Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity

Food Supply And Dietary Guidelines Mismatch: Policy Recommendations To Improve Human And Planetary Health

At this time, global agricultural policies encourage the growing of crops that are detrimental to human and planetary health. In 2019, the EAT-Lancet Commission on Food, Planet, Health published dietary guidelines to promote human and planetary health, but it is unknown whether countries currently provide enough of these recommended foods. To fill this knowledge gap, we used Food and Agriculture Organization food availability data from the period 2016-20 to compare food supplies from twelve countries against the EAT-Lancet guidelines. Our findings indicate that there is an oversupply of grains, animal products, and sugar, while no country's food supply offers enough vegetables or nuts, and many countries lack fruit and seafood. We recommend four agricultural policy actions to address this disconnect: redirect direct agricultural subsidies from commodity crops to specialty crops, increase the presence and scale of crop insurance subsidies for specialty crops, increase investment in research and development for specialty crops, and reduce tariff levels.

Cardiovascular-Endocrine-Metabolic Medicine: Proposing a New Clinical Sub-Specialty Amid the Cardiometabolic Pandemic

Cardiovascular-Renal-Hepatic-Metabolic diseases are on the rise worldwide, creating major challenges for patient care and clinical research. Although these conditions share common mechanisms and often respond to similar treatments-such as lifestyle changes and newer cardiometabolic drugs (e.g., SGLT2 inhibitors, GLP-1 receptor agonists)-clinical management remains divided among multiple specialties. Recently proposed curricula in Cardiometabolic Medicine and Preventive Cardiology reflect an effort to address this fragmentation. In addition, recent studies reveal that hormonal deficiencies may increase cardiovascular risk and worsen heart failure, with emerging data showing that correcting these imbalances can improve exercise capacity and possibly reduce major cardiac events. To overcome gaps in care, we propose a new sub-specialty: Cardiovascular-Endocrine-Metabolic Medicine. This approach unifies three main pillars: (1) Lifestyle medicine, emphasizing nutrition, physical activity, and smoking cessation; (2) the Integrated Medical Management of obesity, diabetes, hypertension, dyslipidemia, heart failure with preserved ejection fraction, early-stage kidney disease, metabolic-associated liver disease, and related conditions; and (3) hormonal therapies, focused on optimizing sex hormones and other endocrine pathways to benefit cardiometabolic health. By bridging cardiology, endocrinology, and metabolic medicine, this sub-specialty offers a more seamless framework for patient care, speeds up the adoption of new treatments, and sets the stage for innovative research-all critical steps in addressing the escalating cardiometabolic pandemic.

The Role of Well-Being, Divergent Thinking, and Cognitive Reserve in Different Socio-Cultural Contexts

BACKGROUND

Many protective factors promote psychological well-being (PWB) in the elderly and contribute to healthy aging, such as engagement, positive emotions, and cognitive reserve (CR), which includes education, leisure, and work activities. CR sustains cognitive functioning and positively correlates with creativity, particularly divergent thinking (DT), helping older adults cope with everyday challenges and enhancing their PWB.

OBJECTIVES

The present study aimed to investigate the relationships between DT, CR, PWB, memory functions, depression, stress, and anxiety indexes even in the Blue Zone (BZ), an area known for extraordinary longevity and high PWB.

METHODS

A total of 165 Italian healthy older adults (Mage = 73.8, SD = 6.7) from Milan (MI), Bergamo (BG), Cagliari (CA), and BZ were enrolled and divided into four groups according to their origin. Generalized linear models (GLMs) with normal and gamma link functions were used.

RESULTS

BZ presented higher DT and PWB indices than the cities but lower CR, particularly in education.

CONCLUSIONS

This study highlights the influence of DT in supporting cognitive functions and PWB, suggesting that PWB and DT are key protective factors in aging.

The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento

Aging and longevity are shaped by the exposome, a dynamic network of environmental, social, and biological factors. Understanding how these exposures interact with biological mechanisms can inform strategies for healthier aging. Background/Objectives: This review explores the exposome as a dynamic system encompassing both protective and risk factors, with a specific focus on how beneficial environmental exposures, microbiome diversity, lifestyle behaviors, and resilience mechanisms contribute to successful aging. By analyzing high-longevity populations, such as the Blue Zones and Cilento, it aims to identify common determinants of successful aging. Methods: A mixed-method study was conducted, combining a systematic review of the English literature (2003-2024) with a comparative analysis of longevity regions. A structured search was performed in PubMed, Scopus, and Google Scholar using keywords such as "longevity", "Blue Zones", "Cilento", "microbiome", "environmental factors", and related terms. Additionally, qualitative and quantitative analysis were applied to assess key protective factors across different aging models. Results: This study identified key factors contributing to successful aging in longevity hotspots, including sustained exposure to biodiverse natural environments, adherence to Mediterranean or plant-based diet rich in polyphenols and probiotics, regular physical activity, strong social networks, and psychological resilience. A novel aspect of this review is the role of the gut microbiome as a mediator between environmental exposures and immune-metabolic health, influencing inflammation modulation and cellular aging. Despite geographic and cultural differences, case studies reveal a shared pattern of protective factors that collectively enhance lifespan and healthspan. Conclusions: The exposome is a critical determinant of aging trajectories, acting through complex interactions between environmental and biological mechanisms. By integrating insights from high-longevity populations, this mixed-method study proposes a comprehensive framework for optimizing microbiome health, enhancing resilience, and promoting protective environmental exposures. These findings provide a translational perspective to guide future interventions in aging research and global health initiatives.

Climbing the longevity pyramid: overview of evidence-driven healthcare prevention strategies for human longevity

Longevity medicine is an emerging and iterative healthcare discipline focusing on early detection, preventive measures, and personalized approaches that aim to extend healthy lifespan and promote healthy aging. This comprehensive review introduces the innovative concept of the "Longevity Pyramid." This conceptual framework delineates progressive intervention levels, providing a structured approach to understanding the diverse strategies available in longevity medicine. At the base of the Longevity Pyramid lies the level of prevention, emphasizing early detection strategies and advanced diagnostics or timely identification of potential health issues. Moving upwards, the next step involves lifestyle modifications, health-promoting behaviors, and proactive measures to delay the onset of age-related conditions. The Longevity Pyramid further explores the vast range of personalized interventions, highlighting the importance of tailoring medical approaches based on genetic predispositions, lifestyle factors, and unique health profiles, thereby optimizing interventions for maximal efficacy. These interventions aim to extend lifespan and reduce the impact and severity of age-related conditions, ensuring that additional years are characterized by vitality and wellbeing. By outlining these progressive levels of intervention, this review offers valuable insights into the evolving field of longevity medicine. This structured framework guides researchers and practitioners toward a nuanced strategic approach to advancing the science and practice of healthy aging.

Sexuality in Older Adults: Comprehensive Strategies for Clinicians and Patient-Centered Care

INTRODUCTION

Healthcare providers play a crucial role in promoting sexual health among older adults, an important yet often neglected aspect of aging well. Although sexuality evolves beyond the reproductive years, it remains a meaningful part of life for many. Despite the natural decline in sexual activity with age, numerous older adults continue to value and engage in fulfilling sexual relationships. Unfortunately, targeted interventions to support later-life sexuality are lacking, creating gaps in care.

INTERVENTION

Sexuality in older adults is influenced by biological, psychological, and social factors. Clinicians should include comprehensive sexual health assessments, including STI screenings, as part of routine care. Providing age-appropriate sexual education and resources helps promote lifelong sexual wellness. Open communication between healthcare providers and patients is vital for addressing sexual concerns, often left unspoken due to stigma or discomfort. Additionally, adopting lifestyle medicine principles-such as balanced nutrition, regular exercise, stress management, and social connection-can enhance sexual health and overall well-being.

CONCLUSION

Specialized training for healthcare professionals on the unique aspects of older adult sexuality is essential to bridge knowledge gaps. A holistic, evidence-based approach will empower providers to better support the evolving sexual health needs of older adults, improving their quality of life.

Nationwide mortality trends from 2001 to 2020 in Greece: health policy implications under the scope of aging societies

OBJECTIVE

This nationwide study aims to analyze mortality trends for all individual causes in Greece from 2001 to 2020, with a specific focus on 2020, a year influenced by the COVID-19 pandemic. As Greece is the fastest-aging country in Europe, the study's findings can be generalized to other aging societies, guiding the reevaluation of global health policies.

METHODS

Data on the population and the number of deaths were retrieved from the Hellenic Statistical Authority. We calculated age-standardized mortality rates (ASMR) and cause-specific mortality rates by sex in three age groups (0-64, 65-79, and 80+ years) from 2001 to 2020. Proportional mortality rates for 2020 were determined. Statistical analysis used generalized linear models with Python Programming Language.

RESULTS

From 2001 to 2020, the ASMR of cardiovascular diseases (CVD) decreased by 42.7% (p < 0.0001), with declines in most sub-causes, except for hypertensive diseases, which increased by 2.8-fold (p < 0.0001). In 2020, the proportional mortality rates of the three leading causes were 34.9% for CVD, 23.5% for neoplasms, and 9.6% for respiratory diseases (RD). In 2020, CVD were the leading cause of death among individuals aged 80+ years (39.3%), while neoplasms were the leading cause among those aged 0-79 years (37.7%). Among cardiovascular sub-causes, cerebrovascular diseases were predominant in the 80+ year age group (30.3%), while ischemic heart diseases were most prevalent among those aged 0-79 years (up to 60.0%).

CONCLUSIONS

The global phenomenon of population aging necessitates a reframing of health policies in our aging societies, focusing on diseases with either a high mortality burden, such as CVD, neoplasms, and RD, or those experiencing increasing trends, such as hypertensive diseases.

Effect of a 15-Week Whole Foods, Plant-Based Diet, Physical Activity, and Stress Management Intervention on Cardiometabolic Risk Factors in a Population of US Veterans: A Retrospective Analysis

Military Veterans have a higher risk of incident atherosclerotic cardiovascular disease (ASCVD) than the general population and are often clinically complex. We studied the changes in cardiovascular risk factors with a lifestyle intervention in this population. We retrospectively analyzed data from 67 participants (mean age 69.2 (SD 7.9) years; 97% male) with atherosclerotic heart disease and/or type 2 diabetes in a 15-week, multiple health behavior change (MHBC) intervention implemented in a Veterans Affairs (VA) Behavioral Medicine Clinic. The intervention promoted a whole foods, plant-based (WFPB) diet, physical activity, and cognitive-behavioral stress management. We assessed cardiometabolic risk factors at baseline, 1 month into the intervention, and at 15 weeks (post-treatment). Among intervention completers (n = 67), we observed statistically significant improvements in waist circumference (-2.8 inches, P = .03), systolic blood pressure (-7.9 mmHg, P = .03), LDL cholesterol (-11.27 mg/dL, P = .04), fasting glucose (-15.10 mg/dL, P = .03), and hemoglobin A1c (-0.55%, P = .017) at post-treatment. Participants with type 2 diabetes (n = 34) achieved improvements in hemoglobin A1c (-0.80%, P = .007), systolic blood pressure (-10.98 mmHg, P = .01), and diastolic blood pressure (-6.65 mmHg, P = .03) at post-treatment. Medication usage did not significantly change. Veterans who completed the MHBC intervention achieved significant improvements in cardiometabolic risk in a routine VA clinical practice setting.

Cognitive Reserve, Physical Reserve, and Cognitive Efficiency of Older People Living in the Sardinian Blue Zone. An Exploratory Study

This study mainly intended to disentangle the role played by physical reserve as a mediator of the relationship between cognitive reserve and global cognitive functioning in older people aging well. A sample of 120 67-101-year-old community-dwellers was recruited in the Sardinian Blue Zone, an area characterized by the extreme longevity of its inhabitants. Each respondent completed a battery of tests examining cognitive functioning, perceived physical health, cognitive reserve, and physical reserve (objectively assessed through accelerometric-derived measures). Significant associations were found among measures of cognitive reserve, physical reserve, perceived physical health, and cognition. Besides, two mediational analyses pointed out that physical reserve and distinct indexes of cognitive reserve explained 18% and 32% of the variance associated with global cognitive functioning. In conclusion, the combination of high cognitive reserve and more preserved motor functioning seems to contribute to the maintenance of healthy cognition in older people aging well.

Redefining Age-Friendly Neighbourhoods: Translating the Promises of Blue Zones for Contemporary Urban Environments

The longevity and healthy ageing observed in Blue Zones offer valuable insights for contemporary urban neighbourhood planning and design. This paper reviews the age-friendly features of the built environment in Blue Zones, aiming to translate these insights into actionable strategies for urban neighbourhood development. Employing a systematic literature review and Convolutional Neural Networks (CNNs) analysis of Google Street View imagery, this study assesses the built environments in Blue Zones, including housing, public spaces, and transportation systems. Key findings highlight the presence of adaptable housing, building designs that foster a connection with nature, and semi-public spaces that encourage social interaction and physical activity. A notable emphasis on walkability and limited public transport access was observed. The CNN analysis corroborated these findings, providing a quantitative view of age-friendly features. This research contributes to the academic discourse in urban planning and design by providing practical insights for developing age-friendly neighbourhoods, inspired by Blue Zones. It concludes by offering policy advice and future research directions for creating sustainable and inclusive urban environments conducive to ageing populations.

Using Ecological Momentary Assessments to Study How Daily Fluctuations in Psychological States Impact Stress, Well-Being, and Health

Despite great interest in how dynamic fluctuations in psychological states such as mood, social safety, energy, present-focused attention, and burnout impact stress, well-being, and health, most studies examining these constructs use retrospective assessments with relatively long time-lags. Here, we discuss how ecological momentary assessments (EMAs) address methodological issues associated with retrospective reports to help reveal dynamic associations between psychological states at small timescales that are often missed in stress and health research. In addition to helping researchers characterize daily and within-day fluctuations and temporal dynamics between different health-relevant processes, EMAs can elucidate mechanisms through which interventions reduce stress and enhance well-being. EMAs can also be used to identify changes that precede critical health events, which can in turn be used to deliver ecological momentary interventions, or just-in-time interventions, to help prevent such events from occurring. To enable this work, we provide examples of scales and single-item questions used in EMA studies, recommend study designs and statistical approaches that capitalize on EMA data, and discuss limitations of EMA methods. In doing so, we aim to demonstrate how, when used carefully, EMA methods are well poised to greatly advance our understanding of how intrapersonal dynamics affect stress levels, well-being, and human health.

Is Cognitive Reserve a Determinant of Functional and Mental Health in Older People of the Sardinian Blue Zone? A Mediational Approach

The main purpose of this study was to examine the mediating role of cognitive reserve in the relationship between functional health (expressed through the amount and intensity of performed physical activity objectively assessed using wearable accelerometers) and psychological well-being (i.e., assessed in terms of self-reported depressive signs) of older people living in an area of exceptional longevity, the so-called Sardinian Blue Zone. A further goal was to investigate the impact of gender on the cognitive reserve and physical health of our participants, using global cognitive functioning as a covariate. A battery of tests assessing motor efficiency, cognitive reserve, global cognitive functioning, and self-reported depressive symptoms was individually presented to 120 community dwellers (Mage = 82 years, SD = 8.4 years) of the Sardinian Blue Zone. Significant associations were found between cognitive reserve, motor efficiency, and self-reported depressive signs. Moreover, three mediation analyses documented that distinct indexes of cognitive reserve and motor efficiency explain 27.2-31% of the variance in the self-reported depression condition. Following this, it was also found that people with scarce cognitive reserve tended to exhibit significant signs of depression and showed worse motor abilities. In addition, after controlling for the effect of global cognitive functioning, motor efficiency, and cognitive reserve were generally more preserved in males than in females. Overall, these findings suggest that cognitive reserve is a compensatory resource that contributes significantly to the enhancement of health-related quality of life in the last decades of life.