Nutritional genomics, inflammation and obesity

ABSTRACT The Human Genome Project has significantly broadened our understanding of the molecular aspects regulating the homeostasis and the pathophysiology of different clinical conditions. Consequently, the field of nutrition has been strongly influenced by such improvements in knowledge - especially for determining how nutrients act at the molecular level in different conditions, such as obesity, type 2 diabetes, cardiovascular disease, and cancer. In this manner, characterizing how the genome influences the diet and vice-versa provides insights about the molecular mechanisms involved in chronic inflammation-related diseases. Therefore, the present review aims to discuss the potential application of Nutritional Genomics to modulate obesity-related inflammatory responses. Arch Endocrinol Metab. 2020;64(3):205-22

Factores de riesgo cardiovascular no convencionales / Unconventional cardiovascular risk factor

Desde hace varias décadas se conocen los clásicos factores de riesgo cardiovascular (género, edad, hipertensión arterial, dislipidemias, tabaquismo, obesidad, sedentarismo). También existen factores de riesgo "no convencionales", es decir situaciones no descriptas ni contenidas en la mayoría de los puntajes de riesgo tradicionales, pero de las cuales existen evidencias científicas. En esta revisión se analizan algunos de ellos, tales como factores socioeconómicos, horarios prolongados de trabajo, factores ambientales, aislamiento social, cantidad y calidad del sueño. También hay factores de "protección" cardiovascular como la dieta mediterránea. La literatura cuenta con un número muy elevado de publicaciones que abarcan estos factores. En la presente descripción se incluyeron algunas que fuesen representativas, con buen diseño experimental y que hayan realizado análisis multivariado de los resultados para controlar potenciales confundidores que invaliden las conclusiones. Finalmente, se discuten los mecanismos fisiopatológicos involucrados en la generación de los eventos cardiovasculares finales. (AU)

The classical cardiovascular risk factors have been known for several decades (gender, age, arterial hypertension, dyslipidemia, smoking, obesity, sedentary lifestyle). There also exist "non conventional" risk factors, that are those not described or not included in the majority of the traditional cardiovascular risk scores, but for whom scientific evidence is available. In this review some of them are analyzed, such as socio economic factors, prolonged work schedules, environmental factors, social isolation, sleep quantity and quality. There are also some "preventive" cardiovascular factors as the Mediterranean diet. There exist considerable amount of publications in the literature analyzing these issues. In the present paper some of them are discussed. They have been selected as they were representative of the corresponding aspect, well designed and with multivariate statistical analysis of the results, in order to control potential confounders that could invalidate the conclusions. Finally, the pathophysiological mechanisms involved are discussed. (AU)

Adherence to the Mediterranean Dietary Pattern and Common Mental Disorders in elderly living in São Paulo-SP-Brazil: population-based study / Adesão ao Padrão da dieta mediterrânea e Transtornos Mentais Comuns em idosos de São Paulo-SP-Brazil: estudo de base populacional

Introduction: The presence of Common Mental Disorders (CMD) becomes more common with advancing age. The literature shows the beneficial effects of the Mediterranean Diet on the mental health of the elderly, but few studies have been conducted in Western countries. In addition, studies conducted in non-Mediterranean regions generally do not take into account the peculiarities of food, which do not always meet all the Mediterranean characteristics. Objective: (i) to describe the adherence to the Mediterranean dietary pattern, considering two points of view: including only foods characteristic of the original standard Mediterranean diet and including foods with non-Mediterranean characteristics (ii) to verify the association between the adherence to the two Mediterranean Dietary Patterns (MDP) and CMD in the elderly. Methods: cross-sectional population-based study; Data from the 2015 Health Survey of São Paulo were used. The presence of CMD was identified through the Self Reporting Questionnaire-20. The MDP was constructed using the Mediterranean Diet Score (calculated from data from two 24-hour dietary recall), considering two points of view: Mediterranean pattern origin-like (MPOL), which included only foods from the original Mediterranean diet; Mediterranean pattern including foods with non-Mediterranean characteristics (MPNM), which included foods submitted to procedures that diverge from the original dietary pattern. The other variables were identified through a previously structured questionnaire. The association between TMC and adherence to MPOL and MPNM was investigated through logistic regression models. The covariates for the adjustment were selected for biological plausibility. A significance level of 5% (p <0.05) was considered for final statistical tests. All data analyses were performed using Stata software (version 14). To accomplish the objectives of the present research, two manuscripts were elaborated. The aims of the 1st manuscript were: (i) describe the degree of adherence to this dietary pattern by elders from São Paulo-SP-Brazil; (ii) to identify modifications made in the form of intake of the different components of the original MDP, investigating associations with demographic and socioeconomic variables. The aims of the 2nd manuscript were: (i) To evaluate the association between the adherence to the MDP with the presence of mental disorders in these elders; (ii) To investigate these associations taking into account the two different points of view of MDP. Results: The 1st manuscript showed a moderate adherence to the two views of MDP. The greater adherence to the two proposed dietary patterns was characterized by higher intakes of vegetables, fruits, nuts, cereals, legumes and greater proportion between monounsaturated and saturated lipids and, as well as lower consumption of meat and dairy products. MPOL and MPNM were associated with formal education and age, respectively. From the 2nd manuscript, we identified that moderate and high adherence to MPOL, compared to low adherence, was associated with a lower prevalence of CMD, after adjustment for gender, age, body mass index, number of chronic diseases, per capita household income, physical activity and smoking status. The presence of CMD was not associated with MPNM adherence. Additionally, the presence of CMD was different between gender, physical activity and number of referred chronic diseases. Main conclusions (from the two manuscripts): the protective effect of MDP on CMD in elderly was observed only when the particularities of this diet were fulfilled. Other factors, associated to lifestyle, showed to be important to improve the associations with CMD. The results support the importance of programs that encourage the maintenance of healthy eating habits among the elderly

Introdução: A presença de Transtornos mentais comuns (TMC) torna-se mais frequente com o avançar da idade. A literatura evidencia os efeitos benéficos da Dieta mediterrânea sobre a saúde mental do idoso, porém poucos estudos foram realizados em países ocidentais. Ademais, os estudos realizados em regiões não mediterrâneas geralmente não levam em consideração as peculiaridades dos alimentos, que nem sempre atendem a todas as características mediterrâneas. Objetivos: (i) descrever a adesão ao padrão da dieta mediterrânea considerando dois pontos de vista: incluindo apenas alimentos característicos do original padrão da dieta mediterrânea e incluindo alimentos com características não mediterrâneas (ii) verificar a associação entre a adesão aos dois padrões da dieta mediterrânea (PDM) construídos e TMC em idosos. Métodos: trata-se de um estudo transversal de base populacional; foram utilizados dados do Inquérito de Saúde de São Paulo 2015 (ISA-Capital). A presença de TMC foi identificada através do Self Reporting Questionnaire-20. O PDM foi construído através do Escore da dieta mediterrânea (calculado com base em dois recordatórios alimentares de 24h), considerando dois pontos de vista: Padrão mediterrâneo similar ao original (PMSO) - com a inclusão de apenas alimentos originais da dieta mediterrânea; Padrão mediterrâneo com características não mediterrâneas (PMNM) - com a inclusão de alimentos que foram submetidos a procedimentos que divergem do padrão mediterrâneo original. As demais variáveis foram identificadas por meio de um questionário previamente estruturado. A associação entre TMC e a adesão ao PMSO e PMNM foi investigada por meio de modelos de regressão logística. As covariáveis para o ajuste foram selecionadas por plausibilidade biológica. Adotou-se nível de significância de 5% (p < 0,05) para os testes estatísticos finais. Todas as análises de dados foram realizadas utilizando o software Stata (versão 14). Para atender os objetivos da presente pesquisa, foram elaborados dois manuscritos. O manuscrito 1 teve como objetivos (i) descrever o grau de adesão ao PMD por idosos de São Paulo-SP-Brasil; (ii) construir dois pontos de vista do PMD, de acordo com as modificações frequentes na forma de ingestão dos diferentes componentes desse padrão dietético, investigando associações com variáveis demográficas e socioeconômicas. O manuscrito 2 teve como objetivos: (i) avaliar a associação entre a aderência ao PMD e transtornos mentais comuns nesses idosos; (ii) investigar essas associações levando em consideração as duas visões construídas para esse padrão. Resultados: No manuscrito 1 foi encontrada uma adesão moderada pelos idosos às duas visões do PMD. A maior adesão a ambas as visões do PMD foi caracterizada pela ingestão mais elevada de vegetais, frutas, oleaginosas, cereais, leguminosas e maior proporção de lipídios monoinsaturados e saturados, além de um menor consumo de carne e laticínios. O PMSO e o PMNM apresentaram associação com escolaridade e idade, respectivamente. No Manuscrito 2, identificou-se que as adesões moderada e alta ao PMSO, em comparação a uma baixa adesão, foram associadas a uma menor prevalência de TMC, após ajuste para sexo, idade, índice de massa corporal, número de doenças crônicas, renda domiciliar per capita, atividade física e tabagismo. Por sua vez, a presença de TMC não mostrou associação significativa com nenhum grau de adesão ao PMNM. Adicionalmente, a presença de TMC foi significativamente diferente entre os gêneros, a atividade física e o número de doenças crônicas referidas. Conclusões principais (a partir de ambos os manuscritos): o efeito protetor de uma maior adesão ao PDM sobre os TMC em idosos foi observado apenas quando as particularidades originais desse padrão foram atendidas. Outros fatores, associados ao estilo de vida, mostraram-se importantes para melhorar as associações com TMC. Os resultados encontrados reforçam a importância de programas que incentivem a manutenção de hábitos alimentares saudáveis entre idosos

Какие инициативы на национальном или субнациональном уровнях, основанные на использовании средиземноморской и скандинавской диет, рекомендуются к внедрению в Европейском регионе ВОЗ, и существуют ли доказательства их эффективности для противодействия неинфекционным заболеваниям?

Данный обзор посвящен инициативам и мерам политики на национальном или субнациональном уровнях, основанным на использовании средиземноморской и скандинавской диет, в Европейском регионе ВОЗ. В условиях растущего бремени неинфекционных заболеваний (НИЗ) и нездорового рациона питания возникает особая потребность в обоснованных фактическими данными оптимальных рационах питания и вмешательствах в сфере профилактики и борьбы с НИЗ. В качестве здоровых рационов питания регионального значения были особо выделены средиземноморская и скандинавская диеты. Приведенное в обзоре краткое описание и анализ бремени НИЗ и проводимых в Регионе мероприятий, пользы для здоровья (в контексте НИЗ) от средиземноморской и скандинавской диет, вмешательств и стратегий в 15 странах, 4 исследований эффективности применения указанных диет для борьбы с НИЗ, а также вариантов и возможностей для выработки и проведения политики, помогут лицам, принимающим решения, формировать меры политики в области питания в соответствии с конкретным контекстом. Что касается применения средиземноморской и скандинавской диет в инициативах по борьбе с НИЗ, то в масштабах всего Региона сохраняется потребность в активных действиях, основанных на фактических данных, в мониторинге и оценке эффекта проводимой политики для распространенности НИЗ, а также в распространении передовых примеров таких действий через открытые платформы.

What national and subnational interventions and policies based on Mediterranean and Nordic diets are recommended or implemented in the WHO European Region, and is there evidence of effectiveness in reducing noncommunicable diseases?

This review focuses on national and subnational Mediterranean diet (MD) and Nordic diet (ND) interventions and policies in the WHO European Region. In the context of increasing noncommunicable disease (NCD) burden and unhealthy diets, there is a need to continue identifying optimal, evidence-informed diets and interventions for the prevention and control of NCDs. The MD and ND have been identified as region-specific healthy diets. To support decision-makers in shaping context-specific diet and nutrition policies, this review provides a summary of the NCD burden and activities in the Region; outlines the NCD-related health benefits of the MD and ND; describes interventions and policies in 15 countries; reviews four identified studies into the effectiveness of MD and ND policies on NCD outcomes; and discusses policy implications and options. In the context of MD and ND interventions for NCDs, there remains a Region-wide need to increase translation of evidence into action, monitor and evaluate the impact of existing policies on NCD outcomes and share activities through public platforms to support information sharing.

The association between healthy lifestyle behaviors and health-related quality of life among adolescents / Associação entre comportamentos de estilo de vida saudável e a qualidade de vida relacionada à saúde entre adolescentes

Abstract Objective: The aim of this research was to examine the association between body mass index, physical activity, adherence to the Mediterranean diet, and health-related quality of life in a sample of Spanish adolescents. Method: The study involved 456 adolescents aged between 11 and 14 years. They completed questionnaires on the Mediterranean diet (KIDMED), physical activity (Physical Activity Questionnaire for Older Children [PAQ-C]), and quality of life (KIDSCREEN-27). Body mass index was calculated. Hierarchical linear regression analyses were used to determine whether health-related quality of life could be predicted by the measured variables. The variables were analyzed in a stepwise manner, with Mediterranean diet entered in the first step, body mass index in the second, and physical activity in the third. Results: Mediterranean diet accounted for 4.6% of the variance in adolescent's health-related quality of life, with higher adherence to the Mediterranean diet predicting higher health-related quality of life-scores. Body mass index accounted for a further 4.1% of the variance, with a higher body mass index predicting lower health-related quality of life scores. Finally, physical activity explained an additional 11.3% of the variance, with a higher level of physical activity being associated with higher health-related quality of life scores. Together, these variables explained 20% of the variance in the adolescents' health-related quality of life. Conclusions: Physical activity, body mass index, and adherence to the Mediterranean diet are important components to consider when targeting improvements in the health-related quality of life of adolescents, with physical activity representing the component with the greatest influence.

Resumo Objetivo: O objetivo desta pesquisa foi examinar a associação entre o índice de massa corporal, a atividade física, a adesão à dieta mediterrânea e a qualidade de vida relacionada à saúde em uma mostra de adolescentes espanhóis. Método: O estudo envolveu 456 adolescentes entre 11 e 14 anos. Eles preencheram questionários sobre a dieta mediterrânea (Kidmed), atividade física (Questionário de Atividade Física para Crianças mais velhas, PAQ-C) e qualidade de vida (Kidscreen-27). Foi calculado o índice de massa corporal. Análises de regressão linear hierárquica foram usadas para determinar se a qualidade de vida relacionada à saúde pode ser prevista pelas variáveis medidas. As variáveis foram introduzidas de forma gradual com a dieta mediterrânea na primeira etapa, índice de massa corporal na segunda etapa e atividade física na terceira. Resultados: A dieta mediterrânea representou 4,6% da variância na qualidade de vida relacionada à saúde dos adolescentes e uma maior adesão à dieta mediterrânea foi preditiva de maiores escores de qualidade de vida relacionados à saúde. O índice de massa corporal representou um adicional de 4,1% de variância e um maior índice de massa corporal foi preditivo de menores escores de qualidade de vida relacionada à saúde. Por fim, a atividade física representou um adicional de 11,3% da variância e um maior nível de atividade física foi associado a maiores escores de qualidade de vida relacionada à saúde. Juntas, essas variáveis representam 20% da variância na qualidade de vida relacionada à saúde dos adolescentes. Conclusões: A atividade física, o índice de massa corporal e a adesão à dieta mediterrânea são importantes componentes para considerar ao visar melhorias na qualidade de vida relacionada à saúde dos adolescentes, a atividade física é o componente com maior influência.

Ingesta dietética y actividad física en el tiempo libre de adultas mayores en ámbito rural mediterráneo / Dietary intake and physical activity in leisure time of adult-elderly women in Mediterranean rural areas

Las mujeres mayores de ámbito rural presentan un marcado rol de trabajo familiar y agrícola, tipo de ingesta específica y diverso aprovechamiento del tiempo libre. El objetivo del presente estudio es comparar las diferencias entre los tipos de alimentos consumidos y características tanto clínicas como socio-demográficas que poseen los grupos de mujeres mayores de poblaciones rurales en función del gasto energético durante la práctica de actividad física en su tiempo libre. Un total de 117 mujeres con edades comprendidas entre los 60 y 79 años, que asistían a un programa de condición física en poblaciones rurales pequeñas y medianas en la provincia de Málaga (España), fueron clasificas en función del gasto energético utilizado: sedentarias (inferior a 1.250METs-min/14 días), moderadamente activas (1.250-2.999 METs-min/14 días), activas (3.000-4.999 METs-min/14 días) y muy activas (superior a 5.000 METs-min/14 días). Se evaluaron las características socio-demográficas y clínicas de las participantes (índice de masa corporal, hipertensión y hábitos alimentarios. Los resultados indican que las participantes de más edad son las sedentarias y las muy activas (p<0.001), teniendo mayor peso e índice de masa corporal las primeras (p<0.001; p<0.01, respectivamente) y consumiendo más verdura las participantes que son moderadamente activas (p<0.01). Como conclusión, una dieta rica en verduras, fruta y el control en la ingesta de carne roja podría inferir en una disminución del IMC de las participantes(AU)

Dietary intake and physical activity in leisure time of adultelderly women in Mediterranean rural areas. Elderly women in rural areas have a strong role in household and farming work, and they show food intake and use of leisure time. It is interesting to compare the differences between groups of elderly women of rural villages according to type of consumed food and energy expenditure during physical activity. A total of 117 women aged between 60 and 79 years who attended a physical fitness program in rural areas of Malaga province (Spain) participated in this study. The participants were classified in different energy expenditure groups: sedentary (less than 1.250METs-min/14 days), moderately active (1.250-2.999 METs-min/14 days), active (3.000- 4.999 METs-min/14 days) and highly active (over 5.000 METs-min/14 days). Sociodemographic and clinical characteristics of participants (body mass index hypertension and food habits) were measured. The results indicate that the oldest participants are in the sedentary group or in the highly active group (p<0.001). In addition, the sedentary group shows higher weight and body mass index (p<0.001; p<0.01, respectively), and the moderately active group consumes more vegetables (p<0.01). In conclusion, a rich diet of vegetables, fruits with a control of red meat intake could induce to decrease of BMI in participants(AU)

Evidencia actual sobre los beneficios de la dieta mediterránea en salud / Current evidence on health benefits of the mediterranean diet

The Mediterranean diet is currently considered a functional diet with an increasing amount of scientific evidence that supports its beneficial effects in human health. Several observational cross-sectional and prospective cohort studies show an association between this diet and a lower prevalence and incidence of chronic diseases, such as cardiovascular disease, cancer, metabolic syndrome, diabetes, and neurodegenerative diseases as well as a reduced overall mortality. Additionally, clinical interventional studies, particularly the PREDIMED (Prevención con Dieta Mediterránea) initiative, have shown, with high quality scientific evidence, that a Mediterranean diet -supplemented either with olive oil or nuts- can lower by 30% the incidence of cardiovascular disease, reverse the metabolic syndrome, and prevent the development of diabetes and aging-related cognitive decline. Chile has one of the five Mediterranean ecosystems in the world, and therefore the implementation of this food pattern and lifestyle in our country may determine large benefits to the health status and quality of life in the Chilean population.

Promoting a healthy diet for the WHO Eastern Mediterranean Region: user-friendly guide

Promoting a healthy diet for the WHO Eastern Mediterranean Region provides dietary advice to promote health and reduce the risk of major chronic diseases through diet and physical activity. This user-friendly guide presents a set of dietary recommendations that are compatible with the different cultures and eating patterns of consumers in the Region based on the availability of local and affordable foods. This publication represents an essential tool in supporting national and regional strategies to improve nutrition outcomes and health in the Region. It is primarily intended for use by policymakers, health care providers, nutritionists, nutrition educators and anyone involved in food distribution and food service. It can also be used by schools, homes, cafeterias and businesses to improve the food choices of a range of consumers

La dieta mediterránea y la prevención de enfermedades crónicas / The Mediterranean Diet and the prevention of chronic diseases

Existe evidencia científica que con-firma la relación entre los diferentes componentes de la dieta mediterránea y la prevención de enfermedades crónicas no trasmisibles, como es el caso de la obesidad, la diabetes mellitus tipo 2, la dislipidemia, las enfermedades cardio-vasculares, el cáncer y aunque faltan más estudios, también se ha encontrado asociación con la prevención de la artritis reumatoidea. Se ha sugerido que este estilo de alimentación tradicional del mediterráneo sea adoptado como un todo y no cada componente por separado, no obstante, se deben hacer modificaciones en el estilo de vida, al igual que en el entorno, para mejorar las condiciones de salud de una población y prevenir la incidencia de las enfermedades crónicas que tienen su origen principalmente, en unos hábitos de alimentación inadecuados. Entre las sustancias nutritivas y no nutritivas que ofrece esta dieta y que tienen una relación directa con el mantenimiento de la salud se destacan: Los ácidos grasos monoinsaturados, que se encuentran en el aceite de oliva y en frutos secos como las nueces; los polifenoles y el resveratrol, antioxidantes que están presentes en el vino rojo; la fibra soluble e insoluble, la cual hace parte de las frutas, de las verduras y de los cereales integrales, al igual que los ßcidos grasos omega 3 presentes en el pescado y también en las nueces.

The Mediterranean diet has become an important issue for research dueto of its benefits on health and the prevention of both primary and secondary strokes and cardiovascular diseases. There is scientific evidence that has shown the relationship betweenthe components of the mediterrane an diet and its role in the prevention of non transmissible chronic diseases like obesity, diabetes Mellitustype 2, dyslipidemia, stroke, cancer and arthritis. It has been sugested that Traditional mediterranean diet may be adopted as a integral diet to get all the benefits instead of to take each component of the diet separately. Eventhougth this diet help to decrease cardiovascular risks, some life style modifications should be done, inorder to improve the health conditions of a population and prevent the incidence of chronic diseases, which could increase with un healthy diet.The main nutrients present in the mediterranean diet which have benenfical effects on health are monounsaturated fatty acids contained in olive oil and nuts; omega 3 fattyacids mainly in fish, polyphenols,resveratrol and antioxidants in redwine, fiber in most of the fruits,vegetables and whole grains.