence to Med-Diet is independently associated with an increase of 25(OH)D suggesting that higher vitamin D levels may contribute to the protective effect of the Med-Diet on osteoporosis.

Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review

While the role of diet and nutrition in cognitive health and prevention of dementia in older adults has attracted much attention, the efficacy of different dietary patterns remains uncertain. Previous reviews have mainly focused on the Mediterranean diet, but either omitted other dietary patterns, lacked more recent studies, were based on cross-sectional studies, or combined older and younger populations. We followed PRISMA guidelines, and examined the efficacy of current research from randomized controlled trials and cohort studies on the effects of different dietary patterns. We reviewed the Mediterranean diet, Dietary Approach to Stop Hypertension (DASH) diet, the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet, Anti-inflammatory diet, Healthy diet recommended by guidelines via dietary index, or Prudent healthy diets generated via statistical approaches, and their impact on cognitive health among older adults. Of 38 studies, the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults. Evidence from other dietary patterns such as the MIND, DASH, Anti-inflammatory, and Prudent healthy diets was more limited but showed promising results, especially for those at risk of cardiovascular disease. Overall, this review found positive effects of dietary patterns including the Mediterranean, DASH, MIND, and Anti-inflammatory diets on cognitive health outcomes in older adults. These dietary patterns are plant-based, rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods. Better understanding of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult.