The Mediterranean diet and health: a comprehensive overview

Impact of diet and exercise on mitochondrial quality and mitophagy in Alzheimer's disease

Alzheimer's disease (AD) is a devastating neurodegenerative disorder that affects millions of people worldwide. It is characterized by the accumulation of beta-amyloid and phosphorylated tau, synaptic damage, and mitochondrial abnormalities in the brain, leading to the progressive loss of cognitive function and memory. In AD, emerging research suggests that lifestyle factors such as a healthy diet and regular exercise may play a significant role in delaying the onset and progression of the disease. Mitochondria are often referred to as the powerhouse of the cell, as they are responsible for producing the energy to cells, including neurons to maintain cognitive function. Our article elaborates on how mitochondrial quality and function decline with age and AD, leading to an increase in oxidative stress and a decrease in ATP production. Decline in mitochondrial quality can impair cellular functions contributing to the development and progression of disease with the loss of neuronal functions in AD. This article also covered mitophagy, the process by which damaged or dysfunctional mitochondria are selectively removed from the cell to maintain cellular homeostasis. Impaired mitophagy has been implicated in the progression and pathogenesis of AD. We also discussed the impact of impaired mitophagy implicated in AD, as the accumulation of damaged mitochondria can lead to increased oxidative stress. We expounded how dietary interventions and exercise can help to improve mitochondrial quality, and mitochondrial function and enhance mitophagy in AD. A diet rich in antioxidants, polyphenols, and mitochondria-targeted small molecules has been shown to enhance mitochondrial function and protect against oxidative stress, particularly in neurons with aged and mild cognitively impaired subjects and AD patients. Promoting a healthy lifestyle, mainly balanced diet and regular exercise that support mitochondrial health, in an individual can potentially delay the onset and progression of AD. In conclusion, a healthy diet and regular exercise play a crucial role in maintaining mitochondrial quality and mitochondrial function, in turn, enhancing mitophagy and synaptic activities that delay AD in the elderly populations.

Efficacy of dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis

BACKGROUND

Patients with irritable bowel syndrome (IBS) are often interested in dietary interventions as a means of managing their symptoms. However, the relative efficacy of available diets for the management of IBS is unclear. We aimed to examine the relative efficacy of various dietary interventions in IBS.

METHODS

For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials from database inception to Feb 7, 2025, to identify randomised controlled trials comparing an active dietary intervention requiring changes to the intake of more than one food in IBS with either a control intervention, such as a habitual diet, sham diet, a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, or alternative miscellaneous dietary advice, or any other active dietary intervention requiring changes to the intake of more than one food. We assessed efficacy using dichotomous assessments of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. We pooled data using a random-effects model, with the efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked interventions according to their P-score, which measures the mean extent of certainty that one intervention is better than another, averaged over all competing interventions.

FINDINGS

We identified 28 eligible randomised controlled trials (comprising 2338 patients) of 11 different dietary interventions compared with four control interventions, of which six (low FODMAP diet, British Dietetic Association/National Institute for Health and Care Excellence [BDA/NICE] diet, lactose-reduced diet, starch-reduced and sucrose-reduced diet, a personalised diet, and a Mediterranean diet) were studied in more than one trial. For global IBS symptoms, assessed in 28 randomised controlled trials and when considering only the dietary interventions studied in more than one trial, a starch-reduced and sucrose-reduced diet ranked first (RR of global IBS symptoms not improving 0·41 [95% CI 0·26-0·67]; P-score 0·84; two trials), a low FODMAP diet ranked fourth (0·51 [0·37-0·70]; P-score 0·71; 24 trials), and a BDA/NICE diet ranked tenth (0·62 [0·43-0·90]; P-score 0·44; eight trials), versus a habitual diet. For abdominal pain, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised controlled trial, a starch-reduced and sucrose-reduced diet ranked second (RR of abdominal pain not improving 0·54 [95% CI 0·33-0·90]; P-score 0·73; two trials), and a low FODMAP diet ranked fifth (0·61 [0·42-0·89]; P-score 0·64; 23 trials), versus a habitual diet. For abdominal bloating or distension, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised trial, only a low FODMAP diet (RR of abdominal bloating or distension not improving 0·55 [95% CI 0·37-0·80]; P-score 0·64; 23 trials) was superior to a habitual diet and ranked fourth. For bowel habit, assessed in 23 randomised trials, none of the dietary interventions was superior to any of the control interventions, but a low FODMAP diet was superior to a BDA/NICE diet (RR of bowel habit not improving 0·79 [95% CI 0·63-0·99]). All comparisons across the network were rated as low or very low confidence, except for direct comparisons between a low FODMAP diet or a starch-reduced and sucrose-reduced diet and habitual diet, both of which were rated as moderate confidence.

INTERPRETATION

In terms of dietary interventions for IBS, the most evidence exists for a low FODMAP diet, but other promising therapies are emerging and should be the subject of further study.

FUNDING

None.

Adherence to the mediterranean diet and physical activity in relation to sarcopenia: a cross-sectional epidemiological cohort study

BACKGROUND

Adoption of healthy lifestyle habits has been proposed as successful strategies to counteract sarcopenia.

AIMS

To explore the association of physical activity (PA) and adherence to the mediterranean diet (MD), individually and synergically, with sarcopenia.

METHODS

The present cross-sectional study examined data of the Toledo Study of Healthy Ageing. Data of community-dwelling adults aged 65 + years were analyzed. Sarcopenia was defined according to the Foundation for the National Institutes of Health, standardized to our population (sFNIH) and the European Working Group on Sarcopenia (EWGSOP2). PA levels (Physical Activity Scale for the Elderly, PASE) and adherence to the MD (MEDiterranean Diet Adherence Screener-MEDAS) were estimated using self-reported instruments. Binary regression models were conducted to test associations.

RESULTS

Data of 1457 individuals (mean age 74.68 ± 5.77 years; 54.91% women) were analyzed. Among them, 331 (22.72%, sFNIH) and 202 (13.86%, EWGSOP2) met sarcopenia criteria. PA levels (ORs: 0.91-0.95, p < 0.05) and adherence to the MD (ORs: 0.82-0.86, p < 0.05) were significantly and negatively associated with the prevalence of sarcopenia, regardless of the definition used. Nevertheless, no significant interactions were observed among healthy lifestyle habits. According to sarcopenia-related domains, PA levels and adherence to the MD were negatively associated with dynapenia, meanwhile, PA levels were associated with low lean mass (sFNIH) and adherence to the MD was inversely associated with poor mobility.

CONCLUSIONS

PA and adherence to the MD are independently associated with sarcopenia. Moreover, specific associations were observed between sarcopenia domains. Nevertheless, no significant interaction was observed between them.

Research progress and hotspots of the impact of Mediterranean diet on aging from 2004 to 2023: A bibliometric analysis

OBJECTIVE

This study aims to identify research hotspots and trends by conducting a bibliometric report regarding the impact of MD on aging.

METHODS

Publications on MD and aging were extracted from the Web of Science Core Collection. R software, VOSviewer and CiteSpace were employed to detect research hotspots and frontiers.

RESULTS

The number of annual articles has grown rapidly. The core research content in this field are the mechanism of the antiaging action of MD (inflammation, oxidative stress and gut microbiome) and age-related diseases (particularly cardiovascular diseases, Alzheimer's disease and metabolic syndrome). The interplay between MD and the gut microbiome or physical activity impacting healthy aging has been the recent hotspot and research frontier.

CONCLUSION

This study quantitatively and objectively described the research status and research focus of the impact of MD on aging, which provides reference for future research in this field.

Adherence to plant based diets reduce the risk of hepatic fibrosis in nonalcoholic fatty liver disease

Adherence to plant-based diets has significantly increased in popularity recently, with claims that they reduce the risk of non-communicable diseases. This study investigated whether high adherence to plant-based diets can reduce the risk of hepatic steatosis and fibrosis. In this study, 8516 participants from the Ravansar Noncommunicable Disease cohort completed a validated food frequency questionnaire (FFQ) to assess their plant-based diet scores. The study used the fatty liver index and fibrosis-4 index to predict hepatic steatosis and fibrosis. The plant-based diet index (PDI) was used to measure the overall quality of diets from healthy and unhealthy plant-derived foods and animal-derived foods. Associations were determined using binary logistic regression, considering potential confounders. Participants in the highest tertiles of plant-based diet scores had higher energy-adjusted intakes of fructose than those in the lowest tertiles (16.09 ± 12.11 vs. 26.65 ± 12; P-value < 0.001). In multivariable-adjusted models, participants in the highest tertile of PDI had lower odds of hepatic fibrosis than those in the lowest tertile (OR: 0.59; 95%CI: 0.43-0.81). There was no significant association between adherence to PDI and hepatic steatosis after adjustment for potential confounders (OR: 0.989; 95%CI 0.78 - 1.25). The odds of hepatic fibrosis decreased by 6% for each unit increase in healthy plant-based foods (OR: 0.94; 95%CI: 0.91-0.97). The odds of hepatic steatosis increased by 14% for each 1 SD increase in fructose intake (OR: 1.14; 95% CI: 1.02-1.28). This study highlights the potential benefits of high adherence to plant-based diets in reducing the risk of hepatic fibrosis, but high fructose content in some plant-based foods may have an unfavorable role in hepatic steatosis. These findings highlight the importance of selecting whole, fiber-rich plant foods and minimizing intake of fructose-dense products in plant-based diets to promote liver health. Therefore, selecting low-fructose food items in plant-based diets is recommended, though further research is needed to confirm these findings.

A Greater Adherence to the Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Nuts During Pregnancy Is Associated with Improved Offspring Health at Six Years of Age

Background/Objectives: Children's health may be influenced by maternal eating habits during pregnancy. A Mediterranean diet (MedDiet)-based pattern has been associated with benefits in infectious disease and allergies in children. Methods: From a total 2228 pregnant women evaluated between 2015 and 2017 in the St. Carlos cohort, 1292 women belonging to the intervention group (IG) undertook a MedDiet supplemented with extra virgin olive oil (EVOO) and nuts from early on in pregnancy. The control group (CG) consisted of 516 pregnant women who were advised to follow a fat-restricted MedDiet. The modified 12-point Mediterranean diet adherence screener (MEDAS) was applied. A total of 1808 (81.2%) children were analyzed at 6 years postpartum. All women from both groups received the same postpartum nutritional recommendations as the IG had during pregnancy. Results: Children from the IG showed lower rates of bronchiolitis and atopic eczema compared to the CG. Children whose mother's MEDAS score was ≥6 at 24-28 GW vs. MEDAS scores < 6 presented lower rates of bronchiolitis [222/695 (28.8%) vs. 441/1113 (39.6%); p = 0.022] and atopic eczema [311/695 (39.0%) vs. 564/1113 (50.7%); p = 0.039]. The offspring of mothers with MEDAS scores ≥ 8 (n = 176) vs. MEDAS scores ≤ 3 (n = 564) showed a lower relative risk (RR) (95% CI) for developing bronchiolitis [0.75 (0.58-0.97)] and atopic eczema [0.82 (0.69-0.98)], with both having a p < 0.001 trend. Conclusions: A higher adherence to a MedDiet supplemented with EVOO and nuts during pregnancy is associated with health benefits in offspring at 6 years of age.

The Impact of Different Nutritional Approaches on Body Composition in People Living with Obesity

PURPOSE OF REVIEW

This narrative review aimed to provide an overview of the current evidence on the impact of various nutritional strategies on body composition in people living with obesity (PLwO), with particular attention to fat mass (FM), fat-free mass (FFM), and fat distribution.

RECENT FINDINGS

Obesity is increasingly linked to cardiometabolic complications, yet common diagnostic metrics such as body mass index (BMI) do not capture changes in FM or FFM. Recent studies highlight the variable effects of different dietary interventions on body compartments. High-protein and ketogenic diets are associated with greater preservation of FFM and reductions in visceral adipose tissue (VAT), while the Mediterranean diet shows promise for long-term adherence and improvements in metabolic health. Intermittent fasting and time-restricted eating demonstrate efficacy in FM reduction but present mixed results regarding FFM retention and sustainability. Dietary strategies exert diverse effects on body composition in PLwO, underscoring the importance of tailoring interventions to individual metabolic profiles and health goals. Personalized nutrition approaches that prioritize the preservation of lean mass and reduction of VAT, along with sustainable adherence, are critical for optimizing obesity management beyond weight loss alone.

Exercise, Diet, and Brain Health: From the Perspective of Gut Microbiota Regulation

The existing body of evidence has highlighted gut microbiota as a versatile regulator of body wellness affecting not only multiple physiological metabolisms but also the function of remote organs. Emerging studies revealed a reciprocal relationship between physical exercise and intestinal microbiota, suggesting that physical exercise could enhance gut health, including regulating intestinal barrier integrity, increasing microbial diversity, and promoting beneficial microbial metabolism. Furthermore, the beneficial outcomes of exercise on the intestine may also promote brain health through the gut-brain axis. Diet is an important factor in boosting exercise performance and also greatly impacts the structure of gut microbiota. Abundant research has reported that diet alongside exercise could exert beneficial effects on metabolism, immune regulation, and the neuropsychiatric system. In this paper, we used a narrative review, primarily searching PubMed, Web of Science, and Elsevier, to review the existing research on how moderate-intensity exercise promotes gut health, and we introduced the effects of exercise on the nervous system through the gut-brain axis. We also proposed dietary strategies targeting the regulation of gut microbiota to provide guidelines for boosting brain health. This review highlights that moderate exercise and a healthy diet promote gut and brain health.

The Inverse Association of Mediterranean Diet with Emotional Eating: A Cross-Sectional Study in Greek Adults

BACKGROUND/OBJECTIVES

Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association between Mediterranean diet (MD), a dietary pattern promoting mental health, and emotional eating via the Three-Factor Eating Questionnaire (TEFQ).

METHODS

This is a cross-sectional survey including 328 adults aged 18-75 years. Appropriate questionnaires were applied for evaluating adherence to the Mediterranean diet (MedDiet score) and types of feeding and the expression of emotional food consumption (TFEQ).

RESULTS

A mean MedDiet score equal to 30.97 ± 4.93 and a total TFEQ score equal to 45.40 ± 6.31 were noted. MedDiet score was significantly inversely associated with TFEQ total score (r = 0.23, p = 0.026) as well as with TFEQ emotional score (r = 0.37, p < 0.0001). Fruits and vegetables consumption was positively associated with TFEQ emotional score (r = 0.25, p = 0.014, and r = 0.20, p = 0.049, respectively).

CONCLUSIONS

In order to produce data showing improvements in eating behavior, our findings have highlighted the significance of conducting large, prospective, well-designed, randomized, interventional clinical studies to confirm the inverse association of MD with EE. The interpretation of the results is complicated due to cross-sectional design, the social desirability bias and the self-report nature of both dietary and emotional assessments.

Integrative Strategies for Preventing and Managing Metabolic Syndrome: The Impact of Exercise and Diet on Oxidative Stress Reduction-A Review

Metabolic syndrome (MetS) is characterized by central obesity, insulin resistance, hypertension, dyslipidemia, and chronic inflammation, significantly increasing the risk of cardiovascular disease and type 2 diabetes. Effective management of MetS is critical, with exercise being a key intervention. This review analyzed the effects of different exercise intensities-low, moderate, and high-intensity interval training (HIIT)-on metabolic health, oxidative stress (OS), inflammation, and cardiovascular function. A search of Medline, PEDro, and EBSCO identified 2251 articles, with 159 studies published between 1999 and 2025 included after screening. Low-intensity exercise improved insulin sensitivity, reduced OS markers (e.g., MDA, 8-OHdG), and enhanced antioxidant enzyme activity. Moderate-intensity exercise showed similar benefits with notable reductions in inflammatory markers (e.g., IL-1β, TNF-α). HIIT promoted fat loss and improved metabolic markers but temporarily increased OS and inflammation. Dietary strategies also play a critical role. The Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diets are well established, emphasizing nutrient-dense foods like unsaturated fats and fiber to reduce inflammation and manage weight. The ketogenic diet (KD), a high-fat, low-carbohydrate approach, has recently gained attention for its metabolic benefits. KD induces ketosis, improving insulin sensitivity, reducing triglycerides, and enhancing fat oxidation. Studies show KD effectively reduces body weight and glucose levels, though long-term adherence and nutrient deficiencies remain challenges. Intermittent fasting also showed potential benefits, though effects on glucose metabolism were inconsistent. This review underscores the need for tailored approaches combining exercise, diet, and fasting to optimize MetS outcomes, offering integrative strategies for prevention and management.

Cultural and emotional intelligence correlates with healthy lifestyles

A healthy lifestyle is essential to prevent illness and live a happy life. Previous research has shown that social intelligence, such as emotional intelligence (EQ) and cultural intelligence (CQ), is related to a healthy lifestyle. However, there are fewer studies that clarify the relationship between CQ and lifestyle compared to EQ and lifestyle, and the relationship between the facets that make up these intelligences and lifestyle is also unclear. Therefore, in this study, we aimed to clarify the relationship between the eight facets of these intelligences and the seven lifestyles by multiple regression analysis and relative importance analysis. As a result, consistent with the Self-Regulated Learning (SRL) strategy theory, which is based on motivation and metacognition, it was shown that the two intelligences, Use of emotion EQ and Metacognitive CQ, were most broadly correlated with the five lifestyles, and Self-emotional appraisal EQ was also correlated with the two lifestyles. These results suggest that in today's globalized society, in addition to the intelligence required to understand and utilize one's own emotions, there is a need for intelligence to understand different cultures and to verify and correct the accuracy of knowledge about them.

Investigation of the mechanism of Buyang Huanwu decoction in improving learning and memory impairment in Alzheimer's disease mice based on lipidomics

In this study, a lipid disorder Alzheimer's disease (AD) model was developed with high-fat diet and D-galactose injected intraperitoneally (HFD & D-gal) to evaluate the activities of Buyang Huanwu Decoction (BYHWD) compared with donepezil hydrochloride. The learning and memory abilities of BYHWD were evaluated by Morris water maze test (MWM). The lipid levels in serum, histopathology, and immunohistochemistry of hyperphosphorylated tau protein in hippocampal neurons were conducted to prove the therapy effects of BYHWD. After the identification of constituents absorbed into the brain using LC-MS, UPLC-TQ-MS was employed to analyze endogenous lipid metabolites in the hippocampi of mice. Based on the validated differential markers identified through lipidomics analysis, we further substantiated potential therapeutic pathway of BYHWD through the application of molecular docking technology. The mechanism underlying BYHWD was subsequently confirmed by palmitic acid-injured HT22 cells. The results showed that BYHWD significantly improved the cognitive deficits and regulated the lipid levels of HFD & D-gal mice. BYHWD also protected the neuronal cell condition of hippocampal neurons, increased the density of dendritic spines, and reduced the expression of P-tau. Lipidomics revealed that 41 differential lipid metabolites were retuned after BYHWD administration, and this change may be related to the PPARγ pathway. Calycosin-7-glucoside showed good interaction with PPARγ in vivo composition analysis. Calycosin-7-glucoside increased the mRNA expression levels of lipid metabolism-related enzymes and PPARγ, as well as the expression of PPARγ protein in vitro study. BYHWD activated the PPARγ pathway to induce peroxisome proliferation and regulated lipid metabolism disorders in the AD mice brain.

Pasta, What a Feeling! A Multi-Method Study on the Relationship Between Pasta Consumption and Happiness

The relationship between food consumption and emotions is complex and influenced by a variety of factors. Pasta, a staple of the Mediterranean diet, has not been extensively studied in terms of its emotional impact on consumers. This study aims to evaluate the emotions associated with pasta consumption, examining whether pasta consumption increases happiness levels and identifying individual characteristics that predict these reactions. A multi-method approach was employed across two interconnected studies. Study 1 involved an online survey with a representative sample of 1532 Italians to assess explicit and implicit emotional associations with pasta. Study 2 monitored a subset of these participants (n = 83) over 2 weeks using ecological momentary assessment (EMA) to record emotions before and after meals, focusing on pasta consumption. Pasta consumption was consistently associated with positive emotions, particularly happiness, across different methods. Thematic analysis of open-ended responses highlighted associations with family gatherings, warmth, comfort, and Italian traditions. Quantitative analyses revealed significant correlations between pasta appreciation and lower stress, higher quality of life, and greater mindfulness. Implicit Association Tests indicated a strong positive bias towards pasta-related emotions. EMA data showed a significant positive effect of pasta consumption on happiness, especially when consumed in social settings. Pasta consumption is significantly linked to positive emotional experiences, particularly happiness, and is influenced by social and cultural contexts. These findings suggest that pasta can play a role in promoting psychological well-being and highlight the importance of considering the emotional and social dimensions of food consumption in both health promotion and marketing strategies.

Prevented fractions of cardiovascular disease cases, by long-term adherence to the Mediterranean diet; the ATTICA study (2002-2022)

BACKGROUND AND AIMS

Cardiovascular disease (CVD) and its related co-morbidities, i.e., type 2 diabetes mellitus (T2DM), hypertension and hypercholesterolemia, have an enormous burden on population health and healthcare systems. Mediterranean diet can reduce this burden; quantifying this reduction via the calculation of the Prevented Fraction for the Population (PFP) could offer positive-framed messages to encourage adherence to this healthful dietary pattern. Hence, the aim of this study was to calculate PFP of CVD, T2DM, hypertension, and hypercholesterolemia by long-term adherence to the Mediterranean type of diet, during a 20-year period, in a Mediterranean population.

METHODS AND RESULTS

The sample consisted of adult participants, initially free-of-CVD, from the ATTICA prospective cohort study (2002-2022). At all evaluations (2002, 2006, 2012, 2022), CVD, T2DM, hypertension, and hypercholesterolemia were assessed according to WHO-ICD-10, and Mediterranean diet adherence was assessed via MedDietScore. PFP by Mediterranean diet was computed for each outcome in different population groups. It was found that approximately 30 % of CVD, T2DM, hypertension and hypercholesterolemia cases were prevented due to the high long-term adherence to the Mediterranean diet. Concerning different population groups, it was observed that due to their decreased adherence and PFPs, male participants, older participants and participants with comorbidities might benefit more from following the Mediterranean diet during a long-term period.

CONCLUSION

The study findings suggest that future public health strategies should aim to make the Mediterranean diet a long-term lifestyle change rather than a short-term diet intervention, while shedding light on which population groups should be targeted first.

Optimal dietary patterns for healthy aging

As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35-1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71-2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01-2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.

Expatriates' Cultural Intelligence Mediates the Relationship Between Lifestyle and Performance: A Cross-Sectional Analysis and a Longitudinal Pilot Study

INTRODUCTION

Cultural intelligence (CQ) has been attracting increasing attention in recent years as a necessary caability for adapting to a different culture and improving expatriate performance (EP). However, the methods for improving this intelligence have not been fully elucidated, and in particular, the relationship with lifestyle (LS) has hardly been clarified.

METHODS

In this paper, we therefore conducted a cross-sectional analysis using questionnaire response data obtained from 184 Japanese expatriates working for Japanese subsidiaries overseas in Study 1, and in Study 2, we measured changes in 15 of them as an exploratory pilot study after using a smartphone app with health promotion functions for two weeks.

RESULTS

The results showed that CQ mediated the relationship between LS and EP in both Study 1 and Study 2.

CONCLUSION

The results of this study suggest that a health science approach that improves LS can be effective in improving the EP of businesspeople working in different cultural environments through improving their CQ.

Impact of Mediterranean Diet Adherence in Early Pregnancy on Nausea, Vomiting, and Constipation

OBJECTIVES

Common maternal digestive symptoms, such as nausea, vomiting, and constipation during pregnancy, can impair pregnant women's quality of life. The Mediterranean diet (MedDiet), characterized by a high consumption of olive oil, vegetables, fruits, legumes, and grains; moderate fish and dairy intake; and low meat consumption, could alleviate these symptoms. This study aims to study the prevalence of maternal digestive symptoms in the different pregnancy trimesters and to examine the association between baseline MedDiet adherence and the prevalence of maternal digestive symptoms during pregnancy.

METHODS

A secondary analysis of the Walking Preg_Project trial was conducted in a cohort of adult Spanish pregnant women (N = 237) who provided data about MedDiet adherence and maternal digestive symptoms (nausea, vomiting, constipation) at baseline (12th ), 19th, and 32nd Gestational Week (GW). MedDiet adherence was appraised through a 13-item questionnaire and categorized into low, medium, and high adherence. Digestive symptoms were assessed by the Pregnancy Symptoms Inventory. The association between baseline MedDiet adherence and maternal digestive symptoms was evaluated through adjusted multinomial analysis.

RESULTS

Differences among MedDiet adherence categories were considerable during pregnancy. Some of the greatest decreases were observed in high adherence to MedDiet in comparison with low MedDiet adherence at 32nd GW vs. 19th GW for the prevalence of nausea (10.0% vs. 18.8%, p < 0.001) and vomiting (5.0% vs. 8.7%, p < 0.001). Constipation remained during pregnancy. There was no significant association between the baseline MedDiet adherence and maternal gastrointestinal symptoms.

CONCLUSION FOR PRACTICE

Baseline adherence to the MedDiet was not proven to influence nausea, vomiting, and constipation during pregnancy. For all MedDiet adherence groups, nausea and vomiting prevalence decreased throughout pregnancy, but not constipation.

Cardiorespiratory Fitness in Spanish Youth: The Roles of Sex, Age, Body Composition, and Healthy Lifestyle Habits in Cor-School Study

Background/Objectives: Cardiorespiratory fitness (CRF) is a key indicator of current and future health in children and adolescents, and is influenced by both physiological and behavioral factors. This study examined the associations between CRF, body composition, and health-related habits in 685 children and adolescents (aged 8-16 years) who regularly participated in extracurricular sports programs in northeastern Spain. Methods: Participants underwent anthropometric assessments, completed a 20 m shuttle run test to evaluate CRF, and filled out validated questionnaires on physical activity levels, sleep quality, and adherence to the Mediterranean diet. Results: Significant sex differences were observed, with boys achieving higher CRF performance (p < 0.001), primarily associated with greater muscle mass (p < 0.001) and lower body fat percentage (p < 0.001). Age positively correlated with improved CRF (p < 0.001), whereas higher body mass index (p = 0.003) and fat mass (p = 0.020) negatively impacted fitness outcomes. Conclusions: These findings underscore the critical role of physical activity and optimal body composition in promoting cardiorespiratory fitness among youth, emphasizing the importance of targeted interventions to foster healthy behaviors from early childhood. Future research should adopt longitudinal designs to better elucidate the dynamic interactions between lifestyle factors, body composition, and physical fitness throughout childhood and adolescence.

From motivation to mediterranean diet intention and behavior: a combined self-determination theory and theory of planned behavior approach

OBJECTIVE

The Mediterranean diet (MD) is recognized as one of the healthiest and most sustainable dietary patterns worldwide. This study combines the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) alongside past MD adherence behavior to predict MD adherence among young and adult Italians.

METHODS AND MEASURES

Using a two-wave prospective design, 706 participants (Women = 60.5%, mean age = 31.82) completed measures of past behavior, SDT and TPB variables at baseline (T1) and reported their adherence behavior to MD two weeks later (T2).

RESULTS

Results revealed that both intention and past adherence to MD predicted actual adherence. In turn, affective attitude, descriptive norm, perceived behavioral control (PBC), and autonomous motivation were positively associated with intention. Past adherence further predicted autonomous motivation, affective attitude, and PBC, and indirectly influenced MD adherence at T2 through its effect on these factors and intention. Finally, invariance tests showed no differences between women and men and between student and non-student samples.

CONCLUSION

Overall, our findings support the integration of TPB and SDT, emphasizing the need for interventions that address both conscious decision-making and established dietary habits, acknowledging the multifaceted nature of dietary behavior change.

Association of adherence to Mediterranean diet and changes over time with all-cause mortality in older adults: the Seniors-ENRICA cohorts

BACKGROUND

Despite the well-recognized nutritional quality and health benefits of the Mediterranean diet (MD), its adherence appears to be declining. However, the extent of this decline and its relationship with mortality in the older population remains unclear.

OBJECTIVES

This study aims to analyze the associations between adherence to MD and its changes over time with all-cause mortality in older adults.

METHODS

We used data from 3518 and 3273 older adults, aged 60-96 y at baseline, participating in the Seniors-ENRICA-1 and 2 cohorts, respectively. Adherence to MD was assessed by the 14-item Mediterranean Diet Adherence Screener (MEDAS) and classified as low (<7 points), moderate (7-8 points), and high (≥9 points). All-cause mortality was ascertained up to 31 January, 2024. Analyses were performed using Cox regression models adjusted by main confounders.

RESULTS

Baseline [n = 6083; follow-up of 7.9 y; per 1-point: hazard ratio (HR) = 0.92; 95% confidence interval (CI): 0.89, 0.95] and changes (n = 2070; follow-up of 11.2 y; per 1-point increase: HR = 0.91; 95% CI: 0.86, 0.97) in MEDAS were associated with a lower mortality. At baseline, moderate (HR = 0.87; 95% CI: 0.77, 0.99) and high (HR = 0.70; 95% CI: 0.59, 0.82) adherence to MD were associated with lower mortality, compared with low adherence. In addition, participants who maintained high adherence to MD in both examinations had the lowest mortality compared with consistently low adherence (HR = 0.54; 95% CI: 0.38, 0.76). Baseline and maintained adherence in items of carbonated sweetened beverages (<1 serving/d), fish/seafood (≥3 servings/wk), commercial pastry (<2 servings/wk), and nuts (≥3 servings/wk) was associated with lower mortality.

CONCLUSIONS

Initial adherence to MD, as well as subsequent maintained or increased adherence, is associated with lower all-cause mortality in older adults, with some foods as the main drivers.

Efficacy of Mediterranean Diet vs. Low-FODMAP Diet in Patients With Nonconstipated Irritable Bowel Syndrome: A Pilot Randomized Controlled Trial

INTRODUCTION

Mediterranean diet (MD) has been proposed as a dietary therapy for irritable bowel syndrome (IBS) but its efficacy remains unclear. We compared the efficacy of MD to a diet low in fermentable oligo-, di-, monosaccharides, and polyols (LFD).

METHODS

In this pilot-feasibility, randomized controlled trial (RCT), adult patients with diarrhea-predominant IBS (IBS-D) or mixed bowel pattern (IBS-M) were randomized to MD versus LFD for 4 weeks. Meals were provided for both groups (ModifyHealth, GA). Daily variables included abdominal pain intensity (API) and bloating, while IBS symptom severity score (IBS-SSS) and IBS adequate relief (IBS-AR) were scored weekly. The primary endpoint was the proportion of patients with ≥ 30% decrease in API for ≥ 2/4 weeks.

RESULTS

Of 26 randomized patients, 20 finished the study (10 per group). Seventy-three percent of the MD group met the primary endpoint compared to 81.8% of the LFD group (p = 1.0). Although not statistically significant, a numerically higher proportion of the LFD group reported adequate relief and met the responder endpoint for IBS-SSS (50-point reduction) compared to the MD group (54.6% vs. 27.3% for IBS-AR and 81.8% vs. 45.5% for IBS-SSS, p = 0.39 and 0.18, respectively). The LFD group also had a significantly greater reduction in IBS-SSS score over the 4-week treatment period compared to the MD group (-105.5 vs. -60, p = 0.02).

CONCLUSION

MD provides symptom relief in IBS-D and IBS-M; however, the magnitude of relief was higher with the LFD. Larger diet comparison studies in real-world settings are needed before MD can be routinely recommended to IBS patients.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT05807919.

Nutritional Approaches in Autism Spectrum Disorder: A Scoping Review

PURPOSE OF REVIEW

This review was conducted to discuss the etiology of autism in the light of current information, to draw attention to the fact that defects in different biological mechanisms cause autism, and to examine the effectiveness of dietary interventions and supplements in relieving ASD symptoms.

RECENT FINDINGS

Autism spectrum disorder (ASD) is an extremely heterogeneous condition characterized by delays in reciprocal social interaction and communication skills, stereotyped behaviors, and a narrowed range of interests and limited activities. Comorbid conditions such as cognitive impairment, epilepsy, psychiatric diseases, and behavioral symptoms such as impaired social communication, repetitive behaviors, lack of interest in the environment, nutritional disorders, gastrointestinal diseases and abnormal (dysbiotic) states, sleep disorders, and dysmorphism are frequently encountered in individuals with ASD. Although nutrition is one of the environmental factors affecting ASD, it can also be effective in alleviating the behavioral and gastrointestinal symptoms of ASD. Various dietary models (GFCF diet, low glycemic index diet, ketogenic diet, specific carbohydrate diet, Mediterranean diet, GAPS, Feingold, Candida body ecology, allergy elimination diets, etc.) and supplements (vitamin D, polyunsaturated fatty acids, probiotics and prebiotics, phytochemicals) can be used to alleviate symptoms in individuals with ASD. The effectiveness and reliability of dietary interventions in individuals with ASD are a matter of significant debate, and the evidence for these practices is limited. Furthermore, there is no consensus on establishing an ideal nutritional model for individuals with ASD.

The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. This study aims to investigate the association between adherence to the Mediterranean Diet (Med-Diet) and the Prime Diet Quality Score (PDQS) and the risk of PCOS.

METHOD

This case-control study included 472 women aged 18-45, with 180 PCOS cases and 292 controls. PCOS diagnosis was based on the Rotterdam criteria. Dietary intake was assessed using a validated food frequency questionnaire, and adherence to the Med-Diet and PDQS was calculated. Statistical analyses included logistic regression to examine associations between diet quality and PCOS.

RESULTS

Higher adherence to both the Med-Diet and PDQS was significantly associated with lower odds of PCOS. Participants in the highest quartile of the Med-Diet score had a 41% reduced risk of PCOS in the crude model (OR = 0.59, 95% CI: 0.48-0.67) and a 32% reduced risk in the fully adjusted model (OR = 0.68, 95% CI: 0.57-0.79), after adjusting for potential confounders, including age, body mass index (BMI), physical activity, and total energy intake. Similarly, those in the highest PDQS quartile showed a 53% reduced risk in the crude model (OR = 0.47, 95% CI: 0.35-0.56) and a 43% reduced risk in the fully adjusted model (OR = 0.57, 95% CI: 0.44-0.68), accounting for the same confounders.

CONCLUSION

The findings suggest that higher adherence to the Med-Diet and PDQS is associated with a reduced risk of developing PCOS. Further research is warranted to explore the underlying biological mechanisms and to establish causality through prospective cohort studies and randomized controlled trials.

Sex-specific associations between diet quality and mortality in adults with diabetes: findings from NHANES 2001-2018

Objective

To investigate the impact of diet on cardiovascular (CV)/all-cause mortality among individuals with diabetes, and to explore whether this relationship changes by gender.

Methods

We collected data from the National Health and Nutrition Examination Survey (NHANES) database pertaining to 5,875 individuals with diabetes (3,068 males and 2,807 females) and used the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and the alternative Mediterranean Diet (aMED) index to assess diet quality. Multivariate Cox models were used to determine the association between dietary quality scores and CV/all-cause mortality, stratified by genders. Dose-response relationships were assessed using the Restricted Cubic Spline (RCS). As a secondary objective, a further analysis was conducted on the connection between CV/all-cause mortality and different dietary components.

Results

During a median 9.25-year follow-up period, we observed 1,488 all-cause deaths, including 486 CV deaths. Sex-stratified analyses revealed that higher diet quality, as indicated by each standard deviation increase in the score, was significantly associated with a reduced risk of cardiovascular mortality in males (p < 0.05). No significant associations were observed in females (p > 0.05). Among the component scores of the aMED, legume intake was unfavorable for males with diabetes but was remarkably associated with lower CV/all-cause mortality in females.

Conclusion

In the diabetic population, high dietary scores are significantly associated with lower CV/all-cause mortality in males but not in females.

Assessment of the Risk of Insulin Resistance in Workers Classified as Metabolically Healthy Obese

Introduction and Objectives: Obesity constitutes a significant public health concern and is frequently linked to metabolic dysfunctions, particularly insulin resistance (IR). Nevertheless, a subset of obese individuals, referred to as metabolically healthy obese (MHO), do not exhibit overt metabolic abnormalities. The present study aims to assess the risk of developing IR among MHO workers and to explore the determinants contributing to this risk. Methods: This cross-sectional investigation utilized data from a cohort of 68,884 obese workers across multiple occupational sectors in Spain. The classification of participants as MHO was based on the number of metabolic syndrome components, in accordance with the criteria established by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). Anthropometric, clinical, and biochemical parameters-including body mass index (BMI), waist circumference, lipid profile, glycemic levels, and blood pressure-were systematically assessed. The likelihood of developing IR was estimated through various validated risk assessment models. Results: The analysis indicates that, despite having a relatively favorable metabolic profile, individuals classified as MHO also show signs of metabolic deterioration, such as an increased risk of insulin resistance. Key risk factors such as physical inactivity, low adherence to the Mediterranean diet, and socioeconomic disparities were identified as significant contributors to the transition from the MHO phenotype to a metabolically unhealthy state. Logistic regression analyses corroborated that insufficient physical activity and suboptimal dietary habits were strongly associated with an elevated risk of IR. Conclusions: The findings underscore the dynamic and potentially transient nature of the MHO phenotype, emphasizing the necessity of proactive monitoring and early preventive strategies. Encouraging physical activity, promoting adherence to a nutritionally balanced diet, and implementing workplace health initiatives emerge as critical measures to attenuate the risk of IR and metabolic deterioration in MHO individuals. Future longitudinal studies are warranted to enhance risk stratification and to formulate tailored preventive interventions.

Gut Microbiota in Heart Failure-The Role of Inflammation

Heart failure (HF) has become an immense health concern affecting almost 1-2% of the population globally. It is a complex syndrome characterized by activation of the sympathetic nervous system and the Renin-Angiotensin-Aldosterone (RAAS) axis as well as endothelial dysfunction, oxidative stress, and inflammation. The recent literature points towards the interaction between the intestinal flora and the heart, also called the gut-heart axis. The human gastrointestinal tract is naturally inhabited by various microbes, which are distinct for each patient, regulating the functions of many organs. Alterations of the gut microbiome, a process called dysbiosis, may result in systemic diseases and have been associated with heart failure through inflammatory and autoimmune mechanisms. The disorder of intestinal permeability favors the translocation of microbes and many metabolites capable of inducing inflammation, thus further contributing to the deterioration of normal cardiac function. Besides diet modifications and exercise training, many studies have revealed possible gut microbiota targeted treatments for managing heart failure. The aim of this review is to demonstrate the impact of the inflammatory environment induced by the gut microbiome and its metabolites on heart failure and the elucidation of these novel therapeutic approaches.

Correlation of cognitive impairment with Mediterranean diet and mortality: a prospective cohort study

Background and aim

Long-term adherence to the Mediterranean Diet has been shown to improve cognitive function in patients. However, there is a lack of evidence regarding the impact of the Mediterranean diet and cognitive impairment on long-term mortality outcomes. This study aims to explore whether there is an interaction between the degree of adherence to the Mediterranean diet and cognitive impairment on long-term mortality outcomes.

Methods

The study included 2,520 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2014. The adherence to the Mediterranean diet was assessed using the 9-point alternative Mediterranean diet index (aMED index). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's disease (CERAD), the Animal Fluency Test (AFT), and the Digital Symbol Substitution Test (DSST). By accessing public records from the National Death Index (NDI), NHANES participants' information was linked to death certificate records to determine mortality and causes of death during the follow-up period, up to December 31, 2019, with causes specified according to ICD-10. Participants were categorized based on the median aMED score into low adherence (scores 0-3), moderate adherence (score 4), and high adherence (scores 5-9) groups. Cognitive impairment was assessed by calculating the arithmetic mean of standardized scores (Z-scores) for each cognitive test. Participants with scores below the first quartile of the arithmetic mean were considered to have cognitive impairment. Cox proportional hazards regression models were used to assess the relationship between cognitive impairment, aMED, and all-cause and cardiovascular mortality outcomes. Additionally, the interaction between cognitive impairment and aMED on these outcomes was evaluated.

Results

The study included 2,520 participants, with 481 deaths during the follow-up period, of which 129 (26.8%) were cardiovascular-related. The median aMED score in the population was 4, and 632 individuals (25.1%) were considered to have cognitive impairment. A higher aMED score was associated with a reduced risk of long-term all-cause mortality and cardiovascular-related mortality (HR, 0.65; 95% CI, 0.52-0.81, p < 0.001; HR, 0.73; 95% CI, 0.47-0.91, p = 0.039). Cognitive impairment was associated with an increased risk of long-term all-cause mortality and cardiovascular mortality (HR, 1.78; 95% CI, 1.46-2.18, p < 0.001; HR, 1.80; 95% CI, 1.22-2.64, p = 0.003). Individuals with both lower aMED scores and cognitive impairment had higher risks of all-cause and cardiovascular mortality. Subgroup analysis indicates that only in the cognitive impairment subgroup is a higher Mediterranean diet score associated with a reduced risk of cardiovascular mortality. There is an interaction between lower aMED scores and cognitive impairment in increasing cardiovascular-related mortality (p for interaction = 0.028).

Conclusion

There is an interaction between adherence to the Mediterranean diet and cognitive impairment concerning cardiovascular-related mortality, but not all-cause mortality. Among individuals with cognitive impairment, adherence to the Mediterranean diet has a more significant impact on cardiovascular-related mortality.

Planetary health diet, mediterranean diet and micronutrient intake adequacy in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

Our study aimed to investigate and compare the association between adherence to a priori Planetary Health Diet Index and two well-known Mediterranean indices, the Mediterranean Diet Score (MDS) and the Mediterranean Adherence Screener (MEDAS), and micronutrient intake adequacy.

METHODS

We assessed 18,259 Spanish university graduates at baseline who participated in the SUN cohort using a validated semi-quantitative food frequency questionnaire. Inadequate intake of Zn, I, Se, Fe, Ca, P, Mg, Cr, K, vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid was evaluated using the estimated average requirement (EAR) cut-point approach and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients.

RESULTS

Participants with higher adherence to the Planetary Health Diet had a lower risk of overall inadequacy, while the Mediterranean Diet (MedDiet) showed even greater nutritional adequacy. The adjusted Odds Ratio (OR) for failing to meet ≥ 3 EAR was 0·24 (95% CI 0·21 - 0·27) for the Planetary Health Diet Index, whereas it was substantially lower for MEDAS with OR = 0·12, 95% CI 0·11 - 0·13, and for MDS with OR = 0·09, 95% CI 0·08 - 0·10, always for the comparison of the fourth v. first quartile and using the probabilistic approach method.

CONCLUSION

In this Mediterranean cohort, better adherence to both the Planetary Health Diet and the MedDiet (with a stronger inverse association) showed lower risk of micronutrient inadequacy.

Sleep and the Mediterranean diet: A systematic review and meta-analysis

We conducted the current systematic review and meta-analysis to critically review and synthesize available evidence regarding the association between sleep duration, sleep quality, and chronotype with the Mediterranean diet (MedDiet) among the general population using observational studies. Online databases, including PubMed, Scopus, and ISI Web of Science, were searched from the earliest available date until December 2024. We enrolled 62 studies with a total sample size of 328,493. The mean age and BMI of the participants in the enrolled studies ranged from 6.1 to 74.7 years and 18.1-32.1 kg/m2. Individuals with sufficient sleep duration (OR: 1.39; 95 % CI, 1.04, 1.85; P = 0.030; I2 = 97.89 %, PQ-test < 0.001), good-quality sleep (OR: 1.38; 95 % CI, 1.10, 1.73; P < 0.001; I2 = 93.83 %, PQ-test < 0.001), and earlier chronotype (OR: 1.74; 95 % CI, 1.21, 2.50; P = 0.002; I2 = 89.72 %, PQ-test < 0.001) had significantly increased odds of high MedDiet scores, compared to those with insufficient sleep duration, poor-quality sleep, and later chronotype, respectively. Our study revealed that sleep duration, sleep quality, and chronotype are lifestyle-related factors linked to MedDiet. However, more longitudinal studies and clinical trials are needed to investigate causality, mediating factors, and underlying mechanisms.

Intervention design and adherence to Mediterranean diet in the Cardiovascular Risk Prevention with a Mediterranean Dietary Pattern Reduced in Saturated Fat (CADIMED) randomized trial

Effective interventions targeting modifiable cardiovascular disease (CVD) risk factors, such as diet, are urgently needed. The Cardiovascular Risk Prevention with a Mediterranean Dietary Pattern Reduced in Saturated Fat study hypothesizes that eliminating red and processed meat in the context of a Mediterranean diet (MD) will significantly modify circulating low-density lipoprotein cholesterol concentration and the fatty acid profile compared to general CVD prevention advice. Here we describe the intervention design and summarize baseline dietary intakes (mean ± standard deviation) related to MD adherence and red/processed meat intakes in a sample of 81 participants. The Cardiovascular Risk Prevention with a Mediterranean Dietary Pattern Reduced in Saturated Fat study is a two-arm, 8-week parallel randomized controlled intervention trial involving a final sample of 156 adults (≥18 years) with dyslipidemia (not undergoing pharmacological treatment) recruited from healthcare and community settings in Granada (Spain). The primary outcome will assess changes in circulating low-density lipoprotein cholesterol and the fatty acid profile, whilst secondary outcomes will measure changes in CVD-related metabolites/biomarkers, gut microbiome, diet/lifestyle, and intervention feasibility/acceptability. Preliminary findings indicate low MD adherence (Mediterranean Diet Adherence Screener score 7.6 ± 1.9), and high consumption of red and processed meat (1.04 ± 0.90) servings/d). These results underscore the need for targeted dietary interventions to address the growing burden of dyslipidemia and CVD. If successful, this intervention holds potential for scalability and significant impact on public health, dietary guidelines, and advancements in nutrition science by improving MD adherence and reducing CVD risk factors in adults with dyslipidemia.

Ecological impact and metabolic food waste of overweight and obese adults in Northern European and Mediterranean countries

Introduction

Overeating is one of the main drivers of obesity due to the accumulation of excess body fat (EBF). This issue not only impacts human health but also depletes the planet's environmental resources through the production of excess food. Thus, the Metabolic Food Waste (MFW) index was developed to measure the food wasted due to EBF accumulation, associated greenhouse gas (GHG) emissions, and the water and land resources used in its production.

Methods

The present study aims to evaluate and compare the MFW and ecological footprints of some Mediterranean countries (MC) and North European countries (NEC). The MFW for six Mediterranean and North European countries (NEC) was calculated using the following: (i) EBF: This is defined as the difference between ideal and actual body weight in overweight and obese adults, with data sourced from the FAOSTAT and WHO databases; (ii) Food waste: This includes the food wasted due to EBF accumulation and energy intake from major food categories. Data for food waste were obtained from the FAO Food Balance Sheets; and (iii) Environmental Impact: This encompasses GHG emissions, water consumption, and land use associated with EBF by different foods. Data were obtained from the WWF Virtual Shopping Cart and the Barilla Centre for Food and Nutrition. Data were analyzed for the total population and standardized per 100,000 citizens.

Results

The results showed that NEC had the highest rates of obesity, while MC recorded slightly higher rates of individuals classified as overweight. Overall, higher EBF values for 100,000 citizens, including both obese and overweight individuals, were found in NEC compared to MC, with smaller population countries predominantly contributing to these trends. Data on MFW and ecological footprints showed that, regardless of the country, the impact of obesity is two to three times greater than that of being overweight. The highest values of MFW and ecological footprints were found in MC, both in the total and among overweight/obese populations.

Discussion

The present study highlights the harmful role of the overeating as on human health as on the resource exploitations of the Earth. In particular, both MC and NEC showed similar alarming data about overeating and, consequently, negative impact on EBF and ecological footprints, suggesting that residence in countries close or far from Mediterranean basin is not a proxy of adherence to healthy dietary patterns. For this reason, informative campaigns should be developed to improve the knowledge on conscious dietary choices for human and planet healthiness.

Mitochondria at the Crossroads: Linking the Mediterranean Diet to Metabolic Health and Non-Pharmacological Approaches to NAFLD

Nonalcoholic fatty liver disease (NAFLD) is a growing global health concern that is closely linked to metabolic syndrome, yet no approved pharmacological treatment exists. The Mediterranean diet (MD) emerged as a first-line dietary intervention for NAFLD, offering metabolic and hepatoprotective benefits. Now conceptualized as a complex chemical matrix rich in bioactive compounds, the MD exerts antioxidant and anti-inflammatory effects, improving insulin sensitivity and lipid metabolism. Mitochondria play a central role in NAFLD pathophysiology, influencing energy metabolism, oxidative stress, and lipid homeostasis. Emerging evidence suggests that the MD's bioactive compounds enhance mitochondrial function by modulating oxidative phosphorylation, biogenesis, and mitophagy. However, most research has focused on individual compounds rather than the MD as a whole, leaving gaps in understanding its collective impact as a complex dietary pattern. This narrative review explores how the MD and its bioactive compounds influence mitochondrial health in NAFLD, highlighting key pathways such as mitochondrial substrate control, dynamics, and energy efficiency. A literature search was conducted to identify relevant studies on the MD, mitochondria, and NAFLD. While the search was promising, our understanding remains incomplete, particularly when current knowledge is limited by the lack of mechanistic and comprehensive studies on the MD's holistic impact. Future research integrating cutting-edge experimental approaches is needed to elucidate the intricate diet-mitochondria interactions. A deeper understanding of how the MD influences mitochondrial health in NAFLD is essential for developing precision-targeted nutritional strategies that can effectively prevent and manage the disease.

Bibliometric analysis and description of research trends on nutritional management in Alzheimer's disease patients (1988-2024)

Background

Alzheimer's disease (AD) is a severe neurodegenerative disorder. Nutritional management has been recognized as a potential therapeutic approach to mitigate AD progression. This study aimed to analyze the bibliometric characteristics and research trends of publications on nutritional management in AD.

Methods

A systematic search was conducted on the Web of Science Core Collection database to identify publications related to nutritional management in AD from 1988 to 2024. Bibliometric analysis was performed using VOSviewers (V 1.6.20), CiteSpace (V 6.3.R1) and R 4.3.3.

Results

A total of 554 publications from 311 countries led by the USA were identified. The number of publications has increased annually. The most cited article discussed the role of diet in providing antioxidants to combat oxidative stress in neurodegenerative diseases. The University of California system published the most articles, and Rush University had the most international collaborations. These publications came from 3,298 authors, among which Mattson MP had the highest total publications and citations. The Journal of Alzheimer's Disease published the most articles and received the most citations. Keywords analysis revealed evolving trends, with early emphasis on "precursor protein" and later shifts to "dietary restriction," and more recently, "insulin resistance" and "synaptic plasticity." Emerging keywords include "obesity," "cognitive impairment" and "association."

Conclusion

This study represents the first summary of research trends in AD nutritional management. Future research is likely to focus on the associations between nutrition, insulin resistance, synaptic plasticity, and cognitive impairment in AD patients. This information provides valuable insights for scholars and practitioners in the field.

Adherence to the Mediterranean Diet Among Families from Four Countries in the Mediterranean Basin

Background/Objectives: The cultural and socioeconomic changes to which societies are exposed can alter individuals' lifestyles and dietary habits. The nutritional patterns of Mediterranean countries may also be affected by these factors at varying levels, depending on the changing social characteristics of the countries. This study aimed to determine Mediterranean diet (MedDiet) adherence among family members from four Mediterranean countries (Türkiye, Spain, Italy, and Lebanon). Methods: The survey was structured around sociodemographic data, family relationships, the Mediterranean diet adherence screener (MEDAS), the Mediterranean lifestyle index (MEDLIFE), the Mediterranean diet quality index (KIDMED), and the obstacles and drivers of MedDiet adherence. Results: The data were obtained from adults (n = 812), with the contribution of their children (n = 500) if they had any. According to the MEDAS, 22% of the adults strongly adhered to the MedDiet. Similar results were obtained when Mediterranean lifestyle adherence was analyzed using the MEDLIFE score, with 20% of the adults presenting a strong adherence, while significantly stronger adherence was found in Lebanon than in the other countries. Regarding the children and adolescents, around 30% presented strong adherence to the MedDiet. Price, availability, and accessibility were significant obstacles, whereas the perceptions of health and diet quality were identified as the drivers of the MedDiet. Conclusions: Overall, our results highlight the need for national policies to reduce the economic burden of healthy food options while encouraging equitable access to re-popularize the MedDiet pattern. Future research should focus on intervention strategies tailored to different age groups and socioeconomic backgrounds, the long-term impact of family-based strategies, and the cultural influences on MedDiet adherence.

The annual feasibility and affordability of a healthy diet for families with children in Israel by income quintile and geographic area of residency

BACKGROUND

Dietary guidelines for families with children are designed to meet the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear.

METHODS

The age distribution and the number of children per household by income quintile and geographic area in Israel in 2018 were obtained from the Central Bureau of Statistics. Food cost information was purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children (by age group) was calculated using standard food portions and meal frequency and expressed as a percentage of the households net income. The proportion of households for which food expenditures exceeded 15% of the net income was calculated, followed by changes in food prices during 2018.

RESULTS

The average daily cost of a healthy diet for an average Israeli family was 35.5 ± 7.7 New Israeli shekels (equivalent to $9.7 ± $2.11). For households with children, the median monthly cost of the recommended diet, as a percentage of net household income was 20%. There was an inverse association with socioeconomic status, as the median monthly food expenses for the first (lowest) quintile were 55% of the household's net income and only 9.3% of the 5th (highest) income quintile. By geographic residential area, the median percentage of the net income from monthly dietary costs was 23%. The highest costs were in Judea, Samaria, and Jerusalem. Lunch made up 47% of food expenditures, if theoretically omitted, diet expenditures for households with children would decrease by an average of 15%. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%).

CONCLUSION

This theoretical calculation shows that two-thirds of the households with children in Israel could not purchase the recommended diet in 2018, with significant disparities according to socioeconomic status. Policymakers should consider steps to decrease health inequality in food affordability, targeting the three middle-lower income quintiles. Our findings suggest the need to expand the provision of school lunches. Further research is required to examine how changes in household food costs influence consumers' food choices and the potential health implications of the high expenses identified in this study.

The Role of Recreational Physical Activity in Adherence to the Mediterranean Diet in the Greek Population: Public Health and Sustainability Implications

The Mediterranean diet (MedDiet) is renowned for its health benefits and cultural significance in Mediterranean populations. The present study investigates the question of whether individuals who participate in recreational activities exhibit higher adherence to the MedDiet than those who do not engage in such activities. A cross-sectional survey was conducted with participants completing questionnaires assessing demographic characteristics, MedDiet adherence, and dietary habits. A total of 1055 participants of both sexes with an average age of 32.2 ± 10.1 years participated in the survey, and they were classified based on their engagement in recreational physical activity. Statistical analyses included independent samples t-tests, chi-squared tests, analysis of variance (ANOVA), and multiple regression analysis. The results demonstrated that physically active individuals exhibited significantly higher adherence to the MedDiet than non-exercisers (p < 0.001), supporting the hypothesis that exercise is associated with healthier dietary choices. Regression analysis further revealed that exercise, olive oil consumption, and family meals were significant predictors of MedDiet adherence. Additionally, group comparisons highlighted differences in BMI (p < 0.001), meal frequency (p < 0.001), and food preparation habits (p < 0.001), indicating that exercisers were more likely to adopt a holistic Mediterranean lifestyle. These findings emphasize the importance of integrating physical activity with dietary education in public health policies. Promoting an active lifestyle alongside MedDiet principles may enhance overall well-being and contribute to sustainable health strategies.

A Pilot Study on Ad Libitum Mediterranean Diet Intervention for Women with PCOS: A Mixed-Methods Exploration of Acceptability, Adherence, and Participant Lived Experience

Background/Objectives: A healthy diet is essential for managing Polycystic Ovary Syndrome (PCOS), yet optimal recommendations remain unclear, highlighting the need to explore alternative lifestyle interventions. The Mediterranean diet (MedDiet) supports cardiometabolic health; however, challenges with adherence within this population are unknown. This study examines the acceptability and experiences of an ad libitum MedDiet in women with PCOS, offering recommendations for implementation. Methods: A 12-week MedDiet intervention was conducted with women aged 18-45 years, diagnosed with PCOS and a BMI ≥ 25 kg/m2 (n = 12). Adherence was assessed using the Mediterranean Diet Adherence Screener. Surveys and semi-structured interviews, guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model, explored participants' experiences. Thematic analysis identified barriers and facilitators, which were mapped to the COM-B and Theoretical Domains Framework (TDF), with all findings subsequently aligned with the Behaviour Change Wheel to inform implementation strategies. Results: MedDiet adherence significantly improved from baseline to week 12 (Baseline: 4.1 ± 1.8; week 12: 8.3 ± 2.3; p = 0.001), alongside increases in knowledge (p = 0.004), cooking confidence (p = 0.01), and time management (p = 0.01). Adherence factors were mapped to 12 of the 14 TDF domains. Key facilitators included health benefits, reduced weight pressure, educational resources, and simple guidelines. Barriers involved organisation, food availability, and external influences. Effective implementation should integrate MedDiet education, behaviour change support, practical resources, and professional training for nutrition professionals and healthcare providers to support referrals and weight-neutral dietary management. Conclusions: A short-term ad libitum MedDiet is acceptable for women with PCOS. Strategies for patients and healthcare providers, aligned with the intervention functions of education, training, and enablement, are key to supporting adherence.

Relationship between adherence to the mediterranean food pattern and food self-efficacy of higher education students in Portugal: A cross-sectional study

When students begin their academic life, they are subject to psychological, environmental, and economic changes, which may have implications for their dietary habits. This study aims to assess the relationship between adherence to the Mediterranean food pattern (MFP), nutritional status, and food self-efficacy among a sample of higher education students in Portugal. This cross-sectional study was conducted between May and June 2023, through an online questionnaire. A total of 114 students from public and private higher education participated in this study, predominantly female (68.7%) with a median age of 23 (20; 27) years. It was found that higher body mass index (BMI), older age (p > 0.003; r: 0.273), and greater adherence to the MFP were associated with higher food self-efficacy (p > 0.003; r: 0.273). No correlations were found between the other variables. When feeling stressed, students tend to consume more sweets, fast food, and fewer fruits and vegetables. Based on the correlations between BMI, adherence to the MFP, perceived stress, and food self-efficacy, it can be concluded that higher BMI, older age, and greater adherence to the MFP are associated with higher food self-efficacy. These results can be explored for future dietary interventions in this population group.

The Two Dimensions of Nutrition for the Planet: Environment and Health

PURPOSE OF REVIEW

Protecting the planet is protecting the future. Food production systems are among the most important human activities threatening planetary health. Diet, food systems, the environment, and health are interconnected. Accordingly, this review aims to assess the effects of nutrition on the planet and the relationship between some types of diets defined as sustainable and the planet and human health.

RECENT FINDINGS

Many diets have been proposed to protect the planet and human health, but there is no consensus on which diet is best. It should not be forgotten that planetary health diets, plant-based diets, and vegetarian/vegan diets can reduce environmental pressure. Still, they cannot have the same effect in every country, and these diets may have different effects depending on the differences in the countries' income level, nutritional culture, and food systems. Moreover, it should not be overlooked that these diets may cause difficulties in terms of adaptation, cause deficiencies in some nutrients, and may not be suitable for all segments of society. Sustainable diets such as the Mediterranean and New Nordic, as well as Dietary Approaches to Stop Hypertension, are more flexible and acceptable. Instead of a globally recommended reference diet to protect the planet and human health, each country can analyze its food systems and choose the most appropriate food production methods and sustainable diet style to reduce environmental burden, improve health, and create policies accordingly, which can help achieve sustainable goals faster.

Eating Disorder Risk Among Adolescents: The Influence of Dietary Patterns, Physical Activity, and BMI

BACKGROUND/OBJECTIVES

Eating disorders (EDs) are rising among adolescents. BMI, diet, and physical activity influence ED risk, but their interactions are complex and vary by population. Considering sociocultural changes, this study investigated the prevalence and risk factors for EDs in Romanian adolescents. We evaluated demographic factors, BMI, dietary behaviors, physical activity (PA), and previous specialist consultations using the Eating Attitudes Test-26 (EAT-26) and assessed the psychometric properties of the EAT-26 in this population.

METHODS

A cross-sectional study included 423 youths aged 13 to 20 from Cluj-Napoca. Participants completed an online survey on demographics, BMI, diet, physical activity, and previous health consultations. ED risk was assessed using the EAT-26. Confirmatory and exploratory factor analyses were conducted on the EAT-26, and binary logistic regression identified predictors of ED risk.

RESULTS

The prevalence of ED risk was 26.5%, with females having 1.61 times higher odds than males. Consulting a weight or mental health specialist increased the odds of increased ED risk (OR = 3.76). Higher BMI showed a trend in the unadjusted model (OR = 1.06). An initial CFA of the EAT-26 showed a suboptimal fit. Over 60% of the sample reported frequent consumption of ultra-processed foods.

CONCLUSIONS

Our findings highlight a significant ED risk in Romanian youth, filling a critical gap in regional public health evidence. Despite limitations due to the cross-sectional design and self-reported data, the results stress the need for measures promoting balanced diets, positive body image, and improved mental health access to reduce the growing prevalence of adolescent ED risk in Romania.

Role of gut microbiota in thalassemia: a review of therapeutic prospects

In recent years, the study of gut microbiota has gradually become a research hotspot in the field of medicine, as gut microbiota dysbiosis is closely related to various diseases. Thalassemia, as a hereditary hemoglobinopathy, has a complex pathophysiological mechanism, and traditional treatment methods show limited efficacy. With a deeper understanding of the gut microbiome, researchers have begun to focus on its role in the pathogenesis of thalassemia and its therapeutic effects. This article aims to review the role of gut microbiota in thalassemia and its potential therapeutic prospects, analyze the latest research findings, and explore the impact and mechanisms of gut microbiota on patients with thalassemia, with the goal of providing new ideas and directions for future research and clinical treatment of thalassemia.

State-of-the-Art and Future Challenges for Nutritional Interventions in Facioscapulohumeral Dystrophy: A Narrative Review

Facioscapulohumeral dystrophy (FSHD), the second most common inherited muscular dystrophy in adulthood, is characterized by progressive muscle loss, accompanied by an increase in fat mass. Beyond these alterations in body composition, which contribute to the risk of sarcopenic obesity, FSHD is associated with systemic inflammation and oxidative stress. These interconnected mechanisms may worsen muscle atrophy, leading to a decline in physical efficiency and quality of life. While the therapeutic benefits of physical therapy and exercise have been investigated, the impact of dietary interventions remains underexplored. Given the established role of nutrition in managing various chronic diseases, there is growing interest in understanding how it might influence the clinical management of FSHD. By addressing current gaps in the literature, this review aims to investigate the potential role of dietary patterns and specific nutrients in modulating muscle metabolism within the context of FSHD. Some studies have indicated various compounds (flavonoids, curcumin, L-carnitine, coenzyme Q10, and omega-3), vitamins (C and E), and minerals (zinc and selenium) with antioxidant and anti-inflammatory properties as promising treatment strategies for FSHD. Instead, few data regarding the effects of proteins and creatine supplementation are available. Furthermore, the potential benefits of essentials amino acids, β-hydroxy-β-methylbutyrate, and vitamin D in contrasting muscle atrophy and enhancing muscle function remain unexplored. Despite these preliminary findings, the existing body of evidence is limited. Identifying novel therapeutic strategies to complement existing treatments could provide a more comprehensive management framework, aimed at improving the long-term health outcomes and quality of life of FSHD patients.

Cancers attributable to diet in Italy

Cancer burden can be reduced by controlling modifiable risk factors, including diet. We provided an evidence-based assessment of cancer cases and deaths attributable to diet in Italy in 2020. We considered dietary factor-cancer type pairs for which the World Cancer Research Fund/American Institute for Cancer Research - Continuous Update Project reported either 'convincing' or 'probable' evidence of causal association. Relative risks were retrieved from recent meta-analyses and dietary intakes (around 2005) from a national food consumption survey. Sex-specific population attributable fractions (PAFs) were computed by comparing the distribution of dietary intakes in the Italian population against counterfactual scenarios based on dietary recommendations. Using data from national cancer and mortality registries in 2020, we estimated the number of attributable cancer cases and deaths, assuming ~15-year lag period. Unhealthy diet accounted for 6.3% (95% CI: 2.5%-9.9%) of all cancer cases in men and 4.5% (95% CI: 1.7%-7.4%) in women. PAFs of colorectal cancer were 10.5% and 7.0% for any intake of processed meat, 3.3% and 2.0% for high red meat, 4.8% and 4.3% for low dairy products, and 7.9% and 9.0% for low fiber intakes in men and women, respectively. PAFs for low intake of non-starchy vegetables and fruit ranged from 0.8% to 16.5% in men and 0.6%-17.8% in women for cancers of the aerodigestive tract. The estimated cancer burden associated with unfavorable dietary habits in Italy is considerable, but appears lower than for other high-income countries, reflecting the typically Mediterranean diet.

Weight Reduction with GLP-1 Agonists and Paths for Discontinuation While Maintaining Weight Loss

Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.

Evaluating adherence of hospital meals to Mediterranean diet: the case of a developing country

This study aimed to assess the nutritional composition of meals served to and consumed by patients in Lebanese hospitals and to evaluate the extent to which these meals adhere to Mediterranean diet guidelines. Conducted between April 2023 and September 2023, this cross-sectional study involved 155 in-patients from various departments across 16 hospitals in Lebanon. Food quantities served were measured, and nutritional analysis was performed to evaluate the nutritional content of meals provided and eaten by patients. On average, served meals weighed 1.24 kg (SD: 0.43), providing an average of 1489 kcal energy (SD: 546.55) and 72 g of protein per hospital bed per day. These meals typically met 79% of a patient's daily estimated energy requirement (EER). On the other hand, patients consumed an average of 0.85 kg of food, providing 1084.3 kcal energy (57.3% of EER) and 50 g of protein per day. The most served food group in hospitals was the 'grains and cereals' group. Compared to the Mediterranean diet, our results showed that hospitals exceeded the recommended servings for dairy and meat products, while they served less than the recommended amounts from the vegetables, fruits, legumes. Patients did not meet their daily requirements for almost all the macro- and micro-nutrients. This study highlights the importance of public health policies, interventions, and food service management strategies to ensure patients receive adequate diets aligned with their nutritional needs.

Health and environmental dietary impact: Planetary health diet vs. Mediterranean diet. A nationwide cohort in Spain

BACKGROUND

Plant-based diets, such as the Planetary Health Diet (PHDI) and the Mediterranean Diet (Med), offer notable advantages for human and planetary health. However, knowledge on the PHDI's benefits is limited, particularly in Southern European countries where the Med is culturally rooted and is an environmentally sustainable dietary pattern.

OBJECTIVE

to evaluate the association of both PHDI and Med with mortality and assess their environmental burden in the adult population of Spain.

METHODS

Data were taken from the study on Nutrition and Cardiovascular Risk in Spain (ENRICA) comprising 13,105 participants representative of the Spanish adult population. The PHDI score (0-140 points) was based on 15 food groups, while adherence to Med was assessed with the 14-item MEDAS score (0-14 points). Environmental impact was assessed using the SHARP-ID database (including greenhouse gas emissions and land use). Analyses were performed with Cox regression and adjusted for main confounders.

RESULTS

During a mean 14.4-year follow-up, 1157 all-cause deaths occurred. The mortality hazard ratio (95 % CI) for the highest vs lowest tertile of the PHDI score was 0.78 (0.66, 0.91) but reached a plateau level at 90 points of PHDI. For the MEDAS, the corresponding results for the highest vs lowest tertile was 0.79 (0.68, 0.93) with a continuous inverse dose-response association. Adherence to some components of the PHDI (fruits, dairy, and unsaturated oils) and of MEDAS (nuts, and low consumption of soda and pastries) was independently and significantly associated with lower mortality. Results remained robust in sensitivity analyses. In terms of environmental impact, both plant-based diets had similar low footprints, with dairy and meat products being the largest contributors.

CONCLUSION

In this large cohort of Spanish adults, higher adherence to the PHDI and MEDAS was similarly associated with lower all-cause mortality and showed comparable low environmental impact.

Dietary patterns in Tanzania's transitioning rural and urban areas

BACKGROUND

Like other Sub-Saharan Africa (SSA) countries, Tanzania is undergoing socio-economic changes that impact lifestyles and dietary choices. Traditionally, differences in dietary habits between rural and urban areas in Tanzania and other SSA countries were prominent. However, recent research indicates converging lifestyles and dietary choices associated with increased risk of cardiometabolic diseases. The objective of the current study was hence to investigate differences and similarities in dietary patterns, energy, and food groups intake in urban and rural Tanzania.

METHODS

Dietary habits were assessed by use of a Food Frequency Questionnaire (FFQ) for 442 respondents aged 44-65 years in urban (Ubungo -Dar es Salaam) and rural (Kilindi- Tanga) districts of Tanzania. Dietary patterns were determined using Principal Components Analysis (PCA). Bivariate analyses identified determinants of dietary patterns in urban and rural Tanzania.

RESULTS

Two dietary patterns, a "mixed pattern" characterized by whole grains, potatoes, fruits, vegetables, meat, fried potatoes and tubers, alcohol, sugar-sweetened beverages (SSB), sugar and sweets, and added oils and a "plant-rich pattern" characterized by whole grains, fruits, pulses and peas, seasoning vegetables and salads, SSB, sugar and sweets, and added oils were identified. Urban residents contributed more to the mixed pattern, while rural residents had a higher contribution to the plant-rich pattern. Overall, dietary diversity was greater in urban than rural Tanzania. The estimated median daily energy intake was 2,902 kcal (IQR: 1449.2) with a lower energy intake in rural (2,817 kcal, IQR: 1,274) as compared to urban residents (3,052 kcal, IQR: 1558) (p = 0.021). The percent contribution to the median average daily energy intake for grains, fruits, and milk was higher in rural than urban participants. No differences were observed for meat, poultry and eggs.

CONCLUSION

We identified two distinct dietary patterns: a "mixed pattern" prominent in urban and a "plant-rich pattern" more common in rural. Urban diets were more diverse with slightly higher energy intake. These findings underscore the effects of urbanization on diets and the need for targeted nutritional intervention for both rural and urban populations.

Personalizing product sets to individual health priorities increases the healthfulness of hypothetical food choices in US adults

Recently, the potential for dietary personalization based on genetic/phenotypic characteristics to improve health has been studied. While promising, inputs into this biology-focused personalization process are intensive and may not align with an individual's own health priorities, which drive health behaviors. Here, we examine how personalizing food suggestions based on individuals' health priorities affects the healthiness of their food choices. We conducted a pre-registered experiment examining hypothetical food choices from three food categories in six conditions: (1) control, (2) health priority prime, (3) healthy product subset, (4) health priority prime + healthy product subset, (5) health priority prime + priority subset, and (6) health priority-based personalized product suggestions. Participants in conditions 2, 4, 5, and 6 first encountered a question asking them to select their top health priority from a list of options. In conditions 5, the subset of healthy items was described as foods beneficial for the selected health priority, while in condition 6, participants immediately saw the set of foods beneficial for the selected health priority, but had the option to see all foods instead. After making food choices, participants completed a survey with questions about the choice process, health priorities, and demographic variables. We used logistic regression to analyze the impact of condition on healthiness of food choices, and ordered logistic regression to examine the impact of condition on satisfaction with choices made. The experiment and survey were completed by 4171 adults (≥ 19 years) in the US, with the sample closely matching US distribution of age, sex, education, and income characteristics. There were no significant differences in the distribution of demographic characteristics among conditions. All intervention conditions significantly increased the likelihood that an individual chose a healthy food. However, interventions that combined priming with healthy subsets were significantly more effective than single interventions. Conditions that connected the healthy subsets to individuals' health priorities were particularly effective. The adjusted odds ratio (aOR) of selecting a healthy food was 4.77 (95% CI 4.12, 5.52) relative to the control condition when participants could view a subset described as helpful for their health priority. When people immediately viewed the personalized product set, the aOR increased to 11.67 (95% CI 0.1, 13,5). Likewise, analysis of nutrient content from food choices revealed that personalization decreased saturated fat, added sugar, and sodium and increased dietary fiber, potassium, iron, and calcium. However, product choice satisfaction was significantly lower in the personalized product set, which appears to be partially due to a tendency in this condition to forego choosing a product rather than selecting an unhealthy product. Personalization of product options based on individual health priorities should be tested in real-choice environments.

Eating distractions as predictors of ultra-processed food consumption and Mediterranean diet adherence in adolescents

Previous studies have examined the relationships between some eating distractions and diet quality in the young population. However, to our knowledge, no study has analyzed the associations between multiple eating distractions (e.g., using a mobile phone, watching television [TV], eating while standing) and diet quality, particularly in terms of ultra-processed food (UPF) consumption and adherence to the Mediterranean diet (MedDiet) among adolescents. The objective of the current study was to analyze the relationships of eating distractions with UPF consumption and adherence to the MedDiet in a sample of Spanish adolescents. This cross-sectional study used data from 826 adolescents aged 12-17 years from the Eating Healthy and Daily Life Activities study in Spain. The following eating distractions were assessed via a self-report questionnaire: "(1) eating while talking on the phone/sending short message service [SMS]/emails or using social networks", (2) watching TV while dinner, and (3) eating while standing". The Mediterranean Diet Quality Index for children and adolescents (KIDMED) was utilized to evaluate adherence to the MedDiet. A self-administered food frequency questionnaire, previously validated for the Spanish population, was used to assess UPF consumption. The associations of eating distractions with UPF consumption and MedDiet adherence were analyzed via generalized linear models. The models were adjusted for sex, age, socioeconomic status, body mass index, physical activity, sedentary behavior, and sleep duration. A significant association was found, with a higher eating distraction score corresponding to greater UPF consumption (unstandardized beta coefficient [B] = 71.25; 95% confidence interval [CI] 34.69-107.82; p < 0.001). Furthermore, a higher eating distraction score was associated with a lower KIDMED score (B - 0.29; 95% CI - 0.39 to - 0.18; p < 0.001). Individually, for grams of UPFs consumed, a significant association was observed for eating while using a phone or social network, which was linked to higher UPF consumption (B = 120.70; 95% CI 57.83-183.57; p < 0.001). However, the associations for eating while watching TV (B = 49.60; 95% CI - 9.01 to 108.21; p = 0.098) and eating while standing (B = 63.66; 95% CI - 37.92 to 165.25; p = 0.220) did not reach statistical significance. For KIDMED score, all the eating distractions were associated with a significant decrease, with the largest effect observed for phone or social network use (B = - 0.44; 95% CI - 0.62 to - 0.26). Watching TV (B = - 0.18; 95% CI - 0.35 to - 0.01; p = 0.037) and eating while standing (B = - 0.42; 95% CI - 0.71 to - 0.13; p = 0.004) also showed significant negative associations. Although diet quality is influenced by multiple factors, eating distractions may negatively impact adolescents by increasing UPF consumption and reducing adherence to the MedDiet. These findings underscore the importance of understanding the role of the eating environment in shaping healthy dietary habits.