The complex relationship between diet, quality of life and life expectancy: a narrative review of potential determinants based on data from Italy

Life expectancy in relation to societal development level: significant discordant factors

OBJECTIVES

The aim of this study is to determine the interdependence between life expectancy and numerous social indicators, i.e., to determine the factors that encourage an increase or decrease in life expectancy.

METHODS

Pearson coefficients as well as linear and logarithmic trends and correlations between the dependent variable of life expectancy and numerous independent variables were calculated and analysed. The calculations were carried out for all countries in the world for which data is available. Based on the strength of the correlations between life expectancy and numerous indicators, we have tried to determine the reasons for the different values of life expectancy in the various countries.

RESULTS

Important factors for achieving high life expectancy values are economic development and healthcare spending but the spread of "diseases of the modern era", such as obesity or diabetes, have a significant negative impact on life expectancy. Other important limiting factors for life expectancy are large income inequalities, a higher share of private healthcare expenditure in total healthcare expenditure and lower total healthcare expenditure. Less developed societies can significantly increase their life expectancy by providing clean water and safe sanitation and by combating various infectious diseases (especially HIV).

CONCLUSIONS

Life expectancy is a meaningful indicator of the state of social development and accurately reflects the general state of a particular society. It has been shown that GDP per capita (PPP) is a key determinant of life expectancy, while other important factors play the role of a further modifier.

Fostering wellbeing and healthy lifestyles through conviviality and commensality: Underappreciated benefits of the Mediterranean Diet

Among the often-neglected features of healthy diets, such as the Mediterranean diet, is the preparation and sharing of food, which is (or was) done in a social environment governed by social rules rather than by time constraints. The act of eating is a daily human practice that is not limited to meeting nutritional and energy needs but also involves a constructed social dimension of sharing meals that is part of the process of human civilization and food cultures around the world. In this narrative review, we outline the importance of conviviality in steering part of the health effects of healthful diets, with special reference to the Mediterranean diet. Based on the available evidence, we suggest that public health initiatives (such as nudging to promote conviviality) to improve people's eating and living styles, reduce loneliness, and promote the sharing of meals could improve health. Interventions aimed at directly increasing/improving people's social relationships, networking, and conviviality can-directly and indirectly-improve both psychological well-being and general health.

Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists’ Knowledge and Adherence to Evidence-Based Practice

The average life expectancy of the Italian population has increased over the last decades, with a consequent increase in the demand for healthcare. Rehabilitation after hip fracture surgery is essential for autonomy, recovery, and reintegration into the social context. The aim of this study was to determine the level of knowledge and adherence to the recent treatment recommendations of the Italian physiotherapists. A web-based survey, composed of 21 items, was conducted and the frequencies and percentages of the responses were analyzed to evaluate if there was an integration and adherence to the recommendations of greater than 70%, with respect to the desired response. A total of 392 responses were collected and analyzed. Recommendations regarding the multidisciplinary approach, early mobilization, and progressive muscle strength training, achieved the desired value in the inpatient setting. Intensive rehabilitation and full weight bearing did not reach the threshold values. The results of this survey show a partial integration of the recommendations for rehabilitation after hip fracture surgery by Italian physiotherapists. Adherence seems to be better in the inpatient setting and with physiotherapists with higher levels of education.

How Much Do Front-Of-Pack Labels Correlate with Food Environmental Impacts?

Nutrient profiling and front-of-pack labeling (FOPL) have been developed to categorize food products as more or less healthy based on their nutrient content and to easily communicate this information to consumers. The goal is to change individual food choices toward a healthier diet. Since global climate change has recently become an urgent matter, this paper also aims to investigate the correlations between different food health scales, including some FOPLs currently adopted by one or more countries, and several sustainability indicators. For this purpose, a food sustainability composite index has been developed to summarize environmental indicators and compare food scales. Results indicate, as expected, that well-known healthy and sustainable diets are strongly correlated with both environmental indicators and the composite index, while FOPLs based on portions or on 100 g show moderate and weak correlation values, respectively. Within-category analysis has not found any associations that explain these results. Hence, 100 g standard, on which FOPLs are usually developed, seems not to be the ideal basis for developing a label that aspires to communicate healthiness and sustainability in a unique format, as required by the need for simple messaging. On the contrary, FOPLs based on portions appear to be more likely to achieve this goal.

Nutritional Impact on Metabolic Homeostasis and Brain Health

Aging in modern societies is often associated with various diseases including metabolic and neurodegenerative disorders. In recent years, researchers have shown that both dysfunctions are related to each other. Although the relationship is not fully understood, recent evidence indicate that metabolic control plays a determinant role in neural defects onset. Indeed, energy balance dysregulation affects neuroenergetics by altering energy supply and thus neuronal activity. Consistently, different diets to help control body weight, blood glucose or insulin sensitivity are also effective in improving neurodegenerative disorders, dampening symptoms, or decreasing the risk of disease onset. Moreover, adapted nutritional recommendations improve learning, memory, and mood in healthy subjects as well. Interestingly, adjusted carbohydrate content of meals is the most efficient for both brain function and metabolic regulation improvement. Notably, documented neurological disorders impacted by specific diets suggest that the processes involved are inflammation, mitochondrial function and redox balance as well as ATP production. Interestingly, processes involving inflammation, mitochondrial function and redox balance as well as ATP production are also described in brain regulation of energy homeostasis. Therefore, it is likely that changes in brain function induced by diets can affect brain control of energy homeostasis and other brain functions such as memory, anxiety, social behavior, or motor skills. Moreover, a defect in energy supply could participate to the development of neurodegenerative disorders. Among the possible processes involved, the role of ketone bodies metabolism, neurogenesis and synaptic plasticity, oxidative stress and inflammation or epigenetic regulations as well as gut-brain axis and SCFA have been proposed in the literature. Therefore, the goal of this review is to provide hints about how nutritional studies could help to better understand the tight relationship between metabolic balance, brain activity and aging. Altogether, diets that help maintaining a metabolic balance could be key to both maintain energy homeostasis and prevent neurological disorders, thus contributing to promote healthy aging.

A comprehensive overview of the complex relationship between epigenetics, bioactive components, cancer, and aging

Among age-related diseases, the incidence of cancer increases significantly due to the overlap of some molecular pathways between cancer and aging. While the genetic influence on the human lifespan is estimated to be about 20-25%, epigenetic changes play an important role in modulating individual health status, aging. Aging and age-related conditions are processes that can be modified by both genetic, environmental factors, including dietary habits. Epigenetics is a new discipline has significant potential to be applied for the prevention, management of certain carcinomas and diseases. Epigenetic modifications may play an important role in disease occurrence and pathogenesis. Some nutritional components can be significantly effective in the prevention of breast, skin, esophagus, colorectal, prostate, pancreatic, lung cancers. It contains minerals, vitamins, and some bioactive components (curcumin, indole 3 carbinol, di-indolylmethane, sulforaphane, epigallocatechin-3-gallate, genistein, resveratrol, pterostilbene, apigenin, etc.) regulatory processes. However, compelling evidence suggests that dietary habits can manipulate the aging process and/or its consequences, have health benefits. Aging processes become complex when combined with the relational role of bioactive nutritional components on gene expression. In this review, the relationship between epigenetic processes caused by DNA methylylation, histone modification, non-coding m-RNA, and telomerase activity, the risk of aging and cancer is discussed.

The Nordic prudent diet prolongs survival with good mental and physical functioning among older adults: The role of healthy lifestyle

BACKGROUND & AIMS

Healthy diet has been associated with decreased mortality, but its impact on survival without disability is less clear. We aimed to investigate the association between the Nordic Prudent Diet Pattern (NPDP) and dementia- and disability-free survival, and to assess its interaction with other healthy lifestyle behaviors.

METHODS

Within the Swedish National Study on Aging and Care-Kungsholmen, 2290 dementia- and disability-free adults aged ≥60 were followed up to 12 years to detect survival free from dementia (standard criteria) and disability (Katz's Activities of Daily Living). NPDP index was assessed at baseline with a 98-item food frequency questionnaire (characterized mainly by more frequent intakes of vegetable, fruit, cooking, cereals, whole grains, fish, and water) and was further categorized into tertiles (low, moderate, or high). Information on lifestyle factors was collected via baseline questionnaire. A favorable (vs unfavorable) lifestyle profile was determined based on smoking status, social network and physical activity. Data were analyzed using Cox proportional hazard regression models and Laplace regression.

RESULTS

During the follow-up, 1074 participants survived without dementia and disability (614 died, 518 became disabled, and 84 developed dementia). Compared to low NPDP adherence, the hazard ratio (HR) of high NPDP adherence was 1.19 (95% CI 1.04-1.34) for dementia- and disability-free survival. High NPDP adherence prolonged lifespan without mental and physical disability by an average of 1.24 years (95% CI 0.11-2.37). Further, among participants with high NPDP adherence, a favorable lifestyle profile was associated with an even higher HR (1.96, 95% CI 1.52-2.42) of dementia- and disability-free survival, corresponding to an average of 3.80 (95% CI 2.25-5.35) years longer life compared to those with low NPDP adherence and an unfavorable lifestyle profile.

CONCLUSION

High adherence to NPDP prolongs survival with good mental and physical function for more than one year, and this could increase to almost four years with a favorable lifestyle.

Organic Food Consumption in Italy: The Role of Subjective Relevance of Food as Mediator between Organic Food Choice Motivation and Frequency of Organic Food Consumption

Nowadays, the problems that afflict our planet (climate change, loss of biodiversity, etc.) are leading to the implementation of a more sustainable type of consumption. Increasing the consumption of organic products is a way to face and try to solve these problems. In order to reach this aim, it is important to understand how consumers’ subjective relevance of these products impacts on their consumption. The recent literature, in fact, highlighted how food consumption is salient for the individual to express their identity and life orientations, even more in the case of organic food consumption. Nonetheless, little is known about how subjective relevance of food affects organic food consumption. The present research aims to measure the role of subjective relevance in organic food consumption. Data were collected with a self-report questionnaire that was filled out by a sample of 964 Italians, representative of the population. We used structural equation modelling (SEM) and the bootstrap technique to test the hypothesis. The results show that subjective food relevance is a mediator between the motivations of organic food consumption and the frequency of consumption of it. This research points out the necessity to study consumers in a wider way, using communication that emphasizes the role that these products have in satisfying the psychological needs of consumers.

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.

Entomophagy: A Narrative Review on Nutritional Value, Safety, Cultural Acceptance and A Focus on the Role of Food Neophobia in Italy

In recent years, the consumption of insects, or entomophagy, has produced an increasing interest amongst scientists and ecologists as a potential source of animal protein. Eating insects is also interesting in terms of low greenhouse gas emissions and low land use. In contrast to tropical countries, where most of the 2000 edible insect species are traditionally consumed, the concept of eating insects is still new to Western culture and diet. Culture and eating habits exert a great influence on what is considered edible in the Mediterranean area, especially in Italy, where the preservation of culinary traditions is a predominant factor affecting dietary behaviour. The purpose of this narrative paper is to provide an overview of the main topics related to entomophagy. The introduction presents some information about the nutrient content and safety aspects, the second part summarises the cultural acceptance of insect in the world, while the role of food neophobia on the intention to consume insects in Italy is focused on in part three. The discussion displays important viewpoints of previously published studies and based on these perspectives it can be concluded that the Italian diet is still clearly influenced by local tradition. In conclusion, in order to introduce insects into the Italian diet, psychological motivation has to be enhanced.