Ageing and the Mediterranean diet: a review of the role of dietary fats

Consumers are becoming increasingly aware of the relationship between food and health. Concerns have been raised about dietary fats and their relative nutritional advantages or disadvantages. In investigations of the associations between health and fat intake, special emphasis has been placed on the benefits of virgin olive oil for counteracting certain neurodegenerative diseases and ageing. With respect to ageing, accumulating evidence indicates that an improvement in quality of life can be reached by modulation of the extrinsic factors that influence many ageing processes. Of the modifiable factors, nutrition appears to be one of the strongest elements known to influence the rate of ageing as well as the incidence of age-associated diseases such as atherosclerosis and neurodegenerative pathologies. This paper reviews the theory of ageing and the role of fatty acids in the mechanisms affecting its evolution. It also confirms that virgin olive oil, an essential component of the Mediterranean diet, provides large amounts of stable and not easily oxidizable fatty acids as well as remarkable quantities of powerful antioxidant molecules.     

Mediterranean diet and cancer

OBJECTIVE: To analyse the role of various aspects of the Mediterranean diet in several common epithelial cancers, including digestive and selected non-digestive tract neoplasms. DESIGN: Systematic analysis of data from a series of case-control studies. SETTING: Northern Italy, between 1983 and 1998. SUBJECTS: Over 12,000 cases of 20 cancer sites and 10,000 controls. RESULTS: For most epithelial cancers, the risk decreased with increasing vegetable and fruit consumption, with relative risk (RR) between 0.3 and 0.7 for the highest versus the lowest tertile. For digestive tract cancers, population-attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. A protective effect was observed also for breast, female genital tract, urinary tract and a few other epithelial neoplasms. A number of antioxidants and other micronutrients showed an inverse relationship with cancer risk, but the main components responsible for the favourable effect of a diet rich in vegetables and fruit remain undefined. Fish tended to be another favourable diet indicator. In contrast, subjects reporting frequent red meat intake showed RRs above unity for several common neoplasms. Intake of whole-grain foods was related to a reduced risk of several types of cancer, particularly of the upper digestive tract. This may be due to a favourable role of fibre, but the issue is still open to discussion. In contrast, refined grain intake and, consequently, glycaemic load and glycaemic index were associated with increased risk of different types of cancer including, among others, breast and colorectal. CONCLUSIONS: A low-risk diet for cancer in the Mediterranean would imply increasing the consumption of fruit and vegetables, as well as avoiding increasing the intakes of meat and refined carbohydrates. Further, olive oil and other unsaturated fats, which are also typical aspects of the Mediterranean diet, should be preferred to saturated ones.     

Mediterranean diet and cognitive decline

OBJECTIVE: To investigate the possible role of diet in age-related cognitive decline (ARCD) and cognitive impairment of both degenerative (Alzheimer's disease, AD) and vascular (vascular dementia, VaD) origin. DESIGN: Literature review. RESULTS: In an elderly population of southern Italy with a typical Mediterranean diet, high energy intake of monounsaturated fatty acids (MUFA) appeared to be associated with a high level of protection against ARCD. In addition, dietary fat and energy in the elderly seem to be risk factors, while fish consumption and cereals are found to reduce the prevalence of AD in European and North American countries. Finally, the relative risk of dementia (AD and VaD) was lower in the subjects of a French cohort who drank three or four glasses of red wine each day compared with total abstainers. CONCLUSION: Essential components of the Mediterranean diet--MUFA, cereals and wine--seem to be protective against cognitive decline. As such, dietary antioxidants and supplements, specific macronutrients of the Mediterranean diet, oestrogens and anti-inflammatory drugs may act synergistically with other protective factors, opening up new therapeutic interventions for cognitive decline.     

Globalisation and income growth promote the Mediterranean diet

OBJECTIVE: To examine global food demand patterns and how changing diets may stimulate demand for and trade of Mediterranean diet products. DESIGN: Literature review. Trends in global and US food consumption patterns are examined and trade data are reviewed to evaluate the impact of changing diets on trade of Mediterranean diet products. Market access issues are also addressed briefly to highlight the role of policy in the trade of Mediterranean diet products. RESULTS: Diets are shifting towards higher-value products such as meats, fruits and vegetables, and a wider array of packaged food products. Trade in these products has also grown in the past two decades, with several non-traditional importers and exporters becoming increasingly active in the global market. CONCLUSIONS: Income-driven demands for quality and variety are likely to increase the demand for Mediterranean diet products globally. While the middle-income countries appear to be the best growth prospects, the USA remains a potential growth market if these products can meet the growing consumer demand for variety, quality and convenience. Although consumer trends globally indicate growth in demand for Mediterranean diet products, the additional demand may not be reflected by a corresponding growth in trade. Trade in Mediterranean diet products continues to be hampered by higher than average trade barriers and high transportation costs for perishables.     

Mediterranean diet and overall mortality differences in the European Union

OBJECTIVE: To assess whether the Mediterranean diet contributes to overall mortality differences and trends between Mediterranean and non-Mediterranean European Union (EU) countries.Design: Routinely recorded adjusted overall mortality and food availability data in Mediterranean and non-Mediterranean EU countries. A Mediterranean diet score designed a priori was used as instrument. SETTING: Fifteen EU countries in the 1960s and the 1990s. SUBJECTS: The general population in the 15 EU countries. RESULTS: The difference between Mediterranean and non-Mediterranean EU countries in a 7-point Mediterranean diet score was reduced from 2.9 in the 1960s to 1.6 in the 1990s. This reduction may underlie the reduction in the difference in general mortality between these countries, from about 100 deaths per 100,000 person-years in the early 1970s to about 50 deaths per 100,000 person-years in the 1990s. CONCLUSIONS: The decline in overall mortality in the 15 EU countries over the last 25 years is probably unrelated to diet. However, the gradual loss of the survival advantage of Mediterranean EU citizens, compared with other EU citizens, may be linked to the gradual abandonment by the former of their dietary traditions.     

Mediterranean diet in relation to body mass index and waist-to-hip ratio

OBJECTIVE: The Mediterranean diet is rich in fat and starch, and hence may be related to overweight. We therefore investigated the relationship between adherence to a Mediterranean diet and body mass index (BMI) and waist-to-hip ratio (WHR). DESIGN AND SETTING: Data were obtained from the control group of a network of case-control studies on cancer conducted in major teaching and general hospitals in four Italian areas between 1991 and 2002. An interviewer-administered validated 78-item food-frequency questionnaire was used to obtain information on the subjects' habitual diet. Information on socio-economic factors, lifestyle habits and anthropometric measures was also collected. A Mediterranean diet score (MDS) was derived on the basis of eight characteristics of the Mediterranean diet. SUBJECTS: Subjects were 6619 patients (3090 men, 3529 women) admitted to hospital for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for cancer and long-term modifications of diet. RESULTS: In multiple linear regression models adjusted for age, study centre, education, tobacco smoking, occupational physical activity and total energy intake, the MDS was not related to BMI (beta = 0.05 for men and -0.04 for women) or WHR (beta = 0.000 and 0.001, respectively) in both sexes. CONCLUSIONS: Adherence to the major characteristics of the Mediterranean diet is unrelated to BMI and WHR, confirming previous data from Greece and Spain.     

Nutrition education and Mediterranean diet: exploring the teaching process of a school-based nutrition and media education project in Cretan primary schools

BACKGROUND: During the past few decades there has been a gradual abandoning of the traditional Mediterranean diet by the population of Crete and especially among the younger generations. Since this is related to the rapidly increasing morbidity and mortality rates from chronic diseases, the need for educating young people on the principles of good nutrition becomes increasingly important. It is also acknowledged that the epidemiological field needs to focus on studying the implementation process, since this will allow for a deeper understanding of the outcomes. OBJECTIVES: The aims of the present study were to explore the process of implementing an innovation in Cretan primary schools and to identify best teaching practices and principles. DESIGN: In three state primary schools on the island of Crete, 107 children took part in a 30-h nutrition and media education programme. Classroom observations were used to define attitudes towards the programme and teaching methods. Besides baseline and post evaluation, the pupils were also interviewed about 11 months after the end of the programme. IMPLEMENTATION: During observation of the teaching process, emerging issues were the teacher's motivation and interest in the course, his/her preparation before each class, teaching ability and communication skills, the respect and discipline he/she kept and the innovative teaching methods used. In some cases researcher intervention in the classroom could not be avoided. FINDINGS AND CONCLUSIONS: Overall, individual teacher willingness and teaching skills were mainly responsible for the quality of teaching, the variety of educational methods used in classrooms and pupils' interest in the course. Changes in pupils' knowledge and recall of the course were related to teacher enthusiasm but also to researcher intervention. Exploring the teaching and learning process allowed a deeper understanding of the data. It is concluded that attempts to introduce the principles of a Mediterranean diet to children through nutrition education require innovative, enthusiastic and highly motivated teachers.     

Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

OBJECTIVE: To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. DESIGN: Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). SETTING: Spain. SUBJECTS: In total, 3850 children and youths aged 2-24 years residing in Spain. RESULTS: Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. CONCLUSIONS: The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.     

Traditional Agrarian Landscape in the Mediterranean Mountains. A Regional and Local Factor Analysis in the Central Spanish Pyrenees

Development of rural areas needs information about sustainable use of the land. The main objective of this research is to study the spatial distribution pattern of different field types in the traditional agricultural landscape in the Central Spanish Pyrenees (flat fields, four different terrace fields, sloping field and shifting agriculture) related to different geoecological variables: slope, exposition, altitude, distance to the villages, rainfall (intensity and volume), lithology and demographic pressure. Agricultural land patterns were mapped in five valleys in the Central Pyrenees from aerial photographs (1957). These maps were digitised and implemented in a Geographic Information System on a scale 1:50,000. We determined the influence of different geoecological variables in the spatial distribution of land agricultural patterns at local and regional valley using statistical analysis. The results showed that the agricultural area occupied a large extension, despite physical environment limitations, extending even in marginal slopes, with little agricultural skills, creating a complex landscape with different field patterns. At the local scale (valley), slope and distance are the more influence variables to explain the spatial distribution of the different field types. At the regional scale, in the Western valleys, sloping fields and shifting agriculture predominate, while terraces dominate in the Eastern valleys. Distance to the village and rainfall intensity is the more determinant factors in the spatial distribution. Copyright © 2017 John Wiley & Sons, Ltd.     

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

OBJECTIVES: To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. DESIGN AND SETTING: Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. SUBJECTS: In total, 1475 traced, surviving cohort members aged 60 years and over. RESULTS: Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. CONCLUSIONS: The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.     

Copper toxicity and chemistry in the environment: a review

Copper compounds have been widely used in industrial processes and agriculture. As a result, elevated Cu concentrations can be found in certain areas of the biosphere. To better understand the toxicity of Cu to organisms it is necessary to understand the mechanism by which Cu influences biological and chemical processes in the environment. This review will examine Cu toxicity, microbial resistance mechanisms and factors influencing Cu speciation and toxicity in the environment