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Randomized controlled trial
Epidemiological and clinical trial studies have demonstrated the beneficial effects of a Mediterranean Diet (MD) on cardiovascular risk. However, the adherence duration to achieve these beneficial effects remains unclear. A new randomized controlled trial measured the impact of Mediterranean Diet adherence on the skin microvascular circulation besides secondary outcomes such as quality of life, blood pressure, lipidemic profile or dietary intake. The study was a two-center, parallel-arm, open-label intervention trial. The control group was from Greece, considered long-term MD adherers, and non-adherers (intervention group) were recruited in the UK. The trial concluded that short-term adherers (4 weeks of intervention) experimented quick benefits related to vasodilation mechanisms. Nevertheless, longer interventions (more than 5 years of MD adhesion) are required to achieve full microcirculatory benefits. Therefore, this study highlights a new aspect to take into consideration for further investigation of adherence duration.
Regarding the Mediterranean Diet Pattern, a descriptive study carried out in Spanish university students showed a lack of compliance (only 3.8%) with the recommendations for fresh and processed meat. The results of the investigation confirmed the gradual deviation from the Mediterranean Pattern mostly by young people.
Furthermore, the Mediterranean Diet is a well-established diet for all stages of life and different clinical situations. Concerning pregnancy, a longitudinal study of pregnant women until the post-partum period, investigated the adherence to Spanish dietary guidelines, to the MD and possible changes in diet during this period. The best adherence to the MD was observed in women who are older, higher social class, higher education level, and who not smoke or drink. However, in general, the adherence to healthy foods was low, whereas consumption of red, processed meat and sweet food was higher than recommendations.
In conclusion, the epidemiological studies reflected a lack of adherence to the MD even in Mediterranean countries. Thus, the level and duration of adherence depends on different factors such as age, social class, education, lifestyle or culture.
Basic research studies have set the spotlight on different pathways for lipid metabolism with MD. An in vitro study was carried out to evaluate the protective effect of Mediterranean diet vegetable foods on meat lipid oxidation. Gastrointestinal digestion of lipids yields oxidative compounds such as hydroperoxides which are toxic compounds for human health. Vegetables contain phenolic compounds known for their antioxidant effects. Olive oil, one of the main components of the Mediterranean salad, is a vegetable rich in phenolic compounds like flavonols or anthocyanins, which were the most effective in reducing the oxidation after co-digestion with meat. This study provides information about a significative difference in lipid peroxidation between co-digestion of meat with salad or alone. In conclusion, in vitro co-digestion of meat and vegetables from Mediterranean salad (such as olive oil), reduced the oxidative compounds from lipid metabolism.
Finally, the aim of a new in vivo study was to analyze the mechanism behind the cardiovascular prevention of an MD in mice feed with milkfat, simulating a Western Diet (WD), or with extra-virgin olive oil and nuts (EVOND). This study reminds the PREDIMED trial with three different diets: a control diet (advice to reduce dietary fat), MD supplemented with mixed nuts or MD supplemented with extra-virgin olive oil. Nevertheless, in the in vitro study, the objective was to understand the specific mechanisms involved in cardiovascular prevention. Results show that mice with EVOND diet, compared to those whit WD, lowered plasma cholesterol and triglyceride levels, inhibited foamy monocyte formation, inflammation, and adhesion, and reduced atherosclerosis.