Traditional Mediterranean Diet Research Articles

The Impacts of the Low-FODMAP Diet on the Management of Irritable Bowel Syndrome Symptoms: Possibilities, Feasibility, and Alternatives

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition characterized by a myriad of GI symptoms (e.g., diarrhea, nutrient malabsorption) that vary in severity. Due to its complex and individual nature, there is no known cure for IBS, but many diets have been assessed for their viability in managing symptoms. The low-FODMAP diet has recently been investigated for its potential benefits for IBS patients. FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols are short- and medium-chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon. Consumption of these FODMAPs correlates with increasing severity of IBS symptoms. The purpose of this randomized controlled trial systematic review was to compile various evidence-based dietary recommendations for the low-FODMAP diet for adult patients suffering from IBS from randomized controlled and clinical trials. The possibilities, feasibilities, and potential alternatives are proposed to determine if there is sufficient evidence to recommend the low-FODMAP diet for this patient population. Over 1,000 studies were screened and 6 were reviewed to determine the benefits of this diet. It was found that the low-FODMAP diet has demonstrated efficacy in delivering IBS symptom relief by changing patients’ metabolomes, microbiomes, and physiology. Specifically, this diet showed a greater overall decrease in abdominal pain, bloating, stool consistency, frequency, and urgency. Greater diversity of actinobacteria was found in the stool samples of these patients. Nociceptive neurons were also shown to be less sensitive and GI gas production was also markedly decreased. Despite these benefits, the low-FODMAP diet is more recommended for acute flare-ups due to its difficult adherence and attrition. Instead, we conclude that the balanced Mediterranean diet contains aspects of the traditional Mediterranean and low-FODMAP diet that can relieve IBS symptoms for daily life, while the low-FODMAP diet can be an effective treatment to ameliorate conditions when severe symptoms are experienced.

Can the Mediterranean diet be a key to unlocking women’s reproductive health?

The traditional Mediterranean Diet (MedDiet) is consistent with a dietary pattern and time-honoured eating behaviours by populations living in the olive-tree growing areas of the Mediterranean basin before the mid-1960’s. The MedDiet is described in the literature as a plant-based dietary pattern, consistent with a high intake of vegetables, fruits, nuts, legumes, wholegrains cereals, and daily use of extra-virgin olive oil incorporated into all meals; moderate consumption of fish, shellfish, fermented dairy products (cheese and yogurt), and wine (typically during meals); and a low or infrequent consumption of meat and processed meat products, processed cereals, sweets, vegetable oils, and butter(1). Being predominately plant-based, the MedDiet is naturally low in saturated fat, and rich in several functional components, including vitamins and minerals, carotenoids, unsaturated fatty acids, and phenolic compounds, depicted by antioxidant and anti-inflammatory properties. As a result of its putative beneficial health effects, the MedDiet is one of the most widely evaluated dietary patterns in the scientific literature(2). In both observational and intervention studies, there is a large and consistent body of evidence to support that a MedDiet is protective against chronic and inflammatory conditions, including cardiovascular disease, metabolic syndrome, management and prevention of type 2 diabetes, central adiposity, cancer, neurodegenerative conditions, and frailty(3). The effect of the MedDiet on women’s reproductive health is an emerging area in the literature. There have been a range of studies (observational and interventional) examining outcomes related to menarche, menstrual cycle, pregnancy, infertility, lactation, and menopause. The MedDiet has also been studied for the management of conditions such as polycystic ovary syndrome and endometriosis. These conditions are often associated with hormonal imbalances, inflammation, and oxidative stress, all of which can be influenced by the diet’s key components. The MedDiet may be a promising nutritional strategy for promoting women’s reproductive health. However, more extensive, and rigorous studies, including randomized controlled trials and longitudinal investigations, are necessary to establish a causal relationship between the MedDiet and women’s reproductive health outcomes. While the adoption of a MedDiet in non-Mediterranean populations is appealing, consideration needs to be given about potential barriers and enablers towards adherence(4). Furthermore, while the primary focus has been on nutritional strategies within the framework of the Mediterranean Diet, equal attention must be given to the eating behaviours and lifestyle factors associated with it.

Dietary habits among 177,091 Greek schoolchildren by age, sex, weight status, region, and living area. A cross-sectional study

BackgroundThis study aimed to investigate the dietary habits from early childhood to adolescence among participants from all regions of the country and living areas (rural/urban) and assess potential associations between dietary habits and obesity in both sexes. MethodsPopulation data were derived from a cross-sectional health survey on a representative sample of 177,091 children aged 6–18 years. Dietary habits were considered via a self-completed questionnaire (Mediterranean diet quality index for children and adolescents [KIDMED]). Trained investigators assessed the anthropometric data. ResultsKIDMED scores were 6.7 ± 2.4 and 6.8 ± 2.3 for boys and girls, respectively, whereas a percentage of almost 10% of the total study population had insufficient dietary habits. Dietary habits peaked around age 11 years and then gradually worsened until the end of adolescence in both sexes, with an annual trend equal to −0.28 ± 0.02 (p < 0.001) for boys and −0.31 ± 0.03 (p < 0.001) for girls. Schoolchildren who are overweight/obese presented higher percentages in all unhealthy dietary habits (e.g., skipping breakfast, going often to a fast food restaurant, and consuming a lot of sweets) than children with a normal weight (all p-values < 0.001). Dietary habits did not noteworthy differ by area of living, that is, urban versus rural, of participants in both sexes. In addition, no noticeable differences in the values of the KIDMED index were found among all regions of Greece, with the highest values in Attica and Crete in both sexes. ConclusionsBecause Greek schoolchildren do not fully adopt the traditional cardio-protective Mediterranean diet, it could be helpful to provide certain recommendations, especially for adolescents, to decrease the risk for future adverse health consequences.

Adherence to the Mediterranean Diet among high-school pupils in the North Moroccan Rif region

BACKGROUND: The traditional Moroccan diet is typical of the Mediterranean diet (MD), but there have been few studies of the adherence of Moroccans adolescents to this diet and associated factors. OBJECTIVE: To evaluate MD adherence and its association with socioeconomic factors, nutritional status and dietary intake in a sample of secondary school pupils in the Rif region of Morocco. METHODS: In a cross-sectional study of a sample (n = 302) of Moroccan Riffian adolescents (13–18 years) from three secondary schools, we measured adherence to MD with the Mediterranean Diet Quality Index for children and teenagers questionnaire (KIDMED). A score below 8 was qualified as poor to average adherence to MD, while an optimal adherence was defined as a score of 8 or higher. Bivariate analyses and a logistic regression model were used to examine associations between adherence to MD and socioeconomic factors, nutritional status and dietary intake. RESULTS: Only 14.9% of adolescents had an optimal adherence to the MD (score≥8 points), 72.8% had average adherence (score 4–7) and 12.3% had poor adherence to the MD (score≤3). The factors associated with optimal adherence to MD were female sex (OR 2.28; 95% CI 1.07 –4.85; p = 0.031), high monthly family income &gt; 8000 MAD (OR 7.10; 95% CI 1.52 –33.1; p = 0.013) and living in an apartment (OR 3.85; 95% CI 1.43 –10.3; p = 0.007). For others factors such as nutritional status and dietary intake, no associations were observed. CONCLUSION: We found a low level of adherence to the MD among adolescents in the Rif region, supporting the hypothesis that the dietary pattern of these Moroccan adolescents is in a transitional state characterised by a shift away from the traditional MD. The findings of this study suggest that interventions to optimize MD adherence should target boys, shared residences and lower income families.

Artichoke (Cynara scolymus L.) water extract alleviates palmitate-induced insulin resistance in HepG2 hepatocytes via the activation of IRS1/PI3K/AKT/FoxO1 and GSK-3β signaling pathway

BackgroundArtichoke (Cynara scolymus L.) is a typical element of a traditional Mediterranean diet and has potential health advantages for insulin resistance (IR) and type 2 diabetes mellitus (T2DM). This study aims to evaluate the effect and underlying mechanism of artichoke water extract (AWE) on palmitate (PA)-induced IR in human hepatocellular carcinoma (HepG2) cells.MethodsThe effect of AWE on cell viability was determined using CCK8 assay. Cellular glucose uptake, glucose consumption, glucose production, and glycogen content were assessed after AWE treatment. The gene expression and protein levels were examined by real-time polymerase chain reaction (qRT-PCR) and western blotting.ResultsThe results showed that AWE dose-dependently increased cell viability in IR HepG2 cells (P < 0.01). AWE treatment significantly promoted glucose uptake and consumption, decreased glucose production, and increased the cellular glycogen content in IR HepG2 cells (P < 0.01). Mechanistically, AWE elevated the phosphorylation and total protein levels of major insulin signaling molecules in IR HepG2 cells, which resulted in a decrease in the expression of phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase) and the inhibition of glycogen synthase (GS) phosphorylation in IR HepG2 cells. Furthermore, the protective effect of AWE on IR HepG2 cells might be ascribed to the inhibition of the endoplasmic reticulum (ER) stress.ConclusionWe conclude that AWE may improve glucose metabolism by regulating IRS1/PI3K/AKT/FoxO1 and GSK-3β signaling associated with the inhibition of ER stress in IR HepG2 cells induced by PA.

Consumption of herbal infusions/decoctions and tea in Greece: a Planeterranean perspective on the results of Hydria survey

BackgroundThe consumption of various herbal infusions was and is common in the traditional Mediterranean diet, and apparently are used in many other regions of the world outside of the Mediterranean region. The present study aimed to investigate the consumption of herbal infusions/decoctions and tea in a nationally representative sample of Greece, considering also their Planetary use.Methods3951 adult participants of the HYDRIA Survey (2013–2014) were included from the 13 regions of Greece. The diet of participants was assessed by two 24-h dietary recalls (24-HDR) and the Food Propensity Questionnaire (FPQ). All food items were analyzed through the HYDRIA Food Composition Tables. Information on socio-demographics, lifestyle, and health characteristics during the baseline was also provided.Results26.9% of herbal infusions and decoctions consumers are ≥ 75 years old, pensioners with a low level of education, and residents of urban areas. However, 22.2% of tea consumers belong to the 18–34-year age group, being employed with an intermediate level of education and living in an urban area. Elderly men and women use more herbal infusions/decoctions (55.4%; 40.6%) compared to tea (41.8%; 25.2%). According to FPQ, 7.1% of men and 9.7% of women use herbal infusions and decoctions four times or more per week, while 7.1 and 10.9% of men and women, respectively, consume tea at the same frequency. Green tea, mountain tea (Sideritis spp.), and black tea are reported most frequently. In addition, mountain tea (61.2%), black tea (60.3%), mixed herbal infusions/decoctions (58.4%), and sage (59.4%) are consumed mostly at breakfast, while chamomile was reported mainly at dinner or during the night (42.4%).ConclusionsBased on the FPQ results, the moderate and high consumption of herbal infusions/decoctions and tea is low in Greece, especially among adults (18–64 years). Thus, our results indicate the existence of a generation gap to the attachment to the traditional Med Diet and the consumption of herbal infusions. The present study could encourage future research to focus on herbal infusions and decoctions consumption by other populations for cross-cultural comparison, as well as on emphasizing the value of consuming locally available herbs in a Planeterranean perspective.Graphical

Survival and longevity of European rulers: geographical influences and exploring potential factors, including the Mediterranean diet - a historical analysis from 1354 to the twentieth century.

Significant regional variability in lifespan in Europe is influenced by environmental factors and lifestyle behaviors, including diet. This study investigates the impact of geographical region on the lifespan of European rulers spanning from the fourteenth century to the present day. By analyzing historical records and literature, we aim to identify region-specific dietary patterns and lifestyle factors that may have contributed to longer lifespans among rulers. The hypothesis to be tested is that rulers from Southern European countries, where the traditional Mediterranean diet is consumed by the local people, may exhibit longer lifespans compared to rulers from other regions, due to the well-documented health benefits associated with this dietary pattern. We extracted comprehensive information for each ruler, encompassing their sex, birth and death dates, age, age of enthronement, duration of rulership, country, and cause of death (natural vs. non-natural). To determine their nationality, we coded rulers based on their hypothetical present-day residence (2023). Utilizing the EuroVoc Geographical classification, we categorized the countries into four regions: Northern, Western, Southern, Central and Eastern Europe. While Cox regression models did not find significant differences in survival rates among regions, further analysis stratified by time periods revealed intriguing trends. Contrary to our initial predictions, the Northern region displayed better survival rates compared to the Southern region between 1354 and 1499, whereas survival rates were similar across regions from 1500 to 1749. However, after 1750, all regions, except the Southern region, exhibited significantly improved survival rates, suggesting advancements in healthcare and lifestyle factors. These findings underscore the dynamic influence of both region and time period on health and longevity. Interestingly, despite the prevalence of the Mediterranean diet in the Southern region of Europe, rulers from this region did not demonstrate longer lifespans compared to their counterparts in other regions. This suggests that additional lifestyle factors may have played a more prominent role in their longevity. In conclusion, our study sheds light on the intricate relationship between region, time period, and lifespan among European rulers. Although the Mediterranean diet is often associated with health benefits, our findings indicate that it alone may not account for differences in ruler longevity across regions. Further research is warranted to explore the impact of other lifestyle factors on the health and lifespan of European rulers throughout history.

Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review.

Although the Mediterranean diet has been associated with a lower risk of hip fracture, the effect of other dietary patterns on bone density and risk of fracture is unknown. This scoping review aims to investigate the association between adherence to alternative dietary patterns (other than the traditional Mediterranean diet) and osteoporosis or osteoporotic fracture risk in older people. A systematic search was carried out on three electronic databases (Medline, EMBASE, and Scopus) to identify original papers studying the association between alternative dietary patterns (e.g., Baltic Sea Diet (BSD), modified/alternative Mediterranean diet in non-Mediterranean populations, Dietary Approaches to Stop Hypertension (DASH)) assessed using 'prior' methods (validated scores) and the risk of osteoporotic fracture or Bone Mineral Density (BMD) in people aged ≥50 (or reported average age of participants ≥ 60). Results from the included studies were presented in a narrative way. Six observational (four prospective cohort and two cross-sectional) studies were included. There was no significant association between BMD and BSD or DASH scores. Higher adherence to DASH was associated with a lower risk of lumbar spine osteoporosis in women in one study, although it was not associated with the risk of hip fracture in another study with men and women. Higher adherence to aMED (alternative Mediterranean diet) was associated with a lower risk of hip fracture in one study, whereas higher adherence to mMED (modified Mediterranean diet) was associated with a lower risk of hip fracture in one study and had no significant result in another study. However, diet scores were heterogeneous across cohort studies. There is some evidence that a modified and alternative Mediterranean diet may reduce the risk of hip fracture, and DASH may improve lumbar spine BMD. Larger cohort studies are needed to validate these findings.

Greater adherence to a mediterranean diet is associated with lower C-reactive protein (CRP) levels, but not to lower odds of having dry eye disease

PurposeTo investigate the hypothesis that a Mediterranean diet is associated with a lower risk of having dry eye disease (DED) in the general population. MethodsDED was assessed using the Women's Health Study (WHS) dry eye questionnaire in 58,993 participants from the Dutch Lifelines Cohort with complete available dietary data (20–94 years, 60% female). Level of adherence to a traditional Mediterranean diet was assessed using the modified Mediterranean Diet Score (mMDS). High-sensitivity C-reactive Protein (hsCRP) was included as a marker of whole-body inflammation. Logistic regressions were used to examine the relationship between WHS-defined DED and mMDS, corrected for age, sex, BMI, education, income, and 48 potentially confounding comorbidities. The association between mMDS and hsCRP, and hsCRP and DED, was further explored in separate regressions. ResultsOf all participants, 9.1% had DED. In contrast to the hypothesis, higher mMDS levels were associated with greater odds of DED, corrected for demographics, smoking status, BMI, and comorbidities (OR 1.034, 95%CI: 1.015 to 1.055, P = 0.001). Moreover, there was a highly significant relationship between increasing mMDS and lower circulating hsCRP levels; however, there was no significant relationship between hsCRP and DED. ConclusionsStronger adherence to a Mediterranean diet does not appear to be associated with lower odds of having DED in the general population. Furthermore, there was no association between hsCRP and DED in this study. However, the previously described link between a Mediterranean diet and lower hsCRP was confirmed in this large population-based study.

Yearly attained adherence to Mediterranean diet and incidence of diabetes in a large randomized trial

BackgroundSeveral large observational prospective studies have reported a protection by the traditional Mediterranean diet against type 2 diabetes, but none of them used yearly repeated measures of dietary intake. Repeated measurements of dietary intake are able to improve subject classification and to increase the quality of the assessed relationships in nutritional epidemiology. Beyond observational studies, randomized trials provide stronger causal evidence. In the context of a randomized trial of primary cardiovascular prevention, we assessed type 2 diabetes incidence according to yearly repeated measures of compliance with a nutritional intervention based on the traditional Mediterranean diet.MethodsPREDIMED (‘‘PREvención con DIeta MEDiterránea’’) was a Spanish trial including 7447 men and women at high cardiovascular risk. We assessed 3541 participants initially free of diabetes and originally randomized to 1 of 3 diets: low-fat diet (n = 1147, control group), Mediterranean diet supplemented with extra virgin olive (n = 1154) or Mediterranean diet supplemented with mixed nuts (n = 1240). As exposure we used actual adherence to Mediterranean diet (cumulative average), yearly assessed with the Mediterranean Diet Adherence Screener (scoring 0 to 14 points), and repeated up to 8 times (baseline and 7 consecutive follow-up years). This score was categorized into four groups: < 8, 8–< 10, 10– < 12, and 12–14 points. The outcome was new-onset type 2 diabetes.ResultsMultivariable-adjusted hazard ratios from time-varying Cox models were 0.80 (95% confidence interval, 0.70–0.92) per + 2 points in Mediterranean Diet Adherence Screener (linear trend p = .001), and 0.46 (0.25–0.83) for the highest (12–14 points) versus the lowest (< 8) adherence. This inverse association was maintained after additionally adjusting for the randomized arm. Age- and sex-adjusted analysis of a validated plasma metabolomic signature of the Mediterranean Diet Adherence Screener (constituted of 67 metabolites) in a subset of 889 participants also supported these results.ConclusionsDietary intervention trials should quantify actual dietary adherence throughout the trial period to enhance the benefits and to assist results interpretation. A rapid dietary assessment tool, yearly repeated as a screener, was able to capture a strong inverse linear relationship between Mediterranean diet and type 2 diabetes.Trial registration ISRCTN35739639

Socioeconomic status, lifestyle characteristics and adherence to the Mediterranean diet among Greece adolescents

ObjectiveThe study aims to assess the relationship between socioeconomic status, lifestyle characteristics and adherence to the Mediterranean diet within a representative sample of secondary school children from Attica, Greece. Research methods & proceduresIn this cross-sectional school-based study, 2088 adolescents aged 12–18 from different socioeconomic status areas of Attica in Greece have been recruited. The study occurred in May-December 2021 when schools reopened due to COVID-19 closure. Socioeconomic status was determined using Family Affluence Scale (FAS) III questionnaire. The Mediterranean Diet Quality Index for children and adolescents (KIDMED test) was used to assess the adherence to the Mediterranean diet. The empirical investigation was based on bivariate analysis following chi-square tests and multivariate approaches employing Generalized Ridge Regression models and Blinder-Oaxaca decomposition techniques. ResultsA very low percentage of 9.1% of the adolescents had optimal adherence to the Mediterranean diet, while 57.9% and 33% had moderate and low adherence, respectively. Boys, younger adolescents, adolescents from two parents' families, with higher maternal education and socioeconomic status had higher adherence to the Mediterranean diet. Additionally, healthier lifestyle with more studying, efficient night sleep, frequent physical activity, going out, and having hobbies were positively associated with adherence to the Mediterranean diet. On the contrary, more screen viewing was related negatively. ConclusionsSeveral demographic, lifestyle, and socioeconomic characteristics significantly affect adherence to the Mediterranean diet. In particular, findings showed that higher socioeconomic status and a healthier lifestyle are associated with optimal adherence. Greek adolescents move away from the traditional Mediterranean Diet.

Sociodemographic, nutritional and health status factors associated with adherence to Mediterranean diet in an agricultural Moroccan adult's population.

Numerous studies have demonstrated beneficial effects of adherence to the Mediterranean diet (MD) on many chronic diseases, including chronic kidney disease (CKD). The aim of this study was to assess the adherence of a rural population to the Mediterranean diet, to identify the sociodemographic and lifestyle determinants and to analyze the association between adherence to MD and CKD. In a cross-sectional study, data on sociodemographic, lifestyle factors, clinical, biochemical parameters and diet were collected on a sample of 154 subjects. Adherence to MD was assessed according to a simplified MD score based on the daily frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and MUFA/SFA), using the sex specific sample medians as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. According to the simplified MD score, the study data show that high adherence (44.2%) to MD was characterized by intakes high in vegetables, fruits, fish, cereals, olive oil, and low in meat and moderate in dairy. Furthermore, several factors such as age, marital status, education level, and hypertension status were associated with the adherence to MD in the study population. The majority of subjects with CKD have poor adherence to the MD compared to non-CKD with a statistically insignificant difference. In Morocco, maintaining the traditional MD pattern play crucial role for public health. More research is needed in this area to precisely measure this association.

Ernährung und Demenz – Demenz und Ernährung

Nutrition and Dementia - Dementia and Nutrition Abstract: Nutritional aspects play an important role both in the prevention of dementia and in its course. There is a mutual relationship between cognitive impairment and nutrition. In terms of prevention, nutrition is one of the potentially modifiable risk factors for the development of the disease, since it can influence both the structures and the functionality of the brain in a variety of ways. A food selection based on the traditional Mediterranean diet or on a generally healthy diet also seems to be advantageous for maintaining cognitive function. In the course of dementia, various symptoms of the disease sooner or later lead to nutritional problems, which make it difficult to achieve a varied, needs-based diet and are associated with an increased risk of a qualitatively and quantitatively inadequate nutrition. In order to maintain a good nutritional status in people with dementia for as long as possible, early detection of nutritional problems is fundamental. Strategies for the prevention and treatment include the elimination of potential causes of malnutrition and various supportive measures to promote adequate eating. The diet itself can be supported by an attractive, varied range of food, additional snacks, enrichment of the food with energy and nutrients and by oral nutritional supplements. Enteral or parenteral administration of nutrients, on the other hand, should be reserved for justified exceptional cases.

Greek traditional Mediterranean diet and plant-based culinary practices: HYDRIA Greek national survey

Greek traditional Mediterranean diet and plant-based culinary practices: HYDRIA Greek national survey

Mediterranean Diet Adherence and Physical Activity Level in Adolescents During the Lockdown in the COVID-19 Pandemic: A Cross-sectional Study in Greek Island of Rhodes

Background: Nutrition is involved in various ways in the 17 distinct SDGs of United Nations Agenda 2030. The COVID-19 pandemic is testing the world threatening health, nutrition, education, and social protection. Objective: The objective of this study was to assess the adolescents’ adherence to the Mediterranean diet that attended senior high school in the Greek city of Rhodes during the lockdown period. Methods: In this cross-sectional, observational study the sample of the research was 227 students aged 11-15 years old, that self-reported their weight and height and completed validated questionnaires for their nutritional attitudes. Results: The percentages of students who were overweight/obese were 22.5% of the total sample (17.2% overweight and 5.3% obese) according to the IOTF (International Obesity Taskforce) cutoffs and 30.4% (21.6% overweight and 8.8% obese) according to the WHO (World Health Organization) cutoffs. The average KIDMED score of the sample was medium (6.00) and the adherence to the Mediterranean diet of the sample needs improvement. Conclusion: Results support a shift from traditional Mediterranean diet to more unhealthy eating patterns. Adolescents' limited physical activity mainly on weekdays was reported, and further research could examine the role of distant education for this behavior. Policies and strategies targeting the students’ population are essential for adolescents’ nutrition education and the improvement of their dietary habits toward the sustainable Mediterranean diet, during the specific circumstances of covid pandemic.

Increased Adherence to a Mediterranean Diet Is Associated with Reduced Low-Grade Inflammation after a 12.7-Year Period: Results from the Moli-sani Study.

There is little knowledge on the association of changes over time in adherence to a Mediterranean diet (MD) with changes in modifiable cardiovascular disease (CVD) risk factors and of markers of low-grade inflammation. To evaluate the association between long-term changes in MD adherence and concurrent changes in established CVD risk factors and in markers of low-grade inflammation among adult Italians. A prospective cohort study was conducted. Dietary and health data were obtained both at baseline (2005-2010) and at follow-up (2017-2020). Adherence to the MD was estimated by a Mediterranean Diet Score ranging from zero to nine points, and the exposure was change in this score measured after a median 12.7-year period. This study included a subgroup of 897 men and 1,126 women aged ≥35 years at enrolment in the Moli-sani Study (n= 24,325). Changes in two composite z scores, including nine established CVD risk factors (eg, serum lipid levels and blood pressure) and four inflammatory markers (including C-reactive protein), respectively, were measured both at enrolment and after the same 12.7-year period. Multivariable-adjusted linear regression models were used. In a multivariable-adjusted analysis, an increased Mediterranean Diet Score over time was associated with decreased levels in the Inflammatory score (β= -0.372, 95% CI -0.720 to -0.025), but had little or no influence on the CVD risk score (β= -0.200, 95% CI -0.752 to 0.351), compared with individuals who had decreased their MD adherence. Among individual food groups/nutrients included in the Mediterranean Diet Score, an increased intake of monounsaturated over saturated fats over time was associated with lower CVD Risk Score, whereas increased consumption of cereals was inversely linked to the Inflammatory Score, compared with the reduced consumption group. An increased adherence to a traditional MD over time was associated with reduced low-grade inflammation. These findings suggest the potential of a traditional Mediterranean eating pattern to help reduce the long-term risk of inflammation-related chronic diseases in an ageing population.

Ultra-Processed Foods in the Mediterranean Diet according to the NOVA Classification System; A Food Level Analysis of Branded Foods in Greece

While the Mediterranean diet (MD) is championed as a healthy and sustainable dietary pattern, the NOVA classification is discussed as a tool to identify ultra-processed foods and further specify healthy food choices. We tested whether the NOVA System aligns with the MD recommendations as presented in the MD pyramids. Foods from the Greek branded food composition database, HelTH, (n = 4581) were scored according to NOVA and assigned to the tiers of the traditional and/or sustainable MD pyramids. Nutritional quality was measured as nutrient content and Nutri-Score grades. NOVA identified 70.2% of all foods as UPFs, and 58.7% or 41.0% of foods included in the sustainable and the traditional MD, respectively. Although foods at the top of the pyramids were mostly (>80%) UPFs, NOVA identified > 50% of foods in the MD base as UPFs. Only 22-39% of foods in the MD base were not UPFs and of high nutritional quality (Nutri-Score A-B). NOVA has low discriminatory capacity across the MD tiers, and it restricts food choices to <30% of foods currently available in supermarkets and <60% within the recommended MD tiers. Therefore, the NOVA classification cannot always identify suitable food choices under the MD pyramid in the modern packaged food environment.

Habitual adherence to a traditional Mediterranean diet and risk of SARS-CoV-2 infection and Coronavirus disease 2019 (COVID-19): a longitudinal analysis

Evidence on habitual Mediterranean diet (MD) and risk of SARS-CoV-2 infection, and COVID-19 is limited. 1,520 participants from the Moli-sani Study (2017-2020) were tested during January-September 2021 and adherence to MD was ascertained through the Mediterranean Diet Score (MDS). SARS-CoV-2 infection cases were determined through serology, and previous clinical diagnosis of COVID-19 disease was self-reported. Results were presented as odd ratios (OR) with 95% confidence intervals (CI). The MDS was not associated with the likelihood of SARS-CoV-2 infection (OR= 0.94; 95% CI: 0.83–1.06) and COVID-19 (OR= 0.82; 95% CI: 0.62–1.10) diagnosis. High consumption of cereals was associated with lower odds of SARS-CoV-2 infection (OR = 0.91; 95% CI: 0.83–1.00; for each 25 g/d increase). Likelihood of having being diagnosed with COVID-19 disease decreased in association with increasing olive oil intake (OR= 0.10; 95% CI: 0.01–0.79; for each additional 10 g/d), moderate alcohol consumption (OR= 0.18; 95% CI: 0.04–0.82) and higher intakes of fruits and nuts (OR = 0.89; 95% CI: 0.79–0.99). Our findings emphasise the adoption and maintenance of a balanced MD as a key strategy to reduce the risk of future SARS-CoV-2 infections and COVID-19.

Serum from Adolescents with High Polyphenol Intake Exhibits Improved Lipid Profile and Prevents Lipid Accumulation in HepG2 Human Liver Cells.

The traditional Mediterranean diet (MD) is characterized by a high phenolic-rich food intake, including in particular vegetables and fruits, but also legumes, whole grain cereals, nuts, and extra virgin olive oil. Evidence for beneficial effects of polyphenols in humans depends on the amount consumed and on their bioavailability. Here, we evaluated the association between the estimated polyphenol intake by fruits and vegetables food source and serum biochemical parameters in healthy adolescents, recruited into the DIMENU research project. Categorizing adolescents into three groups according to their estimated total polyphenol intake, we found that adolescents who declared high consumption of polyphenols had a higher adherence to the MD and had a better serum lipid profile than adolescents consuming low amounts of polyphenols. Moreover, using human HepG2 liver cells treated with oleic acid as an in vitro model for studying lipid accumulation, we showed that intracellular lipid accumulation is alleviated by serum from adolescents consuming a polyphenol-rich diet following MD recommendations. Our data underline the importance of promoting adherence to the typical MD foods as a superior strategy to prevent metabolic and chronic diseases and to ensure a better quality of life among adolescents.

Hydroxytyrosol and Its Potential Uses on Intestinal and Gastrointestinal Disease

In recent years, the phytoconstituents of foods in the Mediterranean diet (MD) have been the subject of several studies for their beneficial effects on human health. The traditional MD is described as a diet heavy in vegetable oils, fruits, nuts, and fish. The most studied element of MD is undoubtedly olive oil due precisely to its beneficial properties that make it an object of interest. Several studies have attributed these protective effects to hydroxytyrosol (HT), the main polyphenol contained in olive oil and leaves. HT has been shown to be able to modulate the oxidative and inflammatory process in numerous chronic disorders, including intestinal and gastrointestinal pathologies. To date, there is no paper that summarizes the role of HT in these disorders. This review provides an overview of the anti-inflammatory and antioxidant proprieties of HT against intestinal and gastrointestinal diseases.