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Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (25 October 2021) | Viewed by 31681

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Prof. Dr. Daniela Bonofiglio

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Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via P. Bucci, Arcavacata di Rende (CS), 87036 Cosenza, Italy
Interests: natural compounds; omega-3 polyunsaturated fatty acid; PPAR gamma; breast cancer; Mediterranean diet; iodine deficiency
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Dear Colleagues,

Over the last few decades, the Mediterranean Diet (MD), characterised by high intake of vegetables, legumes, fruits, nuts, dairy products and non-refined cereals, moderate intake of fish and poultry, low intake of red meat and sweets, has been recognised as a model for healthy eating. Indeed, adhering to the MD reduces risk of metabolic and non-communicable diseases, including type 2 diabetes, metabolic syndrome, obesity cardiovascular disease and cancer. As an integral part of the traditional Mediterranean lifestyle, regular physical activity (PA) is also associated with reduced risk of chronic degenerative diseases, even if results often vary according to different types, duration and intensity or volume of PA. The World Health Organisation recommends performing moderate-intensity PA for ≥150 min/week, and vigorous-intensity PA for ≥2 days/week to have these health benefits. It is viable to hypothesise that promoting the aherence to the MD along with PA guidelines might provide a more comprehensive endorsement to obtain greater health benefits, over and above those acquired separately by the MD and PA.

Thus, the ongoing promotion and monitoring of the MD pattern, including eating habits and PA, is crucially important at all life stages. Potential topics may include, but are not limited to examining the impact of adherence to the MD and PA on health in different life stages as well as on metabolic risk factors and subsequent disease outcomes.

This Special Issue of Nutrients entitled “Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health” welcomes original research and reviews of the literature concerning this important topic.

Prof. Dr. Daniela Bonofiglio
Guest Editor

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Keywords

Mediterranean Diet
Physical Activity
Lifestyle intervention
Nutrition Education program
Dietary behavior
Nutritional recommendation
Health benefits

Published Papers (11 papers)

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Editorial

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4 pages, 217 KiB

Open AccessEditorial

Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health

by Daniela Bonofiglio

Nutrients 2022, 14(12), 2514; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14122514 - 17 Jun 2022

Cited by 9 | Viewed by 2170

Abstract

Health status is influenced by several factors, such as proper dietary pattern and regular physical activity (PA), which are crucial elements of lifestyle in terms of the prevention and treatment of metabolic and chronic diseases in all stages of life and particularly during [...] Read more.

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

Research

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14 pages, 737 KiB

Open AccessArticle

Impact of Mediterranean Diet Food Choices and Physical Activity on Serum Metabolic Profile in Healthy Adolescents: Findings from the DIMENU Project

by Fabrizio Ceraudo, Giovanna Caparello, Angelo Galluccio, Ennio Avolio, Giuseppina Augimeri, Daniela De Rose, Adele Vivacqua, Catia Morelli, Ines Barone, Stefania Catalano, Cinzia Giordano, Diego Sisci and Daniela Bonofiglio

Nutrients 2022, 14(4), 881; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040881 - 19 Feb 2022

Cited by 9 | Viewed by 2423

Abstract

Adolescent nutrition and healthy dietary patterns, particularly the Mediterranean diet (MD), have been associated with improved health status and decreased risk of various chronic and metabolic diseases later in life. The aim of this study was to evaluate the impact of the Mediterranean food choices on lipid and glycemic metabolic profile in the total population and in adolescents grouped according to their physical activity (PA) levels at the time of recruitment (T0) and after six months from the administration of a personalized Mediterranean meal plan (T1). As part of the DIMENU study, 85 adolescents underwent measurements of lipid and glucose metabolic profile at T0 and T1. Using three positive items from KIDMED test related to the consumption of typical Mediterranean food (olive oil, fish, and nuts) and three negative items on dietary habits (going to fast-food, consuming biscuits, and candies), we categorized adolescents into six sets in which biochemical parameters were analyzed. In the total sample, significant reductions in serum total cholesterol, LDL, and glucose concentrations were observed for all the sets over the study period. Notably, active subjects, who had a better serum metabolic profile, showed significant improvements of glycemic control after 6 month follow up, while in sedentary adolescents and in those performing moderate PA significant reduction in glycemia, total cholesterol, and LDL was found in all sets. In conclusion, adopting the typical Mediterranean food choices led to a significant reduction in glucose and lipid profile in healthy adolescents, thus making the MD and PA a winning combination for health status. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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15 pages, 340 KiB

Open AccessArticle

Adherence to the Mediterranean Diet Is Associated with Better Metabolic Features in Youths with Type 1 Diabetes

by Valentina Antoniotti, Daniele Spadaccini, Roberta Ricotti, Deborah Carrera, Silvia Savastio, Filipa Patricia Goncalves Correia, Marina Caputo, Erica Pozzi, Simonetta Bellone, Ivana Rabbone and Flavia Prodam

Nutrients 2022, 14(3), 596; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14030596 - 29 Jan 2022

Cited by 14 | Viewed by 2684

Abstract

Our aim was to evaluate adherence to the Mediterranean diet (MedDiet) among children and adolescents with type 1 diabetes (T1D) in relation to metabolic control. Adherence to the MedDiet was assessed with the Mediterranean Diet Quality Index (KIDMED) questionnaire and physical activity by the International Physical Activity Questionnaire for Adolescent (IPAQ-A) on 65 subjects (32 males, 9–18 years) with T1D. Clinical and metabolic evaluation was performed (standardized body mass index (BMI-SDS), hemoglobin A1C (HbA1c), continuous glucose monitoring metrics when present, blood pressure, lipid profile). Parental characteristics (age, body mass index (BMI), socio-economic status) were reported. The adherence to the MedDiet was poor in 12.3%, average in 58.6%, and high in 29.1% of the subjects. Furthermore, 23.4% of patients were overweight/obese. The most impacting factors on BMI-SDS were skipping breakfast and their father’s BMI. HbA1c and time in range % were positively associated with sweets and fish intake, respectively. Additionally, the father’s socio-economic status (SES) and mother’s age were associated with glucose control. Blood pressure was associated with travelling to school in vehicles, extra-virgin olive oil intake and milk/dairy consumption at breakfast. The promotion of the MedDiet, mainly having a healthy breakfast, is a good strategy to include in the management of T1D to improve glucose and metabolic control. This research is valuable for parents to obtain the best results for their children with T1D. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

13 pages, 1049 KiB

Open AccessFeature PaperArticle

Adherence to the Mediterranean Diet among Children and Youth in the Mediterranean Region in Croatia: A Comparative Study

by Antonela Matana, Ivana Franić, Endica Radić Hozo, Ante Burger and Petra Boljat

Nutrients 2022, 14(2), 302; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14020302 - 12 Jan 2022

Cited by 10 | Viewed by 2136

Abstract

The Mediterranean diet (MD) is considered one of the healthiest dietary patterns. The aim of this study was to assess MD adherence in children and youth living in the Mediterranean region in Croatia and evaluate the differences in adherence to the MD among different educational stages. In total, 2722 individuals aged 2 to 24 years were enrolled in this study. Subjects were divided into different groups according to the Croatian educational system. Mediterranean Diet Quality Index (KIDMED) was used to assess adherence to the MD. In the total sample, the adherence to the MD was poor in 19.2%, average in 60.8%, and good in 20.1% of the study participants. The prevalence rate of poor adherence to the MD increased with higher educational stage, i.e., the highest prevalence rate of poor MD adherence was observed for college students (39.3%). Children having a higher number of snacks on days-off, those with lower physical activity, and not having breakfast together with a family are more likely to have poor MD adherence, while children having a higher number of snacks on working days are less likely to have a poor MD. The results of this study showed low adherence to the principles of the MD, confirming the need for improvement of adherence to the MD pattern in the studied population. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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14 pages, 616 KiB

Open AccessArticle

Adherence to a Mediterranean-Style Dietary Pattern and Cancer Risk in a Prospective Cohort Study

by Ioanna Yiannakou, Martha R. Singer, Paul F. Jacques, Vanessa Xanthakis, R. Curtis Ellison and Lynn L. Moore

Nutrients 2021, 13(11), 4064; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13114064 - 13 Nov 2021

Cited by 10 | Viewed by 2812

Abstract

A Mediterranean-style diet is a healthy eating pattern that may benefit cancer risk, but evidence among Americans is scarce. We examined the prospective association between adherence to such a diet pattern and total cancer risk. A Mediterranean-style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire at exam 5 (1991–1995). Subjects included 2966 participants of the Framingham Offspring Study who were free of prevalent cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, lifestyle, and anthropometric measures. Cox-models were also used to examine effect modification by lifestyle and anthropometric measures. During 18 years of median follow-up, 259 women and 352 men were diagnosed with cancer. Women with moderate or higher adherence to the MSDP had ≥25% lower risks of cancer than women with the lowest MSDP (HR (moderate vs. lowest): 0.71, 95% CI: 0.52–0.97 and HR (highest vs. lowest): 0.74; 95% CI: 0.55–0.99). The association between MSDP score and cancer risk in men was weaker except in non-smokers. Beneficial effects of the MSDP in women were stronger among those who were not overweight. In this study, higher adherence to MSDP was associated with lower cancer risk, especially among women. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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13 pages, 1616 KiB

Open AccessArticle

Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study

by Dinko Martinovic, Daria Tokic, Lovre Martinovic, Marko Kumric, Marino Vilovic, Doris Rusic, Josip Vrdoljak, Ivan Males, Tina Ticinovic Kurir, Slaven Lupi-Ferandin and Josko Bozic

Nutrients 2021, 13(11), 4038; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13114038 - 12 Nov 2021

Cited by 6 | Viewed by 2420

Abstract

The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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23 pages, 1519 KiB

Open AccessArticle

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

by Ajka Pribisalić, Romana Popović, Fiorella Pia Salvatore, Maja Vatavuk, Marija Mašanović, Caroline Hayward, Ozren Polašek and Ivana Kolčić

Nutrients 2021, 13(11), 3802; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13113802 - 26 Oct 2021

Cited by 6 | Viewed by 2651

Abstract

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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15 pages, 726 KiB

Open AccessArticle

Deprivation Index and Lifestyle: Baseline Cross-Sectional Analysis of the PREDIMED-Plus Catalonia Study

by Josep Basora, Felipe Villalobos, Meritxell Pallejà-Millán, Nancy Babio, Albert Goday, María Dolores Zomeño, Xavier Pintó, Emilio Sacanella and Jordi Salas-Salvadó

Nutrients 2021, 13(10), 3408; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103408 - 27 Sep 2021

Cited by 4 | Viewed by 3160

Abstract

This baseline cross-sectional analysis from data acquired in a sub-sample of the PREDIMED-Plus study participants aimed to evaluate the relation between the Composite Socioeconomic Index (CSI) and lifestyle (diet and physical activity). This study involved 1512 participants (759 (52.2%) women) between 55 and 80 years with overweight/obesity and metabolic syndrome assigned to 137 primary healthcare centers in Catalonia, Spain. CSI and lifestyle (diet and physical activity) were assessed. Multiple linear regression or multinomial regression were applied to the data. Cluster analysis was performed to identify dietary patterns. The multiple linear regression model showed that a high deprivation index was related to a higher consumption of refined cereals (11.98 g/d, p-value = 0.001) and potatoes (6.68 g/d, p-value = 0.001), and to a lower consumption of fruits (−17.52 g/d, p-value = 0.036), and coffee and tea (−8.03 g/d, p-value = 0.013). Two a posteriori dietary patterns were identified by cluster analysis and labeled as “healthy” and “unhealthy”. In addition, the multinomial regression model showed that a high deprivation index was related to an unhealthy dietary pattern and low physical activity (OR 1.42 [95% CI 1.06–1.89]; p-value < 0.05). In conclusion, a high deprivation index was related to an unhealthy lifestyle (diet and physical activity) in PREDIMED-Plus study participants. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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14 pages, 294 KiB

Open AccessArticle

Adherence to the Mediterranean Diet in Association with Self-Perception of Diet Sustainability, Anthropometric and Sociodemographic Factors: A Cross-Sectional Study in Italian Adults

by Beatrice Biasini, Alice Rosi, Davide Menozzi and Francesca Scazzina

Nutrients 2021, 13(9), 3282; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13093282 - 20 Sep 2021

Cited by 23 | Viewed by 3806

Abstract

The adoption of sustainable dietary models, such as the Mediterranean Diet (MD), can be a valuable strategy to preserve ecosystems and human health. This study aims to investigate in an Italian adult representative sample the adherence to the MD and to what extent it is associated with the self-perceived adoption of a sustainable diet, the consideration of the MD as a sustainable dietary model, and anthropometric and sociodemographic factors. By applying an online survey (n = 838, 18–65 years, 52% female), an intermediate level of MD adherence (median: 4.0, IR: 3.0–4.0) in a 0–9 range was observed. Only 50% of the total sample confirmed the MD as a sustainable dietary model, and 84% declared no or low perception of adopting a sustainable diet. Being female, having a higher income and education level, considering the MD as a sustainable dietary model, as well as the perception of having a sustainable diet were the most relevant factors influencing the probability of having a high score (≥6) of adherence to the MD. This study suggests a gradual shift away from the MD in Italy and supports the need to address efforts for developing intervention strategies tailored to adults for improving diet quality. Furthermore, a public campaign should stress the link between a diet and its environmental impact to foster nutritionally adequate and eco-friendly dietary behaviors. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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11 pages, 301 KiB

Open AccessArticle

Adherence to the Mediterranean Diet in a Portuguese Immigrant Community in the Central Valley of California

by Roberto M. Couto, Andrew D. Frugé and Michael W. Greene

Nutrients 2021, 13(6), 1989; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13061989 - 09 Jun 2021

Cited by 2 | Viewed by 2351

Abstract

The Mediterranean Diet (MedDiet) is a healthy eating pattern associated with a better quality of life among older adults and reduced risk of non-communicable diseases. Little is known about the MedDiet in immigrant communities from countries in which the MedDiet is a settled cultural heritage. Thus, we examined MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in a Portuguese immigrant community in Turlock, California. A cross-sectional study was conducted with 208 participants in Turlock and Livermore, California, which was used as a reference population. Univariate, multivariable, and logistic regression models were used for data analysis. Compared to the Livermore group, the Turlock group was younger and less educated, but had a higher average MedDiet score and active adherence to a MedDiet (p < 0.001 for both). In the Turlock group, convenience, sensory appeal, and health were observed to be significant barriers to the MedDiet (p < 0.05), while health, weight loss, natural content, familiarity, price, sensory appeal, and mood were significant benefit factors (p < 0.05). In conclusion, participants in Turlock had greater MedDiet adherence despite lower education attainment. Furthermore, the perceived benefits of the MedDiet were key factors in MedDiet perception and adherence in a Portuguese immigrant community. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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Review

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11 pages, 794 KiB

Open AccessEditor’s ChoiceReview

Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations

by Elisa Mattavelli, Elena Olmastroni, Daniela Bonofiglio, Alberico L. Catapano, Andrea Baragetti and Paolo Magni

Nutrients 2022, 14(10), 2040; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14102040 - 13 May 2022

Cited by 18 | Viewed by 3539

Abstract

The Mediterranean diet has emerged as a comprehensive lifestyle, including specific foods and meal composition and a set of behavioural and social features. Adherence to the Mediterranean diet has been shown to promote health and reduce the prevalence of chronic diseases. The actual implementation of the Mediterranean diet is affected by several sociocultural factors as well as geographical components. Indeed, the geographical location, such as a specific country or different areas in a country and specific latitude and climate, appears to be an important factor that may strongly affect the implementation of the Mediterranean diet or some of its principles as well as the adherence to it. Another dynamic component affecting personal nutritional choices, also regarding adherence to the Mediterranean diet and its principles, is the individual life-long trajectory of food preference and nutrition habits and awareness. In this review, we discuss the current evidence on the impact of geographical location on adherence to the Mediterranean diet. Full article

(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)

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