Mediterranean diet

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The Mediterranean diet (sometimes referred to as MedDiet) is a diet rich in seafood, fruits, vegetables, whole grains, nuts, cheese and healthy fats, such as olive oil.[1] On average, the MedDiet contains three to nine serves of vegetables, half to two serves of fruit, one to 13 serves of cereals and up to eight serves of olive oil daily. It contains approximately 9300 kJ: 37% as total fat, 18% as monounsaturated and 9% as saturated, and 33g of fibre per day.[1]

The majority of studies emphasize the same key dietary components and principles for the benefits associated to the MedDiet: an increased intake of vegetables, wholegrains, and the preferential consumption of white meat as a substitute of red and processed meat, as well as abundant use of olive oil. However, the reporting of specific dietary recommendations for fruit, legumes, nuts, bread, red wine, and fermentable dairy products are generally less consistent or not reported.[2][3]

Heath benefits of the Mediterranean Diet

Mechanisms of Interplay between Mediterranean Diet and Aging (according to article.[2] Molecules that promote aging are shown in yellow, while molecules with anti-aging properties are shown in light green. Red lines indicate inhibited or slowed pathways and blue lines indicate activated pathways that together promote healthy aging. GH (growth hormone); IGF-1 (insulin-like growth factor-1); mTOR (protein mammalian target of rapamycin); AMPK (adenosine monophosphate-activated protein kinase); FOXO (Forkhead Box); PGC-1α (peroxisome proliferator-activated receptor gamma 1-alpha); SIRT-1 (sirtuine-1).

Irrespective of the discordance in the interpretation of a MedDiet, a number of studies have reported health benefits such as improved glycaemic control and favorable cardiovascular outcomes with adherence to a Mediterranean-style diet.[4][5][6] The Mediterranean diet (MedDiet) is recognised to reduce risk of coronary heart disease (CHD), in part, via its anti-inflammatory and antioxidant properties, which may be mediated via effects on body fat distribution.[7]

Several randomized controlled trials have showed the positive effects of the MedDiet style on several cardiovascular risk factors, such as body mass index, waist circumference, blood lipids, blood pressure, inflammatory markers and adhesion molecules, and diabetes and how these advantages of the MeDi are maintained in comparison of a low-fat diet. Some studies reported a positive effect of adherence to a Mediterranean Diet and heart failure incidence, whereas some studies showed that the incidence of major cardiovascular events was lower among those assigned to MedDiet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet.[8]

Mediterranean diet adherence had, in general, a positive role in muscle mass and muscle function with a lower risk of sarcopenia.[9][10] Adherence to the MedDiet was inversely related to type 2 diabetes risk in a dose-response manner.[11][12] Higher adherence to a MedDiet was also associated with lower dementia risk, independent of genetic risk, underlining the importance of diet in dementia prevention interventions.[13] Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and especially elders above 65 years old.[14]

Olive Oil in the Mediterranean Diet

One of the most examined oils for its health properties is olive oil, especially extra virgin olive oil (EVOO).[15][16] Olive oil is rich in monounsaturated oleic acid and phenolic compounds, as well as squalene. The capacity of olive oil to stop or slow down the inflammatory processes linked to chronic degenerative disorders also supports its role as an anti-atherosclerotic, therefore improving the lipid profile. The phenolic components of olive oil, such as luteolin, apigenin, ferulic, coumaric acid, or caffeic acid, have antibacterial effects and promote the regeneration of fibroblasts.[17] The lipid fraction constituting about 98% of the olive oil composition and comprised of fatty acids (mainly in the form of triglycerides) such as oleic acid (monounsaturated omega-9 fatty acid accounting for about 55% and up to 83% of the total fatty acid content of the olive oil, depending on the reference cultivar and on the extraction techniques), linoleic acid (omega-6 polyunsaturated fatty acid accounting for 3–21% of the total fatty acid content of the olive oil), α-linolenic acid (omega-3 polyunsaturated fatty acid accounting for less than 1% of the total fatty acid content of the olive oil), and palmitic acid (long-chain saturated fatty acid accounting for 10–23% of the total fatty acid content of the olive oil). [18] The set of secondary metabolites (constituting about 1–2% of the Extra Virgin Olive Oil (EVOO) composition) is generally defined as that of the “minor compounds,” such as phenolic compounds and lipophilic compounds (like α-tocopherol or vitamin E). Hydrophilic phenolic compounds present in EVOO belong to different classes: secoiridoids, phenolic acids, phenolic alcohols, lignans and flavonoids.[18] For the extra virgin olive oil quality index the most relevant approach is to select the concentrations of seven selected phenols, namely: gallic acid, β-tocopherol, oleuropein aglycone, ligstroside aglycone, oleacein, hydroxytyrosol and apigenin.[19]

Tomatoes in the Mediterranean Diet

Among the most consumed fruits and vegetables, tomatoes also deserve to be investigated as they are fundamental components of the Mediterranean diet, are available all year round, have an affordable price and have various benefits also in terms of cancer prevention.[20]

Tomatoes are a rich source of antioxidants, such as ascorbic acid, polyphenols, or carotenoids. Tomatoes contain minerals, vitamins, proteins, essential amino acids (leucine, threonine, valine, histidine, lysine, arginine), monounsaturated fatty acids (linoleic and linolenic acids), carotenoids (lycopene and β-carotenoids) and phytosterols (β-sitosterol, campesterol and stigmasterol). Lycopene is the main dietary carotenoid in tomato and tomato-based food products and lycopene consumption by humans has been reported to protect against cancer, cardiovascular diseases, cognitive function and osteoporosis.[21] Among the phenolic compounds present in tomato, quercetin, kaempferol, naringenin, caffeic acid and lutein are the most common. Many of these compounds have antioxidant activities and are effective in protecting the human body against various oxidative stress-related diseases.[22][23]

The anti-inflammatory and anti-allergic active compound, which strongly inhibited histamine release in tomato skin has been identified as naringenin chalcone (trans-2'4'6'4-tetrahydroxychalcone).[24][25] Naringenin chalcone is bioavailable in humans from cherry tomatoes as a dietary source.[26]

Naringenin can suppress cancer development in various body parts, alleviating the conditions of cancer patients by acting as effective alternative supplementary remedies. Their anticancer activities are pleiotropic, and they can modulate different cellular signaling pathways, suppress cytokine and growth factor production and arrest the cell cycle.[27] Naringenin improved memory and learning ability in aging mice by influencing TNF-α, which is involved in aging-associated cognitive impairment, protected cardiac muscle from aging. Naringenin promotes the synthesis of the extracellular matrix (ECM) in cartilage and, in turn, improves aging in both lipopolysaccharide- and reactive oxygen species (ROS)-induced skin senescence. This appears to occur through the sirtuin SIRT1-mediated inhibition of NF-κΒ, NADPH oxidase, and matrix metalloproteinases (MMPs) as seen in human dermal fibroblasts, suggesting a regenerative and anti-aging effect on the dermal cell structure.[28]

Like metformin, naringenin displays in vitro and in vivo antidiabetic effects by sensitizing insulin signaling in insulin-sensitive cells and tissues, inhibiting gluconeogenesis in hepatocytes, suppressing adipocyte proliferation and adipogenesis, and protecting pancreas β-cells from apoptosis.[29] Antioxidant activity of naringenin may be related to its upregulation through a transcriptional mechanism of intracellular heat shock protein 70 (HSP70), by which naringenin improves diabetic- or hyperglycemia-induced impairment of endothelial function.[30]

The Mediterranean Lifestyle

There is already robust evidence supporting the cardiometabolic health benefits of the traditional Mediterranean diet, rich in colourful fruits, vegetables, olive oil, edible wild greens, whole grains, seafood, and protein such as, fermented dairy products; whereas less information is available on the potential synergistic effects of a general healthy lifestyle.[31] Other individual components such as for example, reducing sedentary behavior and increasing physical activity, sleep duration, taking naps, regular cheerful connection and communication with people, limiting salt and sugar intake—are also known to have positive effects on cardiometabolic health.[32][33]


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