Mediterranean Diet and Workplace Health Promotion

Towards a Thriving Workplace: A Feasibility Study on Mindfulness and the Mediterranean Lifestyle for Corporate Wellness

Background/Objectives: This study explores the potential of integrating mindfulness and the Mediterranean lifestyle into corporate wellness programs to enhance workplace well-being. Methods: A survey of 485 employees from Greece and Cyprus examined how mindfulness, resilience, adherence to the Mediterranean lifestyle, and work ability are connected. Results: Pearson correlation analysis showed statistically significant positive relationships between mindfulness, resilience, and work ability (p < 0.001 and p < 0.001, respectively). Mindfulness was associated with higher job satisfaction (p < 0.001) and was a significant predictor of good (OR = 1.112, 95% CI: 1.043-1.186, p = 0.001) and excellent (OR = 1.163, 95% CI: 1.087-1.245, p < 0.001) work ability, while adherence to the Mediterranean lifestyle had a lower yet significant positive correlation with resilience (p < 0.01) and work ability (p < 0.05). Differences in wellness across job sectors were observed: employees in health and retail sectors had lower resilience, work ability, and mindfulness compared to those in manufacturing, technology, education, and services. Notably, 78% of participants expressed interest in future wellness programs, favoring a combination of online and onsite formats. Conclusions: These findings suggest that mindfulness and the Mediterranean lifestyle can enhance employee well-being and productivity, but sector-specific strategies may be necessary to address unique challenges. Practical applications include tailoring interventions to meet the needs of employees in sectors with lower wellness scores. Future research should investigate the long-term benefits of such programs across diverse industries and employee groups.

Mediterranean Diet Adherence, Gut Microbiota and Parkinson's Disease: A Systematic Review

BACKGROUND

There is mounting evidence to suggest that high adherence to the Mediterranean diet (MedDiet) may reduce the risk of age-related diseases, including Parkinson's disease (PD). However, evidence for the role of the MedDiet in the relief of motor and non-motor symptoms in patients with PD remains limited and inconclusive. We provide a systematic review of the effects of the MedDiet on the clinical features of PD using data from randomised controlled trials (RCT) and prospective observational studies.

METHODS

We searched MEDLINE, EMCare, EMBASE, Scopus and PubMed from inception until June 2023. Reference lists and the grey literature were also searched. Human studies with no restriction on language or publication date, examining associations between MedDiet adherence and the symptoms of PD, were included. We employed standard methodological procedures for data extraction and evidence synthesis and used the Quality Criteria Checklist for assessing the studies included.

RESULTS

Four studies from three unique cohorts, including two observational studies (n = 1213) and one RCT (n = 70), met the inclusion criteria. Despite the short study duration reported in all included reports, high MedDiet adherence was associated with changes in the gut microbiota (e.g., increased abundance of short-chain fatty acids producers). These outcomes correlated with a significant improvement in several non-motor symptoms including cognitive dysfunction, dyspepsia and constipation. However, there were no significant changes in diarrhoea, gastrointestinal reflux, abdominal pain and motor symptoms.

CONCLUSION

High MedDiet adherence may be associated with significant improvement in global cognition and several gastrointestinal symptoms, possibly associated to changes in gut microbiota composition. Further studies are warranted to clarify potential cause-and-effect relationships and to elucidate MedDiet impact on motor symptoms.

Role of Mediterranean diet in endocrine diseases: a joint overview by the endocrinologist and the nutritionist

PURPOSE

The purpose of this review is to examine the current evidence on the potential role of Mediterranean diet (MD) in the prevention and management of endocrine disorders and to highlight the importance of interdisciplinary collaboration between endocrinologists and nutritionists.

METHODS

A literature search was conducted using PubMed and Google Scholar databases to identify relevant studies published in English. Studies were selected based on their relevance to the role of MD in the prevention and management of endocrine disorders. The search terms included "Mediterranean diet," "endocrine disorders," "thyroid disorders," "gonadal disorders," and "neuroendocrine tumors".

RESULTS

The studies reviewed suggest that MD may have a beneficial effect in the prevention and management of various endocrine disorders, including thyroid disorders, gonadal disorders, and neuroendocrine tumors. MD has been associated with decreased risk of nodular thyroid disease and thyroid cancer, improved male and female reproductive health, and a potential role in the management of neuroendocrine tumors. MD's anti-inflammatory and antioxidant properties, as well as its high levels of phytochemicals, may play a role in its beneficial effects.

CONCLUSION

Interdisciplinary collaboration between endocrinologists and nutritionists is essential for the optimal management of endocrine disorders, including the potential role of MD in their prevention and management. While further research is needed, the current evidence suggests that MD may have a protective effect against endocrine disorders, and its incorporation into dietary recommendations may be beneficial.

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

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

Implementing federal food service guidelines in federal and private worksite cafeterias in the United States leads to improved health outcomes and is cost saving

Poor diet increases cardiometabolic disease risk, yet the impact of food service guidelines on employee health and its cost effectiveness is poorly understood. Federal food service guidelines (FFSG) aim to provide United States (U.S.) government employees with healthier food options. Using microsimulation modeling, we estimated changes in the incidence of cardiometabolic disease, related mortality, and the cost effectiveness of implementing FFSG in nationally representative model populations of government and private company employees across 5 years and lifetime. We based estimates on changes in workplace intake of six FFSG dietary targets and showed lifetime reductions of heart attacks (- 107/million), strokes (- 30/million), diabetes (- 134/million), ischemic heart disease deaths (- 56/million), and stroke deaths (- 8/million). FFSG is cost saving overall, with total savings in discounted healthcare costs from $4,611,026 (5 years) to $539,809,707 (lifetime) $U.S. This study demonstrates that FFSG improves health outcomes and is cost saving.

Effectiveness of Workplace Mediterranean Diet Interventions on Cardiometabolic Risk Factors: A Systematic Review

BACKGROUND

There are numerous health benefits related to high adherence to the Mediterranean diet (MedDiet), providing a protective effect against cardiometabolic diseases, but there are very few MedDiet studies conducted in the workplace. Therefore, the purpose of this systematic review is to analyze the effectiveness of MedDiet workplace interventions on cardiovascular risk factors.

METHODS

Studies were identified in four databases: PubMed, Scopus, Web of Science, and CINAHL, published from the earliest time point until 15 May 2021. The inclusion criteria were (a) adults aged 18 to 70 years; (b) MedDiet intervention only; (c) intervention was conducted in a workplace; and (d) the outcomes included measurement of cardiometabolic biomarkers. Exclusion criteria were (a) abstract not in English; (b) full-text non-available; and (c) review articles. Ninety-five studies were retrieved and assessed for inclusion by two independent reviewers, who also used the Cochrane Collaboration Tool to assess study quality and risk of bias.

RESULTS

Five high-quality studies were included (n = 436, 89% male). MedDiet interventions carried out within the workplace were effective in improving cardiovascular risk factors such as lipid profile and insulin sensitivity compared with a low-fat diet, especially among obese participants. Blood pressure and inflammatory markers were not improved after the MedDiet interventions.

CONCLUSIONS

Worksite occupational health teams should consider promoting MedDiet by conducting regular nutritional sessions and providing tailored menus in workplace cafeterias. However, more high-quality studies are necessary to bring more evidence to this topic.

Female Fertility and the Nutritional Approach: The Most Essential Aspects

Infertility is an increasing problem that affects couples attempting pregnancy. A growing body of evidence points to a link between diet and female fertility. In fact, data show that a diet high in trans fats, refined carbohydrates, and added sugars can negatively affect fertility. Conversely, a diet based on the Mediterranean dietary patterns, i.e., rich in dietary fiber, omega-3 (ɷ-3) fatty acids, plant-based protein, and vitamins and minerals, has a positive impact on female fertility. An unhealthy diet can disrupt microbiota composition, and it is worth investigating whether the composition of the gut microbiota correlates with the frequency of infertility. There is a lack of evidence to exclude gluten from the diet of every woman trying to become pregnant in the absence of celiac disease. Furthermore, there are no data concerning adverse effects of alcohol on female fertility, and caffeine consumption in the recommended amounts also does not seem to affect fertility. On the other hand, phytoestrogens presumably have a positive influence on female fertility. Nevertheless, there are many unanswered questions with regard to supplementation in order to enhance fertility. It has been established that women of childbearing age should supplement folic acid. Moreover, most people experience vitamin D and iodine deficiency; thus, it is vital to control their blood concentrations and consider supplementation if necessary. Therefore, since diet and lifestyle seem to be significant factors influencing fertility, it is valid to expand knowledge in this area.

The Mediterranean diet from past to future: Key concepts from the second "Ancel Keys" International Seminar

The year 2020 celebrated the tenth anniversary of the recognition of the Mediterranean Diet as Intangible Cultural Heritage of Humanity by the UNESCO Intergovernmental Committee. This event represented a milestone in the history of nutrition, as the Mediterranean diet was the first traditional food practice to receive such award. Since then, a lot has been discussed not only on the beneficial aspects of the Mediterranean diet, but also on its complex role as a lifestyle model that includes a set of skills, knowledge and intercultural dialogue. This process ended up with the recognition in 2019 of Mediterranean diet as a possibly universal model of healthy diet from the EAT-Lancet Commission. These concepts were widely debated at the 2019 "Ancel Keys" International Seminar, held in Ascea (Italy) (for more information see: www.mediterraneandietseminar.org) with the aim to stimulate interest and awareness of a young group of participants on the current problems inherent to the effective implementation of the Mediterranean diet. The present article collects the contributions of several lecturers at the Seminar on key issues such as methodological and experimental approach, sustainability, molecular aspects in disease prevention, future exploitation, without neglecting a historical view of the Seven Countries Study. From the Seminar conclusions emerged a still vibrant and modern role of Mediterranean diet. The years to come will see national and international efforts to reduce the barriers that limit adherence to Mediterranean diet in order to plan for multi-factorial and targeted interventions that would guide our populations to a sustainable healthy living.

The Beneficial Health Effects of Vegetables and Wild Edible Greens: The Case of the Mediterranean Diet and Its Sustainability

The Mediterranean diet (MD) concept as currently known describes the dietary patterns that were followed in specific regions of the area in the 1950s and 1960s. The broad recognition of its positive effects on the longevity of Mediterranean populations also led to the adoption of this diet in other regions of the world, and scientific interest focused on revealing its health effects. MD is not only linked with eating specific nutritional food products but also with social, religious, environmental, and cultural aspects, thus representing a healthy lifestyle in general. However, modern lifestyles adhere to less healthy diets, alienating people from their heritage. Therefore, considering the increasing evidence of the beneficial health effects of adherence to the MD and the ongoing transitions in consumers’ behavior, the present review focuses on updating the scientific knowledge regarding this diet and its relevance to agrobiodiversity. In addition, it also considers a sustainable approach for new marketing opportunities and consumer trends of the MD.

Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters

The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the "Feeding America's Bravest" study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (β-coefficient -0.028, p = 0.002) and an increase of HDL-cholesterol (β-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.

Non-Systematic Review of Diet and Nutritional Risk Factors of Cardiovascular Disease in Obesity

Although cardiovascular disease and its risk factors have been widely studied and new methods of diagnosis and treatment have been developed and implemented, the morbidity and mortality levels are still rising-cardiovascular disease is responsible for more than four million deaths each year in Europe alone. Even though nutrition is classified as one of the main and changeable risk factors, the quality of the diet in the majority of people does not follow the recommendations essential for prevention of obesity and cardiovascular disease. It demonstrates the need for better nutritional education in cardiovascular disease prevention and treatment, and the need to emphasize dietary components most relevant in cardiovascular disease. In our non-systematic review, we summarize the most recent knowledge about nutritional risk and prevention in cardiovascular disease and obesity.

Trends in adherence to the Mediterranean diet in South Italy: A cross sectional study

BACKGROUND AND AIMS

Increasing literature data show that adherence to the Mediterranean diet is undergoing profound changes in recent years, albeit with marked differences across nations. In Italy, one of the cradles of the Mediterranean diet, the literature regarding the trend for Mediterranean diet adherence is conflicting. Thus, we aimed to explore the trends of adherence to the Mediterranean diet in a large cohort of participants living in South Italy, over 20 years from 1985-86 to 2005-06.

METHODS AND RESULTS

Cross-sectional study with two evaluations, one made in 1985-86 and another in 2005-06; all participants were adults aged 30-70 years of age. The adherence to the Mediterranean diet was evaluated using the score proposed by Panagiotakos et al. This score features values ranging from 0 to 55, higher scores reflecting a greater adherence. The data are reported by age (30-49 vs. 50-69 years). Overall, 2451 subjects were included in 1985-86 and 2375 in 2005-06. A significant reduction was observed in the adherence to the Mediterranean diet (age 30-49 years: 31.82 ± 4.18 in 1985-86 vs. 29.20 ± 4.48 in 2005-06, reduction by 8.2%, p < 0.0001; age 50-69: 32.20 ± 4.09 in 1985-86 vs.30.15 ± 4.27 in 2005-06, reduction by 6.3%, p < 0.0001). Among all these items, the most dramatic change was observed for olive oil consumption, that decreased by 2.35 points in younger and 0.89 in older people.

CONCLUSION

The adherence to the Mediterranean diet decreased from 1985-86 to 2005-06 in South Italy, particularly in younger people, above all due to a decreased olive oil consumption.

Adherence to the Mediterranean diet pattern among university staff: a cross-sectional web-based epidemiological study in Southern Italy

In this cross-sectional web-survey, carried out in 340 employees (24-67 years) among university staff of Southern Italy, we assessed the adherence to the Mediterranean Diet (MD). Using an online questionnaire based on validated 14-point MD Adherence Screener (MEDAS), the mean of the score was 7.34 (±1.9) for total population independently of sex. In population divided by the cut-off age of 45 years, MD adherence resulted significantly lower in younger respect to older group (p = .003). In multiple regression analyses we observed the direct association between MEDAS score and older age group also after adjustments. Importantly, in all sample the percentage of adherers to recommendations for fruits, nuts and fish resulted outside dietary guidelines. The present findings underscore the need to develop healthy education programmes aimed to improve the consumption of several components of the MD, particularly among young adults, in order to prevent the early onset of chronic non-transmittable diseases.

Consumption of fried foods and risk of atrial fibrillation in the Physicians' Health Study

PURPOSE

Atrial fibrillation (AF) is a frequently encountered cardiac arrhythmia in clinical practice. While fried food consumption is common in United States, little is known about the association between fried food consumption and incident AF.

METHODS

We prospectively examined the association of fried food consumption with incident AF in 18,941 US male physicians. Fried food consumption was assessed via a self-administered food frequency questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF.

RESULTS

The average age at baseline was 66 ± 9 years. During a mean follow up of 9.0 ± 3.0 years, 2099 new cases of AF occurred. Using < 1/week of fried food consumption as the reference group, multivariable adjusted hazard ratios ( 95% confidence interval) for AF were 1.07 (0.97, 1.18) and 1.03 (0.91, 1.17), for people reporting an average fried food consumption of 1-3/week and ≥ 4/week, respectively, p linear trend 0.4. In a secondary analysis, the results did not change after exclusion of participants with prevalent coronary heart disease or congestive heart failure. Lastly, the source of fried food (away from home or at home) did not influence the relation of fried food with AF risk.

CONCLUSIONS

In conclusion, our study does not provide evidence for an association between fried food consumption and incident AF among US male physicians.

A Novel Approach to Improve the Estimation of a Diet Adherence Considering Seasonality and Short Term Variability - The NU-AGE Mediterranean Diet Experience

In this work we present a novel statistical approach to improve the assessment of the adherence to a 1-year nutritional intervention within the framework of the NU-AGE project. This was measured with a single adherence score based on 7-days food records, under limitations on the number of observations per subject and time frame of intervention. The results of the NU-AGE dietary intervention were summarized by variations of the NU-AGE index as described in the NU-AGE protocol. Food and nutrient intake of all participants was assessed by means of 7-days food records at recruitment and after 10 to 14 months of intervention (depending on the subject availability). Sixteen food groups and supplementations covering the dietary goals of the NU-AGE diet have been used to estimate the NU-AGE index before and after the intervention. The 7-days food record is a reliable tool to register food intakes, however, as with other tools used to assess lifestyle dietary compliance, it is affected by uncertainty in this estimation due to the possibility that the observed week is not fully representative of the entire intervention period. Also, due to logistic limitations, the effects of seasonality can never be completely removed. These variabilities, if not accounted for in the index estimation, will reduce the statistical power of the analyses. In this work we discuss a method to assess these uncertainties and thus improve the resulting NU-AGE index. The proposed method is based on Hierarchical Bayesian Models. This model explicitly includes country-specific averages of the NU-AGE index, index variation induced by the dietary intervention, and country based seasonality. This information is used to evaluate the NU-AGE index uncertainty and thus to estimate the "real" NU-AGE index for each subject, both before and after the intervention. These corrections reduce the possibility of misinterpreting measurement variability as real information, improving the power of the statistical tests that are performed with the resulting index. The results suggest that this method is able to reduce the short term and seasonal variability of the measured index in the context of multicenter dietary intervention trials. Using this method to estimate seasonality and variability would allow one to obtain better measurements from the subjects of a study, and be able to simplify the scheduling of diet assessments. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01754012.

Associations between Adherence to the Mediterranean Diet and Lifestyle Assessed with the MEDLIFE Index among the Working Population

The adherence to the Mediterranean diet is beneficial for cardiovascular diseases prevention. The study aim is to use Mediterranean lifestyle (MEDLIFE) questionnaire for estimation of Mediterranean lifestyle habits among the working population and to establish MEDLIFE score correlation with the risk factors for cardiovascular diseases. In the study has participated 366 workers from Croatia, which fulfilled MEDLIFE and validated food frequency questionnaire (FFQ) questionnaire. The multivariate logistic regression was performed to evaluate the association between MEDLIFE index, workers’ obesity and cardiovascular diseases risk. The lowest adherence to Mediterranean lifestyle was associated to younger, low education, body fat above acceptable ranges and unfavorable lipid profile. Significant association to Mediterranean lifestyle was more among women (p = 0.002), middle aged (p = 0.02), highly physically active (p = 0.009) and those who play collective sports >2 h/w (p = 0.001), having body fat within acceptable range (p = 0.003), total cholesterol less (p = 0.03) and high-density lipoproteins (HDL-C) (p = 0.04) more than recommended. Inverse significant association was for high educational level (p = 0.02). The Mediterranean lifestyle adherence is associated to lower risk factors for cardiovascular diseases among studied working population. MEDLIFE index revealed that physical activity and conviviality are better ingrained among younger population but not the Mediterranean diet.

Periconceptional Maternal Mediterranean Diet Is Associated With Favorable Offspring Behaviors and Altered CpG Methylation of Imprinted Genes

Background: Maternal diet during pregnancy has been shown to influence the child neuro-developmental outcomes. Studies examining effects of dietary patterns on offspring behavior are sparse. Objective: Determine if maternal adherence to a Mediterranean diet is associated with child behavioral outcomes assessed early in life, and to evaluate the role of differentially methylated regions (DMRs) regulating genomically imprinted genes in these associations. Methods: Among 325 mother/infant pairs, we used regression models to evaluate the association between tertiles of maternal periconceptional Mediterranean diet adherence (MDA) scores derived from a Food Frequency Questionnaire, and social and emotional scores derived from the Infant Toddler Social and Emotional Assessment (ITSEA) questionnaire in the second year of life. Methylation of nine genomically imprinted genes was measured to determine if MDA was associated with CpG methylation. Results: Child depression was inversely associated with maternal MDA (Bonferroni-corrected p = 0.041). While controlling for false-discovery, compared to offspring of women with the lowest MDA tertile, those with MDA scores in middle and high MDA tertiles had decreased odds for atypical behaviors [OR (95% CI) = 0.40 (0.20, 0.78) for middle and 0.40 (0.17, 0.92) for highest tertile], for maladaptive behaviors [0.37 (0.18, 0.72) for middle tertile and 0.42 (0.18, 0.95) for highest tertile] and for an index of autism spectrum disorder behaviors [0.46 (0.23, 0.90) for middle and 0.35 (0.15, 0.80) for highest tertile]. Offspring of women with the highest MDA tertile were less likely to exhibit depressive [OR = 0.28 (0.12, 0.64)] and anxiety [0.42 (0.18, 0.97)] behaviors and increased odds of social relatedness [2.31 (1.04, 5.19)] behaviors when compared to low MDA mothers. Some associations varied by sex. Perinatal MDA score was associated with methylation differences for imprinted control regions of PEG10/SGCE [females: Beta (95% CI) = 1.66 (0.52, 2.80) - Bonferroni-corrected p = 0.048; males: -0.56 (-1.13, -0.00)], as well as both MEG3 and IGF2 in males [0.97 (0.00, 1.94)] and -0.92 (-1.65, -0.19) respectively. Conclusion: In this ethnically diverse cohort, maternal adherence to a Mediterranean diet in early pregnancy was associated with favorable neurobehavioral outcomes in early childhood and with sex-dependent methylation differences of MEG3, IGF2, and SGCE/PEG10 DMRs.

Nutrition and Inflammation: Are Centenarians Similar to Individuals on Calorie-Restricted Diets?

Individuals capable of reaching the extreme limit of human life such as centenarians are characterized by an exceptionally healthy phenotype—that is, a low number of diseases, low blood pressure, optimal metabolic and endocrine parameters, and increased diversity in the gut microbiota—and they are epigenetically younger than their chronological age. We present data suggesting that such a remarkable phenotype is largely similar to that found in adults following a calorie-restricted diet. Interviews with centenarians and historical data on the nutritional and lifestyle habits of Italians during the twentieth century suggest that as children and into adulthood, centenarians lived in an environment that was nonobesogenic, but at the same time the environment did not produce malnutrition. Centenarians appear to be creatures of habit, and we argue that their habit of eating meals at the same time each day favored the maintenance of circadian rhythms, including their sleep cycle. Finally, we argue that centenarians’ chronic inflammatory status, which we dubbed inflammaging, is peculiar, likely adaptive, and less detrimental than in younger people.

Beneficial Effects of Elderly Tailored Mediterranean Diet on the Proteasomal Proteolysis

Aging is a multifactorial process characterized by the accumulation of proteins undergoing oxidative modifications, either due to enhanced levels of oxidative stress or due to their decreased clearance; both facts are related to the establishment of chronic inflammatory processes. These processes are directly associated with functional and structural modifications of a key cellular component, namely the proteasome. In this study, levels of oxidized proteins, along with proteasome and immunoproteasome composition and activity on a selected group of 120 elderly volunteers were analyzed before and after the administration of a specific dietary protocol, based on an elderly tailored Mediterranean diet (the "NU-AGE diet"). A significant negative correlation between levels of oxidized/carbonylated proteins and proteasome function was confirmed, both before and after intervention. Furthermore, it was demonstrated that subgroups of non-frail subjects and women receive a greater benefit after the intervention, concerning specifically the proteasome content and activity. These data highlight the putative beneficial effects of Mediterranean diet on the major cellular proteolytic mechanism, the proteasome, in elderly people.

Survival Mediterranean Style: Lifestyle Changes to Improve the Health of the US Fire Service

Cardiovascular disease (CVD) causes almost half of all on-duty deaths in US firefighters and is an important and costly cause of morbidity. In addition, cancer is a growing health concern in this population. Obesity and obesity-associated, cardiometabolic risk clustering are major, modifiable risk factors for fire service CVD and cancer risk. The Mediterranean diet (MedDiet) is proven effective in primary and secondary CVD prevention. It is also associated with a decreased risk of cancer and other chronic diseases. Moreover, it can be adapted into successful workplace interventions. Emerging data from our group regarding the US Fire Service show that greater compliance with the MedDiet is associated with improved CVD risk profiles and less weight gain among career firefighters. Moreover, the fact that career firefighters take a considerable number of meals communally on the job also represents an excellent opportunity for a workplace Mediterranean Diet Nutritional Intervention (MDNI). The devastating effects of obesity, CVD, and cancer on the US fire service are recognized, but currently few effective preventive programs exist. The consistently positive health benefits from following a MedDiet and promising preliminary data in the fire service justify translational research to determine the most effective means of delivering MDNIs to US firefighters. Therefore, a high priority should be assigned to efforts, which can help further disseminate and implement our program of novel behavior change strategies, "Survival Mediterranean Style," throughout the US fire service and eventually to other occupations.

Mediterranean diet and inflammaging within the hormesis paradigm

A coherent set of epidemiological data shows that the Mediterranean diet has beneficial effects capable of preventing a variety of age-related diseases in which low-grade, chronic inflammation/inflammaging plays a major role, but the underpinning mechanism(s) is/are still unclear. It is suggested here that the Mediterranean diet can be conceptualized as a form of chronic hormetic stress, similar to what has been proposed regarding calorie restriction, the most thoroughly studied nutritional intervention. Data on the presence in key Mediterranean foods of a variety of compounds capable of exerting hormetic effects are summarized, and the mechanistic role of the nuclear factor erythroid 2 pathway is highlighted. Within this conceptual framework, particular attention has been devoted to the neurohormetic and neuroprotective properties of the Mediterranean diet, as well as to its ability to maintain an optimal balance between pro- and anti-inflammaging. Finally, the European Commission-funded project NU-AGE is discussed because it addresses a number of variables not commonly taken into consideration, such as age, sex, and ethnicity/genetics, that can modulate the hormetic effect of the Mediterranean diet.

Promoción de la salud en los lugares de trabajo: un camino por recorrer

Resumen Es necesario trascender en el desarrollo conceptual y en la aplicación de la promoción de la salud en los lugares de trabajo (PSLT), ya que éstos han sido considerados como un espacio propicio y prioritario para la promoción de la salud. Se realizó un estudio cualitativo con aproximación hermenéutica que emplea como técnica el estado del arte, para lo cual se estudiaron 131 documentos de organismos nacionales e internacionales y de las bases de datos Embase, Science Direct y SciELO. Emergieron tres categorías principales: desarrollo conceptual de la PSLT, metodologías en el estudio de la PSLT y medición de resultados de la PSLT. La producción científica se genera principalmente en Norteamérica, Europa y Brasil en América Latina. Se han documentado impactos positivos en salud, productividad y costos. La amplitud de acción de la PSLT se restringe al ámbito empresarial formal, con mínimos acercamientos a entornos laborales de trabajadores informales. La PSLT debe ser orientada a la mejora de las condiciones de la organización, condiciones de trabajo, participación activa y desarrollo individual de los trabajadores, sin embargo, las investigaciones se han limitado en acciones puntuales relacionadas con reducción de algunos factores de riesgo, programas de prevención de enfermedades e intervención sobre hábitos individuales.

Dietary Preferences and Nutritional Information Needs Among Career Firefighters in the United States

Background:

Considerable cardiovascular disease and cancer risk among firefighters are attributable to excess adiposity. Robust evidence confirms strong relationships between dietary patterns and the risk of chronic disease. Dietary modification is more likely to be effective when the strategy is appealing and addresses knowledge gaps.

Objective:

To assess career firefighters' diet practices and information needs, compare the relative appeal of proposed diet plans, and examine how these vary in association with body composition.

Methods:

Cross-sectional, online survey distributed to members of the International Association of Fire Fighters.

Results:

Most firefighters do not currently follow any specific dietary plan (71%) and feel that they receive insufficient nutrition information (68%), but most are interested in learning more about healthy eating (75%). When presented with written descriptions of diets without names or labels and asked to rank them in order of preference, firefighters most often rated the Mediterranean diet as their favorite and gave it a more favorable distribution of relative rankings (P<.001) compared to the Paleo, Atkins, Therapeutic Lifestyle Changes, and Esselsteyn Engine 2 (low-fat, strictly plant-based) diets. Obese respondents reported more limited nutritional knowledge (P<.001) and were more likely to feel that they received insufficient nutritional information (P=.021) than participants with normal body weight.

Conclusions:

Most career firefighters are overweight or obese and do not practice a specific diet; however, 75% want to learn more about healthy eating. Among popular dietary choices, firefighters were most receptive to a Mediterranean diet and least receptive to a strictly plant-based diet.

Chocolate Consumption and Risk of Atrial Fibrillation (from the Physicians' Health Study)

Chocolate consumption has been shown to protect against various cardiovascular end points; however, little is known about the association between chocolate consumption and incident atrial fibrillation (AF). Therefore, we prospectively examined the association between chocolate consumption and incident AF in a cohort of 18,819 US male physicians. Chocolate consumption was ascertained from 1999 to 2002 through a self-administered food frequency questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF. The average age at baseline was 66 years (±9.1). During a mean follow-up of 9.0 years (±3.0), 2,092 cases of AF occurred. Using <1 per month of chocolate consumption as the reference group, multivariable adjusted hazard ratios (95% confidence interval) for AF were 1.04 (0.93 to 1.18), 1.10 (0.96 to 1.25), 1.14 (0.99 to 1.31), and 1.05 (0.89 to 1.25) for chocolate intake of 1 to 3 per month and 1, 2 to 4, and ≥5 per week (p for trend 0.25), respectively. In a secondary analysis, there was no evidence of effect modification by adiposity (p interaction = 0.71) or age (p interaction = 0.26). In conclusion, our data did not support an association between chocolate consumption and risk of AF in US male physicians.