Should we remove wine from the Mediterranean diet?: a narrative review

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

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

Urinary tartaric acid as a biomarker of wine consumption and cardiovascular risk: the PREDIMED trial

BACKGROUND AND AIMS

Moderate wine consumption has been associated with lower cardiovascular disease (CVD) risk in older populations. However, wine consumption information through self-reports is prone to measurement errors inherent to subjective assessments. The aim of this study was to evaluate the association between urinary tartaric acid, an objective biomarker of wine consumption, and the rate of a composite clinical CVD event.

METHODS

A case-cohort nested study was designed within the PREDIMED trial with 1232 participants: 685 incident cases of CVD and a random subcohort of 625 participants (including 78 overlapping cases). Wine consumption was registered using validated food frequency questionnaires. Liquid chromatography-tandem mass spectrometry was used to measure urinary tartaric acid at baseline and after one year of intervention. Weighted Cox regression models were used to estimate hazard ratios (HRs) of CVD.

RESULTS

Tartaric acid was correlated with self-reported wine consumption at baseline [r = 0.46 (95% CI 0.41; 0.50)]. Five categories of post hoc urinary tartaric acid excretion were used for better representation of risk patterns. Concentrations of 3-12 and 12-35 μg/mL, which reflect ∼3-12 and 12-35 glasses/month of wine, were associated with lower CVD risk [HR 0.62 (95% CI 0.38; 1.00), P = .050 and HR 0.50 (95% CI 0.27; 0.95), P = .035, respectively]. Less significant associations between self-reported wine consumption and CVD risk were observed.

CONCLUSIONS

Light-to-moderate wine consumption, measured through an objective biomarker (tartaric acid), was prospectively associated with lower CVD rate in a Mediterranean population at high cardiovascular risk.

Wine Phenolic Compounds: Chemistry, Functionality and Health Benefits

Wine phenolic compounds, often known as polyphenols, are a diverse group of secondary bioactive compounds derived from grapes. They play a crucial role in defining the sensory characteristics, functionality, and health benefits of wine. This review explores the complex chemistry of these compounds, focusing on key classes such as flavonoids, which include flavanones, flavonols, anthocyanins, and flavan-3-ols, and non-flavonoids, such as hydroxycinnamic acids, hydroxybenzoic acids, and stilbenes. The health benefits of wine phenolics, particularly their antioxidant and anti-inflammatory properties, are also discussed in relation to preventing and reducing the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, and neurodegenerative conditions. Furthermore, this review summarized the most current data from human population-based research that investigated the bioactivity of these red wine phytochemicals with relevant health benefits for NCDs. Finally, this review proposes some perspectives for future research to better understand the bioavailability, metabolism, and long-term health effects of these compounds.

Influence of Mediterranean Diet on Sexual Function in People with Metabolic Syndrome: A Narrative Review

Metabolic syndrome (MS), a cluster of cardiometabolic disorders, and sexual dysfunction are two conditions that impact a large proportion of the general population. Although they can occur independently, they are frequently linked and significantly affect people's quality of life. In recent years, research has increasingly focused on the importance of diet, particularly the Mediterranean diet (MD), in modulating sexual function due to its anti-inflammatory, antioxidant, and vasodilatory properties. In this narrative review, we examined the relationship between MS and sexual function in both men and women, with a special emphasis on the MD's therapeutic efficacy in improving sexual dysfunction. In men, MD has been shown to ameliorate erectile dysfunction, as well as several sperm parameters, perhaps leading to improved fertility. On the other hand, adherence to MD has been demonstrated to partially recover several sexual dysfunctions in women, such as those related to their menstrual cycle, menopause, endometriosis, and polycystic ovary syndrome. These favorable effects of MD have been demonstrated in both sexes also among people affected by MS. However, more targeted studies are needed to validate these data for different dietary approaches as well.

Effect of Mediterranean diet on body mass index and fatigue severity in patients with multiple sclerosis: A systematic review and meta-analysis of clinical trials

BACKGROUND

Recent studies imply that Mediterranean Diet (MeD) may play an important role in the management of Multiple Sclerosis (MS). This meta-analysis aimed to evaluate the effectiveness of MeD in addressing MS-related complications.

METHODS

A thorough search was performed in MEDLINE (PubMed), Scopus, EMBASE, ScienceDirect, Google Scholar, Web of Science, and the Central Cochrane Library, covering trials published until September 2023. The quantitative data were synthesized using random effect models through STATA14.

RESULTS

After analyzing 228 entries, we found five Randomized Controlled Trials (RCTs) with a total of 540 participants, who had an average disease duration of 8.5 years. The combined effect size revealed a decrease in Body Mass Index (BMI) (Weighted Mean Difference [WMD] = -0.88 kg/m2; 95 % Confidence Interval [CI] = -1.68, -0.08; P = 0.030). There was also a non-significant marginal improvement in fatigue severity (WMD = -8.29; 95 % CI = -16.74, 0.16; P = 0.054).

CONCLUSION

Adherence to MeD may improve BMI and fatigue severity in MS patients. Further RCTs are needed to confirm the current results.

Alcohol Drinking Impacts on Adiposity and Steatotic Liver Disease: Concurrent Effects on Metabolic Pathways and Cardiovascular Risks

PURPOSE OF REVIEW

This integrative search aimed to provide a scoping overview of the relationships between the benefits and harms of alcohol drinking with cardiovascular events as associated to body fat mass and fatty liver diseases, as well as offering critical insights for precision nutrition research and personalized medicine implementation concerning cardiovascular risk management associated to ethanol consumption.

RECENT FINDINGS

Frequent alcohol intake could contribute to a sustained rise in adiposity over time. Body fat distribution patterns (abdominal/gluteus-femoral) and intrahepatic accumulation of lipids have been linked to adverse cardiovascular clinical outcomes depending on ethanol intake. Therefore, there is a need to understand the complex interplay between alcohol consumption, adipose store distribution, metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular events in adult individuals. The current narrative review deals with underconsidered and apparently conflicting benefits concerning the amount of alcohol intake, ranging from abstention to moderation, and highlights the requirements for additional robust methodological studies and trials to interpret undertrained and existing controversies. The conclusion of this review emphasizes the need of newer multifaceted clinical approaches for precision medicine implementation, considering epidemiological strategies and pathophysiological mechanistic. Newer investigations and trials should be derived and performed particularly focusing both on alcohol's objective consequences as putatively mediated by fat deposition, including associated roles in fatty liver disease as well as to differentiate the impact of different levels of alcohol consumption (absence or moderation) concerning cardiovascular risks and accompanying clinical manifestations. Indeed, the threshold for the safe consumption of alcoholic drinks remains to be fully elucidated.