Mediterranean Diet Adherence Score Research Articles

Determinants for Mediterranean diet adherence beyond the boundaries: a cross-sectional study from Sharjah, the United Arab Emirates

BackgroundSubstantial evidence embraced the nutrition competence of the Mediterranean diet (MD) as a healthy model for decreasing the risk of chronic diseases and increasing longevity, with the bonus of ensuring environmental sustainability. Measuring adherence to this diet is marginally investigated in the Arabian Gulf region, an area away from the Mediterranean region. The current study aimed to assess the MD adherence among adults in Sharjah/the United Arab Emirates (UAE), and to identify the most influential predictors for MD adherence among the study participants.MethodsA cross-sectional study design was employed using a self-reported, web-based electronic questionnaire that questioned sociodemographics, lifestyle factors, and familiarity with the MD. The MD adherence was assessed by the Mediterranean Diet Adherence Screener validated questionnaire. The adherence level was classified as low for a total score of [0–5], medium [score 6–7], and high (8–13).ResultsThe study included 1314 participants (age 25–52 years) comprised 822 (62.6%) females and 492 (37.4%) males. There was a moderate adherence score (5.9 ± 1.9) among the study participants. The food constituent expressed the lowest contribution to the MD was fish (9.3%), followed by fruits (12.3%), and legumes (18.3%). The multivariable linear regression analysis showed an overall significant linear trend for the association between the MD adherence score and physical activity, while nutrition information from dietitians and social media were the most two strongly related predictors for the higher adherence (β = 0.747; 95% CI 0.51–0.98, and β 0.60; 95% CI 0.269–0.93; p < 0.001, respectively). On the other side, being a smoker and from a non-Mediterranean country was associated with lower adherence scores (β = 0.538; 95% CI 0.252–0.82, p < 0.001).ConclusionThe findings of the current study showed a moderate adherence, low proportion for high adherence, and a gap in the familiarity with the diet name. Being married, physically active, non-smoker, and getting nutrition information from dietitians and social media were the strongest predictors for higher adherence. It is warranted that public health and nutrition specialists/dietitians to tailor new modern approaches for promoting healthy dietary behaviours consistent with the MD.

Maternal pre-pregnancy diet and prenatal depression: The mediating role of pre-pregnancy weight status and prenatal inflammation.

Depression is a common prenatal psychological complication. We aimed to investigate if maternal pre-pregnancy diet can impact prenatal depressive symptoms, and the mediating role of pre-pregnancy body mass index (BMI) and inflammation. We used data (N=1141) from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study. We calculated Mediterranean diet adherence (MED) and dietary inflammatory index (DII) scores using data from pre-pregnancy food frequency questionnaire (FFQ). In the 3rd-trimester, we assessed depressive symptoms using Edinburgh Postpartum Depression Scale (EPDS), and inflammation through serum C-reactive protein (CRP) levels. BMI was calculated from self-reported pre-pregnancy weight. Race-stratified analyses (white and people of color) were run. We observed no association between MED or DII tertiles and depressive symptoms. However, white participants in the MED tertile-3 had lower risk of depression (EPDS<10) compared to tertile-1 (OR=0.56, 95% CI, 0.33, 0.95). White individuals in MED tertile-3 had lower BMI (MD=-1.08; 95%CI, -1.77, -0.39), and CRP (MD=-0.53; 95%CI, -0.95, -0.11) than tertile-1, and those in DII tertile-2 (MD=0.44;95%CI, 0.03, 0.84) and tertile-3 (MD=0.42; 95%CI, 0.01, 0.83) had higher CRP than tertile-1. Among people of color, neither MED nor DII were associated with BMI or CRP, but BMI was negatively associated with depressive symptoms (β=-0.25, 95%CI, -0.43, -0.06). We found no association between diet and depressive symptoms through BMI or CRP, in either race. Pre-pregnancy diet might affect the risk of prenatal depression in a race-specific way. Further research is required to explore the racial differences in the association between maternal diet and prenatal depressive symptoms/depression risk.

Differences of skin carotenoids and adherence to the Mediterranean Diet pattern in adults from Southern Italy and Dominican Republic

BackgroundThe measurement of the skin carotenoids using the Veggie Meter® has emerged as a rapid objective method for assessing fruit and vegetable intake, highly recommended by the Mediterranean Diet (MD), which represents one of the healthiest dietary patterns, worldwide. This study aimed to examine differences in skin carotenoid content and degree of adherence to the MD pattern between two adult populations from Southern Italy and the Dominican Republic.MethodsThis cross-sectional study enrolled a total of 995 adults, 601 subjects from Italy and 394 from the Dominican Republic. All participants underwent anthropometric measurements and skin carotenoid assessment by Veggie Meter®. Adherence to the MD and lifestyle were evaluated using the Mediterranean Diet Adherence Screener (MEDAS) and the Mediterranean Lifestyle Index (MEDLIFE) questionnaires. Correlations between the skin carotenoid and MEDAS score were estimated using Pearson’s correlation coefficient. Multiple linear regression models were created to determine variables that affect skin carotenoid score for both populations.ResultsMean total skin carotenoids were higher in the Italian compared to the Dominican Republic population (342.4 ± 92.4 vs 282.9 ± 90.3; p < 0.005) regardless of sex (women: 318.5 ± 88.9 vs 277.3 ± 91.9, p < 0.005 and men: 371.7 ± 88.3 vs 289.5 ± 88.1, p < 0.005), and remaining statistically significant after age-adjustment of the Dominican Republic sample. Using the MEDAS questionnaire, we found a higher MD adherence score in the Italian than in the Dominican Republic population also after age-adjusting data (7.8 ± 2.1 vs 6.2 ± 3.7; p < 0.005) and even when categorized by sex (Italian vs age-adjusted Dominican Republic women: 7.9 ± 2.1 vs 6.3 ± 2.6; Italian vs age-adjusted Dominican Republic men: 7.7 ± 2.2 vs 6.0 ± 4.7; p < 0.005). Using the MEDLIFE test, total Italians presented a lower score with respect to the age-adjusted Dominican Republic population (3.2 ± 1.2 vs 3.4 ± 1.4; p < 0.05). In multiple regression analysis, skin carotenoids were associated with sex and negatively associated with BMI in the Italian population (sex: β: 54.95; 95% CI: 40.11, 69.78; p < 0.0001; BMI: β: − 1.60; 95% CI: − 2.98,0.86; p = 0.03), while they resulted associated with age and sex in the Dominican Republic population (age: β: 2.76; 95% CI: 1.92, 3.56; p < 0.001; sex: β: 23.29; 95% CI: 5.93, 40.64; p = 0.009). Interestingly, skin carotenoids were positively correlated with MEDAS score in both populations (Italy: r = 0.03, p < 0.0001, Dominican Republic: r = 0.16, p = 0.002).ConclusionsThis study provides the assessment of the adherence to the MD and skin carotenoid content in adults living in Southern Italy and the Dominican Republic, showing a higher MD adherence score and a skin carotenoid content in inhabitants from the Mediterranean region. Our findings highlight the need to globally encourage fruit and vegetable intake, particularly in non-Mediterranean area.

A Study on Footballers: Is the Mediterranean diet a Good Defender of the Gastrointestinal System?

In football, diet has a highly important role in the development of performance. Assessing the nutrition-related knowledge of footballers and increasing their awareness may affect their health and performance. In this study, which was carried out for this purpose, whether the Mediterranean diet had an effect on the gastrointestinal health of professional footballers was investigated. The sample of the study included a total of 196 active licensed male footballers who were professional players in the 2nd and 3rd football leagues of Turkey. The mean age of the participants was 23.46±4.18 and their mean experience in licensed football was 11.73±5.07 years. The adherence of the participants to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener, while the frequencies of gastrointestinal symptoms were examined using the Gastrointestinal Symptom Rating Scale. The data were transferred to the SPSS 26.0 program and analyzed using Pearson’s Correlation Analysis, Independent-Samples T-Tests, One-Way ANOVA and descriptive statistics. According to the results of the analyses, no significant relationship was found between adherence to the Mediterranean diet and gastrointestinal symptoms (p&gt;0.05). While the gastrointestinal symptom scores of the participants did not vary significantly based on their league tiers or positions (p&gt;0.05), their Mediterranean diet adherence scores varied significantly based on their league tiers (p&lt;0.05). Consequently, it was determined that the adherence of the participants to the Mediterranean diet increased as their league tier increased, but adherence to the Mediterranean diet did not create any positive or negative effect on their gastrointestinal system symptoms.

Adherence to the Mediterranean diet in two Moroccan populations living at different distances from the Mediterranean Sea.

There is growing strong scientific evidence over the past few decades that the Mediterranean diet (MD) has protective effects on cardiometabolic health. This study aimed to assess MD adherence and its association with sociodemographic and lifestyle factors among women living in two Moroccan provinces, El Jadida and Tetouan, located at different distances from the Mediterranean Sea. It is a cross-sectional study involved 355 subjects of which 55.8% reside in the province of El Jadida, and data on socio-demographic characteristics, lifestyle, cardiovascular risks, medical history and of food frequency consumption were collected. Compliance with the MD was assessed with a simplified MD adherence score based on the weekly frequency of consumption of eight food groups. The overall mean Simplified Mediterranean Diet Score was 4.37 ± 1.47 with inadequate compliance in 55.2% of the sample. No significant association was found between adherence to MD and geographic, socio-demographic, lifestyle or the major cardiovascular risk factors. However, the participants do not comply with half of the recommendations based on the Mediterranean diet pyramid. The lowest level of compliance was observed for olive oil, followed by sweets, eggs, potatoes, fruits, red meat, vegetables, legumes, olives, nuts and seeds. The increased contribution of sugars, dairy products and meat to the overall food intake is significant in the category with high adherence to MD. The study data indicate that Mediterranean Diet is far from being a global pattern in this Moroccan population. The study draws attention to the need for a promoting intervention to maintain this pattern as the original diet in the region.

Dietary intake and adherence to the Mediterranean diet in semi-professional female soccer players: a cross-sectional study.

Adequate energy and nutrient intakes in athletes contribute to optimal performance and recovery, decrease the risk of injury, and help preserve athletes' health. The Mediterranean diet (MD) is considered suitable for covering the nutritional needs of athletes, while contributing to improve eating habits. The aim of the present study was to investigate the energy and nutrient intakes of semi-professional female soccer players and their adherence to the MD, during the competitive season. A cross-sectional observational study was conducted on twenty-three female soccer players, who were invited to fill in a 3-day food diary twice, one month apart, to assess their energy and nutrient intakes and a validated questionnaire (MEDI-LITE) to evaluate their adherence to MD. Exercise energy expenditure during three training and match-play days was monitored by GPS. On average, the participants consumed 1,981 kcal/day, with 44% of their energy deriving from carbohydrates, 21% from protein, and 34% from fat; the mean MD adherence score was 10.1 ± 1.8, corresponding to a good MD adherence. A substantial percentage of athletes were at risk of insufficient nutrient intakes for vitamin D (100%), iodine (87%), potassium (87%), vitamin E (39%), iron and zinc (17 and 30%, respectively). The evaluation of the dietary intake in female soccer players showed energy deficiency in relation to training level, mainly due to the insufficient intake of carbohydrates, and micronutrient deficiencies. The technical staff should promote adequate consumption of starchy foods in female athletes and emphasize the importance of a proper distribution of energy intake among different eating occasions, including snacks. Periodic monitoring of the nutritional status of micronutrients (vitamin D and some minerals) could help reduce deficiency risk. Over all, nutrition education to improve eating habits of athletes seems worthy of attention, in order to preserve athletes' health and performance.

A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial.

Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, "Olitor," designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called "Olitor" and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR -0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. This pilot study revealed the potential of the mobile intervention "Olitor" in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712.

Relationship between Mediterranean Diet and Phase Angle in a Sample of Patients with Obesity and Metabolic Syndrome

Introduction: The potential influence of a Mediterranean diet (MD) on PhA values has been little researched. The aim of this study was to investigate the association between adherence of a MD and PhA on adult sample population with obesity and metabolic syndrome. Methods: We conducted a cross-sectional study in 331 patients with obesity and metabolic syndrome. Anthropometrics’ data (weight, height, body mass index, and waist circumference), bioelectrical bioimpedance (BIA) parameters (resistance reactance, PhA, fat mass [FM], fat-free mass [FFM], skeletal muscle mass [SMM]), and biochemical parameters were recorded. Dietary intakes with a 3-day written food records and MD adherence with a validated 14-item questionnaire were evaluated. Patients were divided into two groups by median value of PhA. Results: Percentage of patients with high MD adherence (score >7) in high PhA group was 77.2% and in low PhA group was 41.4% (odds ratio 1.91, 95% CI = 1.27–3.54; p = 0.01). Total fat intake (saturated, monounsaturated, and polyunsaturated fats), protein intake, and cholesterol intake were higher in high PhA group than low PhA group. Total score of MD was higher in high PhA than low PhA group (3.5 ± 1.1 points; p = 0.04). FFM (3.3 ± 0.9 kg; p = 0.01), FFM index (3.9 ± 1.1 kg/m²; p = 0.01), SMM (4.6 ± 1.2 kg; p = 0.01) and SMM index (3.3 ± 0.7 kg/m²; p = 0.03) were higher in subjects of high adherence of MD group than subjects of low adherence. FM (−3.2 ± 1.1 kg; p = 0.03) was lower in subjects with good adherence to MD. MD score (Beta 1.71, CI 95% 1.06–2.16), FFM (Beta 3.99, CI 95% 1.87–7.16), and SMM (Beta 4.21, CI 95% 1.76–8.19) remained in the multivariate model. Conclusion: We concluded that a high adherence to a MD in subjects with obesity and metabolic syndrome is associated with values of PhA.

Adherence to the Mediterranean diet and nuclear magnetic resonance spectroscopy biomarkers in older individuals at high cardiovascular disease risk: cross-sectional and longitudinal analyses

BackgroundThe Mediterranean diet (MedDiet) has been related to a decreased risk of cardiovascular disease (CVD) and diabetes. ObjectivesWe aimed to prospectively assess the relationship between adherence to the MedDiet and advanced lipoprotein subclass profiles and glucose metabolism and inflammation markers, as determined by nuclear magnetic resonance (NMR) spectroscopy. DesignWe conducted cross-sectional and longitudinal analyses within the framework of the PREvención con DIeta MEDiterránea study in 196 participants from the Reus-Tarragona center. Adherence to the MedDiet was assessed using a 14-item validated questionnaire [Mediterranean Diet Adherence Score (MEDAS)]. Plasma lipoprotein subclasses and molecular metabolite profiles were determined using NMR spectra collected on a Vantera Clinical Analyzer at baseline and after 1 y of follow-up. Baseline and 1-y categories of MEDAS were related to measures of lipoprotein atherogenicity and diabetes risk using multivariable-adjusted analysis of covariance models. ResultsCompared with participants in the lowest category of baseline MEDAS, those in the highest category showed higher concentrations of total high-density lipoprotein (HDL) particles and H1P HDL, lower concentrations of very low-density lipoprotein (VLDL)-triglyceride, smaller size of VLDL, and lower concentrations of very large VLDL, as well as lower concentrations of branched-chain amino acids, leucine, and GlycA and reduced Diabetes Risk Index (DRI) scores. In addition, participants who increased by 3 or more points in their 1-y MEDAS showed an increase in concentrations of H7P-HDL, H5P-HDL, and citrate, and reduced acetone and DRI scores compared with those with lesser adherence increases. ConclusionsIn older adults at high cardiometabolic risk, higher MEDAS was associated with modest beneficial changes in lipoprotein and glucose metabolism. The results suggest that lipoprotein subclass distribution and glycemic control are potential mechanisms behind the well-known salutary effects of MedDiet on CVD and diabetes risk. Future clinical trials exploring the effects of the MedDiet on advanced lipoprotein subclass profiles and glucose metabolism markers are needed to confirm the results of our study. Trial registration numberThis trial was registered at controlled-trials.com as ISRCTN35739639.

Impact of COVID-19 Lockdown on Metabolic/Inflammatory Profile in Adolescents: Cellular Studies and Predictive Biomarkers.

The COVID-19 pandemic and its lockdown restrictions changed people's lifestyles with potential negative impact on health. This longitudinal study aimed to assess the COVID-19 lockdown influence on the adherence to the Mediterranean Diet (MD) pattern and its effects on the metabolic inflammatory profile in a cohort of healthy adolescents. We analyzed anthropometric measurements, body composition, and MD adherence along with serum metabolic and inflammatory profile in 77 healthy adolescents from Southern Italy before and after the COVID-19 pandemic lockdown. Additionally, we evaluated the biological properties of pre- and post-lockdown serum on human HepG2 and HuH-7 hepatic cells. We didn't observe any significant differences in anthropometric and body composition parameters as well as in MD adherence score in adolescents between pre- and post-lockdown COVID-19. Intriguingly, despite the metabolic profile of adolescents in post-lockdown was within the normal range, we evidenced increased levels of fasting glucose, triglycerides, Total Cholesterol and LDL along with a reduction in HDL, in post- compared to pre-lockdown adolescent serum. In addition, elevated levels of TNF-α, IL-1β and ferritin were found in post-lockdown adolescents when compared to their pre-lockdown counterparts. Consistent with biochemical parameters, were observed in HepG2 and HuH-7 cells treated with pooled serum from post- respect to pre-lockdown period enhanced lipid accumulation with altered mitochondrial functions and increased reactive oxygen species production. Receiver operator characteristic curve analysis identified Total C Cholesterol, LDL, HDL, TNF-α and ferritin as predictive serum markers for metabolic and inflammatory profiling after lockdown period. Our findings highlight that the COVID-19 lockdown, forcing sedentary behavior, had a negative impact on adolescents' metabolic and inflammatory profile which may result in long-term unhealth outcomes.

Evaluation of food insecurity and associated factors in women of childbearing age: A community-based study from Turkey.

Food security is an important factor in ensuring a healthy diet. However, it has been reported that women are more vulnerable to food insecurity than men in many countries. In addition, there is little evidence that Mediterranean diet (MD) adherence is associated with a lower risk of food insecurity. Therefore, this study aimed to evaluate food insecurity and associated factors in women of childbearing age. In addition, women's adherence to MD and its relationship with food insecurity were evaluated. This descriptive and cross-sectional study was conducted with 2675 adult women aged 18-49. The demographic characteristics, anthropometric measurements, nutritional habits, compliance with the MD, and the level of food insecurity were evaluated using the structured, self-administered, web-based questionnaire form. The mean age of the individuals was 29.5 ± 10.35 years. 21.6% of individuals had food insecurity, and 5.2% had severe food insecurity. 36.4% of the individuals adhere to the MD. There was a statistically significant difference between the individuals with and without food security regarding age, marital status, and income status (p < .05). However, there was no statistically significant difference in terms of the Mediterranean diet adherence score (MEDAS) and MEDAS classification between individuals with and without food security (p > .05). It was determined that age, marital status, and income status affected food insecurity (R 2 = 0.374; p < .001). Also, it was determined that age, number of main meals and snacks, and income status affected adherence to MD (R 2 = 0.286; p < .001). In conclusion, considering the fragility of women in food insecurity, more comprehensive studies should be conducted in this area to better define the factors associated with food insecurity in women and inform policymakers. In addition, the results of this study can shed light on comprehensive intervention studies in this area.

Diet quality and nutrient density in pregnant women according to adherence to Mediterranean diet.

The dietary pattern followed during pregnancy, specifically healthy dietary patterns such as the Mediterranean diet, is a key factor in the mother's and the offspring's health. Pregnant women dietary intake is not enough to cover the micronutrient requirements of pregnancy, and higher adherence to the Mediterranean diet may improve dietary quality and nutritional density. The aim of the present study was to describe the dietary nutrient intake and diet quality during pregnancy and to evaluate whether a high adherence to Mediterranean diet was associated with a more adequate intake of micronutrients. This was a cross-sectional study with 1,356 pregnant women selected during the routine second trimester ultrasound scan (19-23 weeks' gestation). Energy and nutrient intake were calculated using a validated 151-item semi-quantitative food frequency questionnaire and nutrient density was estimated dividing the absolute nutrient intake by total energy intake. Adherence to the Mediterranean diet was evaluated with a 17-item Mediterranean diet adherence score. The criterion used for risk of inadequate nutrient intake has been set below two thirds (2/3) of the dietary reference intakes. The differences were assessed by multivariate linear regression models adjusted for confounders. A significant proportion of pregnant women had an inadequate intake of macro and micronutrient that was lower in those with high adherence to the Mediterranean diet (≥12 points, n = 122, 19%), including calcium (the Mediterranean diet high adherence 2.5% vs. low adherence 26.7%, p < 0.001), magnesium (0% vs. 7.6%, p = 0.001), iron (24.5% vs. 74.1%, p < 0.001), and vitamin B9 (0% vs. 29.8%, p < 0.001), vitamin C (0% vs. 1.9%, p = 0.033), and vitamin D (61.5% vs. 92.8%, p < 0.001) intake. High adherence to Mediterranean diet was associated with higher intake of protein, monounsaturated fatty acids, fiber, vitamins (B1, B9, C, D), calcium, magnesium, iron, zinc, phosphor, potassium, essential fatty acids, and α-linolenic acid, and with a lower intake of α-linoleic acid and trans fatty acids as compared to low adherence to Mediterranean diet. High adherence to Mediterranean diet was associated with higher diet quality and lower proportion of inadequate micro and macronutrient intake. The Mediterranean diet promotion, particularly among pregnant women, may be a useful and public health strategy to avoid overweight and nutrient deficiencies.

Low adherence to the Mediterranean diet is associated with increased prevalence and number of atherosclerotic plaques in the ILERVAS cohort

Background and aimsCurrent research on the association between dietary patterns and subclinical atherosclerotic disease (SAD) is still limited, and published results are inconsistent and often consist of small population sizes. We aimed to evaluate the association between the Mediterranean diet (MDiet) and SAD in a large cohort of Mediterranean individuals. MethodsThis was a cross-sectional study that included 8116 subjects from the ILERVAS cohort. The presence of atherosclerotic plaques (AP) was assessed by ultrasound examination. Adherence to the MDiet was assessed using the 14-item Mediterranean Diet Adherence Score (MEDAS). Inclusion criteria were subjects with at least one cardiovascular risk factor. Exclusion criteria were a clinical history of diabetes, chronic kidney disease, or a prior cardiovascular event. Bivariable and multivariable models were performed. ResultsCompared with subjects without SAD, participants with SAD were older and had a higher frequency of smoking habit, hypertension, dyslipidemia, HbA1c and waist circumference. The adjusted multivariable analysis showed that a higher MEDAS was associated with a lower risk of AP (incidence rate ratios [IRR] 0.97, 95% CI [0.96–0.98]; p<0.001). Furthermore, moderate or high adherence to the MDiet was associated with a lower number of AP compared with a low MDiet adherence (IRR 0.90, 95% CI [0.87–0.94]; p<0.001). In both models, female sex was associated with a lower risk of AP. ConclusionsOur findings point to a potentially protective role of MDiet for SAD in a Mediterranean population with low-to-moderate cardiovascular risk. Further research is needed to establish a causal relationship between both variables.

Macronutrient Intake, Sleep Quality, Anxiety, Adherence to a Mediterranean Diet and Emotional Eating among Female Health Science Undergraduate Students.

COVID-19 provoked a myriad of challenges for people's health, poor life satisfaction and an unhealthy diet that could be associated with serious negative health outcomes and behaviours. University is a stressful environment that is associated with unhealthy changes in the eating behaviours of students. The association between diet and mental health is complex and bidirectional, depending on the motivation to eat; emotional eaters regulate their emotions through the increased consumption of comfort foods. The aim of this study was to compare the nutritional habits, alcohol consumption, anxiety and sleep quality of female health science college students. A cross-sectional study of 191 female undergraduate students in Madrid was used. Their body mass index and waist hip ratio were measured. The questionnaires used included the Mediterranean Diet Adherence test, AUDIT, Emotional Eater Questionnaire, Pittsburgh Sleep Quality Index, and Food Addiction, Perceived Stress Scale and STAI questionnaires. We observed a high intake of protein, fat, saturated fatty acids and cholesterol. Overall, 9.5% never had breakfast, and 66.5% consciously reduced their food intake. According to Pittsburgh Sleep Quality Index, they mainly slept 6-7 h, and 82% presented with a poor sleep quality; 13.5% presented moderate-high food addiction, and 35% had moderate Mediterranean Diet Adherence score. Female students' macronutrient imbalances were noted, with a high-level protein and fat intake diet and a low proportion of carbohydrates and fibre. A high proportion of them need alcohol education and, depending on the social context, they mainly drank beer and spirits.

Akademisyenlerin Beslenme Bilgi Düzeylerinin ve Akdeniz Diyetine Uyumlarının Değerlendirilmesi

Objective: In this study, it was aimed to evaluate the nutritional knowledge levels of academicians and their adherence to the Mediterranean diet.&#x0D; Methods: The research data were collected face to face with the help of a questionnaire created by the researchers. Demographic characteristics, anthropometric measurements, nutritional habits, nutritional knowledge levels and adherence to the Mediterranean diet were questioned with the questionnaire form. Nutritional knowledge levels of individuals were evaluated with the ‘Nutrition Knowledge Level Scale for Adults (NKLSA)’. Mediterranean diet pattern characteristics were identified with the ‘Mediterranean diet adherence score (MEDAS)’.&#x0D; Results: The mean age of the individuals was 40.2±9.20 years, 42.2% of individuals were overweight and 7.8% are obese. 8.4% of the individuals had bad, 24.7% moderate, 44.8% good, 22.1% very good basic nutrition knowledge levels. 7.1% of the individuals had bad, 26.6% moderate, 27.9% good, 38.3% very good knowledge levels about food preference. 68.2% of individuals were in compliance with the Mediterranean diet. A statistically significant difference was found between individuals who did and did not comply with the Mediterranean diet in terms of the total score of NKLSA, basic nutrition knowledge score and food preference knowledge score (p

Relationship between the Presence of Chronic Pain and Adherence to the Mediterranean Diet in University Students

Purpose: This study evaluated the presence of chronic pain and adherence to the Mediterranean diet and to examine the relationship between diet and pain among university students.&#x0D; &#x0D; Material and Methods: This descriptive cross-sectional study was conducted with volunteer students from November-December 2019. Students' demographic and health information, nutritional habits were questioned, 24-hour retrospective food consumption was recorded, they were asked to fill in the pain assessment form, the Mediterranean diet adherence scale, and the international physical activity questionnaire, finally, their measurements (height, weight) were made.&#x0D; &#x0D; Results: The study included 595 students (87.2% female) with a mean age of 20.2±1.48 years. The prevalence of chronic pain was 37.8%. The majority of these students (58.7%) had moderate pain intensity (5-7 points). In the Mediterranean diet adherence score, 75% of students had

Beneficial effects associated to a healthy lifestyle in systemic lupus erythematosus: A cross-sectional study.

To assess whether a healthy lifestyle is associated to beneficial effects on various systemic lupus erythematosus (SLE) health domains. In a cross-sectional study, Mediterranean Diet Adherence Score (MEDAS), physical activity energy expenditure (PAEE), and smoking status were assessed by questionnaires, along with clinical parameters and various health domains including Systemic Lupus Disease Activity Score (SLEDAI), Depression Scale (CES-D), Fatigue Severity (FSS), functional status (FFbH), physical and mental quality of life (PCS, MCS). Lifestyle choices were assessed with respect to health domains by linear regression modeling. Additionally, SLE patients with a healthy lifestyle (MEDAS ≥ 4, ≥ 1 h sport per week, no smoking) were compared to those without by Wilcoxon's signed-rank test. 49 of 145 SLE patients (44.3 ± 31.7 years, 87.6% female) followed a healthy lifestyle and showed a higher physical quality of life (β = 4.5 (95%-CI 1.5-7.9) p = 0.01), lower depression (β = -5.0 (-8.2 to -0.2) p = 0.02) and lower fatigue (β = -0.8 (-1.5 to -0.2) p = 0.01) independently of SLE disease activity. Furthermore, dsDNA-antibodies were lower (146 ± 540 vs 266 ± 146 U/mL, p = 0.049). In a more detailed analysis, physical activity had the highest impact on the various health domains when compared to smoking or diet adherence, which was consistent even after adjusting for multiple potential confounders. Each 1,000kcal of weekly PAEE was associated to a 1.8 (0.9-2.6) point increase in the PCS (p = 0.0001), a 0.2 (0.03-0.4) point decrease in the CES-D (p = 0.01) and a 2.8 (1.2-4.4) point increase in the FFbH (p = 0.0006). A healthy lifestyle, especially physical activity is associated with beneficial effects including quality of life, depression and fatigue in SLE.

"ADHERENCE TO THE MEDITERRANEAN DIET IN MEDICAL STUDENTS".

The protective effect of the Mediterranean Diet (MeDi) is undisputed. However, adherence to MeDi has decreased in recent years, particularly in young people. The aim of this study was to evaluate adherence to MeDi in medical students and to assess the influence of knowledge acquisition as well as other factors on dietary compliance. A cross-sectional study was conducted on medical students. The data were obtained through anonymous surveys that collected demographic characteristics, medical history, alcohol and tobacco consumption, physical activity and adherence to MeDi - using 14-point Mediterranean Diet Adherence Score (MEDAS)-. Adherence to MeDi and related factors were evaluated by univariate and multivariable analysis. Medical students from the first to the sixth year of the 2018-2019 academic year. The study was conducted at the university of Las Palmas de Gran Canaria. Of 589 respondents (73% women) mean aged 22 years (range 18 to 39), 58.9% showed good adherence to MeDi. Adherence was significantly associated with age (p=0.017) but not with sex or the presence of comorbidities. Independently, adherence to MeDi was higher in last academic courses (OR=2.1; 95% CI=1.3-3.2; p=0.001), in those who consumed alcohol more frequently (OR=1.5; 95% CI=1.0-2.1; p=0.039) and in those who practiced more exercise (OR=1.5; 95% CI=1.2-1.9; p<0.001). Half of all medical students did not have a good adherence to MeDi. Adherence was higher at older age, in higher academic years and related to greater physical activity. It would be convenient to quantify dietary knowledge as well as implement nutritional educational programs, favoring a healthy lifestyle.

Evaluation of adherence to the Mediterranean diet with sustainable nutrition knowledge and environmentally responsible food choices.

Dietary patterns and their possible effects on health and the environment are becoming increasingly important. It is thought that nutritionally balanced diets can also be compatible with environmental targets and, therefore, the Mediterranean diet (MD), which is regarded as a sustainable diet model, comes to the fore. This study was carried out to evaluate adherence to the MD with sustainable nutrition knowledge and environmentally responsible food choices and to determine the factors affecting adherence. A questionnaire prepared by the researchers was sent to individuals online and 1732 adults living in Turkey participated in this cross-sectional study. Adherence to the MD was evaluated with the Mediterranean Diet Adherence Screener (MEDAS). In addition, questions were asked about nutritional knowledge and environmentally responsible food choices to evaluate the sustainable nutritional behaviors of individuals. Half of the participants (51.1% of men / 53% of women) adhere to the MD at a moderate level. Even the individuals with the highest adherence to the MD had low compliance with the recommendations for fruit (43.4%) and fish (37.3%) consumption. A one-unit increase in age, sustainable nutrition knowledge score, and environmentally responsible food choices score increases the MD adherence score by 0.08, 0.125, and 0.148 points, respectively (p < 0.005). Individuals with high adherence to the MD avoid consuming genetically modified organism food more (p < 0.001), prefer to consume environmentally labeled foods (p < 0.001), and buy food more from local businesses (p < 0.001), while they prefer to buy imported food less (p = 0.034). The results of this study showed that some strategies should be developed to increase the adaptation of individuals to the MD and sustainable nutritional behaviors. Nutritionally adequate, sustainable, and eco-friendly nutritional behaviors should be encouraged to increase the possible health benefits of nutrition and minimize environmental effects. To promote sustainable nutrition, firstly it is important to determine the knowledge level of individuals concerning sustainable nutrition and, for this purpose, it is thought that an international valid sustainable nutrition knowledge assessment tool is needed.

Components of the mediterranean dietary pattern and COVID-19 symptoms

INTRODUCTION: Coronavirus disease (COVID-19) has affected millions of lives globally. Despite the favourable impact of Mediterranean Dietary Pattern on cardiometabolic disorders that predispose themselves to COVID-19 infection, it is important to know the dietary components with potential to improve disease-related outcomes. OBJECTIVES: To investigate the association of the Mediterranean Dietary Pattern and its components with the severity of COVID-19 symptoms. METHODOLOGY: Cross-sectional study with a sample of adults recovered from COVID-19 infection, residents of Funchal and unvaccinated. Data on sociodemographic variables, lifestyle, presence of chronic diseases, and intake of supplements food, self-perceived health status, COVID-19 symptoms and dietary consumption was collected using the Computer Assisted Telephone Interview method. Mediterranean Dietary Pattern adherence was obtained from the MEDAS (Mediterranean Diet Adherence Score) questionnaire. Simple and multiple logistic regression models were used to analyse the severity of COVID-19 symptoms and different metrics. RESULTS: A total of 541 adults were included in the study, 60.0% were female and 53.9% were 40-59 years old. Data show that 15.7% of the participants were asymptomatic for COVID-19 infection and 26.9% had severe symptoms. A strong adherence to Mediterranean Dietary Pattern was found in 14.8% of the participants, and it was significantly higher among the asymptomatic participants than those who reported mild or severe symptoms. A low ingestion of red/ processed meats, fats (butter/cream/margarine), commercial pastry and carbonated/ sugar-sweetened drinks, as well as consumption of poultry more than red meat, was associated with less severe COVID-19 symptoms, after adjustment for sex, age and education level. Participants who reported an adequate consumption of olive oil (OR=0.47; 95% CI: 0.25-0.88) and vegetables (OR=0.57; 95% CI: 0.35-0.94) were less likely to experience any symptoms of disease. Nevertheless, results were not consistent when several items, associated in bivariate analysis and in unadjusted logistic regression models, were taken into consideration. CONCLUSIONS: Adherence to Mediterranean Dietary Pattern, in particular adequate consumption of olive oil and vegetables, and limited ingestion of commercial pastry, red/ processed meat, fats and carbonated/ sugar-sweetened drinks, was associated with less severe symptoms of COVID-19 infection.