High adherence to Mediterranean diet, but not individual foods or nutrients, is associated with lower likelihood of being obese in a Mediterranean cohort

Critical evaluation of the questionnaires assessing adherence to the Mediterranean diet that are based on servings

BACKGROUND AND AIMS

The Mediterranean Diet (MD) is characterized by a high intake of vegetables, fruit, legumes, nuts, and olive oil, and moderate fish, dairy, and wine intake. A high adherence to MD has been associated with numerous health benefits, including reduced risk of chronic diseases such as cardiovascular disease, cancer, and type 2 diabetes. The clinical assessment of MD adherence is complicated by the absence of a univocally accepted tool and by the abundance of questionnaires developed to determine adherence, whose reliability and validity is uncertain. In this inter-associative document, we critically evaluated servings-based questionnaires for the assessment of MD adherence, aiming to identify the most valuable tool for the use in clinical practice.

METHODS AND RESULTS

For each questionnaire, we analyzed the structure, evidence on health-related outcomes and agreement with the recommendations of MD. We found that most questionnaires do not accurately reflect the principles of MD in terms of the food groups and their optimal consumption frequency. Additionally, the comparison of questionnaires revealed low agreement and some concerns with regard to the scoring assumptions.

CONCLUSIONS

Among the available questionnaires, we suggest the use of the 15-Items Pyramid based Mediterranean Diet Score (PyrMDS), which is the one with fewer flaws and a strong supporting body of theoretical and scientific evidence. The use of the PyrMDS may facilitate the assessment of MD adherence in clinical practice, which is instrumental in reducing the risk of non-communicable chronic diseases.

The Effect of Short-term Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet on Hunger Hormones, Anthropometric Parameters, and Brain Structures in Middle-aged Overweight and Obese Women: A Randomized Controlled Trial

Background

The rising prevalence of obesity, as well as its detrimental effects on the brain, has drawn attention to specific dietary patterns. This study aimed to examine the effect of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) pattern on anthropometric parameters, hunger hormones, and brain structures in overweight and obese women.

Methods

This randomized trial was conducted in Shiraz between October 2018 and March 2019. We analyzed 37 healthy women with a mean age of 48±5.38 years and a Body Mass Index (BMI) of 32±0.69 Kg/m². Participants were randomly allocated to a hypocaloric modified MIND diet or a hypocaloric control diet. Differences in anthropometric, laboratory analysis, and brain structure were determined at baseline and three-month follow-up. Data were analyzed using SPSS 22.0. Independent and paired sample t test were used to determine between and within differences. We also used mixed-model ANOVA to compare the mean differences between two-factor groups.

Results

A more significant weight reduction (P<0.0001), BMI (P<0.0001), percentage of body fat (P=0.03), waist circumference (P=0.01), and Leptin concentration (P=0.03) were found in the MIND diet group. The results also showed a significant increase in Ghrelin (P=0.002) and GLP-1 (P=0.01) levels in the MIND diet group. The findings revealed no differences in the whole and regional brain structures between the two groups.

Conclusion

For the first time, this study showed that the MIND diet intervention could improve the devastating effect of obesity on metabolic profiles and anthropometric parameters. However, we could not find its effect on brain structures.Trial registration number: IRCT20190427043387N1.A preprint of this study was published at https://www.medrxiv.org/content/10.1101/2020.06.28.20142018v1.

Adherence to the Mediterranean Diet and COVID-19: A Segmentation Analysis of Italian and US Consumers

The COVID-19 pandemic has led many countries to implement restrictions on individual freedom to stop the contagion. The imposition of lockdowns has affected many socio-economic aspects and, in particular, eating habits, highlighting the need to analyse the healthiness of new consumption patterns. The aim of our study was to investigate the changes in adherence to the Mediterranean diet, a dietary model universally recognized as healthy, that have occurred both during and since the lockdown. The subsequent profiling of consumers allowed us to understand which sociodemographic and psychographic factors favoured the development of more or less adherence to Mediterranean diet consumption patterns. The study was conducted by administering a questionnaire to a representative sample of Italians and New Yorkers. Both groups, defined by deep socio-economic differences and by their own eating habits compared to the Mediterranean diet model, were affected by similar lockdown measures. The data collected were processed by cluster analysis that allowed to identify four homogeneous groups with respect to the adherence to the Mediterranean diet model. The results highlight a worrying situation with respect to the impacts of the pandemic on maintaining a proper dietary style according to the principles of the Mediterranean diet. In fact, there has been a general worsening trend due to an increase in consumption, in part linked to emotional eating, which is a cause for concern about the potential future impacts on the health of consumers. The study highlights the need, therefore, to implement actions by public decision-makers aimed at raising the awareness of citizens on the issue of correct eating habits and at developing adequate food policies to stem the trend towards unhealthy diets.

Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study

The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being.

Adherence to the Mediterranean Diet, Five-Year Weight Change, and Risk of Overweight and Obesity: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Findings from earlier studies on the association between adherence to a Mediterranean diet and risk of overweight/obesity were inconsistent. We summarized cohort studies investigating the association between the Mediterranean diet and risk of overweight and/or obesity and weight change in adults. A systematic search of PubMed, Scopus, ISI Web of Science, and Google Scholar was conducted up to May 2021. Prospective cohorts that examined the Mediterranean diet adherence in adults as the exposure, and overweight and/or obesity or weight change as the outcomes, and reported RRs or β coefficients and 95% CIs as the effect sizes were included. Seven prospective cohort studies were included of which 6 studies (with 244,678 adult participants) reported the risk of overweight and/or obesity, and 4 cohorts (with 436,617 participants) reported the weight change (3 cohorts reported both overweight and/or obesity risk and weight change). Combining 15 effect sizes from 6 cohorts revealed that greater adherence to the Mediterranean diet was significantly associated with a 9% decreased risk of overweight and/or obesity (RR: 0.91; 95% CI: 0.88, 0.94; I2 = 44.7%; PQ-test = 0.031). This association was significant in the case of studies investigating combined overweight and obesity (RR: 0.92; 95% CI: 0.88, 0.96; I2 = 29.4%; PQ-test = 0.166), but not for studies that reported on obesity (RR: 0.68; 95% CI: 0.43, 1.10, I2 = 50.6%, PQ-test = 0.132). Linear dose-response analysis of 6 studies showed a 2% decreased risk of overweight and/or obesity for 1 additional Mediterranean diet score (RR: 0.98; 95% CI: 0.96, 0.99). Each unit increase in the Mediterranean diet score was associated with 0.04 kg less weight gain over 5 y (-0.04 kg; 95% CI: -0.07, -0.02 kg; 13 effect sizes from 4 cohorts). In conclusion, Mediterranean diet adherence is inversely associated with risk of overweight and/or obesity as well as 5-y weight gain and thus has practical importance for public health.

A higher dietary restraint is associated with higher BMI: a cross-sectional study in college students

BACKGROUND

College students tend to have eating and lifestyle habits that can lead to weight gain. Paradoxically, weight gain could also lead to calorie restriction, a practice that is common among those who are concerned about their body weight. Thus, the objective of this study was to investigate the association between habits related to overweight and obesity and dietary intake, physical activity, and BMI among college students.

METHODOLOGY

One hundred ninety-two participants (18-26 years; 75% female) were included in this cross-sectional study. Participants completed the 'habits related to overweight and obesity questionnaire' which evaluates five dimensions: the concern about caloric intake, healthy eating, physical activity, alcohol consumption, and eating for psychological well-being. Additionally, anthropometric parameters, dietary intake, and physical activity were evaluated. Linear regression models were used to examine the associations between outcome and exposure variables.

RESULTS

Higher concern about caloric intake was associated with higher BMI (1.05 kg/m² [95%CI: 0.58, 1.51]), but lower energy (-312.2 kcal/day [95%CI: -404.6, -219.8]) and fat intake (-1.88% [95%CI: -2.94, -0.83]). Furthermore, healthy eating was related to better diet quality 0.96 [95%CI: 0.47,1.44] and lower energy intake (-231.4 kcal/day [95%CI: -367.7, -95.2]). Meanwhile, higher scores in the physical activity dimension were associated with better diet quality (0.41 [95%CI: 0.16,0.66]).

CONCLUSIONS

College students with the highest dietary restraint had the greatest BMI and the lowest energy and fat intake. Our results highlight the importance of promoting healthy behaviors among college students.

Mediterranean diet scoring systems: understanding the evolution and applications for Mediterranean and non-Mediterranean countries

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

Association between alcohol intake and overweight and obesity: a systematic review and dose-response meta-analysis of 127 observational studies

Several studies have assessed the relationship between alcohol intake and overweight/obesity; however, the reported results are inconsistent. Therefore, the present systematic review and dose-response meta-analysis of observational studies was designed to investigate the association between alcohol intake and general and abdominal obesity among the adults. Literature search was conducted in the PubMed/Medline and Web of Science databases up to August 2020. Odds ratio (OR), risk ratio (RR), or hazard ratio (HR) with 95% confidence interval (95% CI) were used to pool effect size. To conduct dose-response meta-analysis, amount of alcohol intake was classified into three categories including light (<14 g/d), moderate (14-28 g/d), and heavy (>28 g/d). In the present study, 127 eligible studies were included. In cohort studies, there was no significant association between alcohol drinking and risk of overweight (OR: 0.93, 95% CI: 0.46 to 1.89), obesity (OR: 0.84, 95% CI: 0.52 to 1.37), overweight/obesity (OR: 1.15, 95% CI: 0.84 to 1.58), and abdominal obesity (OR: 1.13, 95% CI: 0.90 to 1.41). In cross-sectional studies, alcohol intake was associated with the increased odds of overweight (OR: 1.11, 95% CI: 1.05 to 1.18), overweight/obesity (OR: 1.23, 95% CI: 1.11 to 1.37), and abdominal obesity (OR: 1.19, 95% CI: 1.09 to 1.29); but not obesity (OR: 1.03, 95% CI: 0.95 to 1.12). Results of dose-response analysis indicated that heavy alcohol drinking was positively associated with odds of overweight (OR: 1.12, 95% CI: 1.01 to 1.24), overweight/obesity (OR: 1.32, 95% CI: 1.16 to 1.51), and abdominal obesity (OR: 1.25, 95% CI: 1.12 to 1.38) compared to non- or light alcohol drinking. There was no publication bias among studied on outcomes of interest. In conclusion, our results revealed alcohol drinkers, especially heavy alcohol drinkers, had increased odds of overweight, overweight/obesity, and abdominal obesity than non-alcohol drinker or light alcohol drinkers among cross-sectional studies but not cohort studies.

Factors associated with overweight and obesity in adults using structural equation model: mediation effect of physical activity and dietary pattern

PURPOSE

This study aimed to determine the indirect effect of risk factors associated with overweight and obesity through physical activity (PA) and dietary pattern (DP), using structural equation model in the adults' population.

METHODS

This cross-sectional study was conducted on 10,000 adults from baseline data of Ravansar Non Communicable Disease cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on obesity and overweight as the outcome.

RESULTS

In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of socioeconomic status (SES) on overweight and obesity was - 0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (β = 0.024) and indirectly, through the variables of PA and DP, had a significant effect (β = 0.088) on the outcome. The same situation has been observed in men. That is a weak direct effect of SES (β = 0.070) and a significantly indirect effect, through three variables such as PA, DP, and smoking status, on the outcome.

CONCLUSION

Factors associated with overweight and obesity not only by direct effect, but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study

PURPOSE

Adopting a Mediterranean-like dietary pattern may help in preventing several chronic diseases. We assessed the eating behaviour and compliance with the Mediterranean diet pyramid recommendations in Italy.

METHODS

This is a cross-sectional study conducted in subjects aged ≥ 20 years. A 14-question survey based on the updated Mediterranean diet pyramid was launched online from April 2015 to November 2016. At test completion, a personalized pyramid displaying the possible deficiencies and/or excesses was generated, that could be the basis to plan diet and lifestyle modifications.

RESULTS

Overall, 27,540 subjects completed the survey: the proportion of females (75.6%), younger subjects (20.7%) and people with a University degree (33.1%) resembled those of the Italian population of Internet users rather than of the general population. 37.8% of participants declared a sedentary lifestyle, including 29.6% of those aged 20-29 years. A lower-than-recommended intake of all food categories included in the Mediterranean diet pyramid, along with excess of sweets, red and processed meats, emerged, that may affect health in the long term. Low adherence to recommendations was observed especially among females and older people. Notably, a discrepancy surfaced between the responders' perceived and actual behaviour toward the regular consumption of fruits and vegetables (81.8% vs 22.7-32.8%, respectively).

CONCLUSIONS

The nutritional habits and lifestyle of Italian participants are poorly adherent to the Mediterranean diet recommendations. The personalized pyramid tool may help in raising the awareness of individuals and their families on where to intervene, possibly with the support of healthcare professionals, to improve their behaviour.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Exploring the relationship between the Mediterranean diet and weight loss maintenance: the MedWeight study

Weight loss maintenance is crucial for obesity management, yet optimal dietary patterns for this period are not established. We aimed to explore the relationship between adherence to the Mediterranean diet and weight loss maintenance. Sample includes 565 adults (62 % women) of the MedWeight study. Eligible volunteers were those reporting intentional weight loss of ≥10 %, starting from a BMI ≥ 25 kg/m², over 12 months prior to enrolment. Based on current weight, participants were characterised as maintainers (≤90 % maximum weight) or regainers (>95 % maximum weight). Socio-demographics and weight history were recorded. Dietary intake was assessed by two non-consecutive 24-h recalls within 10 d and analysed in energy, macronutrient and food group intakes. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Score (MedDietScore) (range 0–55, greater scores showing higher adherence). Protein intake was higher in maintainers than in regainers (P < 0·001). When MedDietScore quartiles were considered, a linear trend for weight loss maintenance was revealed (P < 0·05). After adjustment for basic demographic characteristics, being in the third or fourth quartile of the MedDietScore (v. first) was associated with 2·30 (95 % CI 1·29, 4·09) and 1·88 (95% CI 1·10, 3·22) increased odds of maintenance. Regarding individual MedDietScore components, only fruit intake is associated with increased odds for maintenance (1·03 (95% CI 1·01, 1·06)). The leave-one-out approach revealed that at least six MedDietScore components were essential for the observed relationship. Higher adherence to the Mediterranean diet was associated with 2-fold increased likelihood of weight loss maintenance. Future studies should replicate these findings in non-Mediterranean populations as well.

The Influence of Physical Activity, Diet, Weight Status and Substance Abuse on Students' Self-Perceived Health

The objective of this study was to determine the level and relationship between the self-perceived health of adolescents in relation to the level of practice of physical activity, adherence to the Mediterranean diet, weight status and consumption of substance abuse, such as alcohol and tobacco. A total of 516 adolescent students between the ages of 12 and 16 completed a series of questionnaires to assess their health, physical activity, compliance with the Mediterranean diet and alcohol and tobacco consumption. Adolescents who practice more physical activity have better health and greater adherence to the Mediterranean diet. The level of health is higher among adolescents with greater adherence to the Mediterranean diet, evidencing better health among those who consume less tobacco. These results show the need to involve the educational community, families and the media to promote healthy lifestyle habits that can help physical activity and sports professionals in the development of theoretical-practical proposals aimed at improving the health of students.

Adherence to the Mediterranean Diet and Its Association with Body Composition and Physical Fitness in Spanish University Students

The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course–Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming >2 vegetables/day (OR = 20.1; CI: 10.1–30.1; p < 0.001), using olive oil (OR = 10.6; CI: 1.4–19.8; p = 0.021), consuming <3 commercial sweets/week (OR = 10.1; IC: 5.1–19.7; p < 0.001), and consuming ≥3 fruits/day (OR = 8.8; CI: 4.9–15.7; p < 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.

Dietary Polyphenol Intake, Blood Pressure, and Hypertension: A Systematic Review and Meta-Analysis of Observational Studies

Background: Dietary polyphenols, including flavonoids, have been the focus of major recent attentions due to their wide content in a variety of foods commonly consumed and the findings from numerous studies showing evidence of an association with positive outcomes on human health. Methods: A systematic search using electronic databases PubMed and EMBASE was performed to retrieve English language studies published from the earliest indexing year of each database to April 2019, reporting on the association between dietary flavonoids intake and hypertension. Results: The search strategy resulted in the final selection of 20 studies including 15 cross-sectional investigations and 7 prospective cohorts (1 study reported on 3 prospective cohorts). 5 prospective cohorts, comprising 200,256 individuals and 45,732 cases of hypertension were included in the quantitative analysis. Analysis by extreme quantiles of intake of flavonoid showed a non-significant association with decreased risk of hypertension (RR (risk ratio): 0.96, 95% CI (confidence interval): 0.89, 1.03). Taking into consideration individual flavonoid subclasses, dietary anthocyanins intake was associated with 8% reduction in risk of hypertension, when comparing highest vs. lowest exposure (RR: 0.92, 95% CI: 0.88, 0.97). Conclusions: Further studies are needed to strengthen the retrieved association between anthocyanins consumption and decreased risk of hypertension and clarify whether total flavonoids or rather individual subclasses may exert beneficial effects on blood pressure.

Adherence to a Mediterranean Dietary Pattern Is Associated with Higher Quality of Life in a Cohort of Italian Adults

Background: The observed rise in non-communicable diseases may be attributed to the ongoing changes of urban environment and society, as well as greater awareness of health-related issues and subsequent higher rates of diagnosis, which all contribute to the overall quality of life. The aim of the study was to test the association between adherence to the Mediterranean dietary pattern and self-reported quality of life in a cohort of Italian adults. Methods: The demographic and dietary characteristics of 2044 adults living in southern Italy were analyzed. Food frequency questionnaires (FFQs) and a Mediterranean diet adherence score were used to assess dietary intake. The Manchester Short Appraisal (MANSA) was used to assess self-rated quality of life. Multivariate logistic regression analyses were used to test the associations. Results: A significant linear trend of association was found for the overall quality of life and adherence to Mediterranean diet score. All of the components of the MANSA, with the exception of self-rated mental health, were individually associated with higher adherence to this dietary pattern. Conclusions: Adherence to a healthy dietary pattern is associated with the measures of better overall perceived quality of life.

Adherence to the Mediterranean Diet is Associated with Better Sleep Quality in Italian Adults

BACKGROUND

Sleep quality has been associated with human health and diseases, including cognitive decline and dementia; however major determinants of sleep disorders are largely unknown. The aim of this study was to evaluate the association between sleep quality and adherence to the Mediterranean dietary pattern in a sample of Italian adults.

METHODS

A total of 1936 individuals were recruited in the urban area of Catania during 2014-2015 through random sampling. A food frequency questionnaire and validated instruments were used to assess the adherence to the Mediterranean diet and sleep quality (Pittsburg sleep quality index). Multivariate logistic regressions were performed to determine the association between exposure and outcome.

RESULTS

A total of 1314 individuals (67.9% of the cohort) reported adequate sleep quality: for each point increase of the Mediterranean diet score, individuals were 10% more likely to have adequate sleep quality. In an additional analysis stratifying the sample by weight status, the association between sleep quality and high adherence to the Mediterranean diet was observed only among normal/overweight individuals but not in obese participants.

CONCLUSIONS

high adherence to a Mediterranean diet is associated with better sleep quality either toward direct effect on health or indirect effects through improvement of weight status.

Relationship between Obesity and Korean and Mediterranean Dietary Patterns: A Review of the Literature

Obesity is a well-known risk factor for various chronic diseases. Among the various risk factors for obesity, diet is one of the most modifiable. This study aimed to review current research on the association between obesity and the Korean diet compared with the Mediterranean diet. An electronic literature search was conducted using Medline and Embase. Totals of 10 and 17 studies were included in this review for the Korean dietary pattern (KDP) and the Mediterranean dietary pattern (MDP), respectively. These studies mainly applied factor analysis for the KDP and index analysis for the MDP. Only one of 10 KDP articles reported a significant inverse association with obesity, while most MDP studies showed a preventive association with obesity. There are a limited number of KDP studies compared with MDP studies, and the methods of deriving the dietary patterns are different between the KDP and MDP. To produce more conclusive evidence on the association between the KDP and obesity, well-designed and controlled trials or large prospective cohort studies are needed.

Adherence to Mediterranean diet and prostate cancer risk in Sicily: population-based case-control study

Prostate cancer (PCa) is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer worldwide. Countries following a Mediterranean-type dietary pattern, has been reported to have lower PCa incidence and mortality compared with other European regions. A population-based case-control study has been conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy. A total of 118 PCa and 238 population-based controls were collected. Controls had significantly higher adherence to the Mediterranean diet, which was evident for several subgroups (including age groups, overweight and obese men, current smokers, alcohol intake, low and medium physical activity levels). PCa cases were found to consume lower amount of vegetables (223 g/d vs. 261 g/d; p = 0.001), legumes (34.26 g/d vs. 53.55 g/d; p = 0.003), and fish (47.75 g/d vs. 58.3 g/d) than controls; other differences emerged were related to alcohol intake (12.37 g/d vs 5.07 g/d; p < 0.01), cereals (254.06 g/d vs.235.94 g/d; p < 0.001), dairy (196 g/d vs. 166 g/d; p < 0.001), and meat consumption (98.09 g/d vs. 70.15 g/d; p < 0.001). However, no statistically significant differences between cases and controls were found regarding fruit, legumes, and olive oil consumption. The Mediterranean diet score was inversely associated with lower likelihood of having PCa in a linear manner (odds ratio [OR]: 0.86 [95% CI 0.77-0.96]). Specifically, individuals in the highest group of adherence had 78% less likelihood of have PCa and 14% less likelihood for each point increase of the score. The model adjusted for total polyphenol intake showed still a significant inverse association between adherence to the Mediterranean diet and PCa, but the relation was no more linear and not significant for one-point increase of the score (OR: 0.88 [95% CI 0.77-1.01]). In our cohorts of Italian men, we observed that high adherence to the Mediterranean diet was inversely associated with likelihood of having PCa cancer.

Dietary Polyphenol Intake and Depression: Results from the Mediterranean Healthy Eating, Lifestyle and Aging (MEAL) Study

Background: The epidemiological evidence for a relation between dietary polyphenol intake and depression is limited. Therefore, the aim of this study was to assess the association between habitual dietary intake of total polyphenols, their classes, subclasses and individual compounds and depressive symptoms among the participants of the Mediterranean healthy Eating, Lifestyle and Aging (MEAL) study. Methods: Demographic and dietary characteristics of 1572 adults living in southern Italy were analyzed. Food frequency questionnaires and Phenol-Explorer were used to calculate habitual dietary intakes of polyphenols. The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used as screening tool for depressive symptoms. Multivariate logistic regression analyses were used to test associations and were expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: A total of 509 individuals reported having depressive symptoms. Based on multivariate logistic regression analyses, total polyphenol intake was not associated with depressive symptoms. After adjustment for potential confounding factors, dietary intake of phenolic acid (OR = 0.64, 95% CI: 0.44, 0.93), flavanones (OR = 0.54, 95% CI: 0.32, 0.91), and anthocyanins (OR = 0.61, 95% CI: 0.42, 0.89) showed significant inverse association with depressive symptoms, when comparing the highest with the lowest quartile. Moreover, flavanones and anthocyanins, were associated with depressive symptoms in a dose-response manner. Among individual compounds, inverse association was observed for quercetin (OR = 0.53, 95% CI: 0.32, 0.86) and naringenin (OR = 0.51, 95% CI: 0.30, 0.85), for the highest versus lowest quartile of intake. When taking into consideration the major sources of the polyphenols, only citrus fruits and wine consumption was inversely associated with depressive symptoms (Q4 vs. Q1: OR= 0.51, 95% CI: 0.35, 0.75; Q4 vs. Q1: OR = 0.53, 95% CI: 0.38, 0.74, respectively). Conclusions: Higher dietary intake of flavonoid may be inversely associated with depressive symptoms. Further studies are needed to definitively confirm these observed associations.

Macronutrient and Major Food Group Intake in a Cohort of Southern Italian Adults

Background: Dietary intake of macronutrient and foods is considered crucial to decrease the risk of diet-related non-communicable diseases. Methods: The aim of this study was to describe the intake of major food groups and macronutrients in a random sample of 1838 southern Italian adults. Results: No significant differences of macronutrient consumption between sexes were found. By contrast, younger individuals had significantly higher intake of animal protein than older ones. Men reported consuming significantly more total processed meats and less eggs than women; egg consumption significantly increased by age groups. Significantly lower intake of fruit in the younger age group compared to older ones was found. Various patterns of correlation between food groups were described. More than half of individuals reached the suggested recommendations for carbohydrate and fiber intake, and about two-thirds met the recommendations for total protein and cholesterol intake, while only a minority met for total fat intake. Total and plant protein, monounsaturated and omega-6 fatty acids, were significantly inversely related with BMI (body mass index), while trans fatty acids and cholesterol were directly correlated. A direct association with unprocessed meats and an inverse association with processed meats was also found. Conclusions: The overall findings suggest that relatively healthy dietary habits are common in southern Italy.

Fluid Intake and Beverage Consumption Description and Their Association with Dietary Vitamins and Antioxidant Compounds in Italian Adults from the Mediterranean Healthy Eating, Aging and Lifestyles (MEAL) Study

The aim of the present study was to investigate the total water intake (TWI) from drinks and foods and to evaluate the correlation between the different types of drinks on energy and antioxidant intake. The cohort comprised 1602 individuals from the city of Catania in Southern Italy. A food frequency questionnaire was administered to assess dietary and water intake. The mean total water intake was 2.7 L; more than about two thirds of the sample met the European recommendations for water intake. Water and espresso coffee were the most consumed drinks. Alcohol beverages contributed about 3.0% of total energy intake, and sugar sweetened beverages contributed about 1.4%. All antioxidant vitamins were significantly correlated with TWI. However, a higher correlation was found for water from food rather than water from beverages, suggesting that major food contributors to antioxidant vitamin intake might be fruits and vegetables, rather than beverages other than water. A mild correlation was found between fruit juices and vitamin C; coffee, tea and alcohol, and niacin and polyphenols; and milk and vitamin B12. The findings from the present study show that our sample population has an adequate intake of TWI and that there is a healthy association between beverages and dietary antioxidants.

Association between dietary flavonoids intake and obesity in a cohort of adults living in the Mediterranean area

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

Resveratrol in Patients with Minimal Hepatic Encephalopathy

BACKGROUND

Minimal Hepatic Encephalopathy (MHE) is characterized by an impairment of social interaction, emotional behavior, sleep disorders, physical and mental symptoms, and diminished Quality of Life (QoL). The aim of our study is evaluating the potential liver health promoting a perspective of Resveratrol (RV) activities and evaluate whether RV treatment may improve health related quality of life (HRQL) and reduce depression and anxiety in patients with MHE.

METHODS

We evaluated depression using the Beck Depression Inventory test, anxiety with State-trait anxiety inventory test, quality of life through SF-36 test, and ammonia serum levels in 70 MHE patients that were randomized into two groups.

RESULTS

In the comparison between RV group and placebo group we observed a decrease in Back Depression Inventory (BDI) (p < 0.001), in State-trait anxiety inventory (STAI) (p < 0.001), and improve in physical function (p < 0.001), in role physical (p < 0.05), in body pain (p < 0.05), in general health (p < 0.001), in vitality (p < 0.05), and in social function (p < 0.001).

CONCLUSIONS

Resveratrol showed efficacy in the treatment of depression, anxiety, and ammonia serum levels, and improved the quality of life Of MHE patients.

Dietary Phytoestrogen Intake is Inversely Associated with Hypertension in a Cohort of Adults Living in the Mediterranean Area

Background: Dietary polyphenols, including phytoestrogens are abundantly present in a balanced diet. Evidence for their role in preventing non-communicable diseases is emerging. Methods: We examined the association between estimated habitual intakes of dietary phytoestrogens and hypertension in a cohort study. The baseline data included 1936 men and women aged 18 years and older. Intakes of total phytoestrogens, isoflavones, and lignans were calculated from validated food frequency questionnaire. Data on the polyphenols content in foods were retrieved from the Phenol-Explorer database. Results: Individuals in the highest quartile of dietary phytoestrogens intake were less likely to be hypertensive (OR: 0.66, 95% CI: 0.44–0.98); moreover, the association showed a significant decreasing trend. Isoflavones and lignans were not associated with lower odds of hypertension; however, some individual compounds, such as biochanin A and pinoresinol showed an independent inverse association with hypertension. Conclusions: Dietary phytoestrogens are associated with lower likelihood of hypertension in adults living in the Mediterranean area. Future studies are needed to confirm the present findings (i.e., prospective cohort studies) and to better understand the mechanisms underlying such associations.