Mediterranean Food Pattern Research Articles

Household diet quality in relation to mortality in Portuguese regions: an ecological study

The aim of this study was to investigate the association between regional household diet quality and corresponding mortality data. Two household diet quality scores derived from household budget survey food and nutrient data were used: the Mediterranean Adequacy Index (MAI), assessing adherence to a Mediterranean food pattern, and a revised Healthy Diet Indicator (HDIr), based on compliance with WHO population dietary goals. Seven Portuguese regions were considered, in accordance with the officially adopted national territorial division NUT II. The corresponding regional age-standardised death rates were calculated for selected diet-related mortality causes. In order to allow for a minimum of 10 years latency period between exposure and outcome, dietary scores from 1989/1990 and its components were correlated to the 3-year average 1999/2001 death rates. Tobacco expenses were included for adjustment. Significant negative correlations with the proportion of families with highest MAI (≥4) or HDIr (≥7) scores were observed for mortality from diabetes mellitus (−0.87, P < 0.05; −0.89, P < 0.5), cardiovascular diseases (−0.89, P < 0.05; −0.96, P < 0.01) and ischaemic heart disease (−0.89, P < 0.05; −0.90, P < 0.05). Malignant neoplasms were positively correlated with protein, cholesterol and soft drinks, but inversely with polyunsaturated fatty acids (PUFA). Diabetes showed significant positive correlations with simple sugars and animal fat intake, but inversely with fruits and vegetables. Cardiovascular diseases presented positive correlations with simple sugars, milk and dairy products and animal fat, but inverse with fruits and vegetables and vegetable oils. Despite the limitations of ecological approaches in general and of the statistical power in this particular study, due to the use of broad geographical areas, significant correlations in the expected direction of reduced mortality risk with improved household diet quality was reported. The use of diet quality scores in data from household budget surveys could depict variations in Portuguese regional food and nutrient patterns, which were revealed to be related and partially explain differences in regional cause-specific mortality rates from diet-related diseases.

Effect of a nutritional intervention promoting the Mediterranean food pattern on anthropometric profile in healthy women from the Québec city metropolitan area

To evaluate the impact of a nutritional intervention promoting a Mediterranean food pattern on anthropometric profile in healthy women. Nutritional intervention study. Laval University, Canada. Seventy-seven healthy women started the study and four did not complete the study. A 12-week nutritional intervention in free-living conditions consisted of two group courses on nutrition and seven individual sessions with a dietitian. A follow-up visit was performed 12 weeks after the end of the intervention (week 24). A Mediterranean dietary score (MedScore), based on the 11 components of the Mediterranean pyramid, was established to evaluate the adherence to the Mediterranean food pattern. Small but significant decreases in body weight and waist circumference were observed after 12 weeks of intervention (0.5 kg and 1.2 cm, respectively (P<0.01)). Increase in partial MedScore for legumes, nuts and seeds (increase in consumption) as well as increase in partial MedScore for sweets (decrease in consumption) were significantly associated with changes in waist circumference (r=-0.36, P=0.001; r=0.24, P=0.05, respectively). No association was observed between changes in anthropometric profile and changes in the consumption of olive oil. Changes in dietary food pattern, more specifically an increase in the consumption of legumes, nuts and seeds, and a decrease in the consumption of sweets, were associated with some beneficial changes in anthropometric profile.

Carotid intima-media thickness is inversely associated with olive oil consumption

Background Intima-media thickness (IMT) is a valid marker for generalized vascular disease whose main risk factors are associated with food habits and lifestyle. A Mediterranean food pattern may have a protective effect on cardiovascular mortality. Objective To assess the relationship between carotid IMT and olive oil consumption. Methods One hundred and ninety nine patients were randomly extracted from 1055 asymptomatic high cardiovascular risk participants at the AP-UNAV recruitment center of the PREDIMED (PREvención con DIeta MEDiterránea) project. Demographic and clinical variables were collected, and a validated semiquantitative food frequency questionnaire (137 items) was administered at the inclusion interview. A B-mode ultrasound imaging technique was used to measure the mean common carotid IMT. Results The mean age was 67.3 years and 53.3% were women. Energy-adjusted olive oil consumption quintiles were assessed as the main exposure after adjusting for potential dietary and non-dietary confounders. Using continuous carotid IMT as the outcome in an ANCOVA analysis, the adjusted IMT means throughout quintiles showed an inverse association with a plateau after the second quintile, with statistical differences when the adjusted IMT mean of the merged four upper quintiles were compared with the lowest quintile ( p < 0.05). The averaged (both sides) mean IMT of the common carotid was dichotomised and values above the median (0.804 mm) were used to identify carotid atherosclerotic damage. We also found an inverse association of olive oil consumption with high IMT, throughout the second to the fifth quintile as compared with the lowest quintile. The adjusted OR was of 0.08 (95% confidence interval, CI, of 0.02–0.37; p = 0.001) after merging the four upper quintiles. Conclusion The inverse association between the olive oil consumption and the carotid IMT could suggest a protective role of olive oil against the development of carotid atherosclerosis in persons at high cardiovascular risk.

Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore

Objective. We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity. Methods. A diet score (range 0–55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants ( n = 3042, enrolment 2001–02 in Athens metropolitan area, aged 18–89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too. Results. The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%–48%), 46% (95% CI 44%–49%), 12% (95% CI 11%–14%) and 33% (95% CI 30%–35%), while the negative predictive values are 86% (95% CI 85%–88%), 71% (95% CI 69%–74%), 98% (95% CI 97%–99%) and 97% (95% CI 96%–98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (± 0.1%, p < 0.001). Conclusion. The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease.

Factors influencing the dietary response to a nutritional intervention promoting the Mediterranean food pattern in healthy women from the Quebec City metropolitan area

The purpose of this study was to evaluate the influence of sociodemographic characteristics and baseline food habits on the dietary response to a nutritional intervention promoting the Mediterranean food pattern and maintenance of dietary modifications in 73 healthy women. The 12-week nutritional intervention in free-living conditions consisted of two group courses and seven individual sessions with a dietitian. A follow-up visit was performed 12 weeks after the end of the intervention (week 24). A Mediterranean dietary score was derived from a food frequency questionnaire, administered at 0, 6, 12 and 24 weeks. Marital status, socioeconomic level, educational level and household size did not seem to influence the dietary response, whereas women without children followed more closely dietary advice than women with children (OR, 3.6; 95% CI, 1.3-10.0). Planning food purchases in function of weekly discounts was also associated with better dietary response to the intervention (OR, 3.3; 95% CI, 1.3-8.8). Nutritional intervention promoting the Mediterranean food pattern was effective in modifying food habits of healthy women. The fact of having children or not and food purchase habits seem to influence the response to a nutritional intervention promoting the Mediterranean food pattern.

Mediterranean Diet and Cardiovascular Disease

In the early 60s, data from the Seven Countries Study demonstrated that diet was a key risk factor for cardiovascular disease (CVD). Several epidemiological studies have since then provided further support to this concept by demonstrating that adherence to a Mediterranean food pattern was associated with a reduction in total and CVD mortality. The mechanisms underlying the cardioprotective effects of the Mediterranean diet (MEDdiet) remain unclear. Our objective was to provide an overview of how a Mediterranean food pattern modulates traditional and non-traditional risk factors for CVD. Data reviewed herein indicated that the MEDdiet may beneficially alter total cholesterol, LDL-C and TG levels, although this has not been a consistent finding. However, the impact of the MEDdiet on non-traditional risk factors such as a lower plasma apolipoprotein B concentrations, a lower high-sensitivity C-reactive protein and interleukin-6 levels, and a better endothelial function appears to be more consistent. In conclusion, adherence to a MEDdiet has been almost unequivocally associated with a decrease in mortality and this may be largely attributable to the more consistent impact of this food pattern on non-traditional risk factors for CVD rather than on traditional risk factors.

Olive oil consumption and weight change: The SUN prospective cohort study

The aim of this dynamic prospective follow-up study was to assess the association between olive oil consumption and the likelihood of weight gain or the incidence of overweight or obesity in a large Mediterranean cohort of 7,368 male and female Spanish university graduates (the SUN Project) who were followed for a median period of 28.5 mon. A validated Food Frequency Questionnaire was administered at baseline, and respondents also completed a follow-up questionnaire after 28.5 mon. Changes in participants' consumption of olive oil and their weight were assessed during follow-up. A higher baseline consumption of olive oil was associated with a lower likelihood of weight gain, although the differences were not statistically significant. The adjusted difference in weight gain (kg) was -0.16 [95% confidence interval (CI): -0.42 to +0.11] for participants in the upper quintile of olive oil consumption (median: 46 g/d) compared with those in the lowest quintile (median: 6 g/d). For participants with a high baseline consumption of olive oil whose olive oil consumption also increased during follow-up, we found a slightly increased but nonsignificant risk of incidence of overweight or obesity (adjusted odds ratio = 1.19, 95% CI: 0.73 to 1.95). Our study, carried out in a sample of free-living people, shows that a high amount of olive oil consumption is not associated with higher weight gain or a significantly higher risk of developing overweight or obesity in the context of the Mediterranean food pattern.

The SUN cohort study (Seguimiento University of Navarra)

Cohort study (the SUN project) to identify dietary determinants of hypertension, diabetes, obesity and coronary heart disease (CHD), among other conditions. The SUN project is a Mediterranean dynamic prospective follow-up (cohort) study assessing participants every 2 years. The recruitment started in 2000 and it is permanently open (this is a dynamic cohort). A preliminary case-control study of myocardial infarction was also conducted, selecting incident cases of myocardial infarction and matched hospital controls. The SUN study is conducted in Spain with university graduates, most of them being former students of the University of Navarra. The case-control study was conducted in three tertiary hospitals in the city of Pamplona (Spain). The case-control study included 171 cases and 171 controls. We have currently enrolled more than 17,500 participants in the SUN cohort. Approximately 7500 of them were enrolled less than 2 years ago, and have not received yet the invitation to complete the 2-year follow-up assessment. The follow-up rate for the first 10,000 participants approaches 90%. The case-control study found inverse associations between olive oil (or adherence to a Mediterranean food pattern) and myocardial infarction. In the SUN cohort, after 28.5 months of follow-up a higher adherence to a Mediterranean food pattern rich in olive oil was associated with a reduced risk of hypertension, though the results were statistically significant only among men. The SUN study and the accompanying case-control study support the benefits of a Mediterranean diet and olive oil against CHD and hypertension.

A Nutritional Intervention Promoting the Mediterranean Food Pattern Is Associated with a Decrease in Circulating Oxidized LDL Particles in Healthy Women from the Québec City Metropolitan Area

The aim of the present study was to evaluate the effect of a nutritional intervention promoting the Mediterranean food pattern under free-living conditions on circulating oxidized LDL (ox-LDL) in a group of 71 healthy women from the Quebec City metropolitan area. The 12-wk nutritional intervention consisted of 2 courses on nutrition and 7 individual sessions with a dietitian. A score based on the 11 components of the Mediterranean pyramid was established to determine the women's adherence to the Mediterranean food pattern. Plasma ox-LDL concentrations were measured by a monoclonal antibody mAb-4E6-based competition ELISA. Among all women, plasma ox-LDL decreased by 11.3% after 12 wk of nutritional intervention (P < 0.0001) despite a lack of change in plasma LDL cholesterol (LDL-C). Also, an increase in the Mediterranean dietary score was significantly correlated with a decrease in ox-LDL concentrations (r = -0.30; P = 0.01). More specifically, increases in servings of fruits (r = -0.25; P < 0.05) and vegetables (r = -0.24; P < 0.05) were associated with decreases in ox-LDL concentrations. Changes in the food pattern in response to a nutritional intervention promoting the Mediterranean food pattern were accompanied by beneficial effects in circulating ox-LDL concentrations in healthy women.

Effect of a nutritional intervention promoting the Mediterranean food pattern on electrophoretic characteristics of low-density lipoprotein particles in healthy women from the Québec City metropolitan area.

The objective of the present study was to evaluate the effect of a nutritional intervention promoting the Mediterranean food pattern in free-living conditions on LDL electrophoretic characteristics in a group of seventy-one healthy women, aged between 30 and 65 years. The 12-week nutritional intervention consisted of two courses on nutrition and seven individual sessions with a dietitian. The first course provided information on the Mediterranean food pattern and the second was a cooking lesson. LDL peak particle diameter (LDL-PPD) and cholesterol levels in small (LDL-cholesterol<255 A) and large LDL fractions (LDL-cholesterol>260 A) were obtained by 2-16 % polyacrylamide gel electrophoresis of whole plasma. The sample was divided on the basis of baseline LDL-PPD using tertiles of the distribution (258.4 A and 260.0 A). Among the total sample of women, no significant change in LDL-PPD was observed in response to the nutritional intervention. However, subjects who at baseline were in the first tertile of the LDL-PPD distribution (<258.4 A) showed a significant increase in LDL-PPD and in the proportion of LDL %>260 A in response to the 12-week nutritional intervention (P<0.05). In contrast, LDL-PPD decreased significantly (P=0.007) among women with large LDL particles at baseline (LDL-PPD >260 A) while the proportion of LDL %<255 A and of LDL %>260 A remained unchanged. To conclude, changes in the food pattern, in response to a nutritional intervention promoting the Mediterranean food pattern, were accompanied by beneficial modifications in LDL electrophoretic characteristics in women who were characterised at baseline by smaller LDL particles.

Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women

The present study examined the effect of a nutritional intervention promoting the Mediterranean food pattern in uncontrolled ‘real life’ conditions among a group of 77 French-Canadian women. The principal objective was to document changes in the plasma lipid-lipoprotein profile and in body weight that occurred in response to the intervention. The 12-week nutritional intervention included two group sessions, three individual sessions and four 24-h recalls (phone interview) with a registered dietitian. A score based on the 11 components of the Mediterranean pyramid, ranging from 0 to 44 points, was established to evaluate the adhesion to the Mediterranean food pattern. The Mediterranean score increased from 21.1±3.6 at baseline to 28.6±4.4 after 6 weeks of intervention ( P<0.0001) with no further increase at week 12. Small but significant decreases in total cholesterol and apolipoprotein B (apoB) as well as in body mass index (BMI) were observed after 6 weeks of intervention. No significant change in plasma concentrations of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were observed in response to the nutritional intervention. In conclusion, a nutritional intervention program promoting the Mediterranean food pattern was effective in modifying food habits of healthy women from the Québec City metropolitan area and resulted in small but significant effects on specific cardiovascular risk factors.

Spanish food patterns.

Data from household food budgetary surveys and regional, population-based, cross-sectional studies show a declining trend in energy intake in the last decades, also applicable to protein, fat and carbohydrate intakes in absolute terms. The pattern suggests a lower fat content in the diet. Protein intake is 200% of the recommended level. Spanish food patterns underwent dramatic changes between the 1960s and the 1980s, including an important increase in fat intake, up to 44% energy intake from fat in the 1980s. The trend changed in the 1990s, and current fat supply provides an average of 37% of energy intake. Main sources of fat in the Spanish diet are added fats for cooking (49% of total fat intake), especially olive oil; meat and meat products (25%); and a lower percentage provided by milk and dairy products. Most saturated fatty acids are supplied by meats (30%) and dairy products (27%). Rapid urbanisation processes and the growing proportion of females in the active workforce have led to important changes in food patterns in the last decades. On the one hand, some changes had a positive impact, such as increasing variety in the diet and access to food; on the other hand, some changes moved the Spanish diet away from the traditional Mediterranean food pattern. Current food patterns evidence high consumption of animal products: meat, fish, milk and dairy products. It seems advisable to increase consumption of plant foods, particularly whole-grain cereals, potatoes and pulses. Intake of fruit and vegetables shows a shift towards a greater consumption of processed foods rather than fresh products, and overall a greater consumption would be recommended.