Mediterranean diet

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The Mediterranean diet (sometimes referred to as MedDiet) is a diet rich in seafood (fish), beans, fruits, vegetables, whole grains, nuts, cheese and healthy fats, such as olive oil.[1] Occasionally also a moderate amount of red wine.[2][3] 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.[4][5]

Heath benefits of the Mediterranean Diet

Mechanisms of Interplay between Mediterranean Diet and Aging (according to article.[4] 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.[6][7][8] 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.[9]

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.[10]

Mediterranean diet adherence had, in general, a positive role in muscle mass and muscle function with a lower risk of sarcopenia.[11][12]

Cardiovascular events and cardiovascular mortality are significantly reduced when associated with the Mediterranean Diet.[13][14]

Adherence to the MedDiet was inversely related to type 2 diabetes risk in a dose-response manner.[15][16] 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.[17] Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and especially elders above 65 years old.[18]

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).[19][20] 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.[21] 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). [22] 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.[22] 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.[23]

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.[24]

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.[25] 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.[26][27]

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).[28][29] Naringenin chalcone is bioavailable in humans from cherry tomatoes as a dietary source.[30]

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.[31] 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.[32]

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.[33] 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.[34]

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.[35] 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.[36][37]

References

  1. ↑ 1.0 1.1 Davis, C., Bryan, J., Hodgson, J., & Murphy, K. (2015). Definition of the Mediterranean diet: a literature review. Nutrients, 7(11), 9139-9153. PMID: 26556369 PMCreference DOI: 10.3390/nu7115459
  2. ↑ Willett, W. C., Sacks, F., Trichopoulou, A., Drescher, G., Ferro-Luzzi, A., Helsing, E., & Trichopoulos, D. (1995). Mediterranean diet pyramid: a cultural model for healthy eating. The American journal of clinical nutrition, 61(6), 1402S-1406S.
  3. ↑ Sofi, F., Abbate, R., Gensini, G. F., & Casini, A. (2010). Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. The American journal of clinical nutrition, 92(5), 1189-1196.
  4. ↑ 4.0 4.1 Andreo-López, M. C., Contreras-Bolívar, V., Muñoz-Torres, M., García-Fontana, B., & García-Fontana, C. (2023). Influence of the Mediterranean Diet on Healthy Aging. International Journal of Molecular Sciences, 24(5), 4491. https://doi.org/10.3390/ijms24054491
  5. ↑ McClure, R., & Villani, A. (2019). Greater adherence to a Mediterranean Diet is associated with better gait speed in older adults with type 2 diabetes mellitus. Clinical nutrition ESPEN, 32, 33-39. PMID: 31221287 DOI:reference
  6. ↑ Villani, A., Sultana, J., Doecke, J., & Mantzioris, E. (2019). Differences in the interpretation of a modernized Mediterranean diet prescribed in intervention studies for the management of type 2 diabetes: how closely does this align with a traditional Mediterranean diet?. European journal of nutrition, 58, 1369-1380. PMID: 29943276 DOI:reference
  7. ↑ Allcock, L., Mantzioris, E., & Villani, A. (2022). Adherence to a Mediterranean Diet is associated with physical and cognitive health: A cross-sectional analysis of community-dwelling older Australians. Frontiers in Public Health, 10, 4360. PMID: 36466491 PMCreference DOI: 10.3389/fpubh.2022.1017078
  8. ↑ Devranis, P., Vassilopoulou, Ε., Tsironis, V., Sotiriadis, P. M., Chourdakis, M., Aivaliotis, M., & Tsolaki, M. (2023). Mediterranean Diet, Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review. Life, 13(1), 173. https://doi.org/10.3390/life13010173
  9. ↑ Bayerle, P., Beyer, S., Tegtbur, U., Kück, M., Adel, J., Kwast, S., ... & Busse, M. (2023). Exercise Capacity, Iron Status, Body Composition, and Mediterranean Diet in Patients with Chronic Heart Failure. Nutrients, 15(1), 36. PMID: 36615693 PMCreference DOI: 10.3390/nu15010036
  10. ↑ Tuttolomondo, A., Simonetta, I., Daidone, M., Mogavero, A., Ortello, A., & Pinto, A. (2019). Metabolic and vascular effect of the Mediterranean diet. International journal of molecular sciences, 20(19), 4716. PMID: 31547615 PMCreference DOI: 10.3390/ijms20194716
  11. ↑ Papadopoulou, S. K., Detopoulou, P., Voulgaridou, G., Tsoumana, D., Spanoudaki, M., Sadikou, F., ... & Nikolaidis, P. (2023). Mediterranean Diet and Sarcopenia Features in Apparently Healthy Adults over 65 Years: A Systematic Review. Nutrients, 15(5), 1104. PMID: 36904104 PMCreference DOI: 10.3390/nu15051104
  12. ↑ Cacciatore, S., Calvani, R., Marzetti, E., Picca, A., Coelho-Júnior, H. J., Martone, A. M., ... & Landi, F. (2023). Low Adherence to Mediterranean Diet Is Associated with Probable Sarcopenia in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project. Nutrients, 15(4), 1026. PMID: 36839385 PMCreference DOI: 10.3390/nu15041026
  13. ↑ Sebastian, S. A., Padda, I., & Johal, G. (2024). Long-Term Impact of Mediterranean Diet on Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Current Problems in Cardiology, 102509. PMID: 38431146 DOI: 10.1016/j.cpcardiol.2024.102509
  14. ↑ Barbosa, A. R., Pais, S., Marreiros, A., & Correia, M. (2024). Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial. Nutrients, 16(15), 2443. PMID: 39125324 PMC11314620 DOI: 10.3390/nu16152443
  15. ↑ Zeraattalab-Motlagh, S., Jayedi, A., & Shab-Bidar, S. (2022). Mediterranean dietary pattern and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of prospective cohort studies. European journal of nutrition, 1-14. PMID: 35001218 DOI: 10.1007/s00394-021-02761-3
  16. ↑ Sarsangi, P., Salehi-Abargouei, A., Ebrahimpour-Koujan, S., & Esmaillzadeh, A. (2022). Association between Adherence to the Mediterranean Diet and Risk of Type 2 Diabetes: An Updated Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies. Advances in Nutrition, 13(5), 1787-1798. PMID: 35472102 PMCreference DOI: 10.1093/advances/nmac046
  17. ↑ Shannon, O. M., Ranson, J. M., Gregory, S., Macpherson, H., Milte, C., Lentjes, M., ... & Stevenson, E. (2023). Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study. BMC medicine, 21(1), 1-13. PMID: 36915130 PMC10012551 DOI: 10.1186/s12916-023-02772-3
  18. ↑ Poursalehi, D., Lotfi, K., & Saneei, P. (2023). Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment. Ageing Research Reviews, 87, 101903. PMID: 36871780 DOI:10.1016/j.arr.2023.101903
  19. ↑ Riolo, R., De Rosa, R., Simonetta, I., & Tuttolomondo, A. (2022). Olive Oil in the Mediterranean Diet and Its Biochemical and Molecular Effects on Cardiovascular Health through an Analysis of Genetics and Epigenetics. International Journal of Molecular Sciences, 23(24), 16002. PMID: 36555645 PMCreference DOI: 10.3390/ijms232416002
  20. ↑ Fernández del Río, L., Gutiérrez-Casado, E., Varela-López, A., & Villalba, J. M. (2016). Olive oil and the hallmarks of aging. Molecules, 21(2), 163. PMID: 26840281 PMCreference DOI: 10.3390/molecules21020163
  21. ↑ Melguizo-Rodríguez, L., Illescas-Montes, R., Costela-Ruiz, V. J., Ramos-Torrecillas, J., de Luna-Bertos, E., García-Martínez, O., & Ruiz, C. (2021). Antimicrobial properties of olive oil phenolic compounds and their regenerative capacity towards fibroblast cells. Journal of Tissue Viability, 30(3), 372-378. PMID: 33810929 DOI:reference
  22. ↑ 22.0 22.1 Infante, R., Infante, M., Pastore, D., Pacifici, F., Chiereghin, F., Malatesta, G., ... & Della-Morte, D. (2023). An Appraisal of the Oleocanthal-Rich Extra Virgin Olive Oil (EVOO) and Its Potential Anticancer and Neuroprotective Properties. International Journal of Molecular Sciences, 24(24), 17323. PMID: 38139152 PMC10744258 DOI: 10.3390/ijms242417323
  23. ↑ Różańska, A., Russo, M., Cacciola, F., Salafia, F., Polkowska, Ż., Dugo, P., & Mondello, L. (2020). Concentration of potentially bioactive compounds in Italian extra virgin olive oils from various sources by using LC-MS and multivariate data analysis. Foods, 9(8), 1120. PMID: 32823794 PMC7466375 DOI: 10.3390/foods9081120
  24. ↑ Shannon, O. M., Ashor, A. W., Scialo, F., Saretzki, G., Martin-Ruiz, C., Lara, J., ... & Mathers, J. C. (2021). Mediterranean diet and the hallmarks of ageing. European Journal of Clinical Nutrition, 75(8), 1176-1192. PMID: 33514872 DOI:reference
  25. ↑ Imran, M., Ghorat, F., Ul-Haq, I., Ur-Rehman, H., Aslam, F., Heydari, M., ... & Rebezov, M. (2020). Lycopene as a natural antioxidant used to prevent human health disorders. Antioxidants, 9(8), 706. PMID: 32759751 PMCreference DOI: 10.3390/antiox9080706
  26. ↑ Ali, M. Y., Sina, A. A. I., Khandker, S. S., Neesa, L., Tanvir, E. M., Kabir, A., ... & Gan, S. H. (2020). Nutritional Composition and Bioactive Compounds in Tomatoes and Their Impact on Human Health and Disease: A Review. Foods (Basel, Switzerland), 10(1), 45. PMID: 33375293 PMCreference DOI: 10.3390/foods10010045
  27. ↑ Yang, Z., Li, W., Li, D., & Chan, A. S. (2023). Evaluation of Nutritional Compositions, Bioactive Components, and Antioxidant Activity of Three Cherry Tomato Varieties. Agronomy, 13(3), 637. https://doi.org/10.3390/agronomy13030637
  28. ↑ Yamamoto, T., Yoshimura, M., Yamaguchi, F., Kouchi, T., Tsuji, R., Saito, M., ... & Kikuchi, M. (2004). Anti-allergic activity of naringenin chalcone from a tomato skin extract. Bioscience, biotechnology, and biochemistry, 68(8), 1706-1711. PMID: 15322354 DOI:reference
  29. ↑ Escribano-Ferrer, E., Queralt Regue, J., Garcia-Sala, X., Boix Montanes, A., & Lamuela-Raventos, R. M. (2019). In vivo anti-inflammatory and antiallergic activity of pure naringenin, naringenin chalcone, and quercetin in mice. Journal of natural products, 82(2), 177-182. PMID: 30688453 DOI:reference
  30. ↑ Kolot, C., Rodriguez-Mateos, A., Feliciano, R., Bottermann, K., & Stahl, W. (2019). Bioavailability of naringenin chalcone in humans after ingestion of cherry tomatoes. International Journal for Vitamin and Nutrition Research. PMID: 30961461 DOI:reference
  31. ↑ Stabrauskiene, J., Kopustinskiene, D. M., Lazauskas, R., & Bernatoniene, J. (2022). Naringin and naringenin: Their mechanisms of action and the potential anticancer activities. Biomedicines, 10(7), 1686. PMID: 35884991 PMCreference DOI: 10.3390/biomedicines10071686
  32. ↑ Lim, K. H., & Kim, G. R. (2018). Inhibitory effect of naringenin on LPS-induced skin senescence by SIRT1 regulation in HDFs. Biomedical Dermatology, 2(1), 26-34. doi: 10.1186/s41702-018-0035-6.
  33. ↑ Nyane, N. A., Tlaila, T. B., Malefane, T. G., Ndwandwe, D. E., & Owira, P. M. O. (2017). Metformin-like antidiabetic, cardio-protective and non-glycemic effects of naringenin: Molecular and pharmacological insights. European Journal of Pharmacology, 803, 103-111. PMID: 28322845 DOI:reference
  34. ↑ Zhang, Z., Liu, H., Hu, X., He, Y., Li, L., Yang, X., ... & Tao, S. (2022). Heat Shock Protein 70 Mediates the Protective Effect of Naringenin on High-Glucose-Induced Alterations of Endothelial Function. International Journal of Endocrinology, 2022:7275765 PMID: 35958293 PMCreference DOI: 10.1155/2022/7275765
  35. ↑ Christodoulou, E., Deligiannidou, G. E., Kontogiorgis, C., Giaginis, C., & Koutelidakis, A. E. (2023). Natural Functional Foods as a Part of the Mediterranean Lifestyle and Their Association with Psychological Resilience and Other Health-Related Parameters. Applied Sciences, 13(7), 4076. https://doi.org/10.3390/app13074076
  36. ↑ Romero‐Cabrera, J. L., García‐Ríos, A., Sotos‐Prieto, M., Quintana‐Navarro, G., Alcalá‐Díaz, J. F., Martín‐Piedra, L., ... & Pérez‐Martínez, P. (2023). Adherence to a Mediterranean lifestyle improves metabolic status in coronary heart disease patients: A prospective analysis from the CORDIOPREV study. Journal of Internal Medicine, 293(5), 574-588. PMID: 36585892 DOI: 10.1111/joim.13602
  37. ↑ Maroto-Rodriguez, J., Delgado-Velandia, M., Ortolá, R., Perez-Cornago, A., Kales, S. N., Rodríguez-Artalejo, F., & Sotos-Prieto, M. (2023, August). Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank. In Mayo Clinic Proceedings. Elsevier. https://doi.org/10.1016/j.mayocp.2023.05.031

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