Mediterranean Index Research Articles

Adherence to Mediterranean Diet and Biomarkers of Redox Balance and Inflammation in Old Patients Hospitalized in Internal Medicine.

We have previously described that low adherence to the Mediterranean diet (MD) in elderly patients admitted in internal medicine wards is linked to poorer clinical outcomes. This investigation was designed to explore whether adherence to the MD is related to circulating markers of redox balance and inflammation in this clinical scenario. A cross-sectional study was performed on 306 acute old patients hospitalized in internal medicine wards. Adherence to the MD was estimated by the Italian Mediterranean Index (IMI). The circulating markers of redox balance were assessed in serum and erythrocytes and correlated with inflammatory markers across different MD adherence groups. Compared to the patients with high adherence, those with low adherence to the MD exhibited severely impaired redox balance, as evidenced by a higher GSSG/GSH ratio and increased serum hydroxynonenal/malondialdehyde-protein adducts. No modifications were described in the expression of antioxidant enzymes in peripheral blood mononuclear cells. Patients with low adherence to the MD exhibited a higher neutrophil-to-lymphocyte ratio and markers of systemic inflammation, as well as raised levels of interleukin-6 and tumor necrosis factor, compared to those with high MD adherence. A strong association was observed between the circulating markers of redox balance and inflammation/immune response, with the highest regression coefficients found in the low adherence group. Old patients admitted to internal medicine wards with low adherence to the MD display unfavorable profiles of the circulating markers of redox balance and inflammation. It is conceivable that such effects on redox balance can be linked to the high polyphenol content of MD. This study supports the rationale for intervention trials that attest to the effectiveness of MD as a nutritional strategy for disease prevention.

Adherence to Diet Quality Indices and Breast Cancer Risk in the Italian ORDET Cohort.

Breast cancer (BC) is the most common cancer in women, with 2.3 million diagnoses in 2020. There is growing evidence that lifestyle factors, including dietary factors, particularly the complex interactions and synergies between different foods and nutrients (and not a single nutrient or food), may be associated with a higher risk of BC. The aim of this work was to evaluate how the Italian Mediterranean Index (IMI), the Greek Mediterranean Index, the DASH score, and the EAT-Lancet score can help lower the risk of BC, and analyze if chronic low-grade inflammation may be one of the possible mechanisms through which dietary patterns influence breast cancer risk. We evaluated the effect of adherence to these four dietary quality indices in the 9144 women of the ORDET cohort who completed a dietary questionnaire. The effect of adherence to dietary patterns on chronic inflammation biomarkers was evaluated on a subsample of 552 participants. Hazard ratios (HRs) with 95% confidence intervals (CIs) for BC risk in relation to the index score categories used were estimated using multivariable Cox models adjusted for potential confounders. Regression coefficients (β), with 95% CI for C-reactive protein (CRP), TNF-α, IL-6, leptin, and adiponectin levels in relation to adherence to dietary patterns were evaluated with the linear regression model adjusted for potential confounders. IMI was inversely associated with BC in all women (HR: 0.76, 95% CI: 0.60-0.97, P trend = 0.04), particularly among postmenopausal women (HR: 0.64, 95% CI: 0.42-0.98, P trend = 0.11). None of the other dietary patterns was associated with BC risk. Higher IMI and Greek Mediterranean Index scores were inversely associated with circulating CRP (β: -0.10, 95% CI: -0.18, -0.02, and β: -0.13, 95% CI: -0.21, -0.04). The higher score of the EAT-Lancet Index was instead associated with a higher concentration of circulating levels of CRP (β: 0.10, 95% CI: 0.02, 0.18). In conclusion, these results suggest that adherence to a typical Italian Mediterranean diet protects against BC development, especially among postmenopausal women, possibly through modulation of chronic low-grade inflammation.

Lower Multiple Sclerosis Severity Score Is Associated with Higher Adherence to Mediterranean Diet in Subjects with Multiple Sclerosis from Northwestern Italy.

The Mediterranean Diet (MD) is described in the literature as a beneficial dietary pattern for neurodegenerative diseases such as Multiple Sclerosis (MS). The objective of this study was to evaluate the dietary habits in people with MS (pwMS) and to test whether adherence to the MD could have an impact on the severity of the disease measured as the MS severity score (MSSS). Adherence to the MD was assessed in 31 PwMS using the Mediterranean Diet Adherence Screener (MEDAS), the Pyramid-based Mediterranean Diet Score (PyrMDS) index, and the Italian Mediterranean Index (IMI), and their eating habits were recorded in a food diary for a one-year follow-up. When data obtained from dietary analysis were compared to the MSSS, results showed that pwMS with lower MSSS adhere more to the MD than the other pwMS groups according to the MEDAS index. Furthermore, a high consumption of fiber in the MS mild severity class was observed. Further studies are needed to clarify which of the nutritional components of the MD may impact the course of MS and if the sensitization of pwMS to MD adherence can be a strategy for mitigating the disease.

Health-Promoting Food Labelling – Benefits and Drawbacks

Abstract This work systematizes the knowledge on several food labelling systems, namely the Nutri-Score, the NutrInform, and the Mediterranean Index (Med Index). The Nutri-Score system assesses nutritional value of a product per 100 g or 100 ml with no consideration of usually consumed serving as well as vitamins, minerals, and bioactive compounds. The concept of NutrInform does not label food products as ‘good’ or ‘bad’. Instead, it indicates energy content in a serving (50 or 100 g) and contents of individual nutrients in a serving along with the percentage of their reference values of recommended daily intake. Thus, the NutrInform label placed on a product by a manufacturer participating in the system presents information in the following order: energy content in calories, contents of fatty acids, saturated fatty acids, sugars, and salt (everything expressed in grams). The Med Index covers three pillars of sustainability, taking into account nutritional, environmental, and social aspects. This labelling system assesses 27 criteria (9 for each pillar), the presence or absence of which is immediately visible to the consumer by a different colour of a label on the front of the pack (where blue reflects to the best score). A single graphic symbol allows consumers to simultaneously analyse various properties of the product and/or its production process in a few seconds. It forms a useful tool for comparing food products belonging to the same category and a useful system for ending the information asymmetry that characterizes the market of many food products. In our opinion, the concept of the Med Index would be the most useful considering health-promoting labelling of food products in Poland.

The Effect of Remote Teleconnection Patterns on Temperature and Precipitation of the Euphrates-Tigris Basin

The Euphrates-Tigris Basin is the most important water source in the Middle East. The present study examined the relationship between the precipitation and temperature characteristics of the basin using remote teleconnection patterns on a monthly time scale. The effects of the North Atlantic, Arctic Oscillations, North Sea Caspian Pattern, and Western Mediterranean indices were examined. The relationship between teleconnection patterns and precipitation/temperature was investigated by adopting Spearman’s Correlation test. All of the remote teleconnection patterns had significant effects on the temperature and precipitation characteristics of the basin. However, the North Sea Caspian Pattern significantly affected the temperatures of the entire basin. Similarly, the Western Mediterranean index had a significant effect on the average temperatures for four months (February, April, November, and December) in almost the entire basin. Also, the Western Mediterranean Index corralates positively with the precipitation of the basin in January, while the correlation is negative in October, and November. Especially, the Western Mediterranean Index and the North Sea Caspian Pattern showed one-month and two-month delayed relationships in monthly total precipitation in some months. At the extremes of the index values, relationships often became strong and distinct. The study results may be useful for seasonal temperature and precipitation forecasts of the Euphrates-Tigris basin.

Tropical nights (1976–2019) as an indicator of climate change in Ukraine

The article presents the results of an analysis of the number, frequency and intensity of tropical nights in Ukraine. We have selected such weather stations that are located at different latitudes and correspond with the north, west, east, and south as well as the central part of Ukraine. This was done in order to analyse the differences in tropical nights across latitudes. Also we have weather stations located at the approximately one latitude to analyse how tropical nights vary in longitude. Data from weather stations for 1976-2019 were under analysis. We can say that the increase in the minimum air temperature during summer is on the whole territory of Ukraine. This leads to the fact that since the mid-1990s tropical nights begin to be observed in the east of Ukraine, as well as in the south. After 2000, tropical nights also have begun to be observed in the centre and even in the west of Ukraine. Between two half-periods (1976-1997 and 1998-2019) the increase of number of tropical night events in the south of Ukraine (up to 300 cases) is much more significant than the increase in their number in the northwest (up to 20 cases). As well as the frequency, the intensity of tropical nights also increases. There are cases with minimum daily air temperatures above 25°C. The analysis of the North Atlantic Oscillation (NAC) and the Mediterranean (Cairo-Algeria) indices in the context of explaining the tropical night’s occurrence in Ukraine turned out to be quite effective.

Towards a new food labelling system for sustainable food production and healthy responsible consumption: The Med Index Checklist

By 2024, the European Commission will examine a new sustainable labeling framework. Here we describe the development of a new food product labeling system, named Mediterranean Index (Med Index), aimed at promoting adherence to the Mediterranean diet (healthy and sustainable nutritional pattern) by stimulating citizens to practice physical activity consistent with the energy intake of meals and encouraging producers to make healthier and more sustainable food products. It is characterized by the possibility of integrating 27 criteria addressing the issue of sustainable food production processes in the frame of three pillars: nutritional, environmental, and social sustainability. It is conceived as a holistic front-of-pack (FOP) label, complete and applicable by food producers as it is based on measurable criteria, widely shared by stakeholders, but usually adopted on an individual basis.

Processed meat consumption and associated factors in Chile: A cross-sectional study nested in the MAUCO cohort.

Processed meat consumption is increasing in Latin America. While in developed countries processed meat consumption has been associated with cardiovascular diseases and cancer, our region lacks data associated to its consumption and health impact. We characterized processed meat intake and associated factors in a population-based cohort of a Chilean agricultural county, MAUCO. We analyzed baseline dietary data of 7,841 participants, 4,358 women and 3,483 men (38-77 years), who answered an adapted Mediterranean index food frequency questionnaire. Eight percent of the participants presented high processed meat consumption (≥5 times per week). We explored associations of processed meat consumption with participant characteristics using multinomial logistic regression models. Main factors associated with higher consumption were being men, younger and currently employed, and having a high intake (>4 times per week) of red meat (Odds ratio, 2.71, 95% CI 2.10-3.48), butter/cream (1.96, 1.60-2.41), whole-fat dairy products (1.32, 1.04-1.67) and a high intake (≥1 time per day) of sugary snacks/sweets (2.49, 2.04-3.03) and sugary drinks (1.97, 1.63-2.38). Processed meat consumption associated to chronic diseases, particularly cardiovascular disease (Prevalence ratio, 2.28, 95% CI 1.58-3.29). Obesity mediated this association in a proportion of 5.0%, whereas for diabetes the proportion was 13.9%. In this population, processed meat was associated with other unhealthy dietary and lifestyle factors, as well as with chronic diseases, particularly cardiovascular disease.

Dietary Patterns and Blood Biochemical and Metabolic Parameters in an Italian Population: A Cross-Sectional Study

Diet has long been identified as a major determinant of cardiovascular and other chronic diseases. In this study, we assess the relation between adherence to different dietary patterns and biochemical and metabolic parameters as well as the 10-year risk of major cardiovascular diseases (CVDs) in a community of blood donors in Northern Italy. We assess their adherence to four dietary patterns, namely, the Dietary Approach to Stop Hypertension (DASH) diet, the Mediterranean diet through the Greek and Italian Mediterranean Indices (GMI and IMI) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, using a validated semi-quantitative food frequency questionnaire (FFQ). We then assess their association with blood parameters and the 10-year risk of major CVD using a spline regression model. We found an inverse association between the DASH and MIND diets and total and LDL cholesterol, and triglyceride and HDL cholesterol values for the Mediterranean diets (IMI and GMI). Additionally, according to our sex-stratified analyses, men who have greater adherence to dietary patterns have a decreased risk of major CVD for all patterns. The results suggest that greater adherence to dietary patterns positively influences blood biochemical and metabolic parameters, thus reducing the risk of developing cardiovascular disease and delaying the use of drug treatments.

Adherence to the Mediterranean diet and its association with environmental footprints among women of childbearing age in the United Arab Emirates.

To examine the association of adherence to the Mediterranean Diet (MD) with Environmental Footprints (EFPs) among women of childbearing age in the United Arab Emirates (UAE). Data belonging to a nationally representative sample of 482 women (19-50years) were derived from a previous survey in the UAE. In face-to-face interviews, participants completed questionnaires addressing sociodemographic, physical activity, and dietary intake characteristics; the latter assessed using a multiple pass 24-h recall. The composite Mediterranean (c-MED) index was used to examine the adherence to the MD. Metrics for the EFPs (water use, energy use, and GHG emissions) were calculated using Life Cycle Analyses. Descriptive statistics and linear regressions were used in data analysis. In the study sample, the distribution of the c-MED scores was skewed to the right, indicating a low adherence to the MD. The lowest contributions to the total c-MED score were observed for legumes (2.9%) and olive oil (1.8%). The EFPs associated with food consumption per 1000kcal were: water use: 1256.89 ± 544.95 L/day; energy use: 18.01 ± 7.85MJ/day, and GHG: 2.46 ± 1.46kg CO2 eq/day. After adjustment for age, energy intake, and potential confounders, being adherent to the MD was associated with 540.57 [95% CI (-726.6; -354.54)] units decrease in water use and 0.94 units decrease in GHG emissions [95% CI (-1.45; -0.43)]. The findings of this study revealed an inverse association between adherence to the MD and EFPs. As such, the MD may represent a promising dietary strategy to improve health outcomes and reduce the environmental impact. Public health programs addressing the low adherence to the MD among women of childbearing age in the UAE are warranted.

Med-index: a food product labeling system to promote adherence to the mediterranean diet encouraging producers to make healthier and more sustainable food products

Consumers are increasingly demanding transparency in food labeling as they want more and better information about what they are eating and where their food comes from. Several food indexes have been developed in the last decades to promote healthy eating with the aim of reducing certain diseases such as obesity, cancer, and diabetes. The Mediterranean diet is known to be one of the healthiest dietary patterns, and it is associated with a lower incidence of mortality from all-causes, and it is also related to a lower incidence of cardiovascular diseases, type 2 diabetes, certain types of cancer, and neurodegenerative diseases; however, a comprehensive index that quantifies the Mediteraneaness of foods is still missing. The real European challenge is to identify a uniform labeling system for the whole of Europe which promotes a healthy lifestyle. This article describes the development of the Mediterranean Index (MI), which aims to accurately measure the degree of food Mediterraneaness. The MI simultaneously integrates nutritional and sustainability characteristics of foods. The MI may provide an objective basis for the use of the “Mediterraneaness” label on food products, which can ultimately promote adherence to the Mediterranean diet encouraging producers to make healthier and more sustainable food products. Growing consumer concern toward health foods for better health can be a factor useful to promote the applicability of the precision nutrition principles by means of conscious choice.

Climate index; Cold events; Extreme; Precipitations.

The cold events and Precipitation conditions having special attention in the last years due to their impact on human health, ecosystems, and other aspects such as agriculture, hydrology. The ECMWF ERA-Interim 12-hourly (03 and 15 UTC) total precipitations and Tmin in a 1º x 1º grid covering Iraq, from 29° N to 38° N and from 39° W to 48° E, with a total of 10 by 10 cells, was used. At each grid point, extremes were defined as those events in which total precipitations were above 99th percentile for the 25 years period 1994-2018. For more investigation, the Hybrid Single-Particle Lagrangian Integrated The trajectory (HYSPLIT) model was used to study the dynamical mechanism that led to producing the cold events in Iraq. The number of extreme precipitations patterns shows an increasing behavior in the number of extreme events especially in the last decade, farther more there is a significant increase in the number of extreme precipitations in the last three years ago. No correlations were found with NAO, EA index, in contrast, there is a significant negative correlation with winter Arctic oscillations index. The aim of this work is studying the precipitation and cold extreme events in Iraq and their relations of most hemispheric pattern which influence in the Middle East region such as North Atlantic Oscillation (NAO), East Atlantic index (EA), Artic oscillation index (AO) and Mediterranean index (MOi). We speculate that the results of this study can provide a better understanding of extreme cold and precipitations anomalies in Iraq from a large-scale view.The cold events and Precipitations conditions having special attention in the last years due to their impact on human health, ecosystems and other aspects such as agriculture, hydrology. The ECMWF ERA-Interim 12-hourly (03 and 15 UTC) total precipitations and Tmin in a 1º x 1º grid covering the Iraq, from 29° N to 38° N and from 39° W to 48° E, with a total of 10 by 10 cells, was used. At each grid point, extremes were defined as those events in which total precipitations were above its 99th percentile for the 25 years’ period 1994-2018. For more investigation, the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model was used to study the dynamical mechanism that led to produce the cold events over Iraq. The number of extreme precipitations pattern shows an increasing behavior in the number of extreme events especially in last decade, farther more there is a significant increase in the number of extreme precipitations in last three years ago. No correlations were found with NAO, EA index, in contrast, there is a significant negative correlation with winter Arctic oscillations index. The aim of this work is studying the precipitation and cold extreme events in Iraq and their relations of most hemispheric pattern which influence in the Middle East region such as North Atlantic Oscillation (NAO), East Atlantic index (EA), Artic oscillation index (AO) and Mediterranean index (MOi). We speculate that the results of this study can provide a better understanding of extreme cold and precipitations anomalies in Iraq a large-scale view.

Adherence to the Mediterranean diet and body composition of breast-feeding mothers: the potential role of unsaturated fatty acids.

A paucity of evidence is available regarding the impact of diet's quality during pregnancy and lactation on the body composition of breast-feeding mothers. The purpose of the present study was to evaluate the association between maternal degree of adherence to the Mediterranean diet (MD) and body composition measures specifically those relating to body fat, in the lactation period. A cross-sectional study on healthy mothers of full-term babies has been conducted. At 30 ± 10 d after delivery, anthropometric measurements and body composition were assessed. A food frequency questionnaire was performed to compute the Italian Mediterranean Index (IMI) score as an index of adherence to the MD. Data related to pregnancy such as pre-pregnancy weight, gestational weight gain and morbidities were also collected. The 147 mothers included were categorised in IMI-1 (IMI score < 5; n 92) and IMI-2 (IMI score ≥ 5; n 55) groups. IMI-2 mothers showed higher daily energy, total carbohydrates, starch and fibre intakes than IMI-1. The dietary habits of IMI-2 mothers reflect the typical characteristics of MD: they consumed higher quantities of proteins and lipids of vegetal origin, higher amounts of monounsaturated and polyunsaturated fatty acids (PUFAs) and lower saturated to PUFAs ratio. The IMI-2 group showed lower absolute fat mass and fat mass index compared to IMI-1 [(20⋅2 ± 5⋅9) v. (22⋅9 ± 8⋅4) kg; P 0⋅036 and (7⋅5 ± 2⋅2) v. (8⋅5 ± 3⋅1) kg/m2; P 0⋅036, respectively], whereas body weight [(61⋅1 ± 8⋅0) v. (63⋅3 ± 9⋅2) kg] and body mass index [(22⋅4 ± 2⋅6) v. (23⋅3 ± 3⋅5) kg/m2] were similar. The degree of adherence to the MD during pregnancy and lactation is positively associated with lower maternal fat deposition in the breast-feeding period. The higher quality of dietary lipids, probably in synergy with the assumption of starchy carbohydrates and fibre, could influence maternal body fat.

Comparison of Different Dietary Indices as Predictors of Inflammation, Oxidative Stress and Intestinal Microbiota in Middle-Aged and Elderly Subjects.

During the last decades the gut microbiota has been identified as a key mediator in the diet-health interaction. However, our understanding on the impact of general diet upon microbiota is still limited. Dietary indices represent an essential approach for addressing the link between diet and health from a holistic point of view. Our aim was to test the predictive potential of seven dietary ratings on biomarkers of inflammation, oxidative stress and on the composition and metabolic activity of the intestinal microbiota. A cross-sectional descriptive study was conducted on a sample of 73 subjects aged >50 years with non-declared pathologies. Dietary inflammatory index (DII), Empirical Dietary Inflammatory Index (EDII), Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Mediterranean adapted Diet Quality Index-International (DQI-I), Modified Mediterranean Diet Score (MMDS) and relative Mediterranean Diet Score (rMED) were calculated based on a Food Frequency Questionnaire. Major phylogenetic types of the intestinal microbiota were determined by real time polymerase chain reaction (qPCR) and fecal short chain fatty acids (SCFAs) by gas chromatography. While DII, HEI, DQI-I and MMDS were identified as predictors of Faecalibacterium prausnitzii levels, AHEI and MMDS were negatively associated with Lactobacillus group. HEI, AHEI and MMDS were positively associated with fecal SCFAs. In addition, DII and EDII explained lipoperoxidation level and Mediterranean scores the serum IL-8 concentrations. The lower detection of IL-8 in individuals with higher scores on Mediterranean indices may be partially explained by the increased levels of the anti-inflammatory bacterium F. prausnitzii in such individuals.

Gender, Age, Geographical Area, Food Neophobia and Their Relationships with the Adherence to the Mediterranean Diet: New Insights from a Large Population Cross-Sectional Study.

The Mediterranean diet (MD) is associated with many health benefits. The association between the MD and food neophobia (FN) is still unexplored in adults. The present cross-sectional study was aimed to explore the relationships between adherence to the MD, FN, and sociodemographic variables in a large Italian cohort. Familiarity and frequency use (FFI) of prototypical and non-prototypical Mediterranean foods were used to calculate a new adherence index: the Italian Taste Mediterranean Index (ITMI). The FFI of all Mediterranean foods increased with age, while butter, soft drinks, red/cured meat, and sweets were more common in younger people. Accordingly, ITMI increased with age (F2,2384 = 54.11; p < 0.0001). Women recorded a higher ITMI (6.70) than men (6.10). Individuals with high FN showed higher FFI for soft drinks and sweets and lower ones for most typical MD foods, than individuals with low FNs. A decrease of ITMI was recorded with the increase of the FN(F2,2384 = 22.84; p < 0.0001). With ageing, ITMI increased even in individuals with a high FN. The results suggest that FN may negatively affect adherence to the MD, lowering its potential health benefits, in the adult population. Monitoring of food habits, dietary education, and anxiety management, may be valuable tools to control FN and support the adherence to the MD.

Towards instability index development for heavy rainfall events over Egypt and the Eastern Mediterranean

The main objective of this study is to develop two indices capable to identify areas where rain showers are possible over Egypt and the Eastern Mediterranean Region (EEMR). This is done by adding a coefficient to each K index variable. The coefficients are obtained from a multiple linear regression that is constructed between rainfall as predictant and K index variables as predictors. This is the case of the first Egypt and Eastern Mediterranean Index (EEM1). The other developed index (EEM2) differs from EEM1 by adding dew point at 500 hPa as other predictor. Six hourly dataset from European Centre for Medium-Range Weather Forecasts (ECMWF) for three wet events with heavy rainfall during January, March and November are used to construct the new regression equations. On the other hand, the validation of this technique is applied to different six wet events with heavy rain showers (two events for each of winter, spring and autumn season). The category scale of the two developed indices is adjusted to be compatible with the K index. The results show that rainfall occurs only over EEMR when K and EEM indices are ≥ 20, respectively. The result of estimating spatial and temporal distribution of rain showers shows that EEM2 is more accurate than EEM1 and K index due to including dew point temperature at 500 hPa. The average EEM2 (EEM1) Rain Area Relative Error (RARE) in November, January and March reaches 31.84% (47.61%), 43.82% (50.43%) and 49.72% (55.22%), respectively. On the other hand, the corresponding average K index RARE is 164.97%, 74.43% and 163.09%, respectively.

Improving the quality of foods available in a rural kibbutz cafeteria in Israel to align with a freshly prepared Mediterranean-style diet through a community culinary coaching programme.

To examine the impact of a community culinary coaching programme (CCCP) on cafeteria food alignment with a freshly prepared Mediterranean-style diet, and diners' consumption habits and satisfaction. A non-randomized, controlled, community-based participatory research programme. CCCP included eight 90 min coaching sessions with a community steering committee, 22 h of kitchen staff training, 12 h of pre-school staff training and 30 h of education for diners; control communities received no intervention. Outcomes, measured before and 12 months after programme initiation, included cafeteria food alignment with a freshly prepared Mediterranean-style diet through a food items list derived from the cafeteria food purchasing software, and adult diners' consumption habits and satisfaction through questionnaires. Communal cafeterias of rural kibbutzim. Intervention: kibbutz with 493 adults and 214 children. Control: Two kibbutzim with a total of 487 adults and 206 children. Intervention cafeteria food improved significantly in all Mediterranean index categories except nuts (legumes, wholegrain products, fish, MUFA/SFA P < 0·0001; fruits, vegetables P < 0·001; processed meats P = 0·004), and in the proportion of ultra-processed and unprocessed or minimally processed foods categories of the NOVA classification (-22 %, P < 0·001 and +7 %, P < 0·001, respectively), compared with the control community. The intervention group's satisfaction was significantly improved in twenty-five (83 %) out of the thirty satisfaction items, compared with twelve (40 %) in the control group. No changes were identified in diners' consumption habits in either intervention or control communities. CCCP might be useful in improving alignment of cafeteria food with a freshly prepared Mediterranean-style diet.

Impact of hydromorphological pressures on the macrophytes bioindicators of the ecological water quality in Mediterranean rivers

One of the important tools to evaluate the ecological quality of surface water is the Macrophytes indices based on the bioindication capacity of aquatic plants. In Mediterranean rivers (France, Spain, and Portugal), the development of some macrophytes indices like l’Indice Biologique Macrophytes Rivières (IBMR), the biological metric score (BMS), as well as the Fluvial Macrophyte Index (IMF) are founded on the determination of the indicator values of the floristic reference lists.The aim of this study was to test the impact of the eco-Mediterranean differences (from one country to another) on the indicator taxa by comparing the indicator values of the Euro‐ Mediterranean macrophyte indices. With this in mind, we explore the possibility of the introduction of the Euro‐Mediterranean macrophytes-based indices in Morocco (i.e. the hydrological basin of Sebou (HBS)) as a part of a preliminary attempt to develop the first Afro-Mediterranean macrophyte index.We confirm that the ecological amplitude and species optima vary between Mediterranean ecoregions, and indicator taxa differ between countries: There are medium to small correlations between Mediterranean indices: IBMR/BMS (p = 0.000, R2= 0.57), IMF/BMS (p = 0.000, R2= 0.34), and IBMR/IMF (p = 0.000, R2= 0.30). Five species exhibit major differences in indicator values:ZannichelliapalustrisandPotamogetonpectinatushave more eutrophic indicator values in France (IBMR) than in Spain (IMF).Potamogetonnodosus,AmblystegiumripariumandLycopuseuropaeushave broader ecological amplitudes in Portugal (BMS) than in France (IBMR) and in Spain (IMF), where it is restricted to eutrophic conditions. Furthermore, the three indicator systems include different indicator-taxon numbers.The comparison of the HBS elaborated list with the Euro‐Mediterranean indices revealed the low level of common taxa approximately 6.76% of all indicator species used in the French index (IBMR), 10.48% in the Portuguese index (IMF) and 12.38% in the Spanish index (BMS).These results show the inadequacy of the trophic indices approach with the HBS conditions and thus the need for the development of an index based on biotic indices approach.

Adherence to Mediterranean Diet, Malnutrition, Length of Stay and Mortality in Elderly Patients Hospitalized in Internal Medicine Wards.

This investigation aimed to explore the adherence to a Mediterranean Diet and its relationship with length of stay and in-hospital mortality, circulating interleukins, body composition, and frailty, in elderly patients hospitalized in internal medicine wards. Thus, a cross-sectional study in 194 acute hospitalized, community-dwelling elderly patients was performed. Adherence to a Mediterranean Diet was evaluated by the Italian Mediterranean Index (IMI). Length of stay, but not in-hospital mortality rate, was higher in patients with a low IMI score, as compared to subjects with high IMI score. Markers of systemic inflammation, as well as circulating interleukin-6 and tumor necrosis factor alpha, were higher in patients with a low IMI score, with respect to patients with high IMI score. Furthermore, patients with low IMI score had increased fat mass and reduced lean mass, together with a higher prevalence of frailty, as compared to those presenting with high IMI score. In a multivariate logistic regression model, an IMI score < 3 resulted as an independent predictor of longer length of stay. In conclusion, low adherence to a Mediterranean Diet in elderly patients hospitalized in internal medicine wards is associated with higher length of stay and related to unfavorable changes in circulating pro-inflammatory markers and body composition.

Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet?

Background and AimsThe only treatment for celiac disease (CD) is strict, lifelong adherence to a gluten-free (GF) diet. To date, there are contrasting data concerning the nutritional adequacy of GF products and diet. There have been no studies that have assessed the adherence of individuals with CD to a Mediterranean diet (MD), a protective dietary regimen against major non-communicable diseases (NCDs). Therefore, we examined the adherence to an MD of a group of Italian individuals with CD and compared it with that of a healthy control group. Methods and ResultsIn a cross-sectional study, a sample of individuals with CD and a group of healthy subjects were included. The dietary habits of all participants were recorded using a validated food frequency questionnaire, and the adherence to an MD was determined using the Italian Mediterranean Index. Typical Mediterranean food consumption was not significantly different between individuals with CD and the healthy participants, except for fruits (P = 0.017). However, individuals with CD consumed significantly higher amounts of potatoes (P = 0.003) and red and processed meat (P = 0.005) than healthy participants. The resulting mean Italian Mediterranean Index was significantly higher in healthy participants than in individuals with CD (P < 0.001). ConclusionThe results raise questions concerning the food choices of individuals with CD, suggesting the need of encouraging them to make better food choices more in line with an MD, which would improve their nutritional status and better protect them from NCDs at long term. Protocol registrationClinicalTrials.gov (ID NCT01975155) on November 4 2013.