Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials

The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

AIMS

This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.

METHODS

Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.

RESULTS

Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.

CONCLUSIONS

This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.

Associations between cardiac rehabilitation structure and processes and dietary habits after myocardial infarction: a nationwide registry study

AIMS

Improved dietary habits are important for successful secondary prevention after myocardial infarction (MI), with counselling and support on healthy dietary habits constituting a cornerstone of cardiac rehabilitation (CR). However, there is limited knowledge on how to optimize CR organization to motivate patients to adopt healthy dietary habits. We aimed to explore associations between CR programme structure, processes, and self-reported dietary habits 1 year post-MI.

METHODS AND RESULTS

Organizational data from 73 Swedish CR centres and patient-level data from 5248 CR patients were analysed using orthogonal partial least squares discriminant analysis to identify predictors for healthy dietary habits. Variables of importance for the projection (VIP) values exceeding 0.80 were considered meaningful. Key predictors included the CR centre having a medical director [VIP (95% confidence interval)] [1.86 (1.1-2.62)], high self-reported team spirit [1.63 (1.29-1.97)], nurses have formal training in counselling methods [1.20 (0.75-1.65)], providing discharge information on risk factors [2.23 (1.82-2.64)] and lifestyle [1.81 (1.31-2.31)], time dedicated to patient interaction during follow-up [1.60 (0.80-2.40)], and centres aiming for patients to have the same nurse throughout follow-up [1.54 (1.17-1.91)]. The more positive predictors a CR centre reported to follow, the further improvement in patient-level dietary habits, were analysed by multivariable regression analysis [odds ratio for each additional positive predictor reported 1.03 (1.02-1.05), P < 0.001].

CONCLUSION

Several variables related to CR structure and processes were identified as predictors for patients reporting healthier dietary habits. These findings offer guidance for CR centres in resource allocation and optimizing patient benefits of CR attendance.

Biochemical and In Silico Aspects of Active Compounds From Nyctanthes arbor-tristis Flower As Antidiabetic Agent

Targeting alpha-glucosidase (maltase-glucoamylase [MGAM] and sucrase-isomaltase [SI]) under diabetes conditions is important to overcome hyperglycemia. Moreover, it is necessary to mitigate hyperglycemia-mediated oxidative stress to evade the progression of diabetes-associated secondary complications. Hence, in the present study, under-explored Nyctanthes arbor-tristis flowers (NAFs) were studied for inhibition of alpha-glucosidase activities. The NAF methanolic extract (NAFME) was prepared. Through liquid chromatography/electrospray ionization tandem mass spectrometry (LC-ESI/MS/MS) analysis, various phytocompounds belonging to different classes-flavonoids, iridoid glycosides, proanthocyanidin, anthocyanin, polyphenol, phenolic acid, fatty acid ester, and carotenoid-were identified. NAFME showed in vitro antioxidant activity. NAFME inhibited maltase, sucrase, glucoamylase, and isomaltase in mixed mode with Ki values of 179.93, 176.38, 126.03, and 201.56 µg/mL, respectively. In silico screening of phytocompounds identified in NAFME indicated that hinokiflavone (HKF), pelargonidin-3-O-glucoside (PG), isorhamnetin-3-glucoside-7-rhamnoside (IGR), and petunidin-3-rutinoside (PR) showed better interactions with different subunits of human alpha-glucosidase, namely, N-terminal (Nt-MGAM and Nt-SI) and C-terminal (Ct-MGAM and Ct-SI). Molecular dynamics (MD) simulation, binding free energy study (molecular mechanics-generalized Born surface area [MM/GBSA]), and post-MD simulation studies (principal component analysis [PCA] and dynamic cross-correlation matrix [DCCM]) provided an in-depth understanding of these ligands' interactions with proteins. The overall efficacy of NAFME against oxidative stress and alpha-glucosidase in vitro is understood. Moreover, in silico analysis has shown the possible potential of HKF, PG, IGR, and PR to act as alpha-glucosidase inhibitors. Further studies on the antidiabetic potential of NAFME, HKF, PG, IGR, and PR in in vivo conditions are required to fully unveil the applicability of NAFME in the management of T2DM as a complementary medicine.

Association between the number of glucose-lowering drugs in use, diet quality, and nutrient intake among adults with type 2 diabetes mellitus

BACKGROUND

The use of several glucose-lowering drugs (GLDs) in individuals with type 2 diabetes mellitus is common, but their effects on dietary intake have been little explored.

AIM

Our study aimed to examine the association between the number of GLDs used by adults with type 2 diabetes mellitus and their diet quality and nutrient intake.

METHODS

This is a cross-sectional analysis of baseline data from a Brazilian national multicenter randomized clinical trial involving participants with type 2 diabetes mellitus aged >30 years. We collected sociodemographic, clinical, biochemical, and anthropometric information and food intake data (24-h dietary recall). Diet quality was assessed by the modified Alternative Healthy Eating Index. Multiple linear regression models were used to examine the association of dietary intake with the number of GLDs in use.

RESULTS

Our analysis included data from a total of 363 participants, mean age of 60.8 ± 9.5 years, and mean glycated hemoglobin of 8.7 ± 1.5%. Of these, 28.1% were taking one GLD; 48.8% were taking two GLDs; and 23.1% were taking ≥3 GLDs. We found no difference in diet quality, but the intake of total polyunsaturated fatty acids and omega-3 and omega-6 fatty acids was different between the three groups (p ≤ 0.03). However, this association was no longer seen after adjusting for age, sex, duration of diabetes, prior diagnosis of dyslipidemia, physical activity and mean monthly family income.

CONCLUSIONS

We did not find an association between the number of GLDs in use and either diet quality or nutrient intake in individuals with type 2 diabetes mellitus.

Research progress on the relationship between free fatty acid profile and type 2 diabetes complicated by coronary heart disease

Patients with type 2 diabetes mellitus (T2DM) have a 2 to 3 times higher risk of cardiovascular disease compared to non-diabetic individuals, and cardiovascular disease has consistently been a leading cause of death among diabetic patients. Therefore, preventing cardiovascular disease in diabetic patients remains a significant challenge. In addition to classic indicators such as cholesterol and lipoproteins, previous studies have demonstrated that plasma level of free fatty acid (FFA) is closely related to the occurrence of atherosclerosis, particularly in T2DM patients. In recent years, with further research and advancements in testing technologies, the FFA profile has garnered widespread attention. The FFA profile includes many different types of FFAs, and changes in the plasma FFA profile and concentrations in T2DM patients may lead to the development of insulin resistance, causing damage to vascular endothelial cells and promoting the occurrence and progression of atherosclerosis. Furthermore, some FFAs have shown potential in predicting cardiovascular complications in T2DM and are associated with the severity of these complications. Here, we aim to review the changes in the FFA profile in T2DM and discuss the relationship between the FFA profile and the occurrence of vascular complications in T2DM.

The Mediterranean Diet, the DASH Diet, and the MIND Diet in Relation to Sleep Duration and Quality: A Narrative Review

In 2022, healthy sleep was included as part of Life's Essential 8, which are a cluster of fundamental factors for cardiovascular health. In many studies, sleep duration and/or quality have also been found to be related to human health. The purpose of this narrative review was to present the relationship between the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet, and the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet and sleep quality and duration in different populations. A literature search was conducted based on the phrases "Mediterranean diet", "DASH diet", and "MIND diet" appearing together with "sleep" or "insomnia" in papers' titles or abstracts. Studies on obstructive sleep apnea or shift work were excluded. The electronic databases were searched via EBSCOhost. Main results: The vast majority of studies showed that there was a beneficial association between the three diets discussed in this review and sleep duration and/or quality; however, most of these results were obtained in cross-sectional analyses. There were only a few studies in which an association between sleep parameters and these diets was not observed. Direction for future studies: Taking into account the significant role of adequate sleep quality in various diseases, even in all-cause mortality, the implementation of randomized controlled trials and prospective cohort studies seems to be necessary to provide further evidence that would allow these associations to be confirmed. In conclusion, the results obtained so far in various populations strongly suggest that healthy dietary patterns abundant in plant foods, are associated with better sleep quality, as well as with a more adequate length of sleep.

Impact of ketogenic diet on cardiovascular disease

OBJECTIVES

A comprehensive review of the current literature was conducted to summarize the potential therapeutic and management roles of ketogenic diet (KD) for cardiovascular disease (CVD).

BACKGROUND

Consensus has not been reached on the optimal diet for individuals with cardiovascular risk factors. KDs are characterized by high-fat, low-carbohydrate, and appropriate protein content, and have gained popularity in recent years in the management of various conditions, including cardiovascular and metabolic diseases.

METHODS

Original research, systematic reviews, and meta-analyses available in the PubMed, Web of Science, and Google Scholar databases were reviewed.

RESULTS

The current body of preclinical and clinical evidence on the efficacy of KD in the management of CVD remains limited. Specific applications of KD seem to suggest a positive impact on management of CVD. However, conflicting results and a lack of precise molecular and biochemical mechanisms of action provide ample opportunity for future investigation.

CONCLUSION

More multidisciplinary studies are needed to determine the true clinical benefit of KD in the management of CVD and so justify its expanded clinical use.

Diabetes Mellitus and Cardiovascular Disease: Exploring Epidemiology, Pathophysiology, and Treatment Strategies

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rates of CVD is alarmingly high among diabetic individuals, particularly in North America and the Caribbean (46.0%), and Southeast Asia (42.5%). The predominant form of CVD among diabetic patients is coronary artery disease (CAD), accounting for 29.4% of cases. The pathophysiology of DM is complex, involving insulin resistance, β-cell dysfunction, and associated cardiovascular complications including diabetic cardiomyopathy (DCM) and cardiovascular autonomic neuropathy (CAN). These conditions exacerbate CVD risks underscoring the importance of managing key risk factors including hypertension, dyslipidemia, obesity, and genetic predisposition. Understanding the genetic networks and molecular processes that link diabetes and cardiovascular disease can lead to new diagnostics and therapeutic interventions. Imeglimin, a novel mitochondrial bioenergetic enhancer, represents a promising medication for diabetes with the potential to address both insulin resistance and secretion difficulties. Effective diabetes management through oral hypoglycemic agents (OHAs) can protect the cardiovascular system. Additionally, certain antihypertensive medications can significantly reduce the risk of diabetes-related CVD. Additionally, lifestyle changes, including diet and exercise are vital in managing diabesity and reducing CVD risks. These interventions, along with emerging therapeutic agents and ongoing clinical trials, offer hope for improved patient outcomes and long-term DM remission. This study highlights the urgent need for management strategies to address the overlapping epidemics of DM and CVD. By elucidating the underlying mechanisms and risk factors, this study aims to guide future perspectives and enhance understanding of the pathogenesis of CVD complications in patients with DM, thereby guiding more effective treatment strategies.

Associations of advanced lung cancer inflammation index with all-cause and respiratory disease mortality in adults with asthma: NHANES, 1999-2018

The Advanced Lung Cancer Inflammation Index (ALI) represents both the inflammatory and nutritional status of the host, but its link with mortality in asthma patients is uncertain. The purpose of this study was to look at the relationship between ALI levels and all-cause and respiratory disease mortality in asthmatic patients. We conducted our research using cohort data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The National Death Index was used to calculate mortality until December 31, 2019. The study employed multivariate logistic regression to look into the relationship between ALI levels and asthma prevalence. Weighted Kaplan-Meier and multivariate-adjusted Cox analyses were utilized for investigating the relationship between ALI levels and all-cause and respiratory disease mortality in individuals with asthma. A restricted cubic spline (RCS) analysis was used to assess their nonlinear relationship. Subgroup and sensitivity analyses were also performed to evaluate the robustness of the results that were obtained. We enrolled 40,497 people in our study, and 5,469 of them had asthma, representing a 14% prevalence. A median follow-up of 11.19 (9.38, 14.29) years revealed 109 fatalities from respiratory diseases and 724 deaths from all causes. After correcting for several covariates, there was no longer any link (P-trend = 0.2) between ALI levels and the prevalence of asthma. When compared to the lowest quartile, the highest quartile of ALI levels was substantially linked to a lower risk of mortality from respiratory diseases and all causes (all P-trend < 0.001). In the RCS regression model, the relationship between ALI level and both all-cause and respiratory disease mortality in asthmatic participants was nonlinear, with P for nonlinearity of 0.006 and 0.015, respectively. We also discovered that the probability of mortality from respiratory disease decreased progressively to a nadir at an ALI level of 109.13 and then increased as the ALI level increased. Multiple subgroup and sensitivity analyses revealed that ALI was consistently related to lower all-cause and respiratory disease mortality in asthma patients. Our findings suggest that ALI is associated with a reduced risk of all-cause and respiratory disease mortality in asthma patients.

Association Between Monounsaturated Fatty Acid Intake and Risk of Total Stroke and Its Subtypes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

There are contradictory results regarding the relationship between dietary intakes of monounsaturated fatty acids (MUFAs) and risk of stroke.

OBJECTIVE

The purpose of this study was to review the existing body of research on the relationship between MUFA consumption and stroke risk through a systematic review and meta-analysis.

DATA SOURCE

PubMed, Scopus, and ISI Web of Science were all systematically searched up to January 2023.

DATA EXTRACTION

A total of 11 prospective cohort studies that investigated MUFA consumption in relation to stroke risk were included.

DATA ANALYSIS

Relative risk (RR) and 95% CIs for the highest vs lowest category of dietary MUFA intake were combined using a random-effects model. Linear and nonlinear dose-response relations were assessed through 1-stage weighted mixed-effects meta-analysis. These studies included 475 207 participants and 8438 cases. In highest vs lowest consumption analysis, MUFA intake was inversely associated with total stroke (RR: 0.80; 95% CI: 0.67, 0.96; I2 =65.2%, Q-test P = .001; n = 11) and hemorrhagic stroke (RR: 0.80; 95% CI: 0.68, 0.95; I2 = 0.0%, Q-test P = .77; n = 5) risk. Conversely, this association was not significant for ischemic stroke (RR: 0.86; 95% CI: 0.69, 1.07; I2 =62.3%, Q-test P = .01; n = 8). An inverse association was observed between each 10-g/d MUFA intake and hemorrhagic stroke (RR: 0.79; 95% CI: 0.65, 0.96) but not total and ischemic stroke. We did not find any evidence for a nonlinear association between MUFA intake and total stroke and its subtypes.

CONCLUSION

This meta-analysis shows that higher MUFA intake could lower the risk of total and hemorrhagic, but not ischemic, stroke. This could be important for public health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023458555.

Mediterranean Diet in Older Adults: Cardiovascular Outcomes and Mortality from Observational and Interventional Studies-A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

there is conflicting evidence on the role of the Mediterranean Diet (MD) in reducing the risk of long-term outcomes in older adults. The aim of our study was to assess the effectiveness of high adherence to MD in reducing all-cause mortality and cardiovascular outcomes among older adults.

METHODS

PubMed database was searched up to 31 May 2023. We included randomized controlled trials (RCT) and cohort studies in the English language which evaluated the Mediterranean diet's adherence to exposure on a population with a mean age > 60 years. The main outcomes were cardiovascular fatal and non-fatal events, and all-cause mortality. A sub-analysis on individuals > 70 years old was conducted. Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for assessing data quality and validity. Pooled data were obtained by using random-effects models.

RESULTS

a total of 28 studies were included in this meta-analysis (26 observational studies and 2 randomized trials), reporting a total of 679,259 participants from different continents. Our results showed that high adherence to the MD reduces all-cause mortality risk by 23% (95% CI: 0.70-0.83), while it decreases the risk of cardiovascular mortality by 27% (95% CI: 0.64-0.84) and that of non-fatal cardiovascular events by 23% (95% CI: 0.55-1.01).

CONCLUSIONS

MD is a promising dietary pattern for promoting health among older adults, as it is associated with reduced risks of all-cause and cardiovascular mortality, and non-fatal cardiovascular events. Adopting a Mediterranean Diet may contribute to better overall health and a lower likelihood of cardiovascular-related health issues in older individuals.

Alzheimer's Disease as Type 3 Diabetes: Understanding the Link and Implications

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) are two prevalent conditions that present considerable public health issue in aging populations worldwide. Recent research has proposed a novel conceptualization of AD as "type 3 diabetes", highlighting the critical roles of insulin resistance and impaired glucose metabolism in the pathogenesis of the disease. This article examines the implications of this association, exploring potential new avenues for treatment and preventive strategies for AD. Key evidence linking diabetes to AD emphasizes critical metabolic processes that contribute to neurodegeneration, including inflammation, oxidative stress, and alterations in insulin signaling pathways. By framing AD within this metabolic context, we can enhance our understanding of its etiology, which in turn may influence early diagnosis, treatment plans, and preventive measures. Understanding AD as a manifestation of diabetes opens up the possibility of employing novel therapeutic strategies that incorporate lifestyle modifications and the use of antidiabetic medications to mitigate cognitive decline. This integrated approach has the potential to improve patient outcomes and deepen our comprehension of the intricate relationship between neurodegenerative diseases and metabolic disorders.

Associations of minimally processed and ultra-processed food intakes with cardiovascular health in Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES VI), 2013-2015

BACKGROUND

Although recent studies have suggested the adverse effects of processed foods on cardiovascular disease, few studies have been conducted on the effects of food processing on cardiovascular health (CVH) in Koreans.

OBJECTIVE

This study aimed to investigate the associations of minimally processed foods (MPF) and ultra-processed foods (UPF) intakes with CVH.

METHODS

We used the data of 6945 adults (≥19) from the sixth Korea National Health and Nutrition Examination Survey. MPF and UPF intakes were based on the NOVA food classification. Using Life's simple 7 (LS7) proposed by the American Heart Association, the CVH indicator was estimated as the sum (0-12) of the scores of six components. Multiple linear and multinomial logistic regressions were used to estimate the associations between processed food intakes and CVH.

RESULTS

The mean (standard error) of MPF and UPF intake was 61.28 (0.28) and 20.27 (0.24) %kcal/day, respectively. After adjusting for sex, age, household income, educational attainment, family history of CVD, and stress, we found significant positive associations between MPF intake and CVH (p value < 0.001), while associations between UPF intake and CVH were significantly negative (p value < 0.001). Moreover, the magnitude of the observed association was more distinctive in females (p-interaction < 0.01) and with increasing age (p-interaction < 0.001).

CONCLUSIONS

A high intake of MPF is associated with improved CVH, while a high intake of UPF is associated with poorer CVH in Korean adults. Therefore, public health policies should be established to promote the choice of less processed foods to improve CVH among South Korean adults.

IMPACT STATEMENT

In modern society, processed foods have become ubiquitous and South Korea's consumption of processed foods is very high. This study had shown that the more processed a food is, the more negative impact it can have on cardiovascular health. Therefore, researching the effects of processed foods on the human body can increase understanding of population health and aid in the development of prevention and treatment strategies.

The effect of unhealthy lifestyle on the pathogenesis of sick sinus syndrome: A life-guiding review

Sick sinus syndrome (SSS), also known as sinoatrial node dysfunction, has been widely concerned by the medical community. The incidence rate of SSS is increasingly, which poses a great threat to public health. Through decades of repeated research in the medical field, great progress has been made in the pathogenesis of SSS and the interaction mechanism between SSS and other cardiovascular diseases. In this paper, we pay special attention to the mental stimulation factors under various pressures such as society and work, and the influence of smoking, drinking, and unhealthy diet on the pathogenesis of SSS. It also explains the mechanism of negative factors in the pathogenesis of SSS. These unhealthy lifestyle will lead to the occurrence of sinoatrial node disease and arrhythmia, and then induce SSS. Therefore, in the premise of increasing incidence rate of SSS and difficult to cure, how to avoid these harmful factors and ensure a healthy lifestyle is extremely important for preventing and treating SSS. This study also has guiding significance for the daily life of high-risk population of SSS and reducing the mortality of SSS patients.

Combined associations of physical activity, diet quality and their changes over time with mortality: findings from the EPIC-Norfolk study, United Kingdom

BACKGROUND

Physical activity (PA) and diet quality have each been shown to be inversely associated with mortality but their combined impact on longevity has been less explored, particularly when considering their changes over time. This study aimed to examine the separate and combined associations of PA, diet quality and their changes over time with mortality outcomes.

METHODS

A prospective cohort study was performed on 9349 adults aged 40 to 79 years from the population-based European Prospective Investigation into Cancer in Norfolk Study, with repeated measurements of PA and diet (from 1993 till 2004) and subsequent follow-up till 2022 (median follow-up 18.8 years). Validated questionnaires were used to derive physical activity energy expenditure (PAEE) as a proxy of total PA and adherence to the Mediterranean diet score (MDS, range 0-15 points) as an indicator of overall diet quality, and their changes over time (∆PAEE and ∆MDS). Cox regression models adjusted for potential confounders and mediators were used to estimate hazard ratios (HRs) and 95% CIs.

RESULTS

Over 149,681 person-years of follow-up, there were 3534 deaths. In adjusted models, for each 1-SD difference in baseline PAEE (4.64 kJ/kg/day), ∆PAEE (0.65 kJ/kg/day per year), baseline MDS (1.30 points) and ∆MDS (0.32 points per year), HRs (95% CI) for all-cause mortality were 0.90 (0.86 to 0.94), 0.89 (0.85 to 0.93), 0.95 (0.91 to 0.99) and 0.93 (0.90 to 0.97), respectively. Compared with participants with sustained low PAEE (< 5 kJ/kg/day) and low MDS (< 8.5 points), those with sustained high PAEE and high MDS had lower all-cause mortality (HR 0.78; 95% CI: 0.68-0.91), as did those who improved both PAEE and MDS (0.60; 0.44-0.82). There was no evidence of interaction between PA and diet quality exposures on mortality risk. Population impact estimates suggested that if all participants had maintained high levels of PA and diet quality consistently, cumulative adjusted mortality rate would have been 8.8% (95% CI: 2.4 to 15.3%) lower.

CONCLUSIONS

These findings suggest that adopting and maintaining higher levels of PA and diet quality are associated with lower mortality. Significant public health benefits could be realised by enabling active living and healthy eating through adulthood.

Adherence to a Mediterranean-style diet and severity of menopausal symptoms in perimenopausal and menopausal women from Australia: a cross-sectional analysis

PURPOSE

To explore the independent associations between adherence to a Mediterranean-style diet and severity of menopausal symptoms in perimenopausal and menopausal women living in Australia.

METHODS

Dietary adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS), the Menopause Rating Scale (MRS) was used to assess the severity of menopausal symptoms, and the 36-item short form survey instrument (SF-36) was used to assess health-related quality of life (HRQoL).

RESULTS

A total of n = 207 participants (50.7 ± 4.3 years; BMI: 28.0 ± 7.4 kg/m2) were included in the final analyses. Participants reported low-moderate adherence to a Mediterranean-style diet (5.2 ± 1.8; range: 1-11). Adherence was not associated with severity of menopausal symptoms. However, low consumption of sugar-sweetened beverages was inversely associated with joint and muscle complaints, independent of all covariates (β = -0.149; CI: -0.118, -0.022; P = 0.042). Adherence to a Mediterranean-style diet was positively associated with the physical function subscale of HRQoL (β = 0.173, CI: 0.001, 0.029; P = 0.031) and a low intake of red and processed meat was positively associated with the general health subscale (β = 0.296, CI: 0.005, 0.014; P = < 0.001).

CONCLUSION

Diet quality may be related to severity of menopausal symptoms and HRQoL in perimenopausal and menopausal women. However, exploration of these findings using longitudinal analyses and robust clinical trials are needed to better elucidate these findings.

Sex-specific dietary patterns and their association with metabolic syndrome: Insights from a cross-sectional analysis

AIMS

This study aims to identify a posteriori dietary patterns with a sex approach and to evaluate their association with metabolic syndrome criteria.

METHODS

Cross-sectional study conducted in 6821 men and women between 55 and 75 years of age. Forty-two food groups were analyzed from dietary information collected with food frequency questionnaires, using principal component analysis and cluster analysis and then information from both statistical methods was compared. Prevalences were calculated foreach cluster group, based on the number and types of metabolic syndrome criteria they met.

RESULTS

Following principal component analysis, two dietary patterns labeled "healthy" and "unhealthy" were identified in both men and women, due to the presence of foods that are considered more or less healthy. These same dietary patterns were found in cluster analysis plus an "intermediate" cluster consisting of both healthy and unhealthy foods. The presence of metabolic syndrome is related to the "healthy" dietary pattern in women and to the "unhealthy" dietary pattern in men. Comparison of the two statistical approaches showed a high level of correlation between them (weighted Kappa = 0.703 in women and weighted Kappa = 0.691 in men).

CONCLUSIONS

Adherence to both healthy and unhealthy dietary pattern appears to be related to the development of MS. The differences found by sex make it necessary to develop interventions with a sex-specific approach.

Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease?

Metabolic dysfunction-associated steatotic liver disease (MASLD) closely associates with obesity and type 2 diabetes. Lifestyle intervention and bariatric surgery aiming at substantial weight loss are cornerstones of MASLD treatment by improving histological outcomes and reducing risks of comorbidities. Originally developed as antihyperglycemic drugs, incretin (co-)agonists and SGLT2 inhibitors also reduce steatosis and cardiorenovascular events. Certain incretin agonists effectively improve histological features of MASLD, but not fibrosis. Of note, beneficial effects on MASLD may not necessarily require weight loss. Despite moderate weight gain, one PPARγ agonist improved adipose tissue and MASLD with certain benefit on fibrosis in post-hoc analyses. Likewise, the first THRβ-agonist was recently provisionally approved because of significant improvements of MASLD and fibrosis. We here discuss liver-related and metabolic effects induced by different MASLD treatments and their association with weight loss. Therefore, we compare results from clinical trials on drugs acting via weight loss (incretin (co)agonists, SGLT2 inhibitors) with those exerting no weight loss (pioglitazone; resmetirom). Furthermore, other drugs in development directly targeting hepatic lipid metabolism (lipogenesis inhibitors, FGF21 analogs) are addressed. Although THRβ-agonism may effectively improve hepatic outcomes, MASLD treatment concepts should consider all cardiometabolic risk factors for effective reduction of morbidity and mortality in the affected people.

The association between energy-adjusted dietary inflammatory index and 10-year cardiovascular risk: Fasa adult cohort study

A healthy diet is dominant in cardiovascular disease (CVD) prevention. Inflammation is pivotal for CVD development. This study aimed to evaluate the association between the pro-inflammatory diet and the CVD risk. This cross-sectional study involved 10,138 Fasa adult cohort study participants. After excluding participants with missing data, the Energy-Adjusted Dietary Inflammatory Index (E-DII) was calculated to assess the inflammatory potential of diet using the recorded Food Frequency Questionnaire. Framingham risk score (FRS) was used to predict the 10-year risk of CVD. The association between E-DII and high risk for CVD was investigated using multinominal regression. After exclusion, the mean age of studied individuals (n = 10,030) was 48.6 ± 9.6 years, including 4522 men. Most participants were low risk (FRS <10%) for CVD (87.6%), while 2.7% of them were high risk (FRS ≥20%). The median FRS was 2.80 (1.70, 6.30). The E-DII ranged from -4.22 to 4.49 (mean E-DII = 0.880 ± 1.127). E-DII was significantly associated with FRS. This result persisted after adjusting for confounding factors and in both genders. This study revealed that the pro-inflammatory diet significantly increases the CVD risk. Consequently, reducing the inflammatory potential of diet should be considered an effective dietary intervention in CVD prevention.

Introduction of the Mediterranean diet in pregnancy and the incidence of gestational diabetes mellitus: A systematic review of randomised controlled trials and meta-analysis

OBJECTIVES

To determine if introducing the Mediterranean diet in pregnancy reduces the incidence of gestational diabetes.

STUDY DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs). A literature search was conducted using the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and CINAHL with no language or date restrictions. Studies were deemed eligible if the population was pregnant women, the intervention was the Mediterranean diet, and the outcome was gestational diabetes. Quality assessment was carried out using the Cochrane risk of bias tool. A random effects model using Revman software was used to pool results, generating a summary risk ratio with 95 % confidence intervals (95 %CI).

RESULTS AND CONCLUSIONS

The search identified three eligible studies. Across the trials, 2348 women were included. Two of the three trials defined the intervention as the Mediterranean diet supplemented with extra virgin olive oil (EVOO) and pistachios, with the control group being Mediterranean diet alone. Meta-analysis of these trials found a significant reduction in the incidence of gestational diabetes in the intervention group compared to the control group (risk ratio=0.71, 95% confidence interval=(0.57, 0.88)). In addition, this was consistent with the results of the remaining eligible trial which defined the intervention as Mediterranean diet and the control as a standard UK diet (risk ratio = 0.71, 95% confidence interval = (0.55, 0.90)). At present evidence is scarce regarding whether adopting a Mediterranean diet reduces the risk of gestational diabetes. A large multi-centre randomised controlled trial is needed to definitively determine the impact of the Mediterranean diet in pregnancy on the incidence of gestational diabetes.

Adherence to the Mediterranean Diet and Cardiovascular Risk Factors among the Lebanese Population: A Nationwide Cross-Sectional Post Hoc Study

OBJECTIVE

This study aims to identify the association between adherence to healthy eating, using the Lebanese Mediterranean Diet Scale (LMDS), and cardiovascular risk factors in the Lebanese population.

MATERIALS AND METHODS

A cross-sectional study using a multistage cluster sample was conducted in Lebanon. Sociodemographic characteristics were collected through structured interviews and self-administered questionnaires. The LMDS assessed dietary habits. The associations between diabetes, dyslipidemia, and cardiovascular disease were investigated using stratification analysis.

RESULTS

The study included 2048 people (mean age: 41.54 ± 17.09 years). Higher adherence to the Mediterranean diet was associated with older age (Beta = 0.175, p < 0.001), being female (Beta = 0.085, p = 0.001), being married (Beta = 0.054, p = 0.047), participating in regular physical activity (Beta = 0.142, p < 0.001), and having cardiovascular disease (Beta = 0.115, p < 0.001) and diabetes (Beta = 0.055, p = 0.043). Adherence was, however, negatively associated with being a smoker (Beta = -0.083, p = 0.002), a previous smoker (Beta = -0.059, p = 0.026), and having higher distress levels (Beta = -0.079, p = 0.002). Stratification analysis by diabetes, dyslipidemia, and cardiovascular disease (CVD) consistently demonstrated these associations.

CONCLUSIONS

These findings suggest that demographic and health factors influence the Lebanese population's adherence to the Mediterranean diet. Older age, female gender, married status, physical activity, CVD, and diabetes were all found to be associated with adherence to the Mediterranean diet in the Lebanese population. In contrast, smoking and distress were inversely associated with it.

Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries

Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles.

Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome

Background

This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran.

Materials and Methods

The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline.

Results

The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease.

Conclusion

Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans.

Effects of Mediterranean diets and nutrigenomics on cardiovascular health

The field of nutrigenomics studies the interaction between nutrition and genetics, and how certain dietary patterns can impact gene expression and overall health. The Mediterranean diet (MedDiet), characterized by a high intake of fruits, vegetables, whole grains, and healthy fats, has been linked to better cardiovascular health (CVH) outcomes. This review summarizes the current state of research on the effects of nutrigenomics and MedDiet on cardiovascular health. Results suggest that MedDiet, through its impact on gene expression, can positively influence CVH markers such as blood pressure, lipid profile, and inflammation. However, more research is needed to fully understand the complex interactions between genetics, nutrition, and CVH, and to determine the optimal dietary patterns for individualized care. The aim of this scientific review is to evaluate the current evidence on the effects of nutrigenomics and MedDiet on cardiovascular health. The review summarizes the available studies that have investigated the relationship between nutrition, genetics, and cardiovascular health, and explores the mechanisms by which certain dietary patterns can impact CVH outcomes. The review focuses on the effects of MedDiet, a dietary pattern that is rich in whole foods and healthy fats, and its potential to positively influence CVH through its impact on gene expression. The review highlights the limitations of current research and the need for further studies to fully understand the complex interplay between nutrition, genetics, and cardiovascular health.

Effect of the Mediterranean diet in cardiovascular prevention

The Mediterranean diet is the best evidence-based model for cardiovascular prevention. In addition to 2 major randomized secondary prevention trials (Lyon Heart and CORDIOPREV) and 1 primary prevention trial (PREDIMED) that have demonstrated these benefits, there is an unprecedented body of high-quality prospective epidemiological evidence supporting these beneficial effects. The key elements of this traditional pattern are the abundant use of extra-virgin olive oil and high consumption of foods of natural plant-based origin (fruits, vegetables, nuts, and legumes) and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, with meals is an essential element of this traditional pattern. Although removing wine consumption from the Mediterranean diet has been associated with a reduction in its preventive efficacy, doubts have recently arisen about the possible adverse effect of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, will randomize 10 000 drinkers aged 50 to 75 years to abstention or moderate consumption. UNATI aims to answer these doubts with the best possible evidence.

Olive oil intake and cardiovascular disease, cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

Background: Currently, the reported links between olive oil intake and cardiovascular disease (CVD), cancer morbidity and mortality, and all-cause mortality are inconsistent. The aim of this meta-analysis is to study the reported correlations of olive oil intake with CVD, coronary heart disease (CHD), stroke and cancer incidence and mortality, and all-cause mortality. Methods: PubMed, Embase, and Web of Science were searched until March 7, 2024. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by the random-effects model. Nonlinear dose-response relationships were modeled with restricted cubic splines. This study has been registered at PROSPERO (CRD42023419001). Results: Overall, 30 articles covering 2 710 351 participants were identified. Higher olive oil intake was linked with a reduced risk of CVD incidence (RR: 0.85; 95% CI: 0.77, 0.93), CHD incidence (RR: 0.85; 95% CI: 0.72, 0.99), CVD mortality (RR: 0.77; 95% CI: 0.67, 0.88), and all-cause mortality (RR: 0.85; 95% CI: 0.81, 0.89). For a 10 g d-1 increment of olive oil intake, the risk of CVD incidence, stroke incidence, CVD mortality, and all-cause mortality decreased by 7%, 5%, 8%, and 8%, respectively. No association was found between olive oil intake and cancer incidence and mortality. Nonlinear relationships between olive oil intake and CVD and all-cause mortality were observed, with a reduced risk from intakes ranging from 0 to 18 g d-1 and 0 to 22 g d-1, respectively. Conclusion: Our study found that high olive oil intake was related to a lower risk of CVD and CHD incidence and CVD mortality and all-cause mortality.

Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women

Importance

Higher adherence to the Mediterranean diet has been associated with reduced risk of all-cause mortality, but data on underlying molecular mechanisms over long follow-up are limited.

Objectives

To investigate Mediterranean diet adherence and risk of all-cause mortality and to examine the relative contribution of cardiometabolic factors to this risk reduction.

Design, Setting, and Participants

This cohort study included initially healthy women from the Women's Health Study, who had provided blood samples, biomarker measurements, and dietary information. Baseline data included self-reported demographics and a validated food-frequency questionnaire. The data collection period was from April 1993 to January 1996, and data analysis took place from June 2018 to November 2023.

Exposures

Mediterranean diet score (range, 0-9) was computed based on 9 dietary components.

Main Outcome and Measures

Thirty-three blood biomarkers, including traditional and novel lipid, lipoprotein, apolipoprotein, inflammation, insulin resistance, and metabolism measurements, were evaluated at baseline using standard assays and nuclear magnetic resonance spectroscopy. Mortality and cause of death were determined from medical and death records. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for Mediterranean diet adherence and mortality risk, and mediation analyses were used to calculate the mediated effect of different biomarkers in understanding this association.

Results

Among 25 315 participants, the mean (SD) baseline age was 54.6 (7.1) years, with 329 (1.3%) Asian women, 406 (1.6%) Black women, 240 (0.9%) Hispanic women, 24 036 (94.9%) White women, and 95 (0.4%) women with other race and ethnicity; the median (IQR) Mediterranean diet adherence score was 4.0 (3.0-5.0). Over a mean (SD) of 24.7 (4.8) years of follow-up, 3879 deaths occurred. Compared with low Mediterranean diet adherence (score 0-3), adjusted risk reductions were observed for middle (score 4-5) and upper (score 6-9) groups, with HRs of 0.84 (95% CI, 0.78-0.90) and 0.77 (95% CI, 0.70-0.84), respectively (P for trend < .001). Further adjusting for lifestyle factors attenuated the risk reductions, but they remained statistically significant (middle adherence group: HR, 0.92 [95% CI, 0.85-0.99]; upper adherence group: HR, 0.89 [95% CI, 0.82-0.98]; P for trend = .001). Of the biomarkers examined, small molecule metabolites and inflammatory biomarkers contributed most to the lower mortality risk (explaining 14.8% and 13.0%, respectively, of the association), followed by triglyceride-rich lipoproteins (10.2%), body mass index (10.2%), and insulin resistance (7.4%). Other pathways, including branched-chain amino acids, high-density lipoproteins, low-density lipoproteins, glycemic measures, and hypertension, had smaller contributions (<3%).

Conclusions and Relevance

In this cohort study, higher adherence to the Mediterranean diet was associated with 23% lower risk of all-cause mortality. This inverse association was partially explained by multiple cardiometabolic factors.

Long-term impact of mediterranean diet on cardiovascular disease prevention: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Dietary modification plays a pivotal role in the prevention of cardiovascular disease (CVD), with particular emphasis on the potential benefits associated with adopting a Mediterranean diet (MedDiet). Numerous observational studies have explored the impact of the MedDiet on CVD prevention, addressing both primary and secondary prevention. However, a substantial portion of the primary evidence comes from specific Randomized Controlled Trials (RCTs), such as the Lyon Diet Heart Study, the Indo-Mediterranean Diet Heart Study, the PREDIMED Study, and the recent CORDIOPREV Study. To provide a comprehensive assessment of the long-term clinical effects, we conducted a meta-analysis, systematically synthesizing findings from RCTs to better understand the preventive impact of MedDiet on cardiovascular health.

METHODS

We searched for RCTs exploring the efficacy of MedDiet on CVD prevention from inception until January 2024, utilizing databases such as MEDLINE (via PubMed), Google Scholar, the Cochrane Library, ClinicalTrials.gov, and the ScienceDirect portal. Statistical analysis used RevMan 5.4 with a random-effects model, presenting dichotomous outcomes as odds ratios (OR) with a 95 % confidence interval (CI) and assessing heterogeneity using the I2 test.

RESULTS

Our analysis incorporated four RCTs involving a total of 10,054 participants, with an average age of 57 years and a mean follow-up duration ranging from 2 to 7 years. In our pooled analysis, the composite endpoint of major adverse cardiovascular events (MACE) demonstrated a statistically significant reduction in incidence in participants on MedDiet versus control diet with an OR of 0.52 (95 % CI: 0.32 to 0.84, p = 0.008; I2 = 87 %). Additionally, our study revealed a notable decrease in the incidence of cardiovascular events, both myocardial infarction (MI) and stroke in the the MedDiet group, with an OR of 0.62 (95 % CI: 0.41 to 0.92, p = 0.02; I2 = 56 %) and 0.63 (95 % CI: 0.48 to 0.87, p = 0.002; I2 = 0 %), respectively. However, no statistically significant change in the rate of revascularization was observed, with an OR of 0.74 (95 % CI: 0.30 to 1.27, p = 0.06; I2 = 16 %). Concerning mortality rates, MedDiet significantly reduced the risk of cardiovascular death with an OR of 0.54 (95 % CI: 0.31 to 0.94, p = 0.03; I2 = 55 %), while no significant change was noted in all-cause mortality, with an OR of 0.77 (95 % CI: 0.51 to 1.15, p = 0.20; I2 = 58 %).

CONCLUSION

MedDiet serves as an effective intervention for both primary and secondary prevention of CVD, demonstrating a substantial and long-term impact in reducing the incidence of MACE, MI, stroke, and cardiovascular-related mortality while showing no observed effect on all-cause mortality. Nevertheless, it is essential to acknowledge the current limitations in available clinical trial evidence, emphasizing the need for additional trials to substantiate and strengthen these findings.

Mediterranean diet for cardiovascular disease: an evidence mapping study

OBJECTIVE

This study aimed to evaluate the methodological quality of existing meta-analyses (MA) and the quality of evidence for outcome indicators to provide an updated overview of the evidence concerning the therapeutic efficacy of the Mediterranean diet (MD) for various types of CVD.

DESIGN

We conducted comprehensive searches of PubMed, Cochrane Library, and Embase databases. The quality of the MA was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence evaluation system was employed to evaluate the quality of evidence for significant outcomes.

SETTING

The CVD remains a significant contributor to global mortality. Multiple MA have consistently demonstrated the efficacy of medical interventions in managing CVD. However, due to variations in the scope, quality and outcomes of these reviews, definitive conclusions are yet to be established.

PARTICIPANTS

This study included five randomized trials and twelve non-randomized studies, with a combined participant population of 716 318.

RESULTS

The AMSTAR 2 checklist revealed that 54·55 % of the studies demonstrated high quality, while 9·09 % exhibited low quality, and 36·36 % were deemed critically low quality. Additionally, there was moderate evidence supporting a positive correlation between MD and CHD/acute myocardial infarction, stroke, heart failure, cardiovascular events, coronary events and major adverse cardiovascular events.

CONCLUSIONS

This study indicates that although recognizing the potential efficacy of MD in managing CVD, the quality of the methodology and the evidence for the outcome indicators remain unsatisfactory.

The Mediterranean Diet as a Potential Solution to the Gut Microbiome Dysbiosis in Psoriasis Patients

Background

Adherence to a Mediterranean Diet (MeD) has been associated with lower disease severity in patients with psoriasis. However, the mechanism behind how this diet may lead to disease modification remain understudied. Recent studies have revealed dysbiosis of the gut microbiome in patients with psoriasis suggestive of inflammation and altered immune regulation. Diet affects the gut microbiome and this review aims to evaluate whether correcting this dysbiosis may be one theoretical mechanism by which the MeD may be associated with lower psoriasis severity.

Methods

A literature search of the PubMed database was conducted for the terms 1) 'psoriasis' and 'microbiome' or 'microbiota,' and 2) 'Mediterranean diet' and 'microbiome' or 'microbiota' with manual screening for relevant articles. In total, we identified 9 relevant primary research studies investigating the gut microbiome in patients with psoriasis and 16 relevant primary research studies investigating changes in the microbiota for those consuming a MeD.

Results

Though varying in exact levels of certain bacteria, studies analyzing the microbiome in psoriasis revealed dysbiosis. Those analyzing the effect of the Mediterranean diet on the microbiome revealed beneficial changes, including alleviating some of the same alterations seen in the microbiome of those with psoriasis.

Conclusion

Microbiota change is a possible mechanism why the MeD has previously been associated with lower psoriasis severity.

Association between adult food insecurity and mortality among adults aged 20-79 years with diabetes: A population-based retrospective cohort study

AIMS

There is limited research on the relationship between food insecurity and mortality among individuals with diabetes. This study aims to investigate the impact of food insecurity on all-cause and cause-specific mortality in adults with diabetes.

RESEARCH DESIGN AND METHODS

This study included 5749 adults with diabetes from the National Health and Nutrition Examination Survey cycles 2003-2018 and followed up until 31 December 2019. Food insecurity was measured by the Food Security Survey Module. Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% confidence intervals for both all-cause mortality and cause-specific mortality.

RESULTS

The weighted prevalence of full food security, marginal food security, low food security, and very low food security was 70.8%, 11.0%, 10.4%, and 7.8%, respectively. Food insecurity demonstrated a significant correlation with diminished diet quality and reduced consumption of healthy foods. Over the course of 42,272.0 person-years of follow-up, we documented 1091 deaths, of which 370 were attributed to cardiovascular disease and 180 to cancer. After adjusting for multiple variables, food insecurity scores were significantly and linearly associated with increased all-cause mortality. Comparing to full food security, participants experiencing very low food security had a multivariate-adjusted HR of 1.48 (1.12, 1.95) for all-cause mortality (ptrend  = 0.010).

CONCLUSIONS

Food insecurity was associated with increased all-cause mortality and compromised diet quality, especially in individuals experiencing very low food security. Future strategies may necessitate the monitoring of and interventions for food insecurity among individuals with diabetes.

Dietary inflammation index association with serum levels of nitric oxide, prostacyclin, and thromboxane B2 among prinzmetal angina patients and healthy persons

BACKGROUND AND AIM

This study aimed to assess the association between dietary inflammation index with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons.

METHODS AND RESULTS

This case-control study was conducted among 120 Prinzmetal angina patients and 120 healthy persons referred to the Ardabil Imam Khomeini Hospital between 2021 and 2022. Blood samples were gained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. The serum Nitric oxide in patients who had higher DII was less than in patients with less dietary inflammation index (β = -0.75 p = 0.02). The serum Prostacyclin level in patients with greater dietary inflammation index was 0.68 ng/ml less than in patients with less dietary inflammation index (β = -0.68 p = 0.04). The level of serum Thromboxane B2 had a positive association with dietary inflammation index (β = 0.81 p = 0.04).

CONCLUSION

In Prinzmetal angina patients, more dietary inflammation index can increase the serum Thromboxane B2 and decrease the serum Nitric oxide and Prostacyclin. More clinical trial study is needed to confirm these results.

Personalizing Nutrition Strategies: Bridging Research and Public Health

In recent years, although life expectancy has increased significantly, non-communicable diseases (NCDs) continue to pose a significant threat to the health of the global population. Therefore, eating habits have been recognized as key modifiable factors that influence people's health and well-being. For this reason, it is interesting to study dietary patterns, since the human diet is a complex mixture of macronutrients, micronutrients, and bioactive compounds, and can modulate multiple physiological processes, including immune function, the metabolism, and inflammation. To ensure that the data we acquired were current and relevant, we searched primary and secondary sources, including scientific journals, bibliographic indexes, and databases in the last 15 years with the most relevant articles. After this search, we observed that all the recent research on NCDs suggests that diet is a critical factor in shaping an individual's health outcomes. Thus, cardiovascular, metabolic, mental, dental, and visual health depends largely on the intake, habits and patterns, and nutritional behaviors. A diet high in processed and refined foods, added sugars, and saturated fats can increase the risk of developing chronic diseases. On the other hand, a diet rich in whole, nutrient-dense foods, such as vegetables, fruits, nuts, legumes, and a high adherence to Mediterranean diet can improve health's people.

Maternal Mediterranean-Style Diet Adherence during Pregnancy and Metabolomic Signature in Postpartum Plasma: Findings from the Boston Birth Cohort

BACKGROUND

The health benefits of a Mediterranean-style diet (MSD) are well observed, but the underlying mechanisms are unclear. Metabolomic profiling offers a systematic approach for identifying which metabolic biomarkers and pathways might be affected by an MSD.

OBJECTIVES

This study aimed to identify postpartum plasma metabolites that are associated with MSD adherence during pregnancy and to further test whether these identified metabolites may vary by maternal characteristics.

METHODS

We analyzed data from 1410 mothers enrolled in the Boston Birth Cohort (BBC). A maternal food frequency questionnaire (FFQ) was administered and epidemiologic information was obtained via an in-person standard questionnaire interview within 24-72 h postpartum. Maternal clinical information was extracted from electronic medical records. A Mediterranean-style diet score (MSDS) was calculated using responses to the FFQ. Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-MS. Linear regression models were used to assess the associations of each metabolite with an MSDS, adjusting for covariates.

RESULTS

Among the 380 postpartum plasma metabolites analyzed, 24 were associated with MSDS during pregnancy (false discovery rate < 0.05). Of 24 MSDS-associated metabolites, 19 were lipids [for example, triacylglycerols, phosphatidylcholines (PCs), PC plasmalogen, phosphatidylserine, and phosphatidylethanolamine]; others were amino acids (methionine sulfoxide and threonine), tropane (nor-psi-tropine), vitamin (vitamin A), and nucleotide (adenosine). The association of adenosine and methionine sulfoxide with MSDS differed by race (P-interaction = 0.033) and maternal overweight or obesity status (P-interaction = 0.021), respectively.

CONCLUSIONS

In the BBC, we identified 24 postpartum plasma metabolites associated with MSDS during pregnancy. The associations of the 2 metabolites varied by maternal race and BMI. This study provides a new insight into dietary effects on health under the skin. More studies are needed to better understand the metabolic pathways underlying the short- and long-term health benefits of an MSD during pregnancy.

Functional medicine health coaching improved elimination diet compliance and patient-reported health outcomes: Results from a randomized controlled trial

BACKGROUND

The objective of this study was to determine whether an elimination diet with virtually provided functional medicine health coaching support would be more effective than a typical self-guided elimination diet with respect to dietary compliance and patient-reported health and quality of life.

METHODS

A parallel arm, randomized controlled trial was conducted among a sample of healthcare professionals. Participants were randomized to either an elimination diet with 5 sessions of functional medicine health coaching support (intervention arm) or a self-guided elimination diet (control arm). Outcomes assessed at baseline and at the conclusion of the 10-week study included PROMIS Global Health (GH) and medical symptoms questionnaire (MSQ). Compliance with the elimination diet was assessed at the conclusion of the study. Baseline and end of study outcomes were compared within study arms via paired t tests and between study arms with unpaired t tests. Subgroup analysis of symptomatology at baseline was performed.

RESULTS

125 randomized participants (n = 64 intervention, n = 61 control) provided baseline outcomes data. There were statistically and clinically significant within-group improvements in patient-reported outcomes in both the intervention arm (PROMIS GH-physical = 4.68, PROMIS GH-mental = 3.53, MSQ = 28.9) and control arm (PROMIS GH-physical = 48.4, PROMIS GH-mental = 3.18, MSQ = 24.1). There were no between-group differences in the primary analysis (P > .1). However, participants with more symptoms at baseline had statistically and clinically significant between-group differences in PROMIS GH-mental health (3.90, P = .0038) and MSQ (12.3, P = .047) scores that favored the functional medicine health coaching arm.

CONCLUSIONS

An elimination diet, whether self-guided or with functional medicine health coaching support, may improve patient-reported health outcomes among relatively healthy healthcare professionals. While studies in more diverse samples are needed, functional medicine health coaching support appears to be superior to a self-guided approach with regard to both dietary compliance and improving health outcomes among those with greater symptomatology.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Association of a healthy beverage score with total mortality in the adult population of Spain: A nationwide cohort study

BACKGROUND

Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population.

METHODS AND FINDINGS

We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up.

CONCLUSIONS

In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.

Use of Olives-derived Phytochemicals for Prevention and Treatment of Atherosclerosis: An Update

Mediterranean diet is frequently associated with longevity and a lower incidence of adverse cardiovascular events because of the biological activities and health effects of olives - its key component. Olive oil, olive leaf extract, fruits and different by-products contain many bioactive components that exert anti-oxidant, anti-inflammatory and anti-apoptotic activities. In this review, we focus on the recent studies exploring molecular mechanisms underlying the cardioprotective properties of different olive oils, olive leave extracts, and specific micro-constituents (such as oleuropein, tyrosol, hydroxytyrosol and others) in vitro on rodent models and in clinical trials on human subjects. Particularly, hydroxytyrosol and oleuropein were identified as the major bioactive compounds responsible for the antioxidant, anti-inflammatory, anti-platelet aggregation and anti-atherogenic activities of olive oil. In total, the discussed results demonstrated a positive association between the consumption of olive oil and improvement in outcomes in atherosclerosis, diabetes, myocardial infarction, heart failure, hypertension and obesity.

MASLD treatment-a shift in the paradigm is imminent

MASLD prevalence is growing towards the leading cause of end-stage liver disease. Up to today, the most effective treatment is weight loss. Weight loss interventions are moving from lifestyle changes to bariatric surgery or endoscopy, and, more recently, to a new wave of anti-obesity drugs that can compete with bariatric surgery. Liver-targeted therapy is a necessity for those patients who already present liver fibrosis. The field is moving fast, and in the near future, we will testify to a disruptive change in MASLD treatment, similar to the paradigm-shift that occurred for hepatitis C almost one decade ago with direct antiviral agents.

Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies

BACKGROUND

The plant-based Portfolio dietary pattern includes recognized cholesterol-lowering foods (ie, plant protein, nuts, viscous fiber, phytosterols, and plant monounsaturated fats) shown to improve several cardiovascular disease (CVD) risk factors in randomized controlled trials. However, there is limited evidence on the role of long-term adherence to the diet and CVD risk. The primary objective was to examine the relationship between the Portfolio Diet Score (PDS) and the risk of total CVD, coronary heart disease (CHD), and stroke.

METHODS

We prospectively followed 73 924 women in the Nurses' Health Study (1984-2016), 92 346 women in the Nurses' Health Study II (1991-2017), and 43 970 men in the Health Professionals Follow-up Study (1986-2016) without CVD or cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every 4 years using a PDS that positively ranks plant protein (legumes), nuts and seeds, viscous fiber sources, phytosterols (mg/day), and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and cholesterol.

RESULTS

During up to 30 years of follow-up, 16 917 incident CVD cases, including 10 666 CHD cases and 6473 strokes, were documented. After multivariable adjustment for lifestyle factors and a modified Alternate Healthy Eating Index (excluding overlapping components), comparing the highest with the lowest quintile, participants with a higher PDS had a lower risk of total CVD (pooled hazard ratio [HR], 0.86 [95% CI, 0.81-0.92]; Ptrend<0.001), CHD (pooled HR, 0.86 [95% CI, 0.80-0.93]; Ptrend=0.0001), and stroke (pooled HR, 0.86 [95% CI, 0.78-0.95]; Ptrend=0.0003). In addition, a 25-percentile higher PDS was associated with a lower risk of total CVD (pooled HR, 0.92 [95% CI, 0.89-0.95]), CHD (pooled HR, 0.92 [95% CI, 0.88-0.95]), and stroke (pooled HR, 0.92 [95% CI, 0.87-0.96]). Results remained consistent across sensitivity and most subgroup analyses, and there was no evidence of departure from linearity for CVD, CHD, or stroke. In a subset of participants, a higher PDS was associated with a more favorable blood lipid and inflammatory profile.

CONCLUSIONS

The PDS was associated with a lower risk of CVD, including CHD and stroke, and a more favorable blood lipid and inflammatory profile, in 3 large prospective cohorts.

A Review of Healthy Dietary Choices for Cardiovascular Disease: From Individual Nutrients and Foods to Dietary Patterns

Cardiovascular disease (CVD) remains the first cause of mortality globally. Diet plays a fundamental role in cardiovascular health and is closely linked to the development of CVD. Numerous human studies have provided evidence on the relationship between diet and CVD. By discussing the available findings on the dietary components that potentially influence CVD progression and prevention, this review attempted to provide the current state of evidence on healthy dietary choices for CVD. We focus on the effects of individual macronutrients, whole food products, and dietary patterns on the risks of CVD, and the data from population-based trials, observational studies, and meta-analyses are summarized. Unhealthy dietary habits, such as high intake of saturated fatty acids, sugar-sweetened beverages, red meat, and processed meat as well as high salt intake are associated with the increased risk of CVD. Conversely, increased consumption of plant-based components such as dietary fiber, nuts, fruits, and vegetables is shown to be effective in reducing CVD risk factors. The Mediterranean diet appears to be one of the most evidence-based dietary patterns beneficial for CVD prevention. However, there is still great debate regarding whether the supplementation of vitamins and minerals confers cardioprotective benefits. This review provides new insights into the role of dietary factors that are harmful or protective in CVD, which can be adopted for improved cardiovascular health.

Association between Total Dietary Phytochemical Intake and Cardiometabolic Health Outcomes-Results from a 10-Year Follow-Up on a Middle-Aged Cohort Population

Dietary phytochemical intake associations with cardiovascular health and mortality remain unknown. We studied the relations between total dietary phytochemical intake and cardiovascular health outcomes in a middle-aged Swiss population. We analyzed data spanning 2009 to 2021 from a prospective cohort study in Lausanne, Switzerland, including 3721 participants (54.8% women, 57.2 ± 10.3 years) without cardiovascular disease (CVD) history. Dietary intake was assessed using a validated self-reported food frequency questionnaire. The Dietary Phytochemical Index (DPI) and the healthy Dietary Phytochemical Index (hDPI) were calculated as the total energy intake percentage obtained from phytochemical-rich food consumption. The Healthy Plant-Based Diet Index (hPBD) was estimated by scoring healthy plant foods positively and less-healthy plant foods negatively. Indices tertiles and cardiometabolic outcome associations were determined using Cox proportional hazard models. Over 30,217 person-years of follow-up, 262 CVD events, and 178 deaths occurred. Unadjusted analyses found 36%, 33%, and 32% lower CVD risk for the highest hDPI, DPI, and hPBD tertiles, respectively. After adjustment, only the second hDPI tertile showed a 30% lower CVD risk (HR 0.70, 95% CI 0.51-0.95; P for trend 0.362). No other associations emerged. In this middle-aged Swiss cohort, no associations between dietary indices reflecting a phytochemical-rich dietary pattern and incident CVD, all-cause, or CVD mortality were observed.

The Association between the EAT-Lancet Diet and Diabetes: A Systematic Review

Several studies have explored the association between diabetes and the EAT-Lancet diet. Thus, the objective of our study was to conduct a systematic review to analyze and summarize all clinical studies concerning the association between diabetes and the EAT-Lancet diet. We undertook a comprehensive search of the Embase, Cochrane, and PubMed databases up to 15 August 2023. All clinical studies concerning the association between diabetes and the EAT-Lancet diet were summarized and analyzed. In total, our systematic review included five studies of four prospective studies and one cross-sectional study, encompassing 259,315 participants. All the included studies were evaluated as high quality. The outcomes from all studies indicated that adherence to the EAT-Lancet diet was correlated with a reduced risk of diabetes. In conclusion, the EAT-Lancet diet may be an effective dietary intervention for diabetes. Nevertheless, the number of studies examining the association between diabetes and the EAT-Lancet diet is limited. Further high-quality studies are required to expand our understanding of the benefits of the EAT-Lancet diet for patients with diabetes.

The Mediterranean Diet, Cardiometabolic Biomarkers, and Risk of All-Cause Mortality: A 25-Year Follow-Up Study of the Women's Health Study

Background

Higher consumption of Mediterranean diet (MED) intake has been associated with reduced risk of all-cause mortality but limited data are available examining long-term outcomes in women or the underlying molecular mechanisms of this inverse association in human populations. We aimed to investigate the association of MED intake with long-term risk of all-cause mortality in women and to better characterize the relative contribution of traditional and novel cardiometabolic factors to the MED-related risk reduction in morality.

Methods

In a prospective cohort study of 25,315 initially healthy women from the Women's Health Study, we assessed dietary MED intake using a validated semiquantitative food frequency questionnaire according to the usual 9-category measure of MED adherence. Baseline levels of more than thirty cardiometabolic biomarkers were measured using standard assays and targeted nuclear magnetic resonance spectroscopy, including lipids, lipoproteins, apolipoproteins, inflammation, glucose metabolism and insulin resistance, branched-chain amino acids, small metabolites, and clinical factors. Mortality and cause of death was ascertained prospectively through medical and death records.

Results

During a mean follow-up of 25 years, 3,879 deaths were ascertained. Compared to the reference group of low MED intake (0-3, approximately the bottom tertile), and adjusting for age, treatment, and energy intake, risk reductions were observed for the middle and upper MED groups with respective HRs of 0.84 (95% CI 0.78-0.90) and 0.77 (95% CI 0.70-0.84), p for trend <0.0001. Further adjusting for smoking, physical activity, alcohol intake and menopausal factors attenuated the risk reductions which remained significant with respective HRs of 0.92 (95% CI 0.85-0.99) and 0.89 (95% CI 0.82-0.98), p for trend 0.0011. Risk reductions were generally similar for CVD and non-CVD mortality. Small molecule metabolites (e.g., alanine and homocysteine) and inflammation made the largest contributions to lower mortality risk (accounting for 14.8% and 13.0% of the benefit of the MED-mortality association, respectively), followed by triglyceride-rich lipoproteins (10.2%), adiposity (10.2%) and insulin resistance (7.4%), with lesser contributions (<3%) from other pathways including branched-chain amino acids, high-density lipoproteins, low-density lipoproteins, glycemic measures, and hypertension.

Conclusions

In the large-scale prospective Women's Health Study of 25,315 initially healthy US women followed for 25 years, higher MED intake was associated with approximately one fifth relative risk reduction in mortality. The inverse association was only partially explained by known novel and traditional cardiometabolic factors.

Associations between the inflammatory potential of diets with adherence to plant-based dietary patterns and the risk of new-onset cardiometabolic diseases in Chinese adults: findings from a nation-wide prospective cohort study

Aims: convincing evidence is still limited for the validation of associations between the inflammatory potential of diets, based on the dietary inflammatory index (DII), and cardiometabolic outcomes. We aimed to investigate the associations between the DII with adherence to plant-based dietary patterns and the risk of new-onset cardiometabolic diseases (CMDs), including stroke, type 2 diabetes mellitus (T2DM) and myocardial infarction (MI). Methods: adults (N = 14 652) from the China Health and Nutrition Survey (1997-2015) were included in the current analysis. Dietary intake data were collected using a combination of 3 day consecutive 24 h dietary recalls and the food weighing method. The DII was calculated with established and validated methods. CMDs were identified using validated self-reported questionnaires. The Cox proportional hazard regression model was used for statistical analysis. Results: during a mean follow-up of 10 years, a total of 404 new-onset stroke, 1051 new-onset T2DM and 280 new-onset MI cases were identified. Lower PDI, hPDI, ERD, WISH and PHDI scores and higher uPDI scores were associated with higher DII scores (all P-trend < 0. 0001). A pro-inflammatory diet, as reflected by relatively higher DII scores, was positively associated with an increased risk of stroke (Q5 vs. Q1: HR = 1.90; 95% CI: 1.26-2.88; P-trend = 0.0006), T2DM (Q5 vs. Q1: HR = 2.08; 95% CI: 1.61-2.69; P-trend < 0.0001) and MI (Q5 vs. Q1: HR = 1.70; 95% CI: 1.04-2.76; P-trend = 0.0114) in the entire cohort. Sex and BMI significantly modified the association between the DII and the risk of T2DM, and sex significantly modified the association between the DII and the risk of MI. Conclusions: lower adherence to healthy and sustainable plant-based dietary patterns and higher adherence to unhealthy plant-based dietary patterns were associated with higher DII scores. With the use of the DII, we reported long-term positive associations between a pro-inflammatory diet and an increased risk of new-onset stroke, T2DM and MI in Chinese adults who were free from CMDs and cancer at the baseline. These findings provided evidence for the validation of associations between the DII and cardiometabolic health, and contributed to the current literature suggesting careful evaluations of whether the DII should be incorporated into dietary guidelines and utilized as an effective tool for improving the diet quality and CMD prevention in the Chinese population.

[Déterminants de la qualité de vie liée à la santé chez les adolescents : le rôle de la diète méditerranéenne]

BACKGROUND

A number of physical, emotional, cognitive and psychological changes shape the adolescence phase, which may influence health and well-being. Therefore, it is important to develop healthy eating habits that will persist into adulthood.

OBJECTIVE

This study was conducted in order to investigate in depth the association between components of the Mediterranean diet (MD) and health-related quality of life (HRQoL), along with its different subscales, among Lebanese adolescent students attending schools in Tripoli, North Lebanon.

METHODS

A cross-sectional survey was undertaken among 798 teenagers aged 11 to 18. All responded to a questionnaire that evaluated their HRQoL, sociodemographic characteristics and adherence to the Mediterranean diet.

RESULTS

The results of the study revealed that only 15.9% of the students had a high adherence to the MD. With regard to the components of the MD associated with the HRQoL, it was revealed that fruit intake by the students (once daily) was associated with a better general well-being (P = 0.047). In addition, fish consumption (two to three times per week) and daily intake of a dairy product for breakfast were positively associated with the total KIDSCREEN score (P < 0.001 and P = 0.003, respectively). Finally, skipping breakfast was correlated with a poorer general well-being (P = 0.013).

CONCLUSION

Our results suggest a strong correlation between MD adherence and HRQoL in Lebanese adolescents. However, future studies are warranted in order to strengthen the evidence of this association.