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Influence of Mediterranean Diet on Chronic Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (6 June 2023) | Viewed by 26065

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Dr. Karen Murphy

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Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
Interests: Mediterranean diet; lipids, fatty acids; omega-3 fatty acids; dairy foods; antioxidants; dietary flavonoids; cardiovascular disease dementia risk; cognitive performance; psychological wellbeing
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Dear Colleagues,

Who has not heard of the Mediterranean diet by now? It is a UNESCO-heritage-listed dietary pattern that is not just a diet but a lifestyle, including social activity, conviviality, frugality, physical activity, agricultural practices, and other aspects. It is the traditional diet of many countries surrounding the Mediterranean basin, rich in vegetables, fruit, wholegrains, oily fish, legumes and nuts, herbs and spices, extra-virgin olive oil as the main culinary fat, moderate amounts of dairy foods and white meat, and low amounts of red and processed meats as well as discretionary foods. Red wine is enjoyed moderately, socially, and with meals.

By no means is it a new diet, but back in the 1960s the dietary traditions of Crete, Greece, and Southern Italy exhibited low rates of chronic disease and healthy longevity. Sixty years later, to date, research has consistently shown that adherence to a Mediterranean diet is associated with a reduction in total mortality, mortality from cardiovascular disease, and reduces the risk of a range of chronic diseases, including diabetes, some cancers, cognitive disorders, dementia, Alzheimer’s disease, stroke, hypertension, dyslipidemia, and metabolic syndrome, in addition to assisting in weight loss and weight management. This evidence from longitudinal, prospective, and intervention studies is convincing in Mediterranean countries; however, research in non-Mediterranean countries also suggests that Western countries could adopt the dietary pattern. Unfortunately, the Westernization of the dietary pattern threatens its health-providing properties, which is why scientifically robust evidence is needed for public health recommendations.

In this Special Issue, we aim to provide new insights into the Mediterranean diet and human health, and we encourage authors to submit their research or reviews that will help to better elucidate this Special Issue.

Dr. Karen Murphy
Guest Editor

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Published Papers (9 papers)

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Research

16 pages, 2478 KiB

Open AccessArticle

Interactions between Mediterranean Diet Supplemented with Dairy Foods and the Gut Microbiota Influence Cardiovascular Health in an Australian Population

by Jocelyn M. Choo, Karen J. Murphy, Alexandra T. Wade, Yanan Wang, Ella L. Bracci, Courtney R. Davis, Kathryn A. Dyer, Richard J. Woodman, Jonathan M. Hodgson and Geraint B. Rogers

Nutrients 2023, 15(16), 3645; https://doi.org/10.3390/nu15163645 - 19 Aug 2023

Cited by 1 | Viewed by 4047

Abstract

The impact of a Mediterranean diet on the intestinal microbiome has been linked to its health benefits. We aim to evaluate the effects of a Mediterranean diet supplemented with dairy foods on the gut microbiome in Australians at risk of cardiovascular disease. In a randomised controlled cross-over study, 34 adults with a systolic blood pressure ≥120 mmHg and with risk factors for cardiovascular disease were randomly allocated to a Mediterranean diet with 3–4 daily serves of dairy foods (Australian recommended daily intake (RDI) of 1000–1300 mg per day (MedDairy)) or a low-fat (LFD) control diet. Between each 8-week diet, participants underwent an 8-week washout period. Microbiota characteristics of stool samples collected at the start and end of each diet period were determined by 16S rRNA amplicon sequencing. MedDairy-associated effects on bacterial relative abundance were correlated with clinical, anthropometric, and cognitive outcomes. No change in the overall faecal microbial structure or composition was observed with either diet (p > 0.05). The MedDairy diet was associated with changes in the relative abundance of several bacterial taxa, including an increase in Butyricicoccus and a decrease in Colinsella and Veillonella (p < 0.05). Increases in Butyricicoccus relative abundance over 8 weeks were inversely correlated with lower systolic blood pressure (r = −0.38, p = 0.026) and positively correlated with changes in fasting glucose levels (r = 0.39, p = 0.019), specifically for the MedDairy group. No significant associations were observed between the altered taxa and anthropometric or cognitive measures (p > 0.05). Compared to a low-fat control diet, the MedDairy diet resulted in changes in the abundance of specific gut bacteria, which were associated with clinical outcomes in adults at risk of CVD. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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12 pages, 875 KiB

Open AccessArticle

Adherence to the Mediterranean Diet in Preventing Major Cardiovascular Events in Patients with Ischemic Heart Disease: The EVA Study

by Roberto Cangemi, Marzia Miglionico, Tania D’Amico, Salvatore Fasano, Marco Proietti, Giulio Francesco Romiti, Bernadette Corica, Lucia Stefanini, Gaetano Tanzilli, Stefania Basili, Valeria Raparelli, Maria Grazia Tarsitano and EVA Collaborative Group

Nutrients 2023, 15(14), 3150; https://doi.org/10.3390/nu15143150 - 14 Jul 2023

Viewed by 1522

Abstract

Background: Adherence to healthy dietary patterns, such as the Mediterranean diet (Med-diet), is recommended for the maintenance of cardiovascular health. The determinants for adherence to Med-diet and its importance in secondary cardiovascular disease prevention are still unclear. The aim of the study was to evaluate the influence of sex- and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence and its role in preventing major cardiovascular events (MACEs) in patients with ischemic heart disease (IHD). Methods: Med-diet adherence was evaluated among 503 consecutive adults with IHD. MACEs were collected during a long-term follow-up. Results: Male Bem Sex-Role Inventory score (i.e., male personality traits) and physical functional capacity were associated with higher adherence, while cohabitation with a smoker and physical inactivity with poorer adherence. During a median follow-up of 22 months, 48 participants experienced MACEs (17.5%, 8.1%, and 3.9% of patients with low, medium, and high adherence, respectively; p = 0.016). At multivariate Cox--regression analysis, a greater adherence remained inversely associated with MACEs (HR: 0.49; 95% CI: 0.29–0.82; p = 0.006) after adjusting for confounding factors. Conclusion: The study suggests that gender-related factors have a role in maintaining a healthy dietary pattern. Improving Med-diet adherence may lower the risk of recurring cardiovascular events. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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12 pages, 389 KiB

Open AccessArticle

Association between the Mediterranean Diet and Vitamin C and the Risk of Head and Neck Cancer

by Constanza Saka-Herrán, Tanya Pereira-Riveros, Enric Jané-Salas and José López-López

Nutrients 2023, 15(13), 2846; https://doi.org/10.3390/nu15132846 - 23 Jun 2023

Cited by 1 | Viewed by 2002

Abstract

Diet may modulate the risk of head and neck cancer (HNC) through antioxidant and anti-inflammatory effects. To date, there is limited evidence regarding the effects of the Mediterranean diet on HNC risk. The purpose of the study was to assess the association between Mediterranean diet adherence, type of diet, and vitamin C and the risk of HNC. A case–control study was conducted at the Dentistry Hospital, University of Barcelona, including 101 cases of HNC and 101 controls matched by age and sex. Dietary habits were assessed using a 14-question Mediterranean diet score that classified the type of diet into healthy diet (10–14 points), regular diet (5–9 points), and unhealthy diet (≤4 points). Multivariate logistic regression models were used to assess the association between Mediterranean diet adherence, type of diet, and vitamin C and the risk of HNC. Higher adherence to the Mediterranean diet was significantly associated with a lower risk of HNC (OR = 0.88, 95% CI: 0.79–0.98). A healthy diet (OR = 0.29, 95% CI: 0.10–0.84) and vitamin C intake (OR = 0.25, 95% CI: 0.10–0.62) were strongly associated with lower odds of HNC. Moderate egg intake was the only type of food significantly associated with a lower risk of HNC. Dietary patterns that emphasize a high intake of antioxidant and anti-inflammatory bioactive components may have a protective effect on the risk of HNC. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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24 pages, 350 KiB

Open AccessArticle

Developing a Mediterranean Healthy Food Basket and an Updated Australian Healthy Food Basket Modelled on the Australian Guide to Healthy Eating

by Ella L. Bracci, Courtney R. Davis and Karen J. Murphy

Nutrients 2023, 15(7), 1692; https://doi.org/10.3390/nu15071692 - 30 Mar 2023

Cited by 1 | Viewed by 3275

Abstract

Introduction: Australian healthy food baskets are typically modelled off the Government Guidelines for healthy eating. However, these baskets have not been updated recently, nor has there been a Mediterranean Diet basket developed for an Australian population despite research suggesting high adherence is possible and subsequent health benefits observed. Food baskets typically only present the nutrition profile or the cost of a basket, seldom both. Methods: Baskets were developed based on the Australian Guide to Healthy Eating, The Mediterranean Diet and typical Australian dietary intake (Western Diet). Four reference families were created based on data from Australian censuses and population statistics. Seven-day meal plans for reference families were entered into Foodworks software and aimed to meet 100% of nutrition and energy requirements. Basket costs were calculated from Coles Australia online. Results: The AGHE basket met all NRVs except for VLCN3 for the 7-year-old male (73% adequate intake). The Mediterranean Diet met all NRVs except zinc (44-year-old male) ranging from 98 to 257% of the RDI. The Western Diet failed to meet NRVs for numerous nutrients. The MedDiet baskets were generally cheaper ($78 for a one-person household to $285 for a four-person household) than AGHE and Western Diet. Discussion: Meeting nutrition requirements over seven days for zinc can be challenging for males. Fortified products provide an opportunity to improve nutrient profile; however, nutrient intake should equilibrate over time. Further, cost saving strategies can increase affordability. This research suggests a MedDiet is not more costly than a typical Western Diet or healthy AGHE diet. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

14 pages, 1848 KiB

Open AccessArticle

Adherence to a Mediterranean Diet for 6 Months Improves the Dietary Inflammatory Index in a Western Population: Results from the MedLey Study

by Jessie S. Clark, Kathryn A. Dyer, Courtney R. Davis, Nitin Shivappa, James R. Hébert, Richard Woodman, Jonathan M. Hodgson and Karen J. Murphy

Nutrients 2023, 15(2), 366; https://doi.org/10.3390/nu15020366 - 11 Jan 2023

Cited by 4 | Viewed by 6226

Abstract

Increasing evidence supports that a higher dietary inflammatory index (DII^®) score is associated with inflammation and cardiovascular disease (CVD) risk, events, and mortality. This randomized trial sought to determine if a change to a Mediterranean diet resulted in a reduction in the DII score, and then it evaluated the relationship between the DII and cardiometabolic outcomes following the administration of a traditional Mediterranean diet in older Australian adults. A total of 152 Australian adults (mean age 71 ± 5 years) was randomly allocated either a MedDiet (n = 80) or to continue their habitual diet (HabDiet) (n = 72) for 6 months. Diet and cardiovascular outcomes were measured at baseline and 3 and 6 months of the intervention. DII and energy-adjusted DII (E-DII^TM) scores were calculated from 3-day weighed food records. There was a significant reduction in the DII score at 2 and 4 months for the MedDiet group (−1.40 ± 0.20 p < 0.001 and −1.47 ± 0.20 p < 0.001, respectively), which was significantly different from the HabDiet group over time (p < 0.001). The HabDiet DII score did not change significantly at the 2 and 4 months timepoints (0.47 ± 0.21 p = 0.35 and 0.54 ± 0.21 p = 0.21, respectively). The improvement in the DII in the MedDiet group was not related to any cardiometabolic outcome. Baseline cross-sectional analyses identified a positive association between the E-DII score and average BMI, body weight, WHR, abdominal adiposity, and SBP, and a negative association with HDL-C. We demonstrate that a MedDiet intervention significantly reduced DII scores compared with a habitual Australian diet in older Australians. This could be beneficial for healthy ageing and the avoidance of chronic disease in Western populations. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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12 pages, 306 KiB

Open AccessArticle

Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles

by Ella L. Bracci, Rachel Milte, Jennifer B. Keogh and Karen J. Murphy

Nutrients 2022, 14(16), 3414; https://doi.org/10.3390/nu14163414 - 19 Aug 2022

Cited by 1 | Viewed by 1971

Abstract

A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern’s nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

15 pages, 340 KiB

Open AccessArticle

Associations of the Mediterranean-Style Dietary Pattern Score with Coronary Artery Calcification and Pericardial Adiposity in a Sample of US Adults

by Leigh Ann Richardson, Arpita Basu, Lung-Chang Chien, Amy C. Alman and Janet K. Snell-Bergeon

Nutrients 2022, 14(16), 3385; https://doi.org/10.3390/nu14163385 - 18 Aug 2022

Cited by 2 | Viewed by 1607

Abstract

Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

18 pages, 1404 KiB

Open AccessArticle

Long-Term Adherence to a Mediterranean Diet 1-Year after Completion of the MedLey Study

by Karen J. Murphy, Kathryn A. Dyer, Belinda Hyde, Courtney R. Davis, Ella L. Bracci, Richard J. Woodman and Jonathan M. Hodgson

Nutrients 2022, 14(15), 3098; https://doi.org/10.3390/nu14153098 - 28 Jul 2022

Cited by 8 | Viewed by 1948

Abstract

Mediterranean populations enjoy the health benefits of a Mediterranean diet (MedDiet), but is it feasible to implement such a pattern beyond the Mediterranean region? The MedLey trial, a 6-month MedDiet intervention vs habitual diet in older Australians, demonstrated that the participants could maintain high adherence to a MedDiet for 6 months. The MedDiet resulted in improved systolic blood pressure (BP), endothelial dilatation, oxidative stress, and plasma triglycerides in comparison with the habitual diet. We sought to determine if 12 months after finishing the MedLey study, the participants maintained their adherence to the MedDiet principles and whether the reduction in the cardiovascular disease (CVD) risk factors that were seen in the trial were sustained. Participants completed a food frequency questionnaire, and a 15-point MedDiet adherence score (MDAS; greater score = greater adherence) was calculated. Home BP was measured over 6 days, BMI was assessed, and fasting plasma triglycerides were measured. The data were analysed using intention-to-treat linear mixed effects models with a group × time interaction term, comparing data at baseline, 2, 4, and 18 months (12 months post-trial). At 18 months (12 months after finishing the MedLey study), the MedDiet group had a MDAS of 7.9 ± 0.3, compared to 9.6 ± 0.2 at 4 months (p < 0.0001), and 6.7 ± 0.2 (p < 0.0001), at baseline. The MDAS in the HabDiet group remained unchanged over the 18-month period (18 months 6.9 ± 0.3, 4 months 6.9 ± 0.2, baseline 6.7 ± 0.2). In the MedDiet group, the consumption of olive oil, legumes, fish, and vegetables remained higher (p < 0.01, compared with baseline) and discretionary food consumption remained lower (p = 0.02) at 18 months. These data show that some MedDiet principles could be adhered to for 12 months after finishing the MedLey trial. However, improvements in cardiometabolic health markers, including BP and plasma triglycerides, were not sustained. The results indicate that further dietary support for behaviour change may be beneficial to maintaining high adherence and metabolic benefits of the MedDiet. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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15 pages, 1042 KiB

Open AccessArticle

Association between Adherence to Swedish Dietary Guidelines and Mediterranean Diet and Risk of Stroke in a Swedish Population

by Esther González-Padilla, Zhen Tao, Almudena Sánchez-Villegas, Jacqueline Álvarez-Pérez, Yan Borné and Emily Sonestedt

Nutrients 2022, 14(6), 1253; https://doi.org/10.3390/nu14061253 - 16 Mar 2022

Cited by 6 | Viewed by 2513

Abstract

Dietary factors associated with stroke risk are still rather unknown. The aim was to examine the association between adherence to healthy dietary patterns and incidence of stroke among 25,840 individuals from the Swedish Malmö Diet and Cancer Study cohort. Dietary data were obtained using a combination of a 7-day food record, diet questionnaire, and interview. A Swedish Dietary Guidelines Score (SDGS), including five dietary components based on the current Swedish dietary guidelines, and a modified Mediterranean diet score (mMDS), composed of ten dietary components, were constructed. Over a mean follow-up period of 19.5 years, 2579 stroke cases, of which 80% were ischaemic, were identified through national registers. Weak, non-significant associations were found between the dietary indices and the risk of stroke. However, after excluding potential misreporters and individuals with unstable food habits (35% of the population), we observed significant inverse association (p-trend < 0.05) between SDGS and mMDS and total and ischaemic stroke (HR per point for total stroke: 0.96; 95% CI: 0.92–1.00 for SDGS and 0.95; 95% CI: 0.91–0.99 for mMDS). In conclusion, high quality diet in line with the current Swedish dietary recommendations or Mediterranean diet may reduce the risk of total and ischaemic stroke. Full article

(This article belongs to the Special Issue Influence of Mediterranean Diet on Chronic Diseases)

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