Impact of War and Resettlement on Vietnamese Families Facing Dementia: A Qualitative Study.

OBJECTIVES: Most Vietnamese immigrants in the U.S. today arrived as political refugees due to the Vietnam War in the late 20th century. Refugees are disproportionally affected by health and mental health disparities as a result of experiencing distress and potentially traumatic experiences before, during, and after their migration processes. This study involved Vietnamese families facing dementia and used a qualitative approach to investigate participants' experiences before, during, and right after their resettlement in the U.S. METHODS: In-person interviews were conducted with 11 Vietnamese adults who cared for their family member with dementia. A descriptive analysis approach was used. RESULTS: Five major themes emerged from the interviews:1) immigrating separately from family members, 2) difficult and unsafe journeys, 3) experiences of loss, 4) lack of support systems in the U.S., and 5) feelings of unhappiness, sadness, or signs of depression. CONCLUSIONS: This study provides a close examination of Vietnamese refugees' unique backgrounds and how individuals with dementia and their caregivers from this population may be disproportionally impacted by stress. CLINICAL IMPLICATIONS: To reduce health disparities, we recommend that providers and policymakers allocate more resources for culturally appropriate routine assessment, treatment, and referrals of those with dementia and their caregivers.

Non-invasive evaluation techniques to efficacy of anti-cellulite treatment: the high frequency (HF) ultrasound as a useful imaging technique of the skin and subcutaneous tissue.

Cellulite is defined as lipodystrophy of the subcutaneous adipose tissue, is a serious problem for about 90% of women. The fight against the symptoms is a challenge for cosmetology and esthetic medicine. The most promising method of skin and subcutaneous tissue imaging appears to be the ultrasound method. The aim of the study was to evaluate the effectiveness of classic and high frequency ultrasonography in monitoring the anti-cellulite treatment. The study involved 144 women at mean age of 40.01 (± 11.90) years. The women were divided into groups: due to age and due to the degree of cellulite. The study was divided into two stages: "before" treatment (stage I) and "after" treatment (stage II), to which patients reported after a monthly anti-cellulite specifics application. In the initial phase, inspection and palpation tests have been executed to determine the severity of cellulite.The Nümberger-Müller cellulite severity assessment scale has been used. All women had a thigh circumference measured at its widest point. Epidermal tests have been performed in all women in order to eliminate allergy to preparation components. Based on the study, it was observed that there was a significant reduction in the thickness of the subcutaneous tissue as a result of therapy. The reduction of thickness of the dermis after treatment may indicate improvement in microcirculation which leads to elimination of edemas. A reduction of thigh circumference, which is one of the main indicative parameters of the therapy effectiveness, has been obtained.

Automation der Bestimmung von Vitamin D in Serum und Plasma.

Vitamins play an important role in many processes in the human organism. The detection of insufficient supply of vitamins is therefore of particular importance to avoid significant effects for human health. An increasing number of tests is only possible with suitable automated procedures. For the determination of vitamin D3 and vitamin D2 in serum samples, three methods were automated and compared with regard to their performance. All three methods enable reliable detection of 25(OH)D2 and 25(OH)D3 in serum in the ng/ml range.

Futures and fears in the freezer: Danish women's experiences with ovarian tissue cryopreservation and transplantation.

RESEARCH QUESTION: Ovarian tissue cryopreservation (OTC) and subsequent re-transplantation is gaining ground as a valid technique to preserve fertility in patients facing imminent cancer treatment. This study explores patients' experiences with OTC and transplantation, including their reflections on long-term storage of tissue and the use of surplus tissue. DESIGN: Semi-structured qualitative interviews with 42 Danish women undergoing OTC between 2003 and 2018, 32 of whom had ovarian tissue transplanted. RESULTS: Overall, OTC was associated with positive experiences linked to the production of future-oriented hope and reproductive possibilities. It also generated a range of worries, particularly regarding hormone-sensitive cancers and the risk of re-transplanting malignant cells, and the women's arduous journeys to conceive after cancer resonated through the accounts. Moreover, the women's understanding of, and access to, information about the OTC procedure and its prospects affected the ways in which they approached storage and transplantation of their frozen tissue. Finally, the interviews showed how the stored ovarian tissue was also infused with potentiality beyond the scope of reproduction, both as a remedy to restore hormonal cycles and in the imagination of the-yet-to-be-discovered potential informing the women's reflections on donation and destruction. CONCLUSION: Although OTC is a 'hope technology' compared with freezing of oocytes and embryos, ovarian tissue is interlinked with risk and disease and positioned as an asset beyond the scope of reproduction. Importantly, this study underscores the need for provision of specialized information, follow-up, and fertility counselling after OTC and cancer treatment.

Neighborhood Characteristics and Caregiver Depressive Symptoms in the National Study of Caregiving.

Objectives: We examined the association between neighborhood characteristics and depressive symptoms in a population-based sample of dementia caregivers. Methods: Data came from the 2017 National Health and Aging Trends Study (NHATS) and National Study of Caregiving. The sample included 956 caregivers of those with dementia. Linear regression was used to examine associations between neighborhood physical disorder neighborhood social cohesion, and depressive symptoms, and to test the moderating effect of social support on these relations. Results: Results suggested that having friends and family (1) to talk to buffered the effect of high NPD and low cohesion on depressive symptoms, (2) to help with daily activities buffered the effect of low cohesion on depressive symptoms, and finally, and (3) to help with care had a protective effect on depressive symptoms if social cohesion was high. Discussion: Neighborhood contextual characteristics and social support interact to affect caregiver depressive symptoms in complex ways.

Frailty in kidney transplant candidates: a comparison between physical frailty phenotype and FRAIL scales.

BACKGROUND: Frailty is common among advanced chronic kidney disease (CKD) patients who are kidney transplant (KT) candidates, and predisposes to poor outcomes after transplantation. However, frailty is not routinely measured during pretransplant work-up and it is unknown which metric should be used in this specific population. Our aim was to establish frailty prevalence in KT candidates according to different frailty scales. METHODS: Prospective longitudinal study of 451 KT candidates evaluated for frailty by both Physical Frailty Phenotype (PFP) and FRAIL scale at the time of inclusion on the KT waiting list. Clinical and functional characteristics including sociodemographics, comorbidities, disability and nutritional status were recorded. Agreement between PFP and FRAIL scales as well as dissonant patients were analyzed. RESULTS: Mean age was 60.9 years and 31.7% were female. Comorbidity burden among patients was high, with 36.9% and 16.2% presenting with diabetes and ischemic coronary disease, respectively. Disabilities were also frequent. More than 70% of patients presented with ≥ 1 PFP criteria while this percentage for ≥ 1 FRAIL criteria was 45.4%. Agreement between PFP and FRAIL was not good (kappa index 0.317). There were 132 patients who were pre-frail or frail according to PFP but non-frail according to the FRAIL scale and they presented with fewer comorbidities and less disability. CONCLUSIONS: Frailty is frequent in advanced CKD patients, although its prevalence may vary according to different scales. Agreement between PFP and FRAIL scale is not good, and FRAIL scale might misclassify as robust patients those frail/prefrail patients who are in better health conditions.

Frailty among chronic kidney disease patients on the kidney transplant waiting list: the sex-frailty paradox.

BACKGROUND: Frailty is defined as decreased physiologic reserve and resistance to stressors that predisposes patients towards poor health results. Its prevalence in chronic kidney disease (CKD) patients who are kidney transplant (KT) candidates is high. Frailty is associated with a higher rate of complications and mortality after transplant. It is unknown whether frailty phenotype differs depending on sex in this population. METHODS: This was a prospective longitudinal study of 455 KT candidates evaluated for frailty by physical frailty phenotype at the time of inclusion on the KT waiting list. Pre-frailty was defined as the presence of two criteria and frailty as three or more criteria. Univariate and multivariate analyses searched for associations of frailty status, frailty components and gender differences. RESULTS: Thirty percent of the total cohort resulted to be pre-frail (20%) or frail (10.3%), but disparities were observed between sexes, with 22.5% of men and 47.2% of women falling into one of these categories. Among frailty criteria, women presented with a higher percentage of exhaustion (39.6% versus 17%) and slowness (22.2% versus 9.6%) compared with men. Comorbidity burden was higher among frail men, whereas social factors were poorer between frail women. Disability was common among those patients who were frail, both men and women. CONCLUSIONS: Frailty is twice as frequent in advanced CKD women as men. Frailty criteria distribution and phenotype seem to differ among sexes, which might have implications in terms of specific and individualized interventions to improve their status before transplantation.

Outcomes of Frail Patients While Waiting for Kidney Transplantation: Differences between Physical Frailty Phenotype and FRAIL Scale.

Frailty is associated with poorer outcomes among patients waiting for kidney transplantation (KT). Several different tools to measure frailty have been used; however, their predictive value is unknown. This is a prospective longitudinal study of 449 KT candidates evaluated for frailty by the Physical Frailty Phenotype (PFP) and the FRAIL scale. During the study period, 296 patients received a KT, while 153 remained listed. Patients who did not get receive a transplant were more frequently frail according to PFP (16.3 vs. 7.4%, p = 0.013). Robust patients had fewer hospital admissions during the 1st year after listing (20.8% if PFP = 0 vs. 43.4% if ≥1, and 27.1% if FRAIL = 0 vs. 48.9% if ≥1) and fewer cardiovascular events (than FRAIL ≥ 1) or major infectious events (than PFP ≥ 1). According to PFP, scoring 1 point had an impact on patient survival and chance of transplantation in the univariate analysis. The multivariable analysis corroborated the result, as candidates with PFP ≥ 3 had less likelihood of transplantation (HR 0.45 [0.26-0.77]). The FRAIL scale did not associate with any of these outcomes. In KT candidates, pre-frailty and frailty according to both the PFP and the FRAIL scale were associated with poorer results while listed. The PFP detected that frail patients were less likely to receive a KT, while the FRAIL scale did not.

Increased mortality after kidney transplantation in mildly frail recipients.

Background: Physical Frailty Phenotype (PFP) is the most used frailty instrument among kidney transplant recipients, classifying patients as pre-frail if they have 1-2 criteria and as frail if they have ≥3. However, different definitions of robustness have been used among renal patients, including only those who have 0 criteria, or those with 0-1 criteria. Our aim was to determine the impact of one PFP criterion on transplant outcomes. Methods: We undertook a retrospective study of 296 kidney transplant recipients who had been evaluated for frailty by PFP at the time of evaluating for transplantation. Results: Only 30.4% of patients had 0 criteria, and an additional 42.9% showed one PFP criterion. As PFP score increased, a higher percentage of women and cerebrovascular disease were found. Recipients with 0-1 criteria had lower 1-year mortality after transplant than those with ≥2 (1.8% vs 10.1%), but this difference was already present when we only considered those who scored 0 (mortality 1.1%) and 1 (mortality 2.4%) separately. The multivariable analysis confirmed that one PFP criterion was associated to a higher risk of patient death after kidney transplantation [hazard ratio 3.52 (95% confidence interval 1.03-15.9)]. Conclusions: Listed kidney transplant candidates frequently show only one PFP frailty criterion. This has an independent impact on patient survival after transplantation.

Optimization of Automated Sample Preparation for Vitamin D Determination on a Biomek i7 Workstation.

Vitamin D belongs to the fat-soluble vitamins and is an integral part of bone metabolism. In the human body, a decreased vitamin D level can be an additional risk factor for diseases like cancer, diabetes, and mental diseases. As a result, an enormous increase in the demand for vitamin D testing has been observed in recent years, increasing the demand for powerful methods for vitamin D determination at the same time.Automation is the key factor in increasing sample throughput. This study compares three fully automated sample preparation methods for the determination of 25(OH)D2 and 25(OH)D3 in plasma and serum samples. Starting from a semiautomated reference method, the method is tested manually and subsequently fully automated on the Biomek i7 Workstation by integrating a centrifuge and a positive pressure extractor into the workstation. Alternatively, the centrifugation for the separation of protein aggregates and supernatant is replaced by a filter plate. Finally, the sample throughput is further increased by using phospholipid removal cartridges. The results show that phospholipid removal significantly increases the recovery rates in liquid chromatography-mass spectrometry. With the phospholipid removal cartridges, recovery rates of 97.36% for 25(OH)D2 and 102.5% for 25(OH)D3 were achieved, whereas with the automated classic automated preparation method, the recovery rates were 83.31% for 25(OH)D2 and 86.54% for 25(OH)D3. In addition to the technical evaluation, the different methods were also examined with regard to their economic efficiency. Finally, the qualitative and quantitative performance of the developed methods is benchmarked with a selected semiautomatic reference method.

Changes in the Allostatic Response to Whole-Body Cryotherapy and Static-Stretching Exercises in Chronic Fatigue Syndrome Patients vs. Healthy Individuals.

This study represents a comparison of the functional interrelation of fatigue and cognitive, cardiovascular and autonomic nervous systems in a group of Chronic Fatigue Syndrome (CFS) patients compared with those in healthy individuals at different stages of analysis: at baseline and after changes induced by whole-body cryotherapy (WBC) combined with a static-stretching (SS) program. The study included 32 patients (Fukuda criteria) and 18 healthy controls. Fatigue, cognitive, cardiovascular and autonomic function and arterial stiffness were measured before and after 10 sessions of WBC with SS. In the patients, a disturbance in homeostasis was observed. The network relationship based on differences before and after intervention showed comparatively higher stress and eccentricity in the CFS group: 50.9 ± 56.1 vs. 6.35 ± 8.72, p = 0.002, r = 0.28; and 4.8 ± 0.7 vs. 2.4 ± 1, p < 0.001, r = 0.46, respectively. Before and after intervention, in the CFS group increased fatigue was related to baroreceptor function, and baroreceptor function was in turn related to aortic stiffness, but no such relationships were observed in the control group. Differences in the network structure underlying the interrelation among the four measured criteria were observed in both groups, before the intervention and after ten sessions of whole cryotherapy with a static stretching exercise.

Inmunonutrición y (su impacto en la) salud. Micronutrientes y factores debilitantes / Immunonutrition and (its impact on) health. Micronutrients and debilitating factors

Introducción: la interacción entre la inmunidad y la nutrición es compleja y multifacética. Los micronutrientes, incluidos las vitaminas y losminerales, son esenciales para la función inmunológica. A su vez, la función inmunológica y los hábitos de vida pueden afectar las necesidadesnutricionales y la utilización de micronutrientes, creando una interdependencia entre la nutrición y la inmunidad que puede ser modulada porfactores externos e internos.Objetivos: examinar la relación entre la ingesta de micronutrientes y la función inmunológica y cómo factores debilitantes, como el envejecimiento,la enfermedad y el estrés, pueden afectar esta relación.Métodos: se realizó una revisión de la evidencia científica y de las recomendaciones de las principales sociedades científicas internacionalespara identificar la importancia de los micronutrientes en la función inmunológica y cómo los factores debilitantes pueden alterar su impacto.Resultados: se describe el efecto de diferentes micronutrientes sobre la función inmunológica. Los factores debilitantes como el envejecimiento,el estrés y las enfermedades crónicas pueden comprometer el sistema inmunológico y hacer que el cuerpo sea más susceptible a las infecciones.Sin embargo, una ingesta adecuada de micronutrientes y unos hábitos saludables pueden ayudar a fortalecer la inmunidad y mitigar los efectosde estos factores debilitantes.Conclusión: la nutrición inmunológica es un componente crítico para mantener un sistema inmunológico fuerte y saludable. Una ingesta suficientede micronutrientes y unos hábitos de vida saludables pueden ayudar a mejorar la inmunidad, especialmente en presencia de factores debilitantes. (AU)

Introduction: the interaction between immunity and nutrition is complex and multifaceted. Micronutrients, including vitamins and minerals, areessential for immune function. In turn, immune function and lifestyle habits can affect nutritional needs and micronutrient utilization, creating aninterdependence between nutrition and immunity that can be modulated by both external and internal factors.Objectives: to examine the relationship between micronutrient intake and immune function, and how debilitating factors such as aging, disease,and stress can impact this relationship.Methods: a review of scientific evidence and recommendations from major international scientific societies was conducted to identify theimportance of micronutrients in immune function and how debilitating factors can alter their impact.Results: the effect of different micronutrients on immune function is described. Debilitating factors like aging, stress, and chronic diseases cancompromise the immune system and make the body more susceptible to infections. However, adequate intake of micronutrients and healthyhabits can help to strengthen immunity and mitigate the effects of these debilitating factors.Conclusion: immunonutrition is a critical component for maintaining a strong and healthy immune system. Sufficient intake of micronutrientsand healthy lifestyle habits can help improve immunity, especially in the presence of debilitating factors. (AU)

Comparison of the antifibrotic effects of the pan-histone deacetylase-inhibitor panobinostat versus the IPF-drug pirfenidone in fibroblasts from patients with idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with a poor prognosis. Pirfenidone is the first antifibrotic agent to be approved for IPF-treatment as it is able to slow down disease progression. However, there is no curative treatment other than lung transplantation. Because epigenetic alterations are associated with IPF, histone deacetylase (HDAC)-inhibitors have recently been proven to attenuate fibrotic remodeling in vitro and in vivo. This study compared the effects of pirfenidone with the pan-HDAC-inhibitor panobinostat/LBH589, a FDA-approved drug for the treatment of multiple myeloma, head-to-head on survival, fibrotic activity and proliferation of primary IPF-fibroblasts in vitro. METHODS: Primary fibroblasts from six IPF-patients were incubated for 24h with vehicle (0.25% DMSO), panobinostat (LBH589, 85 nM) or pirfenidone (2.7 mM), followed by assessment of proliferation and expression analyses for profibrotic and anti-apoptosis genes, as well as for ER stress and apoptosis-markers. In addition, the expression status of all HDAC enzymes was examined. RESULTS: Treatment of IPF-fibroblasts with panobinostat or pirfenidone resulted in a downregulated expression of various extracellular matrix (ECM)-associated genes, as compared to vehicle-treated cells. In agreement, both drugs decreased protein level of phosphorylated (p)-STAT3, a transcription factor mediating profibrotic responses, in treated IPF-fibroblasts. Further, an increase in histone acetylation was observed in response to both treatments, but was much more pronounced and excessive in panobinostat-treated IPF-fibroblasts. Panobinostat, but not pirfenidone, led to a significant suppression of proliferation in IPF-fibroblasts, as indicated by WST1- and BrdU assay and markedly diminished levels of cyclin-D1 and p-histone H3. Furthermore, panobinostat-treatment enhanced α-tubulin-acetylation, decreased the expression of survival-related genes Bcl-XL and BIRC5/survivin, and was associated with induction of ER stress and apoptosis in IPF-fibroblasts. In contrast, pirfenidone-treatment maintained Bcl-XL expression, and was neither associated with ER stress-induction nor any apoptotic signaling. Pirfenidone also led to increased expression of HDAC6 and sirtuin-2, and enhanced α-tubulin-deacetylation. But in line with its ability to increase histone acetylation, pirfenidone reduced the expression of HDAC enzymes HDAC1, -2 and -9. CONCLUSIONS: We conclude that, beside other antifibrotic mechanisms, pirfenidone reduces profibrotic signaling also through STAT3 inactivation and weak epigenetic alterations in IPF-fibroblasts, and permits survival of (altered) fibroblasts. The pan-HDAC-inhibitor panobinostat reduces profibrotic phenotypes while inducing cell cycle arrest and apoptosis in IPF-fibroblasts, thus indicating more efficiency than pirfenidone in inactivating IPF-fibroblasts. We therefore believe that HDAC-inhibitors such as panobinostat can present a novel therapeutic strategy for IPF.

Actualización sobre deficiencias nutricionales en la mujer deportista a partir de la literatura científica / Update on nutritional deficiencies in women athletes from the scientific literature

Los déficits nutricionales en la mujer deportista causan numerosos problemas de salud, así como un empeoramiento en el rendimiento deportivo, como consecuencia de estas deficiencias nutricionales. El conocimiento de estos déficits y su prevención deben ser un aspecto principal para cualquier responsable deportivo. Establecer la importancia del estudio de los déficits de energía, proteínas, minerales (Fe, Ca y Mg) y vitaminas (Vitamina D, ácido fólico y vitamina B12) que pueden desarrollar las mujeres deportistas y su relación con la prevalencia de la tríada femenina y constatar la importancia del conocimiento por parte de los responsables deportivos de los problemas derivados de los déficits nutricionales. Se realizó una búsqueda bibliográfica de artículos, entre 2013-2020, relevantes para el objetivo de estudio. Se usaron bases de datos científicas como PubMed y Pennutrition, siguiendo los criterios de exclusión e inclusión elegidos para este estudio. 51 artículos fueron encontrados. Los resultados mostraron la prevalencia de energía, Fe, vitamina D y Ca, así como un suficiente aporte proteico, faltan estudios para determinar los niveles de vitamina B12 y ácido fólico. Se observó, además la prevalencia de mujeres que cumplen con uno o varios factores de riesgo para el desarrollo de la tríada de la deportistas femenina. Es imprescindible la prevención o, el tratamiento, de los déficits nutricionales en las mujeres deportistas para asegurar un correcto estado de salud y un rendimiento deportivo óptimo(AU)

Nutritional deficiencies in women athletes cause numerous health problems, as well as a worsening of sports performance, as a result of these nutritional deficiencies. Awareness of these deficiencies and their prevention should be a major aspect for any sports manager. The aim of the study was to establish the importance of studying the deficits of energy, protein, minerals (Fe, Ca and Mg) and vitamins (Vitamin D, folic acid and vitamin B12) that can be developed by female athletes and their relationship with the prevalence of the female triad and to establish the importance of knowledge by sports managers of the problems arising from nutritional deficiencies. 51 papers were found. A bibliographic search of relevant articles for the study objective was carried out (2013-2020). Scientific databases such as PubMed and Pennutrition were used, following the exclusion and inclusion criteria chosen for this study. The results showed the prevalence of energy, Fe, vitamin D and Ca, as well as sufficient protein intake and a lack of studies to determine the levels of vitamin B12 and folic acid. In addition, the prevalence of women meeting one or more risk factors for the development of the female sports triad was observed. It is essential the prevention or, treatment, of nutritional deficits in female athletes to ensure proper health status and optimal sports performance(AU)

[Trail use of new phytoindicators in connection with passive sampling of traffic air pollution monitoring [especially for (synergistic) effects NO2 and SO2]]. / Próba zastosowania nowych fitoindykatorów w powiazaniu z metoda pasywna monitoringu zanieczyszczen motoryzacyjnych powietrza atmosferycznego (ze szczególnym uwzglednieniem synergistycznych oddzialywan NO2, SO2).

Introduced research was connected with exposure of liverword Marchantia polymorpha in selected places in the area of Krakow. Places differing in regard to average concentration of air pollution [especially for (synergistic) effects NO2 and SO2]. Purpose of research was to check correlation between exposure to different concentrations of NO2 and SO2 (in regard to their synergistic effects) and possible differences in dynamics of growth of M. polymorpha. Samples of M. polymorpha located in soil, which was standardly analysed (in regard to contents of trace elements) before and after exposure. Research was simultaneously performed with similar exposure culture in vitro of Petunia hybrida. To growing tissues of petunia was used standard Murashige & Skoog medium and was protected against infections (with using filter of fibre). Described biomonitoring was completed by measurements of concentration of NO2 and SO2 by passive method with use of samplers of Amaya and Krochmal, in the same places, where was located exposure of plants. Observed was inhibition of growth in places, where was high concentration both gases.

Induction of bulb organogenesis in in vitro cultures of tarda tulip (Tulipa tarda Stapf.) from seed-derived explants.

A protocol for obtaining bulbs via in vitro organogenesis was developed for tarda tulip (Tulipa tarda Stapf). Scale explants were obtained from bulbs formed at the base of seedlings or from adventitious bulbs that developed from callus tissue forming on stolons or on germinating seeds. Some explants were subjected to chilling at 5°C for 12 wk. The culture media contained 3 or 6% sucrose and was supplemented with either no growth regulators, either 0.5 µM 6-benzyl-aminopurine (BAP) or 18.9 or 94.6 µM abscisic acid (ABA). Cultures were maintained in the dark at 20°C. Callus tissue developed mainly on media without growth regulators or with BAP. Callus was formed from up to 96% of explants derived from non-chilled adventitious bulbs that were treated with 3% sucrose and 0.5 µM BAP. Less callus was formed from chilled explants compared with non-chilled explants. Newly formed adventitious bulbs appeared on the explants via direct and indirect organogenesis. The media with BAP promoted the formation of adventitious bulbs at a rate of 56-92% from non-chilled explants, whereas a maximum rate of 36% was observed from chilled explants. ABA inhibited the induction of adventitious bulbs and callus. The adventitious bulbs obtained in these experiments contained a meristem, which was evidence that they had developed properly.

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review.

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components. Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations. A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.