Mediterranean-type Diet Research Articles

Assessment Of Physical Activity And Mediterranean-type Diet: A Preliminary Report

PURPOSE: Higher consumption of fruits, vegetables, legumes, cereal and fish and lower in red meat and poultry, as well as physical activity have been proved beneficial regarding the prevention of a pleiad of medical conditions. We aimed to investigate whether better adherence to a Mediterranean-type diet was associated with greater levels of physical activity METHODS: A preliminary telephone interview was conducted in 79 randomly enrolled adults from the Greater area of Athens, Greece during the year 2010. Adherence to Mediterranean diet was assessed through a diet-score (range: 0 - 55) that was based on a validated food-frequency questionnaire. Three levels of physical activity (low, moderate, high) were derived from the short version of the International Physical Activity Questionnaire (IPAQ). The study's questionnaire also included demographic characteristics (age and gender) and educational level RESULTS: A statistically significant difference in physical activity among males and females was observed. More than half of females (56.4%) were classified in the low physical category, contrary to 20.8% of males (p<0.01). Females presented with a statistically significant higher Mediterranean Diet Score (MDS) contrary to males (MDS=31.4 ± 5.47 vs. MDS=29.1 ± 3.22, respectively, p=0.02). Age was significantly and negatively correlated with physical activity (r=-0.26, p=0.04), but did not correlate with Mediterranean-type diet (r=0.02, p=0.84). No differences were found in either physical activity or MDS with respect to educational level. Mediterranean-type diet also did not find to be correlated with physical activity (r=0.06, p=0.64) CONCLUSIONS: Although women were more often compliant with Mediterranean dietary pattern, they presented with lower levels of physical activity. Given the well-established long-term health benefits of Mediterranean-type diet and physical activity, such population-based observations may be proved useful in public health policy makers and public health practitioners

Diet and Alzheimer’s disease risk factors or prevention: the current evidence

Preventing or postponing the onset of Alzheimer’s disease (AD) and delaying or slowing its progression would lead to a consequent improvement of health status and quality of life in older age. Elevated saturated fatty acids could have negative effects on age-related cognitive decline and mild cognitive impairment (MCI). Furthermore, at present, epidemiological evidence suggests a possible association between fish consumption, monounsaturated fatty acids and polyunsaturated fatty acids (PUFA; in particular, n-3 PUFA) and a reduced risk of cognitive decline and dementia. Poorer cognitive function and an increased risk of vascular dementia (VaD) were found to be associated with a lower consumption of milk or dairy products. However, the consumption of whole-fat dairy products may be associated with cognitive decline in the elderly. Light-to-moderate alcohol use may be associated with a reduced risk of incident dementia and AD, while for VaD, cognitive decline and predementia syndromes, the current evidence is only suggestive of a protective effect. The limited epidemiological evidence available on fruit and vegetable consumption and cognition generally supports a protective role of these macronutrients against cognitive decline, dementia and AD. Only recently, higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline, although the Mediterranean diet (MeDi) combines several foods, micro- and macro-nutrients already separately proposed as potential protective factors against dementia and predementia syndromes. In fact, recent prospective studies provided evidence that higher adherence to a Mediterranean-type diet could be associated with slower cognitive decline, reduced risk of progression from MCI to AD, reduced risk of AD and a decreased all-cause mortality in AD patients. These findings suggested that adherence to the MeDi may affect not only the risk of AD, but also of predementia syndromes and their progression to overt dementia. Based on the current evidence concerning these factors, no definitive dietary recommendations are possible. However, following dietary advice for lowering the risk of cardiovascular and metabolic disorders, high levels of consumption of fats from fish, vegetable oils, nonstarchy vegetables, low glycemic index fruits and a diet low in foods with added sugars and with moderate wine intake should be encouraged. Hopefully this will open new opportunities for the prevention and management of dementia and AD.

Weight loss is associated with improved endothelial dysfunction via NOX2-generated oxidative stress down-regulation in patients with the metabolic syndrome

The aim of this study was to assess whether adherence to a restricted-calorie, Mediterranean-type diet improves endothelial dysfunction and markers of oxidative stress in patients with metabolic syndrome. A moderately low-calorie (600 calories/day negative energy balance), low-fat, high-carbohydrate diet (<30% energy from fat, <10% from saturated fat and 55% from carbohydrate) was prescribed to 53 outpatients with the metabolic syndrome. Participants were divided into two groups according to body weight loss > or < 5% after 6 months. Group A (n = 23) showed a remarkable decrease in body weight (-6.8%), body-mass-index (-4.6%), waist circumference (-4.8%), HOMA-IR (-27.2%), plasma glucose, glycosylated haemoglobin, total and LDL-cholesterol, blood pressure, serum NOX2 (the catalytic core of NADPH oxidase) (-22.2%) and urinary8-isoprostanes (-39.0%) and an increase of serum NOx (Nitrite/Nitrate) (+116.8%) and adiponectine (+125.5%) as compared with those in group B (n = 30). A statistically significant increase in brachial artery flow-mediated dilatation was observed in group A (+24.7%; p < 0.001), while no changes were present in group B. Variations of flow-mediated dilatation were statistically and negatively correlated with changes of serum NOX2 levels (p = 0.04), body-mass-index (p < 0.01), waist circumference (0.01), glycosylated haemoglobin (p < 0.01), LDL-cholesterol (p < 0.01) and triglycerides (p < 0.05) and positively correlated with changes of serum NOx (p < 0.001) and adiponectin (p = 0.01). The results show that moderate weight loss is able to improve endothelial dysfunction in patients with the metabolic syndrome. The coexistent decrease of NOX2 activation suggests a role for oxidative stress in eliciting artery dysfunction.

The role of Mediterranean diet in health and disease: an updated mini review

PurposeThe purpose of this paper is to review the Mediterranean diet and its association to disease and health benefits derived from the adherence to it.Design/methodology/approachThe review includes the most updated studies found in PubMed all in relation to the adaptation of the Mediterranean diet.FindingsThe cardioprotection of Mediterranean diet has been established. A number of cancer types could be prevented by following the Mediterranean type diet and the specific ingredients of it are also investigated to find their impact on health. Longevity is also favored by the adoption of this dietary pattern as is the population group diagnosed with metabolic syndrome and mental health disorders. The results about its consumption and obesity need further investigation. Patients with HIV, being on specific treatment, are advised not to follow the Mediterranean diet.Originality/valueThis paper gives a concise, up‐to‐date overview to nutritionists and dietitians on the Mediterranean diet and its relation to health and disease.

Mediterranean diet and magnetic resonance imaging–assessed cerebrovascular disease

Cerebrovascular disease is 1 of the possible mechanisms of the previously reported relationship between Mediterranean-type diet (MeDi) and Alzheimer's disease (AD). We sought to investigate the association between MeDi and MRI infarcts. High-resolution structural MRI was collected on 707 elderly 65 years or older community residents of New York with available dietary assessments administered an average of 5.8 years (3.22 standard deviations [SDs]) before the MRI. Participants were divided into 3 groups of adherence to MeDi (low, middle, and high tertiles). We examined the association of increasing adherence to MeDi with presence of infarcts on MRI. Models were run without adjustment, adjusted for basic demographic and clinical factors, and adjusted for vascular risk factors. A total of 222 participants had at least 1 infarct. In the unadjusted model, compared to the low adherence group, those in the moderate MeDi adherence group had a 22% reduced odds of having an infarct (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.55-1.14), while participants in the highest MeDi adherence group had a 36% reduced odds (OR, 0.64; 95% CI, 0.42-0.97; p for trend = 0.04). In adjusted models, the association between MeDi adherence and MRI infarcts remained essentially unchanged. The association of high MeDi adherence with infarcts was comparable to that of hypertension (40% reduced probability), did not vary by infarct size or after excluding patients with dementia (n = 46) or clinical strokes (n = 86). There was no association between MeDi and white matter hyperintensities. Higher adherence to the MeDi is associated with reduced cerebrovascular disease burden.

Adherence to Mediterranean Diet and Erectile Dysfunction in Men with Type 2 Diabetes

INTRODUCTION There are no reported studies assessing the relation between diet and erectile dysfunction (ED) in men with diabetes. AIM In the present study, we explored the relation between consumption of a Mediterranean-type diet and ED in a population of type 2 diabetic men. METHODS Patients with type 2 diabetes were enrolled if they had a diagnosis of type 2 diabetes for at least six months but less than 10 years, age 35-70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher, treatment with diet or oral drugs. All diabetic patients were invited to complete a food-frequency questionnaire and self-report measures of sexual function. A total of 555 (90.8%) of the 611 diabetic men completed both questionnaires and were analyzed in the present study. MAIN OUTCOME MEASURES Adherence to a Mediterranean diet was assessed by a 9-point scale that incorporated the salient characteristics of this diet (range of scores, 0-9, with higher scores indicating greater adherence). ED was assessed with the International Index of Erectile Function-5. RESULTS Diabetic men with the highest scores (6-9) had lower BMI, waist circumference, and waist-to-hip ratio, a lower prevalence of obesity and metabolic syndrome, a higher level of physical activity, and better glucose and lipid profiles than the diabetic men who scored <3 points on the scale. The proportion of sexually active men showed a significant increase across tertiles of adherence to Mediterranean diet (from 65.1% to 74.4%, P = 0.01). Moreover, men with the highest score of adherence were more likely to have a lower prevalence of global ED (51.9% vs. 62%, P = 0.01) and severe ED (16.5% vs. 26.4%, P = 0.01) as compared with low adherers. CONCLUSIONS In men with type 2 diabetes, greater adherence to Mediterranean diet is associated with a lower prevalence of ED.

Nutraceutical Properties of Mediterranean Diet and Cognitive Decline: Possible Underlying Mechanisms

Recent prospective studies provided evidence that higher adherence to a Mediterranean-type diet could be associated with slower cognitive decline, reduced risk of progression from mild cognitive impairment to Alzheimer's disease (AD), reduced risk of AD, and decreased mortality in AD patients. Furthermore, the Mediterranean diet (MeDi) combines several foods, micro- and macronutrients already separately proposed as potential protective factors against dementia and predementia syndromes. At present, epidemiological evidence suggests a possible association between fish consumption, monounsaturated fatty acids, and polyunsaturated fatty acids (PUFA) (particularly, n-3 PUFA), and reduced risk of cognitive decline and dementia. Light to moderate alcohol use may be associated with a reduced risk of incident dementia and AD, while for vascular dementia, cognitive decline, and predementia syndromes, the current evidence is only suggestive of a protective effect. Finally, the limited epidemiological evidence available on fruit and vegetable consumption and cognition generally support a protective role of these macronutrients against cognitive decline, dementia, and AD. We reviewed evidence on the possible mechanisms underlying the suggested protective role of MeDi against age-related changes in cognitive function, predementia syndromes, and dementia, examining the possible role of macronutrients and food nutrients of the MeDi and their nutraceutical properties in modulating the risk of cognitive decline. Although vascular variables are likely to be in the causal pathway between MeDi and dementia syndromes and should be considered as possible mediators, other nonvascular biological mechanisms (i.e., metabolic, oxidative, and inflammatory) may be invoked to explain the complex epidemiological association between MeDi and cognitive decline.

Maternal Nutrition and Perinatal Outcomes

Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling.

Dietary monounsaturated fatty acids appear not to provide cardioprotection.

Dietary interventions have been consistently proposed as a part of a comprehensive strategy to lower the incidence and severity of coronary heart disease (CHD), in the process providing long-term cardioprotection. Replacement of dietary saturated fatty acids (SFA) with higher intakes of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) has been reported to be inversely associated with risk of CHD. The observed lower incidence of CHD among populations consuming a Mediterranean-type diet, mainly enriched in MUFA from olive oil, has long supported the belief that MUFA are an optimal substitution for SFA. However, both epidemiologic and interventional studies suggest that although substituting MUFA-rich foods for SFA-rich foods in the diet can potentially lower total plasma cholesterol concentrations, this substitution does not lower the extent of coronary artery atherosclerosis. In addition, although recent evidence suggests that the source of MUFA (animal fat vs vegetable oils) may differentially influence the correlation between MUFA intake and CHD mortality, animal studies suggest that neither source is cardioprotective.

Nutraceuticals and Atherosclerosis: Human Trials

The high prevalence of obesity, atherosclerosis, and cardiovascular disease (CVD) is largely attributable to the contemporary lifestyle that is often sedentary and includes a diet high in saturated fats and sugars and low ingestion polyunsaturated fatty acids (PUFAs), fruit, vegetables, and fiber. Epidemiological studies have confirmed a strong association between fat intake, especially saturated- and transfatty acids, plasma cholesterol levels, and rate of coronary heart disease (CHD) mortality. In counterpart, beneficial cardiovascular effects have been reported in populations consuming the "healthy" Mediterranean-type diet. Indeed, many nutrients and phytochemicals in fruits, vegetables, and wine, including fiber, vitamins, minerals, antioxidants, have shown to be independently or jointly responsible for the apparent reduction in CVD risk. Therefore, in patients with overt CVD, efforts have focused on combining both drug treatments and nutrition interventions. Undoubtedly, the advances in the knowledge of both the disease processes and healthy dietary components have provided new avenues to develop pharmaceutical and/or dietary strategies to halt the development of vascular disease. In this regard, within the last years, pioneering nutritional strategies, such as nutraceuticals, have been developed aimed at reducing the main atherosclerotic risk factors and promoting cardiovascular health. Furthermore, a growing body of clinical evidence has demonstrated positive cardiovascular effects associated with dietary fibers, cholesterol-lowering natural agents, olive oil, omega-3 PUFAs, antioxidants, and polyphenols intake. Moreover, monounsaturated fatty acids intake has shown to modulate the expression of key atherosclerotic-related genes. Yet, in the case of antioxidants, some large clinical trials have failed to confirm such atheroprotective effects. Furthermore, there might be interactions between these natural food supplements and cardiovascular medications that cannot be overlooked. Hence, there is a need for a better understanding and more scientific evidence of the relative contribution of major nutraceutical constituents to the inhibition of the progression of atherosclerosis and its clinical consequences.

Lipogenesis Is Decreased by Grape Seed Proanthocyanidins According to Liver Proteomics of Rats Fed a High Fat Diet

Bioactive proanthocyanidins have been reported to have several beneficial effects on health in relation to metabolic syndrome, type 2 diabetes, and cardiovascular disease. We studied the effect of grape seed proanthocyanidin extract (GSPE) in rats fed a high fat diet (HFD). This is the first study of the effects of flavonoids on the liver proteome of rats suffering from metabolic syndrome. Three groups of rats were fed over a period of 13 weeks either a chow diet (control), an HFD, or a high fat diet supplemented for the last 10 days with GSPE (HFD + GSPE). The liver proteome was fractionated, using a Triton X-114-based two-phase separation, into soluble and membrane protein fractions so that total proteome coverage was considerably improved. The data from isobaric tag for relative and absolute quantitation (iTRAQ)-based nano-LC-MS/MS analysis revealed 90 proteins with a significant (p < 0.05) minimal expression difference of 20% due to metabolic syndrome (HFD versus control) and 75 proteins due to GSPE treatment (HFD + GSPE versus HFD). The same animals have previously been studied (Quesada, H., del Bas, J. M., Pajuelo, D., Díaz, S., Fernandez-Larrea, J., Pinent, M., Arola, L., Salvadó, M. J., and Bladé, C. (2009) Grape seed proanthocyanidins correct dyslipidemia associated with a high-fat diet in rats and repress genes controlling lipogenesis and VLDL assembling in liver. Int. J. Obes. 33, 1007-1012), and GSPE was shown to correct dyslipidemia observed in HFD-fed rats probably through the repression of hepatic lipogenesis. Our data corroborate those findings with an extensive list of proteins describing the induction of hepatic glycogenesis, glycolysis, and fatty acid and triglyceride synthesis in HFD, whereas the opposite pattern was observed to a large extent in GSPE-treated animals. GSPE was shown to have a wider effect than previously thought, and putative targets of GSPE involved in the reversal of the symptoms of metabolic syndrome were revealed. Some of these novel candidate proteins such as GFPT1, CD36, PLAA (phospholipase A(2)-activating protein), METTL7B, SLC30A1, several G signaling proteins, and the sulfide-metabolizing ETHE1 and SQRDL (sulfide-quinone reductase-like) might be considered as drug targets for the treatment of metabolic syndrome.

Introduction to Nutraceuticals Special Issue

Despite that the therapeutic armamentarium to prevent cardiovascular disease grew in the last two decades, myocardial infarction and stroke still represent the first cause of mortality and morbility in the western country. New antiatherothrombotic therapies added to ACE-inhibitors, statins and antiplatelet drugs are far from entry in the market also because identification of novel mechanisms involved in the process of athero-trombosis are still in progress. Antioxidants therapy represented a potentially attractive approach because of the putative role of oxidative stress in the initiation and progression of atherosclerosis. However, trials with antioxidants failed to show beneficial effects also for serious methodological issues related to patients inclusion, drug compliance, follow-up duration and confounding factors such as concomitant use of antioxidant molecules like statins [1]. In absence of new therapeutic approach in the near future, dietary intervention may represent an interesting alternative to retard the progression of atherosclerosis and its clinical sequelae. There are at least three dietary interventions that have been associated with reduced incidence of cardiovascular disease. Since the classic study by Kyes et al [2], several observational studies showed people living in the South of Europe following a Mediterranean diet had lower incidence of cardiovascular disease compared to people living in the North of Europe. Mediterranean diet is characterized by high intake of fruits, vegetables, legumes, monounsaturated fatty acids (essentially olive oil), and a moderate intake of fish and wine. The beneficial effect of Mediterranean diet in preventing cardiovascular disease has been documented in interventional studies performed in patients with or without previous cardiovascular diseases. In a large prospective study performed in 22,043 adults in Greece [3]: people who closely followed the Mediterranean diet had lower probability (−25%) to die compared to those who poorly adhered to the diet during a median follow-up of 44 months. The beneficial effect of Mediterranean diet has also been demonstrated in secondary prevention trial in which patients with previous cardiovascular diseases following a typical Mediterranean diet had reduced risk of myocardial infarction and stroke [4, 5]. Several nutrients of the Mediterranean diet have been suggested to play a role in reducing cardiovascular events. Fruits, vegetables and wine are supposed to play an important role among them. For instance, the Nurses’ Health Study and the Health Professionals’ Follow-up Study demonstrated that consumption of fruits and vegetables are associated with reduced risk of coronary heart disease [6]. The Indian Heart Study randomized 505 survivors of myocardial infarction to a usual care or a diet rich in fruits, vegetables, nuts and grains. After one year of follow-up, there were fewer cardiac events and lower overall mortality in patients on interventional diet [7]. Assumption of wine has also been associated with reduced risk of cardiovascular diseases as suggested by a meta-analysis showing an inverse association between 200 mL/day wine intake and cardiovascular diseases [8]. Together these data prompted to speculate that the antioxidants contained in fruits and vegetables and the polyphenols contained in the wine were responsible for such beneficial effects. A series of studies have been done in experimental models of atherosclerosis and in humans to assess the efficacy of these supplements containing antioxidants and polyphenols. Nutrition based on high fish intake has also proved to protect against coronary heart disease. Since the pioneering studies in Greenland showing that consumption of fish protect Eskimos against cardiovascular disease [9], many observational studies have provided support to this preliminary research. In a recent meta-analysis of these observational studies, the rate of weekly fish consumption inversely correlated with mortality from cardiovascular disease: fish consumption up to two to four times weekly was associated with 38% risk reduction [10]. Also, in the Physicians’ Health Study the risk of sudden death was inversely correlated with the blood concentration of n-3 fatty acids [11]. As in the case of the Mediterranean diet interventional trials with fish oils or n-3 fatty acids supplements have been planned to assess their efficacy in preventing cardiovascular diseases. There are several questions that should be addressed concerning the use of supplements in clinical practice. A crucial issue regards the real effectiveness of such supplements in preventing cardiovascular disease and the potential harmful effects especially in case of long-term assumption. Another issue is related to the population who could potentially benefit from such treatment. In other words, it is to define if supplements are useful for primary of secondary prevention and if early assumption may halt atherosclerotic progression. This is another crucial issue as the use of supplements has been investigated in the early infancy in children at risk of cardiovascular disease [12]. For all these reasons I believe that a special issue regarding supplements will be of interest for readers who are looking for new approaches for prevention of cardiovascular diseases.

Cholesterol and Triglyceride Management

The medications we use for cholesterol and triglyceride lowering are powerful and have substantial outcome data. However, even with aggressive statin therapy, there is residual risk for recurrent cardiovascular events. Strict dietary modification has been shown to reduce low-density lipoprotein (LDL) cholesterol by 20% to 30%. Low-fat and Mediterranean-type diets have also been associated with atherosclerosis regression and fewer coronary heart disease events. On the other hand, a high-fat diet can produce postprandial lipemia and an increase in cardiovascular disease risk. Patients with atherogenic dyslipidemia (low high-density lipoprotein cholesterol, increased triglycerides and non-high-density lipoprotein cholesterol, small dense low-density lipoprotein particles) and visceral adiposity are particularly prone to postprandial lipemia. These individuals typically have insulin resistance, which is associated with endothelial dysfunction and an increased risk for thrombosis. Lifestyle intervention is the key to reducing postprandial lipemia, specifically weight reduction and increased physical activity. Although medications can improve postprandial lipemia, poor dietary choices can overwhelm the effects of medication and negatively impact the health of arteries, thus promoting atherosclerosis. Therefore, patients who are treated with medications for dyslipidemia must be counseled on consuming a heart-healthy diet.

Clinical physiology of NAFLD: a critical overview of pathogenesis and treatment

The shared physiopathologic derangements linking nonalcoholic fatty liver disease (NAFLD) with the metabolic syndrome (MetS), along with the biological basis of treatment, will be discussed in this review. The role of macrophages in the ‘adipositis’ of the obese individual mirrors that of Kupffer cells in NAFLD. The gut plays a major role in the pathogenesis of NAFLD by contributing to the development of insulin resistance and inflammation. Mitochondrial dysfunction is the cellular basis for impaired energy homeostasis in adipose, muscle and liver tissues. NAFLD is an essential component of the MetS. However, ethnicity, gender, genetic and hormonal influxes – via body fat distribution – modulate the propensity to develop NAFLD, accounting for the finding that few NAFLD patients are seemingly spared from developing the MetS. Future studies should aim at evaluating the role of hypathalamic inflammation in MetS in humans. Furthermore, moderate calorie restriction and weight loss provide prompt metabolic benefit in NAFLD, with indications suggesting that the Mediterranean-type diet has the potential for curing the MetS and NAFLD. The controversial role of alcohol and the molecular mechanism of actions exerted by physical training on NAFLD are discussed in this article. Additionally, specific molecular/cellular targets for innovative treatment strategies based on NAFLD physiology are also reviewed.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Adherence to Mediterranean Diet and Erectile Dysfunction in Men with Type 2 Diabetes

ABSTRACT Introduction There are no reported studies assessing the relation between diet and erectile dysfunction (ED) in men with diabetes. Aim In the present study, we explored the relation between consumption of a Mediterranean-type diet and ED in a population of type 2 diabetic men. Methods Patients with type 2 diabetes were enrolled if they had a diagnosis of type 2 diabetes for at least six months but less than 10 years, age 35–70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher, treatment with diet or oral drugs. All diabetic patients were invited to complete a food-frequency questionnaire and self-report measures of sexual function. A total of 555 (90.8%) of the 611 diabetic men completed both questionnaires and were analyzed in the present study. Main Outcome Measures Adherence to a Mediterranean diet was assessed by a 9-point scale that incorporated the salient characteristics of this diet (range of scores, 0–9, with higher scores indicating greater adherence). ED was assessed with the International Index of Erectile Function-5. Results Diabetic men with the highest scores (6–9) had lower BMI, waist circumference, and waist-to-hip ratio, a lower prevalence of obesity and metabolic syndrome, a higher level of physical activity, and better glucose and lipid profiles than the diabetic men who scored &amp;lt;3 points on the scale. The proportion of sexually active men showed a significant increase across tertiles of adherence to Mediterranean diet (from 65.1% to 74.4%, P = 0.01). Moreover, men with the highest score of adherence were more likely to have a lower prevalence of global ED (51.9% vs. 62%, P = 0.01) and severe ED (16.5% vs. 26.4%, P = 0.01) as compared with low adherers. Conclusions In men with type 2 diabetes, greater adherence to Mediterranean diet is associated with a lower prevalence of ED.

ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Adherence to Mediterranean Diet and Sexual Function in Women with Type 2 Diabetes

ABSTRACT Introduction There are no reported studies assessing the relation between diet and sexual function in women with diabetes. Aim In the present study, we explored the relation between consumption of a Mediterranean-type diet and sexual function in a population of type 2 diabetic women. Methods Patients with type 2 diabetes were enrolled if they had a diagnosis of type 2 diabetes for at least six months but less than 10 years, age 35–70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher, treatment with diet or oral drugs. All diabetic patients were invited to complete a food-frequency questionnaire and self-report measures of sexual function. A total of 595 (90.2%) of the 659 women completed both questionnaires and were analyzed in the present study. Main Outcome Measures Adherence to a Mediterranean diet was assessed by a 9-point scale that incorporated the salient characteristics of this diet (range of scores, 0–9, with higher scores indicating greater adherence). The Female Sexual Function Index (FSFI) was used for assessing the key dimensions of female sexual function. Results Diabetic women with the highest scores (6–9) had lower BMI, waist circumference, and waist-to-hip ratio, a lower prevalence of depression, obesity and metabolic syndrome, a higher level of physical activity, and better glucose and lipid profiles than the diabetic women who scored &amp;lt;3 points on the scale. The proportion of sexually active women showed a significant increase across tertiles of adherence to Mediterranean diet (from 54.2% to 65.1%, P = 0.01). Based on the FSFI cutoff score for female sexual dysfunction (FSD) of 23, women with the highest score of adherence had a lower prevalence of sexual dysfunction as compared with women of lower tertiles (47.6%, 53.9%, and 57.8%, higher, middle, and lower tertile, respectively, P = 0.01). These associations remained significant after adjustment for many potential confounders. Conclusions In women with type 2 diabetes, greater adherence to Mediterranean diet is associated with a lower prevalence of FSD.

Advances in Vascular Cognitive Impairment

Advances in Vascular Cognitive Impairment

Proposal of a Mediterranean diet index for pregnant women

Numerous studies have addressed the nutritional needs of pregnant women. The nutritional status of the woman before and during gestation affects the growth of the fetus and the course of the pregnancy and influences the risk of obesity for mother and infant. The aim of this study was to propose a diet quality index for pregnancy based on a Mediterranean-type diet (MDS-P), evaluating the diet of a group of pregnant women by applying the Mediterranean Diet Score (MDS) and evaluating their intake of micronutrients required in optimal amounts during pregnancy, such as Fe, folic acid and Ca. The data used to construct this index (MDS-P) were gathered by means of a FFQ specifically designed for pregnant women. The mean MDS of this group, was 4.31 (sd 1.32), considered to represent satisfactory compliance with the Mediterranean diet (range 0-8). The mean MDS-P (range 0-11), which also takes account of dietary intake or supplements of folic acid, Fe and Ca was 7.53 (sd 1.44), indicating a compliance of around 70 %. The present study findings suggest that the MDS-P, which evaluates the adequacy of folic acid, Fe and Ca as well as compliance with the Mediterranean diet, may represent a valid tool for the specific assessment of the diet of pregnant women living in countries in the Mediterranean area. Further studies are required to complete the validation process.

Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial

Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated. To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk factors, and baseline dietary habits. A total of 1,048 asymptomatic subjects aged 55-80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants' characteristics were assessed at baseline among subjects. Dietary changes were evaluated after 12 months. Main outcome measures were: attained changes in five dietary goals: increases in (1) fruit consumption, (2) vegetable consumption, (3) monounsaturated fatty acid (MUFA)/saturated fatty acid (SFA) ratio, and decreases in (4) sweets and pastries consumption, (5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet). Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet. Some participant characteristics (marital status and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet, and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.

Nutrigenetics: links between genetic background and response to Mediterranean-type diets

It has been substantiated that the onset of most major diseases (CVD, diabetes, obesity, cancers, etc.) is modulated by the interaction between genetic traits (susceptibility) and environmental factors, especially diet. We aim to report more specific observations relating the effects of Mediterranean-type diets on cardiovascular risk factors and the genetic background of subjects. In the first part, general concepts about nutrigenetics are briefly presented. Human genome has, overall, only marginally changed since its origin but it is thought that minor changes (polymorphisms) of common genes that occurred during evolution are now widespread in human populations, and can alter metabolic pathways and response to diets. In the second part, we report the data obtained during the Medi-RIVAGE intervention study performed in the South-East of France. Data obtained in 169 subjects at moderate cardiovascular risk after a 3-month dietary intervention indicate that some of the twenty-three single nucleotide polymorphisms (SNP) studied exhibit interactions with diets regarding changes of particular parameters after 3-month regimens. Detailed examples are presented, such as interactions between SNP in genes coding for microsomial transfer protein (MTTP) or intestinal fatty acid binding protein (FABP2) and triglyceride, LDL-cholesterol or Framigham score lowering in responses to Mediterranean-type diets. The data provided add further evidence of the interaction between particular SNP and metabolic responses to diets. Finally, improvement in dietary recommendations by taking into account known genetic variability has been discussed.