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The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet. Nutrients 2019; 11:nu11102373. [PMID: 31590352 PMCID: PMC6835480 DOI: 10.3390/nu11102373] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/31/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.
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George ES, Kucianski T, Mayr HL, Moschonis G, Tierney AC, Itsiopoulos C. A Mediterranean Diet Model in Australia: Strategies for Translating the Traditional Mediterranean Diet into a Multicultural Setting. Nutrients 2018; 10:E465. [PMID: 29642557 PMCID: PMC5946250 DOI: 10.3390/nu10040465] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 01/22/2023] Open
Abstract
Substantial evidence supports the effect of the Mediterranean Diet (MD) for managing chronic diseases, although trials have been primarily conducted in Mediterranean populations. The efficacy and feasibility of the Mediterranean dietary pattern for the management of chronic diseases has not been extensively evaluated in non-Mediterranean settings. This paper aims to describe the development of a MD model that complies with principles of the traditional MD applied in a multiethnic context. Optimal macronutrient and food-based composition was defined, and a two-week menu was devised incorporating traditional ingredients with evidence based on improvements in chronic disease management. Strategies were developed for the implementation of the diet model in a multiethnic population. Consistent with the principles of a traditional MD, the MD model was plant-based and high in dietary fat, predominantly monounsaturated fatty acids from extra virgin olive oil. Fruits, vegetables and wholegrains were a mainstay, and moderate amounts of nuts and seeds, fish, dairy and red wine were recommended. The diet encompassed key features of the MD including cuisine, biodiversity and sustainability. The MD model preserved traditional dietary components likely to elicit health benefits for individuals with chronic diseases, even with the adaptation to an Australian multiethnic population.
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Affiliation(s)
- Elena S George
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Building J, 221 Burwood Hwy, Burwood, VIC 3125, Australia.
| | - Teagan Kucianski
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Hannah L Mayr
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - George Moschonis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Audrey C Tierney
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
- School of Allied Health, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland.
| | - Catherine Itsiopoulos
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Health Sciences 3, Kingsbury Drive, Bundoora, VIC 3086, Australia.
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Bonaccio M, Di Castelnuovo A, Bonanni A, Costanzo S, De Lucia F, Pounis G, Zito F, Donati MB, de Gaetano G, Iacoviello L. Adherence to a Mediterranean diet is associated with a better health-related quality of life: a possible role of high dietary antioxidant content. BMJ Open 2013; 3:e003003. [PMID: 23943771 PMCID: PMC3752056 DOI: 10.1136/bmjopen-2013-003003] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/20/2013] [Accepted: 07/02/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Mediterranean diet (MD) is associated with a reduced risk of major chronic disease. Health-related quality of life (HRQL) is a valid predictor of mortality. The aim of this study is to investigate the association between MD and HRQL and to examine the possible role of dietary antioxidants, fibre content and/or fatty acid components. DESIGN Cross-sectional study on a sample of Italian participants enrolled in the Moli-sani Project, a population-based cohort study. Food intake was recorded by the Italian European prospective investigation into cancer and nutrition study food frequency questionnaire. Adherence to MD was appraised by a Greek Mediterranean diet score (MDS), an Italian Mediterranean diet index (IMI) and by principal component analysis (PCA). HRQL was assessed by the 36-Item Short Form Health Survey. SETTING Molise region, Italy. PARTICIPANTS 16 937 participants of 24 325 Italian citizens (age≥35). MAIN OUTCOMES Dietary patterns and HRQL. RESULTS Mental health was associated consistently and positively with MDS, IMI and an 'Olive oil and vegetable' pattern (PCA1), but negatively with an 'Eggs and sweets' pattern (PCA3). Physical health was associated positively with MDS and PCA1, but negatively with a 'Meat and pasta' pattern. Subjects with the highest MD adherence had 42% (MDS), 34% (IMI) or 59% (PCA1) statistically significant multivariable odds of being in the uppermost level of mental health, as compared with subjects in the lowest category. The associations disappeared after further adjustment for either total food antioxidant content or dietary fibre, while they were not modified by the inclusion of either monounsaturated or polyunsaturated fatty acids. Individuals in the highest PCA1 or PCA3 had significantly higher odds of being in the top level of physical health. CONCLUSIONS Adherence to an MD pattern is associated with better HRQL. The association is stronger with mental health than with physical health. Dietary total antioxidant and fibre content independently explain this relationship.
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Affiliation(s)
- Marialaura Bonaccio
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Isernia, Italy
| | - Augusto Di Castelnuovo
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Americo Bonanni
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Epicomed Research Srl, Campobasso, Italy
| | - Simona Costanzo
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesca De Lucia
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - George Pounis
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Zito
- Laboratory of Genetic and Environmental Epidemiology, Laboratori di Ricerca, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Isernia, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Isernia, Italy
- Laboratory of Cardiovascular and Neurovascular Epidemiology, Casa di Cura Montevergine, Mercogliano, Avellino, Italy
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Carluccio MA, Ancora MA, Massaro M, Carluccio M, Scoditti E, Distante A, Storelli C, De Caterina R. Homocysteine induces VCAM-1 gene expression through NF-kappaB and NAD(P)H oxidase activation: protective role of Mediterranean diet polyphenolic antioxidants. Am J Physiol Heart Circ Physiol 2007; 293:H2344-54. [PMID: 17586618 DOI: 10.1152/ajpheart.00432.2007] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperhomocysteinemia is a recognized risk factor for vascular disease, but pathogenetic mechanisms involved in its vascular actions are largely unknown. Because VCAM-1 expression is crucial in monocyte adhesion and early atherogenesis, we evaluated the NF-kappaB-related induction of VCAM-1 by homocysteine (Hcy) and the possible inhibitory effect of dietary polyphenolic antioxidants, such as trans-resveratrol (RSV) and hydroxytyrosol (HT), which are known inhibitors of NF-kappaB-mediated VCAM-1 induction. In human umbilical vein endothelial cells (HUVEC), Hcy, at 100 micromol/l, but not cysteine, induced VCAM-1 expression at the protein and mRNA levels, as shown by enzyme immunoassay and Northern analysis, respectively. Transfection studies with deletional VCAM-1 promoter constructs demonstrated that the two tandem NF-kappaB motifs in the VCAM-1 promoter are necessary for Hcy-induced VCAM-1 gene expression. Hcy-induced NF-kappaB activation was confirmed by EMSA, as shown by the nuclear translocation of its p65 (RelA) subunit and the degradation of the inhibitors IkappaB-alpha and IkappaB-beta by Western analysis. Hcy also increased intracellular reactive oxygen species by NAD(P)H oxidase activation, as shown by the membrane translocation of its p47(phox) subunit. NF-kappaB inhibitors decreased Hcy-induced intracellular reactive oxygen species and VCAM-1 expression. Finally, we found that nutritionally relevant concentrations of RSV and HT, but not folate and vitamin B6, reduce (by >60% at 10(-6) mol/l) Hcy-induced VCAM-1 expression and monocytoid cell adhesion to the endothelium. These data indicate that pathophysiologically relevant Hcy concentrations induce VCAM-1 expression through a prooxidant mechanism involving NF-kappaB. Natural Mediterranean diet antioxidants can inhibit such activation, suggesting their possible therapeutic role in Hcy-induced vascular damage.
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Rosenthal RL. Effectiveness of altering serum cholesterol levels without drugs. Proc (Bayl Univ Med Cent) 2006; 13:351-5. [PMID: 16389340 PMCID: PMC1312230 DOI: 10.1080/08998280.2000.11927704] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Drug therapy with statins and other agents can result in dramatic lipid-lowering effects. Despite the wealth of data supporting the beneficial effects of pharmacologic therapy on cardiovascular risk, patients often express a desire to accomplish similar goals with diet alone. And, except for patients with extreme cholesterol elevations, consensus panels all promote dietary therapy as an initial step in the treatment of hyperlipidemia. This review examines a variety of dietary strategies designed to lower lipid levels, including the American Heart Association diet, the Ornish diet, the Mediterranean diet, exercise, phytosterols, fiber, soy products, and fish oil. Though the declines in low-density lipoprotein cholesterol levels with these methods range from 0% to 37%, cardiovascular risk may be more significantly impacted than would be predicted from these changes alone. Significant benefits can be reaped from nonpharmacologic measures.
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Affiliation(s)
- R L Rosenthal
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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