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

The impact of the timing of pasta intake on sleep quality and health outcomes: a protocol for a randomized controlled trial

BACKGROUND

Pasta is a fundamental component of the Mediterranean diet and a key source of carbohydrates. Despite its nutritional benefits, misconceptions persist regarding its potential to promote weight gain, particularly when consumed at dinner. While no evidence supports this concern, emerging chrononutritional research suggests that evening carbohydrate intake may positively influence sleep quality by promoting serotonin production. This study aims to assess, for the first time, whether pasta consumption (lunch vs. dinner) affects sleep quality, circadian rhythms, cardiometabolic health, and gut microbiota composition in healthy, normal-weight adults.

METHODS

A 7-month randomized, open-label, cross-over trial will enroll 70 participants, assigned to two isocaloric, Mediterranean-style diets differing only in pasta consumption timing. Each phase will last 3 months, separated by a 1-month wash-out period. At the beginning and end of each phase, participants will wear an actigraph for 7 days and provide saliva, blood, and stool samples. Additional assessments include body composition analysis, indirect calorimetry, and food and lifestyle diaries. The primary outcome will be changes in sleep quality from baseline. Secondary outcomes include anthropometric measurements, body composition, metabolic rate, biochemical and hormonal markers, inflammatory and oxidative stress markers, gut microbiota composition, and short-chain fatty acid production. The study has been approved by the Tuscany Regional Ethics Committee of the Azienda Ospedaliera Universitaria (AOU)-Careggi, Florence.

DISCUSSION

This study will provide experimental data on how the timing of pasta consumption affects sleep quality and a range of health outcomes, contributing to the debate on the optimal timing of carbohydrate intake.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06185634. Registered on 07/01/2024.

The impact of breakfast skipping on plasma glucose levels in non-diabetic individuals: gender-based differences and implications

Chrono-nutritional factors may play a significant role in glucose regulation and the risk of type 2 diabetes (T2D). We investigated the association between breakfast skipping (BS) and fasting plasma glucose (FPG) levels in a non-diabetic cohort of the ABCD project (nutrition, cardiovascular wellness and diabetes) representing the general population of Palermo, Italy Among the 623 participants included in the analysis, 118 individuals were identified as BS. In men, BS was associated with higher values of FPG (p < .05), glycated haemoglobin (p < .01), triglycerides (p < .05) and insulin (p < .005). Among women, no significant differences were observed between BS and non-skippers. Multivariate regression analysis confirmed that BS was an independent predictor of higher FPG levels in men (p < .01); waist circumference emerged as the primary predictor of FPG in women (p < .001). This study supports the importance of dietary habits in glycaemic control and T2D risk.

Mediterranean Diet Adherence in Celiac Patients: A Nested Cross-Sectional Study

Background/Objectives: The Mediterranean diet (MD) reduces cardiovascular risk, which is higher in celiac disease (CD). We aimed to investigate adherence to the MD in newly diagnosed CD patients, CD patients on a gluten-free diet (GFD), and in a non-celiac control group. Additionally, we aimed to establish an association between GFD and MD adherence. Methods: In this nested, cross-sectional Hungarian study, MD adherence was assessed using the Mediterranean Diet Score (MDS), and GFD adherence was assessed using the Standardized Dietitian Evaluation (SDE). Results: A total of 215 subjects were enrolled, 128 of which were CD patients on a GFD for a minimum of 1 year, 24 were newly diagnosed CD patients, and 63 were non-CD healthy control subjects. Although the control subjects had a higher mean MDS, the groups did not differ statistically significantly from each other (CD on GFD: 5.55 ± 1.57, newly diagnosed CD: 5.35 ± 1.81, controls: 6.05 ± 1.73; p > 0.05)-all groups had suboptimal scores. Both CD groups consumed fewer whole grains than the controls (p < 0.001). Adequate GFD adherence was associated with higher MDS (5.62 ± 1.54 vs. 4.71 ± 1.21, respectively; p = 0.009). Conclusions: Our study highlights the low adherence to MD in celiac patients with insufficient consumption of whole grains. Adherence to GFD is associated with better MD adherence, which underlines the role of dietary education during follow-up. Targeted nutritional counseling could improve the quality of diet in CD patients to reduce cardiovascular risk.

Hazelnut Skin Fortification of Dehulled Lentil Chips to Improve Nutritional, Antioxidant, Sensory, and Chemical Properties

Legumes consumption is still low in Western countries, and their incorporation into bakery products could be a solution. However, a minimally processed legume-based product is still a challenge because of its negative impact on acceptance by consumers. Here, an oven-baked chip recipe, based on lentil flour, was fortified with 5% hazelnut skin (HS), a byproduct of hazelnut industrial processing, to improve the nutritional, antioxidant, and sensory features of this innovative food. Indeed, HS addition allows a nutritional profile improvement, increasing the fibers from 11.71% to 15.63%, and maintaining a high protein content (24.03 g/100 g). Furthermore, HS fortification increased total phenolic compounds and total antioxidant capacity by 1.6- and 2-fold, respectively, compared to the control. Finally, HS significantly improved the overall judgment score by 1.2 points (from 5.6 to 6.8 in control and experimental chips, respectively) halving the pulse-like aroma from 8.6 to 4.3 due to the strong decrease in the dodecane compound and due to HS volatile composition, rich in hexanal. Therefore, HS could be a valuable ingredient in improving the nutritional and functional features of bakery products as well as the sensory profiles of less palatable but healthy legume-based foods.

Nut Consumption Is Associated with Cognitive Status in Southern Italian Adults

BACKGROUND

Nut consumption has been considered a potential protective factor against cognitive decline. The aim of this study was to test whether higher total and specific nut intake was associated with better cognitive status in a sample of older Italian adults.

METHODS

A cross-sectional analysis on 883 older adults (>50 y) was conducted. A 110-item food frequency questionnaire was used to collect information on the consumption of various types of nuts. The Short Portable Mental Status Questionnaire was used to assess cognitive status. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between nut intake and cognitive status after adjusting for potential confounding factors.

RESULTS

The median intake of total nuts was 11.7 g/day and served as a cut-off to categorize low and high consumers (mean intake 4.3 g/day vs. 39.7 g/day, respectively). Higher total nut intake was significantly associated with a lower prevalence of impaired cognitive status among older individuals (OR = 0.35, CI 95%: 0.15, 0.84) after adjusting for potential confounding factors. Notably, this association remained significant after additional adjustment for adherence to the Mediterranean dietary pattern as an indicator of diet quality, (OR = 0.32, CI 95%: 0.13, 0.77). No significant associations were found between cognitive status and specific types of nuts.

CONCLUSIONS

Habitual nut intake is associated with better cognitive status in older adults.

Evaluation of the Phenolic Components, Fiber Content, Antioxidant Activity, and Prebiotic Capacity of a Shortbread Cookie Fortified with Hazelnut Skin Waste

Food reformulation is a strategy to make healthier foods by using food waste matrices that are still nutritionally valid. A shortbread cookie was reformulated replacing hazelnut skin (HS) of the Tonda Gentile Romana variety (5% and 10%) to refined flour and proportionally decreasing the butter amount. This resulted in significant, two- and five-fold, increases in the antioxidant capacity compared with the control, in the 5% and 10% fortified recipes, respectively. Among the most important antioxidants, gallic acid, catechin, phloridzin, and protocatechuic acid were found. Moreover, here we found, for the first time, that HS from the Romana variety had a high total fiber content (44.13 g/100 g), most of which was insoluble fiber. Therefore, HS 10% addition to the shortbread cookie recipe caused a significant increase in fiber content, making the experimental cookie earn the nutritional claim of "high fiber content". Finally, preliminary evidence demonstrated that 10% HS, in comparison to 5%, following in vitro upper gastrointestinal digestion, conferred significant prebiotic activity in an in vitro culture of L. rhamnosus. Therefore, from the perspective of the circular economy, HS could be a valuable ingredient to increase the antioxidant and prebiotic activities of conventional foods.

Youth Healthy Eating Index (YHEI) and Diet Adequacy in Relation to Country-Specific National Dietary Recommendations in Children and Adolescents in Five Mediterranean Countries from the DELICIOUS Project

BACKGROUND/OBJECTIVES

The diet quality of younger individuals is decreasing globally, with alarming trends also in the Mediterranean region. The aim of this study was to assess diet quality and adequacy in relation to country-specific dietary recommendations for children and adolescents living in the Mediterranean area.

METHODS

A cross-sectional survey was conducted of 2011 parents of the target population participating in the DELICIOUS EU-PRIMA project. Dietary data and cross-references with food-based recommendations and the application of the youth healthy eating index (YHEI) was assessed through 24 h recalls and food frequency questionnaires.

RESULTS

Adherence to recommendations on plant-based foods was low (less than ∼20%), including fruit and vegetables adequacy in all countries, legume adequacy in all countries except for Italy, and cereal adequacy in all countries except for Portugal. For animal products and dietary fats, the adequacy in relation to the national food-based dietary recommendations was slightly better (∼40% on average) in most countries, although the Eastern countries reported worse rates. Higher scores on the YHEI predicted adequacy in relation to vegetables (except Egypt), fruit (except Lebanon), cereals (except Spain), and legumes (except Spain) in most countries. Younger children (p < 0.005) reporting having 8-10 h adequate sleep duration (p < 0.001), <2 h/day screen time (p < 0.001), and a medium/high physical activity level (p < 0.001) displayed a better diet quality. Moreover, older respondents (p < 0.001) with a medium/high educational level (p = 0.001) and living with a partner (p = 0.003) reported that their children had a better diet quality.

CONCLUSIONS

Plant-based food groups, including fruit, vegetables, legumes, and even (whole-grain) cereals are underrepresented in the diets of Mediterranean children and adolescents. Moreover, the adequate consumption of other important dietary components, such as milk and dairy products, is rather disregarded, leading to substantially suboptimal diets and poor adequacy in relation to dietary guidelines.

Effects of Replacing Cow's Milk with Plant-Based Beverages on Potential Nutrient Intake in Sustainable Healthy Dietary Patterns: A Case Study

More consumers are replacing cow's milk (CM) with plant-based drinks (PBD), but data indicating the nutritional impact are limited. This theoretical study aims to assess the effect of substituting CM with PBD sold in Italy on nutrient intake within two dietary patterns: one aligned with the EAT-Lancet Commission reference diet adapted to Italian food habits (EAT-IT) and another one in line with the Italian Dietary Guidelines (IDG). Nutrition information from 368 PBD were collected and categorized according to their descriptive name and their fortification or not with calcium (Ca- and nCa-fortified). The substitution of CM with each PBD category in both dietary patterns was conducted, and an analysis of nutrient content and adequacy was performed. Substituting CM with all PBD resulted in reduced protein intake, except for nCa-fortified soy drinks, decreased saturated fat and vitamins B2 and B12, and increased fiber intake. Replacing CM with nCa-fortified PBD within both diets decreased Ca intake. Following the substitution of CM with Ca-fortified PBD, variations in vitamin D intake depended on the PBD category. The main risk of nutritional inadequacy was observed in Ca and vitamin D levels, which may even be amplified considering the different bioavailability based on the source of nutrients. This study highlighted the important role of CM in meeting calcium requirements and the potential unintended consequences of substituting CM with PBD without considering their nutritional differences.

Nutrient Composition of Four Dietary Patterns in Italy: Results from an Online Survey (the INVITA Study)

Though Italy is a native land of Mediterranean diet, its adherence in the Italian population is low, witnessed by the high rates of overweight in its inhabitants. Vegetarian dietary patterns (i.e., lacto-ovo-vegetarian and vegan) are increasing in western countries, and also in Italy, where 9.5% of the population self-declared as vegetarian in 2023. Though the vegetarian diet has been associated with beneficial health effects, speculation on its alleged nutrient inadequacy exists. For this reason, we assessed the nutrient composition of the diet of 470 participants enrolled in an online survey (the INVITA study), who completed a weighted food questionnaire on three different days. Participants were divided into four dietary groups obtained according to their self-declared dietary intakes: 116 Meat Eaters (MEs), 49 Fish Eaters (FEs), 116 Lacto-Ovo-Vegetarians (LOVs), and 189 VegaNs (VNs). The mean intake of most of the main nutrients was similar among all groups and within the normal range expected for the Italian population, supporting the adequacy of diets within our Italian sample, especially the LOV and VN diet. Since the Mediterranean diet is a plant-based diet, some of its components still persist in the current Italian diet, representing a staple also for people adopting a vegetarian diet.