Adherence to the Mediterranean diet and risk of metabolic syndrome and its components

Associations and predictive power of dietary patterns on metabolic syndrome and its components

BACKGROUND AND AIMS

Metabolic syndrome (MetS) defines important risk factors in the development of cardiovascular diseases and other serious health conditions. This study aims to investigate the influence of different dietary patterns on MetS and its components, examining both associations and predictive performance.

METHODS AND RESULTS

The study sample included 10,750 participants from the seventh survey of the cross-sectional, population-based Tromsø Study in Norway. Diet intake scores were used as covariates in logistic regression models, controlling for age, educational level and other lifestyle variables, with MetS and its components as response variables. A diet high in meat and sweets was positively associated with increased odds of MetS and elevated waist circumference, while a plant-based diet was associated with decreased odds of hypertension in women and elevated levels of triglycerides in men. The predictive power of dietary patterns derived by different dimensionality reduction techniques was investigated by randomly partitioning the study sample into training and test sets. On average, the diet score variables demonstrated the highest predictive power in predicting MetS and elevated waist circumference. The predictive power was robust to the dimensionality reduction technique used and comparable to using a data-driven prediction method on individual food variables.

CONCLUSIONS

The strongest associations and highest predictive power of dietary patterns were observed for MetS and its single component, elevated waist circumference.

A machine learning approach to personalized predictors of dyslipidemia: a cohort study

Introduction

Mexico ranks second in the global prevalence of obesity in the adult population, which increases the probability of developing dyslipidemia. Dyslipidemia is closely related to cardiovascular diseases, which are the leading cause of death in the country. Therefore, developing tools that facilitate the prediction of dyslipidemias is essential for prevention and early treatment.

Methods

In this study, we utilized a dataset from a Mexico City cohort consisting of 2,621 participants, men and women aged between 20 and 50 years, with and without some type of dyslipidemia. Our primary objective was to identify potential factors associated with different types of dyslipidemia in both men and women. Machine learning algorithms were employed to achieve this goal. To facilitate feature selection, we applied the Variable Importance Measures (VIM) of Random Forest (RF), XGBoost, and Gradient Boosting Machine (GBM). Additionally, to address class imbalance, we employed Synthetic Minority Over-sampling Technique (SMOTE) for dataset resampling. The dataset encompassed anthropometric measurements, biochemical tests, dietary intake, family health history, and other health parameters, including smoking habits, alcohol consumption, quality of sleep, and physical activity.

Results

Our results revealed that the VIM algorithm of RF yielded the most optimal subset of attributes, closely followed by GBM, achieving a balanced accuracy of up to 80%. The selection of the best subset of attributes was based on the comparative performance of classifiers, evaluated through balanced accuracy, sensitivity, and specificity metrics.

Discussion

The top five features contributing to an increased risk of various types of dyslipidemia were identified through the machine learning technique. These features include body mass index, elevated uric acid levels, age, sleep disorders, and anxiety. The findings of this study shed light on significant factors that play a role in dyslipidemia development, aiding in the early identification, prevention, and treatment of this condition.

Metabolic syndrome in relation to dietary acid load: a dose-response meta-analysis of observational studies

Background and aim

Several studies have identified that dietary acid load (DAL) may be associated with the odds of metabolic syndrome (MetS); however, the evidence is inconclusive. This dose-response meta-analysis aimed to examine the relation of DAL to MetS.

Methods

A systematic literature search was carried out in PubMed and Scopus up to April 2023 for pertinent studies evaluating the relation of DAL scores, including potential renal acid load (PRAL) and net endogenous acid production (NEAP), to the odds of MetS. The odds ratios (OR) with 95% confidence intervals (CI) were pooled using a random-effects meta-analysis to test the association.

Results

Eight studies, with an overall sample size of 31,351 participants, were included in this meta-analysis. Higher DAL scores were significantly related to the elevated odds of MetS (NEAP: OR = 1.42, 95%CI = 1.12-1.79; PRAL: OR = 1.76, 95%CI = 1.11-2.78), with significant evidence of heterogeneity across studies. The linear dose-response analysis proposed that a 10 mEq/day elevation in NEAP and PRAL was linked to a 2% (OR = 1.02, 95%CI = 1.001-1.05) and 28% (OR = 1.28, 95%CI = 1.11-1.47) increased odds of MetS, respectively. No non-linear association was observed between MetS and NEAP (P-non-linearity = 0.75) and PRAL (P-non-linearity = 0.92).

Conclusion

This study revealed a significant direct relationship between DAL and MetS. Therefore, lower acidogenic diets are suggested for the prevention of MetS.

The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study

The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the study. The population under study (n = 24) had a median age of 47.5 (41.5-52.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33-89) vs. 85 (54-95), p < 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02-0.09) vs. 0.05 (0.02-0.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6-37.3) vs. 35.3 (31.2-39.0), p < 0.0001), WC (106.5 (95.0-112.5) vs. 110.0 (103.0-124.0), p < 0.0001), neck circumference (38.0 (35.0-41.5) vs. 39.5 (38.0-42.5), p < 0.0001), fat mass (32.3 (23.4-40.7) vs. 37.9 (27.7-43.5), p < 0.0001), and extracellular water (17.3 (15.2-20.8) vs. 18.3 (15.9-22.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5-39.0) vs. 38.0 (34.0-40.5), p = 0.01), triglycerides (72 (62-90) vs. 90 (64-132), p = 0.03), and the liver markers AST (17 (14-19) vs. 18 (15-27), p = 0.01) and γGT (16 (13-20) vs. 16 (14-27), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.

Role of Nutrition in the Etiopathogenesis and Prevention of Nonalcoholic Fatty Liver Disease (NAFLD) in a Group of Obese Adults

Nonalcoholic fatty liver disease (NAFLD) is liver damage characterized by an accumulation of triglycerides in hepatocytes of >5% (due to an alteration of the balance of the lipid metabolism in favour of lipogenesis compared to lipolysis) that is not induced by the consumption of alcohol. The pathology includes simple steatosis and nonalcoholic steatohepatitis, or NASH (steatosis associated with microinflammatory activities), which can evolve in 15% of subjects with hepatic fibrosis to cirrhosis and the development of hepatocellular carcinoma. The aim of this study is to report the role of macro- and micronutrients in the pathogenesis and prevention of NAFLD in obese subjects. A total of 22 obese or overweight patients with hepatic steatosis were monitored periodically, evaluating their eating habits, fasting glycaemia, lipid picture, liver enzymes, anthropometric parameters, nutrition status, liver ultrasound, oxidative stress, and adherence to the Mediterranean diet. A statistical analysis shows a significant positive relationship between total cholesterol and the Mediterranean adequacy index (MAI) (r = -0.57; p = 0.005) and a significant negative relationship between ALT transaminases and the MAI (r = -0.56; p = 0.007). Nutrition and diet are important factors in the pathogenesis and prevention of NAFLD. The dietary model, based on the canons of the Mediterranean diet, prevents and reduces the accumulation of fat in hepatocytes. Therefore, in agreement with other studies in the literature, we can state that a dietary model characterized by foods rich in fibre, carotenoids, polyphenols, ω3 fatty acids, folic acid, and numerous other molecules is inversely correlated with the serum levels of ALT transaminases, an enzyme whose level increases when the liver is damaged and before the most obvious symptoms of organ damage appear.

The Effects of Eight Weeks' Very Low-Calorie Ketogenic Diet (VLCKD) on Liver Health in Subjects Affected by Overweight and Obesity

Very low-calorie ketogenic diets (VLCKD) are widely employed in successful weight-loss strategies. Herein, we evaluated the efficacy and safety of a VLCKD on non-alcoholic fatty liver disease (NAFLD) and parameters commonly associated with this condition in overweight and obese subjects who did not take any drugs. This prospective, real-life study included thirty-three participants who followed a VLCKD for 8 weeks. NAFLD was diagnosed using transient elastography (FibroScan). Data on anthropometric measurements, bioimpedance analysis, and biochemical assays were gathered both before and after the dietary intervention. BMI (kg/m²) (from 33.84 ± 6.55 to 30.89 ± 6.38, p < 0.01), waist circumference (cm) (from 106.67 ± 15.51 to 98.64 ± 16.21, p < 0.01), and fat mass (Kg) (from 38.47 ± 12.59 to 30.98 ± 12.39, p < 0.01) were significantly lower after VLCKD. CAP (db/m), the FibroScan parameter quantifying fatty liver accumulation, showed a significant reduction after VLCKD (from 266.61 ± 67.96 to 223 ± 64.19, p < 0.01). After VLCKD, the fatty liver index (FLI), a benchmark of steatosis, also revealed a significant decline (from 62.82 ± 27.46 to 44.09 ± 31.24, p < 0.01). Moreover, fasting blood glucose, insulin, triglycerides, total cholesterol, LDL-cholesterol, ALT, γGT, and FT3 blood concentrations, as well as insulin resistance (quantified by HOMAIR) and systolic and diastolic blood pressure levels, were significantly lower after VLCKD (p < 0.01 for all the parameters). By contrast, HDL-cholesterol, 25 (OH) vitamin D, and FT4 blood concentrations were higher after VLCKD (p < 0.01 for all parameters). The variation (δ) of CAP after VLCKD did not show a correlation with the δ of any other parameter investigated in this study. We conclude that VLCKD is a helpful approach for NAFLD independent of changes in factors commonly associated with NAFLD (obesity, fat mass, insulin resistance, lipids, and blood pressure) as well as vitamin D and thyroid hormone levels.

Adherence to the Mediterranean Diet Is Inversely Associated with the Prevalence of Metabolic Syndrome in Older People from the North of Spain

Background: The aim of this study was to relate adherence to the Mediterranean diet (MedDiet) to the prevalence of metabolic syndrome (MetS) in an elderly population from the north of Spain. Methods: We carried out an observational, descriptive, cross-sectional, and correlational study involving 556 non-institutionalised individuals aged 65 to 79 years. The MEDAS-14 questionnaire score was used to define the degree of adherence to the Mediterranean diet. The diagnosis of MetS was conducted using the International Diabetes Federation (IDF) criteria. Results: In 264 subjects with an average age of 71.9 (SD: ±4.2), 39% of whom were men, 36.4% had good adherence (score ≥ 9 in MEDAS-14), with no differences by gender or age. The prevalence of MetS was 40.2%, with 47.6% in men and 35.4% in women (p < 0.05). The prevalence of MetS was 2.4 times more frequent among individuals who consumed less than two servings (200 g) of vegetables daily compared with those who consumed two or more servings of vegetables daily (OR: 2.368, 95%CI: 1.141−4.916, p = 0.021). Low adherence to the MedDiet (MEDAS-14 score ≤ 8) was associated with an 82% higher prevalence of MetS (OR: 1.817, 95%CI: 1.072−3.081, p = 0.027). Conclusion: An inverse relationship was established between adherence to the MedDiet and the prevalence of MetS.

Foods of the Mediterranean diet: tomato, olives, chili pepper, wheat flour and wheat germ

Mediterranean people, which follows a diet rich in minimally-processed plant-based foods, are believed to live longer and healthier lives than many other populations in the Western world. Epidemiological and clinical data suggest that the Mediterranean diet has beneficial effects for several chronic diseases, such as cardiovascular diseases, obesity, cancer and diabetes. Although the mechanisms of action of the Mediterranean diet are not completely clear, the synergistic effects of a number of its components and their bioactive phytochemicals exert antioxidant, anti-inflammatory, anti-microbial and anti-cancer effects. The Mediterranean diet includes daily consumption of whole cereals, fruit, vegetables and legumes in moderate proportions, weekly consumption of white meat in low to moderate proportions and occasionally sweets and chocolates in small amounts. Since olive oil is the main lipids source, it has special significance for health. Healthy fruit and vegetables, rich in phytochemicals, are a major proportion of this diet and contribute to the overall nutritional value and bioactivity of its components. Here we review the nutritional and health benefits of wheat germ, tomatoes, olives and chili pepper, items at the base of Mediterranean diet food pyramid that provides beneficial molecules, such as polyphenols, vitamins and flavonoids, and exert anti-inflammatory, anti-microbial and anti-oxidative actions.

High fat diets induce early changes in gut microbiota that may serve as markers of ulterior altered physiological and biochemical parameters related to metabolic syndrome. Effect of virgin olive oil in comparison to butter

Butter and virgin olive oil (EVOO) are two fats differing in their degree of saturation and insaponifiable fraction. EVOO, enriched in polyphenols and other minority components, exerts a distinct effect on health. Using next generation sequencing, we have studied early and long-term effects of both types of fats on the intestinal microbiota of mice, finding significant differences between the two diets in the percentage of certain bacterial taxa, correlating with hormonal, physiological and metabolic parameters in the host. These correlations are not only concomitant, but most noticeably some of the changes detected in the microbial percentages at six weeks are correlating with changes in physiological values detected later, at twelve weeks. Desulfovibrionaceae/Desulfovibrio/D. sulfuricans stand out by presenting at six weeks a statistically significant higher percentage in the butter-fed mice with respect to the EVOO group, correlating with systolic blood pressure, food intake, water intake and insulin at twelve weeks. This not only suggests an early implication in the probability of developing altered physiological and biochemical responses later on in the host lifespan, but also opens the possibility of using this genus as a marker in the risk of suffering different pathologies in the future.

Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial

BACKGROUND

Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease.

METHODS

The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death. This study is registered with ClinicalTrials.gov, NCT00924937.

FINDINGS

From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49·9%) in the low-fat diet group and 502 (50·1%) in the Mediterranean diet group. The mean age was 59·5 years (SD 8·7) and 827 (82·5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group (crude rate per 1000 person-years: 28·1 [95% CI 27·9-28·3] in the Mediterranean diet group vs 37·7 [37·5-37·9] in the low-fat group, log-rank p=0·039). Multivariable-adjusted hazard ratios (HRs) of the different models ranged from 0·719 (95% CI 0·541-0·957) to 0·753 (0·568-0·998) in favour of the Mediterranean diet. These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group (multiadjusted HR 0·669 [95% CI 0·489-0·915], log-rank p=0·013), than in 175 women for whom no difference was found between groups.

INTERPRETATION

In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.

FUNDING

Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union.

Effects of Anthocyanin-rich Berries on the Risk of Metabolic Syndrome: A Systematic Review and Meta-analysis

OBJECTIVE: Metabolic syndrome (MetS) can lead to fatal complications, including cardiovascular disease. Emerging evidence suggests has emerged that increased fruit and vegetable intake and decreased intake of saturated fats, simple sugars, and processed foods can improve cardiovascular health. Anthocyanins (color pigments) have anti-inflammatory and antioxidant capacities but are of low bioavailability. In this systematic review and metaanalysis, we investigate the possible beneficial effects of the intake of berries high in anthocyanins on MetS risk factors. We also investigate the influences of high-density lipoprotein (HDL), lowdensity lipoprotein (LDL), triglycerides (TG), and total cholesterol (TC). METHODS: We identified 2,274 articles from PUBMED and EMBASE following a search input designed to include studies of interest of these, 21 met inclusion criteria. RESULTS: The studies showed an overall reduction in low-density lipoprotein (p=0.04). Increases in HDL were found with cranberry and freeze-dried berry intake during a 4-6-week intervention. No statistically significant findings were detected for fasting glucose, Hb1Ac, insulin levels, blood pressure, oxidized LDL (OX-LDL), BMI, and overall HDL. CONCLUSIONS: We conclude from this systematic review and meta-analysis that increased berry intake improves MetS key risk factors and reduces the risk of cardiovascular disease. Pronounced effects were apparent for concentrated berry products, such as freeze-dried strawberries.

The role of positive psychological constructs in diet and eating behavior among people with metabolic syndrome: A qualitative study

Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.

An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study

BACKGROUND

Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis.

METHODS

This 9-week single-arm feasibility study recruited participants aged 40-85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval.

RESULTS

Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m-2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection.

CONCLUSION

This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis.

TRIAL REGISTRATION

ACTRN12620000229976 prospectively on 25/2/2020.

Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults

Depression is a leading cause of disability, yet current prevention and treatment approaches have only had modest effects. It is important to better understand the role of dietary patterns on depressive symptoms, which may help prevent depression or complement current treatments. This study examined whether adherence to a Mediterranean diet (Med Diet), determined by the Alternate Med Diet score (aMED), was associated with depressive symptoms in a representative sample of U.S. adults. The aMED score (range 0–9) was calculated from a 24-h diet recall with gender-specific quartiles (Q) estimated. The Patient Health Questionnaire-9 (PHQ-9) was used to define depressive symptoms, which was dichotomized as no to mild (0–9) versus moderate to severe symptoms (10–27). Logistic regression was used to investigate the association between quartiles of aMED and depressive symptoms when controlling for sociodemographics, total calories, and the time of year of diet recall; 7.9% of the sample had moderate to severe depressive symptoms. Compared to individuals with the lowest aMED (Q1), individuals in Q3 and Q4 had 40% and 45% lower odds of moderate to severe depressive symptoms (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.50, 0.74; OR = 0.55, 95% CI: 0.36, 0.84, respectively). This study provides modest support of Med Diet’s role in supporting positive mental health.

Inflammation Parameters Associated with Metabolic Disorders: Relationship Between Diet and Microbiota

The metabolic syndrome (MetS) includes numerous interrelated clinical, anthropometric, biochemical, and metabolic components and has become a public health problem due to its impact on morbimortality. Inflammation is a central mechanism underlying the etiology and clinical manifestations of MetS, contributing to its related pathological outcomes. Dietary patterns have been associated with the promotion of the diversity of microbiota in the digestive tract. Recently, research has focused on the importance of microbiota changes associated with MetS and inflammation. Other studies have been performed to understand the impact of prebiotics, probiotics, and synbiotics as allies on diet, inflammation, and MetS parameters. This review analyses the correlation between metabolic disorders, inflammation parameters, gut microbiota, and how diet has been involved as treatment of MetS and the modulation of inflammation and microbiota.

The association between dietary approaches to stop hypertension diet and mediterranean diet with metabolic syndrome in a large sample of Iranian adults: YaHS and TAMYZ Studies

Dietary patterns are considered as a modifiable risk factor for metabolic syndrome (MetS). Therefore, the present study aimed to evaluate the association between the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean (MED) dietary patterns and MetS. This cross-sectional study was conducted on the data from recruitment phase of prospective studies on Iranian adults known as Yazd Health Study (YaHS) and Yazd Nutrition Study (TAMYZ). MetS was diagnosed among 2,221 adults based on the Adult Treatment Panel III criteria. The participants' dietary intake was assessed by a validated food frequency questionnaire. According to the predefined methods, DASH and MED scores were calculated. Multivariate logistic regression was used to evaluate the relationship of DASH and MED dietary patterns with MetS. The prevalence of MetS was 28.8% in the present study. Women who were in the highest quintile of DASH in comparison with those who were in the first quintile tended to decrease the odds of MetS after adjusting for the potential confounders (OR: 0.50, CI: 0.27-0.95). There was a significant decreasing trend in the odds of MetS across increasing quintiles of the DASH in women (p-trend = .006). Also, the highest adherence to DASH reduced the odds of abdominal obesity (OR: 0.34, CI: 0.15-0.77) in women. Although adherence to MED dietary pattern had no significant relationship with MetS, moderate adherence to this dietary pattern could decrease the odds of fasting blood glucose levels (OR: 0.57, CI: 0.33-0.97) and abdominal obesity (OR: 0.42, CI: 0.20-0.87) in women. We found evidence indicating a significant protective association between DASH and METs and its component in women. Hence, more prospective studies are needed to confirm our findings in other populations.

Impact of Christian Orthodox Church dietary recommendations in Metabolic Syndrome risk factors: a scoping review

Fasting has been a practice among followers of different religions for many years. Christian Orthodox Church (COC) fasting is a periodic vegetarian-type diet while seafood and snails are allowed on most fasting days. The present scoping review aimed to present available data regarding the benefits of COC fasting on metabolic syndrome (MetS) risk factors. Databases were searched for available studies. Twenty publications, with a total of 1226 fasting participants, provided data on the effects on different variables of the MetS, including blood pressure, blood lipids and anthropometric measurements. Fasters' diet is characterized by low saturated and trans fat intake, high complex carbohydrate and fiber consumption, due to foods allowed to consume. COC fasting has no deficiency in essential amino acids intake since seafood and snails allowed on fasting days. Fasters have healthier blood lipid profiles during and after COC fasting periods, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, body weight and body mass index are reduced after a fasting period. Due to restricted or forbidden intake of specific foods during the COC fasting periods, one might expect that fasters may have reduced intake of macro- and micro-nutrients, but as showed in the available literature there are no deficiencies. Future research on COC fasting is needed in areas not investigated at all, like MetS, before reaching definite conclusions.

Mediterranean diet enriched in extra-virgin olive oil or nuts modulates circulating exosomal non-coding RNAs

PURPOSE

Exosomes are extracellular vesicles secreted by cells, which can transport different molecules, including nucleic acids. Dietary habits may induce gene regulation through the modulation of exosomal RNAs. We aimed at characterizing exosomal lncRNAs, mRNA and miRNAs modulation after a 1-year adherence to a low-fat diet (LFD) or to Mediterranean-based diets enriched in extra-virgin olive oil (MedDiet + EVOO) or in a mixture of nuts (MedDiet + Nuts).

METHODS

Plasma samples were collected, at baseline and after 1 year of dietary interventions, from 150 participants included in the PREDIMED study (Reus Center). LncRNAs, mRNAs and miRNAs were isolated from plasma exosomes and screened. RT-qPCR validation was performed for miRNAs.

RESULTS

Compared with LFD, 413 lncRNAs and 188 mRNAs, and 476 lncRNAs and 235 mRNAs were differentially modulated in response to the MedDiet + EVOO and MedDiet + Nuts interventions, respectively. In addition, after 1 year of dietary interventions, 26 circulating miRNAs were identified as differentially expressed between groups. After 1 year of intervention, 11 miRNAs significantly changed in LFD group, while 8 and 21 were modulated in response to the MedDiet enriched with EVOO or nuts, respectively. Bioinformatic analyses of differentially expressed miRNAs and their validated target genes suggest certain metabolic pathways are modulated by LFD (PI3K-Akt and AMPK), MedDiet + EVOO (PI3K-Akt, NF-kappa B, HIF-1, and insulin resistance), and MedDiet-Nuts (FoxO, PI3K-Akt, AMPK, p53 and HIF-1) interventions.

CONCLUSION

Results show that 1-year MedDiet + Nuts and MedDiet + EVOO dietary interventions modulate exosomal RNA content, with the former affecting a higher number of miRNAs. The modulation of exosomal RNAs could help explain how the adherence to a Mediterranean diet may lead to beneficial effects and deserves further investigation.

Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study

OBJECTIVE

To analyse the influence of the Mediterranean diet (Med Diet) on SLE activity, damage accrual and cardiovascular disease risk markers.

METHODS

A cross-sectional study was conducted on 280 patients with SLE [46.9 (12.85) years]. Med Diet adherence was assessed through a 14-item questionnaire on food consumption frequency and habits (total score from 0 to 14 points; higher score is greater adherence to the Med Diet). CRP, homocysteine, SLEDAI-2K (SLE disease activity), and SLICC/ACR and SDI (damage accrual) were measured. Obesity, diabetes mellitus, hypertension and blood lipids, among others, were considered cardiovascular disease risk factors.

RESULTS

Greater adherence to the Med Diet was significantly associated with better anthropometric profiles, fewer cardiovascular disease risk factors, and lower disease activity and damage accrual scores (P ≤ 0.001 for SLEDAI and SDI). An inverse relationship between the Med Diet score and SLEDAI (P ≥ 0.001; β = -0.380), SDI (P ≤ 0.001; β = -0.740) and hsCRP (P = 0.039; β = -0.055) was observed. The odds ratio for having active SLE (SLEDAI ≥5) or the presence of damage (SDI ≥1) was lower among patients whose Med Diet score was higher (P ≤ 0.001). Finally, greater consumption of Med Diet foods (olive oil, fruits, vegetables, fish, etc.) and abstaining from red meat and meat products, sugars and pastries was associated with less SLE clinical activity and damage.

CONCLUSION

Greater adherence to the Med Diet seems to exert a beneficial effect on disease activity and cardiovascular risk in SLE patients. To confirm these findings, further longitudinal studies would be of interest.

Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes

Obesity-related type 2 diabetes represents one of the most difficult challenges for the healthcare system. This retrospective study aims to determine the efficacy, safety and durability of a very-low-calorie ketogenic diet (VLCKD), compared to a standard low-calorie diet (LCD) on weight-loss, glycemic management, eating behavior and quality of life in patients with type 2 diabetes (T2DM) and obesity. Thirty patients with obesity and T2DM, aged between 35 and 75 years, who met the inclusion criteria and accepted to adhere to a VLCKD or a LCD nutritional program, were consecutively selected from our electronic database. Fifteen patients followed a structured VLCKD protocol, fifteen followed a classical LCD. At the beginning of the nutritional protocol, all patients were asked to stop any antidiabetic medications, with the exception of metformin. Data were collected at baseline and after 3 (T1) and 12 (T2) months. At T1 and T2, BMI was significantly reduced in the VLCKD group (p < 0.001), whereas it remained substantially unchanged in the LCD group. HbA1c was significantly reduced in the VLCKD group (p = 0.002), whereas a slight, although not significant, decrease was observed in the LCD group. Quality of life and eating behavior scores were improved in the VLCKD group, whereas no significant changes were reported in the LCD group, both at T1 and T2. At the end of the study, in the VLCKD group 26.6% of patients had stopped all antidiabetic medications, and 73.3% were taking only metformin, whereas 46.6% of LCD patients had to increase antidiabetic medications. The study confirms a valuable therapeutic effect of VLCKD in the long-term management of obesity and T2DM and its potential contribution to remission of the disease.

Adherence to the Mediterranean diet decreases the risk of stroke in the Lebanese population: a case-control study

Objective:

The objective of this study was to assess adherence to the Mediterranean diet (MeD) and the risk of stroke in the Lebanese population.

Methods:

A hospital based case-control study was conducted in Lebanon between January 1^st, 2015 and December 31^st, 2016. Data were collected prospectively using a standardized questionnaire. Adherence to the MeD was assessed based on the total number of points a patient can have on the MeD scale. Data were analysed using SPSS version 24. The strength of association between the risk of stroke and adherence to MeD was expressed in odds ratio (OR) through 95% confidence interval. P-value <0.05 determined statistical significance.

Results:

Around 205 stroke cases and 445 hospitalized stroke-free patients were included in this study. In the total study sample, the MeD had a minimum of 2 and a maximum of 11 points with a median of 7 points. Stroke patients had a lower MeD median compared to controls (6 vs 8 points). Around 29.5% of the total sample had a MeD score within the first quartile (52.3% of them had a stroke) and 24% of all included subjects scored within the last quartile (7% of them hospitalized for stroke) (p<0.001). The higher the adherence to MeD the lower the risk of stroke. High adherence to MeD was associated with a decreased risk of stroke, OR 0.1 (95%CI, 0.04-0.24; p<0.001).

Conclusions:

Higher adherence to MeD significantly decreases the risk of stroke in the Lebanese population. Good lifestyle choices are encouraged in order to prevent many vascular diseases including stroke.

Eating behavior: The influence of age, nutrition knowledge, and Mediterranean diet

BACKGROUND

Student life during the university period is characterized by many changes in eating behaviors and dietary patterns due to adaptation to a new environment, study stress, lack of proper time management, and busy class schedules. These unhealthy actions may be detrimental to cognitive processing and influence academic performance, which is related to professional success.

AIM

To assess different eating patterns in Portuguese university students and relate them to several sociodemographic variables.

METHODS

Cross-sectional information about eating behavior was assessed using the Dutch Eating Behavior Questionnaire in 169 students between 18 and 50 years of age, from the Universidade Lusófona de Humanidades e Tecnologias and from different academic courses, some related to health sciences. Mediterranean diet adherence was also assessed using a validated 14-item questionnaire.

RESULTS

According to the analyses of the 169 participants included in the sample, 33 presented restrained eating behavior, with 73 presenting external and 63 emotional. In the same line of thought, 62.10% of nutrition sciences students presented emotional eating behavior and overall it was observed that these students were more likely to have emotional eating behavior. Otherwise, presenting restrained eating behavior was statistically associated with being older and having higher Mediterranean diet adherence.

CONCLUSIONS

Studying nutrition sciences was associated with having emotional eating behavior. Older students and those who adhere more closely to the Mediterranean diet were associated with having restrained eating behavior.

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.

Adherence to a Mediterranean Diet and Thyroid Function in Obesity: A Cross-Sectional Apulian Survey

Much research suggests that Mediterranean eating habits and lifestyle contribute to counteract the risk of chronic diseases while promoting longevity, but little information is available on the effects of the Mediterranean diet (Med-Diet) on thyroid function, particularly among overweight/obese subjects. Nevertheless, consistent data reported a slight increase in serum levels of the thyroid-stimulating hormone (TSH) and a higher rate of conversion of thyroxine (T4) to triiodothyronine (T3) in obesity. This cross-sectional study was aimed at investigating the relationship between adherence to the Med-Diet and circulating thyroid hormones in a cohort of overweight/obese subjects from Apulia (Southern Italy). Methods: We studied 324 consecutive outpatient subjects (228 women and 96 men, age range 14-72 years) taking no drug therapy and showing normal levels of thyroid hormones, but complicated by overweight and obesity (body mass index (BMI) ≥ 25 Kg/m2). The PREDIMED (PREvención con DIeta MEDiterránea) questionnaire was cross-sectionally administered to assess the adherence to the Med-Diet, and hormonal, metabolic, and routine laboratory parameters were collected. Results: Higher adherence to Med-Diet was found to be inversely related to free T3 (p < 0.01) and T4 (p < 0.01) serum levels. Considering each item in the PREDIMED questionnaire, people consuming at least four spoonfuls of extra-virgin olive oil (EVOO) per day, as well as those consuming at least two servings of vegetables per day, had lower free T3 levels (p 0.033 and p 0.021, respectively). Furthermore, consuming at least four spoonfuls of EVOO per day was found to be associated to lower free T4 serum concentrations (p 0.011). Multinomial logistic regression models, performed on tertiles of thyroid hormones to further investigate the relationship with Med-Diet, corroborated the significance only for free T4. Conclusion: Increased adherence to the Med-Diet was independently associated to a slightly reduced thyroid function, but still within the reference range for free T3 and T4 serum levels. This first finding in this field opens up a research line on any underlying biological interplay.

Association between adherence to the Mediterranean diet and renal function biomarkers and cardiovascular risk factors among diabetic patients with nephropathy

BACKGROUND AND AIM

Although the relationship between a Mediterranean diet (Med diet) and cardiovascular disease (CVD) risk factors has been widely established, no reports exist regarding this association in patients with Diabetes Nephropathy (DN). The aim of this study was to determine the association between level of adherence to a Med diet and renal and CVD risk factors among patients with DN.

STUDY DESIGN

A cross-sectional study.

METHODS

The current study was conducted in 270 patients with DN. A validated food frequency questionnaire was used to assess dietary intake. The Med diet score was determined based on the eight characteristics of a traditional Med diet. Anthropometrics, fasting blood glucose (FBS), total cholesterol (TC), low-density lipoproteins (LDL-c), triacylglycerol (TG), hemoglobin A1C (HbA1c), creatinine (Cr) and blood urea nitrogen (BUN) were detected using standard methods. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) formula for estimated glomerular filtration rate (eGFR).

RESULTS

In fully-adjusted models, high serum TC and diastolic blood pressure (DBP) were reduced in participants that demonstrated a greater adherence to a Med diet, but did not reach statistical significance (OR: 0.20; 95% CI: 0.01, 5.52; P = 0.299; OR: 0.81; 95% CI: 0.28, 2.36; P = 0.667). Waist circumference (WC) was non-significantly lower in male participants (OR: 0.91; 95% CI: 0.27, 3.05; P = 0.889). Greater compliance with a Med diet showed a non-significant reduced risk for increased bodyweight (OR: 0.82; 95% CI: 0.23, 2.85; P = 0.730) and obesity (OR: 0.45; 95% CI: 0.03, 6.06; P = 0.493).

CONCLUSION

Adherence to a Med diet was not significantly associated with cardiovascular risk factors and renal function among patients with Diabetes Nephropathy.

Association of dietary patterns and practices on metabolic syndrome in adults with central obesity attending a mission hospital in Kenya: a cross-sectional study

OBJECTIVE

Dietary patterns and practices can predispose or protect against metabolic syndrome (MetS) in humans. Despite the growing problem of MetS in adults, the underpinning dietary behaviour is poorly understood. We determined the dietary patterns and practices relevant to MetS in adults with central obesity attending a mission hospital in Kenya.

STUDY DESIGN

Descriptive, cross-sectional.

SETTING

Outpatient clinic of a mission-based hospital in Nairobi.

PARTICIPANTS

Adults (N=404) aged 18-64 years diagnosed with central obesity as per the International Diabetes Federation definition for MetS.

PRIMARY OUTCOMES

Anthropometric measurements, clinical-biochemical markers and dietary components, quantity and frequency of food intake, as well as time-lapse between consumption of dinner and sleeping.

RESULTS

A high (87.2%) prevalence of MetS was observed for respondents who reported consumption of large amount of carbohydrates (p<0.001), proteins (p<0.001), processed/fast foods (p<0.001) and sugar (p=0.009). Frequent consumption of legumes (p<0.001), nuts (p<0.001), fruits (p<0.001) and vegetables (p=0.021) was linked to reduced MetS. Additionally, longer interval between eating dinner and going to bed was associated with reduced MetS.

CONCLUSION

Regular consumption of fruits, vegetables, legumes and nuts, as well as observing sometime after eating dinner before sleeping, was the dietary pattern significantly associated with a lower risk of MetS. Whereas, consumption of a large quantity of carbohydrates, proteins, processed/fast foods and sugar is likely to predispose to MetS. The findings underscore the need to focus on specific dietary intake patterns including frequency, quantity, quality and variety for MetS prevention and management. The MetS-related interventions could be implemented during individual consultation, group and community health messaging sessions.

Mediterranean diet and cardio-metabolic health: what is the role of meat?

Traditional Mediterranean diet is known for its health benefits in prevention of cardio-metabolic diseases and risk factors associated with it. The role of red meat in Mediterranean diet is to some extent overlooked with the main focus on foods of plant origin. The majority of existing guidelines encourage general population to limit intakes of red meat. However, in reality, it is a significant part of the Mediterranean cuisine. Red meat is an excellent source of macro and micronutrients: high-quality protein, B vitamins, essential amino acids, omega-3 polyunsaturated fatty acids, phosphorus, zinc, iron, and selenium. Currently, there is not enough scientific evidence to suggest the strict limitation of the red meat consumption among the general population, however, there is a substantial evidence to support the advice to eliminate the consumption of processed meat from the diet.

Association of whole-grain and dietary fiber intake with cardiometabolic risk in children and adolescents

BACKGROUND

Diet is known to affect many risk factors of cardiovascular disease (CVD), a leading cause of mortality and morbidity.

AIM

The objective of this study was to explore the potential association between whole grain and dietary fiber with CVD risk factors, including metabolic syndrome (MetS) in children and adolescents using National Health and Nutrition Examination Survey (NHANES) 2003-2014.

METHODS

Two days of 24-hour recall data from 16,507 children and adolescents age 2-18 years were used to estimate dietary intakes. Continuous MetS scores (cMetS) were computed by aggregating age/sex regressed z-scores of waist circumference, mean arterial blood pressure, high-density lipoprotein-cholesterol, triglycerides, and glucose. Regression analyses were used to assess association of fiber and whole grain intake with cardiometabolic markers including MetS after adjusting for demographic factors.

RESULTS

Increasing tertiles of fiber intake were significantly associated with 3% lowered risk MetS in adolescents age 13-18 years. Additionally, increasing intake tertiles of fiber were associated with reduced risk elevated cholesterol (5-11% reduction), elevated diastolic blood pressure (10-23% reduction) in adolescents age 13-18 years, and risk of obesity (3-5% reduction) in children and adolescent age 2-18 years. Increasing tertiles of whole grain intake were only associated with reduced risk of elevated triglycerides (52% risk reduction) in adolescents age 13-18 years.

CONCLUSION

The results suggest that intake of dietary fiber was inversely associated with several markers of cardiovascular disease risk including MetS.

Association of nutrient patterns and metabolic syndrome and its components in adults living in Tehran, Iran

Purpose

Identification of nutrient patterns (NPs) may be helpful to evaluate the overall quality of diet and its relation to metabolic syndrome (MetS). We investigated the association of major nutrient patterns with MetS and its components among apparently healthy adults living in Tehran.

Methods

We included 522 adults (24-83 years old) who referred to health centers in Tehran. Fasting blood samples were collected to measure glycemic indicators and lipid profile. Principal component analysis (PCA) based on the 26 nutrient items were applied. Metabolic syndrome was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

Results

Three major nutrient patterns were identified: "Mono and disaccharides pattern", "Macronutrient pattern" and "Antioxidant pattern". After controlling for potential confounders, serum HDL (p < 0.001) increased across tertiles of "Antioxidant pattern". A significant inverse association was observed between adherence to "Antioxidant pattern" and odds of MetS (OR: 2.36, 95% CI: 1.51, 3.69) in crude model which was disappeared after adjusting for age, sex, education, physical activity, smoking, marital status, energy and BMI. Moreover, we found that adherence to "Antioxidant pattern" was inversely related to odds of reduced levels of serum high density lipoprotein (HDL) (OR: 0.09, 95% CI: 0.02, 0.35). No association was found between "Mono and disaccharides pattern", "Macronutrient pattern", MetS and its components.

Conclusions

In general, adherence to "Antioxidant pattern "resulted in lower level of HDL concentrations. More studies are needed to investigate the possible causal relationship of these results.

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.

Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials

Diet is a crucial variable for a healthy life. A rapidly growing number of studies in recent years support the hypothesis that the Mediterranean diet (MedDiet) has a beneficial effect on certain body systems, but the highly varied objectives and quality of these publications warrants an updated assessment. In the present review we performed a comprehensive evaluation of current evidence on the impact of the MedDiet on human health, assessing its effect on the incidence or progression of the main non-communicable diseases and their intermediate outcomes and risk factors. We scrutinised the clinical evidence from observational studies and randomised controlled trials. Cardiovascular disease was the condition with most information. The MedDiet showed a general preventive effect, which was reproduced to varying degrees for certain intermediate cardiovascular outcomes such as blood pressure, lipids, obesity, metabolic syndrome and diabetes. Benefits were also found for several types of cancer, brain function (including cognition, mood and to a lesser extent Parkinson's disease) and mortality. The quality of the published evidence was, however, generally moderate or low. In conclusion, the MedDiet shows a favourable impact on health. General adoption of a MedDiet is concordant with current policies promoting healthy and sustainable nutrition worldwide. Nonetheless, more high-quality research is needed to improve the consistency of the findings.

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.

Relationship between legume consumption and metabolic syndrome: A systematic review and meta-analysis of observational studies

AIMS

The prevalence of metabolic syndrome (MetS) has been increasing in recent years. Investigation of whether consumption of legumes as a part of healthy diet could reduce the odds of MetS has led to inconsistent conclusions. Here, we performed the first meta-analysis of observational studies to analyze the association between legume consumption and prevalence of MetS.

DATA SYNTHESIS

PubMed, EMBASE, and Web of Science databases were searched to identify observational studies up to June 1, 2019. We extracted data from the studies included and performed quality assessments. Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias and subgroup and sensitivity analyses were also performed. We finally included four cross-sectional studies, two cohort studies, and one case-control study involving 56,028 participants. The summary OR revealed no statistically significant association between legume consumption and odds of MetS (OR = 0.93, 95% CI = 0.76-1.12, I² = 73.5%). Subgroup analysis of study characteristics and adjustment for confounding along with sensitivity analyses revealed no statistically significant differences. No evidence of publication bias was detected.

CONCLUSION

Legume consumption is not associated with the odds of MetS. These findings require validation in well-designed cohort studies and randomized clinical trials with accurate measurement of legume intake and strict control of confounders.

REGISTRATION

This study was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42019131777).

Adherence to the 2017 French dietary guidelines and adult weight gain: A cohort study

BACKGROUND

The French dietary guidelines were updated in 2017, and an adherence score to the new guidelines (Programme National Nutrition Santé Guidelines Score 2 [PNNS-GS2]) has been developed and validated recently. Since overweight and obesity are key public health issues and have been related to major chronic conditions, this prospective study aimed to measure the association between PNNS-GS2 and risk of overweight and obesity, and to compare these results with those for the modified Programme National Nutrition Santé Guidelines Score (mPNNS-GS1), reflecting adherence to 2001 guidelines.

METHODS AND FINDINGS

Participants (N = 54,089) were recruited among French adults (≥18 years old, mean baseline age = 47.1 [SD 14.1] years, 78.3% women) in the NutriNet-Santé web-based cohort. Mean (SD) score was 1.7 (3.3) for PNNS-GS2 and 8.2 (1.6) for mPNNS-GS1. Selected participants were those included between 2009 and 2014 and followed up to September 2018 (median follow-up = 6 years). Collected data included at least three 24-hour dietary records over a 2-year period following inclusion, baseline sociodemographics, and anthropometric data over time. In Cox regression models, PNNS-GS2 was strongly and linearly associated with a lower risk of overweight and obesity (HR for quintile 5 versus quintile 1 [95% CI] = 0.48 [0.43-0.54], p < 0.001, and 0.47 [0.40-0.55], p < 0.001, for overweight and obesity, respectively). These results were much weaker for mPNNS-GS1 (HR for quintile 5 versus quintile 1 = 0.90 [0.80-0.99], p = 0.03, and 0.98 [0.84-1.15], p = 0.8, for overweight and obesity, respectively). In multilevel models, PNNS-GS2 was negatively associated with baseline BMI and BMI increase over time (β for a 1-SD increase in score [95% CI] = -0.040 [-0.041; -0.038], p < 0.001, and -0.00080 [-0.00094; -0.00066], p < 0.001, respectively). In "direct comparison" models, PNNS-GS2 was associated with a lower risk of overweight and obesity, lower baseline BMI, and lower BMI increase over time than mPNNS-GS1. Study limitations include possible selection bias, reliance on participant self-report, use of arbitrary cutoffs in data analyses, and residual confounding, but robustness was tested in sensitivity analyses.

CONCLUSIONS

Our findings suggest that adherence to the 2017 French dietary guidelines is associated with a lower risk of overweight and obesity. The magnitude of the association and the results of the direct comparison reinforced the validity of the updated recommendations.

TRIAL REGISTRATION

The NutriNet-Santé Study ClinicalTrials.gov (NCT03335644).

Update on childhood/adolescent obesity and its sequela

PURPOSE OF REVIEW

We aim to describe current concepts on childhood and adolescent obesity with a strong focus on its sequela. Childhood obesity is a national epidemic with increasing prevalence over the past three decades placing children at increased risk for many serious comorbidities, previously felt to be only adult-specific diseases, making this topic both timely and relevant for general pediatricians as well as for subspecialists.

RECENT FINDINGS

Childhood obesity develops through an interplay of genetics, environment, and behavior. Treatment includes lifestyle modification, and now metabolic and bariatric surgery is more commonly considered in carefully selected adolescents. The off-label use of adjunct medications for weight loss in childhood and adolescent obesity is still in its infancy, but will likely become the next logical step in those with lifestyle modification refractory obesity. Obesity can lead to several comorbidities, which can persist into adulthood potentially shortening the child's lifespan.

SUMMARY

Efforts should be focused primarily on reducing childhood and adolescent obesity, and when indicated treating its sequela in effort to reduce future morbidity and mortality in this precious population. VIDEO ABSTRACT: http://links.lww.com/MOP/A36.

Application of 1H-NMR Metabolomics for the Discovery of Blood Plasma Biomarkers of a Mediterranean Diet

The Mediterranean diet (MD) is a dietary pattern well-known for its benefits in disease prevention. Monitoring adherence to the MD could be improved by discovery of novel dietary biomarkers. The MEDiterranean Diet in Northern Ireland (MEDDINI) intervention study monitored the adherence of participants to the MD for up to 12 months. This investigation aimed to profile plasma metabolites, correlating each against the MD score of participants (n = 58). Based on an established 14-point scale MD score, subjects were classified into two groups (“low” and “high”). ¹H-Nuclear Magnetic Resonance (¹H-NMR) metabolomic analysis found that citric acid was the most significant metabolite (p = 5.99 × 10⁻⁴*; q = 0.03), differing between ‘low’ and ‘high’. Furthermore, five additional metabolites significantly differed (p < 0.05; q < 0.35) between the two groups. Discriminatory metabolites included: citric acid, pyruvic acid, betaine, mannose, acetic acid and myo-inositol. Additionally, the top five most influential metabolites in multivariate models were also citric acid, pyruvic acid, betaine, mannose and myo-inositol. Metabolites significantly correlated with the consumption of certain food types. For example, citric acid positively correlated fruit, fruit juice and vegetable constituents of the diet, and negatively correlated with sweet foods alone or when combined with carbonated drinks. Citric acid was the best performing biomarker and this was enhanced by paired ratio with pyruvic acid. The present study demonstrates the utility of metabolomic profiling for effectively assessing adherence to MD and the discovery of novel dietary biomarkers.

Fruit and vegetable consumption and the metabolic syndrome: a systematic review and dose-response meta-analysis

A systematic review and meta-analysis of observational studies were performed to assess the dose-response associations between fruit or vegetable consumption and the chance of the metabolic syndrome (MetS). Studies on the association between fruit or vegetable consumption and the risk of the MetS published from January 1958 to 30 October 2018 were searched using the PubMed, MEDLINE and Embase databases, and the references of relevant articles were reviewed. Random-effects models were used to estimate the summary OR with 95 % CI for the MetS, and dose-response analysis was conducted to quantify the associations. Heterogeneity among studies was evaluated using Q and I2 statistics. A total of nine observational studies (seven cross-sectional studies and two cohort studies) were included in the meta-analysis. In a dose-response analysis of cohort studies and cross-sectional studies, the summary estimate of the MetS for an increase of 100 g/d in fruit consumption (nine studies) was 0·97 (95 % CI 0·95, 0·99; I2 = 26·7 %), whereas an increase of 100 g/d in vegetable consumption (nine studies) was not associated with a reduction in the MetS (OR 0·98; 95 % CI 0·96, 1·01; I2 = 54·6 %). In conclusion, an increased intake of fruit may reduce the risk of the MetS. For future research, prospective studies or randomised clinical trials are needed to identify the effects of fruits and vegetables by variety on the risk of the MetS.

Benefits of the Mediterranean diet: Epidemiological and molecular aspects

More than 50 years after the Seven Countries Study, a large number of epidemiological studies have explored the relationship between the Mediterranean diet (MD) and health, through observational, case-control, some longitudinal and a few experimental studies. The overall results show strong evidence suggesting a protective effect of the MD mainly on the risk of cardiovascular disease (CVD) and certain types of cancer. The beneficial effects have been attributed to the types of food consumed, total dietary pattern, components in the food, cooking techniques, eating behaviors and lifestyle behaviors, among others. The aim of this article is to review and summarize the knowledge derived from the literature focusing on the benefits of the MD on health, including those that have been extensively investigated (CVD, cancer) along with more recent issues such as mental health, immunity, quality of life, etc. The review begins with a brief description of the MD and its components. Then we present a review of studies evaluating metabolic biomarkers and genotypes in relation to the MD. Other sections are dedicated to observation and intervention studies for various pathologies. Finally, some insights into the relationship between the MD and sustainability are explored. In conclusion, the research undertaken on metabolomics approaches has identified potential markers for certain MD components and patterns, but more investigation is needed to obtain valid measures. Further evaluation of gene-MD interactions are also required to better understand the mechanisms by which the MD diet exerts its beneficial effects on health. Observation and intervention studies, particularly PREDIMED, have provided invaluable data on the benefits of the MD for a wide range of chronic diseases. However further research is needed to explore the effects of other lifestyle components associated with Mediterranean populations, its environmental impact, as well as the MD extrapolation to non-Mediterranean contexts.

Association between fruit and vegetable consumption and risk of metabolic syndrome determined using the Korean Genome and Epidemiology Study (KoGES)

PURPOSE

This study examined the association between fruit and vegetable consumption and the risk of metabolic syndrome (MetS) and its components in middle-aged and older adults using data from the Korean Genome and Epidemiology Study.

METHODS

A total of 5688 participants aged 40-69 years without MetS at baseline were recruited and followed for 8 years. Fruit and vegetable consumption was assessed using a semi-quantitative food-frequency questionnaire at baseline and after 4 years. A multivariate Cox proportional hazards model was used to examine the risk of incident MetS and its components according to fruit and vegetable consumption.

RESULTS

A total of 2067 participants (1020 men and 1047 women) developed MetS during the 8-year follow-up period. Frequent fruit consumers (≥ 4 servings/day) had a lower risk of incident MetS than did rare consumers (< 1 serving/day) in both men and women (hazard ratio (HR) = 0.55, 95% CI 0.44-0.67, p < 0.0001 for men; HR = 0.57, 95% CI 0.47-0.70, p for trend < 0.0001 for women) after adjusting for confounders. Frequent fruit consumption was inversely associated with incidence of abdominal obesity, hypertriglyceridemia, and elevated blood pressure. Frequent vegetable consumption was inversely associated with a risk of hyperglycemia only in men (HR = 0.65, 95% CI 0.44-0.96, p for trend = 0.0275), but no association was observed with risk of incident MetS.

CONCLUSIONS

High fruit consumption was associated with a reduced risk of incident MetS and its components, whereas high vegetable consumption was associated with a reduced risk of incident hyperglycemia, but not with MetS in middle-aged and older adults.

Effect of patient education on metabolic syndrome components among females in Zagazig University outpatient clinics, Egypt: An intervention study

BACKGROUND

Metabolic syndrome (MS) is a major health problem worldwide. This study aimed to assess the effectiveness of lifestyle modification regarding MS components among adult females.

METHODS

An intervention study performed on 120 adult females with MS (60 intervention and 60 controls) selected randomly from Zagazig University outpatient clinics. Intervention group received patient education program while controls received traditional management. MS components were compared with three months interval representing Pre-Post follow up results.

RESULTS

Two groups showed significant improvement in all MS components but mean change was significantly higher in intervention group. Three months follow up demonstrated that 63.4% of intervention group had reversal of their MS versus 15% of control group.

CONCLUSION

Patient education improved all MS components and considered significantly more effective than traditionally adopted management. So, we recommend its application on all MS patients.

Dietary and Lifestyle Risk Factors and Metabolic Syndrome: Literature Review

Metabolic syndrome (MetS) is considered a threat to public health due to its rapid growing prevalence worldwide. MetS can result from interrelated metabolic abnormalities including insulin resistance (IR), hypertension, dyslipidemia, and abdominal adiposity. Although the pathogenesis of this syndrome is not distinctly understood, it is strongly influenced by multiple genetic variations that interact with many environmental factors such as positive family history of MetS, adherence to unhealthy dietary patterns, low physical activity and smoking and that explain the variations in the prevalence of the MetS within and across populations. All of these factors were found to be associated with IR, obesity, and triglycerides elevation which therefore increase the risk of the MetS Several studies highlighted the effective preventive approach includes lifestyle changes, primarily losing weight, adopting healthy diet, and practicing exercise. All of the mentioned factors can reduce the risk of MetS.

Efficacy of Cognitive Behavioral Therapy in Adherence to the Mediterranean Diet in Metabolic Syndrome Patients: A Randomized Controlled Trial

OBJECTIVE

Verify the efficacy of cognitive behavioral therapy (CBT) in adherence to the Mediterranean diet (MedDiet) in metabolic syndrome (MetS) patients.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION

In the Multimodal Intervention Program for Patients with Metabolic Syndrome clinical trial, 79 MetS patients completed the intervention. Of those, 48 belonged to the experimental group and 31 to the control group. The intervention received by the experimental group was CBT; the control group followed usual care and attended a workshop on healthy lifestyle.

MAIN OUTCOME MEASURE(S) AND ANALYSIS

Anthropometric, biochemical, psychological, and lifestyle measures were taken before and after the intervention at 3 and 6 months. Analyses included paired t tests, ANOVA, and ANCOVA.

RESULTS

The ANOVA results showed a statistically significant interaction between the 2 groups in waist circumference (P = .009), triglycerides (P = .015), and adherence to the MedDiet (P = .026). The ANCOVA results indicated between-group difference in waist circumference (P = .026 and .062 at 3 and 6months, respectively), in triglycerides (P = .009 and .860 at 3 and 6 months, respectively), and in MedDiet (P = .024 and .273 at 3 and 6 months, respectively).

CONCLUSIONS AND IMPLICATIONS

In interventions in which CBT was applied, significant improvements were observed in MetS patients, especially in adherence to the MedDiet.

The dietary inflammatory index and insulin resistance or metabolic syndrome in young adults

OBJECTIVE

The aim of this study was to assess the association between the inflammatory potential of diet, as measured by the dietary inflammatory index (DII) and insulin resistance (IR) or metabolic syndrome (MetS).

METHODS

A cross-sectional study (nested within a cohort) was conducted on 2017 adults 23 to 25 y of age in Ribeirão Preto, Brazil. Food consumption was assessed using a validated food frequency questionnaire. DII scores were calculated from 35 available food parameters. IR was determined from the classification of homeostatic model assessment (HOMA) values (≥2.7 uU mL-1). MetS was diagnosed based on the Joint Interim Statement (JIS) criterion. The association of DII score with IR or MetS was determined by Poisson regression analysis. The variables included in the multivariable model were selected from directed acyclic graphs.

RESULTS

The diet of the young adults studied showed a high inflammatory potential, with a mean DII score of +1.10 (range: -4.69 to +5.28). The prevalence of MetS was 12.2% and IR 12.3%; both were higher in men than in women. The correlation between DII and HOMA-IR values was -0.038 (P = 0.09). The DII was not associated with IR or MetS in either sex.

CONCLUSION

Although the association between DII and the outcomes was not detected in this sample, the study demonstrated that the diets of these young adult Brazilians had a high inflammatory potential when compared with other studies. Future studies, preferably using longitudinal designs, are recommended.

Weight loss and metabolic health effects from energy-restricted Mediterranean and Central-European diets in postmenopausal women: A randomized controlled trial

We conducted a randomized controlled trial to examine the effect of two energy-restricted diets on body weight (BW), visceral fat (VF) loss, and the risk factors for metabolic syndrome. A total of 144 centrally obese postmenopausal women were assigned to the moderate in fat Mediterranean diet (MED) or to the Central European diet (CED), which is moderate in carbohydrates and high in dietary fiber (DF), for 16 weeks. BW, waist circumference and VF were significantly reduced by 8.8%, 7.0%, and 24.6%, respectively, over the trial (P < 0.001), with no difference between groups. A similar trend was seen for total cholesterol, triglycerides, glucose, and blood pressure. Within each diet group, the more adherent participants lost significantly more BW than did their less adherent counterparts. VF was significantly reduced only in women who were more adherent to the CED, and the reduction in VF correlated with an increase in the proportion of DF. Short-term dietary treatment with the CED or the MED was associated with similar improvements in some anthropometric, lipid, and nonlipid parameters; however, adequate adherence to the prescribed diet is important in weight loss success and in achieving improvements in metabolic health.

Stress, anger and Mediterranean diet as predictors of metabolic syndrome

BACKGROUND AND OBJECTIVE

Metabolic syndrome (MetS) is a cluster of metabolic conditions that include abdominal obesity, reduction in cholesterol concentrations linked to high density lipoproteins (HLDc), elevated triglycerides, increased blood pressure and hyperglycaemia. Given that this is a multicausal disease, the aim of this study is to identify the psychological, emotional and lifestyle variables that can have an influence on the different MetS components.

PATIENTS AND METHODS

A cross-sectional study with 103 patients with diagnostic criteria for MetS (47 male and 56 female). Anthropometric, clinical and analytical measurements were collected to assess the variables associated with MetS. The main psychological and emotional variables were also assessed.

RESULTS

Different multiple linear regression tests were performed to identify which variables were predictive of MetS. The dependent variables were body mass index (BMI), abdominal circumference, HDLc, and quality of life, and the predictive variables were psychological stress, anger and adherence to a Mediterranean diet. The results showed that psychological stress was a predictor of quality of life (β=-0.55, P≤0). Similarly, anger was a predictor of BMI (β=0.23, P=.047) and abdominal circumference (β=0.27, P=.021). As expected, adherence to a Mediterranean diet was a predictor of HDLc (β=0.2, P=.045) and of quality of life (β=-0.18, P=.031).

CONCLUSIONS

The results confirm a link between adherence to certain dietary habits and lifestyle, however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components.

A modified Mediterranean diet score is inversely associated with metabolic syndrome in Korean adults

BACKGROUND/OBJECTIVES

Findings from studies in Western countries showed that Mediterranean diet is inversely associated with metabolic syndrome, but little is known about this association in Asian countries. To evaluate the association between Mediterranean diet and metabolic syndrome in Korean population, this study was conducted.

SUBJECTS/METHODS

A total of 8387 adults 19-64 years of age from the Korea National Health and Nutrition Examination Survey 2012-2015 were assessed. A 112-item dish-based semiquantitative food frequency questionnaire was used to assess dietary intakes. Mediterranean diet was assessed by a modified Mediterranean diet score, which was based on the alternate Mediterranean diet score of Fung et al. Multivariable logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for other dietary and lifestyle variables.

RESULTS

Participants with 5-6 and 7 or higher modified Mediterranean diet scores had a lower prevalence of metabolic syndrome by 27% (OR = 0.73, 95% CI: 0.56-0.96) and 36% (OR = 0.64, 95% CI: 0.46-0.89; P-trend = 0.0031), compared with those with 2 or lower modified Mediterranean diet scores, respectively. Higher modified Mediterranean diet scores were associated with a lower prevalence of abdominal obesity and hypertriglyceridemia, which are components of metabolic syndrome CONCLUSIONS: Our findings suggest that diet rich in fruit, vegetables, whole grains, legumes, peanuts and fish is associated with a lower prevalence of metabolic syndrome in Korean adults.

Associations between adherence to the Danish Food-Based Dietary Guidelines and cardiometabolic risk factors in a Danish adult population: the DIPI study

Diet is recognised as one modifiable lifestyle factor for ischaemic heart disease (IHD). We aimed at investigating the associations between adherence to the Danish Food-Based Dietary Guidelines (FBDG) indicated by a Dietary Quality Index (DQI) and selected cardiometabolic risk factors in a cross-sectional study with 219 Danish adult participants (59 %women; age 31–65years) with a minimum of one self-rated risk marker of IHD. Information regarding diet was obtained using web-based dietary assessment software and adherence to the Danish FBDG was expressed by a DQI calculated from 5 food and nutrient indicators (whole grain, fish, fruit and vegetables, energy from saturated fat and from added sugar). Background information, blood samples and anthropometrics were collected and blood pressure was measured. Linear regression analyses were used to evaluate the association between DQI and cardiometabolic risk factors. DQI was inversely associated with LDL:HDL ratio and TAG (−0·089 per unit; 95 % CI −0·177, −0·002 and −5 % per unit; 95 % CI −9, 0, respectively) and positively associated with HDL-cholesterol (0·047 mmol/l per unit; 95 % CI 0·007, 0·088). For men, DQI was inversely associated with BMI (−3 %per unit; 95 % CI −5, −1), trunk fat (−1 % per unit; 95 % CI −2, −1), high-sensitivity C-reactive protein (−30 % per unit; 95 % CI −41, −16 %), HbA1c(−0·09 % per unit; 95 % CI −0·14, −0·04), insulin (−13 % per unit; 95 % CI −19, −7) and homoeostatic model assessment-insulin resistance (−14 % per unit; 95 % CI −21, −7). In women, DQI was positively associated with systolic blood pressure (2·6 mmHg per unit; 95 % CI 0·6, 4·6). In conclusion, higher adherence to the current Danish FBDG was associated with a more beneficial cardiometabolic risk profile in a Danish adult population with a minimum of one self-rated risk factor for IHD.

Influence of a diet enriched with virgin olive oil or butter on mouse gut microbiota and its correlation to physiological and biochemical parameters related to metabolic syndrome

The type of fat in the diet determinates the characteristics of gut microbiota, exerting a major role in the development of metabolic syndrome. We hypothesize that a diet enriched with extra virgin olive oil (EVOO) has a distinctive effect on the intestinal microbiome in comparison with an enriched butter diet (BT) and this effect is related to the physiological benefits exerted by EVOO. Swiss Webster mice were fed standard (SD) or two high fat diets enriched with EVOO or butter. Hormonal, physiological and metabolic parameters were evaluated. At the end of the feeding period, DNA was extracted from faeces and the 16S rRNA genes were pyrosequenced. Among the main significant differences found, BT triggered the highest values of systolic blood pressure, correlating positively with the percentage of Desulfovibrio sequences in faeces, which in turn showed significantly higher values in BT than in EVOO. EVOO had the lowest values of plasmatic insulin, correlating inversely with Desulfovibrio, and had the lowest plasmatic values of leptin which correlated inversely with Sutterellaceae, Marispirillum and Mucilaginibacter dageonensis, the three showing significantly higher percentages in EVOO. The lowest total cholesterol levels in plasma were detected in SD, correlating positively with Prevotella and Fusicatenibacter, both taxa with significantly greater presence in SD. These results may be indicative of a link between specific diets, certain physiological parameters and the prevalence of some taxa, supporting the possibility that in some of the proposed effects of virgin olive oil the modulation of intestinal microbiota could be involved.