Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet.

Over the last decades, the Mediterranean diet gained enormous scientific, social, and commercial attention due to proven positive effects on health and undeniable taste that facilitated a widespread popularity. Researchers have investigated the role of Mediterranean-type dietary patterns on human health all around the world, reporting consistent findings concerning its benefits. However, what does truly define the Mediterranean diet? The myriad of dietary scores synthesizes the nutritional content of a Mediterranean-type diet, but a variety of aspects are generally unexplored when studying the adherence to this dietary pattern. Among dietary factors, the main characteristics of the Mediterranean diet, such as consumption of fruit and vegetables, olive oil, and cereals should be accompanied by other underrated features, such as the following: (i) specific reference to whole-grain consumption; (ii) considering the consumption of legumes, nuts, seeds, herbs and spices often untested when exploring the adherence to the Mediterranean diet; (iii) consumption of eggs and dairy products as common foods consumed in the Mediterranean region (irrespectively of the modern demonization of dietary fat intake). Another main feature of the Mediterranean diet includes (red) wine consumption, but more general patterns of alcohol intake are generally unmeasured, lacking specificity concerning the drinking occasion and intensity (i.e., alcohol drinking during meals). Among other underrated aspects, cooking methods are rather simple and yet extremely varied. Several underrated aspects are related to the quality of food consumed when the Mediterranean diet was first investigated: foods are locally produced, minimally processed, and preserved with more natural methods (i.e., fermentation), strongly connected with the territory with limited and controlled impact on the environment. Dietary habits are also associated with lifestyle behaviors, such as sleeping patterns, and social and cultural values, favoring commensality and frugality. In conclusion, it is rather reductive to consider the Mediterranean diet as just a pattern of food groups to be consumed decontextualized from the social and geographical background of Mediterranean culture. While the methodologies to study the Mediterranean diet have demonstrated to be useful up to date, a more holistic approach should be considered in future studies by considering the aforementioned underrated features and values to be potentially applied globally through the concept of a "Planeterranean" diet.

Acceptability of alternative ready-to-use therapeutic foods in acute malnutrition management-a systematic review.

"Commercial" Ready-To-Use Therapeutic Foods (RUTFs) are used in acute malnutrition management, but they are not always appropriate being expensive and unfamiliar. Much research has tried to develop alternative RUTF formulations and this work systematically reviewed eight articles discussing the approaches used to assess the children's sensory satisfaction, families' acceptance, and the cultural appropriateness of 13 alternative RUTFs. Different approaches were used by the authors and much research to standardise methodologies and findings is urgent to ensure that food products are culturally appropriate, acceptable and appreciated, with the final aim of completing the development process of alternative RUTFs. This work proposed some indications to follow in alternative RUTF acceptability evaluation processing. Moreover, community engagement and education resulted key aspects in alternative RUTF acceptance. An innovative, multi-disciplinary, multi-stakeholder approach could develop alternative "fit-for-the-purpose" RUTFs to help food-insecure communities acquire sufficient, safe, nutritious food in long-term Community Management of Acute Malnutrition.

Effect of Coffee and Cocoa-Based Confectionery Containing Coffee on Markers of DNA Damage and Lipid Peroxidation Products: Results from a Human Intervention Study.

The effect of coffee and cocoa on oxidative damage to macromolecules has been investigated in several studies, often with controversial results. This study aimed to investigate the effect of one-month consumption of different doses of coffee or cocoa-based products containing coffee on markers of DNA damage and lipid peroxidation in young healthy volunteers. Twenty-one volunteers were randomly assigned into a three-arm, crossover, randomized trial. Subjects were assigned to consume one of the three following treatments: one cup of espresso coffee/day (1C), three cups of espresso coffee/day (3C), and one cup of espresso coffee plus two cocoa-based products containing coffee (PC) twice per day for 1 month. At the end of each treatment, blood samples were collected for the analysis of endogenous and H2O2-induced DNA damage and DNA oxidation catabolites, while urines were used for the analysis of oxylipins. On the whole, four DNA catabolites (cyclic guanosine monophosphate (cGMP), 8-OH-2'-deoxy-guanosine, 8-OH-guanine, and 8-NO2-cGMP) were detected in plasma samples following the one-month intervention. No significant modulation of DNA and lipid damage markers was documented among groups, apart from an effect of time for DNA strand breaks and some markers of lipid peroxidation. In conclusion, the consumption of coffee and cocoa-based confectionery containing coffee was apparently not able to affect oxidative stress markers. More studies are encouraged to better explain the findings obtained and to understand the impact of different dosages of these products on specific target groups.

Effect of coffee and cocoa-based confectionery containing coffee on markers of cardiometabolic health: results from the pocket-4-life project.

PURPOSE: Coffee is an important source of bioactive compounds, including caffeine, trigonelline, and phenolic compounds. Several studies have highlighted the preventive effects of coffee consumption on major cardiometabolic (CM) diseases, but the impact of different coffee dosages on markers of CM risk in a real-life setting has not been fully understood. This study aimed to investigate the effect of coffee and cocoa-based confectionery containing coffee consumption on several CM risk factors in healthy subjects. METHODS: In a three-arm, crossover, randomized trial, 21 volunteers were assigned to consume in a random order for 1 month: 1 cup of espresso coffee/day, 3 cups of espresso coffee/day, and 1 cup of espresso coffee plus 2 cocoa-based products containing coffee, twice per day. At the last day of each treatment, blood samples were collected and used for the analysis of inflammatory markers, trimethylamine N-oxide, nitric oxide, blood lipids, and markers of glucose/insulin metabolism. Moreover, anthropometric parameters and blood pressure were measured. Finally, food consumption during the interventions was monitored. RESULTS: After 1 month, energy intake did not change among treatments, while significant differences were observed in the intake of saturated fatty acids, sugars, and total carbohydrates. No significant effect on CM markers was observed following neither the consumption of different coffee dosages nor after cocoa-based products containing coffee. CONCLUSIONS: The daily consumption of common dosages of coffee and its substitution with cocoa-based products containing coffee showed no effect on CM risk factors in healthy subjects. TRIAL REGISTRATION NUMBER: Registered at clinicaltrials.gov as NCT03166540, May 21, 2017.

Comprehensive dietary evaluation of Italian primary school children: food consumption and intake of energy, nutrients and phenolic compounds.

Information on children's diet including bioactive compounds is quite scarce. This observational study investigated the composition of the diet of children living in Parma (Italy; n = 172, 8-10 years) using 3-day food records completed in winter and spring. Mean daily intakes of food groups, energy and nutrients were obtained using the national food database, while (poly)phenol contents were estimated from Phenol-Explorer or by specific literature searches. Food consumption, energy and nutrient intakes decreased in spring and were partially in line with national data. Adherence to the nutritional recommendations was not satisfied for the majority of nutrients. Main contributors to the phenolic intake were flavonoids (flavan-3-ols) and phenolic acids (hydroxycinnamic acids), while main dietary sources were fruit, chocolate-based products, vegetables, and tea & coffee (decaffeinated). This study provided the first comprehensive analysis of the nutritional composition of children's diet. Future research should look at the health implications of dietary choices in children.

Food quality, effects on health and sustainability today: a model case report.

The Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico is a five-century institution that, besides the unique clinical role in the center of Milan, may rely on benefactor donations such as fields and farming houses not far from the city, for a total of 8500 ha, all managed by the "Sviluppo Ca' Granda' Foundation". Presently, the main products of these fields are represented by rice and cow's milk. During the latest years, farmers and managers have developed a model of sustainable food production, with great attention to the product quality based on compositional analysis and functional nutritional characteristics. This experience represents a new holistic model of food production and consumption, taking great care of both sustainability and health.

In Vitro Bioaccessibility of Phenolic Acids from a Commercial Aleurone-Enriched Bread Compared to a Whole Grain Bread.

Wheat aleurone, due to its potentially higher bioaccessibility and bioavailability of micronutrients and phenolic acids, could represent a useful ingredient in the production of commonly consumed cereal-based food. The aim of the present study was to investigate the in vitro bioaccessibility of phenolic acids both from an aleurone-enriched bread and from a whole grain bread. The two bread samples were firstly characterized for the phenolic acid content. An in vitro digestion was then performed in order to evaluate the release of phenolic acids. The results obtained suggest that the bioaccessibility of the phenolic acids in the aleurone-enriched bread is higher than in the whole grain bread. These in vitro results suggest the potential use of aleurone in the production of foods, and this may represent an attractive possibility to vehicle nutritionally interesting components to consumers.

Nutritive Evaluation of the Bambara Groundnut Ci12 Landrace [Vigna subterranea (L.) Verdc. (Fabaceae)] Produced in Côte d'Ivoire.

The nutritional evaluation of the Bambara groundnut Ci12 landrace (Vigna subterranea (L.) Verdc.) seeds produced in Côte d'Ivoire shows a 19% content of protein, containing all the essential amino acids with tryptophan as the limiting amino acid, a total dietary fiber level of 10%, with a low soluble fraction content, and a fat content of 1.4%, with a high proportion of total unsaturated fatty acids (61%) of which 36% were n-6 fatty acids. This legume contains phosphorus, as the major mineral, followed by magnesium and calcium, and trace elements (iron, copper and zinc). It is characterized by the same amount of α-tocopherol and antioxidant capacity as common legumes. The high concentration of essential amino acids, n-6 fatty acids and minerals, mainly Fe, in the Ci12 landrace of Bambara groundnut indicates that this local legume has the potentiality to improve the nutritional status in Côte d'Ivoire and it could be regarded as a nutrient dense food.

Evaluation of iodine content and stability in recipes prepared with biofortified potatoes.

Iodine is an essential micronutrient of the human diet. Deficiency of iodine is diffused in many areas of the world and mild deficiency is present also in developed countries around Europe. Biofortification of vegetables could represent a better strategy with respect to iodized salt in order to increase iodine intake. The aim of this study was evaluating the stability of iodine, derived from biofortified potatoes, in the preparation process of three Italian typical dishes: dumplings, vegetable pie, and focaccia bread. The obtained results showed a good stability of iodine in cooking processes, in particular, during baking of focaccia bread. Significant losses of iodine were detected during boiling of dumplings and baking of vegetable pie. Although the different stability during the cooking processes, the three dishes maintained a good final content of iodine, ranging from the 33.3% to 52.7% of daily recommended intake in adults for individual serving size.

A hand-made supplementary food for malnourished children.

We tested the possibility to prepare a hyperproteic and hyperenergetic supplementary food for malnutrition rehabilitation in children starting from available ingredients in popular markets in Sierra Leone. Twelve residents in Paediatrics from University of Parma, Italy, prepared in a hospital near the capital Freetown with modest technology a mixture of peanut flour, palm oil, milk powder, sugar and vitamins to which they gave the name of "Parma pap". Three hundred and thirty-two malnourished children (mean age 14±6.3 months) who were receiving Feeding Program Supplementations (FPS), were enrolled in the study: 177 participants received randomly FSP portions only (Group 1), and 159 participants were treated with FSP regimen plus a supplement of "Parma pap" (Group 2). Outcomes of the study were computed as WHZ-score increment (Δ value) by subtracting the discharge WHZ-score from the admission WHZ-score. The best Δ-WHZ-scores (>+4) were recorded among participants of Group 2 (64%) rather than in Group 1 (21%; p=0.040). The children receiving FSP portions plus "Parma pap" recovered faster (5.54 week on average) than those treated with FSP regimen only (8.16 on average). The percentage of children who did not recover was higher in Group 1 (25.3%) than in Group 2 (; 13%; p=0.05). A slight positive correlation has been found between WHZ-scores at admission and at the end of the study (r=0.19; p=0.045). During the experience in Sierra Leone we have had the chance to give "Parma pap" to twenty one malnourished children admitted to Xaverian Mission in Makeni, northern Sierra Leone, not taking other supplementary food. Sixteen of these children recovered in 4.9 week on average and five in 6 to 8 weeks. Mean Δ-WHZ-scores ranged between + 1 and + 5. The data from the present study suggest that "Parma pap" could be an effective additional food to FPS regimen in malnutrition recovering. Further researches are needed on the contrary to prove if "Parma pap" could be defined as a veritable ready to use therapeutic food, although this characteristic seems already to result from the experience in Makeni Mission.

Colonic metabolism of polyphenols from coffee, green tea, and hazelnut skins.

Dietary polyphenolic compounds are poorly absorbed in the small intestine. The absorbed fraction follows the common metabolic pathway of drugs, undergoing phase II enzymatic detoxification with the conjugation of glucuronic acid, sulfate, and methyl groups. However, the unabsorbed fraction can reach the colon, becoming available for the wide array of enzymes produced by the local commensal microbiota. Gut bacteria can hydrolyze glycosides, glucuronides, sulfates, amides, esters, and lactones and are able to break down the polyphenolic skeleton and perform reactions of reduction, decarboxylation, demethylation, and dehydroxylation. These complex modifications generate several low-molecular-weight metabolites that can be efficiently absorbed in situ, subsequently undergoing further phase II metabolism, locally and/or at the liver level, before entering the systemic blood circulation and finally being excreted in urine in substantial quantities that exceed the excretion of phenolic metabolites formed in the upper gastrointestinal tract. This brief work focuses on the phenolic composition and colonic microbial transformation of 2 of the most polyphenol-rich dietary sources, namely, green tea and coffee, and a new interesting and innovative ingredient, hazelnut skin, recently evaluated as one of the richest edible sources of polyphenolic compounds.

Effects of different maturity stages on antioxidant content of Ivorian Gnagnan (Solanum indicum L.) berries.

Gnagnan (Solanum indicum L.) is a spontaneous plant widely distributed in Ivory Coast. During ripening stages, Solanum indicum L. presents different colours (green, yellow and red) and is reported to contain several albeit poorly characterized antioxidant compounds. This paper describes in detail the antioxidant profile (ascorbic acid, carotenoids and polyphenols), antioxidant capacity (FRAP test and Folin-Ciocalteau assay) and the colour changes of Gnagnan berries at different ripening levels. Ascorbic acid content was similar in green and yellow berries, but significantly lower in red ones. Red berries showed a higher content of carotenoids compared to green and yellow ones. Regarding polyphenols, several phenolic acids and flavonoids were found in all berries. The content of caffeoylquinic acids, caffeic acid, flavonol glycosides and naringenin was higher in red berries, while the content of p-coumaric acid and feruloylquinic acids was similar among the three colours. The FRAP assay increased with the ripening process, whereas total polyphenols were similar among berries. Significant differences were found for the colorimetric indexes among products of different degrees of ripening. The present results show the important role of the ripening stage in increasing the antioxidant content of Gnagnan berries.

Bioavailability of catechins from ready-to-drink tea.

OBJECTIVE: Because consumption of teas may be associated with potential health benefits due to its content in polyphenols and in Western countries the consumption of tea is equally divided between the hot and the ready-to-drink (RTD) cold versions of this typical beverage, the aim of this work was to study the absorption and metabolism of flavan-3-ols in human volunteers after the ingestion of a commercial RTD tea. METHODS: A feeding study was carried out in 20 healthy human volunteers and urine samples were collected for 24h after tea ingestion. Flavan-3-ols-derived molecules were identified and quantified in urine samples by high-performance liquid chromatography with tandem mass spectrometric detection. RESULTS: Eight relevant metabolites were identified in urine, all modified flavan-3-ols with the exception of unmetabolized gallic acid. The urinary excretion of flavan-3-ols was equal to 7.2% of the intake with tea. Gallic acid, which was abundant in the RTD tea used in this study, reached a 4.5% of the drunken amount. CONCLUSIONS: The bioavailability values observed are in agreement with previous reports, although the dosage of polyphenols ingested in this study is remarkably lower. Moreover, the use of a group of 20 volunteers, more than the average number of subjects used for usual human acute-feeding studies involving polyphenols, provides additional credibility to the results. After drinking the RTD ice tea used in this study, the internal compartments are exposed to non-marginal doses of flavanols and flavanol metabolites up to 24h.