An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition: An Interim Subgroup Analysis of the PREDIMED-Plus Randomized Clinical Trial

Three Decades of the Mediterranean Diet Pyramid: A Narrative Review of Its History, Evolution, and Advances

The Mediterranean Diet Pyramid was officially published in the American Journal of Clinical Nutrition in 1995. Since then, our understanding of the role of the Mediterranean diet (MedDiet) and its role in reducing risk of chronic diseases has grown substantially. The aim of this article is to provide a narrative review of the historical context of the MedDiet and its environmental impact, summarize health-related evidence from the past three decades, and explore its practical applications and cultural adaptations. A large body of evidence from prospective cohort studies, randomized controlled trials, and mechanistic studies consistently supports the benefits of the MedDiet for the prevention of chronic diseases, particularly cardiometabolic diseases and improving healthy aging. Growing evidence demonstrates that the MedDiet promotes favorable changes in circulating metabolites and gut microbiome composition, providing novel insights into biological mechanisms underlying its health benefits and informing the development of precision nutrition strategies. The MedDiet aligns with the principles of the Planetary Health Diet recommended by the EAT-Lancet Commission, which aims to promote both human health and environmental sustainability. The development of the MedDiet pyramid 30 years ago inspired the creation of the Asian, African, and Latin American Heritage Diet Pyramids. Despite robust evidence, further studies are needed to evaluate the long-term effectiveness and adaptability of the MedDiet across diverse populations, cultural settings, and food environments.

Recent advances in precision nutrition and cardiometabolic diseases

A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications.

Recent advances in precision nutrition and cardiometabolic diseases

A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications.

Dietary vitamin D intake and changes in body composition over three years in older adults with metabolic syndrome

BACKGROUND

Adequate intake of vitamin D through diet may offer benefits in terms of body composition.

OBJECTIVES

We aimed to evaluate the longitudinal relationship between dietary vitamin D intake and changes in body composition in older adults over one and three years under the context of a weight loss and lifestyle behavioral intervention.

DESIGN

Longitudinal study.

SETTING

Multicenter.

PARTICIPANTS

This longitudinal study included 715 aged participants (mean age 65.3 ± 5.0 years, 38% women) with overweight/obesity and metabolic syndrome.

MEASUREMENTS

Multivariable-adjusted mixed-effects linear regression models were fitted to investigate the longitudinal associations between dietary vitamin D intake (exposure) and body composition (outcome) with available data at baseline, one, and three years of follow-up. Data on dietary vitamin D intake was assessed using a validated 143-item food frequency questionnaire. Body composition variables (total body weight (kg), total fat mass (%), total lean mass (%), muscle-to-fat mass ratio, visceral adipose tissue (kg), and android-to-gynoid fat ratio) were measured by dual-energy X-ray absorptiometry.

RESULTS

Higher dietary vitamin D intake (for each μg/day) was associated with higher total lean mass (β: 0.10 %; 95% CI: 0.02 to 0.18; P: 0.017) and muscle-to-fat mass ratio (β: 1.00 × 10-2; 95% CI: 0.22 × 10-2 to 1.78 × 10-2; P: 0.011), and lower total body weight (β: -0.20 kg; 95% CI: -0.34 to -0.05; P: 0.007), total fat mass (β: -0.11 %; 95% CI: -0.19 to -0.02; P: 0.015), and visceral adipose tissue (β: -1.74 × 10-2 kg; 95% CI: -3.47 × 10-2 to -0.01 × 10-2; P: 0.048) at one year of follow-up in the group following the intervention in the multivariable-adjusted model.

CONCLUSION

Dietary vitamin D intake was associated with better body composition changes in the context of a weight loss and lifestyle intervention which led to notable changes in body composition at short term.

Body Fat and Visceral Fat Values in Spanish Healthcare Workers: Associated Variables

BACKGROUND/OBJECTIVES

Excessive body adiposity is a significant public health challenge on a global scale. This study aimed to investigate the association between various sociodemographic factors and healthy lifestyle habits and the presence or absence of elevated body adiposity levels.

METHODOLOGY

Two studies were conducted, a retrospective longitudinal study and a cross-sectional descriptive study. The analysis included 44,939 healthcare workers, categorised into four professional groups, to explore the relationship between age, sex, smoking, physical activity, and adherence to the Mediterranean diet and body adiposity, assessed as elevated body fat (BF) and visceral fat (VF) levels. Descriptive statistics encompassed categorical and quantitative variables, analysed using frequencies, Student's t-tests, chi-square tests, and multinomial logistic regression models. Associations, concordances, and correlations were further examined using logistic regression and Cohen's and Pearson's kappa coefficients.

RESULTS

Age, sex, and physical activity were the factors most strongly associated with elevated BF and VF levels. Odds ratios (ORs) indicated the following significant associations: individuals aged 60 years and older exhibited ORs of 6.71 (95% CI: 5.68-7.74) for BF and 12.18 (95% CI: 10.01-14.26) for VF; male sex was associated with ORs of 2.21 (95% CI: 2.06-2.36) for BF and 12.51 (95% CI: 11.29-13.74) for VF. Sedentary behaviour was linked to ORs of 3.69 (95% CI: 3.41-3.97) for BF and 4.20 (95% CI: 3.78-4.63) for VF. Among healthcare professionals, nursing assistants and orderlies demonstrated the highest levels of adipose tissue accumulation.

CONCLUSIONS

Elevated BF and VF levels among healthcare personnel are significantly associated by lifestyle factors, sex, and age, with the most pronounced risk observed in nursing assistants and orderlies. Further research focusing on the causal relationships between lifestyle behaviours and adiposity in this population will provide valuable insights and support the design of targeted preventive strategies to mitigate its prevalence.

In vivo medical imaging for assessing geroprotective interventions in humans

There is a growing interest in developing drugs with a general geroprotective effect, aimed at slowing down aging. Several compounds have been shown to increase the lifespan and reduce the incidence of age-related diseases in model organisms. Translating these results is challenging, due to the long lifespan of humans. To address this, we propose using a battery of medical imaging protocols that allow for assessments of age-related processes known to precede disease onset. These protocols, based on magnetic resonance imaging, positron emission-, computed-, and optical coherence tomography, are already in use in drug development and are available at most modern hospitals. Here, we outline how an informed use of these techniques allows for detecting changes in the accumulation of age-related pathologies in a diverse set of physiological systems. This in vivo imaging battery enables efficient screening of candidate geroprotective compounds in early phase clinical trials, within reasonable trial durations.

Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management

The 'Body Mass Index' (BMI) is an anachronistic and outdated ratio that is used as an internationally accepted diagnostic criterion for obesity, and to prioritise, stratify, and outcome-assess its management options. On an individual level, the BMI has the potential to mislead, including inaccuracies in cardiovascular risk assessment. Furthermore, the BMI places excessive emphasis on a reduction in overall body weight (rather than optimised body composition) and contributes towards a misunderstanding of the quiddity of obesity and a dispassionate societal perspective and response to the global obesity problem. The overall objective of this review is to provide an overview of obesity that transitions away from the BMI and towards a novel vista: viewing obesity from the perspective of the skeletal muscle (SM). We resurrect the SM as a tissue hidden in plain sight and provide an overview of the key role that the SM plays in influencing metabolic health and efficiency. We discuss the complex interlinks between the SM and the adipose tissue (AT) through key myokines and adipokines, and argue that rather than two separate tissues, the SM and AT should be considered as a single entity: the 'Adipo-Muscle Axis'. We discuss the vicious circle of sarcopenic obesity, in which aging- and obesity-related decline in SM mass contributes to a worsened metabolic status and insulin resistance, which in turn further compounds SM mass and function. We provide an overview of the approaches that can mitigate against the decline in SM mass in the context of negative energy balance, including the optimisation of dietary protein intake and resistance physical exercises, and of novel molecules in development that target the SM, which will play an important role in the future management of obesity. Finally, we argue that the Adipo-Muscle Ratio (AMR) would provide a more clinically meaningful descriptor and definition of obesity than the BMI and would help to shift our focus regarding its effective management away from merely inducing weight loss and towards optimising the AMR with proper attention to the maintenance and augmentation of SM mass and function.

Complete Lifestyle Medicine Intervention Program-Ontario: Implementation Protocol for a Rural Study

BACKGROUND

Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use, limited social connections, and high stress contribute to the growing prevalence of chronic diseases. Lifestyle medicine, emphasizing therapeutic lifestyle changes for prevention and treatment, has demonstrated effectiveness but remains underutilized in clinical settings. The Complete Lifestyle Medicine Intervention Program-Ontario (CLIP-ON) was developed to educate the rural population of Northern Ontario in lifestyle medicine to improve health outcomes and engagement.

OBJECTIVE

This study evaluates the implementation and effectiveness of the CLIP-ON program for patients with chronic diseases in the Parry Sound area, focusing on lifestyle behaviors, health outcomes, enrollment, retention rates, and interdisciplinary team engagement.

METHODS

This observational cohort study guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) includes pre- and postintervention assessments from participants and health care providers. A hybrid type II mixed methods design evaluates the intervention's effectiveness and implementation process in real-world settings through quantitative and qualitative data collection. CLIP-ON is tailored to the residents of the Parry Sound catchment area in Northern Ontario. Participants (≥18 years old) with chronic conditions such as prediabetes, type II diabetes, systemic hypertension, cardiovascular vascular disease, dyslipidemia, or high BMI (≥25) will be recruited through self-referral or provider referral. Approximately 10 participants per cohort will be enrolled in the CLIP-ON program, consisting of 22 weeks of weekly group sessions and monthly individual consultations with physicians, health coaches, kinesiologists, and registered dieticians either in person or through a web-based platform. CLIP-ON will cover the 6 pillars of lifestyle medicine through 14 group sessions followed by an 8-week supervised exercise program. Anthropometric and cardiometabolic variables will be measured before and after the program. Participants will be surveyed on lifestyle habits, wellness, perceived barriers, and program satisfaction at 3 and 6 months. Focus groups and dropout interviews with participants (n=10 per cohort) and providers (n=6 per cohort) will guide program adaptations. Quantitative and qualitative data collected at baseline and follow-up will assess the program's implementation and identify barriers and opportunities for improvement.

RESULTS

This study was approved by the Laurentian University Research Ethics Board (6021397) on July 6, 2023. The first cohort was enrolled in late 2023 and is still under evaluation. The second cohort began in mid-2024, and data collection is currently underway. A mixed methods analysis will be used at enrollment, program completion (22 weeks), and follow-up (6 months after program completion). Focus groups assessing the program's effectiveness and implementation will take place after the 22-week intervention. Data will be analyzed in early 2025.

CONCLUSIONS

This protocol provides insights into the implementation of this lifestyle medicine program and its impact on participants' health. The findings will guide future advancements and establish a scalable model for other communities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06192251; https://clinicaltrials.gov/study/NCT06192251.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59179.

Effects of a One-Year Intensified Weight Loss Program on Body Composition Parameters in Patients with Severe Obesity and Obstructive Sleep Apnea (OSA): A Randomized Controlled Trial

Background: Studies focusing on the effects of lifestyle strategies on patients with obstructive sleep apnea (OSA) that go beyond body weight and explore body composition are currently scarce and inconclusive. Objectives/Methods: The aim of this study was to evaluate the effects of a 12-month intensive life intervention program (ILI), based on a hypocaloric Mediterranean diet, on changes in the body composition parameters as assessed by abdominal computed tomography (CT) and the cardiorespiratory profile of patients with severe OSA and grade I-II obesity, compared to patients receiving standard care. Resultts:Thirty-four patients (30 males and four females) were randomly assigned to an intervention group (IG) (n = 18) or a control group (CG) (n = 16). We observed an improvement in OSA severity following the intervention. Patients in the IG lost 8.2% of their body weight compared to 0.1% of the patients in the CG (p < 0.001), and this loss was primarily due to reductions in total body fat, visceral adipose tissue index (VATI) [IG -19.4 (18.1) cm2/m2 versus CG 2.32 (11.6) cm2/m2, p < 0.001], and a tendency toward lower intramuscular adipose tissue index (IMATI) [IG -0.69 (0.85) cm2/m2 versus CG 0.04 (1.3) cm2/m2, p = 0.098]. These changes were associated with an improvement in patients' metabolic and inflammatory profile. Younger age and a higher degree of obesity at baseline were associated with greater weight loss. Conslusions: In conclusion, the ILI was effective in reducing 8.2% of body weight at 12 months, leading to favorable changes in patients' body composition profile that resulted in healthier metabolic and inflammatory parameters.

Associations Between Metabolic Age, Sociodemographic Variables, and Lifestyle Factors in Spanish Workers

BACKGROUND

Metabolic age is defined as an estimation of a person's age based on their basal metabolic rate (BMR) and other physiological health indicators. Unlike chronological age, which simply measures the number of years lived since birth, metabolic age is based on various health and fitness markers that estimate the body's "true" biological age and can be assessed using various methodologies, including bioimpedance. The aim of this study was to evaluate how age, sex, social class, smoking habits, physical activity, and adherence to the Mediterranean diet influence metabolic age.

METHODS

A cross-sectional, descriptive study was conducted on 8590 Spanish workers in the Balearic Islands. A series of sociodemographic variables and health-related habits were assessed, while metabolic age was measured using bioimpedance. A metabolic age exceeding chronological age by 12 years or more was considered high. A descriptive analysis of categorical variables was performed by calculating their frequency and distribution. By applying multivariate models, specifically multinomial logistic regression, we observe that all independent variables (sex, age, social class, physical activity, mediterranean diet, and smoking) show varying levels of association with the occurrence of high metabolic age values. Among these independent variables, those showing the highest degree of association, represented by odds ratios, are physical activity, adherence to the Mediterranean diet, and social class. In all cases, the observed differences demonstrate a high level of statistical significance (p < 0.001).

RESULTS

The factors with the greatest influence were physical inactivity, with an OR of 5.07; and low adherence to the Mediterranean diet, with an OR of 2.8; followed by social class, with an OR of 2.51. Metabolic age increased with chronological age and was higher in males, with an OR of 1.38. Smoking also had a negative impact on metabolic age, with an OR of 1.19.

CONCLUSIONS

Mediterranean diet is associated with a higher metabolic age. The most influential factors on metabolic age are physical activity and adherence to the Mediterranean diet, followed by the individual's socioeconomic class. Smoking also contributes to increased metabolic age, albeit to a lesser extent.

Regular exercise ameliorates high-fat diet-induced depressive-like behaviors by activating hippocampal neuronal autophagy and enhancing synaptic plasticity

Exercise enhances synaptic plasticity and alleviates depression symptoms, but the mechanism through which exercise improves high-fat diet-induced depression remains unclear. In this study, 6-week-old male C57BL/6J mice were administered a high-fat diet (HFD, 60% kcal from fat) to a HFD model for 8 weeks. The RUN group also received 1 h of daily treadmill exercise in combination with the HFD. Depressive-like behaviors were evaluated by behavioral assessments for all groups. The key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors was detected by RNA-seq. The morphology and function of the neurons were evaluated via Nissl staining, Golgi staining, electron microscopy and electrophysiological experiments. The results showed that exercise attenuated high-fat diet-induced depressive-like behavior and reversed hippocampal gene expression changes. RNA-seq revealed Wnt5a, which was a key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors. Further work revealed that exercise significantly activated neuronal autophagy in the hippocampal CA1 region via the Wnt5a/CamkII signaling pathway, which enhanced synaptic plasticity to alleviate HFD-induced depressive-like behavior. However, the Wnt5a inhibitor Box5 suppressed the ameliorative effects of exercise. Therefore, this work highlights the critical role of Wnt5a, which is necessary for exercise to improve high-fat diet-induced depression.

Influence of a structured, 1-year-long dietary intervention regarding body composition and cardiovascular risk (ARCTIC) in coeliac disease: a protocol of a multicentre randomised controlled trial

INTRODUCTION

Coeliac disease (CD) affects 1% of the population worldwide. The only available evidence-based treatment is a strict gluten-free diet (GFD), which can readily lead to weight gain and unfavourable metabolic changes (eg, dyslipidaemia, fatty liver disease and insulin resistance) if followed without adequate dietary control. That can lead to increased cardiovascular risk (CV). We planned a randomised controlled trial to test the effect of a group-based, structured, 1-year, advanced dietary education, per the proposal of a Mediterranean diet vs standard of care, regarding the most relevant CV risk factors (eg, metabolic parameters and body composition) in CD patients.

METHODS AND ANALYSIS

Randomisation will occur after the baseline dietary education and interview in a 1:1 allocation ratio. Outcomes include anthropometric parameters (body composition analysis including weight, Body Mass Index, fat mass, per cent body fat, skeletal muscle mass, visceral fat area and total body water) and CV risk-related metabolic parameters (eg, lipid profile, homocysteine, fasting glucose, haemoglobin A1c, Homeostatic Model Assessment Index, metabolic hormones, waist circumference, blood pressure, liver function tests, liver steatosis rate and diet composition). In this study, we aim to draw attention to a new aspect regarding managing CD: dietary education can lead to a better quality of the GFD, thereby reducing the risk of potential metabolic and CV complications.

ETHICS AND DISSEMINATION

The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (27521-5/2022/EÜIG). Findings will be disseminated at research conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05530070.

Telomere length and 4-year changes in cognitive function in an older Mediterranean population at high risk of cardiovascular disease

BACKGROUND

Cognitive decline, a common process of brain ageing, has been associated with telomere length (TL). Delving into the identification of reliable biomarkers of brain ageing is essential to prevent accelerated cognitive impairment.

METHODS

We selected 317 non-smoking 'Prevención con Dieta Mediterránea-Plus' (PREDIMED-Plus) participants (mean age, 65.8 ± 5.0 years) with metabolic syndrome from two trial centres who were following a lifestyle intervention. We measured TL and cognitive function at baseline and after 3 and 4 years of follow-up, respectively. Associations between baseline or 3-year changes in TL and baseline or 4-year changes in cognitive function were analysed using multivariable regression models.

RESULTS

Baseline TL was not associated with baseline cognitive performance. Nevertheless, longer baseline TL was associated with improved 4-year changes in the Executive Function domain (β: 0.29; 95%CI: 0.12 to 0.44; P < 0.001) and the Global Cognitive Function domain (β: 0.19; 95%CI: 0.05 to 0.34; P = 0.010). Besides, a positive association was found between longer baseline TL and improved 4-year changes in the animal version of the Verbal Fluency Test (β: 0.33; 95%CI: 0.12 to 0.52; P = 0.002). By contrast, 3-year changes in TL were not associated with changes in cognitive function after 4 years.

CONCLUSIONS

Longer baseline TL could protect from cognitive decline and be used as a useful biomarker of brain ageing function in an older Mediterranean population at risk of cardiovascular disease and cognitive impairment.

Pharmacotherapy of Weight-loss and Obesity with a Focus on GLP 1-Receptor Agonists

Obesity is a disease of epidemic proportions in the United States and contributes to morbidity and mortality for a large part of the population. In addition, the financial costs of this disease to society are high. Lifestyle modifications are key to prevention and treatment but adherence and long-term success have been challenging. Bariatric surgery has been available and pharmacologic approaches, first developed in the 1950s, continue to be an option; however, existing formulations have not provided optimal clinical efficacy and have had many concerning adverse effects. Over the last decade, glucagon-like peptide-1 (GLP-1) receptor agonists, a novel group of medications for the treatment of type 2 diabetes, were found to produce significant weight loss. Several formulations, at higher doses, received FDA approval for the treatment of obesity or those overweight with weight-related co-morbidities. More hormone-based therapies were and are being developed, some with dual or triple-receptor agonist activity. Their use, however, is not without questions and concerns as to long-term safety and efficacy, problems with cost and reimbursement, and how their use may intersect with public health efforts to manage the obesity epidemic. This review will focus on the GLP-1 receptor agonists currently used for weight loss and discuss their pharmacology, pertinent research findings establishing their benefits and risks, issues with prescribing these medications, and a perspective from a public health point of view.

Glycated hemoglobin, type 2 diabetes, and poor diabetes control are positively associated with impulsivity changes in aged individuals with overweight or obesity and metabolic syndrome

Impulsivity has been proposed to have an impact on glycemic dysregulation. However, it remains uncertain whether an unfavorable glycemic status could also contribute to an increase in impulsivity levels. This study aims to analyze associations of baseline and time-varying glycemic status with 3-year time-varying impulsivity in older adults at high risk of cardiovascular disease. A 3-year prospective cohort design was conducted within the PREDIMED-Plus-Cognition substudy. The total population includes 487 participants (mean age = 65.2 years; female = 50.5%) with overweight or obesity and metabolic syndrome. Insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), presence of type 2 diabetes mellitus, and type 2 diabetes control were evaluated. Impulsivity was measured using the Impulsive Behavior Scale questionnaire and various cognitive measurements. Impulsivity z-scores were generated to obtain Global, Trait, and Behavioral Impulsivity domains. Linear mixed models were used to study the longitudinal associations across baseline, 1-year, and 3-year follow-up visits. HOMA-IR was not significantly related to impulsivity. Participants with higher HbA1c levels, type 2 diabetes, and poor control of diabetes showed positive associations with the Global Impulsivity domain over time, and those with higher HbA1c levels were further related to increases in the Trait and Behavioral Impulsivity domains over the follow-up visits. These results suggest a potential positive feedback loop between impulsivity and glycemic-related dysregulation.

Level of body mass index, functional fitness, quality of life, and satisfaction with life among women aged 60+ years participating in an organised pro-health training programme

Introduction

The aim of the study is to assess changes in body mass index (BMI), functional fitness, satisfaction with and quality of life among women 60+ years after participating in a 9-month organised health training programme.

Material and methods

Research on a group of 74 women aged 60-83 years (M = 67.8; SD = 5.1) was conducted twice, at the beginning and after 9 months of the health training programme (90 minutes, twice a week). The following tools were used in the research: SECA model 764 device, Fullerton functional fitness test, the World Health Organization Quality of Life questionnaire, and the satisfaction with life scale. Calculations were performed using the Statistica 13.1 program, via Pearson's and Spearman's correlation coefficients as well as Student's t-test for dependent measurements and the Wilcoxon paired test. Interactive repeated measures analysis of variance was also used. The assumed level of significance was α = 0.05.

Results

Comparing the results before and after implementing the health training programme, it was found that the average BMI value decreased (p < 0.001), while the functional fitness indicators, including the tests: 30-second chair stand (p < 0.001), 30-second arm curl (p < 0.001), back scratch (p = 0.001) and two-minute step-in-place (p = 0.002), increased. Between the first and second measurement, differences in quality of life profiles were also demonstrated, with 3 aspects of quality of life intensifying (somatic, psychological, and environmental), the psychological aspect increasing the most.

Conclusions

The obtained results confirmed the positive impact of the 9-month health training programme on the BMI, functional fitness, and quality of life of women above the age of 60 years.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Nuts and seeds consumption impact on adolescent obesity: sex-specific associations from 2003 to 2018 National Health and Nutrition Examination Survey

The nutritional benefits and immunological advantages of consuming nuts and seeds are well-established. However, the link between nuts and seeds consumption and the susceptibility of being overweight or obese among adolescents is not clear. This study aims to explore this relationship in adolescents aged 12-19. Using a weighted multiple logistic regression model, we analysed data of the Food Patterns Equivalents Database and the U.S. National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. We found a significant association between nuts and seeds consumption and a reduced odds of being overweight or obese in females. Specifically, females who habitually consumed nuts and seeds had lower odds of being overweight or obese (OR = 0.55, 95% CI: 0.32-0.94). Additionally, we found an L-shaped relationship between nuts and seeds consumption and appropriate waist-to-height ratio in males. The findings suggest that nuts and seeds consumption may contribute to healthier physical development in adolescents.

Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. This study focused on evaluating the impact of a Mediterranean-type diet combined with physical exercise on CVD risk factors of high-risk individuals. A randomized clinical trial (RCT) recruited individuals (≥50 years old) with no history of acute myocardial infarction, but with high CVD risk criteria according to the SCORE2/SCORE2 OP. Anthropometric and biochemical parameters were assessed at baseline and after 12 weeks of diet and exercise intervention. Participants were randomly assigned into 3 groups: no intervention group (Group 1a), physical exercise group (Group 1b), and physical exercise (±2 h/week) plus diet group (Group 2). Briefly, the dietary intervention was based on the principles of an isocaloric Mediterranean diet (MD), with seven main meals/week centered on plant-based foods (legumes and pulses). The combined effect of exercise and the diet showed significant decrease in WC (p = 0.002), BST (p < 0.001), visceral fat (p < 0.001), and TG (p = 0.029), compared with control groups. The intervention significantly increased legume intake (p < 0.001), as well as adherence to the MD, which associates with WC decrease (p = 0.024) and visceral fat (p = 0.017). A combined intervention of exercise and diet should be endorsed as an efficient modifier of cardiometabolic parameters.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

Mediterranean-Type Diet Adherence and Body Mass Index through 20 Years of Follow-Up: Results from the ATTICA Cohort Study (2002-2022)

Evidence of the association between dietary habits and long-term body weight status is scarce. This study aimed to evaluate changes in Mediterranean-type diet (MTD) adherence in relation to body weight during 20 years of follow-up. Data from n = 1582 participants from the ATTICA cohort study (2002-2022) were used. MTD adherence was assessed via MedDietScore, and body weight status via body mass index (BMI) by 3 different measurements. We found that MTD adherence and changes in this adherence were inversely related to BMI at 20 years and the mean BMI during the 20-year follow-up. In multi-adjusted linear regression models, a 1/55 increase in baseline, 10-year, and 20-year MedDietScore was associated with a decrease of 0.05-0.13 kg/m2 in BMI at 20 years and of 0.08-0.09 kg/m2 in the mean BMI. Being consistently close to the MTD for 20 years was associated with a >90% decreased risk of maintaining overweight/obesity during the 20-year period. Strong, protective, long-lasting effects of the MTD were observed, even in those who deviated from the MTD in the follow-up (41% of the sample). Our results highlight the need to focus on the overall diet quality to minimize the risk of maintaining an excessive body weight during the life-course.

Mediterranean diet adherence and sleep pattern: a systematic review of observational studies

BACKGROUND AND AIMS

Despite a huge body of evidence on the linkage between dietary intakes and pattern of sleeping, the findings are controversial. The current study aimed to summarize earlier findings on the association between adherence to Mediterranean diet (MD) and pattern of sleeping.

METHODS

This study performed based on PRISMA guideline. Systematically search was applied in PubMed, Scopus and Google Scholar to find out relevant publications appeared up to February 2023. No restrictions on language and time of publication were applied. Duplicate citations were removed. We included observational studies which assessed MD as the main exposure and kind of sleep disorders as the main outcome.

RESULTS

A total of 20 observational studies included. Out of these studies, two were cohort studies and 18 had a cross-sectional design. A total of 21,714 participants included. Usual dietary intakes were assessed using a validated Food Frequency Questionnaire, and a diet history questionnaire. Some studies did not report methods of measuring habitual dietary intakes. Adherence to MD was evaluated by KIDMED questionnaire, PREMED, alternate Mediterranean (aMed) questionnaire, MEDAS questionnaire, MedDietScore, MEDI-LITE score, modified Mediterranean Diet Score (mMDS), Mediterranean food pattern (MFP) and modified Mediterranean diet score (mMED). Pattern of sleeping was examined as sleep quality, sleep duration, sleep latency, sleep efficacy, sleepiness, sleep disturbance, taking a nap and some other sleep disorders.

CONCLUSION

In conclusion, findings of published studies highlighted the importance of consumption of MD for better sleep quality.

Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management

BACKGROUND

Diabesity, the intersection of obesity and diabetes, presents a global health crisis with profound implications. Addressing diabesity requires multifaceted strategies, with diet playing a pivotal role. Over the last 15 years, clinical studies have intensified their exploration of various dietary approaches in diabesity management. This literature review aims to synthesize findings from clinical studies conducted in the last 15 years, shedding light on the efficacy, mechanisms, and nuances of different diet types in diabesity management with special focus on the Mediterranean diet (MD).

METHODS

Thorough research of academic databases yielded a collection of relevant clinical studies. These studies encompassed a range of dietary strategies, including the MD, low-carbohydrate diets, plant-based diets, high-protein diets, low-fat regimens, and intermittent fasting. Key findings, methodologies, and outcomes were thoroughly extracted and analyzed.

RESULTS

The last 15 years have witnessed considerable improvements in recognizing the role of human nutritional habits in diabesity management. The MD appears to be the most well-recognized diet, exerting favorable effects against both obesity and diabetes. Low-carbohydrate diets were found to enhance glycemic regulation and decrease insulin resistance. Plant-based diets demonstrated potential benefits in weight management and cardiometabolic health. High-protein, low-fat dietary models exhibited positive effects on satiety and body weight decline. Intermittent fasting regimens also exerted metabolic improvements and body weight decline. Personalization emerged as a crucial factor in dietary recommendations.

CONCLUSIONS

Clinical studies from the last 15 years underscore the intricate relationship between diet types and diabesity management. The above results contribute to an increasing body of evidence, emphasizing the need for tailored dietary approaches and especially the MD. Healthcare providers can utilize this knowledge to offer personalized dietary recommendations for individuals with diabesity, potentially curbing the rise of these twin epidemics and improving the well-being of affected populations.

The Impact of Diet and Physical Activity on Fat-to-Lean Mass Ratio

In this retrospective study, we evaluated the efficacy of a personalised low-calorie Mediterranean Diet (MD) in promoting fat mass (FM) reduction while preserving fat-free mass (FFM). This study involved 100 Caucasian adults aged 18-65 years who followed a tailored low-calorie MD for two months. The total energy expenditure was assessed using a multi-sensor armband. The change in body composition (BC) was evaluated using the Δ% FM-to-FFM ratio, calculated as the difference in the FM to FFM ratio before and after the diet, divided by the ratio before the diet, and multiplied by 100. A negative value indicates a greater decrease in FM than FFM, while a positive value suggests a greater increase in FM than FFM. This study demonstrated a significant FM reduction, with an average decrease of 5% (p < 0.001). However, the relationship between caloric reduction and the Δ% FM-to-FFM ratio showed a weak negative correlation (r = -0.03, p > 0.05). This suggests that the calorie deficit had a minimal direct impact on the BC changes. Subjects over the age of 30 showed an increase in muscle mass, while younger subjects showed no significant changes. Moreover, a direct correlation was observed between the changes in MET (Metabolic Equivalent of Task) values and the Δ% FM-to-FFM ratio, indicating that improved average physical activity intensity positively influences BC. In the female subgroup, high protein intake, exercise intensity, and the duration of physical activity were positively correlated with an improvement in the Δ% FM-to-FFM ratio. However, for individuals with BMI 20-25 kg/m2, high fibre intake was surprisingly negatively correlated with the Δ% FM-to-FFM ratio. This study underscores the intricate interplay between calorie restriction, physical activity intensity, and BC changes. It also suggests that individual factors, including age, gender, and BMI, may influence the response to a low-calorie MD. However, further prospective studies with larger sample sizes are necessary to confirm and expand upon these findings.