Principles Of Mediterranean Diet Research Articles

ADHERENCE TO THE MEDITERRANEAN DIET IN PATIENTS WITH HIGH CARDIOVASCULAR RISK

Introduction. Recommendations for the use of the Mediterranean diet apply to many nosologies, which made it expedient to consider the principles of such nutrition and adherence to it for patients with high cardiovascular risk. Objectives. In order to evaluate the nature of the diet of patients with high cardiovascular risk and their adherence to the Mediterranean diet, the principles of the diet were described according to the data from the Pubmed database. Adherence to and compliance with the principles of Mediterranean diet in patients with high cardiovascular risk were determined according to the Food Questionnaire in 29 outpatients with stable chronic forms of coronary heart disease and arterial hypertension: 18 men, 11 women aged 55.72±2.59 years with excessive body weight; the results were processed by the methods of variational statistics. Results. The Mediterranean diet is recommended for patients with high cardiovascular risk, excess body weight, steatotic liver disease, inflammatory bowel diseases, autoimmune changes in the thyroid gland, dementia, chronic obstructive pulmonary diseases, and oncological processes. It is based on grains, cereals, vegetables and fruits, beans, nuts, and seeds; a small amount of meat, eggs, fish, and poultry; olive oil and moderate daily consumption of cheeses and yogurts. According to the Food Questionnaire, patients with a high cardiovascular risk are not sufficiently aware of the principles of this diet, do not fully follow the recommendations for replacing fats with extra virgin olive oil, do not consume enough fish, vegetables, fruits, nuts, whole grain pasta and hard cereals. In addition, they tend to consume meat, soft cereals, ordinary types of bread and pasta, sweets, carbonated beverages, beer, and spirits in excessive amounts or too often. Conclusions. Insufficient awareness and non-adherence to the Mediterranean diet require the activation of educational work to deepen knowledge about its principles and details.

A personalized diet intervention improves depression symptoms and changes microbiota and metabolite profiles among community-dwelling older adults.

The impact of diet on mental well-being and gut microorganisms in humans is well recognized. However, research on the connections between food nutrients, gut microbiota, and mental health remains limited. To address this, the present study aimed to assess the effects of a personalized diet, based on individual needs and aligned with the Mediterranean diet principles, on depression symptoms, quality of life, nutritional intake, and gut microbiota changes among older adults living in the community. The intervention involved regular visits from a registered dietitian, who provided tailored dietary recommendations. During the 6-month study, participants completed questionnaires to evaluate their depression levels, quality of life, and dietary habits. Additionally, they provided stool samples for analysis of gut microbiota and metabolites. The results demonstrated that the personalized dietary intervention reduced depression symptoms and improved the quality of life among older adults. Furthermore, significant changes in the intake of certain nutrients, such as folate, lutein, zeaxanthin, EPA, and DHA, were observed following the intervention. Moreover, the intervention was associated with increased diversity in the gut microbiome and reduced total short-chain fatty acids, the main metabolites produced by gut microorganisms. The study also revealed correlations between food nutrients, gut microbiota, and mental health parameters. In conclusion, this research highlights the potential advantages of personalized dietary interventions in managing depression and enhancing overall well-being among older populations. It also sheds light on the role of gut microbiota and its metabolites in these effects. The findings offer valuable insights into the significance of nutrition and gut health for mental well-being in older adults.

Is weight gain preventable in women with early breast cancer undergoing chemotherapy? A real-world study on dietary pattern, physical activity, and body weight before and after chemotherapy

PurposeWe aimed to investigate the role of a lifestyle intervention and clinical and therapeutic factors for preventing weight gain in early breast cancer (BC) patients from one week before to 12 months after chemotherapy.MethodsDietary assessments were conducted by a trained dietician using a food-frequency questionnaire at each clinical assessment. Total energy, macronutrients intakes, and physical activity were estimated and the Mediterranean Diet Score (MDS) for adherence to Mediterranean diet was calculated. At each follow-up visit, patients were provided with dietary advices according to Mediterranean and Italian guidelines by a registered dietician, after evaluation of their food records. The associations of clinical characteristics, dietary pattern, and physical activity with weight gain were evaluated by multiple logistic regression, with weight gain ≥5% from baseline value as a dichotomous dependent variable.Results169 early BC patients who met all follow-up visits and provided complete data were included in the analysis. From baseline to last assessment, weight loss (≥5% decrease from baseline value), stable weight, and weight gain were observed in 23.1%, 58%, and 18.9% women, respectively. Overall, a 0.68 kg mean decrease in women’s weight (−1.1% from baseline) was observed. The risk of gaining weight increased for having normal weight/underweight at baseline, receiving hormone therapy, MDS worsening, and physical activity decreasing from baseline to last assessment.ConclusionProviding simple suggestions on Mediterranean diet principles was effective for preventing weight gain in normal weight women and favoring weight loss in overweight and obese women.

Combined Impact of the Mediterranean Diet and Physical Activity on the Nutritional Status Formation

The Mediterranean diet is one of the scientifically based types of nutrition aimed at maintaining health and active longevity. The diet implies high consumption of unsaturated fats, cereals, fresh fruits and vegetables, low-fat dairy products, and involves moderate physical activity. The research aims at studying the influence of the Mediterranean diet combining with physical activity on the nutritional status indicators of the adult population. The experiment involved 13 people aged 34 to 55 years (12 women and 1 man) with nutritional disorders. Developed recommendations were based on the catering using the Mediterranean diet principles. A man divided the group into two parts: during the study 7 people did physical activity (strength and aerobic exercises of medium and low intensity) besides following the nutrition recommendations; 6 people followed only the nutritional advice. The researchers specified the Mediterranean diet and physical activity impact on the nutritional status of the experimental subjects using two biomarkers groups: anthropometric indicators (waist circumference, body weight, body mass index) and biochemical blood parameters (fasting glucose, total cholesterol, low-density lipoproteins, high-density lipoproteins). Based on a comprehensive assessment of nutritional status, a man revealed the positive Mediterranean diet impact on health indicators. Every subject in the experiment demonstrated an improvement in one or more nutritional status indicators. At the same time, combining diet and physical activity determined more significant positive changes: in the experiment three subjects from this category had their nutritional status indicators normalized completely.

Adherence to Mediterranean Diet in Croatia: Lessons Learned Today for a Brighter Tomorrow.

Non-communicable diseases (NCD) and lifestyle, particularly diet, have a close relationship. Based on the recent statistics, Croatian men and women lead in European overweight lists, which implies pessimistic prognosis in terms of incidence and prevalence of NCDs in the future. One of the possible solutions to overcome weight problems is turn to traditional balanced and sustainable diets, such as the Mediterranean diet. In this study, we assessed adherence towards Mediterranean diet using a validated questionnaire in an online survey and associated adherence scores with several demographic and anthropometric data. Based on the results of a validated Mediterranean Diet Adherence Screener (N = 3326), we assessed the adherence score to be 7.6 ± 2.5. The score tended to depend on sex, residence, age, education, income, and body mass index (BMI); indeed, women, residents of a coastal part of the country, older volunteers, those possessing a higher education degree, those with higher income, and those with lower BMI were associated with higher scores. As income was one of the significant findings related to higher adherence scores, we developed a dietary plan complying with Mediterranean diet principles that, on average, costed less than the average traditional balanced diet menu. Taken together, this study brought new findings regarding target groups who need to be encouraged to make lifestyle changes, and highlighted the first steps on how to make them.

H-FABP Levels and Psycho-Emotional Improvement of CABG Patients during Cardiac Rehabilitation.

(1) Background: The heart-type fatty acid-binding protein (H-FABP) is a specific myocardial biomarker and high levels indicate ischemia regardless of patient-reported symptoms. Concurrently, major adverse cardiovascular events and surgery such as coronary artery by-pass grafting (CABG) cause substantial psycho-emotional distress e.g., depression and anxiety. Comprehensive cardiac rehabilitation is, therefore, essential to both physical and psychological recovery. (2) Methods: This is a unicentric, prospective study on 120 consecutive post-CABG patients undergoing a 6-month cardiac rehabilitation program based on physical exercise, Mediterranean diet principles, and Q10 coenzyme antioxidant supplements. H-FABP levels, depression, and anxiety scores (Hamilton HAM-D and HAM-A scales) were monitored after surgery and at 6 months. (3) Results: Mean H-FABP dropped from 60.56 to 4.81. Physical ability increased from 1–2 to 4–5 METS. Mean depression and anxiety improved from 15.88 to 6.96 and from 25.13 to 15.68, respectively. Median scores went down 50% for depression and 9% for anxiety. Explored associations between H-FABP and psycho-emotional status were statistically insignificant. (4) Conclusions: patients adhered to the program and improved significantly in all studied aspects. Clinical significance is discussed in the context of countries like Romania, where such programs are limited by systemic and financial constraints. Further research directions are identified.

Dietary intake of patients with inflammatory bowel disease aligns poorly with traditional Mediterranean diet principles.

Previous research has shown that individuals with inflammatory bowel disease avoid specific food items, such as fibre rich foods, in order to manage symptoms. Dietary fibre and the traditional Mediterranean diet are both associated with reduced mucosal and systemic inflammation, gut barrier integrity, and microbiota diversity. There is limited data on the diet composition of individuals with inflammatory bowel disease. The aim of this study was to evaluate how it compares to the traditional Mediterranean diet and national dietary guidelines. Outpatients with inflammatory bowel disease were recruited to the study between February and August 2019. Demographic and medical information was obtained for consenting participants. All participants completed a dietary assessment of usual intake (24-h diet recall and 17-point ready reckoner) from which a Mediterranean diet adherence score was calculated. Dietary intake of core food groups was compared to the recommended number of serves outlined in the Australian Guide to Healthy Eating. 100 participants were recruited. The mean Mediterranean diet adherence score was 5.1± 1.3 (maximum 14 points), 4% of participants scored ≥9 (commonly agreed criteria for Mediterranean diet adherence). Participants also consumed considerably less grains and vegetables than national dietary guidelines recommendations. The diet of outpatients with inflammatory bowel disease did not align with Mediterranean diet characteristics. Participants consumed significantly less grains and vegetables than national guidelines, suggesting a low fibre intake. These findings suggest that dietary interventions focusing on improving the diet of individuals with inflammatory bowel disease to align with Mediterranean diet characteristics are warranted.

Effect of healthy lifestyle promotion on anthropometric variables, eating behavior and cardiometabolic risk factors in women with polycystic ovarian syndrome

Background: In women with Polycystic Ovarian Syndrome (PCOS), metabolic abnormalities are common, including insulin resistance, obesity, and dyslipidemia, suggesting an increased risk for cardiovascular disease (CVD). Objectives: To evaluate the effect of healthy lifestyle promotion on eating behavior and metabolic biomarkers in women with PCOS. Subjects and Methods: The study was carried out in 102 women (30±7 years) with PCOS. Patients received nutritional counseling based on Mediterranean diet principles and recommendations to practice a regular physical activity, and were followed up during six weeks. Dietary survey and biomarkers analysis were assessed at baseline (T0), after three weeks (T1) and 6 weeks (T2). Results: After six weeks of intervention, there was a significant decrease in total energy intake by (-30%) at T1 and (-32%) at T2 (p˂0.001), compared to baseline. Significant decrease was recorded in carbohydrates, proteins and lipids intake at T1 and T2 (p˂0.001). An increase in monounsaturated fatty acid intake was noted at T1 and T2 (p˂0.001). The body mass index (BMI) diminished at T2 (p˂0.01), and waist circumference at T1 and T2 (p˂0.001). Glucose values decreased at T1 (p˂0.05) and T2 (p˂0.001). Total cholesterol decreased at T1 (p˂0.05) and T2 (p˂0.01). HDL-C increased at T1 (p˂0.001) and T2 (p˂0.001), when CRP values remained unchanged. A decrease in Thiobarbituric acid reactive substances concentrations was observed at T1 and T2 (p˂0.05). Superoxyde Dismutase, Catalase activities and thiols amount increased at T2 (p˂0.001). Conclusion: In the long term, healthy lifestyle promotion could be beneficial to prevent or reverse the clustering of metabolic abnormalities and prevent CVD in women with PCOS. Keywords: Polycystic ovary syndrome, Metabolic abnormalities, Healthy Lifestyle, Mediterranean diet, Cardiometabolic risk.

Eating Habits and Lifestyle during COVID-19 Lockdown in the United Arab Emirates: A Cross-Sectional Study.

The coronavirus disease is still spreading in the United Arab Emirates (UAE) with subsequent lockdowns and social distancing measures being enforced by the government. The purpose of this study was to assess the effect of the lockdown on eating habits and lifestyle behaviors among residents of the UAE. A cross-sectional study among adults in the UAE was conducted using an online questionnaire between April and May 2020. A total of 1012 subjects participated in the study. During the pandemic, 31% reported weight gain and 72.2% had less than eight cups of water per day. Furthermore, the dietary habits of the participants were distanced from the Mediterranean diet principles and closer to “unhealthy” dietary patterns. Moreover, 38.5% did not engage in physical activity and 36.2% spent over five hours per day on screens for entertainment. A significantly higher percentage of participants reported physical exhaustion, emotional exhaustion, irritability, and tension “all the time” during the pandemic compared to before the pandemic (p < 0.001). Sleep disturbances were prevalent among 60.8% of the participants during the pandemic. Although lockdowns are an important safety measure to protect public health, results indicate that they might cause a variety of lifestyle changes, physical inactivity, and psychological problems among adults in the UAE.

Dietary education provision within a cardiac rehabilitation programme in the UK: a pilot study

Background/aims The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation, as a means to optimise nutrient and energy intakes. A secondary aim was to evaluate patients' habitual physical activity levels. Methods Thirty patients (males: n=24, 61.8±11.2 years; females: n=6, 66.7±8.5 years) attended a 6-week early outpatient cardiac rehabilitation programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. Energy intakes and nutrient intakes were measured through completion of 3-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n=13) of patients had their physical activity levels assessed via accelerometery to assess the impact of the cardiac rehabilitation programme on physical activity. Results Estimated energy requirements at week one (1988±366 kcal d−1) were not matched by actual energy intakes (1785±561 kcal d−1) (P=0.047, d=−0.36). Energy intakes reduced to 1655±470 kcal d−1 at week six (P=0.66, d=−0.33) whereas estimated energy requirements increased as a function of increased activity (cardiac rehabilitation sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which are core elements of a Mediterranean diet. Statistically significant increases were not observed in physical activity; however, patients decreased sedentary time by 11±12% in week six compared with week one (P=0.009; d=−0.54). Conclusions The present study findings suggest that two 30-minute dietary education sessions did not positively influence energy intakes and nutrient intakes, while habitual physical activity levels were not significantly increased as a result of the cardiac rehabilitation programme. Future research should explore means of optimising nutrition and habitual physical activity within UK cardiac rehabilitation.

Development of Criteria for a Positive Front-of-Package Food Labeling: The Israeli Case.

Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of-package labeling (FOPL) may support the consumers to make an informed decision at the point of purchase and encourage industry to reformulate food products. The Israeli Ministry of Health (MOH) implemented a unique FOPL system, using two colors: A mandatory warning (red) label alongside a voluntary positive (green) label. An independent Scientific Committee, from academia, the healthcare system, and MOH was appointed to determine the core principles for the positive FOPL. The criteria were based on the Mediterranean diet principles, with adjustments to the Israeli dietary habits, focusing on the health advantages of the food and considering its processing level. The food products eligible for positive FOPL are foods in their natural form or with added spices or herbs, or those that underwent minimal processing, with no food additives. Based on population consumption data, 19.8% of food products were eligible for positive FOPL; of them, 54% were fruits and vegetables, 20% dairy, and 14% grains. An evaluation plan is needed to assess the degree of acceptance of the positive FOPL by the industry, retailers, and the public, and its impact on food consumption and on public health.

Prior Knowledge of the Mediterranean Diet Is Associated With Dietary Adherence in Cardiac Patients

Cardiovascular disease (CVD) is the leading cause of death in the United States, and cardiovascular events have been shown to be reduced and prevented when patients follow the Mediterranean diet. To understand how familiarity with the Mediterranean diet affects dietary habits in cardiology patients by using social cognitive theory. This cross-sectional study included patients at a metropolitan outpatient cardiology clinic in Oklahoma. A survey was used to analyze patient knowledge of the Mediterranean diet. Patients were separated into low-, medium-, and high-diet adherence groups based on their daily consumption of fruits, vegetables, fish, whole grains, and nuts. Multinomial logistic regression was used to analyze patients' knowledge of Mediterranean diet principles with dietary adherence. A total of 337 patients were included in the study. Patients with a college education, patients reporting familiarity with the diet, and women were 6.7, 4.0, and 3.2 times as likely, respectively, to have strong adherence to the Mediterranean diet. The finding that familiarity with the Mediterranean diet was closely associated with adherence to its principles indicates that patient education on heart-healthy diets may improve the eating habits of patients, especially patients at risk for cardiac events.

A Pilot Low-Inflammatory Dietary Intervention to Reduce Inflammation and Improve Quality of Life in Patients With Familial Adenomatous Polyposis: Protocol Description and Preliminary Results.

Patients with familial adenomatous polyposis (FAP) depend on a lifelong endoscopic surveillance programme and prophylactic surgery, and usually suffer nutritional problems. Intestinal inflammation has been linked to both FAP and colorectal cancer. Epidemiological studies show a relationship between diet and inflammation. Preventive dietary recommendations for FAP patients are so far lacking. We have designed a nonrandomized prospective pilot study on FAP patients to assess whether a low-inflammatory diet based on the Mediterranean diet principles and recipes, by interacting with the microbiota, reduces gastrointestinal markers of inflammation and improves quality of life. This report describes the scientific protocol of the study and reports the participants’ adherence to the proposed dietary recommendations. Thirty-four FAP patients older than 18 years, bearing the APC pathogenic variant, who underwent prophylactic total colectomy with ileo-rectal anastomosis were eligible into the study. During the 3-month dietary intervention, they reported improvements in their consumption of Mediterranean foods (vegetables, fruits, fish, and legumes), and a reduction in pro-inflammatory foods (red/processed meat and sweets); this led to a significant increase in their adherence to the Mediterranean diet. The improvement was accompanied by a decrease in the number of diarrhoeal discharges. These preliminary results are encouraging with regard to feasibility, dietary outcome measures, and safety.

New and traditional foods in a modernized Mediterranean diet model.

Mediterranean diet is definitely one of the healthiest dietary models. Next questions are: is the traditional Mediterranean diet adapted to the modern environmental and existential conditions? Could and/or should it be "modernized" to adapt to the various geographical, environmental, ethnic, and religious characteristics? If "modernization" is required, which traditional Mediterranean foods should be imperatively conserved as they are? Alternatively, which "new" foods-not traditional or not Mediterranean-could be introduced to help people to still respect the basic healthy Mediterranean diet principles? The present article intends to help solving these new questions.

Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

ObjectivesTo assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.Research design and methodsThis is...

Improving breakfast patterns of portuguese children-an evaluation of ready-to-eat cereals according to the European nutrient profile model.

Ready-to-eat cereal (RTEC) breakfasts have been increasing in Portugal, among children. Eat Mediterranean (EM), a Portuguese comprehensive community-based intervention, proposed to improve breakfast patterns of children and adolescents and to evaluate the healthiness of RTEC according to WHO/Europe nutrient profile model (Euro-NP). EM Program was developed during two scholar years (15/16 and 16/17) toward 2333 students (pre to secondary education). Data on breakfast was provided using a family record form. The intervention consisted of 257 educational sessions addressing the principles of Mediterranean Diet, and promoting a "healthy breakfast at home". To check for compliance with Euro-NP, RTEC package food labels' nutritional composition was used. After intervention 92.9% of children/adolescents had breakfast daily with no report of breakfast skippers. RTECs were one of the most frequent (66.5%) breakfasts. Statistically significant improvements were showed for: daily qualitative and complete breakfast frequency (5.6%) and fruit (11.2%). Consumption of RTEC decreased 28%. According to Euro-NP, 84.6% of the RTECs were non-compliant, regarding sugar content. Children's RTECs presented 5% more of energy and 26% more sugar than the "non-children's" RTECs. EM strategy showed to be a successful program to improve patterns and quality of breakfast of the children and adolescents, reinforcing the importance of school-based nutritional programs in changing lifestyles. Nutrient profiling can be a useful tool to provide a selection of foods to be part of a healthy diet and can be used by policy-makers to design policies to identify the foods to which marketing restrictions to children, will apply.

Medical Nutrition Therapy for Gestational Diabetes Mellitus (GDM) Based on Mediterranean Diet Principles

Background: Medical nutrition therapy (MNT) is the first-line therapy to achieve glycemic control in women with gestational diabetes mellitus (GDMw). It has been associated with better pregnancy outcomes. Whether MNT can make pregnancy outcomes like women without GDM remains unknown. Objective: To assess if a Mediterranean-diet-based medical nutrition therapy (MNT) facilitates near-normoglycemia (determined by HbA1c levels) at 36-38 gestational weeks in GDMw, and observe its effects on adverse pregnancy outcomes. Study Design: A sub-analysis of the St Carlos GDM Prevention Study. It was conducted between January-December 2015 in the Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive normoglycemic women were included before 12th gestational weeks, and 874 included in the final analysis: 177 were diagnosed with GDM (IADPSG criteria) and 697 had normal glucose tolerance. GDMw received Mediterranean diet-based MNT, with a daily intake of ≥40 ml extra-virgin olive oil and a handful of nuts (mainly pistachios). Results: GDMw had higher HbA1c levels, fastinG insulin and HOMA-IR at 24-28 gestational weeks as compared with NGT. At 36-38 gestational weeks these values became similar. Insulin therapy was necessary in 26.6% of GDMw. Rates of macrosomia, large-for-gestational-age, pregnancy-induced hypertensive disorders, prematurity and c-sections were similar between groups. Crude RR analysis showed that GDMw had a higher risk of insufficient weight gain [2.37(1.64-3.30), P=.001], urinary tract infection [1.69(1.20-2.38), P=.005], small-for-gestational age newborns [2.05(1.29-3.24), P=.009] and neonate ICU admission [3.42(1.45-8.04), P=.006]. Conclusions: Using a Mediterranean-diet-based MNT in GDMw helps to achieve a near-normoglycemia, making most pregnancy outcomes similar to women with NGT. The higher rates of small-for-gestational-age and insufficient weight gain require further analysis. Disclosure A. Duran: None. C. Assaf-Balut: None. N. Garcia de la Torre: None. M. Fuentes: None. E. Bordiu: None. L. Del Valle: None. A.M. Barabash: None. M. Cuesta: None. M.A. Rubio: None. A.L. Calle: None.

The Adherence of the Diet to Mediterranean Principle and Its Impacts on Human and Environmental Health

The Mediterranean Adequacy Index (MAI) trends from 1961to 2007, for 48 countries pooled in 4 clusters according to their geographical location (Mediterranean European (ME) countries, Other Mediterranean (OM) countries, Northern European (NE) countries, Eastern European (EE) countries), has been analysed. In almost all the countries the adherence to Mediterranean diet is decreasing from 1961up to 2007, even if with different trend linked to the geographical and cultural characteristic of the clusters (respectively -56% for European Mediterranean and -21 for non-European Mediterranean). The cluster more adherent to healthy Mediterranean diet principles is the OM one, where the incidence of colorectal cancer is shown to be around 50% lower respect to the incidence in ME countries, and around 60% lower respect to the incidence in EE and NE countries. A significant relationship was observed between colorectal cancer incidence and animal protein consumption. On the other hand, vegetable protein intake is suggested to be slightly protective against colorectal cancer incidence. The ecological footprint of food production is higher in ME and NE than in OM and EE countries, even if it is generally higher than the biocapacity. In the 70% of the analysed countries water consumption for food production exceeds the total water exploitable, with an increasing trend from 1961 to 2007. An increase of 1 unit of MAI can decrease the ecological, carbon and water footprint (around 20-25%), in dependence on the initial level of MAI. Due to the environmental and health beneficial effects, the Mediterranean diet can be promoted as a win-win diet system.