The Effect of the Traditional Mediterranean-Style Diet on Metabolic Risk Factors: A Meta-Analysis

SuperAgers and centenarians, dynamics of healthy ageing with cognitive resilience

Graceful healthy ageing and extended longevity is the most desired goal for human race. The process of ageing is inevitable and has a profound impact on the gradual deterioration of our physiology and health since it triggers the onset of many chronic conditions like dementia, osteoporosis, diabetes, arthritis, cancer, and cardiovascular disease. However, some people who lived/live more than 100 years called 'Centenarians" and how do they achieve their extended lifespans are not completely understood. Studying these unknown factors of longevity is important not only to establish a longer human lifespan but also to manage and treat people with shortened lifespans suffering from age-related morbidities. Furthermore, older adults who maintain strong cognitive function are referred to as "SuperAgers" and may be resistant to risk factors linked to cognitive decline. Investigating the mechanisms underlying their cognitive resilience may contribute to the development of therapeutic strategies that support the preservation of cognitive function as people age. The key to a long, physically, and cognitively healthy life has been a mystery to scientists for ages. Developments in the medical sciences helps us to a better understanding of human physiological function and greater access to medical care has led us to an increase in life expectancy. Moreover, inheriting favorable genetic traits and adopting a healthy lifestyle play pivotal roles in promoting longer and healthier lives. Engaging in regular physical activity, maintaining a balanced diet, and avoiding harmful habits such as smoking contribute to overall well-being. The synergy between positive lifestyle choices, access to education, socio-economic factors, environmental determinants and genetic supremacy enhances the potential for a longer and healthier life. Our article aims to examine the factors associated with healthy ageing, particularly focusing on cognitive health in centenarians. We will also be discussing different aspects of ageing including genomic instability, metabolic burden, oxidative stress and inflammation, mitochondrial dysfunction, cellular senescence, immunosenescence, and sarcopenia.

Effect of DASH vs. mediterranean diet accompanied by a salt restriction on metabolic syndrome and cardiometabolic risk factors in adults with high normal blood pressure or grade 1 hypertension: secondary analyses of a randomized controlled trial

OBJECTIVE

Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic risk factors. However, studies directly comparing the cardiometabolic effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) accompanied by salt restriction are currently lacking. Thus, with the present secondary analyses of a randomized trial, we aimed to assess the cardiometabolic effects of a 3-month intensive dietary intervention implementing salt restriction alone or on top of the DASH and MedDiet compared to no/minimal intervention in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension.

METHODS

We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60).

RESULTS

According to the intention-to-treat analysis, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of metabolic syndrome compared to the SRG and lower odds of elevated BP levels than the DDG and the SRG. Moreover, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/diastolic BP were reduced in all three intervention groups compared to the CG.

CONCLUSION

On a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.

Association between Baltic sea diet and healthy Nordic diet index with risk of non-alcoholic fatty liver disease: a case-control study

Recent evidence shows the beneficial effects of Baltic Sea diet score (BSDS) and healthy Nordic diet index (HNDI) on chronic diseases, however, there is no evidence to investigate them on the risk of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to investigate the associations between BSDS and HNDI with the risk of NAFLD. In this case-control study, 552 people in good health and 340 people with NAFLD over the age of 18 took part. The evaluation of BSDS and HNDI employed a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Binary logistic regression was used to determine how OBS and NAFLD are related. The mean BSDS and HNDI were 16.00 ± 2.49 and 11.99 ± 2.61, respectively. The final model's confounder adjustment revealed that greater HNDI adherence scores gave protection against the occurrence of NAFLD (odds ratio [OR]: 0.42; 95% confidence interval [CI] 0.18-0.98; P for trend = 0.043). In addition, those with the highest BSDS scores had significantly lower risks of developing NAFLD compared to subjects with the lowest scores (OR = 0.48, 95% CI 0.32-0.89; p for trend = 0.003). Our findings showed that following a healthy Nordic diet can significantly prevent the risk of developing NAFLD, and suggest that the highly nutritious components of the Nordic diet are beneficial for the prevention of NAFLD.

Consumer Knowledge about Dietary Relevance of Fruits and Vegetables: A Study Involving Participants from Portugal and France

Fruits and vegetables are recommended as low-calorie foods that contribute to the proper intake of necessary micronutrients, macronutrients, and bioactive compounds with health benefits. However, the recommendations for the dietary intake of these foods fail to be attained in most European countries. For this reason, promoting more knowledge about the health effects of fruits and vegetables is essential to decrease the incidence of chronic diseases. This study was conducted to investigate the knowledge of the health benefits of fruits and vegetables among the population of Portugal and France. The present work involved a questionnaire survey of 639 participants (257 from Portugal and 382 from France). The results revealed that most participants were young females (68.9%) with good education (76%) and an average weight range. They consumed a varied diet (57%) but had body dissatisfaction (63.2%). The respondents had good knowledge about the health effects of fruits and vegetables. However, the French population knew more about the theme than the Portuguese. Portuguese individuals were more likely to have incomplete information. Gender and education significantly influenced knowledge levels, with females and highly educated individuals demonstrating greater understanding. Dissatisfaction with body weight drives individuals to seek nutrition information. This investigation enhances our comprehension of the factors that affect knowledge of vegetable and fruit consumption among young adults in Portugal and France. Moreover, it highlights the importance of implementing focused educational programs to enhance nutrition literacy, particularly for less-aware demographic groups. Going forward, a more in-depth analysis of these factors could assist in creating more efficient strategies to encourage healthier dietary habits and improve nutrition literacy among these communities.

Scientific evidence supporting the newly developed one-health labeling tool "Med-Index": an umbrella systematic review on health benefits of mediterranean diet principles and adherence in a planeterranean perspective

BACKGROUND

Med-Index is a one-health front-of-pack (FOP) label, based on Mediterranean diet (MedDiet) principles, developed to summarize information about the nutritional properties and related-health benefits of any food as well as its sustainable production processes, and the associated food company's social responsibility parameters in a new "Planeterranean" perspective. Thus, Med-Index can be adopted in and by any European region and authority as well as worldwide; this is achieved by consumption and cooking of locally available and sourced foods that respect MedDiet principles, both in terms of healthy nutrition and sustainable production. The huge body of scientific evidence about the health benefits of the MedDiet model and principles requires a comprehensive framework to encompass the scientific reliability and robustness of this tool. A systematic review was carried out to examine the association between human health and adherence to MedDiet patterns upon which the "Med-Index" tool was subsequently developed.

METHODS

MEDLINE and PubMed databases were searched for eligible publications from 1990 to April 2023. Systematic literature reviews, with or without meta-analysis, of clinical trials and observational studies were screened by two independent investigators for eligibility, data extraction, and quality assessment. English language and the time interval 1990-2023 were applied. A registry code CRD42023464807 was generated on PROSPERO and approved for this search protocol. The corrected covered area (CCA), calculated to quantify the degree of overlap between reviews, gave a slight overlap (CCA = 4%).

RESULTS

A total of 84 systematic reviews out of 6681 screened records were selected. Eligible reviews included studies with predominantly observational designs (61/84, 72.6%%), of which 26/61 referenced studies of mixed observational and RCT designs, while 23/84 (27.4%) were RCT-only systematic reviews. Seventy-nine different entries were identified for health outcomes, clustered into 10 macro-categories, each reporting a statistically significant association with exposure to the MedDiet. Adherence to MedDiet was found to strongly benefit age-related chronic diseases (21.5%), neurological disorders (19%), and obesity-related metabolic features (12.65), followed by CVDs (11.4%), cancer (10.1%), diabetes (7.5%), liver health (6.3%), inflammation (5%), mortality (5%), and renal health (1.2%). The quality of the studies was moderate to high.

CONCLUSION

In the context of a "Planeterranean" framework and perspective that can be adopted in any European region and worldwide, MedDiet represents a healthy and sustainable lifestyle model, able to prevent several diseases and reduce premature mortality. In addition, the availability of a FOP, such as Med-Index, might foster more conscious food choices among consumers, paying attention both to human and planetary health.

Weighted Gene Co-Expression Network Analysis Identifies a Functional Guild and Metabolite Cluster Mediating the Relationship between Mucosal Inflammation and Adherence to the Mediterranean Diet in Ulcerative Colitis

Diet influences the pathogenesis and clinical course of inflammatory bowel disease (IBD). The Mediterranean diet (MD) is linked to reductions in inflammatory biomarkers and alterations in microbial taxa and metabolites associated with health. We aimed to identify features of the gut microbiome that mediate the relationship between the MD and fecal calprotectin (FCP) in ulcerative colitis (UC). Weighted gene co-expression network analysis (WGCNA) was used to identify modules of co-abundant microbial taxa and metabolites correlated with the MD and FCP. The features considered were gut microbial taxa, serum metabolites, dietary components, short-chain fatty acid and bile acid profiles in participants that experienced an increase (n = 13) or decrease in FCP (n = 16) over eight weeks. WGCNA revealed ten modules containing sixteen key features that acted as key mediators between the MD and FCP. Three taxa (Faecalibacterium prausnitzii, Dorea longicatena, Roseburia inulinivorans) and a cluster of four metabolites (benzyl alcohol, 3-hydroxyphenylacetate, 3-4-hydroxyphenylacetate and phenylacetate) demonstrated a strong mediating effect (ACME: -1.23, p = 0.004). This study identified a novel association between diet, inflammation and the gut microbiome, providing new insights into the underlying mechanisms of how a MD may influence IBD. See clinicaltrials.gov (NCT04474561).

Association between Adherence to the Mediterranean Diet and Anthropometric and Health Variables in College-Aged Males

The present study aimed to verify the association between adherence to the Mediterranean diet (MD) and anthropometric and health variables. Four-hundred-and-ninety-five college-aged males aged 18–25 participated in this cross-sectional research. The KIMED (Mediterranean Diet Quality Index for children and adolescents) was used to assess the adherence to MD. The following variables were also assessed: body mass (BM), height (HE), body mass index (BMI), body fat percentage (%FAT), lean mass (LEAN), abdominal girth (AG), waist-to-hip ratio (WHR), oxygen saturation (SPO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), and fasting blood glucose (GLU). The results showed that adherence to MD presented a strong negative correlation with most of the anthropometric parameters (BM: r = −0.571; BMI: r = −0.614; %FAT: r = −0.558; and AG: r = −0.564), a moderate or weak correlation with most of the health variables (GLU: r = −0.407; SBP: r = −0.238; DBP: r = −0.217, and DP: r = −0.265) and LEAN (r = −0.497), and a very weak correlation with WHR (r = −0.090). Many anthropometric parameters (BM, BMI, %FAT, LEAN, AG, WHR) present significant correlations with health variables (SBP, DBP, DP, and GLU). We conclude that greater adherence to Mediterranean diet is associated with healthier values of the selected anthropometric and health parameters. Since most of the anthropometric and health parameters present significant correlations among themselves, this finding could be useful in medical diagnosis, health monitoring, and risk detection. Based on the level of adherence to Mediterranean diet and the KIDMED found in the present study, and considering the prevalence of obesity in the Middle East, it is imperative to implement nutritional interventions with the target population of this research to prevent nutrition-related diseases and promote public health.

Application of Mediterranean Diet in Cardiovascular Diseases and Type 2 Diabetes Mellitus: Motivations and Challenges

Objective: Cardiovascular disease (CVD) is the leading cause of disability and death in many countries. Together with CVD, Type 2 diabetes mellitus (T2DM) accounts for more than 80% of all premature non-communicable disease deaths. The protective effect of the Mediterranean diet (MedDiet) on CVD and its risk factors, including T2DM, has been a constant topic of interest. Notwithstanding, despite the large body of evidence, scientists are concerned about the challenges and difficulties of the application of MedDiet. This review aims to explore the motivations and challenges for using MedDiet in patients with CVD and T2DM. Design: An electronic search was conducted for articles about MedDiet published in PubMed, ScienceDirect, Scopus, and Web of Science up to December 2021, particularly on CVD and T2DM patients. From a total of 1536 studies, the final eligible set of 108 studies was selected. Study selection involved three iterations of filtering. Results: Motivation to apply MedDiet was driven by the importance of studying the entire food pattern rather than just one nutrient, the health benefits, and the distinct characteristics of MedDiet. Challenges of the application of MedDiet include lacking universal definition and scoring of MedDiet. Influences of nutritional transition that promote shifting of traditional diets to Westernized diets further complicate the adherence of MedDiet. The challenges also cover the research aspects, including ambiguous and inconsistent findings, the inexistence of positive results, limited evidence, and generalization in previous studies. The review revealed that most of the studies recommended that future studies are needed in terms of health benefits, describing the potential benefits of MedDiet, identifying the barriers, and mainly discussing the effect of MedDiet in different populations. Conclusions: In general, there is consistent and strong evidence that MedDiet is associated inversely with CVD risk factors and directly with glycemic control. MedDiet is the subject of active and diverse research despite the existing challenges. This review informs the health benefits conferred by this centuries-old dietary pattern and highlights MedDiet could possibly be revolutionary, practical, and non-invasive approach for the prevention and treatment CVD and T2DM.

Quality and Presence of Behaviour Change Techniques in Mobile Apps for the Mediterranean Diet: A Content Analysis of Android Google Play and Apple App Store Apps

Smartphone apps might represent an opportunity to promote adherence to the Mediterranean diet (MedDiet). This study aimed to evaluate the quality of commercially available apps for the MedDiet and the presence of behavioural change techniques (BCTs) used by these apps. A systematic search was conducted on the Apple App and Google Play stores in November 2021. Apps were included if they provided information on the MedDiet or if their objective was to promote a healthy lifestyle through adherence to the MedDiet. Eligible apps were independently evaluated by two reviewers with regard to their quality (engagement, functionality, aesthetics and information quality) using the 5-point Mobile App Rating Scale (MARS; with higher scores indicating higher quality), and the presence of BCTs using an established 26-item BCT taxonomy. Of the 55 analysed apps, 52 (94.5%) were free, 50 (90.9%) provided recipe ideas, 29 (52.7%) provided meal plans, and 22 (40%) provided information on the health benefits of the MedDiet. The overall quality mean MARS score was 2.84 (standard deviation (SD) = 0.42), with functionality being the highest scored MARS domain (mean = 3.58, SD = 0.44) and engagement the lowest (mean = 2.29, SD = 0.61). The average number of BCTs in the analysed apps was 2.3 (SD = 1.4; range: 0-6 per app). The number of BCTs was positively correlated with app information quality (rrho = 0.269, p = 0.047), overall MARS score (rrho = 0.267, p = 0.049), app subjective quality (rrho = 0.326, p = 0.015) and app-specific quality (rrho = 0.351, p = 0.009). These findings suggest that currently available apps might provide information on the MedDiet, but the incorporation of more BCTs is warranted to maximise the potential for behaviour change towards the MedDiet.

Most Frequently Consumed Red/Processed Meat Dishes and Plant-Based Foods and Their Contribution to the Intake of Energy, Protein, and Nutrients-to-Limit among Canadians

Using cross-sectional data from the 2015 Canadian Community Health Survey–Nutrition, we aimed to identify and characterize the top 10 most frequently consumed plant-based foods and red/processed meat dishes in the Canadian population. Plant-based foods and red/processed meat dishes categories included 659 and 265 unique food codes, respectively, from the Canadian Nutrient File. A total of 20,176 Canadian individuals aged ≥1 year were included in our analysis. The most frequently consumed plant-based food was “Cooked regular long-grain white rice”, which made a significant contribution to energy (12.1 ± 0.3%) and protein (6.1 ± 0.2%) intake among consumers. The most frequently consumed red/processed meat dish in Canada was “Cooked regular, lean or extra lean ground beef or patty”. Among red/processed meat dishes, “ham and cheese sandwich with lettuce and spread” made the most significant contribution to the intake of energy (21.8 ± 0.7%), saturated fat (31.0 ± 1.0%), sodium (41.8 ± 1.3%), and sugars (8.2 ± 0.5%) among the consumers. Ground beef is the most frequently consumed red/processed meat dish and white rice is the most frequently consumed plant-based food among Canadians. Red/processed meat dishes are major drivers of the excessive intake of nutrients-to-limit.

Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol Cohort Study (AmolCS)

Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver diseases and a major health problem worldwide. Dietary patterns may play a critical role in controlling and preventing this disease, but the available evidence is scarce. The current study aims to ascertain the association of adherence to the Dietary Approach to Stop Hypertension (DASH) diet and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) among Iranian adults of the Amol Cohort Study (AmolCS). In a cross-sectional analysis among 3220 adults (55.3% men), age ≥ 18 years (46.96 ± 14.67), we measured usual dietary intake with a validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for DASH and MeD. Sociodemographic and lifestyle factors were collected by a structured questionnaire. The presence and degree of NAFLD were also determined by abdominal sonography. Multiple regression models were used to estimate NAFLD odds across tertiles of DASH and Mediterranean dietary scores. Dietary DASH and Mediterranean components were adjusted for total energy intake, based on the residual methods. After adjusting for multiple potential confounders, we found an inverse association of DASH and MeD with NAFLD (Ptrend = 0.02, and Ptrend = 0.002, respectively). Those in the highest tertiles of adherence to the DASH and MeD had the lowest risk for NAFLD (OR = 0.80, 95%CI = 0.66–0.96, OR = 0.64, 95%CI = 0.52–0.78, respectively). The results of logistic analysis of MeD, stratified by gender and abdominal obesity, revealed the favorable association was more pronounced in women (OR = 0.42, 95%CI = 0.29–0.61, Ptrend = 0.004), and in participants with or without abdominal obesity (OR = 0.62, 95% CI = 0.47–0.81, Ptrend = 0.03, OR = 0.64, 95%CI = 0.475–0.91, Ptrend = 0.04, respectively). Similar results were obtained for the adherence to DASH diet score with the prevalence of NAFLD patients with abdominal obesity (OR = 0.75, 95% CI = 0.57–0.97, Ptrend = 0.04). The findings suggested the favorable association between DASH and MeD with NAFLD in Iranian adults, especially women and subjects with or without abdominal obesity. Further prospective investigations are needed to confirm the integrity of our findings.

Effect of a Remotely Delivered Weight Loss Intervention in Early-Stage Breast Cancer: Randomized Controlled Trial

Limited evidence exists on the effects of weight loss on chronic disease risk and patient-reported outcomes in breast cancer survivors. Breast cancer survivors (stage I-III; body mass index 25-45 kg/m²) were randomized to a 12-month, remotely delivered (22 telephone calls, mailed material, optional text messages) weight loss (diet and physical activity) intervention (n = 79) or usual care (n = 80). Weight loss (primary outcome), body composition, metabolic syndrome risk score and components, quality of life, fatigue, musculoskeletal pain, menopausal symptoms, fear of recurrence, and body image were assessed at baseline, 6 months, 12 months (primary endpoint), and 18 months. Participants were 55 ± 9 years and 10.7 ± 5.0 months post-diagnosis; retention was 81.8% (12 months) and 80.5% (18 months). At 12-months, intervention participants had significantly greater improvements in weight (-4.5% [95%CI: -6.5, -2.5]; p < 0.001), fat mass (-3.3 kg [-4.8, -1.9]; p < 0.001), metabolic syndrome risk score (-0.19 [-0.32, -0.05]; p = 0.006), waist circumference (-3.2 cm [-5.5, -0.9]; p = 0.007), fasting plasma glucose (-0.23 mmol/L [-0.44, -0.02]; p = 0.032), physical quality of life (2.7 [0.7, 4.6]; p = 0.007; Cohen's effect size (d) = 0.40), musculoskeletal pain (-0.5 [-0.8, -0.2]; p = 0.003; d = 0.49), and body image (-0.2 [-0.4, -0.0]; p = 0.030; d = 0.31) than usual care. At 18 months, effects on weight, adiposity, and metabolic syndrome risk scores were sustained; however, significant reductions in lean mass were observed (-1.1 kg [-1.7, -0.4]; p < 0.001). This intervention led to sustained improvements in adiposity and metabolic syndrome risk.

Mediterranean dietary pattern and non-alcoholic fatty liver diseases: a case-control study

The Mediterranean (MED) diet was associated with a reduced risk of chronic disease, but the epidemiological studies reported inconsistent findings related to the MED diet and non-alcoholic fatty liver disease (NAFLD) risk. This age and the gender-matched case-control study were conducted among 247 adult patients. The MED diet score was obtained based on the Trichopoulou model. Multivariate logistic regression was used to examine the association between the MED diet and NAFLD risk. NAFLD prevalence in people with low, moderate and high adherence to the MED diet was 33, 13⋅1 and 4⋅6 %, respectively. The increasing intake of the MED diet was significantly related to the increment intake of nuts and fruits, vegetables, monounsaturated fatty acid/polyunsaturated fatty acid ratio, legumes, cereals and fish. However, total energy consumption, low-fat dairy and meats intake were reduced (P for all < 0⋅05). Following control for age, the person in the highest of the MED diet tertile compared with the lowest, the odds of NAFLD decreased (OR: 0⋅40, 95 % CI: 0⋅17-0⋅95). This relation became a little stronger after further adjusting for sex, diabetes, physical activity and supplement intake (OR: 0⋅36, 95 % CI: 0⋅15-0⋅89). However, this association disappeared after adjusting for body mass index, waist and hip circumference (OR: 0⋅70, 95 % CI: 0⋅25-1⋅97). High adherence to the MED diet was associated with a 64 % reduction in NAFLD odds before some anthropometric variable adjustments. However, further prospective studies are required, particularly in BMI-stratified models.

The short- and long-term effects of dietary patterns on cardiometabolic health in adults aged 65 years or older: a systematic review

CONTEXT

Cardiometabolic diseases are leading causes of death and morbidity. Aging increases the risk of disease development. Diet has protective and causal effects on cardiometabolic health.

OBJECTIVE

To consolidate the current evidence on the short- and long-term effects of dietary patterns on cardiometabolic health in adults aged ≥ 65 years.

DATA SOURCES

The Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, Global Health, and Pre-Medline databases, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched.

DATA EXTRACTION

A total of 40 042 records were identified. Quality assessment involved using the revised Cochrane risk-of-bias tool for randomized trials and Joanna Briggs Institute checklists. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation.

RESULTS

Thirteen articles were included (n = 5 cohort studies and n = 3 randomized controlled trials). The low-fat dietary pattern reduced adiposity; however, no effects were evident for hypertension incidence, composite coronary heart disease incidence (including myocardial infarction, coronary heart disease, and coronary revascularization), high-density lipoprotein cholesterol level, and increased blood pressure in the long term. The Mediterranean dietary pattern resulted in reduced triglyceride levels and systolic blood pressure, and had no effects on diastolic blood pressure and glucose in the short term. Other dietary patterns had inconclusive effects.

CONCLUSIONS

The Mediterranean dietary pattern showed the most benefits without harm on cardiometabolic health in older adults. The current body of evidence is small, indicating the need for more research to confirm these findings at a high certainty of evidence, and to include dietary patterns combined with other dietary components, subgroups with cardiometabolic disease or risk factors, longer follow-up, and outcomes that have not yet been investigated. Studies including these factors may help identify the most effective dietary pattern for cardiometabolic health benefits in older adults, to inform future guidelines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020141400.

The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy

BACKGROUND

The Mediterranean diet (MedDiet) is associated with good health. We aimed to estimate the effect of levels of adherence to the MedDiet on lifespan by performing treatment effects survival analysis.

METHODS

A sample of 5250 subjects aged ≥18 years were randomly selected from the electoral list of Castellana Grotte and Putignano (Apulian Region, Italy). Cohorts were enrolled in 2005-06 and followed-up until December 2018. The adherence to the MedDiet was measured by the relative Mediterranean score (rMED) and categorized as high, medium and low. Time-to-death (all-causes) as estimated by average treatment effect on the treated (ATET), potential outcome mean (POM) and relative efficiency of exposure were the outcomes.

RESULTS

A total of 4896 subjects were included. The median follow-up time was 12.82 (inter quartile range (IQR) 12.22-13.05), 12.91 (IQR 12.21-13.27) and 12.84 (IQR 12.19-13.03) years for high, medium and low rMED subjects respectively. By December 2018, 453 (9.25%) had died. There was a strong effect of medium and low rMED {ATET, -5.10 [95% confidence interval (CI) -9.39, -0.80] and -8.91 (95%CI -13.37, -4.45), respectively}. High rMED has an important effect on mean age at death [POM 90.16 (95% CI 86.06, 94.25)]. The relative effect size for medium and low rMED subjects was a lower lifespan of 5.62% (95% CI 1.01, 10.3) and 9.90% (95% CI 5.30, 5.30), respectively.

CONCLUSIONS

We observed an important benefit in additional years of survival from adherence to MedDiet in this southern Italian cohort. Further investigation corroborating our findings in other population groups in other geographic regions will be an important contribution to promoting health and longevity.

Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study

OBJECTIVE

To analyse the influence of the Mediterranean diet (Med Diet) on SLE activity, damage accrual and cardiovascular disease risk markers.

METHODS

A cross-sectional study was conducted on 280 patients with SLE [46.9 (12.85) years]. Med Diet adherence was assessed through a 14-item questionnaire on food consumption frequency and habits (total score from 0 to 14 points; higher score is greater adherence to the Med Diet). CRP, homocysteine, SLEDAI-2K (SLE disease activity), and SLICC/ACR and SDI (damage accrual) were measured. Obesity, diabetes mellitus, hypertension and blood lipids, among others, were considered cardiovascular disease risk factors.

RESULTS

Greater adherence to the Med Diet was significantly associated with better anthropometric profiles, fewer cardiovascular disease risk factors, and lower disease activity and damage accrual scores (P ≤ 0.001 for SLEDAI and SDI). An inverse relationship between the Med Diet score and SLEDAI (P ≥ 0.001; β = -0.380), SDI (P ≤ 0.001; β = -0.740) and hsCRP (P = 0.039; β = -0.055) was observed. The odds ratio for having active SLE (SLEDAI ≥5) or the presence of damage (SDI ≥1) was lower among patients whose Med Diet score was higher (P ≤ 0.001). Finally, greater consumption of Med Diet foods (olive oil, fruits, vegetables, fish, etc.) and abstaining from red meat and meat products, sugars and pastries was associated with less SLE clinical activity and damage.

CONCLUSION

Greater adherence to the Med Diet seems to exert a beneficial effect on disease activity and cardiovascular risk in SLE patients. To confirm these findings, further longitudinal studies would be of interest.

The Effects of Dietary Nutrition Intake on Glycemic Variability in Type 1 Diabetes Mellitus Adults

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is characterized by an absolute deficiency of insulin and dependence on insulin therapy. Therefore, glycemic control and management are important for T1DM patients, particularly glycemic variability, which is associated with the development of diabetic complications. However, insufficient attention has been paid to the glycemic variability in T1DM patients so far. Our objective was to identify the effects of food intake on glycemic variability in T1DM patients.

METHODS

This was a single-center study that took place in the outpatient clinics of Peking Union Medical College Hospital. A total of 68 Chinese T1DM patients between June 2018 and June 2019 were enrolled. After the baseline demographic and clinical characteristics were evaluated, each participant underwent 14-day flash glucose monitoring (FGM). They recorded caloric intake of breakfast, lunch, and dinner at least 3 days/week using a "Menthol Health" app. After 2 weeks, we obtained the FGM data and did further data analysis. Baseline characteristics and glycemic variability index generated by FGM were compared among groups. A general linear model was used to compare data among groups after adjusting for potential confounding factors. The quantitative relationship between two continuous variables was explored by constructing a linear regression equation.

RESULTS

The results showed that the C-peptide level was independently correlated with the mean of daily differences (MODD) after adjusting for the possible confounders (β =  - 0.239, p = 0.046). The dietary nutrition intake had no effect on glycemic variability. However, the nutritional composition of carbohydrate, fat, and protein was an independent risk factor for time spent in hypoglycemia (TBR) post adjustment (β =  - 0.213, p = 0.054). However, there was no impact of daily total energy intake on glycemic variability index.

CONCLUSION

In our study, dietary nutrition intake had no effect on glycemic variability, but residual β-cell function was identified as an influencing factor for glycemic variability in T1DM adults. However, nutritional macronutrient composition played some roles in the occurrence of hypoglycemia. This might provide new evidence for the clinical glycemic control and management of T1DM in the Chinese population.

Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND & AIMS

It is unclear whether the Mediterranean diet (MedDiet) has a favorable effect on blood pressure (BP) levels because among randomized controlled trials (RCTs) investigating the MedDiet-mediated BP reduction significant methodological and clinical differences are observed. The purpose of this study was to comprehensively assess the MedDiet BP-effect compared to the usual diet or another dietary intervention (e.g. low-fat diet) in adults with and without hypertension, accounting for methodological and clinical confounders.

METHODS

We systematically searched Medline and the Cochrane Collaboration Library databases and identified 35 RCTs (13,943 participants). Random-effects model was used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted.

RESULTS

Compared to the usual diet and all other active intervention diets the MedDiet reduced SBP and DBP (difference in means: -1.5 mm Hg; 95% CI: -2.8, -0.1; P = 0.035, and -0.9 mm Hg; 95% CI: -1.5, -0.3; P = 0.002, respectively). Compared only to the usual diet the MedDiet reduced SBP and DBP, while compared to all other active intervention diets or only to the low-fat diet the MedDiet did not reduce SBP and DBP. The MedDiet reduced DBP levels to a higher extent in trials with mean baseline SBP ≥130 mm Hg, while both SBP and DBP were reduced more in trials with a mean follow-up period ≥16 weeks. The quality of evidence was rated as moderate for both outcomes according to the grading of recommendations, assessment, development and evaluation (GRADE) approach.

CONCLUSIONS

The adoption of the MedDiet was accompanied by a relatively small, but yet significant BP reduction, while higher baseline SBP levels and longer follow-up duration enhanced the BP-lowering effect of the intervention. This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42020167308.

REGISTRY NUMBER

CRD42020167308.

[Adherence to the Mediterranean diet in a sample of Colombian schoolchildren: an evaluation of the psychometric properties of the KIDMED questionnaire]

Introduction

Objective: since childhood and adolescence are critical periods for the acquisition of eating habits and lifestyles that will persist into adulthood, having a questionnaire that estimates adherence to the Mediterranean diet among the school-age population is necessary. The aim of this study was to assess the validity, reliability, and factor structure of the KIDMED questionnaire in a group of children and adolescents from Cali, Colombia. Methods: this was a cross-sectional study using a self-reported questionnaire in 167 schoolchildren (53.8% girls, mean age 13.3 ± 3.2 years). Cronbach's alpha and Cohen's kappa (κ) were calculated as reliability and reproducibility indicators. The extraction of main components by varimax rotation allowed to define the communalities of the proposed items as a measure of validity. Results: overall, one in every 3 schoolchildren showed an optimal Mediterranean diet pattern. The KIDMED questionnaire showed moderate reliability and reproducibility values (Cronbach's alpha = 0.79, 95% CI: 0.71-0.77, and κ = 0.66, 95% CI: 0.45-0.77). The factor structure showed six factors that accounted for 60.6% of the total variance with an adequate goodness-of-fit test (Kaiser-Meyer-Olkin = 0.730), and Bartlett's sphericity test (X2 = 414.8, p < 0.001, g/l = 120). Conclusions: the KIDMED questionnaire shown evidence adequate psychometric properties as an instrument for assessing adherence for assessing adherence to the Mediterranean diet in schoolchildren in Colombia. Future studies should focus on investigating the confirmatory structure and/or convergent validity of the questionnaire in different age groups for generating comparable data.

The Effect of the Mediterranean Diet on Metabolic Health: A Systematic Review and Meta-Analysis of Controlled Trials in Adults

The Mediterranean diet (MD) may provide metabolic benefits but no systematic review to date has examined its effect on a multitude of outcomes related to metabolic health. This systematic review with meta-analysis (International Prospective Register of Systematic Reviews, PROSPERO; number CRD42019141459) aimed to examine the MD’s effect on metabolic syndrome (MetSyn) incidence, components and risk factors (primary outcomes), and incidence and/or mortality from MetSyn-related comorbidities and receipt of pharmacologic treatment for MetSyn components and comorbidities (secondary outcomes). We searched Pubmed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science for controlled trials published until June 2019, comparing the MD with no treatment, usual care, or different diets in adults. Studies not published in English and not promoting the whole MD were excluded. Two authors independently extracted data and assessed risk of bias using the Cochrane Collaboration’s and Risk of Bias in non-randomised studies (ROBINS-I) tools. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effects meta-analyses, subgroup analyses and meta-regressions were performed, and heterogeneity was quantified using the I² statistic. We identified 2654 reports and included 84 articles reporting 57 trials (n = 36,983). In random effects meta-analyses, the MD resulted in greater beneficial changes in 18 of 28 MetSyn components and risk factors (body weight, body mass index, waist circumference, systolic and diastolic blood pressure, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR) index, total-, low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol, triglycerides, alanine transaminase, hepatic fat mass, C-reactive protein, interleukin-6, tumour necrosis factor-a, and flow-mediated dilatation) and lower risk of cardiovascular disease incidence (risk ratio (RR) = 0.61, 95% confidence intervals (CI) 0.42–0.80; I² = 0%), and stroke (RR = 0.67, 95% CI 0.35–0.98; I² = 0%). Only six studies reported effects on pharmacotherapy use, and pooled analysis indicated no differences between diet groups. Lack of consistency in comparator groups and other study characteristics across studies resulted in high heterogeneity for some outcomes, which could not be considerably explained by meta-regressions. However, a consistent direction of beneficial effect of the MD was observed for the vast majority of outcomes examined. Findings support MD’s beneficial effect on all components and most risk factors of the MetSyn, in addition to cardiovascular disease and stroke incidence. More studies are needed to establish effects on other clinical outcomes and use of pharmacotherapy for MetSyn components and comorbidities. Despite the high levels of heterogeneity for some outcomes, this meta-analysis enabled the comparison of findings across studies and the examination of consistency of effects. The consistent direction of effect, suggesting the MD’s benefits on metabolic health, supports the need to promote this dietary pattern to adult populations.

Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition

Achieving most of the UN Sustainable Development Goals requires a strong focus on addressing the double burden of malnutrition, which includes both diet-related maternal and child health (MCH) and non-communicable diseases (NCDs). Although, the most optimal dietary metric for assessing malnutrition remains unclear. Our aim was to review available global dietary quality metrics (hereafter referred to as dietary metrics) and evidence for their validity to assess MCH and NCD outcomes, both separately and together. A systematic search of PubMed was done to identify meta-analyses or narrative reviews evaluating validity of diet metrics in relation to nutrient adequacy or health outcomes. We identified seven dietary metrics aiming to address MCH and 12 for NCDs, no dietary metrics addressed both together. Four NCD dietary metrics (Mediterranean Diet Score, Alternative Healthy Eating Index, Healthy Eating Index, and Dietary Approaches to Stop Hypertension) had convincing evidence of protective associations with specific NCD outcomes, mainly mortality, cardiovascular disease, type 2 diabetes, and total cancer. The remaining NCD dietary metrics and all MCH dietary metrics were not convincingly validated against MCH or NCD health outcomes. None of the dietary metrics had been validated against both MCH and NCD outcomes. These findings highlight major gaps in assessing and addressing diet to achieve global targets and effective policy action.

Association between diet quality and obesity indicators among the working-age adults in Inner Mongolia, Northern China: a cross-sectional study

Background

Obesity is a major risk factor for the global burden of disease in countries that are economically developed or not. This study aimed to investigate the association between diet quality and obesity indicators applying DASH and aMed.

Methods

This cross-sectional study on adult nutrition and chronic disease in Inner Mongolia (n = 1320). Dietary data were collected using 24-h diet recall for 3 consecutive days and weighing method. DASH and aMed were used to assess the dietary quality. WC, BMI and WC-BMI were used as obesity indicators. Logistic regression models were used to examine the associations between diet quality and obesity indicators.

Results

Higher diet quality, assessed by DASH, was only associated with WC. The odds ratio (OR) for abdominal obesity in the highest tertile of DASH scores compared with the lowest was 0.71 (95% confidence interval (CI) 0.53, 0.96; P_trend = 0.03). Furthermore, aMed was inversely associated with obesity indicators. OR for abdominal obesity in the highest tertile of aMed score compared with the lowest were 0.63 (95% CI 0.47, 0.87; P_trend = 0.005) and 0.57 (95% CI 0.41, 0.77; P_trend = 0.02) for overweight and obesity, respectively, and 0.60 (95% CI 0.44, 0.81; P_trend = 0.02) for high obesity risk.

Conclusions

Our findings suggest that dietary quality assessed using aMed is more closely associated with obesity than assessment using DASH in working-age adults in Inner Mongolia. The Mediterranean diet can be recommended as a healthy diet to control weight.

The effectiveness and cost-effectiveness of an integrated osteoporosis care programme for postmenopausal women in Flanders: study protocol of a quasi-experimental controlled design

Osteoporosis causes high individual and societal burden, due to limited attention to fracture prevention. Integrated care for chronic conditions has shown to facilitate management of these conditions, improving clinical outcomes alongside quality of life and cost-effectiveness. This manuscript describes an integrated osteoporosis care programme that will be implemented in primary care.

OBJECTIVE

To provide a comprehensive description of a quasi-experimental study design in which a newly developed integrated osteoporosis care (IOC) programme for the management of postmenopausal osteoporosis (PO) in primary care (PC) is implemented and will be compared with care as usual (CAU).

METHODS

A literature research was performed and expert meetings have been taking place, which has led to the development of a complex PC intervention based on framework for integrated people-centred health services (IPCHS).

RESULTS

This manuscript describes the developmental process of the preclinical phase of a quasi-experimental real-world design and the interventions as a result of this process that will be implemented during the clinical phase, along with the evaluation that will take place alongside the clinical phase: An integrative approach for the management of PO in primary care was developed and will be implemented in greater region of Ghent (GRG), Belgium. The approach consists of a complex intervention targeting patients and PC stakeholders in osteoporosis care (e.g. general practitioners (GPs), physiotherapists, nurses, pharmacists). A comparison will be made with CAU using medication possession ratios (MPR) of included patients as primary outcome. These data will be obtained from the national health database. Secondary outcomes are physician outcomes, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). A cost-effectiveness evaluation will be performed if the programme appears to be effective in terms of MPR.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT03970902.

The Mediterranean diet and menopausal health: An EMAS position statement

INTRODUCTION

Globally, 985 million women are aged 50 and over, leading to increasing concerns about chronic conditions such as cardiovascular disease, osteoporosis, dementia, and cognitive decline, which can adversely affect quality of life and independent living.

AIM

To evaluate the evidence from observational studies and randomized trials on the effects of the Mediterranean diet on short- and long-term menopausal health: estrogen deficiency symptoms, cardiovascular disease, osteoporosis, cognitive and mental health, breast cancer, and all-cause mortality.

MATERIALS AND METHODS

Literature review and consensus of expert opinion.

SUMMARY RECOMMENDATIONS

The Mediterranean diet is a non-restrictive dietary pattern common in the olive-growing areas of the Mediterranean basin. It may improve vasomotor symptoms, cardiovascular risk factors such as blood pressure, cholesterol and blood glucose levels, as well as mood and symptoms of depression. Long-term adherence may: improve cardiovascular risk and events, and death; improve bone mineral density; prevent cognitive decline; and reduce the risk of breast cancer and all-cause mortality.

Effects of Popular Diets on Anthropometric and Cardiometabolic Parameters: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials

The prevalence of overweight, obesity, and their related complications is increasing worldwide. The purpose of this umbrella review was to summarize and critically evaluate the effects of different diets on anthropometric parameters and cardiometabolic risk factors. Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, and Web of Science, from inception to April 2019, were used as data sources to select meta-analyses of randomized controlled trials that examined the effects of different diets on anthropometric parameters and cardiometabolic risk factors. Strength and validity of the evidence were assessed through a set of predefined criteria. Eighty articles reporting 495 unique meta-analyses were examined, covering a wide range of popular diets: low-carbohydrate (n = 21 articles), high-protein (n = 8), low-fat (n = 9), paleolithic (n = 2), low-glycemic-index/load (n = 12), intermittent energy restriction (n = 6), Mediterranean (n = 11), Nordic (n = 2), vegetarian (n = 9), Dietary Approaches to Stop Hypertension (DASH) (n = 6), and portfolio dietary pattern (n = 1). Great variability in terms of definition of the intervention and control diets was observed. The methodological quality of most articles (n = 65; 81%), evaluated using the "A MeaSurement Tool to Assess systematic Reviews-2" questionnaire, was low or critically low. The strength of evidence was generally weak. The most consistent evidence was reported for the Mediterranean diet, with suggestive evidence of an improvement in weight, BMI, total cholesterol, glucose, and blood pressure. Suggestive evidence of an improvement in weight and blood pressure was also reported for the DASH diet. Low-carbohydrate, high-protein, low-fat, and low-glycemic-index/load diets showed suggestive and/or weak evidence of a reduction in weight and BMI, but contrasting evidence for lipid, glycemic, and blood pressure parameters, suggesting potential risks of unfavorable effects. Evidence for paleolithic, intermittent energy restriction, Nordic, vegetarian, and portfolio dietary patterns was graded as weak. Among all the diets evaluated, the Mediterranean diet had the strongest and most consistent evidence of a beneficial effect on both anthropometric parameters and cardiometabolic risk factors. This review protocol was registered at www.crd.york.ac.uk/PROSPERO/ as CRD42019126103.

Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors

Objective:

to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up.

Method:

a cross-sectional descriptive study was carried out on a cohort of 23,729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet.

Results:

51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86).

Conclusions:

our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified.

Adherence to the Mediterranean Diet and Chronic Disease in Australia: National Nutrition and Physical Activity Survey Analysis

The Mediterranean diet (MD) is linked to decreased risk of chronic disease, such as cardiovascular disease, obesity, hypertension, diabetes mellitus and cognitive disease. Given the health promoting aspects of this diet, we conducted a secondary analysis of data from the National Nutrition and Physical Activity Survey (NNPAS), which is the largest health study in Australia and the first nutrition-specific national-based study. The primary aim of this analysis was to determine the proportion of Australian adults adhering to the MD and to examine the association between adherence to the MD and markers of noncommunicable diseases, such as cardiovascular disease, diabetes mellitus and chronic kidney disease. Out of the 9435 participants included in the study (mean age = 48.6 ± 17.6 years), 65% were in the middle tertile of the MD score. Participants who were married, employed, of a high-socioeconomic level, nonsmokers, educated and had a healthy body mass index (BMI) and waist circumference were more likely to have higher adherence levels to the MD, which was associated with lower diastolic blood pressure (p < 0.05). Multivariate logistic regression analysis showed that, even after accounting for all possible confounders, higher adherence to the MD was associated with lower risk of dyslipidaemia, OR = 1.06 (1.01–1.10). In conclusion, this analysis is the first to assess adherence to the MD on a national level. Our results indicated that MD adherence may contribute to reducing the prevalence of dyslipidaemia, cerebrovascular disease and elevated blood pressure in a multi-ethnic, non-Mediterranean country.

Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials

Diet is a crucial variable for a healthy life. A rapidly growing number of studies in recent years support the hypothesis that the Mediterranean diet (MedDiet) has a beneficial effect on certain body systems, but the highly varied objectives and quality of these publications warrants an updated assessment. In the present review we performed a comprehensive evaluation of current evidence on the impact of the MedDiet on human health, assessing its effect on the incidence or progression of the main non-communicable diseases and their intermediate outcomes and risk factors. We scrutinised the clinical evidence from observational studies and randomised controlled trials. Cardiovascular disease was the condition with most information. The MedDiet showed a general preventive effect, which was reproduced to varying degrees for certain intermediate cardiovascular outcomes such as blood pressure, lipids, obesity, metabolic syndrome and diabetes. Benefits were also found for several types of cancer, brain function (including cognition, mood and to a lesser extent Parkinson's disease) and mortality. The quality of the published evidence was, however, generally moderate or low. In conclusion, the MedDiet shows a favourable impact on health. General adoption of a MedDiet is concordant with current policies promoting healthy and sustainable nutrition worldwide. Nonetheless, more high-quality research is needed to improve the consistency of the findings.

The Nutrition Health Alliance (NutriHeAl) Study: A Randomized, Controlled, Nutritional Intervention Based on Mediterranean Diet in Greek Municipalities

Objective: The aim of this study was to evaluate the effects of Mediterranean diet on weight loss in a large population in a municipality setting.Methods: A 6-month nutritional intervention was implemented in 50 randomly selected municipalities in Greece. In each municipality, approximately 180 overweight or obese patients were recruited and randomly assigned to an intervention group (n = 4500) or to a control group (n = 4500); 1816 and 2210 patients, respectively, completed the study. At baseline, the intervention group attended a 20-minute session where they received recommendations to follow a personalized, slightly hypocaloric, Mediterranean-type diet. The diet was adjusted every 2 weeks. The control group was provided with a leaflet on healthy nutrition and Mediterranean diet. Adherence to Mediterranean diet was evaluated with the Mediterranean diet score (MedDietScore).Results: Subjects in the intervention group were less frequently males and current smokers, had higher body mass index, and followed a healthier diet at baseline than subjects in the control group. In the intervention group, weight, waist circumference, and body fat percentage decreased. In the control group, weight and waist circumference increased. In the intervention group, 48.8% of subjects lost > 5% of body weight compared with 4.2% in the control group (p < 0.001). The MedDietScore increased in the intervention group and did not change in the control group. Independent predictors of loss > 5% of body weight were the decrease in intake of full-fat dairy products and alcohol and the increase in intake of vegetables, in MedDietScore, in walking and in consuming breakfast.Conclusions: Lifestyle change programs focusing on the adoption of Mediterranean diet with frequent monitoring can be implemented successfully in everyday clinical practice. However, retention rates in such programs need to be improved.

The Relevance of Insulin Action in the Dopaminergic System

The advances in medicine, together with lifestyle modifications, led to a rising life expectancy. Unfortunately, however, aging is accompanied by an alarming boost of age-associated chronic pathologies, including neurodegenerative and metabolic diseases. Interestingly, a non-negligible interplay between alterations of glucose homeostasis and brain dysfunction has clearly emerged. In particular, epidemiological studies have pointed out a possible association between Type 2 Diabetes (T2D) and Parkinson’s Disease (PD). Insulin resistance, one of the major hallmark for etiology of T2D, has a detrimental influence on PD, negatively affecting PD phenotype, accelerating its progression and worsening cognitive impairment. This review aims to provide an exhaustive analysis of the most recent evidences supporting the key role of insulin resistance in PD pathogenesis. It will focus on the relevance of insulin in the brain, working as pro-survival neurotrophic factor and as a master regulator of neuronal mitochondrial function and oxidative stress. Insulin action as a modulator of dopamine signaling and of alpha-synuclein degradation will be described in details, too. The intriguing idea that shared deregulated pathogenic pathways represent a link between PD and insulin resistance has clinical and therapeutic implications. Thus, ongoing studies about the promising healing potential of common antidiabetic drugs such as metformin, exenatide, DPP IV inhibitors, thiazolidinediones and bromocriptine, will be summarized and the rationale for their use to decelerate neurodegeneration will be critically assessed.

Diet and Oxidative Status. The Dietary Pattern and Urinary 8-Isoprostane in Healthy Spanish Women

The Mediterranean diet is associated with a low incidence of physiologic and metabolic non-communicable diseases such as hypertension, obesity, and insulin resistance. These chronic diseases are closely related to oxidative status, which is determined by the balance between oxidant and antioxidant levels. The Mediterranean diet is rich in foods with important antioxidant properties, such as fruits and extra virgin olive oil. The aim of this work was to establish the relationship between dietary patterns, the total intake of polyphenols, and the levels of 8-isoprostanes in urine, as a marker of lipid peroxidation, in a group of healthy Spanish women. The main sources of dietary polyphenols were fruits, vegetables, pulses, nuts, and extra virgin olive oil. There was a significant and positive correlation between the estimated intake of polyphenols, total polyphenols excreted in urine, adherence to the Mediterranean diet, and the intake of specific food groups. A positive correlation was established between the total polyphenols in urine and the intake of raw extra virgin olive oil. However, a negative correlation was established between the amount of 8-isoprostanes in urine, total intake of polyphenols, adherence to the Mediterranean diet, and the intake of fruits and nuts. These results indicate an association between oxidative status and the intake of foods that are typical of the Mediterranean diet, in healthy women. Furthermore, the results demonstrate the use of urine 8-isoprostanes as a marker of adherence to the Mediterranean diet.

Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

The aim of this study was to assess the effects of different dietary approaches on low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels in patients with type 2 diabetes (T2D) by applying network meta-analysis (NMA). Systematic electronic and hand searches were conducted until January 2018. Randomized controlled trials (RCTs) with an intervention period of ≥ 12 weeks, focussing on adults with T2D, and comparing dietary approaches regarding LDL, HDL or TGs, were included. For each outcome measure, random effects NMA was performed in order to determine the effect of each dietary approach compared to every other dietary intervention. Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated, and for the ranking, the surface under the cumulative ranking curves (SUCRA) was determined. Additionally, the credibility of evidence was evaluated. 52 RCTs (44 for LDL, 48 for HDL and 52 for TGs) comparing nine dietary approaches (low fat, vegetarian, Mediterranean, high protein, moderate carbohydrate, low carbohydrate, control, low glycaemic index/glycaemic load and Palaeolithic diet) enrolling 5360 T2D patients were included. The vegetarian diet most effectively reduced LDL levels [MD (95% CI): - 0.33 (- 0.55, - 0.12) mmol/L; compared to the control diet]. The Mediterranean diet beneficially raised HDL [MD (95% CI): 0.09 (0.04, 0.15) mmol/L] and decreased TG levels [MD (95% CI): - 0.41 (- 0.72, - 0.10) mmol/L] compared to the control diet. The Mediterranean diet was the most effective dietary approach to manage diabetic dyslipidaemia altogether (SUCRA: 79%). The overall findings are mainly limited by low credibility of evidence.

From sugar to liver fat and public health: systems biology driven studies in understanding non-alcoholic fatty liver disease pathogenesis

Non-alcoholic fatty liver disease (NAFLD) is now a major public health concern with an estimated prevalence of 25-30% of adults in many countries. Strongly associated with obesity and the metabolic syndrome, the pathogenesis of NAFLD is dependent on complex interactions between genetic and environmental factors that are not completely understood. Weight loss through diet and lifestyle modification underpins clinical management; however, the roles of individual dietary nutrients (e.g. saturated and n-3 fatty acids; fructose, vitamin D, vitamin E) in the pathogenesis or treatment of NAFLD are only partially understood. Systems biology offers valuable interdisciplinary methods that are arguably ideal for application to the studying of chronic diseases such as NAFLD, and the roles of nutrition and diet in their molecular pathogenesis. Although present in silico models are incomplete, computational tools are rapidly evolving and human metabolism can now be simulated at the genome scale. This paper will review NAFLD and its pathogenesis, including the roles of genetics and nutrition in the development and progression of disease. In addition, the paper introduces the concept of systems biology and reviews recent work utilising genome-scale metabolic networks and developing multi-scale models of liver metabolism relevant to NAFLD. A future is envisioned where individual genetic, proteomic and metabolomic information can be integrated computationally with clinical data, yielding mechanistic insight into the pathogenesis of chronic diseases such as NAFLD, and informing personalised nutrition and stratified medicine approaches for improving prognosis.

Cardiometabolic risk factors differ among adolescents with obesity in three European countries - a cross-sectional study

Aim

We aimed to compare modifiable cardiometabolic risk factors among treatment‐seeking adolescents with obesity in Italy, Germany and Norway.

Methods

This retrospective, registry‐based, cross‐sectional cohort study included 2,327 (59% girls) 12–18 year‐old adolescents with obesity from three tertiary care outpatient clinics in Europe, between 1999 and 2015. The prevalence of cardiometabolic risk factors was compared between clinics, and multivariate logistic regression models including gender, age, waist circumference and body mass index were used to assess the associations between population and cardiometabolic risk.

Results

In total, 1,396 adolescents (60% girls) from Italy, 654 (58% girls) from Germany and 277 (51% girls) from Norway were included. The mean ± SD age was 15.2 ± 1.6 years, body mass index 38.8 ± 6.5 kg/m² and body mass index standard deviation score 3.21 ± 0.43. The prevalence of elevated nonhigh‐density lipoprotein‐cholesterol in Norway, Germany and Italy was 60%, 54% and 45%, while the prevalence of high systolic or diastolic blood pressure (≥130 or ≥85 mmHg) were 15%, 46% and 66%, respectively.

Conclusion

Cardiometabolic risk factors among treatment‐seeking adolescents with obesity from Italy, Germany and Norway differed across the populations in this study, which might imply that preventive clinical work should reflect such differences.

Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients

Purpose

This work aimed to design and validate a novel short food frequency questionnaire (SFFQ) to assess habitual intakes of food items related to non-alcoholic fatty liver disease (NAFLD) in a cohort of European patients.

Methods

A 48-item SFFQ was created, with questions from existing FFQs and expert knowledge, emphasizing foods and nutrients implicated in NAFLD pathogenesis. Consenting, fibroscan-diagnosed, NAFLD patients completed the SFFQ during a short interview and were asked to complete a 4-day diet diary (4DDD) at home for return by mail. Nutritional intakes were assessed utilizing the myfood24™ food composition dataset and estimated energy requirements (EER) were calculated using sex-, age- and weight-specific equations. Agreement between the dietary instruments was assessed by Spearman correlations and Bland Altman analysis.

Results

Fifty-five patients completed both the SFFQ and the 4DDD within 30 weeks; 42 (76%) were diagnosed with simple steatosis, whereas 13 (24%) had biopsy-proven steatohepatitis; the majority were overweight or obese, with a median (25th; 75th percentile) BMI of 33.2 kg/m² (29.3; 36.0). Reported energy intakes were well below EER with a median intake of 73% of requirements, suggesting widespread under-reporting. Significant correlations were observed between sugar (r = 0.408, P = 0.002), fat (r = 0.44, P = 0.001), fruits (r = 0.51, P = 0.0001) and vegetables (r = 0.40, P = 0.0024) measurements by the SFFQ and 4DDD. Bland Altman plots with regression analysis demonstrated broad comparability with the 4DDD for intakes of fat (bias − 13.8 g/day) and sugar (bias  + 12.9 g/day).

Conclusions

A novel SFFQ designed to be minimally burdensome to participants was effective at assessing dietary intakes in NAFLD patients.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-01926-5) contains supplementary material, which is available to authorized users.

Effects of Mediterranean Diet and Physical Activity on Pulmonary Function: A Cross-Sectional Analysis in the ILERVAS Project

A few studies showed that both adherence to Mediterranean diet (MedDiet) and physical activity practice have a positive impact on pulmonary function in subjects with lung disease. These associations are not well studied in subjects free from lung disease. In a cross-sectional study conducted in 3020 middle-aged subjects free of lung disease, adherence to the MedDiet using the Mediterranean Diet Adherence Screener, and physical activity practice using the International Physical Activity Questionnaire short form were recorded. Respiratory function was assessed using forced spirometry and the results were evaluated according to the Global initiative for Chronic Obstructive Lung Disease. Logistic regression models were used to analyze the associations between adherence to the MedDiet and physical activity practice with the presence of ventilatory defects. Participants with a high adherence to MedDiet, in comparison to those with low adherence, had both higher forced vital capacity (FVC; 100 (87–109) vs. 94 (82–105) % of predicted, p = 0.003) and forced expired volume in the first second (FEV1; 100 (89–112) vs. 93 (80–107) % of predicted, p < 0.001). According to their degree of physical activity, those subjects with a high adherence also had both higher FVC (100 (88–107) vs. 94 (83–105) % of predicted, p = 0.027) and FEV1 (100 (89–110) vs. 95 (84–108) % of predicted, p = 0.047) in comparison with those with low adherence. The multivariable logistic regression models showed a significant and independent association between both low adherence to MedDiet and low physical activity practice, and the presence of altered pulmonary patterns, with differences between men and women. However, no joint effect between adherence to MedDiet and physical activity practice on respiratory function values was observed. Low adherence to MedDiet and low physical activity practice were independently associated with pulmonary impairment. Therefore, the lung mechanics seem to benefit from heart-healthy lifestyle behaviors.

Roles of Phenolic Compounds in the Reduction of Risk Factors of Cardiovascular Diseases

The population is now living longer during the period classified as "elderly" (60 years and older), exhibiting multimorbidity associated to the lengthening of the average life span. The dietary intake of phenolic compounds (PC) may affect the physiology, disease development and progression during the aging process, reducing risk factors of age related diseases. The aim of this review is to briefly describe some of the possible effects of a series of PC on the reduction of risk factors of the onset of cardiovascular diseases, considering their potential mechanisms of action. The main actions described for PC are associated with reduced platelet activity, anti-inflammatory effects, and the protection from oxidation to reduce LDL and the generation of advanced glycation end products. Preclinical and clinical evidence of the physiological effects of various PC is presented, as well as the health claims approved by regulatory agencies.

The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m², 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.

Efficacy of Cognitive Behavioral Therapy in Adherence to the Mediterranean Diet in Metabolic Syndrome Patients: A Randomized Controlled Trial

OBJECTIVE

Verify the efficacy of cognitive behavioral therapy (CBT) in adherence to the Mediterranean diet (MedDiet) in metabolic syndrome (MetS) patients.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION

In the Multimodal Intervention Program for Patients with Metabolic Syndrome clinical trial, 79 MetS patients completed the intervention. Of those, 48 belonged to the experimental group and 31 to the control group. The intervention received by the experimental group was CBT; the control group followed usual care and attended a workshop on healthy lifestyle.

MAIN OUTCOME MEASURE(S) AND ANALYSIS

Anthropometric, biochemical, psychological, and lifestyle measures were taken before and after the intervention at 3 and 6 months. Analyses included paired t tests, ANOVA, and ANCOVA.

RESULTS

The ANOVA results showed a statistically significant interaction between the 2 groups in waist circumference (P = .009), triglycerides (P = .015), and adherence to the MedDiet (P = .026). The ANCOVA results indicated between-group difference in waist circumference (P = .026 and .062 at 3 and 6months, respectively), in triglycerides (P = .009 and .860 at 3 and 6 months, respectively), and in MedDiet (P = .024 and .273 at 3 and 6 months, respectively).

CONCLUSIONS AND IMPLICATIONS

In interventions in which CBT was applied, significant improvements were observed in MetS patients, especially in adherence to the MedDiet.

The association between olive oil consumption and primary prevention of cardiovascular diseases

INTRODUCTION

American Heart Association and many other recommend Mediterranean diet for patients with cardiovascular risk. This systematic review and meta-analysis are conducted to review the effects of Mediterranean diet on the cardiovascular events as reported in randomized controlled trials (RCTs).

METHODS

A systematic research is conducted on MEDLINE via Ovid, Embase, PubMed, Google Scholar, Web of Science, and Informit. Databases of studies conducted between 2000 and 2017 were included in the analysis. All the collected studies were screened, and at the end, seven RCTs met the inclusion criteria. All the characteristics of trails such as study design, interventions, follow-up duration, and primary and secondary outcomes were recorded. RevMan was used to evaluate risk reduction in each trial individual using forest plot and fixed effects.

RESULTS

Four studies were included in the review, having a total of 25,195 participants. The effects of Mediterranean diet were found in cardiovascular events (627), coronary events (251), and all-cause death (887). The analysis revealed that there is a statistically significant relationship between Mediterranean diet and reduction in cardiovascular events at P = 0.02. However, other parameters did not show any statistically significant results that need further investigation.

CONCLUSION

The individual RCT provides evidence of protective effects of the Mediterranean diet on cardiovascular events. However, the quality and quantity of data available in those trails are not reliable and limited. Therefore, the results of those trails must be cautiously interpreted.

Diet in patients with metabolic syndrome: What is the ideal macronutrient composition?

Metabolic syndrome is currently a worldwide epidemic. First-line interventions consist of profound changes in lifestyle, particularly in diet, for which moderate and balanced consumption of macronutrients associated with calorie restriction is recommended. However, in recent years, several studies have proposed that diets that restrict certain macronutrients even further may be better for controlling both weight and metabolic risk factors. In the present paper, we review the currently available evidence on this question, which is difficult to address and control in clinical practice.

Mediterranean Diet and Cardiovascular Disease Prevention: What Do We Know?

Cardiovascular disease (CVD) morbidity and mortality is increasing, representing an important public health issue worldwide. It is well-known that risk of CVD is substantially influenced by lifestyle, including poor diet, tobacco smoking and physical inactivity. In the last years, the so-called Mediterranean Diet (MedDiet) has been associated with broad healthy benefits on human health, including protection against CVD. The present narrative review aimed to summarize and discuss the evidence from meta-analyses of epidemiological and clinical trials analyzing MedDiet and CVD risk. The MedDiet is one of the best dietary patterns analyzed in relation to CVD risk and other health outcomes. Studies demonstrated that MedDiet has beneficial effects in the prevention of total and specific types of CVD, albeit a moderate-high degree of inconsistency has been reported and few studies have been included in most of the meta-analyses. As consequence, more high-quality prospective cohorts and randomized clinical trials are warranted in order to increase the confidence in the effect estimates.

Waist circumference is a mediator of dietary pattern in Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is an example of pathological fat accumulation in the liver and one of the major health conditions in the world. This study aimed to examine the independent role of dietary patterns in the development of NAFLD. In a cross-sectional study, 1500 individuals referred to a nutrition clinic were randomly selected, their demographic, anthropometric and blood metabolic indices were obtained, and food frequency questionnaires were completed for them. Liver stiffness was calculated using the NAFLD score formula and fibroscan. The two dominant dietary patterns identified were the “healthy” and “unhealthy dietary patterns”. A significant percentage of those with NAFLD (45%) were in the upper quartile of the unhealthy model; however, only 10% had the healthy pattern (p < 0.001). In this study, 32.9 and 13.9% of the healthy and unhealthy participants were in the upper quartile of the healthy diet pattern. Also, it was shown that waist circumference is a strong mediator of dietary patterns and NAFLD relationship, and the indirect effect of diet through abdominal circumference is 28 times greater than the direct effect on NAFLD. The results suggested that healthy and unhealthy dietary patterns are respectively associated with lower- and higher-risk of NAFLD but the role of waist circumference as a mediator deserves more consideration.

Mediterranean Diet and Cardiometabolic Diseases in Racial/Ethnic Minority Populations in the United States

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.

Lifestyle genomics and the metabolic syndrome: A review of genetic variants that influence response to diet and exercise interventions

Metabolic syndrome (MetS) comprises a cluster of risk factors that includes central obesity, dyslipidemia, impaired glucose homeostasis and hypertension. Individuals with MetS have elevated risk of type 2 diabetes and cardiovascular disease; thus placing significant burdens on social and healthcare systems. Lifestyle interventions (comprised of diet, exercise or a combination of both) are routinely recommended as the first line of treatment for MetS. Only a proportion of people respond, and it has been assumed that psychological and social aspects primarily account for these differences. However, the etiology of MetS is multifactorial and stems, in part, on a person's genetic make-up. Numerous single nucleotide polymorphisms (SNPs) are associated with the various components of MetS, and several of these SNPs have been shown to modify a person's response to lifestyle interventions. Consequently, genetic variants can influence the extent to which a person responds to changes in diet and/or exercise. The goal of this review is to highlight SNPs reported to influence the magnitude of change in body weight, dyslipidemia, glucose homeostasis and blood pressure during lifestyle interventions aimed at improving MetS components. Knowledge regarding these genetic variants and their ability to modulate a person's response will provide additional context for improving the effectiveness of personalized lifestyle interventions that aim to reduce the risks associated with MetS.