Adherence to Mediterranean Diet and its main determinants in a sample of Italian adults: results from the ARIANNA cross-sectional survey

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.

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.

Switching Mediterranean Consumers to Mediterranean Sustainable Healthy Dietary Patterns (SWITCHtoHEALTHY): Study Protocol of a Multicentric and Multi-Cultural Family-Based Nutritional Intervention Study

BACKGROUND/OBJECTIVES

Populations in Mediterranean countries are abandoning the traditional Mediterranean diet (MD) and lifestyle, shifting towards unhealthier habits due to profound cultural and socioeconomic changes. The SWITCHtoHEALTHY project aims to demonstrate the effectiveness of a multi-component nutritional intervention to improve the adherence of families to the MD in three Mediterranean countries, thus prompting a dietary behavior change.

METHODS

A parallel, randomized, single-blinded, and controlled multicentric nutritional intervention study will be conducted over 3 months in 480 families with children and adolescents aged 3-17 years from Spain, Morocco, and Turkey. The multi-component intervention will combine digital interactive tools, hands-on educational materials, and easy-to-eat healthy snacks developed for this study. Through the developed SWITCHtoHEALTHY app, families will receive personalized weekly meal plans, which also consider what children eat at school. The engagement of all family members will be prompted by using a life simulation game. In addition, a set of activities and educational materials for adolescents based on a learning-through-playing approach will be codesigned. Innovative and sustainable plant-based snacks will be developed and introduced into the children's dietary plan as healthy alternatives for between meals. By using a full-factorial design, families will be randomized into eight groups (one control and seven interventions) to test the independent and combined effects of each component (application and/or educational materials and/or snacks). The impact of the intervention on diet quality, economy, and the environment, as well as on classical anthropometric parameters and vital signs, will be assessed in three different visits. The COM-B behavioral model will be used to assess essential factors driving the behavior change. The main outcome will be adherence to the MD assessed through MEDAS in adults and KIDMED in children and adolescents.

CONCLUSIONS

SWITCHtoHEALTHY will provide new insights into the use of sustained models for inducing dietary and lifestyle behavior changes in the family setting. It will facilitate generating, boosting, and maintaining the switch to a healthier MD dietary pattern across the Mediterranean area. Registered Trial, National Institutes of Health, ClinicalTrials.gov (NCT06057324).

The Development of a Food Frequency Questionnaire for the Assessment of Ultra-Processed Food Consumption in the Italian Adult Population: Protocol for a Validity and Reproducibility Study

BACKGROUND

Over the last decade, while studies on the detrimental effects of ultra-processed food (UPF) consumption have increased, methodological limitations on the quality of available evidence have emerged. Starting from a critical reassessment of the NOVA classification, this project will aim to develop and validate a food frequency questionnaire (FFQ), which is based on the processing of consumed foods and specifically designed to estimate the UPF consumption and total dietary intake of macro- and micronutrients in the Italian adult population.

METHODS

This study will take place in selected workplaces and include healthy males and females aged ≥18 years, residing in Italy and with Italian citizenship. The FFQ will be online, voluntary, self-administered, semi-quantitative, and designed to assess food intake over the past year and distinguish between industrial, artisanal, and home-made products. This project will consist of two phases. First, a pilot study will be conducted to obtain the final version of the FFQ. The current food consumption of the target population will be investigated, through a 24 h dietary recall, and the face validity of the new tool will be tested. The second phase will involve at least 436 participants. To assess reproducibility, the FFQ will be administered twice (at an interval of 3-10 months), and the test-retest method will be used. A 7-day weighed dietary record (WDR) will also be completed after each FFQ administration. To evaluate criterion validity, data from the two WDRs will be compared against those from the first FFQ administration.

CONCLUSIONS

The results will provide a new valid tool focused on food processing, potentially useful for future studies.

Dietary Approaches for Complementary Feeding: The Greek Mediterranean Diet as a Model for Caregivers

BACKGROUND/OBJECTIVES

Complementary feeding (CF), is defined as the process of providing foods in addition to milk when breast milk or milk formula alone are no longer adequate to meet nutritional requirements. CF affects not only growth but also the subsequent development of the child's dietary preferences. The Mediterranean diet (MedDiet) is one of the most studied dietary patterns worldwide. The main purpose of this article is to provide practical guidance for CF to caregivers introducing the Greek MedDiet, summarizing the current different approaches. The evidence-based information provided could be used by developers to create a reliable digital app for CF based on Mediterranean foods and traditional dishes.

METHODS

An in-depth literature review of the existing guidelines and recently published research data on CF using PubMed, national recommendations, and grey literature were undertaken.

RESULTS

Practical, simple, evidence-based, comprehensive tables are presented. The tables serve as a guide to simplify the process of introducing Mediterranean foods in CF. Τhe tables consist of a total of more than 90 foods and day-to-day guidance for the first 13 weeks of CF. Furthermore, specific dietary guidance and suggestions regarding the order and content of meals during CF are given.

DISCUSSION

The tables are based on updated recommendations, summarizing the optimal feeding practices in a MedDiet-based perspective.

CONCLUSIONS

Conclusively, there are significant contradictions among different organizations that present practical issues and cause confusion among caregivers. An effort was carried out to provide practical evidence-based guidance for caregivers introducing MedDiet during CF.

Exploring the Association between Mediterranean Diet Adherence and Arterial Stiffness in Healthy Adults: Findings from the EvasCu Study

(1) Background: Previous evidence has indicated a connection between a Mediterranean diet and cardiovascular disease. However, evidence for subclinical markers of cardiovascular disease, such as arterial stiffness, is limited. Therefore, the aim of this study was to assess the associations between adherence to the Mediterranean diet (MD), as assessed by the MEDAS-14 questionnaire, and arterial stiffness, as assessed by aortic pulse wave velocity, in healthy adults and according to sex. (2) A cross-sectional study including 386 healthy participants was performed in the EVasCu study. Adjusted and unadjusted differences in adherence to the MD and arterial stiffness were determined using Student's t test and ANCOVA for the total sample and according to sex. (3) Results: Our results showed that individuals with a high adherence to the MD had a greater arterial stiffness, both in the total sample and in females, although this difference was not significant after adjusting for possible confounding variables, such as age. (4) Conclusions: Our findings indicated that, in the unadjusted analyses, healthy subjects with a high adherence to the MD showed a greater arterial stiffness. When these analyses were adjusted, no significant differences were shown in a-PWv according to the categories of MD adherence.

Dietary Intake among Lebanese Adults: Findings from the Updated LEBANese natiONal Food Consumption Survey (LEBANON-FCS)

BACKGROUND

The rates of obesity, undernutrition, and other non-communicable diseases are on the rise among Lebanese adults. Therefore, it is crucial to evaluate the food consumption habits of this population to understand diet quality, analyze consumption trends, and compare them to healthy diets known to reduce risks of non-communicable diseases.

AIM

To evaluate the food consumption patterns, energy intake, as well as macro- and micro-nutrient intake among a nationally representative sample of Lebanese adults aged 18-64 years old.

METHODS

A cross-sectional study was carried out from May to September 2022 involving 444 participants from all eight Lebanese governorates. Sociodemographic and medical information was gathered through a questionnaire, food consumption was evaluated using a validated FFQ and 24 h recall, and anthropometric measurements were recorded.

RESULTS

There was a notable lack of adherence to three healthy diets (Mediterranean, EAT-Lancet, USDA) among Lebanese adults. Their dietary pattern is characterized by high energy, added sugars, sodium, and saturated fat intake while being low in healthy fats, vitamin A, D, and E. Adult women are falling short of meeting their daily calcium, vitamin D, iron, and vitamin B12 requirements, putting them at increased risk of anemia, osteoporosis, and other health issues. Grains and cereals were the most consumed food groups, and most participants were found to be overweight or obese.

CONCLUSIONS

In conclusion, the results highlight the need for public health policies and interventions aimed at encouraging Lebanese adults to make healthier food choices and transition towards diets like the Mediterranean, EAT-Lancet, or USDA diet. These diets have been shown to promote overall health and wellbeing.

Online Questionnaire with Fibromyalgia Patients Shows Negative Correlations between Disease Severity and Adherence to Mediterranean Diet

Fibromyalgia (FM) is a multidimensional disorder in which intense chronic pain is accompanied by a variety of psychophysical symptoms that impose a burden on the patients' quality of life. Despite the efforts and the recent advancement in research, FM pathogenesis and effective treatment remain unknown. Recently, the possible role of dietary patterns and/or components has been gaining attention. The current study aimed to investigate a potential correlation between adherence to the Mediterranean diet (MedDiet) and FM severity in a sample of Italian FM patients. An online survey was designed, composed of customized questions and validated questionnaires with the aim of investigating the intensity and type of pain, the presence of other psychophysical symptoms, the overall impact of FM, general food and lifestyle habits, and adherence to the MedDiet. The collected responses were analyzed for descriptive statistics, linear regression, and propensity score analyses. The results show that, despite considerable use of pharmaceuticals and supplements, FM participants suffered from a high-severity grade disease. However, those with good adherence to the MedDiet experienced a lower pain intensity and overall FM impact. A propensity score analysis indicates a positive influence of the MedDiet against FM severity, thus unveiling the need for well-designed intervention studies to evaluate the therapeutic potential of different dietary patterns.