Adherence to the Mediterranean diet among adults in Mediterranean countries: a systematic literature review

Adherence to the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet and trajectories of depressive symptomatology in youth

BACKGROUND

The rising prevalence of youth depression underscores the need to identify modifiable factors for prevention and intervention. This study aims to investigate the protective role of Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on depressive symptoms in adolescents.

METHODS

Participants were identified from the Adolescent Brain Cognitive Development study. Adherence to the MIND diet was measured by the Child Nutrition Assessment or the Block Kids Food Screener. Depressive symptoms were measured annually using the Child Behavior Checklist's depression subscale. We utilized regression analyses and cross-lagged panel modeling (CLPM) to examine longitudinal associations. Additional analyses adjusted for polygenic risk scores for depression, and changes in Body Mass Index (BMI) and waist-to-height ratio.

RESULTS

Of the 8459 children (52.3 % male; mean age 10.9 [SD, 0.6] years), 2338 (27.6 %) demonstrated high MIND diet adherence, while 2120 (25.1 %) showed low adherence. High adherence was prospectively associated with reduced depressive symptoms (adjusted β, -0.64, 95 % CI, -0.73 to -0.55; p < 0.001) and 46 % lower odds of clinically relevant depression (adjusted odds ratio, 0.54, 95 % CI, 0.39 to 0.75; p < 0.001) at two-year follow-up. CLPM analyses showed significant cross-lag paths from MIND diet scores to less depressive symptoms across three time points. These associations persisted independently of changes in BMI and waist-to-height ratios, and were not significantly moderated by genetic predisposition to depression.

CONCLUSIONS

Higher adherence to the MIND dietary pattern was longitudinally associated with decreased risk of depressive symptoms in adolescents. Promoting MIND diet may represent a promising strategy for depression prevention in adolescent populations.

Association of adherence to Mediterranean diet and changes over time with all-cause mortality in older adults: the Seniors-ENRICA cohorts

BACKGROUND

Despite the well-recognized nutritional quality and health benefits of the Mediterranean diet (MD), its adherence appears to be declining. However, the extent of this decline and its relationship with mortality in the older population remains unclear.

OBJECTIVES

This study aims to analyze the associations between adherence to MD and its changes over time with all-cause mortality in older adults.

METHODS

We used data from 3518 and 3273 older adults, aged 60-96 y at baseline, participating in the Seniors-ENRICA-1 and 2 cohorts, respectively. Adherence to MD was assessed by the 14-item Mediterranean Diet Adherence Screener (MEDAS) and classified as low (<7 points), moderate (7-8 points), and high (≥9 points). All-cause mortality was ascertained up to 31 January, 2024. Analyses were performed using Cox regression models adjusted by main confounders.

RESULTS

Baseline [n = 6083; follow-up of 7.9 y; per 1-point: hazard ratio (HR) = 0.92; 95% confidence interval (CI): 0.89, 0.95] and changes (n = 2070; follow-up of 11.2 y; per 1-point increase: HR = 0.91; 95% CI: 0.86, 0.97) in MEDAS were associated with a lower mortality. At baseline, moderate (HR = 0.87; 95% CI: 0.77, 0.99) and high (HR = 0.70; 95% CI: 0.59, 0.82) adherence to MD were associated with lower mortality, compared with low adherence. In addition, participants who maintained high adherence to MD in both examinations had the lowest mortality compared with consistently low adherence (HR = 0.54; 95% CI: 0.38, 0.76). Baseline and maintained adherence in items of carbonated sweetened beverages (<1 serving/d), fish/seafood (≥3 servings/wk), commercial pastry (<2 servings/wk), and nuts (≥3 servings/wk) was associated with lower mortality.

CONCLUSIONS

Initial adherence to MD, as well as subsequent maintained or increased adherence, is associated with lower all-cause mortality in older adults, with some foods as the main drivers.

Micronutrients adequacy according to six diet quality indices in the "Seguimiento Universidad de Navarra" cohort

Introduction

Objectives: diet quality indices (DQI) tend to relate positively to micronutrient intake. Our aim was to investigate the association between six DQIs and inadequate intake for 19 micronutrients in the SUN ("Seguimiento Universidad de Navarra") cohort. Methods: we assessed 16,768 participants (59.3 % women, 37.8 years for mean age). Diet quality was evaluated using Dietary Approaches to Stop Hypertension (DASH); Mediterranean Diet Adherence Screener (MEDAS); Alternate Healthy Eating Index (AHEI-2010); Food-Based Global Diet Quality Score (GDQS); Alternative Mediterranean Diet Score (aMED) and Mediterranean Diet Score (MDS). Logistic regression analyses were conducted to estimate the probability of failing to meet Estimate Average Requirement (EAR) for either ≥ 3 or ≥ 6 micronutrients. Results: overall, the lower and higher prevalence of inadequacy in fifth quintiles was for vitamins A, C, B1, B2, B3, B6, for Fe, P and Cr, and for vitamins E and D, respectively. In the multivariable adjusted model, the OR for failing to meet ≥ 3 DRI for the highest versus the lowest quintiles of DASH, MEDAS, AHEI-2010, GDQS, aMED and MDS were: 0.03 (95 % CI, 0.02 to 0.03), 0.06 (95 % CI, 0.05 to 0.07), 0.10 (95 % CI, 0.09 to 0.12), 0.05 (95 % CI, 0.04 to 0.06), 0.03 (95 % CI, 0.03 to 0.04), and 0.07 (95 % CI, 0.06 to 0.09), respectively. Conclusions: adherence to six DQIs showed inverse associations with micronutrient inadequacy. Food-based DQIs could be a useful prevention tool. GDQS and MEDAS do not require deriving nutrient intake data, particularly MEDAS, which is even easier and quicker to fill out.

The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. This study aims to investigate the association between adherence to the Mediterranean Diet (Med-Diet) and the Prime Diet Quality Score (PDQS) and the risk of PCOS.

METHOD

This case-control study included 472 women aged 18-45, with 180 PCOS cases and 292 controls. PCOS diagnosis was based on the Rotterdam criteria. Dietary intake was assessed using a validated food frequency questionnaire, and adherence to the Med-Diet and PDQS was calculated. Statistical analyses included logistic regression to examine associations between diet quality and PCOS.

RESULTS

Higher adherence to both the Med-Diet and PDQS was significantly associated with lower odds of PCOS. Participants in the highest quartile of the Med-Diet score had a 41% reduced risk of PCOS in the crude model (OR = 0.59, 95% CI: 0.48-0.67) and a 32% reduced risk in the fully adjusted model (OR = 0.68, 95% CI: 0.57-0.79), after adjusting for potential confounders, including age, body mass index (BMI), physical activity, and total energy intake. Similarly, those in the highest PDQS quartile showed a 53% reduced risk in the crude model (OR = 0.47, 95% CI: 0.35-0.56) and a 43% reduced risk in the fully adjusted model (OR = 0.57, 95% CI: 0.44-0.68), accounting for the same confounders.

CONCLUSION

The findings suggest that higher adherence to the Med-Diet and PDQS is associated with a reduced risk of developing PCOS. Further research is warranted to explore the underlying biological mechanisms and to establish causality through prospective cohort studies and randomized controlled trials.

Planetary health diet, mediterranean diet and micronutrient intake adequacy in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

Our study aimed to investigate and compare the association between adherence to a priori Planetary Health Diet Index and two well-known Mediterranean indices, the Mediterranean Diet Score (MDS) and the Mediterranean Adherence Screener (MEDAS), and micronutrient intake adequacy.

METHODS

We assessed 18,259 Spanish university graduates at baseline who participated in the SUN cohort using a validated semi-quantitative food frequency questionnaire. Inadequate intake of Zn, I, Se, Fe, Ca, P, Mg, Cr, K, vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid was evaluated using the estimated average requirement (EAR) cut-point approach and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients.

RESULTS

Participants with higher adherence to the Planetary Health Diet had a lower risk of overall inadequacy, while the Mediterranean Diet (MedDiet) showed even greater nutritional adequacy. The adjusted Odds Ratio (OR) for failing to meet ≥ 3 EAR was 0·24 (95% CI 0·21 - 0·27) for the Planetary Health Diet Index, whereas it was substantially lower for MEDAS with OR = 0·12, 95% CI 0·11 - 0·13, and for MDS with OR = 0·09, 95% CI 0·08 - 0·10, always for the comparison of the fourth v. first quartile and using the probabilistic approach method.

CONCLUSION

In this Mediterranean cohort, better adherence to both the Planetary Health Diet and the MedDiet (with a stronger inverse association) showed lower risk of micronutrient inadequacy.

Mediterranean diet and prime diet quality score are associated with reduced risk of premature coronary artery disease in Iran: a multi-centric case-control study

The Mediterranean diet (Med-Diet) is widely recognized for its protective effect in cardiovascular diseases (CVDs), less is known about the associations between health and adherence to the Prime Diet Quality Score (PDQS). This study investigates the relationship between adherence to the Med-Diet and PDQS with the risk of premature coronary artery disease (PCAD) in an Iranian population. A total of 3287 participants were included in this multicenter case-control study across various ethnic groups in Iran, categorized into PCAD cases (n = 2106) and controls (n = 1181). PCAD cases were defined as individuals with at least one coronary artery exhibiting ≥ 75% stenosis or a left main coronary artery with ≥ 50% stenosis, while controls had normal coronary arteries. Dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ), previously validated for accuracy in the Iranian population Adherence to the Med-Diet was assessed using a standardized scoring system, awarding one point for higher consumption of beneficial food groups (such as vegetables, whole grains, legumes, fish, nuts, and a high monounsaturated-to-saturated fat ratio) and one point for lower consumption of less favorable foods (such as red and processed meats). The total score ranged from 0 to 9, with higher scores indicating greater adherence to the Med-Diet. The PDQS, a dietary quality index, evaluated adherence across 14 healthy and 7 unhealthy food groups, with higher scores reflecting better diet quality. Logistic regression models were employed to examine the association between dietary scores and PCAD risk. Participants with higher adherence to both the Med-Diet and PDQS had significantly lower odds of PCAD (OR = 0.30, 95% CI: 0.22, 0.40; P for trend < 0.001 for PDQS), with a stronger association observed for the Med-Diet (OR = 0.08, 95% CI: 0.06, 0.10; P for trend < 0.001). Additionally, higher adherence to the Med-Diet (OR = 0.04, 95% CI 0.03, 0.05) and PDQS (OR = 0.21, 95% CI: 0.17, 0.26) was inversely associated with PCAD severity in the fully adjusted model. This study showed a protective association of the Med-Diet and PDQS with reduced risk of PCAD in the Iranian population.

Unexpected effects of treating insulin-resistant obese women with high-dose D-chiro-inositol: opening Pandora's box

Purpose

The combination of lifestyle changes and nutraceuticals, such as inositols, can reduce excess weight, leading to a reduction in insulin resistance and a normalization of the metabolic profile. As such, this study investigated the metabolic and hormonal changes observed in women who were overweight/obese with insulin resistance undergoing a hypocaloric Mediterranean diet combined with high-dose D-chiro-inositol (DCI) treatment.

Methods

In total, 48 insulin-resistant women between 25 and 40 years old, with a body mass index (BMI) between 26 and 32 were divided into two groups: both groups followed a hypocaloric Mediterranean diet for 4 months, and patients in the treated group also underwent treatment with 2400 mg/day of DCI for the same period. We evaluated the homeostasis model assessment (HOMA) index, body weight, BMI, blood glucose, fasting insulin, lipid profile [cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides] and hormonal profile [total testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and menstrual length] at baseline and at the end of treatment.

Results

After 4 months, both groups displayed a significant improvement in insulin sensitivity, as reflected by a reduction in the HOMA index, blood glucose level, fasting insulin level, and lipid profile. Furthermore, we observed a significant decrease in body weight and BMI in both groups. However, the evaluation of the hormonal profiles revealed unexpected findings, with the DCI-supplemented group exhibiting hyperandrogenism and menstrual irregularity, as demonstrated by the significant increase of total testosterone, androstenedione, LH, and menstrual length.

Conclusion

The study strengthens the evidence regarding the metabolic benefits of the hypocaloric Mediterranean diet, independent from the association with DCI, on women with insulin resistance and excess weight, while also acknowledging the complex hormonal impact of high-dose DCI supplementation for medium-to-long periods.

Exploring Determinants of Adherence to the Mediterranean Diet Among Adults in Lebanon During the Economic Crisis: A Qualitative Study

INTRODUCTION

Adherence to MD is declining in its native region, posing public health concerns. To improve adherence, it is important to understand its determinants. Deriving from socio-ecological models (SEM), determinants may include socio-demographic, environmental and behavioural factors. Lebanon is a Mediterranean country that faces serious challenges due to an ongoing economic crisis, which may affect MD adherence and its determinants. The aim of this study is, therefore, to explore the determinants influencing adherence to the MD in Lebanon, as well as the impact of the economic crisis on these factors.

METHODS

This study employed a qualitative approach consisting of individual face-to-face interviews. A purposive sample of 25 generally healthy adults from different regions in Lebanon was recruited. Data collection started with a brief questionnaire to collect background socio-demographic information, followed by assessing MD adherence using the Mediterranean Diet Adherence Screener. Next, participants were interviewed using a semi-structured interview guide, focusing on barriers and enablers to adhering to the MD.

RESULTS

Participants maintained a moderate adherence to MD with many reporting improving or sustaining healthy eating habits. Because of the economic crisis, the consumption of local produce became more prevalent due to import shortages, aligning with MD recommendations. Determinants included individual attitudes beliefs, particularly concerns about the quality and trustworthiness of food products during the economic crisis, and environmental factors like the unavailability of imported foods. Convenience and proximity were prioritized over cost in food purchases.

CONCLUSION

Despite economic constraints, many participants prioritized diet quality. People shifted to traditional, healthy diets. Emphasizing tradition, food availability, accessibility and affordability could be crucial for interventions.

Traditional Arabic & Islamic Medicine (TAIM): Principles of Dietary Practices and the TAIM Food Pyramid

Middle Eastern and Mediterranean culinary tradition and dietary practices are used interchangeably due to geographical proximity and similarities in their cuisine. While these regions share historical impact and cultural exchanges there are differences that delineate each region's dietary influences. Dietary practices are one of five core elements of an overarching Traditional Arabic and Islamic Medicine (TAIM) conceptual framework, yet current dietary guidelines are lacking. We introduce the TAIM food pyramid as a visual representation of TAIM's historical and regional nuance, illustrate dietary patterns, and provide a cultural competency strategy. We used Oldways as a model for creating the TAIM food pyramid while illustrating its extension of a wholistic paradigm representing the medical and indigenous traditions, beliefs and practices of a geographic region and cultural community. We focus on two important aspects: historical roots of traditional Arabic Medico-Culinary cuisine coupled with Islamic medicine and influences of Prophetic tradition on foods. The TAIM food pyramid is an illustration of a healing tradition emphasizing sound nutrition, food safety, social connection, community and sustainability. The pyramid is similar in structure to global traditional healing diets within the context of culture and lifestyle of the Middle East and North African communities. Despite trends in research focusing on the Mediterranean diet, little is known about the Middle Eastern diet. The absence of a TAIM food pyramid is a clear gap in research and a missed opportunity for further analysis. Health care delivery that is culturally competent improves health equity and translates to patient centered, whole-person care.

Adherence to the Mediterranean Diet Among Families from Four Countries in the Mediterranean Basin

Background/Objectives: The cultural and socioeconomic changes to which societies are exposed can alter individuals' lifestyles and dietary habits. The nutritional patterns of Mediterranean countries may also be affected by these factors at varying levels, depending on the changing social characteristics of the countries. This study aimed to determine Mediterranean diet (MedDiet) adherence among family members from four Mediterranean countries (Türkiye, Spain, Italy, and Lebanon). Methods: The survey was structured around sociodemographic data, family relationships, the Mediterranean diet adherence screener (MEDAS), the Mediterranean lifestyle index (MEDLIFE), the Mediterranean diet quality index (KIDMED), and the obstacles and drivers of MedDiet adherence. Results: The data were obtained from adults (n = 812), with the contribution of their children (n = 500) if they had any. According to the MEDAS, 22% of the adults strongly adhered to the MedDiet. Similar results were obtained when Mediterranean lifestyle adherence was analyzed using the MEDLIFE score, with 20% of the adults presenting a strong adherence, while significantly stronger adherence was found in Lebanon than in the other countries. Regarding the children and adolescents, around 30% presented strong adherence to the MedDiet. Price, availability, and accessibility were significant obstacles, whereas the perceptions of health and diet quality were identified as the drivers of the MedDiet. Conclusions: Overall, our results highlight the need for national policies to reduce the economic burden of healthy food options while encouraging equitable access to re-popularize the MedDiet pattern. Future research should focus on intervention strategies tailored to different age groups and socioeconomic backgrounds, the long-term impact of family-based strategies, and the cultural influences on MedDiet adherence.

The Role of Recreational Physical Activity in Adherence to the Mediterranean Diet in the Greek Population: Public Health and Sustainability Implications

The Mediterranean diet (MedDiet) is renowned for its health benefits and cultural significance in Mediterranean populations. The present study investigates the question of whether individuals who participate in recreational activities exhibit higher adherence to the MedDiet than those who do not engage in such activities. A cross-sectional survey was conducted with participants completing questionnaires assessing demographic characteristics, MedDiet adherence, and dietary habits. A total of 1055 participants of both sexes with an average age of 32.2 ± 10.1 years participated in the survey, and they were classified based on their engagement in recreational physical activity. Statistical analyses included independent samples t-tests, chi-squared tests, analysis of variance (ANOVA), and multiple regression analysis. The results demonstrated that physically active individuals exhibited significantly higher adherence to the MedDiet than non-exercisers (p < 0.001), supporting the hypothesis that exercise is associated with healthier dietary choices. Regression analysis further revealed that exercise, olive oil consumption, and family meals were significant predictors of MedDiet adherence. Additionally, group comparisons highlighted differences in BMI (p < 0.001), meal frequency (p < 0.001), and food preparation habits (p < 0.001), indicating that exercisers were more likely to adopt a holistic Mediterranean lifestyle. These findings emphasize the importance of integrating physical activity with dietary education in public health policies. Promoting an active lifestyle alongside MedDiet principles may enhance overall well-being and contribute to sustainable health strategies.

Adherence to Mediterranean Diet and Health Outcomes in Adolescents: An Umbrella Review

CONTEXT

Proper nutrition represents 1 of the domains of adolescents' well-being. In this context, the Mediterranean diet (MD), as a healthy, traditional, and sustainable dietary pattern, plays a crucial role in promoting adequate growth and preventing chronic noncommunicable diseases.

OBJECTIVE

The currently available evidence on the effects of adherence to the MD (AMD) in association with several physical health outcomes in adolescence is summarized in this review.

DATA SOURCES

Five electronic databases were searched.

STUDY SELECTION

Systematic reviews with or without meta-analysis of observational studies and randomized clinical trials, published in English during 2013-2022, and that assessed the health impact of AMD among adolescents were eligible.

DATA EXTRACTION

Details on study design, methods, population, assessment of dietary patterns, health outcomes, and main results were extracted.

RESULTS

The search yielded 59 references after removal of duplicates. Applying PICOS criteria, 4 systematic reviews and 3 meta-analyses ultimately were included in this review. The AMD was evaluated in association with overweight/obesity and adiposity in 2 studies, musculoskeletal health in another 2, inflammation in 1 study, and cardiometabolic health in 1 study. The seventh review examined all mentioned health outcomes (overweight and obesity, musculoskeletal health, inflammation, and cardiometabolic health) in relation to AMD.

CONCLUSIONS

Overall, this umbrella review showed limited evidence and a lack of consistency about the relation between AMD and health outcomes of interest in adolescence, indicating the need for more studies to better understand it.

SYSTEMIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023428712.

From Liking to Following: The Role of Food Preferences, Taste Perception, and Lifestyle Factors in Adherence to the Mediterranean Diet Among Young Individuals

BACKGROUND AND AIMS

The Mediterranean diet (MedDiet) is a healthy dietary pattern associated with reduced risk of chronic diseases. However, adherence is declining, particularly among younger populations. Therefore, it is crucial to identify the main aspects that affect its adherence, particularly food preferences and sensory function, which have received insufficient attention. Our aims were to investigate the impact of socio-demographic and lifestyle factors on adherence to the MedDiet among young individuals; to assess the association of taste preferences and food liking with MedDiet adherence; and to evaluate the associations between taste perception modalities, taste and food preferences, and adherence.

METHODS

A cross-sectional study on young adults (aged 20.5 ± 4.7 years) in a Mediterranean country (n = 879) was carried out. Demographic characteristics, clinical characteristics, anthropometric characteristics, lifestyle characteristics, MedDiet adherence, taste preferences, and food preferences were assessed. Taste perception for bitter, salty, sweet, sour, and umami was determined by rating different concentrations of prototypical tastants. We computed a total taste perception score and three scores to combine food preferences.

RESULTS

We identified several socio-demographic and lifestyle factors associated with adherence to the MedDiet, as well as food preferences, taste preferences, and taste perception determinants. Food preferences were significantly associated with total adherence to the MedDiet. Higher preference for olive oil, oranges, broccoli, fish, and legumes was associated with higher MedDiet adherence (p < 0.05 for all). Conversely, higher preference for sweet foods, red meat, and butter was associated with lower adherence (p < 0.05 for all). The combined positive score for food preference was strongly associated with higher MedDiet adherence (p = 1.4 × 10-23) in the multivariate adjusted model. The combined negative food preference score was inversely associated (p = 1.9 × 10-8). Likewise, taste preferences were significantly associated with adherence to the MedDiet (strong inverse association for sweet taste preference and direct association for bitter taste preference; both p < 0.001). Moreover, bitter taste perception was inversely associated with adherence to the MedDiet and with bitter foods (p < 0.05). In conclusion, future precision nutrition studies should measure food liking and taste preferences, which are crucial determinants of MedDiet adherence, especially in young people.

Determinants of adherence to the Mediterranean diet among individuals with type 2 diabetes mellitus living in Mediterranean countries: a systematic review

Background

Patients with type 2 diabetes mellitus (T2DM) are often encouraged to adopt a healthy diet, such as the Mediterranean Diet (MD) yet limited evidence exists about adherence. An increased shift toward a "Western" dietary pattern was observed.

Objective

This systematic review aims to gain insight into the various factors that may enhance or reduce adherence to the MD in patients with T2DM residing in Mediterranean countries.

Method

We retrieved published studies from 2000 to 2023 from PubMed, Cochrane, Embase, CINAHL, Web of Science, Medline, and PsycINFO databases. The criteria for inclusion included individuals residing in Mediterranean countries aged 18+ with T2DM who underwent assessment using a validated MD scoring tool. We included 17 studies, with participant numbers ranging from 106 to 7,447.

Results

Compliance with the MD was moderate, with the most significant determinants of adherence being age, physical activity, body mass index (BMI), marital status, and educational level. However, limited information is available on psychological and economic determinants.

Conclusion

Various factors, especially sociodemographic ones, influence adherence to the MD among patients with T2DM. Future research should explore economic and psychological factors that may significantly impact adherence.

Systematic review register

Prospero: CRD42023396094.

Socio-Demographic Determinants of Mediterranean Diet Adherence: Results of the EU-National Health Interview Survey (EHIS-3)

BACKGROUND

Despite the well-known benefits of the Mediterranean diet (MD), low adherence is observed globally, highlighting the need to investigate the underlying causes of this trend. Large-scale, periodically repeated surveys, such as the European Health Interview Survey (EHIS), could be useful for the investigation of the factors that influence adherence to healthy dietary patterns. National EHIS-3 in Greece was designed to collect data on the consumption of all food groups, making it possible to determine adherence to MD.

METHODOLOGY

This study aimed to investigate the socioeconomic factors that influence MD adherence by conducting a secondary data analysis from 7706 participants aged 15-85 years who participated in the 2019 national EHIS. MD adherence was evaluated by MedDietScore. Bivariate comparisons between the score tertiles and socioeconomic groups were performed. Logistic regression analyses were used to estimate the association between MedDietScore tertiles and demographic and socioeconomic factors, using high adherence as the reference category. Finally, cluster analysis was applied to identify the most significant factors in relation to the classification of the participants in MD adherence groups.

RESULTS

Educational level, followed by income status, emerged as the most significant factor associated with adherence to MD. Individuals who have attained only primary education had a 3.80 times higher likelihood of presenting low MD adherence instead of high MD adherence compared to persons with tertiary education. Individuals in the lower income group had 2.53 times higher odds of being in the low MD adherence instead of high MD adherence than individuals in the higher income group. These relationships remained statistically significant after adjusting for confounding factors. The group that most frequently adhered to high MD (53.4%) comprised individuals who had tertiary education, higher income, and were couples without children. Conversely, those with primary or secondary education who are single parents or live in one-person households and fall into the lower and medium income groups are most likely to have low MD adherence (44.8%).

CONCLUSIONS

Public policies to promote MD adherence should consider socioeconomic factors. Integrating questions to evaluate adherence to dietary patterns into EHIS would allow for future intercountry and longitudinal comparisons.

The Relationship Between a Mediterranean Diet and Frailty in Older Adults: NHANES 2007-2017

BACKGROUND

Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status.

METHODS

We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0-2, 3-4, and 5-9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence.

RESULTS

Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively).

CONCLUSIONS

Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit.

Knowledge, attitudes, and use of the Mediterranean diet in practice among dietitians in the United Arab Emirates: a cross-sectional study

Dietitians are uniquely positioned to promote the Mediterranean Diet (MedDiet), a diet recognized for its health benefits and sustainability. This study aimed to assess the knowledge and attitudes regarding the MedDiet among dietitians in the United Arab Emirates (UAE), and to examine the frequency and correlates of using this diet in clinical practice. Practicing dietitians (n = 220) completed a 44-item web-based questionnaire, verified for face, content and construct validity, as well as internal and parallel form reliability. Total scores were computed as sum of items for knowledge and attitudes. The mean knowledge score was 6.48 ± 1.85 out of 10, with gaps related to MedDiet's benefits and nutrient composition. Despite positive attitudes, many dietitians did not agree that it is easy to encourage patients to decrease red meat (68%) and increase fruits/vegetables intake (70%). In clinical practice, 35% of dietitians rarely/never used the MedDiet. Dietitians were more likely to recommend the MedDiet if they had a Mediterranean country of origin (p = 0.037), higher knowledge (p = 0.022) and attitude (p = 0.013) scores, and acquired information about the MedDiet through university education (p = < 0.001) or conferences/seminars/workshops (p = 0.002). Using the findings of this study, evidence-based interventions can be developed to support the role of dietitians in promoting adherence to the MedDiet.

Gender and sex differences in adherence to a Mediterranean diet and associated factors during the COVID-19 pandemic: a systematic review

Background

The COVID-19 pandemic has led to significant lifestyle changes, including alterations in dietary habits and increases in sedentary behavior. The Mediterranean diet (MD) has been associated with various health benefits, which are especially important given the health challenges posed by the pandemic. During the pandemic, an overall shift towards consuming more highly processed foods has been observed.

Methods

This systematic review investigated adherence to MD during the COVID-19 pandemic, focusing on gender differences and factors influencing adherence to MD in the general public. The literature search focused on papers published between January 1, 2019, and July 8, 2024, across various databases such as Web of Science (WOS), Scopus, PubMed MEDLINE, and PsycINFO.

Results

Following the PRISMA guidelines, this search identified 14,347 references, of which 5,734 were duplicates. After a thorough multi-level screening process, 29 studies, encompassing 55,242 participants, met the inclusion criteria. While seven studies reported that men adhered to a MD more than women during the COVID-19 pandemic, 12 studies also indicated that women had higher adherence to a MD compared to men. Nine studies, however, found no significant gender differences in MD adherence. Additionally, older age, higher education levels, higher socioeconomic status, and increased physical activity were linked to greater adherence to a MD in the pandemic context.

Conclusion

Gender-specific differences in dietary behavior are influenced by factors such as socioeconomic status, gender roles, and pandemic phases as well as biases in sample composition and methodological weaknesses. Significant gaps in the evidence, particularly concerning sexual and gender minorities, are highlighted.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421727.

Evaluation of university students' Mediterranean diet quality and sustainable eating behaviors: a cross-sectional study

The study aimed to evaluate University Students' diet quality and sustainable eating behaviors, with the intention of developing strategies to promote healthy eating habits. We questioned the sociodemographic characteristics and general eating habits of the students. We administered Mediterranean diet quality scale (KIDMED) and Behaviors Scale Towards Sustainable Nutrition (BSTSN) to 300 Turkish students. We found that 163 of the students' diet quality was moderate level. KIDMED score positively correlated with the BSTSN score (r=0.306, p<0.001). When higher night eating habits predicted lower diet quality (β=-0.117, p=0.038), higher main meals and sustainable eating behavior predicted higher diet quality (β=0.145, p=0.009 and β=0.258, p<0.001, respectively). The results indicate that students generally have moderate diet quality, which sustainable eating behaviors can enhance. Night eating habits and dietary patterns impact diet quality, highlighting the importance of meal planning. To promote healthy eating, universities should incorporate sustainability into curricula and provide supportive facilities.

Nutrition literacy and its relationship with diet quality and quality of life among white-collar employees: a study from Türkiye

BACKGROUND

Nutrition literacy is an important component of health and healthy eating behaviors. The aim of this study was to determine the nutrition literacy (NL) status of white-collar employees and its relationship with adherence to the Mediterranean diet, anthropometric measurements, and lifestyle behaviors, including eating habits, dietary intake, and physical activity level.

METHODS

This cross-sectional study was conducted with 3459 white-collar employees aged 18-65 who lived in Türkiye. A questionnaire prepared by the researchers was used to obtain information about the demographic characteristics and anthropometric measurements of the participants. Evaluation Instrument of Nutrition Literacy on Adults (EINLA) was used to assess NL, the Mediterranean Diet Adherence Screener (MEDAS) was used to assess diet quality, and the Quality of Life Test Short Form-36 (SF-36) was used to determine quality of life. Data analysis was conducted using the IBM SPSS Statistics 21.0 program.

RESULTS

With an average age of 24.3 ± 10.5 years and 50.7% women, women presented higher nutrition literacy than men did (p < 0.001). Most participants held university or postgraduate degrees with medium to high income levels and the majority demonstrated sufficient NL. Compared with other participants, those with adequate NL had significantly higher Mediterranean diet adherence, and SF-36 physical (77.27 ± 16.26), and mental (65.45 ± 17.00) scores (p < 0.001). Negative correlations were found between the EINLA score and BMI (r=-0.082), waist circumference (r=-0.072), hip circumference (r=-0.036), waist/hip ratio (r=-0.074), and waist/height ratio (r=-0.056) (p < 0.05). Additionally, weak positive correlations were observed between the EINLA score and the SF-36 physical (r = 0.158) and mental scores (r = 0.088), as well as the metabolic equivalent of task (MET) score (r = 0.042) (p < 0.05).

CONCLUSIONS

The results of this study demonstrated that NL is a significant predictor of anthropometric measurements and healthy lifestyle behaviors including dietary habits, and quality of life among adults. Nutrition literacy can enable individuals to make informed choices and thus contribute to the prevention of many noncommunicable chronic diseases.

Adherence to the healthy and sustainable dietary recommendations for the Spanish population and all-cause mortality

INTRODUCTION AND OBJECTIVES

The healthy and sustainable dietary recommendations for the Spanish population have recently been launched. We aimed to develop a food-based dietary index to measure adherence to these guidelines and assess its association with all-cause mortality.

METHODS

Data were drawn from 11 904 individuals, representative of the Spanish population aged 18 and older, recruited between 2008 and 2010, and followed-up until 2022. The healthy and sustainable dietary recommendations for the Spanish population index (HS-DRSI) includes 20 food components, scored dichotomously to reflect adherence to the recommendations. The association between the HS-DRSI and all-cause mortality was examined using Cox proportional hazard models adjusted for sociodemographic, lifestyle, and morbidity factors, within a retrospective cohort design.

RESULTS

The mean±SE age of participants was 46.9±0.3 years and 50.5% were female. After a median follow-up of 12.9 years, 939 all-cause deaths were recorded. Compared with participants in the lowest quartile of adherence (HS-DRSI range: 1-5), those in the highest quartile (HS-DRSI range: 9-17) had a lower risk of mortality (HR, 0.76; 95%CI, 0.60-0.96; P for trend=.02). A 2-point increase in the HS-DRSI was associated with a 7% lower risk of mortality (HR, 0.93; 95%CI, 0.86-1.00; P=.04). This protective association was also observed among participants without chronic diseases at baseline (HR per 2-point increment: HR, 0.80; 95%CI, 0.70-0.92; P=.002). Results were robust in sensitivity analyses.

CONCLUSIONS

Higher adherence to the healthy and sustainable dietary recommendations for the Spanish population was associated with lower all-cause mortality.

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.

Chronotype is associated with Mediterranean dietary adherence and environmental footprints

This cross-sectional study was carried out to determine the relationship between nutrition according to chronotype and the Mediterranean diet and environmental footprints. "Morningness Eveningness Questionnaire" was used to determine the chronotype classification, and "Mediterranean Diet Adherence Screener" was used to evaluate adherence to the Mediterranean diet. In addition, the food consumption record of the participants was taken and the carbon and water footprints were calculated. A total of 472 adults with a mean age of 22.7 ± 5.0 years participated in the study. Accordingly, 61.0% of the participants were morning type, 15.7% were intermediate type, and 23.3% were evening type. Individuals with higher chronotype values (morning) tended to be more adherent to the Mediterranean diet and had lower environmental (carbon and water) footprints (p < 0.05). The results of this study; showed that diet according to chronotype affects adherence to the Mediterranean diet and environmental footprints.

Energy, Macronutrients and Micronutrients Intake Among Pregnant Women in Lebanon: Findings from the Updated Lebanese National Food Consumption Survey (LEBANON-FCS)

BACKGROUND

Pregnancy is a crucial period for maternal and fetal health, and in Lebanon, where cultural and economic factors influence dietary practices, there is an urgent need to evaluate the food consumption patterns and diet quality of pregnant women.

AIM

To evaluate the food consumption patterns, energy intake, as well as macro- and micro-nutrient intake among a nationally representative sample of Lebanese pregnant women aged 18-49 years old.

METHODS

A cross-sectional study was carried out from March to October 2023, involving 500 pregnant women from all eight Lebanese governorates. Sociodemographic and medical information was gathered, food consumption was evaluated using a validated Food Frequency Questionnaire (FFQ) and three 24-h recall, and anthropometric measurements were recorded.

RESULTS

The current population did not meet the USDA healthy pattern recommendations for whole grain, seafood, dairy, nuts, seeds and soy products consumption but exceeded the guidelines for vegetables, meats, poultry, eggs, oils, and refined grains. According to Mediterranean diet guidelines, the sample fell short in recommended intakes for fruits, olives/nuts/seeds, eggs, and olive oil, while surpassing the recommended levels for potatoes, legumes, pulses, sweets, red meat, processed meat, and fish and seafood. None of the participants met the energy requirements for their trimester and age group. In terms of macronutrient intake, the requirements for protein, unsaturated fats, and fiber were not met, while intakes of fats and sugars were exceeded. Regarding micronutrients, the recommended levels were not fully achieved, with particularly low intakes of vitamin D and iodine, as well as inadequate adherence to recommendations for iron, calcium, vitamin A, vitamin E, zinc, and choline. Additionally, a third of the participants did not meet the recommended intakes for folate and vitamin B12.

CONCLUSIONS

The findings reveal significant dietary inadequacies among the current population, with participants failing to meet essential recommendations for whole grains and key food groups, alongside insufficient energy intake for their trimesters and age groups. Critical micronutrient deficiencies, particularly in vitamin D, iodine, and B vitamins, highlight the urgent need for targeted nutritional interventions and public health initiatives to improve dietary practices among pregnant women in Lebanon.

Mediterranean diet and spirituality/religion: eating with meaning

The interest in the Mediterranean diet has grown considerably due to its potential health benefits on the prevention of diverse age-related chronic diseases and its association with longevity. This dietary pattern, considered among the healthiest in the world, is not simply a combination of healthy foods but goes further in its historical and cultural roots. Mediterranean diet is not intrinsically tied to any specific religion or spiritual system, but its cultural and geographical context has influenced the dietary practices of its inhabitants, encompassing the history of Western civilization and of the three Monotheistic religions Christianity, Judaism, and Islam. These religions may have some impact on dietary choices due to religious customs and practices. In 2010 the Mediterranean diet was inscribed on the UNESCO's Representative List of Intangible Cultural Heritage of Humanity, highlighting it as a social and cultural expression of the different food cultures of the Mediterranean region and indicating that the importance of this dietary and lifestyle pattern lies not only in its specific foods and nutrients, but in the way in which its characteristic foods are produced, cooked, and eaten. In this narrative review we will discuss the possible connections between the main religions originated in the Mediterranean basin and their influence on the composition of the Mediterranean diet, and the links between spirituality/religion and this dietary pattern. This traditional model can represent a form of conscious healthy eating and lifestyle in contrast to the unhealthy Western lifestyle and ultra-processed food consumption widespread throughout the world.

Is Boiling Bitter Greens a Legacy of Ancient Crete? Contemporary Foraging in the Minoan Refugium of the Lasithi Plateau

Wild greens (WGs) play a significant role in Mediterranean diets (MDs), reflecting botanical and cultural diversities, mainly influenced by a complex conglomerate of local human ecologies. This study investigates local ecological knowledge (LEK) linked to traditional gathering and consumption of WGs in the Lasithi Plateau of eastern Crete, where human genetic studies one decade ago showed very peculiar patterns, hypothesising that the Minoan civilisation took refuge there before it disappeared. A field ethnobotanical study was conducted to document the diversity of WGs and their detailed local culinary uses in the Lasithi area by interviewing 31 study participants. Fifty-nine folk taxa (species and subspecies) were recorded, corresponding to fifty-eight botanical taxa. A quotation index was measured to assess the cultural significance of WGs in the study areas; logistic regression analysis was adopted to understand the impact of sensory classifications of WGs and their local cooking methods. Lasithi's foraging showed a notable prevalence of bitter-tasting WGs, which play a central role in local cognition and culinary practices. This bitterness aspect of WGs, potentially influenced by cultural preferences and genetic factors, probably suggests a connection to the ancient Lasithi's inhabitants, i.e., Minoan dietary habits. We found that bitterness is the predominant sensory attribute in Lasithi, characterising 45.76% of the WGs. These findings underscore the complex interplay between local ecologies and biodiversity, LEK, and dietary traditions, highlighting the importance of WGs in understanding the evolution of foraging and plant culinary diversities across the Mediterranean.

The dietary fiber and micronutrient composition of traditional foods from Lebanon and their contribution to dietary adequacy: A call for action

Traditional Lebanese cuisine is based on traditional dishes, where Arabic sweets play an important role in daily consumption. This study focuses on the evaluation of total fibers and trace elements, especially vitamins A, D, E, and C of traditional foods and Arabic sweets commonly consumed in Lebanon by chemical analysis. A total of thirty types of Arabic sweets were chosen from reputable confectionery establishments, while thirty varieties of traditional Lebanese dishes were collected from central kitchens in the main Lebanese governorates. It was discovered that 23% percent of Arabic sweets and 30% of traditional dishes were rich in total dietary fiber. Moreover, Arabic sweets had trace amounts of vitamin A, vitamin E, and vitamin C. In specific sweets, vitamin A content showed variability, with values ranging from 8ug to 15 ug per 100 g of edible portions. Most of the traditional dishes contained traces of vitamin C. However, Tabboula stood out as the only dish that contributed to over 23% of the recommended daily value for vitamin C. Trace amounts of vitamins A, D, E, and C were present in almost all traditional Lebanese foods and Arabic sweets. This study revealed that these foods lack essential micronutrients and total dietary fibers.

Relationship Between Mediterranean Diet Adherence and Body Composition Parameters in Older Adults from the Mediterranean Region

In recent decades, the rapid spread of various communication media has led to changes in traditional eating habits. In the Mediterranean region, the classic (Mediterranean) dietary pattern has been lost as a result. This has led to a shift in eating habits towards unhealthy eating patterns, which in turn has resulted in an inadequate distribution of body composition. It is known that, among other things, the number of non-communicable diseases increases with the inadequate distribution of body composition. The aim of our study was to examine the level of adherence to the Mediterranean diet (MD) of older adults in the Mediterranean region in relation to specific body composition parameters. This study included 521 older adults with a mean age of 69.6 ± 6.3 years. Body composition was measured using the BIA 101 Anniversary device (Akern s.r.l., Florence, Italy) and adherence to the MD was assessed using the MEDLIFE index questionnaire. This study found significant differences in body composition between males and females. The mean adherence to the MD was 17.0 ± 3.3 points among the participants and there was higher adherence in females (p = 0.002, ηp2 = 0.019). A multiple linear regression was performed to assess the relationship between the body composition parameters and MD. Multiple linear regression models were significant for reactance, fat mass (%), fat-free mass (%), skeletal muscle index, and total body water (%), with specific individual MEDLIFE items such as the consumption of processed meat, meat, white meat, fruit, vegetables, olive oil and limiting snacks between meals. Moreover, promising correlations were found between certain MD characteristics and BIA parameters, but the overall health effects of the MD remain unclear.

Nutritional Counseling Promotes Adherence to the Mediterranean Diet and Healthy Eating in Italian Patients Affected by Phenylketonuria and Treated with Pegvaliase

BACKGROUND/OBJECTIVES

Pegvaliase, a subcutaneous therapy to treat phenylketonuria (PKU), has allowed these patients to maintain adequate phenylalanine (Phe) blood values without following a Phe-controlled diet; this brings up the challenge of promoting healthy eating while moving away from prescription diets. In our center, every patient treated with Pegvaliase undergoes routine nutritional counseling aimed at promoting adherence to the Mediterranean diet (MedDiet) during regular inpatient visits. This study aims to assess adherence to MedDiet and the adequacy of the diets of patients treated with Pegvaliase regarding micro- and macronutrients.

METHODS

Seven patients on chronic therapy with Pegvaliase underwent a dietetic evaluation to assess the composition of their diets in terms of micro- and macronutrients; they were also administered the Mediterranean Diet Score (MDS) questionnaire. Subcategories from MDS were extracted to evaluate the consumption of foods typically included (vegetables, olive oil, etc.) and typically excluded (red meat, etc.) in the MedDiet. To assess the adequacy of the diet, nutrient and energy levels were compared with guidelines for the Italian population.

RESULTS

MedDiet adherence in our sample was comparable to the general population; in terms of macronutrients, good adherence to the recommendations was observed, with every one of them met except for excessive simple sugar consumption. Micronutrient dietary intake was inadequate for zinc, iron, selenium, folate, thiamine, and riboflavin.

CONCLUSIONS

While more work is necessary to help patients treated with Pegvaliase to progress toward healthy eating, our study suggests that nutritional counseling routinely performed during inpatient visits, typically twice a year, effectively promotes healthier eating habits than those observed in the general population.

Exploring culinary diversity to enhance Mediterranean diet adherence: A randomized controlled trial

We Investigated how promoting diverse, healthy food options affects long-term dietary choices. We hypothesized that encouraging exploration of nutritious plant-based foods would lead to lasting improvements in diet. Participants (N = 211) were randomly assigned into two groups for a 6-week intervention: The fixed menu group was given the same large menu every week, while the changing menu group received a new small menu each week. At the end of the intervention both groups were exposed to the same menu suggestions. Food diversity evaluation was based on weekly reports collected during the intervention. Self-reported adherence to Mediterranean diet components was assessed using the I-MEDAS screener. The proportion of plant-based foods in participants' diets was estimated using a 0-100% scale based on self-report. Both items were evaluated using online questionnaires given to participants at baseline, at the end of the intervention, as well as three and six months after the intervention concluded. Results mean(SD) demonstrated that participants in fixed menu group explored a significantly wider array of items 26.33(11.64) than those in the changing menus group [19.79(10.29), t(202) = 4.25, p < 0.001, Cohen's d = 0.60]. A repeated measures analysis of covariance rmANCOVA revealed that short-term increase in I-MEDAS and PBD score were noted in both groups; however, only participants with the fixed menu sustained this increase at months follow-up [diff = 1.50, t(132) = 4.50, p < 0.001 Our findings suggest that manipulating the rate of exposure to food suggestions may affect overall dietary variety. It seems that early presentation with options may increase overall dietary variety and may even support longer-term habits. This study contributes to developing effective interventions and highlights the challenge of promoting exploratory behavior in nutrition.

Adherence to a Mediterranean-style diet and severity of menopausal symptoms in perimenopausal and menopausal women from Australia: a cross-sectional analysis

PURPOSE

To explore the independent associations between adherence to a Mediterranean-style diet and severity of menopausal symptoms in perimenopausal and menopausal women living in Australia.

METHODS

Dietary adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS), the Menopause Rating Scale (MRS) was used to assess the severity of menopausal symptoms, and the 36-item short form survey instrument (SF-36) was used to assess health-related quality of life (HRQoL).

RESULTS

A total of n = 207 participants (50.7 ± 4.3 years; BMI: 28.0 ± 7.4 kg/m2) were included in the final analyses. Participants reported low-moderate adherence to a Mediterranean-style diet (5.2 ± 1.8; range: 1-11). Adherence was not associated with severity of menopausal symptoms. However, low consumption of sugar-sweetened beverages was inversely associated with joint and muscle complaints, independent of all covariates (β = -0.149; CI: -0.118, -0.022; P = 0.042). Adherence to a Mediterranean-style diet was positively associated with the physical function subscale of HRQoL (β = 0.173, CI: 0.001, 0.029; P = 0.031) and a low intake of red and processed meat was positively associated with the general health subscale (β = 0.296, CI: 0.005, 0.014; P = < 0.001).

CONCLUSION

Diet quality may be related to severity of menopausal symptoms and HRQoL in perimenopausal and menopausal women. However, exploration of these findings using longitudinal analyses and robust clinical trials are needed to better elucidate these findings.

Effect of the Mediterranean Diet (MeDi) on the Progression of Retinal Disease: A Narrative Review

Worldwide, the number of individuals suffering from visual impairment, as well as those affected by blindness, is about 600 million and it will further increase in the coming decades. These diseases also seriously affect the quality of life in working-age individuals. Beyond the characterization of metabolic, genetic, and environmental factors related to ocular pathologies, it is important to verify how lifestyle may participate in the induction of the molecular pathways underlying these diseases. On the other hand, scientific studies are also contributing to investigations as to whether lifestyle could intervene in modulating pathophysiological cellular responses, including the production of metabolites and neurohormonal factors, through the intake of natural compounds capable of interfering with molecular mechanisms that lead to ocular diseases. Nutraceuticals are promising in ameliorating pathophysiological complications of ocular disease such as inflammation and neurodegeneration. Moreover, it is important to characterize the nutritional patterns and/or natural compounds that may be beneficial against certain ocular diseases. The adherence to the Mediterranean diet (MeDi) is proposed as a promising intervention for the prevention and amelioration of several eye diseases. Several characteristic compounds and micronutrients of MeDi, including vitamins, carotenoids, flavonoids, and omega-3 fatty acids, are proposed as adjuvants against several ocular diseases. In this review, we focus on studies that analyze the effects of MeDi in ameliorating diabetic retinopathy, macular degeneration, and glaucoma. The analysis of knowledge in this field is requested in order to provide direction on recommendations for nutritional interventions aimed to prevent and ameliorate ocular diseases.

Recreational Physical Activity and the Mediterranean Diet: Their Effects on Obesity-Related Body Image Dissatisfaction and Eating Disorders

Obesity is a non-communicable disease that is associated with a number of serious physical and mental health conditions. The present study examines the effect of recreational physical activity and the Mediterranean diet on body image dissatisfaction and propensity for eating disorders. It is based on 1311 participants categorized by body mass index (BMI) into a normal ΒΜΙ group (NBG; N = 513), an overweight and obese ΒΜΙ group (OBG; N = 492), and a control group (CG; N = 309). All participants completed the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), Rosenberg Self-esteem Scale (RSES), Eating Attitudes Test-26 (EAT-26), Mediterranean Diet Score (MedDietScore), and Fitness Evaluation and Fitness Orientation subscales from the original Multidimensional Body-Self Relations Questionnaire (MBSRQ). The results of the multiple regression analysis indicated that the overall prediction of the variables was statistically significant. A multivariate analysis of variance (MANOVA) demonstrated the existence of significant interactions between groups and gender across a range of scales. Despite higher body image dissatisfaction in the OBG group, they maintained positive self-esteem and did not exhibit eating disorder tendencies. Notably, women reported greater dissatisfaction than men across all three groups. Our findings have practical implications for public health promotion strategies, policymaking, future research, and clinical practice. Encouraging regular exercise and adherence to the Mediterranean diet could improve body satisfaction and reduce eating disorder risk. Policymakers can advocate for community-based policies promoting physical activity and healthy eating habits.

Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries

Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles.

Exploring food consumption patterns in the province of Kenitra, Northwest of Morocco

BACKGROUND

Morocco is currently undergoing rapid changes in diets and lifestyles, influenced by globalization and urbanization, leading to a shift away from the Mediterranean diet (MedDiet) toward Western diets.

OBJECTIVE

Describe and explore the food consumption patterns of the population of Kenitra province and their adherence to the MedDiet using a validated survey.

METHOD

The current cross-sectional study involved 442 respondents from Kenitra province, comprising individuals aged 18 and above. The survey included a combination of closed and open-ended questions regarding food consumption patterns and socio-demographic characteristics. Adherence to the MedDiet was assessed using the Panagiotakos method to calculate the MedDiet score (MDS). Additionally, each participant's adherence to the MedDiet was evaluated using a method based on Martínez-González's approach.

RESULTS

The results indicate that 31% of the participants eat vegetables, 28% eat fruits, and 19% eat wholegrain bread daily. Furthermore, 58% regularly use olive oil in their cooking. Eating out of home (OOH) was high, with popular places being restaurants and cafes (70%), fast food outlets (20%), and workplace canteens (7%). Overall, participants showed moderate adherence to the MedDiet, with a mean MDS of 36.3 ± 19.7.

CONCLUSIONS

Promoting healthy eating habits is crucial in Kenitra. With moderate consumption of nutrient-dense foods and the popularity of the MedDiet, targeted interventions and educational initiatives can promote healthy dietary behaviors, improving overall public health.

Gen Z's Willingness to Adopt Plant-Based Diets: Empirical Evidence from Greece, India, and the UK

Comprising the largest population cohort on this planet, Gen Z presents a future-oriented consumer segment driven by climate change and food. This study sought to investigate Gen Z's perceptions toward plant-based foods and diets and explore the relationship that attitude components, meal preparation involvement, personal and lifestyle factors, and perceived barriers in adopting a plant-based diet have with willingness to adopt green-eating practices. Using cross-sectional data from university students in Greece, India, and the UK, various tools were employed to determine the factors influencing youths' consumer behavior toward animal-protein substitutes. PCA indicated the underlying dimensions of students' viewpoints on plant-based foods, whereas hierarchical and k-means clustering provided the cluster structure. An ordered probit model was estimated to delineate Gen Z's willingness to adopt plant-based diets and distinguish among mostly unwilling, somewhat willing, and mostly willing youths. Our findings identified two consumer segments, namely proponents and opponents of plant-based foods and diets, with statistically significant differences in the perceived health benefits of plant-based diets, attachment to animal-based proteins, perceived exclusion of animal-based foods, dissatisfaction with plant-based foods' attributes, and demand for ensuring adequate protein intake. The ordered probit model estimates showed that there is a "homogeneity" in the factors influencing youths' intention to adopt plant-based diets, with attitude components, meal preparation indicators, perceived barriers to eating "green", and personal factors, such as self-assessed knowledge of healthy eating and physical activity, being strongly associated with students' willingness to switch to plant-based diets in all three countries. Mapping potential obstacles and enablers in terms of shifting to more green-eating behaviors, our findings could add information to better understand the factors affecting food choice and youths' transition to a more sustainable lifestyle.

Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations

Adherence to the Mediterranean diet has been shown to lower the risk of developing chronic non-communicable diseases like cardiovascular and neurodegenerative diseases and cancer. Improvements in depression, participation in daily activities in older individuals, weight loss and a reduction in adverse pregnancy outcomes are associated with adherence to the Mediterranean diet. The number of studies that have evaluated barriers to adherence to the Mediterranean diet in the US and, in particular, in racial and ethnic minority populations within the US are few. Among Native American and Alaskan Native populations, studies evaluating traditional or alternative Mediterranean diet adherence for chronic non-infectious diseases is unavailable. Mediterranean diet scoring instruments used in studies in European and Mediterranean countries and among white participants in the US fail to capture the dietary patterns of racial and ethnic minority populations. In this narrative review, the food components of the traditional Mediterranean diet are discussed, adherence to the Mediterranean diet is examined in Mediterranean and non-Mediterranean countries and barriers preventing adherence to the Mediterranean diet in the US and among racial and ethnic minority populations is reviewed. Recommendations for improving nutrition education and intervention and for increasing adherence and cultural adaptions to the Mediterranean diet are provided.

The impact of the COVID-19 pandemic on Mediterranean diet adherence: A narrative systematic review

BACKGROUND

The COVID-19 pandemic upended many aspects of daily life. For some individuals, this was an opportunity to re-evaluate their life and make better choices, while others were overwhelmed with stressors, leading to a deterioration in mental and physical health.

AIM

The aim of this narrative systematic review is to explore the effects of the COVID-19 pandemic on Mediterranean diet adherence.

METHODS

A systematic literature search was carried out on PubMed, Scopus and Web of Science electronic databases utilising the search terms 'Mediterranean diet' AND 'COVID-19'. This yielded 73 articles that fulfilled the inclusion criteria.

RESULTS

The data suggests that a substantial proportion of individuals adhered less to the Mediterranean diet during the COVID-19 lockdown period. However, individuals receiving some form of lifestyle intervention had better adherence to the Mediterranean diet than their unassisted counterparts.

CONCLUSION

This emphasises the importance of professional support during times of crisis to avoid deterioration of a population's health.

Mediterranean Dietary Pattern for Healthy and Active Aging: A Narrative Review of an Integrative and Sustainable Approach

The global population is on a trajectory of continuous growth, with estimates projecting an increase from 7.7 billion in 2019 to approximately 9.7 billion by 2050. Longevity is also expected to rise rapidly, with advancements in healthcare contributing to increased life expectancies and an increase in the maximum lifespan. The aging process is accompanied by different changes, often leading to a decline in daily life activities and an increased susceptibility to disease. Age-related changes can cause cellular damage and subsequent cellular death. Oxidative stress and inflammation play significant roles in this process contributing to molecular damage and mitochondrial dysfunction. Active aging has been associated with improved quality of life and a reduced risk of morbidity and premature mortality. In this context, the Mediterranean diet has emerged as a promising approach to promoting healthy aging and sustainability. The phytochemical compounds within the Mediterranean diet have been linked to a lower risk of developing cardiovascular disease, type 2 diabetes, obesity, cancer and neurodegenerative diseases. The findings of peer-reviewed articles regarding the use of the Mediterranean diet as a healthy and sustainable dietary pattern written in Portuguese, Spanish or English were included in this narrative literature review. This dietary pattern's emphasis on the consumption of fresh and local food aligns with both health and environmental sustainability goals. This work provides a comprehensive review of the benefits of the Mediterranean diet and its components in a healthy aging process and highlights the importance of this dietary pattern as a sustainable approach.

Differences of skin carotenoids and adherence to the Mediterranean Diet pattern in adults from Southern Italy and Dominican Republic

BACKGROUND

The measurement of the skin carotenoids using the Veggie Meter® has emerged as a rapid objective method for assessing fruit and vegetable intake, highly recommended by the Mediterranean Diet (MD), which represents one of the healthiest dietary patterns, worldwide. This study aimed to examine differences in skin carotenoid content and degree of adherence to the MD pattern between two adult populations from Southern Italy and the Dominican Republic.

METHODS

This cross-sectional study enrolled a total of 995 adults, 601 subjects from Italy and 394 from the Dominican Republic. All participants underwent anthropometric measurements and skin carotenoid assessment by Veggie Meter®. Adherence to the MD and lifestyle were evaluated using the Mediterranean Diet Adherence Screener (MEDAS) and the Mediterranean Lifestyle Index (MEDLIFE) questionnaires. Correlations between the skin carotenoid and MEDAS score were estimated using Pearson's correlation coefficient. Multiple linear regression models were created to determine variables that affect skin carotenoid score for both populations.

RESULTS

Mean total skin carotenoids were higher in the Italian compared to the Dominican Republic population (342.4 ± 92.4 vs 282.9 ± 90.3; p < 0.005) regardless of sex (women: 318.5 ± 88.9 vs 277.3 ± 91.9, p < 0.005 and men: 371.7 ± 88.3 vs 289.5 ± 88.1, p < 0.005), and remaining statistically significant after age-adjustment of the Dominican Republic sample. Using the MEDAS questionnaire, we found a higher MD adherence score in the Italian than in the Dominican Republic population also after age-adjusting data (7.8 ± 2.1 vs 6.2 ± 3.7; p < 0.005) and even when categorized by sex (Italian vs age-adjusted Dominican Republic women: 7.9 ± 2.1 vs 6.3 ± 2.6; Italian vs age-adjusted Dominican Republic men: 7.7 ± 2.2 vs 6.0 ± 4.7; p < 0.005). Using the MEDLIFE test, total Italians presented a lower score with respect to the age-adjusted Dominican Republic population (3.2 ± 1.2 vs 3.4 ± 1.4; p < 0.05). In multiple regression analysis, skin carotenoids were associated with sex and negatively associated with BMI in the Italian population (sex: β: 54.95; 95% CI: 40.11, 69.78; p < 0.0001; BMI: β: - 1.60; 95% CI: - 2.98,0.86; p = 0.03), while they resulted associated with age and sex in the Dominican Republic population (age: β: 2.76; 95% CI: 1.92, 3.56; p < 0.001; sex: β: 23.29; 95% CI: 5.93, 40.64; p = 0.009). Interestingly, skin carotenoids were positively correlated with MEDAS score in both populations (Italy: r = 0.03, p < 0.0001, Dominican Republic: r = 0.16, p = 0.002).

CONCLUSIONS

This study provides the assessment of the adherence to the MD and skin carotenoid content in adults living in Southern Italy and the Dominican Republic, showing a higher MD adherence score and a skin carotenoid content in inhabitants from the Mediterranean region. Our findings highlight the need to globally encourage fruit and vegetable intake, particularly in non-Mediterranean area.

Influence of culinary skills on ultraprocessed food consumption and Mediterranean diet adherence: An integrative review

The Mediterranean diet is a diet pattern with several healthy characteristics, including a high consumption of fresh fruits, vegetables, whole-grain products, and extra virgin olive oil as the main fat source. It is also characterized by a low consumption of processed foods and high-fat meats. However, there has been a nutritional transition such that, because of globalization and economic growth, the consumption of ultraprocessed foods is increasing, comprising 14% to 57% of total energy intake. North America and Australia have the worst prognosis. Further, the younger population consumes greater amounts of ultraprocessed foods compared with adults, whereas the older population has the lowest rates. Among the various factors responsible for the nutritional transition, culinary skills seem an important function of diet quality, but, unfortunately, culinary skills have been little investigated by the scientific community. Higher culinary skills may be related to increased consumption of homemade meals, higher diet quality, and greater consumption of vegetables and fruits and may be associated with higher Mediterranean diet adherence. Consequently, ultraprocessed foods, ready-to-eat food, and delivered meals, as well as meals outside the home, are reduced. Unfortunately, the process of generational transmission of cooking skills is progressively weakening, aggravated by the reduction of free time for home cooking. Still, even though there are few interventions conducted to improve culinary skills, especially those focused on children, the available results suggest that there have been positive changes in the direction of a healthier dietary pattern. This integrative review analyzes consumption levels of ultraprocessed foods. We then consider the extent to which culinary skills affect ultraprocessed food consumption levels and the relative impact on obesity.

Assessment of Mediterranean diet adherence and comparison with Italian dietary guidelines: a study of over 10,000 adults from 2019 to 2022

Despite the many well-documented benefits of the Mediterranean diet (MD), many Mediterranean countries seem to be moving away from it. The aim of this study was to investigate the MD adherence in 10,916 adults who completed the validated Medi-Lite questionnaire from January 2019 to December 2022 in Italy, and to assess the consumption of its food groups by comparing them with current national dietary guidelines. The sample showed a good level of MD adherence (12 ± 2.5). However, from 2019 to 2022, a significant (p < 0.001) decline in the adherence level emerged. An overconsumption of fresh red meat, cheese and poultry compared to dietary guidelines was observed. In contrast, an under-consumption of vegetables, bread, legumes, fish and milk and dairy products emerged. In recent years, a decline in MD adherence was observed in Italy, probably determined by an excessive consumption of animal products.

Mediterranean Diet Favors Vitamin K Intake: A Descriptive Study in a Mediterranean Population

The Mediterranean diet (MD) is associated with improved longevity and the prevention and management of chronic inflammatory diseases (CIDs). Vitamin K, which is present in MD core components such as leafy green vegetables, is also known as a protective factor for CIDs. Estimates of vitamin K intake in Mediterranean settings are still scarce, and the association between MD and vitamin K intake is yet to be established. This study analyzed vitamin K intake and MD adherence in the Algarve region, in Portugal. We conducted a cross-sectional study in a nonrandom sample of adults using an online questionnaire which included a validated food-frequency questionnaire and a screener for MD adherence. A total of 238 participants were recruited (68% women and 32% men). Adherence to the MD was low (11%). Only 10% of the participants had vitamin K intake below the adequate intake. Adherence to the MD was positively correlated with vitamin K intake (r = 0.463; p < 0.001) and age (r = 0.223; p < 0.001). Our findings underscore the importance of promoting adherence to the MD for optimal vitamin K intake, and future research should focus on developing effective interventions to promote this dietary pattern, particularly among younger individuals and men.

Acne Vulgaris and adherence to the mediterranean diet among university students: a case‒control study

BACKGROUND

Western diets, characterized by a high glycemic index and dairy content, can be risk factors for acne vulgaris. A few studies have suggested that adherence to non-Western diets, such as the Mediterranean diet (MD), may be protective against acne. This study aimed to explore the relationships between adherence to the MD and acne diagnosis and severity.

METHODS

This was a matched case‒control study carried out among university students studying health sciences to explore the relationship between adhering to the MD and an acne diagnosis. Convenience sampling was utilized for the initial recruitment of eligible participants, who were then 1:1 individually matched for age, gender, and body mass index (BMI). Adherence to the MD was assessed using the Mediterranean Diet Adherence Screener (MEDAS) tool, and acne severity was assessed using the Global Acne Grading System (GAGS). The data were analyzed using descriptive statistics, bivariate analysis, and conditional logistic regression, which included two models based on clinical data and the backward elimination technique.

RESULTS

A final sample of 121 cases was individually matched to 121 controls. Each group consisted of 28.9% males and 71.1% females, with most having a BMI within the healthy range (71.9%). Both the case (80.2%) and control groups (77.7%) demonstrated a predominant pattern of low adherence to the MD. At the bivariate level, family history significantly differed between the case and control groups (OR = 2.01, CI = 1.17-3.44), while adherence to the MD (OR = 0.86, CI = 0.46-1.60) did not reach statistical significance. According to the regression analysis, family history remained significant in the backward elimination model (aOR = 1.94, CI = 1.14-3.34), while it disappeared in the full model (aOR = 1.95, CI = 1.14-3.34). Neither model revealed a significant association between acne and the other variables. Among the participants in the case group, neither adherence to the MD nor adherence to its components was significantly associated with acne severity, except for vegetables (p = 0.022).

CONCLUSIONS

Adherence to the MD was not correlated with acne diagnosis or clinical severity. More research on the association between acne and adherence to the MD is needed, as earlier studies are few, were conducted in specific settings, and used variable methodologies. To improve the validity and reliability of the research methodology, the development of detailed and culturally adapted MD definitions and practical guides is recommended.

Adherence to Mediterranean Diet and its main determinants in a sample of Italian adults: results from the ARIANNA cross-sectional survey

Introduction

Over the last years, many Mediterranean countries, including Italy, have witnessed a shift away from the Mediterranean Diet, thus contributing to the high rates of overweight and obesity. The survey "Adherence to Mediterranean Diet in Italy (ARIANNA)" aimed to evaluate the Adherence to Mediterranean Diet (AMD) and its main determinants in the Italian population.

Materials and methods

This study started on March 2023 and was addressed to adults aged ≥17 years, born and resident in Italy, proficient in Italian. Data are collected electronically through a voluntary, anonymous and self-administered questionnaire on the project website. Univariate and then multivariate logistic regressions were performed to evaluate associations between AMD and demographic characteristics, socio-economic status, health status, and lifestyle.

Results

On a total of 3,732 completed questionnaires, the 87.70% of the respondents was female and the 71.28% was 17-40 years old. The 83.82% of the respondents had medium AMD, 11.33% low and only 4.85% high. The multivariate analysis revealed that being male (p < 0.001), aged >40 years (p < 0.05), workers (p ≤ 0.001), and unemployed (p < 0.05), determined the probability of having a lower AMD. Vegans and vegetarian's diets positively contributed to a higher AMD (p < 0.001).

Discussion

These results highlighted a medium AMD in the Italian adult participants and suggested the necessity to implement tailored public health intervention strategies to improve food habits.

Association between healthy eating and depression symptoms among Chinese older adults: A cross-sectional study based on the Chinese Longitudinal Healthy Longevity survey

Introduction

This study aimed to assess the relationship between the healthy eating index (HEI) and depression symptoms in an older adult population using the Chinese Longevity Health Survey.

Methods

The HEI was constructed based on the frequency of intake of 13 dietary variables, with higher scores indicating better diet quality. Depression symptoms was assessed by the Center for Epidemiologic Studies Depression-10 scale. We used multivariate binary logistic regression to explore the association between the HEI and depression symptoms and reported as odds ratio (OR) and 95 % confidence interval (95 % CI).

Results

A total of 12,078 older adults were included. The average HEI for this group of older adults was 26.4 ± 7.1. After adjusting for covariates, compared with participants in the lowest quartile of a healthy eating index, those in the second to the fourth quartile group had a 0.93- (95 % CI: 0.83 to 1.03), 0.84- (95 % CI: 0.75 to 0.95) and 0.69- (95 % CI: 0.62 to 0.77) fold risk of depression symptoms, respectively. Restricted cubic spline curves showed that the risk of depression symptoms decreased with increasing HEI, especially above 26, and for each unit increase in the HEI, the risk of depression symptoms in older adults decreased by 3 % (OR = 0.97; 95 % CI: 0.96 to 0.99).

Conclusions

This study found an association between higher levels of the HEI and reduced risk of depression symptoms in older Chinese adults. This result emphasizes the need to focus on dietary diversity in older adults to promote healthy aging.

Mediterranean diet trajectories and 20-year incidence of cardiovascular disease: The ATTICA cohort study (2002-2022)

BACKGROUND AND AIMS

Only few studies have assessed longitudinal dietary trends in relation to cardiovascular disease (CVD) risk. We aimed to evaluate the association between adherence to the Mediterranean diet, both baseline and longitudinal, and 20-year CVD incidence.

METHODS AND RESULTS

This was a prospective study among 1988 Greek adults (50% men, age: 45 ± 14years). Adherence to the Mediterranean diet was evaluated at baseline and 10 years through the MedDietScore, based on which longitudinal Mediterranean diet trajectories were identified. CVD incidence was recorded at 20 years. Each one-unit increase in baseline MedDietScore was associated with an 8% reduction in 20-year CVD incidence. Compared to subjects in the lowest tertile of baseline MedDietScore, those in the highest exhibited a 44% lower 20-year CVD risk (relative risk: 0.56, 95% confidence interval: 0.32, 0.97) adjusted for age, sex, baseline body mass index, smoking, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, and family history of CVD; further adjustment for high-sensitivity C-reactive protein, uric acid and estimated glomerular filtration rate attenuated this association. Results were similar in models adjusted for longitudinal changes in body weight, physical activity and smoking, and 10-year medical status. Mediterranean diet trajectory analysis revealed that 24.7%, 8.6%, 45.8% and 20.9% of participants longitudinally sustained a low adherence, moved closer, moved away or sustained a high adherence, respectively; among those, the corresponding CVD incidence was 63.3%, 65.5%, 28.1% and 9.4% (p-value<0.001).

CONCLUSION

The Mediterranean diet offers long-term protection against CVD, part of which is mediated by inflammation, uricemia and renal function.

Mediterranean Diet and Cardiovascular Disease: The Moderating Role of Adequate Sleep-Results from the ATTICA Cohort Study (2002-2022)

The relationship between diet, sleep duration and cardiovascular disease (CVD) has not been well understood. The aim of the present study was to test the potential modifying role of sleep duration in the association between adherence to the Mediterranean-type diet (MD) and CVD risk. The study consisted of n = 313 initially free-of-CVD adults, from the ATTICA cohort study (2002-2022), with available information on sleep habits. Sleep habits were categorized as inadequate and adequate sleep duration (< or ≥7 h/day, respectively). In multi-adjusted analysis, MD adherence was inversely associated with CVD risk [Hazard Ratio-HR per 1/55 in MedDietScore: 0.80, 95% Confidence Interval-CI: 0.65, 0.98]. A significant interaction between sleep duration and MedDietScore was observed (p < 0.001). In subgroup analysis, the protective association between MD adherence and CVD risk was found only in participants who slept adequately, i.e., >7 h/day [HR:0.80, 95%CI: 0.65, 0.98]. Those who had a high adherence to the MD along with adequate sleep habits, had a 70% reduced 20-year CVD risk [HR:0.30, 95%CI: 0.11, 0.80], compared to those who had a low MD adherence and inadequate sleep habits. Sleep duration should be a part of an individual's lifestyle, together with dietary and other habits, to effectively evaluate CVD risk for future events.