Despite numerous reports on the beneficial effects of olive oil in the cardiovascular context, very little is known about the olive tree’s wild counterpart (Olea europaea, L. var. sylvestris), commonly known as acebuche (ACE) in Spain. The aim of this study was to analyse the possible beneficial effects of an extra virgin ACE oil on vascular function in a rodent model of arterial hypertension (AH) induced by NG-nitro-l-arginine methyl ester (L-NAME). Four experimental groups of male Wistar rats were studied: (1) normotensive rats (Control group); (2) normotensive rats fed a commercial diet supplemented with 15 % (w/w) ACE oil (Acebuche group); (3) rats made hypertensive following administration of L-NAME (L-NAME group); and (4) rats treated with L-NAME and simultaneously supplemented with 15 % ACE oil (LN + ACE group). All treatments were maintained for 12 weeks. Besides a significant blood pressure (BP)-lowering effect, the ACE oil-enriched diet counteracted the alterations found in aortas from hypertensive rats in terms of morphology and responsiveness to vasoactive mediators. In addition, a decrease in hypertension-related fibrotic and oxidative stress processes was observed in L-NAME-treated rats subjected to ACE oil supplement. Therefore, using a model of AH via nitric oxide depletion, here we demonstrate the beneficial effects of a wild olive oil based upon its vasodilator, antihypertensive, antioxidant, antihypertrophic and antifibrotic properties. We postulate that regular inclusion of ACE oil in the diet can alleviate the vascular remodelling and endothelial dysfunction processes typically found in AH, thus resulting in a significant reduction of BP.

Practice guidelines for non-alcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians’ perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multi-ethnic setting. Semi-structured individual interviews were conducted with fourteen clinicians (seven doctors, three nurses, three dietitians and one exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinicians described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone’s role, whereby doctors and nurses raise awareness and dietitians provide individualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss; in-depth knowledge of the dietary pattern; access to patient education and monitoring resources and; service culture, including an interdisciplinary clinic goal, and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from diverse cultural and socio-economic backgrounds and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.

Elevated levels of liver enzymes are the main markers of liver dysfunction. Liver enzymes are the important indicators of non-alcoholic fatty liver disease (NAFLD) in the general population. Previous randomised clinical trials (RCT) investigated the effects of Mediterranean diet (MedDiet) as a plant-based diet on features of NAFLD like liver enzymes, but their results are contradictory. This study aimed to systematically review and meta-analyse RCT investigating the effect of MedDiet on liver enzymes. PubMed, Web of Science, Scopus and Google Scholar were searched until December 2020. A total of ten RCT (n 705 participants) evaluating the effect of MedDiet on liver enzymes including aspartate aminotransferase (AST), alanine transaminase (ALT) and γ-glutamyltransferase (GGT) were included. A random effects model was used to estimate the pooled effect size. To evaluate the heterogeneity among the included studies, the Cochran’s Q-test and I-squared test were used. The MedDiet significantly reduced AST (weighted mean difference (WMD) = −0·38 IU/l; 95 % CI − 0·73, −0·03 IU/l; P = 0·03) and GGT (WMD = −0·16 IU/l; 95 % CI − 0·32, −0·006 IU/l; P = 0·04) but had no significant effect on ALT (WMD = −0·55 IU/l; 95 % CI − 1·25, 0·13 IU/l; P = 0·11). However, sensitivity analysis revealed that the overall effects of MedDiet on AST, GGT and ALT were significantly influenced by removing some studies. There was no publication bias based on Begg’s and Egger’s tests. Generally, MedDiet can improve liver enzymes. To better conclusion, further RCT investigating the effect of MedDiet on liver enzymes, especially in patients with NAFLD, are still required.

The relationship between adherence to a Mediterranean diet (MedDiet) and health-related quality of life (HRQoL) is unclear, particularly in vulnerable older adults. This cross-sectional analysis explored the association between adherence to a MedDiet and subscales of HRQoL in two independent cohorts of overweight and obese middle-aged to older adults with and without type 2 diabetes mellitus (T2DM). Both cohorts were community-dwelling (T2DM aged ≥ 50 years; non-T2DM aged ≥ 60 years) with a BMI ≥ 25 kg/m2. Adherence to a MedDiet was assessed using the Mediterranean Diet Adherence Screener, and HRQoL was determined using the 36-item short-form health survey. Multiple regression analysis was used to examine the association between adherence to a MedDiet and HRQoL subscales. A total of 152 middle-aged to older adults were included (T2DM: n 87, 71·2 (sd 8·2) years, BMI: 29·5 (sd 5·9) kg/m2; non-T2DM: n 65, 68·7 (sd 5·6) years, BMI: 33·7 (sd 4·9) kg/m2). Mean adherence scores for the entire cohort were 5·3 (sd 2·2) (T2DM cohort: 5·6(sd 2·3); non-T2DM cohort: 4·9 (sd 2·0)). In the adjusted model, using pooled data from both study cohorts, adherence to a MedDiet was significantly associated with the general health subscale of HRQoL (β = 0·223; 95 % CI 0·006, 0·044; P = 0·001). Similar findings were also observed in the T2DM cohort (β = 0·280; 95 % CI 0·007, 0·054; P = 0·001). However, no additional significant associations between adherence to a MedDiet and HRQoL subscales were observed. We showed that adherence to a MedDiet was positively associated with the general health subscale of HRQoL in middle-aged to older adults with T2DM. However, larger longitudinal data in older adults with a wider range of adherence scores, particularly higher adherence, are required to better understand the direction of this relationship.

Although the long-term effects of a Mediterranean-style dietary pattern (MDP) on cognition and overall mental well-being have been consistently described, the short-term effects of the MDP on cognitive performance, mood and anxiety have not been as widely reviewed. Therefore, the aims of this systematic review were to synthesise the evidence from randomised controlled trials (RCT), to examine whether a MDP can alter cognition and overall mental well-being in the short-term (up to 10 d). This will also be used to identify research gaps and to inform the design of future acute RCT in the area. Ovid Embase, Ovid MEDLINE and Web of Science Core Collection were searched from inception to 8 December 2020. The data were synthesised narratively with no quantitative synthesis. The detailed protocol is available on PROSPERO, with the registration number CRD42021221085. A total of 3002 studies were initially identified. After the deduplication and screening stages, four studies (three articles and one conference proceeding) were eligible to be included. Despite the very limited data obtained, the literature suggests that a MDP can improve cognition and mood in the short-term. Specifically, improvements in attention, alertness and contentment were consistently reported. A MDP appears as a promising strategy to improve short-term cognitive and mental health. A limitation of this review is the small number of studies identified; therefore, future studies are required to confirm these initial novel findings and to provide granularity as to which domains are most responsive and in which population subgroups.

Colorectal cancer (CRC) is one of the major causes of death across the world and incidence rate of CRC increasing alarmingly each passing year. Diet, genomic anomalies, inflammation and deregulated signalling pathways are among the major causes of CRC. Because of numerous side effects of CRC therapies available now, researchers all over the world looking for alternative treatment/preventive strategy with lesser/no side effects. Olive oil which is part of Mediterranean diet contains numerous phenolic compounds that fight against free radicals and inflammation and also well-known for protective role against CRC. The current review focused on the recent evidences where olive oil and its phenolic compounds such as hydroxytyrosol, oleuropein and oleocanthal showed activities against CRC as well to analyse the cellular and molecular signalling mechanism through which these compounds act on. These compounds shown to combat CRC by reducing proliferation, migration, invasion and angiogenesis through regulation of numerous signalling pathways including MAPK pathway, PI3K-Akt pathway and Wnt/β-catenin pathway and at the same time, induce apoptosis in different CRC model. However, further research is an absolute necessity to establish these compounds as nutritional supplements and develop therapeutic strategy in CRC.

Scientific evidence has been reporting the health and environmental benefits of the Mediterranean diet. However, countries of the Mediterranean region, Portugal included, are gradually abandoning this traditional food pattern. The aim of the present work was to develop the Portuguese Mediterranean diet wheel. Three main steps were followed: (1) establishment of the most relevant Mediterranean diet and lifestyle principles to improve this pattern among the Portuguese population; (2) converting those principles into a captivating and easy to understand tool and (3) obtaining experts’ opinion. By a matter of consistency, the preservation and transmission of the Mediterranean heritage was represented through an upgrade of the current Portuguese food wheel guide. This complementary tool highlights the Mediterranean diet enlarged character that encompasses a healthy lifestyle and reinforces sociocultural and environmental features. It was launched at the end of 2016 and was nationally disseminated with the support of the Portuguese Health Directorate. Initially it was presented in a poster format image that was subsequently spread in different communication formats. This newly developed Mediterranean food guide is a complementary educational tool that will support health and education professionals in the never ending mission of promoting healthy food choices.

Adhering to a Mediterranean diet (MD) is associated with reduced CVD risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet was a 12-month pilot parallel group RCT involving individuals aged ≥ 40 year, with low MD adherence, who were overweight, and had an estimated CVD risk ≥ 20 % over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64 %) were eligible. After 12 months, there was a retention rate of 69 % (peer support group 59 %; DSG 88 %; MSG 63 %). For all participants, increases in MDS were observed over 12 months (P < 0·001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards an MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.

The first investigation of dietary intake in the Mediterranean region was undertaken at the initiative of the government of Greece in 1948. Plant foods (cereals, pulses, nuts, potatoes, vegetables and fruits) accounted for 61 % of total energy intake (TEI), animal foods (meat, eggs, fish and dairy products) for 7 % of TEI and olive oil was the main oil used. In 1950s, Ancel Keys undertook studies in USA, Italy, Spain, England, Japan, Australia and Canada leading him to hypothesise that a link could exist between diet, plasma cholesterol and CHD. Between 1958 and 1964, Keys and co-workers carried out the Seven Countries Study, which enrolled men aged 40–59 years in one of sixteen cohorts from seven countries (Finland, Greece, Italy, Yugoslavia, Japan, USA and Italy). After 15-, 25- and 50-year follow-up, a strong positive relation was observed between saturated fat intake and CHD mortality, and a negative one with Mediterranean Dietary Index. In 1975, Keys and his wife published a book entitled: ‘How to eat well and stay well. The Mediterranean way’, which popularised Mediterranean Diet (MedDiet). After 45-year follow-up, longevity without CHD death was 12·9 years higher in Crete than in Finland. Protecting effect of MedDiet towards CHD incidence and risk is now confirmed by Prevencion con Dieta Mediterranea study and by cohorts’ studies gathered in several recent meta-analyses. MedDiet is sustainable and recognised by UNESCO as an intangible cultural heritage, which is the most beautiful homage that can be paid to Ancel Keys and all his co-workers.

The Mediterranean diet (MD) is a model of a healthy diet and healthy lifestyle. Adherence to the MD has been correlated with a reduction in many metabolic disorders including cancers. The factors associated with adolescents’ adherence to the MD in North Lebanon using the KIDMED index have never been explored. Therefore, we thought to examine these factors amongst a sample of them. A cross-sectional survey was conducted in the city of Tripoli, North Lebanon. A total of 798 adolescents aged 11–18 years were randomly selected to participate in this study. All participants completed a questionnaire assessing adherence to the MD (KIDMED index), physical activity (physical activity questionnaires for older children and adolescents), health-related quality of life (KIDSCREEN-27 index) and sociodemographic characteristics (age, sex, grade level and parents’ educational status). Anthropometric measurements, including weight, height and waist circumference, were also collected. Adherence to the MD was good amongst only 13·3 % of the adolescents. The prevalence rate of overweight and obesity was elevated, affecting 36·9 % of the students. Lower adherence to the MD was significantly correlated with skipping meals (P = 0·001). Meanwhile, adolescents who were engaged in a high level of physical activity, those who consumed more meals with their families and those who benefited from better physical well-being had a better diet quality (P < 0·001). Nutrition intervention programmes, as well as public health policies, would be of interest in order to improve diet quality amongst Lebanese adolescents.

There is limited information regarding the nutrition profile and diet quality of meal plans from currently popular weight loss (WL) diets in Australia. This includes the energy content (kilojoules), the macronutrient distribution and the micronutrient composition. Further, these diets have not been compared with current government guidelines and healthy eating principles (HEP) for nutritional adequacy. Popular diets were identified through grey literature, trending searches and relative popularity in Australia. Meal plans for each diet were analysed using Foodworks Dietary Software to determine food group intake, micronutrient and macronutrient distribution. The results indicated that all popular diets assessed deviated from government recommended HEP such as the Australian Guide to Healthy Eating and the Mediterranean diet. In most cases, both popular diets and the HEP had low intakes of multiple food groups, low intakes of essential micronutrients and a distorted macronutrient distribution. Popular diets may not provide adequate nutrition to meet needs, particularly in the long term and potentially resulting in micronutrient deficiency. When energy restricting for WL, meal plans should be highly individualised in conjunction with a qualified nutrition professional to ensure adequate dietary intake.

Adherence to the Mediterranean diet (MD) has been decreasing in southern Europe, which could be linked to several cultural or educational factors. Our aim is to evaluate the extent to which economic aspects may also play a role, exploring the relationship between food prices in Portugal and adherence to the MD. We evaluated data from the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015–2016) (n 3591). Diet expenditures were estimated by attributing a retail price to each food group, and the diet was transposed into the Mediterranean Diet Score used in the literature. Prices were gathered from five supermarket chains (65 % of the Portuguese market share). Linear regression models were used to assess the association between different adherence levels to the MD levels and dietary costs. Greater adherence to the MD was associated with a 21·2 % (P < 0·05) rise in total dietary cost, which accounts for more 0·59€ in mean daily costs when compared with low adherence. High adherence individuals (v. low adherence) had higher absolute mean daily costs with fish (0·62€/+285·8 %; P < 0·05), fruits (0·26€/+115·8 %; P < 0·05) and vegetables (0·10€/+100·9 %; P < 0·05). The analysis stratified by education and income level showed significantly higher mean daily diet cost only amongst higher income groups. Our findings suggest that greater adherence to the MD was positively and significantly associated with higher total dietary cost. Policies to improve population’s diet should take into consideration the cost of healthy foods, especially for large low- and middle-income families.

During the first 1000 d of life, gestational weight gain (GWG) and postpartum weight retention (PPWR) are considered critical determinants of nutritional status. This study examined the effect of adherence to the Mediterranean diet (MD) during pregnancy on GWG and PPWR at 2 and 6 months among women in the United Arab Emirates (UAE), using data from the Mother-Infant Study Cohort. The latter is a prospective study, for which pregnant women were recruited (n 243) during their third trimester and were followed up for 18 months. Data on socio-demographic characteristics and anthropometric measurements were obtained. An eighty-six-item FFQ was used to examine dietary intake during pregnancy. Adherence to the MD was assessed using the alternate MD (aMED) and the Lebanese MD (LMD). Adherence to the MD, PPWR2 (2 months) and PPWR6 (6 months) were considered high if participants belonged to the third tertile of the respective measures. Results indicated that 57·5 % of participants had excessive GWG while 50·7 % and 45 % retained ≥ 5 kg at 2 and 6 months postpartum, respectively. After adjustment, adherence to both MD scores was associated with lower odds of excessive GWG (aMED, OR:0·41, 95 % CI:0·18, 0·93; LMD, OR:0·40, 95 % CI: 0·16, 0·98). Adherence to MD was also associated with PPWR2 (aMED: OR: 0·23, 95 % CI: 0·06, 0·88) and PPWR6 (aMED OR:0·26; 95 % CI:0·08–0·86; LMD, OR:0·32; 95 % CI: 0·1, 0·98). The findings of this study showed that adherence to the MD may reduce GWG and PPWR and, hence, underscored the importance of promoting the MD for better health of the mother and infant.

The aim of the present study was to describe Mediterranean diet (MD) adherence within a population of adolescents and to analyse the association of multiple factors with adherence. This included a consideration of diverse physical and mental health indicators. The present study was conducted with a representative sample of 761 adolescents (14·51 (sd 1·63) years) from twenty-five educational centres in a northern region of Spain. MD adherence was evaluated, alongside their health-related quality of life, self-esteem, body image satisfaction, BMI, physical activity (PA) level, maximum oxygen consumption, hours of nightly sleep, socio-demographic factors and academic performance. Of the adolescent population, 49 % reported high MD adherence. Being female and having higher levels of PA were found to be predictive factors of adherence to the MD. In addition, maximum oxygen consumption, the presence of environments favourable towards PA engagement and higher self-esteem were also predictive in females, whilst better academic performance and more nightly sleep were additional predictors in males. The associations found between the MD and other health indicators and habits highlight the need to develop promotion strategies from an inter-disciplinary and transversal standpoint.