The Mediterranean diet and mortality--olive oil and beyond

Diet strategies for promoting healthy aging and longevity: An epidemiological perspective

In recent decades, global life expectancies have risen significantly, accompanied by a marked increase in chronic diseases and population aging. This narrative review aims to summarize recent findings on the dietary factors influencing chronic diseases and longevity, primarily from large cohort studies. First, maintaining a healthy weight throughout life is pivotal for healthy aging and longevity, mirroring the benefits of lifelong, moderate calorie restriction in today's obesogenic food environment. Second, the specific types or food sources of dietary fat, protein, and carbohydrates are more important in influencing chronic disease risk and mortality than their quantity. Third, some traditional diets (e.g., the Mediterranean, Nordic, and Okinawa) and contemporary dietary patterns, such as healthy plant-based diet index, the DASH (dietary approaches to stop hypertension) diet, and alternate healthy eating index, have been associated with lower mortality and healthy longevity. These patterns share many common components (e.g., a predominance of nutrient-rich plant foods; limited red and processed meats; culinary herbs and spices prevalent in global cuisines) while embracing distinct elements from different cultures. Fourth, combining a healthy diet with other lifestyle factors could extend disease-free life expectancies by 8-10 years. While adhering to core principles of healthy diets, it is crucial to adapt dietary recommendations to individual preferences and cultures as well as nutritional needs of aging populations. Public health strategies should aim to create a healthier food environment where nutritious options are readily accessible, especially in public institutions and care facilities for the elderly. Although further mechanistic studies and human trials are needed to better understand molecular effects of diet on aging, there is a pressing need to establish and maintain long-term cohorts studying diet and aging in culturally diverse populations.

Perspective: Promoting Healthy Aging through Nutrition: A Research Centers Collaborative Network Workshop Report

Within 20 y, the number of adults in the United States over the age of 65 y is expected to more than double and the number over age 85 y is expected to more than triple. The risk for most chronic diseases and disabilities increases with age, so this demographic shift carries significant implications for the individual, health care providers, and population health. Strategies that delay or prevent the onset of age-related diseases are becoming increasingly important. Although considerable progress has been made in understanding the contribution of nutrition to healthy aging, it has become increasingly apparent that much remains to be learned, especially because the aging process is highly variable. Most federal nutrition programs and nutrition research studies define all adults over age 65 y as "older" and do not account for physiological and metabolic changes that occur throughout older adulthood that influence nutritional needs. Moreover, the older adult population is becoming more racially and ethnically diverse, so cultural preferences and other social determinants of health need to be considered. The Research Centers Collaborative Network sponsored a 1.5-d multidisciplinary workshop that included sessions on dietary patterns in health and disease, timing and targeting interventions, and health disparities and the social context of diet and food choice. The agenda and presentations can be found at https://www.rccn-aging.org/nutrition-2023-rccn-workshop. Here we summarize the workshop's themes and discussions and highlight research gaps that if filled will considerably advance our understanding of the role of nutrition in healthy aging.

[Evolution of the diet and physical activity of university students after the COVID-19 pandemic]

OBJECTIVE

to assess the evolution of adherence to Mediterranean diet and level of physical activity of university students of Health Sciences in Castilla-La Mancha during the COVID-19 lockdown and one year afterwards.

METHODS

a cross-sectional observational study using questionnaires on adherence to the Mediterranean diet and level of physical activity. A total of 893 students enrolled in Health Sciences degrees at the University of Castilla la Mancha participated, 575 in the first survey (during the lockdown) and 318 in the second (one year later). By sex, 672 women and 221 men (in the first survey 77.7 % were women and 22.3 % men while in the second survey these were 70.8 % and 29.2 %, respectively). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The level of physical activity was assessed with the Rapid Assessment of Physical Activity Scale (RAPA).

RESULTS

one year after the COVID-19 confinement, consumption of olive oil has almost tripled. Daily fruit consumption has also doubled. Similarly, the consumption of wine and alcoholic beverages has doubled. Conversely, there was a reduction in the consumption of butter and margarine, as well as of carbonated drinks and sweetened beverages. Likewise, the percentage of university students with high adherence to the Mediterranean diet increased significantly (from 26 % to 34.3 %). Regarding physical activity level, there was a significant increase in the percentage of university students who engaged in light, moderate and even intense physical activity on an irregular basis. This increase was not found in the case of muscular strength and flexibility training activities.

CONCLUSION

the results of the study indicate that, although the levels of adherence to the Mediterranean diet and physical activity have improved after the COVID-19 confinement, adherence to Mediterranean diet and physical activity level among the university population analyzed is still low. It is necessary to implement strategies for the achievement or maintenance of a healthy lifestyle in this population.

Squalene Loaded Nanoparticles Effectively Protect Hepatic AML12 Cell Lines against Oxidative and Endoplasmic Reticulum Stress in a TXNDC5-Dependent Way

Virgin olive oil, the main source of fat in the Mediterranean diet, contains a substantial amount of squalene which possesses natural antioxidant properties. Due to its highly hydrophobic nature, its bioavailability is reduced. In order to increase its delivery and potentiate its actions, squalene has been loaded into PLGA nanoparticles (NPs). The characterization of the resulting nanoparticles was assessed by electron microscopy, dynamic light scattering, zeta potential and high-performance liquid chromatography. Reactive oxygen species (ROS) generation and cell viability assays were carried out in AML12 (alpha mouse liver cell line) and a TXNDC5-deficient AML12 cell line (KO), which was generated by CRISPR/cas9 technology. According to the results, squalene was successfully encapsulated in PLGA NPs, and had rapid and efficient cellular uptake at 30 µM squalene concentration. Squalene reduced ROS in AML12, whereas ROS levels increased in KO cells and improved cell viability in both when subjected to oxidative stress by significant induction of Gpx4. Squalene enhanced cell viability in ER-induced stress by decreasing Ern1 or Eif2ak3 expressions. In conclusion, TXNDC5 shows a crucial role in regulating ER-induced stress through different signaling pathways, and squalene protects mouse hepatocytes from oxidative and endoplasmic reticulum stresses by several molecular mechanisms depending on TXNDC5.

Markers of a plant-based diet relate to memory and executive function in older adults

BACKGROUND

Although it is known that plant-based foods are important for physical health, little is known about the relationship between plant-based foods and cognitive health. Emerging evidence suggests that some macronutrients may influence cognition, but it is unclear which domains of cognition are involved; more importantly, it is unknown how a plant-based diet relates to cognition.

OBJECTIVE

To examine associations between a plant-based dietary pattern and cognitive functioning.

METHODS

Participants were 3,039 older adults who participated in the 2011-2014 waves of the National Health and Nutrition Examination Survey (NHANES). The present cross-sectional study used data on macronutrient intake from 24-hour dietary interviews, as well as performance on tests of long-term memory and executive function (i.e., delayed word recall, digit symbol substitution test, and animal fluency). Principal component analysis was used to extract a dietary pattern consistent with a plant-based diet.

RESULTS

Greater adherence to a dietary pattern consistent with a plant-based diet was related to better performance on all cognitive tasks. Secondary analyses indicated that the associations between a plant-based dietary pattern and executive function accounted for the association between a plant-based dietary pattern and memory. Furthermore, this same plant-based dietary pattern was associated with reduced baseline inflammation in a separate dataset.

CONCLUSIONS

Experimental manipulations are needed to determine the potential causal relations of these associations, but these results suggest that a plant-based diet relates to better cognition, especially through improved executive control. Future work should also attempt to extend these results by examining potential mechanisms underlying these associations, such as reduced inflammation.

Adherence to index-based dietary patterns in childhood and BMI trajectory during the transition to adolescence: the EPOCH study

BACKGROUND

In the United States, one in five adolescents are obese. Index-based dietary patterns are measures of the overall diet that have the potential to serve as valuable obesity risk stratification tools. However, little is known about the association between adherence to index-based dietary patterns in childhood and BMI during the transition from childhood to adolescence.

OBJECTIVE

To prospectively examine the relationship between adherence to three index-based dietary patterns in childhood and BMI trajectory during the transition to adolescence.

METHODS

The study included 581 children enrolled in a Colorado prospective cohort study conducted between 2006 and 2015. Dietary intake was assessed with the Block Kids Food Frequency Questionnaire at age 10 years. Scores were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternate Mediterranean (aMED) diet, and the Dietary Approaches to Stop Hypertension (DASH) diet. Weight and height were assessed via anthropometry at two research visits (ages 10 and 16 years), with interim clinical measurements extracted from Kaiser Permanente medical records. Separate mixed models were used to assess the association between each diet index score and BMI over a 6-year period. Models were stratified by sex and adjusted for age, race/ethnicity, income, and exposure to gestational diabetes.

RESULTS

Median (IQR) number of BMI assessments was 14 (10-18). Among girls, for every ten-unit increase in HEI-2010 score, there was an average 0.64 kg/m² decrease (p = 0.007) in BMI over time, after adjustment for covariates. Among girls, there was no association between BMI and aMED (β = -0.19, p = 0.24) or DASH (β = 0.28, p = 0.38). Among boys, there was no statistically significant association between BMI and HEI-2010 (0.06, p = 0.83), aMED (0.07, p = 0.70), or DASH (0.42, p = 0.06).

CONCLUSIONS

Efforts to prevent adolescent obesity could benefit from considering the degree of adherence to federal dietary guidance, as assessed by the HEI, in the period preceding adolescence, especially among girls.

4BR: Educational Training Programme for the Prevention of Sports Injuries in Young Athletes

This article provides a vision of the importance of the recovery process for the prevention of injuries in young athletes. From a sports psychology perspective, it presents a proposal for an optimisation programme to reduce the negative impact of exertion and subsequent risk of injury. The 4BR programme consists of three sub-programmes (technician advice, vulnerability detection, and the implementation of four recovery habit blocks). An interdisciplinary approach is taken to configure the four healthy blocks: nutrition-hydration, relaxation-rest, social life and personal moments. It demonstrates the importance of personalised adaptation to the sports context and moment in order to achieve maximum effectiveness of the proposed 4BR programme, which comprises workshops, exercises, evaluation systems and information feedback. The presented programme facilitates recovery, optimizes the return to training and reduces the risk of intrinsic injuries in young people. The conclusion drawn from the study is that there is a need to conduct further research to find empirical evidence of the positive effects of applying the 4BR programme to different sports.

The role of diet in hyperuricemia and gout

PURPOSE OF REVIEW

Although gout's cardinal feature is inflammatory arthritis, it is closely associated with insulin resistance and considered a manifestation of the metabolic syndrome. As such, both gout and hyperuricemia are often associated with major cardiometabolic and renal comorbidities that drive the persistently elevated premature mortality rates among gout patients. To that end, conventional low-purine (i.e., low-protein) dietary advice given to many patients with gout warrant reconsideration.

RECENT FINDINGS

Recent research suggests that several healthy diets, such as the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets, in combination with weight loss for those who are overweight or obese, can drastically improve cardiometabolic risk factors and outcomes. By treating gout as a part of the metabolic syndrome and shifting our dietary recommendations to these healthy dietary patterns, the beneficial effects on gout endpoints should naturally follow for the majority of typical gout cases, mediated through changes in insulin resistance.

SUMMARY

Dietary recommendations for the management of hyperuricemia and gout should be approached holistically, taking into consideration its associated cardiometabolic comorbidities. Several healthy dietary patterns, many with similar themes, can be tailored to suit comorbidity profiles and personal preferences.

The association of the Mediterranean diet with heart failure risk in a Dutch population

BACKGROUND AND AIMS

It is still unclear whether a healthy diet can prevent heart failure (HF). Therefore, this study aimed to investigate the association between adherence to a Mediterranean-style diet, reflected by modified Mediterranean Diet Scores (mMDS), and the incidence of HF in men and women.

METHODS AND RESULTS

This observational study comprised 9316 men and 27,645 women from the EPIC-NL cohort free from cardiovascular disease at baseline. Dietary intakes were assessed using a validated food frequency questionnaire. mMDS was calculated using a 9-point scale based on consumption of vegetables, legumes, fruit, nuts, seeds, grains, fish, fat ratio, dairy, meat and alcohol. HF events were ascertained by linkage to nation-wide registries. Multivariable Hazard Ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression models. Over a median follow-up of 15 years (IQR 14-16), 633 HF events occurred: 144 in men (1.5%) and 489 in women (1.8%). The median mMDS was 4 (IQR 3-5). There was significant effect modification by sex (P-value for interaction <0.001), therefore results are stratified for men and women. For men, a higher mMDS associated with lower HF risk (HR: 0.88; 95% CI: 0.79, 0.98 per point increase in mMDS; HR upper category: 0.53; 95% CI: 0.33, 0.86), whereas no association was found in women (HR: 0.98; 95% CI: 0.93, 1.04 per point increase; HR upper category: 1.07; 95% CI: 0.83, 1.36).

CONCLUSION

Adherence to a Mediterranean-style diet may reduce HF risk, particularly in men. The underlying reasons for the differences in findings between men and women need further study.

Effects of Low-Fat, Mediterranean, or Low-Carbohydrate Weight Loss Diets on Serum Urate and Cardiometabolic Risk Factors: A Secondary Analysis of the Dietary Intervention Randomized Controlled Trial (DIRECT)

OBJECTIVE

Weight loss diets may reduce serum urate (SU) by lowering insulin resistance while providing cardiometabolic benefits, something urate-lowering drugs have not shown in trials. We aimed to examine the effects of weight loss diets on SU and cardiometabolic risk factors.

RESEARCH DESIGN AND METHODS

This secondary study of the Dietary Intervention Randomized Controlled Trial (DIRECT) used stored samples from 235 participants with moderate obesity randomly assigned to low-fat, restricted-calorie (n = 85); Mediterranean, restricted-calorie (n = 76); or low-carbohydrate, non-restricted-calorie (n = 74) diets. We examined SU changes at 6 and 24 months overall and among those with hyperuricemia (SU ≥416 μmol/L), a relevant subgroup at risk for gout.

RESULTS

Among all participants, average SU decreases were 48 μmol/L at 6 months and 18 μmol/L at 24 months, with no differences between diets (P > 0.05). Body weight, HDL cholesterol (HDL-C), total cholesterol:HDL-C ratio, triglycerides, and insulin concentrations also improved in all three groups (P < 0.05 at 6 months). Adjusting for covariates, changes in weight and fasting plasma insulin concentrations remained associated with SU changes (P < 0.05). SU reductions among those with hyperuricemia were 113, 119, and 143 μmol/L at 6 months for low-fat, Mediterranean, and low-carbohydrate diets (all P for within-group comparison < 0.001; P > 0.05 for between-group comparisons) and 65, 77, and 83 μmol/L, respectively, at 24 months (all P for within-group comparison < 0.01; P > 0.05 for between-group comparisons).

CONCLUSIONS

Nonpurine-focused weight loss diets may simultaneously improve SU and cardiovascular risk factors likely mediated by reducing adiposity and insulin resistance. These dietary options could provide personalized pathways to suit patient comorbidity and preferences for adherence.

An Innovative Olive Pâté with Nutraceutical Properties

Food plays a central role in health, especially through consumption of plant-derived foods. Functional foods, supplements, and nutraceuticals are increasingly entering the market to respond to consumer demand for healthy products. They are foods, supplements, and ingredients which offer health benefits beyond the standard nutritional value. Some benefits are associated with phenolic compounds and phytochemicals with antioxidant properties. An olive pâté (OP) was added with antioxidants derived from olive mill wastewater (OMWW) to obtain a functional product rich in phenolic compounds. The olive pâté is produced from the ground olive pericarp, which shows an excellent natural antioxidant content. The OMWW is a waste product from oil processing, which is also rich in phenolic compounds. The result was a product rich in trans-resveratrol, OH tyrosol, and tyrosol in concentrations such as satisfying the European community’s claims regarding the possible antioxidant action on plasma lipids with excellent shelf-life stability. The total phenolic content was assayed by a colorimetric method, the antioxidant activity by the ABTS [(2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid)] test, the phenolic profile by Q Exactive Orbitrap LC-MS/MS. The shelf-life stability was confirmed by yeast, molds, and total microbial count, pH, and water activity determinations, and the best pasteurization parameters were determined. The palatability was judged as excellent.

Effects of the Mediterranean diet on cardiovascular risk factors in non-alcoholic fatty liver disease patients: A systematic review and meta-analysis

BACKGROUND & AIMS

We aimed to investigate the effect of the Mediterranean diet (MedDiet) on cardiovascular risk factors in patients with non-alcoholic fatty liver disease (NAFLD).

METHOD

A systematic search was performed in Scopus, Web of Science, Cochrane library and PubMed databases to find randomized controlled trials (RCTs) related to the effect of the MedDiet in patients with NAFLD, up to July, 2019. There was no language and time limitation. Meta-analyses were performed using both the random and fixed effects model where appropriate, and I2 index was used to evaluate the heterogeneity.

RESULTS

Primary search yielded 467 publications. Five RCTs were eligible. Our meta-analysis indicated that the MedDiet resulted in a significant decrease in serum levels of triglyceride and total cholesterol, and a decrease in body weight and HOMA-IR in comparison to a control diet, in NAFLD patients. Whereas, there were no significant improvement in the MedDiet group compared with the control group regarding other variables such as liver enzymes and blood pressure.

CONCLUSIONS

This meta-analysis indicated the advantageous effects of the MedDiet on some cardiovascular risks factors, as compared with a control diet. It seems that the MedDiet can be considered as an appropriate strategy to reduce cardiovascular risk factors in NAFLD patients.

Reinforced Olive Pâté as a Source of Antioxidants with Positive Effects on Young Smokers

Background and objectives: Olive pâté (OP) is an olive-derived product with potentially beneficial effects on human health due to the presence of natural antioxidants. The present dietary supplementation study aimed to evaluate the effects on blood antioxidant levels of an olive pâté reinforced with natural antioxidants (ROP) recovered from olive mill waste. Materials and methods: Ninety-eight healthy volunteers (M = 54, 55%, age 18–25) were divided into two groups: A (n = 49), practicing three or more days of physical activity a week, and B (n = 49), practicing less than two. Each group was split into two subgroups, receiving dietary supplementation with OP or ROP. The status of smoker was also recorded, and a biological antioxidant potential (BAP) test was performed on each subject. Results: The BAP values increased with both OP (n = 30) and ROP (n = 68) but ROP supplementation showed higher increments (736.9 μmol/L) than OP (339.6). The increment was significantly higher for smokers (n = 15), 1122.9 vs. non-smokers (n = 53), 635.7, with values in percent of baseline, respectively, 34.6% and 16.2% (P < 0.01). Conclusions: The ROP nutritional supplementation appears useful to increase antioxidant activity, with better effect in smokers; further studies should confirm the finding and investigate its biological bases.

Feasibility and acceptability of a Mediterranean-style diet intervention to reduce cardiovascular risk for low income Hispanic American women

OBJECTIVE

Evidence for the cardioprotective effects of a Mediterranean-style (Med-style) diet is strong, however few Med-style dietary interventions have been developed for and tested among Hispanic Americans (HAs), especially younger HAs of reproductive age whose dietary habits may strongly influence dietary intake for all family members.

DESIGN

We adapted a previously tested and evidence-informed lifestyle intervention to reduce CVD risk and evaluated its feasibility, acceptability, and effects on self-reported lifestyle behaviors in this study enrolling low-income HA women attending a Title X family planning clinic in eastern North Carolina. The 3-month long intervention, given to all participants, promoted a Med-style dietary pattern with a focus on increasing consumption of foods commonly consumed by HA that have high quality dietary fats (polyunsaturated and monounsaturated fats primarily from plant sources and fish) and carbohydrates (fruits, vegetables, and whole grains). The intervention also recommended increasing physical activity and was given during 2 face-to-face counseling sessions and 2 telephone counseling sessions. Major outcomes were engagement with study activities and intervention acceptability; lifestyle behavior change at 3-month follow-up is also reported.

RESULTS

Baseline characteristics (n = 36) were: mean age 33 years, 35 (97%) without health insurance, 32 (89%) born in Mexico, and mean BMI 30 kg/m2. Engagement was high among the 36 participants with 33 (92%) completing the intervention and follow-up measures. At follow-up, most participants thought the intervention was helpful (range: 85-100%) and acceptable (100% agreed 'I would recommend the program to others'). The mean dietary fat quality score improved by 0.5 units (95% CI: 0.0-1.1) and the mean fruit-vegetable servings/day improved by 0.7/day (95% CI: 0.1-1.3).

CONCLUSION

Intervention engagement and acceptability were high and there was improvement in self-reported dietary behaviors. This type of Med-style dietary pattern intervention should be evaluated in randomized trials enrolling HAs at risk for CVD.

Intestinal permeability after Mediterranean diet and low-fat diet in non-alcoholic fatty liver disease

BACKGROUND

In non-alcoholic fatty liver disease (NAFLD), a high-fat or high-fructose diet increases intestinal permeability and promotes derangement of the gut-liver axis. We hypothesize that, diet could be able to modulate intestinal permeability in patients with NAFLD.

AIM

To detect diet-induced modification of intestinal permeability in patients with NAFLD undergoing a Mediterranean diet or a low-fat diet.

METHODS

The current study was a dietary intervention for non-diabetic, patients with biopsy-verified NAFLD and increased transaminases. A crossover design was employed: participants underwent 16 weeks of Mediterranean diet, 16 wk of free wash-out, and 16 weeks of low-fat diet. Both diets were hypocaloric and no consumption of supplements was allowed. All patients were followed bimonthly by a dietitian. Evaluations of clinical and metabolic parameters were completed at baseline and at the end of each dietary period. Intestinal permeability was assessed by chromium-51 ethylene diamine tetraacetate excretion testing (51Cr-EDTA).

RESULTS

Twenty Caucasian patients, 90% male, median age 43 years, body mass index (BMI) 30.9, with biopsy-verified NAFLD were enrolled. At the end of 16 weeks of a Mediterranean diet, a significant reduction in mean body weight (-5.3 ± 4.1 kg, P = 0.003), mean waist circumference (-7.9 ± 4.9 cm, P = 0.001), and mean transaminase levels [alanine aminotransferase (ALT) -28.3 ± 11.9 IU/L, P = 0.0001; aspartate aminotransferase (AST) -6.4 ± 56.3 IU/L, P = 0.01] were observed. These benefits were maintained after 16 wk of wash-out and also after 16 wk of low-fat diet, without further improvements. Fourteen of the 20 patients had intestinal permeability alteration at baseline (mean percentage retention of 51Cr-EDTA = 5.4%), but no significant changes in intestinal permeability were observed at the end of the 16 wk of the Mediterranean diet or 16 wk of the low-fat diet.

CONCLUSION

Mediterranean diet is an effective strategy for treating overweight, visceral obesity and serum transaminase in patients with NAFLD. If the Mediterranean diet can improve intestinal permeability in patients with NAFLD, it deserves further investigation.

OliveNet™: a comprehensive library of compounds from Olea europaea

Accumulated epidemiological, clinical and experimental evidence has indicated the beneficial health effects of the Mediterranean diet, which is typified by the consumption of virgin olive oil (VOO) as a main source of dietary fat. At the cellular level, compounds derived from various olive (Olea europaea), matrices, have demonstrated potent antioxidant and anti-inflammatory effects, which are thought to account, at least in part, for their biological effects. Research efforts are expanding into the characterization of compounds derived from Olea europaea, however, the considerable diversity and complexity of the vast array of chemical compounds have made their precise identification and quantification challenging. As such, only a relatively small subset of olive-derived compounds has been explored for their biological activity and potential health effects to date. Although there is adequate information describing the identification or isolation of olive-derived compounds, these are not easily searchable, especially when attempting to acquire chemical or biological properties. Therefore, we have created the OliveNet™ database containing a comprehensive catalogue of compounds identified from matrices of the olive, including the fruit, leaf and VOO, as well as in the wastewater and pomace accrued during oil production. From a total of 752 compounds, chemical analysis was sufficient for 676 individual compounds, which have been included in the database. The database is curated and comprehensively referenced containing information for the 676 compounds, which are divided into 13 main classes and 47 subclasses. Importantly, with respect to current research trends, the database includes 222 olive phenolics, which are divided into 13 subclasses. To our knowledge, OliveNet™ is currently the only curated open access database with a comprehensive collection of compounds associated with Olea europaea.

Database URL: https://www.mccordresearch.com.au

Dietary Fats and Chronic Noncommunicable Diseases

The role of dietary fat has been long studied as a modifiable variable in the prevention and treatment of noncommunicable cardiometabolic disease. Once heavily promoted to the public, the low-fat diet has been demonstrated to be non-effective in preventing cardiometabolic disease, and an increasing body of literature has focused on the effects of a relatively higher-fat diet. More recent evidence suggests that a diet high in healthy fat, rich in unsaturated fatty acids, such as the Mediterranean dietary pattern, may, in fact, prevent the development of metabolic diseases such as type 2 diabetes mellitus, but also reduce cardiovascular events. This review will specifically focus on clinical trials which collected data on dietary fatty acid intake, and the association of these fatty acids over time with measured cardiometabolic health outcomes, specifically focusing on morbidity and mortality outcomes. We will also describe mechanistic studies investigating the role of dietary fatty acids on cardiovascular risk factors to describe the potential mechanisms of action through which unsaturated fatty acids may exert their beneficial effects. The state of current knowledge on the associations between dietary fatty acids and cardiometabolic morbidity and mortality outcomes will be summarized and directions for future work will be discussed.

Mortality patterns in Southern Adriatic islands of Croatia: a registry-based study

Aim

To investigate the mortality patterns on the Southern Adriatic islands of Croatia and compare them with those in two, mainly coastal, mainland counties.

Methods

In this registry-based study we used the official mortality register data to analyze the mortality patterns on seven Croatian islands (Brač, Hvar, Korčula, Lastovo, Mljet, Šolta, and Vis) and Pelješac peninsula in the 1998-2013 period and calculated the average lifespan, life expectancy, and standardized mortality ratios (SMR). We compared the leading causes of death with those in the mainland population of two southernmost Croatian counties.

Results

The average lifespan of the island population was 3-10 years longer for men and 2-7 years longer for women than that on the mainland. All-cause SMRs were significantly lower for both men and women on Korčula, Brač, Mljet, and Pelješac but significantly higher for women on Šolta (1.22; 95% confidence intervals 1.07-1.38). The leading causes of death on the islands were cardiovascular diseases, with higher percentages in men and lower in women in comparison with those on the mainland. There were no substantial differences in the life expectancy at birth.

Conclusions

Despite longer lifespan, lack of differences in life expectancy at birth suggests that the recent generations of islanders no longer show beneficial mortality patterns, possibly due to diminishing adherence to the Mediterranean diet and lifestyle. Restoring the traditional lifestyles is a public health priority, with the ultimate aim of reducing inequalities and improving the health of island inhabitants.

Association of Breakfast Quality and Energy Density with Cardiometabolic Risk Factors in Overweight/Obese Children: Role of Physical Activity

There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8–12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders (β = −0.172, p = 0.028), but the relationship was attenuated after further controlling for total PA (p < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all p < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all p < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.

The antioxidant potential of the Mediterranean diet in patients at high cardiovascular risk: an in-depth review of the PREDIMED

Cardiovascular disease (CVD) is the leading global cause of death. Diet is known to be important in the prevention of CVD. The PREDIMED trial tested a relatively low-fat diet versus a high-fat Mediterranean diet (MedDiet) for the primary prevention of CVD. The resulting reduction of the CV composite outcome resulted in a paradigm shift in CV nutrition. Though many dietary factors likely contributed to this effect, this review focuses on the influence of the MedDiet on endogenous antioxidant systems and the effect of dietary polyphenols. Subgroup analysis of the PREDIMED trial revealed increased endogenous antioxidant and decreased pro-oxidant activity in the MedDiet groups. Moreover, higher polyphenol intake was associated with lower incidence of the primary outcome, overall mortality, blood pressure, inflammatory biomarkers, onset of new-onset type 2 diabetes mellitus (T2DM), and obesity. This suggests that polyphenols likely contributed to the lower incidence of the primary event in the MedDiet groups. In this article, we summarize the potential benefits of polyphenols found in the MedDiet, specifically the PREDIMED cohort. We also discuss the need for further research to confirm and expand the findings of the PREDIMED in a non-Mediterranean population and to determine the exact mechanisms of action of polyphenols.

Dietary Patterns and Long-Term Survival: A Retrospective Study of Healthy Primary Care Patients

BACKGROUND

Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.

METHODS

In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Tex), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987 and 1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality.

RESULTS

Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P < .02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.

CONCLUSIONS

The DASH dietary pattern was associated with significantly lower all-cause mortality over approximately 2 decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.

Adherence to a Mediterranean dietary pattern and overweight and obesity among female adolescents in Iran

Background Given the high prevalence of overweight and obesity in Iran, identification of a healthy diet is essential. Objective This study aimed to assess the association between adherence to a Mediterranean diet and overweight and obesity in female adolescents. Methods Two hundred and eighty female adolescents from high schools in Tehran were recruited. General information, physical activity and food frequency questionnaires were completed. Adherence to the Mediterranean diet was evaluated using the Mediterranean Style Dietary Pattern Score (MSDPS). Results Under and over reporters of energy intake were excluded from the analysis (n = 37). Results indicated that prevalence of overweight and obesity was 13.3% and 12.5%, respectively. The mean of MSDPS was low in this population (15.99 ± 5.64). The MSDPS was positively associated with mother's education level and energy intake (p < 0.05). No significant relation was observed between MSDPS and overweight and obesity among adolescents. However, there was a negative significant association between MSDPS and WHR just among students who had educated mothers [high: second median v. low: first median, odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.12-1.03]. Conclusion Adherence to a Mediterranean dietary pattern is low among adolescent females in Tehran, with no association with overweight and obesity.

Oleuropein improves insulin resistance in skeletal muscle by promoting the translocation of GLUT4

As the beneficial effects of the Mediterranean diet on human health are well established, the phenolic compounds in olive oil have been gaining interest. Oleuropein, a major phenolic compound in olives, is known to reduce the blood glucose levels in alloxan-induced diabetic rats and rabbits, however, its effect on type 2 diabetes caused by obesity is not clear. The purpose of this study is clarifying the effect of oleuropein on the glucose tolerance in skeletal muscle under the condition of lipotoxicity caused by type 2 diabetes. Oleuropein enhanced glucose uptake in C2C12 cells without insulin. Translocation of glucose transporter 4 (GLUT4) into the cell membrane was promoted by activation of adenosine monophosphate-activated protein kinase (AMPK) but not protein kinase B (Akt). Physiological concentration of oleuropein (10 µM) was sufficient to express beneficial effects on C2C12 cells. Oleuropein prevented palmitic acid-induced myocellular insulin resistance. Furthermore, in gastrocnemius muscles of mice fed a high fat diet, oleuropein also induced the GLUT4 localization into cell membrane. These results suggest the possibility of oleuropein to be effective for type 2 diabetes by reducing insulin resistance in skeletal muscles.

Dietary oleic acid regulates hepatic lipogenesis through a liver X receptor-dependent signaling

Olive oil consumption is beneficial for health as it is associated with a decreased prevalence of cancer and cardiovascular diseases. Oleic acid is, by far, the most abundant component of olive oil. Since it can be made through de novo synthesis in animals, it is not an essential fatty acid. While it has become clear that dietary oleic acid regulates many biological processes, the signaling pathway involved in these regulations remains poorly defined. In this work we tested the impact of an oleic acid-rich diet on hepatic gene expression. We were particularly interested in addressing the contribution of Liver X Receptors (LXR) in the control of genes involved in hepatic lipogenesis, an essential process in whole body energy homeostasis. We used wild-type mice and transgenic mice deficient for both α and β Liver X Receptor isoforms (LXR-/-) fed a control or an oleate enriched diet. We observed that hepatic-lipid accumulation was enhanced as well as the expression of lipogenic genes in the liver of wild-type mice fed the oleate enriched diet. In contrast, none of these changes occurred in the liver of LXR-/- mice. Strikingly, oleate-rich diet reduced cholesterolemia in wild-type mice and induced signs of liver inflammation and damage in LXR-/- mice but not in wild-type mice. This work suggests that dietary oleic acid reduces cholesterolemia while promoting LXR-dependent hepatic lipogenesis without detrimental effects to the liver.

Ten-Year Trends (1999-2010) of Adherence to the Mediterranean Diet among the Balearic Islands' Adult Population

The aim of this work was to assess ten-year trends (1999-2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands' adult population. Two independent cross-sectional dietary surveys (1999-2000, n = 1200 and 2009-2010 n = 1388, including participants aged 16-65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999-2000 and 44.6% (SD 8.3) in 2009-2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island's natives than among people born abroad. In 2009-2010, individuals in the MDP's fourth quartile were more likely to be older (aged 46-65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999-2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands' adult population in the last decade.

Antiurolithic effect of olive oil in a mouse model of ethylene glycol-induced urolithiasis

Purpose

At present, commercially available antiurolithic drugs have more adverse effects than potential therapeutic or preventive effects with chronic use. With this in mind, the present study was designed to assess the antiurolithic effect of olive oil in a mouse model of ethylene glycol (EG)-induced urolithiasis.

Materials and Methods

Adult albino mice were divided into 6 groups. Group I was fed the vehicle only. Group II was supplemented with 0.75% EG alone in drinking water during the experimental period to initiate deposition of calcium oxalate in kidneys, which leads to urolithiasis in animals. Groups III (olive oil control group) through V were fed olive oil orally at various doses during the experimental period. Group VI received cystone (750 mg/kg). Groups IV–VI additionally received 0.75% EG in drinking water ad libitum. SPSS ver.17.0 was used for statistical analysis.

Results

The study results showed significantly higher levels of serum urea, uric acid, and creatinine (p<0.05) in group II than in groups III–VI and I. Administration of olive oil at different doses restored the elevated serum parameters in groups IV and V compared with group II. Urine and kidney calcium, oxalate, and phosphate levels in groups IV–VI were significantly lower (p<0.05) than in animals with EG-induced urolithiasis (group II). Group V mice showed a significant restoration effect on serum as well as urine and kidney parameters compared with group II.

Conclusions

Supplementation with olive oil (1.7 mL/kg body weight) reduced and prevented the growth of urinary stones, possibly by inhibiting renal tubular membrane damage due to peroxidative stress induced by hyperoxaluria.

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients' lives. In the early years of dialysis, potassium was identified as "the killer", and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the "third era" finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the "magic numbers" of nutritional requirements (calories: 30-35 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on "conventional" thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of "vascular healthy" food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations.

Restoration of Tear Secretion in a Murine Dry Eye Model by Oral Administration of Palmitoleic Acid

Sea buckthorn (Hippophae rhamnoides)-derived products have traditionally been used as food and medicinal ingredients in Eastern countries. The purpose of this study was to investigate the effect of oral intake of sea buckthorn oil products on tear secretion using a murine dry eye model. Orally administered sea buckthorn pulp oil (not seed oil) restored aqueous tear secretion to its normal value under a dry eye condition. Palmitoleate (C16:1), a fatty acid present in sea buckthorn pulp oil, preserved tear secretion and suppressed inflammatory cytokines in the lacrimal gland to the same extent as that by pulp oil. These results suggest that an oral intake of sea buckthorn pulp oil has a potency to preserve tear secretion capacity in the dry eye state and palmitoleate, its main constituent fatty acid, is an active component of the oil. This effect may enable a potent diet-based treatment for the prevention of dry eye.

Effects of Integrated Health Management Intervention on Overweight and Obesity

Overweight or obese adults aged 20~55 years and living in Beijing more than one year were randomly divided into different management groups. A one-year integrated health management intervention was applied in the health management groups. The physical indicators and metabolic indicators changed after one-year intervention on the overweight and obese adults. The annual reduction of the physical indicators was significant in all groups (p < 0.05) except the weight loss in the placebo + general management group. The health management and the dietary supplement have statistically significant (p < 0.001, p < 0.001) effects on the annual reduction of these indicators and interactive effect between them was found on some of these indicators such as bodyweight, body mass index (BMI), body fat ratio (BFR), and hipline (p < 0.05). The dietary supplement + health management group had the best annual reduction effects for the indicators among the groups. Integrated health management interventions including both dietary supplements intervention and health management could improve metabolic indicators in overweight and obese adults together with the physical indicators, suggesting the intermediated role of metabolic indictors in controlling obesity.

A novel acenocoumarol pharmacogenomic dosing algorithm for the Greek population of EU-PACT trial

Aim: To generate and validate a pharmacogenomic-guided (PG) dosing algorithm for acenocoumarol in the Greek population. To compare its performance with other PG algorithms developed for the Greek population. Patients & methods: A total of 140 Greek patients participants of the EU-PACT trial for acenocoumarol, a randomized clinical trial that prospectively compared the effect of a PG dosing algorithm with a clinical dosing algorithm on the percentage of time within INR therapeutic range, who reached acenocoumarol stable dose were included in the study. Results: CYP2C9 and VKORC1 genotypes, age and weight affected acenocoumarol dose and predicted 53.9% of its variability. EU-PACT PG algorithm overestimated acenocoumarol dose across all different CYP2C9/VKORC1 functional phenotype bins (predicted dose vs stable dose in normal responders 2.31 vs 2.00 mg/day, p = 0.028, in sensitive responders 1.72 vs 1.50 mg/day, p = 0.003, in highly sensitive responders 1.39 vs 1.00 mg/day, p = 0.029). The PG algorithm previously developed for the Greek population overestimated the dose in normal responders (2.51 vs 2.00 mg/day, p < 0.001). Conclusion: Ethnic-specific dosing algorithm is suggested for better prediction of acenocoumarol dosage requirements in patients of Greek origin.

Association of Empirically Derived Dietary Patterns with Cardiovascular Risk Factors: A Comparison of PCA and RRR Methods

Introduction

Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study aimed to compare both types of DP and theirs associations with cardiovascular risk factors (CVRF).

Materiel and Methods

Data were derived from the cross sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater region’s population (Grand duchy of Luxembourg, Wallonia (Belgium), Lorraine (France)). 2298 individuals were included for this study and dietary intake was assessed using a 134-item food frequency questionnaire.

Results

We found that CVRF-related patterns also reflect eating behaviours of the population. Comparing concordant food groups between both dietary pattern methods, a diet high in fruits, oleaginous and dried fruits, vegetables, olive oil, fats rich in omega 6 and tea and low in fried foods, lean and fatty meat, processed meat, ready meal, soft drink and beer was associated with lower prevalence of CVRF. In the opposite, a pattern characterized by high intakes of fried foods, meat, offal, beer, wine and aperitifs and spirits, and low intakes of cereals, sugar and sweets and soft drinks was associated with higher prevalence of CVRF.

Conclusion

In sum, we found that a “Prudent” and “Animal protein and alcohol” patterns were both associated with CVRF and behaviourally meaningful. Moreover, the relationships of those dietary patterns with lifestyle characteristics support the theory that food choices are part of a larger pattern of healthy lifestyle.

Dietary Patterns and Cognitive Decline Among Chinese Older Adults

BACKGROUND

Prospective evidence of associations of dietary patterns with cognitive decline is limited and inconsistent. We examined how cognitive changes among Chinese older adults relate to either an adapted Mediterranean diet score or factor analysis-derived dietary patterns.

METHODS

This prospective cohort study comprised 1,650 adults ≥55 years of age, who completed a cognitive screening test at two or more waves of the China Health and Nutrition Survey in 1997, 2000, or 2004. Outcomes were repeated measures of global cognitive scores, composite cognitive z scores (standardized units [SU]), and standardized verbal memory scores (SU). Baseline diet was measured by 24-hour recalls over 3 days. We used linear mixed effects models to evaluate how changes in cognitive scores were associated with adapted Mediterranean diet score and two dietary pattern scores derived from factor analysis.

RESULTS

Among adults ≥65 years of age, compared with participants in the lowest tertile of adapted Mediterranean diet, those in the highest tertile had a slower rate of cognitive decline (difference in mean SU change/year β = 0.042; 95% confidence interval [CI]: 0.002, 0.081). A wheat-based diverse diet derived by factor analysis shared features of the adapted Mediterranean diet, with the top tertile associated with slower annual decline in global cognitive function (β = 0.069 SU/year; 95% CI: 0.023, 0.114). We observed no associations among adults <65 years of age.

CONCLUSIONS

Our findings suggest that an adapted Mediterranean diet or a wheat-based, diverse diet with similar components may reduce the rate of cognitive decline in later life in the Chinese population.

The Fatty Acid Composition of Virgin Olive Oil from Different Cultivars Is Determinant for Foam Cell Formation by Macrophages

Although the beneficial role of Extra Virgin Olive Oil (EVOO) in the Mediterranean diet is well-known, its effects on health cannot be attributed solely to oleic acid. In addition to minor components, the presence of other fatty acids (FA), which depend largely on the cultivar among other factors, needs to be considered. The present study examined the effect of chylomicron remnant-like particles (CRLP) enriched in fatty acids of EVOO from 'Chetoui', 'Buidiego', 'Galega', 'Blanqueta', and 'Picual' cultivars on the foam cell formation by THP-1 macrophages. THP-1 cells were incubated with EVOO-CRLP for 24 h. Lipid accumulation in cells was measured by determining intracellular total triacylglycerol (TAG) concentration and FA composition. Intracellular TAG concentrations were higher in cells incubated with 'Chetoui' and 'Blanqueta' CRLP (0.33 ± 0.05 and 0.38 ± 0.07 μmol/mg of protein, respectively) than with 'Buidiego' and 'Picual' CRLP (0.20 ± 0.05 and 0.24 ± 0.06 μmol/mg of protein, respectively). In conclusion, linoleic acid-rich EVOO induced higher TAG incorporation into THP-1 macrophages compared to oleic acid-rich EVOO, the 18:1/18:2 ratio being consistently correlated with intracellular TAG accumulation. The results of this study demonstrated that the differences in EVOO-FA composition may have an important role in foam cell formation.

The role of olive oil in disease prevention: a focus on the recent epidemiological evidence from cohort studies and dietary intervention trials

Consumption of olive oil within the Mediterranean diet has been long known to have many health benefits. However, only over the last decade has epidemiological research confirmed its protective role against developing several chronic diseases. The objective of this review was to give an overview of the state of art epidemiological evidence concerning the relationship between olive oil and key public health outcomes including mortality, CVD, diabetes, metabolic syndrome (MetS), obesity and cancer, with a particular focus on recent results from cohort studies and dietary intervention trials. Recent epidemiological research has shown that regular consumption of olive oil is associated with increased longevity. This benefit is partly due to the olive oil's unequivocal cardio-protective role. There is converging evidence on the benefits of olive oil for preventing several CVD risk factors, including diabetes, MetS and obesity. Olive oil is also implicated in preventing certain cancers, with the most promising findings for breast and digestive tract cancers, although the data are still not entirely consistent and mainly from case–control studies. These health benefits are supported by strong mechanistic evidence from experimental studies, demonstrating that specific components of olive oil have antihypertensive, antithrombotic, antioxidant, antiinflammatory and anticarcinogenic action. Despite the accumulating epidemiological research, there is still a lack of consistent results from high-quality studies for many health outcomes (i.e. certain cancers and metabolism-related disorders). Further research is mandatory, above all from prospective studies and randomised dietary intervention trials when feasible, to confirm some of the still potential health benefits.

Fruit and vegetable intake in relation to prostate cancer in Iranian men: a case-control study

BACKGROUND

Findings of epidemiologic studies on the relationship between fruit and vegetable consumption and prostate cancer (PCa) risk have been inconclusive. We therefore examined the association between intake of fruits and vegetables and PCa risk in Iran.

MATERIALS AND METHODS

In this hospital based, case-control study, a total of 50 patients with PCa and 100 controls underwent face-to-face interviews. Regression analysis was used to examine the relation between fruit and vegetable intake and PCa risk.

RESULTS

A protective independent effect was observed for the highest tertile of total fruit and vegetable (OR: 0.33, CI: 0.04-0.30, p value<0.001), total fruit (OR: 0.30, CI: 0.06-0.4, p value=0.03) and total vegetable (OR: 0.31, CI: 0.02-0.21, p value<0.001) consumption. Within the group of fruits, a significant inverse association was observed for apple and pomegranate (p trends were 0.01 and 0.016, respectively). In the vegetable group, a significant inverse association was observed for tomatoes (p trend<0.001) and cabbage (p trend=0.021).

CONCLUSIONS

The results of the present study suggested that fruits and vegetable intake might be negatively associated with PCa risk.

Associations of adherence to the New Nordic Diet with risk of preeclampsia and preterm delivery in the Norwegian Mother and Child Cohort Study (MoBa)

Preeclampsia and preterm delivery are serious complications of pregnancy and leading causes of perinatal mortality and morbidity worldwide. Dietary factors might be associated with these adverse outcomes. We investigated whether adherence to the New Nordic Diet (NND) was associated with preeclampsia and preterm delivery risks in the Norwegian Mother and Child Cohort Study (MoBa). Participants were recruited from all over Norway during the period 1999-2008. A previously constructed diet score assessing meal frequency, and the consumption of Nordic fruits, root vegetables, cabbages, potatoes, oatmeal porridge, whole grains, wild fish, game, berries, milk and water, was used to assess NND adherence. Associations between NND adherence and the outcomes were estimated in adjusted multivariate logistic regression models. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated. A total of 72,072 women was included in the study. High versus low NND adherence was associated with lower risk of total preeclampsia (OR 0.86; 95 % CI 0.78-0.95) and early preeclampsia (OR 0.71; 95 % CI 0.52-0.96). High compared with low NND adherence was associated with a lower risk of spontaneous preterm delivery among nulliparous women (OR 0.77; 95 % CI 0.66-0.89), whereas multiparous women with high NND adherence had a marginally significant higher risk of preterm delivery (OR 1.24; 95 % CI 1.00-1.53). High NND adherence was associated with a lower relative risk of preeclampsia and of spontaneous preterm delivery among nulliparous women; however, among multiparous women there was a higher relative risk of preterm delivery.

Mediterranean diet and non-fatal acute myocardial infarction: a case-control study from Italy

OBJECTIVE

To add epidemiological data on the association of adherence to the Mediterranean diet with non-fatal acute myocardial infarction (AMI) in a Southern European population.

DESIGN

Hospital-based case-control study. Conformity to the traditional Mediterranean diet was assessed through a score (i.e. the Mediterranean diet score, MDS) based on nine dietary components (high consumption of vegetables, legumes, fruit and nuts, cereals, and fish and seafood; high ratio of monounsaturated to saturated lipids; low consumption of dairy and meat; and moderate alcohol consumption). The score ranged between 0 (lowest adherence) and 9 (highest adherence). The association of the MDS, or its components, with the risk of AMI was evaluated through multiple logistic regression models, controlling for potential confounding variables.

SETTING

The study was conducted in the greater Milan area (Italy) between 1995 and 2003.

SUBJECTS

Seven hundred and sixty patients with a first episode of non-fatal AMI and 682 controls.

RESULTS

High consumption of vegetables and legumes were inversely associated with non-fatal AMI risk. As compared with MDS<4, the OR of non-fatal AMI were 0.85 (95 % CI 0.65, 1.12) for MDS of 4-5 and 0.55 (95 % CI 0.40, 0.75) for MDS ≥ 6, with a trend in risk (P<0.01). Results were consistent in strata of selected risk factors and an apparently stronger association emerged for individuals with a lower BMI.

CONCLUSIONS

The Mediterranean diet is inversely associated with the risk of non-fatal AMI in this Southern European population.

Dietary pattern among schoolchildren with normal nutritional status in Navarre, Spain

A nutrition survey was carried out (food intake registration of three consecutive school days) in a randomly selected group of 353 schoolchildren (188 males and 165 females) with normal nutritional status. The average age of the surveyed students was 10.5 years (CI 95%: 10.3–11.7). There were no significant differences between both sexes in mean values for calorie intake (males: 2072.7 ± 261.7 and females: 2060.9 ± 250.6) and intake of macronutrients, minerals and vitamins. Cereals (34%), dairy products (19%) and meats (17%) were responsible for approximately 70% of total calorie intake. Protein accounted for 20.3% of energy intake, carbohydrates for 48.8%, total fat for 30.9%, and saturated fat for 12.6%. Cholesterol intake was excessive and over two-thirds of protein intake was from animal sources. The mean intakes of calcium, iodine and Vitamins A, D and E were below recommended levels. The dietary patterns of the schoolchildren with normal nutritional status differed from the Mediterranean diet. Intakes of meat were too high and dairy products and cereals consumption was relatively limited; while that of vegetables; legumes; fruits and fish were insufficient; leading to excessive protein and fat intake from animal sources and insufficient mineral (calcium and iodine) and Vitamins A; D and E intake.

Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway

The discovery that dietary (inorganic) nitrate has important vascular effects came from the relatively recent realization of the 'nitrate-nitrite-nitric oxide (NO) pathway'. Dietary nitrate has been demonstrated to have a range of beneficial vascular effects, including reducing blood pressure, inhibiting platelet aggregation, preserving or improving endothelial dysfunction, enhancing exercise performance in healthy individuals and patients with peripheral arterial disease. Pre-clinical studies with nitrate or nitrite also show the potential to protect against ischaemia-reperfusion injury and reduce arterial stiffness, inflammation and intimal thickness. However, there is a need for good evidence for hard endpoints beyond epidemiological studies. Whilst these suggest reduction in cardiovascular risk with diets high in nitrate-rich vegetables (such as a Mediterranean diet), others have suggested possible small positive and negative associations with dietary nitrate and cancer, but these remain unproven. Interactions with other nutrients, such as vitamin C, polyphenols and fatty acids may enhance or inhibit these effects. In order to provide simple guidance on nitrate intake from different vegetables, we have developed the Nitrate 'Veg-Table' with 'Nitrate Units' [each unit being 1 mmol of nitrate (62 mg)] to achieve a nitrate intake that is likely to be sufficient to derive benefit, but also to minimize the risk of potential side effects from excessive ingestion, given the current available evidence. The lack of data concerning the long term effects of dietary nitrate is a limitation, and this will need to be addressed in future trials.