Adherence to Mediterranean diet and health status: meta-analysis

Immune checkpoint inhibitors in cancer patients with autoimmune disease: Safety and efficacy

The utilization of immune-checkpoint inhibitors (ICIs) in cancer immunotherapy frequently leads to the occurrence of immune-related adverse events (irAEs), making it generally not recommended for patients with preexisting autoimmune diseases. Hence, we conducted a meta-analysis on safety and efficacy of ICIs in cancer patients with preexisting autoimmune diseases to provide further insights. PubMed, EMBASE, and Cochrane Library were systematically searched until December 20, 2024. The main summary measures used were pooled rate and risk ratio (RR) with 95% confidential interval (CI), which were analyzed using R statistic software. A total of 52 articles were included in the study. When cancer patients with preexisting autoimmune diseases received ICIs treatment, the overall incidence was 0.610 (95% CI: 0.531-0.686) for any grade irAEs, 0.295 (95% CI: 0.248-0.343) for flares, 0.325 (95% CI: 0.258-0.396) for de novo irAEs, 0.238 (95% CI: 0.174-0.309) for grade ≥3 irAEs, and 0.143 (95% CI: 0.109-0.180) for discontinuation due to immunotoxicity. Compared with those without autoimmune diseases, cancer patients with autoimmune diseases experienced a higher risk of any-grade irAEs (RR: 1.23, 95% CI: 1.12-1.35) and discontinuation due to immunotoxicity (1.40, 95% CI: 1.11-1.78). However, no statistically significant differences were observed in the incidence of grade ≥3 irAEs, objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) between the two groups. During ICIs treatment, irAEs are common among cancer patients with autoimmune diseases, but severe irAEs is relatively low. ICIs are effective in this population, but should be strictly monitored when used to avoid immunotoxicity.

Microbiota-centered interventions to boost immune checkpoint blockade therapies

Immune checkpoint blockade therapies have markedly advanced cancer treatment by invigorating antitumor immunity and extending patient survival. However, therapeutic resistance and immune-related toxicities remain major concerns. Emerging evidence indicates that microbial dysbiosis diminishes therapeutic response rates, while a diverse gut ecology and key beneficial taxa correlate with improved treatment outcomes. Therefore, there is a growing understanding that manipulating the gut microbiota could boost therapy efficacy. This review examines burgeoning methods that target the gut microbiome to optimize therapy and innovative diagnostic tools to detect dysbiosis, and highlights challenges that remain to be addressed in the field.

Association of diet quality scores with risk of metabolic-associated fatty liver disease in Iranian population: a nested case-control study

Background and aim

A healthy diet has been recommended for non-alcoholic fatty liver disease (NAFLD). We aim to investigate the associations of diet quality indices with the risk of developingmetabolic-associated fatty liver disease (MAFLD).

Methods

We conducted this nested case-control study by recruiting 968 cases with MAFLD and 964 controls from the participants of the baseline phase of the Sabzevar Persian Cohort Study (SPCS). MAFLD was defined as having a fatty liver index ≥ 60 plus at least one of the following: overweight or obese, Type II diabetes mellitus, or evidence of metabolic dysregulation. Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) were calculated from a validated food frequency questionnaire. We estimated the associations of HEI-2015 and AHEI-2010 with MAFLD risk using multivariable logistic regression.

Results

Among those in the highest relative to the lowest quintile of HEI-2015 and AHEI-2010, the multivariable-adjusted odds ratios (OR) were 0.45 (95% CI [confidence interval] 0.29-0.69; P trend = 0.002) and 0.55 (95% CI 0.35-0.85; P trend = 0.04), respectively.

Conclusion

The results of our study suggest that there is a significant associationbetween adherence to a healthy diet, indicated by a higher score of HEI or AHEI, and a reduced likelihood of developingMAFLD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01544-x.

Healthy dietary patterns in relation to cognitive performance and Alzheimer's disease mortality

BACKGROUND

Dietary factors play a major role in cognitive aging, but few studies have assessed and compared the associations between specific dietary patterns and Alzheimer's disease (AD) mortality.

METHODS

We included 27,773 U.S. participants (mean age = 59.8 years, 51.4 % female) from the National Health and Nutrition Examination Survey (NHANES) between 1998 and 2016, with follow-up for AD mortality until December 2019. Five dietary pattern scores were calculated utilizing one (1999-2002) or two repeated (2003-2016) 24hr dietary recalls, including the Healthy Eating Index (HEI-2015), the healthful plant-based diet index (hPDI), the alternate Mediterranean diet (aMED), the Dietary Approach to Stop Hypertension diet (DASH), and the Mediterranean-DASH Intervention for Neurodegeneration Delay diet (MIND) scores. We utilized Cox proportional hazard models to evaluate the associations of these dietary pattern scores with AD mortality.

RESULTS

A total of 260 AD deaths occurred during a median follow-up of 9.8 years. Higher aMED score was associated with a lower risk of AD mortality (HRT3vs T1: 0.72, 95 % CI, 0.52-1.00, p-trend = 0.041). In a sub-sample of 2,713 participants in NHANES 2011-2014, 432 individuals had prevalent psychometric mild cognitive impairment (p-MCI). Higher aMED, MIND, HEI-2015, and hPDI were associated with lower odds of p-MCI. The potential contributors to these associations included higher intake levels of vegetables and nuts, moderate alcohol consumption, and lower intake level of sweets.

CONCLUSIONS

The Mediterranean dietary pattern was associated with more favorable cognitive outcomes among middle-aged and older adults, underscoring the importance of a healthy diet for long-term benefits in cognitive and brain health.

Fish consumption and gastric cancer within the Stomach cancer Pooling (StoP) Project

Gastric cancer is among the most common cancer and cause of cancer death. We conducted a meta-analysis of 25 case-control studies from the Stomach cancer Pooling Project to assess the association between fish or canned fish consumption and the risk of gastric cancer. 10,431 cases and 24,903 controls were available. We found no association between fish consumption and risk of gastric cancer (pooled odds ratios (OR) = 0.99; 95% confidence interval (CI) 0.86-1.13, for at least one serving/week vs none). Geographical differences were found: in Asia an increased intake of fish was associated with a lower stomach cancer risk. In the sensitivity analyses, fish consumption was associated to a lower risk of gastric cancer in models adjusted for family history of gastric cancer (OR = 0.80, 95% CI 0.72-0.89) and Helicobacter Pylori infection (OR = 0.72, 95% CI 0.60-0.88), but not for body mass index or energy intake. Seven studies collected information on canned fish (4525 cases and 8073 controls). No association was found for canned fish (OR = 0.96, 95% CI 0.82-1.13). In conclusion, our results provide evidence that fish and canned fish intake are not associated with gastric cancer risk, although geographical differences have been highlighted, with a lower risk of gastric cancer in Asia.

Impact of Mediterranean diet on mortality in vertebral compression fracture patients

BACKGROUND

Vertebral compression fractures (VCF) is a common fragility fracture with high mortality worldwide. The management and prevention of VCF start with a proper nutrition. The Mediterranean diet (MD) is rich in balanced nutrients and has been shown to be beneficial for several chronic diseases. However, the association of adherence to Mediterranean diet (aMED) and prognosis of VCF patients remains unclear.

PURPOSES

To explore the association between aMED and all-cause and cardiovascular disease (CVD)-cause morality in VCF patients.

METHODS

In present study, patients aged ≥ 40 years old and with the VCF patients measurement were extracted from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) was used to diagnose VCF. We used the weighted univariable Cox proportional hazards model to screen the covariates related to the prognosis of VCF patients. We utilized the weighted multivariable Cox proportional hazards models to explore the association between aMED and the risk of mortality in VCF patients, and were described as hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different complications were further assessed the association.

RESULTS

A total of 2,730 eligible VCF patients were included. Until 12 December 2019, 218 (7.99%) deaths were documented. After adjusting for all VCFs, we found a high risk of all-cause mortality (HR = 1.75, 95%CI: 1.13-2.73, P = 0.041) and CVD-cause mortality (HR = 2.35, 95%CI: 1.12-4.91, P = 0.038); however, we found no significant association between aMED and all-cause mortality or CVD-cause mortality (all P > 0.05). Compared to patients without VCF and with aMED score ≥ 6, patients with VCF and aMED score < 6 has a higher risk of all-cause (HR = 2.27, 95%CI: 1.25-4.13, P = 0.025) and CVD-cause mortality (HR = 4.25, 95%CI: 1.64-11.06, P = 0.013). Our study also suggested that compared to patients with aMED ≥ 6, those patients with aMED < 6 has high all-cause (HR = 2.26, 95%CI: 1.22-4.17, P = 0.002) and CVD-cause mortality (HR = 3.31, 95%CI: 1.28-8.57, P = 0.018), this results suggested that aMED may have a moderating effect on the association of VCF and mortality. Subgroups analysis shown this moderating effect remain robust, especially in patients with dyslipidemia (HR: 2.49, 95%CI: 1.29-4.80, P = 0.009), CVD (HR: 3.48, 95%CI: 1.56-7.74, P < 0.001) and CKD (HR: 3.64, 95%CI: 1.50-8.78, P < 0.001).

CONCLUSION

We found aMED have a moderating effect on the association between VCF patients and mortality. Our research further supports the importance of the MD as a potentially healthy eating pattern.

Association between dietary inflammatory index and cardiovascular-kidney-metabolic syndrome risk: a cross-sectional study

BACKGROUND

Dietary inflammation has been linked to various diseases. The dietary inflammatory index (DII) is a tool used to assess the inflammatory potential of a diet. The aim of this study was to explore the relationship between the DII and the risk of developing cardiovascular-kidney-metabolic syndrome (CKMS) in a U.S.

POPULATION

METHODS

Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020, which included 24,071 participants, were analyzed. CKMS was defined as the coexistence of cardiometabolic syndrome (CMS) and chronic kidney disease (CKD). The DII was calculated on the basis of the anti-inflammatory and pro-inflammatory scores of foods and nutrients. Weighted multivariable logistic regression models were used to estimate the associations between the DII and the risk of developing CKMS. Restricted cubic spline (RCS) regression was conducted to test nonlinear relationships. Subgroup analyses were performed by sex, age, race, smoking status, and alcohol consumption status.

RESULTS

After adjusting for confounders, compared with those of the lowest quartile of the DII, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for higher DII quartiles were 1.17 (0.93-1.47), 1.43 (1.13-1.81), and 1.76 (1.42-2.18), respectively. Each one-unit increase in the DII was associated with a 12% greater risk of developing CKMS (OR: 1.12, 95% CI: [1.08, 1.18]). RCS regression indicated a significant nonlinear positive association between the DII and the risk of developing CKMS.

CONCLUSIONS

This study revealed a nonlinear positive association between the DII and the risk of developing CKMS in the U.S.

POPULATION

Further longitudinal studies are needed to establish causality and explore the underlying biological mechanisms involved.

Adherence to the Mediterranean diet and allergic diseases in Korean adults: KNHANES 2013-2016

Background

The prevalence of allergic diseases [e.g., asthma, allergic rhinitis (AR), atopic dermatitis (AD)] has increased significantly in recent years, which is coincides with a shift in modern eating habits. The Mediterranean diet, due to its anti-inflammatory properties, may be beneficial in the prevention of allergic diseases. However, its effects on allergic diseases have not been sufficiently studied. We investigated the relationship between adherence to the Mediterranean diet and allergic diseases.

Methods

This study analyzed the relationship between adherence to the Mediterranean diet (using the modified Mediterranean diet score, mMED) and atopic dermatitis, asthma, and allergic rhinitis in 12,080 participants using data from the 2013-2016 Korean National Health and Nutrition Examination Survey (KNHANES). Multiple logistic regression analyses were used to control for confounding factors such as age, gender, education level, income, and lifestyle.

Results

In multivariable adjusted models, participants with higher mMED had a significantly lower risk of developing AD (OR 0.57; 95% CI, 0.36-0.92; p trend = 0.0201). When stratified by sex, this risk reduction was more significant in females (OR 0.50; 95% CI, 0.27-0.96; p trend <0.05). Across mMED components, fish and peanut intake were negatively associated with the occurrence of AD and AR (OR 0.55; 95% CI, 0.40-0.76; p trend <0.05, OR 0.75; 95% CI, 0.65-0.87; p trend <0.05). There was no significant association between asthma and AR and mMED scores.

Conclusion

High adherence to the Mediterranean diet is associated with a lower prevalence of atopic dermatitis, especially in women. Fish and peanut intake have an important protective role against atopic diseases.

Diet Quality Indices, All-Cause Mortality, Cardiovascular Disease, and Dementia-Outcomes from the Australian Longitudinal Study on Women's Health

BACKGROUND

Cardiovascular disease (CVD) and dementia are the leading causes of death for Australian women. Diet is a modifiable risk factor; however, extent of risk reduction by type of diet is unclear.

OBJECTIVES

This study aimed to evaluate the relationship between indices of diet quality: Australian Recommended Food Score (ARFS), Mediterranean diet food score (MDFS), and cluster analysis, with all-cause mortality, CVD, and dementia in women. A secondary aim was to investigate the influence of socioeconomic status (SES) on the relationship.

METHODS

In total, 9584 participants from the Australian Longitudinal Study on Women's Health (ALSWH) 1946-1951 cohort, with diet information from Food Frequency Questionnaires in 2001 and outcomes assessed at 2020. Five food clusters were identified using the K-means approach. Cox models were used to obtain hazard ratios (HRs) and 95% CIs for all-cause mortality, CVD and dementia according to quarters of the ARFS and MDFS and by food group clusters, with final models adjusted for health status, behaviors and SES.

RESULTS

There were 656 deaths, 1585 incidents of CVD and 165 dementia diagnoses during 17.2 years of follow-up. For all-cause mortality, HRs comparing the highest (best) to lowest quarter of diet quality were 0.60 (95% CI: 0.46, 0.78; P < 0.001) for the ARFS, 0.64 (95% CI: 0.47, 0.87; P = 0.005) for the MDFS, and 0.67 (95% CI: 0.47, 0.95; P = 0.02) when comparing a diet higher in protein intake and lower milk/yogurt intake to diets higher in discretionary foods and lower in fruit and vegetables. There were no associations between diet indices with CVD and dementia outcomes or influence of SES on findings.

CONCLUSIONS

Better quality diets were associated with a lower risk of all-cause mortality, and there were no associations identified between diet and CVD or dementia outcomes. These findings provide insights into the potential benefits of improving diet quality of Australian women to improve longevity.

Exploring Determinants of Adherence to the Mediterranean Diet Among Adults in Lebanon During the Economic Crisis: A Qualitative Study

INTRODUCTION

Adherence to MD is declining in its native region, posing public health concerns. To improve adherence, it is important to understand its determinants. Deriving from socio-ecological models (SEM), determinants may include socio-demographic, environmental and behavioural factors. Lebanon is a Mediterranean country that faces serious challenges due to an ongoing economic crisis, which may affect MD adherence and its determinants. The aim of this study is, therefore, to explore the determinants influencing adherence to the MD in Lebanon, as well as the impact of the economic crisis on these factors.

METHODS

This study employed a qualitative approach consisting of individual face-to-face interviews. A purposive sample of 25 generally healthy adults from different regions in Lebanon was recruited. Data collection started with a brief questionnaire to collect background socio-demographic information, followed by assessing MD adherence using the Mediterranean Diet Adherence Screener. Next, participants were interviewed using a semi-structured interview guide, focusing on barriers and enablers to adhering to the MD.

RESULTS

Participants maintained a moderate adherence to MD with many reporting improving or sustaining healthy eating habits. Because of the economic crisis, the consumption of local produce became more prevalent due to import shortages, aligning with MD recommendations. Determinants included individual attitudes beliefs, particularly concerns about the quality and trustworthiness of food products during the economic crisis, and environmental factors like the unavailability of imported foods. Convenience and proximity were prioritized over cost in food purchases.

CONCLUSION

Despite economic constraints, many participants prioritized diet quality. People shifted to traditional, healthy diets. Emphasizing tradition, food availability, accessibility and affordability could be crucial for interventions.

Clinical Assessment of Altered Eating Behaviors in People with Obesity Using the EBA-O Questionnaire

Background/Objectives: Over the past decade, numerous studies have explored the bidirectional relationship between obesity and mental health, mainly eating disorders (EDs). This study aimed to assess the prevalence and characteristics of altered eating behaviors (AEBs) in a cohort of people with obesity (PwO) using the validated Eating Behaviors Assessment for Obesity (EBA-O). Methods: We conducted a cross-sectional study from May 2023 to April 2024, recruiting consecutive PwO seeking weight loss. Participants completed the 18-item EBA-O questionnaire, which focuses on five primary eating behaviors: night eating, food addiction, sweet eating, hyperphagia, and binge eating. Unlike other validated tools, the EBA-O is specifically designed to capture these behaviors in PwO and is easy for patients to self-administer. We also collected sociodemographic and clinical data. Results: A total of 127 participants were included (76 women, median age 52 years, median BMI 42.9 kg/m2). We found a significant prevalence of AEBs: 33.1% for sweet eating, 23.6% for hyperphagia, 15.7% for food addiction, 14.2% for binge eating, and 7.1% for night eating. The EBA-O scores correlated positively with BMI (r = 0.201, p = 0.024) and increased across BMI categories (p = 0.001). Males had higher scores for night eating and hyperphagia (p = 0.01), and active smokers had higher hyperphagia scores (p = 0.043) than ex-smokers and non-smokers. The night eating scores were inversely correlated with sleep hours (r = -0.197, p = 0.026), and food addiction was positively correlated with age (r = 0.261, p = 0.003); conversely, hyperphagia (r = -0.198, p = 0.025) and binge eating (r = -0.229, p = 0.010) were inversely correlated with age. PwO without diabetes had higher scores for food addiction (p = 0.01) and binge eating (p = 0.004) compared to those with diabetes. Conclusions: These results highlight the potential to characterize PwO based on their AEBs, offering new opportunities to tailor treatment strategies for PwO by targeting specific eating behaviors.

A Single Lesson on Dietary Education Improves Dietary Knowledge in Adults with Type 2 Diabetes: A Real-Life Monocentric Italian Study

Background. It is unclear if dietary education may increase adherence to the Mediterranean diet (MD). Study aim. We estimated the effect of dietary counseling on nutritional knowledge and adherence to MD in T2D adult patients. Methods. T2D patients who attended the Diabetology Center of the Grande Ospedale Metropolitano Niguarda were recruited (April to September 2019) and categorized into two groups: the intervention group (IG), receiving a 2.5-h education, and the control group (CG). The Moynihan questionnaire and the Mediterranean Diet Adherence Assessment Questionnaire (MDAAQ) were administered to estimate the overall knowledge and adherence to MD at baseline (T0), 1 week (T1), and 1 month (T2) later. Results. Seventy-two individuals (69.5 ± 8.6 years old) were included in the IG, and 52 (67.7 ± 9.2 years old) were included in the CG. All patients had sufficient dietary knowledge and intermediate adherence to MD at baseline. Those assigned to the IG showed a significant reduction in the Moynihan score from T0 (24.9 ± 2.6) to T1 (20.3 ± 1.8; p < 0.001) and T2 (20.4 ± 2.2; p < 0.001). CG had the same Moynihan score as IG individuals at T0 (24.8 ± 1.8), but their dietary knowledge was unchanged at T1 and T2 (24.9 ± 1.8). MD adherence was similar at each time in the IG, with a MDAAQ score of 4.4 ± 1.7 (T0), 5.1 ± 1.7 (T1), and 5.3 ± 1.8 (T2), and in the CG (T0: 5.1 ± 1.7; T1: 5 ± 1.5; T2: 5.1 ± 1.5). Discussion and Conclusions. The 2.5-h dietary counseling session improves dietary knowledge, but it is not enough to improve adherence to MD.

Fruit and Vegetable Consumption and Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

Controversy exists regarding the association between fruit and vegetable consumption and all-cause and cause-specific mortality among individuals with type 2 diabetes (T2D).

OBJECTIVE

This study aims to inform dietary recommendations and add to the body of evidence by providing a thorough investigation of the association between the consumption of fruits and vegetables and the mortality risk in patients with T2D. The literature on this association was evaluated by a comprehensive systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, and Web of Science were searched up to 29 June 2024.

DATA EXTRACTION

Prospective cohort studies involving participants with diabetes aged over 18 years reporting risk estimates for the association between total fruit and vegetable intake and all-cause or cause-specific mortality (including cardiovascular disease [CVD], coronary heart disease, and stroke) were included.

DATA ANALYSIS

A random-effects approach was applied for combining risk estimates, and dose-response relationships were assessed using restricted cubic splines. Overall, 9 studies with 75 082 participants and 7590 deaths were included. Compared with the lowest intake, the highest fruit intake was associated with a decreased risk of all-cause (hazard ratio [HR]: 0.82; 95% CI: 0.75, 0.90; n = 6) and CVD (HR: 0.90; 95% CI: 0.84, 0.97; n = 4) mortality. The highest vegetable intake was also related to reduced all-cause (HR: 0.85; 95% CI: 0.73, 0.98; n = 6) and CVD (HR: 0.97; 95% CI: 0.94, 0.99; n = 2) mortality risk. An additional 200 g/day of fruit and vegetable consumption was associated with a 26% and 14% lower risk of all-cause mortality.

CONCLUSION

This meta-analysis indicates an inverse association between fruit and vegetable intake and mortality from all causes and CVD in T2D patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024571094.

Contributions of Dietary Patterns and Factors to Regulation of Rheumatoid Disease

Rheumatoid arthritis (RA) is a systemic autoimmune disease that commonly causes pain in joints and the progressive destruction of cartilage and bone, which significantly reduces the quality of life and increases the social burden. However, there is still no cure for RA, so it is highly important to explore additional adjuvant treatment methods. Studies have indicated that malnutrition, changes in intestinal microbiota, and changes in immune status caused by dietary imbalance are directly related to the onset of RA, indicating that dietary intervention may offer a simple, economical, and practical avenue to relieve RA. Therefore, in this review, we discuss the pathogenesis of RA and summarize the influence of different dietary patterns on RA. In particular, we pointed out that high-fat, high-sugar, and high-salt diets contribute to RA progression, whereas the Mediterranean diet (MD) is beneficial for preventing RA. Furthermore, the ingredients of food, such as dietary fiber, probiotics, and vitamins, help reduce the level of inflammation and relieve joint pain, which may play critical roles in the treatment of RA. Therefore, dietary intervention provides a potential effective approach for adjuvant therapy of RA.

Association between improved erectile function and dietary patterns: a systematic review and meta-analysis

ABSTRACT

Erectile dysfunction (ED) is prevalent among men, but its relationship with dietary habits is uncertain. The aim of our study was to assess whether dietary patterns enhance erectile function by reviewing the literature published before August 1, 2022, via PubMed, Web of Science, and EMBASE databases. The data compiled included author details; publication dates, countries, treatments, patient numbers, ages, follow-ups, and clinical trial outcomes, such as ED cases, odds ratios (ORs), confidence intervals (CIs), and International Index of Erectile Function-5 (IIEF-5) scores with means and standard deviations. An analysis of 14 studies with 27 389 participants revealed that plant-based diets (OR = 0.71, 95% CI: 0.66-0.75; P < 0.00001), low-fat diets (OR = 0.27, 95% CI: 0.13-0.53; P = 0.0002), and alternative diets such as intermittent fasting and organic diets (OR = 0.54, 95% CI: 0.36-0.80; P = 0.002) significantly reduced ED risk. High-protein low-fat diets (hazard ratio [HR] = 1.38, 95% CI: 1.12-1.64; P < 0.00001) and high-carb low-fat diets (HR = 0.79, 95% CI: 0.55-1.04; P < 0.00001) improved IIEF-5 scores. Combined diet and exercise interventions decreased the likelihood of ED (OR = 0.49, 95% CI: 0.28-0.85; P = 0.01) and increased the IIEF-5 score (OR = 3.40, 95% CI: 1.69-5.11; P < 0.0001). Diets abundant in fruits and vegetables (OR = 0.97, 95% CI: 0.96-0.98; P < 0.00001) and nuts (OR = 0.54, 95% CI: 0.37-0.80; P = 0.002) were also correlated with lower ED risk. Our meta-analysis underscores a strong dietary-ED association, suggesting that low-fat/Mediterranean diets rich in produce and nuts could benefit ED management.

Association between Mediterranean diet and metabolic syndrome: analysis of NHANES 2007-2020

Changing poor dietary habits is effective for treating metabolic syndrome (MetS). Despite the global reputation of the Mediterranean diet (MD) for health, research on its link to MetS is limited, especially in non-Mediterranean regions. This study aimed to investigate the relationship between the MD and MetS. Data from the 2007 to 2020 NHANES were analysed using multiple logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis. Among 20,991 participants, a negative association between Mediterranean diet score (MDS) and MetS prevalence was observed. RCS regression indicated a linear relationship. Subgroup analysis revealed a significant negative association in most groups, except those with high school education, other Hispanics, and non-Hispanic blacks. In the American population, greater adherence to the Mediterranean diet is associated with a reduced risk of metabolic syndrome, emphasising its protective effects and relevance in public health strategies. Future research should focus on promoting its adoption and investigating causal mechanisms and the impact of specific dietary components through longitudinal studies.

Mediterranean diet: Why a new pyramid? An updated representation of the traditional Mediterranean diet by the Italian Society of Human Nutrition (SINU)

In recent decades, an increasing body of research has highlighted significant scientific evidence linking adherence to the Mediterranean diet with a reduced risk of chronic diseases. Simultaneously, concerns about the environmental impact of the food system have intensified, particularly considering projected population growth in the coming years. This work introduces a new graphical representation of the traditional Mediterranean dietary model, developed by a dedicated Working Group of the Italian Society of Human Nutrition (SINU). This new model emphasizes plant-based foods, including fruits, vegetables, whole grains, legumes, and extra-virgin olive oil, at its foundation, reflecting their historical and scientific significance in the Mediterranean diet. Animal products, particularly red and processed meats, are de-emphasized, with dairy, white meats, and eggs recommended for moderate, weekly consumption. The pyramid also advocates limiting added sugars, salt, and alcohol to address their links with chronic diseases. Sustainability principles are woven into the framework, prioritizing local, seasonal, and minimally processed foods while discouraging food waste. The pyramid aligns with global recommendations from FAO and WHO, offering a comprehensive guide to adopting a healthy, sustainable dietary lifestyle while preserving cultural traditions and addressing contemporary nutritional and environmental challenges.

Exploring the Cardiovascular Benefits of Extra Virgin Olive Oil: Insights into Mechanisms and Therapeutic Potential

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, driven by complex interactions among genetic, environmental, and lifestyle factors, with diet playing a pivotal role. Extra Virgin Olive Oil (EVOO), a cornerstone of the Mediterranean diet (MedDiet), is a plant-based fat that has garnered attention for its robust cardiovascular benefits, which are attributed to its unique composition of monounsaturated fatty acids (MUFAs), particularly oleic acid (OA); and bioactive polyphenols, such as Hydroxytyrosol (HT) and oleocanthal. These compounds collectively exert antioxidant, anti-inflammatory, vasodilatory, and lipid-modulating effects. Numerous clinical and preclinical studies have demonstrated that EVOO's properties reduce major modifiable cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and type 2 diabetes. EVOO also promotes endothelial function by increasing nitric oxide (NO) bioavailability, thus favoring vasodilation, lowering blood pressure (BP), and supporting vascular integrity. Furthermore, it modulates biomarkers of cardiovascular health, such as C-reactive protein, low-density lipoprotein (LDL) cholesterol, and NT-proBNP, aligning with improved hemostatic balance and reduced arterial vulnerability. Emerging evidence highlights its interaction with gut microbiota, further augmenting its cardioprotective effects. This review synthesizes current evidence, elucidating EVOO's multifaceted mechanisms of action and therapeutic potential. Future directions emphasize the need for advanced extraction techniques, nutraceutical formulations, and personalized dietary recommendations to maximize its health benefits. EVOO represents a valuable addition to dietary strategies aimed at reducing the global burden of cardiovascular diseases.

Targeting Ferroptosis in Parkinson's: Repurposing Diabetes Drugs as a Promising Treatment

This review explores the promising potential of repurposing type 2 diabetes (T2D) medications for the treatment of Parkinson's disease (PD), highlighting the shared pathophysiological mechanisms between these two age-related conditions, such as oxidative stress, mitochondrial dysfunction, and ferroptosis. The overlap suggests that existing diabetes drugs could target the common pathways involved in both conditions. Specifically, the review discusses how T2D medications, including metformin (Met), peroxisome-proliferator-activated receptor gamma (PPAR-γ) agonists, sodium-glucose cotransporter-2 (SGLT2) inhibitors, incretins, and dipeptidyl-peptidase 4 (DPP-4) inhibitors, can improve mitochondrial function, reduce neuroinflammation and oxidative stress, and potentially inhibit ferroptosis. The connection between ferroptosis and existing treatments, including diabetes medication, are only beginning to be explored. The limited data can be attributed also to the complexity of mechanisms involved in ferroptosis and Parkinson's disease and to the fact that the specific role of ferroptosis in Parkinson's disease pathogenesis has not been a primary focus until recent. Despite the promising preclinical evidence, clinical findings are mixed, underscoring the need for further research to elucidate these drugs' roles in neurodegeneration. Repurposing existing diabetes medications that have well-established safety profiles for Parkinson's disease treatment could significantly reduce the time and cost associated with drug development and could offer a more comprehensive approach to managing Parkinson's disease compared to treatments targeting a single mechanism.

Changes in Sexual Functioning in Women with Severe Obesity After Bariatric Surgery: Impact of Postoperative Adherence to Mediterranean Diet

BACKGROUND

This study analyzes the effects of bariatric surgery on female sexual function, assessed using the Female Sexual Function Index (FSFI), and explores the impact of adherence to the Mediterranean diet during the postoperative period.

PATIENTS AND METHODS

A retrospective observational study was conducted using a prospectively collected database, including heterosexual women with morbid obesity undergoing bariatric procedures. The FSFI questionnaire was applied before the intervention and 24 months after surgery. Adherence to the Mediterranean diet was evaluated using the PREDIMED questionnaire.

RESULTS

Among the 240 participants, 70.8% presented preoperative sexual dysfunction, which decreased to 20.5% two years post-surgery. Significant improvements were observed in all FSFI domains except for pain. Good adherence to the Mediterranean diet was associated with higher scores in the lubrication, orgasm, and satisfaction domains.

CONCLUSIONS

Bariatric surgery significantly improves female sexual function, with the Mediterranean diet enhancing these benefits during the postoperative period. Future studies must investigate additional variables such as psychological factors, physical activity, and other lifestyle changes that may also influence sexual function.

A plant-based diet index and all-cause and cause-specific mortality: a prospective study

Background: A plant-based dietary pattern has been recently suggested to have health benefits. However, its relationship with mortality is not completely consistent in prior studies. We aimed to investigate whether a plant-based diet was associated with a lower death risk in a Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening study. Methods: We included 91 414 participants from the PLCO study. Dietary data were collected using a diet history questionnaire (DHQ). We used three plant-based diet indices including an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model. Results: During a median of 17.1 years of follow-up, we documented 19 456 deaths, including 5489 deaths from cardiovascular disease (CVD) and 6172 deaths from cancer. Comparing the highest versus lowest quintiles of the PDI, the multivariable-adjusted HR of all-cause mortality was 0.83 (95% CI 0.80-0.87, P for trend < 0.001). Those in the highest quintile of the PDI also had lower risks of CVD mortality (HR 0.87, 95% CI 0.80-0.95, P for trend < 0.001) and cancer mortality (HR 0.89, 95% CI 0.82-0.96, P for trend = 0.003) compared to those in the lowest quintile. Participants in the highest quintile of the hPDI had a decreased risk of all-cause and cause-specific mortality, whereas participants with the highest uPDI scores had an increased death risk. Conclusion: Greater adherence to a plant-based dietary pattern was significantly associated with lower all-cause and cause-specific mortality.

Dietary influence on cancer progression: Gut health and genomic profiles

This scholarly review comprehensively examines the connection between dietary habits, gut health, cancer prognosis, and genomic profiles. It emphasizes the crucial role of gut microbiota in mediating genomic changes and oncogenic processes through metabolic derivatives.It advocatеs for pеrsonalizеd nutrition stratеgiеs based on individual microbiomе and gеnomic profilеs and proposеs that customized diеtary intеrvеntions could play a crucial rolе in cancеr prеvеntion thеrapy. Thе article highlights thе influеncе of spеcific nutriеnts and such as diеtary fibеr and polyphеnols found in cеrtain foods and dеmonstrating thеir potеntial to altеr gеnе еxprеssions associatеd with inflammation and tumorigеnеsis. Thе rеviеw citеs rеcеnt studiеs that support thе idеa that diеtary modifications can influеncе gеnе rеgulation and thеrеby potеntially altеring cancеr progrеssion. Nevertheless, it calls for morе rigorous rеsеarch including longitudinal and randomizеd studies, to substantiatе thе еvidеncе nеcеssary for developing diеtary guidеlinеs tailorеd for cancеr patiеnts. Thе rеviеw еmphasizеs thе nееd for a multidisciplinary approach and highlight thе importancе of collaboration across thе fiеlds of nutrition gеnomics microbiology and oncology to improve cancеr trеatmеnts and patiеnt quality of lifе. It posits thе rеviеw as a cornеrstonе for a divеrsе audiеncе within thе scientific and mеdical communitimphasizing thе nеcеssity for ongoing rеsеarch in nutritional gеnomics which it dеpicts as a fiеld full of opportunitiеs to transform cancеr carе.

Use of special diets in Brazil: II National Food Survey, 2017-2018

This study aims to estimate the prevalence of special diets and analyze the sociodemographic profile, nutritional status, and eating habits of the Brazilian population that uses special diets. This cross-sectional study was conducted with data from the second 2017/2018 National Food Survey (n=45,689 individuals aged at least 10 years). We questioned the use of hypertension, diabetes, cholesterol, heart disease, and weight-loss diets. Dieting prevalence was estimated by sociodemographic characteristics and nutritional status, and logistic regression models were employed to assess factors associated with dieting. All analyses considered sample design and expansion factors. The prevalence of special diets was 14.3%. Weight-loss (5.2%) and hypertension (4.6%) diets were the most prevalent. Women, older adults, individuals with higher incomes, and obese individuals were more likely to follow any type of special diet than their peers.

Pasta: Is It an Unhealthy Refined Food?

Pasta is a low glycemic index food, an essential part of the Mediterranean diet, and is a good source of fiber. Pasta is generally made from durum wheat semolina, which comprises coarse endosperm with largely structurally intact cell walls (that is, dietary fiber), unlike finely milled wheat flour that contains fragmented endosperm cells. Yet, pasta is considered a refined carbohydrate food and classified under "unhealthy plant-based diets" despite the health benefits and lack of negative effects observed in epidemiological and clinical trial data. There is, therefore, a need to redefine dietary carbohydrates, because the current terminology is no longer sufficient to understand their structural complexity or to fully define all positive attributes.

The Role of Genetic, Environmental, and Dietary Factors in Alzheimer's Disease: A Narrative Review

Alzheimer's disease (AD) is one of the most common and severe forms of dementia and neurodegenerative disease. As life expectancy increases in line with developments in medicine, the elderly population is projected to increase in the next few decades; therefore, an increase in the prevalence of some diseases, such as AD, is also expected. As a result, until a radical treatment becomes available, AD is expected to be more frequently recorded as one of the top causes of death worldwide. Given the current lack of a cure for AD, and the only treatments available being ones that alleviate major symptoms, the identification of contributing factors that influence disease incidence is crucial. In this context, genetic and/or epigenetic factors, mainly environmental, disease-related, dietary, or combinations/interactions of these factors, are assessed. In this review, we conducted a literature search focusing on environmental factors such as air pollution, toxic elements, pesticides, and infectious agents, as well as dietary factors including various diets, vitamin D deficiency, social factors (e.g., tobacco and alcohol use), and variables that are affected by both environmental and genetic factors, such as dietary behavior and gut microbiota. We also evaluated studies on the beneficial effects of antibiotics and diets, such as the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) and Mediterranean diets.

Psychological-Emotional Aspect and Lifestyle in Professional Males Rugby Athletes

BACKGROUND

Recent research emphasizes the importance of integrating psychological-emotional factors with nutrition and body composition in athletes. This study investigates the correlations between these aspects in 36 professional rugby players, aiming to identify relationships that could optimize sports performance and overall well-being.

METHODS

The study sample included 36 male athletes (mean age: 24.4 ± 2.1 years, weight: 86.5 ± 7.1 kg, and height: 181.8 ± 5.7 cm). Four assessment tools were used: the Short Form Health Survey Questionnaire (SF-36) to evaluate quality of life, the Mediterranean diet adherence (MEDI-LITE), the International Physical Activity Questionnaire (IPAQ), and body composition measurements (stadiometer and BIVA). Statistical analyses, including the Shapiro-Wilk test, Pearson, and Spearman correlations, were conducted to explore relationships between the variables.

RESULTS

The athletes' mental and physical health was comparable to the general population (mean MCS = 50.5 ± 7.4, PCS = 49.6 ± 9.6). Mediterranean diet adherence was low (mean MEDI-LITE = 8.6 ± 2.6), while physical activity levels were high (mean IPAQ = 2560.5 ± 950.1). Body composition indicated overweight status (mean BMI = 26.15 ± 1.62 kg/m2, body fat = 22 ± 4.3%). Positive correlations were observed between mental health, diet adherence, and physical activity, with a stronger link between physical activity and body composition.

CONCLUSIONS

This study confirms a relationship between psychological-emotional factors, nutrition, and body composition in athletes, suggesting an integrated approach to optimize performance. However, causality remains unconfirmed, and the small sample size limits generalizability. Future research should include larger, more diverse samples to expand these findings.

The Role of Diet in Inflammatory Bowel Disease Onset, Disease Management, and Surgical Optimization

The concept of using diet as therapy in inflammatory bowel disease is of interest to clinicians and patients. Once considered to play a minor role, diet is now known to not only affect disease onset but may also serve as a therapeutic tool for inducing and maintaining remission and improving surgical outcomes. Further research is needed to fully elucidate how, when, and in whom diet therapies may be best applied to improve clinical and disease outcomes. The aim of this review was to summarize current research findings and serve as a tool to help facilitate patient-clinician conversations.

Natural Products to Promote Vascular Health

Maintaining good vascular health is a major component in healthy ageing as it reduces the risk of cardiovascular diseases. Endothelial dysfunction, in particular, is a key mechanism in the development of major cardiovascular diseases including hypertension, atherosclerosis and diabetes. Recently, endothelial senescence has emerged as a pivotal early event in age-related endothelial dysfunction. Endothelial function is characterized by an imbalance between the endothelial formation of vasoprotective mechanisms, including the formation of nitric oxide (NO) and endothelium-dependent hyperpolarization responses, and an increased level of oxidative stress involving several pro-oxidant enzymes such as NADPH oxidases and, often also, the appearance of cyclooxygenase-derived vasoconstrictors. Pre-clinical studies have indicated that natural products, in particular several polyphenol-rich foods, can trigger activating pathways in endothelial cells promoting an increased formation of NO and endothelium-dependent hyperpolarization. In addition, some can even exert beneficial effects on endothelial senescence. Moreover, some of these products have been associated with the prevention and/or improvement of established endothelial dysfunction in several experimental models of cardiovascular diseases and in humans with cardiovascular diseases. Therefore, intake of certain natural products, such as dietary and plant-derived polyphenol-rich products, appears to be an attractive approach for a healthy vascular system in ageing.

Efficacy and safety of tebentafusp in patients with metastatic uveal melanoma: A systematic review and meta-analysis

Patients with metastatic uveal melanoma (mUM) have a poor prognosis, and few appropriate medications are available. Tebentafusp is approved by the Food and Drug Administration for mUM recently. However, the real efficacy and safety of tebentafusp are still unclear. We searched PubMed, Embase, and Cochrane Library from inception to March 20, 2024. The research was reported based on the preferred reporting items for systematic reviews and meta-analysis guidelines. We used random effects models to aggregate data on the response rates and adverse events of tebentafusp therapy. Six studies met the inclusion criteria with a total sample of 589 participants. The pooled objective response rate was 0.08 (95% CI: 0.05-0.12), and pooled disease control rate was 0.51 (95% CI: 0.44-0.57). The overall incidence was 0.99 (95% CI: 0.95-1.00) for any grade adverse events, 0.50 (95% CI: 0.41-0.59) for grade 3-4 adverse events, and 0.01 (95% CI: 0-0.03) for discontinuation due to adverse events. Tebentafusp exhibits promising treatment outcomes for mUM patients. Although accompanied with a common occurrence of adverse events, which can typically be managed and controlled. Future research is necessary for substantiating these findings and refining guidelines for management of mUM.

The role of olive oil and its constituents in mental health: a scoping review

Mounting evidence suggests that the Mediterranean diet has a beneficial effect on mental health. It has been hypothesised that this effect is mediated by a variety of foods, nutrients and constituents; however, there is a need for research elucidating which of these components contribute to the therapeutic effect. This scoping review sought to systematically search for and synthesise the research on olive oil and its constituents and their impact on mental health, including the presence or absence of a mental illness or the severity or progression of symptoms. PubMed and OVID MEDLINE databases were searched. The following article types were eligible for inclusion: human experimental and observational studies, animal and preclinical studies. Abstracts were screened in duplicate, and data were extracted using a piloted template. Data were analysed qualitatively to assess trends and gaps for further study. The PubMed and OVID MEDLINE search yielded 544 and 152 results, respectively. After full-text screening, forty-nine studies were eligible for inclusion, including seventeen human experimental, eighteen observational and fourteen animal studies. Of these, thirteen human and four animal studies used olive oil as a comparator. Observational studies reported inconsistent results, specifically five reporting higher rates of mental illness, eight reporting lower and five reporting no association with higher olive oil intake. All human experimental studies and nine of ten animal studies that assess olive oil as an intervention reported an improvement of anxiety or depression symptoms. Olive oil may benefit mental health outcomes. However, more experimental research is needed.

Potential of Anthocyanin-rich Products to Prevent and Improve Endothelial Function and Senescence: Focus on Anthocyanins

Endothelial dysfunction is a pivotal early event in the development of major cardiovascular diseases including hypertension, atherosclerosis, diabetes, and aging. The alteration of the endothelial function is often triggered by an imbalance between the endothelial formation of vasoprotective factors, including nitric oxide (NO) and endothelium-dependent hyperpolarization (EDH), and vasocontracting factors, such as arachidonic acid-derived mediators generated by cyclooxygenases, and an increased level of oxidative stress. Recently, endothelial senescence was reported to be an early trigger of endothelial dysfunction. Preclinical studies indicate that polyphenol-rich food, including anthocyanin-rich products, can activate pathways promoting an increased formation of vasoprotective factors and can prevent the induction of endothelial dysfunction in endothelial cells and isolated blood vessels. Similarly, intake of anthocyanin-rich products has been associated with the prevention and/or the improvement of an endothelial dysfunction in several experimental models of cardiovascular diseases, including physiological aging. Moreover, clinical data indicate that polyphenol-rich and anthocyanin-rich products can improve endothelial function and vascular health in humans with cardiovascular diseases. The present review will discuss both experimental and clinical evidence indicating that several polyphenol-rich foods and natural products, and especially anthocyanin-rich products, can promote endothelial and vascular health, as well as the underlying mechanisms.

Healthy eating patterns associated with reduced risk of inflammatory bowel disease by lowering low-grade inflammation: evidence from a large prospective cohort study

BACKGROUND

Limited epidemiological evidence exists regarding the role of healthy eating patterns in reducing the risk of Crohn's disease (CD) and ulcerative colitis (UC). This study aimed to investigate the association between adherence to four established healthy eating patterns and subsequent CD or UC risk, and further examined whether these associations are linked to anti-inflammatory mechanisms.

METHODS

We conducted a prospective cohort study of 197,391 participants from the UK Biobank who completed at least one dietary questionnaire and were free from inflammatory bowel disease or cancer at baseline. Four dietary patterns were assessed, including Alternate Mediterranean Diet (AMED), Healthy Eating Index 2015 (HEI-2015), Healthful Plant-based Diet Index (HPDI), and EAT-Lancet. Cox proportional models with restricted cubic splines were applied to explore the associations. The potential role of low-grade inflammation in these associations was examined through mediation analysis.

RESULTS

During 2,193,436 person-years follow-up, 260 CD and 601 UC cases were identified. Higher AMED and HEI-2015 scores were associated with a reduced risk of CD but no UC, with no evidence against nonlinearity. These associations remained consistent across multiple sensitive and subgroup analyses. For dietary components, the fruits and monounsaturated fatty acids: saturated fatty acids ratio in AMED, and total fruits, total protein foods and fatty acid in HEI-2015 were linked to a decreased CD risk. Both diets were also associated with lower plasma inflammation biomarkers. Mediation analysis indicated that 7.66% and 13.40% of the reductions in CD risk attributed to AMED and HEI-2015 diets, respectively, were mediated by low-grade inflammation scores.

CONCLUSIONS

Higher adherence to AMED and HEI-2015 might significantly reduce CD risk, partly due to their anti-inflammatory properties.

Non-pharmaceutical treatments for irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction that impacts a significant portion of the population and is associated with substantial morbidity, reduced quality of life, and economic impact globally. The pathophysiology of IBS is complex and incompletely understood, and the heterogeneity of IBS is reflected in the variety of pharmaceutical and non-pharmaceutical therapies utilized for the management of IBS. Given limitations with pharmaceutical treatments, many patients with IBS seek non-pharmaceutical options. Several non-pharmaceutical treatments such as the low FODMAP diet and brain-gut behavior interventions such as gut directed hypnosis and cognitive behavioral therapy are now considered standard of care and are part of all major guidelines for the treatment of IBS. However, challenges with access to and optimal implementation of these therapies remain. This review focuses on the current evidence for common non-pharmaceutical treatments for IBS, including the latest advances in dietary and brain-gut behavioral care, in addition other complementary and integrative health practices and emerging therapies.

Effects of 10 Weeks of Walking With Mobile Step-Tracking Apps on Body Composition, Fitness, and Psychological State in Adolescents Who Are Overweight and Obese: Randomized Controlled Trial

BACKGROUND

In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature.

OBJECTIVE

This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese.

METHODS

The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded.

RESULTS

An increase was found in the EG in corrected arm girth (mean difference -0.46; P=.05), curl-up repetitions (mean difference -6.35; P=.02) and push-up repetitions (mean difference -2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference -1.37; P=.05), corrected thigh girth (mean difference -1.28; P=.04), and muscle mass (mean difference -0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG.

CONCLUSIONS

A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876.

The role of Mediterranean diet in cancer incidence and mortality in the older adults

The magnitude of benefit of Mediterranean diet in cancer prevention and mortality in older adults is still unclear, therefore we conducted a systematic review and meta-analysis. Outcomes considered were cancer incidence and cancer mortality. In studies evaluating cancer incidence as a time-to-event endpoint and adherence as quantiles, HR was 0.885 (95% CI 0.773-1.013, I2 = 44%). Including ORs, exploratory pooled effect size was 0.876 (0.794-0.966, I2 = 34%), consistently with results of studies evaluating ORs for adherence as one-point increase (OR 0.744, 0.570-0.972, I2 = 90%). No clear benefit was observed on cancer mortality, with pooled HR of 0.935 (0.800-1.093, I2 = 0%). Significant differences were observed for ORs according to cancer type but not between medium and high adherence for both outcomes. Certainty of evidence was low. Our findings suggest that MD could play a protective role in cancer incidence in advanced age, but no clear effect on cancer mortality was observed.

Exploring Biases of the Healthy Eating Index and Alternative Healthy Eating Index When Scoring Low-Carbohydrate and Low-Fat Diets

BACKGROUND

The Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010) are commonly used to measure dietary quality in research settings. Neither index is designed specifically to compare diet quality between low-carbohydrate (LC) and low-fat (LF) diets. It is unknown whether biases exist in making these comparisons.

OBJECTIVE

The aim was to determine whether HEI-2010 and AHEI-2010 contain biases when scoring LC and LF diets.

DESIGN

Secondary analyses of the Diet Intervention Examining the Factors Interacting With Treatment Success (DIETFITS) weight loss trial were conducted. The trial was conducted in the San Francisco Bay Area of California between January 2013 and May 2016. Three approaches were used to investigate whether biases existed for HEI-2010 and AHEI-2010 when scoring LC and LF diets.

PARTICIPANTS/SETTING

DIETFITS participants were assigned to follow healthy LC or healthy LF diets for 12 months (n = 609).

MAIN OUTCOMES MEASURES

Mean diet quality index scores for each diet were measured.

STATISTICAL ANALYSIS

Approach 1 examined both diet quality indices' scoring criteria. Approach 2 compared scores garnered by exemplary quality LC and LF menus created by registered dietitian nutritionists. Approach 3 used 2-sided t tests to compare the HEI-2010 and AHEI-2010 scores calculated from 24-hour dietary recalls of DIETFITS trial participants (n = 608).

RESULTS

Scoring criteria for both HEI-2010 (100 possible points) and AHEI-2010 (110 possible points) were estimated to favor an LF diet by 10 points. Mean scores for exemplary quality LF menus were higher than for LC menus using both HEI-2010 (91.8 vs 76.8) and AHEI-2010 (71.7 vs 64.4, adjusted to 100 possible points). DIETFITS participants assigned to a healthy LF diet scored significantly higher on HEI and AHEI than those assigned to a healthy LC diet at 3, 6, and 12 months (all, P < .001). Mean baseline scores were lower than mean scores at all follow-up time points regardless of diet assignment or diet quality index used.

CONCLUSIONS

Commonly used diet quality indices, HEI-2010 and AHEI-2010, showed biases toward LF vs LC diets. However, both indices detected expected changes in diet quality within each diet, with HEI-2010 yielding greater variation in scores. Findings support the use of these indices in measuring diet quality differences within, but not between, LC and LF diets.

Gender differences in adherence and retention in Mediterranean diet interventions with a weight-loss outcome: A systematic review and meta-analysis

BACKGROUND

The Mediterranean diet has been shown to be effective in improving health outcomes and for weight loss. Adherence and retention in dietary interventions are critical to ensure the benefits of the exposure. No studies to date have assessed the role of gender in understanding participants who remain engaged and adhere to Mediterranean diet interventions.

AIMS

This study aimed to explore gender differences in recruitment, adherence, and retention for Mediterranean diet interventions and whether these were associated with differences in weight-loss outcomes.

METHODS

A systematic search was completed in EMBASE, Medline, Cochrane, and clinicaltrials.gov from inception to March 2023. A meta-analysis of studies reporting retention by gender was completed using odds ratios comparing female to male dropout numbers. A second meta-analysis was completed for adherence comparing standardized mean difference of Mediterranean diet scores stratified by gender. Newcastle Ottawa score was used to assess risk of bias.

RESULTS

A total of 70 articles were included in the systematic review with six articles included in the adherence meta-analysis and nine in the dropout meta-analysis. No statistically significant difference was shown for adherence or retention by gender. Weight-loss outcomes were inconsistent.

CONCLUSIONS

The results of the study suggest a higher adherence and lower dropout for women although these results were not statistically significant. Future studies of Mediterranean diet interventions should include adherence, retention, and weight-loss data stratified by gender to allow further investigation of this relationship.

Emerging EAT-Lancet planetary health diet is associated with major cardiovascular diseases and all-cause mortality: A global systematic review and meta-analysis

BACKGROUND & AIMS

In 2019, the EAT-Lancet Commission promoted a plant-based diet, emphasizing its potential to enhance human health and environmental sustainability. Nevertheless, a thorough evaluation of health benefits associated with EAT-Lancet diet requires robust statistical backing. This synthesis seeks to compile evidence related to the effects of the EAT-Lancet diet on major cardiovascular disease (CVD) and mortality.

METHODS

A systematic review and meta-analysis were conducted utilizing data from MEDLINE, EMBASE, PubMed, Web of Science, and medRxiv, covering the period from January 2019 to October 8, 2024. We included all cohort and case-control studies that investigated the association between the emerging EAT-Lancet diet and outcomes such as diabetes, CVD, all-cause mortality, and cancer. Summary effect size estimates are presented as hazard ratios (HRs) and were analyzed using random-effects models. Study heterogeneity was assessed with the Q statistic and I2 statistic. Subgroup analyses were performed to identify potential sources of variability, while publication bias was evaluated using Begg's and Egger's tests. Additionally, sensitivity analyses were conducted to assess the robustness of the results.

RESULTS

We identified 28 publications that included a total of over 2.21 million participants. Adhering to the EAT-Lancet dietary patterns was negatively associated with diabetes, CVD (mortality), all-cause mortality, and cancer (mortality), with HRs of 0.78 (95 % CI: 0.65-0.92), 0.84 (95 % CI: 0.81-0.87), 0.83 (95 % CI: 0.78-0.89), and 0.86 (95 % CI: 0.80-0.92), respectively. Significant heterogeneity was observed for diabetes (I2 = 94.0 %), all-cause mortality (I2 = 85.5 %), and cancer incidence (I2 = 79.3 %). Importantly, no evidence of publication bias was found for any of the clinical outcomes analyzed. Sensitivity analyses confirmed the robustness of the results across various dietary scoring systems for CVD mortality, all-cause mortality, and cancer.

CONCLUSION

Following the EAT-Lancet diet was significantly associated with reduced odds of diabetes, CVD, cancer and mortality. These findings are clinically important, highlighting the beneficial effects of the recent EAT-Lancet diet on various health outcomes.

The Relationship Between Dietary Patterns, Cognition, and Cardiometabolic Health in Healthy, Older Adults

BACKGROUND

Healthy dietary patterns can support the maintenance of cognition and brain health in older age and are negatively associated with cardiometabolic risk. Cardiometabolic risk factors are similarly important for cognition and may play an important role in linking diet to cognition.

AIM

This study aimed to explore the relationship between dietary patterns and cognition and to determine whether cardiometabolic health markers moderate these relationships in older adulthood.

DESIGN

A cross-sectional analysis of observational data from the baseline of the ACTIVate study.

PARTICIPANTS

The cohort included 426 cognitively normal adults aged 60-70 years.

METHODS

The Australian Eating Survey (AES) Food Frequency Questionnaire was used to collect data on usual dietary intake, along with additional questions assessing intake of dietary oils. Principal component analysis (PCA) was applied to reduce the dimensionality of dietary data. Cardiometabolic risk was quantified using the metabolic syndrome severity score (MetSSS). Tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to derive composite scores on four cognitive domains: processing speed, executive function, short-term memory, and long-term memory.

RESULTS

Three dietary patterns were identified using PCA: a plant-dominant diet, a Western-style diet, and a meat-dominant diet. After controlling for age, sex, total years of education, energy intake, and moderate-to-vigorous physical activity (MVPA), there was a small, negative association between the meat-dominant diets and long-term memory. Subsequent moderation analysis indicated that MetSSS significantly moderated this relationship.

CONCLUSIONS

Findings highlight the link between diet, cardiometabolic health, and cognitive function in older, cognitively healthy adults. However, longitudinal studies are needed to confirm observations and evaluate the dynamics of diet, cardiometabolic health, and cognitive function over time.

Adherence to the Mediterranean diet is associated with reduced chronic pancreatitis risk: a longitudinal cohort study

Background: The role of diet on the risk of chronic pancreatitis (CP) is understudied. The health benefits of the Mediterranean diet (MedDiet) pattern have long been recognized, but its association with CP risk is unclear. We aimed to investigate the association between adherence to MedDiet and the incidence of CP in a large-scale cohort. Methods: 190 790 participants from the UK Biobank were involved, all free of CP and with typical diet recall data at recruitment. The diagnosis of CP was ascertained by the combination of hospital inpatient data, primary care data, and death registry data. Multivariable Cox regression models were used to evaluate the associations between MedDiet adherence, measured by the Mediterranean Diet Adherence Screener (MEDAS) continuous score, and the incidence of CP. The mediating role of inflammation (assessed by C-reactive protein) and metabolic status between MedDiet adherence and CP risk was also investigated. Results: During a mean of 10.8 years of follow-up, 214 participants developed CP. Individuals with the highest adherence to MedDiet, defined by continuous MEDAS scores, exhibited significantly lower risk of developing CP (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.40-0.82; p = 0.002) compared to those in the lowest tertiles. Metabolic status mediated 4.74% of the association between MedDiet adherence and CP risk, while the mediating role of C-reactive protein was not significant. Conclusion: Greater Mediterranean diet adherence is associated with reduced chronic pancreatitis risk.

Diet Quality and Dietary Intake in Breast Cancer Survivors Suffering from Chronic Pain: An Explorative Case-Control Study

Background/Objectives: Dietary factors may significantly influence pain management in cancer survivors. However, a substantial gap exists regarding the relationship between nutrition and chronic pain in this population. This study examined differences in diet quality and dietary intake between breast cancer survivors (BCS) experiencing chronic pain and healthy controls (HC). It also aimed to understand the associations between dietary elements and pain-related outcomes within the BCS group. Methods: A case-control study was conducted with 12 BCS experiencing chronic pain and 12 HC (ages 18-65). Data collection included body composition, experimental pain assessments, pain-related questionnaires, and a 3-day food diary to calculate diet quality using the Healthy Eating Index-2015 (HEI-2015) and Dietary Inflammatory Index (DII). Statistical analyses evaluated group differences and associations between dietary factors and pain within the BCS group. Results: There were no significant differences in HEI-2015 scores between BCS and HC, but BCS had a significantly lower DII score (p = 0.041), indicating a more anti-inflammatory diet. BCS also showed higher intake of omega-3, vitamins B6, B12, A, D, and magnesium (p < 0.05). While total diet quality scores did not correlate with pain outcomes, several HEI-2015 and DII components, such as dairy, sodium, protein, vitamin C, and vitamin D, showed moderate positive or negative correlations with pain measures. Conclusions: Despite no overall differences in diet quality, BCS with chronic pain consumed more anti-inflammatory nutrients than HC. Complex correlations between specific dietary components and pain outcomes emphasise the need for further research to explore these links for chronic pain management in BCS.

Correlation of mediterranean diet pattern and lifestyle factors with semen quality of men attending fertility clinics: A cross-sectional study

BACKGROUND

While numerous studies have examined the impact of individual or combined nutrients on semen quality, research on the correlation between overall dietary patterns and semen quality remains limited. This cross-sectional study investigates the relationship between adherence to the alternative Mediterranean diet (aMED) and semen quality.

METHODS

A total of 274 men, presenting with both normal and abnormal semen parameters, participated in this study. Dietary data were collected using a 147-item semi-quantitative food frequency questionnaire (FFQ). Participants were divided into three groups based on their adherence to the Mediterranean diet (T1, T2, and T3). Statistical analyses, including ANOVA for numerical data and Chi-square tests for categorical data, were conducted. Multivariable logistic regression models were employed to estimate the association between aMED scores and abnormal semen parameters.

RESULTS

Participants in the highest adherence group (T3) were younger and had lower BMI compared to those in the other tertiles. Significant differences in sperm parameters were observed across the tertiles. T3 recorded the highest levels of sperm concentration, total sperm count, motility, progressive motility, and normal morphology (57.53 ± 36.16, 213.8 ± 158.9, 73.4 ± 25.9, 61.2 ± 24.6, and 6.42 ± 1.51, respectively), whereas T1 had the lowest values (11.92 ± 22.29, 43.3 ± 73.8, 36.7 ± 33.8, 4.6 ± 5.7, respectively). No significant differences were found in semen volume and viscosity. The regression analysis revealed a significant positive correlation between aMED scores and sperm concentration (B = 1.32, P = 0.001), total sperm count (B = 1.12, P = 0.001), and total motility (B = 0.71, P = 0.001).

CONCLUSION

Adherence to a high-quality Mediterranean diet is positively associated with improved semen quality and increased male fertility potential. Promoting healthy dietary patterns may be an effective strategy to enhance sperm motility and overall male reproductive health.

Association between Mediterranean diet adherence and peripheral artery disease in type 2 diabetes mellitus: An observational study

INTRODUCTION

To evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM).

METHODS

An observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis.

RESULTS

ABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003-0619), age (OR = 0.139, 95 % CI 0.029-0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523-35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415-26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000-0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000-0.534).

CONCLUSIONS

Adherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.

Maternal Mediterranean Diet During Lactation and Infant Growth

Background: Human milk is considered the optimal source of nutrition for infants. Maternal diet is associated with the composition of human milk. The Mediterranean diet (MedDiet) has been studied in pregnancy and during lactation, and it has been associated with changes in milk composition, yet there is a lack of research on MedDiet during lactation and infant outcomes. Methods: Mother-infant dyads (n = 167) from ABC Baby, a prospective observational study, were included in this analysis. Maternal diet was obtained using an adapted version of the National Cancer Institute Diet History Questionnaire II, at 2 weeks or 2 months postpartum. Maternal MedDiet score was calculated using servings of vegetables, fruits, whole grains, nuts and seeds, legumes, fish, monounsaturated-to-saturated fatty acid ratio, red and processed meats, and added sugar. Infants' length, weight, and flank skinfold thickness were measured at 6 months. Using World Health Organization standards, weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) Z-scores were calculated. Multiple linear regression models were adjusted for potential confounders. Results: Higher maternal MedDiet score and intake of fruit and fish were associated with lower flank skinfold thickness (β = -0.33, -0.52, and -1.26, respectively). Intake of nuts and seeds was associated with higher WLZ (β = 0.29). Intake of red and processed meats was associated with lower WAZ (β = -0.18) and LAZ (β = -0.18). Energy-adjusted added sugar intake was associated with lower WLZ (β = -0.02). Conclusions: The maternal MedDiet score was associated with lower skinfold thickness, while its components were associated with differences in anthropometric Z-scores. Further research on the maternal MedDiet and corresponding human milk composition is needed to explore this relationship.

Proinflammatory Diet Increases the Risk of Irritable Bowel Syndrome: A Prospective Study of 129,408 UK Biobank Participants and Mendelian Randomization Analysis

BACKGROUND

Patients with irritable bowel syndrome (IBS) often have chronic low-grade inflammation in the intestinal mucosa. Some dietary components are known to be associated with inflammation. However, there is currently limited research on the relationship between dietary inflammatory potential and the risk of IBS.

METHODS

A total of 129,408 participants in the UK Biobank were included in this study. Energy-Adjusted Dietary Inflammatory Index (E-DII) based on 26 nutrients and the Empirical Dietary Inflammatory Pattern (EDIP) based on 17 food groups were constructed, and on the basis of the tertiles, the continuous score was categorized into proinflammatory, neutral, and antiinflammatory categories. Associations between IBS and E-DII and EDIP were investigated by multivariable Cox proportional hazard models. Potential confounders including sociodemographic, lifestyle, body mass index (BMI), psychological state, type 2 diabetes, and thyroiditis were adjusted. In addition, subgroup analysis and sensitivity analysis were also performed. Finally, a two-sample Mendelian randomization (MR) analysis was employed to explore the independent causality of nutrients and dietary-derived serum antioxidants with IBS.

RESULTS

In the cohort study, over a median follow-up period of 13.26 years, 2421(1.87%) participants developed IBS. In the E-DII categories, after adjusting for the confounders, individuals in the proinflammatory diet category had a higher risk of IBS compared with the antiinflammatory category (HR 1.15, 95% CI 1.03-1.28, p = 0.015, p trend = 0.017) and neutral category (HR 1.13, 95% CI 1.01-1.26, p = 0.030, p trend = 0.017). In the EDIP categories, after adjusting for the confounders, individuals in the proinflammatory diet category had a higher risk of IBS compared with antiinflammatory category (HR 1.19, 95% CI 1.06-1.33, p = 0.002, p trend = 0.002) but no significant association compared with neutral category (HR 1.10, 95% CI 0.99-1.23, p = 0.067, p trend = 0.002). In the MR analysis, genetically determined intake levels of 16 nutrients and 6 dietary sources of circulating antioxidants did not have a causal effect on IBS.

CONCLUSIONS

Our findings indicate that proinflammatory dietary components are independent risk factors for IBS. However, there is no causal relationship between individual nutrient intake or serum antioxidants from dietary sources and IBS.

Epidemiology of Inflammatory Bowel Disease across the Ages in the Era of Advanced Therapies

BACKGROUND AND AIMS

The incidence of inflammatory bowel diseases [IBD] has risen over the past decade to become a global issue. The objectives of this review were to describe the incidence and/or prevalence of IBD in the era of advanced therapies, and to describe the association between environmental risk factors and both pathogenesis and disease course across the ages.

METHODS

We performed a search of English language publications listed in PubMed regarding the epidemiology of IBD and key environmental factors implicated in IBD from January 2000 to December 2023.

RESULTS

Annual incidence rates varied by geographical region with IBD estimates ranging from 10.5 to 46.14 per 100 000 in Europe, 1.37 to 1.5 per 100 000 in Asia and the Middle East, 23.67 to 39.8 per 100 000 in Oceania, 0.21 to 3.67 per 100 000 in South America, and 7.3 to 30.2 per 100 000 in North America. The burden of IBD among children and adolescents, and older people is rising globally. Key environmental factors implicated in IBD pathogenesis include exposure to tobacco smoking, antibiotics, non-steroidal anti-inflammatory drugs, oral contraceptives, infections, and ultra-high processed foods. Breastfeeding and a high-quality diet rich in fruit, vegetables, fish, and other fibre sources are important protective factors. Smoking has consistently been shown to negatively impact disease outcomes for Crohn's disease.

CONCLUSION

The epidemiology of IBD has undergone considerable change in recent decades, with an increase in the burden of disease worldwide. Optimally studying and targeting environmental triggers in IBD may offer future opportunities for disease modification.

Mediterranean diet and atrial fibrillation: a case-control study from China

Objective

The aim of this study was to assess the association between adherence to Mediterranean diet and the presence of atrial fibrillation (AF) in a Northern Chinese population.

Methods

This study was a single center, case-control study. A total of 952 low risk participants in Beijing Anzhen Hospital from 2016 to 2021 were collected, including 476 patients with first diagnosed of atrial fibrillation and 476 age and sex matched controls. According to the food frequency questionnaire (FFQ), the alternate Mediterranean diet score (AMED) was calculated, which was 0-9 points, indicating the adherence to the Mediterranean diet from low to high.

Results

The average age of the participants was 57.6 ± 9.1 years old, and 70.2% were men. After analyzing every component of AMED, vegetable consumption shows a negative correlation with the risk of AF, whereas alcohol consumption demonstrates a positive correlation with it (OR = 0.61, 95% CI 0.44-0.80, p < 0.001; OR = 1.99, 95% CI 1.48-2.58, p < 0.001). All patients were grouped according to AMED score. A significant inverse association between AMED and the risk of AF was observed. Compared with participants with AMED<4, the multivariable-adjusted ORs of AF were 0.75 (95% CI 0.55-1.06) for AMED 4-5 and 0.61 (95% CI 0.43-0.89) for AMED ≥6, with a trend in risk (p = 0.008). Results were consistent in stratified analyses of gender, age, BMI and smoking.

Conclusion

The Mediterranean diet was inversely associated with the risk of AF in this Northern Chinese population.

Factors Associated with Dietary Diversity in Community-Dwelling Brazilian Older Adults

BACKGROUND

Older populations are at high risk of nutritional inadequacy and monotonous diets, and assessing dietary diversity can be a practical measure to indicate groups at nutritional risk. We aimed to explore the dietary diversity of older adults enrolled in primary health care services in Brazil and to evaluate its associated factors.

METHODOLOGY

In this cross-sectional study, we evaluated the dietary diversity score (DDS) of 581 participants (≥60 years) registered in primary care services. All foods mentioned in a 24 h food recall were classified into 10 groups, and factors associated with the DDS were analyzed using hierarchical linear regression models in two blocks: (1) sociodemographic and (2) health conditions and lifestyle.

RESULTS

The mean DDS was 5.07 (±1.34), and 67.5% of the sample reached the minimum dietary diversity (≥5 groups). In the final model, income, previous diagnosis of cancer, and sporadic intake of alcohol were positively associated with DDS. In contrast, cognitive decline, sedentary lifestyle, and anorexia of aging were negatively associated with DDS.

CONCLUSIONS

These findings show that the entire structural, economic, and social system needs to facilitate access to quality food, adequate places and conditions for the practice of physical activity, and policies regarding tobacco and alcohol abuse, in addition to nutritional guidance.

Mediterranean Diet Is a Predictor of Progression of Subclinical Atherosclerosis in a Mediterranean Population: The ILERVAS Prospective Cohort Study

Atherosclerotic cardiovascular disease remains a major health issue, often developing silently as subclinical atherosclerotic disease (SAD). The Mediterranean diet (MDiet) is known for its cardiovascular benefits, but the combined influence of both MDiet adherence and physical activity (PA) on SAD progression has not been previously documented. Objective: We aimed to investigate how adherence to a healthy lifestyle, defined as MDiet adherence and PA level, influences SAD progression in subjects from the ILERVAS cohort follow-up. Methods: A study on 3097 participants from the ILERVAS prospective cohort was conducted. MDiet adherence was assessed using the MEDAS score, and PA categories were established using the IPAQ, both categorized into low, moderate, and high levels. Two different lifestyle scores integrating the MDiet and PA categories were built. The presence of atherosclerotic plaques was assessed by carotid and femoral ultrasound examination. Demographic, clinical, and biochemical data were also obtained. Multivariable linear, logistic, and Poisson regression models adjusted for potential confounders were used to analyze the association between the lifestyle scores and SAD progression, as well as the MDiet and PA as separate variables and number of territories with plaque. Results: A healthier lifestyle score did not show an effect on SAD progression. However, a higher MEDAS score was associated with a 3% decrease in the number of territories with plaque (IRR 0.97, 95% CI 0.96-0.99, p < 0.001), suggesting a protective effect of the adherence to the MDiet. PA did not show a significant association (IRR 1.00, 95% CI 1.00-1.00, p = 0.269). Older age, hypertension, dyslipidemia, smoking, and lower eGFR were associated with SAD progression, while the female sex was protective (IRR 0.67, 95% CI 0.63-0.72, p < 0.001). Conclusions: The findings of this study show that higher adherence to the MDiet is associated with reduced incidence of SAD, indicating its potential role in cardiovascular prevention strategies. Although a higher lifestyle score or physical activity levels did not show any significant effect, promoting the MDiet, alongside managing traditional cardiovascular risk factors, could be an effective public health intervention to prevent atherosclerosis and reduce the burden of cardiovascular disease.