Traditional Mediterranean Dietary Pattern Research Articles

Correlates of adherence to a posteriori derived dietary patterns of an Italian sample of adults

Abstract There is emerging evidence that the Italian population is switching away from the traditional Mediterranean dietary pattern towards unhealthy eating habits. We derived adults’ dietary patterns (DP) using a principal component analysis (PCA) on food groups intake of a representative sample of the Italian population (INRAN-SCAI 2005-2006), and correlated diet adherence scores with sociodemographic characteristics through multivariable linear regressions. After PCA, “High-fat”, “Western”, “Health-conscious”, “Italian, traditional” and “Junk, out of meal” DPs were retained. Female gender (β = 0.5103; p < 0.001) showed an association with higher adherence scores on the Health conscious pattern. Conversely, being female was associated with lower Z-scores on the High fat (β=-0.1849; p = 0.024), Western (β= -0.0711;p= 0.004) and Italian traditional (β=-0.4799;p<0.001) patterns. Age (β per one year increase=-0.0077;p<0.001) was associated with lower adherence scores in the Western and in the Junk, out of meal (β=-0.0078;p<0.001) pattern. Having either a secondary (β=-0.1301;p=0.016) or tertiary (β=-0.2156;p= 0.001) education level were independently associated with lower dietary Z- scores in the Italian traditional” pattern. Finally, there was wide regional variation, coming from different regions predicted adherence to different DPs. A substantial share of our sample showed unhealthy eating habits, which is consistent with the latest Italian dietary trends. Key messages • Future policies to improve diet quality at the national level should promote food literacy interventions targeting the differences between women and man among different age groups. • This work will provide the basis to investigate the environmental impact of higher pattern adherence scores.

Adherence to a Mediterranean Diet Pattern, Physical Activity, and Physical Self-Concept in Spanish Older Adults.

Background: The aging world population is accelerating rapidly. Physical self-concept (PSC) is one of the psychosocial factors with the greatest influence on an individual’s well-being and health. The traditional Mediterranean dietary pattern (MDP) is considered one of the healthiest dietary models, as it is nutritionally complete and easy to follow. Objective: To assess the adherence to MDP and its association with the practice of physical activity (PA) and PSC levels in the older adult Spanish population. Methods: A cross-sectional study was conducted on a representative sample of Spanish older adults (n = 342; older than 55 years old). Their PSC was assessed using a previously validated PSC questionnaire. Adherence to an MDP was assessed using a validated Mediterranean Diet Adherence Screener questionnaire. Their PA was measured using the Spanish version of the Rapid Assessment of Physical Activity Questionnaire. Data on age, sex, hypertension, cholesterol or diabetes suffered in the last 12 months, as well as weight, height, and BMI, were collected. Results: At the lowest levels of PSC, the percentage of individuals who were non-active and non-adhering to the MDP was lower compared to the highest levels (75.0% vs. 19.6; p = 0.001; Cramer’s V = 0.414, and 83.3% vs. 57.9%; p = 0.001; Cramer’s V = 0.221, respectively). This sample showed an abandonment of the most classic habits of the MDP, such as the consumption of olive oil, vegetables, fruits, nuts and fish. Conclusions: Non-adherence to the MDP and low levels of PA are associated with low levels of PSC in older adults.

Role of plant-based diet in late-life cognitive decline: results from the Salus in Apulia Study

ABSTRACT Objectives Consistency among population-based studies investigating the relationship between diet and cognition in older inhabitants in the Mediterranean area is poor. The present study investigated whether diet changes over 12 years were associated with cognitive function in older people in Southern-Italy. Methods From the ‘Salus in Apulia Study’, that includes the MICOL and GreatAGE Studies, 584 participants were selected, firstly enrolled in MICOL3 (M3) and later in the GreatAGE Study (MICOL4, M4). Foods and micronutrients intake were recorded in both studies, and global cognitive function in M4, assessed with the Mini Mental State Examination. Results Plant-based foods, particularly coffee and vegetables, as well as vitamin A sources, were inversely associated to age-related cognitive impairment. Alcohol consumption showed a detrimental role on cognition, while red meat appeared to be beneficial in the present study, although its role is traditionally considered harmful for cognitive function. Discussion Our study confirmed that a traditional Mediterranean dietary pattern based on agricultural products and low alcohol consumption may help to prevent/delay age-related cognitive impairment.

Acute and chronic improvement in postprandial glucose metabolism by a diet resembling the traditional Mediterranean dietary pattern: Can SCFAs play a role?

Postprandial metabolic abnormalities are considered important and independent risk factors for cardiovascular diseases. However, the effects of the Mediterranean diet on postprandial metabolism and the mechanism underpinning the effects on clinical variables have not been exhaustively explored. Therefore, the aims of the present study were to evaluate the acute and medium-term effects (8 weeks) on postprandial glucose and lipid metabolism of a diet resembling a typical Mediterranean diet (Med-D) compared to a western-type diet (Control-D), and the mechanisms underlying those effects. Twenty-nine overweight/obese individuals of both genders, aged 20-60 years, were enrolled and randomly assigned to two isoenergetic dietary interventions: 1) a Med-D (n=16), and 2) a Control-D (n=13). Adherence to the dietary interventions was assessed by a 7-day food record. A meal test resembling the assigned diet was performed at baseline and after 8 weeks of intervention. Blood samples at fasting and over 4-h after the meal were collected to assess metabolic parameters and short chain fatty acid (SCFA) levels. Fecal samples were also collected to evaluate the microbiota composition. Glucose and insulin responses were significantly reduced at baseline after the Med test meal compared to the Control meal (p<0.05) and this effect was strengthened after 8 weeks of intervention with the Mediterranean diet (p<0.05); together with an improvement in OGIS. At the end of the intervention, postprandial plasma butyric acid incremental area under the curve (IAUC) was significantly increased in the Med-D group (p=0.019) and correlated inversely with plasma insulin IAUC and directly with oral glucose insulin sensitivity (OGIS) (r:-0.411, p=0.046 and r: 0.397, p=0.050 respectively). These metabolic changes were accompanied by significant changes in gut microbiota, such as an increase in the relative abundance of Intestinimonas butyriciproducens and Akkermansia muciniphila (p<0.05) in the Med-D compared to Control-D group. Our study provides strong evidence that a diet resembling the traditional Med-D improves postprandial glucose metabolism and insulin sensitivity. Furthermore, the study highlights a possible involvement of gut microbiota metabolites - such as butyric acid, and of dietary fiber as a precursor - in improving glucose metabolism and insulin sensitivity.

Association between the adherence to the Mediterranean dietary pattern and common mental disorders among community-dwelling elders: 2015 Health Survey of São Paulo, SP, Brazil

BackgroundSome questions regarding the benefits of the Mediterranean Dietary Pattern (MDP) are still unanswered, especially in non-Mediterranean areas. As such, this study intends to evaluate the association between the adherence to the MDP with the presence of Common Mental Disorders (CMD) in Brazilian older adults, adopting two different concepts of MDP. MethodsThe sample included 545 elders from 2015 Health Survey of São Paulo City (cross-sectional population-based study). CMD were identified through the Self Reporting Questionnaire-20 (SRQ-20). Data from two 24-hour dietary recall were used to construct two concepts of MDP according to the Mediterranean-diet score (MDS): Traditional MDP (included only foods with characteristics of the original MDP) and Brazilian-MDP (included foods with non-Mediterranean characteristics). The analyses included two different models (crude model and adjusted model for potential confounders) of logistic regression. ResultsModerate and high adherence to Traditional MDP were associated with a lower prevalence of CMD (OR: 0.59; 95% CI: 0.35–0.98 and OR: 0.42, 95% CI: 0.18–0.96, respectively), after adjustment for sociodemographic, lifestyle and health status variables. In turn, the presence of CMD was not significantly associated with any level of adherence to the Brazilian-MDP. Limitationsdue to the cross-sectional feature of the study, we cannot determine a cause-effect relationship; some covariates were self-reported; the results cannot apply to the elderly from other regions. ConclusionModerate and high adherence to the traditional MDP was found to reduce the risk of mental disorders in Brazilian elderly. Nevertheless, an increased intake of non-Mediterranean food components can limit this effect.

Hydroxytyrosol Decreases LPS- and α-Synuclein-Induced Microglial Activation In Vitro.

Neuroinflammation is a common feature shared by neurodegenerative disorders, such as Parkinson’s disease (PD), and seems to play a key role in their development and progression. Microglia cells, the principal orchestrators of neuroinflammation, can be polarized in different phenotypes, which means they are able to have anti-inflammatory, pro-inflammatory, or neurodegenerative effects. Increasing evidence supports that the traditional Mediterranean dietary pattern is related to the reduction of cognitive decline in neurodegenerative diseases. A considerable intake of plant foods, fish, and extra virgin olive oil (EVOO), as well as a moderate consumption of red wine, all characteristic of the Mediterranean diet (MD), are behind these effects. These foods are especially rich in polyphenols, being the most relevant in the MD hydroxytyrosol (HT) and their derivatives present in EVOO, which have demonstrated a wide array of biological activities. Here, we demonstrate that HT is able to reduce the inflammation induced by two different stimuli: lipopolysaccharide and α-synuclein. We also study the possible molecular mechanisms involved in the anti-inflammatory effect of HT, including the study of nuclear factor kappa B (NF-κB), mitogen-activated protein kinases (MAPKs), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, and inflammasome. Our data support the use of HT to prevent the inflammation associated with PD and shed light into the relationship between MD and this neurological disorder.

Current Food Consumption amongst the Spanish ANIBES Study Population.

Dietary habits amongst the Spanish population are currently a relevant cause for concern, as macronutrient profiles and micronutrient intakes seem to be inadequate and globally moving away from the traditional Mediterranean dietary pattern. However, recent food consumption patterns have not been fully assessed. In the present study, our aim was therefore to describe the current food consumption from the “anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain” (ANIBES) study population by assessing data defined by age and gender. The ANIBES study is a cross-sectional study of a nationally representative sample of the Spanish population. A three-day dietary record was used to obtain information about food and beverage consumption. The sample comprised 2009 individuals aged 9–75 years, plus a boost sample for the youngest age groups (9–12, 13–17, and 18–24 years, n = 200 per age group). The most consumed food group across all age segments were non-alcoholic beverages followed by milk and dairy products and vegetables. Consumption of cereals and derivatives, milk and dairy products, sugars and sweets, and ready-to-eat meals by children was significantly higher than those by the adult and older adult populations (p ≤ 0.05). Conversely, intakes of vegetables, fruits, and fish and shellfish were significantly higher in adults and older adults (p ≤ 0.05). In order to comply with recommendations, adherence to the Mediterranean dietary patterns should be strengthened, especially amongst younger population groups. Therefore, substantial nutritional interventions may be targeted to improve the Spanish population’s dietary patterns nowadays.

Mediterranean diet adherence and cognitive function in older UK adults: the European Prospective Investigation into Cancer and Nutrition–Norfolk (EPIC-Norfolk) Study

In Mediterranean countries, adherence to a traditional Mediterranean dietary pattern (MedDiet) is associated with better cognitive function and reduced dementia risk. It is unclear if similar benefits exist in non-Mediterranean regions. The aims of this study were to examine associations between MedDiet adherence and cognitive function in an older UK population and to investigate whether associations differed between individuals with high compared with low cardiovascular disease (CVD) risk. We conducted an analysis in 8009 older individuals with dietary data at Health Check 1 (1993-1997) and cognitive function data at Health Check 3 (2006-2011) of the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk). Associations were explored between MedDiet adherence and global and domain-specific cognitive test scores and risk of poor cognitive performance in the entire cohort, and when stratified according to CVD risk status. Higher MedDiet adherence defined by the Pyramid MedDiet score was associated with better global cognition (β±SE=-0.012±0.002; P<0.001), verbal episodic memory (β±SE=-0.009±0.002; P<0.001), and simple processing speed (β±SE=-0.002±0.001; P=0.013). Lower risk of poor verbal episodic memory (OR: 0.784; 95% CI: 0.641, 0.959; P=0.018), complex processing speed (OR: 0.739; 95% CI: 0.601, 0.907; P=0.004), and prospective memory (OR: 0.841; 95% CI: 0.724, 0.977; P=0.023) was also observed for the highest compared with the lowest Pyramid MedDiet tertiles. The effect of a 1-point increase in Pyramid score on global cognitive function was equivalent to 1.7 fewer years of cognitive aging. MedDiet adherence defined by the Mediterranean Diet Adherence Screener (MEDAS) score (mapped through the use of both binary and continuous scoring) showed similar, albeit less consistent, associations. In stratified analyses, associations were evident in individuals at higher CVD risk only (P<0.05). Higher adherence to the MedDiet is associated with better cognitive function and lower risk of poor cognition in older UK adults. This evidence underpins the development of interventions to enhance MedDiet adherence, particularly in individuals at higher CVD risk, aiming to reduce the risk of age-related cognitive decline in non-Mediterranean populations.

The Mediterranean Diet Reduces the Risk and Mortality of the Prostate Cancer: A Narrative Review.

Prostate cancer is the second most common cancer in the world among men, and is the fifth most common cause of cancer death among men. The aim of our review was to analyze observational and case–control studies to point out the effects of overweight and diets components on the cancer risk, particularly on risk of prostate cancer, and the effect of the Mediterranean diet (MD) on the reduction of risk and mortality of prostate cancer. It is known that incidence and progression of cancer is multifactorial. Cancer of the large bowel, breast, endometrium, and prostate are due also to a high body mass index and to high consumption of high carcinogenic dietary factors, as red and processed meat or saturated fats rich foods, and to a low consumption of vegetables and fruits. Previous meta-analysis suggested that high adherence to diet model based on the traditional MD pattern gives a significant protection from incidence and mortality of cancer of all types. The main component of the MD is olive oil, consumed in high amount by Mediterranean basin populations. In addition, phenolic compounds exert some strong chemo-preventive effects, which are due to several mechanisms, including both antioxidant effects and actions on cancer cell signaling and cell cycle progression and proliferation. The protective effect of the MD against the prostate cancer is also due to the high consumption of tomato sauce. Lycopene is the most relevant functional component in tomatoes; after activating by the cooking of tomato sauce, it exerts antioxidant properties by acting in the modulation of downregulation mechanisms of the inflammatory response. MD, therefore, represents a healthy dietary pattern in the context of a healthy lifestyle habits. In conclusion, our narrative review allows us to reaffirm how nutritional factors play an important role in cancer initiation and development, and how a healthy dietary pattern represented by MD and its components, especially olive oil, could exert a protective role by the development and progression of prostate cancer.

Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)

Abstract Objective To assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). Methodology A cross-sectional study conducted on a representative sample of schoolchildren aged 6–12 years, using a questionnaire to determine their general dietary habits and a record of their 24-h intake. Results A total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3 ± 1.7 years of age. The frequency of food intake was 4.62 ± 0.6 times a day, which decreased with the age of the schoolchildren (P = .044), and increased with the educational level of parents (P = .004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI) (P Conclusion The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat.

Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real)

ObjectiveTo assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). MethodologyA cross-sectional study conducted on a representative sample of schoolchildren aged 6 to 12 years, using a questionnaire to determine their general dietary habits and a record of their 24-hour intake. ResultsA total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3±1.7 years of age. The frequency of food intake was 4.62±0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI) (P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. ConclusionThe dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat.

Diet quality of Mediterranean adolescents evaluated by Mediterranean adaptation of the Diet Quality Index-Internationa(DQI I):socioeconomic, anthropometric, lifestyle and body image determinants

Title: Diet quality of Mediterranean adolescents evaluated by Mediterranean adaptation of the Diet Quality Index-International (DQI-I): socioeconomic, anthropometric, lifestyle and body image determinants. Background: Epidemiological evidences suggest that dietary patterns in the Mediterranean countries are changing rapidly. Objective: To assess the diet quality of Mediterranean adolescents by means of the Mediterranean adaptation of the DQI-I, and its association with socioeconomic, anthropometric, lifestyle and body image characteristics. Methods & Findings: Cross-sectional survey (n=1231; 12−17 years old) carried out in the Balearic Islands, a Mediterranean region. Diet quality was assessed by means of the DQI-I’s Mediterranean adaptation. Body composition, body image, socioeconomic factors, and physical activity were also assessed. The mean total modified DQI score was around 47.0% (standard deviation: 9.8%) of the possible score (100%). The univariate linear regression analysis showed that age and media screen time were inversely correlated with the DQI score; whereas a direct correlation with parental educational level was found. The DQI score also decreased in physically inactive adolescents and in those adolescents who wish a thicker body shape; whereas increased in those adolescents who wish a thinner body shape. The multivariate linear regression showed that age group, parental educational level, media screen time and body image dissatisfaction were the main associated variables with the DQI score. Conclusions: The assessed Mediterranean adolescents showed a poor-quality diet. Programs to promote the traditional Mediterranean dietary pattern among adolescents and their relatives, combined with active lifestyle, would likely result in a more favorable future health profile.

Effect of the Mediterranean diet on heart failure biomarkers: a randomized sample from the PREDIMED trial

Scarce data are available on the effect of the traditional Mediterranean diet (TMD) on heart failure biomarkers. We assessed the effect of TMD on biomarkers related to heart failure in a high cardiovascular disease risk population. A total of 930 subjects at high cardiovascular risk (420 men and 510 women) were recruited in the framework of a multicentre, randomized, controlled, parallel-group clinical trial directed at testing the efficacy of the TMD on the primary prevention of cardiovascular disease (The PREDIMED Study). Participants were assigned to a low-fat diet (control, n = 310) or one of two TMDs [TMD + virgin olive oil (VOO) or TMD + nuts]. Depending on group assignment, participants received free provision of extra-virgin olive oil, mixed nuts, or small non-food gifts. After 1 year of intervention, both TMDs decreased plasma N-terminal pro-brain natriuretic peptide, with changes reaching significance vs. control group (P < 0.05). Oxidized low-density lipoprotein decreased in both TMD groups (P < 0.05), the decrease in TMD + VOO group reaching significance vs. changes in control group (P = 0.003). Changes in lipoprotein(a) after TMD + VOO were less than those in the control group (P = 0.046) in which an increase (P = 0.035) was observed. No changes were observed in urinary albumin or albumin/creatinine ratio. Individuals at high risk of cardiovascular disease (CVD) who improved their diet toward a TMD pattern reduced their N-terminal pro-brain natriuretic peptide compared with those assigned to a low-fat diet. The same was found for in vivo oxidized low-density lipoprotein and lipoprotein(a) plasma concentrations after the TMD + VOO diet. From our results TMD could be a useful tool to mitigate against risk factors for heart failure. From our results TMD could modify markers of heart failure towards a more protective mode.

Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects

BackgroundPopulations living in the area of the Mediterranean Sea suffered by decreased incidence of cancer compared with those living in the regions of northern Europe and US countries, attributed to healthier dietary habits. Nowadays, we are assisting to a moving away from the traditional Mediterranean dietary pattern, but whether this changing is influencing risk of cancers is still unclear. The aim of the study was to review recent evidence on potential relationship between the adherence to the Mediterranean diet and cancer.DiscussionThe most recent pooled analyses of epidemiological studies supported strongly the hypothesis that the Mediterranean diet may play a role in preventing several types of cancers, especially those of digestive tract, whereas contrasting results were reported for hormone-dependent cancers. Specific aspects of the Mediterranean diet such as high fruit and vegetables and low red processed meat intake may explain such protective effects. Moreover, evidence regarding olive oil and whole grains increase the beneficial effects of such dietary pattern against cancer.ConclusionsLiterature evidence actually demonstrates that the increased adherence to the Mediterranean dietary pattern is beneficial to health across populations and may translate a protective effect with certain cancers.

Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial

BackgroundHypertension can be prevented by adopting healthy dietary patterns. Our aim was to assess the 4-year effect on blood pressure (BP) control of a randomized feeding trial promoting the traditional Mediterranean dietary pattern.MethodsThe PREDIMED primary prevention trial is a randomized, single-blinded, controlled trial conducted in Spanish primary healthcare centers. We recruited 7,447 men (aged 55 to 80 years) and women (aged 60 to 80 years) who had high risk for cardiovascular disease. Participants were assigned to a control group or to one of two Mediterranean diets. The control group received education on following a low-fat diet, while the groups on Mediterranean diets received nutritional education and also free foods; either extra virgin olive oil, or nuts. Trained personnel measured participants’ BP at baseline and once yearly during a 4-year follow-up. We used generalized estimating equations to assess the differences between groups during the follow-up.ResultsThe percentage of participants with controlled BP increased in all three intervention groups (P-value for within-group changes: P<0.001). Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group (−1.53 mmHg (95% confidence interval (CI) −2.01 to −1.04) for the Mediterranean diet supplemented with extra virgin olive oil, and −0.65 mmHg (95% CI -1.15 to −0.15) mmHg for the Mediterranean diet supplemented with nuts). No between-group differences in changes of systolic BP were seen.ConclusionsBoth the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP. However, we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group.Trial registrationCurrent Controlled Trials ISRCTN35739639

Lifestyles and Risk Factors Associated with Adherence to the Mediterranean Diet: A Baseline Assessment of the PREDIMED Trial

BackgroundThe traditional Mediterranean dietary pattern (MedDiet) is associated with longevity and low rates of cardiovascular disease (CVD). However, there is little information on who is more likely to follow this food pattern.AimTo evaluate how different factors are associated with lower MedDiet adherence in older Spanish subjects.MethodsWe included 7305 participants (men aged 55–80 y, women 60–80 y) at high-risk of CVD recruited into the PREDIMED trial (ISRCTN35739639). Socioeconomic, anthropometric, lifestyle characteristics and CVD risk factors were recorded. A validated 14-item questionnaire was used to evaluate MedDiet adherence at baseline. Multivariate models were used to estimate odds ratios (OR) and 95% confidence intervals for lower adherence to the MedDiet (<9 points out of 14) and ascertain factors independently associated with it.ResultsFormer smoking (OR = 0.87; 95% CI, 0.78–0.98), physical activity (OR for the 3rd vs. the 1sttertile: 0.69; 0.62–0.78), and higher educational level (OR for university vs. less than primary school: 0.54; 0.38–0.77) were associated with higher MedDiet adherence. Conversely, having a larger waist-to-height ratio (OR for 0.1 units, 1.35; 1.22–1.49), being diabetic (OR = 1.13; 1.03–1.24), being single (OR = 1.27; 1.01–1.61) or divorced or separated (OR = 1.44; 1.09–1.89), and current smoking (OR = 1.28; 1.11–1.47) were associated with lower adherence.ConclusionsParticipants with little education, a larger waist-to-height ratio, or diabetes and those who were less physically active, single, divorced or separated, or smokers were less likely to adhere to the MedDiet, an ideal model for food choices. Stronger efforts of health promotion are needed in these groups to foster adoption of the MedDiet.

Clustering of lifestyle factors in Spanish university students: the relationship between smoking, alcohol consumption, physical activity and diet quality.

To ascertain the prevalence of and association between main lifestyle factors (diet, physical activity, alcohol consumption and smoking) in students from the Balearic Islands University. A cross-sectional, descriptive study. A questionnaire including questions on lifestyle, dietary habits and physical activity habits was administered to the students. Four different diet quality scores were calculated (Diet Diversity Score, Mediterranean Diet Score, Dietary Guidelines Score and Global Dietary Guidelines Score). A sample of students from the Balearic Islands University. Nine hundred and eighty-seven students (45·5 % males; mean age 21·5 (sd 3·3) years). The dietary pattern of the student population was characterized by a low consumption of cereals and tubers, fruits, vegetables, olive oil, legumes and nuts, and a high consumption of processed meat, sweets, snacks, soft drinks and pastries. Linear, positive and statistically significant correlations were found between the number of meals consumed daily and all of the diet quality scores determined. Determinants of diet quality, both in the univariate and multivariate analyses, were physical activity practice, sex, age and number of meals consumed daily. Risk factors such as smoking, diet and physical inactivity had a tendency of clustering among Spanish university students. Overall diet quality was low, due to important departures from dietary recommendations and loss of the traditional Mediterranean dietary pattern. Nutritional education campaigns that include promotion of physical activity practice are needed to improve the overall health status of this population.

Western and Mediterranean dietary patterns among Balearic Islands’ adolescents: socio-economic and lifestyle determinants

To assess prevailing food patterns among Balearic Islands' adolescents, and socio-economic and lifestyle determinants. Cross-sectional nutritional survey carried out (2007-2008) in the Balearic Islands, a Mediterranean region. Dietary assessment was based on a 145-item semi-quantitative FFQ and two non-consecutive 24 h recalls. Anthropometric measurements and questions related to socio-economic, lifestyle, physical activity and body image were assessed. Data obtained from a representative sample of all inhabitants living in the Balearic Islands aged 12-17 years. A random sample (n 1231) of the adolescent population (12-17 years old) was interviewed. Factor analysis identified two major dietary food patterns: 'Western' and 'Mediterranean'. The 'Western' dietary pattern was higher among boys than girls, associated with spending ≥4 h/d on media screen time, but less prevalent among those adolescents who desired a thinner body and those girls who desired to remain the same weight. The 'Mediterranean' dietary pattern was mainly followed by girls, and also boys who spent < 2 h/d on media screen time and girls with high parental socio-economic status. The present study shows the existence of two major dietary patterns among Balearic Islands' adolescents: 'Western' and 'Mediterranean', but girls are more 'Mediterranean' than boys. This evidence supports that the food pattern of Balearic Islands' adolescents is in a transitional state characterised by the loss of the traditional Mediterranean dietary pattern towards a Western dietary pattern. Low parental socio-economic status, much leisure-time on sedentary behaviours such as media screen time and body image are factors associated with the 'Western' dietary pattern.

Effect of a traditional Mediterranean diet on apolipoproteins B, A-I, and their ratio: A randomized, controlled trial

ObjectivesApolipoprotein (Apo)B, ApoA-I, and their ratio could predict coronary heart disease (CHD) risk more accurately than conventional lipid measurements. Our aim was to assess the effect of a traditional Mediterranean diet (TMD) on apolipoproteins. MethodsHigh-cardiovascular risk subjects (n=551, 308 women and 243 men), aged 55–80 years, were recruited into a large, multicenter, randomized, controlled, parallel-group, clinical trial (The PREDIMED Study) aimed at testing the efficacy of TMD on primary cardiovascular disease prevention. Participants assigned to a low-fat diet (control) (n=177), or TMDs (TMD+virgin olive oil (VOO), n=181 or TMD+nuts, n=193) received nutritional education and either free VOO (ad libitum) or nuts (dose: 30g/day). A 3-month evaluation was performed. ResultsBoth TMDs promoted beneficial changes on classical cardiovascular risk factors. ApoA-I increased, and ApoB and ApoB/ApoA-I ratio decreased after TMD+VOO, the changes promoting a lower cardiometabolic risk. Changes in TMD+VOO versus low-fat diet were −2.9mg/dL (95% CI, −5.6 to −0.08), 3.3mg/dL (95% CI, 0.84 to 5.8), and −0.03mg/dL (−0.05 to −0.01) for ApoB, ApoA-I, and ApoB/ApoA-I ratio, respectively. ConclusionsIndividuals at high-cardiovascular risk who improved their diet toward a TMD pattern rich in virgin olive oil, reduced their Apo B and ApoB/ApoA-I ratio and improved ApoA-I concentrations.

Diet and Inflammation

The emerging role of chronic inflammation in the major degenerative diseases of modern society has stimulated research into the influence of nutrition and dietary patterns on inflammatory indices. Most human studies have correlated analyses of habitual dietary intake as determined by a food frequency questionnaire or 24-hour recall with systemic markers of inflammation like high-sensitivity C-reactive protein (HS-CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). An occasional study also includes nutrition analysis of blood components. There have been several controlled interventions which evaluated the effect of a change in dietary pattern or of single foods on inflammatory markers in defined populations. Most studies reveal a modest effect of dietary composition on some inflammatory markers in free-living adults, although different markers do not vary in unison. Significant dietary influences have been established for glycemic index (GI) and load (GL), fiber, fatty acid composition, magnesium, carotenoids, and flavonoids. A traditional Mediterranean dietary pattern, which typically has a high ratio of monounsaturated (MUFA) to saturated (SFA) fats and ω-3 to ω-6 polyunsaturated fatty acid (PUFAs) and supplies an abundance of fruits, vegetables, legumes, and grains, has shown anti-inflammatory effects when compared with typical North American and Northern European dietary patterns in most observational and interventional studies and may become the diet of choice for diminishing chronic inflammation in clinical practice.