Dietary habits, cardiovascular and other causes of death in a practically extinct cohort of middle-aged men followed-up for 61 years.

BACKGROUND AND AIM: To test a dietary score produced from individual data of middle-aged-men enrolled in 1960 based on an a-posteriori approach and to study its association with some specific causes of death during 61 years until their practical extinction. METHODS AND RESULTS: In 1960 the Italian Rural Areas of the Seven Countries of Cardiovascular Diseases were enrolled and 1712 men aged 40-59 were examined with measurement of several risk factors and the collection of dietary history. Using 18 food groups a factor score was obtained from a Principal Component Analysis, that was divided into three classes, arbitrarily called non-Mediterranean, Intermediate and Mediterranean diets. Follow-up for mortality was extended for 61 years and dietary habits were related to several causes of death. There were 1708 deaths (99.8%) and Cox proportional hazards models, adjusted for five major risk factors, showed a significant protective effect of Mediterranean diet for coronary heart disease [Hazard Ratio (HR) = 0.67], cancer other than lung (0.74) and other causes, as from an operational definition (0.71), covering overall about 60% of all deaths. HR for all-cause mortality was of 0.85. In parallel, Kaplan-Meier curves provided significant p of log rank test for the same end-points (<0.0001, 0.0002, 0.0002 and < 0.0001, respectively). On the other hand, stroke, heart diseases of uncertain etiology, lung cancer, chronic bronchitis, unknown causes were not associated to dietary habits. CONCLUSION: In a 61-year follow-up of middle-aged men, the Mediterranean diet was beneficial for a large part of the causes of death and for total mortality.

Determinants of longevity and age at death in a practically extinct cohort of middle-aged men followed-up for 61 years.

OBJECTIVES: To explore possible determinants of longevity as a function of many personal characteristics in a cohort of middle-aged men followed-up until practical extinction. MATERIALS AND METHODS: In the Italian Rural Area of the Seven Countries Study, 1712 men aged 40-59 were examined in 1960 and 35 personal characteristics were measured. The subsequent follow-up for life status was of 61 years when only 3 men survived. A Kaplan-Meier curve was computed. A Cox model was solved with all-cause mortality as end-point and 35 potential determinants as covariates. A Multiple Linear Regression (MLR) model was also solved with the same covariates and age at death (AD) as end-point. RESULTS: After 61 years, 99.8% of men had died and median age at death was 75. Beneficial risk factors for both models (p < 0.05) were: never smoker, vigorous physical activity, prudent and Mediterranean diets, arm circumference, subscapular skinfold, and vital capacity. Adverse risk factors (p < 0.05) were: mother early death, laterality/linearity index, systolic blood pressure, serum cholesterol, corneal arcus, xanthelasma, cardiovascular diseases, cancer, diabetes, and chronic bronchitis. Some arbitrary combinations of selected risk factors were used to estimate AD as a function of coefficients of the MLR, showing large differences up to 10 years or more. CONCLUSIONS: Several personal characteristics of anthropometric, behavioral, biophysical, biochemical, and clinical nature are strongly associated with longevity when measured in middle-aged men and then followed up until extinction.

Lifestyle as determinant of all-cause mortality and age at death. A middle-aged male population followed-up 60 years until the survivors were aged 100 years.

OBJECTIVES: To relate major lifestyle habits with all-cause mortality in an almost extinct male middle-aged population. MATERIAL AND METHODS: A 40-59 aged male population of 1712 subjects was enrolled and examined in 1960 and then followed-up for 60 years. Baseline smoking habits, working physical activity and dietary habits, each subdivided into 3 classes, were related to 60-year mortality, by Kaplan-Meier survival curves, Cox proportional hazards model and to age at death during 60 years by multiple linear regression. RESULTS: Death rate in 60 years was of 99.7% with only 5 survivors and 2 lost to follow-up after 50 years. Two out of three classes of each behavior were significantly protective versus the third class in all the statistical approaches. Cox hazard ratios (and their 95% confidence limits) of never smokers versus smokers was 0.71 (0.63-0.79); that of vigorous physical activity versus sedentary activity was 0.75 (0.64-0.89); that of Mediterranean diet versus Not Mediterranean diet was 0.74 (0.66-0.84). The gain of age at death for never smokers versus smokers was 3.32 years (2.05-4.54); of vigorous physical activity versus sedentary activity was 3.53 years (1.68-5.37); that of Mediterranean diet versus Not Mediterranean diet was 3.67 years (2.32-5.02). Age at death was more than 10 years longer for men with the 3 best behaviors than for those with the 3 worst behaviors. CONCLUSIONS: Some lifestyle habits are strongly related to lifetime mortality and longevity.

Age at death as a useful indicator of healthy aging at population level: a 50-year follow-up of the Italian Rural Areas of the Seven Countries Study.

OBJECTIVES: To explore age at death (AD), overall and for different causes of death, in a cohort followed up to quasi-extinction. MATERIALS AND METHODS: In 1960, in the Italian Rural Areas of the Seven Countries Study, 1712 men aged 40-59 years were enrolled, examined and then followed up for 50 years. AD was computed for all fatal events and compared across 12 groups of causes of death. Multiple linear regression model was used to estimate AD and Cox model to predict each of the 12 causes of death, as a function of 28 selected baseline risk factors. RESULTS: After 50 years, 97.5% of men had died. Mean AD was 75.0 years (median 76), while large variation was found across the 12 causes of death, with the highest levels for Heart Disease of Uncertain Etiology (HDUE) and Senility plus Causes Unknown (SNUNK), having means of 79.2 and 84.5 (median of 80 and 86) years, respectively. Many risk factors were directly associated with overall AD, the most significant being subscapular skinfold, arm circumference, Mediterranean diet, age at baseline examination, never smokers and vigorous physical activity. Systolic blood pressure (SBP) was inversely related. The relevant modifiable risk factors predicting single causes of death were SBP and the lifestyle behaviors of dietary, motion and smoking habits. CONCLUSIONS: AD proved to be a useful indicator of previous health and aging of populations. HDUE and SNUNK seem the most "physiological" causes of death. SBP and lifestyle risk factors are the most relevant characteristics associated with AD.

Fruit juice drinks prevent endogenous antioxidant response to high-fat meal ingestion.

High-fat meals (HFM) induce metabolic stress, leading to the activation of protective mechanisms, including inflammation and endogenous antioxidant defences. In the present study, we investigated the effects of antioxidant-rich fruit juice drinks on the endogenous antioxidant response induced by HFM. In a double-blind, cross-over design (10 d washout), fourteen overweight volunteers were randomly assigned to one of the following interventions: HFM+500 ml placebo beverage (HFM-PB, free from fruit); HFM+500 ml antioxidant beverage 1 (HFM-AB1; apple, grape, blueberry and pomegranate juices and grape skin, grape seed and green tea extracts); HFM+500 ml antioxidant beverage 2 (HFM-AB2; pineapple, black currant and plum juices). HFM-PB consumption increased the plasma levels of thiols (SH) (4 h, P< 0·001) and uric acid (UA) (2 h, P< 0·01) and total radical-trapping antioxidant parameter (TRAP) (4 h, P< 0·01). Following the consumption of drinks, UA production was significantly reduced with respect to placebo beverage consumption 8 h after HFM-AB2 consumption (P< 0·05). SH levels were reduced 0·5 (P< 0·05), 1 (P< 0·05) and 2 h (P< 0·01) after HFM-AB1 consumption and 2, 4 and 8 h (P< 0·05) after HFM-AB2 consumption. Plasma TRAP (2 h, P< 0·001) and urinary ferric reducing antioxidant power (0-8 h, P< 0·01) were increased by HFM-AB1 consumption, the drink with the highest in vitro antioxidant capacity, but not by HFM-AB2 consumption. In urine, UA levels were significantly increased from basal levels after the consumption of HFM-PB and HFM-AB2. However, neither of the beverages increased the urinary excretion of UA with respect to the placebo beverage. In conclusion, the increase in UA and SH levels induced by HFM as part of an endogenous antioxidant response to postprandial stress can be prevented by the concomitant ingestion of antioxidant-rich fruit juice drinks.

Antioxidant and inflammatory response following high-fat meal consumption in overweight subjects.

PURPOSE: Postprandial metabolic stress as a consequence of ingestion of high-energy meals is recognized as an important risk factor for cardiovascular disease. The objective of this study was to evaluate the inflammatory and antioxidant response of the body to the acute ingestion of a high-fat meal (HFM). METHODS: Fifteen healthy overweight subjects were recruited for the study. After HFM consumption, plasma glucose, insulin, uric acid (UA), triglycerides (TG), total cholesterol (TC), thiols (SH), inflammatory cytokines (IL-6 and TNF-α) and dietary antioxidants were measured at 0, 0, 5, 1, 2, 4, 6 and 8 h points from ingestion. RESULTS: The ingestion of HFM induced significant increases in both TG and TC, with peaks at 4 h (p < 0.001) and 8 h (p < 0.01), respectively. IL-6 and TNF-α significantly increased postprandially, reaching maximum concentrations 8 h after meal consumption (p < 0.001). Whereas plasma concentrations of vitamins and carotenoids were not changed by HFM, SH and UA increased, peaking 2-4 h postingestion (p < 0.001 and 0.01, respectively). Increments of SH and UA were positively correlated with AUC for TG (Pearson coefficient 0.888, p < 0.001 and 0.923, p < 0.001, respectively). CONCLUSIONS: Present results indicate that as a consequence of an excess of dietary fat, the body responds through an inflammatory reaction, which is accompanied by an increment of endogenous antioxidant defenses, mediated by UA and SH, but not by vitamins C and E and carotenoids. Although further studies are needed, results of the current investigation represent novel findings on endogenous strategies of redox defense from fat overloads.

Use of market share data to select food products for an occurrence survey on flavourings in eight EU countries within the FACET project.

Dietary exposure assessment to flavourings presents a challenge due to the very large number of food products in which they may be present and the lack of knowledge of their actual presence. Industry claims to be adding more than 2800 different chemically defined flavourings in the European Union (EU). Within the Flavours, Additives and Food Contact Material Exposure Task (FACET) EU project, an occurrence survey was performed to explore the possible use of the information that can be collected from the labels to reduce the uncertainty in exposure assessment. An ad hoc procedure based on the use of market share data of food and drinks was developed for the selection of products to be collected. A database of information retrieved from the food labels of branded products from large and small companies was created. Such information may be used to populate some databases of the software developed within the FACET project to assess total dietary exposure to flavourings.

Food consumption and nutrient intake in Italian school children: results of the ZOOM8 study.

The food consumption and food habits of Italian third-class-primary-school children were assessed and their energy and nutrient intakes were compared with requirements. The study involved 1740 subjects (900 males and 840 females) aged 8-9 years, from the north, centre and south of Italy. Body weight and height were measured. Parents filled in a semi-quantitative Food Frequency Questionnaire for their child. The results showed that the diet of Italian children is unbalanced in terms of macronutrients and deficient in fiber. The average daily intakes of fruit (234 g/d), vegetables (134 g/d) and legumes (17 g/d), were lower than the nationally recommended ones. The percentages of energy intake from fats (41%) and from carbohydrates (45%) were higher and lower respectively than recommended. Low intakes of fiber (13.5 g/d) were reported. A national nutrition policy in Italy should focus on nutrition education programs in schools and for parents.

Fatty acid content of serum lipid fractions and blood lipids in normolipidaemic volunteers fed two types of cheese having different fat compositions: a pilot study.

The aim of this randomised, double-blind, crossover study in normolipidaemic volunteers was to investigate the effect of consumption of an experimental cheese (from cows fed a grass and maize silage-based diet with 5% of linseed oil added) or a control cheese (without linseed oil) on both plasma lipids and fatty acid content of serum lipid fractions. A lower content of medium-chain saturated fatty acids as well as a higher content of stearic acid and polyunsaturated fatty acids were found in the experimental cheese; its consumption was successful in limiting the enhanced blood concentration of atherogenic fatty acids, without affecting fatty acid content of serum lipid fractions. These results indicate that dairy products could be considered as key foods for fat modifications with the objective of optimizing their nutritional quality.

Lifestyle behaviours predicting major cardiovascular diseases mortality in a practically extinct cohort of middle-aged men followed-up for 61 years.

To study lifetime relationships of three major lifestyle behaviours with cardiovascular mortality in a cohort of middle-aged men that reached practical extinction. In the Italian Areas of the Seven Countries Study of Cardiovascular Diseases (SCS), 1712 men were enrolled and examined in 1960, and behavioural habits were measured: smoking habits, physical activity and diet each divided into three classes. Follow-up for mortality was extended for 61 years. Three groups of major cardiovascular diseases (CVD) were used for analysis, coronary heart disease (CHD), STROKE and other Heart Diseases of Uncertain Aetiology (HDUE). Kaplan-Meier curves, death rates in classes of behaviours and Cox proportional hazard models were computed, the last ones adjusted for other major risk factors.In 61 years of follow-up, 1708 men died and 727 were cases of CVD as defined above. Clear separation of classes in Kaplan-Meier survival curves were seen only for physical activity and diet in CHD, and physical activity for STROKE. Cox proportional hazard ratios (HR, adjusted for age, blood pressure and serum cholesterol) showed the significant protective effect on CHD of Mediterranean diet (HR = 0.72), vigorous physical activity (0.55), never smoking (0.73); on STROKE of vigorous physical activity (0.67); on HDUE of never smoking (0.57). Combination of three healthy versus three unhealthy behaviours was associated for CHD to a lower mortality of 39%. This comparison was not coherent for STROKE and HDUE.Lifetime healthy behaviours are clearly beneficial versus CHD mortality but not necessarily for mortality from HDUE and STROKE that probably represent different morbid conditions.

Dietary assessment training: The Italian IV SCAI study on 10-74 year-old individuals' food consumption.

Dietary surveys are conducted to examine the population's dietary patterns that require a complex system of databases, and rules for constructing the data matrix (precision, coding, deriving new variables, e.g., body mass index from individual's height and weight, classes, e.g., age-class, socio-economic status, physical activity, etc.). Management of the data collection requires specialized fieldworkers to allow for the collection of harmonized and standardized data. In this way, only statistical variability is envisaged and any eventual biases are due to probabilistic distribution but data are not affected by inaccuracy. Training the fieldworkers is a crucial part of each dietary survey. The idea to provide constant training throughout the whole survey period, from the preparatory phase to the data collection phase, relies on the necessity to train fieldworkers and monitor the skills acquired during the study, in addition to helping fieldworkers to gain the necessary experience. This study aims to relate the experience in conducting the course path to high specialized interviewers who carried out the cycle devoted to the 10-74 age class of the fourth nationwide food consumption study in Italy (IV SCAI ADULT) according to the European Food Safety Authority (EFSA) guide. A course path was structured in three steps corresponding to the preparation, pilot, and collection phases. The whole path achieved the goal of collecting data related to 12 individuals by each participant, with an overall success rate (successful trainees/total participants) of 16.8% (84 out of an initial 500). The study aimed to provide good quality data in the short term and a highly specialized community in the long term. Surveillance nutritional systems can count on a highly skilled community, so decision-making in public health nutrition and a sustainable and healthy food system can rely on this infrastructure.

Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents. The HELENA Study.

Breakfast consumption has been shown to be an important indicator of a healthy lifestyle. Little is known however about factors influencing breakfast consumption and food choices at breakfast in adolescents. The aim of the present study was therefore to describe breakfast habits, and factors influencing food choices at breakfast within the framework of the EU-funded HELENA Study, in 3528 adolescents from ten European cities. Additionally, socio-demographic differences in breakfast habits and in influencing factors were investigated. Half of the adolescents (and fewer girls than boys) indicated being regular breakfast consumers. Girls with mothers with a high level of education, boys from 'traditional' families and boys who perceived low family affluence were positively associated with breakfast consumption. Boys whose parents gave encouragement and girls whose peers ate healthily were more likely to be regular breakfast consumers. 'Hunger', 'taste', 'health concerns' and 'parents or guardian' were the most important influences on the adolescents' food choices at breakfast. Adolescents from southern Europe and girls reported to be more influenced by personal and socio-environmental factors. Socio-demographic differences, in particular regional and gender differences, need to be considered in discussions surrounding the development of nutritional intervention programs intended for adolescents.

Differential effect of cheese fatty acid composition on blood lipid profile and redox status in normolipidemic volunteers: a pilot study.

The present study investigated the effect of the consumption of two cheese varieties differing for fat quality on blood lipid profile and redox status biomarkers in 30 selected healthy volunteers, consuming either the experimental cheese (from milk produced by cows fed a grass and maize silage based diet with 5% of linseed oil added) or the control cheese (from normal cows' milk) for 4 weeks according to a crossover design. The experimental cheese had a lower content of medium-chain saturated fatty acids and a higher content of stearic acid and polyunsaturated fatty acids; its consumption led to higher levels of vitamins C and E and stearic acid in blood, while myristic acid and oxidized low-density lipoprotein concentrations were significantly lower. As myristic acid and oxidized low-density lipoprotein are highly correlated with increased atherogenic risk and vitamins C and E with antioxidant activity, the enrichment of cows' diet with linseed oil could provide a dietary option to prevent cardiovascular diseases risk.

A Dietary Assessment Training Course Path: The Italian IV SCAI Study on Children Food Consumption.

The eating patterns in a population can be estimated through dietary surveys in which open-ended assessment methods, such as diaries and interviews, or semi-quantitative food frequency questionnaires are administered. A harmonized dietary survey methodology, together with a standardized operational procedure, in conducting the study is crucial to ensure the comparability of the results and the accuracy of information, thus reducing uncertainty and increasing the reliability of the results. Dietary patterns (i) include several target variables (foods, energy and nutrients, other food components), (ii) require several explanatory variables (age, gender, anthropometric measurements, socio-cultural and economic characteristics, lifestyle, preferences, attitudes, beliefs, organization of food-related activities, etc.), and (iii) have impacts in several domains: imbalance diets; acute and chronic exposures affect health, specifically non-communicable diseases; and then sanitary expenditure. On the other hand, food demand has impacts on the food system: production, distribution, and food services system; food wastes and other wastes generated by food-related activities of the households (e.g., packaging disposal) have consequences on the "health of the planet" which in turn can have effects on human health. Harmonization and standardization of measurement methods and procedures in such a complex context require an ad hoc structured information system made by databases (food nomenclatures, portion sizes, food atlas, recipes) and methodological tools (quantification methods, food coding systems, assessment of nutritional status, data processing to extrapolate what we consider validated dietary data). Establishing a community of professionals specialized in dietary data management could lead to build a surveillance system for monitoring eating habits in the short term, thus reducing costs, and to arrange a training re-training system. Creating and maintaining the dietary data managers community is challenging but possible. In this context, the cooperation between the CREA Research Centre for Food and Nutrition and the Italian National Health Institute (ISS) promoted and supported by the Italian Ministry of Health may represent a model of best practice that can ensure a continuous training for the professional community carrying out a nutritional study.

Corrigendum: A Dietary Assessment Training Course Path: The Italian IV SCAI Study on Children Food Consumption.

[This corrects the article DOI: 10.3389/fpubh.2021.590315.].

Bioavailability of strawberry antioxidants in human subjects.

Strawberries contain many antioxidant phytochemicals such as vitamin C, carotenoids and phenolic compounds including anthocyanins (ACN). In the present study, antioxidant composition of fresh strawberries (FS) and stored strawberries (SS) and the bioavailability of the main strawberry bioactive compounds were determined in human subjects. Thirteen healthy volunteers consumed 300 g of FS and SS on two separate occasions. Blood, before and at different time points from meal consumption, as well as 24 h urine, was collected, and parent compounds and metabolites of the different compounds were determined by HPLC or LC/MS/MS. A reduction in α-carotene plasma concentrations v. baseline values was recorded after the consumption of FS, although the amount of this carotenoid was higher in the SS. On the contrary, a significant increase of plasma vitamin C after 2, 3 and 5 h (P < 0.05) of FS and SS consumption was recorded. No quercetin and ACN were found in plasma, while coumaric acid, 4-hydroxybenzoic acid (4HBA, 56 and 54% of pelargonidin-3-glucoside (Pel-glc) ingested with FS and SS, respectively) and protocatechuic acid (59 and 34% of cyanidin-3-glucoside ingested with FS and SS, respectively) over 8 h from strawberry consumption were retrieved in the plasma. Pelargonidin glucuronide, pelargonidin glucoside and pelargonidin aglycone peaked in urine within 2 h of strawberry consumption, and the 24 h amount excreted was always approximately 0.9% of the Pel-glc dose ingested. The data indicated that the content of phytochemicals in strawberries may influence the bioavailability of individual compounds. Furthermore, in the present study, the metabolism of Pel-glc was elucidated, and, for the first time, 4HBA was suggested to be a major human metabolite of Pel-glc.

Neutrophil-to-Lymphocyte Ratio, Mediterranean Diet, and Bone Health in Coeliac Disease Patients: A Pilot Study.

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a bone loss index in postmenopausal women and as a marker of inflammation in coeliac patients. The aims of this work were to evaluate the effect of gluten-free diet (GFD) on NLR retrospectively and study the relationship between NLR and Mediterranean diet adherence and selected food groups (fruits, vegetables, red meat, potatoes, and unrefined and refined cereals). Adult individuals (n = 50), who had been on a strict GFD by at least 6 months, were recruited. The degree of adherence to the Mediterranean diet was calculated with two different scores: the Mediterranean Diet Score (MDS-14), assessed through the validated 14-item questionnaire of the PREDIMED study, and the MEDScore (Score-55) proposed by Panagiotakos. The latter includes the consumption of unrefined cereals (UC). High percentages of osteopenia and osteoporosis were found within the recruited subjects, who furnished the reports of bone mineral density (BMD), in particular in postmenopausal (Post-M) women. Recent NLR was higher in subjects with osteoporosis compared to osteopenia and normal BMD. However, retrospective analysis showed both increase and decrease in NLR after GFD, with no significant differences between Marsh grade, anemia, and BMD status. Moreover, premenopausal previous pregnancy (Pre-MPP) and Post-M had higher NLR at diagnosis compared to Men and premenopausal (Pre-M), but higher differences were observed in recent NLR between Pre-MPP and Men only. Chocolate consumption was associated with lower recent NLR, whereas the latter was correlated with Score-55, but not with MDS-14. Moreover, refined cereal consumption was correlated with recent NLR. Although large prospective studies are needed in order to clarify the relationship between UC and NLR in coeliac patients, in this pilot study, we have investigated for the first time the relationship between NLR, dietary habit, and osteoporosis in coeliac disease.

Effects of High Consumption of Vegetables on Clinical, Immunological, and Antioxidant Markers in Subjects at Risk of Cardiovascular Diseases.

High intakes of vegetables have been associated with a lower incidence of cardiovascular diseases (CVD). However, the effect of vegetables on immune function and antioxidant status in human studies have provided contrasting results. In the present study, after a week of run-in period, 38 subjects at risk of CVD were randomly assigned to one of the following 4-week interventions: low vegetable consumption (800 g of vegetables/week) or high vegetable consumption (4200 g of vegetables/week). Vegetables included carrots, topinambur (Jerusalem artichoke, Helianthus tuberosus), tomatoes, red cabbage, and sweet peppers. Blood and salivary samples were collected before and after intervention periods. In addition to clinical, immunological, and antioxidant markers, leukocyte and lymphocyte expression of the gut-homing ß7 integrin was evaluated. No significant changes were detected in clinical, immunological, and antioxidant markers in biological samples, except for an increase in white blood cell count for the low vegetable consumption group (p < 0.05). The study provides additional evidence about the uncertainty of providing a clear evidence for vegetables in modulating markers of immune function and antioxidant status. Further studies are needed in order to unravel the mechanism of effect of vegetable consumption in cardiovascular prevention.

Nutraceutical-based Integrative Medicine: Adopting a Mediterranean Diet Pyramid for Attaining Healthy Ageing in Veterans with Disabilities.

Veterans with disability represent a big burden worldwide and often require long-term rehabilitation. Unhealthy dietary and lifestyle habits, including smoke and alcohol abuse, are common in veterans. In the context of integrative medicine approaches, the "complementary and alternative medicine" has been suggested for the management of chronic diseases. However, the potential risk of interaction between herbal products, dietary supplements and drugs must be considered in veterans. The Mediterranean diet has been suggested as a natural, non-pharmacological nutraceutical for healthy ageing. Although there is a broad consensus on the positive effect of plant foods consumption, the presence of glucosinolates, flavonoids and furanocoumarins in some plant foods and beverages must be taken into consideration owing to their potential interfering with drugs metabolism and bioavailability. Albeit seasonality could ensure the maintenance of the single dose of phytochemical below that at which adverse effects in some individuals genetically predisposed or unpleasant drug interactions in diseased subjects can occur, a personalized nutrition is recommended in veterans who are under treatment for comorbidities. Furthermore, sports practice can lead veterans with motor disabilities and mental impairments to excel in some disciplines, giving rise to the phenomenon of the Paralympics and the development of "recreational therapy". Moreover, outdoor lifestyle, through vitamin D synthesis, and conviviality, improving socialization, could account for the Mediterranean lifestyle health benefits. In this work, we propose for veterans a Mediterranean Pyramid, which could be the basis for integrative medicine for veterans with disabilities, patient-centered approaches and interprofessional (including physical medicine and rehabilitation clinicians, pharmacists and nutritionists) interventions.

Assessment of dietary intake of 10 intense sweeteners by the Italian population.

The aim of the present study was to monitor the consumption of foods containing intense sweeteners present on the Italian food market and to investigate whether the Italian general population (aged >3-65+) was at risk for exceeding the Acceptable Daily Intake (ADI) of 10 intense sweeteners. A food label survey was performed in Rome (Italy), using market share data to identify the brands more representative of the market. A sample of 326 foods (table-top sweeteners included), beverages and food supplements containing intense sweeteners was collected and analyzed in order to establish the concentration levels. Intense sweeteners were only found in foods belonging to 8 sugar-free food categories out of 37 regulated. The dietary exposure was estimated using the tiered approach. Food consumption data from the last Italian national survey (INRAN-SCAI 2005-06) were combined with Maximum Levels at Tier 2, and with the actual concentration of sweeteners in the collected food products at Tier 3. The estimated exposure among consumers of sweeteners in Italy was well below the ADIs, in both tiers; non-alcoholic beverages, table-top sweeteners and food supplements were main contributors to exposure.