Cost and Cost-Effectiveness of the Mediterranean Diet: An Update of a Systematic Review.

It is well known that the Mediterranean diet (DM) is beneficial for health, as years of research globally have confirmed. The aim of this study was to update a previous systematic review that assessed the cost-effectiveness of adherence to the DM as a strategy for the prevention of degenerative diseases by evaluating the economic performance of this diet. The research approach utilized three electronic databases: PubMed, Scopus, and Web of Science. A comprehensive search was conducted to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023493562. Data extraction and analysis were performed on all included studies. One thousand two hundred and eighty-two articles were retrieved, and once duplicates and irrelevant articles were removed, fifteen useful articles were reviewed. The studies indicated a clear link between dietary habits, health, and economic aspects related to dietary cost and health spending. Recognizing the significant health benefits associated with adopting DM and the potential savings on health care spending, it is important for national public health programs to consider policies that support this lifestyle.

The Effect of a Program to Improve Adherence to the Mediterranean Diet on Cardiometabolic Parameters in 7034 Spanish Workers.

BACKGROUND: Cardiovascular and metabolic diseases include a large group of pathologies and constitute one of the most serious chronic health problems facing the 21st century, with high rates of morbidity and mortality worldwide. Unhealthy diets influence the development of these pathologies. The Mediterranean diet can be an important part in the treatment of these diseases. The objective of this study was to assess the effect of a program that aims to increase adherence to the Mediterranean diet on the improvement of different cardiometabolic risk parameters. METHODS: A prospective intervention study was carried out on 7034 Spanish workers. Prior to the intervention, 22 cardiometabolic risk scales were evaluated. Participants in this study were informed both orally and in writing of the characteristics and benefits of the Mediterranean diet and were given the website of the Ministry of Health, Consumption and Social Welfare of Spain, which provides advice on nutrition. Adherence to the Mediterranean diet was reinforced by sending a monthly SMS to their mobile phones. After six months of follow-up, the 22 risk scales were re-evaluated to assess changes. Means and standard deviations were calculated using Student's t test to analyse quantitative variables. Prevalence was calculated using the Chi-square test when the variables were qualitative. RESULTS: All the cardiometabolic risk scales studied decreased after implementing a program to improve and enhance adherence to the Mediterranean diet. The number of losses in the sample was very low, standing at 4.31%. CONCLUSIONS: The Mediterranean diet is effective in reducing all cardiovascular risk scales evaluated. The mean values and prevalence of high values of the different cardiometabolic risk scales analysed led to lower values after the implementation of the program to increase adherence to the Mediterranean diet. We observed a significant positive difference in metabolic age in both sexes. We have obtained a significant improvement in the insulin resistance index, especially in the SPISE-IR index, data that we have not found in previous publications. Easy access to the Internet and new information and communication technologies facilitate adherence to a diet and can reduce the number of losses.

Adherence to the Mediterranean Diet in Saudi Arabia and Its Association with Socioeconomic Status and Depression.

Background and Objectives: Several RCTs have reported significant reductions in depression symptoms with the Mediterranean diet (MedDiet), but observational studies have reported inconsistent findings. Moreover, studies have rarely investigated the mediating role of socioeconomic status (SES), including objective material status, in adherence to the MedDiet and its impact on depressive symptoms in the same population. Therefore, this cross-sectional study investigated the relationship between adherence to the MedDiet, socioeconomic factors, and depression severity. Materials and Methods: A cross-sectional online survey was conducted between June and December 2022 across Saudia Arabia. The snowball sampling technique was used to recruit participants aged ≥18 years. Mediterranean diet adherence screener (MEDAS) and Patient Health Questionnaire-9 (PHQ-9) were used to assess adherence to the MedDiet and depression severity. An SES index, validated in the Saudi Arabian context, was used to assess SES. The data were analyzed using the Chi-square and Pearson's correlation tests. Results: Only 21% of our study population (n = 467) was MedDiet adherent. Adherence was significantly associated with education (p = 0.014) but not employment status among traditional SES indicators. Similarly, only television ownership (p = 0.009) was associated with MedDiet adherence among the 20 objective material possessions investigated. Nonetheless, the MedDiet-adherent group had a significantly lower PHQ-9 score than the non-adherent group (6.16 ± 0.68 vs. 8.35 ± 0.31, p = 0.002). A moderate but significantly negative correlation between MEDAS and PHQ-9 scores (r = -0.16, p = 0.001) was noted. Conclusions: MedDiet adherence was associated with lower depression severity scores. In addition to education and television ownership, adherence was not associated with any objective indicators of SES.

Assessment of Mediterranean diet adherence and comparison with Italian dietary guidelines: a study of over 10,000 adults from 2019 to 2022.

Despite the many well-documented benefits of the Mediterranean diet (MD), many Mediterranean countries seem to be moving away from it. The aim of this study was to investigate the MD adherence in 10,916 adults who completed the validated Medi-Lite questionnaire from January 2019 to December 2022 in Italy, and to assess the consumption of its food groups by comparing them with current national dietary guidelines. The sample showed a good level of MD adherence (12 ± 2.5). However, from 2019 to 2022, a significant (p < 0.001) decline in the adherence level emerged. An overconsumption of fresh red meat, cheese and poultry compared to dietary guidelines was observed. In contrast, an under-consumption of vegetables, bread, legumes, fish and milk and dairy products emerged. In recent years, a decline in MD adherence was observed in Italy, probably determined by an excessive consumption of animal products.

Factors associated with Mediterranean diet adherence in a sample of high socio-economic status children from southern Spain.

OBJECTIVE: The present study examined the association of BMI, fat mass, physical activity engagement (PA), maximal oxygen consumption (VO2max), screen time and academic performance (AP) with Mediterranean diet (MD) adherence in a sample of high socio-economic status (SES) children. DESIGN: A non-randomised design was used. A multilinear regression model was developed using backward elimination. Analysis included variables pertaining to age, BMI, VO2max, fat percentage, AP, PA engagement and screen time. All participants had a high SES and so this variable was not included as a predictor. Data met the assumptions required for multiple regressions in terms of linearity, homoscedasticity, normality, independence and non-multicollinearity. SETTING: Two state and three mixed funding schools in Granada, Spain. PARTICIPANTS: Data were collected from 244 children aged between 10 and 12 years. RESULTS: Better AP, higher PA engagement and lower screen time were found to be predictive of MD adherence. These variables explained 22·9 % of the variance in data measuring adolescent MD adherence. CONCLUSIONS: The present study suggests that, in addition to SES, PA, AP and screen time are important components to consider when targeting improvements in MD adherence in children. It is, therefore, concluded that interventions targeting improvements in PA, AP and screen time are needed to promote MD adherence in children, regardless of SES.

A Clustering Study of Dietary Patterns and Physical Activity among Workers of the Uruguayan State Electrical Company.

Recent studies have shown that certain nutrients, specific food groups, or general dietary patterns (DPs) can promote health and prevent noncommunicable chronic diseases (NCCDs). Both developed and developing countries experience a high prevalence of NCCDs due to poor lifestyle habits, DPs, and low physical activity levels. This study aims to examine the dietary, physical activity, sociodemographic, and lifestyle patterns of Uruguayan State Electrical Company workers (the IN-UTE study). A total of 2194 workers participated in the study, providing information about their sociodemographics, lifestyles, and dietary habits through different questionnaires. To identify DPs from 16 food groups, principal component analysis (PCA) was performed. A hierarchical cluster algorithm was used to combine food groups and sociodemographic/lifestyle variables. Four DPs were extracted from the data; the first DP was related to the intake of energy-dense foods, the second DP to the characteristics of the job, the third DP to a Mediterranean-style diet, and the fourth DP to age and body mass index. In addition, cluster analysis involving a larger number of lifestyle variables produced similar results to the PCA. Lifestyle and sociodemographic factors, including night work, working outside, and moderate and intense PA, were significantly correlated with the dietary clusters, suggesting that working conditions, socioeconomic status, and PA may play an important role in determining DPs to some extent. Accordingly, these findings should be used to design lifestyle interventions to reverse the appearance of unhealthy DPs in the UTE population.

Food insecurity, Mediterranean diet adherence, and psychosocial health among university students in Türkiye.

The aim was to examine the relationship between food insecurity and adherence to the Mediterranean diet, academic achievement, depression, anxiety, and stress among university students. This cross-sectional study was conducted with 2039 university students studying in Türkiye. Sixty-eight point two per cent of the students were food insecure. Food security (FS) scores were negatively associated with adherence to the MD and academic achievement, and positively associated with depression, anxiety, and stress scores. A 1-unit increase in FS score resulted in a statistically significant increase of 0.458, 0.468, and 0.400 units in depression, anxiety, and stress scores, respectively, and a significant decrease of 0.140 units in the MD adherence screener score. Food insecurity among university students in Türkiye is very common, and students with food insecurity have low adherence to the MD and low academic achievement and high depression, anxiety, and stress scores. Financial support as well as financial and food literacy provided to students play an important role in managing food insecurity.

Achievement of sustainable development goals through the Mediterranean diet.

The prosperity of our planet relies on the cardinal concept of sustainable development. The dietary choices of humans play a pivotal role in creating a peaceful and contented world. In this context, the Mediterranean diet (MD) has emerged as a valuable approach to accomplishing such progress, wherein the rights of all living beings are equally honored. This review aims to analyze the significance of a plant-based diet, particularly the Mediterranean diet, in attaining sustainable development goals. A comprehensive search of the literature was conducted to gather the most reliable and published scientific evidence from books and papers. Within this research endeavor, specific Sustainable Development Goals (SDGs) are individually addressed in relation to the adoption of the Mediterranean diet as a foundational nutritional paradigm. Our research findings underscore the immense importance of the MD and advocate for its worldwide implementation to accomplish sustainable development objectives. The MD emerges as the most suitable dietary option for fostering sustainability and tranquility in our world. It is crucial to prioritize the global implementation of the MD to genuinely achieve sustainable development.

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics.

BACKGROUND: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. OBJECTIVE: The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. METHODS: MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. TRIAL REGISTRATION: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).

Association of monetary diet cost of foods and diet quality in Spanish older adults.

Background: A major barrier to a healthy diet may be the higher price of healthy foods compared to low-quality foods. Objectives: This study aimed to assess the association between the monetary cost of food and diet quality in Spanish older adults at high risk of cardiovascular disease. Methods: Cross-sectional analysis was carried out in Spanish older adults (n = 6,838; 48.6% female). A validated food frequency questionnaire was used to assess dietary intake. Metabolic syndrome severity, adherence to the Mediterranean diet (MedDiet), adherence to a provegetarian dietary pattern, and dietary inflammatory index were assessed. The economic cost of the foods was obtained from the Spanish Ministry of Agriculture Fisheries and Food database (2015-2017, the period of time when the participants were recruited). The total cost of diet adjusted per 1,000 kcal was computed. Results: The healthier dietary pattern was associated with a higher cost of the diet. Higher adherence to the MedDiet, anti-inflammatory diet, and the healthy version of the provegetarian dietary pattern were related to higher costs of the diet. Conclusion: Higher diet quality was associated with a higher dietary cost of the diet per 1,000 kcal/day. Food prices can be an important component of interventions and policies aimed at improving people's diets and preventing diet-related chronic diseases. Clinical trial registry number: The trial was registered in 2014 at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870) with the number 89898870.

Adherence to a Mediterranean Diet, Body Composition and Energy Expenditure in Outpatients Adolescents Diagnosed with Anorexia Nervosa: A Pilot Study.

Weight restoration is the primary goal of treatment for patients with Anorexia Nervosa (AN). This observational pilot study aims to describe adherence to the Mediterranean Diet (MD) and the consequent process of weight and functional recovery in outpatient adolescents diagnosed with AN. Eight patients with a median age of 15.1 (14.0-17.1) years were seen at baseline and after six months. Anthropometrics, body composition, and resting energy expenditure (REE) were assessed. The KIDMED questionnaire, the 24 h recall, and a quantitative food frequency questionnaire were used to evaluate adherence to the MD. The median KIDMED score increased from 5.5 (T0) to 10 (T1), which was not significant. Intakes of grams of carbohydrates, lipids, mono-unsaturated fatty acids, and fiber increased (p = 0.012, p = 0.036, p = 0.036, p = 0.025). Weight significantly increased (p = 0.012) as well as lean body mass (p = 0.036), with a resulting improvement of the REE (p = 0.012). No association between anthropometrics and body composition and the KIDMED score was found. The MD could represent an optimal dietary pattern for weight gain and nutritional restoration in patients with AN, and it could lead to an improvement in body composition and resting energy expenditure.

Association between Mediterranean lifestyle and perception of well-being and distress in a sample population of university Italian students.

We investigated the extent to which adherence to the Mediterranean diet (MD) in combination with Mediterranean lifestyle factors influenced students' perceptions of subjective well-being (SWB) and distress. 939 undergraduates completed a survey to assess sociodemographic and lifestyle characteristics, including adherence to the MD, depression, anxiety, stress, and SWB. Data were analysed with correlation, logistic, and multiple linear regression models. Higher adherence to MD correlated with better SWB. Fruit, red meat, sweet and caffeinated beverages contributed significantly. However, it was the combination of adherence to MD with other factors, including quality of social relationships, income, smoking, sleep, and physical activity that better predicted SWB. Our results confirm the positive influence of MD on SWB. However, they also suggest the need to consider perceptions of well-being by a more holistic approach that considers physical and social factors simultaneously to improve the development of more effective educational and motivational programmes.

Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment.

BACKGROUND: Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability. OBJECTIVES: Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use. DESIGN: A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome. METHODS: Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were calculated by means of the Agribalyse® 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Linear Models. RESULTS: Participants with major reductions in their UPF consumption reduced their impact by -0.6 kg of CO2eq and -5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced. CONCLUSIONS: Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection. TRIAL REGISTRATION: ISRCTN, ISRCTN89898870. Registered 05 September 2013, http://www.isrctn.com/ISRCTN89898870.

Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment.

BACKGROUND: Several studies have explored the association between Mediterranean diet and frailty, but reported inconsistent results. This systematic review and dose-response meta-analysis summarized the existing evidence on the relationship between Mediterranean diet and risk of frailty and pre-frailty in elderly adults. METHODS: A systematic search on MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science and Google Scholar was conducted up to January 2023. Study selection and data extraction were performed by two reviewers working in parallel. Epidemiologic studies reporting relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for frailty/pre-frailty in relation to Mediterranean diet (as a priori dietary pattern) were considered. The overall effect size was determined using a random effects model. The body of evidence was assessed by the GRADE approach. RESULTS: A total of 19 studies (12 cohorts and 7 cross-sectionals) were included. In cohort studies (89,608 participants/ 12,866 cases), the highest versus lowest category of Mediterranean diet was inversely associated with frailty (RR: 0.66; 95%CI: 0.55, 0.78; I2:52.4%, PQ-test=0.02). This association was also significant in cross-sectional studies with 1093 cases among 13,581 participants (OR: 0.44; 95%CI: 0.28, 0.70; I2:81.8%, PQ-test<0.001). Moreover, each 2-point increase in Mediterranean diet score was related to decreased risk of frailty in cohort (RR: 0.86; 95%CI: 0.80, 0.93) and cross-sectional (OR: 0.79; 95%CI: 0.65, 0.95) studies. Nonlinear association showed a decreasing slope in curve, sharper at high scores for cohort studies and a steadily reduction for cross-sectional studies. The certainty of the evidence was graded as high in both cohort and cross-sectional studies. Combining 4 effect sizes of 4 studies (12,745 participants/ 4363 cases), the highest adherence to Mediterranean diet was linked to a lower risk of pre-frailty, as well (pooled OR: 0.73; 95%CI: 0.61, 0.86; I2:40.9%, PQ-test=0.17). CONCLUSION: Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and thus, has a considerable impact on health of this population.

NMR foodomics in the assessment of diet and effects beyond nutrients.

PURPOSE OF REVIEW: This review provides an overview of most recent research studies employing nuclear magnetic resonance (NMR)-based metabolomics in the assessment of effects of diet and food ingestion. RECENT FINDINGS: NMR metabolomics is a useful tool in the elucidation of specific diets, for example, the Mediterranean diet, the New Nordic diet types, and also for comparing vegan, vegetarian and omnivore diets where specific diet-linked metabolite perturbations have been identified. Another core area where NMR metabolomics is employed involves research focused on examining specific food components or ingredients, including dietary fibers and other functional components. In several cases, NMR metabolomics has aided to document how specific food components exert effects on the metabolic activity of the gut microbiota. Research has also demonstrated the potential use of NMR metabolomics in assessing diet quality and interactions between specific food components such as meat and diet quality. The implications of these findings are important as they address that background diet can be decisive for if food items turn out to exert either harmful or health-promoting effects. SUMMARY: NMR metabolomics can provide important mechanistic insight and aid to biomarker discovery with implications for compliance and food registration purposes.

A peer support dietary change intervention for encouraging adoption and maintenance of the Mediterranean diet in a non-Mediterranean population (TEAM-MED): lessons learned and suggested improvements.

Peer support interventions for dietary change may offer cost-effective alternatives to interventions led by health professionals. This process evaluation of a trial to encourage the adoption and maintenance of a Mediterranean diet in a Northern European population at high CVD risk (TEAM-MED) aimed to investigate the feasibility of implementing a group-based peer support intervention for dietary change, positive elements of the intervention and aspects that could be improved. Data on training and support for the peer supporters; intervention fidelity and acceptability; acceptability of data collection processes for the trial and reasons for withdrawal from the trial were considered. Data were collected from observations, questionnaires and interviews, with both peer supporters and trial participants. Peer supporters were recruited and trained to result in successful implementation of the intervention; all intended sessions were run, with the majority of elements included. Peer supporters were complimentary of the training, and positive comments from participants centred around the peer supporters, the intervention materials and the supportive nature of the group sessions. Attendance at the group sessions, however, waned over the intervention, with suggested effects on intervention engagement, enthusiasm and group cohesion. Reduced attendance was reportedly a result of meeting (in)frequency and organisational concerns, but increased social activities and group-based activities may also increase engagement, group cohesion and attendance. The peer support intervention was successfully implemented and tested, but improvements can be suggested and may enhance the successful nature of these types of interventions. Some consideration of personal preferences may also improve outcomes.

Inequalities in the association between adherence to the Mediterranean diet and physical fitness in the young population during the COVID-19 lockdown.

Introduction: Objective: this study analyzed the association between adherence to the Mediterranean diet and proxy-reported physical fitness among Spanish and Brazilian youths during the COVID-19 lockdown according to several inequality indicators. Methods: we conducted a cross-sectional study with parents and guardians of children and adolescents from Spain and Brazil. The evaluation process was through the use of online questionnaires. Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index in Children and Adolescents. Proxy-reported physical fitness was determined using the International Fitness Scale. Inequality indicators (gender, nationality, socioeconomic status, and parents/guardians' education level) were evaluated with a survey completed by the participants' parents/guardians. Binary logistic regression models estimated the association between adherence to the Mediterranean diet and proxy-reported physical fitness, with stratification according to inequality variables. A total sample of 1,099 Spanish and Brazilian individuals (47.6% girls, aged 3 to 17 years) were included in the analysis. Results: compared to the "improvement needed to Mediterranean diet" category, the "optimal Mediterranean diet" group was significantly associated with "very good" physical fitness in boys (OR = 1.5; 95 % CI: 1.0-2.1) and in participants with parents/legal guardians' education level without university studies (OR = 1.5; 95 % CI: 1.0-2.4). Conclusions: gender and parents/guardians' education level plays a significant role in the association between the "optimal Mediterranean Diet" and "very good" physical fitness level in Spanish and Brazilian children and adolescents. Future prospective studies are needed to investigate the role of inequality indicators in this relationship.

Introducción: Objetivo: este estudio analizó la asociación entre la adherencia a la dieta mediterránea y la aptitud física autoinformada entre jóvenes españoles y brasileños durante el confinamiento de COVID-19 según varios indicadores de desigualdad. Métodos: se realizó un estudio transversal con padres y tutores de niños y adolescentes de España y Brasil. El proceso de evaluación fue a través del uso de cuestionarios online. La adherencia a la dieta mediterránea se evaluó mediante el Índice de Calidad de la Dieta Mediterránea en Niños y Adolescentes. La aptitud física declarada por los padres se determinó mediante la Escala Internacional de Aptitud Física. Los indicadores de desigualdad (género, nacionalidad, estatus socioeconómico y nivel educativo de los padres/tutores) se evaluaron con una encuesta completada por los padres/tutores de los participantes. Los modelos de regresión logística binaria estimaron la asociación entre la adherencia a la dieta mediterránea y la aptitud física informada por los progenitores, estratificando según las variables de desigualdad. Se incluyó en el análisis una muestra total de 1099 individuos españoles y brasileños (47,6 % niñas, de 3 a 17 años). Resultados: en comparación con la categoría de "necesidad de mejorar la dieta mediterránea", la de "dieta mediterránea óptima" se asoció significativamente con una aptitud física "muy buena" en los chicos (OR = 1,5; IC del 95 %: 1,0-2,1) y en los participantes con nivel educativo de los padres/tutores sin estudios universitarios (OR = 1,5; IC del 95 %: 1,0-2,4). Conclusiones: el género y el nivel educativo de los padres/tutores legales desempeñan un papel significativo en la asociación entre la "dieta mediterránea óptima" y el nivel de condición física "muy bueno" en niños y adolescentes españoles y brasileños. Se necesitan futuros estudios prospectivos para investigar el papel de los indicadores de desigualdad en esta relación.

Mediterranean Diet Adherence in Community-Dwelling Older Adults in Spain: Social Determinants Related to the Family.

The Mediterranean diet (MD), a well-established quality diet model, and regular physical activity are associated with reducing the appearance or progression of several chronic diseases and reducing morbidity and mortality. However, reduction of these goals, adherence to the MD, and regular physical activity occur at all ages, including older individuals in Mediterranean countries such as Spain, where at least adherence to the MD is culturally rooted. Objective: To evaluate the degree of adherence to the MD and physical activity in older individuals. Methods: The sample comprises 679 older adults aged 60 and over who attended activities in municipal centers for older adults in Valencia. Adherence to the Mediterranean diet, frequency of physical activity, and anthropometric assessment were used. Results: High adherence (score ≥ 9) to MD was observed only in 23.7% of the study sample. Smoking habits or having meals in fast-food restaurants on a weekly basis were significantly (p < 0.05) associated with lower MD adherence. Age, BMI, marital status, and physical activity were not significantly associated with MD adherence. Physical activity was significantly (p < 0.05) lower in individuals who were divorced or widow/ers and in those taking care of their grandchildren several times a week. Conclusions: Adherence to the MD in a big Spanish city is low among older individuals. Socio-family factors seem to play a role. Public health and governmental strategies should reinforce adherence to the MD among older individuals as a gold standard for nutrition.

Assessment of Dietary Adequacy and Quality in a Sample of Patients with Crohn's Disease.

Both under-and over-nutrition are prevalent in patients with Crohn's Disease (CD). The aim of the present study was to evaluate dietary intake and compare it with relevant recommendations during active disease and remission, also taking into consideration the adequacy of energy reporting. Dietary quality was assessed through adherence to the Mediterranean diet and to the European dietary guidelines for cardiovascular disease prevention (CVD-score). Malnutrition was diagnosed with the GLIM criteria. There were 237 patients evaluated (54.9% males, 41.3 ± 14.1 years and 37.6% with active disease). In the total sample, high prevalence of overweight/obesity (61.6%) and low prevalence of malnutrition (11.4%) were observed, whereas 25.5% reported low protein intake in the sub-sample of adequate energy reporters. The mean MedDietScore was 28.0 ± 5.5 and the mean CVD-score was 5.25 ± 1.36, both reflecting moderate dietary quality. Patients with active disease reported higher prevalence of low protein intake, lower carbohydrate, fibers, fruits, vegetables, legumes, and sweets consumption and a lower MedDietScore compared to patients in remission. Consumption of fibers, fruits, vegetables, and legumes while in remission did not result in reaching the recommended intakes, and dietary quality was low as reflected by the MedDietScore. In conclusion, both protein undernutrition and energy overconsumption were prevalent in the current sample and overall patients adhered to a moderate quality diet irrespective of disease stage.

Assessment of Mediterranean Diet Adherence and Lifestyle Change during COVID-19 National Lockdown in Tunisian Adult Population.

The Mediterranean diet (MD) is a plant-based diet associated with a reduction in the risk of developing COVID-19 comorbidities. Lockdown instigation during the COVID-19 pandemic has affected eating habits and lifestyles, highlighting the need to analyze the healthiness of new consumption patterns. We conducted a survey to assess lifestyle change in Tunisian adults and their MD adherence. A total of 1082 respondents completed a self-administered online survey designed to assess their food and lifestyle habits. Poor overall adherence to MD was observed (mean MEDAS score 6.6, SD 1.07) in a preponderance of the mid-MD adherent subgroup (71.2% of the participants). Location, age, profession, and household welfare proxy were the main determinants of high MD adherence. When adjusting for sociodemographic variables, location and income remained statistically significant. Positive health outcomes were noticed in respondents with high MEDAS scores. Most importantly, binary logistic regression showed that risk of COVID-19 infection decreased as MEDAS score increased for unvaccinated obese participants (OR = 0.63; confidence interval (CI) 0.4-0.98; p = 0.045). Regarding lifestyle changes, confinement had contributed to an overall reduction in cigarette consumption, sleeping hours, and physical activity. Long-term consequences of these changes on health outcomes must be further explored.