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Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 November 2017) | Viewed by 187277

Special Issue Editors

Prof. Dr. Miguel A. Martínez-González

E-Mail Website
Guest Editor
1. University of Navarra, Preventive Medicine & Public Health Department, Irunlarrea 1, 31008, Pamplona, Navarra, Spain
2. Harvard University, Department Nutrition, Harvard TH Chan School of Public Health, Boston, USA
Interests: mediterranean diet; dietary patterns; nutritional epidemiology; cardiovascular disease; obesity; chronic diseases; lifestyle; metabolomics
Assoc. Prof. Miguel Ruiz-Canela

E-Mail Website
Guest Editor
University of Navarra, Preventive Medicine & Public Health Department, Irunlarrea 1, 31008, Pamplona, Navarra, Spain
Interests: mediterranean diet; dietary patterns; nutritional epidemiology; cardiovascular disease; obesity; chronic diseases; lifestyle; metabolomics

Special Issue Information

Dear Colleagues,

This Special Issue of Nutrients, entitled “Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Diseases and Interventions”, welcomes the submission of manuscripts describing either original research or reviewing the scientific literature. Manuscripts should focus on different alternatives to measure adherence to the Mediterranean Diet (MedDiet). How this adherence is scored using different indexes and also the association of these scores with the risk of chronic disease.

Potential topics may include, but are not limited to:

  • Indexes used to score the adherence to a MedDiet-style pattern, strengths, limitations and comparability of the different scores
  • Adherence to the MedDiet and scoring approaches in non-Mediterranean countries.
  • Association between MedDiet indexes and the risk of cardiovascular disease, cancer and other chronic diseases.
  • Transferability of the Mediterranean diet to non-Mediterranean countries
  • Evaluation of MedDiet-based interventions for the prevention of chronic diseases.
  • MedDiet indexes and their relationship with indexes developed to assess other a priori healthy dietary patterns.

Prof. Miguel A. Martínez-González
Dr. Miguel Ruiz-Canela
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Mediterranean Diet
  • Dietary pattern
  • Healthy dietary patterns
  • Chronic disease
  • Prevention
  • Nutritional epidemiology

Published Papers (16 papers)

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24 pages, 386 KiB  
Article
Mediterranean Diet and Health Outcomes in the SUN Cohort
by Silvia Carlos, Carmen De La Fuente-Arrillaga, Maira Bes-Rastrollo, Cristina Razquin, Anaïs Rico-Campà, Miguel Angel Martínez-González and Miguel Ruiz-Canela
Nutrients 2018, 10(4), 439; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10040439 - 31 Mar 2018
Cited by 175 | Viewed by 16464
Abstract
The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It [...] Read more.
The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018. Data on diet, lifestyle and clinical diagnosis are collected at baseline and every two years. After reviewing 21 publications from the SUN cohort on the effects of the MedDiet, we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality, fatal and non-fatal major cardiovascular disease (CVD), type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis. An inverse dose-response relationship was found for many of these associations. The MedDiet was also associated with lower average heart rate, a mitigation of the harmful effects of overweight/obesity on the risk of CVD, and an attenuation of the effects of obesity on type 2 diabetes. A suggestion that the MedDiet may enhance fertility was also found. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
11 pages, 242 KiB  
Article
Mediterranean Diet and Breast Cancer Risk
by Federica Turati, Greta Carioli, Francesca Bravi, Monica Ferraroni, Diego Serraino, Maurizio Montella, Attilio Giacosa, Federica Toffolutti, Eva Negri, Fabio Levi and Carlo La Vecchia
Nutrients 2018, 10(3), 326; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10030326 - 08 Mar 2018
Cited by 99 | Viewed by 17480
Abstract
The Mediterranean diet has been related to a reduced risk of several common cancers but its role on breast cancer has not been quantified yet. We investigated the association between adherence to the Mediterranean diet and breast cancer risk by means of a [...] Read more.
The Mediterranean diet has been related to a reduced risk of several common cancers but its role on breast cancer has not been quantified yet. We investigated the association between adherence to the Mediterranean diet and breast cancer risk by means of a hospital-based case-control study conducted in Italy and Switzerland. 3034 breast cancer cases and 3392 controls admitted to the same network of hospitals for acute, non-neoplastic and non-gynaecologic diseases were studied. Adherence to the Mediterranean diet was quantitatively measured through a Mediterranean Diet Score (MDS), summarizing the major characteristics of the Mediterranean dietary pattern and ranging from 0 (lowest adherence) to 9 (highest adherence). We estimated the odds ratios (ORs) of breast cancer for the MDS using multiple logistic regression models, adjusting for several covariates. Compared to a MDS of 0–3, the ORs for breast cancer were 0.86 (95% confidence interval, CI, 0.76–0.98) for a MDS of 4–5 and 0.82 (95% CI, 0.71–0.95) for a MDS of 6–9 (p for trend = 0.008). The exclusion of the ethanol component from the MDS did not materially modify the ORs (e.g., OR = 0.81, 95% CI, 0.70–0.95, for MDS ≥ 6). Results were similar in pre- and post-menopausal women. Adherence to the Mediterranean diet was associated with a reduced breast cancer risk. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
14 pages, 561 KiB  
Article
Exploring the Adherence to the Mediterranean Diet and Its Relationship with Individual Lifestyle: The Role of Healthy Behaviors, Pro-Environmental Behaviors, Income, and Education
by Alessia Cavaliere, Elisa De Marchi and Alessandro Banterle
Nutrients 2018, 10(2), 141; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10020141 - 28 Jan 2018
Cited by 70 | Viewed by 7408
Abstract
The reduction of diet-related diseases and the improvement of environmental sustainability represent two of the major 21st century food policy challenges. Sustainable diets could significantly contribute to achieving both of these goals, improving consumer health and reducing the environmental impact of food production [...] Read more.
The reduction of diet-related diseases and the improvement of environmental sustainability represent two of the major 21st century food policy challenges. Sustainable diets could significantly contribute to achieving both of these goals, improving consumer health and reducing the environmental impact of food production and consumption. The Mediterranean diet (MD) represents an excellent example of sustainable diet, however recent evidence indicates that such a dietary pattern is now progressively disappearing in Mediterranean countries. In such a context, this paper explores how individual lifestyle and habits are related to a high/low adherence to the MD model. The goal is to examine whether there is a relationship between individuals’ healthy and pro-environmental behaviors and their level of adherence to the MD. The analysis also explores the role of consumer income and education. The study is based on the Italian population (n = 42,000) and uses a structural equation model approach. The results outline that the MD is part of a sustainability-oriented lifestyle and stress the key role of both income and education in affecting adherence to MD. Future policy aimed at contrasting the gradual disappearance of the MD should emphasize the sustainable dimension of the MD, meanwhile reducing socio-economic disparities among different population segments. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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16 pages, 941 KiB  
Article
Validation of the English Version of the 14-Item Mediterranean Diet Adherence Screener of the PREDIMED Study, in People at High Cardiovascular Risk in the UK
by Angeliki Papadaki, Laura Johnson, Zoi Toumpakari, Clare England, Manmita Rai, Stu Toms, Chris Penfold, Itziar Zazpe, Miguel A. Martínez-González and Gene Feder
Nutrients 2018, 10(2), 138; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10020138 - 28 Jan 2018
Cited by 97 | Viewed by 9866
Abstract
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial [...] Read more.
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0–14) was calculated from the MEDAS’ administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (κ = 0.19, 95% CI 0.07–0.31, p = 0.002; 95% limits of agreement −2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (κ = 0.38, 95% CI 0.24–0.52, p < 0.001; 95% limits of agreement −3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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13 pages, 485 KiB  
Article
Adherence to the Mediterranean Diet and Inflammatory Markers
by Antoni Sureda, Maria Del Mar Bibiloni, Alicia Julibert, Cristina Bouzas, Emma Argelich, Isabel Llompart, Antoni Pons and Josep A. Tur
Nutrients 2018, 10(1), 62; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10010062 - 10 Jan 2018
Cited by 152 | Viewed by 13396
Abstract
The aim was to assess inflammatory markers among adults and adolescents in relation to the adherence to the Mediterranean diet. A random sample (219 males and 379 females) of the Balearic Islands population (12–65 years) was anthropometrically measured and provided a blood sample [...] Read more.
The aim was to assess inflammatory markers among adults and adolescents in relation to the adherence to the Mediterranean diet. A random sample (219 males and 379 females) of the Balearic Islands population (12–65 years) was anthropometrically measured and provided a blood sample to determine biomarkers of inflammation. Dietary habits were assessed and the adherence to the Mediterranean dietary pattern calculated. The prevalence of metabolic syndrome increased with age in both sexes. The adherence to the Mediterranean diet in adolescent males was 51.3% and 45.7% in adults, whereas in females 53.1% and 44.3%, respectively. In males, higher adherence to the Mediterranean diet was associated with higher levels of adiponectin and lower levels of leptin, tumor necrosis factor alpha (TNF-α), plasminogen activator inhibitor 1 (PAI-1) and high-sensitivity C-reactive protein (hs-CRP) in adults, but not in young subjects. In females, higher adherence was associated with lower levels of leptin in the young group, PAI-1 in adults and hs-CRP in both groups. With increasing age in both sexes, metabolic syndrome increases, but the adherence to the Mediterranean diet decreases. Low adherence to the Mediterranean dietary pattern (MDP) is directly associated with a worse profile of plasmatic inflammation markers. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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1199 KiB  
Article
Impact of Consuming Extra-Virgin Olive Oil or Nuts within a Mediterranean Diet on DNA Methylation in Peripheral White Blood Cells within the PREDIMED-Navarra Randomized Controlled Trial: A Role for Dietary Lipids
by Ana Arpón, Fermín I. Milagro, Cristina Razquin, Dolores Corella, Ramón Estruch, Montserrat Fitó, Amelia Marti, Miguel A. Martínez-González, Emilio Ros, Jordi Salas-Salvadó, José-Ignacio Riezu-Boj and J. Alfredo Martínez
Nutrients 2018, 10(1), 15; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10010015 - 23 Dec 2017
Cited by 74 | Viewed by 10567
Abstract
DNA methylation could be reversible and mouldable by environmental factors, such as dietary exposures. The objective was to analyse whether an intervention with two Mediterranean diets, one rich in extra-virgin olive oil (MedDiet + EVOO) and the other one in nuts (MedDiet + [...] Read more.
DNA methylation could be reversible and mouldable by environmental factors, such as dietary exposures. The objective was to analyse whether an intervention with two Mediterranean diets, one rich in extra-virgin olive oil (MedDiet + EVOO) and the other one in nuts (MedDiet + nuts), was influencing the methylation status of peripheral white blood cells (PWBCs) genes. A subset of 36 representative individuals were selected within the PREvención con DIeta MEDiterránea (PREDIMED-Navarra) trial, with three intervention groups in high cardiovascular risk volunteers: MedDiet + EVOO, MedDiet + nuts, and a low-fat control group. Methylation was assessed at baseline and at five-year follow-up. Ingenuity pathway analysis showed routes with differentially methylated CpG sites (CpGs) related to intermediate metabolism, diabetes, inflammation, and signal transduction. Two CpGs were specifically selected: cg01081346–CPT1B/CHKB-CPT1B and cg17071192–GNAS/GNASAS, being associated with intermediate metabolism. Furthermore, cg01081346 was associated with PUFAs intake, showing a role for specific fatty acids on epigenetic modulation. Specific components of MedDiet, particularly nuts and EVOO, were able to induce methylation changes in several PWBCs genes. These changes may have potential benefits in health; especially those changes in genes related to intermediate metabolism, diabetes, inflammation and signal transduction, which may contribute to explain the role of MedDiet and fat quality on health outcomes. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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639 KiB  
Article
Transferability of the Mediterranean Diet to Non-Mediterranean Countries. What Is and What Is Not the Mediterranean Diet
by Miguel Ángel Martínez-González, Maria Soledad Hershey, Itziar Zazpe and Antonia Trichopoulou
Nutrients 2017, 9(11), 1226; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9111226 - 08 Nov 2017
Cited by 181 | Viewed by 25229 | Correction
Abstract
Substantial evidence has verified the Mediterranean diet’s (MedDiet) nutritional adequacy, long-term sustainability, and effectiveness for preventing hard clinical events from cardiovascular disease (CVD), as well as increasing longevity. This article includes a cumulative meta-analysis of prospective studies supporting a strong inverse association between [...] Read more.
Substantial evidence has verified the Mediterranean diet’s (MedDiet) nutritional adequacy, long-term sustainability, and effectiveness for preventing hard clinical events from cardiovascular disease (CVD), as well as increasing longevity. This article includes a cumulative meta-analysis of prospective studies supporting a strong inverse association between closer adherence to the MedDiet and the incidence of hard clinical events of CVD. The MedDiet has become an increasingly popular topic of interest when focusing on overall food patterns rather than single nutrient intake, not only in Mediterranean countries, but also globally. However, several myths and misconceptions associated with the traditional Mediterranean diet should be clearly addressed and dispelled, particularly those that label as “Mediterranean” an eating pattern that is not in line with the traditional Mediterranean diet. The transferability of the traditional MedDiet to the non-Mediterranean populations is possible, but it requires a multitude of changes in dietary habits. New approaches for promoting healthy dietary behavior consistent with the MedDiet will offer healthful, sustainable, and practical strategies at all levels of public health. The following article presents practical resources and knowledge necessary for accomplishing these changes. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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878 KiB  
Article
Mediterranean Diet Adherence and Genetic Background Roles within a Web-Based Nutritional Intervention: The Food4Me Study
by Rodrigo San-Cristobal, Santiago Navas-Carretero, Katherine M. Livingstone, Carlos Celis-Morales, Anna L. Macready, Rosalind Fallaize, Clare B. O’Donovan, Christina P. Lambrinou, George Moschonis, Cyril F. M. Marsaux, Yannis Manios, Miroslaw Jarosz, Hannelore Daniel, Eileen R. Gibney, Lorraine Brennan, Christian A. Drevon, Thomas E. Gundersen, Mike Gibney, Wim H. M. Saris, Julie A. Lovegrove, Keith Grimaldi, Laurence D. Parnell, Jildau Bouwman, Ben Van Ommen, John C. Mathers and J. Alfredo Martinezadd Show full author list remove Hide full author list
Nutrients 2017, 9(10), 1107; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9101107 - 11 Oct 2017
Cited by 27 | Viewed by 10447
Abstract
Mediterranean Diet (MedDiet) adherence has been proven to produce numerous health benefits. In addition, nutrigenetic studies have explained some individual variations in the response to specific dietary patterns. The present research aimed to explore associations and potential interactions between MedDiet adherence and genetic [...] Read more.
Mediterranean Diet (MedDiet) adherence has been proven to produce numerous health benefits. In addition, nutrigenetic studies have explained some individual variations in the response to specific dietary patterns. The present research aimed to explore associations and potential interactions between MedDiet adherence and genetic background throughout the Food4Me web-based nutritional intervention. Dietary, anthropometrical and biochemical data from volunteers of the Food4Me study were collected at baseline and after 6 months. Several genetic variants related to metabolic risk features were also analysed. A Genetic Risk Score (GRS) was derived from risk alleles and a Mediterranean Diet Score (MDS), based on validated food intake data, was estimated. At baseline, there were no interactions between GRS and MDS categories for metabolic traits. Linear mixed model repeated measures analyses showed a significantly greater decrease in total cholesterol in participants with a low GRS after a 6-month period, compared to those with a high GRS. Meanwhile, a high baseline MDS was associated with greater decreases in Body Mass Index (BMI), waist circumference and glucose. There also was a significant interaction between GRS and the MedDiet after the follow-up period. Among subjects with a high GRS, those with a high MDS evidenced a highly significant reduction in total carotenoids, while among those with a low GRS, there was no difference associated with MDS levels. These results suggest that a higher MedDiet adherence induces beneficial effects on metabolic outcomes, which can be affected by the genetic background in some specific markers. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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1216 KiB  
Article
Inverse Associations between a Locally Validated Mediterranean Diet Index, Overweight/Obesity, and Metabolic Syndrome in Chilean Adults
by Guadalupe Echeverría, Emma E. McGee, Inés Urquiaga, Paulina Jiménez, Sonia D’Acuña, Luis Villarroel, Nicolás Velasco, Federico Leighton and Attilio Rigotti
Nutrients 2017, 9(8), 862; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9080862 - 11 Aug 2017
Cited by 31 | Viewed by 5462
Abstract
Obesity and metabolic syndrome (MetS) are key risk factors for chronic disease. Dietary patterns are critical in the incidence and persistence of obesity and MetS, yet there is few data linking diet to obesity and MetS in Chile. Our objective was to use [...] Read more.
Obesity and metabolic syndrome (MetS) are key risk factors for chronic disease. Dietary patterns are critical in the incidence and persistence of obesity and MetS, yet there is few data linking diet to obesity and MetS in Chile. Our objective was to use a locally validated diet index to evaluate adherence to a Mediterranean dietary pattern and its correlations with overweight/obesity (OW/O) and MetS prevalence in Chilean adults. We conducted a nationwide, cross-sectional online survey of Chilean adults with complete self-reported diet and body mass index data (n = 24,882). A subsample of 4348 users (17.5%) had valid MetS data. An inverse association was observed between adherence to Mediterranean diet and OW/O and MetS prevalence. As diet quality decreased from healthy, to moderately-healthy, to unhealthy, prevalence increased from 44.8, 51.1, to 60.9% for OW/O and from 13.4, 18.5, to 28.9% for MetS (p-values < 0.001). Adjusted odds ratios for OW/O and MetS were significantly higher in moderately-healthy (OR = 1.58 and 1.54) and unhealthy (OR = 2.20 and 2.49, respectively) diet groups in comparison to the healthy diet group. This study represents the first report on the relationship between Mediterranean diet and chronic disease risk in Chile. It suggests that the Mediterranean diet may be applied to manage chronic disease risk beyond the Mediterranean basin. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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299 KiB  
Article
Ten-Year Trends (1999–2010) of Adherence to the Mediterranean Diet among the Balearic Islands’ Adult Population
by Maria Del Mar Bibiloni, Mónica González, Alicia Julibert, Isabel Llompart, Antoni Pons and Josep A. Tur
Nutrients 2017, 9(7), 749; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9070749 - 14 Jul 2017
Cited by 18 | Viewed by 4113
Abstract
The aim of this work was to assess ten-year trends (1999–2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands’ adult population. Two independent cross-sectional dietary surveys (1999–2000, n = 1200 and 2009–2010 n = 1388, including participants aged 16–65 [...] Read more.
The aim of this work was to assess ten-year trends (1999–2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands’ adult population. Two independent cross-sectional dietary surveys (1999–2000, n = 1200 and 2009–2010 n = 1388, including participants aged 16–65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999–2000 and 44.6% (SD 8.3) in 2009–2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island’s natives than among people born abroad. In 2009–2010, individuals in the MDP’s fourth quartile were more likely to be older (aged 46–65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999–2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands’ adult population in the last decade. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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249 KiB  
Article
Trends of Adherence to the Mediterranean Dietary Pattern in Northern Italy from 2010 to 2016
by Alessandro Leone, Alberto Battezzati, Ramona De Amicis, Giulia De Carlo and Simona Bertoli
Nutrients 2017, 9(7), 734; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9070734 - 11 Jul 2017
Cited by 47 | Viewed by 4132
Abstract
Little information is available on the trends of adherence to the Mediterranean dietary pattern (MDP). This study investigates food consumption trends from 2010 to 2016 in subjects living in Northern Italy. A cross-sectional study of 8584 subjects enrolled between January 2010 and December [...] Read more.
Little information is available on the trends of adherence to the Mediterranean dietary pattern (MDP). This study investigates food consumption trends from 2010 to 2016 in subjects living in Northern Italy. A cross-sectional study of 8584 subjects enrolled between January 2010 and December 2016 was conducted. Socio-demographic, nutrition and lifestyle characteristics were collected. A 14-item questionnaire was used to evaluate adherence to MDP. Multivariable Poisson regression was used to evaluate the trends of and the determinants for the adherence to MDP. The overall prevalence of adherence to MDP was 14% and the trend remained constant over the six years. However, there was a marked increase in nuts consumption and a slight one in white meat consumption. Furthermore, we observed a decrease in the consumption of fruit, red meat, sweets and sugar-sweetened beverages and in the use of soffritto. Finally, higher education, being older, married, physically active, and ex-smoker was associated with greater adherence to MDP, whereas the prevalence of adherence was lower in the obese. In conclusion, the consumption of some Mediterranean and non-Mediterranean food groups changed over the six years. However, overall, the prevalence of adherence to MDP did not change. Additional strategies promoting healthy dietary habits are needed. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
268 KiB  
Article
Western and Mediterranean Dietary Patterns and Physical Activity and Fitness among Spanish Older Adults
by Maria Del Mar Bibiloni, Alicia Julibert, Emma Argelich, Raquel Aparicio-Ugarriza, Gonzalo Palacios, Antoni Pons, Marcela Gonzalez-Gross and Josep A. Tur
Nutrients 2017, 9(7), 704; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9070704 - 06 Jul 2017
Cited by 29 | Viewed by 6100
Abstract
Objectives: To assess prevailing food patterns, and its association with physical activity and fitness among Spanish older adults. Methods: Cross-sectional study in Spain, collecting data from a sample (n = 380; 54% female) aged 55–80 years (men) and 60–80 years (women) with [...] Read more.
Objectives: To assess prevailing food patterns, and its association with physical activity and fitness among Spanish older adults. Methods: Cross-sectional study in Spain, collecting data from a sample (n = 380; 54% female) aged 55–80 years (men) and 60–80 years (women) with no previously documented cardiovascular disease. Body weight, body fat and waist circumference were assessed. Physical activity performed was measured using the Minnesota Leisure-time Physical Activity Questionnaire (LTPA). Physical fitness was assessed using a validated physical fitness test battery. Food consumption was assessed by a validated semi-quantitative food-frequency questionnaire. Factor analysis identified two major dietary food patterns: “Western” (WDP) and “Mediterranean” (MDP) dietary patterns. Results: Participants in MDP’s fourth quartile were classified in the second (men) and third (men and women) tertile of LTPA. After adjusting for age, body fat, waist-to-height ratio, and METs, in both sexes, a negative significant association was found between 30-s Chair stand and 6-min walking test, a positive significant association was found between 30-m Gait speed and 8-foot Time Up-and-Go (except in men) tests with WDP. The 30-m Gait speed test was negatively associated with MDP in men. Conclusions: MDP is associated with more time spent on LTPA, and this association was independent of body composition and a fast gait speed in men. WDP is associated with slower gait speed and lower body strength, agility and aerobic endurance. MDP has protective effect on healthy physical fitness, and WDP may be a contributor to frailty. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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3934 KiB  
Article
Brain Functional Connectivity Is Modified by a Hypocaloric Mediterranean Diet and Physical Activity in Obese Women
by Natalia García-Casares, María R. Bernal-López, Nuria Roé-Vellvé, Mario Gutiérrez-Bedmar, Jose C. Fernández-García, Juan A. García-Arnés, José R. Ramos-Rodriguez, Francisco Alfaro, Sonia Santamaria-Fernández, Trevor Steward, Susana Jiménez-Murcia, Isabel Garcia-Garcia, Pedro Valdivielso, Fernando Fernández-Aranda, Francisco J. Tinahones and Ricardo Gómez-Huelgas
Nutrients 2017, 9(7), 685; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9070685 - 01 Jul 2017
Cited by 14 | Viewed by 6935
Abstract
Functional magnetic resonance imaging (fMRI) in the resting state has shown altered brain connectivity networks in obese individuals. However, the impact of a Mediterranean diet on cerebral connectivity in obese patients when losing weight has not been previously explored. The aim of this [...] Read more.
Functional magnetic resonance imaging (fMRI) in the resting state has shown altered brain connectivity networks in obese individuals. However, the impact of a Mediterranean diet on cerebral connectivity in obese patients when losing weight has not been previously explored. The aim of this study was to examine the connectivity between brain structures before and six months after following a hypocaloric Mediterranean diet and physical activity program in a group of sixteen obese women aged 46.31 ± 4.07 years. Before and after the intervention program, the body mass index (BMI) (kg/m2) was 38.15 ± 4.7 vs. 34.18 ± 4.5 (p < 0.02), and body weight (kg) was 98.5 ± 13.1 vs. 88.28 ± 12.2 (p < 0.03). All subjects underwent a pre- and post-intervention fMRI under fasting conditions. Functional connectivity was assessed using seed-based correlations. After the intervention, we found decreased connectivity between the left inferior parietal cortex and the right temporal cortex (p < 0.001), left posterior cingulate (p < 0.001), and right posterior cingulate (p < 0.03); decreased connectivity between the left superior frontal gyrus and the right temporal cortex (p < 0.01); decreased connectivity between the prefrontal cortex and the somatosensory cortex (p < 0.025); and decreased connectivity between the left and right posterior cingulate (p < 0.04). Results were considered significant at a voxel-wise threshold of p ≤ 0.05, and a cluster-level family-wise error correction for multiple comparisons of p ≤ 0.05. In conclusion, functional connectivity between brain structures involved in the pathophysiology of obesity (the inferior parietal lobe, posterior cingulate, temporo-insular cortex, prefrontal cortex) may be modified by a weight loss program including a Mediterranean diet and physical exercise. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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Article
A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study
by Alexandra T. Wade, Courtney R. Davis, Kathryn A. Dyer, Jonathan M. Hodgson, Richard J. Woodman, Hannah A. D. Keage and Karen J. Murphy
Nutrients 2017, 9(2), 145; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9020145 - 16 Feb 2017
Cited by 20 | Viewed by 10665
Abstract
The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate [...] Read more.
The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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Review

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21 pages, 268 KiB  
Review
Mediterranean Diet and Cardiometabolic Diseases in Racial/Ethnic Minority Populations in the United States
by Mercedes Sotos-Prieto and Josiemer Mattei
Nutrients 2018, 10(3), 352; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10030352 - 14 Mar 2018
Cited by 23 | Viewed by 5655
Abstract
The Mediterranean diet (MedDiet) has been recommended to the general population by many scientific organizations as a healthy dietary pattern, based on strong evidence of association with improved cardiometabolic health, including lower risk of cardiovascular disease, diabetes, and obesity. However, most studies have [...] Read more.
The Mediterranean diet (MedDiet) has been recommended to the general population by many scientific organizations as a healthy dietary pattern, based on strong evidence of association with improved cardiometabolic health, including lower risk of cardiovascular disease, diabetes, and obesity. However, most studies have been conducted in Mediterranean or European countries or among white populations in the United States (US), while few exist for non-Mediterranean countries or racial/ethnic minority populations in the US. Because most existing studies evaluating adherence to the MedDiet use population-specific definitions or scores, the reported associations may not necessarily apply to other racial/ethnic populations that may have different distributions of intake. Moreover, racial/ethnic groups may have diets that do not comprise the typical Mediterranean foods captured by these scores. Thus, there is a need to determine if similar positive effects from following a MedDiet are observed in diverse populations, as well as to identify culturally-relevant foods reflected within Mediterranean-like patterns, that can facilitate implementation and promotion of such among broader racial/ethnic groups. In this narrative review, we summarize and discuss the evidence from observational and intervention studies on the MedDiet and cardiometabolic diseases in racial/ethnic minority populations in the US, and offer recommendations to enhance research on MedDiet for such populations. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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Review
Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis
by Lukas Schwingshackl, Carolina Schwedhelm, Cecilia Galbete and Georg Hoffmann
Nutrients 2017, 9(10), 1063; https://0-doi-org.brum.beds.ac.uk/10.3390/nu9101063 - 26 Sep 2017
Cited by 428 | Viewed by 32208
Abstract
The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer [...] Read more.
The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I2 = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I2 = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I2 = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I2 = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I2 = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I2 = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I2 = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies. Full article
(This article belongs to the Special Issue Assessing the Mediterranean Diet in Public Health: Scoring Systems, Effects on Chronic Disease and Interventions)
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