From Mediterranean diet to Mediterranean lifestyle: a narrative review

Online pilot intervention to improve nutritional and lifestyle in Spanish breast-feeding women

Introduction

Introduction: breastfeeding women often cannot adequately follow dietary and healthy habits recommendations. In addition, after delivery, their care is usually focused on the newborn and the mother´s health may be neglected. The Mediterranean Diet is the standard of healthy eating, with the Healthy Food Pyramid (HFP) being its graphic representation. Objective: the aim of this study was to determine whether a nutritional and lifestyle online intervention may improve HFP adherence in breastfeeding women. Methods: a total of 181 breastfeeding women in the first sixth months postpartum were enrolled in a non-randomized interventional pilot study. These women answered three questionnaires: sociodemographic and for adherence to Healthy Food Pyramid (APQ), before and after an online intervention for 13 weeks, providing information about nutrition and healthy habits. The APQ ranges from 0 to 10, with higher scores corresponding to greater adherence to HFP. The intervention consisted of lifestyle and nutritional information, which was provided through e-mail. Results: a low adherence to HFP was found, which was improved after 13 weeks of intervention. The online intervention significantly increased the scores for physical activity, grain, seeds and legumes consumption, olive oil use, dairy products, and ani-mal proteins, as well as the HFP adherence global score. The adjusted models showed that the online intervention was associated with adherence to the HFP and physical activity. Conclusion: we conclude that an online intervention for breastfeeding women had an impact on their lifestyle, improving nutritional and healthy habits, and can be a useful tool to monitor their health status. Given the importance of this stage for women and their newborns, this is an aspect postnatal healthcare professionals should consider.

Differences of skin carotenoids and adherence to the Mediterranean Diet pattern in adults from Southern Italy and Dominican Republic

BACKGROUND

The measurement of the skin carotenoids using the Veggie Meter® has emerged as a rapid objective method for assessing fruit and vegetable intake, highly recommended by the Mediterranean Diet (MD), which represents one of the healthiest dietary patterns, worldwide. This study aimed to examine differences in skin carotenoid content and degree of adherence to the MD pattern between two adult populations from Southern Italy and the Dominican Republic.

METHODS

This cross-sectional study enrolled a total of 995 adults, 601 subjects from Italy and 394 from the Dominican Republic. All participants underwent anthropometric measurements and skin carotenoid assessment by Veggie Meter®. Adherence to the MD and lifestyle were evaluated using the Mediterranean Diet Adherence Screener (MEDAS) and the Mediterranean Lifestyle Index (MEDLIFE) questionnaires. Correlations between the skin carotenoid and MEDAS score were estimated using Pearson's correlation coefficient. Multiple linear regression models were created to determine variables that affect skin carotenoid score for both populations.

RESULTS

Mean total skin carotenoids were higher in the Italian compared to the Dominican Republic population (342.4 ± 92.4 vs 282.9 ± 90.3; p < 0.005) regardless of sex (women: 318.5 ± 88.9 vs 277.3 ± 91.9, p < 0.005 and men: 371.7 ± 88.3 vs 289.5 ± 88.1, p < 0.005), and remaining statistically significant after age-adjustment of the Dominican Republic sample. Using the MEDAS questionnaire, we found a higher MD adherence score in the Italian than in the Dominican Republic population also after age-adjusting data (7.8 ± 2.1 vs 6.2 ± 3.7; p < 0.005) and even when categorized by sex (Italian vs age-adjusted Dominican Republic women: 7.9 ± 2.1 vs 6.3 ± 2.6; Italian vs age-adjusted Dominican Republic men: 7.7 ± 2.2 vs 6.0 ± 4.7; p < 0.005). Using the MEDLIFE test, total Italians presented a lower score with respect to the age-adjusted Dominican Republic population (3.2 ± 1.2 vs 3.4 ± 1.4; p < 0.05). In multiple regression analysis, skin carotenoids were associated with sex and negatively associated with BMI in the Italian population (sex: β: 54.95; 95% CI: 40.11, 69.78; p < 0.0001; BMI: β: - 1.60; 95% CI: - 2.98,0.86; p = 0.03), while they resulted associated with age and sex in the Dominican Republic population (age: β: 2.76; 95% CI: 1.92, 3.56; p < 0.001; sex: β: 23.29; 95% CI: 5.93, 40.64; p = 0.009). Interestingly, skin carotenoids were positively correlated with MEDAS score in both populations (Italy: r = 0.03, p < 0.0001, Dominican Republic: r = 0.16, p = 0.002).

CONCLUSIONS

This study provides the assessment of the adherence to the MD and skin carotenoid content in adults living in Southern Italy and the Dominican Republic, showing a higher MD adherence score and a skin carotenoid content in inhabitants from the Mediterranean region. Our findings highlight the need to globally encourage fruit and vegetable intake, particularly in non-Mediterranean area.

Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet

Over the last decades, the Mediterranean diet gained enormous scientific, social, and commercial attention due to proven positive effects on health and undeniable taste that facilitated a widespread popularity. Researchers have investigated the role of Mediterranean-type dietary patterns on human health all around the world, reporting consistent findings concerning its benefits. However, what does truly define the Mediterranean diet? The myriad of dietary scores synthesizes the nutritional content of a Mediterranean-type diet, but a variety of aspects are generally unexplored when studying the adherence to this dietary pattern. Among dietary factors, the main characteristics of the Mediterranean diet, such as consumption of fruit and vegetables, olive oil, and cereals should be accompanied by other underrated features, such as the following: (i) specific reference to whole-grain consumption; (ii) considering the consumption of legumes, nuts, seeds, herbs and spices often untested when exploring the adherence to the Mediterranean diet; (iii) consumption of eggs and dairy products as common foods consumed in the Mediterranean region (irrespectively of the modern demonization of dietary fat intake). Another main feature of the Mediterranean diet includes (red) wine consumption, but more general patterns of alcohol intake are generally unmeasured, lacking specificity concerning the drinking occasion and intensity (i.e., alcohol drinking during meals). Among other underrated aspects, cooking methods are rather simple and yet extremely varied. Several underrated aspects are related to the quality of food consumed when the Mediterranean diet was first investigated: foods are locally produced, minimally processed, and preserved with more natural methods (i.e., fermentation), strongly connected with the territory with limited and controlled impact on the environment. Dietary habits are also associated with lifestyle behaviors, such as sleeping patterns, and social and cultural values, favoring commensality and frugality. In conclusion, it is rather reductive to consider the Mediterranean diet as just a pattern of food groups to be consumed decontextualized from the social and geographical background of Mediterranean culture. While the methodologies to study the Mediterranean diet have demonstrated to be useful up to date, a more holistic approach should be considered in future studies by considering the aforementioned underrated features and values to be potentially applied globally through the concept of a "Planeterranean" diet.

Physical activity habits prevent psychological distress in female academic students: The multiple mediating role of physical and psychosocial parameters

Background

Psychological distress is recognised as the most common mental health difficulty in emerging adult (18-to-24-year-old) female academic students. This study aimed to test a novel model positing physical activity habits as a protective factor for psychological distress through the mediating role of physical and psychological parameters. Adherence to the Mediterranean diet and self-reported physical health status were included as physical parameters. Self-reported psychological health status and time spent on leisure activities were the psychological parameters considered.

Method

Data were collected between April and May 2021. Correlation analyses and a multiple mediation model were computed on 411 online questionnaires filled out by 18-to-24-year-old female students from the University of blind (Italy).

Results

The multiple indirect effects were significant (β = -0.088; p < 0.001). This means that physical activity habits reduce psychological distress through high adherence to the Mediterranean diet, a good self-assessment of one's physical and psychological health status, and more time spent on leisure activities outdoors, with friends, and with family members.

Conclusions

Results show that academic policies should be adopted so as to design physical activity programmes that may improve the students' healthy behaviours and social interactions, which, in turn, mitigate the detrimental effects of psychological distress.

The gut microbiome: an important role in neurodegenerative diseases and their therapeutic advances

There are complex interactions between the gut and the brain. With increasing research on the relationship between gut microbiota and brain function, accumulated clinical and preclinical evidence suggests that gut microbiota is intimately involved in the pathogenesis of neurodegenerative diseases (NDs). Increasingly studies are beginning to focus on the association between gut microbiota and central nervous system (CNS) degenerative pathologies to find potential therapies for these refractory diseases. In this review, we summarize the changes in the gut microbiota in Alzheimer's disease, Parkinson's disease, multiple sclerosis, and amyotrophic lateral sclerosis and contribute to our understanding of the function of the gut microbiota in NDs and its possible involvement in the pathogenesis. We subsequently discuss therapeutic approaches targeting gut microbial abnormalities in these diseases, including antibiotics, diet, probiotics, and fecal microbiota transplantation (FMT). Furthermore, we summarize some completed and ongoing clinical trials of interventions with gut microbes for NDs, which may provide new ideas for studying NDs.

Ghanaian clients' perception of fitness instructors' adherence to exercise delivery services codes of conduct: An exploratory study

Background and Aims

Patronage for fitness and wellness activities has increased in Ghana, but the perception of primary consumers regarding exercise delivery service codes of conduct (EDCC) remains undocumented. This study reported the perception of clients about fitness instructors' adherence to EDCC.

Methods

Three hundred and seventy-nine (mean age = 26.12 ± 8.83 years) clients registered with National Sports for ALL Association, Ghana (NASFAAG) were recruited. The participants were not living with any diagnosed disability, using psychiatric medication, and had consistently participated in fitness training, at least three times a week for a year, and not below the age of 18 years. The participants were recruited from fitness and wellness centers, gyms, and fitness clubs in three regions (Greater Accra-GA, Upper East-UE, and Ashanti-A) of Ghana. A closed-ended, self-structured and validated awareness and adherence exercise delivery codes of conduct questionnaires was administered. The questionnaire focused on data protection and responsibility, informed consent, competence, and professional and personal conduct adapted from the British Association of Sports and Exercise Science codes of conduct was administered. Statistical Package for Social Sciences (SPSS) version 23.0 was used to run factor analysis which determined factorial distribution of clients' perception of instructors on codes of conduct.

Results

In total, 50.99% (UE), 47.68% (A), and 46.02% (GA) clients indicated that identities were unprotected when trainers displayed information. In all, 31.05% (UE), 40.34% (A), and 36.48% (GA) showed they were introduced to substances without consent. In total, 38.89% (UE), 32.70% (A), and 53.55% (GA) clients participated in training to realize that the expertise expected was not provided. In all, 38.10% (UE) and 36.23% (A) agreed that instructors put safety at risk, while 23.02% (GA) exploited clients for personal gain.

Conclusion

Fitness instructors need enlightenment to adhere ethically to EDCC activities in Ghana. Activities related to wellness and fitness in Ghana require regulations.

Bitter Is Better: Wild Greens Used in the Blue Zone of Ikaria, Greece

The current study reports an ethnobotanical field investigation of traditionally gathered and consumed wild greens (Chorta) in one of the five so-called Blue Zones in the world: Ikaria Isle, Greece. Through 31 semi-structured interviews, a total of 56 wild green plants were documented along with their culinary uses, linguistic labels, and locally perceived tastes. Most of the gathered greens were described as bitter and associated with members of Asteraceae and Brassicaceae botanical families (31%), while among the top-quoted wild greens, species belonging to these two plant families accounted for 50% of the wild vegetables, which were consumed mostly cooked. Cross-cultural comparison with foraging in other areas of the central-eastern Mediterranean and the Near East demonstrated a remarkable overlapping of Ikarian greens with Cretan and Sicilian, as well as in the prevalence of bitter-tasting botanical genera. Important differences with other wild greens-related food heritage were found, most notably with the Armenian and Kurdish ones, which do not commonly feature many bitter greens. The proven role of extra-oral bitter taste receptors in the modulation of gastric emptying, glucose absorption and crosstalk with microbiota opens new ways of looking at these differences, in particular with regard to possible health implications. The present study is also an important attempt to preserve and document the bio-cultural gastronomic heritage of Chorta as a quintessential part of the Mediterranean diet. The study recommends that nutritionists, food scientists, and historians, as well as policymakers and practitioners, pay the required attention to traditional rural dietary systems as models of sustainable health.

Combined Aerobic Training and Mediterranean Diet Is Not Associated with a Lower Prevalence of Sarcopenia in Italian Older Adults

Previous studies found a lower prevalence of sarcopenia in older adults engaged in regular aerobic training (AT) or with greater adherence to a Mediterranean (MED) diet. However, the effect of their combination on sarcopenia indices is unknown. The present study tested the association between AT plus a MED diet and the presence of sarcopenia and its defining elements in a sample of Italian older adults enrolled in the Longevity Check-up 7+ (Lookup 7+) project. Analyses were conducted in participants 65+ years, with a body mass index of at least 18.5 kg/m2, engaged in regular AT, and without missing information for the variables of interest. MED diet adherence was evaluated via a modified version of the MEDI-LITE score and categorized as low, moderate, or high. The presence of sarcopenia was established by handgrip strength and appendicular skeletal muscle mass (ASM) values below sex-specific cut-points recommended by the European Working Group on Sarcopenia in Older People 2. Data from 491 older adults were analyzed for the present study. The mean age was 72.7 ± 5.7 years, and 185 (37.7%) were women. MED diet adherence was low in 59 (12.0%) participants, moderate in 283 (57.6%), and high in 149 (30.3%). Sarcopenia was identified in 26 participants (5.3%), with no differences across MED diet adherence groups. The results of binary logistic regression showed no significant associations between AT plus adherence to a MED diet and dynapenia, low ASM, or sarcopenia. The findings of the present study indicate that the combination of AT with a MED diet is not associated with a lower probability of sarcopenia or its defining elements in Italian older adults enrolled in Lookup 7+. Further research is warranted to establish whether exercise frequency, volume, intensity, and length of engagement in AT impact the association between MED diet and sarcopenia.

Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment

BACKGROUND

Several studies have explored the association between Mediterranean diet and frailty, but reported inconsistent results. This systematic review and dose-response meta-analysis summarized the existing evidence on the relationship between Mediterranean diet and risk of frailty and pre-frailty in elderly adults.

METHODS

A systematic search on MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science and Google Scholar was conducted up to January 2023. Study selection and data extraction were performed by two reviewers working in parallel. Epidemiologic studies reporting relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for frailty/pre-frailty in relation to Mediterranean diet (as a priori dietary pattern) were considered. The overall effect size was determined using a random effects model. The body of evidence was assessed by the GRADE approach.

RESULTS

A total of 19 studies (12 cohorts and 7 cross-sectionals) were included. In cohort studies (89,608 participants/ 12,866 cases), the highest versus lowest category of Mediterranean diet was inversely associated with frailty (RR: 0.66; 95%CI: 0.55, 0.78; I²:52.4%, P_Q-test=0.02). This association was also significant in cross-sectional studies with 1093 cases among 13,581 participants (OR: 0.44; 95%CI: 0.28, 0.70; I²:81.8%, P_Q-test<0.001). Moreover, each 2-point increase in Mediterranean diet score was related to decreased risk of frailty in cohort (RR: 0.86; 95%CI: 0.80, 0.93) and cross-sectional (OR: 0.79; 95%CI: 0.65, 0.95) studies. Nonlinear association showed a decreasing slope in curve, sharper at high scores for cohort studies and a steadily reduction for cross-sectional studies. The certainty of the evidence was graded as high in both cohort and cross-sectional studies. Combining 4 effect sizes of 4 studies (12,745 participants/ 4363 cases), the highest adherence to Mediterranean diet was linked to a lower risk of pre-frailty, as well (pooled OR: 0.73; 95%CI: 0.61, 0.86; I²:40.9%, P_Q-test=0.17).

CONCLUSION

Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and thus, has a considerable impact on health of this population.

Sarcopenia, obesity, and their association with selected behavioral factors in active older adults

Introduction: The number of obese people in the world is increasing, as is the number of sarcopenic people among the older adults. Although both states are concerning, they can be positively influenced by selected behavioral factors such as adequate nutrition and physical activity. We were interested in the prevalence of sarcopenic obesity in active older people and the influence of behavioral factors on this phenomenon. Methods: The study included 38 older adults (21 women) with a mean age of 75.3 ± 5.0 years. Sarcopenic parameters were determined with different tests: Handgrip Test, Chair Stand Test, Gait Speed, Timed Up and Go Test, and Short Physical Performance Battery. Body composition was measured by dual-energy x-ray absorptiometry. Physical activity level was measured using accelerometers, and nutritional status was assessed using the Mini-Nutritional Assessment and MEDLIFE Index questionnaire. Results: Of all included active participants (the average number of steps per day was 8,916 ± 3,543), 47.4% of them were obese. Of all included women, 52.4% were obese. Sarcopenic obesity was found in three (7.9%) participants. Nutritional status correlated with strength of lower extremities and physical performance tests (gait speed, Timed Up and Go Test and Short Physical performance battery). Higher number of steps per day positively correlates with physical performance. Discussion: Interestingly, we did not find any correlation between the main obesity parameter such as percent body fat or body mass index (and thus sarcopenic obesity) and any of the selected behavioral factors (physical activity, sedentary behavior, or dietary habits). In conclusion, reaching the recommended levels of physical activity in older adults may not be sufficient to prevent the occurrence of obesity and sarcopenic obesity.

Association between Adherence to the Healthy Food Pyramid and Breast Milk Fatty Acids in the First Month of Lactation

In lactating women, breast milk (BM) fatty acids may come from the diet or stored adipose tissue. Our objective was to evaluate the influence of the adherence to the healthy food pyramid (HFP), the dietary pattern in the Mediterranean region, and the maternal body composition on the BM fatty acids pattern. Fifty breastfeeding women answered a socioeconomic survey and the adherence to the HFP questionnaire (AP-Q). In addition, they provided a BM sample at 7 ± 1, 14 ± 1, and 28 ± 1 days postpartum. The body's composition was analyzed at days 7 and 28 by bioimpedance. The BM fatty acids were analyzed by gas chromatography-mass spectroscopy. We found a negative association between the consumption of olive oil and the BM palmitic acid levels (β = -3.19 ± 1.40; p = 0.030), and the intake of cereals and legumes was positively associated with the BM saturated fatty acids (β = 11.48 ± 3.87; p = 0.005). The intake of proteins and vegetables was positively associated with the omega-3 fatty acids and negatively with the omega-6:omega-3 ratio in BM. A negative association between the maternal age (β = -0.43 ± 0.11; p = 0.001) and the α-linolenic acid (ALA) levels was observed, being overall AP-Q positively associated with the ALA levels (β = 0.39 ± 0.15; p = 0.016). Physical activity reduced both the omega-3 and omega-6 fatty acids in BM. Diet had a larger influence than the maternal body's composition on BM fatty acids during the first month of lactation, demonstrating a better adherence to the HFP and positively impacting on the omega-3 content in BM, a fact that is modulated by one's maternal age.

Mediterranean Diet versus Very Low-Calorie Ketogenic Diet: Effects of Reaching 5% Body Weight Loss on Body Composition in Subjects with Overweight and with Obesity-A Cohort Study

The best nutritional strategy to fight the rise in obesity remains a debated issue. The Mediterranean diet (MD) and the Very Low-Calorie Ketogenic diet (VLCKD) are effective at helping people lose body weight (BW) and fat mass (FM) while preserving fat-free mass (FFM). This study aimed to evaluate the time these two diets took to reach a loss of 5% of the initial BW and how body composition was affected. We randomized 268 subjects with obesity or overweight in two arms, MD and VLCKD, for a maximum of 3 months or until they reached 5% BW loss. This result was achieved after one month of VLCKD and 3 months of MD. Both diets were effective in terms of BW (p < 0.0001) and FM loss (p < 0.0001), but the MD reached a higher reduction in both waist circumference (p = 0.0010) and FM (p = 0.0006) and a greater increase in total body water (p = 0.0017) and FFM (p = 0.0373) than VLCKD. The population was also stratified according to gender, age, and BMI. These two nutritional protocols are both effective in improving anthropometrical parameters and body composition, but they take different time spans to reach the goal. Therefore, professionals should evaluate which is the most suitable according to each patient's health status.

Assessment Strategies to Evaluate the Mediterranean Lifestyle: A Systematic Review

The Mediterranean Lifestyle (MLS) has been related to better health and quality of life. However, there is no consensus on how to assess this lifestyle. The main objective of this work was to systematically review the methodology used in different studies on the evaluation of the MLS. The specific objectives were (1) to analyze the MLS components evaluated in previous studies, (2) to explore the assessment instruments available for the analysis of the MLS, and (3) to identify the psychometric properties of these instruments. The search was carried out using the PubMed, Scopus, Web of Science, and ScienceDirect databases with the purpose of identifying those published articles in which the MLS was assessed. The review included 26 studies linked to the assessment of the MLS. Of these studies, only four exclusively used a tool to analyze MLS components globally. These studies included two questionnaires and three different indexes. None of them, however, evaluated all of the recognized MLS components, and food preparation was the least frequently evaluated component. Given the clear importance of analyzing MLS adherence and the lack of consensus in previous research, an evaluation tool needs to be created to comprehensively assess all of the MLS dimensions by means of appropriate psychometric properties.

The Effect of Message Framing in Promoting the Mediterranean Diet: The Moderating Role of Eating Self-Efficacy

Although a Mediterranean diet (MeDiet) provides several psychophysical health benefits, research on how to effectively promote MeDiet adherence is still lacking. In the present study, we tested the effectiveness of a messaging intervention aimed at promoting the adherence to the Mediterranean diet. A total of 435 Italian participants responded to a questionnaire on their eating self-efficacy and adherence to the MeDiet at Time 1. Then, participants were randomly assigned to three different conditions: (a) gain messages focused on the positive outcomes of MeDiet adherence; (b) non-loss messages focused on the avoided negative outcomes associated with MeDiet adherence; (c) no messages (control). After the 2 week intervention, participants answered some questions regarding their perception of threat and distress, evaluation of the messages, and adherence to the MeDiet at Time 2. We also tested whether the messaging intervention influenced participants' MeDiet adherence at Time 2. Results confirmed that the messaging intervention enhanced the MeDiet adherence (F(2,432) = 4.61; p = 0.01, ηp² = 0.02), with no difference between exposure to gain or non-loss messages (95% LLCI = -0.32; 95% ULCI = 0.54). We then tested whether message framing effectiveness was influenced by eating self-efficacy, and results showed that gain messages were more persuasive for participants with low eating self-efficacy (effect size = 0.01; p for interaction = 0.03). Discussion suggests that tailoring messages according to receivers' psychological characteristics seems to be pivotal to enhance the persuasiveness of messages aimed at promoting the MeDiet adherence.

The Psychosocial Antecedents of the Adherence to the Mediterranean Diet

OBJECTIVE

Most previous research on the antecedents of healthy food choice has not investigated the links between these antecedents and has focused on specific food choice rather than on an overall diet. In the present study, we tested the plausibility of an integrated theoretical model aiming to explain the role of different psychosocial factors in increasing the intention to adhere to the Mediterranean Diet (MeDiet).

DESIGN AND PARTICIPANTS

A sample of 1940 Italian adults participated in an online survey that measured their attitude and perceived behavioral control (i.e., rational antecedents), subjective norm (i.e., social antecedent), positive and negative anticipated emotions (i.e., emotional antecedents), food choice health and mood motives (i.e., motivational antecedents), past adherence to the MeDiet (i.e., behavioral antecedent), and the intention to adhere to the MeDiet.

RESULTS

Structural Equation Modelling (SEM) analyses confirmed the plausibility of the proposed model. Perceived behavioral control was the strongest rational antecedent of intention, followed by the emotional (i.e., anticipated emotions) and the social (i.e., subjective norm) antecedents. Mediation analysis showed that motivational antecedents had only an indirect impact on intention via emotional antecedents. Finally, multigroup SEM analysis highlighted that past adherence to the MeDiet moderated the hypothesized paths among all the study variables.

CONCLUSIONS

The above findings advance our comprehension of which antecedents public communication might leverage to promote an increase in the adherence to the MeDiet.

Digital Tourism: An Alternative View on Cultural Intangible Heritage and Sustainability in Tavira, Portugal

The digitalization of cultural routes and virtual storytelling has emerged as a way of showcasing to individuals the heritage of different cultural universes. Regarding this fractional environment, and as a by-product of the international EU funded iHERITAGE project, (B_A.2.1_0056), the goal is to create, through an innovation-driven growth process and technological transfer, brand strategies for the affirmation and better knowledge of intangible realities in the Mediterranean region. The Sicilian Tourism Department in Italy is the project’s lead beneficiary, with representative partners throughout six Mediterranean countries (Italy, Egypt, Spain, Jordan, Lebanon, Portugal). The case study in Portugal is being developed in Tavira, through the intangible cultural heritage of the Mediterranean diet. The research based on the cultural experience, the history of the landscape and the sense of identity and continuity of knowledge is reassigned into a digital platform—the creation of apps and, within this, the design of a virtual route that navigates key geographical places. These apps will later revolve around one of the cultural elements of the Mediterranean, namely, the olive oil activity, with a detailed presentation of the manufacturing process, as well as its didactic interpretation and dissemination about the protection and conservation of Mediterranean research. The methodological approach is developed through the analysis and interpretation of a detailed list of references, fieldwork in a plurality of sites, contextual inquiries and interviews. As a powerful tool for internet marketing and research, these apps will reinforce identity, hospitality and tourism enterprises connected through the virtual itinerary, allowing a closer interaction between tourists and locals, endorsing the rise of technological development, as well as to drastically reduce environmental and ecological risks.

Impact of Mediterranean Diet Food Choices and Physical Activity on Serum Metabolic Profile in Healthy Adolescents: Findings from the DIMENU Project

Adolescent nutrition and healthy dietary patterns, particularly the Mediterranean diet (MD), have been associated with improved health status and decreased risk of various chronic and metabolic diseases later in life. The aim of this study was to evaluate the impact of the Mediterranean food choices on lipid and glycemic metabolic profile in the total population and in adolescents grouped according to their physical activity (PA) levels at the time of recruitment (T0) and after six months from the administration of a personalized Mediterranean meal plan (T1). As part of the DIMENU study, 85 adolescents underwent measurements of lipid and glucose metabolic profile at T0 and T1. Using three positive items from KIDMED test related to the consumption of typical Mediterranean food (olive oil, fish, and nuts) and three negative items on dietary habits (going to fast-food, consuming biscuits, and candies), we categorized adolescents into six sets in which biochemical parameters were analyzed. In the total sample, significant reductions in serum total cholesterol, LDL, and glucose concentrations were observed for all the sets over the study period. Notably, active subjects, who had a better serum metabolic profile, showed significant improvements of glycemic control after 6 month follow up, while in sedentary adolescents and in those performing moderate PA significant reduction in glycemia, total cholesterol, and LDL was found in all sets. In conclusion, adopting the typical Mediterranean food choices led to a significant reduction in glucose and lipid profile in healthy adolescents, thus making the MD and PA a winning combination for health status.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Exploring Hedonic and Eudaimonic Items of Well-Being in Mediterranean and Non-Mediterranean Countries: Influence of Sociodemographic and Lifestyle Factors

Increased understanding of subjective well-being (SWB), as well as factors that influence it, are essential to enhance well-being at the individual and national level. We have applied a hedonic and eudaimonic 9-item composed tool (SWB score) to measure SWB across several Mediterranean (MED) and non-Mediterranean (non-MED) countries, and to explore the association between the SWB score and a range of sociodemographic, health and Mediterranean lifestyle factors. A specifically designed web-based questionnaire was distributed to adult participants (N = 2400) from Spain, Italy, Portugal, Bulgaria and Republic of North Macedonia. Results showed that the SWB score was significantly different across the examined countries with the MED participants displaying slightly higher average scores than the non-MED ones (6.3 ± 1.5 vs. 6.1 ± 1.6, p = 0.002). Several sociodemographic, health status and lifestyle factors displayed a significant but limited association with the 9-item SWB score, with a multiple regression model explaining around 17% of the variance. Nevertheless, our results support that a closer adherence to Mediterranean lifestyle habits—the Mediterranean Diet, spending time with friends, family, and in nature, being active, and getting adequate rest at night—has a positive influence on the 9-item SWB score. Further research is needed to advance the understanding of the measuring and differentiating of SWB across different populations and to establish all the factors that influence it.

Weight loss interventions and nonalcoholic fatty liver disease: Optimizing liver outcomes

The growth in prevalence of obesity, type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) has become one of the most important global health challenges. The three chronic diseases are closely linked in their epidemiology and pathophysiology. Currently, weight loss is the most effective treatment for NAFLD (even in the minority of patients with NAFLD who do not have obesity) and is recommended in all national and international guidelines. Accumulating evidence has shown that weight loss, whether achieved by diet and lifestyle interventions, bariatric surgery or pharmacotherapy, can improve biomarkers of NAFLD, as well as prevent progression and, in some cases, reverse fibrosis. There is a dose dependency of weight loss with NAFLD improvement. Pharmacotherapy with antiobesity medications, alone or in combination with intensive lifestyle interventions or other weight-loss drugs, is closing the efficacy gap between diet and exercise and weight-loss surgery in efficacy at reversing obesity. Given the importance of providing effective weight-loss treatment to patients with NAFLD, weight management services need to be made increasingly available and embedded within hepatology services. This narrative review addresses the evidence that weight loss optimizes liver outcomes in people with NAFLD.

The Mediterranean Lifestyle and the Risk of Depression in Middle-Aged Adults

BACKGROUND

Recent evidence has indicated a greater number of protective factors are associated with a greater decreased risk for depression and depressive symptoms compared with individual factors alone. Moreover, adherence to healthy modifiable lifestyle behaviors may lower the risk of depression regardless of underlying genetic risk.

OBJECTIVES

We longitudinally evaluated the association of the Mediterranean lifestyle (MEDLIFE) with the risk of depression.

METHODS

We prospectively analyzed data from 15,279 participants (6089 men and 9190 women, mean age 37 y) in the Seguimiento Universidad de Navarra cohort. The MEDLIFE index is composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, each of which was assigned 0 or 1 point. Final scores ranged from 0 to 28 points and were categorized into quartiles of MEDLIFE adherence. Cox proportional regression models determined the association of total MEDLIFE adherence, each item, and block with incident depression.

RESULTS

After a mean follow-up of 11.7 y, 912 (6%) incident cases of depression were reported. The mean ± SD final score for MEDLIFE adherence was 11.9 ± 2.7 points. The multivariable model showed that compared with the first quartile, the second and third quartiles of MEDLIFE adherence were significantly associated with a decreased relative risk for incident depression (HR: 0.82; 95% CI: 0.69, 0.96 and HR: 0.74; 95% CI: 0.61, 0.89, respectively). The fourth quartile did not show a statistically significant association with incident depression (HR: 0.89; 95% CI: 0.73, 1.09).

CONCLUSIONS

MEDLIFE adherence may decrease the risk of depression in a Spanish cohort of university graduates. Given no clear association was observed among the highest MEDLIFE adherence, future studies are warranted to better understand the nature of this association. Evidence on MEDLIFE, beyond the Mediterranean diet, may contribute toward more effective prevention strategies for depression.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Mediterranean diet, lifestyle and quality of life in Sardinian patients affected with Hidradenitis suppurativa

Background: Hidradenitis Suppurativa is a chronic inflammatory skin disease with a strong negative impact on physical and psychological health. Obesity, especially visceral adiposity, but also smoking or unhealthy nutritional habits, have been reported to be significantly associated with hidradenitis suppurativa.

Design and methods: Case-control study in 35 patients of both sexes affected with hidradenitis suppurativa, and 35 healthy subjects matched for sex, age, and geographic origin (Sardinia, Italy).

Results: Several anthropometric measures (body mass index, waist circumference, body composition), lifestyle (Mediterranean diet adherence, and physical activity level), and the perceived physical and mental health status were evaluated in case and controls. Hidradenitis patients showed significantly higher values of body mass index, waist circumference, body composition, fat mass, and lower values of physical and mental health status compared to controls, while both groups showed a similar moderate physical activity level which can be assumed to counteract the negative effects of obesity or poor nutritional pattern in hidradenitis patients. However, none of the evaluated variables were correlated with the severity of the disease, assessed by means of the Hurley stage system or the Sartorius score. Instead, the Sartorius score showed a positive correlation with the duration of hidradenitis, mainly imputable to the diagnostic delay and the consequent long lasting inflammatory status.

Conclusions: Although nutritional factors and lifestyle can be important and modifiable factors in the hidradenitis suppurativa course, the detrimental effect of chronic inflammation and delayed management are clearly prevalent and heavily influence the disease burden.

Mobility and muscle strength trajectories in old age: the beneficial effect of Mediterranean diet in combination with physical activity and social support

INTRODUCTION

Decline in physical function varies substantially across older individuals due to several extrinsic modifiable factors such as dietary patterns, physical activity and social support. We aimed to determine the association of these factors and their interaction with mobility and muscle strength decline.

METHODS

We analyzed data from 1686 functionally healthy individuals aged 60 + from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The Mediterranean Diet Score (MDS) was calculated based on a validated food frequency questionnaire. Self-reported physical activity was categorized based on current recommendations, and social support was measured according to participants' perceived material and psychological support from relatives and friends. Participants' physical function was assessed over 12 years through changes in walking speed (m/s) and chair stand time (s). Linear mixed models adjusted for socio-demographic and clinical factors were used. In order to explore the combined effect of the different exposures, two indicator variables were created by cross-classifying individuals' levels of Mediterranean diet adherence and social support or physical activity.

RESULTS

Participants with a high adherence to Mediterranean diet were primarily < 78 years (82.3%), women (56.1%), married (61.1%), with university education (52.8%), high levels of social support (39.3%) and health-enhancing levels of physical activity (51.5%). A one-point increase in MDS (score range 0-9) was associated with less annual deterioration in walking speed (β*time[year] = 0.001; p = 0.024) and chair-stand time (β*time[year] = -0.014; p = 0.008). The potential protective effect of Mediterranean diet was highest among participants reporting high social support (β*time[year] = -0.065, p = 0.026 for chair stands) and high physical activity (β*time[year] = 0.010, p = 0.001 for walking speed), beyond the effect of each exposure individually.

CONCLUSION

A higher adherence to Mediterranean diet, especially in combination with recommended levels of physical activity and high social support, may contribute to delay the decline in physical function observed with aging.

Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis

OBJECTIVES

The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults.

METHODS

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254).

RESULTS

Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies.

DISCUSSION

Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias.

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

BACKGROUND

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

Assessment of Adherence to the Healthy Food Pyramid in Pregnant and Lactating Women

There are numerous dietary recommendations during pregnancy. However, there are limited recommendations during the lactation period, a nutritionally vulnerable period for women. The Mediterranean Diet and adherence to the Healthy Food Pyramid (HFP) is considered as the standard for healthy eating. In this study, we investigated the differences in adherence to the HFP in pregnant, lactating, and non-pregnant/non-lactating (NPNL) women concerning sociodemographic factors. A sociodemographic and nutritional and lifestyle questionnaire (AP-Q) were used to assess adherence to the HFP, including lifestyle. The AP-Q score ranges from 0 to 10 meaning the higher the score, the greater the adherence to the HFP. Lactating women had the lowest AP-Q score (6.13 [5.31; 6.82]) compared to the pregnant (6.39 [5.56; 7.05]) and NPNL women (6.27 [5.43; 6.88]), while pregnant women had the highest scores. Maternal age was positively correlated with AP-Q score in pregnant (rho = 0.22; p-Value < 0.001) and lactating women (rho = 0.18; p-Value < 0.001), but not in NPNL women. Educational level and monthly income had a positive influence on the degree of adherence to the HFP. In conclusion, breastfeeding mothers of young age and low socioeconomic and educational level would be the target population to carry out nutritional interventions that improve their adherence to the HFP. The knowledge gained from this study can help to design recommendation guidelines and nutritional educational interventions for a given population.

A Mediterranean lifestyle reduces the risk of cardiovascular disease in the "Seguimiento Universidad de Navarra" (SUN) cohort

BACKGROUND AND AIMS

A healthy lifestyle is essential to prevent cardiovascular disease (CVD). However, beyond dietary habits, there is a scarcity of studies comprehensively assessing the typical traditional Mediterranean lifestyle with a multi-dimensional index. We assessed the association between the Mediterranean lifestyle (measured with the MEDLIFE index including diet, physical activity, and other lifestyle factors) and the incidence of CVD.

METHODS AND RESULTS

The "Seguimiento Universidad de Navarra" (SUN) project is a prospective, dynamic and multipurpose cohort of Spanish university graduates. We calculated a MEDLIFE score, composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, for 18,631 participants by assigning 1 point for each typical Mediterranean lifestyle factor achieved, for a theoretically possible final score ranging from 0 to 28 points. During an average follow-up of 11.5 years, 172 CVD cases (myocardial infarction, stroke or cardiovascular death) were observed. An inverse association between the MEDLIFE score and the risk of primary cardiovascular events was observed, with multivariable-adjusted hazard ratio (HR) = 0.50; (95% confidence interval, 0.31-0.81) for the highest MEDLIFE scores (14-23 points) compared to the lowest scores (0-9 points), p (trend) = 0.004.

CONCLUSION

A higher level of adherence to the Mediterranean lifestyle was significantly associated with a lower risk of CVD in a Spanish cohort. Public health strategies should promote the Mediterranean lifestyle to preserve cardiovascular health.

A Mediterranean lifestyle is associated with favourable cardiometabolic markers in people with non-dialysis dependent chronic kidney disease

Adherence to a Mediterranean lifestyle may be a useful primary and secondary prevention strategy for chronic kidney disease (CKD). This cross-sectional study aimed to explore adherence to a Mediterranean lifestyle and its association with cardiometabolic markers and kidney function in 99 people aged 73⋅2 ± 10⋅5 years with non-dialysis dependant CKD (stages 3-5) at a single Australian centre. Adherence was assessed using an a priori index, the Mediterranean Lifestyle (MEDLIFE) index. Cardiometabolic markers (total cholesterol, LDL-cholesterol, HbA1c and random blood glucose) and kidney function (estimated GFR) were sourced from medical records and blood pressure measured upon recruitment. Overall, adherence to a Mediterranean lifestyle was moderate to low with an average MEDLIFE index score of 11⋅33 ± 3⋅31. Adherence to a Mediterranean lifestyle was associated with employment (r 0⋅30, P = 0⋅004). Mediterranean dietary habits were associated with cardiometabolic markers, such as limiting sugar in beverages was associated with lower diastolic blood pressure (r 0⋅32, P = 0⋅002), eating in moderation with favourable random blood glucose (r 0⋅21, P = 0⋅043), having more than two snack foods per week with HbA1c (r 0⋅29, P = 0⋅037) and LDL-cholesterol (r 0⋅41, P = 0⋅002). Interestingly, eating in company was associated with a lower frequency of depression (χ ² 5⋅975, P = 0⋅015). To conclude, Mediterranean dietary habits were favourably associated with cardiometabolic markers and management of some comorbidities in this group of people with non-dialysis dependent CKD.

The Mediterranean lifestyle (MEDLIFE) index and metabolic syndrome in a non-Mediterranean working population

BACKGROUND & AIMS

The Mediterranean lifestyle (MEDLIFE), as an overall lifestyle pattern, may be associated with a lower prevalence of metabolic syndrome. We assessed the association of a validated MEDLIFE index with metabolic syndrome and its components in a non-Mediterranean working population.

METHODS

A cross-sectional analysis was conducted at baseline among 249 US career firefighters in Feeding America's Bravest 2016-2018. The MEDLIFE index consisted of 26 items on food consumption, dietary habits, physical activity, rest, and social interactions that scored 0 or 1 point. Thus, total scores could range from 0 to 26 points. Multivariable logistic regression models were used to determine the associations across tertiles of MEDLIFE adherence with metabolic syndrome and each of its individual components. Multivariable linear models further assessed each component as a continuous outcome.

RESULTS

The prevalence of metabolic syndrome was 17.7%. Participants with higher MEDLIFE adherence (T3: 11-17 points) had 71% lower odds of having metabolic syndrome compared to those with lower MEDLIFE adherence (T1: 2-7 points) (OR = 0.29; 95%CI: 0.10 to 0.90, p for trend = 0.04). Furthermore, significant inverse associations were found for T3 versus T1 on abdominal obesity (OR = 0.42; 95%CI: 0.18 to 0.99, p for trend = 0.07) and hypertriglyceridemia (OR = 0.24; 95%CI: 0.09 to 0.63, p for trend = 0.002). Significant inverse associations for continuous outcomes included total-cholesterol (total-c), low-density lipoprotein (LDL) cholesterol, and total-c:high-density lipoprotein (HDL) cholesterol (p for trend <0.05).

CONCLUSION

Higher adherence to traditional Mediterranean lifestyle habits, as measured by a comprehensive MEDLIFE index, was associated with a lower prevalence of metabolic syndrome and a more favorable cardiometabolic profile in a non-Mediterranean working population. Future studies employing the MEDLIFE index in other populations are warranted to support this hypothesis.

The Association Between the Mediterranean Lifestyle Index and All-Cause Mortality in the Seguimiento Universidad de Navarra Cohort

INTRODUCTION

Overall lifestyle patterns rather than individual factors may exert greater reductions on chronic disease risk and mortality. The objective is to study the association between a Mediterranean lifestyle index and all-cause and cause-specific mortality.

METHODS

Investigators analyzed data from 20,494 participants in the Seguimiento Universidad de Navarra cohort in 2019. The Mediterranean lifestyle index is composed of 28 items on food consumption, dietary habits, physical activity, rest, and social interactions that score 0 or 1 point; scores theoretically could range from 0 to 28 points.

RESULTS

After a median follow-up of 12.1 years, 407 deaths were observed. In the multivariable-adjusted model, high adherence (>14 points) to the Mediterranean lifestyle was associated with a 41% relative reduction in all-cause mortality (hazard ratio=0.59, 95% CI=0.42, 0.83) compared with low adherence (3-10 points, p<0.001 for trend). For each additional point, the multivariable hazard ratios for all-cause mortality were 0.95 (95% CI=0.89, 1.02) for food consumption; 1.00 (95% CI=0.92, 1.08) for dietary habits; and 0.73 (95% CI=0.66, 0.80) for physical activity, rest, social habits, and conviviality. Significant interaction with age at last contact (p<0.001) suggested a lower risk for each additional point among participants aged ≥50 years (hazard ratio=0.50, 95% CI=0.34, 0.74), whereas no association was found for participants aged <50 years (hazard ratio=1.15, 95% CI=0.54, 2.44).

CONCLUSIONS

Adherence to a Mediterranean lifestyle may reduce the risk of mortality in a Spanish cohort of university graduates. Inverse associations were found for the overall Mediterranean lifestyle score and lifestyle block, whereas no associations were observed for the dietary blocks. Future research should consider the Mediterranean lifestyle beyond the Mediterranean diet in different populations for the promotion of healthy longevity.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02669602.

Adherence to the Mediterranean Lifestyle and Desired Body Weight Loss in a Mediterranean Adult Population with Overweight: A PREDIMED-Plus Study

Background. Body weight dissatisfaction is a hindrance to following a healthy lifestyle and it has been associated with weight concerns. Objectives. The aim of this study was to assess the association between the adherence to the Mediterranean lifestyle (diet and exercise) and the desired body weight loss in an adult Mediterranean population with overweight. Methods. Cross-sectional analysis in 6355 participants (3268 men; 3087 women) with metabolic syndrome and BMI (Body mass index) between 27.0 and 40.0 kg/m² (55–75 years old) from the PREDIMED-Plus trial. Desired weight loss was the percentage of weight that participants wished to lose. It was categorized into four cut-offs of this percentage (Q1: <10%, n = 1495; Q2: 10–15%, n = 1804; Q3: <15–20%, n = 1470; Q4: ≥20%, n = 1589). Diet was assessed using a validated food frequency questionnaire and a 17-item Mediterranean diet questionnaire. Physical activity was assessed by the validated Minnesota-REGICOR and the validated Spanish version of the Nurses’ Health Study questionnaire. Results. Participants reporting higher percentages of desired weight loss (Q3 and Q4) were younger, had higher real and perceived BMI and were more likely to have abdominal obesity. Desired weight loss correlated inversely to physical activity (Q1: 2106 MET min/week; Q4: 1585 MET min/week. p < 0.001) and adherence to Mediterranean diet (Q1: 8.7; Q4: 8.3. p < 0.001). Conclusions. In older Mediterranean individuals with weight excess, desired weight loss was inversely associated with Mediterranean lifestyle adherence. Deeply rooted aspects of the MedDiet remained similar across groups. Longitudinal research is advised to be able to establish causality.

Is Extra Virgin Olive Oil an Ally for Women's and Men's Cardiovascular Health?

Noncommunicable diseases are long-lasting and slowly progressive and are the leading causes of death and disability. They include cardiovascular diseases (CVD) and diabetes mellitus (DM) that are rising worldwide, with CVD being the leading cause of death in developed countries. Thus, there is a need to find new preventive and therapeutic approaches. Polyphenols seem to have cardioprotective properties; among them, polyphenols and/or minor polar compounds of extra virgin olive oil (EVOO) are attracting special interest. In consideration of numerous sex differences present in CVD and DM, in this narrative review, we applied "gender glasses." Globally, it emerges that olive oil and its derivatives exert some anti-inflammatory and antioxidant effects, modulate glucose metabolism, and ameliorate endothelial dysfunction. However, as in prescription drugs, also in this case there is an important gender bias because the majority of the preclinical studies are performed on male animals, and the sex of donors of cells is not often known; thus a sex/gender bias characterizes preclinical research. There are numerous clinical studies that seem to suggest the benefits of EVOO and its derivatives in CVD; however, these studies have numerous limitations, presenting also a considerable heterogeneity across the interventions. Among limitations, one of the most relevant in the era of personalized medicine, is the non-attention versus women that are few and, also when they are enrolled, sex analysis is lacking. Therefore, in our opinion, it is time to perform more long, extensive and lessheterogeneous trials enrolling both women and men.

Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases

Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.

A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden

The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10-12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.

[Adherence to the Mediterranean diet, and importance in the physical activity and screen time in High School adolescents from Extremadura (Spain)]

Introduction

Introduction: in Spain, one third of young people from 7 to 14 years of age are overweight or obese. Health-related behaviors such as a high level of physical activity, low screen time, and good eating habits can prevent overweight and obesity in young people. Objectives: to assess adherence to the Mediterranean diet and quality of food pattern in an adolescent sample from Extremadura (Spain). Method: the present research is a cross-sectional, descriptive study in 1566 adolescents aged 12-14 years, 857 boys (13.12 ± 0.89) and 709 girls (13.05 ± 0.82). Physical activity was measured through the physical activity questionnaire for adolescents (PAQ-A). Screen time was analyzed through the youth leisure-time sedentary behaviour questionnaire (YLSBQ). Adherence to the Mediterranean diet was calculated using the KIDMED questionnaire. Results: 24.5 % of adolescents reported having good adherence to the Mediterranean diet. The youngest schoolchildren (p < 0.001) had a better eating pattern, with no difference between genders or body mass indices. Students who met recommendations for physical activity and screen time had greater adherence to the Mediterranean diet (p < 0.01). Conclusions: results showed that most children and adolescents needed to improve their eating pattern. Participants who met the recommendations for physical activity and screen time showed greater adherence to the Mediterranean diet.

Nutraceutical polyphenols: New analytical challenges and opportunities

Nowadays, the research for secondary metabolites with health promoting effects in countering or slowing-down chronic and degenerative diseases (e.g. cancer, cardiovascular, and neurodegenerative diseases) identify phenols and polyphenols, widespread and mostly copious in dietary plant sources, as beneficial for human health. These compounds, as intrinsically antioxidant, are claimed as nutraceuticals with preventive efficacy in offsetting oxidant species over-genesis in normal cells, and with the potential ability to halt or reverse oxidative stress-related diseases. In this context, pure (poly)phenols and/or their herbal/food complexes were found to exert both anti- and pro-oxidant activities, suggesting also a promising chemopreventive efficacy. In fact, different evidence further highlights their ability to induce apoptosis, growth arrest, DNA synthesis inhibition and/or modulation of signal transduction pathways. Indeed, a full understanding of the phenolic and polyphenolic composition of plant species, which still now represent their inestimable and worth exploring source, is an important challenge, which today can and must be favourably pursued in the consciousness that the bioactivity of a plant extract is always in its chemistry. To reach this purpose a number of new and advanced techniques are available for extraction, purification and structural identification purposes, but, taking into account how, when and where (poly)phenols are biosynthesized, their use must be highly rationalized. This is particularly true for mass spectrometry techniques which, although representing one of the most powerful tools and in continuous evolution in this era, often suffer from an automatism that does not give justice to the chemical goodness of a plant species and particularly those of nutraceutical interest. This review will deepen into polyphenol research, focusing on biosynthesis, analytical approaches for a conscious exploitability of nutraceutical plant extracts rich in antioxidant and anti-inflammatory polyphenols and/or pure isolated polyphenols.