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Sam-Yellowe TY. Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations. Foods 2024; 13:1750. [PMID: 38890978 PMCID: PMC11171913 DOI: 10.3390/foods13111750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Adherence to the Mediterranean diet has been shown to lower the risk of developing chronic non-communicable diseases like cardiovascular and neurodegenerative diseases and cancer. Improvements in depression, participation in daily activities in older individuals, weight loss and a reduction in adverse pregnancy outcomes are associated with adherence to the Mediterranean diet. The number of studies that have evaluated barriers to adherence to the Mediterranean diet in the US and, in particular, in racial and ethnic minority populations within the US are few. Among Native American and Alaskan Native populations, studies evaluating traditional or alternative Mediterranean diet adherence for chronic non-infectious diseases is unavailable. Mediterranean diet scoring instruments used in studies in European and Mediterranean countries and among white participants in the US fail to capture the dietary patterns of racial and ethnic minority populations. In this narrative review, the food components of the traditional Mediterranean diet are discussed, adherence to the Mediterranean diet is examined in Mediterranean and non-Mediterranean countries and barriers preventing adherence to the Mediterranean diet in the US and among racial and ethnic minority populations is reviewed. Recommendations for improving nutrition education and intervention and for increasing adherence and cultural adaptions to the Mediterranean diet are provided.
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Affiliation(s)
- Tobili Y. Sam-Yellowe
- Graduate College, Canisius University, 2001 Main Street, Buffalo, NY 14208-1098, USA;
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
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Aaseth J, Ellefsen S, Alehagen U, Sundfør TM, Alexander J. Diets and drugs for weight loss and health in obesity - An update. Biomed Pharmacother 2021; 140:111789. [PMID: 34082399 DOI: 10.1016/j.biopha.2021.111789] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023] Open
Abstract
Numerous combinations of diets and pharmacological agents, including lifestyle changes, have been launched to treat obesity. There are still ambiguities regarding the efficacies of different approaches despite many clinical trials and the use of animal models to study physiological mechanisms in weight management and obesity comorbidities, Here, we present an update on promising diets and pharmacological aids. Literature published after the year 2005 was searched in PubMed, Medline and Google scholar. Among recommended diets are low-fat (LF) and low-carbohydrate (LC) diets, in addition to the Mediterranean diet and the intermittent fasting approach, all of which presumably being optimized by adequate contents of dietary fibers. A basic point for weight loss is to adopt a diet that creates a permanently negative and acceptable energy balance, and prolonged dietary adherence is a crucial factor. As for pharmacological aids, obese patients with type 2 diabetes or insulin resistance seem to benefit from LC diet combined with a GLP-1 agonist, e.g. semaglutide, which may improve glycemic control, stimulate satiety, and suppress appetite. The lipase inhibitor orlistat is still used to maintain a low-fat approach, which may be favorable e.g. in hypercholesterolemia. The bupropion-naltrexone-combination appears promising for interruption of the vicious cycle of addictive over-eating. Successful weight loss seems to improve almost all biomarkers of obesity comorbidities. Until more support for specific strategies is available, clinicians should recommend an adapted lifestyle, and when necessary, a drug combination tailored to individual needs and comorbidities. Different diets may change hormonal secretion, gut-brain signaling, and influence hunger, satiety and energy expenditure. Further research is needed to clarify mechanisms and how such knowledge can be used in weight management.
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Affiliation(s)
- Jan Aaseth
- Research Department, Innlandet Hospital, PO Box 104, N-2381 Brumunddal, Norway; Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, N-2624 Lillehammer, Norway.
| | - Stian Ellefsen
- Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, N-2624 Lillehammer, Norway
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Se-581 85 Linköping, Sweden
| | - Tine M Sundfør
- Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Jan Alexander
- Norwegian Institute of Public Health, P.O. Box 222 Skøyen, N-0213 Oslo, Norway
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Modified Mediterranean diet score adapted to a southern Mediterranean population and its relation to overweight and obesity risk. Public Health Nutr 2020; 24:4064-4070. [DOI: 10.1017/s1368980020002062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:The current study aimed to develop a modified Mediterranean diet (MMD) score adjusted to the southern Mediterranean countries’ cultural specificities and to evaluate associations between adherence to this modified score and overweight/obesity risk in Moroccan adults.Design:Population-based cross-sectional study.Setting:Rural and urban areas of the five greatest provinces of Morocco.Participants:In total, 1516 participants were recruited between September 2009 and February 2017. Dietary assessment was obtained using a validated Moroccan FFQ. We constructed a MMD score focusing on twelve components. The MMD score ranged from 0 (no adherence to the traditional southern Mediterranean diet (MD)) to 12 (maximal adherence) and was categorised as low (scores 0–4), moderate (scores 5–7) and high (scores 8–12).Results:Among the whole population, 754 (50·5 %) were women and 738 (49·5 %) were men, and the mean age was about 55·60 ± 13·70. In total, 58 % of participants were moderately active. Regarding educational level, 50·7 % were illiterate. The prevalence of overweight and obesity was 43·3 and 8·6 %, respectively. In multivariate analyses, close adherence to MMD (scores 8–12) was associated with reduced overweight/obesity risk (OR 0·61, 95 % CI 0·44, 0·84).Conclusion:The prevalence of overweight and obesity was very high among Moroccan adults. Adherence to the traditional southern MD may help prevent overweight and obesity.
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Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets. Nutrition 2019; 69:110549. [PMID: 31525701 DOI: 10.1016/j.nut.2019.07.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
New dietary strategies have been created to treat overweight and obesity and have become popular and widely adopted. Nonetheless, they are mainly based on personal impressions and reports published in books and magazines, rather than on scientific evidence. Animal models and human clinical trials have been employed to study changes in body composition and metabolic outcomes to determine the most effective diet. However, the studies present many limitations and should be carefully analyzed. The aim of this review was to discuss the scientific evidence of three categories of diets for weight loss. There is no one most effective diet to promote weight loss. In the short term, high-protein, low-carbohydrate diets and intermittent fasting are suggested to promote greater weight loss and could be adopted as a jumpstart. However, owing to adverse effects, caution is required. In the long term, current evidence indicates that different diets promoted similar weight loss and adherence to diets will predict their success. Finally, it is fundamental to adopt a diet that creates a negative energy balance and focuses on good food quality to promote health.
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Tseng E, Dalcin AT, Jerome GJ, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Maruthur NM, Daumit GL, Wang NY. Effect of a Behavioral Weight Loss Intervention in People With Serious Mental Illness and Diabetes. Diabetes Care 2019; 42:804-809. [PMID: 30765433 PMCID: PMC6489111 DOI: 10.2337/dc18-2201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes. RESEARCH DESIGN AND METHODS Using data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model. RESULTS Of the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, P = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: P-interaction = 0.08; % weight change: P-interaction = 0.10). CONCLUSIONS A behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD .,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - Arlene T Dalcin
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | | | - Joseph V Gennusa
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacy Goldsholl
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Courtney Cook
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence J Appel
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nisa M Maruthur
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Gail L Daumit
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nae-Yuh Wang
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Sotos-Prieto M, Mattei J. Mediterranean Diet and Cardiometabolic Diseases in Racial/Ethnic Minority Populations in the United States. Nutrients 2018; 10:E352. [PMID: 29538339 PMCID: PMC5872770 DOI: 10.3390/nu10030352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/02/2023] Open
Abstract
The Mediterranean diet (MedDiet) has been recommended to the general population by many scientific organizations as a healthy dietary pattern, based on strong evidence of association with improved cardiometabolic health, including lower risk of cardiovascular disease, diabetes, and obesity. However, most studies have been conducted in Mediterranean or European countries or among white populations in the United States (US), while few exist for non-Mediterranean countries or racial/ethnic minority populations in the US. Because most existing studies evaluating adherence to the MedDiet use population-specific definitions or scores, the reported associations may not necessarily apply to other racial/ethnic populations that may have different distributions of intake. Moreover, racial/ethnic groups may have diets that do not comprise the typical Mediterranean foods captured by these scores. Thus, there is a need to determine if similar positive effects from following a MedDiet are observed in diverse populations, as well as to identify culturally-relevant foods reflected within Mediterranean-like patterns, that can facilitate implementation and promotion of such among broader racial/ethnic groups. In this narrative review, we summarize and discuss the evidence from observational and intervention studies on the MedDiet and cardiometabolic diseases in racial/ethnic minority populations in the US, and offer recommendations to enhance research on MedDiet for such populations.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Department of Food Sciences and Nutrition, School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA.
- Diabetes Institute, Ohio University, Athens, OH 45701, USA.
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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