Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet

Mediterranean Diet Patterns Are Positively Associated with Maximal Fat Oxidation and VO2max in Young Adults: The Mediating Role of Leptin

Background: Adherence to the Mediterranean diet (MedDiet) offers multiple metabolic benefits. However, its relationship with maximal fat oxidation (MFO) and cardiorespiratory fitness (VO2max), alongside the potential mediating role of leptin, remains underexplored in young adults. Objective: The objective was to investigate the associations between MedDiet adherence and the body mass index (BMI), MFO, and VO2max and to evaluate whether leptin mediates these relationships. Methods: Sixty-five young adults (n = 23 women), aged 18-38, were assessed for body composition, MedDiet adherence (14-Item Mediterranean Diet Adherence Screener), MFO, and VO2max through indirect calorimetry. Plasma leptin concentrations were measured in fasting conditions. Multiple linear regression models were performed, adjusting for sex, age, and both. Mediation analyses were conducted. Results: Higher MedDiet adherence was significantly associated with lower BMI (β = -0.339, p = 0.006) and leptin values (β = 0.284, p = 0.022) and higher absolute MFO (β = 0.338, p = 0.006) and VO2max values (β = 0.462, p < 0.001). These associations remained significant in all models except BMI and leptin when adjusted for sex and sex and age. Leptin was positively associated with the BMI (β = 0.550, p < 0.001) and inversely associated with absolute MFO (β = -0.650, p < 0.001) in all models. There was a trend in the association between leptin and VO2max (β = -0.233, p = 0.061) only in the unadjusted model. Mediation analysis revealed that the leptin levels significantly mediated the associations between MedDiet adherence and BMI (β = -0.358, 95% CI [-0.677, -0.077]) and VO2max (β = 1.043, 95% CI [0.280, 1.833]). Conclusions: MedDiet adherence is associated with a lower BMI and higher MFO and VO2max in young adults. Our findings further suggest that leptin plays a mediating role in how MedDiet adherence influences the BMI and VO2max.

A Remote Nursing-Guided Secondary Prevention Programme in Acute Coronary Syndrome. The SPRING Randomised Controlled Trial

AIM

To assess the impact of a nurse-led remote secondary cardiovascular prevention programme versus usual follow-up in patients who have suffered an acute coronary syndrome in terms of major adverse clinical events (MACE), diet, physical exercise, smoking, emotional state, adherence to medical treatment, cardiometabolic profile and anthropometric parameters within one year of discharge.

DESIGN

Prospective, randomised, open-label, evaluator-blinded, multicentre trial.

METHODS

Between October 17, 2017, and February 5, 2023, patients were randomly assigned to either a usual follow-up of two cardiology visits over 12 months or the nurse-led remote secondary cardiovascular prevention programme, which also included 5 nursing visits (one face-to-face and four remote).

RESULTS

At 12 months, the nurse-led remote prevention programme group (interventional group) had lower smoking rates, greater adherence to medication, greater adherence to the Mediterranean diet, more physical activity, and better perceived health status compared to the usual follow-up group. The interventional group demonstrated a reduction in major adverse clinical events (20.7%) compared to the usual follow-up group (12.4%). This reduction was observed particularly in Acute Coronary Syndrome recurrence, all-cause hospitalisation, and hospitalisation for cardiovascular causes.

CONCLUSIONS

Patients randomised to the nurse-led remote prevention programme showed a significant reduction of the MACE, improved lifestyle, and medication adherence at 12 months compared to the usual follow-up group.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study illustrates the feasibility and efficacy of a remote secondary cardiovascular prevention programme led by advanced practice nurses in patients who have suffered an Acute Coronary Syndrome.

REPORTING METHOD

CONSORT.

PATIENT OR PUBLIC CONTRIBUTION

None.

TRIAL REGISTRATION

The study was prospectively registered at www.

CLINICALTRIALS

gov: NCT03234023.

EFINUTRILES Study: Integrative Extra Virgin Olive Oil and Multimodal Lifestyle Interventions for Cardiovascular Health and SLE Management

OBJECTIVES

To analyze the effects of the combination of Extra Virgin Olive Oil (EVOO) supplementation and a health-related lifestyle intervention on disease activity and cardiovascular disease risk factors in Systemic Lupus Erythematosus (SLE).

METHODS

A total of 38 women with SLE were randomly assigned to EVOO (n = 9) and EVOO combined with multicomponent health promotion and physical exercise program (EVOO + HRLI) (n = 15) or control (CG) (n = 14) groups for 24 weeks. Baseline and post-intervention assessments were performed, collecting data on disease activity, accrual damage, blood biochemical parameters, arterial stiffness parameters, Framingham risk score, anthropometric and body composition measurements, and cardiovascular risk factors.

RESULTS

No changes in disease activity were observed in any group after the intervention. For cardiovascular risk, significant differences were observed in the intervention groups for systolic and mean blood pressure, with greater reductions in the EVOO + HRLI (p = 0.036 vs. p < 0.001; p = 0.017 vs. p < 0.001, respectively). The EVOO group showed significant reductions in BFM and BFP (p = 0.042, p = 0.022, respectively). The EVOO+ HRLI group also showed significant reductions in triglycerides (p < 0.001), Aix brachial (p = 0.037), central systolic blood pressure (p < 0.001), central pulse pressure (p = 0.05), body mass index (p = 0.006), body fat mass and skeletal muscle mass (p = 0.039) after the intervention.

CONCLUSIONS

Our findings suggest that a multidisciplinary program integrating nutritional interventions, health education, and the promotion of regular physical activity in SLE patients has the potential to significantly improve cardiovascular risk factors and body composition parameters. Thus, integrating this approach into clinical practice alongside usual pharmacological treatments would be beneficial for SLE patients.

CLINICAL TRIAL REGISTRATION

NCT05261529.

Association Between Anthropometric Measurements and Mediterranean Lifestyle in Women Diagnosed with Hashimoto's Thyroiditis: Data from the Mediterranean Region

BACKGROUND/OBJECTIVES

Hashimoto's thyroiditis (HT) is the most common autoimmune disease which lowers a patient's quality of life. Our study aimed to assess the association between Mediterranean lifestyle and anthropometric measurements in patients with HT.

METHODS

This study was conducted with 120 female patients previously diagnosed with HT. The 'Mediterranean Diet Adherence Screener-(MEDAS)' and 'MEDiterranean LIFEstyle-(MEDLIFE)' scales were used to assess diet quality and lifestyle. Also, some anthropometric measurements were collected. Spearman's Correlation Test was used to determine correlations between two quantitative variables.

RESULTS

The average age of the participants was 37.49 ± 7.47 years. The average diet quality scores were 7.80 ± 1.93 for MEDAS and the total life quality score was 16.41 ± 3.74 for MEDLIFE. Significant negative correlations were observed between the MEDLIFE total score and hip and waist circumferences, body weight, and body fat (%) (p < 0.05), as well as with the score of physical activity, rest, social habits, and conviviality (p < 0.05). Furthermore, an increase the Mediterranean dietary habits score was associated with a decrease in these measurements (p < 0.05).

CONCLUSIONS

The MEDLIFE score, beyond only the Mediterranean dietary habits sub-score, was found to be associated with lower anthropometric measurements in patients with HT, who are at higher risk of pre-obesity and obesity.

A Narrative Review of Intermittent Fasting With Exercise

Intermittent fasting is a dietary pattern that encompasses the 5:2 diet, alternate-day fasting, and time-restricted eating. All 3 involve alternating periods of fasting and ad libitum eating. Like other dietary strategies, intermittent fasting typically induces loss of both fat mass and lean mass. Exercise may thus be a useful adjuvant to promote lean mass retention while adding cardiometabolic, cognitive, mental, and emotional health improvements. In this narrative review, we summarize current evidence regarding the combination of intermittent fasting and exercise and its influence on body weight, body composition, cardiometabolic risk, and muscular and cardiorespiratory fitness. A PubMed search was conducted to identify all trials lasting >4 weeks that combined 5:2 diet, alternate-day fasting, or time-restricted eating with any modality exercise and had body weight as an end point. A total of 23 trials (26 publications) were identified. Evidence suggests that combining intermittent fasting with exercise leads to decreased fat mass regardless of weight status. However, evidence is equivocal for the influence on other aspects of weight loss and body composition, fat-free mass, and cardiometabolic risk factors and may be dependent on weight status or exercise doses (ie, frequency, intensity, duration, and modality). Higher-powered trials are needed to determine the efficacy of combining exercise and intermittent fasting for benefits on body weight and cardiometabolic risk. Current evidence suggests that intermittent fasting does not impair adaptation to exercise training, and may improve explosive strength, endurance, and cardiopulmonary measures such as maximal oxygen consumption. In addition, we discuss limitations in the current evidence base and opportunities for continued investigation. Future trials in this area should consider interventions that have increased sample size, longer intervention duration, broadened inclusion criteria, objective measures of diet and exercise adherence, and diversity of sample population.

Effects of an intervention with EVOO and physical exercise in systemic lupus erythematosus patients: Efinutriles trial protocol

BACKGROUND

Health-related lifestyle management could improve related symptoms and adverse events in patients with systemic lupus erythematosus (SLE). The phenolic compounds in extra virgin olive oil (EVOO) and physical exercise (PE) have both shown benefits for autoimmune conditions, but no intervention has synergised the two approaches.

AIM

To analyse the effects of an intervention combining EVOO and a multicomponent health promotion and PE programme on disease activity, clinical characteristics, cardiovascular risk, physical fitness, and the molecular level in SLE sufferers.

METHODS

Three-arm prospective randomised controlled 24-week clinical trial. 90 participants will be randomised into one of three groups: control; EVOO supplements; or EVOO and multicomponent health promotion and PE programme.

RESULTS

Pre-, mid- and post-intervention assessments will record disease activity, clinical characteristics, nutritional evaluation, cardiovascular risk assessment, physical condition and functioning, and molecular markers.

CONCLUSIONS

The proposed trial will help clarify whether a combined intervention adding an EVOO supplement to a Mediterranean Diet intake pattern and adherence to an active-healthy lifestyle are beneficial for SLE patients, as well as the need for health and pharmacological care, increasing knowledge of the organic mechanisms mediated by EVOO and PE adherence, allowing new useful biomarkers to be characterised at the diagnostic/prognostic level.

Gut Microbiota Interacts with Dietary Habits in Screenings for Early Detection of Colorectal Cancer

BACKGROUND/OBJECTIVES

Gut microbiota interacts with nutrients, which may be relevant to assigning a microbial signature to colorectal cancer (CRC). We aim to evaluate the potential of gut microbiota combined with dietary habits in the early detection of pathological findings related to CRC in the course of a screening program.

METHODOLOGY

The colonoscopy performed on 152 subjects positive for fecal occult blood test showed that 6 subjects had adenocarcinoma, 123 had polyps, and 23 subjects had no pathological findings. Gut microbiota was analyzed by 16S metagenomic. Caret package was used to build the classification models in R.

RESULTS

Random forest (RF) classifier models were used to test the potential of gut microbiota alone or combined with dietary habits as a biomarker to discern between individuals with CRC-related lesions (polyps or adenocarcinoma) versus individuals without pathological findings. RF classifier models yielded an area under the curve of 0.790 using gut microbiota data, 0.710 using dietary habits data, and 0.804 in the combined model including gut microbiota and dietary habits data. The abundance of Suterella, Oscillospirales, Proteobacteria, and Burkholderiales was highly discriminant between groups, together with the consumption of fruit and vegetables and the consumption of carbonated and/or sweetened beverages.

CONCLUSIONS

Our results suggest that the interaction between gut microbiota and dietary habits is relevant when a microbial signature is used as a marker in CRC. Moreover, gut microbiota signature and information about the dietary habits of the individuals seem to be important for improving screening programs for the early detection of CRC.

Endoscopic Sleeve Gastroplasty Plus Lifestyle Intervention in Patients With Metabolic Dysfunction-associated Steatohepatitis: A Multicentre, Sham-controlled, Randomized Trial

BACKGROUND & AIMS

Metabolic dysfunction-associated steatohepatitis (MASH) is commonly seen in biopsy-proven steatotic liver disease. Lifestyle intervention reaching a weight loss higher than 10% promotes MASH resolution, but this goal is only achieved by a small number of patients. Endoscopic sleeve gastroplasty (ESG) has recently emerged as a safe and effective option to promote weight loss in the obese population. We report the results of a multicenter, randomized, controlled, and double-blind study to evaluate the effectiveness and safety of ESG in patients with MASH.

METHODS

Forty patients were randomized 1:1 to ESG plus lifestyle modification vs sham endoscopy (SE) plus lifestyle intervention. Inclusion criteria included biopsy-proven MASH with nonalcoholic fatty liver disease activity score (NAS) ≥3 and fibrosis stage F0 to F3. Eighteen patients from the ESG group and 19 from the endoscopic simulated intervention (ESI) group completed follow-up over 72 weeks. Baseline to end of follow-up changes in body weight, liver tests, liver stiffness (vibration-controlled transient elastography), and liver histology were recorded RESULTS: Total body weight loss (TBWL) was 9.47% (±9.38%) in the ESG group vs 3.91% (±5.43%) in the ESI group (P < .05). Liver stiffness decreased 5.63 (±7.17) KPa in the ESG group vs 0.2 (±5.38) KPa in the ESI group (P < .05). Steatosis was significantly reduced in the ESG group (-0.94 ± 0.87) vs the ESI group (-0.26 ± 0.99) (P = .033). No differences on NAS (-1.89 ± 2.11 vs -1.47 ± 2.01) score or fibrosis (-0.1 ± 0.91 vs -0.84 ± 1.21) was seen. In patients achieving weight loss >10%, we found a significant improvement on NAS score (-4 ± 0.94 vs -0.81 ± 1.62; P < .01), but not in fibrosis stage (-0.3 ± 1.06 vs -0.59 ± 1.25). Only 2 patients from the ESG group had adverse events that required admission; these resolved conservatively in 72 hours.

CONCLUSION

ESG is an effective and safe method to promote weight reduction associated with significant improvement in patients with MASH and obesity.

CLINICALTRIALS

gov, Number: NCT03426111.

Characterisation of type 2 diabetes subgroups at diagnosis: the COPERNICAN prospective observational cohort study protocol

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a highly heterogeneous and complex metabolic disease harbouring different metabolic characteristics. Adequate characterisation of subjects is essential to allow the implementation of precision medicine for the prevention, diagnosis, prognosis and treatment of this condition.

METHODS AND ANALYSIS

This prospective observational cohort study aims to identify and characterise relevant clinical clusters that are reproducibly associated with various clinical outcomes in T2DM in our Mediterranean region. The COPERNICAN study will include 1200 subjects with newly diagnosed T2DM from 28 primary care centres from the city of Barcelona and the healthcare district of Lleida in Catalonia (Spain). Participants will undergo a comprehensive phenotypic evaluation including, among others, six relevant variables: age, antibodies against glutamic acid decarboxylase, body mass index, glycated haemoglobin (HbA1c), indexes of insulin sensibility (HOMA2-IR) and secretion (HOMA2-beta). We will collect additional comprehensive data on glucose-lowering and other drug treatments, clinical evaluation (including complications), laboratory parameters, advanced lipoprotein profile, dietary habits and physical activity. The linkage with the population database will be done to perform a pragmatic follow-up of participants as part of their usual clinical care. A state-of-the-art cluster analysis (k-means and hierarchical clustering) will be performed.

ETHICS AND DISSEMINATION

The present study complies with all the ethical aspects and protection of participant subjects complying with all current local and European Union legislation. All Ethics Committees from the institutions involved in the study (IR Sant Pau Ethics Committee, Ethics Committee for Drug Research at IDIAP Jordi Gol and University Hospital of Bellvitge Ethics Committee for Research) approved this protocol. Confidentiality and anonymity of the data are ensured according to the current Spanish Organic Law 3/2018 of 05 December.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov. registration number NCT05333718, 27 January 2023.

Impact of suspected preterm labour in foetal cardiovascular and metabolic programming: a prospective cohort study protocol

INTRODUCTION

Suspected preterm labour (SPL) is an obstetric complication that occurs in 9% of all pregnancies and is the leading cause of antenatal hospital admissions. More than half of women with SPL deliver a premature baby which is a known risk factor for developing cardiovascular and metabolic disorders in childhood and later in adult life. On the other hand, the other half of these women will deliver at term, labelled as 'false preterm labour'. Although this has been thought to be a benign condition, accumulating evidence reported in recent years showed long-term effects for the foetus, neonate and infant even when birth occurs at term. However, the impact of SPL on cardiovascular and metabolic programming has not been studied yet. The aim of this prospective cohort study is to evaluate the impact of SPL on cardiac remodelling and function and on cardiovascular and metabolic profiles independently of gestational age at birth.

METHODS AND ANALYSIS

Prospective cohort study of subjects exposed and not exposed to an episode of SPL. Women with singleton pregnancies who are admitted at a tertiary hospital due to SPL and matched controls will be recruited. Evaluation of cardiovascular remodelling by foetal echocardiography will be performed during admission. Cord blood will be collected at birth in order to analyse different metabolomic footprints and several cardiovascular and metabolic risk biomarkers. Moreover, children will undergo an echocardiography 6 months after birth. The relationship between SPL and cardiovascular and metabolic programming will be modelled considering different covariates such as socioeconomic factors, perinatal characteristics, lifestyle, diet and exercise.

ETHICS AND DISSEMINATION

Ethical approval was granted in April 2020 from CEIC Aragón (CEICA) (C.P.-C.I. PI20/136). Study outcomes will be disseminated at international conferences and published in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

NCT05670665.

Physical activity, sedentary behavior and microbiome: A systematic review and meta-analysis

BACKGROUND

The effects of physical activity and sedentary behavior on human health are well known, however, the molecular mechanisms are poorly understood. Growing evidence points to physical activity as an important modulator of the composition and function of microbial communities, while evidence of sedentary behavior is scarce. We aimed to synthesize and meta-analyze the current evidence about the effects of physical activity and sedentary behavior on microbiome across different body sites and in different populations.

METHODS

A systematic search in PubMed, Web of Science, Scopus and Cochrane databases was conducted until September 2022. Random-effects meta-analyses including cross-sectional studies (active vs. inactive/athletes vs. non-athletes) or trials reporting the chronic effect of physical activity interventions on gut microbiome alpha-diversity in healthy individuals were performed.

RESULTS

Ninety-one studies were included in this systematic review. Our meta-analyses of 2632 participants indicated no consistent effect of physical activity on microbial alpha-diversity, although there seems to be a trend toward a higher microbial richness in athletes compared to non-athletes. Most of studies reported an increase in short-chain fatty acid-producing bacteria such as Akkermansia, Faecalibacterium, Veillonella or Roseburia in active individuals and after physical activity interventions.

CONCLUSIONS

Physical activity levels were positively associated with the relative abundance of short-chain fatty acid-producing bacteria. Athletes seem to have a richer microbiome compared to non-athletes. However, high heterogeneity between studies avoids obtaining conclusive information on the role of physical activity in microbial composition. Future multi-omics studies would enhance our understanding of the molecular effects of physical activity and sedentary behavior on the microbiome.

Associations of nutritional status and dietary habits with the development of female infertility. A case-control study

Introduction

Female infertility is a multifactorial condition influenced by lifestyle and dietary factors. Understanding the relationship between nutritional status, dietary habits, and infertility could provide insights for targeted interventions.

Methods

A case-control study was conducted in health centers and hospitals in Alicante, Spain. The study included 60 infertile and 30 fertile women aged 18-40, selected through consecutive sampling. Data on body composition and dietary intake were collected and analyzed.

Results

Infertile women exhibited significantly lower muscle mass (p = 0.005) and larger hip circumference (p = 0.034) compared to fertile women. Additionally, a significant association was found between high red meat consumption and an increased risk of female infertility (p = 0.011).

Discussion

These results suggest that body composition and dietary habits, particularly muscle mass and red meat intake, play a key role in female fertility. Interventions aimed at improving muscle mass, reducing localized body fat, and limiting red meat consumption may enhance fertility outcomes. Further longitudinal research is needed to confirm these findings across diverse populations.

An app promoting weight gain prevention via healthy behaviours amongst young women with a family history of breast cancer: Acceptability and usability assessment

BACKGROUND

Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk.

METHODS

The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18-35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures.

RESULTS

Both recruitment methods were successful. Thirty-five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2-34.5) years, the majority (94.1%) were of White ethnicity. Thirty-four participants were included in the analyses, of which 94% downloaded the app. Median self-monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8-28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1-5). Eighty-nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period.

CONCLUSIONS

This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing.

Mediterranean Diet Prior to Ischemic Stroke and Potential Circulating Mediators of Favorable Outcomes

Background/Objectives. A Mediterranean diet (MD) has been associated with neuroprotective effects. We aimed to assess the MD's association with stroke prognosis and the potential mediators involved. Methods. Seventy patients with acute anterior circulation ischemic stroke were included. Dietary patterns were evaluated using the MEDAS scale, a food-frequency questionnaire, and a 24 h recall. Circulating biomarkers including insulin resistance (HOMA index), adipokines (resistin, adiponectin, leptin), choline pathway metabolites (TMAO, betaine, choline), and endothelial progenitor cells (EPCs) were measured. Early neurological improvement (ENI) at 24 h, final infarct volume, and functional outcome at 3 months were assessed. Results. Adherence to MD and olive oil consumption were associated with a lower prevalence of diabetes and atherothrombotic stroke, and with lower levels of fasting glycemia, hemoglobinA1C, insulin resistance, and TMAO levels. Monounsaturated fatty acids and oleic acid consumption correlated with lower resistin levels, while olive oil consumption was significantly associated with EPC mobilization. Multivariate analysis showed that higher MD adherence was independently associated with ENI and good functional prognosis at 3 months. EPC mobilization, lower HOMA levels, and lower resistin levels were associated with ENI, a smaller infarct volume, and good functional outcome. Conclusions. MD was associated with better prognosis after ischemic stroke, potentially mediated by lower insulin resistance, increased EPC mobilization, and lower resistin levels, among other factors.

Obesity-associated inflammation countered by a Mediterranean diet: the role of gut-derived metabolites

The prevalence of obesity has increased dramatically worldwide and has become a critical public health priority. Obesity is associated with many co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. Although the physiology of obesity is complex, a healthy diet and sufficient exercise are two elements known to be critical to combating this condition. Years of research on the Mediterranean diet, which is high in fresh fruits and vegetables, nuts, fish, and olive oil, have demonstrated a reduction in numerous non-communicable chronic diseases associated with this diet. There is strong evidence to support an anti-inflammatory effect of the diet, and inflammation is a key driver of obesity. Changes in diet alter the gut microbiota which are intricately intertwined with human physiology, as gut microbiota-derived metabolites play a key role in biological pathways throughout the body. This review will summarize recent published studies that examine the potential role of gut metabolites, including short-chain fatty acids, bile acids, trimethylamine-N-oxide, and lipopolysaccharide, in modulating inflammation after consumption of a Mediterranean-like diet. These metabolites modulate pathways of inflammation through the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, toll-like receptor 4 signaling, and macrophage driven effects in adipocytes, among other mechanisms.

Development and psychometric testing of the nutritional and social health habits scale (NutSo-HH): A methodological review of existing tools

Habits represent repeated patterns of behavior over time that exert a significant influence on individual health. While specific tools exist to measure individual habits, the number of instruments capable of simultaneously exploring multiple dimensions of health is limited. This research had two main objectives: 1) to examine the literature to find existing tools for evaluating health habits, especially in the Spanish population; 2) through a methodological review, to develop and validate a tool capable of measuring multiple dimensions of health habits. The Nutritional and Social Health Habits Scale (NutSo-HH) was conceived, tested, and refined through pilot testing with cognitive interviews and expert content validation. Construct validity was explored through confirmatory factor analysis and known-group validity, while criterion validity was verified in comparison with the ``Healthy Nutrition Index for the Spanish Population.'' Reliability was assessed using omega coefficients. Confirmatory factor analysis yielded satisfactory fit indices. The final model included two second-order factors (nutritional habits and health habits) and two first-order factors (Mediterranean diet and alcohol consumption). Omega coefficients ranged from 0.521 to 0.815. The NutSo-HH Scale emerges as a valid and reliable tool to assess nutritional and social habits among Spanish young adults. This novel instrument fills a gap in the field, allowing exploration of various health determinants through a single scale and providing support for decision-making in the realm of public health nutrition.

Telomere length as biomarker of nutritional therapy for prevention of type 2 diabetes mellitus development in patients with coronary heart disease: CORDIOPREV randomised controlled trial

BACKGROUND

Telomere Length (TL), a marker of cellular aging, holds promise as a biomarker to elucidate the molecular mechanism of diabetes. This study aimed to investigate whether shorter telomeres are associated with a higher risk of type 2 diabetes mellitus (T2DM) incidence in patients with coronary heart disease; and to determine whether the most suitable dietary patterns, particularly a Mediterranean diet or a low-fat diet, can mitigate the development of diabetes in these patients after a follow-up period of five years.

METHODS

The CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study) was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive two healthy diets. Clinical investigators were masked to treatment assignment; participants were not. Quantitative-PCR was used to assess TL measurements.

FINDINGS

1002 patients (59.5 ± 8.7 years and 82.5% men) were enrolled into Mediterranean diet (n = 502) or a low-fat diet (n = 500) groups. In this analysis, we included all 462 patients who did not have T2DM at baseline. Among them, 107 patients developed T2DM after a median of 60 months. Cox regression analyses showed that patients at risk of short telomeres (TL < percentile 20th) are more likely to experience T2DM than those at no risk of short telomeres (HR 1.65, p-value 0.023). In terms of diet, patients at high risk of short telomeres had a higher risk of T2DM incidence after consuming a low-fat diet compared to patients at no risk of short telomeres (HR 2.43, 95CI% 1.26 to 4.69, p-value 0.008), while no differences were observed in the Mediterranean diet group.

CONCLUSION

Patients with shorter TL presented a higher risk of developing T2DM. This association could be mitigated with a specific dietary pattern, in our case a Mediterranean diet, to prevent T2DM in patients with coronary heart disease.

TRIAL REGISTRATION

Clinicaltrials.gov number NCT00924937.

Association of five diet scores with severe NAFLD incidence: A prospective study from UK Biobank

AIM

This study aimed to contrast the associations of five common diet scores with severe non-alcoholic fatty liver disease (NAFLD) incidence.

MATERIALS AND METHODS

In total, 162 999 UK Biobank participants were included in this prospective population-based study. Five international diet scores were included: the 14-Item Mediterranean Diet Adherence Screener (MEDAS-14), the Recommended Food Score (RFS), the Healthy Diet Indicator (HDI), the Mediterranean Diet Score and the Mediterranean-DASH Intervention for Neurodegenerative Delay score. As each score has different measurements and scales, all scores were standardized and categorized into quartiles. Cox proportional hazard models adjusted for confounder factors investigated associations between the standardized quartiles and severe NAFLD incidence.

RESULTS

Over a median follow-up of 10.2 years, 1370 participants were diagnosed with severe NAFLD. When the analyses were fully adjusted, participants in quartile 4 using the MEDAS-14 and RFS scores, as well as those in quartiles 2 and 3 using the HDI score, had a significantly lower risk of severe incident NAFLD compared with those in quartile 1. The lowest risk was observed in quartile 4 for the MEDAS-14 score [hazard ratio (HR): 0.76 (95% confidence interval (CI): 0.62-0.94)] and the RFS score [HR: 0.82 (95% CI: 0.69-0.96)] and as well as in quartile 2 in the HDI score [HR: 0.80 (95% CI: 0.70-0.91)].

CONCLUSION

MEDAS-14, RFS and HDI scores were the strongest diet score predictors of severe NAFLD. A healthy diet might protect against NAFLD development irrespective of the specific approach used to assess diet. However, following these score recommendations could represent optimal dietary approaches to mitigate NAFLD risk.

Protocol of the MOVI-ageing randomized controlled trial: a home-based e-Health intervention of cognitively demanding exercise for the improvement of cardiorespiratory fitness and cognitive function in older individuals

Objective

To describe the protocol of the MOVI-ageing randomized controlled trial, a home-based eHealth intervention of cognitive-demanding exercise for older adults, in improving global cognitive function and basic cognitive functions, cardiorespiratory fitness, and muscle fitness.

Methods

This randomized controlled trial will include participants identified in the social centers of Cuenca and Talavera de la Reina who agree to participate and provide informed consent. Adults aged 60-80 years of both genders retired regardless of the reason for retirement, who do not meet frailty criteria according to Fried criteria, and without cognitive impairment will be invited to participate. This study will be developed in two phases: (i) a 12-week randomized efficacy/feasibility trial and (ii) a large-scale implementation randomized trial phase with a 12-week follow-up following similar procedures. In addition, a qualitative study on barriers to and facilitators of the implementation of the physical exercise intervention using eHealth for older people will be conducted. Participants will have access to a platform including videos of cognitively demanding physical exercise. The participants will be remotely and off-line guided through the physical exercise intervention, and the research team will be able to check the degree of compliance with the program and its correct execution. The participants will receive feedback on their compliance with the routines and reinforcement messages.

Implications

The implementations of the findings and their inclusion in guidelines may directly impact in older people's life, and relatives, through the prevention of morbidity and the reduction of years lost to disability. These benefits may be reflected in the reduction of economic expenditure by reducing the demand for social and health care services.

Ethics

The Clinical Research Ethics Committee of the 'Virgen de la Luz' Hospital in Cuenca approved the study protocol (registration number: 2022/PI3222). In addition, this protocol was previously registered in Clinicaltrials.gov (Number: NCT05928078).

Non-targeted LC-MS/MS metabolomic profiling of human plasma uncovers a novel Mediterranean diet biomarker panel

INTRODUCTION

Consumption of a Mediterranean diet (MD) has established health benefits, and the identification of novel biomarkers could enable objective monitoring of dietary pattern adherence.

OBJECTIVES

The present investigation performed untargeted metabolomics on blood plasma from a controlled study of MD adherence, to identify novel blood-based metabolite biomarkers associated with the MD pattern, and to build a logistic regression model that could be used to characterise MD adherence.

METHODS

A hundred and thirty-five plasma samples from n = 58 patients collected at different time points were available. Using a 14-point scale MD Score (MDS) subjects were divided into 'high' or 'low' MDS adherence groups and liquid chromatography-mass spectrometry (LC-MS/MS) was applied for analysis.

RESULTS

The strongest association with MDS was pectenotoxin 2 seco acid (r = 0.53; ROC = 0.78), a non-toxic marine xenobiotic metabolite. Several lipids were useful biomarkers including eicosapentaenoic acid, the structurally related lysophospholipid (20:5(5Z,8Z,11Z,14Z,17Z)/0:0), a phosphatidylcholine (P-18:1(9Z)/16:0) and also xi-8-hydroxyhexadecanedioic acid. Two metabolites negatively correlated with MDS, these were the monoacylglycerides (0:0/16:1(9Z)/0:0) and (0:0/20:3(5Z,8Z,11Z)/0:0). By stepwise elimination we selected a panel of 3 highly discriminatory metabolites and developed a linear regression model which identified 'high MDS' individuals with high sensitivity and specificity [AUC (95% CI) 0.83 (0.76-0.97)].

CONCLUSION

Our study highlights the utility of metabolomics as an approach for developing novel panels of dietary biomarkers. Quantitative profiling of these metabolites is required to validate their utility for evaluating dietary adherence.

The Cantabria Cohort, a protocol for a population-based cohort in northern Spain

Cantabria Cohort stems from a research and action initiative lead by researchers from Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital and University of Cantabria, supported by the regional Goverment. Its aim is to identify and follow up a cohort that would provide information to improve the understanding of the etiology and prognosis of different acute and chronic diseases. The Cantabria Cohort will recruit between 40,000-50,000 residents aged 40-69 years at baseline, representing 10-20% of the target population. Currently, more than 30,000 volunteers have been enrolled. All participants will be invited for a re-assessment every three years, while the overall duration is planned for twenty years. The repeated collection of biomaterials combined with broad information from participant questionnaires, medical examinations, actual health system records and other secondary public data sources is a major strength of its design, which will make it possible to address biological pathways of disease development, identify new factors involved in health and disease, design new strategies for disease prevention, and advance precision medicine. It is conceived to allow access to a large number of researchers worldwide to boost collaboration and medical research.

Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder

Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.

Greater adherence to a mediterranean diet is associated with lower C-reactive protein (CRP) levels, but not to lower odds of having dry eye disease

PURPOSE

To investigate the hypothesis that a Mediterranean diet is associated with a lower risk of having dry eye disease (DED) in the general population.

METHODS

DED was assessed using the Women's Health Study (WHS) dry eye questionnaire in 58,993 participants from the Dutch Lifelines Cohort with complete available dietary data (20-94 years, 60% female). Level of adherence to a traditional Mediterranean diet was assessed using the modified Mediterranean Diet Score (mMDS). High-sensitivity C-reactive Protein (hsCRP) was included as a marker of whole-body inflammation. Logistic regressions were used to examine the relationship between WHS-defined DED and mMDS, corrected for age, sex, BMI, education, income, and 48 potentially confounding comorbidities. The association between mMDS and hsCRP, and hsCRP and DED, was further explored in separate regressions.

RESULTS

Of all participants, 9.1% had DED. In contrast to the hypothesis, higher mMDS levels were associated with greater odds of DED, corrected for demographics, smoking status, BMI, and comorbidities (OR 1.034, 95%CI: 1.015 to 1.055, P = 0.001). Moreover, there was a highly significant relationship between increasing mMDS and lower circulating hsCRP levels; however, there was no significant relationship between hsCRP and DED.

CONCLUSIONS

Stronger adherence to a Mediterranean diet does not appear to be associated with lower odds of having DED in the general population. Furthermore, there was no association between hsCRP and DED in this study. However, the previously described link between a Mediterranean diet and lower hsCRP was confirmed in this large population-based study.

Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial

BACKGROUND

Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population.

OBJECTIVES

This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to 'behavioral support' or 'control condition'.

METHODS

Dyadic couples comprise individuals with SCI (18-65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18-65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden.

DISCUSSION/CONCLUSIONS

This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016.

Cross-Cultural Adaptation of Mediterranean Diet Adherence Screener (MEDAS) Into Moroccan Arabic to Measure the Degree of Mediterranean Diet Adherence

Background The Mediterranean diet (MD) has been recognized by several studies as beneficial for health improvement. The degree of adherence to this diet has also been evaluated using several scales, particularly time-consuming measures such as the Food Frequency Questionnaire (FFQ). This study aims to (a) adapt into Moroccan Arabic the 14-item Mediterranean Diet Adherence Screener (MEDAS), which is a simple and brief tool that assesses the degree of diet adherence and was used in the Prevencion con Dieta Mediterranea (PREDIMED) study, and (b) determine its psychometric properties. Methods MEDAS consists of 12 questions on food frequency and two on dietary habits, with each question scoring 0 or 1. To translate and adapt the scale, Beaton et al.'s six-step cross-cultural adaptation process guidelines were followed. The screener's psychometric properties were tested on staff at the CHU Mohammed VI (Tangier), i.e., the hospital's administrative and maintenance staff, excluding medical and paramedical personnel. Internal consistency was evaluated using the Kuder-Richardson 21 (K-R 21) formula, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Moreover, criterion validity was performed using the Spearman correlation between the MEDAS and the MedQ-Sus scores. Discrimination performance was also tested using the receiving operating characteristic (ROC) curve. Results The validation study included 160 participants who completed both questionnaires. The K-R 21 formula estimated strong internal consistency in the range of 0.851. The ICC of test-retest reliability was significant at 0.876 95% CI [0.831-0.909]. The MEDAS score correlated significantly with the comparative MedQ-Sus score (Spearman's rho = 0.494 95% CI [0.363-0.606], p < 0.001). Also, MEDAS can strongly distinguish between MD adherence and non-adherence (optimal cut-off = 7.5, sensitivity 0.81, specificity = 0.57), with an area under the curve (AUC) value of 0.743 95% CI [0.667-0.819], p < 0.001. Conclusion The results showed that MEDAS is a valid and time-saving instrument for assessing adherence to the MD in the Moroccan population.

Plasma lipidic fingerprint associated with type 2 diabetes in patients with coronary heart disease: CORDIOPREV study

OBJECTIVE

We aimed to identify a lipidic profile associated with type 2 diabetes mellitus (T2DM) development in coronary heart disease (CHD) patients, to provide a new, highly sensitive model which could be used in clinical practice to identify patients at T2DM risk.

METHODS

This study considered the 462 patients of the CORDIOPREV study (CHD patients) who were not diabetic at the beginning of the intervention. In total, 107 of them developed T2DM after a median follow-up of 60 months. They were diagnosed using the American Diabetes Association criteria. A novel lipidomic methodology employing liquid chromatography (LC) separation followed by HESI, and detection by mass spectrometry (MS) was used to annotate the lipids at the isomer level. The patients were then classified into a Training and a Validation Set (60-40). Next, a Random Survival Forest (RSF) was carried out to detect the lipidic isomers with the lowest prediction error, these lipids were then used to build a Lipidomic Risk (LR) score which was evaluated through a Cox. Finally, a production model combining the clinical variables of interest, and the lipidic species was carried out.

RESULTS

LC-tandem MS annotated 440 lipid species. From those, the RSF identified 15 lipid species with the lowest prediction error. These lipids were combined in an LR score which showed association with the development of T2DM. The LR hazard ratio per unit standard deviation was 2.87 and 1.43, in the Training and Validation Set respectively. Likewise, patients with higher LR Score values had lower insulin sensitivity (P = 0.006) and higher liver insulin resistance (P = 0.005). The receiver operating characteristic (ROC) curve obtained by combining clinical variables and the selected lipidic isomers using a generalised lineal model had an area under the curve (AUC) of 81.3%.

CONCLUSION

Our study showed the potential of comprehensive lipidomic analysis in identifying patients at risk of developing T2DM. In addition, the lipid species combined with clinical variables provided a new, highly sensitive model which can be used in clinical practice to identify patients at T2DM risk. Moreover, these results also indicate that we need to look closely at isomers to understand the role of this specific compound in T2DM development. Trials registration NCT00924937.

Cardiovascular Remodeling Post-Ischemia: Herbs, Diet, and Drug Interventions

Cardiovascular disease (CVD) is a serious health burden with increasing prevalence, and CVD continues to be the principal global source of illness and mortality. For several disorders, including CVD, the use of dietary and medicinal herbs instead of pharmaceutical drugs continues to be an alternate therapy strategy. Despite the prevalent use of synthetic pharmaceutical medications, there is currently an unprecedented push for the use of diet and herbal preparations in contemporary medical systems. This urge is fueled by a number of factors, the two most important being the common perception that they are safe and more cost-effective than modern pharmaceutical medicines. However, there is a lack of research focused on novel treatment targets that combine all these strategies-pharmaceuticals, diet, and herbs. In this review, we looked at the reported effects of pharmaceutical drugs and diet, as well as medicinal herbs, and propose a combination of these approaches to target independent pathways that could synergistically be efficacious in treating cardiovascular disease.

The Mediterranean Diet and Age-Related Eye Diseases: A Systematic Review

The Mediterranean diet (MD) is a healthy diet pattern that can prevent chronic age-related diseases, especially age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR) and dry eye syndrome (DES). In this study, we systematically reviewed studies in the literature that had reported associations between adherence to the MD and the five above-mentioned AREDs. Randomized controlled trials as well as prospective and retrospective observational studies were included; 1164 studies were identified, of which 1, 2, 9, 2 and 4 studies met our eligibility criteria for cataract, glaucoma, AMD, DR, and DES, respectively. According to these studies, higher MD adherence was associated with reduced risks of incident DR, incident AMD and progression to late AMD, but whether early and neovascular AMD could be alleviated remained to be debated. The results regarding the effects of the MD on DES were mixed, with three studies reporting an associations between MD and decreased severity or incidence of DES, whereas one study reported the opposite. No significant associations were observed between the MD and cataract or glaucoma. Generally, convincing evidence suggested a protective effect of the MD against AMD and DR. However, the evidence for cataract, glaucoma, and DES was less conclusive, and high-quality studies are needed for comprehensive evaluations of the potential benefits of MD on these eye diseases.

Adherence to Mediterranean Diet: A Population-Based Longitudinal Cohort Study

Adherence to the Mediterranean diet (MedDiet) is recommended for cardiovascular disease prevention. However, recent epidemiological studies report a shift toward lower adherence to MedDiet. We have conducted a prospective cohort study to evaluate changes in individual determinants of MedDiet adherence over time. Clinical information and MedDiet adherence score (MEDAS) were collected in 711 subjects (mean age 68 ± 10 years; 42% males), enrolled in the PLIC study (Progression of Intimal Atherosclerotic Lesions in Carotid arteries), during two visits conducted, on average, 4.5 years apart. MEDAS score worsening and improvements (absolute change, ΔMEDAS) and the variation in the proportion of subjects reporting to meet each MEDAS criteria were assessed. Overall, 34% of the subjects improved their MedDiet adherence (ΔMEDAS: +1.87 ± 1.13), by consuming more olive oil, legumes and fish and use of dishes seasoned with sofrito and 48% subjects worsened their MedDiet adherence (ΔMEDAS: -2.02 ± 1.14) by consuming less fruit, legumes, fish and nuts, with higher rates of worsening in women and subjects aged 50-65 years. Subjects who improved the score were more obese, had higher plasma glucose levels, and metabolic syndrome at the basal visit. In summary, we report an overall decrease in MedDiet adherence, evaluated during a timeframe heavily affected by the COVID-19 pandemic, underlining the need for better dietary interventions.

Critical evaluation of the questionnaires assessing adherence to the Mediterranean diet that are based on servings

BACKGROUND AND AIMS

The Mediterranean Diet (MD) is characterized by a high intake of vegetables, fruit, legumes, nuts, and olive oil, and moderate fish, dairy, and wine intake. A high adherence to MD has been associated with numerous health benefits, including reduced risk of chronic diseases such as cardiovascular disease, cancer, and type 2 diabetes. The clinical assessment of MD adherence is complicated by the absence of a univocally accepted tool and by the abundance of questionnaires developed to determine adherence, whose reliability and validity is uncertain. In this inter-associative document, we critically evaluated servings-based questionnaires for the assessment of MD adherence, aiming to identify the most valuable tool for the use in clinical practice.

METHODS AND RESULTS

For each questionnaire, we analyzed the structure, evidence on health-related outcomes and agreement with the recommendations of MD. We found that most questionnaires do not accurately reflect the principles of MD in terms of the food groups and their optimal consumption frequency. Additionally, the comparison of questionnaires revealed low agreement and some concerns with regard to the scoring assumptions.

CONCLUSIONS

Among the available questionnaires, we suggest the use of the 15-Items Pyramid based Mediterranean Diet Score (PyrMDS), which is the one with fewer flaws and a strong supporting body of theoretical and scientific evidence. The use of the PyrMDS may facilitate the assessment of MD adherence in clinical practice, which is instrumental in reducing the risk of non-communicable chronic diseases.

The association of dietary and nutrient patterns on neurocognitive decline: A systematic review of MRI and PET studies

BACKGROUND

As the global population ages, there has been a growing incidence of neurodegenerative diseases such as Alzheimer's. More recently, studies exploring the relationship between dietary patterns and neuroimaging outcomes have received particular attention. This systematic literature review provides a structured overview of the association between dietary and nutrient patterns on neuroimaging outcomes and cognitive markers in middle-aged to older adults. A comprehensive literature search was conducted to find relevant articles published from 1999 to date using the following databases Ovid MEDLINE, Embase, PubMed, Scopus and Web of Science. The inclusion criteria for the articles comprised studies reporting on the association between dietary patterns and neuroimaging outcomes, which includes both specific pathological hallmarks of neurodegenerative diseases such as Aβ and tau and nonspecific markers such as structural MRI and glucose metabolism. The risk of bias was evaluated using the Quality Assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The results were then organized into a summary of results table, collated based on synthesis without meta-analysis. After conducting the search, 6050 records were extracted and screened for eligibility, with 107 eligible for full-text screening and 42 articles ultimately being included in this review. The results of the systematic review indicate that there is some evidence suggesting that healthy dietary and nutrient patterns were associated with neuroimaging measures, indicative of a protective influence on neurodegeneration and brain ageing. Conversely, unhealthy dietary and nutrient patterns showed evidence pointing to decreased brain volumes, poorer cognition and increased Aβ deposition. Future research should focus on sensitive neuroimaging acquisition and analysis methods, to study early neurodegenerative changes and identify critical periods for interventions and prevention.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no, CRD42020194444).

Assessing the Mediterranean diet adherence during pregnancy: Practical considerations based on the associations with cardiometabolic risk

OBJECTIVE

The aim of the present study was to provide practical considerations for assessing MD adherence during pregnancy based on the association with cardiometabolic risk.

STUDY DESIGN

Longitudinal study.

MAIN OUTCOME MEASURES

A food frequency questionnaire was fulfilled by 152 pregnant women at the 16th gestational week (g.w.). We calculated the Mediterranean Food Pattern (MFP), the MD Scale (MDScale), the Short MD questionnaire (SMDQ), the MD Score (MedDietScore), and the MD scale for pregnant women (MDS-P). The cardiometabolic risk score consisted of pre-pregnancy body mass index, blood pressure, glucose, triglycerides, and high-density lipoprotein-cholesterol (at 16th and 34th g.w.).

RESULTS

Multiple linear regression models showed that the MFP, the MedDietScore, and the SMDQ were associated with lower cardiometabolic risk at the 16th and 34th g.w. (β's: -0.193 to -0.415, all p < 0.05); and the MDS-P at the 34th g.w. (β = -0.349, p < 0.01). A comparison of these models with the J test showed that the MFP and the MedDietScore outperformed the SMDQ at the 16th g.w. (p's < 0.05); while the MedDietScore outperformed the SMDQ, MFP, and MDS-P (p's < 0.05) at the 34th g.w. Receiver-Operating-Characteristic-derived thresholds for the MFP, MedDietScore and MDS-P indices were 21, 30, and 6 points, respectively, to identify women with high cardiometabolic risk.

CONCLUSION

The MFP and MedDietScore are recommended to assess MD adherence during pregnancy, as these showed the strongest associations with cardiometabolic risk. Our validated thresholds might assist in the detection of poor dietary patterns during pregnancy.

Randomised controlled trial of breast cancer and multiple disease prevention weight loss programmes vs written advice amongst women attending a breast cancer family history clinic

BACKGROUND

Overweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including¹ cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice.

METHOD

210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months.

RESULTS

Weight loss at 12 months was -6.3% (-8.2, -4.5) in BCPP, -6.0% (-7.9, -4.2) in MDPP and -3.3% (-6.2, -0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups).

DISCUSSION

BCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted. Clinical Trial Registration ISRCTN16431108.

Lifestyle Intervention Randomized Controlled Trial for Age-Related Macular Degeneration (AMD-Life): Study Design

Age-related macular degeneration (AMD) has a strong genetic basis, but environmental factors such as smoking and a healthy diet can decrease the genetic fate by up to 50%. Current guidelines for clinical management include recommendations for a healthy lifestyle and antioxidant supplementation. However, many ophthalmologists do not inform their patients of this AMD-beneficial lifestyle. An important reason is the lack of trust that transition of lifestyle will be feasible in persons of advanced age and lack of methodology to measure lifestyle or its biological effects. To address these issues, we set up the lifestyle intervention study AMD-Life. It aims to investigate whether personalized risk-profiling (including genetic testing) and/or additional coaching can motivate patients to change their lifestyle. It also explores which biomarkers best reflect lifestyle change beneficial for AMD. The first year is a three-arm, self-contained open-label randomized clinical trial. A total of 150 AMD patients aged 55-85 years were randomized into three arms: (A) merely standard recommendations; (B) A conditions plus personalized risk profiling based on genetics and lifestyle, (C) B conditions plus coaching. The second year tests sustainability of lifestyle changes without active intervention. AMD-Life can provide further insight into the relevance of these interventions for the clinical management of AMD.

Mediterranean Diet, Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review

(1) Background: Compelling evidence shows that dietary patterns can slow the rate of cognitive decline, suggesting diet is a promising preventive measure against dementia. (2) Objective: This systematic review summarizes the evidence of three dietary patterns, the Mediterranean diet, the ketogenic diet and the MIND diet, for the prevention of cognitive decline. (3) Methods: A systematic search was conducted in major electronic databases (PubMed, ScienceDirect and Web of Science) up until 31 January 2022, using the key search terms "Mediterranean diet", "ketogenic diet", "MIND diet", "dementia", "cognition" and "aging". A statistical analysis was performed using RoB 2 and the Jadad scale to assess the risk of bias and methodological quality in randomized controlled trials. (4) Results: Only RCTs were included in this study; there were eleven studies (n = 2609 participants) of the Mediterranean diet, seven studies (n = 313) of the ketogenic diet and one study (n = 37) of the MIND diet. The participants' cognitive statuses were normal in seven studies, ten studies included patients with mild cognitive impairments and two studies included Alzheimer's disease patients. (5) Conclusion: All three dietary interventions have been shown to slow the rate of cognitive decline in the included studies. The Mediterranean diet was shown to be beneficial for global cognition after 10 weeks of adherence, the ketogenic diet had a beneficial effect for patients with diabetes mellitus and improved verbal recognition, while the MIND diet showed benefits in obese patients, improving working memory, verbal recognition, memory and attention.

Comparative efficacy of different eating patterns in the management of type 2 diabetes and prediabetes: An arm-based Bayesian network meta-analysis

AIMS/INTRODUCTION

Diet therapy is a vital approach to manage type 2 diabetes and prediabetes. However, the comparative efficacy of different eating patterns is not clear enough. We aimed to compare the efficacy of various eating patterns for glycemic control, anthropometrics, and serum lipid profiles in the management of type 2 diabetes and prediabetes.

MATERIALS AND METHODS

We conducted a network meta-analysis using arm-based Bayesian methods and random effect models, and drew the conclusions using the partially contextualized framework. We searched twelve databases and yielded 9,534 related references, where 107 studies were eligible, comprising 8,909 participants.

RESULTS

Eleven diets were evaluated for 14 outcomes. Caloric restriction was ranked as the best pattern for weight loss (SUCRA 86.8%) and waist circumference (82.2%), low-carbohydrate diets for body mass index (81.6%), and high-density lipoprotein (84.0%), and low-glycemic-index diets for total cholesterol (87.5%) and low-density lipoprotein (86.6%). Other interventions showed some superiorities, but were imprecise due to insufficient participants and needed further investigation. The attrition rates of interventions were similar. Meta-regression suggested that macronutrients, energy intake, and weight may modify outcomes differently. The evidence was of moderate-to-low quality, and 38.2% of the evidence items met the minimal clinically important differences.

CONCLUSIONS

The selection and development of dietary strategies for diabetic/prediabetic patients should depend on their holistic conditions, i.e., serum lipid profiles, glucometabolic patterns, weight, and blood pressure. It is recommended to identify the most critical and urgent metabolic indicator to control for one specific patient, and then choose the most appropriate eating pattern accordingly.

Metabolomics analysis of type 2 diabetes remission identifies 12 metabolites with predictive capacity: a CORDIOPREV clinical trial study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is one of the most widely spread diseases, affecting around 90% of the patients with diabetes. Metabolomics has proven useful in diabetes research discovering new biomarkers to assist in therapeutical studies and elucidating pathways of interest. However, this technique has not yet been applied to a cohort of patients that have remitted from T2DM.

METHODS

All patients with a newly diagnosed T2DM at baseline (n = 190) were included. An untargeted metabolomics approach was employed to identify metabolic differences between individuals who remitted (RE), and those who did not (non-RE) from T2DM, during a 5-year study of dietary intervention. The biostatistical pipeline consisted of an orthogonal projection on the latent structure discriminant analysis (O-PLS DA), a generalized linear model (GLM), a receiver operating characteristic (ROC), a DeLong test, a Cox regression, and pathway analyses.

RESULTS

The model identified a significant increase in 12 metabolites in the non-RE group compared to the RE group. Cox proportional hazard models, calculated using these 12 metabolites, showed that patients in the high-score tercile had significantly (p-value < 0.001) higher remission probabilities (Hazard Ratio, HR, high versus low = 2.70) than those in the lowest tercile. The predictive power of these metabolites was further studied using GLMs and ROCs. The area under the curve (AUC) of the clinical variables alone is 0.61, but this increases up to 0.72 if the 12 metabolites are considered. A DeLong test shows that this difference is statistically significant (p-value = 0.01).

CONCLUSIONS

Our study identified 12 endogenous metabolites with the potential to predict T2DM remission following a dietary intervention. These metabolites, combined with clinical variables, can be used to provide, in clinical practice, a more precise therapy.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT00924937.

Evaluation of Simplified Diet Scores Related to C-Reactive Protein in Heavy Smokers Undergoing Lung Cancer Screening

The aim of this study was to assess the relationship between adherence to a healthy diet, such as the Mediterranean diet (MedDiet), and C-reactive protein (CRP) in Italian heavy smokers undergoing an LDCT screening program (bioMILD trial), using scores calculated by simple questionnaires. Simple formats of food frequency questionnaires were administered to a sample of 2438 volunteers, and the adherence to a healthy diet was measured by the validated 14-point MEDAS and by two adaptations proposed by us: 17-item revised-MEDAS and 18-item revised-MEDAS. The OR of CRP ≥ 2 mg/L for 1-point increase in 14-point MEDAS score was 0.95 (95% CI 0.91–0.99), for 17-point score was 0.94 (95% CI 0.91–0.98), and for 18-point score was 0.92 (95% CI 0.88–0.97). These inverse associations remained statistically significant also after further adjustment for body mass index. These results showed the efficacy of simplified scores and their relationship with lower levels of CRP in a population of heavy smokers. This suggests that a targeted nutritional intervention might achieve a substantial reduction in CRP levels. The findings will be prospectively tested in a new randomized study on primary prevention during lung cancer screening.

Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial

BACKGROUND

Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease.

METHODS

The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death. This study is registered with ClinicalTrials.gov, NCT00924937.

FINDINGS

From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49·9%) in the low-fat diet group and 502 (50·1%) in the Mediterranean diet group. The mean age was 59·5 years (SD 8·7) and 827 (82·5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group (crude rate per 1000 person-years: 28·1 [95% CI 27·9-28·3] in the Mediterranean diet group vs 37·7 [37·5-37·9] in the low-fat group, log-rank p=0·039). Multivariable-adjusted hazard ratios (HRs) of the different models ranged from 0·719 (95% CI 0·541-0·957) to 0·753 (0·568-0·998) in favour of the Mediterranean diet. These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group (multiadjusted HR 0·669 [95% CI 0·489-0·915], log-rank p=0·013), than in 175 women for whom no difference was found between groups.

INTERPRETATION

In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.

FUNDING

Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union.

Adherence to the Mediterranean-Style Eating Pattern and Macular Degeneration: A Systematic Review of Observational Studies

Age-related macular degeneration (AMD) is a serious degenerative disease affecting the eyes, and is the main cause of severe vision loss among people >55 years of age in developed countries. Its onset and progression have been associated with several genetic and lifestyle factors, with diet appearing to play a pivotal role in the latter. In particular, dietary eating patterns rich in plant foods have been shown to lower the risk of developing the disease, and to decrease the odds of progressing to more advanced stages in individuals already burdened with early AMD. We systematically reviewed the literature to analyse the relationship between the adherence to a Mediterranean diet, a mainly plant-based dietary pattern, and the onset/progression of AMD. Eight human observational studies were analysed. Despite some differences, they consistently indicate that higher adherence to a Mediterranean eating pattern lowers the odds of developing AMD and decreases the risk of progression to more advanced stages of the disease, establishing the way for preventative measures emphasizing dietary patterns rich in plant-foods.

Mediterranean Diet: A Tool to Break the Relationship of Atrial Fibrillation with the Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease

Atrial fibrillation (AF) is the most common supraventricular arrhythmia associated with increased cardiovascular and non-cardiovascular morbidity and mortality. As multiple factors may predispose the onset of AF, the prevention of the occurrence, recurrence and complications of this arrhythmia is still challenging. In particular, a high prevalence of cardio-metabolic comorbidities such as the metabolic syndrome (MetS) and in its hepatic manifestation, the non-alcoholic fatty liver disease (NAFLD), have been described in the AF population. A common pathogenetic mechanism linking AF, MetS and NAFLD is represented by oxidative stress. For this reason, in the past decades, numerous studies have investigated the effect of different foods/nutrients with antioxidant properties for the prevention of, and their therapeutic role is still unclear. In this narrative comprehensive review, we will summarize current evidence on (1) the association between AF, MetS and NAFLD (2) the antioxidant role of Mediterranean Diet and its components for the prevention of AF and (3) the effects of Mediterranean Diet on MetS components and NAFLD.

High Compliance to Mediterranean Diet Associates with Lower Platelet Activation and Liver Collagen Deposition in Patients with Nonalcoholic Fatty Liver Disease

The Mediterranean diet (Med-Diet) is considered the most effective dietary patterns to obtain weight loss in NAFLD patients. Previous evidence suggested that Med-Diet adherence could reduce cardiovascular risk and have a beneficial effect on NAFLD severity. Aim of the study was to investigate the relationship between Med-Diet adherence, platelet activation (PA), and liver collagen deposition. The study was performed in 655 consecutive NAFLD outpatients from the PLINIO study, a prospective observational cohort study aimed to identify non-conventional predictors of liver fibrosis progression in NAFLD. PA was measured by the serum thromboxane B2 (TxB2), and liver collagen deposition by N-terminal propeptide of type III collagen (Pro-C3). Adherence to the Med-diet was investigated by a short nine-item validated dietary questionnaire. Patients with high Med-Diet adherence were older and had less metabolic syndrome and lower serum triglycerides, GGT, TxB2, and Pro-C3. At multivariate regression analyses, in the linear model, the Med-Diet score negatively correlated with both TxB2 (Beta = −0.106; p = 0.009) and Pro-C3 (Beta = −0.121; p = 0.002) and in the logistic model high adherence inversely correlated with higher TxB2 tertiles (II tertile: OR = 0.576, p = 0.044; III tertile: OR = 0.556, p = 0.026) and Pro-C3 tertile (III tertile: OR = 0.488, p = 0.013). Low consumption of red meat inversely correlated with higher TxB2 tertile (II tertile: OR = 0.448, p < 0.001, III tertile: OR = 0.567, p = 0.004). In conclusion, NAFLD patients with high adherence to the Med-Diet show lower PA and liver collagen deposition, suggesting a protective role of the Med-Diet against NAFLD progression and cardiovascular risk. In addition, the correlation between TxB2 and Pro-C3 suggests a link between NAFLD severity and cardiovascular risk.

Manchester Intermittent versus Daily Diet App Study (MIDDAS): A pilot randomized controlled trial in patients with type 2 diabetes

AIMS

To test the feasibility and potential efficacy of remotely supported intermittent low-energy diets (ILEDs) and continuous low-energy diets (CLEDs) in people with type 2 diabetes (T2D) and the feasibility of a randomized controlled trial comparing the two approaches.

MATERIALS AND METHODS

Seventy-nine adults with overweight/obesity and T2D (≤8 years duration) were randomized 1:1 to CLED (8 weeks/56 days of daily Optifast 820 kcal (3430 kJ) diet) or isoenergetic ILED (2 days of Optifast and 5 days of a Mediterranean diet/week for 28 weeks). Weight maintenance/continued weight loss was undertaken for the remainder of the 52 weeks. Both groups received frequent telephone or the Oviva app support. Feasibility outcomes included study uptake, retention, app usage, dietary adherence, weight loss and change in glycated haemoglobin (HbA1c) at 52 weeks.

RESULTS

We enrolled 39 ILED and 40 CLED participants and 27 (69%) ILED and 30 CLED (75%) attended the 52-week follow-up. Eighty-nine per cent (70 of 79) started using the app and 86% (44 of 51) still used the app at 52 weeks. Intention-to-treat analysis at 52 weeks showed percentage weight loss was mean (95% confidence interval) -5.4% (-7.6, -3.1%) for ILED and -6.0% (-7.9, -4.0%) for CLED. HbA1c <48 mmol/mol was achieved in 42% of both groups. Mean (95% confidence interval) changes in the T2D medication effect score were 0.0008 (-0.3, 0.3) for ILED and -0.5 (-0.8, -0.3) for CLED.

CONCLUSION

The study shows the feasibility and potential efficacy of remotely delivered ILED and CLED programmes for weight loss and HbA1c reduction, and the feasibility of a randomized controlled trial comparing the two approaches.

Multisite Medical Student-Led Community Culinary Medicine Classes Improve Patients' Diets: Machine Learning-Augmented Propensity Score-Adjusted Fixed Effects Cohort Analysis of 1381 Subjects

Background. Healthy diet represents one of the largest single modifiable risk factors proven to decrease rates of obesity and associated chronic disease, but practical approaches to improving dietary habits through nutritional intervention are limited. Objective. To evaluate the effectiveness of a medical student-led, 6-week culinary course on participants' dietary knowledge and behaviors, particularly focusing on the tenets of the Mediterranean diet (MedDiet). Design. This study is a prospective multisite cohort study evaluating the effects of a 6-week, hands-on community culinary education course offered at 3 sites. Participants' knowledge of cooking skills, eating habits, and adherence to the MedDiet were evaluated using a survey prior to beginning and 6 weeks after the completion of the course. Analysis was conducted using multivariable regression to assess subjects' diets, associated behaviors, and nutrition beliefs according to the number of classes to which they were exposed (0 to >6). Statistical results were then compared with the machine learning results to check statistical validity after selection of the top-performing algorithm from 43 supervised algorithms using 10-fold cross-validation with performance assessed according to accuracy, root relative square error, and root mean square error. Results. Among the 1381 participants, cooking classes significantly improved patients' overall 9-point MedDiet adherence (β = 0.62, 95% CI 0.23-1.00, P = .002). Participants were more likely to meet MedDiet point requirements for fruit intake (odds ratio [OR] 2.77, 95% CI 1.46-5.23, P = .002), vegetable intake (OR 4.61, 95% CI 1.85-11.53, P = .001), legume intake (OR 2.48, 95% CI 1.45-4.26, P = .001), and olive oil use (OR 2.87, 95% CI 1.44-5.74, P = .003), and were less likely to believe that cooking takes excessive time (OR 0.31, 95% CI 0.16-0.59, P < .001). Conclusion. Hands-on culinary education courses were associated with increased MedDiet adherence and improved knowledge of healthful eating. Such interventions thus represent a cost-effective option for addressing rates of obesity and obesity-related chronic illness.

A plasma fatty acid profile associated to type 2 diabetes development: from the CORDIOPREV study

PURPOSE

The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. For this reason, it is essential to identify biomarkers for the early detection of T2DM risk and/or for a better prognosis of T2DM. We aimed to identify a plasma fatty acid (FA) profile associated with T2DM development.

METHODS

We included 462 coronary heart disease patients from the CORDIOPREV study without T2DM at baseline. Of these, 107 patients developed T2DM according to the American Diabetes Association (ADA) diagnosis criteria after a median follow-up of 60 months. We performed a random classification of patients in a training set, used to build a FA Score, and a Validation set, in which we tested the FA Score.

RESULTS

FA selection with the highest prediction power was performed by random survival forest in the Training set, which yielded 4 out of the 24 FA: myristic, petroselinic, α-linolenic and arachidonic acids. We built a FA Score with the selected FA and observed that patients with a higher score presented a greater risk of T2DM development, with an HR of 3.15 (95% CI 2.04-3.37) in the Training set, and an HR of 2.14 (95% CI 1.50-2.84) in the Validation set, per standard deviation (SD) increase. Moreover, patients with a higher FA Score presented lower insulin sensitivity and higher hepatic insulin resistance (p < 0.05).

CONCLUSION

Our results suggest that a detrimental FA plasma profile precedes the development of T2DM in patients with coronary heart disease, and that this FA profile can, therefore, be used as a predictive biomarker. CLINICAL TRIALS.GOV.

IDENTIFIER

NCT00924937.

An altered microbiota pattern precedes Type 2 diabetes mellitus development: From the CORDIOPREV study

•

Type 2 diabetes (T2DM) increases the risk of recurrence in myocardial infarction patients.

•

A gut microbiota profile is associated to the further T2DM development.

•

Microbiome data improved the prediction of T2DM development when added to clinical parameters.

•

A risk score including the most predictive genera was associated with the probability of T2DM.

•

A high risk score was associated with a higher hepatic insulin resistance and β-cell dysfunction.

Introduction

A distinctive gut microbiome have been linked to type 2 diabetes mellitus (T2DM).

Objectives

We aimed to evaluate whether gut microbiota composition, in addition to clinical biomarkers, could improve the prediction of new incident cases of diabetes in patients with coronary heart disease.

Methods

All the patients from the CORDIOPREV (Clinical Trials.gov.Identifier: NCT00924937) study without T2DM at baseline were included (n = 462). Overall, 107 patients developed it after a median of 60 months. The gut microbiota composition was determined by 16S rRNA gene sequencing and predictive models were created using hold-out method.

Results

A gut microbiota profile associated with T2DM development was determined through a microbiome-based predictive model. The addition of microbiome data to clinical parameters (variables included in FINDRISC risk score and the diabetes risk score of the American Diabetes Association, HDL, triglycerides and HbA1c) improved the prediction increasing the area under the curve from 0.632 to 0.946. Furthermore, a microbiome-based risk score including the ten most discriminant genera, was associated with the probability of develop T2DM.

Conclusion

These results suggest that a microbiota profile is associated to the T2DM development. An integrate predictive model of microbiome and clinical data that can improve the prediction of T2DM is also proposed, if is validated in independent populations to prevent this disease.

The Association of Dietary Intake with Arterial Stiffness and Vascular Ageing in a Population with Intermediate Cardiovascular Risk-A MARK Study

The aim of this study was to analyse the association of diet with arterial stiffness and vascular ageing in a Caucasian population with intermediate cardiovascular risk. We recruited 2475 individuals aged 35–75 years with intermediate cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500^® device. Vascular ageing was defined in two steps. Step 1: The 20 individuals who presented kidney disease, peripheral arterial disease, or heart failure were classified as early vascular ageing (EVA). Step 2: The individuals with percentiles by age and sex above the 90th percentile of baPWV among the participants of this study were classified as EVA, and the rest of the individuals were classified as non-EVA. The diet of the participants was analysed with two questionnaires: (1) the diet quality index (DQI) questionnaire and (2) the Mediterranean diet (MD) adherence questionnaire. The mean age of the sample was 61.34 ± 7.70 years, and 61.60% were men. Adherence to the MD was 53.30%. The DQI was 54.90%. Of the entire sample, 10.70% (11.15% of the men and 9.95% of the women) were EVA. In the multiple linear regression analysis, for each additional point in the DQI questionnaire, there was a decrease of −0.081 (95%CI (confidence intervals) −0.105–−0.028) in baPWV; in the MD adherence questionnaire, there was a decrease of −0.052 (95%CI −0141–−0.008). When performing the analysis, separated by sex, the association remained significant in men but not in women. In the logistic regression analysis, there was an increase in MD adherence and a decrease in the probability of presenting EVA, both with the DQI questionnaire (OR (odds ratio) = 0.65; 95%CI 0.50–0.84) and with the MD adherence questionnaire (OR = 0.75; 95%CI 0.58–0.97). In the analysis by sex, the association was only maintained in men (with DQI, OR = 0.54; 95%CI 0.37–0.56) (with MD, OR = 0.72; 95%CI 0.52–0.99). The results of this study suggest that a greater score in the DQI and MD adherence questionnaires is associated with lower arterial stiffness and a lower probability of presenting EVA. In the analysis by sex, this association is only observed in men.

Modification of Mediterranean Diet Pyramid from an Island’s perspective

ABSTRACT Objective The present study aimed to determine traditional and local food consumption and adherence to the Mediterranean diet in Cyprus. And also, aimed to improve their adherence to the Mediterranean diet and traditional and local food consumption. From this point, this current study aimed to revise the Cyprus Mediterranean Diet Pyramid, based on the Current Mediterranean Diet Pyramid. Methods The sample size was calculated as a minimum of 386 according to a 95.0% confidence interval, and a 5.0% error. This study was conducted online between November 2020-April 2021 in Cyprus. All volunteers were invited to this study on the national public internet platforms. Participant´s adherence to the Mediterranean diet was determined by the Mediterranean Diet Adherence Screener. Traditional and local food consumption frequencies were determined by a Food Frequency Questionnaire. A novel Cyprus Mediterranean Diet Pyramid was developed with traditional and local food items for Cyprus. The modification was also aimed to safeguard planet health, to increase traditional food consumption and adherence to the Mediterranean diet. Results 1,007 adults (78.0% native islanders/Cypriots) participated voluntarily in the current study. The mean Mediterranean Diet Adherence Screener score was 7.55±2.30 points and only 34.4% had high adherence to the Mediterranean diet. According to their responses, there was a need to increase use of olive oil, vegetables, fruits, fish, and red wine consumption and to decrease red meat and dessert consumption. According to responses to the Mediterranean Diet Adherence Screener and their traditional/local food consumption frequencies an up-to-date Cyprus Mediterranean Diet Pyramid was done hence a national food pyramid for Cyprus. Commonly consumed traditional and local foods were added to the pyramid to facilitate increased adaptation of the Mediterranean diet in the general population. Adequately consumed foods were added to make it more region-specific and rarely consumed foods were added to help to increase consumption. Conclusion This modification is believed to be instrumental to increase Mediterranean diet adaptation, traditional/local food consumption and decrease the impact of nutrition on the planet´s health. And also, this modification can shed light on the development of the other traditional food pyramids.

Impact of Mediterranean diet on metabolic and inflammatory status of patients with polyvascular atherosclerotic disease

BACKGROUND AND AIMS

The Mediterranean Diet (MD) represents a key player in cardiovascular disease prevention. Therefore, we aimed to assess the relationship between adherence to the MD and inflammatory, lipid and glycemic profile in patients affected by polyvascular atherosclerotic disease (PAD). We also investigated the incidence of long-term major adverse cardiovascular events (MACEs) according to MD adherence.

METHODS AND RESULTS

We enrolled 107 patients with PAD, defined as the simultaneous involvement of at least two vascular districts. Adherence to the MD was estimated through a 9-item simplified form of the Mediterranean Diet Score. Improved fasting glycemic and LDL-cholesterol levels were reported in the high-adherence group compared with the low-adherence group (p < 0.001 and p = 0.0049, respectively). Both C-reactive protein and platelet-to-lymphocyte ratio were significantly lower in high-adherence patients than those with poor adherence to the MD (p = 0.0045 and p = 0.008, respectively). During follow-up (mean 34 ± 11 months), fatal events happened exclusively in the low-adherence group (58%), with an event-free survival of 37% compared with 87% in the moderate-adherence group and 70% in the high-adherence group (log-rank p-value < 0.001). Low adherence to the MD was associated with a higher incidence of MACEs in the Cox regression model adjusted for atherosclerotic risk factors (HR 12.23, 95% CI 4.00-37.39).

CONCLUSIONS

High adherence to Mediterranean dietary pattern seems to be associated with improving inflammatory and metabolic status in patients suffering from PAD, potentially translating into better long-term cardiovascular outcomes. These findings provide evidence regarding the relevance of MD as a secondary preventive tool in this high-risk population.

Diabetes remission is modulated by branched chain amino acids according to the diet consumed: from the CORDIOPREV study

SCOPE

BCAA plasma levels may be differentially associated with type 2 diabetes mellitus (T2DM) remission through the consumption of the Mediterranean diet (Med) and a low-fat (LF) diet.

METHODS

183 newly-diagnosed T2DM patients within the CORDIOPREV study were randomized to consume the Med or a LF diet. BCAA plasma levels (isoleucine, leucine and valine) were measured at fasting and after 120 min of an oral glucose tolerance test (OGTT) at the baseline of the study and after 5 y of the dietary intervention.

RESULTS

Isoleucine, leucine and valine plasma levels after 120 min of an OGTT in the Med diet (N = 80) were associated by COX analysis with T2DM remission: HR per SD (95%CI): 0.53 (0.37-0.77), 0.75 (0.52-1.08) and 0.61 (0.45-0.82), respectively; no association was found in patients who consumed a LF diet (N = 103). BCAA plasma levels combined in a score showed a HR of 3.33 (1.55-7.19) of T2DM remission for patients with a high score values in the Med diet, while in those with a LF diet no association was found.

CONCLUSION

Our study suggests that BCAA measurements potentially be used as a tool to select the most suitable diet to induce T2DM remission by nutritional strategies. This article is protected by copyright. All rights reserved.