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.

Effects of a dietary intervention with Mediterranean vs lacto-ovo vegetarian diets on HDL function: Results from the CARDIVEG study.

BACKGROUND AND AIM: HDL-cholesterol efflux capacity (CEC) has been shown to be a better cardiovascular (CVD) risk marker than serum HDL concentration. Several foods and nutrients have been shown to improve HDL functions, however no effective dietetic nor pharmacological strategy is available to increase CEC. This study aims to evaluate the possible effect of Mediterranean diet (MD) and lacto-ovo-vegetarian diet (VD) on HDL function in a group of clinically healthy subjects at low-to-moderate CVD risk. METHODS AND RESULTS: Thirty apparently healthy subjects with a low-to-moderate cardiovascular risk profile (21 F; mean age: 51.3 ± 9.7 years) were randomly assigned to a 3-month MD or VD diet and then crossed. Participants on VD showed a reduction in total HDL CEC by 8.99% (p < 0.001) as well as a reduction in ABCA1 mediated-CEC by 18.62% (p < 0.001) compared to participants on MD. Regarding CEC mediated by aqueous diffusion, no significant changes were observed after treatment with either diet. Finally, a significant positive association between CEC mediated by the ABCA1 transporter and adiponectin was found (r = 0.462; p = 0.010). CONCLUSION: The results of this study suggest that HDL activity in promoting cholesterol efflux and thereby reducing the concentration of pro-atherogenic lipoproteins was more effective in participants undergoing MD than VD. Based on these findings, the MD could be considered a better therapeutic strategy for cardiovascular prevention than VD. CLINICAL TRIAL REGISTRATION URL: http://www. CLINICALTRIALS: gov. Unique identifier: NCT02641834.

Morning chronotype is associated with higher adherence to the Mediterranean diet in a sample of Italian adults.

BACKGROUND AND AIMS: A growing body of evidence has associated subjects with an evening chronotype with worse eating behaviours and poorer diet quality. However, only few studies have investigated the relationship between chronotype and Mediterranean diet (MD). The aim of this study was to better understand the chronotype influence on dietary habits and MD adherence in a large sample of Italian adults. METHODS AND RESULTS: A total of 1247 participants (66.7% women) with a mean age of 36.1 ± 14.6 years were included in the analysis. Chronotype was classified as morning in 35.6% of subjects, intermediate in 56.7%, and evening in 7.1%. Regarding meal frequency, evening subjects showed a significantly (p < 0.05) greater tendency to skip breakfast (20.5%) than morning (6.9%) and intermediate (12%) subjects. Similarly, evening subjects were found to skip mid-morning snack more often than morning subjects (59.1% vs. 47.1%; p = 0.04), and lunch more often than intermediate subjects (8% vs. 2.8%; p = 0.01). In addition, all meals were eaten by evening subjects at a significantly delayed time, except for lunch. As to MD adherence a significant (p < 0.001) higher adherence in morning subjects (10.1 ± 2.2) compared to intermediate (9.5 ± 2.1) and evening (9.5 ± 2.2) subjects was observed. At a logistic regression analysis adjusted for possible confounding factors, morning subjects showed an increased probability (OR 1.54, 95%CI 1.19-1.99; p < 0.001) of being in the highest MD adherence tertile. CONCLUSION: Chronotype was associated with MD adherence. In particular, morning subjects showed higher MD adherence than intermediate and evening subjects.

Adherence to the Mediterranean diet increased during the COVID-19 lockdown in Italy: results from the web-based Medi-Lite questionnaire.

The aims of this study were to assess the Mediterranean Diet (MD) adherence in 2566 Italians who completed the validated Medi-Lite questionnaire during the year 2020, and to investigate the effect of COVID-19 confinement on dietary habits and MD adherence. To do this, we compared subjects (n = 389) that answered the questionnaire during the confinement occurred in Italy from March to May 2020 with subjects (n = 653) who completed the questionnaire in the same period (March-May) of the previous year (2019). From the results, a moderate level of MD adherence in the total sample emerged, and a significantly (p<.0001) increased adherence during lockdown was observed. Specifically, during confinement significantly (p < 0.05) higher consumption of vegetables (+9.4%), legumes (+13.5%) and pasta (+12.9%) emerged, while lower consumption was reported for bread (-13.4%) and meat and meat products (-15.4%). This study showed increased adherence to MD and a better-quality diet during the COVID-19 confinement in Italy.

Association between chronotype, sleep pattern, and eating behaviours in a group of Italian adults.

A cross-sectional study was conducted to assess the possible relationship between chronotype, sleeping, and eating patterns in 74 Italian adults (71.6% women). Based on Morningness-Eveningness Questionnare (MEQ) score, participants were classified as morning (n = 24), intermediate (n = 25), and evening (n = 25) chronotypes. From analysis, no significant differences among chronotypes emerged for sleep habits. As to eating behaviours, the evening subjects showed a significant (p < 0.05) shift towards later hours of the day in the consumption of all meals, except dinner. In addition, the evening subjects had a later midpoint of energy intake (EI) of about 35 min and 1 h (p < 0.001), respectively, than the intermediate and morning subjects. Analysing the diet quality, morning subjects reported significantly (p = 0.030) lower consumption of sweets and sweeteners, and significantly (p = 0.035) lower intake of ultra-processed fats and seasonings. Evening subjects showed a significant delay in EI during the day, while morning subjects reported a better-quality diet.

Effects of vegetarian versus Mediterranean diet on kidney function: Findings from the CARDIVEG study.

BACKGROUND: The aim of the present study was to assess the effects of a lacto-ovo-vegetarian diet (VD), compared to a Mediterranean diet (MD), on kidney function in a group of subjects with medium-to-low cardiovascular risk profile. METHODS: We analysed 107 subjects (82 women, 25 men; median age 52) who followed a VD (n = 54) and a MD (n = 53) for 3 months in the CARDIVEG study, a randomized, open, crossover trial that compared the effects of these 2 diets on cardiovascular disease risk. RESULTS: The effect of the two diets on kidney function markers was evaluated by conducting a general linear model for repeated measurements adjusted for possible confounding factors such as age, sex, physical activity, alcohol, smoking, hypertension, LDL cholesterol, glucose and body weight change. A significant reduction in creatinine (-5.3%; P < .001), urea nitrogen levels (-9%; P = .001), blood urea nitrogen (BUN) (-8.7%; P = .001) and BUN/creatinine ratio (-5.8%; P < .001), and an increase in estimated glomerular filtration rate (eGFR) (+3.5%; P = .001) was observed during the VD period. On the contrary, no significant changes were noted in the MD group. Variations obtained in the two dietary interventions were significantly different (P < .0001) for creatinine levels, BUN/creatinine and eGFR, for which opposite trends were observed in the VD and MD groups. CONCLUSIONS: In a selected group of subjects with medium-to-low cardiovascular risk profile, a 3 month VD period determined significant improvements in kidney function markers. Further trials are needed to confirm these results.

Effects of an Olive By-Product Called Pâté on Cardiovascular Risk Factors.

BACKGROUND: The nutraceutical effects of Olea europaea L. products are mainly due to phenolic compounds. During olive milling, most of the total phenols remain in the process by-products. AIM: We aimed to evaluate the effects of a specific by-product of olive oil called "pâté" (OlP) administered as tablets, on cardiovascular and metabolic risk factors. METHODS: The study was a crossover trial with 2 intervention periods. Nineteen participants (mean age: 38 years) took 4 tablets/day of either olive pâté (corresponding to 30 mg/day of hydroxytyrosol) or placebo for 2 months followed by a 2-month washout and another 2 months of crossed over treatment. RESULTS: After the intervention with pâté, participants showed a statistically significant reduction in plasma levels of total cholesterol (-10.8 mg/dL), LDL cholesterol (-10.8 mg/dL) and urea (-4.1 mg/dL), and a significant increase in calcium levels (+0.3 mg/dL). Leukocyte response to exogenous oxidative stress was significantly reduced (-12.8%) and levels of the antioxidant transcription factor Nrf-2 increased by 88.9%. Plasma levels of the pro-inflammatory protein MCP-1 were significantly reduced (-9.0 pg/mL). CONCLUSION: In conclusion, the intake of OlP showed positive effects on several cardiovascular risk factors, demonstrating the nutraceutical potential of a widely available but, to date, underestimated olive oil by-product.

Adherence to the Mediterranean diet among Italian adults: results from the web-based Medi-Lite questionnaire.

The adherence to the Mediterranean diet (MD) was assessed in a sample of 1820 non-selected individuals (1099 females and 721 males aged ≥18 years) who have completed the web version of the Medi-Lite score during the year 2019. Adherence to the MD was found to have a normal distribution and, on a scale from 0 to 18, the mean score was 12.2 ± 2.4. Significantly (p < 0.001) higher adherence scores were observed in females compared to males, in elderly people compared to young people, and in individuals with a university degree compared to those with a primary or a secondary school diploma. At the multivariate analysis, female gender, advanced age (>45 years), and higher education level were associated with a higher probability of being in the highest quartile of the Medi-Lite distribution. In conclusion, we found that some sub-groups of our population (males, younger individuals, and those with lower levels of education) need to improve their diet for reaching higher adherence scores to the MD.

Effect of consumption of ancient grain bread leavened with sourdough or with baker's yeast on cardio-metabolic risk parameters: a dietary intervention trial.

The aim of this study was to compare the effect of consumption of ancient grain "Verna" bread obtained by two different leavening agents, sourdough (SD) and baker's yeast (BY), on inflammatory parameters and cardiometabolic risk factors. Seventeen clinically healthy subjects were included to consume SD or BY bread for 4 weeks each, and blood analyses were carried out. The consumption of "Verna" bread obtained with both leavening agents led to a significant improvement of LDL cholesterol. A reduction of -10.6% and -8.53% was observed after replacement with SD and BY bread, respectively. A significant increase in fasting blood glucose (+6%) was observed only after the intervention with BY bread. A 10.7% decrease of vascular endothelial growth factor was found after the SD bread replacement period. The consumption of "Verna" bread resulted significantly associated with an improvement in the cardiometabolic and inflammatory profile. However, only consumption of BY bread determined a significant increase in blood glucose levels.

Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults.

NOVA is a classification that divides foods into four groups according to processing. Since no questionnaires have been validated to assess the consumption of foods with different levels of processing in the general adult population, we tested the reliability and validity of a 94-item Food Frequency Questionnaire (NFFQ) designed to estimate the intake (g/day) and the weight ratio (%) of the NOVA food groups in Italian adults. Time reliability and validity were tested by administrating the NFFQ to 110 subjects on two different occasions and comparing it with a weighed dietary record (WDR). Strong correlations between NFFQs (r > 0.7, p < 0.001) and intraclass correlation coefficients (ICC) of 0.851-0.940 indicated good test-retest reliability. Moderate correlations between the NFFQ and the WDR (0.6

Influence of a 3-month low-calorie Mediterranean diet compared to the vegetarian diet on human gut microbiota and SCFA: the CARDIVEG Study.

PURPOSE: We evaluated the effect of low-calorie mediterranean (MD) and vegetarian (VD) diets on gut microbiome (GM) composition and short-chain-fatty acids (SCFA) production. METHODS: We performed next generation sequencing (NGS) of 16S rRNA and SCFA analysis on fecal samples of 23 overweight omnivores (16 F; 7 M) with low-to-moderate cardiovascular risk. They were randomly assigned to a VD or MD, each lasting 3 months, with a crossover study design. RESULTS: Dietary interventions did not produce significant diversity in the GM composition at higher ranks (family and above), neither between nor within MD and VD, but they did it at genus level. MD significantly changed the abundance of Enterorhabdus, Lachnoclostridium and Parabacteroides, while VD significantly affected the abundance of Anaerostipes, Streptococcus, Clostridium sensu stricto, and Odoribacter. Comparison of the mean variation of each SCFA between MD and VD showed an opposite and statistically significant trend for propionic acid (+ 10% vs - 28%, respectively, p = 0.034). In addition, variations of SCFA were negatively correlated with changes of some inflammatory cytokines such as VEGF, MCP-1, IL-17, IP-10 and IL-12, only after MD. Finally, correlation analyses showed a potential relationship-modulated by the two diets-between changes of genera and changes of clinical and biochemical parameters. CONCLUSIONS: A short-term dietary intervention with MD or VD does not induce major change in the GM, suggesting that a diet should last longer than 3 months for scratching the microbial resilience. Changes in SCFA production support their role in modulating the inflammatory response, thus mediating the anti-inflammatory and protective properties of MD.

Effectiveness of a Khorasan Wheat-Based Replacement on Pain Symptoms and Quality of Life in Patients with Fibromyalgia.

OBJECTIVE: To investigate the effects of a replacement diet with Khorasan wheat products in patients with fibromyalgia, in comparison with a similar replacement diet with control products made from organic semi-whole-grain modern wheat. DESIGN: Randomized, double-blinded crossover trial. SETTING: Outpatient clinic. SUBJECTS: Twenty subjects (19 female and one male, mean age = 48.9 ± 12.3 years) with fibromyalgia. METHODS: Participants were randomly assigned to consume either Khorasan or control wheat products (pasta, bread, crackers, biscuits) for eight weeks and then crossed. Validated self-administered questionnaires were collected from each subject at the beginning and end of each intervention period. RESULTS: A general linear model for repeated measurement, adjusted for potential confounders, showed that the overall score reported from each questionnaire improved after both intervention and control periods, but the effect was more evident after the intervention with Khorasan. In particular, a statistically significant difference in Widespread Pain Index (WPI) + Severity Scale (SS) and Functional Outcome of Sleep Questionnaire (FOSQ) was observed, which decreased significantly by 21.5% and 11.7% respectively, only after the Khorasan period, while no statistically significant variations were reported after the control period. Similarly, FM Impact Questionnaire scores decreased significantly only after the Khorasan period, with a reduction that was significantly different between the intervention and control periods (-22.5% vs -0.3%, P = 0.037). The improvement was even greater in people with higher symptom severity. CONCLUSIONS: A dietary intervention with Khorasan wheat products seems to benefit patients with fibromyalgia, especially those with greater symptom severity.

Effects of a dietary intervention with Mediterranean and vegetarian diets on hormones that influence energy balance: results from the CARDIVEG study.

A randomised, open, crossover trial with two intervention periods was used to compare the effects of a 3-month dietary intervention with Mediterranean diet (MD) and vegetarian diet (VD) on hormones that influence energy balance, and to investigate the relationship with changes in body composition. After 3 months, no significant differences between the two diets were observed. Both MD and VD resulted in a significant (p < .05) reduction in leptin-to-adiponectin ratio and anthropometric parameters, MD resulted in a significant decrease in leptin levels (-7.4%), while VD determined a significant increase in adiponectin (+6.8%) and a significant decrease in visfatin (-12.7%) levels. In both groups, changes in leptin, insulin and HOMA-IR were significantly and positively correlated with changes in anthropometric parameters. In conclusion, both MD and VD have led to a slight but significant improvement in hormones that influence energy balance. The effect was more evident in participants who lost weight and fat mass.

Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet).

BACKGROUND: Only a few randomized dietary intervention studies that investigated the effects of lacto-ovo vegetarian diet (Vd) in clinically healthy omnivorous subjects are available. METHODS: We randomly assigned to overweight omnivores with a low-to-moderate cardiovascular risk profile a low-calorie Vd compared with a low-calorie Mediterranean diet (MD), each lasting 3 months, with a crossover design. The primary outcome was the difference in body weight, body mass index, and fat mass changes between the 2 groups. Secondary outcomes were differences in circulating cardiovascular disease risk parameters changes between the 2 groups. RESULTS: One hundred eighteen subjects (mean age: 51.1 years, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No differences between the 2 diets in body weight were observed, as reported by similar and significant reductions obtained by both Vd (-1.88 kg) and MD (-1.77 kg). Similar results were observed for body mass index and fat mass. In contrast, significant differences between the 2 interventions were obtained for low-density lipoprotein cholesterol, triglycerides, and vitamin B12 levels. The difference between the Vd and MD groups, in terms of end-of-diet values, was recorded at 9.10 mg/dL for low-density lipoprotein cholesterol (P=0.01), 12.70 mg/dL for triglycerides (P<0.01), and 32.32 pg/mL for vitamin B12 (P<0.01). Finally, no significant difference was found between Vd and MD interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which improved only in the MD group. Forty-six participants during the Vd period and 35 during the MD period reached the target values for ≥1 cardiovascular risk factor. CONCLUSIONS: Both Vd and MD were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them. However, Vd was more effective in reducing low-density lipoprotein cholesterol levels, whereas MD led to a greater reduction in triglyceride levels. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02641834.

Food groups and risk of age-related macular degeneration: a systematic review with meta-analysis.

OBJECTIVE: To systematically review all the available evidence from prospective cohort studies that investigated the association between consumption of food groups and the occurrence of age-related macular degeneration (AMD). METHODS: We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, and bibliographies of retrieved articles up to January, 2018. Studies were included if they analysed prospectively the association between consumption of food groups and AMD. RESULTS: At the end of the selection process, 26 articles were included in the meta-analysis, for a total of 211,676 subjects and 7154 cases of AMD. By comparing the highest vs. the lowest consumption, pooled analyses showed no significant association with AMD for vegetables, fruit, nuts, grains, dairy products, as well as dietary fats such as oils, butter and margarine. Fish determined a significant (p < 0.05) reduction of risk for total AMD (RR 0.82 95% CI 0.75-0.90), as well as for both early (RR 0.84 95% CI 0.73-0.97), and late (RR 0.79 95% CI 0.70-0.90) AMD. On the other hand, high meat consumption was associated with a significant increased risk of early (RR 1.17 95% CI 1.02-1.34), but not late AMD. Finally, a significant increased risk of AMD for the highest consumption of alcohol (RR 1.20 95% CI 1.04-1.39) was reported. CONCLUSIONS: The results of the present meta-analysis show a significant 18% reduced risk for fish and a 20% increased risk for alcohol consumption. In addition, an increased risk was observed for meat, but only in the subgroup of early AMD.

A Khorasan Wheat-Based Replacement Diet Improves Risk Profile of Patients With Nonalcoholic Fatty Liver Disease (NAFLD): A Randomized Clinical Trial.

OBJECTIVE: KAMUT khorasan is an ancient grain with widely acclaimed health benefits. The aim of this study was to investigate the effects of a replacement diet with ancient khorasan wheat products in patients with NAFLD, in comparison to a similar replacement diet with control products made from organic semi-whole-grain modern wheat. METHODS: Forty NAFLD patients (12 M/28 F; age 55.2 ± 10.4 years) with mild to moderate liver steatosis were included. The experimental design was a randomized, double-blind, parallel-arm study with 20 participants assigned to consume either KAMUT khorasan or control wheat products (pasta, bread, crackers, biscuits) over a 3-month period. Anthropometric measurements, blood analyses, and ultrasonography examination were performed at both the beginning and end of each dietary intervention. RESULTS: After the implementation of a general linear model for repeated measurements adjusted for baseline demographic details, risk factors, and medication, alanine aminotransferase (ALT) was significantly reduced by 12%, aspartate aminotransferase (AST) by 14%, alkaline phosphatase (ALP) by 8%, and cholesterol by 6% only in the khorasan group (p < 0.05 for all). Similarly, significant reductions in circulating proinflammatory tumor necrosis factor-alpha by 50%, interleukin l-receptor antagonist-alpha by 37%, interleukin-8 by 24%, and interferon gamma by 24% were evident only in participants who consumed the khorasan products (p < 0.05 for all). Finally, significant improvements in the liver steatosis grading, Doppler perfusion index values, and reactive oxygen species (ROS) production were evident after consumption of both the khorasan and control products. CONCLUSIONS: This study suggests that a short-term replacement diet with ancient KAMUT khorasan products is most effective in reducing metabolic risk factors and ameliorating the liver profile in patients with NAFLD.

Relationship between sleep pattern and efficacy of calorie-restricted Mediterranean diet in overweight/obese subjects.

The association between the sleep pattern and the effectiveness of a calorie-restricted Mediterranean diet in people with overweight/obesity has been investigated in this study. Four hundred and three subjects were provided with a calorie-restricted Mediterranean diet and followed for 9 months. Personal information, including sleep pattern, was obtained at the baseline. Body weight and composition were measured every 3 months. Poor sleepers reported to have significantly (p < .05) higher BMI and fat mass percentage than good sleepers. Among the good sleepers (6-8 h/day), women showed a greater reduction in fat mass than men after dieting (-3.6 vs. -2 kg, p = .05). Women who reported sleeping 6-8 or >8 h/day had an increased probability of losing fat mass than women who reported sleeping <6 h/day (OR = 4.47, 95% CI: 1.42-14.04, p = .010 and OR = 5.10, 95% CI: 1.15-22.70; p = .032, respectively). Our findings confirm that the normal sleep pattern is necessary to maintain body weight and optimal body composition.

A Heart-Healthy Diet: Recent Insights and Practical Recommendations.

PURPOSE OF REVIEW: The purpose of this study is to review the current evidence on the relationship between diet and heart, giving practical recommendations for cardiovascular prevention. RECENT FINDINGS: A heart-healthy diet should maximize the consumption of whole grains, vegetables, fruit, and legumes and discourage the consumption of meat and meat products as well as refined and processed foods. Plant-based diets fully meet these criteria, and the evidence supporting the protective effect of these dietary patterns evolved rapidly in recent years. Among plant-based diets, the Mediterranean and vegetarian diets gained the greater interest, having been associated with numerous health benefits such as reduced levels of traditional and novel risk factors and lower risk of cardiovascular disease. These positive effects may be explained by their high content of dietary fiber, complex carbohydrate, vitamins, minerals, polyunsaturated fatty acids, and phytochemicals. Current evidence suggests that both Mediterranean and vegetarian diets are consistently beneficial with respect to cardiovascular disease.

Validation of a literature-based adherence score to Mediterranean diet: the MEDI-LITE score.

Numerous studies have demonstrated a relationship between adherence to Mediterranean diet and prevention of chronic degenerative diseases. The aim of this study was to validate a novel instrument to measure adherence to Mediterranean diet based on the literature (the MEDI-LITE score). Two-hundred-and-four clinically healthy subjects completed both the MEDI-LITE score and the validated MedDietScore (MDS). Significant positive correlation between the MEDI-LITE and the MDS scores was found in the study population (R = .70; p < .0001). Furthermore, statistically significant positive correlations were found for all the nine different food groups. According to the receiver operating characteristic (ROC) curve analysis, MEDI-LITE evidenced a significant discriminative capacity between adherents and non-adherents to the Mediterranean diet pattern (optimal cut-off point = 8.50; sensitivity = 96%; specificity = 38%). In conclusion, our findings show that the MEDI-LITE score well correlate with MDS in both global score and in most of the items related to the specific food categories.